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PLABABLE 2.0 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What acid-base balance disorder can you find in a patient with pyloric stenosis?

A

Metabolic Alkalosis

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2
Q

FIrst-line treatment for ulcerative colitis

A

Topical Aminosalicylate

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3
Q

In managing ulcerative colitis, what should be added if after giving topical aminosalicylate, remission is not achieved within 4 weeks

A

Oral Aminosalicylates

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4
Q

What to give for severe exacerbation of ulcerative colitis?

A

IV Hydrocortisone

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5
Q

Describe Barret’s esophagus

A

Squamous to columnar metaplasia of the lower 3rd of the esophagus

*** can develop into adenocarcinoma of the lower 3rd of the esophagus

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6
Q

Barret’s: ______ CA of the esophagus

Achalasia: ______ CA of the esophagus

A

Barret’s: Adenocarinoma

Achalasia: SCC

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7
Q

X-ray and Barium enema findings of achalasia

A

X-ray: megaesophagus
Ba enema: bird’s beak

(Remember, increased resting pressure of lower third of esophagus)

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8
Q

Most accurate diagnostic test for achalasia

A

Manometry

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9
Q

Dysphagia + Regurgitation of stale food + chronic cough + halitosis + aspiration

A

Pharyngeal pouch (Zenker’s diverticulum)

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10
Q

Diagnostic test of choice for Zenker’s diverticulum

A

Barium swallow

Do not do endoscopy as it has a risk of perforation

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11
Q

When do you suspect acute exacerbation or severe colitis, in which case, IV hydrocortisone is warranted?

A

6,30,90TH

More than 6 episodes of BM with visible blood in large amounts
ESR > 30
HR > 90
Temp > 37.8
Hgb is low (as presented with pallor and fatigue)

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12
Q

NICE recommends what procedure in what time frame from the diagnosis of acute cholecystitis

A

Laparoscopic cholecystectomy 1 week from diagnosis

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13
Q

Main difference of acute cholecystitis from biliary colic

A

Acute cholecystitis has inflammatory element: leukocytosis + fever + peritonism

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14
Q

Incidental finding of gallstones in an asymptomatic patient

A

Reassure

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15
Q

Incidental finding of stones in the CBD in an asymptomatic patient

A

ERCP or laparoscopic cholecystectomy

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16
Q

Triad of Plummer-Vinson syndrome

A

Dysphagia
Iron-deficiency Anemia
Glossitis

*Remember that plumber Vincent digs a hole for the iron pipe.

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17
Q

Treatment of Plummer-Vinson syndrome

A

Iron supplements + web dilatation

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18
Q

PERSISTENT dysphagia + use of NSAIDs or bisphosphonates (for osteoporosis) + no regurgitation

A

Benign esophageal stricture

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19
Q

What are the endoscopic findings pathognomonic for Crohn’s disease?

A

Transmural ulcers

Skip lesions

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20
Q

Diarrhea + weakness + arreflexia

A

Guillain-Barre syndrome

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21
Q

You suspect acute flare of ulcerative colitis, what is the initial investigation and why?

A

Abdominal X-ray to rule out toxic megacolon

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22
Q

What are the expected abnormal liver function tests in a patient with autoimmune hepatitis?

A

Elevated AST and ALT

Normal or mildly elevated GGT

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23
Q

What are the expected abnormal liver function tests in a patient with alcoholic liver disease?

A

Elevated AST and ALT (AST>ALT), hence, elevated AST:ALT ratio
Elevated GGT

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24
Q

Differentiate HELLP from AFLP

A

HELLP - hemolysis, elevated liver enzymes and low platelet count
AFLP - ELLP + hypoglycemia + hyperammonemia + nausea and vomiting + DIC (prolonged PT/PTT)

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25
Q

Between amylase and lipase, which is more sensitive for acute pancreatitis?

A

Lipase

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26
Q

Between amylase and lipase, which is more specific for acute pancreatitis?

