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MRCP Part II > Gastro > Flashcards

Gastro Flashcards

1
Q

Pattern of LFTs in non-alcoholic steatohepatitis

A

ALT > AST

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2
Q

NASH - US findings

A

Increased echogenicity

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3
Q

Pellagra features

A

4 Ds:

  • dementia
  • dermatitis
  • diarrhoea
  • death
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4
Q

Pellagra = deficiency of

A

Vitamin B3 (Niacin)

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5
Q

Small bowel bacterial overgrowth (SBBOS) - gold standard diagnostic investigation

A

Jejunal aspirate - showing >100,000 bacteria/ml

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6
Q

Hydatid cyst (tapeworm Echinococcus)- clinical features

A

Cyst in liver or lungs
Type 1 hypersensitivity reaction if leaks
Biliary rupture (colic, jaundice + urticaria)

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7
Q

Whipple’s disease - infective agent

A

Tropheryma whippelii

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8
Q

Whipple’s disease - features

A 
Insidious:
Malabsorption
Arthralgia
Lymphadenopathy
Cognitive impairment
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9
Q

Whipple’s disease - diagnosis

A

Jejunal biopsy - shows macrophages containing Periodic acid-Schiff (PAS) granules

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10
Q

Patients with ascites, give antibiotic prophylaxis for SBP if:

A

Had an episode of SBP previously
or
Ascitic fluid protein <15g/l + Child-Pugh score >9 or hepatorenal syndrome

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11
Q

Antibiotic prophylaxis for SBP

A

PO ciprofloxacin / norfloxacin

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12
Q

Blatchford score - Urea 6.5 - 8

A

2

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13
Q

Blatchford score - Urea 8 - 10

A

3

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14
Q

Blatchford score - Urea 10 - 25

A

4

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15
Q

Blatchford score - Urea >25

A

6

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16
Q

Blatchford score - Hb 12 - 13 (Man)

A

1

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17
Q

Blatchford score - Hb 10 - 12 (Man)

A

3

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18
Q

Blatchford score - Hb < 10 (Man)

A

6

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19
Q

Blatchford score - Hb 10 - 12 (Woman)

A

1

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20
Q

Blatchford score - Hb < 10 (Woman)

A

6

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21
Q

Blatchford score - Systolic BP 100 - 109

A

1

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22
Q

Blatchford score - Systolic BP 90 - 99

A

2

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23
Q

Blatchford score - Systolic BP < 90

A

3

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24
Q

Blatchford score - other markers scoring 1

A

Pulse >= 100

Presents with malaena

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25
Q

Blatchford score - other markers scoring 2

A

Presents with syncope

Hepatic disease

Cardiac failure

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26
Q

Treatment of bile acid diarrhoea (BAD)

A

Bile acid sequestrants - cholestyramine

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27
Q

Diagnosis of bile acid malabsorption

A

SeHCAT (selenium homocholic acid taurine) scan shows <15% retention at 7 days

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28
Q

H. pylori eradication - no allergies

A

7 days of

PPI + amoxicillin + clarithromycin/metronidazole

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29
Q

H. pylori eradication - penicillin allergic

A

PPI + clarithromycin + metronidazole

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30
Q

H. pylori eradication - penicillin allergic and previous clarithromycin use

A

PPI + bismuth + metronidazole + tetracycline

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31
Q

Patient with cirrhosis - first scope shows no varices

A

Rescope 2-3 years

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32
Q

Patient with cirrhosis - scope shows Grade 1 varices

A

Rescope 1 year

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33
Q

Patient with cirrhosis - scope shows grade 2 or 3 varices, or signs of bleeding

A

Non-cardio selective beta blocker

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34
Q

Crohns management - what does combined immunomodulator + biological therapy increase risk for

A

Non-melanoma skin cancer

Hepatosplenic T-cell lymphoma

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35
Q

Causes of ascites with SAAG > 11g/L

A

Liver (failure, mets)
Cardiac
Budd-Chiari
Portal vein thrombosis

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36
Q

Causes of ascites with SAAG < 11g/L

non-portal HTN

A

Hypoalbuminemia (nephrotic syndrome, malnutrition)
Malignancy
TB
Pancreatitis, bowel obstruction

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37
Q

Wilsons disease - clinical features

A

Deranged LFTs
Movement disorder
Psychiatric disturbance

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38
Q

Definition SBP

A

Ascites neutrophil count > 250 cells / mm^3

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39
Q

UC patient with increased stool frequency, incontinence after ileal pouch-anal anastamosis

