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Year 4 PassMed Incorrect Qs > Gastro 1 > Flashcards

Gastro 1 Flashcards

1
Q

Side effects of PPI

A
  1. Hyponatraemia
  2. Osteoperosis
  3. Microscopic collitis
  4. INCREASE C.DIFFE INFECTION!
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2
Q

What drugs increase risk of C.diffe? (2)

A
  1. Clindamycin (classically)
  2. Now Cephlasporins
  3. PPI
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3
Q

C. diffe management

1st line
2nd line
3rd line

Life threatening- (2)

A

1st line - ORAL vancomycin
2nd line - oral fidaxomicin except if life threatening
3rd line - oral vancomycin +/- IV metronidazole

Life threatening- oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered

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4
Q

How does ischaemic colitis present?

A

Sudden onset diffuse abdo pain after a meal, intermittent and severe pain, pain out of proportion to clinical findings)

As well as predisposing factors: prev. myocardial infarction, atrial fibrillation, hypertension

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5
Q

Features of achalasia?
1. STEM!
.2
3.
4.

malignant change?

A
  1. STEM! dysphagia of BOTH liquids and solids
  2. typically variation in severity of symptoms
  3. heartburn
  4. regurgitation of food
    may lead to cough, aspiration pneumonia etc

malignant change in small number of patients

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6
Q

What do you need to do before having an appendectomy?

A

Give prophylactic IV ABX! (e.g. Co-amoxiclav TDS pending no penicillin allergy)

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7
Q

How do you differentiate between the 4 different familial CRC diseases?

Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn

A

Peutz-Jeghers syndrome
- numerous hamartomatous polyps in GI
- pigmented freckles on the lips, face, palms and soles

FAP
Gardner’s Syn
Lynch Syn

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8
Q

Familial CRC- what are the genetic patterns and genes affected in each

A
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9
Q

Familial CRC- what are the genetic patterns and genes affected in each

Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn

A

Peutz-Jeghers syndrome
- Auto Dom
- Codes for serine threonine kinase LKB1 or STK11

FAP
Gardner’s Syn
Lynch Syn

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10
Q

Plummer Vinson Syndrome

what is it?
what do you get?

A

(oesophageal web) may occur in association with iron deficiency anaemia (although rare).

Get dysphagia

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11
Q

Criteria for malnutrition:
1. BMI of…

  1. Unintentional weight loss of… in how long?
  2. If BMI < …. then weight loss of…
A
  1. BMI of less than 18.5
  2. Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition
  3. If BMI < 20 and unintentional weight loss greater than 5% within the last 3-6 months
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12
Q

Which part of the bowel is most likely to be affected by ischaemic colitis?

And what artery?

A

splenic flexure

If its hypoperfusion:
Splenic flexure is in between vascular supply of midgut and hindgut (SMA and IMA) - more likely to be affected as in ‘watershed’ area

If its an emboli:
The Sup Mesenteric A. is the first branch off aorta- and the splenic flexure is the furthest point in this blood supply so it’ll get lodged there.

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13
Q

IBS what first-line investigation should you rule out first?

A

Anti-TTG just to rule out ceoliac

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14
Q

Coaliac disease can cause what bone condition and why?

A

Osteomalacia secondary to lack of Vit D absorption from GI due to villous atrophy

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15
Q

What is the guidance for max weekly alcohol intake

what about if preg/ planning on preg?

A

No more than 14 units
If you do as much as 14 units then spread it evenly over 3 days or more

For both men and women

safest approach is do not drink at all and if do keep to a minimum as can lead to long-term health affects for kid, more you drink the greater the risk

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16
Q

When looking at the history of dysphagia and a barium swaloow what would point to oesophageal cancer over achalasia?

A

Achalasia- smooth bieds beak and both solids AND liquids affected!!

Cancer- Irreg- APPLE CORE SIGN and mainly solids first have trouble, obvs FLAWS

17
Q

What can affect coeliac screening antibody test?

A
18
Q

Autoimmune hepatitis management (2)

How do you diff clinically between Auto-immune Hep and PBC (2)

A

Management- steroids +/- Immunosurpression azathioprine

Auto Hep
- ANA +ve
- Amenorrhoea in girls

PBC
- AMA +ve
- ANA +ve

19
Q

What is and how does it Boerhaave syndrome present?