A

Lipase

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27
Q

Treatment for PMC

A

Oral metronidazole or Oral vancomycin

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28
Q

Histology of Crohn

A

Increased goblet cells, granuloma, transmural

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29
Q

Endoscopy of Crohn

A

Skip lesions, cobblestone appearance, deep ulcers (transmural)

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30
Q

How to relieve the symptom of severe dysphagia in a patient with oesephageal cancer with liver metastasis?

A

Endoluminal stenting

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31
Q

Rx for Vit B12 deficiency

A

IM Hydroxycobalamin

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32
Q

Left supraclavicular mass plus anorexia and weight loss

A

Think of gastric CA

***Remember Troisier sign, Virchow node

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33
Q

Differentiate PBC from PSC

A

They are both presenting with pruritus, jaundice and elevated ALP. They are both treated with UDCA and cholestyramine

Primary Biliary Cirrhosis - 3Ms (anti-mitochondria, mid-aged female, IgM), associated with Sjogren
Primary Sclerosing Cholangitis - diagnosed by ERCP, associated with UC

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34
Q

Jejunal or duodenal biopsy findings of coeliac disease

A

Villous atrophy
Crypt hyperplasia
Increased inter-epithelial lymphocytes

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35
Q

Most appropriate test to ensure successful eradication of H pylori

A

C13 urea breath test

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36
Q

When do you request for a C13 urea breath test?

A

Dyspepsia in patient more than 55 years old. Underwent lifestyle modification and intake of antacids. Then tested positive for H pylori serum antibody and was given triple therapy for 4 weeks but did not improve.

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37
Q

C13 urea breath test was positive. What’s next in the management of H pylori?

A

Another attempt in the eradication of H pylori

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38
Q

When do you request for endoscopy if we’re dealing with H pylori infection?

A
  1. If patient tested negative for C13 urea breath test and PATIENT DID NOT IMPROVE from 4-week triple therapy
  2. Tested negative for H pylori serum antibody and was given PPI for 4 weeks but DID NOT IMPROVE
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39
Q

Endoscopy revealed multiple ulcers in multiple sites after patient underwent a full course for H pylori eradication. Next step for investigation?

A

Fasting gastrin level (Best) or secretin stimulation test

***Think of ZES or gastrinoma (multiple ulcers in multiple sites)

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40
Q

Induce remission for mild to moderate ulcerative colitis

A

Rectal 5-ASA (if not responding, shift to oral 5-ASA)

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41
Q

Induce remission for severe ulcerative colitis

A

Admit and start IV hydrocortisone

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42
Q

Maintain remission of UC

A

Oral mesalazine (5-ASA)

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43
Q

Induce remission of Crohn disease

A

Oral prednisone

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44
Q

Maintain remission of Crohn Disease

A

AZP or MCP
Azathioprine
Mercaptopurine

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45
Q

The most likely organ to get cancer from hemochromatosis

A

Liver - since this is the main organ for iron deposition

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46
Q

Triad of hereditary hemochromatosis

A

Hepatomegaly (cirrhosis) + DM + hyperpigmentation (bronze skin)

***Remember: Bronze diabetic

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47
Q

What type of cancer does a patient with hereditary hemochromatosis have a predilection to?

A

HCC

***Remember that liver is the major storage of iron deposition. Iron deposition —> hepatomegaly —> cirrhosis —> HCC

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48
Q

PPVs of Vit B12 deficiency

A

Impaired PPV

Proprioception, position, vibration

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49
Q

X-ray findings of achalasia

A

Megaesophagus

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50
Q

Barium meal finding of achalasia

A

Dilated esophagus that tapers aka bird’s beak appearance

***Remember increased resting pressure of the lower esophagus

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51
Q

Most accurate investigation of a patient with achalasia

A

Esophageal manometry

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52
Q

Middle-aged female with abnormal LFTs present with secondary amenorrhea + history of autoimmune disease (thyroid, vitiligo, DM 1)

A

Autoimmune hepatitis

***Remember, increased AST and ALT and normal or mildly elevated ALP

53
Q

PMH peptic ulcer + underwent surgery + post-op symptoms (abdominal pain, rigidity, tenderness, guarding) + hypotension + tachycardia. Diagnosis and Next step?

