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medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

what is the most common liver cancer?

A

hepatocellular carcinoma

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2
Q

what is a serious complication of ulcerative colitis?

A

toxic megacolon

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3
Q

what is the presentation and treatment of toxic megacolon?

A

tachycardia, fever, hypotension, and dilatation usually of the transverse colon exceeding 6cm
treatment: IV corticosteroids, LMWH, IV fluids and reassess after 72 hours for surgery

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4
Q

what is Zollinger-Ellison syndrome?

A

it is a gastrinoma which is suggested by several peptic ulcers in unusual places in the absence of H. pylori

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5
Q

a 70 year old man presents to the GP with sudden-onset dysphagia during a meal
what is the diagnosis?

A

impacted food bolus

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6
Q

a 75 year old man presents to the GP with a short history of progressive dysphagia and weight loss
what is the diagnosis?

A

oesophageal carcinoma

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7
Q

a 27 year old woman presents to the GP with intermittent dysphagia to both solids and liquids a/w retrosternal discomfort which seems to be getting slowly worse
what is the diagnosis?

A

achalasia

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8
Q

a 57 year old man has a 10 year history of reflux symptoms. He presents to the GP after noticing that solid foods occasionally stick retrosternally
what is the diagnosis?

A

benign stricture - this is caused by the fibrosis

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9
Q

which medication should be given in the risk of a variceal bleed?

A

terlipressin - causes vasoconstriction which decreases portal venous inflow and so decreases the portal pressure

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10
Q

what are the main causes of peptic ulcers?

A

H.pylori and NSAIDs and aspirin

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11
Q

what is naltrexone used for?

A

symptomatic relief of pruritis in patients with primary biliary cholangitis

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12
Q

what is Rovsing sign and what does it indicate?

A

pressure applied to the left lower quadrant of the abdomen produces pain in the lower right quadrant
appendicitis

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13
Q

which meds should be prescribed to reduce the risk of variceal bleeding in a patient with known alcoholic liver disease?

A

propanolol or nadolol - non-specific beta blockers reduce portal inflow

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14
Q

which condition has a corkscrew appearance of barium swallow?

A

oesophageal spasm

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15
Q

what are the features of Plummer-Vinson syndrome?

A

post-cricoid web, iron def anaemia and dysphagia

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16
Q

which condition has serum ceruloplasmin as an investigation?

A

Wilson’s disease

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17
Q

which diuretic should be used for ascites and ankle oedema in liver cirrhosis?

A

spironolactone

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18
Q

which condition is a/w CA 19-9?

A

pancreatic carcinoma

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19
Q

which condition is a/w MEN-1?

A

Zollinger-Ellison syndrome

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20
Q

is amylase raised in chronic pancreatitis? which other investigation indicates chronic pancreatitis?

A

it is not normally raised

a low faecal elastase supports the diagnosis of chronic pancreatitis

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21
Q

which condition is a/w subacute sclerosing panencephalitis?

A

measles - has signs of myoclonus, dementia, visual disturbances etc.

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22
Q

what is primary sclerosing cholangitis and what is present?

A

an autoimmune disease that is most common in men
it results in inflammation and fibrosis of the bile ducts
it is characterised by the presence of p-ANCA and is also a/w ASMA (anti-smooth muscle antibody)

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23
Q

which condition has a positive test for anti-mitochondrial antibodies?

A

primary biliary cholangitis

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24
Q

what is Wernicke’s encephalopathy and what are the symptoms?

A

acute encephalopathy secondary to thiamine deficiency and B1 deficiency
symptoms: nystagmus, ataxia, ophthalmoplegia

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25
Q

which hernia presents as:
80 year old woman with a 2 day history of vomiting and painful lump in right groin which is below and lateral to the pubic tubercle?

A

femoral hernia

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26
Q

which hernia presents as:
78 year old woman with 2 day history of vomiting, on exam there is a subtle fullness in the right groin and Howship-Romberg sign is positive?

A

obturator hernia

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27
Q

which hernia presents as:
45 year old woman with a midline epigastric reducible lump. PMH = perforated duodenal ulcer 5 years ago which was repaired as an emergency open operation complicated by a post-op wound infection?

A

incisional hernia

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28
Q

which hernia presents as:
25 year old builder with a reducible lump in the right groin above and medial to the pubic tubercle. During surgical repair, the defect is seen lateral to the inferior epigastric artery?

