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Year 3 > Gasteroenterology > Flashcards

Gasteroenterology Flashcards

1
Q

Give two signs Coeliac disease is often associated with.

A

Iron deficiency anaemia

Non specific diarrhoea

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2
Q

How do we test for Coeliac disease?

A

Using tTG IgA antibodies
tTG = Tissue transglutaminase antibody
; Coeliac disease is autoimmune

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3
Q

What is the Gold standard for diagnosing Coeliac disease?

Give two features you may see.

A

Duodenal biopsy.
Villus atrophy (smaller villi).
Crypt hyperplasia

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4
Q

What is IBD?

A

Inflammatory bowel disease.
Umbrella term for Crohn’s disease and Ulcerative Colitis.
Inflammation of the GI Tract.

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5
Q

What are Crohn’s and Ulcerative Colitis NOT?

A

IBS

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6
Q

Give two differences between Ulcerative Colitis and Crohn’s disease?

A

Crohn’s disease = affects the entire GI tract and is transmural inflammation.
Ulcerative Colitis = only affects the large colon and there is no inflammation beyond the submucosa. Starts working from the rectum upwards.

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7
Q

How does smoking affect Crohn’s disease and Ulcerative Colitis risk?

A

Smoking increases the risk of Crohn’s disease.

Smoking decreases the risk of Ulcerative Colitis.

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8
Q

Which medication increases the risk of Crohn’s disease/Ulcerative Colitis?

A

NSAIDs

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9
Q

Give one key sign of IBD.

A

Erythema nodosum

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10
Q

What is the Gold standard in diagnosing Crohn’s disease?

A

Colonoscopy (cobblestone appearance)

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11
Q

What is the Gold standard in diagnosing Ulcerative Colitis?

A

Colonoscopy and biopsy. (need biopsy in UC!)

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12
Q

How do we treat Crohn’s disease?

A

Stop smoking
Corticosteroids to reduce inflammation: Prednisolone/ Budenoside
Aminosalicylate, azathioprine
For maintenance: Azathioprine.

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13
Q

How do we treat Ulcerative Colitis?

A

5- ASAs. Topical then oral.
In acute admission of UC, treat as an emergency with:
IV Corticosteroids/Ciclosporin/infliximab

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14
Q

What is the Gold standard in diagnosing Colorectal Carcinoma?

A

Colonoscopy and biopsy.

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15
Q

What is the acronym in identifying Red flag symptoms?

A 
Fatigue
Lethargy
Appetite loss
Weight loss
Sweats (night)
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16
Q

What is one clear way to differentiate between gastric and duodenal ulcers?

A 
Gastric = worse after eating
Duodenal = relieved by eating
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17
Q

What are patients with Ulcerative Colitis at risk of even once treated?

A

Adenocarcinoma so give regular colonoscopies after 10 years.

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18
Q

osce question. How do we investigate for a suspected peptic ulcer?

A

Full Blood count
U&Es for dehydration/ bleed
Upper GI endoscopy
Biopsy

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19
Q

What is the main treatment for peptic ulcers

A

PPIs.

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20
Q

What is a key feature in a history which may indicate pancreatitis?

A

Heavy drinking

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21
Q

Epigastric pain radiating to the back - what are 2 key differentials?

A

AAA - Abdominal aortic aneurysm

Pancreatitis.

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22
Q

What are the investigations to look at in acute pancreatitis?

A

Amylase
Lipase
Ultrasound for ?gallstone

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23
Q

What are the two most common causes of acute pancreatitis?

A

Heavy drinking

Gallstones

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24
Q

What are the key markers in acute pancreatitis Vs. chronic pancreatitis?

A 
Acute = high amylase
Chronic = reduced elastase
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25
Q

With pancreatitis, what are some key features we will see in the presentation?

A

Epigastric pain
Steatorrhoea
Diabetes; pancreas makes insulin!

