pt19

Question 1

What prognostic factor most influences prostate cancer outcome?

Answer 1

Stage at diagnosis

Question 2

How many layers does the GI tract wall have, and what are they?

Answer 2

Four layers—mucosa, submucosa, muscularis (inner circular & outer longitudinal), and serosa

Question 3

What epithelium lines the oesophagus?

Answer 3

Non-keratinised stratified squamous epithelium

Question 4

What is the “functional” lower oesophageal sphincter (LES)?

Answer 4

An acute musculomucosal angle plus mucosal folds at the gastro-oesophageal junction that prevent reflux

Question 5

By what mechanism is a food bolus propelled down the oesophagus?

Answer 5

Coordinated peristalsis under control of the oesophageal (enteric) plexus

Question 6

What is dysphagia and what are its main causes?

Answer 6

Difficulty swallowing; caused by obstructive rings/strictures (scar tissue), carcinoma (late stage), stroke, or neurological disease

Question 7

Define oesophagitis and list its key causes.

Answer 7

Inflammation of oesophageal mucosa; from GORD (reflux HCl), CNS depressants, pregnancy, alcohol relaxing LES

Question 8

What histological changes occur in acute reflux oesophagitis?

Answer 8

Neutrophil infiltration into squamous epithelium and mucosal hyperaemia

Question 9

What is Barrett’s oesophagus and why is it important?

Answer 9

Replacement of squamous mucosa by metaplastic columnar epithelium in chronic GORD (10% cases), a precursor to carcinoma

Question 10

How is oesophageal inflammation visualized endoscopically?

Answer 10

Gastroscopy shows erythematous, friable mucosal patches at the LES

Question 11

What are the three main secretagogues for gastric acid?

Answer 11

Gastrin (endocrine), histamine (paracrine), and acetylcholine (neural)

Question 12

What volume changes can the stomach undergo?

Answer 12

From an empty ~75 mL to a post-prandial capacity of ~2 L

Question 13

Name the protective factors that guard the gastric mucosa.

Answer 13

Mucus layer, bicarbonate secretion, rich blood flow

Question 14

Define gastritis and differentiate acute vs. chronic.

Answer 14

Gastric mucosal inflammation; acute shows neutrophils, chronic shows lymphocytes, atrophy, metaplasia

Question 15

List the four principal aetiologies of gastritis.

Answer 15

NSAIDs (↓ mucus/HCO₃⁻), H. pylori infection, alcohol/tobacco (↑ acid, ↓ blood flow), autoimmune parietal-cell loss

Question 16

How is H. pylori gastritis diagnosed?

Answer 16

Urea-breath test, stool antigen, or biopsy with rapid urease assay

Question 17

What complications arise from untreated gastritis?

Answer 17

Mucosal erosion → ulceration/perforation (peritonitis), bleeding, strictures, cancer risk

Question 18

Outline first-line pharmacological treatments for gastritis.

Answer 18

Antacids (Al/Mg hydroxide), H₂-blockers, proton-pump inhibitors; add antibiotics for H. pylori

Question 19

What endoscopic finding confirms gastric perforation?

Answer 19

Visible hole in gastric wall with free air/fluid on CT or serosal inspection

Question 20

What are the three main categories of malabsorption syndromes in the small intestine?

Answer 20

Defective intraluminal digestion, mucosal (absorptive) defects, and disorders reducing small-intestinal surface area

Question 21

Give three causes of defective intraluminal digestion.

Answer 21

Pancreatic insufficiency (e.g., pancreatitis, cystic fibrosis), biliary insufficiency (no bile for fat emulsification), Small Intestinal Bacterial Overgrowth (SIBO)

Question 22

What is Small Intestinal Bacterial Overgrowth (SIBO)?

Answer 22

Excessive colonic-type bacteria in the small intestine due to impaired peristalsis, loss of gastric acidity, ileocaecal valve failure, or immunodeficiency

Question 23

Name four causes of mechanical small-intestinal obstruction.

Answer 23

Herniation (gut wall defect), surgical adhesions (post-peritonitis scars), intussusception (telescoping), volvulus (twisting from malrotation)

Question 24

Which hernia type commonly causes small-bowel obstruction?

