GI

Question 1

h.pylori eradication

Answer 1

2 weeks of omeprazole + amoxicillin (or metronidazole) + clarithromycin

Question 2

management of bleeding ulcer

Answer 2

high dose IV PPI
endoscopy - adrenaline, heater probe coagulation

if bleed stops after this > omeprazole IV > h.pylori eradication if appropriate + oral PPI course

if bleed cant be stopped with endoscopic tx (try once more first)&raquo_space; surgery

Question 3

management of variceal bleed

Answer 3

resuscitation, abx, terlipressin, early OGD +/- EVL
if bleed stops > propranolol + banding programme
if bleed continues > EVL or S-B tube > TIPPS

Question 4

coeliac blood test

Answer 4

tTGA IgA

Question 5

genes assoc with coeliac

Answer 5

HLA DQ2

DQ8

Question 6

appendicitis - tenderness where?

Answer 6

RIF

more specifically - McBurneys point - 2/3 from umbilicus to right ASIS

Question 7

Rovings sign

Answer 7

pain in RIF when LIF palpated

seen in appendicitis

Question 8

antibiotics used for small bowel obstruction

Answer 8

metronidazole and gentamicin

Question 9

commonest cause of diarrhoea in kids < 3

Answer 9

rotavirus

Question 10

explosive vomiting

Answer 10

norovirus

Question 11

incubation periods

Answer 11

short (1-6 hrs): staph aureus, bacillus cereus

medium (12-48 hrs): salmonella, clostridium perfringens

long (2-14 days): campylobacter, E.coli 0157

Question 12

types of food poisoning that cause bloody diarrhoea

Answer 12

campylobacter
shigella
e coli 0157

Question 13

ix for salmonella, campylobacter and shigella

Answer 13

stool culture

Question 14

ix for typhoid

Answer 14

blood culture

Question 15

ix for giardia, amoeba, parasites

Answer 15

stool microscopy

Question 16

ix for clos.dificille, e.coli 0157

Answer 16

stool toxin

Question 17

ix for norovirus

Answer 17

stool PCR

Question 18

antibiotic for

a. non severe c.diff
b. severe c.diff

Answer 18

a. oral metronidazole

b. oral vancomycin

Question 19

smoking - good or bad for chrons

Answer 19

bad

Question 20

complication of UC and ix for this

Answer 20

toxic megacolon

AXR

Question 21

features of chrons

Answer 21

transmural
cobblestone appearance
anywhere from mouth > anus 
TH1 mediated
non caveating granuloma in 50%
assoc with smoking

Question 22

Chron’s genetic predisposition

Answer 22

NOD2 on chr.16

Question 23

UC features

Answer 23

starts in rectum and extends proximally
NO skip lesions
crypt abscesses
TH1 and TH2 mediated

Question 24

bloody stools - Chron’s or UC

Answer 24

UC

Question 25

PSC assoc with Chron's or UC?

Answer 25

UC

Question 26

diverticular disease features? ix? rx?

Answer 26

``` low fibre usually sigmoid colon left sided abdo pain nausea pr bleeding, sepsis ``` Ix - gastrografin enema, ba enema, CT ... Rx - drainage + abx. Hartmann's procedure

Question 27

Familial adenomatous polyposis aut ? mutations in ? gene more or less than 100 polyps

Answer 27

aut dom mutations in APC gene > 100 polyps

Question 28

HNPCC - mutation in ? gene - more or less than 100 polyps

Answer 28

mutation in DNA mismatch repair gene | < 100 polyps

Question 29

^ ALP and GGT

Answer 29

biliary damage/cholestasis | alcohol abuse

Question 30

^ ALT and AST

Answer 30

hepatocyte damage

Question 31

which type of hepatitis is dependant on presence of hep B for infectivity

Answer 31

hep D

Question 32

classic case of autoimmune hepatitis

Answer 32

young woman on the pill

Question 33

autoantibodies in autoimmune hepatitis

Answer 33

anti ANA, anti SMA, and anti LKM

Question 34

budd chiari what is it triad?

Answer 34

``` occlusion of hepatic veins triad - abdo pain - ascites - liver enlargement ```

Question 35

sinusoids and kuppfer cells, central scar

Answer 35

focal nodular hyperplasia

Question 36

typically contracted from sheep parasites

Answer 36

hydatid cysts

Question 37

what is typically raised in hepatocellular carcinoma

Answer 37

alpha feto protein (AFP)

Question 38

haemachromatosis and wilsons = aut dom or rec?

Answer 38

both out rec

Question 39

kayser-fleisher rings

Answer 39

wilsons disease

Question 40

treatment for wilsons disease

Answer 40

penicillamine

Question 41

how is biliary colic perceived

Answer 41

RUQ colicky pain +/- radiation to shoulder

Question 42

sign seen in acute cholecystitis

Answer 42

murphy's sign

Question 43

ascending cholangitis | - charcots triad?

Answer 43

jaundice fever RUQ pain

Question 44

severe epigastric pain radiating to the back

Answer 44

acute pancreatitis

Question 45

what is raised in acute pancreatitis

Answer 45

amylase, calcium, lipase

Question 46

which type of hernia is below and lateral to the pubic tubercle?

Answer 46

femoral

Question 47

which type of inguinal hernia is medial to the inferior epigastric vessels

Answer 47

direct