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Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

BEST INDICATOR OF UPPER GI BLEED.

YOU ANSWERED THIS CORRECT ON THE BG KNOWLEDGE OF A PATIENT WHO WAS DUE TO HAVE ENDOSCOPY AND THE GASTRO CONS ASKED WHAT IS THE UREA

A

An upper gastrointestinal bleed can act as a ‘protein meal’ and cause a temporary, disproportionate rise in the blood urea.

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2
Q

Blatchford score is used when

A

IS USED ON 1ST ASSESSMENT
Patients with a Blatchford score of 0 may be considered for early discharge

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3
Q

Rockall score is used when

A

used after endoscopy

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4
Q

Resuscitation while endoscopy

A

ABC, wide-bore intravenous access * 2

platelet transfusion if actively bleeding platelet count of less than 50 x 10*9/litre

FFP to patients who have either a fibrinogen level of less than 1 g/litre, or a PT/APTT greater than 1.5 times normal

prothrombin complex concentrate to patients who are taking warfarin and actively bleeding

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5
Q

Management of non variceal bleeding

A

PPI
If further bleeding then options include repeat endoscopy, interventional radiology and surgery

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6
Q

Management of Variceal bleeding

A

Terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)

band ligation

TIPS should be offered if bleeding from varices is not controlled with the above measures

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7
Q

How much a man and a woman can drink in a week?

A

men and women should drink no more than 14 units of alcohol per week
they advise ‘if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more’

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8
Q

1 unit of alcohol is equal to how much ethanol

A

10ml

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9
Q

HOW DO YOU CALCULATE THE NUMBER OF UNITS IN A DRINK?

A

ml * (ABV%) /1000

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10
Q

pigment ladden macrophages/melanosis coli on endoscopy shows?

A

laxative abuse(specially because of Senna)

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11
Q

MILD C DIFF
MODERATE
SEVRE
LIFE THTEATING

A

Normal WCC

↑ WCC ( < 15 x 109/L)
Typically 3-5 loose stools per day

↑ WCC ( > 15 x 109/L)
CR=or an acutely ↑ creatinine (> 50% above baseline)
TEMP=or a temperature > 38.5°C
CT=or evidence of severe colitis(abdominal or radiological signs)

BP=Hypotension
Partial or complete ileus
TOXIC=Toxic megacolon
CT=evidence of severe disease

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12
Q

odynophagia (difficiulty in swallowing) is a common SE od which popular drug?

A

documented complication of inhaled steroid therapy

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13
Q

agar MCV zada hua and hb kum isa Matlab ?

A

Megaloblastic anemia hai

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14
Q

megaloblastic anemia k workup mein

A

Intrinsic factor antibodies karvani chahye (more specific)
Gastric Parietal cell antibodies
to r/o pernicious anemia

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15
Q

anti histone antibodies

A

are involved in drug-induced lupus. This can be caused by several drugs, including infliximab, isoniazid, carbamazepine and procainamide.

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16
Q

Celiac dis ko r/o karnay k lye kon c antibodies krvatay hain

A

anti ttg lekin ye tab karvatay hain jb microcytic anemia hota hai

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17
Q

64-year-old female
severe upper abdominal pain of sudden onset.
history of peptic ulcer disease
O/E; tachy and rectal examination soft stools
what is the initial step in the management.
passing NG tube or getting and or erect CXR?

A

Depends on the diagnosis
does not look like a intestinal obstacle as soft stools so NG won’t be inserted as it is inserted in cases of obstruction for decompensation.

we will get the erect CXR to rule out free air under diaphragm(suggestive of perforated peptic ulcer)

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18
Q

indications of Abd X-ray in case of epigastric pain

A

acute bowel obstruction or a volvulus are suspected.

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19
Q

perforated peptic ulcer

A

erect CXR
then CT
then urgent surgical opinion for management via laparoscopy and with a conservative approach, especially in patients unfit for surgery or with small perforations.

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20
Q

Complications of GORD

A

oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma

NOT ACHLASIA

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21
Q

dysphagia, halitosis,wt stable

A

Pharyngeal pouch

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22
Q

neck gurgles on palpation ,aspirationdysphagia, halitosis,wt stable

A

Pharyngeal pouch

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23
Q

Which vitamin, if taken in high doses, can be teratogenic in pregame’s woman?

A

Vitamin A is teratogenic in high doses, and pregnant women should not exceed a daily intake of >10,000IU.

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24
Q

foods with low GI

A

fruits, vegetables and peanuts

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25
Q

FOODS WITH HIGH GI

A

White rice and white bread
baked potato

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26
Q

medium GI

A

coucous
boiled potato and boiled rice

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27
Q

features of celiac diseases

A

presence of howel jolly bodies
dermatitis herpetiformis
increased incidence of T cell lymphoma
biopsy; villous atrophy(ON DUODENAL BIOPDY)

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28
Q

cyst abscesses are found in?

