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mrcp part 1 > Gastro > Flashcards

Gastro Flashcards

1
Q

monoclonal antibody which targets C. difficile toxin B

A

Bezlotoxumab

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2
Q

plummer vinson syndrome

A

triad of iron deficiency anaemia, dysphagia due to esophageal webs, and atrophic glossitis

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3
Q

babies born to mothers who are chronically infected with hepatitis B or to mothers who’ve had acute hepatitis B during pregnancy should receive?

A

a complete course of vaccination + hepatitis B immunoglobulin

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4
Q

what do coeliacs need to receive every 5 years?

A

pneumococcal vaccine due to functional hyposplenism

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5
Q

what must be checked before starting before offering azathioprine or mercaptopurine

A

assess thiopurine methyltransferase (TPMT) activity

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6
Q

most useful marker of haemochromatosis

A

transferrin saturation

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7
Q

colorectal cancer tumour marker

A

CEA

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8
Q

diagnosis of Zollinger-Ellison syndrome (ZES)

A

fasting gastrin levels: the single best screen test

The secretin stimulation test

a positive result characterised by a marked increase in serum gastrin levels.

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9
Q

What is the most appropriate tool to screen for malnutrition?

A

The Malnutrition Universal Screening Tool (MUST)

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10
Q

histology finding Gastric adenocarcinoma

A

signet cells

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11
Q

histology finding Barret’s

A

Columnar metaplasia –> adenoca

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12
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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13
Q

how does aspirin work?

A

Aspirin works by blocking the action of both cyclooxygenase-1 and 2. Cyclooxygenase is responsible for prostaglandin, prostacyclin and thromboxane synthesis.

The blocking of thromboxane A2 formation in platelets reduces the ability of platelets to aggregate

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14
Q

how to investigated for liver fibrosis in patients with NAFLD?

A

enhanced liver fibrosis (ELF) testing (blood test)

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15
Q

which vitamin deficiency causes angular cheilits?

A

vitamin B2 - riboflavin

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16
Q

types of surgical resection in colon disease

A

total proctocolectomy with ilea pouch annal anastomosis - entire colon out

low anterior resection - resect part of rectum and colon

Hartmann’s procedure - proctosigmoidectomy

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17
Q

management in PBC

A

ursodeoxycholic acid slows disease progression

cholestyramine helps pruritis

fat soluble vitamin supplementation

liver transplant if bili > 100

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18
Q

most common organism causing SBP?

A

E.Coli

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19
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

Hydrogen breath

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20
Q

breath tests

A

hydrogen - SIBO
urea - h.pylori

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21
Q

Diarrhoea + biospy shows pigment laden macrophages

A

Melanosis coli due to laxative abuse

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22
Q

Spontaneous bacterial peritonitis - treatment:

A

intravenous cefotaxime

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23
Q

HLA antigens are encoded for by genes on which chromosome?

A

chromosome 6

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24
Q

dysentery (bloody diarrhoea) after a long incubation period

A

Amoebiasis

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25
Q

when to give prophylactic abx for SBP risk

A

Oral ciprofloxacin. In patients with advanced cirrhosis and low ascitic fluid protein (<15 g/L), there is an increased risk of developing spontaneous bacterial peritonitis (SBP).

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26
Q

Budd chiari causes

A

polycythaemia rubra vera

thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies

pregnancy

combined oral contraceptive pill: accounts for around 20% of cases

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27
Q

Budd chiari symptoms/ signs

A

abdominal pain: sudden onset,

severe ascites → abdominal distension

tender hepatomegaly

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28
Q

H. pylori eradication:

A

PPI + amoxicillin + clarithromycin
or
PPI + metronidazole + clarithromycin

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29
Q

Most common cause of HCC

A

Worldwide - chronic hep B
Europe- chronic hep c

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30
Q

Tumour market for HCC

A

’ AFP

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31
Q

Mx.hepatocellular cancer

A

End stage liver disease =Conservative

Management early disease: surgical resection
liver transplantation
radiofrequency ablation
transarterial chemoembolisation
sorafenib: a multikinase inhibitor options

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32
Q

A recurrent episode of C. difficile within 12 weeks of symptom resolution

A

should be treated with oral fidaxomicin

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33
Q

Coeliac disease is linked to which HLA type

A

HLA-DQ2

34
Q

Cystic fibrosis diet

A

High calorie and high fat with pancreatic enzyme supplementation for every meal.

35
Q

the gold standard for diagnosing Bile acid malabsorption

A

The SeHCAT (Selenium-75-labelled homocholic acid taurine) test

the patient ingests a capsule containing the radiolabelled bile acid analogue SeHCAT. After 7 days, whole-body gamma camera imaging is performed to assess the retention of SeHCAT.
A low retention rate indicates bile acid malabsorption.

