For IPE

Question 1

What is the alcohol recommendations?

Answer 1

14u spread out over at least 3 days with no binging. No safe level

Question 2

What are some differentials of severe oral ulcers?

Answer 2

Crohns and coealiac
Behcets
trauma
Erythema multiforme
lichen planus 
infections

Question 3

What is leukoplasia and what is the consequence of it?

Answer 3

Oral muscoal white plaque that doesnt rub off

Pre malignant lesion

Question 4

What is angular stomatitis? What are the causes?

Answer 4

Fissuring of the mouth corners

causes include poorly fitting dentures, candidiasis and iron deficiency

Question 5

What are the indications for an upper GI endoscopy?

Answer 5

Haematemesis and malena 
Dysphagia
Dyspepsia
Duodenal biopsy
Persistent vomiting 
Iron deficient anaemia cancer

Question 6

Where does a sigmoidoscopy view up to?

Answer 6

Splenic flexure

Question 7

What is the indications for a lower GI endoscopy?

Answer 7

Rectal bleeding 
Iron deficiency 
Persistent diarrhoea
positive FOB
Assessment or suspiscion of IBD
Colon cancer surveliance

Question 8

What is the management of achalsia?

Answer 8

Balloon dilation or Heller’s cardiomyotomy
Botulinum toxin if non invasive procedure needed
CCB and nitrates may also help

Question 9

Where do gastric ulcers tend to occur?

Answer 9

Lesser curvature

Question 10

Why may urea be out of proportion to creatinine in a upper GI bleed?

Answer 10

Blood acts as massive protein rich meal leading to increased urea and no change on creatinine

Question 11

What must be given along side normal management of upper GI bleed if varices suspected?

Answer 11

Teripressin

Question 12

What is used if bleeding cannot be stopped in a varices bleed?

Answer 12

Sengstaken Blakemore tube - compresses varices

Question 13

What are some causes of bloody diarrhoea?

Answer 13

Camplybacter, shingella and salmonella, E coli, IBD and pseudomembranous colitis
ischaemic colitis

Question 14

With someone with explosive diarrhoea what are the first bits of management?

Answer 14

isolate and send sample to the lab

Use PPE

Question 15

What is seen on histology with a patient with gastric adenocarcinoma?

Answer 15

Signet ring cells- contain large amount of mucin which displaces the nucleus to one side

Question 16

What is a MALT associated?

Answer 16

chronic H pylori infection

Question 17

What is found on duodenal biopsy in a patient with suspected coeliac?

Answer 17

Crypt hyperplasia
Vilious atrophy
increased intraepithelial lymphocytes
Lamina propria infiltrated with lymphocytes

Question 18

In a patient with new onset jaundice what are some important questions to ask?

Answer 18

Blood transfusions 
IV drugs
Body piercings and tattoos
Sexual activity 
Travel abroad
Family history
Alcohol use
All medications - now and in the past

Question 19

What is the significance of a painless palpable gallbladder?

Answer 19

Courvisiers law - Likely to be a pancreatic or cholangiocarcinoma

Question 20

What is the management of acute liver failure?

Answer 20

Nurse with head up in ITU - protect airway and insert NG tube
Insert urinary and central venous catheter
Monitor Obs and weight daily
Check bloods daily
Avoid hypoglycaemia with a glucose infusion
Treat cause
Get nutritional advice- thiamine and folate supplements
Treat seizures with phenytoin
If renal failure develops consider dialysis
Try to avoid sedatives and other hepatic metabolism of medications
Consider PPI against stress ulcer
Treat complications

Question 21

Why is lactulose given in hepatic encephalopathy?

Answer 21

Metabolized by bacteria flora to short chain fatty acids which decreased colonic ph and traps NH3 in the colon reducing levels of ammonia in the blood which is thought to contribute to encephalopathy.