Gi

Question 1

Classification used for GORD

Answer 1

Los Angeles classification

Question 2

Metaplasia of squamous to columnar epithelium following chronic GORD

Answer 2

Barrett’s oesophagus

Question 3

Risk factors of oesophageal adenocarcinoma

Answer 3

Male
Caucasian
Barett’s oesophagus

Question 4

Risk factors for squamous cell carcinoma

Answer 4

Alcohol and smoking 
Achalasia of cardia 
Plummer vinson syndrome 
Nutritional deficiencies 
Nitrosamines 
HPV

Question 5

Ethnicity risk factor for Squamous cell oesophageal carcinoma

Answer 5

Afrocarribean

M>f

Question 6

What is stomach lined by?

Answer 6

Gastric mucosa
Columnar epithelium
Glands

Question 7

MHC class of coeliac disease

Answer 7

DQ2

Dq8 HLA

Question 8

Rash seen in coeliac disease

Answer 8

Dermatitis herpetiforms

Question 9

Serological tests to do in coeliac disease

Answer 9

Anti endomysial (best spec and sen)

Anti tissue transglutaminase (IgA)
Anti gliadin (Poor marker of disease control)

Question 10

Gold standard ix of coeliac disease

Answer 10

Upper GI endoscopy and duodenal biopsy

Question 11

What is seen on duodenal biopsy of coeliac disease

Answer 11

Villous atrophy
Crypt hyperplasia
Lymphocyte infiltrate

Question 12

Cancer associated with coeliac disease

Answer 12

Duodenal T cell lymphoma

10% progress to this

Question 13

Location of volvulus in elderly

Answer 13

Sigmoid > caecal

Question 14

Location of volvulus in infants

Answer 14

Small bowel

Question 15

Common location of bowel is charm is

Answer 15

Water shed areas
Eg splenic flexure (where the superior mesenteric artery transitions into the inferior mesenteric artery)

Rectosigmoid (where the inferior mesenteric artery transitions into the internal iliac artery)

Question 16

Abx that increase risk of C. difficile

Answer 16

Cipro

Ceph

Question 17

Tx of C. difficile

Answer 17

Metronidazole

2nd line is vancomycin

Question 18

Investigation for C. difficile

Answer 18

Stool culture

Question 19

Cell origin of tumours causing carcinoid syndrome

Answer 19

Enterochromaffin cell origin

Question 20

What do enterchronaffin cells produce in carcinoid syndrome which causes the symptoms

Answer 20

Serotonin (5HT3)

Question 21

Investigation of choice for carcinoid syndrome

Answer 21

24 hour urine 5-HIAA (which is a metabolite of serotonin)

Question 22

Treatment of carcinoid syndrome

Answer 22

Octreotide

This is a somatostatin analogue

Question 23

What do villous adenomas cause

Answer 23

Hypoproteinasmjc hypokalaemia

Because they leak large amounts of protein and potassium

Question 24

Risk factors for malignancy in adenomas

Answer 24

Large size (over 3.4cm)
Degree of dysplasia
Increased villous component

Question 25

Adenoma to carcinoma sequence

Answer 25

Normal colon is at risk after first hit mutation in the 1st APC gene (those born with FAP have this mutation) Second hit to the remaining APC gene Progression to carcinoma following activation of KRAS, LOF, mutations of p53

Question 26

Juvenile polyposis - autosomal dominant and recessive

Answer 26

Autosomal dominant

Question 27

Mutated gene in Peutz Jeghers syndrome

Answer 27

LKB1 | Autosomal dominant

Question 28

Symptoms and signs of Peutz Jeghers syndrome

Answer 28

Multiple polyps Mucocutaneous hyperpigmentation Freckles around mouth, palm and soles

Question 29

What are those with Peutz Jeghers syndrome at risk of

Answer 29

Intussuception | Malignancy so regular surveillance of GI tract, pelvis, and gonads

Question 30

Age group hyperplastic polyp seems in

Answer 30

50-60 years

Question 31

What type of cancer are the majority of colorectal cancers

Answer 31

98% adenocarcinoma

Question 32

Most colorectal carcinoma’s are located in

Answer 32

Rectum (45%)

Question 33

What is protective for colorectal carcinoma

Answer 33

NSAIDs | COX2 is overexpressed in 90% of cases

Question 34

Clinical feature of right sided colorectal cancer

Answer 34

Anaemia (iron deficiency) | Weight loss

Question 35

Clinical features of left sided colorectal cancer

Answer 35

Weight loss Change in bowel habit Crampy LLQ pain

Question 36

What can be measured after diagnosis of colorectal cancer to monitor disease

Answer 36

``` Carcinoembryonic antigen (CEA) This is raised But not very specific or sensitive to be used as a screening tool ```

Question 37

Staging used for colorectal cancer

Answer 37

Duke’s staging TNM can also be used A, B1-2, C1-2, D

Question 38

Type of surgery carried out for colorectal cancer if tumour is <1-2cm above anal sphincter (lower 1/3 of rectum)

Answer 38

Abdominoperineal resection

Question 39

Type of surgery carried out to remove colorectal cancer tumour >1-2 cm above anal sphincter

Answer 39

Anterior resection

Question 40

Operation for sigmoid cancer

Answer 40

Sigmoid colectomy

Question 41

What treatment given post op for colorectal cancer to decrease local recurrence

Answer 41

Radiotherapy

Question 42

What chemo drug used to tx colorectal cancer

Answer 42

5-FU | Fluorouracil

Question 43

Autosomal DOm or recessive - familial adenomatous polyposis

Answer 43

Autosomal dominant

Question 44

Gene commonly affected in familial adenomatous polyposis

Answer 44

APC gene (70%) - C5q1 A.R. mutation in DNA Mismatch repair genes in 30% cases

Question 45

Number of polyps required for diagnosis of familial adenomatous polyps

Answer 45

>100 adenomatous polyps

Question 46

At birth, what is seen in patients with familial adenomatous polyposis

Answer 46

Hypertrophy of retinal pigment epithelium

Question 47

What is Gardner’s

Answer 47

Familial syndrome similar to familial adenomatous polyposis but also with extra GI features eg Dental carries Osteomas

Question 48

Hereditary non polyposis colorectal cancer / lynch syndrome - AD or AR

Answer 48

Autosomal dominant | Mutation in DNA mismatch repair genes

Question 49

Where do carcinomas usually arise in HNPCC

Answer 49

Right colon | There are few polyps but they Rogers to malignancy fast (<50 years)

Question 50

Cancers associated with HNPCC

Answer 50

Endometrial Ovarian Small bowel Transitional cell and stomach carcinoma