A

Pouchitis

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40
Q

1st line management of pouchitis

A

Metronidazole or ciprofloxacin

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41
Q

Colonoscopy shows normal appearance, but colonic biopsy shows lymphocytic infiltrate

A

Microscopic colitis (chronic inflammatory)

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42
Q

Risk factors for microscopic colitis

A

SSRIs
NSAIDs
PPIs
Smoking

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43
Q

IBS constipation, despite optimal laxatives - next step

A

Linaclotide (guanylate cyclase-C receptor agonist)

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44
Q

C.diff 1st line treatment

A

PO Metronidazole 10 - 14 days

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45
Q

C.diff - 2nd line or severe

A

PO Vancomycin

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46
Q

C.diff - not responding to 1st or 2nd line treatment

A

Fidaxomicin

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47
Q

C.diff - life-threatening

A

PO Vancomycin + IV Metronidazole

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48
Q

Gardner’s syndrome (variant of familial adenomatous polyposis) presents with

A

Osteomas of the skull/jaw

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49
Q

Features of Alkaptonuria (ochronosis) AR disorder

A

Pigmented sclera
Urine turns black in air
Renal stones
Intervertebral disc calcification

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50
Q

Significance of HbsAg (Hepatitis B surface antigen)

A

Implies acute disease (usually present 1-6m)

If present >6m implies chronic disease

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51
Q

Significance of HbsAb (Hepatitis B surface antibody)

A

Immune
(either through exposure or immunisation)

Not present in chronic disease

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52
Q

Significance of HBcAb (Hepatitis B core antibody)

A

Previous (or current) infection

IgM present for ~6 months
IgG persists

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53
Q

Significance of HbeAg (Hepatitis B envelope antigen)

A

Marker of infectivity (breakdown of infected liver cells)

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54
Q

Hepatitis B serology seen in previous immunisation

A

anti-HBs only

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55
Q

Hepatitis B serology seen in previous infection >6 months ago + not a carrier

A

anti-HBc positive

HBsAg negative

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56
Q

Hepatitis B serology seen in previous infection, now a carrier

A

anti-HBc positive

HBsAg positive

57
Q

Budd-Chiari - triad

A

Sudden onset abdominal pain
Ascites
Tender hepatosplenomegaly

58
Q

Features of haemochromatosis

A 
Bronzed
Diabetes
Arthritis/pseudogout
Liver cirrhosis
Cardiomyopathy
Impotence
59
Q

Haemochromatosis + joint pain

A

pseudogout

60
Q

Ulcerative colitis - Inducing remission in mild-moderate proctitis - 1st line

A

Rectal aminosalicylate

61
Q

Ulcerative colitis - Inducing remission in mild-moderate proctitis - 2nd line

A

Add oral aminosalicylate

62
Q

Ulcerative colitis - Inducing remission in mild-moderate proctitis - 3rd line

A

Add topical or oral corticosteroid

63
Q

Medications which cause false positive 5-HIAA urinary collection results

A

Paracetamol
Naproxen
Caffeine
Fluorouracil

64
Q

Medications which cause false negative 5-HIAA urinary collection results

A

Aspirin
Levodopa
Methyldopa
ACTH

65
Q

Foods which cause false positive 5-HIAA urinary collection results

A 
Banana
Avocado
Aubergine
Pineapple
Plums
Walnuts
Tomatoes
66
Q

Antibodies seen in Type I Autoimmune Hepatitis

A

Anti-nuclear antibodies (ANA)
+/-
Anti-smooth muscle antibodies (SMA)

67
Q

Antibodies seen in Type II Autoimmune Hepatitis

A

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

68
Q

Antibodies seen in Type III Autoimmune Hepatitis

A

Soluble liver-kidney antigen

69
Q

Examples of aminosalicylate drugs

A

5-ASA
Sulphasalazine
Mesalazine
Olsalazine

70
Q

Sulphasalazine - side effects

A 
Heinz body anaemia
Megaloblastic anaemia
Fibrosis
Oligospermia
Rash
Agranulocytosis
71
Q

Mesalazine - side effects

A

Pancreatitis
Agranulocytosis
GI upset

72
Q

Crohns flare - 1st line for inducing remission

A

Glucocorticoid (hydrocortisone, prednisolone) oral, topical or IV

73
Q

Crohn’s flare - 2nd line options

A

5-ASAs (eg mesalazine)