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26
Q

Which is the one DNA Hepatitis type?

A

Hepatitis B

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27
Q

What is the Gold standard in diagnosing Cirrhosis?

A

Biopsy

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28
Q

When will you see Hepatitis D?

A

Only if patient already has hepatitis B!

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29
Q

When may someone have negative IgG but still have antibodies?

A

Vaccination

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30
Q

What is Cirrhosis?

A

Chronic liver disease where we see diffuse fibrosis.

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31
Q

With weight loss in a gastroenterology history, which differential diagnoses should you think of?

A

Coeliac disease/ Crohn’s disease.

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32
Q

What do Crohn’s and Coeliac most commonly present with?

A

Iron deficiency anaemia.

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33
Q

Which is the gold standard first test for coeliac disease?

A 
Small bowel biopsy. 
IgA tTG (tissue transglutaminase) also used in Coeliac disease.
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34
Q

Which medications are used primarily in GORD?

A

Proton pump inhibitors

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35
Q

High iron, high ferritin and low TIBC indicates what diagnosis?

A

Primary haemochromatosis.

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36
Q

Give some features of primary haemochromatosis.

A

Hepatomegaly, arthralgia, tiredness.
Autosomal recessive
Treat with venesection to reduce iron/ ferritin.

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37
Q

A carcinoma of a gastrological cause should only be considered given which sign?

A

Weight loss.

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38
Q

Which additional test should we definitely request to assess liver function?

A

Blood glucose.

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39
Q

How do we treat oesophageal varices?

A

Band Ligation.

Beta blockers

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40
Q

High GGT (gamma GT) and High MCV are indicative of what?

A

Alcohol misuse.

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41
Q

Wernicke’s encephalopathy may be due to what?

A

Vitamin B12 Deficiency

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42
Q

What is Wernicke’s encephalopathy?

A

Ataxia
Confusion
Nystagmus

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43
Q

Which are the most important tests to request in liver failure?

A

ANA (antinuclear antibodies) and SMA (smooth muscle antibodies). = excludes autoimmune hepatitis.

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44
Q

Is the prognosis for pancreatic cancer good or bad?

A

Bad; less than 2% for 5-year survival.

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45
Q

What is PBC?

Which markers will be increased?

A

Primary biliary cholangitis = cirrhosis of the liver.

High AST, ALT, gamma-GT (GGT).

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46
Q

What is a contraindication to performing a biopsy?

A

Low platelets, high INR; puts them in danger from bleeding excessively.

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47
Q

Name three signs associated with PBC (primary biliary cirrhosis).

A

Jaundice
Spider naevi
Splenomegaly
Jaundice

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48
Q

Name two signs associated with chronic pancreatis. (Where would the pain be felt)?

A

Epigastric pain

Weight loss.

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49
Q

What colour is stool in steatorrhoea?

A

Pale stool.

Fat malabsorption.

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50
Q

Which is the most common cause of chronic pancreatisi?

A

Alcohol.

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51
Q

Which marker is mainly elevated in hepatocellular carcinoma?

A

serum Alpha-feroprotein. This is a tumour marker.

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52
Q

Name the three main signs of a malignant liver.

A

Weight loss
Jaundice
Hepatomegaly

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53
Q

Which hepatitis forms predispose an individual to hepatocellular carcinoma?

A

B/C.

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54
Q

Hepatitis D is found in co-infection with which other hepatitis form?

A

Hepatitis B.

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55
Q

Which forms of hepatitis are spread vertically?

A

Hepatitis B/C; blood borne and spread from mother to foetus.

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56
Q

Which hepatitis forms are spread via the faecal-oral route?

A

Hepatitis A and E; contaminated water.

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57
Q

Do vaccinations currently exist for Hepatitis C?

A

No. Currently only for hepatitis A and E.

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58
Q

On biopsy what do multiple nodules indicate?

A

Cirrhosis.

