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MSRA my cards > GI cards > Flashcards

GI cards Flashcards

1
Q

Drugs that cause cholestatic pic? PASS FOR?

A

phenothiazides (prochloperazide, chlorpromazine), anabolic steroids/ abx (erythromycin, co-amox, fluclox), sulfonylureas, fibrates, OCP, rare -nifedipine

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2
Q

Alcoholic vs fatty LD AST/ALT ratio?

A

alcoholic - AST:ALT >2
NAFLD: ALT :AST >2
salt before lime in tquila

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3
Q

true love and witt’s criteria?

A

admission crtieria for UC flare. severe: Hb <105, wcc 15+, CRP 45+/ stools 6+ admit for IV

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4
Q

young hepatitis, psych symptoms?

A

wilson’s disease tx penicillamine

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5
Q

gall bladder palpable painless jaundice?/ new diabetes

A

do CT abdo, panc cancer
other signs: migratory thrombophlebitis, double duct,

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6
Q

C diff tX?

Cx of c-diff?

Ix?

Tx if recurring?

A

PO van 10 days (1st time)
if not, PO metronidazole, then IV metro and PO vanc.
CX: PPI, abx
urea breath test is guideline
if recurring - PO fidaxomicin

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7
Q

Oesophageal cancer - which is more common in developing world? where is is?

A

SCC (upper 2/3), AF: plummer vinson dsyndrome,
A/C - in uk/US (AF GORD, barrets, lower 1/3)
barium - apple core appearance

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8
Q

spontaneous bacterial peritonitis when to give proph abx?
which abx?
how do we confirm dx

A

when protein ascites i <15,
give ciproflox/ norflox

DX: paracentesis neutrophils 250+

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9
Q

DM, cirrhosis, skin pigmentation?

A

haemochromatosis. risk of HCC. most common recessive disorder. need TS/ ferritin

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10
Q

HCC RF?

A

Hep B (worldwide), Hep C (europe), Alpha 1 antitrypsin, DM, male, OCP

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11
Q

deranged LFTs with wheeze, cough, SOB? inheritence pattern?
how to smokers present?

A

alpha 1 antitrypsin
deficiency causes neutrophil enzymes to destroy alveoli, ADom, smokers have sx 10 yrs earlier than non smokers

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12
Q

Liver cirrhosis drug causes? (MAM’s liver)

A

methyldopa, methotrexate, amiodarone

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13
Q

drugs causing hepatocellular pic?

A

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

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14
Q

suspected variceal bleed tx before?

A

terlipressin and abx

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15
Q

SE of PPI?

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

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16
Q

c urea breath test should be clear of abx and ppi for how long?

A

no abx for 4 weeks and no ppi for 2 weeks

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17
Q

Features of crohns?

A

crow’s have less blood (non blood diarrhoea), skip lesions (skip through street), goblet cells,all layers, episleritis more common, bowel obstruction/ fistula
N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)

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18
Q

UC features?

A

bloody diarrhoea (sir has more blood), continuous lesions (down the street), likely to make a mark/ scar (PSC), and get colorectal cancer, more common to get uveitis,
C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

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19
Q

features common to both UC and crohns (IBD)

A

pyoderma gangrenosum, arthritis, erythema nodosum, arthritis

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20
Q

surgical options for UC?

A

ileostomy/ J pouch (ileoanal anastomosis)

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21
Q

What is plummer-vinson

A

iron deficiency anaemia, atrophic glossitis and oesophageal webs or strictures. AF - SCC
painless intermittent disphagia. indian subcontinent

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22
Q

bird beak’s sign, dysphagia with both solids and liquids from day 1?

A

achalasia: narrowing of the distal oesophagus

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23
Q

why do endomesial antibody in coelaic testing?

A

IGA antibody needed to exclude IGA deficiency or else a false negative result could arise

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24
Q

Acute liver disease features?

A

jaundice, raised PT, low albumin, renal failure
CX: Hep A/B, alcohol, paracetmaol (most common), acute fatty liver of pregnancy

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25
Q

72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa

A

diverticulitis

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26
Q

haematemesis/ melena with epigastric pain hours after eating. relieved by eating?

