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MRCP Part 2 > Gastro > Flashcards

Gastro Flashcards

1
Q

Pattern of LFTs in non-alcoholic steatohepatitis

A

ALT > AST

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2
Q

NASH - US findings

A

Increased echogenicity

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3
Q

Pellagra features

A

4 Ds:

  • dementia
  • dermatitis
  • diarrhoea
  • death
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4
Q

Pellagra = deficiency of

A

Vitamin B3 (Niacin)

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5
Q

Small bowel bacterial overgrowth (SBBOS) - gold standard diagnostic investigation

A

Jejunal aspirate - showing >100,000 bacteria/ml

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6
Q

Hydatid cyst (tapeworm Echinococcus)- clinical features

A

Cyst in liver or lungs
Type 1 hypersensitivity reaction if leaks
Biliary rupture (colic, jaundice + urticaria)

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7
Q

Whipple’s disease - infective agent

A

Tropheryma whippelii

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8
Q

Whipple’s disease - features

A 
Insidious:
Malabsorption
Arthralgia
Lymphadenopathy
Cognitive impairment
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9
Q

Whipple’s disease - diagnosis

A

Jejunal biopsy - shows macrophages containing Periodic acid-Schiff (PAS) granules

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10
Q

Patients with ascites, give antibiotic prophylaxis for SBP if:

A

Had an episode of SBP previously
or
Ascitic fluid protein <15g/l + Child-Pugh score >9 or hepatorenal syndrome

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11
Q

Antibiotic prophylaxis for SBP

A

PO ciprofloxacin / norfloxacin

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12
Q

Blatchford score - Urea 6.5 - 8

A

2

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13
Q

Blatchford score - Urea 8 - 10

A

3

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14
Q

Blatchford score - Urea 10 - 25

A

4

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15
Q

Blatchford score - Urea >25

A

6

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16
Q

Blatchford score - Hb 12 - 13 (Man)

A

1

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17
Q

Blatchford score - Hb 10 - 12 (Man)

A

3

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18
Q

Blatchford score - Hb < 10 (Man)

A

6

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19
Q

Blatchford score - Hb 10 - 12 (Woman)

A

1

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20
Q

Blatchford score - Hb < 10 (Woman)

