GI

Question 1

Thumb-printing sign

1. Sign
2. Differentials

Answer 1

Thumb-printing sign

1. Thumb imprints along bowel wall
   
   • Oedematous large bowel
   • Enlarged haustrae
2. Inflammatory process
   
   • IBD
   • Infection eg. Pseudomembranous colitis
   • Ischaemia
   • Diverticulitis

Question 2

Bowel Habit

- Five questions

Answer 2

Bowel habit

1. How often?
2. Change in frequency or form?
3. Waking overnight?
4. Blood or mucous?
5. Tenesmus, urgency, or incontinence?

Question 3

Which IBD has:

1. Transmural inflammation
2. Crypt abscesses
3. Decreased incidence in smokers
4. Lymphoid and neutrophil aggregates

Answer 3

IBD

1. Transmural inflammation
   
   • Crohn’s
2. Crypt abscesses
   
   • UC
3. Decreased incidence in smokers
   
   • UC
4. Lymphoid and neutrophil aggregates
   
   • Crohn’s

Question 4

Which endoscopy test for:

1. Bloody diarrhoea
2. Small bowel mucosa
3. Proximal disease

Answer 4

Which endoscopy test for:

1. Bloody diarrhoea
   
   • Flexible sigmoid
2. Small bowel mucosa
   
   • Capsule
3. Proximal disease
   
   • Colonoscopy

Question 5

IBD

- Mainstay Treatment

Answer 5

IBD Steroids

1. Oral prednisolone
2. Oral Budesonide in SB disease
3. IV Hydrocortisone

Question 6

IBD Rescue Therapy

1. UC
2. Crohn’s

Answer 6

IBD Rescue

UC

1. Ciclosporin and biological
2. Surgery

Crohn’s

1. Biological
2. Surgery

Question 7

UC

- Maintaining Remission

Answer 7

UC - Remission

-	Mesalazine

Question 8

Crohn’s

- Maintenance therapy

Answer 8

Crohn’s
- Maintenance therapy

1. Azathioprine
2. Biological (especially peri-anal or fistulating)

Question 9

Coeliac disease

- Untreated progression

Answer 9

Untreated coeliac disease

1. SB lymphoma
2. SB cancer
3. Osteoporosis
4. Gluten ataxia and neuropathy

Question 10

Coeliac disease

- Diagnosis

Answer 10

Coeliac Dx

1. tTG
   
   • Tissue transglutaminase
2. OGD and duodenal biopsies
   
   • Villous atrophy
   • Intra-epithelial lymphocytosis

Question 11

Dyspepsia history

- Five questions

Answer 11

Dyspepsia history

1. Abdo or retrosternal
2. Waterbrash
3. Vomitting
4. Upper GI wind
5. Weight-loss, Dysphagia, older age

Question 12

Dysphagia

1. Phases
2. DDx

Answer 12

Dysphagia

1. Oro-pharyngeal
   
   • Neurological
2. Oesophageal
   
   • Neuromuscular
   • Obstruction

Question 13

Liver disease

- History risk factors

Answer 13

Liver risk factors

1. Family history
2. Sexual history
3. Medication history
   
   • Prescribed/self-prescribed
4. IVDU or dubious sterile procedures
5. 1990 blood transfusion
6. Alcohol/metabolic syndrome
7. Travel

Question 14

Liver disease

- Five self-resolving acute disease

Answer 14

Liver disease

1. Hep A
2. Hep E
3. CMV
4. EBV
5. Drug induced DILI

Question 15

Liver disease

- Five chronic conditions

Answer 15

Liver disease

1. ETOH
2. Hep C
3. NASH (non alcoholic steatohepatitis)
4. AIH (autoimmune hepatitis)
5. PBC, PSC
   
   • Biliary cirrhosis
   • Sclerosing cholangitis

Question 16

Hepatic Encephalopathy

-	Four grades

Answer 16

Hepatic Encephalopathy

1. Psychomotor slowing
2. Lethargy, disorientation
3. Drowsy
4. Coma

Question 17

ALP increase

- Test to confirm liver pathology?

Answer 17

ALP Increase

-	Gamma GT will confirm liver origin

Question 18

Hepatic synthetic function

- Three markers

Answer 18

Hepatic synthetic function

- Three markers: 1. Bilirubin 2. Albumin 3. INR

Question 19

ALT>500

- Four hepatic causes

Answer 19

ALT > 500 (more acute)

- Hepatic causes 1. Viral 2. Ischaemia 3. Toxic 4. Autoimmune

Question 20

ALT 100-200

- Four hepatic causes

Answer 20

ALT 100-200

- Four hepatic causes 1. NASH 2. Autoimmune hepatitis 3. Chronic viral hepatitis 4. Drug induced liver injury

Question 21

Dilated bile ducts

- Two cholestatic pathologies

Answer 21

Dilated bile ducts
- Cholestatic causes

1. Gallstones
2. Malignancy

Question 22

Non-dilated bile ducts

- Three cholestatic pathologies

Answer 22

Non-dilated bile ducts
- Three cholestatic pathologies

1. Alcoholic hepatitis
2. Cirrhosis
   
   • PBC/PSC
   • Alcohol
3. Drug induced liver injury
   
   • ABx

Question 23

Liver diseases

- More common in women

Answer 23

Liver diseases (F)

1. Autoimmune hepatitis
2. PBC

Question 24

Liver diseases

- More common in men

Answer 24

Liver diseases (M)

1. PSC (with IBD)
2. Haemachromatosis (earlier in men)

Question 25

Liver diseases in young people

Answer 25

Youth liver diseases | 1. Wilsons 2. Anti LKM autoimmune hepatitis Liver kidney microsomal antibodies

Question 26

Liver cirrhosis | - Imaging

Answer 26

Liver cirrhosis 1. Fibroscan 2. Varices on endoscopy

Question 27

Liver cirrhosis | - Important screening

Answer 27

Liver cirrhosis | - OGD for varices

Question 28

Ascites | - Treatment

Answer 28

Ascites - Treatment 1. Spironolactone 2. Paracentesis if tense

Question 29

Cirrhosis | - Long term complications

Answer 29

Cirrhosis complications 1. Osteoporosis (DEXA) 2. HCC (Alpha-fetoprotein +USS 6/12)

Question 30

MUST elements

Answer 30

MUST 1. BMI (<20, <18.5) 2. Weight loss 3 - 6/12 (5%, 10%) 3. No intake >5days and ill

Question 31

NG Tube | - Drugs effecting needle aspirate

Answer 31

NG Tube - Drugs and aspirate 1. PPIs effect pH

Question 32

PEG vs RIG

Answer 32

1. PEG Percutaneous endoscopic gastrostomy 2. Radiologically inserted gastrostomy

Question 33

PN feeding 1. Indications 2. Risks 3. Requirements

Answer 33

PN Feeding 1. Indications - GI Blockage - GI failure 2. Risks - Sepsis - Liver dysfunction 3. Requirements - Central line - eg. PICC/Hickman

Question 34

GI Bleeding | - Two risk assessments

Answer 34

GI Bleeding Assessments 1. Rockall (Rebleed/death) 2. Blatchford (Need for intervention)

Question 35

Variceal Bleed | - Management

Answer 35

Variceal Bleed - Management 1. IV access and fluids 2. IV Terlipressin 3. Endoscopy (Banding, Linton/Sengstaken tube) 4. TIPSS (Trans-jugular intrahepatic porto-stystemic shunt)

Question 36

Upper GI bleed | - Non variceal Mx

Answer 36

Non-variceal UGI Bleed Mx: 1. IV access and fluids 2. PPI post-OGD 3. Endoscopy