A

duodenal ulcer.
Anteriorly sited ulcers may perforate and result in peritonitis, posteriorly sited ulcers may erode the gastroduodenal artery and present with haematemesis and/ or malaena.

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27
Q

brisk haematemesis with finding of: prominent blood vessel is identified in the mucosa approximately 6 cm from the O-G junction on the lesser curve of the stomach?

A

Dieulafoy lesion (rare type of vascular malformation)

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28
Q

profuse painless UGIB. malnourished, gynaecomastia, spider naevi, (signs of liver failure) cx?

A

Variceal bleeds, give terlipressin/ abx if sus

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29
Q

Child-pugh score? (ABCDE)

A

prognosis of cirrhosis. severity. (1 - 3 points for each)
Albumin
Biliburin
Clotting
Ddilatation (ascites)
Encephalopathy

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30
Q

sulphasalazine SE?

Mesalasine SE

A

rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

mesalazine: has more gI
(mebelly)upset SE, pancreatitis, interstitial neohritis, agranulocytosis, headache

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31
Q

metaclopramide SE?

A

extrapyramidal effects - extra potato
acute dystonia e.g. oculogyric crisis
(children and young adults)
diarrhoea
hyperprolactinaemia

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32
Q

Ascending cholangitis triad?
what is this?

raynaud’s pentad?

A

RUQ pain, jaundice, fever,

infection of bile duct secondary to gall stones (stasis)

+hypotension, recuced GCS

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33
Q

A woman hx gallstones, RUQ pain. No jaundice, temp 37.8ºC. Palpating under the right costal margin causes her to catch her breath. dx?

A

acute cholecystitis. Murphy’s

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34
Q

RUQ intermittent pain after eating?

A

biliary colic

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35
Q

HX of scleroderma, has pale bulky stools, bloods would show?

A

low ferritin, B12, malabsortopion. scleroderma is RF for small intestine bacterial overgrowth syndrome

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36
Q

young woman, seconday amernohhroea, raised ALT?

A

autoimmune hepatitis

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37
Q

Fatty stools, diarrhoea after travelling in swimming pools?

A

giardia lamblia ( resistant to chlorine)
if confirmed - tx tinidazole 2g dingle dose

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38
Q

post crohns tx iv C/S then acute pain, vomit blood?

A

peptic ulcer post CS tx

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38
Q

PBC?

A

White woman ages 60YO. Anti AMA, Raised IGM
inflammation and damage to small bile ducts causing fibrosis . autoimmune.
AF: systemic sclerosis, RA,m thyoid, sojrens,
Tx: ursodeoxycolic acis

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39
Q

Gilbert’s disease?
caution with which meds?
safe?

A

hereditary benign, -decreased UDP glucuronyl transferase.
caution:gemfibrozil (with statin+),irinotecan, hiv tx (atazanivr/indinavir)
safe- paracetamol

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40
Q

previous peptic ulcer, now bloating and epigastric pain when eating. trialled antacids and PPI?

A

do c -urea breath test.
H pylori - tx clarithromycin, PPI, amoxicillin/ metro

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41
Q

biliary colic +fever/ wcc/ crip?

A

acute cholecystitis

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42
Q

gluconoma 6 Ds?

A

diarrhoea, dVT, DM, rash - necrolytic migratory erythema (itchy, painful), dermatosis, depression

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43
Q

drugs that cx diarrhoea?

A

SSRIs, ppi, acei, allopurinol, theophylline, antacids, metformin, nsaids, thyroxine,

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44
Q

constipation red flags?

A

WL, bleeds rectal, 6 weeks+ chasnge in bowels, loss of appetite, Fe deficiency, abdo pain

45
Q

fatigue, jaundice, pruritus, steatorrheoa, dry eyes, dry mouth, xanthalasma, enlarged liver and spleen?

