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MSRA > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the most common organism found on paracentesis in cases of SBP?

A

E.coli

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2
Q

Which type of diabetes drugs can cause cholestasis?

A

Sulphonylureas - e.g. gliclazide

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3
Q

Which drugs can cause a hepatocellular-type picture?

A
  1. Paracetamol
  2. Sodium valproate, phenytoin
  3. MAOIs
  4. Halothane
  5. Anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
  6. Statins
  7. Alcohol
  8. Amiodarone
  9. Methyldopa
  10. Nitrofurantoin
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4
Q

Which drugs can cause cholestasis?

A
  1. COCP
  2. Antibiotics: flucloxacillin, co-amoxiclav, erythromycin
  3. Anabolic steroids, testosterones
  4. Phenothiazines: chlorpromazine, prochlorperazine
  5. Sulphonylureas
  6. Fibrates
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5
Q

Which drugs can cause liver cirrhosis?

A
  1. Methotrexate
  2. Methyldopa
  3. Amiodarone
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6
Q

When should patients receive fresh frozen plasma?

A

Those who have either a fibrinogen level of less than 1 g/litre, or a prothrombin time (international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal

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7
Q

When should patients receive prothrombin complex concentrate?

A

Those taking warfarin and actively bleeding

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8
Q

What is the first-line management for C.diff?

A

ORAL vancomycin

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9
Q

What is the first-line management for PBC?

A

Ursodeoxycholic acid

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10
Q

Which antibody is highly specific for PBC?

A

AMA M2 subtype - 98% of patients

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11
Q

Which manifestations are indicators of disease activity in IBD?

A
  1. Arthritis - pauciarticular, asymmetric - most common maifestation
  2. Erythema nodosum
  3. Episcleritis - more common in CD than UC
  4. Osteoporosis
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12
Q

What are the reversible complications of haemochromatosis?

A
  1. Skin discolouration

2. Cardiomyopathy

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13
Q

What is mild UC?

A

<4 stools/day, only a small amount of blood

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14
Q

What is moderate UC?

A

4-6 stools/day, varying amounts of blood, no systemic upset

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15
Q

What is severe UC?

A

> 6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

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16
Q

How is mild-moderate UC treated?

A

Proctitis or proctosigmoiditis and left-sided UC - topical (rectal) aminosalicylate –> oral aminosalicylate –> topical/oral steroids

Extensive - topical (rectal) aminosalicylate and a high-dose oral aminosalicylate

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17
Q

How is severe UC treated?

A

In hospital, IV steroids –> consider add IV ciclosporin/surgery if no improvement in 72 hours

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18
Q

Which Abx is associated with a high risk of C diff?

A

Clindamycin

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19
Q

What would suggest high ferritin levels are due to iron overload?

A

High transferrin saturation - >50% in males, >45% in females

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20
Q

What are the causes, other than iron overload that may cause raised ferritin?

A
  1. Inflammation
  2. Alcohol excess
  3. Liver disease
  4. Chronic kidney disease
  5. Malignancy
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21
Q

What is the commonest cause of hepatocellular carcinoma in Europe?

A

Hep C

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22
Q

What is the commonest cause of hepatocellular carcinoma worldwide?

A

Hep B

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23
Q

What is the most appropriate test to test for H.pylori?

A

13C-urea breath test

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24
Q

What is seen on biopsy in gastric cancer?

A

Signet ring cells

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25
Q

What are the signs of lymphatic spread of gastric cancer?

A
  1. Left supraclavicular lymph node (Virchow’s node)

2. Periumbilical nodule (Sister Mary Joseph’s node)

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26
Q

What are the risk factors for gastric cancer?

A 
H.pylori
Atrophic gastritis
Diet
Smoking
Blood group - A
27
Q

How is bile-acid malabsorption managed?

A

Cholestyramine

28
Q

What can distinguish between UC and Crohn’s?

A

UC = crypt abscesses

29
Q

How should H.pylori be treated?

A

7 days BD PPI + amoxicillin + either clarithromycin or metronidazole, then 4-8/52 of PPI

30
Q

What is the AST:ALT ratio in alcoholic hepatitis?

