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MRCP PART 1 > Gastro/hepatology > Flashcards

Gastro/hepatology Flashcards

1
Q

C diff gram stain

A

anaerobic gram positive

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2
Q

Anti mitochondrial antibodies seen in what ?

A

PBC

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3
Q

Rx of puritus

A

Cholestyramine

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3
Q

Usual bugs which cause a liver abscess

A

E coli
Klebsiella
[staph aureus, strep enterococcus]

Candida 10%
Amoeba 10%

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4
Q

Where are amoebic abscesses in liver usually found? Spread from gut how?

A

Right lobe
Through portal system

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5
Q

Usual diagnostic test for liver abscess

A

Ultra sound

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6
Q

Staph food poisoning means it is producing what? Onset?

A

Enterotoxin
fast (often by 2-4 hours)

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7
Q

Salmonella after eating what? how long before symptoms ?

A

Poultry / eggs / milk

12-72hrs

[usually bloody diarrhoea due to ability of organism to invade mucosa]

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8
Q

Listeria seen following eating what? Key features to make suspicious ?

A

Unpasteurised dairy products

Mild diarrhoea + headache/confusion (CNS infection)
-Seen in sepsis of elderly and pregnant

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9
Q

Most common cause of infantile gastroenteritis

A

Rotavirus

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10
Q

Salmonella gram stain

A

gram negative

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11
Q

Shigella appearance on gram stain

A

Gram negative rod

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12
Q

First line Abx for
etamoeba histalogica?
Campylobacter?
giardia?
salmonella?
Shigella?

A

amoeba - Metronidazole

Campylobacter - metronidazole followed by diloxanide

giardia - metronidazole

salmonella - None if healthy. Cipro/trimethoprim for >50 , immunocompromised or have prosthetic valves etc

Shigella - None if healthy, cipro if severe

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13
Q

Colostrum perfringes time to symptoms?

A

6-12 hrs

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14
Q

yersinia enterocolitica is a rare food poisoning from uncooked meat. Time to symptoms? What are the symptoms and rx?

A

1 -4 days - probs back from india
Severe diarrhoea / renal impairment

Cipro

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15
Q

What is the hydrogen breath test used for?

A

Lactose intolerance / bacterial overgrowth

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16
Q

Coeliac which cell in pathogenesis? Genetic assoc? 1st/ second antibody test?

A

T-helper

HLA-DQ2 (95%), HLA-DQ8 (5%)

Anti-ttg, then anti-endomysial if only weakly positive

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17
Q

What do all people with coeliac get?

A

Ca + vit D

[Need to check bone mineral density 1 year following diagnosis too]

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18
Q

Skin condition related to coeliac

A

dermatitis herpeitformis

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19
Q

Flu like illness -> painless jaundice? Important test?

A

Gilberts syndrome
[inherited disorder of bilirubin metabolism]
-> Isolated unconjugated hyperbilirubinaemia

Need to test direct(conjugated) and uncongugated.
Direct/conjugated will be low

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20
Q

Blood test for rotor syndrome? Inheritance

A

Autosomal Recessive

Causes a conjugated(direct) hyperbilirubinemia
(>50%)

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21
Q

Rotor syndrome and Dubin johnson syndrome are both recessive and cause conjugated hyperbilirubinemia. How to differentiate?

A

Liver biopsy in Dubin johnson would show darkly pigmented hepatocytes

Rotor would have norma histology

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22
Q

unconjugated hyperbilirubinaemia in neonates?

A

crigler-najjar syndrome

[Crawling Wriggler = crigler]

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23
Q

What happens in primary sclerosing cholangitis?

A

Chronic progressive inflammatory condition which leads to fibrosis and strictures of bile ducts

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24
Q

PSC linked to? Risk of?

A

IBD
Cholangiocarcinoma

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25
Q

Non-obstructive deranged LFTs with raised IgM?
IgG?

A

IgM - primary biliary cirrhosis
IgG - Active chronic hepatitis

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26
Q

3 ways of testing for H pylori

A

Urea breath test (carbon-13 injested)
Stool antigen
CLO test (during endoscopy)

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27
Q

Where do you biopsy in people with H pylori at endoscopy? Why?

A

Antrum
Helpful for determining abx sensitivities

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28
Q

General Rx for dyspepsia ? if H pylori positive ?

A

PPI for 8 weeks
Add 1 week of amox/clari

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29
Q

Fever, anorexia and malaise which settle before -> Deranged LFTs and jaundice ? Incubation period?

A

Hep A
12-24 days

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30
Q

Briefly on the types/ transmission of Hep virus. Which are RNA ?

A

A - Fecal oral, RNA
-No chronic state

B- Blood/sex, DNA

C- Blood/Sex, RNA

D- Blood borne. Depends on HepB for replication. IncompleteDNA.
-Chronic if Hep B chronic

E- Fecal oral/Vertical.
-Chronic only if immunocompromised

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31
Q

Test for acute/past Hep A?

A

HAV-IgM + IgG = acute infection
HAV-IgG but not IgM = Past infection (IgGONE)

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32
Q

Indicator of current HepB infection?
Infection in past 6 months? Which always positive if past infection?