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59
Q

What is the most likely cause of haematemesis?

A

Oesophageal varices.

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60
Q

What does high anti-SMA indicate?

A

Autoimmune hepatitis.

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61
Q

What do high anti-mitochondrial antibodies indicate?

A

Biliary cirrhosis.

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62
Q

What do high transferrin levels indicate?

A

Haemochromatosis.

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63
Q

Which condition can often be mistake for a GI infection and causes thickening of the ileum/caecum?

A

Crohn’s disease.

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64
Q

Smoking aggravates Ulcerative Colitis. True or false?

A

False. Smoking aggravates Crohn’s disease.

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65
Q

How do we treat Ulcerative Colitis?

A

Corticosteroids.

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66
Q

What is the main cause of duodenal ulcers?

A

H.Pylori infections.

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67
Q

What is a measure for hepatocellular carcinoma?

A

Alpha fetoprotein.

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68
Q

When can we see Hepatitis D?

A

Hepatitis D can only be seen with hepatitis B.

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69
Q

Antimitochondrial antibodies are indicative of what?

A

Primary biliary cirrhosis

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70
Q

Hepatitis B is what kind of virus?

A

DNA virus

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71
Q

Which medication do we use to treat Gout?

A

Allopurinol

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72
Q

What is an alternative to allopurinol intreating Gout patients if they have duodenal ulcers?

A

Colchicine.

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73
Q

What causes most duodenal ulcers?

A

H. Pylori infection

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74
Q

What is a test for H.Pylori?

A

Urea breath test
Stool test
CLO (campylobacter like organism)
Culture

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75
Q

Right upper quadrant pain can present as which differentials?

A 
Cholangitis
Pancreatitis
GORD
Ulcers
Cholecystitis.
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76
Q

What is acute cholangitis?

A

Acute inflammation of the entire biliary tree. Typically presents with Charcot’s triad.

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77
Q

What is Charcot’s triad?

A

Fever, jaundice, RUQ pain.

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78
Q

What is Cholangiocarcinoma?

A

Cancer of the bile duct trees.

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79
Q

What is Murphy’s sign?

A

RUQ tenderness on inspiration

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80
Q

What is Cholecystitis?

A

Inflammation of the gallbladder

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81
Q

How does acute cholecystitis present?

A

RUQ pain, Murphy’s sign, fever

5Fs

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82
Q

What is the most common cause of small bowel obstructions?

A

Adhesions. Surgery causes adhesions. If someone has had surgery, think of this as the cause.

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83
Q

What should you think of regarding surgery and the small bowel?

A

Adhesions.

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84
Q

Which is the most common cause of large bowel obstruction?

A

Colon cancer

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85
Q

Is the presentation of small bowel obstruction acute or chronic?

A

Acute

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86
Q

What is McBurney’s sign?

A

Pain is felt 1/3 distance between the ASIS and umbilicus.

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87
Q

What is a key differential of right iliac fossa pain?

A

Appendicitis. Often starts in the umbilicus and then moves to the RIF. Good to ask patient if they first feel pain in the umbilicus.

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88
Q

What is a key differential of left iliac fossa pain?

A

Diverticulitis

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89
Q

Where are diverticulae most commonly found?

A

In the sigmoid colon

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90
Q

What is the marker for colorectal cancer?

A

CEA - carcinoembryonic antigen.

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91
Q

What is the difference between the indirect and direct hernia?

A 
Indirect = Goes through the deep ring, lateral to the epigastric vessels.
Direct = Goes through the superficial ring, medial to the epigastric vessels.
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92
Q

To check for hernias, what do we ask the patient to do?

A

Cough in the abdomen.

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93
Q

Where is Diverticular pain felt?

A

Left lower abdomen.

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94
Q

How do we test for H.Pylori?

A

CLO, urea breath test.

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95
Q

What is a common complication of using NSAIDs?

A

Ulcers

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96
Q

What is dysentery?

