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1
Q

Name 2 or more drugs/ drug classes which are risk factors for getting peptic ulcers.

A
  1. NSAIDs
  2. Steroids
  3. Bisphosphonates
  4. SSRIs
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2
Q

Zollinger Ellison syndrome is a condition characterised by excess levels of _____ being secreted from a tumour.

Histamine
Stomach acid
Gastrin

A

Gastrin

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3
Q

Name 3 or more conditions which can cause dyspepsia (Indigestion).

A
  1. Peptic ulcers (duodenal or gastric)
  2. Gastritis/ Duodenitis
  3. H. pylori infection
  4. Malignancy
  5. GORD
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4
Q

Bloody diarrhoea is more common in which type of IBD?

A

Ulcerative Collitis

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5
Q

Do rotavirus, norovirus, Giardia and Cholera usually cause bloody or non-bloody diarrhoea?

A

Non bloody diarrhoea (enteritis)

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6
Q

What antibiotic is first line for treating C. difficile infection?

A

Metronidazole 10-14 days

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7
Q

What antibiotic is second line for treating C. difficile infection?

Metronidazole
Amoxicillin
Vancomycin

A

Vancomycin

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8
Q

What antibiotic is used for treating recurrent C. difficile infection?

Amoxicillin
Fidaxomycin
Penicillin

A

Fidaxomycin

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9
Q

What class of laxative are Senna, Castor oil and Sodium Picosulfate?

A

Stimulants

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10
Q

Lactulose, Magnesium salts and Movicol are all in which class of laxatives?

Stimulant
Bulk forming
Osmotic

A

Osmotic

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11
Q

Docusate sodium is from which class of laxatives?

Stool softener
Bulk forming
Osmotic

A

Stool softener

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12
Q

Name 4 or more causes of PRE-hepatic jaundice.

A
  1. Drugs- Paracetamol, Rifampicin
  2. Hereditary Haemolysis eg. G6PD deficiency, Sickle Cell, Thalassaemia
  3. Acquired Haemolysis eg. Malaria, Autoimmune haemolysis
  4. Impaired conjugation- Gilbert’s disease
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13
Q

Name 4 or more causes of HEPATIC jaundice.

A
  1. Drugs- Alcohol, paracetamol, Rifampicin, Isoniazid, Pyrazinamide, Sodium Valproate, MAOIs
  2. Hepatitis-B, C, Autoimmune
  3. Cirrhosis
  4. Malignancy- hepatocellular carcinoma
  5. Haemochromatosis
  6. Wilson’s disease
  7. Alpha 1 antitrypsin deficiency
  8. Right sided HF
  9. Viruses- CMV, EBV
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14
Q

Penicillamine is used primarily for the treatment of which disease?

Haemochromatosis
Wilson’s disease
Gilbert’s syndrome

A

Wilson’s disease

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15
Q

Primary sclerosing cholangitis is more commonly associated with which type of IBD?

A

Ulcerative collitis

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16
Q

Which of these drugs is NOT used to treat Ulcerative Colitis?

Mesalazine
Prednisolone
Azathioprine
Methotrexate

A

Methotrexate

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17
Q

What are the 3 most common causes of malabsorption in the UK? (3 C’s)

A

Crohn’s
Coealiac
Chronic Pancreatitis

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18
Q

Oral Dapsone is used to treat which complication/ association of Coeliac disease?

A

Dermatitis Herpetiformis

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19
Q

What are the ABC symptoms for suspecting Irritable Bowel Syndrome?

A

A- Abdo discomfort/ pain
B- Bloating
C- Change in bowel habit

Need to be for >6 months

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20
Q

Is a colonoscopy needed to diagnose IBS?

A

No- unless red flags are present

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21
Q

Which blood tests should be done when diagnosing IBS to rule out other differentials?

A

FBC
CRP
ESR
Anti TTG

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22
Q

Name 4 or more causes of diarrhoea.

