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Gastrointestinal > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Enteric fever is AKA which type of fever

A

Typhoid

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2
Q

Cruise ships are notorious for which viruses?

A

Rotavirus, norovirus

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3
Q

Commonest cause of Traveller’s Diarrhoea?

A

ETEC

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4
Q

Antibiotic treatment of Traveller’s Diarrhoea?

A

Single dose ciprofloxacin (or clarithromycin if resistant)

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5
Q

Wet stool prep is used to screen for what?

A

Amoebic trophozites

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6
Q

First-line therapy of Traveller’s Diarrhoea?

A

Supportive

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7
Q

Enteric fever is most common in those returning from which 2 areas?

A

India, SE Asia

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8
Q

Incubation time of typhoid?

A

7-18 days

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9
Q

Causative agent of typhoid (2)

A

Salmonella typhi or paratyphi

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10
Q

Treatment of choice in typhoid?

A

IV ceftriaxone

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11
Q

Typhoid vaccine is effective/ineffective against paratyphi?

A

Ineffective

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12
Q

Severe complication of E. coli O157 infection

A

HUS

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13
Q

Weil’s Disease is a severe form of…

A

Leptospiorsis

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14
Q

Rocky Mountain Fever is also known as

A

Rickettsia

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15
Q

Infective hepatic causes of jaundice include

A

Hepatitis A and E, leptospirosis, malaria, enteric fever

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16
Q

Post-hepatic causes of jaundice include

A

Helminths inducing ascending cholangitis

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17
Q

Pre-hepatic causes of jaundice include

A

E. coli (HUS), shigella

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18
Q

Investigations for tropical pathogens (8)

A

Blood film (malaria, fragmentation), FBC, UE, LFT, CS, blood culture, US abdomen, serology

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19
Q

Tropical amoebiasis is caused by

A

Entamoema histolytica

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20
Q

Enatomema histolytica is spread via which route

A

Faecal-oral

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21
Q

Investigations for amoebiasis include (3)

A

Stool microscopy, AXR for toxic megacolon, endoscopy

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22
Q

Giardia is flagellated. True/false?

A

True

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23
Q

Giardia invades which regions of the bowel?

A

Duodenum, proximal jejunum

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24
Q

Incubation time for giardia is around

A

7 days

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25
Q

Antibiotic of choice for giardiasis

A

Metronidazole

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26
Q

Antibiotic of choice for amoebiasis

A

Metronidazole

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27
Q

Incubation time for amoebiasis

A

8-20 weeks

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28
Q

Which specific blood cells are associated with helminth infection?

A

Eosinophils

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29
Q

Nematodes are which type of worm?

A

Roundworm

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30
Q

Trematodes are which type of worm?

A

Flukes

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31
Q

Cestodes are which type of worm?

A

Tapeworms

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32
Q

Most common intestinal nematode is…

A

Ascaris

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33
Q

Common trematode (fluke) example

A

Schistomaisis

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34
Q

Common cestode (tapeworm) example

A

Taenia soliarum (pork) / saginatum (of beef)

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35
Q

Chagas disease is caused by…

A

Trypanasoma cruzi

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36
Q

Chagas disease is transmitted by

A

Triatome bug

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37
Q

Chagas disease results in…

A

Paraysmpathetic denervation, causing megacolon

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38
Q

How much fluid enters the GI tract per day?

A

9.3L

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39
Q

How much of the 9.3L of water received by the GI tract is absorbed in the SI?

A

8.3L

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40
Q

How much of the 9.3L of water received by the GI tract is absorbed in the LI?

A

1L

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41
Q

Water may move either (XXX/YYY) into cells

A

Transcellularly, paracellularly

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42
Q

Two important fluid absorption transporters in the SI are

A

Na+/glucose transporter and Na+/amino acid cotransporter

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43
Q

Are the two clinically relevant fluid transporters in lumen regulayed by cAMP or Ca?

