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1MRCP Part 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

Features of Whipple’s Disease (7)
Gene association

A

Steatorrhoea
Malabsorption
Abdominal Pain
Polyarthralgia
Hyperpigmentation
Petechiae
Photosensitivity
Gene = HLAB27

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2
Q

Factors for liver transplant - paracetamol overdose (4)

A

pH <7.3 after 24 hours
Cr >300
PT >100
Grade III or IV encephalopathy

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3
Q

Determining cause of ascites
- albumin

A

Serum: ascites albumin gradient
serum - ascites albumin value = gradient
SAAG >11 = portal hypertension
- Infectious or malignant ascites results in low gradient (albumin values are approx same because different pathology)

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4
Q

Marker of severity in pancreatitis

A

CRP
- associated rise with pancreatic necrosis

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5
Q

Check for h.pylori following eradication therapy

A

Urea breath test
- ideally wait 4 weeks after finishing treatment

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6
Q

Treatment of pyoderma gangrenosum in IBD

A

Oral prednisolone

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7
Q

Difference between Type 1 and Type 2 Hepatorenal Syndrome

A

Type 1 = rapid, Cr >250
Type 2 = more insidious

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8
Q

Acute alcohol intake in paracetamol overdose - good or bad?

A

May be protective - chronic alcohol excess worse

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9
Q

Best anti-emetic for travel sickness

A

Hyoscine

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10
Q

Blood results in haemochromatosis

A

Raised iron
Raised ferritin
Low or normal transferrin

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11
Q

Management of UC
- >= 2 exacerbations in 12 months

A

PO azathioprine or mercaptupurine as maintenance

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12
Q

Management of UC
- disease beyond L side of colon

A

PO 5ASA + rectal 5ASA
Enemas only go so far

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13
Q

Management of UC
- flare

A

IV steroids
If not improving 72 hours then consider ciclosporin

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14
Q

What is normal oesophageal mucosa made up of?
What happens in Barrett’s?

A

Normal = squamous
Barrett’s = metaplasia from squamous to columnar

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15
Q

HELPP vs Acute Fatty Liver of pregnancy

A

Hypertension VS normotension
Haemolysis VS no haemolysis

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16
Q

Investigation of hepatic vein thrombosis
- initial
- definitive

A

Initial = US with doppler flow
Definitive = hepatic venography

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17
Q

Pathogenesis of achalasia

A

Loss of ganglia of Auerbach’s plexus
= loss of peristalsis and increased tone at lower oesophageal sphincter

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18
Q

Investigation of choice in achalasia

A

Manometry +- barium swallow

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19
Q

Pathogenesis of pharyngeal pouch

A

Posteromedial herniation of pharynx

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20
Q

Management of eosinophilic oesophagitis

A

Dietary modification
(topical steroids are 2nd line)

