Other

Question 1

Which investigation for coeliac disease has the highest negative predictive value?

Answer 1

HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.

Question 1

What is the most sensitive investigation for coeliac disease?

Answer 1

HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.

Question 2

A patient present with an itchy, vesicular rash over shoulders, elbows and knees. What gastrointestinal condition is this most likely associated with?

Answer 2

Coeliac disease

Dermatitis herpetiformis

Question 3

What serology would you send to investigate potential coeliac disease?

Answer 3

tTG-IgA + total IgA level +/- DGP-IgG

Question 4

Why is it particularly important for patients with coeliac disease to be up to date with vaccinations?

Answer 4

Due to hyposplenism are at increased risk for pneumococcal sepsis

Question 5

Hereditary non-polyposis colorectal cancer is caused a mutation in (1), and inheritance is in a (2) pattern.

Answer 5

Mismatch repair gene e.g. MLH2, MSH2, MSH6

Autosomal dominant inheritance

Question 6

Apart from CRC, what other malignancy are patients with HNPCC most at risk of developing?

Answer 6

Endometrial cancer

Question 7

How do you know when to pursue genetic testing for diagnosis of HNPCC in patients with CRC?

Answer 7

Use Amsterdam criteria
3 relatives and 2 generations with assoc ca, one a first degree relative of others, FAP excluded, tumous verified on pathoogy

Question 8

In patients with familial adenomatous polyposis, what is the risk of developing CRC?

Answer 8

100% in classic FAP

Question 9

What is the underlying cause of familial adenomatous polyposis?

Answer 9

Mutated TSG (adenomatous polyposis coli/APC) gene

Question 10

When should CRC screening begin for those with known FAP? What other form of cancer screening is recommended?

Answer 10

Flexi sig annually from age 10-12, progress to colonoscopy if adenomas detected
Annual thyroid ultrasound also recommended

Question 11

What is the main physiological mechanism causing GORD?

Answer 11

Transient lower oesophageal sphincter relaxation

Question 12

Which autoantibodies are associated with primary biliary cirrhosis?

Answer 12

ANA, AMA

Question 13

Does primary biliary cirrhosis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?

Answer 13

Intrahepatic

Question 14

Does primary sclerosing cholangitis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?

Answer 14

Both

Question 15

What is the main pharmacological management of primary biliary cirrhosis?

Answer 15

Ursodeoxycholic acid

Question 16

What is the LFT pattern usually found in those with primary biliary cirrhosis?

Answer 16

Elevated ALP

Question 17

What LFT pattern is seen in primary sclerosing cholangitis?

Answer 17

Cholestatic LFTs

Question 18

How is PSC diagnosed?

Answer 18

MRCP/ERCP to view bile ducts - wall thickening, dilatation, strictures

Question 19

What is the most common autoantibody present in PSC?

Answer 19

pANCA

Question 20

What are the three main indications for H pylori testing?

Answer 20

MALT lymphoma
Peptic ulcer disease
Early gastric cancer

Question 21

What is the treatment for H pylori?

Answer 21

PPI + amoxi + clarithromycin for 7 days

Question 22

What factors can interfere with H pylori testing?

Answer 22

PPI or recent UGIB can cause false negatives

Question 23

Which of the following is not a cause of fat malabsorption?
A) Reduced gastric acid secretion
B) Reduced bile acid secretion
C) Reduced pancreatic lipase
D) Reduced small bowel surface area

Answer 23

A) It is INCREASED gastric acid secretion which inactivates pancreatic enzymes and causes fat malabsorption

Question 24

Allocate the below trait to either the jejunum or the ileum: | Able to adapt better post small bowel resection

Answer 24

Ileum

Question 25

Allocate the below trait to either the jejunum or the ileum: | Location of vitamin B12 absorption

Answer 25

Ileum

Question 26

Allocate the below trait to either the jejunum or the ileum: | Primary site for absorption of most macro and micronutrients

Answer 26

Jejunum

Question 27

Allocate the below trait to either the jejunum or the ileum: | Secretes a large amount of fluid

Answer 27

Jejunum

Question 28

A 34 week pregnant woman presents with right upper quadrant pain and nausea. Bloods: bilirubin 25, ALT 150, Hb 90, Plts 75, PT 14 seconds. Likely dx?

Answer 28

HELLP syndrome | Best management is early delivery, if <34/40 and stable can give betamethasone first

Question 29

A 34 week pregnant woman presents with significant itching of her palms and soles. Bloods: bilirubin 35, ALT 150, Hb 100, Plts 300. Likely dx? Mx?

Answer 29

Intrahepatic cholestasis of pregnancy | Mx is ursodeoxycholic acid

Question 30

A 34 week pregnant woman presents with right upper quadrant pain and nausea. Bloods: bilirubin 25, ALT 1000, AST 1000. Hb 100, WCC 14, Plts 75, INR 2.9. BGL 2.9. Most likely dx?

Answer 30

Acute fatty liver of pregnancy AFLP is most common cause of acute liver failure in pregnancy Significant overlap between this and HELLP/ preeclampsia. Luckily management is all the same!