A
  1. Gastroenteritis
  2. Irritable bowel syndrome
  3. IBD: Crohn’s, UC
  4. Coeliac disease
  5. Drugs- laxatics, antibiotics, cytotoxics, propanolol
  6. Colorectal cancer
  7. Clostridium difficile
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23
Q

Which area of the bowel is most likely to be affected by ishaemic collitis?

Rectum
Descending colon
Splenic flexure

A

Splenic flexure

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24
Q

What medication should be given first for a severe flare up of UC?

Mesalazine
Mercaptopurine
IV Hydrocortisone

A

IV Hydrocortisone

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25
Q

Name 4 or more causes of upper GI bleeding.

A
  1. Peptic ulcers (duoedenal or gastric)
  2. Mallory Weiss tears
  3. Gastro-oesophageal varices
  4. Malignancy
  5. Oesophagitis
  6. Drugs- NSAIDs, Aspirin, Steroids, Anticoagulatio n
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26
Q

The Rockall score is used to assess the risk of rebleed and death following an acute upper GI bleed. What factors are considered in the scoring?

A
  1. Age
  2. Shock- Systolic BP, Pulse
  3. Comorbidities
  4. Endoscopic diagnosis for cause of tear
  5. Signs of recent haemorrhage on endoscopy
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27
Q

If a patient aged 61yrs presents with weight loss and new onset diabetes, which cancer should be suspected and hence an urgent referral done?

A

Pancreatic cancer

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28
Q

Which imaging technique is gold standard for investigating suspected gall bladder cancers via the 2 week wait referral?

AXR
CT
USS

A

USS

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29
Q

Which imaging technique is gold standard for investigating suspected pancreatic cancers via the 2 week wait referral?

A

CT scan

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30
Q

For which of these chemotherapy drugs must a patient with bowel cancer be tested for the RAS wild type gene before they are given it?

Folfox
Folfiri
Capox
Cetuximab

A

Cetuximab

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31
Q

Where do T3 bowel cancers reach?

Muscularis propria
Serosa
Submucosa

A

Serosa

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32
Q

Capectiabine can be given for colorectal cancer and is which type of chemotherapy?

Alkylating agent
Antimetabolite
Topoisomerase inhibitor

A

Antimetabolite

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33
Q

Deficiency of which Vitamin can lead to macrocytic anaemia AND neuropathy?

Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin B12
A

Vitamin B12

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34
Q

Deficiency of which Vitamin can lead to peripheral neuropathy?

Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin A
A

Vitamin B6 (Pyridoxine)

35
Q

Deficiency of which Vitamin can lead to Wenicke’s encephalopathy, Korsakoff’s syndrome or Beriberi?

Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin B12
A

Vitamin B1 (Thiamine)

36
Q

If a patient presents with right upper quadrant abdominal pain, yellow sclera and a temperature of 38.2, which of the following conditions are they most likely to have?

Biliary colic
Acute cholecystitis
Cholangitis

A

Cholangitis

37
Q

A patient presents with a history of colicky abdominal pain followed by abdominal distension and they are now unable to pass stools. AXR shows a small bowel fluid level, pneumobilia and a radiolucent gallstone. What is the most likely diagnosis?

Acute cholecystitis
Mirizzi syndrome
Acute pancreatitis
Gallstone ileus

A

Gallstone ileus

38
Q

What does the mnemonic PANCREAS stand for in the modified glasgow score?

A 
P- PaO2
A- Age
N- Neutrophil count
C- Calcium
R- Renal function (urea)
E- Enzymes (LDH/AST)
A- Albumin
S- Sugar (glucose)
39
Q

Name 5 or more complications of acute pancreatitis.

A
  1. Sepsis
  2. ARDS
  3. Pleural effusion
  4. Peripancreatic fluid collection
  5. Abscess
  6. Pancreatic necrosis
  7. Pseudocyst
  8. Haemorrhage
  9. DIC
  10. Renal failure
  11. Chronic pancreatitis
40
Q

Which autoimmune liver disorder often presents asymptotically or with chronic fatigue, and is associated with raised IgM antibodies?

