4th Year Extra bits Flashcards
1
Q
what causes oral hairy leukoplakia?
A
EBV
increased risk if you have HIV
2
Q
does leukoplakia brush off?
A
no, candidiasis does
3
Q
when should you biopsy an ulcer?
A
> 3 weeks and not healing
4
Q
management of aphthous ulcers
A
tetracyclines
topical steroids
analgesia
5
Q
management of severe aphthous ulcers
A
systemic corticosteroids
thalidomide
6
Q
management of candidiasis
A
nystatin suspension
oral fluconazole
7
Q
what is microstomia?
A
small mouth from thickening/ tightening of perioral skin (burns, systemic sclerosis)
8
Q
when should you stop PPIs before endoscopy?
A
2 weeks beforehand to avoid pathology masking
nil by mouth for 6 hours prior
9
Q
what kind of cancer is barretts?
A
adenocarcinoma
10
Q
what to suspect when urea high and creatinine is not also elevated?
A
upper GI bleed
11
Q
acute management of varices
A
terlipressin, improve bleeding with vitamin K, FFP and IV antibiotics before endoscopy
if bleeding not managed > balloon tamponade (Sengstkain-Blakemore)
12
Q
long-term management of oesophageal varices
A
beta blockers (propranolol) EVL (medium- large, 2 week intervals) sclerotherapy via OGD
13
Q
what is group and save?
A
check patient’s blood group and sample is kept in case
14
Q
what is crossmatch?
A
lab find out if patients blood is compatible and keep blood in fridge ready to use
15
Q
what is Osler-Weber-Rendu syndrome?
A
HHT > telangiectasia and AVM
16
Q
what is Boerhaave’s syndrome?
A
complete rupture of the lower thoracic oesophagus
17
Q
signs in Boerhaave’s syndrome
A
hartmann’s sign (crunching upon heart auscultation)
chest pain
shock
subcutaneous emphysema
18
Q
presentation of Plummer-Vinson syndrome
A
dysphagia
iron deficiency anaemia
oesophageal webs
19
Q
drugs that can cause peptic ulcer
A
SSRIs
NSAIDs
steroids
20
Q
why are posterior duodenal ulcers at the most risk of bleeding excessively?
A
near the gastroduodenal artery
21
Q
pain in gastric ulcers on eating?
A
worsens pain
22
Q
pain in duodenal ulcers on eating?
A
improves pain
23
Q
diagnosis of peptic ulcer
A
<55 with no alarm symptoms do CLO (urea breath test)
>55 or alarm symptoms do OGD
24
Q
repeat endoscopy in peptic ulcer H. pylori
A
6-8 weeks to exclude malignancy
25
test for confirmation of H.pylori eradication
13C urea breath test
26
what is Bechet's syndrome?
vasculitis
27
presentation of Bechet's
```
multiple ulcers (genital)
uveitis
```
28
management of bechet's
steroids
| immunosuppressants
29
score for upper GI bleed severity
Glasgow-Blatchford score
30
what is Zollinger-Ellison syndrome?
formation of tumours in pancreas and duodenum (gastrinomas) which secrete gastrin causing excessive acid production
31
what do GIST gastric cancers look like?
spindle cells
| stain with DOG1
32
acute management of Crohn's
steroids
33
maintenance of Crohn's
azathioprine
mercaptopurine
methotrexate
34
when is infliximab used in Crohn's?
fistulating Corhn's
| not responding
35
what needs to be done before starting infliximab?
screen for TB
36
management of toxic megacolon
IV hydrocortisone
LMWH
IV fluids
assess response in 72 hours > no improvement surgery
37
severity of UC score?
Truelove and Witt criteria
38
mild UC
<4 stools/day
| small amount of blood
39
moderate UC
4-6 stools/day
varying blood
no systemic upset
40
severe UC
```
6+ stools a day
systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
```
41
inducing remission in mild/mod UC
rectal aminosalicylates > can add oral > oral prednisolone
42
inducing remission in severe UC
IV corticosteroids > IV ciclosporin
43
maintaining remission in UC
rectal aminosalicylate, can be combined with oral
azathioprine
mercaptopurine
44
positive PAS stain?
