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even more GI Flashcards

1
Q

severe epigastric pain that radiates to back- after having a few too many drinks the night before

-next step in management after taken serum amylase

A

acute pancreatitis

  • fluid resuscitation as many patietns with acute pancreatitis develop systemic inflammatory response syndrome (SIRS) which can lead to multiple organ dysfunction (MODS)

Supportive measures such as fluid resuscitation and oxygen supplementation are the mainstay of the treatment for acute pancreatitis

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2
Q

cullens sign is

A

bruising around the umbillicus from acute pancreatitis or an ectopic pregnancy

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3
Q

mcburneys sign is

A

pain over mcburneys point seen in acute appendicitis

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4
Q

troisers sign is

A

presence of virchows node in the left supraclavicular fossa and is a marker for gastric cancer

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5
Q

Hearburn (retrosternal discomfort after eating and on lying down), acid taste in mouth (acid brash), excessive salivation (waterbrash), difficulty swallowing and nocturnal asthma

A

Reflux oesophagitis (GORD)

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6
Q

Is gord associated with tight clothes

A

yes

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7
Q
  • progressively worsening swallowing over several years
  • troubled by regurgiation of undigested food and halitosis(bad breath)
  • suffers fits of coughing on lying flat
A

achalasia

  • leads to regurg of undigested foods and halitosis
  • tends to present in middle aged women
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8
Q

CXR- wide mediastinum and shadow behind the heart, with a fluid level

A

achalasia

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9
Q

furthere confirmation of achalasia after xray

A

barium swallow or oesophagoduodenoscopy

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10
Q

treatment of mild and severe achalasia

A

mild- nitates and anticholinergic medications

severe- surgical (Heller’s operation)

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11
Q

loss of the myenteric plexus and failure of relaxation of the lower circular muscles

A

achalasia

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12
Q
  • food sticking in back of throat
  • pale, spoon shaped nails, smooth tongue and angular cheilitis
A

Plummer vinson syndrome

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13
Q

Endoscopy or barium meal shows friable web across the anterior oesophageal lumen

-caused by hyperplasia and hyperkeratosis of the oesophageal mucosa

A

plummer vinson syndrome

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14
Q

is plummer vinson syndrome pre malignant and should be biopsied

A

yes

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15
Q

plummer vinson syndrome consists of

A

iron deficiency anaemia, glossitis, angular cheilitis, dysphagia

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16
Q

difficulty swallowing, first mouthful easy to swallw and then increasingly difficulty and neck swelling

A

Pharyngeal pouch

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17
Q

enlargement of the left atrium, double cardiac silhouette, straightening of the left border of the heart and horizontal left bronchus

A

left atrial hypertrophy

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18
Q

mitral stenosis associated with

A

large left atrium

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19
Q

Budd chairi syndrome classicaly presents with

A

abdo pain, ascites and hepatomegaly

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20
Q

obstruction of IVC causes

A

venous collaterals in the back with upward direction flow and bipedal oedema

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21
Q

-hypopigmented patches on skin, weight loss, loose stools, oligomenorrhoea(infrequent menstrual periods), finger swelling, fine tremor, resting tachycardia, warm peripheries

A

Thyrotoxicosis

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22
Q

soft tissue swelling on fingers that resembles clubbing, bulging eyes, raised waxy lesions on shins

(classical triad)

A

graves disease

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23
Q

16y/o boy with malaise, weight loss, polydipsia(abnormal thirst)

-raised blood glucose

A

Type 1 diabetes

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24
Q

evidence of liver function test that drinking excessive amounts:

A

macrocytic anaemia, low urea and sodium levels, deranged LFTs and elevated INR

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25
Q

AST:ALT ratio greater than 2 suggests

A

alcoholic hepatitis

-wise to prescribe vitamin supplements particularly thiamine

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26
Q

what do these suggest: ascites, hepatomegaly, multiple pulmonary metastases

A

malignancy

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27
Q

weight loss, anorexia, swellin gof abdo, pleural effusion, hepatomegaly, multiple opacities throughout lung fields

51y/o women

A

ovarian cancer

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28
Q

is suspect ovarian cancer what invesigations:

A

CA-125 blood test and pelvic ultrasound to calculate risk of malignancy. (RMI)

Ct scan of abdomen and pelvis will allow for staging

  • If RMI and CT suggest ovarian cancer, diagnosis can be confirmed by histology from tissue obtained during laparotomy
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29
Q

most common primary liver tumour

A

hepatocellular carcinoma

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30
Q

in 60% of patients raised alpha fetoprotein in

A

Hepatocellular carcinoma

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31
Q

Ultrasound- focal lesions(filling defects) and may show involvement of the portal vein