A

indirect inguinal hernia

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29
Q

when should primary sclerosing cholangitis be suspected?

A

an isolated ALP raise in a patient with ulcerative colitis

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30
Q

which Abx has MRSA coverage?

A

vancomycin

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31
Q

a 33 year old woman presents with severe abdo pain radiating to the back. she is shocked and hyperventilating. there is no free gas on X-ray. an opacity is seen at L1 vertebrae
what is the diagnosis?

A

pancreatitis due to gallstones

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32
Q

a 57 year old smoker presents with epigastric pain and sweating and is vomiting clear fluid. he has a pulse of 58bpm and a high JVP
what is the diagnosis?

A

MI due to right-sided heart failure

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33
Q

a 47 year old woman presents with intermittent epigastric pain and vomiting. when present the pain may last for hours. she has mild epigastric pain and right upper quadrant tenderness. bowel sounds are present
what is the diagnosis?

A

biliary colic

34
Q

an 83 year old man presents with collapse. he is not tachycardic but has a postural drop in BP. he also complains of mild epigastric discomfort. you note he also has arthritis and hypertension
what is the diagnosis?

A

bleeding peptic ulcer

arthritis = NSAIDs which increase risk of peptic ulcers

35
Q

what is Murphy’s sign and what is it related to?

A

pain on palpation of right upper quadrant when inspiring

acute cholecystitis

36
Q

which organ is most likely to be enlarged with oesophageal varices?

A

spleen - portal hypertension causes oesophageal varices to burst

37
Q

how does caecal carcinoma present?

A

often presents in an insidious way with microcytic anaemia, weight loss and sometimes an ache or palpable mass in the right iliac fossa

38
Q

a 76 year old male presents with acute abdo pain and an abdo X-ray shows coffee-bean sign
what is the diagnosis?

A

sigmoid volvulus

39
Q

an 82 year old woman presents with a distended abdomen. X-ray shows gross faecal loading in the colon and gas in the small bowel. the rectum is empty
what is the diagnosis?

A

sigmoid carcinoma

40
Q

an elevation in which molecule can lead to dyspepsia as a result of peptic ulcer disease?

A

elevated serum calcium (hypercalcaemia) leads to excess gastric acid secretion, all as a result of primary hyperparathyroidism

41
Q

what is the most common cause of portal hypertension?

A

liver cirrhosis

42
Q

which of these is a RF for gastric cancer:

H. pylori or NSAIDs?

A

H.pylori!

NSAIDs actually protect against gastric cancer

43
Q

what are the most common aminosalicyaltes used in UC? what are the side effects?

A

mesalazine and sulfsalazine

diarrhoea, vomiting, abdo pain and hypersensitivity

44
Q

what is a serious complication of using infliximab?

A

can cause reactivation of TB and hepatitis B

45
Q

what is Budd-Chiari syndrome a/w?

A

pregnancy and being post-partum

it results in hepatosplenomegaly and ascites

46
Q

which antibodies are present in autoimmune liver disease?

A

anti-smooth muscle antibodies (ASMA)

47
Q

does ureteric colic or peritonitis have reduced pain when lying still?

A

peritonitis

48
Q

what is the defining difference with jaundice that is due to haemolytic anaemia?

A

it gives rise to pre-hepatic jaundice

the colours of urine and stools remain unchanged

49
Q

what colour are urine and stools with malaria?

A

normal

50
Q

what is Meckel’s diveritculum?

A

most common congenital abnormality of the GI tract
most commonly the small intestine, ileum
it is caused by a failure of closure of the vitelline duct

51
Q

what is the presentation of Meckel’s diverticulum?

A

normal asymptomatic

presents with bright red per rectum bleeding, constipation and usually in a child <2 years old

52
Q

which 3 factors inhibit and stimulate gastric acid secretion?

A

stimulated: acetylcholine, gastrin and histamine
inhibit: somatostatin, secretin and cholecystokinin

53
Q

which ulcer is worse before meals?

A

duodenal

54
Q

what is the classic presentation of acute diverticulitis?

A

left iliac fossa pain and tenderness, vomiting and pyrexia

55
Q

what is the treatment of H. pylori?

A

amoxicillin, clarithromycin and omeprazole

56
Q

which is for diarrhoea and constipation: senna and loperamide?

