Gastro

Question 1

Hep B serology
what shows infection? acute / chronic / previous
immunisation?
marker of replication?

Answer 1

HbsAg - infected patient
HBsAg normally implies acute disease (present for 1-6 months)
if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)

Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease

Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists

HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity

Question 2

Hep B serology, markers for previous immunisation

Answer 2

anti-HBs positive, all others negative

Question 3

Hep B serology, markers for previous hepB 6 months ago, not a carrier? and carrier?

Answer 3

anti-HBc positive, HBsAg negative
anti-HBc positive, HBsAg positive

Question 4

What medication to give in UC following a severe relapse or >=2 exacerbations in the past year to maintain remission

Answer 4

oral azathioprine or oral mercaptopurine

Question 5

Screening for iron overload in hemochromatosis?

Answer 5

transferrin saturation is considered the most useful marker
testing family members - genetic testing for HFE mutation

Question 6

What is reversible in hemochromatosis?

Answer 6

In haemochromatosis, cardiomyopathy and skin pigmentation are reversible with treatment

Question 7

Drugs causing hepatocellular lft

Answer 7

PHANTASM
(Paracetamol, Halothane, Alcohol, Nitrofurantoin, TB drugs, Amiodarone, Statins, Methyldopa)

Question 8

most common location of gastrinoma

Answer 8

1st part of duodenum

Question 9

Hemochromatosis transferrin and ferritin findings and target

Answer 9

findings -
transferrin sats >55 % in men, >50 % in females
ferritin >500

target
transferrin <50 %, ferritin <50

Question 10

Drugs causing Cholestatic Picture?

Answer 10

Drugs causing Cholestatic Picture: NiCE FAST PC
Nifedipine
Co-amoxiclav
Erythromycin

Flucloxacillin
Anabolic steroid
Sulphonyureas
Testosterone

Prochlorperazine
Chlorpromazine

Question 11

HNPCC most common extra colonic cancer

Answer 11

endometrial cancer

Question 12

Screening for HCC with ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as?

Answer 12

patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
men with liver cirrhosis secondary to alcohol