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step 2 Flashcards

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1
Q

oral leukoplakia vs oral hairy leukoplakia

A

both cause white plaques in the mouth that cannot be scrapped off

oral leukoplakia:
- smoking, alcohol, HPV
- hyperkeratosis, hyperplasia/atrophy, inflammation
- oral mucosa
- risk fo SCC transformation

hair leukoplakia:
- EBV
- lateral tongue
- feathery/hairy in appearance
- no malignant transformation

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2
Q

burning, ulceration and pain of the oral mucosa, chews araca nuts. ?diagnosis ?treatment

A

oral submucosal fibrosis
stop consumption of betel products (.e. araca nuts)

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3
Q

reticular white plaques with mucosal erythema. ?diagnosis

A

oral lichen planus
if symptomatic treat with steroids

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4
Q

oral lesions that have potential to transofrm to SCC

A

oral leukoplakia - white plaques cannot be scrapped off

erythroplakia - erythematous lesions

oral submucosal fibrosis - chews araca nuts, burning ulceration

oral lichen planus - white reticular plaques and mucosal erythema

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5
Q

RULE acromym for deciding which oral lesions to biopsy

A

Red / white lesions
Ulcer
Lumps
Especially in combination or if indurated

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6
Q

most common causative organism of acute suppurative sialadenitis

A

staph aureus

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7
Q

1st line investigation for acute suppurative sialadenitis

A

uss +/- CT

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8
Q

most common cause of acute unilateral salivary gland swelling and how is it managed

A

sialolithiasis (stone in salivary gland)

1st line: warm compress, hydration, massage of gland, NSAIDS
Abx if infected
2nd line: minimally invasive or surgical removal

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9
Q

translucent blue swelling at the floor of the mouth just lateral to the midline

A

Ranula - pseudocyst of the major salivary glands. may be congenital or acquired. Most resolve spontaneously

if not blue in appearance = mucocele (pseudocyst of minor salivary gland)

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10
Q

most common benign and malignant mass of the parotid gland

A

benign - pleomorphic adenoma
malignant - mucoepidermoid carcinoma

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11
Q

patient complains of difficulty initiating swallowing. 1st line investigation?

A

patient has oropharyngeal dysphagia

modified barium swallow +/- mannometry

OGD as 2nd line if suspecting stricture/mass

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12
Q

tx oesophageal candidiasis

A

oral fluconazole (requires oral and not just topical)

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13
Q

upper endoscopy shows oesophageal volcano-like small deep ulcerations. ?diagnosis ?treatment

A

HSV oesophagitis
IV aciclovir

may show multinuclear giant cells with intranuclear inclusions on biopsy +Tzank smear

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14
Q

upper endoscopy shows large, linear, superficial ulcerations. ?diagnosis ?treatment

A

CMV oesophagitis
IV ganciclovir

will also show intranuclear and intracytoplasmic inlcusions on biopsy

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15
Q

common medications that can cause pill induced oesophagitis

A

bisphosphonates
ascorbic acid
NSAIDS
antibiotics (i.e. tetracyclines)
potassium chloride
ferrous sulphate acetaminophen
warfarin
chemotherapy

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16
Q

features of eosinophillic eosophagitis on OGD

A

ring like strictures and thickened linear burrows

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17
Q

1st line treatment for eosinophillic oesophagitis

A

PPI + elimination of possible causes
2nd line: steroids
3rd line: refractory +/- presence of oesophageal rings may require surgical dilatation

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18
Q

additional findings in plummer-vinson syndrome

A

dysphagia, iron deficiency anaemia, esophageal webs

additional features;
- thyromegaly
- splenomegaly
- angular cheilitis
- glossitis
- koilnychia

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19
Q

1st line management of plummer vinson syndrome

A

iron replacement
can significantly improve dysphagia

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20
Q

muscle type of th oesophagus

A

upper 1/3 skeletal
lower 2/3 smooth

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21
Q

initial and most accurate test for suspected oesophageal spasm

A

presents with odynophagia, dysphagia, heart burn and chest pain with ingestion of food

initial: OGD + biopsy.
- may do barium swallow if risk of perforation i.e. proximal lesion

most accurate: oesophageal mannometry

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22
Q

oesophageal spasm vs achalasia

A

oesophageal spasm:
- high amplitude non-peristaltic contraction of the oesophagus
- corkscrew appearance
- 1st line: CCB, TCA, nitrates

achalasia:
- degeneration of inhibitory neurones in myenteric plexus (aucherbah’s)
- birds peak
- 1st line: heller myotomy

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23
Q

patient has sympotms of GERD and has been trialled on PPI for 8 weeks without response. ?next step

