Exam

Question 1

Gastroenteritis- bacteria with short incubation?

Answer 1

Staph aureus
Bacillus cereus
Clostridium perfringens

Question 2

Norovirus- how long after symptoms pass are patients still infective for?

Answer 2

48 hours

Question 3

Risk factors for C diff? (5)

Answer 3

Age
Prolonged hospital stay
PPI use
Recent surgery particularly bowel
Immunosuppression

Question 4

Motile, flagellated trophozoites in the stool?

Answer 4

Giardiasis

Question 5

Transient episode of diarrhoea followed fever, sweats and rose spot rash?

Answer 5

Typhoid fever

Question 6

C difficile treatment? (2)

Answer 6

Non severe- metronidazole

Severe- metronidazole + vancomycin

Question 7

Investigation of coeliac disease? (3)

Answer 7

Unexplained IDA/B12/folate deficiency
Tissue TTG
Jejunal biopsy

Question 8

Non-pharmacological treatment of IBS? (3)

Answer 8

Low FODMAP diet
Peppermint oil
Probiotic yoghurts

Question 9

Investigations to rule other causes in IBS?

Answer 9

TTG
ESR and CRP
Faecal calprotectin

Question 10

Chronic granulomatous inflammation of interlobular bile ducts

Answer 10

Primary biliary cirrhosis

Question 11

Antibody association in PBC?

Answer 11

anti-mitochondrial Ab M2

Question 12

Treatment of itch in PBC?

Answer 12

Cholestyramine, ursodeoxycholic acid

Question 13

Inflammation, fibrosis and stricture of the extra and intra-hepatic bile ducts

Answer 13

Primary sclerosing cholangitis

Question 14

Classical skin sign of PBC?

Answer 14

Xanthelasma of eyelid

Question 15

Risk factors for peptic ulcer? (3)

Answer 15

H. pylori infection
NSAIDs
Smoking

Question 16

ALARMS in dyspepsia?

Answer 16

Anaemia
Loss of weight
Anorexia
Recent onset and progressive
Malaena
Swallowing difficulty

Question 17

Management of dyspepsia?

a) ALARMS or older than 55
b) no alarms

Answer 17

a) upper GI endoscopy

b) stop exacerbating drugs, encourage lifestyle changes, OTC antacids

Question 18

What is the indication for H pylori breath testing?

Answer 18

Failure of symptoms to respond to conservative management

Question 19

Treatment of

a) H pylori -ve dyspepsia
b) H pylori +ve dyspepsia

Answer 19

a) PPI/H2 blocker for 4 weeks

b) Eradication therapy- PPI + amox + erythro

Question 20

Multiple gastric ulcers, diarrhoea, refractory o treatment?

Answer 20

? possible gastrinoma

Question 21

Peptic ulcer disease + gastrinoma….syndrome name?

Answer 21

Zollinger Ellison

Question 22

Underlying cause of most gastric MALT?

Answer 22

H pylori infection

Question 23

Main risk factor for the development of HCC?

Answer 23

Liver cirrhosis secondary to hepatitis, alcohol

Question 24

Screening for HCC in at risk patients? (2)

Answer 24

Liver USS and alpha fetoprotein

Question 25

Jaundice is an early feature in ....cancer and a late feature in....

Answer 25

Cholangiocarcinoma HCC

Question 26

Triad of symptoms in HCC?

Answer 26

Hepatomegaly + ascites + jaundice

Question 27

Tumours which commonly metastazise to liver? (3)

Answer 27

Breast, bronchus, colorectal

Question 28

Young/middle aged woman with acute hepatitis + amenorrhoea?

Answer 28

Autoimmune hepatitis

Question 29

Antibodies implicated in autoimmune hepatitis? (4)

Answer 29

ANA, anti-smooth muscle, LKM1, soluble liver-kidney antigen

Question 30

Management of autoimmune hepatitis? (3)

Answer 30

Steroids to induce and maintain remission AZT as steroid-sparing agent Liver transplantation

Question 31

Toxic accumulation of copper in the liver and CNS>

Answer 31

Wilson's disease

Question 32

Pathognomonic sign in Wilson's disease?

Answer 32

Kayser-Fleischer rings

Question 33

Diagnostic tests for Wilson's disease? (2)

Answer 33

High 24hr urinary copper excretion | Low serum copper and ceruloplasmin

Question 34

Management of Wilson's disease? (3)

Answer 34

Avoidance of foods with high copper content Lifelong penicallamine Liver transplantation

Question 35

Commonest cause of an acute hepatitis, spread by the faecal-oral route?

Answer 35

Hepatitis A

Question 36

Complications of hepatitis B and C? (2)

Answer 36

Chronic carrier state in 85% for HCV, 10% for HBV | Hepatocellular carcinoma

Question 37

Hepatitis B serology: a) Anti-HBS b) implies high infectivity c) defines chronic infection

Answer 37

a) recovery/vaccinated b) HBeAg c) persistence of HBsAg for 6 months

Question 38

Treatment of HCV? (2)

Answer 38

Ribavarin + PEGinterferon alpha

Question 39

Spread of HBV and HCV? (3)

Answer 39

Sexually, IVDU, blood transfusions

Question 40

In chronic liver disease, symptoms resulting from: a) reduced synthetic function b) reduced detox c) portal hypertension

Answer 40

a) ascites, bruising, peripheral oedema (3) b) jaundice, encephalopathy, amenorrhoea (3) c) ascites, haematemesis, PR bleeding/melaena (3)

Question 41

Stigmata of chronic liver disease? (8)

Answer 41

``` Asterixis Bruising Dupuytren's contracture Palmar eyrthema Jaundice Spider naevi Caput medusae Splenomegaly ```

Question 42

Accounts for 50% of liver failure in the UK?

Answer 42

Paracetamol overdose

Question 43

Definition of liver failure?

Answer 43

Severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy

Question 44

Liver failure management of: a) ascites b) hepatic encephalopathy c) cerebral oedema d) hepatorenal syndrome

Answer 44

a) salt and fluid restriction, spironolactone, furosemide, parecentesis, IV albumin b) lactulose c) mannitol d) IV albumin + terlipressin

Question 45

Jaundice + diabetes + arthritis

Answer 45

Hereditary haemochromatosis

Question 46

Tests for hereditary haemochromatosis? (2)

Answer 46

Increased serum ferritin | HFE genotyping

Question 47

Management of hereditary haemochromatosis?

Answer 47

Venesection