A

No

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44
Q

Leading cause of diarrhoea in the UK

A

C. jejuni

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45
Q

4 antibiotics causing CDI

A

Co-amoxiclav, ciprofloxacin, clindamycin, cephlasporin

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46
Q

What situation requires IV fluids in diarrhoea?

A

> 10% of body weight lost in water

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47
Q

Glucose-facilitated sodium absorption in the ileum remains intact even in gastroenteritis. True/false?

A

True

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48
Q

Rehydration in gastroenteritis relies upon which transporter?

A

SGLT1

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49
Q

Antibiotics of choice for CDI?

A

Metronidazole, vancomycin

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50
Q

Anti-motility drug example in diarrhoea

A

Opioids

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51
Q

Main opiates used in diarrhoea are

A

Loperamide, diphenoxylate, codeine

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52
Q

Brand name of loperamide?

A

Imodium

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53
Q

Loperamdie is advantageous as…. (3)

A

It is mainly selective for GIT, low central penetrance, anti-muscarinic effects

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54
Q

Diphenoxylate contains which drug?

A

Atropine

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55
Q

Racecadotril is a pro-drug of…

A

Thiopharn

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56
Q

Impairment of the defecation reflex can occur in which disease?

A

Hirschprung

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57
Q

Difference between laxatives and purgatives?

A

Laxatives result in passage of soft, but formed stools, while purgatives evacuate everything (including fluid)

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58
Q

Potential complication of laxative abuse? (1)

A

Hypokalaemia

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59
Q

Most common type of laxative?

A

Bulk (indigestible fibers)

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60
Q

Other types of laxatives (3)

A

Stimulant purgatives, osmotic laxatives, faecal softners

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61
Q

Times when laxatives are valid (5)

A

At risk patients (e.g. hernia), constipation, bedridden, expulsion of parasites, prepare ailmentary canal before surgery

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62
Q

Most common cause of hospital-acquired diarrhoea?

A

CDI

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63
Q

Toxins produced by clostridium difficile? (2)

A

A (enterotoxin) and B (cytotoxin)

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64
Q

C. difficile’s Gram appearance

A

Gram positive, sporulating bacillus

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65
Q

Treatment of choice for less severe cases of CDI?

A

Metronidazole (oral)

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66
Q

Treatment of choice for severe CDI?

A

Oral vancomycin

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67
Q

Extremely virulent strains of CDI?

A

O27 and O78

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68
Q

Commonest cause of D&V in children <3yo?

A

Rotavirus

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69
Q

Rotavirus is mainly spread via which route?

A

Person to person

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70
Q

Rotavirus in adults is usually

A

Subclinical/mild

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71
Q

Infectious dose for rotavirus?

A

100-1000

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72
Q

The rotavirus vaccineis given in (X) doses, usually at ages _ and _

A

2 doses, 2 and 3 months

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73
Q

The rotavirus vaccine is which type?

A

Live-attenuated

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74
Q

Diagnosis of rotavirus is by…

A

Stool PCR

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75
Q

Rotavirus vaccine is NOT given to infants >XX weeks, due to increased risk of YY

A

24 weeks, intussuspection

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76
Q

Norovirus is spread mainly via (2)

A

Faecal-oral and droplets

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77
Q

Norovirus may survive as a fomite for how long?

A

Weeks

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78
Q

Incubation time for norovirus?

A

<24 hours

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79
Q

CPC of norovirus?

A

Sudden onset D&V

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80
Q

Hepatitis A and E are spread by

A

Faecal-oral route

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81
Q

Persistent diarrhoea lasts how long?

A

2-4 weeks

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82
Q

Acute diarrhoea lasts how long?

A

<2 weeks

83
Q

Short-term onset organisms of gastroenteritis include

A

S. aureus, B. cereus, C. perfringens

84
Q

What is the main reservoir for O157 E. coli?

A

Healthy cattle

85
Q

E. coli O157 infection is more common in which season?

A

Summer

86
Q

The O antigen is

A

Somatic

87
Q

The H antigen is

A

Flagellar

88
Q

Post-diarrhoeal HUS can give what lab findings (3)

A
  • Thrombocytopenia
  • Haemolytic anaemia
  • RBC fragmentation
89
Q

Norovirus is associated with which food?

