Gastro + Endo

Question 1

H pylori post eradication therapy

Answer 1

NICE guidance advises that we should not routinely offer H. pylori re-testing, however we can consider re-testing if:
There has been poor compliance to eradication therapy
Aspirin or NSAID is indicated
There is a family history of gastric malignancy
The person requests re-testing

They advise that re-testing should ideally be done 8 weeks after initial eradication therapy and the carbon-13 urea breath test should be used first-line.

Question 2

GI bleed scoring system

Answer 2

blatchford bleeding risk
rockall rebleeding risk

Question 3

1st-3rd line therapy c diff

Answer 3

first-line therapy is oral vancomycin for 10 days

second-line therapy: oral fidaxomicin

third-line therapy: oral vancomycin +/- IV metronidazole

Question 4

C peptide and type 1 vs type 2 diabetes?

Answer 4

C peptides raised in type 2

Question 5

Prolactinoma treatment

Answer 5

Dopamine agonist (e.g cabergoline, bromocriptine)

surgery if fail to respond

Question 6

acromegaly and elevated IGF-1 (insulin growth factor) investigations

Answer 6

OGTT and serial GH levels

Question 7

acromegaly how to diagnose

Answer 7

1st = serum IGF-1
2nd= OGTT+ serial GH

in normal patients if hyperglycaemic then GH reduced, but in acromegaly GH still high

Question 8

what marker monitors disease In acromegaly

Answer 8

IGF-1

Question 9

crushing syndrome metabolic disturbance

Answer 9

hypokalaemia metabolic alkalosis

Bicarbonate resorption is increased in the tubules with potassium depletion causing metabolic alkalosis.

Question 10

Gynaecomastia causes: drugs

Answer 10

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

Question 11

Treatment for galactorrhoea

Answer 11

bromocriptine (dopamine agonist)

Question 12

how do thiazides impact Ca level

Answer 12

HYPERcalacemia

Question 13

what is subclinical hypothyroid

Answer 13

TSH above range but normal thyroxine

Subclinical hypothyroidism with TSH level of level is 5.5 - 10mU/L: offer patients < 65 years a 6-month trial of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms

Question 14

what medication interacts with thyroxine absorption

Answer 14

iron

Question 15

Kallman’s syndrome hormone level

Answer 15

low LH & FSH and testosterone (failure of GnRH secreting neurones in hypothalamus)

Kallman = Fallman

Poor Kall the man cannot smell

chromosome = X linked drecessive

Question 16

Klinefelter Sx

Answer 16

High FSH and high LH. But low testosterone. Tall, no secondary sexual characteristics. Small firm testes + gynecomastia.

Question 17

Addisons and hyperpigmentation

Answer 17

primary Addison’s is associated with hyperpigmentation whereas secondary adrenal insufficiency is not

secondary causes= tumours, irradiation, infiltration, exogenous steroids

Question 18

Diabetes-specific autoantiboits T2DM vs T1DM

Answer 18

in type 1 C peptide LOW but others present

Question 19

OGTT test: imaired glucose tolerance

Answer 19

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 20

drug causes raised prolactin (and –> galacctoreoa)

Answer 20

metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids

Question 21

non drug causes raised prolactin

Answer 21

prolactinoma
pregnancy
oestrogens
physiological: stress, exercise, sleep
acromegaly: 1/3 of patients
polycystic ovarian syndrome
primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release)

Question 22

T1DM with bloating, vomiting and erratic CGMs? what med to try

Answer 22

metoclopramide

Question 23

tender goitre, hyperthyroidism and raised ESR. The globally reduced uptake on technetium thyroid scan is also typical

Answer 23

Sub acute (De Quervains) thyroiditis

Question 24

diabetes medicaition and BMI>35 - what to consider?

Answer 24

GLP-1 (e.g. exenatide)
FOR SPECIALSITS ONLY

GLP-1 receptor agonists should only be continued if there is a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months.

Question 25

Who avoids SGLT-2?

Answer 25

FOOT ULCER
should be avoided in active foot disease (such as skin ulceration, osteomyelitis, or gangrene) due to the possible increased risk of lower limb amputation (mainly toes).

Question 26

T2DM triple therapy not worked.. what to do?

Answer 26

if a triple combination of drugs has failed to reduce HbA1c then switching one of the drugs for a GLP-1 mimetic is recommended, particularly if the BMI > 35

Question 27

most common cause of cushings SYDNROME

Answer 27

pituitary adeoma (aka cushings DISEASE) - ACTH

Question 28

Thiazolinediones - what is the the side effects?

Answer 28

e.g. Pioglitazone

T2DM medication

weight gain
liver impairment
fluid retention –. CONTRAINDICATED in hearty failure
increased fractures
bladder cancer

Question 29

which diabetic meds cause weight gain

Answer 29

gliclazide and prioglitazone

Question 30

thyrotoxicosis with tender goitre

Answer 30

de Quervains thyroiditis

Question 31

Addisons and vomiting

Answer 31

take IM hydrocortisone until vomiting stops

Question 32

hypoglycaemia - how to investigate cause

Answer 32

Serum insulin and C-peptite

Insulin HIGH C peptide HIGH = endogenous insulin production (insulinoma/ sulfonylrea)

Insulin HIGH C peptide LOW = exogenous (added too much)

Insulin Low C peptide LOW = non inulin cause e.g. alcohol, critical illness, adrenal insufficient, GH deficiency, fasting/ starvation

Question 33

a HbAlc value of less than 48 mmol/mol (6.5%)

Answer 33

does not exclude diabetes (i.e. it is not as sensitive as fasting samples for detecting diabetes) –> consider fasting glucose sample

Question 34

T4 vs T3

Answer 34

T4 is the synthetic form

Question 35

raised ESR

Answer 35

AUTOIMMUNE CONDITIONS e.g. hashimotos thyroiditis

Question 36

Addisons - high or low aldosteronism

Answer 36

PRIMARY HYPOaldosteronism

Question 37

hypercalacemia- two most common causes

Answer 37

malignancy and PTH

-> PTH best test for confimin diagnosis

e.g. if PTH raised or normal = Primary hyperparathyroidism

Question 38

PTHrP tumour

Answer 38

squamous cell lung cancer

Question 39

how do sulfonyluyrea work

Answer 39

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells

–> insulin release

(hence why you get weight gain)