A

Think of perforated PUD. Next step: erect CXR and abdominal X-ray

54
Q

Common anemias associated with coeliac disease, arrange from the commonest to the least

A

Iron deficiency
Folic acid deficiency
Vit B12

55
Q

Aside from anemias, what are the 4 other conditions associated with coeliac disease? OODE

A

Osteoporosis
T-cell lymphoma (intestinal lymphoma)
Dermatitis herpetiformis
DM I

56
Q

Travel to Africa + watery diarrhea

57
Q

Travel to Europe + watery diarrhea + abdominal pain + bloatedness

58
Q

Travel history + prodrome (fever, headache, myalgia) + bloody diarrhea

59
Q

Old age + recent use of co-amoxiclav + abnormal LFTs

A

Cholestatic hepatitis

60
Q

4-mo hx of intermittent diarrhea and abdominal pain + blistering rash of elbow + low hemoglobin + endoscopic findings of shortening of villi and lymphocytosis

A

Coeliac disease

***Remember dermatitis herpetiformis association, and endoscopic findings of villous atrophy, crypt hyperplasia and lymphocytosis

61
Q

How do you differentiate anterior mediastinitis from posterior mediastinitis?

A

Anterior mediastinitis - pain is mainly in the subcostal area
Posterior mediastinitis - pain is in the epigastric area radiating to the interscapular region of the back

***You are presented a patient complaining of chest pain who underwent endoscopy

62
Q

Slow progressive dysphagia + chronic intake of PPI + no weight loss + normal Hgb

A

Peptic stricture

63
Q

Marker of primary adenocarcinoma of the lung

A

TTF-1

Thyroid transcription factor-1

64
Q

How does a primary cancer of the lung metastasize to the liver?

A

Hematogenous spread (Lung, Heart, Aorta, Coeliac trunk, common hep. a., liver)

65
Q

Dysphagia after intake of cold water + Ba swallow shows corkscrew appearance at the time of spasm

A

DES (diffuse esophageal spasm)

66
Q

Most accurate test in the diagnosis of diffuse esophageal spam

A

Manometric studies

67
Q

Fecal impaction + old age + nursing home + taking analgesic

A

Phosphate enema

68
Q

Fecal impaction + young, healthy, no comorbidities

A

Gycerol suppository

69
Q

Constipation in pregnancy

A

Ispaghula (bulk-former), Lactulose (osmotic), Senna (stimulant)

***Remember: I love (to) shit, buo o sabog.

70
Q

Hard stool but not impacted

A

Stool softener

71
Q

1st line and 2nd line in constipation with soft stool

A

1st line: Senna

2nd line: Lactulose or macrogol

72
Q

In a case of achalasia, you would encounter patients presenting with upper respiratory tract infection. What could be responsible for URTI of the patient?

A

In achalasia, there is increased resting pressure in the lower esophageal sphincter resulting in regurgitation of food particles, which might be aspirated leading to pneumonia.

73
Q

Gold standard in the diagnosis of chronic pancreatitis

A

Spiral CT scan of the abdomen with contrast - will show pancreatic calcifications

74
Q

Might not be the most appropriate but helpful in the investigation of chronic pancreatitis

A

Fecal elastase and fecal chymotrypsin

75
Q

Abdominal X-ray findings seen in a patient with chronic pancreatitis

A

Diffuse abdominal calcifications

76
Q

Treatment for Vit B12 deficiency

A

IM Hydroxycobalamin (except if patient is vegan and it is the cause of vitamin B12 deficiency, in which case, oral cobalamin can be given)

77
Q

Step-by-step procedure in the management of acute variceal bleed

A
  1. ABC is priority including IV fluid resuscitation
  2. Start terlipressin and antibiotics
  3. Definitive management is band ligation by endoscopy. However, is this is not available, we can do sclerotherapy by endoscopy (inject N-butyl-2-cyanoacrylate)
  4. If band ligation fails to control the bleeder, we can do transjugular intrahepatic portosystemic shunt (TIPS)
78
Q

Differentiate Gilbert syndrome from Dubin-Johnson syndrome.