A

Diarrhoea associated with passage of blood

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97
Q

What is steatorrhoea and what will the stool look like?

A

Fatty stool. Stool will be pale.

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98
Q

What is the Gold standard in diagnosing Coeliac disease?

A

tTG - tissue transglutaminase.

THEN biopsies.

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99
Q

What is Coeliac disease?

A

Enteropathy triggered by Gliadin in gluten.

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100
Q

What is a difference between UC and Crohn’s?

A

Crohn’s - mouth to anus.

UC - colon.

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101
Q

Are patchy skip lesions found in Crohn’s or UC?

A

Crohn’s. UC is continuous (non-stop) inflammation.

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102
Q

What is dysphagia?

A

Difficulty swallowing

103
Q

Give x3 causes of dysphagia.

A

Oesophagitis
Peptic ulcers
Oesophageal cancer

104
Q

Give 2 features of peptic ulcer disease

A

Worse after eating, radiates to the back.

105
Q

How can we relieve symptoms from peptic ulcer disease.

A

Antacids

106
Q

How may erythromycin concentration affect warfarin concentration?

A

Erythromycin is a cytochrome enzyme inhibitor = inhibits the metabolism of warfarin = INCREASES WARFARIN THERAPEUTIC EFFECT.

107
Q

Which different markers do we look at for acute Vs. chronic pancreatitis?

A

Acute pancreatitis = check amylase

Chronic pancreatitis = check elastase

108
Q

Where is pain in Crohn’s disease most commonly seen?

A

The right iliac fossa.

109
Q

What is Murphy’s sign an indication of?

A

Cholecystitis

110
Q

High evels of unconjugated bilirubin Vs. conjugated bilirubin could be indicative of what?

A

High Unconjugated bilirubin: Liver cannot conjugate fast enough = too much breakdown of Hb into bilirubin. e.g. Haemolytic anaemia. Deficiency of conjugating enzyme e.g. Gilburt’s syndrome.
High Conjugated bilirubin: liver is working (conjugating) but there is obstruction in the bile flow. e.e PBC, Gallstones

111
Q

Which molecule does bilirubin derive from?

A

Haemoglobin.

112
Q

High conjugated bilirubin can be caused by what?

A

Obstruction - Gallstones, primary biliary cirrhosis.

113
Q

Which is more associated with ulcers - Crohn’s or UC?

A

Crohn’s

114
Q

Which is more associated with bloody diarrhoea - Crohn’s or UC?

A

UC

115
Q

Which is more associated with watery diarrhoea - Crohn’s or UC?

A

Crohn’s disease

116
Q

What are the 3 signs of acute pancreatitis

A

Cullen’s
Grey Turner’s
Fox’s sign

117
Q

Which microorganism do we associate as the cause of food poisoning?

A

Campylobacter Jejuni

118
Q

What is cholangitis?

A

Inflammation of the bile duct system.

119
Q

Which vertebral level is the transpyloric plane?

A

L1

120
Q

What is the most common cause of SBO?

A

Adhesions (from previous surgery) and hernia

121
Q

What is the most common cause of LBO?

A

Malignancy

122
Q

What is MRCP and when is it best indicated?

A

Magnetic resonance cholangiopancreatography. Best at evaluating the biliary tree.

123
Q

Describe where the pain of appendicitis is best felt.

A

Firstly central pain then spreads to the right iliac fossa.

124
Q

How do we treat acute pancreatitis?

A

Oral feeding
IV fluids
IV analgesia
Blood gas analysis

125
Q

How do we treat acute cholecystitis?

A

IV fluids and analgesia

126
Q

90% of gallstones are asymptomatic. True or false?

A

True.

127
Q

What is a common recurrence weeks following acute pancreatitis?

A

Pancreatic pseudocyst

128
Q

What is Courvoisier’s Law?