A

PBC (autoimmune inlfammation and damage to small bile ducts)
antimicrobial antibodies

46
Q

vasc RF, 50+, pain after eating, weight loss, anxiety to eat

A

chronic mesenteric iscaemia (rare)
other types od bowel ischaemia - acute (common) and colonic (most favourable and common)

47
Q

UC: TX?

A

CS to induce,
azathiprine if intolerant to CS or needing 2+, aminosalicylatesp

48
Q

appendicitis features?

A

anorexia, RIF pain, fever, furred tongue, rosvigs (more pain toughing LIF)

49
Q

early change in bowel habit, LIF pain, WL, rectal bleed, tenesmus?

A

LEft sided colon cancer (adenocarcinoma)

50
Q

Right sided colon cancer sx?

A

RIF mass, anaemia, late presentation,occult bleeding

51
Q

surgical tx for colorectal cancer?

A

hemicolectomy,
anterior resection- for high sigmoid or low rectum
abdo-perineal resection (tumours in low rectum)

52
Q

vitamin def: bloodshot itchy eyes, cracked red lips at angle of mouth?

A

riboflavin/ vit b2

53
Q

vit b3 / niacin deficinecy?

A

pallegra

54
Q

vit b5 def? panthothentate?

A

dermatitis, enteritis, alopecia, adrenal insufficiency

55
Q

pre hep cx of portan htn?

A

splenic vein/ portal vein thrombosis (spesis, malignancy, pancreatits, high coag state), congenital atresia/ stenosis, extrinsic 0 tumours

56
Q

Rule of cx with PSC?

A

Male, FH. fibrosis and infiltration of intra and extra bile ducts.
AF: UC, cholangiocarinoma (risk), colorectal carcinoma, MRCP dx. PANCA, ANA, anti SMA

57
Q

t1dm, ALT 200-300, IGG, ANA and SMA, raised PT?

A

Autoimmune hepatitis . tX C/s azathiprine

58
Q

tanned skin, t1dm, arthralgia, loss of libido, fatigue?

A

haemochromatosis, Arec, transferrin >45%
triad: cirrhosis, DM, skin pigmentation. RSK HCC, hypogonadism, cardiomyopathy, amen

59
Q

Patient with biliary colic and dilation ALP 300, CBD dilatd 10mm+

A

ERCP and sphincterectomy.
patients needing cholecystectomy:
recent cholangitis, recent acute pan, ALP 2x normal, dilated CBD 10mm+

60
Q

choledocholithiasis

A

gallstones in common bile duct
cholecystolithiasis - gallstones in GB

61
Q

real q: carcinoid syndrome presents with weakness, dermatitis, confusion. which vitamin deficiency?

A

B3 niacin (+tryptophan) - causes pallegra, hypoalbuminsm
carcinoid syndrom also causes skin flushing, bronchospasm, diarrhoea,
DC: urine 5-hydroxyindoleacetic acid, chomrogranin A (mets)
TX: somatostatin analogue, radionuclide therapies

62
Q

what is zenker diverticulum? (actual q)

A

pharyngeal pouch. outpouching at level of hypopharynx. palpable swelling in neck, its of coughing, regurgitated food at night. tx myotomy

63
Q

Small bowel obs vs llarge bowel?

A

SMO: cx incarterated hernias, intemrittent pain, adhesions, tinkling B/S, obstruction sx. central gas shadow, now gas in large bowel. tx drip and suck
LBO - cancers

64
Q

Persistent diarrhoea 2 weeks cause?
most common traveller’s cause?
most commone GE in englans/ wales?

A

giardia lamblia/ cyclospora spp
commoon travellers - e.coli
england/ wales - norrovirus

65
Q

blood diarrhoea cx? - infections?
(bloody diarrhoea isnt SEXY, it’s SEECSY)

A

salmonella ecoli, enteramamoeba, campylobacter/CMV, d.diff, shigella/ schistosomiasis, entamoeba, yersinia
consider clarithromycin tx
c diff - vanc

66
Q

Medications causing blooding diarrhoea?

A

abx, antacids (with MG), SSRI, PPI, statins, vit c, metformin, laxitives, chemo, cholicine, digoxin, abx, acei, allopurinol

67
Q

Rf colorectal cancer?
most common site?