Whipple's disease
45
management of Whipple's?
penicillin V or ceftriaxone
46
management of hep C
direct acting antivirals
47
which liver condition can have secondary amenorrhoea?
AI hepatitis
48
triad in hepatorenal syndrome
cirrhosis
ascites
renal failure
it is due to a reduction in blood flow to the kidneys causing them to not function correctly.
49
management of hepatorenal syndrome?
transplant
terlipressin
TIPPS
50
most common cause of SBP
e. coli
51
management of ascites
```
low sodium diet
spironolactone
prophylactic antibiotics (ciprofloxacin)
paracentesis
TIPPS
```
52
criteria for pancreatitis
Modified Glasgow score
Ranson's criteria
does not include amylase
53
presentation of insulinoma
recurrent hypoglycaemic attacks
54
presentation of glucagonoma
diabetes
| dermatitis
55
VIPoma
vasoactive intestinal peptide
| watery diarrhoea
56
presentation of gastrinoma
recurrent GI ulceration
57
key RF for mesenteric ischaemia
AF
58
first line diagnosis of mesenteric ischaemia
CT contrast
59
triad for chronic mesenteric ischaemia
1. central colicky abdo pain (starts around 30 minutes after eating)
2. weight loss due to food avoidance
3. abdominal bruit
60
management of chronic mesenteric ischaemia
statins, antiplatelets
weight loss
stent insertion
transluminal angioplasty
61
genetic mutation in Lynch syndrome
MSH2/MLH1
62
screening in Lynch
from 25 with annual colonoscopy
women get TVUS/abdo USS
Ca125
63
genetic mutation in FAP
APC gene mutation
64
variant of FAP
Gardner’s syndrome – osteomas of skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on skin.
65
which nerves are affected in Hirschsprung's
parasympathetic nerve dysfunction
66
management of haemorrhoids
- Only if symptomatic
- Topical therapies include anusol and germoloid creams.
- Grade I-III= sclerosation banding or rubber banding ligation
- Grade IV Haemorrhoidectomy
- HALO/THD procedure (US locates arteries supplying the haemorrhoids and ties them off)
67
discharge planning score for major lower GI bleeds
Oakland score
68
perianal haemtoma
rupture of perianal subcutaneous blood vessel
| black/ blue buldge at anal margin
69
diagnosis of carcinoid syndrome
produce serotonin (5-HT) so check urinary 5-HIAA
70
management of carcinoid syndrome
octreotide
71
nerve most likely to be injured during appendicectomy?
ilioinguinal
72
what is geographic tongue
areas of depapillation
| soreness when eating spicy or acidic food
73
what is Mirizzi syndrome?
gallstone impacts neck of gallbladder causing compression of CBD
74
half-life of lipiase
24 hours
75
three types of acute liver failure
1. Hyperactive/fulminant liver failure= encephalopathy develops within 1 week
2. Acute liver failure= encephalopathy develops within 2-4 weeks
3. Subacute liver failure= encephalopathy develops within 4-8 weeks.
76
hepatic encephlopathy
```
I= irritable
II= lethargy, moderate confusion
III= confusion,incoherent
IV= coma
```
77
what is TIPS
connection between portal vein and hepatic vein
78
Los Angeles classification of reflux oesophagitis
- A= one or more mucosal breaks <5mm
- B= mucosal breaks >5mm but with no continuity across mucosal folds
- C= breaks span across two mucosal folds, but <75% oesophageal circumference
- D= mucosal breaks involving >75% circumference
79
SIBO B12 and folate
low B12
| high folate
80
layers of the skin on a midline abdo incision
skin, Camper’s fascia, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, peritoneum
81
colorectal adenoma surveillance
- Low risk= one or two adenomas <10mm > colonoscopy at 5 years.
