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Pass Med finals pack > Gastro 3 > Flashcards

Gastro 3 Flashcards

1
Q

what can be used to monitor hepatocellular carcinoma recurrence?

A

Alpha- fetoprotein afp

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2
Q

28 y/o pregnant lady

  • presents confused and agitated
  • itching arms vigorously
  • RHS abdo pain during palpation
  • sweet, fecal smelling breath

likely diagnosis?

A

feto hepaticus

sign of acute liver failure

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3
Q

45 y/o male

  • 12 hr hx colicky abdo pain
  • abdo distension
  • constipation
  • inability to pass flatus
  • nauseous but has not vommitted

likely diagnosis?

A

bowel obstruction

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4
Q

what medication should be avoided in bowel obstruction?

A

IV metoclopramide

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5
Q

life-threatening clostridium difficile infection is treated with

A

ORAL vancomycin

IV metronidazole

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6
Q

what describes the following triad

  • sudden onset abdominal pain
  • ascites
  • tender hepatomegaly
A

budd-chiari syndrome

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7
Q

what is budd-chiari syndrome

A
  • characterised by obstruction to hepatic venous outflow
  • venous congestion can cause hepatomegaly and portal hypertension
  • can result in splenomegaly and ascites

condition in which the hepatic veins (veins that drain the liver) are blocked or narrowed by a clot (mass of blood cells). This blockage causes blood to back up into the liver, and as a result, the liver grows larger

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8
Q

Crohn’s disease leads to an decrease or increase in number of goblet cells

A

increase in goblet cells

simple columnar goblet shaped epithelial cells that secrete gel-forming mucins

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9
Q

inflammation in ulcerative colitis is usually limited to

A

mucosa and submucosa

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10
Q

deep inflammatory infiltrate from the mucosa to muscularis externa.

numerous granulomata noted.

indicative of:

A

Crohn’s disease

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11
Q

how does loperamide act through to slow down bowel movements

A

reduction in gastric motility

through stimulation of opiod receptors

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12
Q

melanosis coli is…

A

a disorder of pigmentation of the bowel wall

associated with laxative abuse

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13
Q

57 y/o female

  • PMG gallstone
  • progressive RUQ pain
  • rigors
  • jaundice

most likely diagnosis?

A

ascending cholangitis

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14
Q

following histology is indicative of what condition:

  • villous atrophy
  • raised intra-epthelial lymphocytes
  • crypt hyperplasia
A

coeliac disease

removal of gluten from diet

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15
Q

Ursodeoxycholic acid is the first-line medication for

A

primary biliary cholangitis

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16
Q

what class of drugs are generally used to induce remission of Crohn’s disease

A

glucocorticoids

- e.g. prednisolone

17
Q

inferior mesenteric artery branches from the aorta at

A

L3

18
Q

what immunisation is offered to patients with coeliac’s disease?

A

pneumococcal vaccine

due to hyposplenism (reduced functioning of spleen)

19
Q

describe pernicious anaemia

A

autoimmune disorder affecting the gastric mucosa

results in vitamin b12 deficiency

20
Q 
flushing 
diarrhoea 
bronchospasm 
hypotension 
weight loss

typical history of :

A

carcinoid syndrome

21
Q

investigation for carcinoid syndrome

A

urinary 5-HIAA

tumour will secrete serotonin

22
Q

78 y/o female

PC:

  • episodic dysphagia
  • halitosis
  • occasional regurgitation

likely diagnosis?

A

pharyngeal pouch

23
Q

overweight 56 y/o male with longstanding Barrett’s oesophagus complains of worsening dysphagia to solids over past 6 weeks

likely diagnosis

A

adenocarcinoma of the oesophagus

24
Q

RIF pain on palpation of LIF is known as:

A

Rovsing’s sign

seen in appendicitis

25
Q

which blood test, when compared to previous, will best represent changes in the following patients liver function?

patient: 53 y/p male with alcoholic liver cirrhosis,, visibly jaundiced, slightly tremulous with worsening ascites

A

prothrombin time

- demonstrates ability of the hepatocytes to carry out their synthetic function

26
Q

which of the following is most likely to cause hyponatraemia

  • tolvaptan
  • omeprazole
  • ranitidine
  • metformin
  • phenytoin
A

omeprazole

27
Q

combination of deranged LFTs in combination with secondary amenorrhoea in young female is strongly suggestive of:

A

autoimmune hepatitis

28
Q

which antibody is most sensitive and specific to primary biliary cirrhosis?

A

anti-mitochondrial

29
Q

investigations for primary biliary cirrhosis?

A
  1. bloods: ESR raised, IgM raised
  2. LFTs: ALP raised
  3. Autoantibodies
    - anti-mitochondrial antibody
    - anti-nuclear antibodies in 35%
  4. live rrbiopsy
30
Q

Which of the following tumour markers is most associated with hepatocellular carcinoma?

A

serum alpha-fetoprotein

31
Q

two main organs affected by alpha-1-antitrypsin deficiency?

A

liver

lungs: pulmonary basal emphysema

32
Q

What is the normal function of alpha-1-antitrypsin in the body?

A

neutralise neutrophil elastase

elastase digests connective tissues

33
Q

treatment for patient with oesophageal varices when are bleeding?

A
  • resuscitation
  • vasopression analogues cause vasoconstruction and slow bleeding
  • correct coagulopathy with vitamin K and fresh frozen plasma
34
Q

A 24 year old lady presents to her GP with irregular bowel movements and crampy abdominal pain.

She normally opens her bowels between 1 and 3 times per day, and this can vary from normal to loose. Occasionally she has mucus in her stools, but denies any PR bleeding. She tends to get generalised crampy pain in her abdomen prior to opening her bowels, which tends to relieve the pain. These symptoms have not changed in the last year. She denies any weight loss or anorexia.

She only drinks limited alcohol on special occasions and does not smoke.

She is worried as her uncle was recently diagnosed with Crohns disease and she is worried that she may have the condition. She has no other family history.

Abdominal and PR examination are normal.

Routine blood tests come back normal.

What would be the most appropriate investigation for reassuring this patient?

A

typical history of IBS

faecal calprotectin
- useful marker of intestinal inflammation

35
Q

management of haemochromatosis?

A
  • venesection (weekly removal of blood to decrease total iron)
  • monitoring serum ferritin
  • monitoring and treatment of complications
36
Q

first line for mild flare up of ulcerative colitis is:

A

mesalazine

37
Q

severe flares of UC are treated with…

A

steroids

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