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Difficult Passmed- MLA > Gastro > Flashcards

Gastro Flashcards

1
Q

dx:
Benign, self limiting, flu like prodrome, RUQ pain, tender Hepato-megaly, Jaundice, deranged LFTs

A

Hep A

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2
Q

HbsAg =
HbsAB =
HbcAG =
IgM =
, IgG =
HbeAg =

A

HbsAg = Active but if present >6m can be chronic
HbsAB = vacc/past/current
HbcAG = past/current infection
IgM = acute, IgG = past
HbeAg = infectivity

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3
Q

Tx Hep B and is it chronic?

A

Pegylated IF-A treatment
Most recover <2m - some chronic.
Can progress to HCC

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4
Q

After exposure - transient rise in lFTs/Jaundice, fatigue, arthralgia,
Usually in IVDU and in old blood transfusions - dx

A

Hep c - antivirals

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5
Q

3 types of autoimmune hepatitis and the common groups they are seen in and mx

A

T1 = women after menopause. ANA/SMA
T2 = Teens - jaundice, ↑AST/ALT, LKM1
T3 = ↑IgG

steroids , azathioprine

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6
Q

Mx of oesophageal varies in GI bleed

A

Terlipressin + props ABc
If all fails - sengstaken Blakemore tube

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7
Q

Mx H Pyloric

A

PPI + 2Abx (Amoxicillin + Clarithromycin) for 7 days

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8
Q

What is boerhave syndrome

A

Vomit -> severe chest pain/shock = oesophageal perforation +/- suprasternal crepitus

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9
Q

Diagnosis of Pharyngeal pouch

A

Barium swallow combined with dynamic video fluoroscopy

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10
Q

Painless jaundice (pale stool, dark urine, pruritus)
Cholestatic LFTs +/- mass, ↓ weight
DM, Steatorrhoea
CT scan - double duct sign

Diagnosis

A

Pancreatic cancer

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11
Q

What will bloods show for haemachromatosis

A

↑transferrin sat, ↑ ferritin, ↓TIBC, HFE gene C6

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12
Q

Type of inheritance of Wilsons disease, the diagnosis and mx

A

Autosomal Recessive
Liver biopsy is gold standard
Copper chelation - penicillamine, Trientene

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13
Q

Type of inheritance and 2 main problems in alpha 1 antitrypsin def

A

Autosomal recessive
Liver cirrhosis + emphysema

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14
Q

Jaundice in illness/exercise - isolated rise in bilirubin

What is this, pattern of inheritance and mx

A

Gilberts syndrome
Autosomal recessive
Jaundice in illness/exercise - isolated rise in bilirubin
Reassurance, no treatment

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15
Q

Mx small bowel overgrowth and a main RF

A

RF = Scleroderma
Rifaximin

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16
Q

How long before urea breath test for H.Pylori to stop antibacterials and PPIs

A

Urea breath test - not within 4 weeks or antibacterial or PPI

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17
Q

Achalasia - diagnosis and mx

A

Solid + liquid
Dx - oesophageal manometry - birds beaks in barium swallow
Pneumatic dilation
Heller cardiomyotomy

18
Q

Hepatic vein thrombosis, abdo pain, ascites, tender hepatomegaly

What is the condition and how to diagnosis

A

Budd-Chiari
1.US doppler -> Dx -> hepatic venography

19
Q

Persistent biliary colic, anorexia, jaundice, mass RUQ, periumbilical LNs + left supraclavicular LNS

diagnosis

A

CHolangiocarcinoma

20
Q

Autosomal dominant, polyp, pigmented lesions

A

Peutz-jEGHERS

21
Q

campylobacteria jej vs E.Coli

A

Campylobacter jej - Bloody, crampy travellers diarrhoea
(E.Coli is non bloody + watery)

22
Q

C.Diff mx

A

PO VANC
PO Findaxomicin
If recurrent in 12 weeks = Findaxomicin.
If >12w then vanc