A

6

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21
Q

Blatchford score - Systolic BP 100 - 109

A

1

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22
Q

Blatchford score - Systolic BP 90 - 99

A

2

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23
Q

Blatchford score - Systolic BP < 90

A

3

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24
Q

Blatchford score - other markers scoring 1

A

Pulse >= 100

Presents with malaena

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25
Blatchford score - other markers scoring 2
Presents with syncope Hepatic disease Cardiac failure
26
Treatment of bile acid diarrhoea (BAD)
Bile acid sequestrants - cholestyramine
27
Diagnosis of bile acid malabsorption
SeHCAT (selenium homocholic acid taurine) scan shows <15% retention at 7 days
28
H. pylori eradication - no allergies
7 days of | PPI + amoxicillin + clarithromycin/metronidazole
29
H. pylori eradication - penicillin allergic
PPI + clarithromycin + metronidazole
30
H. pylori eradication - penicillin allergic and previous clarithromycin use
PPI + bismuth + metronidazole + tetracycline
31
Patient with cirrhosis - first scope shows no varices
Rescope 2-3 years
32
Patient with cirrhosis - scope shows Grade 1 varices
Rescope 1 year
33
Patient with cirrhosis - scope shows grade 2 or 3 varices, or signs of bleeding
Non-cardio selective beta blocker
34
Crohns management - what does combined immunomodulator + biological therapy increase risk for
Non-melanoma skin cancer Hepatosplenic T-cell lymphoma
35
Causes of ascites with SAAG > 11g/L
Liver (failure, mets) Cardiac Budd-Chiari Portal vein thrombosis
36
Causes of ascites with SAAG < 11g/L | non-portal HTN
Hypoalbuminemia (nephrotic syndrome, malnutrition) Malignancy TB Pancreatitis, bowel obstruction
37
Wilsons disease - clinical features
Deranged LFTs Movement disorder Psychiatric disturbance
38
Definition SBP
Ascites neutrophil count > 250 cells / mm^3
39
UC patient with increased stool frequency, incontinence after ileal pouch-anal anastamosis
Pouchitis
40
1st line management of pouchitis
Metronidazole or ciprofloxacin
41
Colonoscopy shows normal appearance, but colonic biopsy shows lymphocytic infiltrate
Microscopic colitis (chronic inflammatory)
42
Risk factors for microscopic colitis
SSRIs NSAIDs PPIs Smoking
43
IBS constipation, despite optimal laxatives - next step
Linaclotide (guanylate cyclase-C receptor agonist)
44
C.diff 1st line treatment
PO Metronidazole 10 - 14 days
45
C.diff - 2nd line or severe
PO Vancomycin
46
C.diff - not responding to 1st or 2nd line treatment
Fidaxomicin
47
C.diff - life-threatening
PO Vancomycin + IV Metronidazole
48
Gardner's syndrome (variant of familial adenomatous polyposis) presents with
Osteomas of the skull/jaw
49
Features of Alkaptonuria (ochronosis) AR disorder
Pigmented sclera Urine turns black in air Renal stones Intervertebral disc calcification
50
Significance of HbsAg (Hepatitis B surface antigen)
Implies acute disease (usually present 1-6m) If present >6m implies chronic disease
51
Significance of HbsAb (Hepatitis B surface antibody)
Immune (either through exposure or immunisation) Not present in chronic disease
52
Significance of HBcAb (Hepatitis B core antibody)
Previous (or current) infection IgM present for ~6 months IgG persists
53
Significance of HbeAg (Hepatitis B envelope antigen)
Marker of infectivity (breakdown of infected liver cells)
54
Hepatitis B serology seen in previous immunisation
anti-HBs only
55
Hepatitis B serology seen in previous infection >6 months ago + not a carrier
anti-HBc positive | HBsAg negative
56
Hepatitis B serology seen in previous infection, now a carrier
anti-HBc positive | HBsAg positive
57
Budd-Chiari - triad
Sudden onset abdominal pain Ascites Tender hepatosplenomegaly
58
Features of haemochromatosis
``` Bronzed Diabetes Arthritis/pseudogout Liver cirrhosis Cardiomyopathy Impotence ```
59
Haemochromatosis + joint pain
pseudogout
60
Ulcerative colitis - Inducing remission in mild-moderate proctitis - 1st line
Rectal aminosalicylate
61
Ulcerative colitis - Inducing remission in mild-moderate proctitis - 2nd line
Add oral aminosalicylate
62
Ulcerative colitis - Inducing remission in mild-moderate proctitis - 3rd line
Add topical or oral corticosteroid
63
Medications which cause false positive 5-HIAA urinary collection results
Paracetamol Naproxen Caffeine Fluorouracil
64
Medications which cause false negative 5-HIAA urinary collection results
Aspirin Levodopa Methyldopa ACTH
65
Foods which cause false positive 5-HIAA urinary collection results
``` Banana Avocado Aubergine Pineapple Plums Walnuts Tomatoes ```
66
Antibodies seen in Type I Autoimmune Hepatitis
Anti-nuclear antibodies (ANA) +/- Anti-smooth muscle antibodies (SMA)
67
Antibodies seen in Type II Autoimmune Hepatitis
Anti-liver/kidney microsomal type 1 antibodies (LKM1)
68
Antibodies seen in Type III Autoimmune Hepatitis
Soluble liver-kidney antigen
69
Examples of aminosalicylate drugs
5-ASA Sulphasalazine Mesalazine Olsalazine
70
Sulphasalazine - side effects
``` Heinz body anaemia Megaloblastic anaemia Fibrosis Oligospermia Rash Agranulocytosis ```
71
Mesalazine - side effects
Pancreatitis Agranulocytosis GI upset
72
Crohns flare - 1st line for inducing remission
Glucocorticoid (hydrocortisone, prednisolone) oral, topical or IV
73
Crohn's flare - 2nd line options
5-ASAs (eg mesalazine) Azathioprine or mercaptopurine as an adjunct Infliximab
74
Drugs which case a hepatocellular liver injury
``` Paracetamol Nitrofurantoin Sodium valproate, phenytoin Statins Amiodarone Anti-TBs ```