A

DM, absbestsos, familial adenomatous polyposis, HNPCC, peutrz-jegher’s, UC, DM, early menopause nullipatiry, late first pregnancy.
FIT rules out. 10+ - do colonoscopy

rectum, then sigmoid

68
Q

H Pylori associated with?

A

peptic ulcer, MALT lymphoma, gastric adenocarcinoma, menetrier’s disease, coronaritis, Fe deficiency anaemia. (not oesophageal canceR)

69
Q

complications of coeliac?
before testing, how much gluten do patient need to eat?

A

FTT, delayed puberty, OP, anaemia, b12 deficiency
eat 2 meals for last 6 days

70
Q

Rockall score includes? (acute UGIB mortalitiy)

A

co-morbitiies, age, shock, endoscopic findings, stigmata of acute bleed

71
Q

What are alarm sx? in GOrd that raise liklihood of oesophagitis/ peptic stricture/ cancer?

A

anaemia, dysphagia, ahaematemsis, melaena, persisence vomitin, WL. if any of these sx/ 55+, refer to urgent endoscopy

72
Q

dysphagia both solids and liquids, regurg, night coughing, GORD?

A

achalasia 0 failure of LOS relaxation. loss of peristaliss in distal oesphagus

73
Q

central abdo pain radiating to back, better sitting forwards?
scores involved?
drug causes?

A

acute panc,
cullens- umbillicus, grey turnerys - flanks
GLASGOW (PANCREAS): Pa02,<8, Age 55+, neutrophils 15+. Ca<2, Renal (urea 16+), Enzymes (LDH 600+, AST 200+, Albumin <32, sugar 10+

Drug cx: HIv drugs, diuretics, chemo, azathioprine, oestrogen

74
Q

IBS ROME criteria Dx?
What diet is recced?

A

recurrent abdo pain 1 day+/week in 3 months (onset 6months +) and 2+ of related to defecation/ change in frequency of stool/ stool form

diet: low FODMAP

75
Q

most common cx of LGIB requiring hospital admission?

A

diverticular disease

76
Q

RUQ pain, right shoulder pain, vomiting, fever, guarding?

A

Acute cholecystitis

77
Q

hispanic, persistent RUQ pain, palpable mass, jaundice, anorexia?

A

GB carcinoma

78
Q

RUQ pain, fever, jaundice?

A

acute cholangitis - abs cephalosporin+metronidaole

79
Q

Abdo pain, jaundice, ascites, hepatomegaly, CT caudate lobe hypertrophy, occluded hepatic veins?

A

Buddchiari. post hepatic cx or portal HTN. (pobstruction to hepatic venous flow). common underlying thrombotic disease, TX: TIPS

80
Q

post cholecystectomy, hc of dyspepsia. CXR showed pneumoperitoneum?

A

most common perforation of abdo viscus (ulcer) common after abdo surgery

81
Q

Cx of retroperitoneal haemorrhage sign?

A

Grey turner’s acute pan, AAA ruptured, rupturex ectopic, blunt trauma

82
Q

Blumberg sign

A

rebound tenderness (peritonitis)

83
Q

dispepsia with regurg, CXr showed retrocardiac air bubble in intrathoracic portion of stomach?

A

hiatus hernia

84
Q

Electrolyte causes of constipation?

A

high calcium autonomic nervous system, smooth muscle hypertrophy,
others: low K, hypothyroid, high MG, high PTH, t1DM

85
Q

UC, 40YO, pruritus, fatigue?

A

PSC

86
Q

50YO RA, pruritus, xanthelasmis lesions around eye, heatosplenomegaly, jaundice?

A

PBC

87
Q

acute abdo pain, vomit, absolute constipation, AXR - dilated loop large bowel full of air, inverted U

A

sigmoid volvulus. LLQ colicky pain

88
Q

Actual Q: test to exclude crohns?

A

faecal calprotectin

89
Q

Prehepatic causes portal HTN?
intrahepatic?
post hepatic?