A

senna is for constipation

loperamide is for non-infectious diarrhoea

57
Q

which organism is associated with IV drug user infective endocarditis?

A

staph aureus

58
Q

which organism is a/w colorectal cancer and infective endocarditis?

A

strep bovis

59
Q

which organism is a/w prosthetic valve infective endocarditis?

A

staph epidermis

60
Q

what is the finding on small bowel biopsy in coeliac?

A

villous atrophy and crypt hyperplasia

61
Q

a 26 year old man of African origin has acute onset of right upper quadrant pain. abdo US reveals a dilated gall bladder with a thickened wall filled with calculi. post op the gall bladder was found to have several multi-faceted, dark, greenish-black pigments. what is the underlying condition?

A

sickle cell disease

62
Q

what is the following condition:

symptomatic anaemia, chronic diarrhoea, glossitis with decreased B12 and increased folate?

A

small intestinal bowel overgrowth

63
Q

which obstruction has air-fluid obstruction?

A

small bowel

64
Q

what is the most common cause of viral myocarditis?

A

Coxsackie B virus

65
Q

what is the 1st line investigation to identify a perforated peptic ulcer?

A

erect chest X-ray: will show air under the diaphragm (pneumoperitoneum)

66
Q

what are the treatments of primary biliary cholangitis?

A

liver transplant

ursodeoxycholic acid: reduces rate of liver failure progression

67
Q

what is the 1st line treatment of an aphthous ulcer?

A

topical steroids

68
Q

which investigation is best for finding out if B12 def is due to pernicious anaemia?

A

intrinsic factor antibodies

69
Q

which autoantibodies in ulcerative colitis with primary sclerosing cholangitis?

A

p-ANCA

70
Q

a 72 year old woman presents with RUQ pain and intermittent fevers. an abdo US shows a distended, thick-walled gall bladder, with a large septated lesion extending into the liver parenchyma. gas bubbles are also seen. what is the diagnosis?

A

liver abscess

71
Q

for which bowel obstruction is vomiting before or after constipation?

A

small bowel: constipation after vomiting

large bowel: vomiting later on

72
Q

what are high-pitched bowel sounds indicative of?

A

mechanical bowel obstruction

73
Q

what are absent bowel sounds indicative of?

A

functional obstruction (pseudo-obstruction)

74
Q

a 65 year old man complains of constipation, low mood, lower back pain that prevents him from sleeping, fatigue and thirst. he has bony tenderness over his lumbar spine. what is the likely cause for the constipation?

A

hypercalcaemia

75
Q

a 32 year old man from a multinational company returns from an attachment in the Far East feeling very unwell and seeks medical attention. he has suffered from chronic diarrhoea, weight loss and tiredness and fevers. over the past few weeks he has developed chronic leg oedema. labs show macrocytic anaemia, high urine and low albumin. jejunal biopsy shows mild villous atrophy and mononuclear cell infiltration of crypts. what is the diagnosis?

A

tropical sprue - this mimics coeliac disease

76
Q

a 40 year old woman presents with increasing jaundice, pruritis and arthralgia. on exam she has hepatomegaly, clubbing xanthelasmata and hyperpigmentation. what is the diagnosis and most appropriate investigation?

A

AMA - for primary biliary cholangitis

77
Q

a 21 year old man presents with a 2 week history of jaundice, preceded by 3 weeks of anorexia, fever and arthralgia. he has a tender, enlarged liver. what is the most likely diagnosis?

A

hepatitis A

78
Q

a 50 year old man presents with mild jaundice, knee pain and impotence. on exam, he appears hyperpigmented and has an enlarged liver. his cap blood glucose is 10. what is the diagnosis and appropriate investigation?

A

haemochromatosis - ferritin/iron studies

79
Q

a 28 year old man has a 6 month history of increasing jaundice. he also has breathlessness on exercise and recurrent chest infections. lung functions show a predominantly obstructive picture. what is the most likely diagnosis?

A

alpha-1 anti-trypsin deficiency

80
Q

what is the treatment of Wilson’s disease?

A

penicillamine

81
Q

which vessel is a/w ischaemic colitis?

A

the marginal artery

82
Q

which symptoms are suggestive of hereditary haemochromatosis?

A

diabetes, joint pain and jaundice

medicine (15 decks)

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