A

Shellfish

90
Q

GBS is a rare complication of which pathogen causing gastroenteritis?

A

Campylobacter

91
Q

Incubation time for campylobacter?

A

2-5 days

92
Q

Bloody diarrhoea may indicate which pathogens (4)

A
  • C. jejuni
  • Shigella
  • E. coli O157
  • Amoebiasis
93
Q

What is the key to a diagnosis of typhoid?

A

Blood cultures

94
Q

Antibiotic of choice for typhoid?

A

Chloramphenicol and ciprofloxacin (if not resistant) otherwise macrolide

95
Q

The oral typhoid vaccine is what % effective?

A

70%

96
Q

Does the typhoid vaccine protect against paratyphoid?

A

No

97
Q

CDI severity may be gauged by looking at (4)

A
  • Presence of pseudomembrane?
  • WCC >15cells/mm
  • Creatinine >1.5x normal
  • Persistent symptoms despite 2 treatments
98
Q

Amoebiasis is spread via which route?

A

Faecal-oral

99
Q

Giardia infects which areas of the intestine?

A

Duodenum, proximal jejunum

100
Q

Infectious dose of giardia?

A

10-100

101
Q

Commonest way of giardia spreading?

A

Person-to-person

102
Q

Giardia cysts are resistant to chlorination and boiling. True or false?

A

False - they are vulnerable to boiling

103
Q

Antibiotic of choice in giardia?

A

Metronidazole

104
Q

Does giardia spread outside the intestine?

A

No

105
Q

Cryptosporidium primary treatment

A

Supportive (antibiotics ineffective)

106
Q

Commonest bowel symptom PC in Tayside

A

PR bleeding

107
Q

IBD is umbrella for which 2 conditions

A

Ulcerative Colitis, Crohn’s Disease

108
Q

CPC typical to Crohn’s Disease? (2)

A

Abdominal pain and peri-anal disease

109
Q

CPC typical to ulcerative colitis? (2)

A

Diarrhoea and bleeding

110
Q

Countries with high Crohn’s disease incidence?

A

UK, America, Nordic countries

111
Q

CD is commonest in which regions of Scotland?

A

Orkney, highlands

112
Q

Does IBD have a genetic factor?

A

Yes, first degree relative 2.2-16.2% increase

113
Q

Common gene involved in IBD?

A

NOD2/CARD15 (AKA IBD1)

114
Q

Locus of NOD2/CARD15

A

16q12

115
Q

Homozygotes for NOD2 have what fold increase in risk of IBD?

A

20-40

116
Q

Heterozygotes for NOD2 have what fold increase in IBD?

A

2-4

117
Q

NOD2 encodes a protein involved in….

A

Bacterial recognition

118
Q

Crohn’s Disease is mainly a Th1/Th2 response?

A

Th1

119
Q

UC is mainly a Th1 and/or Th2 response?

A

Mixed Th1 and Th2

120
Q

Environmental factors for Crohn’s Disease which are protective against UC include (1)

A

Smoking

121
Q

Ulcerative colitis affects the rectum extending proximally. True/false?

A

True

122
Q

The commonest sequelae of UC is… (2)

A

Proctitis (only rectum) or pancolitis (entire colon)

123
Q

UC CPC include (7)

A
  • Diarrhoea/bleeding
  • Increased bowel frequency
  • Tenesmus
  • Urgency
  • Incontinence
  • Night rising to void bowel
  • LIF pain
124
Q

Severity of UC is determined by which criteria?

A

Truelove and Witt criteria

125
Q

Truelove and Witt criteria examine which factors (4)

A
  • Fever (>37.8)
  • Tachycardia (>90bpm)
  • Anaemia (Hb <10.5g/dL)
  • Elevated ESR (>30mm/hr)
126
Q

Investigations for UC include (5)

A

CRP, albumin (DECREASED in inflammation), plain AXR,endoscopy, histology.