36
Q

Best way to diagnose chronic Pancreatitis

A

CT

37
Q

marker of severity in acute pancreatitis.

A

crp

38
Q

Oesophageal/Gastric Cancer - assessing mural invasion

A

Endoscopic ultrasound (EUS) is better than CT or MRI

39
Q

when to start anti depressants for IBS and which type?

A

NICE recommend considering psychological interventions after 12 months. Tricyclic antidepressants (eg. amytriptylline) should be used in preference to selective serotonin reuptake inhibitors

40
Q

what test for h.pylori erradication?

A

Urea breath test

41
Q

Stauffer syndrome

A

a paraneoplastic disorder associated with renal cell cancer
typically presents as cholestasis/hepatosplenomegaly
it is thought to be secondary to increased levels of IL-6

42
Q

when should statins be discontinued?

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

43
Q

The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest

A

autoimmune hepatitis

44
Q

common factors indicating severe pancreatitis include:

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

45
Q

when to vaccinate before elective splenectomy

A

at least 2 weeks before elective splenectomy

46
Q

treatment
early keloids

A

intra-lesional steroids e.g. triamcinolone

47
Q

preferred diagnostic test for chronic pancreatitis

A

CT pancreas is - looking for pancreatic calcification

48
Q

ifrst line investigation for suspected cholangitis

A

USS

49
Q

antibody associated with miller fisher syndrome

A

anti-GQ1b antibody

50
Q

Nitric oxide effects

A

vasodilation + inhibits platelet aggregation

51
Q

following a gastric bypass what supplements are needed

A

All gastric bypass operations bypass the duodenum.

iron and calcium

Nearly all menstruating women will therefore require iron supplementation.

52
Q

investigations of choice in primary sclerosing cholangitis

A

ERCP/MRCP

53
Q

PPI + non-bloody diarrhoea
disease and diagnosis

A

microscopic colitis

colonoscopy and biopsy

54
Q

FAP disease gene

A

autosomal dominant
mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.

55
Q

small bowel bacterial overgrowth syndrome. What is the treatment of choice?

A

rifaximin

56
Q

Coeliac disease - the first-line test

A

tissue transglutaminase antibodies

57
Q

sickle cell disease treatment of future attacks

A
  1. penicillin until age 5
  2. long term hydroxycarbamide to reduce the incidence of complications and acute crises
58
Q

The most common cause of biliary disease in patients with HIV is

A

sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

58
Q

most common cause of travellers’ diarrhoea

A

E. coli

59
Q

Campylobacter infection management

A

self-limiting

immunocompromised / severe then treatment: clarithromycin

60
Q

Liver failure following cardiac arrest think

A

ischaemic hepatitis

61
Q

which marker is a more specific marker of pancreatitis

A

Raised lipase

62
Q

Lung cancer dermatological manifestation

A

Erythema gyratum repens - ‘wood-grain’ pattern and figurate erythema

63
Q

best first line management for NAFLD

A

Weight loss

64
Q

Primary sclerosing cholangitis is more associated with which IBD disease?

A

UC

65
Q

aortic stenosis and angiodysplasia resulting in chronic gastrointestinal blood loss

A

angiodysplasia

66
Q

ith respect to the coagulopathy associated with liver disease, which clotting factor is characteristically increased?

A

factor 8

67
Q

The most common type of inherited colorectal cancer:

A

Hereditary non-polyposis colorectal carcinoma (HNPCC) Lynch syndrome

68
Q

management of eosinophilic oesophagitis

A

Dietary modification and topical steroids

69
Q

Urea breath test accuracy

A

no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

70
Q

common complication post TIPS procedure?

A

exacerbation of hepatic encephalopathy - now more toxins are entering blood

71
Q

Crypt abscesses

A

ulcerative colitis

72
Q

‘Kantor’s string sign’

A

strictures
Crohns

73
Q

prophylaxis of oesophageal bleeding

A

A non-cardioselective B-blocker (NSBB) eg. propranolol

74
Q

hepatorenal syndrome management

A
  1. liver transplant
  2. vasopressin analogues, for example terlipressin - causing vasoconstriction of the splanchnic circulation
  3. volume expansion with 20% albumin
  4. transjugular intrahepatic portosystemic shunt
75
Q

multiple white plaques or pseudomembranes on the gastrointestinal mucosa

A

Pseudomembranous colitis

multiple white plaques - overgrowth of the bacterium Clostridium difficile following antibiotic use.

76
Q

anti-retroviral drugs most characteristically associated with pancreatitis?

A

Didanosine, a nucleoside reverse transcriptase inhibitor (NRTI),

77
Q

h.pylori and link to oesophageal cancer

A

h.pylori is protective against oesophageal ca

78
Q

acute alcohol hepatitis mx.

A

steroids

79
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

80
Q

encephalopathy grades

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

mrcp part 1 (20 decks)

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