A

Ulcerative Colitis

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29
Q

rapid wt loss
courvisers sign (palpable gall bladder)
pain radiating from epigastrium to the back
pale stools
raised blood sugars

A

pancreatic cancer

courveisers sign is present is present in acute situations; unlikely chronic

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30
Q

features of gastric cancer

A

acanthuses nigricans
enlarged supraclavicular lymph node(virchows node)

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31
Q

causes of gastric cancer

A

h pylori, smoking,gastritis,adenomatous polyposis

NOT ALCOHOL

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32
Q

KAYSER FLESCHER RINGS
hypermobile joints
dx?

A

Wilsons disease

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33
Q

diagnostic for KF rings?

A

liver biopsy

other test for it’s diagnosis;
CERULOPLASMIN concentration
copper in urine
LFT’s and RFT’s

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34
Q

saints triad?

A

Sliding hiatus hernia
gall stones
diverticular dis
nausea and vomting mostly in children

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35
Q

diagnostic for sliding hiatus hernia

A

barium meal

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36
Q

age; less than 50
epigastric pain started 2-3 hrs after meals and releived on eating
dx?

A

Duodenal ulcer
90% of it is associated with h pylori infection

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37
Q

age; over 50
pain worse after meals
less at night time
wt loss
dx?

A

Gastric ulcer

60% is associated with h pylori
30% with NSAIDS

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38
Q

risk factors for oesophageal cancer

A

age more than 60
hx of good of more than 10 years
smoking
obesity

39
Q

normal epithelium of oesophagus

A

squamous

40
Q

barrets esophagus

A

squamous to columnar

41
Q

if the patient had endoscopy and it just shows mild inflammation of oesophagus with squamous epithelium what is the dx?

A

simple esophagitis

use ppt

42
Q

autoimmune hepatitis is common in which gender?

A

Female

43
Q

antibodies for autoimmune hepatitis type 1

A

smooth muscle antibodies
antinuclear antibodies

44
Q

antibodies for autoimmune hepatitis type 2

A

common in kids btw(age; 2-14 years)

anti liver cytosol antigen antibodies
anti LKM antibodies

45
Q

tx of autoimmune hepatitis

A

high dose glucocorticoids
azathioprine
liver transplant

46
Q

patient with a stigmata of alcohol buse,came with Malena and one episode of fresh bleed,obs unstable, on fluids and abcs being transfused.platelets 85
initial management

A

endoscopy after resuscitation
for band ligation of probable varies

47
Q

platelet transfusion would be given when in the above case

A

platelet transfusion would only be given if the platelets are less than 50

48
Q

when will prothrombin concentrate be given?

A

when the patient is actively bleeding and is on an anticoagulant eg warfarin
and there is no time of reversal.

49
Q

ffp should be given only when

A

PT is more than 1.5 times of normal

50
Q

which medication used for ulcerative colitis cause decreased sperm count

A

Sulfasalazine

it also causes headache

51
Q

vit b1 is called

A

thiamine

52
Q

thiamine is given in?

A

wernikes encephalopathy
ophthalmoplegia,confusion,poor coordination

53
Q

vit b3 is called

A

niacin

54
Q

deficiency of vit b3/niacin is called?

A

pellagra

remember by 4D’s;
diarrhoea,dermatitis,dementia and death

55
Q

liver hemangioma is

A

benign liver tumour

56
Q

liver adenoma is associated with

A

oral contraceptive pills

57
Q

angiosarcoma and HCC are what kind of tumours

A

malignant

58
Q

abd pain
diarrhoea
flushed appearance
tender RUQ pain
bibasal crackles in the chest
DX?

A

Carcnoid synd

it is a neuroendocrine tumour
mostly originates from the intestines)appendix and ileum) and has the potential to spread to liver and lungs
it produces 5HT which causes fibrosis in the lungs

it is detected by urinary 5HIAA which is a metabolite of 5HT

Tx is with octrotide;a somatostatin analogue

59
Q

symptoms of right sided intestinal carcinomas
e.g cecal

A

lethargy, malaise,SBO,wt loss and anaemia

60
Q

symptoms of left sided intestinal carcinomas
e.g rectal

A

altered bowel habits, bright red rectal bleeding,LBO

61
Q

IBS is relieved on?

A

defecation

62
Q

which is the diagnostic test for celiac dis?

