Week 7

Question 1

Who tends to consume the most alcohol in the UK?

Answer 1

Mostly older people

Question 2

What’s the risk of minimum pricing on alcohol units?

Answer 2

Trade down

Question 3

What are the UK guidelines on alcohol consumption? (3)

Answer 3

• Men and women <14 units per week
• Drinking spread over 3 days
• At least 2 alcohol free days per week

Question 4

How much more likely are you to die of liver cirrhosis if you live in a deprived area of Scotland versus an affluent area?

Answer 4

16x

Question 5

Wernicke-Korsakoff Syndrome is what & what is it associated with?

Answer 5

Thiamine B1 deficiency, chronic alcohol consumption

Question 6

Alcohol is metabolised by which CYP450 in which “phase”?

Answer 6

2E1, phase 2 enzymes

Question 7

Alcohol is made into what

Answer 7

Ketone bodies

Question 8

How is End Stage Liver Disease classified?

Answer 8

Childs-Turcotte-Pugh classification

Question 9

What are the stigmata of CLD?

Answer 9

Spider naevi, fetor, hepatic encephalopathy

Question 10

Alcoholic hepatitis primary drug treatments (2)

Answer 10

• Prednisolone

- Pentoxifylline

Question 11

A patient with sepsis must have at least two of which criteria

Answer 11

SIRS

Question 12

What is included in the SIRS criteria

Answer 12

Temperature (>38degrees C), heart rate (>90bpm), respiratory rate (>20), WBC (>12K)

Question 13

What’s the problem in treating large abscesses with antibiotics?

Answer 13

They have no blood supply and thus will not be penetrated by antibiotic therapy

Question 14

Coliforms include (4)

Answer 14

Klebsiella, Proteus, Enterobacter, Serratia

Question 15

Pseudomonas has which metabolic profile

Answer 15

Strict aerobe

Question 16

Clostridium and bacteriodes have what metabolic profile?

Answer 16

Strict anaerobe

Question 17

Neisseria have what Gram appearance (2)

Answer 17

Gram negative intracellular cocci

Question 18

Coliforms are covered by which antibiotic?

Answer 18

Gentamicin

Question 19

Anerobes are covered by which antibiotic?

Answer 19

Metronidazole

Question 20

Amoxicillin / flucloxacillin is used for which organisms?

Answer 20

Staphs & Streps

Question 21

Side effects of gentamicin (2)

Answer 21

Nephrotoxic, ototoxic

Question 22

What’re important measures of sepsis? (2)

Answer 22

• Lactate

- Urine output

Question 23

What is the sepsis six? (in general terms, what is it?)

Answer 23

A tool for management of sepsis

Question 24

How is sepsis 6 remembered?

Answer 24

Give 3, take 3

Question 25

What is sepsis 6?

Answer 25

Give: oxygen, IV fluids, IV antibiotics.
Take: Blood cultures, urine output, blood samples (for testing)

Question 26

What’s the most common stone composition: mixed, cholesterol, pigment?

Answer 26

Mixed (80%)

Question 27

Which form of IBD is associated with gallstones?

Answer 27

Crohn’s Disease

Question 28

RUQ, gradual build-up of pain, radiatingto back and shoulders. What is this pain likely to be?

Answer 28

Gallstones

Question 29

What’s the gold standard for diagnosis of gallstones?

Answer 29

Ultrasound

Question 30

Standard treatment of biliary colic due to gallstones?

Answer 30

Low fat diet / lose weight if obese, observe for 3-6 months, if no change ursodeoxycholic acid if surgery not suitable

Question 31

Treatment of cholecystitis is with which drugs (2), which dietary advice is given?

Answer 31

IV antibiotics and IV fluids, ensure patient is nil-by-mouth

Question 32

During INDEX admission, gallstone patients should have a cholecystectomy within what time frame

Answer 32

2 weeks

Question 33

A gallstone ileus is most likely to occur where

Answer 33

Distal ileum

Question 34

What’s a complication of gallstone ileus (serious)?

Answer 34

Fistula into duodenum

Question 35

Cholangiocarcinoma is how common as a hepatobiliary disorder?

Answer 35

2nd most common (after gallstones)

Question 36

Cholangiocarcinoma has what general prognosis and survival estimation at diagnosis?

Answer 36

Poor prognosis, 1-6 months of life