A

HBVsAg
HBV-IgM
HBV-IgG

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33
Q

Hep B antibodies if immunised?

A

Anti-HBs but not Anti-HBc

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34
Q

HepC current infection maker? Prev?

A

Hep-C PCR
Anti-HCV antibodies confirm exposure

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35
Q

HepB/C pharmalogical Rx

A

Hep B - pegylated interferon alpha-2a

Heb C - DAAs (direct acting antivirals)

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36
Q

Which are longer; diverticular or malignant strictures? Other differences between the two

A

Diverticular are longer
They do NOT have apple core appearance
Smooth walled
No mucosal disruption

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37
Q

Indications for elective surgery in diverticulosis

A

Diverticulitis in <50, or 2+ episodes in >50
Fistulae
Chronically immunosuppressed
Perf / abscess

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38
Q

Variceal haemorrhage. What drug as secondary prophylaxis? Why?

A

Propranolol
Reduced portal hypertension and cirrhosis progression

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39
Q

Where are bile acids re-absorbed? What does this lead to if you have surg there? Management of this?

A

Terminal ileium (ileocaecal)
70% of Crohn’s affects here

It can lead to chronic diarrhoea due to bile acids causing increased colonic motility and stimulating water secretion.

Cholestyramine

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40
Q

Which virus causes most rapid acute hepatic failure

A

Hep A

A= Acute

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41
Q

How many people with hep c clear spontaneously/

A

20-50%

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42
Q

Random glucose level for diabetes

A

> 11

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43
Q

Multiple adenomas/ soft tissue tumours eg lipomas
Intestinal bowel Ca young ~35
Hypertrophy of retinal epithelium

Syndrome? Rx?

A

Gardner syndrome - Dominant
Total colectomy after the development of colonic polyps

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44
Q

Intestinal harmatomas + peri oral pigmented macules?

A

Peutz-jeghers syndrome

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45
Q

oesophageal Ca where most common for SCC? adenocarcinoma?

A

SCC - mid thoracic
Adeno - lower oesophagus

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46
Q

Tylosis is what? Key risk?

A

Dominant disorder causing hyperkeratosis of palms and soles

Oesophageal Ca

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47
Q

What testing might you do for metastatic oesophageal adenocarcinoma?

A

HER2 receptor testing

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48
Q

The best test for confirming H pylori eradication? When would you use an invasive test?

A

13CUrea breath test

Endoscopy if complex peptic ulcer disease or MALT lymphoma

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49
Q

What are juvinile polyps, how do they present and Rx?

A

The most common cause of polyps in kids - usually in rectum
Present with prolapse / bleeding in kids
Treated with excision

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50
Q

Single reddish/purple intestinal polyp

A

Benign lymphoma

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51
Q

How to differentiate benign and malignant lymphoma on histology?

A

Benign has well-defined geminal centre

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52
Q

Smooth muscle intestinal tumour?

A

Leiomyoma (GIST)

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53
Q

Hard, pedunculated tumour

A

fibroma

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54
Q

Who gets no surveillance colonoscopy if known polyps?

A

> 75
Life expectancy < 10 years

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55
Q

Following curative resection of Ca, how long for surveillance colonoscopy?

A

1 year

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56
Q

When would you repeat colonoscopy after 2-6months

A

Following resection of large non-pedunculated polyps to check the site of resection.
[Will then get another at 12 months if satisfactory]

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57
Q

Arthralgia, cough, lymphadenopathy, pyrexia
Periodic acid-schiff (PAS) positive macrophages on biopsy? Rx?

A

Whipples disease (Tropheryma whipplei)
Requires Ceftriaxone / Benpen [followed by - 1-2 years of trimethoprim / sulfamethoxazole]
[Relapse in 40% of cases]

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58
Q

Gradual onset bloody diarrhoea, Ulceration on sigmoidoscopy. Hx of travel to funky place. Diagnosis? Rx?

A

Amoeba
[be aware stool sampling only detects in 50%, PCR / serology useful]
Metronidazole

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59
Q

Blood test usually raised in parasite infection

A

eosinophils

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60
Q

Some worms spread from animals to humans
sheep and goats?
Pigs?
Sails?
Key other bits the question will give….

A

sheep, dogs and goats - hydatid (Echinococcus granulosus)
Often chronic cough / general abdo Sx from cysts forming in liver/lungs
Sometime neuro Sx

Pigs - Cysticercosis (tapeworm Taenia solium)
Seizures

Sails - Shisto
Bladder / GI + risk of bladder Ca

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61
Q

Intense perianal itching at night in the UK bug?

A

Threadworm
[enterobius vermicularis]

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62
Q

How does hookworm present?

A

Symotomatic anaemia

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63
Q

Skin lesions and progressive blindness

A

onchocerciasis (river blindness)

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64
Q

Profound often unilateral leg swelling

A

lymphatic filariasis

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65
Q

Intensely itchy erythematous papular rash within 24 hrs of swimming

A

Shisto
[Self limiting]

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66
Q

When does shisto usually present? What is this called sometimes and how?

A

4-8 weeks post exposure
Fever, itch, diarhorrea, hepatosplenomegaly, wheeze and cough
[Katayama fever]

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67
Q

Where does chronic shisto affect?