31
Q

When do you need to stop a PPI to do a H.pylori test?

A

2 weeks before

32
Q

Do femoral hernias have a cough impulse?

33
Q

What are the causes of bloody diarrhoea?

A

Salmonella
Shigella
E.coli

34
Q

What is the commonest types of gallstone in someone in sickle cell disease?

A

Black pigment gallstones

35
Q

When is medication considered in Hep C?

A

If after monitoring for 6 months the viral load is not improving. If it was improving you can just continue to monitor

36
Q

Which type of intestinal polyp is associated with Peutz-Jeghers syndrome?

37
Q

Is IV Vanc effective in C.Diff?

38
Q

How should a recurrent episode of C.diff within 12 weeks of Sx resolution be treated?

A

Oral fidaxomicin

39
Q

Where are femoral hernias relative to the pubic tubercle?

A

Inferior and lateral to the pubic tubercle

40
Q

What screening should individuals with UC receive with regard to colorectal cancer?

A

Colonoscopy - every 1-5 years - with multiple biopsies even if the mucosa appears macroscopically normal

41
Q

What is Courvoisier’s Law?

A

In the presence of a palpable gallbladder, painless jaundice is unlikely to be caused by gallstones (i.e. it is a sign of pancreatic cancer

42
Q

What is a Spigelian hernia?

A

Hernia that occurs between the rectus abdominus and semilunar line, usually at the level of the arcuate line. The hernias are usually small and there is no notable swelling, but their risk of strangulation is high. Most occur on the R-side and at around the age of 50

43
Q

What is dysphagia to liquids particularly characteristic of?

44
Q

How is Gilbert’s syndrome diagnosed?

A

Usually incidentally - raised bilirubin in the absence of other LFTs abnormalities/symptoms

45
Q

What drugs should be avoided in Gilbert’s syndrome?

A

Those that depend on UDP-glucuronyl transferase - e.g. some drugs used in HIV, colorectal cancer and gemofibrizil

46
Q

What cancer does Gardner’s syndrome increase the risk of?

A

Colorectal cancer

47
Q

What does gas in the rectum indicate?

A

Pseudoobstruction

48
Q

What are the pre-hepatic causes of portal hypertension?

A
  1. Portal vein thrombosis

2. Congenital atresia

49
Q

What are the intrahepatic causes of portal hypertension?

A
  1. Liver cirrhosis

2. Hepatic fibrosis - congenital fibrosis; Wilson’s disease; haemochromotosis

50
Q

What are the post-hepatic causes of portal hypertension?

A
  1. Hepatic vein thrombosis
  2. IVC thrombosis
  3. IVC malformation
  4. Constrictive pericarditis
51
Q

Angular stomatitis is caused by deficiency in which vitamin?

A

Vitamin B2 - riboflavin

52
Q

Deficiency in which vitamin causes pellagra?

A

Vitamin B3 - niacin

53
Q

Which part of the bowel is the commonest site for colorectal cancer?

54
Q

What is a Zenker diverticulum?

A

Pharyngeal pouch

55
Q

What F/U is required after a diagnosis of Gilbert’s syndrome?

A

Conjugated and unconjugated bilirubin levels 1-3/12 after probably Dx to confirm

56
Q

What causes a blue-black bulge at the anal margin?

A

Perianal haematoma

57
Q

Patients with what sort of tumour may be deficient in niacin, causing pellagra?

A

Carcinoid tumour

58
Q

Does achalsia show on OGD?

59
Q

What is the pellagra triad?

A

The three D’s:
D - diarrhoea
D - dermatitis
D - dementia

60
Q

What is Saint’s triad?

A

The association of:

  1. Hiatal hernia
  2. Gallstones
  3. Diverticular disease
61
Q

How do you diagnoses a hiatal hernia?

A

Barium meal

62
Q

What is Barratt’s oesophagus?

A

Metaplasia of normal squamous epithelium to columnar epithelium

63
Q

What is the triad of Wernicke’s encephalopathy?

A

Opthalmoplegia
Poor balance
Confusion

64
Q

Which type of IBD has a ‘cobblestone’ appearance?

MSRA (18 decks)

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