Azathioprine or mercaptopurine as an adjunct

Infliximab

74
Q

Drugs which case a hepatocellular liver injury

A 
Paracetamol
Nitrofurantoin
Sodium valproate, phenytoin
Statins
Amiodarone
Anti-TBs
75
Q

Drugs which cause a cholestatic liver disease

A

Co-amoxiclav, Flucloxacillin, Erythromycin
COCP
Sulphonylureas
Fibrates

76
Q

Drugs which cause liver cirrhosis

A

Methotrexate
Amiodarone
Methyldopa

77
Q

Colonoscopy - 1-2 small (<1cm) adenomas

A

Low risk - No follow up, or, 5 yearly until one negative scope

78
Q

Colonoscopy - 3-4 small (<1cm) adenomas

A

Intermediate risk - 3-yearly colonoscopy, until two consecutive negative scopes

79
Q

Colonoscopy - 1-2 adenomas, one is >1cm

A

Intermediate risk - 3-yearly colonoscopy, until two consecutive negative scopes

80
Q

Colonoscopy - 5 or more adenomas

A

High risk - yearly scope

81
Q

Colonoscopy - 3 or more adenomas if one is >1cm

A

High risk - yearly scope

82
Q

Absolute contraindications for TIPSS

A 
High Child-Pugh score
Hepatic encephalopathy
Right heart failure
Sepsis
Biliary obstruction
83
Q

Test for haemochromatosis (no family history)

A

Transferrin saturation - >55%

84
Q

Test for haemochromatosis (with family history)

A

HFE genotyping

85
Q

Crohns - biopsy shows

A

Transmural inflammation with lymphoid aggregates

86
Q

1st line treatment for Entamoeba histolytica

A

Metronidazole

87
Q

Crohns - 1st line for maintaining remission

A

Azathioprine or mercaptopurine

88
Q

Primary biliary cirrhosis - associated conditions

A

Sjogren’s (80%)
RA
Systemic sclerosis
Thyroid disease

89
Q

Primary biliary cirrhosis - complications

A

Cirrhosis + portal hypertension
Hepatocellular carcinoma
Osteomalacia + osteoporosis

90
Q

Antibodies in PBC

A

AMA (anti-mitochondrial) M2 subtype - 98%
Smooth muscle - 30%
Raised serum IgM

91
Q

Features of scurvy

A 
Perifollicular bleeding
Easy bruising
Gingivitis
Sjogren's
Arthralgia
92
Q

Zieve syndrome - triad

A

Haemolytic anemia
Cholestatic jaundice
Transient hyperlipidemia

93
Q

IBD and colorectal cancer screening - what counts as ‘Lower risk’ (5-yearly)

A

Extensive colitis but no inflammation

Left-sided colitis

Crohn’s colitis <50% colon

94
Q

IBD and colorectal cancer screening - what counts as ‘Intermediate risk’ (3-yearly)

A

Extensive colitis with mild inflammation

Post-inflammatory polyps

FH of colorectal Ca in 1st-degree relative (>50yo)

95
Q

IBD and colorectal cancer screening - what counts as ‘Higher risk’ (Yearly)

A

Extensive colitis with mod/severe inflammation

Stricture in past 5 years

Dysplasia in past 5 years, declining surgery

PSC

FH of colorectal Ca in 1-degree relative <50yo

96
Q

Management of acute alcoholic hepatitis

A

Prednisolone, pabrinex, nutritional support

97
Q

Small bowel bacterial overgrowth syndrome - 1st line investigation

A

Hydrogen breath test

98
Q

Risk factors for SBBOS

A

Scleroderma
Congenital GI abnormality (neonates)
Diabetes

99
Q

Barrett’s oesophagus - follow up following eradication of low-grade dysplasia

A

Endoscopy every 6 months for first year, annually thereafter

100
Q

Barrett’s oesophagus - follow up following eradication of high-grade dysplasia

A

Endoscopy every 3 months for first year, every 6 months for second year, annually thereafter

101
Q

Barrett’s oesophagus - follow up if metaplasia (no dysplasia)

A

Endoscopy every 3-5 years

102
Q

Pregnant and on azathioprine for IBD/arthritis/skin disease

A

Continue Azathioprine

103
Q

UGI bleed - criteria for red cell transfusion

A

Hb <70

or Hb 70-80 and actively bleeding/haemodynamically unstable

104
Q

UGI bleed - criteria for platelet transfusion

A

Actively bleeding and platelet count <50

105
Q

UGI bleed - criteria for FFP

A

Fibrinogen <1 g/L
or
PT/APTT/INR >1.5 normal value

106
Q

UGI bleed - criteria for antibiotics

A

All patients with acute variceal bleed > gram-negative cover (Ceftriaxone)