Severe (-<BP, toxic megacolon) = PO Vanc + IV metrondiaxole
Dx - CDT in stool (toxin)

23
Q

What blood gas abnormality would you see in vomiting vs diarrhoea

A

Vom = metabolic alkalosis
Diarrhea = Normal anion metabolic acidosis

24
Q

Remission and maintainance tx of UC

A

Remission = Aminosalicylate or 2. Corticosteroids
Maintenance = Aminosalicylates ( if >2 exac then PO azathioprine or PO Mercaptopurine)
Panprocolectomy

25
Q

Difference between UC and Crohn’s

A

UC= Continuous, colon + rectum, superficial, bloody/mucus, smoking helps, ass with ankylosing spondylitis, PANCA, lead pipe on XR

Crohns = No blood/mucus, entire gIT, skip lesions, transmural, goblet cells, mostly ileum

26
Q

Remission and maintianene mx of Crohn’s

A

R= Steroids
M = Azathioprine/ mercaptopurine (cgeck TPMT activity before)

Perianal abscess - incision and drainage
Symp perianal fistula - PO Metronidazole
Cpmplex perianal fistula - seton

27
Q

What is give for Pain, Consitpation and diarrhoea in IBS

A

Pain - antispasmodic
Constipation - ispaghula husk
Diarrhoea - loperamide

28
Q

Cholestasis - jaundice, pruritis, ↑bilirubin + ALP
RUQ pain, fatigue

what could be the diagnosis, what condition is a RF, and what is a compilation

A

PSC
UC is RF
Cn lead to cholangiocarcinoma

29
Q

Dx of PSC

A

ERCP (beaded appearance - strictures)

30
Q

CHolestatic jaundice + ↑IgM + Anti-mitochondrial Abs (AMA)
May be asymptomatic (eg raised ALP on routine LFTs) Itching + fatigue and may have cholestatic jaundice
Middle aged female

Dx and mx

A

PBC
Ursodeoxycholic acid + cholestyramine (itch control)

31
Q

What would you find on US for NAFLD and the ELF test result

A

Increased ECHOgenecity on US
Elf test <1

32
Q

AST/ALT ratio in alcoholic liver disease and the mx

A

AST/ALT ratio is 2:1
Glucocorticoids in acute episodes

33
Q

Delirium tremens initial mx

A

Chlordiazepoxide for withdrawal

34
Q

Mx of ascites 2ry to liver cirrhosis

A

Aldosterone antagonist, decrease Na in diet, might drain (TIPS) and possible Abx

35
Q

How often do you screen for HCC in liver cirrhosis and how

A

Screen every 6m- HCC (US+AFP)

36
Q

What ix and how often if you re at risk cirrhosis

A

If at risk of cirrhosis then fibroscan every 2 years (transient elastography)

37
Q

tx of folate and Vet B12 def

A

Vitamin B12 replaced BEFORE folate
B12 IM 1 mg 3x weeks then 1mg every 3m

38
Q

Most common cause of inherited colon cancer, pattern inheritance and the commonest extra colonic malignancy

A

Most common form inherited colon cancer - autosomal dominant
MSH2, MLH1 genes
Commonest extra-colonic malignancy is endometrial cancer

39
Q

Rare autosomal dominant bowel cancer with lots polyps by 30-40
What is the mutation and what is Gardner’s syndrome (variant of this)

A

FAP
TSG (APC) mutation
Variant of this - gardner’s syndrome - can feature osteomas of skill, mandible, retinal pigmentation, thyroid ca and epidermoid cysts on skin

40
Q

Pt presents with flushing, diarrhoea, bronchospasm

Colonoscopy reveals nothing
IBS tablets haven’t helped

Dx and Mx?

A

Carcinoid syndrome
Ocreotide
Cyproheptadine can help diarrhoea

Difficult Passmed- MLA (26 decks)

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