A

hepatocellular carcinoma

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32
Q

examination may reveal hepatomegaly or right hypochondrial mass

A

hepatocellular carcinoma

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33
Q

penicillamine (treatment for wilsons disease) is associated with

A

membranous nephropathy

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34
Q

diffuse proliferative glomerulonephritis is associated with

A

SLE

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35
Q

barium study of – shows birds peak on lower oesophagus while manometry reveals abnormally high oesophageal sphincter tone that fails to relax on swallowing

A

oesophgeal achalasia

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36
Q

reduced secretion of - is linked to the development of achalasia

A

nitric oxide

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37
Q

patient is most likely prescribed an opiate like codeine phosphate to manage pain from osteoarthritic knee joint. Opiates like codeine phosphate cause well known to cause

A

constipation

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38
Q

what should be co presrcibed when prescribe an opiate (deal with pain)

A

laxative such as senna

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39
Q

raised bilirubin and ALP suggests may have

A

cholecystitis or cholangitis

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40
Q

what would confirm if its a biliary problem

A

ultrasound scan

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41
Q

is suspect pneumonia by lung consolidation but have raised bilirubin and ALP, do — to rule out biliary problem

A

ultrasound scan

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42
Q

-symptomatic anaemia (PALE), chronic diarrhoea, had glossitis with decreased vitamin b12 level and increased folate

A

suggestive of Small Intestine Bacterial overgrowth

  • definitive treatment =antibiotics!
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43
Q

effective antibiotics in SIBO

A

metronidazole, ciprofloxacin, co-amoxiclav, rifaximin

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44
Q

— results from ingestion of seafood

A

Ciguatera toxicity

treatment -conservative

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45
Q

describe geographic tongue

A

recurrent episodes of tongue soreness by spicey/ acidic foods

depapillation of tongue

affects 2-3% of population

often asymptomatic

no association with oral cancer

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46
Q

most common oral malignancy

A

squamous cell carcinoma

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47
Q

ulcer on lateral border of tongue/ floor of mouth - had for months, is a smoker

A

squamous cell carcinoma

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48
Q

pruritic rash affecting wrists and shins and oral soreness. white striae and ulceration

A

lichen planus- stress is a risk factor - affects skin and mucous memebranes

skin- red papules that may have white on them

oral- painless white streaks or painful ulcers and erosions

49
Q

iron deficiency initially presents with

A

angular stomatatitis and smooth, red sore and depapillated tongue

50
Q

corticoteriod use associated with oral candiasis (__)

A

thrush

51
Q

treatment for oral candiasis

A

mild- topical miconazole gel

severe- oral fluconazole

-rinsing mouth after using inhaler should help prevent this in future

52
Q

high urine 5. hydroxyindoleacetic acid content diagnosis of

A

carcinoid syndrome

53
Q

carcinoid syndrome relates to carcinoid tumour that releases

A

serotonin

54
Q

symptoms of carcinoid syndrome

A

flushing, diarrhoea, bronchospasm- can develop right sided heart failure

55
Q

young man, gait was unsteady, could not see, low comprehension, seemed drunk but not had any alcohol, pooed alot that smelt

low calcium and phosphate levels

A

Vitamin D deficiency - ataxia, steatorrhoea, cognitive decline, visual problems

56
Q

if got vitamin D deficiency give dose of vitamin

A

E ???

57
Q

vitamine B deficiency most commonly occurs in

A

malnourished patietns with a significatn alcohol history

58
Q

patient had progressive forgetfullness, has hepatomegaly and ascites adn now has cirrhosis . what test would suspect diagnossi

A

low serum ceurolplasmin

or low serum copper, urinary copper over last 24hrs raised

liver biopsy is confirmatory

as suffering from wilsons disease progressing to cirrhosis

59
Q

treatment of wilsons disease now causing cirrhosis

A

Penicillamine

60
Q

AST:ALT ratio is often measured to distinguish between

A

alcoholic and viral hepatitis

61
Q

—- is greater than AST in viral hepatitis whereas in alcoholic hepatitis ___ is greater than ALT

A

ALT

AST

62
Q

alpha 1 antitrypsin leads to

A

panacinar emphysema in the lungs and periodic acid schiff (PAS)- positive globules in the liver

  • can increase risk of hepatocellualar carcinoma
63
Q

alpha fetoprotein is a marker for

A

hepatocellular carcinoma

64
Q

anti smooth muslce antibodies are indicative of

A

autoimmune hepatitis

65
Q

signs of iron overload( haemochromatosis)

A

arthralgia and erectile dysfunction

66
Q

intervention if got villous atrophy

A

gluten free diet- coeliac!

67
Q

ive got coeliac disease and not avoiding gluten then may gt

A

persistance of rsh, diarrhoea, and may increase risk of small bowel lymphoma

68
Q

budd chairi syndrome triad

A

abdo pain, tender hepatomegaly, ascites

69
Q

once blood test reveal hep c positive what test next?

