1004. 20/10/20

Question 1

Where do polyps arise from?

Answer 1

Arise from mucosa generally

May also arise from submucosa- lipoma, lymphoma

Question 2

What causes a polyp to become cancerous?

Answer 2

Lack of tumour suppression

Increase in oncogenes

Question 3

What type of polyps cause intusussception?

Answer 3

Pedunculated polyp

Question 4

When does a polyp become a carcinoma?

Answer 4

When it invades the muscalaris propria

Question 5

What is a high risk person with polyps?

Answer 5

5 or more pre malignant polyps

Question 6

What congenital conditions cause polyps?

Answer 6

Familial adenomatous polyposis- autosomal dominant, risk cancer, mean cancer at 35 years

Serrated polyposis syndrome- lack of DNA repair enzyme, yearly endoscopy

Juvenile polyposis- 39% get colorectal cancer

Question 7

What is HNPCC (lynch syndrome)

Answer 7

microsatellite instability- caused by mismatch repair genes

MLH1, MSH2, MSH6, PMS2

Question 8

What scoring systems can be used for heamatemesis?

Answer 8

Rachal risk assessment
Glasgow-blatchford bleeding score (the best one)
AIMS 65

Question 9

What does the glasgow blatchford scoring system test?

Answer 9

Urea
Hemoglobin
Pulse
Liver disease
HF
Pulse

Question 10

What are the differentials for heamatemesis?

Answer 10

Duodenal ulcer
Gastric erosion
Gastric ulcer
Varices
Mallory weiss tear
oesophagitis
Neoplasm

Question 11

What are the signs of endoscopic signs of bleeding?

Answer 11

Yellow slough- no signs of recent bleeding

Redness/clots- bleeding

Question 12

What is endoscopic therapy that is carried out to treat heamatemesis?

Answer 12

Adrenaline
Heat
endochro
Home spray
Variceal bleeding
Cyanochrongic glue

Question 13

What is done for an individual post-endoscopy?(non-variceal)

Answer 13

Bolus 80mg Iv PPI then 8mg/hr for 72hrs
Eradication therpay for H.pylori
Maintain haemoglobin around 90
Watch for re-bleeding
Eye on Obs and Hb

Question 14

What is done for an individual post endoscopy (variceal)

Answer 14

Terlipressin for next 72 hours
Antibiotics for 5 days
Do not over transfuse
Give lactulose and sucrulfate
Endoscopy failure or re-bleed

Question 15

What are the different types of poisoning?

Answer 15

Accidental - children and old people
Deliberate (self, others)-
Environmental
Recreational

Question 16

What are the treatment options for toxicology?

Answer 16

General supportive measures (ABCDE)
Decreased absorption (stomach pumping, charcoal (1hour))
Increase elimination- fluids, laxatives,
Antidotes

Some may need no treatment at all!

Question 17

What can be said about stomach pumping?

Answer 17

Patient has to have an overdose that binds to the stomach or in very series clinical situations

Question 18

Why aren’t children given charcoal?

Answer 18

It’s disgusting, can’t be flavoured as it will lose it properties

Question 19

Where can you find answers about toxicology antidotes?

Answer 19

TOXBASE- need an account

Question 20

What are the normal ranges of bicarbonate?

Answer 20

22-28mEq/l

Question 21

When do you give naloxone?

Answer 21

Need to do an ABCDE first. If you give antidote e.g. naloxone they may have a cardiac arrest when they wake up

Question 22

What do you give to reverse paracetamol poisoning?

How does it work?

Answer 22

N-acetylcysteine

Glutathione damages liver (conjugate of paracetamol) (5% of metabolised paracetamol)

Question 23

Aspirin overdose symptoms

Answer 23

Acidosis

Tinnitus

Question 24

How do you fix an aspirin overdose?

Answer 24

IV fluids

Sodium bicarbonate