A

GIlbert syndrome is unconjugated or indirect hyperbilirubinemia whereas DJ syndrome is conjugated or direct hyperbilirubinemia.

In Gilbert syndrome, patients are usually asymptomatic. There is mild elevation in bilirubin, sometimes, isolated jaundice with history of recent infection. No bilirubin seen in urinalysis.
In Dubin-Johnson syndrome, patients present with jaundice. Bilirubin seen in urinalysis. LFTs are abnormal.

79
Q

Why is reticulocyte count normal in Gilbert syndrome?

A

Because jaundice found in Gilbert syndrome is not due to hemolysis.

80
Q 
Differentiate Crohn from ulcerative colitis in terms of the following parameters:
Nature of diarrhea
Location of abdominal pain
Weight loss
Smoking history
A 
CROHN DISEASE
A. Watery diarrhea
B. Right iliac fossa
C. Weight loss
D. Smoker
ULCERATIVE COLITIS
A. Bloody diarrhea
B. LLQ
C. No weight loss
D. non-smoker or ex-smoker
81
Q

Order of intervention in the management of constipation

A
  1. High-fibre diet
  2. Senna
  3. Lactulose or macrogol (PEG)
  4. Prokinetic agent (domperidone, metoclopramide or erythromycin)
  5. Dantron
  6. Seek specialist advice
82
Q

Site of main absorption of iron, folic acid and vitamin B12.

A

Iron - duodenum
Folic acid - jejunum
Vitamin B12 - ileum

This arrangement is also the same arrangement in terms of the commonest anemia to least anemia associated with coeliac disease.

83
Q

Investigation of choice if pancreatic CA is suspected

84
Q

Painless jaundice + hepatomegaly + RUQ mass + wasting + palpable non-tender gallbladder + atypical back pain

A

Pancreatic cancer

85
Q

When can a cook return to work after an attack of gastroenteritis?

A

48 hours after the LAST episode of diarrhoea or vomiting

86
Q

In an endocopically-proven esophagitis or endoscopically negative reflux disease, treatment starts with PPI for 1-2 months followed by low dose treatment as required if responsive to 1-month PPI. They are with the same management except is there is no response after the initial 1-month PPI.

A

If no response after 1-month PPI on an endoscopically proven esophagitis, double-dose PPI for 1 month.
If no response after 1-month PPI on endoscopically negative reflux disease, H2 receptor antagonist (e.g., ranitidine) or prokinetics are given for 1 month.

87
Q

Management of liver cirrhosis with ascites

A

Spironolactone

88
Q

Liver cirrhosis with ascites: ascitic fluid aspirate analysis shows high neutrophils

A

IV antibiotics

89
Q

Diagnostic modality of choice in the diagnosis of esophageal cancer

A

Upper GI endoscopy and biopsy

90
Q

4Cs of diffuse esophageal spasm

A

chest pain - cold drink - corkscrew appearance - calcium channel blocker

91
Q

Most common type of esophageal cancer

A

Adenocarcinoma

92
Q

Type of esophageal cancer associated with smoking

93
Q

Common type of esophageal cancer in the upper 2/3

94
Q

Esophageal cancer associated with Barret’s esophagus

A

Adenocarcinoma

95
Q

Esophageal cancer associated with achalasia

96
Q

Esophageal cancer associated with GERD

A

Adenocarcinoma

97
Q

Common esophageal cancer that occurs in the lower 1/3 of esophagus

A

Adenocarcinoma

98
Q

How to relieve symptom of severe dysphagia in a patient with esophageal cancer with metastasis

A

Endoluminal stent

99
Q

Long-term feeding for a post-stroke patient with dysphagia

A

Percutaneous gastrostomy

100
Q

Differentiate cirrhosis from spontaneous bacterial peritonitis.