A

Hep C genotype - guides length and type of treatment

70
Q

treatment of hyperkalaemia

A

calcium gluconate should be given immediately - to reduce risk of arrythmias - does not iteself reduce potassium

insulin and dexrtrose corrects potassium levels

71
Q

in achalasia what tests can exclude carcinoma

A

oesophagoscopy and CT scan

72
Q

treatment of achalasia

A

dialtion of the sphincter either using Botox or balloon dilatation. if this fails, surgical management is an option

73
Q

barium swallow — gives a picute of stenosis

A

oesophageal webs

74
Q

corkscrew

A

oesophageal spasm

75
Q

sign that peritonitis is not localised

A

absent bowel sounds

76
Q

board like abdomen suggest

A

generalised peritonitis

77
Q

erythema nodosun is extra manifestation of crohns or uc but not palmar erythema!

A
78
Q

barrets oesophagus associated with –malignancy

A

oesophageal

79
Q

achalasia is particulary associated with

A

squamous cell carcinoma

80
Q

intermittent bloating and diarrhoea in young patient w everything else normal

A

irritable bowel syndrome

81
Q

stool shows- trophozoites and cysts

  • symptoms- diarrhoea, offensive bowel gas, steatorrhoea, abdo cramps and bloating
A

Giardiasis

82
Q

giardiasis treated with

A

metronidazole

83
Q

mimics coeliac (villous atrophy) and occurs after travellers of south east asia and caribean.

A

tropical sprue

84
Q

what leads to catastrophic haematemesis

A

oesophageal varices! not mallory weiss tear-prolonged vomitting causing bright red haematemesis

85
Q

prescence of caput medusae suggests

A

portal hypertension

86
Q

treatment for NAFLD

A

no current medications but weight loss is the mainstay treatment

87
Q

mildly raised ALP and aminotransferases. obesity and type 2 diabetes. Does not drink alcohol. Hepatomegaly.

A

NAFLD

88
Q

azathioprine is used in

A

autoimmune hepatitis

89
Q

before starting azithiprine, what should be testes for

A

Thiopurine methyltransferase (TPMT) acitivty

90
Q

severe itching, mild jaundice

A

primary biliary cholangitis!!!

91
Q

psc is different to pbs

A

psc is more common in men and anti mitocchondrial antibody is negative and p-anca is positive

92
Q

ANA, anti smooth muscle antibody, LKM are elevated in

A

autoimmune hepatitis

93
Q

common presentation of coeliac disease

A

vague abdo pain, bloating, diarrhoea, delayed puberty, anaemia if frquently present

94
Q

first line invstigation for coeliac disease

A

serological blood tests

95
Q

definitive diagnosis of coeliac disease

A

distal duodenal biopsy showing partial or complete villous atrophy, crypt hypertrophy,

96
Q

crohns differ from coeliac

A

crohns have bloody diarrhoea but with MUCUS, more severe abdo pain and more acutely unwell

97
Q

crypts abscess is typical for

A

UC

98
Q

crohns or uc –terminal ileum involement, apthous stomatits , non caseating granulomata, stricturing of bowel wall

A

crohns

99
Q

absence of bilirubin inn the uterine

A

gilberts syndrome

100
Q

diagnosis of tropical sprue

A

small intestinal biopsy

101
Q

been in india and has diarrhoea and had diarrhoeain india what test

A

small intestinal biopsy - determine between giardia or tropical sprue

102
Q

risk factors for ascending cholangitis

A

biliary stent and ERCP

103
Q

asecding cholangitis is most often caused by gram negative rods such as

A

e.coli, klebsiella and enterobacter

104
Q

rigors can be caused by

A

ascending cholangitis

105
Q

triad of gastrinoma

A

recurrent peptic ulcer disease, watery diarrhoea and weight loss

106
Q

–is useful in treatment of gastrinoma

A

octreotide

107
Q

first line diuretic in treatment of ascites secondary to liver cirrhosis

A

spironolactone

108
Q

average recommended calorie intake for men

A

2500

and 2000 for women

109
Q

one unit of alcohol is equivalent to

A

10ml of alcohol

110
Q

one pint of beer at 5% is how may units

A

3

111
Q

how often should colonscopies be done in patietns with UC thats well controlled

A

every 5 years

112
Q

what is associated with coeliac disease

A

iron deficineciy

113
Q

small intestine villous atrophy upon exposure to gliadin( in wheat and grain)

A

coeliac disease

114
Q

abdominal aortic aneurysm is diagnosed when abdominal aorta has diameter greater than

A

3cm

115
Q

management if asymptomatic with multiple gallstones

A

nothing

116
Q

symptomatic gallstone disease presents with

A

colicky right upper quadrant pain that is typically worse after eating fatty foods

117
Q

tenderness over mcburneys point

A

appendicitis

118
Q

mcburneys point is the landmark for – in most people

A

appendix

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