A

if no symptoms/signs of malignancy then increase PPI to twice daily or change to alternative

if no response after this then refer for endoscopy

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24
Q

most accurate test if diagnosis of GERD is uncertain with no red flag symptoms

A

24 hour PH monitoring with impedance

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25
describe the management and surveillence of barretts oesophagus
long term PPI surveillence or further treatment necessary depending on biopsy findings; - No dysplasia: endoscopy every 3-5 yrs - indefinite dysplasia: repeat endoscopy in 2-6 months - dysplasia or intramucosal adenocarcinoma: endoscopic eradication - oesopahgeal adenocarcinoma: refer to cancer specialist
26
management of sliding hiatus hernias vs paraoesophageal hernias
sliding causes GERD symptoms - treat with PPI and lifestyle modifications to reduce GERD symptoms paraoesophageal usually asymptomatic - treat with surgical gastropexy to reduce risk of volvulous in some patients
27
location of SCC vs adenocarcinoma of oesophagus
SCC upper 1/3 adenocarcinoma lower 2/3
28
why does oesophageal cancer metastasise early
lacks a serosa
29
most common oesophageal cance worldwide
SCC (tobacco, alcohol, nitrosamines) adenocarcinoma (GERD) most common in USA
30
budd chiari syndrome and potential complication
hepatic vein obstruction = varices upper GI bleeding
31
what is the role of ocreotide in upper GI bleed
common cause of upper GI bleed is due to high portal venous pressure i.e. budd chiari syndrome, cirrhosis etc leading to varices ocreotide is a somatostatin analogue which has vasoactive properties thereby reducing portal venous blood flow
32
1st line management of upper GI bleed
stabalise patient secure airway
33
investigation of choice for suspected boerhaaves syndrome
boerhaaves syndrome = rupture of oesophagus during straining can cause upper GI bleed (rarely), dysphagia, chest pain and crepitus - contrast oesophagram or CT
34
when ruling out secondary dypepsia, when should patients recieve endoscopy ?
all patients > 60yrs with dyspepsia should receive endoscopy patients < 60yrs with any red flag symptoms should receive endoscopy
35
red flag features of dyspepsia
progressive dysphagia odynophagia anaemia perisistent vomiting lymphadenopathy palpable mass family history of GI malignancy
36
how to test for cure after h.pylori treatment
h.pylori antibodies remains positive after treatment stool antigen or urea breath test can serve as test of cure
37
type A vs type B chronic gastritis
type A ocurs in the fundus. due to parietal cell antibodies and causes pernicious anaemia type B occurs in the antrum and is caused by chronic NSAID use or h.pylori
38
recurrent or refractory peptic ulcer disease ? differential ?how to investigate
consider Zollinger ellison syndrome with recurrent or refractory peptic ulcer disease test gastrin levels - fasting > 1000 - increase in gastrin after secretin administration - PH < 2 CT to characterize and stage disease Nuclear ocreotide scan to detect location of gastrinoma
39
complication of anterior peptic ulcer vs posterior peptic ulcer
anterior tend to cause perforation posterior tend to cause bleeding from erosion of gatsroduodenal artery
40
30 yr old patient presents with recurrent upper abdominal pain that fails to respond to PPI's. bloods show hypercalcaemia. ?diagnosis ?investigations
zollinger ellison syndrome hypercalcaemia due to hyperparathyroidism found in ZES. gatsrin levels - fasting > 1000 - increase after secretin administration - PH < 2 CT scan nuclear ocreotide scan
41
what anti-diabetic medications should be avoided in diabetic patients with gastroparesis
pramlitide GLP-1 agonists they both delay gastric emptying
42
what is menetrier disease
large gastric folds, typically found in adult males with progressive weight loss, abdominal pain, peripheral oedema and vomiting endoscopy + biopsy labs: hypobilirubinaemia and anaemia symptomatic treatment require annual screening for associated carcinoma
43
what is gatsric bezoar
gastric bezoars are foreign bodies made up of ingested material found in the stomach physical examination may show abdominal mass or alopecia (trichobezoars) often found accidentally definitive diagnosis is endoscopy chemical dissolution for mild endoscopic removal for moderate/severe psych, hydration and dietary modification to prevent recurrence
44
indications for bariatric surgery
BMI 40 or above BMI 35-39.9 with at least 1 other co-mordity BMI 30-34.9 with uncontrolled T2DM or metabolic syndrome
45
dumping syndrome presentation and management
common complication of bariatric surgery rapid emptying of content from stomach to small bowel. hyperosmolar content pulls fluid from plasma to the bowel = hypotension, abdo pain and tachycardia usually resolves within 7-10 weeks
46
causes of diarrhoea with a high osmotic gap
high osmotic gap > 100 = osmotic diarrhoea - lactose intolerence - whipples - pancreatic insufficiency - laxative abuse - coeliac disease