A

Urinary - terminal haematuria / fibrosis / calcification

Bowel/liver - Bloody diarrhoea, splenomegaly, ascites, GI bleeding [Due to periportal fibrosis -> portal HTN]

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68
Q

Hydatid cysts often form in liver / occasionally brain / lungs. Key complication if they rupture

A

Anaphylaxis

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69
Q

Asymptomatic eosinophilia might be a parasitic infection. What 2 other causes do you need to consider

A

eosinophilic granulomatosis with polyangiitis (EGPA) [Churg strauss]

Drug reaction

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70
Q

Pharmalogical Rx of…
Isolated hydatid cysts
Lymphatic Filiarasis
Onchocerciasis
Shisto
Hook worm
Threard worm
Round worm
Strongyloides

A

[Harry Potter Loves Dieing Only Iv Some People with Strong Ish/Abs]

Isolated hydatid cysts - Prolonged praziquantel/albendazole [Usually requires srug drainage/ hypertonic saline injection]

Lymphatic Filiarasis - Diethlycarbazine

Onchocerciasis - Ivermectin [one dose]

Shisto - praziquantel

Hook worm - Mebendazole
Threard worm - Mebendazole
Round worm - Mebendazole

Strongyloides - ivermectin / abendazole

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71
Q

Which parasite might last for decades causing vague symptoms such as bulky loose stool, bloating / discomfort and eosinophilia but not have any changes on biopsy?

A

Strongylotide

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72
Q

AFP?
CA-19-9?
CA-125?
CEA?

A

AFP - Liver
CA 19-9 - Pancreatic [ usually post-resection for monitoring recurrence]
CA 125 - Ovarian
CEA - Colorectal [but also sometimes pancreas/gastric/breast/thyroid]

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73
Q

Cancer which has epigastric pain which is ‘relieved by sitting forwards? What other presenting things with it?

A

Pancreatic
Obstructive LFTs
Thromboembolic disease

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74
Q

What is archalasia? Characteristic appearance on barium swallow?

A

Hypertensive lower oesophageal sphincter that fails to relax and some reduced peristalsis
[Usually get simultaneous dysphagia to solids and liquids, unlike in Oeseophageal Ca where starts with solids then goes to liquids]

Dilated oesophagus with ‘birds beak’ tapering

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75
Q

Which infection might cause secondary oesophageal achalasia? Also causes which issues?

A

Chagas disease
[parasite Trypanosoma cruzi - found in Brazil]

Cardiomyopathy, megacolon, megaduodenum, megaureter

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76
Q

‘corkscrew’ appearance of the oesophagus on barium swallow? Other key Ix and finding?

A

Oesophageal spasm

Manometry - high amplitude simultaneous peristalsis with long durations

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77
Q

Drug Rx of achalasia

A

Can use CCBs / nitrates prior to eating
[Usually surgical though]

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78
Q

Oesophageal spasm management

A

Trial of PPI first to rule out GORD
CCBs/nitrates/antidepressants

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79
Q

Surgical Rx of Achalasia

A

Balloon dilation or Cardiomyotomy
[cardia is part of oesophagus not the heart silly]

Can also use botox injection

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80
Q

Surgical Rx of oesophageal spasm

A

Botox
dilation
myotomy

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81
Q

What is zollinger-ellison syndrome also called? Blood test?

A

Gastrinoma -> recurrent peptic ulcers and diarrhoea

Serum gastrin

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82
Q

Iron deficiency anaemia + aortic stenosis? Ix?

A

Angiodysplasia
[causes GI bleeding, usually colonic]

coloscopy [Can get a second one if not found on the first and then capsule endoscopy]

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83
Q

Angiodysplasia [abnormal, tortuous, dilated small blood vessel in the mucosal and submucosal layers of the GI tract] + telangiectasia of skin and mouth

A

olser-weber-rendu

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84
Q

Differentiate angiodysplasia and haemangioma in bowel

A

Angiodysplasia - abnormal, tortuous, dilated small blood vessel in the mucosal and submucosal layers of the GI tract

Haemangioma usually cavernous, involve full thickness and often in rectum

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85
Q

Ix for small bowel overgrowth syndrome? Gold standard test?
Which two usual types of malabsorbtion do you get? Rx

A

Lactulose breath test
Gold standard is culture of small intestinal fluid (>105 CFU/ml)

-b12 deficiency (from bacteria using it) but often high folate from bacteria producing it
-fat malabsorbsion including Vit ADE [but not K as bacteria produce it] due to deconjugation of bile salts from bacteria

ABx for 2 weeks - lots of options [frequent relapses]

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86
Q

Which deficiency most common when
-Partial gastrectomy / duodenum?
-Jejunum ?
- terminal ileum?

A

Dude Is Just Feeling Ill Bro

-Duodenum Partial gastrectomy = iron
As iron absorbed in the first part of the duodenum

-Jej - Folate

  • terminal ileum = b12
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87
Q

What does reduced bile acids lead to?

A

Steathorrea

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88
Q

Any red flag symptom with reflux

A

SCOPE SCOPE SCOPE

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89
Q

[Lethargy, itching, riased ALT, raised ++ ALP.]

