Gastroenterology

Question 1

Ulcerative colitis Mx - Severe

Answer 1

> 6 stools/ day + systemic features (pyrexia, tachycardia, anaemia)

Admission for IV steroids

Question 1

Ulcerative colitis Mx - Mild to Mod

Answer 1

4-6 stools/ day no systemic upset

1st - Topical (rectal) aminosalicylate - Mesalazine
2nd - If no improvement after 4 weeks to add PO Mesalazine

Question 2

Ulcerative colitis Mx following severe relapse or >2 exacerbations/ year

Answer 2

PO Azathioprine
PO mercaptopurine

Question 3

C Diff Mx

Answer 3

1st - PO Vanc 10/7
2nd - PO Fidaxomicin
3rd - PO Vanc +/- IV Metro

Question 4

Drugs causing Cholestasis (raised BR, ALP)

Answer 4

Flucloxacillin, Co-Amox, Erythromycin
COCP
Anabolic steroids
Gliclazide
Prochlorperazine

Question 5

Drugs causes Hepatitis (raised ALT)

Answer 5

Paracetmol
Sodium valproate
Anti TB meds
Statins
Alcohol
Amiodarone
Methyldopa
Nitrofurantoin

Question 6

Drugs causing Liver Cirrhosis

Answer 6

methotrexate
methyldopa
amiodarone

Question 7

Hemochromatosis monitoring

Answer 7

Ferritin and Transferrin saturation

Question 8

PPI side effects

Answer 8

HypoMag
HypoNat
Osteoporosis - risk of fractures
Microscopic colitis
C. Diff

Question 9

Variceal Bleeding prophylaxis in community

Answer 9

Propranolol

Question 10

Hepatitis B immunisation biochemistry

Answer 10

Anti Hep B POS
All other negative

Question 11

Current Hepatitis B infection biochemistry

Answer 11

Hep B surface Antigen (HBsAg) Pos

Question 12

Previous Hepatitis B infection biochemistry, NOT a carrier

Answer 12

Anti-HBc POS
HBsAg neg
Anti-HBs POS

Question 13

Previous Hepatitis B infection biochemistry, current carrier

Answer 13

Anti-HBc POS
HBsAg POS

Question 14

Alcohol dependence screening tool

Answer 14

AUDIT

Question 15

Screening for hemochromatosis

Answer 15

general population - Transferrin saturation
family members +ve - HFE genetic testing

Question 16

Haemochromotosis biochemistry

Answer 16

transferrin sats raised
ferritin raised
TIBC low

Question 17

Coeliac disease in infants Fx

Answer 17

chronic diarrhoea
bloating
failure to thrive

Question 18

Waterlow score is for…

Answer 18

Bed sores

Question 19

MUST score is for…

Answer 19

Malnutrition

Question 20

H Pylori Ix

Answer 20

1st - Stool ANITGEN or Urea breath test

Must be off (before testing):
Abx 4 for weeks
PPI 2 for weeks

Question 21

Causes of C Diff

Answer 21

Clindamycin
Cefalexin
Broad spec Abx - Co-Amox
PPIs

Question 22

H Pylori Mx

Answer 22

PPI
Clarithromycin
Amoxicillin or Metronidazole

Question 23

Risk factors for Crohns disease (relapse)

Answer 23

Smoking
COCP
NSAIDs
Appendicectomy (soon after, risk reduces after 5 years)
Infective gastroenteritis

Question 24

H Pylori association

Answer 24

Peptic ulcer disease (duodenal > gastric) gastric ca B cell lymphoma MALT

Question 25

2WW oesophageal ca criteria

Answer 25

dysphagia >55 + weight loss + upper abdo pain reflux dyspepsia

Question 26

Ulcerative colitis remission medication

Answer 26

1st - Top (rectal) aminosalicylate +/- PO aminosalicylate eg mesalazine

Question 27

Non urgent referral for endoscopy

Answer 27

haematemesis (stable) >55 AND treatment resistant dyspepsia upper abdo pain and anaemia raised platelet count with GI symptoms

Question 28

IBS Mx

Answer 28

1st - anti spasmodics - Hyoscine/ mebeverine; loperamide for diarrhoea and laxatives for constipation. Lactulose should be avoided. 2nd - TCA (amitryptline) 3rd - SSRI 4th Linaclotide

Question 29

UGIB initial scoring system

Answer 29

Glasgow Blatchford - stratifies risk of UGIB Rockall - requires endoscopy results, therefore not initial screening tool - for prognosis after diagnosis