Gastro

Question 1

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

Answer 1

Hep A

Question 2

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

Answer 2

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

Question 3

Tx Hep B and is it chronic?

Answer 3

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

Question 4

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

Answer 4

Hep c - antivirals

Question 5

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

Answer 5

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

steroids , azathioprine

Question 6

Mx of oesophageal varies in GI bleed

Answer 6

Terlipressin + props ABc
If all fails - sengstaken Blakemore tube

Question 7

Mx H Pyloric

Answer 7

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

Question 8

What is boerhave syndrome

Answer 8

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

Question 9

Diagnosis of Pharyngeal pouch

Answer 9

Barium swallow combined with dynamic video fluoroscopy

Question 10

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

Diagnosis

Answer 10

Pancreatic cancer

Question 11

What will bloods show for haemachromatosis

Answer 11

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

Question 12

Type of inheritance of Wilsons disease, the diagnosis and mx

Answer 12

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

Question 13

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

Answer 13

Autosomal recessive
Liver cirrhosis + emphysema

Question 14

Jaundice in illness/exercise - isolated rise in bilirubin

What is this, pattern of inheritance and mx

Answer 14

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

Question 15

Mx small bowel overgrowth and a main RF

Answer 15

RF = Scleroderma
Rifaximin

Question 16

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

Answer 16

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

Question 17

Achalasia - diagnosis and mx

Answer 17

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

Question 18

Hepatic vein thrombosis, abdo pain, ascites, tender hepatomegaly

What is the condition and how to diagnosis

Answer 18

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

Question 19

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

diagnosis

Answer 19

CHolangiocarcinoma

Question 20

Autosomal dominant, polyp, pigmented lesions

Answer 20

Peutz-jEGHERS

Question 21

campylobacteria jej vs E.Coli

Answer 21

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

Question 22

C.Diff mx

Answer 22

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)

Question 23

What blood gas abnormality would you see in vomiting vs diarrhoea

Answer 23

Vom = metabolic alkalosis
Diarrhea = Normal anion metabolic acidosis

Question 24

Remission and maintainance tx of UC

Answer 24

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

Question 25

Difference between UC and Crohn's

Answer 25

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

Question 26

Remission and maintianene mx of Crohn's

Answer 26

R= Steroids M = Azathioprine/ mercaptopurine (cgeck TPMT activity before) Perianal abscess - incision and drainage Symp perianal fistula - PO Metronidazole Cpmplex perianal fistula - seton

Question 27

What is give for Pain, Consitpation and diarrhoea in IBS

Answer 27

Pain - antispasmodic Constipation - ispaghula husk Diarrhoea - loperamide

Question 28

Cholestasis - jaundice, pruritis, ↑bilirubin + ALP RUQ pain, fatigue what could be the diagnosis, what condition is a RF, and what is a compilation

Answer 28

PSC UC is RF Cn lead to cholangiocarcinoma

Question 29

Dx of PSC

Answer 29

ERCP (beaded appearance - strictures)

Question 30

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

Answer 30

PBC Ursodeoxycholic acid + cholestyramine (itch control)

Question 31

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

Answer 31

Increased ECHOgenecity on US Elf test <1

Question 32

AST/ALT ratio in alcoholic liver disease and the mx

Answer 32

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

Question 33

Delirium tremens initial mx

Answer 33

Chlordiazepoxide for withdrawal

Question 34

Mx of ascites 2ry to liver cirrhosis

Answer 34

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

Question 35

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

Answer 35

Screen every 6m- HCC (US+AFP)

Question 36

What ix and how often if you re at risk cirrhosis

Answer 36

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

Question 37

tx of folate and Vet B12 def

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

Pt presents with flushing, diarrhoea, bronchospasm Colonoscopy reveals nothing IBS tablets haven't helped Dx and Mx?

Answer 40

Carcinoid syndrome Ocreotide Cyproheptadine can help diarrhoea