Raised LDL cholesterol

A

PBC

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90
Q

Key risk for colorectal cancer in IBD?

A

duration of disease >10yrs
Age of onset <15
Widespread disease
Poor compliance

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91
Q

How do you measure hepatic encephalopathy ?

A

Conn score
0 - nil
1 - Lack of awareness. Anxiety / euphoria. Impaired addition
2 - Minimal disorientation to time/place. Inappropriate. Imapired subtraction
3 - Solomence / stupor. Responds to verbal stimulation
4 - coma

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92
Q

EEG in hepatic encephalopathy

A

high amplitude low frequency waves and triphasic waves

[not specific]

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93
Q

Why do you use rifaxamin in jhepatic encephalopathy

A

Decreases intesestinal production and absorbsion of ammonia

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94
Q

IBS symptoms in young. Mild iron anaemia, hypocalcaemia, hypoalbumin. What Ix first

A

Anti TTG

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95
Q

Well controlled type 1 diabetes. Why hypo after alcohol consumption

A

Low glycogen reserve

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96
Q

Best diuretic for ascites

A

spironolactone

[people with liver failure get splanchnic vasodilation -> stimulates RAAS and therefore aldosterone production.
Also metabolise aldosterone poorly in cirrhosis]

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97
Q

Oesophageal varicies drain into

A

Azygous vein -> SVC

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98
Q

What causes the renal failure in hepatorenal syndrome? Rx?

A

splanchnic vasodilation
Terlipressin (splanchnic vasoconstrictor]

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99
Q

What does omeprazole actually do?

A

Irreversibly bind to K+/H+ATPase pump.

[Pump has half life of 36 hours which is why effects dont last forever when take PPI]

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100
Q

What are red flag symptoms with reflux

A

Age >55 with ALARM

Anaemia
Loss of weight >10kg in 6 months
Anorexia
Recent onset worsening Sx
Melena / haematemesis

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101
Q

abetalipoproteinemia causes what

A

Lack of absorption of dietary fat + ADEK Vitamins

-> Rickets and clotting issues

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102
Q

High risk of re feeding with encephalopathy - what do you keep low in diet

A

Protein (as adds to ammonia burden)

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103
Q

Which aspergilous may increase risk of hcc

A

A. Flavus - from contaminated food
Produces Aflatoxin

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104
Q

Tired, Jaundiced, raised bilirubin, megaloblastic anaemia, angular stomatitis? Caused by? Rx?

A

pernicious anaemia
Anti-parietal antibodies which prevent production intrinsic factor which is required for B12 Absorption

[Bilirubinaemia due to increased turnover of immature RBCs]

IM b12

105
Q

How to test B12 absorbstion

A

Schilling test (now rare as can just test for anti-parietal antibody)

106
Q

Best long-term Rx of Archlasia

A

Balloon
Botox if elderly and not able to tolerate surg

107
Q

Cocaine user. Bloody diarrhoea =? Where does it affect most? How to differentiate from IBD

A

Ischemic colitis
-Transient ischemic colitis which affects watershed areas of splenic flexure and rectosigmoid area

Faecal calprotectin will be normal / borderline
ESR / CRP will be normal / borderline

108
Q

PSC affects all bile ducts but what is
Usual age?
Most linked to?
Key risk?
Management in late stage?

A

Men <50
UC (more than Crohns)
cholangiocarcinoma
Liver transplant only option in late-stage

109
Q

Which sign is always related to portal hypertension? What pressure is hypertension

A

Caput medusae - distended periumbilical veins

These veins usually shrink away after birth and only recanalize following significant portal hypertension

> 12mmHg

110
Q

What is budd chiari

A

obstruction of the hepatic vein due to
-tumour
-haem disease
-Contraceptive pill

111
Q

What is TIPSS? What happens in 25%

A

Transjugular intrahepatic portosystemic shunting

Connects portal vein (high pressure) to hepatic vein (low pressure)

May precipitate hepatic encephalopathy in 24%

112
Q

Key diagnositic test for achlasia

A

Oesophageal pull through manometry

113
Q

Arthritis, tanned, Liver disease? Gene? Why do women present later in life?

A

Haemochromatosis
HFE [C282Y in white, H63D otherwise]

Women present later due to protective effect of menstruation

114
Q

Best first line Ix in haemochromatosis

A

Transferrin saturation

115
Q

Most important complications of haemochromatosis?
Gene implicated in cancer?

A

Diabetes (pancreatic deposits)
cirrhosis
HCC - 30% if C282Y gene
Cardiomyopathy

116
Q

Where do most pancreatic Ca arise

A

70% in head of pancreas

117
Q

Unoperable pancreatic Ca drug

A

Folfirinox

118
Q

Diabetes, steoto/diarrhoea, gallbladder disease, weight loss, hypoCl = tumour producing what

A

Somatostatinoma

-> Inhibiton of insulin and pancreatic enzymes

119
Q

Which renal transplant drug may give patietns a crohns-like entercolitis

A

Mycophenolate Mofetil

120
Q

How do right sided colon cancers usually present

A

Symptomatic anaemia.
Dont tend to get any altered bowel habit symptoms such as in descending / sigmoid Ca / rectal
[75% all cancers are sigmoid / rectal]

121
Q

Who gets bowel screening

A

60-74 every 2 years

122
Q

Gastrin secreted by? Does what?