75
Drugs which cause a cholestatic liver disease
Co-amoxiclav, Flucloxacillin, Erythromycin COCP Sulphonylureas Fibrates
76
Drugs which cause liver cirrhosis
Methotrexate Amiodarone Methyldopa
77
Colonoscopy - 1-2 small (<1cm) adenomas
Low risk - No follow up, or, 5 yearly until one negative scope
78
Colonoscopy - 3-4 small (<1cm) adenomas
Intermediate risk - 3-yearly colonoscopy, until two consecutive negative scopes
79
Colonoscopy - 1-2 adenomas, one is >1cm
Intermediate risk - 3-yearly colonoscopy, until two consecutive negative scopes
80
Colonoscopy - 5 or more adenomas
High risk - yearly scope
81
Colonoscopy - 3 or more adenomas if one is >1cm
High risk - yearly scope
82
Absolute contraindications for TIPSS
``` High Child-Pugh score Hepatic encephalopathy Right heart failure Sepsis Biliary obstruction ```
83
Test for haemochromatosis (no family history)
Transferrin saturation - >55%
84
Test for haemochromatosis (with family history)
HFE genotyping
85
Crohns - biopsy shows
Transmural inflammation with lymphoid aggregates
86
1st line treatment for Entamoeba histolytica
Metronidazole
87
Crohns - 1st line for maintaining remission
Azathioprine or mercaptopurine
88
Primary biliary cirrhosis - associated conditions
Sjogren's (80%) RA Systemic sclerosis Thyroid disease
89
Primary biliary cirrhosis - complications
Cirrhosis + portal hypertension Hepatocellular carcinoma Osteomalacia + osteoporosis
90
Antibodies in PBC
AMA (anti-mitochondrial) M2 subtype - 98% Smooth muscle - 30% Raised serum IgM
91
Features of scurvy
``` Perifollicular bleeding Easy bruising Gingivitis Sjogren's Arthralgia ```
92
Zieve syndrome - triad
Haemolytic anemia Cholestatic jaundice Transient hyperlipidemia
93
IBD and colorectal cancer screening - what counts as 'Lower risk' (5-yearly)
Extensive colitis but no inflammation Left-sided colitis Crohn's colitis <50% colon
94
IBD and colorectal cancer screening - what counts as 'Intermediate risk' (3-yearly)
Extensive colitis with mild inflammation Post-inflammatory polyps FH of colorectal Ca in 1st-degree relative (>50yo)
95
IBD and colorectal cancer screening - what counts as 'Higher risk' (Yearly)
Extensive colitis with mod/severe inflammation Stricture in past 5 years Dysplasia in past 5 years, declining surgery PSC FH of colorectal Ca in 1-degree relative <50yo
96
Management of acute alcoholic hepatitis
Prednisolone, pabrinex, nutritional support
97
Small bowel bacterial overgrowth syndrome - 1st line investigation
Hydrogen breath test
98
Risk factors for SBBOS
Scleroderma Congenital GI abnormality (neonates) Diabetes
99
Barrett's oesophagus - follow up following eradication of low-grade dysplasia
Endoscopy every 6 months for first year, annually thereafter
100
Barrett's oesophagus - follow up following eradication of high-grade dysplasia
Endoscopy every 3 months for first year, every 6 months for second year, annually thereafter
101
Barrett's oesophagus - follow up if metaplasia (no dysplasia)
Endoscopy every 3-5 years
102
Pregnant and on azathioprine for IBD/arthritis/skin disease
Continue Azathioprine
103
UGI bleed - criteria for red cell transfusion
Hb <70 | or Hb 70-80 and actively bleeding/haemodynamically unstable
104
UGI bleed - criteria for platelet transfusion
Actively bleeding and platelet count <50
105
UGI bleed - criteria for FFP
Fibrinogen <1 g/L or PT/APTT/INR >1.5 normal value
106
UGI bleed - criteria for antibiotics
All patients with acute variceal bleed > gram-negative cover (Ceftriaxone)
107
Signs of acute hepatic decompensation
Asterixis Jaundice Hepatic encephalopathy Constructional apraxia
108
1st line test for IBD
Faecal calprotectin
109
Faecal calprotectin is raised in
``` UC/Crohns Bowel malignancy Coeliac Infectious colitis NSAID use ```
110
Blood marker associated with autoimmune pancreatitis
Raised serum IgG4
111
Monitoring required when starting oral aminosalicylate
FBC and renal function: before, at 3 months, annually thereafter
112
5-year survival rate of: Duke's A bowel cancer (confined to mucosa and submucosa)
95% in men 100% in women
113
5-year survival rate of: Duke's B bowel cancer (extends through muscularis propria)
>80% in men 90% in women
114
5-year survival rate of: Duke's C bowel cancer (regional lymph nodes involved)
65% in men 65% in women
115
5-year survival rate of: Duke's D bowel cancer (distant spread)
>5% in men 10% in women
116
Gastric cancer - suitable for Endomucosal resection if:
Confined to mucosa Less than 2 cm diameter Low/moderate differentiation No ulceration/lymphovascular involvement
117
Gastric cancer - treatment for stage II and III carcinoma
Neoadjuvant chemotherapy, prior to radical surgery
118
HbA1c target for diabetes related to pancreatic resection
53
119
Frequency of bowel screening colonoscopy in patients with both Crohns and PSC
Annual
120
Management of hereditary haemochromatosis
Phlebotomy indicated for all patients with initial ferritin >1000 mcg/L Aim for 50-100mcg/L
121
After lactulose, which other medications can be used to treat hepatic encephalopathy
Rifaximin | Other antibiotics
122
Lysosomal storage disorder which features 'cherry red spot' macula
Tay Sachs
123
Lysosomal storage disorder which causes massive splenomegaly
Gaucher's
124
Glycogen storage disorder which causes cardiomyopathy
Pompe's disease
125
Glycogen storage disorder with rhabdomyolysis after exercise/lactic acidaemia
McArdle's
126
Glycogen storage disorder causing hypoglycaemia + hepatomegaly
Von Gierke

MRCP Part 2 (15 decks)

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