A

Primary Biliary Cholangitis

41
Q

Which autoimmune liver disorder is associated with Ulcerative Colitis and may present with multiple biliary strictures on ERCP/ MRCP?

A

Primary Sclerosing Cholangitis

42
Q

Which autoimmune disorder predominantly affects young women and is associated with amenorrhoea?

A

Autoimmune hepatitis

43
Q

Do HIGH urea levels indicate an upper or lower GI bleed?

A

Upper GI bleed

44
Q

If a patient is in a coma, what Grade encephalopathy is this?

Grade 2
Grade 3
Grade 4

45
Q

If a patient is droswy, with slurred speech and behaving inappropriately, what grade of encephalopathy are they likely to have?

Grade 1
Grade 2
Grade 4

46
Q

Which of these drugs are used to treat hepatic encephalopathy in acute liver failure?

  1. Lactulose and Rifaximin
  2. Tazocin and Fluconazole
  3. Thiamine and Benzodiazepines
A
  1. Lactulose and Rifaximin

(Tazocin and Fluconazole are used as antibiotic prophylaxis in Acute Liver Failure; Thiamine and Benzodiazepines are used to treat Wernicke’s encephalopathy)

47
Q

Name 3 or more causes of acute liver failure.

A
  1. Alcohol
  2. Drugs- Paracetamol overdose, Isoniazid
  3. Ischaemic hepatitis
  4. Infections: Viral hepatitis (A, B), CMV, EBV
  5. Acute fatty liver of pregnancy
  6. Wilson’s disease
  7. Budd Chiari syndrome
  8. Seronegative hepatitis
  9. Autoimmune hepatitis
48
Q

What is the risk of transmitting Hepatitis B via needlestick injury?

0.3%
2%
20-30%

49
Q

What is the risk of transmitting HIV via needlestick injury?

0.3%
2%
20-30%

50
Q

What is the risk of transmitting Hepatitis C via needlestick injury?

0.3%
2%
20-30%

51
Q

In NAFLD, which is usually greater; ALT or AST?

52
Q

Which imaging technique can be used to diagnose NAFLD?

53
Q

What is the ELF blood test used for?

A

Testing for enhanced/ advanced liver fibrosis in people who have been diagnosed with NAFLD.

Is a blood test with 3 serum markers.

54
Q

What is the main treatment for NAFLD?

A

Lifestyle modification

55
Q

What is the Child Pugh classification used for?

A

Assessing prognosis of patients with chronic liver disease (cirrhosis).

56
Q

Which of these factors is NOT considered in the Child Pugh score for cirrhosis prognosis?

Total bilirubin
Albumin
AST
INR
Ascites
Encephalopathy
57
Q

Which technique is recommended at 1st line by NICE for diagnosing liver cirrhosis?

CT scan
Fibroscan (transient elastrography)
Liver biopsy

A

Fibroscan (transient elastrography)

58
Q

Budd Chiari syndrome is a cause of acute or chronic liver disease, and is caused by occlusion of what?

A

The hepatic veins

59
Q

Which of these drugs is NOT associated with causing hepatic cirrhosis?

Methotrexate
Azathioprine
Amiodarone
Methyldopa

A

Azathioprine

60
Q

Name 2 or more causes of ascites with a SAAG of >11g/l.

A
  1. Portal hypertension
  2. Cirrhosis
  3. Alcoholic hepatitis
  4. Portal vein thrombosis
  5. Budd Chiari syndrome
  6. Fatty liver of pregnancy
  7. Large liver mets
  8. Cardiac ascites: RHF or constrictive pericarditis
  9. Fulminant hepatic failure
61
Q

Name 2 or more causes of ascites with a SAAG of <11g/l.

A
  1. Malignancy eg. Peritoneal caricinomatosis
  2. Infection eg. Peritoneal TB
  3. Pancreatitis
  4. Nephrotic syndrome
  5. Bowel obstruction
  6. Biliary ascites
  7. Connective tissue disease
62
Q

If a patient with cirrhosis and ascites has an ascitic neutrophil count of >250cells/ul what does this suggest?