A

Antral G cells in response to gastrointestinal luminal peptides
-> Acid secretion
- smooth muscle contraction
-mucosal growth

123
Q

What does enteroglucagon do

A

Slows GI transit -> increases absorbtion

124
Q

What does pancreatic polypeptide do?

A

Inhibits pancreatic enzyme secretion

125
Q

What stimulates secretin? What does it do?

A

Duodenal acids stimulate
->Stimulates pancreatic enzymes
-reduces gastric acid secretion

126
Q

Somatostatin does?

A

Inhibits gastrin secretion (and all GI secretions)
Reduces GI motility

127
Q

Endocarditis and colorectal Ca

A

Strep Bovis

128
Q

Why is capecitabine a good chemo drug

A

Can take orally -> then metabolised into 5-fluorouracil (great bowel Ca chemo drug)

129
Q

Biopsy of UC would show….

A

Intense infiltration of mucosa with neutrophils
crypt abscesses
Lamina propria with lymphoid aggregates, plasma cells, mast cells and eosinophils

130
Q

How to test pancreatic exocrine function? insufficiency?

A

PABA testing

Fecal elastase (should be >200mcg/G)

131
Q

Oral contraceptive pill causes with hepatic tumour

A

Hepatic adenoma (benign)

132
Q

Hallmark feature of refeeding

A

HypoPO4

133
Q

Intestinal TB on CT

A

Mesenteric thickening with lymph node enlargement

134
Q

What are 80% of gall stones made of? When would they be made of something different

A

Cholesterol

If haemolysis / cirrhosis - made of black pigment

134
Q

What are 80% of gall stones made of? When would they be made of something different

A

Cholesterol

If haemolysis / cirrhosis - made of black pigment

135
Q

Fever jaundice RUQ pain=? What Ix if no stones seen on MRCP?

A

Charcots triad
EUS -

[ERCP is always interventional. No longer used for assessment of stones as invasive with assoc risks]

136
Q

What is couvoisier’s law

A

A palpable gallbladder in the presence of painless jaundice is unlikely to be caused by gallstones

137
Q

What can be used to dissolve gallstones in those unfit for surg?

A

Ursodeoxycarbolic acid

138
Q

Asymptomatic gall stones? Bile duct stones?

A

Gall = watch and wait (can try avoid fatty foods etc)

Bile duct - get them out as lots of complications

139
Q

What causes howel-jolly bodies?

A

They are RBCs which still have thier nuclei which are usually removed by the spleen.
-Seen in splenectomy / asplenia

Functional hyposplenism - sickle cell anaemia, liver cirrhosis, SLE, rheumatoid arteritis, coeliac disease, inflammatory bowel disease, splenic artery / vein thrombosis, amyloidosis, sarcoidosis

140
Q

How to test for bile acid malabsorption? Eg after terminal ilectomy

A

SeHCAT test

141
Q

Most important physiological mechanism preventing reflux

A

Parasympatheic stimulation of lower circular smooth muscle fibres of oesophagus

142
Q

Protein levels in ascites for transudate and exudate? Some examples of each.

A

Transudate <25g/L
-Cirrhosis, R heart failure, nephrotic syndrome / nephritis, bud-chiari

Exudate >35g/L
TB/infection eg SBP, malignancy, inflammation Eg Vasulitis, pancreatitis …

143
Q

Milk-coloured fluid on ascitic tap =?

A

Chylous ascites

[ lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction.]

144
Q

How to identify portal hypertension usuing ascities

A

SAAG (Serum Ascities Albumin gradient)
Serum level minus Ascities level

> 1.1g/L =Portal hypertension

145
Q

3 main causes of bud chiari

A

Tumour
Haem disease
Contraceptive pill

146
Q

Pleural effusion, ascites and a benign ovarian tumour =

A

meigs syndrome

147
Q

Which IBD drug causes pancreatitis

A

Azathioprine

148
Q

What is usually a feature of chronic pancreatitis

A

Calification - seen on XR / CT

149
Q

HNPCC Cancers

A

colorectal cancer (often proximal)
endometrial, ovarian, and skin cancers.

150
Q

FAP vs HNPCC brain tumour
[Polyps + brain tumour = ]

A

FAP - Medulloblastoma

HNPCC - Glioblastoma

[Turcot syndrome]

151
Q

FAP common cancers

A

Usually just 100s of polyps + ColoRECTAL Ca

duodenum, and cancer of the thyroid, pancreas, liver (hepatoblatoma), central nervous system (CNS), and bile ducts, although these typically occur in less than 10% of affected individuals.

152
Q

Gallstones + pancreatitis. Where is stone

A

Ampulla of vata (where ducts join)

153
Q

What would be seen on biopsy of lymph glands in whipples (get lymphadenopathy). Why do they get deranged clotting

A

Diffuse histocytes

Malabsorbsion - Vit K

154
Q

Variceal bleed. Terlipressin vs omeprazole

A

Terlipressin - and continued for 5 days / when definitive hemostasis.