A

Implies a diagnosis in the gallbladder other than gallstones. No pain, palpable gallbladder with jaundice.
Commonly seen in pancreatic carcinoma.

129
Q

Constipation is associated with gallstones. True or false?

A

False.

130
Q

Which test is used primarily to assess stones?

A

ERCP - endoscopic retrograde cholangiopancreatography.

131
Q

What is MRCP commonly used for?

A

To assess the biliary tree.

132
Q

What is one of the first diagnostic tests used to assess GI symptoms

A

OGD - oesophagogastroduodenoscopy

133
Q

What is the standard treatment for a gastric carcinoma?

A

Chemotherapy. Palliative radiotherapy IF there is GI bleeding.

134
Q

Constipation is associated with gallstones. True or false.

A

False.

135
Q

Which symptoms are associated with Achalasia?

A

Dysphagia, cramping, weight loss.

136
Q

What is important apart from weight loss to determine malignancy?

A

Time frame; a time frame of 6 months for example is not suggestive of malignancy.

137
Q

When is barium swallow necessary?

A

Motility disorders e.g GORD.

138
Q

Which test confirms achalasia?

A

Oesophageal manometry

139
Q

Give 3 contraindications to a liver biopsy.

A

INR >1.3
Platelets <100x10^9
Extensive ascites.
Acute confusional state.

140
Q

When is hepatocellular carcinoma likely as a diagnosis?

A

When there is already a background of chronic liver disease

141
Q

What causes asterixis?

A

Encephalopathy due to liver failure.

142
Q

When may you see angular stomatitis?

A

Vitamin B12 deficiency, iron deficiency anaemia.

143
Q

What is Cullen’s sign?

A

Haemorrhagic patch around the umbilicus.

144
Q

What is Grey Turner’s sign?

A

Bilateral flank bruising.

145
Q

What is achalasia?

A

Disorder of the oesophagus = lower oesophageal sphincter (LOS) fails to relax.

146
Q

Name two risk factors of achalasia.

A

Viral infections, autoimmune responses.

147
Q

What are the presenting symptoms of achalasia.

A 
Inability to swallow (dysphagia)
Heartburn
Coughing
Chest pain
Regurgitating food
148
Q

What are the signs of achalasia on physical examination?

A

Weight loss

No specific findings otherwise

149
Q

What is the incidence of achalasia?

A

1/100 000 incidence per year.

150
Q

How do we investigate achalasia?

A

Gold standard = eosophageal manometry. This will show impaired relaxation of the LOS.
EGD - eosophageal gastroduodenoscopy. Dilated oesophagus indicates achalasia.

151
Q

Define acute cholangitis

A

Inflammation of the bile duct

152
Q

Give 2 risk factors of acute cholangitis.

A

Age >50 years
Cholelithiasis
Benign/ malignant stricture

153
Q

What is Charcot’s triad?

A

Fever
Jaundice
RUQ pain

154
Q

Where is Charcot’s triad seen?

A

Acute Cholangitis

155
Q

What are the signs of Acute Cholangitis?

A

Jaundice
RUQ pain, tenderness
Pruritus

156
Q

What is pruritus?

A

Itching of the skin

157
Q

Give x3 first line investigations to consider in acute cholangitis.

A

FBC
Creatinine
Urea
ABG analysis

158
Q

Give x3 further investigations to consider in acute cholangitis.

A

Abdominal CT
MRCP - magnetic resonance cholangiopancreatography
EUS - endoscopic ultrasonography

159
Q

Which is the best liver marker of liver function?

A

INR - international normalised ratio.

160
Q

Which is the best liver marker to assess liver inflammation?

A

AST, ALT.

161
Q

How do we confirm a diagnosis of Primary biliary cirrhosis (PBC)?

A

Anti-mitochondrial antibodies (AMA)

Associated with other autoimmune disorders e.g. RA.

162
Q

How do we confirm a diagnosis of Primary sclerosing cholangitis (PSC)?