127
Q

UC on AXR may appear as (3)

A

Toxic megacolon, marked stool distribution, thumb printing.

128
Q

On endoscopy, UC appears as

A

Confluent inflammation extending proximally from anal margin to transitional zone. Loss of vessel patterns and granular mucosa with contact bleeding. Psuedopolyps.

129
Q

UC long term results in increased/decreased risk of CRC?

A

Increased

130
Q

Extensive colitis is defined as that extending beyond the….

A

Splenic flexure

131
Q

UC is strongly correlated with which other condition?

A

Primary sclerosing cholangitis (chronic inflammation of biliary tree)

132
Q

Common derangements in UC? (3)

A

LFTs, itch, oxalate renal stones.

133
Q

How many patients with CD are diagnosed at or before 40yo?

A

90%

134
Q

Peri-anal disease is associated with CD, true/false?

A

True

135
Q

What proportion of patients with CD have a continuous disease?

A

25%

136
Q

What proportion of patients with CD have intermittent flares?

A

50%

137
Q

What proportion of CD patients need surgery within 8-10 years?

A

75%

138
Q

Is CD surgery curative?

A

No

139
Q

CD symptoms in mouth? (3)

A
  • Painful ulcers
  • Swollen lips
  • Angular chelitis
140
Q

CD symptoms of anus (2)

A
  • Peri-anal pain

- Abscesses

141
Q

Intestinal symptoms of CD?

A
  • Weight loss
  • Cramps
  • Diarrhoea
142
Q

First investigation of CD?

A

Clinical exam (weight loss? RIF mass? Peri-anal signs?)

143
Q

Blood investigations in CD? (5)

A

CRP, albumin, platelets, B12, ferritin

144
Q

CD on colonoscopy will present with

A

Cobble-staining

145
Q

Histology of CD?

A

Large, non-caseating granuloma with “skipping lesions”. Crypt branching.

146
Q

CD affects which regions of GI tract?

A

ENTIRE tract (from mouth to anus)

147
Q

CD is more common in women. True/false?

A

True

148
Q

Complications of CD include

A

Fistula, colic, anal disease (sinuses, fissures, skin tags, abscesses)

149
Q

Which HLAs are associated with CD?

A

HLA-DR1 and HLA-DQw5

150
Q

Immune cell involved in CD?

A

T cells

151
Q

UC is present in which areas of GI tract?

A

Inflammation of rectum and colon

152
Q

UC extends to which layers

A

Mucosal AND submucosal (superficial)

153
Q

UC peak incidence at which decade?

A

3rd

154
Q

CPC of UC? (3)

A

Diarrhoea, mucus and blood PR, frequency

155
Q

UC is discontinuous/continuous

A

Continuous

156
Q

Appearance of colon with UC?

A

Massive influx of inflammatory cells. Basal lymphoplasmcytic infilitrate with irregular crypts.

157
Q

CD inflammation is superficial/deep?

A

Deep (transmural)

158
Q

CD may present in the eyes with

A

Uveitis (rare)

159
Q

CD may present in the liver with

A

Primary sclerosing cholangitis (rare)

160
Q

CD may present in the skin with

A

Pyoderma gangrenosum (rare)

161
Q

CD has what effect on the bowel wall?

A

It thickens and may stricture

162
Q

Overview of therapies for IBD (3)

A

Lifestyle advice, drugs, surgery

163
Q

Example of lifestyle advice to treat CD

A

Smoking cessation

164
Q

Drug therapy options for UC (4)

A
  • 5ASA (sulfasalazine)
  • Steroids
  • Immunosuppresants
  • Anti-TNFalpha drugs
165
Q

Drug therapy options for CD (3)

A
  • Steroids
  • Immunosuppresants
  • Anti-TNFalpha drugs
166
Q

Side effects of 5ASA? (2)

A

Diarrhoea

Idiosyncratic nephritis

167
Q

5ASA is available through which routes?