A

Cirrhosis presents with alcohol abuse, ascites and spider nevi. SBP is complication of ascites; it presents with fever, tenderness in addition to symptoms of cirrhosis.

Rx of cirrhosis without SBP is SPIRONOLACTONE
Rx of SBP - antibiotics (most appropriate to send specimen for culture)

101
Q

Best initial test for ascites

A

Neutrophil count from ascitic fluid aspirate - if it shows > 250 uL; commence antibiotics ASAP

102
Q

Management of ascending cholangitis

A

IVF + antibiotics + correct coagulopathy + early ERCP

103
Q

Management of acute pancreatitis

A

IVF resuscitation + analgesics + nutritional support

104
Q

Dysphagia + anxiety

A

Globus hystericus

105
Q

Dyphagia + EOM weakness

A

Myasthenia gravis

106
Q

A hemodynamically unstable patient was given fluid resuscitation. Despite the fluid resuscitation, patient still deteriorated and blood is not yet available for transfusion and crossmatching. Next step?

A

Transfuse O negative blood.

107
Q

Hepatitis A causative agent

A

Picornavirus

108
Q

Causative agent of Hepatitis B

A

Double-stranded hepadnavirus

109
Q

Indicates acute hepatitis A infection

A

Anti-Hepatitis A IgM antibody

110
Q

Hepatitis B: First marker to become abnormal

A

HBsAg (acute or chronic infection)

111
Q

Hepatitis B: Indicates high infectivity

112
Q

Hepatitis B: Indicates recent vaccination

113
Q

Hepatitis B: Indicates past infection

114
Q

Old age + left lower abdominal pain + †ender mass in the iliac fossa

A

DIverticular Abscess

115
Q

Any patient with dyspepsia + taking PPI for 1 month + no improvement of symptoms + developed dysphagia

A

Urgent EGD

116
Q

Burning sensation in the chest + nausea and vomiting + chest pain + CXR shows air-fluid level in a mass behind the heart

A

Hiatal hernia

117
Q

Management of IBS

A

Low FODMAP diet

118
Q

Management of constipation-predominant IBS

A

Laxatives (Ispaghula husk)

119
Q

Management of diarrhoea-predominant IBS

A

Anti-diarrheal e.g. loperamide

120
Q

IBS is abdominal pain plus 2 of 4 of the following symptoms:

A

Altered bowel habits
Bloatedness
Worse after eating, relieved after defecation
Passage of mucus

121
Q

King’s College Hospital Criteria for liver transplantation

A 
pH < 7.3 24 hours after ingestion
OR
All of the following:
Protime > 100
Crea > 300
Grade III or IV encephalopathy
122
Q

Useful to discriminate between IBD and IBS.

A

Fecal calprotectin

123
Q

Drug of choice for nausea and emesis of metabolic cause (as in renal failure, hypocalcemia, drug-induced or toxin-induced)

A

Haloperidol

Levomepromazine

124
Q

Drug of choice for nausea and emesis on a patient who underwent radiotherapy

A

Ondansetron

Haloperidol

125
Q

Drug of choice for nausea and emesis on a patient who underwent chemotherapy

A

Ondansetron

Metoclopramide

126
Q

Drug of choice for nausea and emesis on a patient with conditions that cause raised intracranial pressure

A

Cyclizine

Dexamethasone

127
Q

Drug of choice for nausea and emesis on a patient who has bowel obstruction

A

Cyclizine
Ondansetron
HNBB
Octreotide

128
Q

Drug of choice for nausea and emesis on a patient who has delayed gastric emptying

A

Metoclopramide

Domperidone

129
Q

Drug of choice for nausea and emesis on a patient who has peripheral vertigo (BPPV, Meniere’s disease, vestibular neuronitis) with severe nausea or vomiting

A

Buccal prochlorperazine

PLABABLE 2.0 (33 decks)

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