gastro

Question 1

Ulcerative colitis severity

mild
moderate
severe

Answer 1

mild: < 4 stools/day, only a small amount of blood

moderate: 4-6 stools/day, varying amounts of blood, no systemic upset

severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 2

UC treatment
mild
moderate
severe

Answer 2

mild/ moderate
if just distal colon then topical (rectal) aminosalicylate - ++ add oral aminosalicylate if left sided / extensive
- 4 weeks no improvement add steroid

severe- in hospital, IV steroids +/- ciclosporin

Question 3

hba1c target
lifestyle only
lifestyle + metformin
lifestyle - other (hypos)

Answer 3

• under 48 aim
• under 48 aim
• under 53 aim

-

Question 4

diabetes treatment
low risk CVD

high risk CVD eg qrisk over 10
eg of one?

when to add further treatment?

Answer 4

1) metformin then if still bad then add DPP-4 inhibitor, pioglitazone
or sulfonylurea

1) metformin then when established add on SGLT2 inhibitor dapagliflozin

if reaches 58 - If the HbA1c has risen to 58 mmol/mol (7.5%) then further treatment is indicated.

Question 5

omeprazole and clopidogrel

Answer 5

interact and reduce efficacy of clopidogrel so use pantoprazole instead

Question 6

diabetic drugs to avoid in
HF-
CKD -

Answer 6

HF - pioglitazone

CKD - Gliclazide - sulphonylureas

Question 7

when to use GLP-1 receptor agonist /exetanide

Answer 7

is only indicated after third-line treatment is ineffective or not tolerated.
(give it a last pop)

Question 8

when to stop omeprazole before ednoscopy

Answer 8

2 weeks

Question 9

units for men and women?

Answer 9

14 units reccomended

Question 10

haemachromotosis triad

tx

Answer 10

bronze pigmentation
hepatomegaly
diabetes (iron damages pancreas)

tx venesection

Question 11

medication for primary biliary cholangitis

Answer 11

Ursodeoxycholic acid slows disease progression
Cholestyramine relieve pruritus

Question 12

crohns
acute tx
remission

Answer 12

steroids or budesonide

azathioprine or mercaptopurine is used first-line then mesalazine
check azathiprine not enzyme def

Question 13

Diabetes meliitus diagnosis

impaired glucose tolerance

Answer 13

fasting > 7.0
random > 11.1
if asymptomatic need two readings

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 14

alcoholic hepatitis

Answer 14

AST/ALT>2 is characteristic
and points toward the diagnosis in this patient.
symptoms include right upper quadrant pain, anorexia, weight loss, jaundice, muscle wasting, and fever