Gastroenterology

Question 1

vomiting
acid base sequence ?

Answer 1

Hypochloremic Hypokalaemic Metabolic Alkalosis

Question 2

raised ion gap metabolic acidosis ?

Answer 2

has to above 18

Question 3

signs of perforated peptic ulcer
Investigation ?

Answer 3

haematemesis - with coffee ground material
+ peritonitis
Investigations :
-> erect Chest X ray

Question 4

how do we calculate alcohol units

Answer 4

volume (ml) x ABV/1000

Question 5

which anti -emetic should you avoid in bowel obstruction

Answer 5

Metoclopramide
- it has pro kinetic properties and can stimulate bowel obstruction and ppt perforation !

Question 6

how do we treat a severe flare of UC?
inducing remission ?
sever relapses of over 2 exacerbations in the last year ?

Answer 6

IV corticosteroids
if no improvement after 72hrs , then add IV CICLOSPORIN or surgery

Inducing remission :
- Topical ASA (RECTAL)
- Oral ASA

Severe :
- oral azathioprine or Mercaptopurine to maintain remission

Question 7

Treatment for C.diff

Answer 7

1st episode :
- Oral Vancomycin
- Oral Fidaxomicin
- Oral Vanc + Fid

Recurrent within 12 weeks:
- ORAL FIDAXOMICIN

life threatening :
- Oral Vacomycin and IV Metronidazole

Question 8

Signs of pancreatic cancer
- DIAGNOSIS

Answer 8

painless jaundice
itch
fatty stools hard to flush

+ HIGH RES CT PANCREAS => CONFIRM DIAGNOSIS

Question 9

management of Crohn’s disease

Answer 9

Inducing remission:
- steroids

Mainiting remission:
- azathioprine or mercaptopurine

Question 10

Obesity associated with abnormal LFTS is indicative of —–

Answer 10

Non alcoholic fatty liver disease

Question 11

treatment of vatical haemorrhage

Answer 11

Terlipressin and prophylactic antibiotics before endoscopy

Question 12

ulcer better on Eating

Answer 12

Duodenal ulcer
abcDE -> D and E are friends :)

Question 13

paracetamol overdose liver screen ?

Answer 13

HIGH ALT
normal ALP
ALT/ALP ratio is high
=> Hepatocellular picture of liver disease

Question 14

Antibodies for auto immune hepatitis
- symptoms
- treatment

Answer 14

+ ANA
+ Anti -smooth muscle antibodies and raised IgG

In children :
+ Anti-LKM1

symptoms :
- acute hepatitis ( fever , jaundice )
- amenorrhoea

treatment is Steroids

Question 15

anaemia of chronic disease vs iron def anaemia

Answer 15

iron def : Decreased serum iron , ferritin (stores iron ) , and TIBC is high

Anemia of chronic disease : Decreased serum iron , Decreased or normal TIBC , Normal or increased Ferritin ( iron stores )

Question 16

T2DM + abnormal LFTS

Answer 16

NAFLD

Question 17

H pylori eradication ?

Answer 17

Lansoprazole + amoxicillin + clarithromycin
( metronidazole)

Question 18

dysphagia of food and liquid from the start

Answer 18

Achalasia

Question 19

mesenteric ischemia signs ?
symptoms ?

Answer 19

Triad of CVD, high lactate, soft but tender abdomen

+ due to embolism
+ sudden onset and sever like MI of bowel

urgent surgery is needed

Question 20

what is pellagra

Answer 20

deficiency of B3 (niacin )
+ dermatitis in sun exposed areas
+diarrhoea
+dementia
+ delusions
leads to death

Question 21

patient is being treated with co - amoxiclav and develops jaundice and raised ALP ? why ?

Answer 21

Co-amoxiclav causes cholestasis

Question 22

Carcinoid syndrome signs
investigation
management

Answer 22

FLUSHING , diarrhoea , bronchospasm, low bP,

investigations :
Urinary 5-HIAA

Management
somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help

Question 23

how can you differentiate from an Upper GI bleed or a Lower GI bleed ?

Answer 23

UREA IS RAISED IN UGIB

Question 24

Haemochromatosis - test and screening

Answer 24

transferrin saturation is the most useful marker
and ferritin