A

Rupture of his oesophagus

Severe vomiting → oesophageal rupture

20
Q

Painless jaundice how to diff Cholangiocarcinoma (3 signs) vs Pancreatic cancer

A

Pancreatic cancer until proven otherwise, its more common
- just painless jaundice
- pain can be quite common

Cholangiocarcinoma
- palpable mass in the right upper quadrant (Courvoisier sign)
- periumbilical lymphadenopathy (Sister Mary Joseph nodes)
- left supraclavicular adenopathy (Virchow node)

21
Q

First line investigation for pancreatic cancer

A

High resolution CT abdo

22
Q

What are the typical features of a pharyngeal pouch (5)

Investigation (1)

Management (1)

A
  1. Dysphagia
  2. Regurg
  3. Halitosis- smelly breathe
  4. Neck swelling which gurgles on palp.
  5. Aspiration

Investigation- Barium swallow

Management- Surgery

23
Q

Who gets prophylytactic antiobiotics if peritonits? (2)

What abx?

A

oral ciprofloxacin or norfloxacin

  • patients who have had an episode of SBP
  • patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome

NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

24
Q

Most common type of inherited colorectal cancer:

A

Hereditary non-polyposis colorectal carcinoma- Lynch

25
Q

Upper GI 2ww referral -Dyspepsia

Urgent
First thing to rule out…
All with
All with +
Age and 1 from: (3)

Non-urgent
All with…

Age who have
- or
- or
-
-

A

Red flags: 2ww endo
- All with dysphagia
- All with upper abdo mass (gastric cancer)

Patients >= 55yo AND one from:
- upper abdominal pain
- reflux
- dyspepsia

Non-Urgent
- All patients with haematemesis

Patients aged >= 55 years who’ve got:
- treatment-resistant dyspepsia or
- upper abdominal pain with low haemoglobin levels or
- raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
- nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

26
Q

Metabolic ketoacidosis and normal glucose, think….

A

Alcoholic ketoacidosis

27
Q

Upper GI bleed from oesophageal varicose vein- you’ve corrected clotting and awaiting OGD, what can you do while waiting?

A

Sengstaken-Blakemore tube has oesophageal and gastric balloons which can be inflated to tamponade the variceal bleeding. It is inserted through the nose.

28
Q

if we think its alcoholic hep what do we look at on LFT?

A

The AST/ALT ratio in alcoholic hepatitis is 2:1

29
Q

Alcohol units formula if given ml

A

Alcohol units = volume (ml) x % ABV / 1,000

30
Q

pathognomonic secondary osteoarthritis STEM for Haemochromatosis (2)

A

hook-like osteophytes at the 2nd and 3rd digits at the metacarpophalangeal joints
slate-grey appearance of the skin.

31
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

Obvs both microcytic

TIBC is high in IDA

low/normal in anaemia of chronic disease

32
Q

Investigation for C.diffe

Screening test =

Diagnostic test for active =

A

Screening test = C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection

Diagnostic test for active = C. difficile toxin (CDT) in the stool

33
Q

Acute Liver failure- synthetic function tests (2)

Which is better indicator in the acute scenario?

A

Prothrombin time (PT) increase

Hypoalbuminaemia

Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure

34
Q

Most common type of oesophageal cancer?

A

adenocarcinoma

arises in the lower third of the oesophagus, near the gastro-oesophageal junction.

35
Q

autoimmune hepatitis

who is it seen in?

Type 1
antibody (2)
Affects who?

Type 2
Antibody (1)
Affects who?

Type 3
Antibody (1)
Affects who?

A

young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3.

Type 1
antibody:
- ANA
- Anti-smooth muscle (SMA)
Affects both adults and kids

Type 2
Antibody:
LKM1- Anti-liver/kidney microsomal type 1
Affects who?
just kids

Type 3
Antibody:
Soluble liver-kidney antigen
Affects who?
Affects adults in middle-age

for all also raised IgG

36
Q

Viral hep

what Ig is raised?

Management (2)

A

IgG

steroids, other immunosuppressants e.g. azathioprine
liver transplantation

37
Q

Plummer-Vinson syndrome. triad

A

triad of
- dysphagia
- glossitis
- iron-deficiency anaemia (some definitions additionally include cheilitis in the syndrome).

38
Q

Small bowel bacterial overgrowth syndrome (SBBOS)

Risk factors for SBBOS (3)

Diagnostic (3)
1st line-
2 other options

Management (1)

A

Risk factors for SBBOS
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

Diagnosis
hydrogen breath test
small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
clinicians may sometimes give a course of antibiotics as a diagnostic trial

Antibiotic therapy: rifaximin

Co-amoxiclav or metronidazole are also effective

39
Q

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?

A

connects the hepatic vein to the portal vein

Year 4 PassMed Incorrect Qs (37 decks)

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