[Omeprazole of no benefit if not bleeding peptic ulcer]

155
Q

Which 2 chronic diseases have a high risk of gallstones

A

Crohns - terminal ileum
Hereditary spherocytosis

156
Q

Stain for GIST tumours

A

CD117

157
Q

Zollinger-Ellison syndrome cancers secrete? Key Sx?
Ix/Dx? Rx + rx for diarrhoea?

A

Gastrin
Pain and dyspepsia from multiple ulcers
Steat/diarrhoea from excess acid

High serum gastrin + increased acid output
Endoscopy +/- CT

High dose PPI
Ocretide for steatorrhoea
Resection

158
Q

Peptic ulcer Surg -> delayed gastric emptying? Rx

A

Stricture
Endoscopic dilatation

159
Q

Rx of HELLP

A

Mg
-> delivery

160
Q

Emboli vs thrombosis in Small bowel ischemia

A

Thrombosis usuallly at origin of SMA -> fucks the lot

Emboli - usually lodge in Middle colic (first branch of SMA) and therefore spares first part of jej

161
Q

MI and reflux disease. What interaction is likely

A

Omeprazole + clopidogrel (reduces clopidogrel)

Change to lansoprazole

162
Q

PSC common immuno blood finding

A

p-ANCA
HLA-DR3 (Also seen in T1DM)

163
Q

Autoimmune hepatitis antibodies

A

ANA
Anti-smooth muscle

164
Q

PSC:
how high is the risk of cholangiocarcinoma
Male / female predominance?
How many have IBD?

A

30-40% risk of Ca
Males 70%
75% have IBD (or will have)

165
Q

Thiamine is vitamin…

A

B1

166
Q

How to make dx of c diff colitis

A

ELISA of toxins (a and b)

167
Q

Systemic sclerosis. Why do they get long standing diarrhoea? rx?

A

Systemic sclerosis -> strictures / diverticulum in small bowel
-> slowed transit -> bacterial overgrowth

Rotating long term abx eg metronidazole / cipro

168
Q

Only organ in contact with left kidney

A

Pancreas

169
Q

What is lynch syndrome ? Drug which reduces risk of Ca?

A

HNPCC
Aspirin reduces risk of colorectal cancer

170
Q

Which type of polyp has highest risk of colon Ca

A

serrated

(serrated are sad)

171
Q

Pruritus and elevated bile acids in pregnancy? Risks? Dx?Rx?

A

Intrahepatic cholestasis of pregnancy

Preterm, baby death, Respiratory distress syndrome, meconium-stained amniotic fluid
-May get malabsorption of ADEK

raised serum bile acids

Ursodeoxycarbolic acid +/- delivery

172
Q

Liver dysfunction in 3rd trimester risk? Rx?

A

Acute fatty liver of pregnancy
May get clotting abnormalities -> death

Prompt delivery

173
Q

Shellfish -> couple of days then abrupt voluminous watery diarrhoea. Rx?

A

Cholera
Rehydration

Oral Abx Eg Doxy / cipro…

174
Q

Which liver enzyme often increased in pregnancy

A

ALP -> secreted by placenta

175
Q

Whipple’s -> 3 weeks (during treatment) get worsening of symptoms again =

A

Immune reconstitution inflammatory syndrome

(if no arthralgia consider C diff)

176
Q

Drug other than terlipressin for variceal bleeding

A

Ocretide [think not Omeprazole but Ocretide]

[Works in lots of ways
-Splanchnic effects
-Decreases acid / panc enzymes [=good for ulcer bleed too]
-Increases oesophageal tone
-Inhibits peptic digestion of blood clots ]

177
Q

UC mild and distal bum rx

A

rectal mesalazine

178
Q

Lots of vomiting in pregnancy and mild deranged LFTS

A

Hyperemesis

179
Q

How to monitor venesection for iron overload

A

Based on ferritin levels

180
Q

Best Ix for suspected h PYLORI

A

Urea breath test
(stool test for kids who cant tollerate breath test)

181
Q

Colon diameter in UC which prompts surg referral

A

> 5.5cm

182
Q

What guides risk of early mets in colorectal ca

A

CEA levels

183
Q

Refeeding and became profoundly weak what electrolyte to replace first

A

PO4

184
Q

Age of onset of symptoms with Wilson’s? Gene? Serum /urine copper?

A

10-25 years
ATP7B gene

Serum copper and ceruloplasmin are usually low
Urine excretion also usually high

185
Q

Who gets banding in varicies for secondary prevention

A

Grade 2 or 3 (or actively bleeding)
Grade 1 just get oral propranolol

186
Q

Angioedema in the absence of urticaria is due to a deficiency of what

A

C1 esterase inhibitor
[Or taking ACEi]

187
Q

Which bilirubin is direct?

A

Conjugated is Direct

UNconjugated is INdirect

188
Q

Child / teen Presents with jaundice and conjugated (direct) hyperbilirubinaemia. Liver Biopsy shows dark pigmented granulocytes =?