A

small bowel biopsy;duodenal
4-6 biopsies(as the dis is patchy)

other tests helpful in it;
Anti endomysial abs
fbc for hb/anaemia
radiological investigation surf tab karin get jab lymphoma associated with it suspected ho.

63
Q

Complications of Hepatic failure

A

Coagulopathy
Encephalopathy
sepsis

64
Q

Breathlessness on exertion and cough
with deranged LFTS

A

Alpha 1 antitripsin deficiency

(liver Cirrhosis and emphysema)

65
Q

treatment of Alpha 1 antitripsin def

A

Augmentation therapy with ATrispisn but is expensive

liver transplantation

66
Q

Desferoxamine which is used for Haemochromotosis is contraindicated in?

A

Cardiomyopathy and anaemia

BTW 1st line is phlebotomy and 2nd line is desferoxamine

67
Q

young age
Abnormal LFT’s
tremors
low mood/depression
difficulty in concentrating
DX?

A

Wilsons dis due to accumulation of copper in liver and Brain.

WILSONS DISEASE;COGNITIVE AND PSYCHIATRIC SYMPTOMS ARE COMMON

68
Q

SULFASALAZINE used for UC has a MAJOR SE in MEN.

A

infertility; reduced sperm count

and headaches.

69
Q

which drug is reserved for the patients who do not tolerate with all the initial drugs for UC and have an allergic reaction to steroids?

A

INFLIXIMAB which itself can cause an anaphylactic reaction

70
Q

Milan criteria for liver transplantation

A

1 nodule of less than 5cm or 2-3 nodules of less than 3cm

and transcatether chemoemobilzation is an option id liver transplant is awaited or for unresectable tumours

71
Q

history of crohns disease with wt loss,constipation and abd pain
which cancer is common

A

colon ca

C C C

72
Q

history of UC,wt loss,RUQ pain, jaundice and deranged LFTS
which cancer is common

A

cholangiocarcinoma;malignancy of the bile ducts

73
Q

Thiamine,
Riboflavin
Niacin

A

B1
B2
B3

74
Q

Pellagra happens because of which bit?

A

niacin b3

75
Q

four Ds of Pellagra

A

Diarrhoea
Dermatitis
Dementia
Death if untreated

76
Q

benign or malignant liver tumours

A

B;
Hemangioma

M;
Angiosarcoma
HCC

77
Q

Hallmarks of Steatorrhea

A

pale
foul smelling
difficult to flush faecal matter

patient has pain on eating fatty and protein containing food

78
Q

bloody diarrhea
wt loss
abd tenderness
pyoderma gangrenosum
erythema nodosum on the shins(tender blue red lesions)
cobble’s stone appearance in the mucosa(deep fissures)
DX?

A

Crohn’s dis

79
Q

common symptoms of cirrhosis

A

jaundice
coagulopathy
ascites

80
Q

UC is also associated with symptoms of

A

apthous ulcers,uveitis and arthritis

81
Q

right sided carcinomas tend to present with

A

anaemia, wt loss and malaise

if it becomes big then it will cause small bowel obstruction by obstructing the ileum

82
Q

left sided carcinomas present with

A

change in bowel habits
large bowel obstruction
PR bleeding

83
Q

Carcinoid Syndrome

dx

tx

A

It produces 5HT which causes Pul stenosis which cause fibrosis and leads to symptoms of HF like SOB

Urinary 5HIAA

Octrotide; somatosattin analogue

84
Q

type 2 autoimmune hepatitis is more common in what age group?

A

2-14 yrs
anti LKM1 antibodies
anti LC1 antibodies

85
Q

type 1 autoimmune hepatitis is associated with which antibodies?

A

Antinuclear and smooth muscle antibodies

86
Q

platelets should only be transfused when they are less than ?

FFP should be transfused when?

A

50 into 10 raised to power 9

PT is more than 10times the normal

87
Q

Diclofenac increases the risk of gastritis

A
88
Q

Flucloxacillin can cause damage to?

A

Liver.

cholestatic jaundice and hepatitis

causes diarrhoea and upset stomach

89
Q

grey turners sign

A

bruising of the flanks
signs of pancreatic haemorrhage which takes 24-48 hrs to develop

90
Q

alcohol is not a known cause of gastric cancer

A
91
Q

pt of chronic pancreatitis
MRI shows;hypertense and hypotenuse lesions
no symptoms

A

pseudocysts

92
Q

isoniazid is one of the drug that causes pancreatitis.

A
93
Q

hx of alcohol abuse
epigastric pain radiating to back
nausea and hypovolemic shock

A

acute necrotising pancreatitis

94
Q

tx of acute necrotising pancreatitis

A

fluid replacement
management of coagulopathy/hypocalcemia and antibiotic prophylaxis

Medicine (18 decks)

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