A

ERCP/MRCP. Beaded bile duct appearance.

163
Q

Abdominal distension and shifting dullness is suggestive of what?

A

Ascites.

164
Q

Which is the primary test we want to use to assess ascites?

A

Paracentesis.

165
Q

When will we see unconjugated bilirubin Vs conjugated bilirubin?

A 
Unconjugated = Pre-hepatic, hepatocellular
Conjugated = hepatocellular, intrahepatic, extrahepatic obstruction.
166
Q

Give x2 causes of high unconjugated bilirubin

A

Haemolytic anaemia, Gilbert’s syndrome

167
Q

Give x2 causes of high conjugated bilirubin

A

Think hepatocellular cases e.g. hepatitis, PBC (cirrhosis),

168
Q

What are the different causes of epididymitis?

A

Epididymitis younger than 35 yrs: STI e.g. Chlamydia, Neisseria
Epididymitis older than 35 yrs: enteric bacteria e.g. E Coli.

169
Q

Give x6 criteria diagnostic of ulcerative colitis.

A 
Fever
Frequency of stool >6
Bloody stool
Tachycardia
Raised ESR
Anaemia
170
Q

Are fistulae associated with Crohn’s or UC?

A

Crohn’s

171
Q

What is an important difference to highlight with blood and stools in an abdominal history?

A

Is the blood on the stools or mixed in with the stools?

172
Q

Which test definitively confirms colorectal carcinoma?

A

Colonoscopy/ sigmoidoscopy + biopsy.

CT Chest, abdomen pelvis will help stage the cancer, not confirm.

173
Q

What is a good acronym for safety netting on the wards?

A 
BODEX.
Bloods
Observation
Drug chart
ECG
X-ray
174
Q

What is the difference between a loop and end ileostomy?

A

Loop ileostomy = 2 orifices.

End ileostomy = 1 orifice.

175
Q

What is an end ileostomy?

A

Everything distal to the ileum is removed. i.e. colectomy.

176
Q

When may you need to perform an end ileostomy?

A

Ulcerative Colitis.

177
Q

Large bowel dilatation with air in the rectum is indicative of what?

A

Mechanical/ Pseudo obstruction unless presenting with ischaemia/sepsis = toxic megacolon.

178
Q

How can we differentiate between the small and large bowel on abdo x ray?

A

small - valvulae conniventes (go all the way round bowel).

large - haustra

179
Q

What is the difference between direct and indirect hernias?

A 
Direct = exit the abdomen via the superficial ring only.
Indirect = exit the abdomen via the superficial and deep ring.
180
Q

Which are more common - inguinal or femoral hernias?

A

Inguinal hernias.

181
Q

How do we initially treat small bowel obstruction?

A

Analgesia
IV fluids; big issue in SBO is severe dehydration.
NG tube (decompresses the stomach).
Nil by mouth

182
Q

What is the main issue with SBO initially?

A

Patient will be severely dehydrated.

183
Q

On the abdominal x ray, which sign will show dilatation of the small bowel?

A

Valvulae conniventes - lines that extend across the whole way. Haustra do not.

184
Q

What is sigmoid volvulus?

A

Obstruction within the sigmoid colon.

185
Q

Which initial test is necessary in bowel obstruction?

A

As well as an xray, a DRE!

DRE is needed to exclude a rectal lesion.

186
Q

Toxic megacolon usually involves which part of the colon?

A

The transverse colon.

187
Q

The coffee bean sign on an abdominal radiograph is usually seen in which pathology?

A

Sigmoid volvulus.

Google coffee bean sign if unsure!

188
Q

Which is the most commonly injured solid organ in the abdomen?

A

Spleen.

189
Q

Sigmoid colonic resection can be used for which procedure? Think location.

A

Left lower flank = diverticular disease.

190
Q

How would we differentiate between small bowel obstruction and small bowel ileus clinically?