A

Dubin-johnson syndrome

189
Q

Which food contains the most vit D

A

Oily fish

190
Q

Key drug to help with carcinoid sx (flushing, wheeze, diarrhoea)

A

Ocretide (somatostatin analouge)

191
Q

% mortality in bleeding varices

A

30%

192
Q

Markers of mortality in acute liver failure
-Ie Indications for referral for Tx

A

Creatinine >300
INR >6.5
pH <7.3

193
Q

Which gastric Ca do you get in H pylori

A

MALT (B cell) lymphoma

194
Q

Low vit what is a risk for gastric Ca

A

Vit C
[And Vit D]

195
Q

Wilson’s uric acid?

A

Low serum uric acid (due to high urinary excretion)

196
Q

2 drugs which cause bile acid malabsorption

A

Metformin
Colchicine

197
Q

who gets melanosis coli [darkish pigmented ] most commonly?

What if there were hyperpigmented spots in the mouth as well?

A

Chronic laxitives

Peutz-jehger (benign polyps mostly with dark areas)

198
Q

Arthralgia and malabsorbtion got to think? Key Ix

A

Whipple’s

biopsy for PAS macrophages

199
Q

carcinoid tumours usually bronchi or where in GI?

A

Jej / ileium

200
Q

The cardiac issue in carcinoid

A

Fibrosis of heart valves

201
Q

What does it mean if APTT does not correct on a 50:50 mixing study?

A

Presence of a Factor VIII inhibitor

[rather than factor VIII deficiency
If haemophilia / VWD it would correct on the mixing study]

Eg Phenytoin, penicillin, sulfa drugs

202
Q

Chronic abdo pain, ERCP - no malignancy with calcification of pancreatic branches. Dx? Rx of pain?

A

Calcification = Chronic pancreatitis

Opiates are mainstay of pain control
Creon may help if Sx of steatohheora

203
Q

What is kernicterus

A

unconjugated hyperbilirubin-induced neurotoxicity
-Seen in criggler Najjar but not gilbers

204
Q

First line for isolated hyperbilirubin and anaemia

A

Coombs

205
Q

Symptoms like coeliac but from a foreign place with megaloblastic anaemia and deficiencies? Rx?

A

Tropical sprue
Ampicillin / doxy for 4-6 weeks

206
Q

> 65 and given course of abx. Now presents with cholestasis and arranged LFTs. Which Abx?

A

Co-amox

207
Q

What is hairy leukoplakia?

A

EBV - white patch on the tongue with ‘hairy appearance’
Usually only in immunocompromosed / HIV

208
Q

Loss of libido, joint pains, polyuria/dipsia, palmar erythema and spider naevi. Bm 10.8 random. Dx?

A

Haemochromatosis

Libido - loss of testosterone
Diabetes - pancreatic deposits
+ Markers of liver disease

209
Q

Glasgow score for pancreatitis - PANCREAS
Pa0₂
Age
Neutrophilia (wcc)
Calcium
Renal (Urea )
Enzymes (AST /LDH)
Albumin
Sugar (Blood Glucose)

A

Pa0₂ <8 kPa
Age >55 years
WBC >15x10⁹/L
Calcium <2mmmol/l
Urea >16 mmol/L
AST >200  U/L
(LDH) >600 U/L
Albumin <32g/L
Blood Glucose >10 mmol/L

210
Q

metformin assoc increased bile acid secretion. 1st line Rx?

A

Switch to MR metformin

211
Q

Goes abroad and comes back with IBS symptoms. Treated with Abx but now has persistent diarrhoea. What has happened?

A

Giardia -> lactose intollerance
[takes weeks/months to resolve]

212
Q

Giardia Rx

A

single dose Tinidazole

213
Q

What does the C282Y gene lead to in Hamochromatosis

A

Decreased Hepcidin formation

[Impaires HFE to bind to beta-2-microglobulin and so it accumulates in intracellular space]

214
Q

Abx for small bowel overgrowth

A

Metronidazole
Cipra
Co-amox

215
Q

Gallstones leading to Derranged LFTs and raised amylase - where is stone

A

Distal common bile duct / ampulla of vata

216
Q

Strep Bovis comes from where to cause endocarditis? Essential Ix after treatment?

A

Bowel
Needs colonoscopy to rule out GI malignancy

217
Q

Features of severe UC attack
Number of poo
Temp
HR
Hb
ESR

A

> poos
37.8
Pulse >90
Hb anaemic
ESR >30

218
Q

Protein losing enteropathies?

A

IBD
C.diff + CMV
Tb
Sarcoid
Connective tissue diseases

219
Q

Obstructive jaundice. What are the 2 causes of intrahepatic and extrahepatic bile duct dilation?

A

PSC
Cholangiocarcinoma

220
Q

Old - malaise nausea weight loss. Raised ALP and GGT. Epigastric tenderness on deep palpation

A

Pancreatic Ca
If not in the head it won’t cause obstructive jaundice until very big

221
Q

Cholangiocarcinoma usually presents with

A

Obstructive jaundice

222
Q

Who gets clubbing in crohns

A

Active small bowel disease

223
Q

SBP most common bug? Rx?