- Intermediate risk= three/four adenomas <10mm or on/two if one is >10mm. colonoscopy at 3 years
- High risks= 5 or more <10mm or 3 or more if one if >10mm. colonoscopy at 1 year.
82
drainage to lymph nods inferior to pectinate line
superficial inguianl nodes
83
pint ml
568ml
84
how can ascites be classified?
serum ascites albumin gradient (SAAG)
85
classification of ascites
1. SAAG >11g/L indicates portal hypertension (transudative)
| 2. SAAG <11g/L indicates hypoalbuminaemia (exudative)
86
causes of high SAAG
portal hypertension:
- liver
- cardiac failure
87
causes of low SAAG
nephrotic syndrome
| severe malnutrition
88
diet in liver problems
high protein
| low sodium
89
what does the portal vein come from?
SMV and splenic vein
90
what is used to treat schistosomiasis?
praziquantel
91
what is used to test exocrine function in the pancreas?
faecal elastase
92
management of sigmoid volvulus
rigid sigmoidoscopy with rectal tube insertion
| if bowel obstruction or peritonitis needs urgent midline laparotomy
93
management of caecal volvulus
right hemicolectomy
94
what is the most common cause of large bowel obstruction?
cancer
95
what needs to be assessed before starting azathioprine or mercaptopurine?
TPMT activity
96
what are SE of aminosalicylates?
haematological e.g. agranulocytosis
97
CT sign for pancreatic cancer?
double duct sign on CT
98
what can OCP cause on LFTs?
drug-induced cholestasis
99
what cancer does achalasia increase the risk of?
SCC
100
indications for splenectomy after trauma?
uncontrollable splenic bleeding
hilar vascular injuries
devascularised spleen
101
what is the Parkland formula used for?
burns
102
what is the Parkland formula?
4 x % area burned x weight (kg) for 24 hours fluids, half of which is given in the first 8 hours
103
what is on colonoscopy of pseudomembranous colitis?
yellow plaques
| often due to c. diff
104
what infection do PPIs increase the risk of?
c. diff
105
c. diff classification
```
MILD= normal WCC
MODERATE= increased WCC <15, 3-5 stools
SEVERE= >15 WCC or raised cr or temp >38.5 or evidence of colitis on XR
LIFE-THREATENING= hypotension, partial/ complete ileus, toxic megacolon or CT evidence of severe disease
```
106
what toxin is in c diff stool
CDT
107
management of c. diff
oral vanc 10 days > oral fidaxomicin > oral vanc +/- IV met
108
management of recurrent c. diff
within 12 weeks = oral fidaxomicin
| after 12 weeks= oral vanc or fidaxomicin
109
Child-Pugh classification for cirrhosis
```
bilirubin= >50
albumin= <35
PT= >6s
encephlopathy
ascites
```
110
what can Barrett's be divided into?
long >3cm
| short <3cm
111
management of Barrett's
endoscopic surveillance every 3-5 years in metaplasia to watch for dysplasia
112
management of bile malabsorption e.g. post-cholecystectomy
cholestyramine
113
preparation for urea breath test
no antibiotics in past 4 weeks
| no PPIs in past 2 weeks
114
Hinchey classification for diverticulitis
```
1a= confined inflammation
1b= abscess <5cm
2= intra-abdo abscess, retroperitoneal abscess
3= generalised purulent peritonitis
4= faecal peritonitis
```
115
Glasgow/ Ranson criteria for pancreatitis
```
PaO2 <7.9kPa
age >55
neutrophils >15
calcium <2
renal function (urea >16)
enzymes (LDH >600)
albumin <32g/L
sugar (glucose >10)
```
3 points is severe
116
indications for antibiotic prophylaxis in SBP in ascites
episode of SPB
fluid protein <15g/l
child-pugh score of 9
hepatorenal syndrome
