Passmed

Question 1

How does haemochromatosis typically present?

Answer 1

With joint pain, liver disease, impotence, skin pigmentation

Question 2

What diagnostic tests would be used for haemochromatosis?

Answer 2

Raised serum transferrin saturation (67%)

Raised serum ferritin

Question 3

What is the mainstay of treatment for haemochromatosis?

Answer 3

Regular venesection

Iron chelators can be used if venesection not tolerated

Question 4

What is Colchicine used for?

Answer 4

Used to treat gout by preventing the formation of uric acid crystals

Question 5

Before starting azathioprine for Crohn’s what test should be done on the patient?

Answer 5

Thiopurine methyltransferase activity (TPMT)

Some people have a genetic deficiency of this enzyme and therefore will experience worse side effects

Question 6

What are the management steps of Crohn’s?

Answer 6

Stopping smoking should be the first aim
Glucocorticoids such as predisolone are used first line (oral, topical, intravenous)
5-ASA drugs such as mesalazine are used as second line but are not as effective as glucocorticoids
Then immunosupressants such as azathioprine can be used as add ons
Infliximab can be used in refactory disease - immunosupressants are typically used alongside this
Next surgery would be considered

Question 7

What is Sister Mary-Josephs Node

Answer 7

the name of a palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

Question 8

What is Virchow’s Node?

Answer 8

Enlarged left supraclavicular lymph node that is seen in various internal abdominal malignancies

Question 9

What does a high serum albumin-ascites gradient indicate about the cause of the ascites?

Answer 9

That it is more likely to be a transudate rather than an exudate. This means it is likely to be caused by liver cirrhosis and this portal vein hypertension forces fluid out into the tissues

Question 10

What is the biochemical indicator of patients at risk of refeeding syndrome?

Answer 10

Hypophosphataemia

Question 11

What is refeeding syndrome and how can you avoid it?

Answer 11

This is the electrolyte abnormalities that are caused by refeeing malnourished patients too quickly. Need to refeed at no more than 50% of requirements for the first 2 days

Question 12

What do the symptoms of hepatomegaly, arthralgia and iron overload on MRI scan indicate?

Answer 12

Haemochromatosis

Question 13

What is the single most sensitive and specific test for liver cirrhosis in the setting of chronic liver disease?

Answer 13

Platelet count will be reduced.

Thrombocytopenia is caused by multiple factors during cirrhosis

Question 14

How would urea change in advanced liver disease?

Answer 14

The liver is responsible for urea production so it would fall

Question 15

How does the AST to ALT ratio change in cirrhosis?

Answer 15

The ratio should be above a ratio of 2.5 with ALT being more specific marker, this should be 10x raised

Question 16

What is carcinoid syndrome? What is the usual triad of symptoms?

Answer 16

This results from carcinoid tumours usually when mets are present in the liver. They secrete a variety of vasoactive amines that cause symptoms.
Crampy abdo pain, diarrhoea and flushing are the typical symptoms

Question 17

What is the least invasive way to diagnose gallstones?

Answer 17

Ultrasound

Question 18

What is pellagra?

Answer 18

Primary pellagra is due to a strict diets causing vitamin b3 deficiency, as described in this case. The patient exhibits the characteristic sunburn-like dermatitis rash, diarrhoea and cognitive deficit (dementia/delusion).

Question 19

What is a side effect of mesalazine?

Answer 19

Acute pancreatitis

Question 20

What are the alarm symptoms of GI malignancy?

Answer 20

A - Anaemia
L - Loss of weight
A - Anorexia
R - Recent onset of progressive symptoms
M- Melaena or haematemesis
Swallowing difficulty