Gastroenterology

Question 1

Lynch syndrome (hereditary non-polyposis colorectal cancer HNPCC) associated cancers

Answer 1

Colorectal (predominantly right sided)
Endometrial (most common extra-colonic cancer)
Ovarian
Stomach
Genitourinary

Question 2

Lynch syndrome pathophysiology

Answer 2

Germline autosomal dominant mutation in one of the DNA mismatch repair
genes (MLH1, MSH2, MSH6, PMS2) or the EPCAM gene

Question 3

What degree of hepatic venous pressure gradient is considered clinically significant portal hypertension

Answer 3

≥10mmHg

Compensated cirrhosis
- 10 mmHg: development of varices and HCC, decompensation after surgery
for HCC
- 12 mmHg: variceal bleeding
- 16 mmHg: first clinical decompensation in patients with varices, mortality
Decompensated cirrhosis:
- 16 mmHg: variceal rebleeding, mortality
- 20 mmHg: failure to control bleeding in patients with active variceal
haemorrhage, low 1 year survival
- 22 mmHg: mortality in alcoholic cirrhosis and acute alcoholic hepatitis
- 30 mmHg: SBP

Question 4

IBD drugs - anti-TNF

Answer 4

Infliximab, adalimumab, golimumab, certolizumab pegol

Question 5

IBD drugs - JAK inhibitors

Answer 5

Tofacitinib, filgotinib

Question 6

Mechanism of ustekinumab

Answer 6

Anti-IL-12p40 - cytokine blockade

Question 7

Mechanism of vedolizumab

Answer 7

Anti-α4β7 - lymphocyte trafficking blockade