47
causes of diarrhoea with a low osmotic gap
osmotic gap < 50 = secretory diarrhoea - infectious - VIPoma - gastrinoma - medullary thyroid cancer
48
abx of choice for c.diff
oral fidaxomicin > oral vancomycin if fulminant: oral vanc + oral metronidazole
49
close contacts with dogs, diarrhoea, liver cysts and egg shell calcifications on CT scan
Echinococcus granulosus cyst aspiration may cause anaphylaxis treat with surgical resection and albendazole
50
what condition can mimic IBD but treatment with steroids causes perforation
E.histolytica history of recent travel abroad incubation lasting up to 3 months endoscopy shows flask shaped ulcers treat with metronidazole
51
abx for salmonella infection
oral flouroquinolone or co-trim
52
abx for shigella infection
flouroquinolone + azithromycin + cephalosporin or co-trim + ampicillin
53
taenia solium presentation and treatment
ingested undercooked pork diarrhoea + signs of raised ICP tx = albendazole
54
trichinella spiralis presentation and treatment
ingestion of undercooked meat in developing countries diarrhoea, myositis, periorbital oedema + eosinophillia can cause vasculitis resulting in splinter haemorrhages tx = albendazole +/- steroids
55
diagnostic test for lactose deficiency
hydrogen breath test
56
vitamin deficiencies associated with carinoid syndrome
niacin (b3) as tryptophan is metabolised into serotonin
57
medication used for symptomatic management in carcinoid syndrome
ocreotide (somatostatin analogue)
58
AXR of small bowel obstruction vs ileus
ileus will show gas present throughout the small and large bowel obstruction will show gas in small but little-no gas in colon (no air distal to obstruction)
59
70 year old patient with PMH hypercholesterolaemia, T2DM presents with a year history of dull abdominal pain after eating which has lead to reduced intake and weight loss. ?diagnosis ?next step in investigation
chronic mesenteric ischaemia duplex ultrasonography
60
ischaemia of multiple organs after cardiac catheterization
cholesterol emboli
61
management of appendicitis with abscess
broad-spectrum abx + CT guided drainage of abscess appendectomy should be delayed 6-8 weeks after resolution of abscess
62
how is toxic megacolon defined
colon diameter of > 7cm or > 12cm in caecum
63
best investigation for diagnosis in suspected diverticulitis
CT scan colonoscopy best for diagnosing diverticular disease but avoid colonoscopy in acute diverticulitis due to risk of perforation
64
medications used to manage IBS symptoms
soluble fibre and antispasmodics TCA, SNRI's IBS-C; - chloride channel activators i.e. lubiprostone - guanylate cyclase activators i.e. linaclotide IBS-D; - rifaximin
65
screening for colon cancer in a patient with IBD
colonoscopy every 1-2 years 8-10 years after diagnosis
66
screening for colon cancer in patients with HNPCC and FAP
HNPCC: colonoscopy every 1-2 years starting from 25yrs old FAP: sigmoidoscopy every year starting from 12 yrs old
67
hernia through the hasselbach triangle can damage what artery
inferior epigastric artery contents of the triangle include inguinal ligament, inferior epigastric artery and rectus abdominus
68
comorbid conditions that increase risk of colorectal cancer
IBD diabetes CF renal transplantation (immunosuppression) abdominopelvic radiation
69
vitamin deficiencies found in coeliac disease
folic acid vitamin B6, B12 vitamin D zinc, iron and copper
70
indications for further colonscopy in patients with polyp
features of polyps i.e. villous, >10mm, high grade dysplasia = colonoscopy in 3 yrs
71
abx regimen for h.pylori eradication in a patient with recent antibiotic use
recent antibiotic use of macrolide increases risk fo resistance therefore quadruple therapy is required; bismuth, metronidazole, tetracyclin e+ omeprazole
72
in a patient with a family history of colorectal cancer, when should they have colonoscopy screening
if FH of colorectal cancer age < 60yrs then screening should begin at 40yrs or 10 yrs before their diagnosis e.g. pt's father had colorectal cancer at 45yrs, they should get screening at 35yrs
73
what treatment for bleeding varices can have a complication of causing encepahlopathy
TIPS (intrahepatic portosystemic shunt) decompresses portal circulation by redirecting blood away from the liver. redirecting blood away from the liver reducing the clearance of toxins allowing ammonia to build up causing encephalopathy.
74
features of severe c.diff and abx of choice
profuse watery diarrhoea with abdominal pain WCC > 15 creatinine > 1.5x normal hypoalbuminaemia bowel wall thickening on CT oral vancomycin (or fidoximicin) for severe oral metronidazole for mild
75
features of mild ulcerative colitis and first line management
stool < 4 per day rectal 5-ASA i.e. mesalazine mild erythema on endoscopy intermittent bloody stool
76
what infectious agent commonly causes gastroenteritis after ingestion of undercooked seafood
vibro parahaemolytica

Gastrointestinal (5 decks)

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