A

Small bowel obstruction would present with bowel sounds.

191
Q

What does Pabrinex involve? When would we give pabrinex?

A

Vitamin B and C.

After a patient is starving/dehydrated. To prevent Wernicke’s encephalopathy.

192
Q

What is the triad for Wernicke’s encephalopathy?

A

Ataxis
Confusion
Nystagmus (opthalmoplegia).

193
Q

Which bacterial microorganisms can mimic Crohn’s disease?

A

Tuberculosis

Yersinia

194
Q

Which are the two most common causes of large bowel obstruction?

A

Colonic carcinoma

Sigmoid volvulus

195
Q

Where would abdominal symptoms of diverticular disease be felt?

A

Lower left abdomen.

Left iliac fossa.

196
Q

How is diverticular disease treated?

A

Firstly conservatively: nil by mouth and IV antibiotics.

Then CT, colonoscopy.

197
Q

Where do most diverticular disease complications occur?

A

Sigmoid region.

198
Q

Toxic megacolon is associated with which three conditions?

A

Ulcerative Colitis
Salmonella
Crohn’s disease

199
Q

Which test is usually requested with an abdominal x ray?

A

Chest x ray.

200
Q

What is a key differential of abdominal pain with quiet bowel sounds and rigidity?

A

Peritonitis.

;rigidity and absent bowel sounds.

201
Q

Define micturition.

A

Passing urine.

202
Q

Define micturition.

A

Passing of urine.

203
Q

Pain and profuse diarrhoea after antibiotic treatment. What is your top differential diagnosis?

A

Pseudomembranous Colitis.

204
Q

Which is the most common causative microorganism of Pseudomembranous Colitis?

A

Clostridium Difficile.

205
Q

What should be avoided in pseudomembranous colitis?

A

Anti-diarrhoeal agents.

206
Q

When will free air beneath the diaphragm be a normal finding?

A

Following surgery.

207
Q

What is the first most appropriate treatment for appendicitis?

A

Nil by mouth and urgent laparotomy and appendicectomy.

208
Q

At which level does the aorta bifurcate?

A

Umbilicus = L4.

209
Q

What must you remember about sigmoid volvulus?

A

Bowel sounds will be increased.

210
Q

Define volvulus

A

Twisted bowel

211
Q

What is the difference between an ileus and a large/ small bowel obstruction?

A

Ileus is not a mechanical obstruction

LBO/SBO is mechanical

212
Q

Name two of the most common causes of SBO.

Name two of the most common causes of LBO.

A 
SBO = adhesions and hernias
LBO = cancer and volvulus.
213
Q

Where can a lead pipe sign be seen from an abdominal x ray?

A

Crohn’s/ UC.

214
Q

Give x3 causes of splenomegaly.

A

Malaria
Inflammatory disease e.g. rheumatoid arthritis
Infection e.g. infective mononucleosis.

215
Q

What does high ALT indicate?

A

Alanine transferase = indicator of injury

Remember high ALT in isolation can be a marker of bone injury, Vitamin D deficiency, bony metastases

216
Q

What does high ALP indicate?

A

Alkaline phosphatase = indicator of obstruction

217
Q

What is Gilbert’s syndrome?

A

Impaired conjugation of bilirubin (so a pre-hepatic issue).

218
Q

Which markers will be high in Gilbert’s syndrome?

A

Bilirubin (Gilbert’s is an issue of conjugating bilirubin). ALT and ALP are normal.

219
Q

Name three functions of the liver.

A

Conjugates and eliminates bilirubin
Makes albumin
Makes clotting factors

220
Q

How is bilirubin produced?

A

Bilirubin is a product of haemoglobin breakdown.

221
Q

When will ALT>AST compared with AST>ALT?

A 
ALT>AST = chronic liver disease (injury)
AST>ALT = Cirrhosis, hepatitis (obstruction)
222
Q

Why will urine be darker in hepatic/post hepatic causes?

