PACES__Gastroenterology/nephrology

Question 1

Give two possible causes of oral ulceration

Answer 1

1. IBD
2. SLE

Question 2

Give 3 possible causes of macroglossia

Answer 2

1. Hypothyroidism
2. Acromegaly
3. Amyloidosis

Question 3

Which immunosuppressant medication causes gingival hypertrophy?

Answer 3

Ciclosporin

Question 4

What is Troisiers sign?

Answer 4

Palpable lymph nodes in the left supraclavicular fossa indicative of proximal gastric cancer. Most likely adenocarcinoma of the stomach.

Question 5

Give 6 causes of acanthosis nigricans

Answer 5

1. Hyper/hypothyroidism
2. Cushing’s syndrome
3. T2DM
4. Paraneoplastic syndrome
5. Acromegaly
6. Obesity

Question 6

What are the 3 most common causes of CLD in the west?

Answer 6

1. Alcohol
2. Viral
3. Metabolic

Question 7

Name 7 complications of CLD

Answer 7

1. Portal HTN
2. UGIB
3. Ascites
4. SBP
5. Hepatorenal syndrome
6. Hepatopulmonary syndrome
7. Hepatic encephalopathy

Question 8

What is the definition of ESRF?

Answer 8

eGFR<15

Question 9

Name 3 barriers to transplantation

Answer 9

1. Deep seated infection
2. Malignancy
3. Lack of donors

Question 10

Name side effects of steroids, ciclopsorin and tacromlimus

Answer 10

1. Steroids: skin thinning, diabetes, proximal myopathy, adipose redistribution
2. Ciclopsorin: hirsutism, gingival hyperplasia
3. Tacrolimus: tremor

Question 11

What is the mode of inheritance of APKD? What gene is the defect located on?

Answer 11

Autosomal dominant
PKD1 and PKD2

Question 12

What is the average age of symptom onset for APKD?

Answer 12

~40

Question 13

Name 2 common extra-renal manifestations of APKD

Answer 13

1. Hepatic cyst
2. Intracerebal berry aneurysm

Question 14

Name 2 disadvantages of peritoneal dialysis in APKD

Answer 14

1. Risk of infected cyst
2. Risk of increased peritoneal volume

Question 15

What score is used to assess need for liver transplant in chronic liver disease? What score is necessary to be considered for transplant?

Answer 15

UK-MELD
49

Question 16

What is the definition of acute liver failure?

Answer 16

A multisystem disorder in which a severe acute impairment of liver function with encephalopathy occurs within 8/52 of initial insult. There should be no evidence of underlying chronic liver disease.

Question 17

Name 6 variant syndromes may lead to liver transplantation?

Answer 17

1. Intractable pruritis
2. Diuretic resistant ascites
3. Hepatopulmonary syndrome
4. PCKD
5. Chronic hepatic encephalopathy
6. Recurrent cholangitis

Question 18

What values go in to calculating a UK-MLED score?

Answer 18

INR
Cr
Bili
Na

Question 19

What is the mode of inheritance of HH? What chromosome is the defective gene on and what gene is defective?

Answer 19

AR
Chromosome 6
HFE

Question 20

What cause of arthralgia is closely associated with HH?

Answer 20

Pseudogout

Question 21

What is the inheritance pattern of hereditary spherocytosis?

Answer 21

AD

Question 22

What is the triad of typical hereditary spherocytosis presentation?

Answer 22

1. Jaundice
2. Anaemia
3. Splenomegaly

Question 23

Name 2 complications of hereditary spherocytosis

Answer 23

1. Pigmented gallstones
2. Aplastic crisis

Question 24

What is the diagnostic test for hereditary spherocystosis? (2 options)

Answer 24

1. EMA binding test
2. Osmotic fragility test

Question 25

Give 5 crucial aspects of management of hereditary spherocytosis

Answer 25

1. Start folate 2. Consider splenectomy 3. Serial RBC transfusions 4. Pneumococcal and meningococcal vaccinations 5. Prophylactic antibiotics

Question 26

What is the definitive diagnostic test for coeliac disease?

Answer 26

D2 biopsy showing total or sub-total villous atrophy

Question 27

Where do transplanted pancreases typically drain?

Answer 27

Traditionally into the bladder Nowadays into the small bowel

Question 28

What is the score for prognosis in CLD?

Answer 28

Child-Pugh score

Question 29

What are the acute and chronic complications of pancreatitis?

Answer 29

Acute: ARDS, SIRS Chronic PV thrombosis, pseudocyst, compression of adjacent structures

Question 30

What type of stent is used to drain pancreatic pseudocysts? How are pseudocysts accessed?

Answer 30

1. Axios stent 2. Via endoscopy

Question 31

What percentage of pancreas exocrine function must be lost before becoming clinically apparent?

Answer 31

~90%

Question 32

What must be remembered with the faecal elastase test?

Answer 32

It will only be low in moderate to severe disease

Question 33

What electrolyte test is most valuable in assessing pancreas dysfunction?

Answer 33

Magnesium

Question 34

What is the criteria for super urgent transplant in paracetamol overdose?

Answer 34

The King’s College Criteria pH < 7.3 or In a 24h period, all 3 of: INR > 6 (PT > 100s) + Cr > 300mmol/L + grade III or IV encephalopathy