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RACP 2022 Written > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which of the following is first line treatment for Hepatitis C in Australia?
A. Sofosbuvir + velpatasvir + voxilaprevir
B. Grazoprevir + elbasvir
C. Glecapravir + pibrentasvir
D. Ledipasvir + sofsbuvir

A

C. Glecapravir + pibrentasvir for 8-12 weeks (Maviret)

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2
Q

Which class of HCV drug is glecaprevir?

A

NS3/4A protease inhibitor

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3
Q

What class of drug is sofosbuvir?

A

Nucleoside (NS5B) polymerase inhibitor (in Epclusa - better in Adv Liver Disease - rather then Maviret)

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4
Q

What class of drug is voxilaprevir? When is it indicated?

A

NS3/4A protease inhibitor
Add to velpatasvir (NS5a inhbitor) + sofosbuvir (Nucleoside NS5B polymerase inhbitor) Epclusa* for refractory HCV - VOSEVR

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5
Q

What class of drug is Velpatasvir?

A

NS5a inhibitor

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6
Q

What class of drug is dasabuvir?

A

Non-nucleoside NS5B polymerase inhibitor

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7
Q

Lanafibranor may be useful in which condition?

A

peroxisome proliferator–activated receptor agonist that reduces ballooning and lobular inflammation in NASH

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8
Q

Which of the following biologics is not helpful in UC?
A. Vedolizumab
B. Tofacitnib
C. Secukinumab
D. Ozanimod

A

C. Secukinumab - anti IL-17a, used in ank spond and psoriatic arthritis

Vedolizumab = anti-integrin a4B7, Tofacitnib =JAK inhibitor, Ozanimod = S1P receptor modulator

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9
Q

Where is iron absorbed?

A

Duodenum

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10
Q

Where is calcium absorbed?

A

Duodenum

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11
Q

Where is B12 absorbed?

A

Terminal ileum

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12
Q

Where are bile salts absorbed?

A

Terminal ileum

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13
Q

Where is folate absorbed?

A

Duodenum

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14
Q

Which class of HCV drugs should not be used in decompensated liver disease?

A

NS3/4a protease inhibitors, due to raised drug levels in setting of hepatic failure

Drug classes ending with -evir (i.e. glecaprevir, voxilaprevir, grasoprevir)

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15
Q

Which coagulation factors are not made in the liver?

A

FVIII (endothelial cell production), FXIIIa (megakaryocytes)

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16
Q

Biopsy findings of primary sclerosing cholangitis

Associated lab and disorder?

A

Degeneration of small bile ducts with periductal Sclerosis/fibrosis
Onion skin pattern

p-ANCA, IBD (UC++)

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17
Q

Biopsy findings of primary biliary cholangitis (same as primary biliary cirrhosis)

Antibody?

A

Bile duct degeneration with periductular GRANULOMATOUS inflammation
“Florid” bile duct lesions

Anti-Mitochondrial antibody (sMall bile ducts)

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18
Q

Inhibitors of gastrin release

A

• Gastric pH <2
• Somatostatin
• Calcitonin
• Gastric inhibitory polypeptide (GIP)
• Glucagon
• Vasoactive inhibitory peptide (VIP).

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19
Q

Stimulators of gastrin release

A

L-Amino acids (i.e. phenylalanine, tryptophan, cysteine, tyrosine)
• Vagal stimulation
• Gastric distension
• Epinephrine (adrenaline)
• Calcium
• Acetylcholine

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20
Q

Biopsy findings of autoimmune hepatitis and assoicated antibodies?

A

lymphocytic piecemeal necrosis

ANA - antinuclear antibody
SMA - anti-smooth muscle
Anti- LKM
AMA - anti-mitochrondrial Ab

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21
Q

Anti-integrins with a role in IBD

A

Vedolizumab (a4B7)
Abrilumab (a4B7)
Etrolizumab (anti-B7)
Ontamalimab (MADCAM)

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22
Q

Jak inhibitors with a role in IBD

A

Filgotinib (JAK1)
Tofacitinib (in UC)
Upadacitnib

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23
Q

Treatment of primary biliary cholangitis

A

Ursodeoxycholic acid).

24
Q

What is Gilbert Syndrome

Treatment?

