GI

Question 0

A past history of relapsing epi gastric pain in a patient presenting with severe abdominal pain could suggest what ?

Answer 0

Perforation of long standing peptic ulcer

Question 1

Recurrent mouth ulcers could be a sign of which GI diseases?

Answer 1

Crohn’s

Ulcerative colitis

Question 2

How might a previous cholecystectomy result jaundice ?

Answer 2

The operation caused a biliary stricture

Question 3

Describe the characteristic radiation of pancreatic pain

Answer 3

Pain radiating straight through to the back

Question 4

Pain radiating loin to groin is characteristic of:

Answer 4

Renal colic

Question 5

Where does the pain of oesophageal reflux radiate ?

Answer 5

Up the neck

Question 6

Referred pain to the tip of the shoulder is due to what ?

Answer 6

Diaphragmatic irritation

Question 7

Colicky pain results from what ?

Answer 7

Obstruction of a hollow viscus (bowel, ureter)

Question 8

Is pancreatic pain usually steady or episodic ?

Answer 8

Steady

Question 9

How might patients attempt to relieve colicky pain (positional)

Answer 9

Rolling around vigorousl

Question 10

How is pancreatic pain characteristically relieved ? (Positionally)

Answer 10

Sitting and leaning forward

Question 11

If abdominal pain is relieved by eating what might the cause be ?

Answer 11

Duodenal ulcer

Question 12

Fatty foods precipitate pain from where ?

Answer 12

Gall bladder

Question 13

A chronic erratic disturbance of defection associated with abdominal pain and bloating is characteristic of which condition ?

Answer 13

IBS

Question 14

Differential diagnoses In a patient with recent diarrhoea or constipation associated with colicky pain, possible blood/mucous in stool

Answer 14

Large bowel malignancy

Stricture formation

Question 15

Typical symptoms of rectal malignancy:

Answer 15

Increased frequency

Tenesmus

Question 16

Classic presentation if gallstones

Answer 16

Jaundice associated with biliary pain

Question 17

Progressive dysphagia, starting with solids and progressing to liquids has which likely causes?

Answer 17

Carcinoma

Stricture

Question 18

Intermittent dysphagia with liquids and solids suggests which cause ?

Answer 18

Motility disorder e.g. Achalasia or diffuse oesophageal spasm

Question 19

How can you differentiate between achalasia and diffuse oesophageal spasm?

Answer 19

If dysphagia eases after first few swallows it is oesophageal spasm

Question 20

If the cause of dysphagia is in the pharynx e.g. A neurological disease such as MND, what is the characteristic symptom ?

Answer 20

Fluid regurgitation into throat and nose

Question 21

What is troisier’s sign ?

Answer 21

Virchows node in the supraclavicular area indicating possible carcinoma of the stomach or oesophagus

Question 22

What food and drinks commonly aggravate reflux symptoms ?

Answer 22

Alcohol, chocolate, caffeine and fatty meals

Question 23

What postural changes are known to aggravate GOR ?

Answer 23

Bending, stooping or lying down

Question 24

Differential diagnoses for early morning vomiting ? (Name 3)

Answer 24

1. Pregnancy 2. Alcoholism 3. Raised ICP

Question 25

Differential if vomiting is delayed by more than 1 hour after meal ?

Answer 25

1. Gastric outlet obstruction | 2. Gastroparesis

Question 26

Differential diagnoses for a patient who has had a short history of jaundice with a prodromal illness ?

Answer 26

1. Hepatitis | 2. Gallstones

Question 27

Itching that's worse over the extremities is suggestive of what ?

Answer 27

Cholestatic liver disease

Question 28

Which liver condition may lead to easily bleeding/bruising ?

Answer 28

Obstructive jaundice ( results in shortage of bile salts (which emulsify fats) in the intestine and therefore reduces vitamin k absorption (which is fat solvable)- which in turn decreases the Production of clotting factors 2, 7, 9 and 10)

Question 29

Which type of diarrhoea persists when the patient fasts ? And what are its causes ?

Answer 29

Secretory diarrhoea - caused by infections or carcinoid syndrome

Question 30

What type of diarrhoea is. Characterised by large volume stools related to the ingestion if food ? And what are its causes ?

Answer 30

Osmotic diarrhoea - caused by: lactose intolerance, magnesium antacids, or gastric surgery

Question 31

The pain of Which GI conditions may be relieved by passing flatus or stool ?

Answer 31

IBS | Diverticulitis

Question 32

What is the significance of commenting on rate and regularity of radial pulse in a GI exam ?

Answer 32

AF may throw off emboli into the mesenteric arteries leading to bowel Ischaemia with severe abdominal pain.

Question 33

3 GI causes of Clubbing

Answer 33

1. GI lymphoma 2. IBS 3. Coeliac disease

Question 34

What does koilonychia indicate ?

Answer 34

Anaemia

Question 35

What is leuconychia and what does it indicate ?

Answer 35

Opacification of the nail bed, may be due to hypoalbinaemia

Question 36

Name a GI cause of palmar erythema

Answer 36

Chronic liver disease

Question 37

Why do we look for Dupuytren's contracture in a GI exam?

Answer 37

Can be a sign of alcoholism May also be because of manual work or familial

Question 38

What is an hepatic flap and when does it occur ?

Answer 38

Coarse irregular tremor when the arms are held outstretched with wrists dorsiflexed (15 secs) - occurs in liver failure

Question 39

Name the 3 things you look for in the eyes during a GI exam

Answer 39

1. Signs if anaemia in the conjunctiva 2. Jaundice in the sclera 3. Kayser-Fleischer rings (as in Wilson's disease which leads to cirrhosis)

Question 40

Signs to look for in the mouth during GI exam ? (4)

Answer 40

1. Angular stomatitis - iron and B12 deficiency 2. Glossitis - B12/folate deficiency (painful) iron deficiency (painless) 3. Circumoral pigmentation - peutz-jeugers syndrome - signifying small bowel polyposis 4. Apthmous ulcers - IBS, coeliac (ulcers on the tongue may be malignant)

Question 41

What are the 5 Fs describing the causes of a distended abdomen ?

Answer 41

1. Fat 2. Flatus 3. Foetus 4. Faeces 5 fluid

Question 42

What condition is likely if the abdomen is still with respiration ?

Answer 42

Peritonitis

Question 43

What causes caput medusae?

Answer 43

Portal hypertension

Question 44

What doors presence of spider naevi on upper abdomen and chest suggest ?

Answer 44

Cirrhosis | If 5 or more present

Question 45

What 4 questions are asked in the CAGE questionnaire ? (Alcohol history)

Answer 45

1. Have you ever felt you should cut down on your drinking ? 2. Have people ever annoyed you by criticising your drinking ? 3. Have you ever felt bad/guilty about your drinking 4. Have you ever had a drink when you wake up in the morning to steady your nerves/ get rid of hangover (eye opener)