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GI AND SURGERY > FORMATIVE REVIEW > Flashcards

FORMATIVE REVIEW Flashcards

1
Q

Whats the most common cause of cholestatic liver disease in middle aged women?

A

Primary biliary cholangitis

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2
Q

What is an aperient?

A

A drug used to relieve constipation - laxative

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3
Q

Which organisms cause vomiting within hours of eating contaminated food?

A

Bacillus cereus - 1-6 hours incubation
Staph aureus - 1-6 hours incubation

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4
Q

Whats the most commonly reported cause of bacterial food poisoning?

A

Campylobacter jejuni

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5
Q

Which foods typically cause find poisoning with campylobacter jejuni?

A

Contaminated meat or dairy

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6
Q

Which causative food poisoning agent can cause haemolytic uraemic syndrome?

A

E.coli 0157

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7
Q

Whats the role of a palliative medicine physician?

A

Has overall responsibility for specialist advice, palliative treatments and liaison with other specialities

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8
Q

Whats the role of a community macmillan nurse?

A

A specialist palliative care nurse acting as a link between the hospice, the community and the hospital
Focuses on those living with cancer

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9
Q

Whats the role of a district nurse?

A

A nurse in the community - they have completed additional training to become a specialist community practitioner

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10
Q

Whats the role of a Marie curie nurse?

A

Marie Curie helps anyone with a terminal diagnosis, providing intensive nursing and hospices to care for people who are very sick. It is not restricted to cancer. e

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11
Q

Which food poisoning cause is most likely to cause severe sudden vomiting?

A

Staph aureus

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12
Q

Whats the most typically cause of bacillus cereus?

A

Rice

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13
Q

Whats the ranson criteria?

A

a scoring system that helps healthcare professionals predict the severity and mortality of acute pancreatitis

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14
Q

What urine sodium suggests hypovolaemia?

A

<20mmol/l

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15
Q

What are post op complications for hernia repair?

A

Urinary retention
Sexual dysfunction/pain
Infertility
Injury to intra-abdominal organs
Cardiovascular events
,mortality

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16
Q

What is refeeding syndrome?

A

potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding

17
Q

Whats the hallmark biochemical feature of refeeding syndrome? What are other biochemical features?

A

Hypophosphataemia

Others - abnormal sodium and fluid balance’ changes in glucose/protein/fat metabolism; thiamine deficiency;hypokalaemia; hypomagnesaemia

18
Q

Outline the pathophysiology of refeeding syndrome?

A

During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted.

19
Q

Is hep A or hep E more common in the UK?

A

Hep E

20
Q

What is the faecal occult blood test used for?

A

To identify individuals from the general population for colonoscopy in the national

21
Q

What is alagille syndrome?

A

an inherited condition in which bile builds up in the liver because there are too few/narrowed/malformed bile ducts to drain the bile. This results in liver damage
It’s also associated with heart problems, facial features
Problems become evident in early childhood

22
Q

Whats the most common presenting feature of an ascending colon tumour?

A

IDA - liquid stool in the right colon means the blood is typically mixed in and not visible. Because the stool is loose a changed bowel habit will not be seen and large BO is a very late feature

23
Q

What are the causes of pancreatitis?

A

Idiopathic
Gallstones
Ethanol
Trauma
Scorpion sting
Mumps
Autoimmune
Steroid use
Hypercalcaemia and hypertriglyceridemia
ERCP
Drugs

24
Q

When are macrocytic target cells seen?

A

Lecithin—cholesterol acyltransferase (LCAT) activity may be decreased in obstructive liver disease. Decreased enzymatic activity increases the cholesterol:phospholipid, producing an absolute increase in surface area of the red blood cell membranes

25
Q

What can H.pylori infection protect against?

A

GERD -> Barrett’s oesophagus and oesophageal adenocarcinoma

26
Q

What does a pathological report of ‘Dukes’ stage B carcinoma’ indicate?

A

The tumour is through the bowel wall
Relates to stage not histology

27
Q

Whats the strongest predisposing factor to developing liver cancer?

A

Hep C

28
Q

What are the monitoring requirements for PPIs?

A

Measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a proton pump inhibitor, especially when used with other drugs that cause hypomagnesaemia or with digoxin.
This is because hypomagnesaemia can cause a ventricular tachycardia

29
Q

What should be avoided when on metronidazole?

A

Alcohol

30
Q

Whats the moa of loperamide?

A

Agonist of mu opioid receptors in the GIT. This increases non-propulsive contractions of the gut smooth muscle but reduced peristaltic contractions -> slowed transit of bowel contents and increased anal sphincter tone -> more time for water absorption -> hardens the stool

31
Q

What length of steroid use should you warn a pt about not stopping steroids abruptly due to adrenal insufficiency?

A

3 weeks or more

32
Q

Why can morphine precipitate pruritus and urticaria?

A

Opioids can stimulate histamine release by directly activating mast cells in the skin which leads to urticaria, pruritus, vasodilation and sweating
Most common with codeine and morphine

33
Q

How do you manage acute dystonia reactions?

A

Injection of an anticholinergic e.g. procyclidine

34
Q

Outline the metabolism of azathioprine?

A

It’s converted to 6-mercaptopurine and then into thiouric acid by xanthine oxidase, and into 6-methyl mercaptopurine by thiopurine meythyltransferase, and into 6-TGN (the active metabolite)

35
Q

What needs testing before treatment with azathioprine?

A

TPMT as if deficient they should not recieve the drug (due to it being a major part of its metabolism)

36
Q

What are adverse efefcts of azathioprine?

A

Bone marrow depression
Nausea and vomiting
Pancreatitis
Increased rusk of non-melanoma skin cancer

37
Q

What drug can significantly interact with azathioprine? And why?

A

Allopurinol - because its a xanthine oxidase inhibitor and this enzyme is needed to convert 6-mercaptopurine down into its metabolites
A lower dose of azathioprine shoud therefore be used if taking this

38
Q

Whats the moa of azathioprine in IBD?

A

Azathioprine’s mechanism of action is not entirely understood but it may be related to inhibition of purine synthesis, along with inhibition of B and T cells

GI AND SURGERY (31 decks)

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