Week 142 Inflammatory B. Disease

Question 0

ASA’s have minimal use in ____

Answer 0

Chron’s disease

Question 1

Aminosalicylates are first line treatment for___

Answer 1

Ulcerative collitis

Question 2

Aminosalicylates prevent ____

Answer 2

Colonic Cancer

Question 3

Mechanism of action of ASAs is ______ _________ by inhibiting synthesis of inflammatory the mediators ______, T________ and P________ Factors.

Answer 3

Prostaglandins

OTHERS - see ppt

Question 4

Sulfasalazine is a type of ______. It’s side effects are ________.

Answer 4

ASA.

5-ASA bond of drug is cleaved, activating the drug. Lots of side effects, however. Leucopenia, rash, male infertility, ORANGE discolouration of body secretions.

Question 5

Mesalazine is a _____. It is absorbed in the ____ and has very few ______.

Answer 5

ASA.
Current first line choice, that is well tolerated, and rapidly and completely absorbed in the upper jejenum.
Oral and rectal administration.

Question 6

Name Two Mesalazine formulations.

Answer 6

Asacol
Pentasa
(mezavant) (third)

Question 7

With mesalazine, you must prescribe ________ .

Answer 7

Brand names.

Question 8

What is the aim of corticosteroid use?

Answer 8

Induce remission. NO role in maintenance therapy.

Question 9

What is the action of corticosteroids?

Answer 9

Anti-inflammatory action sim. to glucocorticoids produced naturally.
Inactivates pro inflammatory transcription factors.

Question 10

What happens with long term corticosteroid use?

Answer 10

ADVERSE EFFECTS
Buffalo hump
Cushing syndrome

Question 11

What do you aim to protect with calcium and bisphosphonates when giving corticosteroid treatment?

Answer 11

BONES.

Question 12

What is prenisolone?

Answer 12

Corticosteroid.

Closely mimics endemic cortisone.

Question 13

Why is it important to taper doese of corticosteroids?

Answer 13

Prevent addisonian crisis.

Question 14

Name 3 oral corticosteroids.

Answer 14

Prednisolone
Budesonide
Beclametasone

Question 15

Name an IV corticosteroid.

Answer 15

Hydrocortisone.

Question 16

When are Thiopurines recommended?

Answer 16

UNLICENSED.
When 5-ASA are ineffective/not tolerated. If steroid dependent. If severe or frequent relapse. If require 2 or more corticosteroid in 12 mth period. If requires more than 50mg sterod (?check that value!)

Question 17

What is azathioprine?

Answer 17

A thiopurine.
Avoid in pregnancy (cytotoxic)
50-150mg bd.
Some mild side effects, but also bone marrow suppression, luekopenia, and hepatotoxicity.

Question 18

What is TPMP? What does it do?

Answer 18

Thiopurine methyltransferase.

Metabolises Azathioprine and 6-MP.

Question 19

Risks with TPMT ?

Answer 19

Higher risk of bone marrow suppression in patients with TMPT insufficiency.

Question 20

Ciclosporin is a ____ used for management of active severe _____. Induces remission in ____ and has NO therapeutic effect in ______.

Answer 20

Calcineurin inhibitor
Ulcerative collitis
50-80%

Chron’s.

Question 21

Ciclosporin is a rescue therapy after ___ days of failed ____ therapy.

Answer 21

7 days

IV steroid therapy

Question 22

Target blood level for Ciclosporin?

Answer 22

150-250 mcg/L

Question 23

Ciclosporing interacts with ________.

Answer 23

PVC giving sets (max 6 hours).

For continuous infucsion, use non-pvc giving sets or change every 6 hours.

Question 24

Adverse effects of ciclosporin?

Answer 24

hypertension infection renal impairment, increased risk of seizure with iv if: -hypocholesterolaemia -Hypomagnesaemia ALSO ////: Gum hypertrophy and hirsuitism.

Question 25

Which drugs should you be aware of if taking ciclosporin?

Answer 25

Macrolide antibiotics - clarithromycin, erythromycin. These inhibit metabolism of the active drug (cyclosporin), so monitor bloods to ensure levels do not as metabolism is induced.

Question 26

What action does methotrexate have?

Answer 26

Anti inflammatory.

Question 27

Methotrexate is used for treatment of ______. NOT _____.

Answer 27

Chrons, NOT Ulcerative collitis.

Question 28

What do you give once weekly (5mg) to prevent or reduce side effects from methotrexate?