A

Conjugated Bilirubin makes the urine darker. Bilirubin is conjugated in the liver so by this point conjugation has happened.

223
Q

When will stool be pale?

A

When there is fat in the stool. i.e. there has been poor fat absorption.

224
Q

Would we typically request an erect or supine X-ray?

A

Supine x-ray.

225
Q

Which test would we request to assess an anastomosis and any evidence of leakage?

A

WATER SOLUBLE enema not barium enema. Barium enema is contraindicated in suspected bowel perforation.

226
Q

What is rapid sequence induction?

A

A technique to rapidly secure the airways with an endotracheal tube.

227
Q

What is a key investigation to request when querying Crohn’s disease or UC?

A

STOOL SAMPLE!

Calprotectin.

228
Q

Which of the causes of right iliac fossa pain is more likely in older patients?

A

Meckel’s diverticulitis

first carcinoma

229
Q

What is Rovsing’s sign?

A

Pain upon palpation in left iliac fossa produces pain in the right iliac fossa.

230
Q

What is Obturator’s sign?

A

Pain when passively internally rotating the hip

231
Q

Which scoring system is used in appendicitis?

A

Alvarado.

232
Q

Which presentation would not be indicated for emergency surgery?

A

An abscess

233
Q

Which is the antibiotic we use to treat Clostridium difficile?

A

Vancomycin

234
Q

Which test should not be performed in acute diverticulitis?

A

Colonoscopy

235
Q

When would we not choose DC cardioversion for a patient with AF who is haemodynamically compromised?

A

If the patient is vomiting. Otherwise WOULD DC cardiovert if patient is unstable but with vomiting firstline = IV fluids.

236
Q

Which is the first line management in patients who are vomiting?

A

IV fluids.

237
Q

What is loin to groin pain indicative of what?

A

Renal colic.

238
Q

What is the first line therapy for renal colic (stones)?

A

Diclofenac = analgesic.

239
Q

What is the first line investigation for gastric cancer?

A

OGD + biopsy.

240
Q

Which is the most appropriate investigation for Colorectal cancer?

A

Colonoscopy + biopsy.

241
Q

Which is a unconventional cause of abdominal pain?

A

Diabetic Ketoacidosis.

242
Q

How do we treat Diabetic Ketoacidosis?

A

IV fluids, K+ replacement,

243
Q

How do we treat hyperkalaemia?

A

Insulin, calcium gluconate, glucose.

244
Q

What affect does insulin have on potassium levels?

A

Insulin lowers blood potassium levels.

245
Q

What is the characteristic cell of Chronic lymphoblastic leukaemia?

A

Smudge cells - remnants of cells.

246
Q

Which two conditions present similarly but are more distinguishable by onset?

A

Abdominal aortic aneurysm (more acute onset)

Pancreatitis (slower onset)

247
Q

What is the difference between cholangitis and cholecystitis?

A

Cholangitis = affects whole of the biliary tree whereas cholecystitis is inflammation of the gallbladder solely.

248
Q

Will we see jaundice in cholangitis or cholecystitis?

A

More in cholangitis.

249
Q

Which conditions are associated with B12 deficiency?

A

Macroglossitis/ stomatitis?

250
Q

Which cell marker is associated with B12 deficiency?

A

Anti-parietal cell

251
Q

Which cell marker is associated with Coeliac disease?

A

tTG - tissue transglutaminase.

252
Q

When would we request a urea breath test?

A

If we were unsure about a H.Pylori confirmation. If stem says H. Pylori, this means we do not need the urea breath test.

253
Q

When may a question point toward a Zollinger-Ellison syndrome diagnosis?

A

High calcium, high gastrin = can cause ulcers; gastric acid.

254
Q

How do we treat Ulcerative Colitis?

A

Azathioprine and Infliximab.

Year 3 (13 decks)

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