A

obstruction of portal/splenic vein, thrombosis, sepsis, tymour, fistula
intrahepatic: schistosomiasis, hepatitis, PBC, drugs, cirrhosis (mos tcommon)
Post hepatic: budd-chiari, constrictive pericarditis, IVC stenosis/ thrombosos/ tumour

90
Q

RLQ pain, N+V, fever, red tender mass below inguinal ligament? woman parous

A

femoral hernia inferior and lateral to pubic tubercule 4x women high strangulation risk
. (but inguinal is more common in women)

91
Q

rf for gastric cancer?

A

diet, smoking, blood group A, hypogammaglobulaenmia, H pylori, men, age 55+, post gastrectomy, pernicious anaemia, atrophic gastritis, poor, menetrier’s disease

92
Q

Haemorrhoids grades and tx?
external vs internal?

A

most common cause of haematochezia
1- not below anal canal, not prolapse,
2 - reduce spontaneously - rubber band?
3 need manual reduction
4 - cant be reduced - need haemorrhoidectomy - rick of urine retention pos top

external distal to dentate line, internal- vascular rich inside anal - need proctoscopy/ sigmoidoscopy

93
Q

painless haematochezia dropping into faeces?

A

internal haemorrhoids

94
Q

HPV anal region name?

A

condylomata acuminata

95
Q

Isolated ALP rise cx?

A

paget’s - bone
nitrofurantoin, phenytoin, erythromycin, disulfiram
pregnancy 3rd trim
adolescents,
40-65YO women (50% higher than 30YO)

96
Q

CKS: if abnormal UCB(<3x rasied)?/ gilberts?

A

check in 1-3 months. if no rise, d/c
exclude haemolysis coombs, haptoglobin, LDH, FBC, reticulocyte, film

97
Q

things associated with reduced risk of colorectal cancer?

A

NSAIDS, aspirin, Mg, folate, fruit, veg, fibre, dairy

98
Q

20YO F, 2 day pain in RLQ, 6KGWL?

A

crohn’s disease

99
Q

areas more prone to mesenteric ischaemia?

A

splenic flexure, rectosigmoid junction

100
Q

bowel obstruction vs post operative leus?

A

ileus 3 days+ hs abscent/ hypoactive BS. obstruction has high pitched. distended abdo. tx with NBM abd NG for relief if vomiting

101
Q

diarrhoea cx: bloody 6 hrs after eating hamburger at BBQ, has AKI and anaemia 8YO?

A

e.coli (most common cx in developed countries)

102
Q

2 day blody diarrhoea, travelling, resolved then had painful knee?

A

cambylobacter - AF with reactive arthritis

103
Q

bloody diarrhoea - resolves after, then 1 year after had pain, fevers, scleral icterus, tender RUQ

A

entamoeba histolytica

104
Q

patient with UC, how to survey for colorectal cancer?

A

colonoscopy 1-5 yrs with multiple biopsies, regular intervals to chekc for dysplasia

105
Q

45 YO, had appendectomy, has colicky abdo pain vomiting, distended abdo, tender, BS hyperactive

A

small bowel obstruction

106
Q

Cx of amylase raised?

A

4 x is pancrreatitis likely (then returned to normal 3-5 dayafter)
renal failure, ectopic pregnancy, DKA, perforated duodenal ulcer, mesenteric ischaemia/infarction

107
Q

factors pointing to toxic megacolon?

A

fever, tachycardia, leuocytosis, anaemia, dehydration/ GCS, U+e not normal, low BP, do AXR (erect) to show 6cm+ colonic dilation.
avoid barium enema due to risk of perforation

108
Q

what is maydl’s hernia?

A

type of incarcerated hernia in W, obstructed loop of bowel within peritoneal cavity

109
Q

Richter’s hernia?

A

anti-mesenteric wall of the intestine potrudes through fascial defect of abso wall. noted in laparoscopic port sites.

110
Q

50YO man small tense red irreducable lump in lower abdomen right sid lateral edge of rectus muscle at semilunar line (coatal arch of pubic tubercule)

A

Spigelian hernia

MSRA my cards (26 decks)

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