Answer 28

Folic acid.

Question 29

Always prescribe methotrexate as a _____ dose.

Answer 29

Weekly.

Question 30

Which drugs are used in biological therapy for UC and CD?

Answer 30

Infliximab Adalimumab These are monoclonal antibodies that target TNF-alpha, an inflammatory mediator.

Question 31

Method of action of infliximab?

Answer 31

Chimeric anti inflammatory action.

Question 32

If ciclosporin is contraindicated or inappropriate in ulcerative collitis, what can you use?

Answer 32

Infliximab.

Question 33

What is Adalimumab?

Answer 33

humanised monoclonal antibody Licenced for UC and Chrons. NICE only recommends CD. Targets TNF-Alpha cells.

Question 34

Benefit of adalimumab over infliximab?

Answer 34

Subcut injections --> easier to give.

Question 35

Monoclonal antibody therapies can activate latent _____ infection.

Answer 35

Tb (Tuberculosis)

Question 36

If Mesalazine and steroid therapy hasn't worked you can use ____

Answer 36

Either ciclosporin or infliximab.

Question 37

Drugs for maintenance of remission os UC?

Answer 37

5-asa (mezalasine) | One other?

Question 38

Treatment of active chrons?

Answer 38

Corticosteroids | If doesnt work, use azathiopine, methotrextrate or monoclonal antibodies.

Question 39

Maintenance of remission in Chron's?

Answer 39

Azathiopine Methotrexate One other? See ppt.

Question 40

what is the fundamental difference between surgery for UC and chron's?

Answer 40

Chron's - operate for complications | UC - operate to cure

Question 41

The most common indication for urgent surgery in UC is _______.

Answer 41

Failed medical treatment.

Question 42

_______ is single factor in reducing mortality in urgent UC.

Answer 42

Colectomy

Question 43

A subtotal colectomy leaves ______ behind.

Answer 43

Sigmoid colon.

Question 44

Further surgery from UC includes_____

Answer 44

Ileo--anal pouch Completion proctectomy

Question 45

Indications for elective surgery for UC?

Answer 45

``` Chronic Steroid dependence Recurrent acute symptoms Extra GI manifestations Retardation of growth ```

Question 46

Which operation has a high rate of morbidity?

Answer 46

Ileo-anal pouch

Question 47

The best surgery for UC is _______ in terms of morbidity.

Answer 47

Proctocolectomy and permanent ileostomy.

Question 48

The best lifestyle factor to reduce Chron's is _____

Answer 48

QUIT SMOKING

Question 49

complications of Chron's disease (operable)?

Answer 49

``` Stenosis Fistulae Abscess Bleeding Perforation ```

Question 50

Isolated small bowel disease most frequently in ____

Answer 50

terminal ileum

Question 51

37% of patients with chron's will have ________.

Answer 51

Peri anal disease.

Question 52

In perianal chron's....________

Answer 52

Drain sepsis, maintain function. Nothing more!

Question 53

For short term Chron's, you can use the antibiotic _______ for beneficial effect. NOT long term solution.

Answer 53

Metronidazole.

Question 54

Which is the loci mutation is the "trigger point" for allowing bacteria into the mucosa in IBD's?

Answer 54

NOD2/CARD15 --> activates nuclear factor kappa B (NF-kB)

Question 55

Describe tenesmus.

Answer 55

The feeling that you need to evacuate bowels constantly.

Question 56

Pertinent question to ask RE IBD suspected?

Answer 56

Does it interrupt you at NIGHT?

Question 57

Ulcers in the mouth would indicate _______.

Answer 57

Chron's disease.

Question 58

VILLOUS ATROPHY AND CRYPT HYPERPLASIA IS FOUND IN _____

Answer 58

COELIAC DISEASE

Question 59

A POSITIVE UREASE TEST INDICATES WHAT?

Answer 59

H. PYLORI INFECTION

Question 60

CRYPT ABSCESSES AND MUCOSAL INFLAMMATION INDICATE WHAT?

Answer 60

ULCERATIVE COLLITIS.

Question 61

EXCESSIVE WIND, SUDDEN OR UNEXPLAINED WEIGHT LOSS, D AND V AND STOMACH CRAMPS INDICATE WHAT?

Answer 61

COELIAC DISEASE

Question 62

BLOOD IN STOOL, ABDOMINAL PAIN AND UNEXPLAINED WEIGHT LOSS MEANS WHAT?

