Gastrointestinal

Question 1

When should UGIB get endoscopy?

Answer 1

If unstable/severe bleeding - as soon as resuscitated

Any other - within 24 hours of admission

Question 2

Haemochromatosis
- management in pregnancy
- considerations

Answer 2

No intervention needed
- if liver and cardiac function is normal

Question 3

Management of vomiting 2y to hypercalcaemia

Answer 3

Dopamine antagonist
e.g. haloperidol/levopromazine

Question 4

Investigation for severity of cirrhosis

Answer 4

Transient elastography
= Fibroscan

Question 5

Positive AMA
Normal LFTs

Answer 5

Not diagnostic of PBC
Monitor annually with blood tests - likely to develop

Question 6

Are there polyps in Lynch syndrome?

Answer 6

Can get colonic polyps

Question 7

Anti-platelets in colonoscopy

Answer 7

Can be continued if straightforward, caution if removing polyps etc

Question 8

Lymphocytic infiltration on colon biopsy =
- causes

Answer 8

Microscopic colitis

Causes = SSRI/NSAID/PPI

Question 9

High risk of colon cancer from FH
- criteria
- management

Answer 9

<50 years 1st degree relative colon cancer

Colonoscopy every 5 years 55-75 years of age

Question 10

Management of small bowel overgrowth

Answer 10

= rifaxamin

Question 11

Deciding on colonoscopy surveillance:

Answer 11

Decide whether low, intermediate or high risk
low = 5 years
intermediate = 3 years
high = 1 year

Question 12

Gastric biopsy
= lymphoepithelial lesions in gastric biopsy
- diagnosis
- management

Answer 12

MALT lymphoma
Eradication therapy for H. pylori

Question 13

Anti-saccharomsces

Answer 13

Crohn’s Disease

Question 14

Haemolytic anaemia
Cholestatic jaundice
Hyperlipidaemia

Answer 14

Zieve’s syndrome

Question 15

IBD + PSC
When do they need colonoscopy

Answer 15

Annually

Question 16

Inclusion bodies
IBD
Neutopaenia
- diagnosis?

Answer 16

CMV colitis

Question 17

Management of varices (non-acute)

Answer 17

Grade 1 = annual endoscopy
Grade 2/3 = non-selective BB

Question 18

Management of resistant IBS

Answer 18

Linaclotide
- used to manage constipation, not for use in children

Question 19

What can you see in dumping syndrome?

Answer 19

Hypoglycaemia

Question 20

Management of autoimmune hepatitis

Answer 20

Prednisolone
- don’t use azathioprine until ALP under control

Question 21

High B12 + signs of infection

Answer 21

Consider liver abscess (stored B12 released during process)

Question 22

Low serum albumin gradient

Answer 22

Ascites not associated with portal hypertension

Question 23

Investigations for patients with unknown primary

Answer 23

Bloods = FBC, U+E, LFT, calcium, LDH

Marker = AFP, hCG

Imaging = CXR, CTAP

Other = urinalysis

Question 24

What can you use to test for bile acid absorption?

Answer 24

SeHCAT test
= test for bile acids using an analogue, first at baseline then 7 days later

Question 25

Management of UC flare - nil steroid response at 72 hours

Answer 25

IV ciclosporin

Question 26

Management in IBD when cannot use azathioprine

Answer 26

Methotrexate

Question 27

Management of Barrett's - metaplasia - dysplasia

Answer 27

Metaplasia only = endoscopy surveillance every 3-5 years Dysplasia = ablation

Question 28

Inducing remission in IBD Maintaining remission in IBD - options

Answer 28

Induction = steroids, infliximab Maintenance = MTX, azathioprine

Question 29

What can haemolytic uraemic syndrome result in?

Answer 29

Microangiopathic haemolytic anaemia Coombs negative

Question 30

Management of Zieve's syndrome

Answer 30

Abstinence from ETOH

Question 31

Management of high output stoma

Answer 31

Can use octreotide = slows down gut transit time, allowing greater absorption

Question 32

How often should venesection be undertaken in haemochromatosis

Answer 32

Every 2 weeks

Question 33

Indications for liver transplant (after 24 hours)

Answer 33

pH <7.3 OR ALL THREE OF PT >100 Cr > 300 Grade III or IV encephalopathy

Question 34

FH of colon cancer in relative >50 - what level of risk is that in someone with UC

Answer 34

Intermediate

Question 35

3rd line management of c.difficile

Answer 35

PO vancomycin and IV metronidazole

Question 36

What bone abnormality do you see in coeliac disease?

Answer 36

Osteomalacia

Question 37

UGIB and IV PPI

Answer 37

NICE do not advocate for the use of PPI pre-endoscopy

Question 38

Diagnosis of Zollinger-Ellison syndrome

Answer 38

Serum gastrin and secretin stimulation test

Question 39

Management of ascending cholangitis

Answer 39

Resuscitation ERCP

Question 40

Increasing stool frequency Urgency Incontinence Pouch anastamosis in situ - management

Answer 40

Pouchitis Trial of metronidazole or ciprofloxacin