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21
Q

Plummer Vinson

A

= glossitis, IDA, oesophageal webs

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22
Q

Boerhave’s Syndrome =

A

= complete transmural oesophageal rupture

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23
Q

Monitoring for Barrett’s oesophagus

A

Endoscopy
- at least every 3-5 years

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24
Q

Staging investigation for oesophageal cancer

A

Endoscopic US

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25
Risk factors for Gastric Cancer (2) Investigation sign
Blood Group A, Smoking = signet ring sign
26
Why is angiodysplasia associated with aortic stenosis?
= theory is turbulence of flow at the aortic valve results in loss of vWF
27
Gene loci associated with Coeliac disease Disease association
HLA DQ2/HLA DQ8 T cell lymphoma
28
Bilirubin metabolism
Haem > iron + bilverdin (haem oxygenase) iron + bilverdin > unconjugated bilirubin (bilverdin reductase) > conjugated bilirubin (UDP-GT)
29
Causes of unconjugated hyperbilirubinaemia (2) Genetic inheritance
Gilbert's Syndrome Crigler-Najjar Syndrome Autosomal recessive
30
Prophylaxis of c.difficile
Bezotoxumab
31
Investigation for small bowel overgrowth Management for small bowel overgrowth
H breath test Rifaximin
32
Organism implicated in Whipple's Disease Management
Tropheryma whipplei Need long duration of antibiotics - IV penicillin then PO co-trimoxazole for at least 1 year
33
Biopsy finding in tropical sprue
Mononuclear cell infiltrates 6 months of tetracyclines
34
Gastroenteritis - severe vomiting immediately after eating food
Staph aureus
35
Colorectal cancer screening
Between 60-74 years Every 2 years, send FIT, if FIT positive then invited for colonscopy
36
What criteria is used for staging colorectal cancer?
Duke's criteria e.g. Grade C = lymph node spread (A/B to do with wall thickness spread)
37
HNPCC - inheritance - gene - presentation
= Lynch syndrome Autosomal dominant Mismatch repair gene - MSH2 Proximal colorectal, endometrial
38
FAP - inheritance - gene - management
= familial adenomatous polyposis Autosomal dominant APC gene on chromosome 5 Total colectomy + ileo-anal pouch
39
Gardener's Syndrome
FAP with facial osteomas, thyroid cancer
40
Peutz-Jegher's Syndrome - inheritance - gene - presentation (3)
Autosomal dominant STK11/LKB1 Harmatous polyps, GI bleeding, intusseption
41
Cowden's Syndrome - gene - presentation - associated cancers (3)
PTEN (tumour suppressor gene) Harmatomous polyps Breast, uterine, thyroid cancer
42
Mechanism of action of 5-ASA
Inhibits prostaglandin synthesis
43
Mechanism of action of azathioprine
Inhibits purine synthesis
44
Mechanism of action of methotrexate
Inhibits dihydrofolate reductase
45
Management of refractory Crohn's disease
Infliximab
46
Medications used for maintaining remission in Crohn's disease Need to check?
Azathioprine/Mercaptopurine Need to check TPMT status prior to commencing
47
Biopsy appearance of Crohn's disease (2)
Transmural Cobblestoning appearance
47
Definition of severe flare of ulcerative colitis
>6 stools/day with blood +- fever, tachycardia, pain
48
Investigation findings of ulcerative colitis (4)
Submucosal Crypt abscesses Pseudopolyps Drainpipe colon
49
Topical 5-ASA, when not to use?
If inflammation extends beyond splenic flexure, need PO as well: enemas can only go so far
50
EEG findings in encephalopathy
Triphasic slow waves
50
Monitoring in ulcerative colitis
All need colonoscopy - either every 1, 3 or 5 years depending on risk
51
Anti-HbC - acute vs chronic infection?
IgM - acute IgG - cleared or chronic infection (HBsAg will be positive in active infection)
52
Associations with hepatitis B (4)
Chronic infection Polyarteritis nodosa Cryoglobulinaemia Hepatocellular Carcinoma
52
Associations with hepatitis C (5)
Chronic hepatitis C Hepatocellular carcinoma Type II cryoglobulinaemia Sjogren's syndrome Porphyria
53
Medical management of HCC
Sorafenib
53
Contra-indications for liver biopsy (5)
INR >1.4 PLT <60 Ascites Anaemia Hydatid cyst disease
54
Pathophysiology of hepatic encephalopathy
Accumulation of ammonia and glutamine
54
SAAG >1.1g/dl
Reflects portal hypertension causing ascites
55
Investigation for pancreatitis
CT with contrast US - determine aetiology e.g. gallstones
56
Most common cause of SBP in alcoholic liver disease
E.coli
56
Gene implicated in Wilson's disease
ATP7B gene on chromosome 13
57
Pathogenesis of hepato-renal syndrome
Vasoactive mediators produced by liver = vasodilation = hypoperfusion of kidneys Activation of RAAS to try and compensate = fluid overload - continuous cycle
57
Investigation findings in Wilson's Disease
Reduced caeruloplasmin levels Decreased total copper levels (reduced transport)
58
Gene locus associated with autoimmune hepatitis
HLA DR3
59
Type 1 autoimmune hepatitis
Adults/kids ANA/smooth muscle antibody
60
Type 2 autoimmune hepatitis
Children Anti-liver kidney microsomal antibody8
61
Type 3 autoimmune hepatitis
Anti-soluble liver antibody
62
Antibody associated with PBC
anti-mitochondrial antibodies subtype M2 - may also see raised IgM and anti-SMA
63
Investigation of PSC - finding
ERCP/MRCP Beaded appearance of the ducts
64
Where is the most common site for pancreatic adenocarcinoma?
Head of pancreas
65
Presentation of pancreatic cancer (3) Investigation of pancreatic cancer
New diabetes, steatorrhoea, migratory thrombophlebitis HRCT
66
C urea breath test - rules around medications
No antibiotics in the last 4 weeks PPI stopped for 2 weeks
67
Barium swallow - oesophageal stricture with apple core effect =
= oesophageal cancer
68
Hepatic vein thrombosis =
Budd Chiari Syndrome Hepatic portal vein thrombus has a more indolent course
69
Gold standard test for bile acid malabsorption
SEHCAT test - nuclear medicine test using selenium: swallow as a capsule
70
Gold standard investigation for GORD
Oesophageal 24 hour pH monitor
71
Ca125 can also be used as marker in...
Peritoneal cancer
72
Pigment laden macrophages on GI biopsy
Laxative abuse
73
What feature of IBD is not associated with disease activity?
Primary sclerosing cholangitis
74
Electrolyte abnormality associated with ileostomy
= hypomagnesaemia (there is impaired PTH secretion which then results in hypocalcaemia = mechanism by which ileostomy causes hypocalcaemia)
75
What cells are responsible for liver fibrosis?
Stellate cells
76
Icthyosis + pancreatic cancer - what associated mutation?
KRAS mutation
77
What is related to the risk of re-feeding syndrome?
BMI

1MRCP Part 1 (20 decks)

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