Answer 62

COLORECTAL CANCER.

Question 63

THICK MUCUS IN BODY SECRETIONS MEANS WHAT?

Answer 63

CYSTIC FIBROSIS

Question 64

FAITGUE, LETHARGY, DYSPNOEA, FAINTNESS...INDICATE POTENTIALLY WHAT?

Answer 64

PERNICIOUS ANAEMIA (ALSO LACK OF B12)

Question 65

WATERY (SOMETIMES BLOODY DIARRHOEA, ABDO CRAMPS, FEVER, MUCUS IN THE STOOL, NAUSEA AND DEHYDRATION MEANS WHAT?

Answer 65

PSEUDOMEMBRANOUS COLITIS

Question 66

IF IT LOOKS LIKE CHRONS DISEASE BUT IT'S NOT CHRONS DISEASE, IT'S...?

Answer 66

TUBERCULOSIS OF TERMINAL ILEUM

Question 67

INFLAMMATORY INFILTRATE WITH NON CASEATING GRANULOMAS MEANS WHAT?

Answer 67

CHRONS

Question 68

PAPILLAE ARE FOUND ON THE ______

Answer 68

TONGUE

Question 69

WHICH PART OF THE SMALL INTESTINE IS DISTINGUISHABLE BY IT'S FINGER SHAPED INTESTINAL VILLLI?

Answer 69

JEJENUM

Question 70

STAPH. AUREUS RELEASES WHICH TOXIN?

Answer 70

EXFOLIATIVE TOXIN

Question 71

WHICH TOXIN AFFECTS cAMP LEVELS IN THE GUT?

Answer 71

CHOLERA TOXIN

Question 72

WHICH TOXIN ACTS AT NEUROMUSCULAR JUNCTIONS CAUSING FLACCID PARALYSIS?

Answer 72

BOTULINUM

Question 73

WHICH TOXIN CAUSES SCARLET FEVER?

Answer 73

ERYTHROGENIC TOXIN

Question 74

BORDATELLA PERTUSSIS CAUSES WHAT?

Answer 74

WHOPPING COUGH

Question 75

COMMON SKIN INFECTION CAUSED BY THE POX VIRUS THAT OCCURS MOST OFTEN IN CHILDREN, WHERE SMALL ROUND PEARLY-WHITE LUMPS APPEAR IN CLUSTERS ON THE BODY?

Answer 75

MOLLUSCUM CONTAGIOSUM

Question 76

WHICH VIRUS USUALLY PRESENTS WITH ERYTHEMA INFECTIOSUM?

Answer 76

PARVOVIRUS

Question 77

WIDELY VACCINATES BUT CAUSES A FINE PINK RASH AND CAN CAUSE DEVELOPMENTAL DEFORMITIES IF ENCOUNTERED INTRAUTERINE.

Answer 77

RUBELLA

Question 78

FEVER, SORE THROAT, FATIGUE AND BACK/NECK/LIMB PAIN/STIFFNESS IS LIKELY WHICH VIRUS?

Answer 78

POLIOVIRUS

Question 79

WHAT ARE THE SYMPTOMS OF ROSEOLA VIRUS?

Answer 79

HIGH FEVER LASTING 3-5 DAYS, ROSY PINK RASH ON TORSO AND NECK . GENERALLY NOT SEVERE.

Question 80

VARICELLA VOSTER VIRUS CAUSES WHAT? WHAT RE ITS SYMPTOMS?

Answer 80

CHICKENPOX FEVER, RASH (SPOTS APPEAR IN CROPS) CAN BE VERY ITCHY.

Question 81

WHICH VACCINE IS AVAILABLE IN THE USA BUT NOT IN THE UK?

Answer 81

VARICELLA - CHICKENPOX.

Question 82

KOPLIKS SPOTS ARE FOUND IN _____

Answer 82

MEASLES

Question 83

WHICH AREAS OF THE GI TRACT CONTAIN M CELLS?

Answer 83

PEYERS PATCHES

Question 84

THE ORIGIN OF ALL LYMPHOCYTES IS IN THE ____ ______.

Answer 84

BONE MARROW.

Question 85

GIARDIA PARASITES RESIDE WHERE?

Answer 85

DUODENUM

Question 86

BACTERIAL FERMENTATION OF COMPLEX CARBOHYDRATES IS DONE WHERE?

Answer 86

THE CAECUM