A

Spontaneous bacterial peritonitis

63
Q

Chronic liver disease is hepatic injury for > __ months.

64
Q

Name 1 cause of portal hypertension other than cirrhosis.

A
  1. Pre-hepatic causes: Portal Vein Thrombi
  2. Hepatic: Sarcoidosis, Schistosomiasis
  3. Post hepatic: Right heart failure, Budd Chiari Syndrome
65
Q

Hyper acute onset of liver failure is onset in __ or less days.

A

7 days or less

66
Q

According to NICE, how frequently should patients with cirrhosis be screened for Hepatocellular carcinoma (HCC)?

A

Every 6 months- with USS and AFP bloods

67
Q

Which enzyme is more specific to the liver, ALT or AST?

68
Q

1 unit of alcohol = ___ml of pure ethanol

69
Q

1 unit of alcohol = ___g of pure ethanol

70
Q

NAFLD and viral hepatitis cause which rise in LFTs?

ALT>AST
AST>ALT

71
Q

Cirrhosis, alcoholic hepatitis and liver metastases cause which rise in LFTs?

ALT>AST
AST>ALT

72
Q

Which 5 factors are used to calculate the Child Pugh Score for disease severity in cirrhosis?

A 
Bilirubin
Albumin
INR/PT
Ascites
Encephalopathy
73
Q

Which diuretic is used 1st line for managing ascites?

Furosemide
Spironalactone
Acetazolamide

A

Spironalactone

74
Q

Which 3 drugs can be used for pharmacological management of alcohol abstinence?

  1. Acamprosate, Naltrexone and Disulfiram
  2. Naltrexone, Disulfiram and Lorazepam
    1. Naltrexone, Disulfiram and SSRIs
A

Acamprosate, Naltrexone and Disulfiram

Acamprosate- GABA analog, reduces cravings
Naltrexone- Partial opiod agonist
Disulfiram- Inhibits aldehyde dehydrogenase so unpleasant taste if drinking alcohol

75
Q

Suggest 1 or more drugs which affect the lower oesophagael sphincter/ oesophageal motility and can lead to GORD.

A
  1. Nitrates eg. GTN
  2. TCAs- Tricyclic antidepressants
  3. Anticholinergics
76
Q

Which type of hiatus hernia is most common?

Sliding hiatus hernia
Rolling hiatus hernis

A

Sliding hiatus hernia (80%)

Gastro-oesophageal sphincter moves above the diaphragm- LOS becomes less competent so can lead to GORD

77
Q

Whipple’s procedure is used in the management of which cancer?

Oesophageal
Gastric
Pancreatic

A

Pancreatic

In particular head of pancreas tumours, cholangiocarcinomas or duodenal cancers.

78
Q

Which cancer does Primary Sclerosing Cholangitis increase the risk of?

Gastric adenocarcinoma
Hepatocellular carcinoma
Cholangiocarcinoma

A

Cholangiocarcinoma

79
Q

What is the first line treatment for Haemochromatosis?

Iron chelation
Penicillamine
Regular venesection

A

Regular venesection

80
Q

5-ASA (Mesalazine) used for Ulcerative Collitis increased the risk of what?

Hepatitis
Pancreatitis
Seizure

A

Pancreatitis

81
Q

What are the 2 main causes of small bowel obstruction?

A
  1. Adhesions

2. Hernias

82
Q

Name 2 or more causes of large bowel obstruction.

A
  1. Colorectal malignancy
  2. Diverticular disease
  3. Volvulus
  4. Constipation
83
Q

Which of these drugs cause a cholestatic picture?

Combined oral contraceptive pill
Steroids
Co-Amoxiclav
Sodium valproate
Chlorpromazine
MAOIs
A

Combined oral contraceptive pill
Steroids
Co-Amoxiclav
Chlorpromazine

Medicine (11 decks)

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