A

Autosomal recessive disorder of unconjugated hyperbilirubinemia due to mutation in UGT1A1

Causes episodes of jaundice

Generally no treatment needed - avoid irinotecan

25
Disorders associated with PBC
Sjogrens (most common) Autoimmune thyroiditis CREST RA
26
Treatment of eosinophilic colitis
Dietary modification (elimination) Steroids
27
Main antibodies associated with T2 AIH
Anti-liver/kidney microsomal-1 (anti-LKM-1) antibodies Anti-liver cytosol-1 (anti-LC1) antibodies
28
Main antibodies associated with T1 AIH
Anti-smooth muscle antibody (ASMA) ANA
29
Micronutrient deficiency causing high output cardiac failure
B1 - "wet beri beri" Dry beri beri = neurologic complications (i.e. convulsions, weakness, numbness, hyperreflexia)
30
PAS-positive macrophages on small bowel biopsy is representative of what?
Whipple's disease (Tropheryma whipplei)
31
Main deficiencies in SIBO
A, B12 (cobalamin consumption), K Folate is elevated due to increased bacterial production
32
What does a raised HPVG represent?
Raised HVPG (>5mmhg) = hepatic cause of portal HTN >10 = varices, >12 = variceal bleeding
33
Which hepatitis c genotype is elbasvir plus grazoprevir recommended for?
G1 and 4
34
Which hepatitis c genotype is sofusbavir plus ledapasvir recommended fro?
G1
35
Most specific antibody for AIH
Anti-SLA/LP
36
First line therapy for unresectable stage C HCC
Atezolizumab (anti-PL1) + bevacizumab
37
Transplant criteria in HCC
2-3 nodules all <3cm OR single lesion <5cm ECOG 0 No macrovascular invasion, regional nodal spread or distal mets
38
S/E of JAK inhibitors
VTE and herpes zoster - increased compareed with other biologics Best described for tofacitinib
39
Bareets esophagus - Intestinal metaplasia distal oesphage when to scope?
No dysplasia:" 3-5 years Low grade dysplasia 6-12 months High-grade dysplasia in the absence eradication therapy 3 months
40
Most Common long term complication liver transplantation?
Metabolic syndrome, 50% will develop.
41
Components of Child-Pugh
A albumin B bilirubin C coag D drain the asciites E encephalopathy
42
IBD extra intestinal dependant on disease?
oral ulcer erythema nodosum large join arthritis episcleritis
43
IBS extra intestinal independaent of GI disease
Primary sclerosing cholangitis Ank Spon Uveitis PYoderma gangrenosum Kidney stones gall stones
44
Ustekinumab target and disease?
IL-12 and IL-23 p40 subunit - Crohn's disease
45
Hormones that stimulate appetite
Ghrelin, AgRP, NPY
46
Most nutrients take place in jejunum where are these exceptions instead absorbed? Iron VIt B12 and bile salts Water/lipids Na Ca Frucotse
Iron - Duodenum Vit B12/Bile sats = terminal ileum Water/lipids passive diffusion all SI Na - active transport Ca - duodenum and upper small intestine. Frutose - faciliated diffusion
47
Common cause responsible to GERD?
Transient relaxations fo lower oesphageal sphincter GERD: p.w heartburn, endoscopy, Ambulatory pH monitoring. 4-8 weeks PPI at start.
48
Drugs cuasing hepatocellular picture:
paracetamol, ioniaside, valproate, phenytoin, statins, ETOH, amiodarone, methyldopa
49
Drugs causing cholestatic picture
Abx: Aug DF, erythromycin, flucloxacillin, methotrexate, amiodarone, sulphonyllureas, fibrates, chlorpromazine
50
What is SA-AG cut off and what are common causes < then vs > then?
>11 - cirrhosis cardiac failure, nephrotic syndrome <11 malignancy pancreatitis and tuberculosis
51
Causes of hypergastrinameia?
Gastrin, released from G cells in Antrum 1. prolonged PPI (most common) 2. Atrophic gastritis - pernicious anemia, H pylori 3. Vagotomy or small bowel resection 4. Gastrin secreting tumor (ZES) - Gastrinoma >1000 5. Renal Failure 6. HyperCa 7. Hyperlipidemia
52
HLA assoicated with Coeliac Disease
DQ2 and DQ8, strong negative predictive value. Useful to rule out
53
Which Liver Disease HCC Rare?
AIH (autoimmune hepatitis) primary billary cirrhosis (PBC) and Wilsons Disease
54
Wilsons Disease inheritance? enzyme defect? classic presentation? serum copper and ceruloplasmin? Treatment:
AUtosomal recessive disase enxyme ATP7B hepaitis, cirrhosisi and pyshciatric disorders high 24hr urine copper excretion low serum copper and low ceruloplasmin Tx: liver trientine and zine, just neuro zinc.
55
Enzyme target for AIH type II and antibody that predicts worse outcome?
Cyp450 2D6, Anti - LMK enzyme.

RACP 2022 Written (21 decks)

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