GI (passmed)

Question 1

What would cause abnormal LFTs in a non-alcoholic patient with T2DM?

Answer 1

Non-alcoholic liver disease

Question 2

What imaging tool would you use to diagnose NAFLD?

Answer 2

Ultrasound

Question 3

How does diabetes cause NAFLD?

Answer 3

Insulin resistance

Question 4

What diagnostic test would you do to confirm H pylori?

Answer 4

Carbon-13 urea breath test

Question 5

What is the triple management therapy for H pylori?

Answer 5

Amoxicillin, Clarithromycin & Omeprazole

Question 6

If a patient has an allergy to penicillin, what other medication is used in the treatment of H pylori?

Answer 6

Metronidazole

Question 7

In crohn patients who develop a perianal fistula, what medication would you prescribe?

Answer 7

Oral Metronidazole

Question 8

What does NESTS stand for in Crohn’s disease? (Don’t set the nest on fire)

Answer 8

N - No blood or mucus  
E - entire GI tract (from mouth to anus) 
S - Skip lesions 
T - Terminal ileum
S - Smoking

Question 9

What is the specific test to diagnose IBD?

Answer 9

Faecal calprotectin

Question 10

What is faecal calprotectin and what does it indicate?

Answer 10

Released by the intestines when inflamed as made by WBC

Indicates IBD and IBS

Question 11

What is faecal elastase and what does it indicate?

Answer 11

Measures digestive enzymes produced by the pancreas that do not degrade through the digestive tract

Helps to detect pancreatitis, cystic fibrosis, diabetes

Question 12

What first line steroid is used in the treatment of crohns?

Answer 12

Oral Prednisolone / IV Hydrocortisone

Question 13

What immunosuppresent medication is used in Crohns disease?

Answer 13

Azathioprine

Question 14

What does CLOSEUP mean in ulcerative colitis? (U - C CLOSEUP)

Answer 14

C - Continuous inflammation
L - limited to colon and rectum 
O - Only superficial mucosa affected 
S - smoking is protective 
E - excrete blood and mucus 
U - use aminosalicylates 
P - primary sclerosing cholangitis

Question 15

If a patient with ulcerative colitis presents with liver symptoms and signs, what condition would you think of as the cause?

Answer 15

primary sclerosing cholangitis

Question 16

What results would you see on the LFTs when investigating primary sclerosing cholangitis to show a cholestatic picture?

Answer 16

Raised ALP
Raised Bilirubin
Raised ALT and AST

Question 17

What is the gold standard test for diagnosing primary sclerosing cholangitis and what would it show?

Answer 17

MRCP

• Bile duct lesions
• Bile duct strictures

Question 18

What is the gold standard investigation for the diagnosis of IBD?

Answer 18

Endoscopy with biopsy

Question 19

What are the two treatments for oesophageal varices?

Answer 19

Terlipressin

Sengstaken-Blakemore tube

Question 20

What are oesophageal varices?

Answer 20

Enlarged veins in the oesophagus

Question 21

In a patient with an ongoing acute upper GI bleed, what is the treatment if endoscopic therapy has not worked?

Answer 21

Laparotomy and surgical exploration

Question 22

What is the treatment of ascites secondary to liver cirrhosis?

Answer 22

Aldosterone antagonist - Spironolactone

Question 23

How does using an aldosterone antagnonist like spironolactone reduce ascities?

Answer 23

By inhibiting aldosterone, it leads to reduced sodium retention and increased sodium excretion through the urine

Question 24

What is a side effect of using a loop diuretic such as furosemide?

Answer 24

Hypokalaemia and alkalosis which promotes the formation of ammonia that can cause hepatic encephalopathy

Question 25

What serious condition do you need to exclude in a patient presenting with painless jaundice?

Answer 25

Pancreatic cancer

Question 26

Why would pancreatic cancer cause painless jaundice?

Answer 26

The blockage of the biliary tree without pain means it is not because of gallstones and instead a pancreatic mass

Question 27

What findings on the LFTs would show and obstructive cause for jaundice?

Answer 27

Bigger raise in ALP and GGT than ALT

Question 28

What is the first line management for UC flare in hospital?

Answer 28

IV hydrocortisone

Question 29

What medication can be used for remission in a mild/moderate flare up of UC?

Question 30

Pt over 55 presents with raised platelets and nausea/vomiting, reflux, weight loss and upper GI Pain - What type of referral would you do and why?

Answer 30

Non Urgent for endoscopy - rule out upper GI cancers

Question 31

Pt over 55 presents with dysphagia/upper abdo mass/weight loss/reflux - what is your management?

Answer 31

Urgent referral to gastro

Question 32

What finding associated with the mouth would you see that is caused by vitB12/folate deficiency?

Answer 32

Glossitis (red swollen tongue)

Question 33

What type of anaemia causes B12 deficiency anaemia?

Answer 33

Pernicious anaemia

Question 34

What is the first line treatment for management of severe ulcerative colitis in hospital?

