Gastroenterology

Question 1

Treatment of Barrett’s with a reduction in adenocarcinoma

Answer 1

High dose PPI and aspirin

Question 2

Barrett’s surveillance

Answer 2

No dysplasia - surveillance
Low grade at 2 endos 6 months apart- RFA
High grade dysplasia - oesophagectomy vs low endo resection followed by RFA
Post RFA - 5 years

Question 3

Portal HTN pressure

Answer 3

> 5mmHg

Question 4

Primary prophylaxis if nil bleed

Answer 4

Non selective b blocker or ligation

Question 5

Prevention of hepatorenal syndrome in SBP

Answer 5

IV albumen at diagnosis and day 3

Question 6

High ALP and GGT and antimitochondrial antibodies

Answer 6

PBC

Question 7

PBC treatment

Answer 7

Ursodeoxycholic acid

Question 8

Liver transplant referral

Answer 8

Kings college criteria (not paracetamol)

PT >100 OR 3 of

Age over 40

Jaundice for 7 days

PT over 50

Bili over 180

Non A or Non B hepatitis, Wilson’s or drugs

Question 9

Type 1 AIH

Answer 9

Anti Smooth muscle antibodies and ANA

Question 10

Type 2 AIH

Answer 10

Anti LKM1

Target antigen: Cyp450 2D6

Question 11

Haemachromatosis gene mutation

Answer 11

HFE gene mutation (C282Y or H63D)

Question 12

Test for Pancreatic insufficiency with chronic pancreatitis

Answer 12

Faecal elastase

Question 13

FAP gene

Answer 13

APC gene chromosome 5

Tumour suppressor gene

Autosomal dominant

Question 14

MYH associated polyposis

Answer 14

MutY gene

Question 15

HNPCC gene mutations

Answer 15

MSH2 (60%) and MLH1 (30%)

Mismatch repair genes causing micro satellite instability

Right sided tumour

> 10 adenomas

3 cases, 2 generations, 1 age <50

Question 16

5-AZA SE

Answer 16

Hepatotoxicity
Myelosuppressions
Allergy/pancreatitis 
NHL 
Non melanomatous skin cancer 

No effect in pregnancy

Question 17

Risk of progression from high grade dysplasia to adenocarcinoma

Answer 17

10%

Question 18

The benefit of IV PPI pre endoscopy

Answer 18

Reduces endoscopy therapy does not reduce mortality, rebleed or death

Question 19

Treatment of acute bleeding UGIB

Answer 19

Adrenaline + diathermy/clip has mortality/rebleed benefit
Post endoscopy PPI IV for 72 hours (oral similarly efficacious)
Restart aspirin at 3 days
Restart warfarin/DOAC 2 weeks

Question 20

High gradient ascites

Answer 20

Serum albumin: ascites alumen >11g/L

Portal HTN

Question 21

Low gradient ascites

Answer 21

<11g/L ‘Leaky capillaries (infection) or cancer

Question 22

Treatment of SBP

Answer 22

WCC >250
Cefotaxime 2g TDS
Cease beta blockers (mortality risk)
Bactrim prophylaxis

Question 23

Histology of alcoholic liver disease

Answer 23

Mallory-Denk hyalines surrounded by neutrophils (termed Mallory-Denk bodies)
macrovesicular steatosis

Question 24

Histology of NASH

Answer 24

fat droplets in the hepatocytes in association with ballooning degeneration and lobular inflammation.

Question 25

DNA stool test for CRC

Answer 25

``` KRAS mutation NDRG4 BMP3 methylation Beta actin Haemoglobin immunoassay ```

Question 26

When to refer cirrhosis for transplant

Answer 26

Evidence of hepatic dysfunction (child’s Pugh 7 or meld >10) or first complication (ascites varicella bleed or hepatic encephalopathy)

Question 27

Child Pugh score

Answer 27

``` Albumin Bilirubin Coagulation (pt inr) Drain the ascites Encephalopathy ```

Question 28

Ferroportin

Answer 28

Stimulates iron release from entericyte into blood stream at basolateral surface

Question 29

Hepcidin

Answer 29

Inhibits iron release from enterocyte ast basolateral membrane

Question 30

Genetic variant of crowns disease which could lead to early initial surgery due to structures

Answer 30

NOD2/CARD15

Question 31

Positive pANCA negative ASCA

Answer 31

UC

Question 32

Negative pANCA pos ASCA

Answer 32

Crohns

Question 33

Drug for Crohn's with anti-IL12/23 action

Answer 33

Ustekinumab

Question 34

Hormones that stimulate appetite

Answer 34

Ghrelin Neuropeptide Agouty related peptide

Question 35

IBD drugs to avoid in pregnancy

Answer 35

MTX contraindicated | Infliximab (anti-TNF) should be avoided in third trimester

Question 36

Indication for elective total colectomy in UC patients

Answer 36

Risk of cancer Unable to wean steroids Steriod side effects

Question 37

UC/Crohn's surveillance

Answer 37

Colonoscopy 8 years from disgnosis every 1-3 years

Question 38

Diarrhoea associated with resection of terminal ileum

Answer 38

Bile malabsorption related

Question 39

Serology coeliac

Answer 39

1) Tissue transglutaminase Ab (IgA-tTG)(most accurate) or Endomysial Ab (IgA-EMA). 2) Anti-gliadin Ab (less sensitive/specific) HLA-DQ2 DQ8 - rule out test

Question 40

When to treat with Abx in acute pancreatitis

Answer 40

If necrosis is present

Question 41

Corckskrew oesophagus

Answer 41

Oesophageal spasm | Most commonly in seting of uncontrolled GERD

Question 42

Most common cause of viral gastro

Answer 42

norovirus

Question 43

therpaeutic effect of lactulose

Answer 43

lowers faeces pH

Question 44

Interferon treatment of HCV

Answer 44

Interferon alfa-2b (5 million U) of subcutaneously daily for 4 weeks and then three times per week for 20 weeks

Question 45

MELD score

Answer 45

Creatinine Bilirubin INR

Question 46

autoimmune pancreatitis serological test?

Answer 46

IgG4

Question 47

Diagnosis of wilsons disease

Answer 47

Low serum copper and ceruloplasmin levels High 24 urine copper Rx: trientine and zinc

Question 48

HCC finding on quad phase imaging

Answer 48

Enhance on arterial imaging rapidly | Wash out in arterial phase

Question 49

Serum albumin gradient > 1.1 and ascites protein <2.5

Answer 49

Cirrhosis Budd Chiari Liver mets

Question 50

Barrett's oesophagus histology

Answer 50

Intestinal metaplasia characterized with goblet cells.

Question 51

Most specific autoimmune hepatitis

Answer 51

Anti-SLA/LP (Soluble Liver Antigen/Liver–Pancreas Antigen)

Question 52

Medication for post-ERCP pancreatitis

Answer 52

NSAIDS i.e. indomethacin pre ERCP