gastro

Question 1

Right-sided tenderness on PR exam, think

Answer 1

appendicitis

Question 2

what type of FBC/CRP results do you get in appendicitis?

Answer 2

a neutrophil-predominant leucocytosis is seen in 80-90% in appendicitis

Question 3

The diagnostic investigation for necrotising enterocolitis is

Answer 3

The diagnostic investigation for necrotising enterocolitis is an abdominal x-ray

Question 4

Men who have sex with men should be offered immunisation against

Answer 4

Hep A

Question 5

management of Crohn’s patients who develop a perianal fistula

Answer 5

Oral metronidazole is useful in the management of Crohn’s patients who develop a perianal fistula

Question 6

most common symptom of Crohn’s disease in children?

Answer 6

abdo pain

Question 7

first-line to maintain remission in patients with Crohn’s

Answer 7

Azathioprine or mercaptopurine is used first-line to maintain remission in patients with Crohn’s

Question 8

Patients with hyposplenism should be vaccinated against

Answer 8

Patients with hyposplenism should be vaccinated against pneumococcal (5-yearly booster), Haemophilus type B and meningococcus type C

Question 9

causes of megaloblastic macrocytic anemia

Answer 9

Question 10

Isolated rise in GGT in the context of a macrocytic anaemia suggests

Answer 10

Isolated rise in GGT in the context of a macrocytic anaemia suggests alcohol excess as the cause

Question 11

Methotrexate therapy may result in

Answer 11

megaloblastic macrocytic anaemia secondary to folate deficiency

Question 12

Patients….. should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

Answer 12

Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

Question 13

which parameters are used to monitor treatment of haemochromatosis

Answer 13

Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis

Question 14

DPP4 mode of action

Answer 14

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

Question 15

The AST/ALT ratio in alcoholic hepatitis is

Answer 15

2:1

Question 16

The characteristic clinical features of alcoholic hepatitis are

Answer 16

• jaundice, anorexia, fever, and tender hepatomegaly.
• AST:ALT ratio of 2 or greater
• may also present with right upper-quadrant/epigastric pain, hepatic encephalopathy, and signs of malnutrition.
• Patients often stop drinking as they become ill, so it is common for patients to have stopped drinking alcohol several weeks prior to presentation.

Question 17

alcoholic liver disease investigations

Answer 17

• gamma-GT is characteristically elevated
• the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis

Question 18

alcoholic liver disease management

Answer 18

• glucocorticoids (e.g. prednisolone) are often used during acute episodes of alcoholic hepatitis
• pentoxyphylline is also sometimes used

Question 19

common causative agent for ascending cholangitis

Answer 19

E.coli

Question 20

nail changes in anemia

Answer 20

Koilonychia, or spooning of nails, is a classic clinical sign of hypochromic anemia, especially iron-deficiency anemia.

Question 21

Patients must eat gluten for at least…before they are tested

Answer 21

Patients must eat gluten for at least 6 weeks before they are tested

Question 22

In life-threatening C. difficile infection treatment is with

Answer 22

In life-threatening C. difficile infection treatment is with ORAL vancomycin and IV metronidazole

Question 23

People with coeliac disease receive the pneumococcal vaccine due to

Answer 23

People with coeliac disease receive the pneumococcal vaccine due to hyposplenism

Question 24

Patients with ascites secondary to liver cirrhosis should be given

Answer 24

Patients with ascites secondary to liver cirrhosis should be given an aldosterone antagonist like spiranolactone

Question 25

acute infection in hepatitis B will give which serology results

Answer 25

HBsAg positive, anti-HBs negative, IgM anti-HBc positive - acute infection

Question 26

previous hepatitis B, now a carrier:

Answer 26

previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive

Question 27

previous hepatitis B (> 6 months ago), not a carrier:

Answer 27

previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative

Question 28

previous immunisation for hep B serology results:

Answer 28

previous immunisation: anti-HBs positive, all others negative

Question 29

Severe hepatitis in a pregnant woman - think hepatitis…

Answer 29

Severe hepatitis in a pregnant woman - think hepatitis E