A

Oral, suppository/enema

168
Q

Example corticosteroids (2)

A

Prednisolone and budenoside

169
Q

To treat IBD, steroids are used in a short/long course, with a low/high initial dose.

A

Short course, high initial dose.

170
Q

Side effects of steroids (4)

A
  • Osteoporosis
  • Acne
  • Thin skin
  • Diabetes
171
Q

In UC, immunosuppresants are used as what kind of therapy?

A

Steroid-sparing therapy

172
Q

In CD, immunosuppresants are used as what kind of therapy?

A

Maintenance therapy

173
Q

Examples of immunosuppresants (3)

A
  • Methotrexate
  • Azathioprine
  • Mercaptopurine
174
Q

Azathioprine has a slow/rapid onset of action

A

Slow (16 weeks)

175
Q

Azathioprine should NOT be prescribed with what drug (1)

A

Allopuriol

176
Q

Example anti-TNF alpha drug usedin IBD? (1)

A

Adaluminab

177
Q

UC emergencies are assessed on which criteria

A

Truelove & Witt

178
Q

Risk factors for STIs (4)

A
  • <25yo
  • Change in sex pattern
  • Non-condom use
  • MSM
179
Q

Gonorrhoea has what Gram appearance

A

Gram negative, intracellular diplococci

180
Q

Incubation period for gonorrhoea?

A

5-10 days

181
Q

Symptoms of GI gonorrhoeal infection

A

Lower abdominal pain, diarrhoea, PR bleeding, anal discharge, tenesmus

182
Q

Rectal-gonnorhoea commonly co-exists with which infection?

A

Syphilis

183
Q

Most common site of chlamydia infection?

A

Rectum

184
Q

Chlamydia has a milder / more severe presentation than gonorrhoea?

A

Milder

185
Q

Antibiotics of choice for rectal chlamydia and how long should they be continued for? (3)

A

Azithromycin and doxycycline for at least 6 months

186
Q

HSV infections of the ano-genital tract or commonly caused by which type of HSV?

A

Type 2

187
Q

Important HPV serotypes

A

6, 11, 16, 18

188
Q

What’s the particularly “dangerous” strain of chlamydia?

A

LGV serovar

189
Q

Gonorrhoea antibiotics of choice?

A

Ceftriazone and doxycycline

190
Q

Kras is a TSG or oncogene?

A

Oncogene

191
Q

p53 is a TSG or oncogene?

A

TSG

192
Q

AMPK is a TSG or oncogene?

A

TSG

193
Q

FAP is early/onset, > or < 100 polyps, around where in the colon?

A

Early onset, >100 polyps, scattered all around colon

194
Q

HNPCC is a mutation in what - is it early/late onset and how many polyps? Around which area of the colon are the centered?

A

DNA mismatch repair mutation, it is late onset and generally has <100 polyps. It presents all over the colon

195
Q

Predisposing factors for colorectal cancer (3)

A
  • Presence of adenomatous polyps
  • Ulcerative colitis
  • Crohn’s Disease
196
Q

Ileocaecal region colorectal cancer presenting symptom

A

Anaemia

197
Q

Descending colon colorectal cancer presenting symptoms (3)

A
  • Pain
  • Change of bowel habit
  • PR bleeding
198
Q

Diagnosis of CRC can be made on which investigations (4)

A
  • barium enema
  • CT colography
  • Sigmoidoscopy
  • Colonoscopy
199
Q

FOBT is offered to those over which age? How often are they invited for screening?

A

> 55 years, every 2 years old

200
Q

Mainstay of CRC treatment (in order of efficacy)

A

1) Surgery
2) Radiotherapy
3) Chemotherapy

201
Q

Is radiotherapy critical in colorectal cancer?

A

No, it’s an adjuvant (as the gut is very sensitive to radiotherapy)

202
Q

Chemotherapy regimen examples for colorectal cancer (2)

A
  • 5-flurouracil (5-FU)

- capecitabine

203
Q

CRC in Scotland has a what % 5-year survival?

A

58.1%

Gastrointestinal (7 decks)

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