GI

Question 1

Give an example of a VEGF inhibitor

Answer 1

Bevacizumab

Question 2

Give an example of a EGFR inhibitor

Answer 2

Cetuximab

Question 3

What tumour marker do we look for in HCC?

Answer 3

AFP

Question 4

CA19-9 is a tumour marker for…

Answer 4

Pancreatic
Gallbladder
Bile duct
Gastric

Question 5

What is the tumour marker for colorectal?

Answer 5

CEA

Question 6

What are the upper GI red flags?

Answer 6

Dysphagia
Abdominal or back pain with weight loss
Haematemesis
Jaundice
Abdominal mass

Question 7

What are the lower GI red flags?

Answer 7

Changes in bowel habit
Rectal bleeding
Anaemia
Perianal pain

Question 8

Describe Dukes staging

Answer 8

A confined to bowel wall
B through the muscularis propria
C lymph node involvement
D metastasised

Question 9

What factors increase the risk of colorectal cancer?

Answer 9

Diet: red meat, alcohol and high calories
Smoking, obesity
IBDs
Genetics - HNPCC, FAP, Lynch

Question 10

FAP is linked to mutations in which gene?

Answer 10

APC tumour suppressor gene

Question 11

70% of all colorectal cancers are what type?

Answer 11

Adenocarcinomas

Question 12

How does a right sided bowel cancer present?

Answer 12

Palpable mass in RIF
Diarrhoea
Weight loss
Anaemia
Occult GI bleeding - Melaena

Question 13

How does a left sided bowel cancer present?

Answer 13

Palpable mass LIF
change to bowel habit
Tenesmus
PR bleeding 
Bowel obstruction

Question 14

What investigations would you order for suspected bowel cancer?

Answer 14

DRE
FBC, U+E, LFTs, bone profile
CEA 
Colonoscopy
CT CAP

Question 15

What is the percentage 5 year survival for each Dukes staging?

Answer 15

A 93
B 77
C 48
D 7

Question 16

How is bowel screening done?

Answer 16

Everyone over 50 years sent a faecal occult blood kit every 2 years
One off flexible sigmoidoscopy between 55-59 years

Question 17

What percentage of gallbladder polyps are benign?

Answer 17

95

Question 18

When do we need to worry about gallbladder polyps?

Answer 18

> 1cm likely to be or become malignant

>1.8cm significant risk

Question 19

What type of cancer occurs in the gallbladder most commonly?

Answer 19

Adenocarcinomas

Question 20

At what age do most patients present with gastric cancer?

Answer 20

55 years old plus

Question 21

Gastric cancer is most common in what blood group?

Answer 21

Group A

Question 22

Name risk factors of gastric cancer

Answer 22

Dietary carcinogens - nitrosamines and salty foods
H pylori
Chronic atopic gastritis
Familial mutations of cadherin 1 gene

Question 23

What are the 2 types of gastric adenocarcinomas?

Answer 23

Intestinal

Diffuse

Question 24

Which type of gastric cancer has the worst prognosis?

Answer 24

Diffuse

Question 25

What are the symptoms of advanced gastric cancer?

Answer 25

Ascites Jaundice Melaena Virchows node

Question 26

What is the treatment of gastric cancer?

Answer 26

Surgery | Combination chemotherapy

Question 27

What is the 5 year survival for gastric cancer?

Answer 27

15%

Question 28

What is the biggest risk factor for pancreatic cancer?

Answer 28

Smoking

Question 29

What proportion of cancers occur in the pancreatic head?

Answer 29

2/3

Question 30

What investigations are needed for suspected pancreatic cancer?

Answer 30

Endoluminal USS CT staging ERCP for biopsy Bloods: FBC, U+E, LFT, CA19-9

Question 31

What proportion of patients present with advanced pancreatic Ca that can only be Sx controlled?

Answer 31

1/3

Question 32

What is the treatment of pancreatic cancer?

Answer 32

Surgery Radiotherapy - locally advanced disease Chemo for palliation

Question 33

What is the 5 year survival of pancreatic cancer?

Answer 33

3%

Question 34

Anal cancer is usually what type?

Answer 34

Squamous cell carcinoma

Question 35

What is the origin of the oesophagus?

Answer 35

Inferior border of cricoid cartilage at C6

Question 36

Describe the muscular layers found in the different third of the oesophagus

Answer 36

Superior - voluntary striated Middle - voluntary striated and smooth Inferior - smooth muscle

Question 37

What vertebral level is the gastro-oesophageal junction found?

Answer 37

T11

Question 38

What are the 4 mechanisms of LOS formation?

Answer 38

Oesophagus enters stomach at acute angle Intraabdominal section of abdomen compressed when positive pressure in abdomen Folds of mucosa present aid to occlude junction Right crus of the diaphragm has a pinch cock effect

Question 39

Where does the lymphatics of the oesophagus drain?

Answer 39

Deep cervical LNs Superior and posterior mediastinal nods Left gastric and coeliac LNs

Question 40

What is Barrett’s oesophagus?

Answer 40

Metaplasia of the lower oesophageal squamous epithelium to columnar Usually caused by chronic acid exposure

Question 41

What is the most common type of oesophageal cancer?

Answer 41

Squamous cell carcinoma

Question 42

What part of the stomach joins to the oesophagus?

Answer 42

Cardia

Question 43

What is the superior curved part of the stomach called?

Answer 43

Fundus

Question 44

What vertebral level does the transpyloric plane lie on?

Answer 44

L1

Question 45

The portal vein is formed by the convergence of ...

Answer 45

Superior mesenteric vein | Splenic vein

Question 46

What structure runs directly behind the neck of the pancreas?

Answer 46

Superior mesenteric vessels

Question 47

Which part of the pancreas is intraperitoneal?

Answer 47

Tail