107
Q

Signs of acute hepatic decompensation

A

Asterixis
Jaundice
Hepatic encephalopathy
Constructional apraxia

108
Q

1st line test for IBD

A

Faecal calprotectin

109
Q

Faecal calprotectin is raised in

A 
UC/Crohns
Bowel malignancy
Coeliac
Infectious colitis
NSAID use
110
Q

Blood marker associated with autoimmune pancreatitis

A

Raised serum IgG4

111
Q

Monitoring required when starting oral aminosalicylate

A

FBC and renal function: before, at 3 months, annually thereafter

112
Q

5-year survival rate of: Duke’s A bowel cancer (confined to mucosa and submucosa)

A

95% in men

100% in women

113
Q

5-year survival rate of: Duke’s B bowel cancer (extends through muscularis propria)

A

> 80% in men

90% in women

114
Q

5-year survival rate of: Duke’s C bowel cancer (regional lymph nodes involved)

A

65% in men

65% in women

115
Q

5-year survival rate of: Duke’s D bowel cancer (distant spread)

A

> 5% in men

10% in women

116
Q

Gastric cancer - suitable for Endomucosal resection if:

A

Confined to mucosa
Less than 2 cm diameter
Low/moderate differentiation
No ulceration/lymphovascular involvement

117
Q

Gastric cancer - treatment for stage II and III carcinoma

A

Neoadjuvant chemotherapy, prior to radical surgery

118
Q

HbA1c target for diabetes related to pancreatic resection

A

53

119
Q

Frequency of bowel screening colonoscopy in patients with both Crohns and PSC

A

Annual

120
Q

Management of hereditary haemochromatosis

A

Phlebotomy indicated for all patients with initial ferritin >1000 mcg/L

Aim for 50-100mcg/L

121
Q

After lactulose, which other medications can be used to treat hepatic encephalopathy

A

Rifaximin

Other antibiotics

122
Q

Lysosomal storage disorder which features ‘cherry red spot’ macula

A

Tay Sachs

123
Q

Lysosomal storage disorder which causes massive splenomegaly

A

Gaucher’s

124
Q

Glycogen storage disorder which causes cardiomyopathy

A

Pompe’s disease

125
Q

Glycogen storage disorder with rhabdomyolysis after exercise/lactic acidaemia

A

McArdle’s

126
Q

Glycogen storage disorder causing hypoglycaemia + hepatomegaly

A

Von Gierke

127
Q

For whom is yearly colonoscopy recommended?

A

High risk; 5+ adenomas <10mm or 3+ adenomas > 10mm+

128
Q

For whom is three-yearly colonoscopy recommended?

A

Intermediate risk; 3-4 adenomas < 10mm or 1-2 adenomas > 10mm+

129
Q

For whom is five yearly colonoscopy reccomended?

A

low risk disease; 1-2 adenomas < 10mm

130
Q

At what age is the surveillance colonoscopy recommended?

A

40 years

131
Q

Which groups are recommended targeted colonoscopy screening?

A 
People with FAP/HNPCC 
close relatives of people with FAP/HNPCC
UC/Crohn's affecting colon/rectum 
Acromegaly 
Previous Colon cancer 
People who have had 1+ colonic polyps removed
132
Q

UC flare, given steroid but no improvement after 72 hours, whats the next Rx?

A

Ciclosporin

133
Q

Following severe relapse or > 2 exacerbation in the past year of UC what is the Rx?

A

Oral Azathiprine or oral mercaptopurine

134
Q

What are the Immunoglobulin findings in patients with alcoholic hepatitis?

A

Markedly raised IgA

Mildly elevated IgG and IgM

135
Q

HLA association of Type 1 Autoimmune Hepatitis?

A

B8 DR3 DR4

136
Q

HLA association of Type 2 Autoimmune Hepatitis?

A

B14, DR3 C4AQO

137
Q

Out of type 1/2/3 autoimmune hepatitis which one has highest risk of progression to Cirrhosis?

A 
Type 2 (82%)
Type 3 (75%)
Type 1 (45%)
138
Q

When should liver transplant be considered in HCC?

A

Any patient with cirrhosis and single small HCC (<5cm) or up to 3 lesions (< 3cm).

139
Q

When should hepatic resection be considered in patients with HCC?

A

any patient with HC and non-cirrhotic liver

MRCP Part II (15 decks)

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