Gastro and Liver

Question 1

How do you diagnose C Diff?

Answer 1

Stool specific antigen testing

Question 2

What is the 1st, 2nd and 3rd line treatments of C.Diff?

Answer 2

1. oral vancomycin 10 days
2. oral fidaxomicin
3. oral vancomycin + IV metronidazole

Question 3

What is the most common type of oesophageal cancer in the UK?

Answer 3

adenocarcinoma

Question 4

What is the first line treatment for life-threatening C.Diff infection?

Answer 4

oral vancomycin and IV metronidazole

Question 5

What tests should be done for someone with a new diagnosis of NAFLD?

Answer 5

enhanced liver fibrosis test

Question 6

What are the risk factors for squamous cell cancer of the oesophagus?

Answer 6

smoking, alcohol, achalasia, diets rich in nitrosamines

Question 7

What blood marker is used to measure acute liver failure?

Answer 7

INR (short half-life) - it is a measure of liver function as it is made by the liver

Question 8

What are the features of acute liver failure?

Answer 8

jaundice, coagulopathy (raised prothrombin time), hypalbuminaemia, hepatic encephalopathy

Question 9

What two blood markers do you use to measure liver function?

Answer 9

Albumin and prothrombin time/INR

Question 10

What is the most common causative organism of travellers diarrhoea?

Answer 10

E.Coli

Question 11

What are the features of campylobacter infection?

Answer 11

a flu-like prodrome, crampy abdominal pain, fever and diarrhoea which may be bloody

Question 12

What are the features of staphylococcus aureus infection?

Answer 12

Severe vomiting, short incubation period

Question 13

What medication would you use first line to induce remission of a crohn’s flare-up?

Answer 13

Glucocorticoids

Question 14

What is the treatment of a perianal fistula in Crohn’s patients?

Answer 14

Metronidazole

Question 15

What are the symptoms of achalasia?

Answer 15

Dysphagia of both liquids and solids
heartburn
regurgitation of food - aspiration pneumonia

Question 16

What are the clinical features of primary biliary cholangitis?

Answer 16

Fatigue, itching (raised ALP), jaundice, usually in middle aged-females, raised IgM

Question 17

What is the first line management of primary biliary cholangitis?

Answer 17

Ursodeoxycholic acid (secondary bile acid that helps with gallstones and cirrhosis)

Question 18

What is the management of a severe flare-up of UC?

Answer 18

IV corticosteroids and IV ciclosporin (or surgery)

Question 19

What are the causes of acute pancreatitis?

Answer 19

IGETSMASHED - idiopathic, gallstones, ethanol, trauma, steroid use, mumps, autoimmune, scorpion stings, hypercalcaemia, hypothermia and hypertriglyceridemia, ERCP, drugs

Question 20

What is the truelove and Witts severity score for?

Answer 20

Assessing the severity of ulcerative colitis in adults

Question 21

What are the criteria for the Truelove and Witts severity score - for severe?

Answer 21

• blood in the stool, passing more than 6 stools a day
• temp > 37.8
• HR > 90
• anaemia
• ESR > 30

Question 22

What is the first line management of a mild-moderate flare of distal UC?

Answer 22

Rectal aminosalicyclates

Question 23

What are the guidelines for treating a mild-moderate flare of UC?

Answer 23

• rectal aminosalicylate
• if no remission in 4 weeks add oral aminosalicylate
• add topic or oral corticosteroid

Question 24

What is the management of severe colitis?

Answer 24

• admission to hospital
• IV steroids 1st line - if not IV ciclosporin
• if no improvement in 72hrs add ciclosporin

Question 25

Which organisms are likely to cause an infection in peritoneal dialysis?

Answer 25

Staph epidermidis and staph aureus