Answer 34

IV steroids

Question 35

What antibody is detected in ulcerative colitis? | *Bianca has ulcerative colitis*

Answer 35

P-ANCA

Question 36

Where do patients normally feel pain with UC?

Answer 36

Left lower quadrant

Question 37

What is the first line treatment for inducing remission and maintaining mild-moderate UC and please give an example?

Answer 37

Topical and/or oral aminosalicylates | Mesalazine

Question 38

How is anaemia a complication of GORD?

Answer 38

GORD can lead to inflamed ulcerated oesophagus/cancers that can lead to chronic bleeds

Question 39

List some complications of GORD

Answer 39

- Benign strictures (narrowing of oesophagus) - Anaemia - Barretts oesophagus (oesophagus lining becomes red) - oesophageal carcinoma

Question 40

Besides lifestyle advice and antacids, what is the management for endoscopically proven GORD?

Answer 40

Full dose PPI for 1/2 months | then put to low dose

Question 41

What is the first line treatment for hemochromatosis?

Answer 41

Venesection

Question 42

What risk factors increase the risk of c diff?

Answer 42

- Prolonged hospital exposure - PPI - Antibiotics (cephalosporins)

Question 43

What is the complication of c difficle?

Answer 43

Toxic megacolon

Question 44

Which of the following confirms the diagnosis of c difficle? - Stool C.difficile antigen - Stool C.difficile toxin

Answer 44

C difficile Toxin confirms current infection C difficile confirms exposure to bacteria

Question 45

What is Achalasia and what symptoms present with this condition?

Answer 45

Smooth muscle fibres in the lower portion of the oesophagus do not relax - Difficulty swallowing - retrosternal pain - regurgitation of food

Question 46

What is Hirschsprung's disease?

Answer 46

Birth defect where nerves are missing from parts of the intestine - presents with constipation

Question 47

What is the difference between a colostomy and ileostomy?

Answer 47

Colostomy - connects the colon to the abdominal wall - - LIF - - Non-spouted - - Formed stool in stoma bag Ileostomy - connects the last part of the small intestine (ileum) to the abdominal wall - - RIF - - Spouted (prevents touching the skin)

Question 48

What scoring system is used to determine the severity of cirrhosis?

Answer 48

Child-pugh score

Question 49

What type of ulcer is associated with UC and crohns?

Answer 49

Pyoderma gangrenosum

Question 50

What two medications can relax the lower oesophageal sphincter and thus help to resolve achlasia? Hint - One drug is used in treating BP and the other is an antiplatelet

Answer 50

CCB | Aspirin

Question 51

How does the cause of difficulty swallowing food differ between achalasia and oesophageal carcinoma?

Answer 51

Achalsia - difficult to swallow foods and liquids at the same time Carcinoma - difficult swallowing foods first and then liquids later as the tumour grows

Question 52

What is the investigation of choice for diagnosing coeliac disease?

Answer 52

Serum IgA tissue transglutaminase antibody testing

Question 53

What skin condition can be associated with coeliac disease and where would you most likely find it on the body?

Answer 53

Dermatitis herpetiformis - very itchy - affects elbows, knees, back and buttocks

Question 54

What other hepatitis does the Hep B vaccination provide immunity to? *Hint* - The...needs company ;)

Answer 54

Hep D | - Needs Hep B in order to replicate

Question 55

List three symptoms that can occur if a patient drinks alcohol whilst on metronidazole

Answer 55

- Flushing - Tacycardia - Nausea

Question 56

Name the 3 symptoms associated with ascending cholangitis? Charcots triad

Answer 56

- RUQ pain - Fever - Jaundice

Question 57

Vit B12 is associated with crohns disease | What social factor is iron deficiency associated with?

Answer 57

Alcoholism

Question 58

List three symptoms of acute pancreatitis

Answer 58

- Sudden severe epigastric pain - Nausea/vomiting - loss of appetite

Question 59

What blood test is associated with acute pancreatitis?

Answer 59

Serum lipase - released by pancreas to digest fats

Question 60

What 4 symptoms are associated with bowel obstruction?

Answer 60

- Abdominal pain - Abdominal distention - Vomiting - Constipation

Question 61

What is acute cholecystitis in comparison to ascending cholangitis?

Answer 61

Acute cholecystitis - inflammation of the gallbladder -- Gallstone stuck in cystic duct that comes out from the gallbladder and so causes the inflammation Ascending cholangitis - inflammation of the bile duct -- Gallstone has started to travel down the common bile duct but has got stuck and therefore causes inflammation

Question 62

How does acute cholangitis present?

Answer 62

- Sudden sharp pain in RUQ that radiates to right shoulder - Worse by deep breathing - Persistent - Can have fever/vomiting - Palpable gallbladder Jaundice less likely

Question 63

What are the 5 common risk factors of gallstone disease? | *Hint* - F

Answer 63

``` Fat Female Forty Fertile Family history ```