A

E coli [then strep]
Cef / cipro are recommended

224
Q

Familial hypercholesterolaemia is due to?
Familal hypertriglyceridemia?
Mixed hyperlipidaemia?

A

Deficiency of LDL receptor

Lipoprotein lipase

Apopprotein E2

225
Q

Familial hypercholesterolaemia is due to?
Familal hypertriglyceridemia?
Mixed hyperlipidaemia?

A

Deficiency of LDL receptor

Lipoprotein lipase

Apoprotein E2

226
Q

Suspect protein losing enteropathy. What stool Ix can you do?

A

Stool A1AT
- Doesn’t get degraded by bowel enzymes->indicator of other plasma proteins being found in the gut

227
Q

Barrets oesophagus How often for endoscopy?- What to do if endoscopy demonstrates low-grade dysplasia (poorly differentiated cells)?
High grade?

A

Endoscopy every 2-5 years

Low grade - repeat biopsy and biopsy every 1cm
-Biopsy every 6 months

High grade
- If visible: endoscopic ablation + mucosal resection
-radiofrequency ablation
-Biopsy every 3 months

228
Q

2 parts of bowel most at risk of ischemic colitis

A

Splenic flexure
Sigmoid

229
Q

Which of the COX inhibitors has least risk of gastric ulceration?

A

Celecoxib
(COX-2)

230
Q

Anti-LKM antibody found in both

A

Autoimmune hepatitis

Drug-induced hepatitis
-Think about this esp if they’ve been on drugs that cause hepatits+ short history of illness

231
Q

4 classic causes of drug-induced hepatitis

A

Methyldopa
Isonazid
Nitrofurantoin
Ketoconazole

with aNtI-LKM

232
Q

ALT:AST ratio >2 indicates

A

Non-alcoholic
AST:ALT > 2 is alcoholic

233
Q

Most common cause of liver abscess?Differentiate from amoeba ?

A

Ecoli and S aureus
-Tend to occur quicker Eg 2 weeks after exposure
-Be multiple
-Pus filled (amoeba is non-pyogenic)

234
Q

Upper GI bleed - what is shown to improve survival the most (pharma Rx)

A

Antibiotics

Then terlipressin
[ocretide no proven benefit]

235
Q

Suspected giardia Dx?

A

Stool antigen test
[often need 3 stool samples to detect bug otherwise]

236
Q

What might falsely elevate urinary 5-HAII levels

A

Diet rich in veg - often need to repeat after dietary restriction

237
Q

When might eradication of H pylori in a MALT lymphoma not save the day

A

t (11:18)

238
Q

What is most associated with H pylori

A

Duodenal ulcers - 90% have h pylori

[Gastric ulcer - 80%
MALT - 80%]

239
Q

Epigastric pain. Endoscopy - giant gastric folds, gland atrophy and hyperplasia of gastric pits =? what key blood finding?

A

Menetriers disease

Hypoalbuminaemia (loss from gastric mucosa)

240
Q

UC often has which antibody

A

p-ANCA

241
Q

Severe malnutrition often get what as a result of the liver trying to maintain albumin concentrations through anabolic processes?

A

Steatohepatitis and hypercholesterolaemia

242
Q

‘thumb printing’ on Xray usually found where indicating what?

A

Splenic flexure - ischemic colitis

243
Q

Vinly cloride is assoc with which Ca?
Nickle?

A

Haemangiosarcoma of liver

Squamous cell of oral cavity

244
Q

Coeliac non Bowel symptoms

A

Deratits herpetiformis
Mouth ulcers

245
Q

Acute pancreatitis and lipaemic blood sample. What is cause?

A

chylomicrons

246
Q

PBC common Ig raised? key Sx is advanced disease

A

IgM
Back pain in advanced disease

247
Q

Key histological finding acute HepE

A

Marked cholestasis

248
Q

Ulcerative colitis for many years, now 4 months of a mild increase in stool frequency. Key ix?

A

Urgent colonsocopy - high risk of colic adenocarcimona

249
Q

Crohns peri anal abscess ix?

A

Pelvic MRI

[josh purves MRI fistulas]

250
Q

Can crohns present in old people

A

Yep >60 happens

251
Q

Ix to determine chronic carrier status of salmonella

A

Intestinal / stool / urine secretion culture

252
Q

Wedged hepatic venous pressure measures what?

A

Hepatic sinusoids

253
Q

Ribavirn key side effect
[used for hepC]

A

Haemolytic anaemia

254
Q

Rx of isolated distal UC

A

Rectal mesalazine

255
Q

Lansoprazole machanism

A

h+/K+ ATP pump blocker

256
Q

New dyspepsia at what age is indication for referral for UGI scope

A

> 55

257
Q

Barrets on biopsy

A

Normal oesophageal squamous epithelium replaced with collumnar and goblet cells

258
Q

Indications for TIPPS

A

Uncontrolled bleeding varies
Refractory ascites
Hepatic pleural effusion (hydrothorax)

259
Q

What time of day do people with functional bowel disorders not get diarrhoea

A

Through night

260
Q

Peutz-Jegher inheritance? chrom? gene

A

Dominant
STK11/LBK1
Chrom 19

MRCP PART 1 (22 decks)

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