FORMATIVE REVIEW

Question 1

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

Answer 1

Primary biliary cholangitis

Question 2

What is an aperient?

Answer 2

A drug used to relieve constipation - laxative

Question 3

Which organisms cause vomiting within hours of eating contaminated food?

Answer 3

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

Question 4

Whats the most commonly reported cause of bacterial food poisoning?

Answer 4

Campylobacter jejuni

Question 5

Which foods typically cause find poisoning with campylobacter jejuni?

Answer 5

Contaminated meat or dairy

Question 6

Which causative food poisoning agent can cause haemolytic uraemic syndrome?

Answer 6

E.coli 0157

Question 7

Whats the role of a palliative medicine physician?

Answer 7

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

Question 8

Whats the role of a community macmillan nurse?

Answer 8

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

Question 9

Whats the role of a district nurse?

Answer 9

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

Question 10

Whats the role of a Marie curie nurse?

Answer 10

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

Question 11

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

Answer 11

Staph aureus

Question 12

Whats the most typically cause of bacillus cereus?

Answer 12

Rice

Question 13

Whats the ranson criteria?

Answer 13

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

Question 14

What urine sodium suggests hypovolaemia?

Answer 14

<20mmol/l

Question 15

What are post op complications for hernia repair?

Answer 15

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

Question 16

What is refeeding syndrome?

Answer 16

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

Question 17

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

Answer 17

Hypophosphataemia

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

Question 18

Outline the pathophysiology of refeeding syndrome?

Answer 18

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.

Question 19

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

Answer 19

Hep E

Question 20

What is the faecal occult blood test used for?

Answer 20

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

Question 21

What is alagille syndrome?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

What are the causes of pancreatitis?

Answer 23

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

Question 24

When are macrocytic target cells seen?

Answer 24

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

Question 25

What can H.pylori infection protect against?

Answer 25

GERD -> Barrett’s oesophagus and oesophageal adenocarcinoma

Question 26

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

Answer 26

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

Question 27

Whats the strongest predisposing factor to developing liver cancer?

Answer 27

Hep C

Question 28

What are the monitoring requirements for PPIs?

Answer 28

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

Question 29

What should be avoided when on metronidazole?

Answer 29

Alcohol

Question 30

Whats the moa of loperamide?

Answer 30

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

Question 31

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

Answer 31

3 weeks or more

Question 32

Why can morphine precipitate pruritus and urticaria?

Answer 32

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

Question 33

How do you manage acute dystonia reactions?

Answer 33

Injection of an anticholinergic e.g. procyclidine

Question 34

Outline the metabolism of azathioprine?

Answer 34

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)

Question 35

What needs testing before treatment with azathioprine?

Answer 35

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

Question 36

What are adverse efefcts of azathioprine?

Answer 36

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

Question 37

What drug can significantly interact with azathioprine? And why?

Answer 37

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

Question 38

Whats the moa of azathioprine in IBD?

Answer 38

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