Answer 24

Loop of intestine protrudes through abdominal wall weakness, strangulates, and blocks lumen & blood supply

Question 25

How do surgical adhesions lead to obstruction?

Answer 25

Fibrous bridges form after surgery or peritonitis, strangling bowel segments and blocking passage

Question 26

What is intussusception and its effect?

Answer 26

A proximal segment of bowel telescopes into a distal one during peristalsis, causing lumen blockage

Question 27

What is volvulus and when does it occur?

Answer 27

A congenital malrotation causing bowel to twist on its mesentery, leading to obstruction and ischaemia

Question 28

What clinical features suggest small-bowel obstruction?

Answer 28

Colicky abdominal pain, distension, vomiting, constipation, and trapped gas

Question 29

What is the small-intestinal “string sign” on barium study?

Answer 29

A thin stream of contrast through a narrowed, inflamed segment as seen in Crohn’s disease

Question 30

How long and wide is the small intestine?

Answer 30

~6–7 m long; “small” refers to its narrow luminal diameter

Question 31

How does the small intestine maximize absorptive surface area?

Answer 31

Mucosal folds, villi, and microvilli increase surface area ~600-fold

Question 32

What separates small and large intestine to prevent SIBO?

Answer 32

The ileocaecal valve, peristalsis, gastric acidity, and mucosal immunity

Question 33

What are the features of lactase deficiency?

Answer 33

↓ brush-border lactase; high at birth, declines in childhood; undigested lactose causes osmotic diarrhoea and bacterial fermentation (gas, cramp), reversible, no mucosal damage

Question 34

What population prevalences exist for lactase deficiency?

Answer 34

≈15% of Caucasians; 70–90% of other ethnic groups

Question 35

How is lactase deficiency managed?

Answer 35

Remove lactose from diet

Question 36

What are general clinical features of maldigestion/malabsorption?

Answer 36

Chronic diarrhoea, steatorrhea (pale, fatty floating stools), weight loss/failure to thrive, anorexia, abdominal distension, borborygmi, and muscle wasting

Question 37

What are three causes of fat malabsorption?

Answer 37

Bile insufficiency (no emulsification), pancreatic lipase deficiency, mucosal chylomicron assembly defects (e.g., abetalipoproteinaemia)

Question 38

How is pancreatic lipase deficiency diagnosed?

Answer 38

Faecal elastase-1 (FE-1) assay

Question 39

What genetic phenotype is linked to coeliac disease?

Answer 39

HLA-DQ2 or DQ8

Question 40

What skin manifestation is pathognomonic for coeliac disease?

Answer 40

Dermatitis herpetiformis—pruritic, subepidermal blisters in 15–25% of patients

Question 41

How is coeliac disease definitively diagnosed?

Answer 41

Small-intestinal biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytes; reversible on gluten-free diet

Question 42

What serological tests support coeliac disease diagnosis?

Answer 42

Anti-gliadin IgA and anti-tissue transglutaminase (tTG) antibodies (95% sensitivity)

Question 43

Which foods must be excluded in coeliac disease?

Answer 43

Gluten sources: wheat (gliadin), barley, rye (oats often contaminated)

Question 44

What complications arise if coeliac disease is untreated?

Answer 44

Persistent malabsorption, nutritional deficiencies, and increased risk of intestinal lymphoma

Question 45

What are the four most common urinary tract diseases?

Answer 45

Benign prostatic hyperplasia (men), urinary tract infection (women), bladder cancer, and urinary incontinence.

Question 46

What two functions does the bladder perform?

Answer 46

Stores urine and voids it under voluntary control.

Question 47

What four symptoms suggest a urinary tract problem?

Answer 47

Frequency, dysuria (pain on urination), haematuria, and urinary retention.

Question 48

How common is UTI in primary care?

Answer 48

UTIs account for about 1–2% of GP consultations.

Question 49

What is the annual incidence of UTIs?

Answer 49

Approximately 50,000 cases per million people per year.

Question 50

Which form of UTI primarily affects the bladder?

Answer 50

Cystitis (bladder inflammation).