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FCRAP > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Haemochromatosis - inheritance, what gene

A

Autosomal recessive
HFE gene - C282Y - most common
H63D mutation

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2
Q

Haemochromatosis - what features

A 
Arthritis
Diabetes
Cardiomyopathy
Bronzed skin
Liver failure
Hypogonadism
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3
Q

Haemochromatosis - reversible organ damage

A

Pigmented skin

Cardiomyopathy

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4
Q

Haemochromatosis - irreversible organ damage

A

Arthritis, Diabetes, Liver disease, Hypogonadism

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5
Q

You suspect a patient has haemochromatosis - what test would you do

A

Screening: Transferrin saturation >50%

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6
Q

A man has haemochromatosis - what test would you do

A

Known mutations: HFE (or other) gene testing = C282Y gene test

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7
Q

What test would you order on liver histology to look for iron accumulation?

A

Perl’s stain

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8
Q

What is the greatest risk factor for isoniazid induced hepatitis?

A

Increasing age (suggest not treating for latent TB unless reactivation risk is high)

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9
Q

UC bowel surveillance

A 
high risk: annual
stricture in past 5 years
extensive mod /evere colitis
dysplasia in past 5 years
PSC or transplant for same
FHx CRC < 50yo
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10
Q

Primary biliary cirrhosis

A 
cholestatic liver disease
raised ALP
ALT / AST > 5 times ULN
AMA +ve 95% pts
ANA +ve
elevated IgG
normal USS
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11
Q

What are the contraindications to liver biopsy

A 
anaemia < 100
INR > 1.4
plts < 100
hydatid cyst with ecchinococcus granulosus (anaphylaxis if punctured)
bile duct obstruction
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12
Q

SE of Boceprevir

A

Anaemia
Direct antiviral against Hep C (esp Genotype 1)
Altered taste

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13
Q

SE of Telaprevir

A

Rash - bad, could be hospitalised

Direct antiviral against Hep C (esp Genotype 1)

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14
Q

Extra intestinal manifestations of IBD in ACTIVE disease

A

Erythema nodosum
Oral ulcers
Arthritis
Episcleritis

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15
Q

Extra intestinal manifestation of IBD independent of active disease (in INACTIVE disease)

A 
PSC
Ank spond
Uveitis
Pyoderma gangrenousum
Kidney stones, gall stones
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16
Q

Rx of eosinophilic oesophagitis

A

Topical steroids
Elimination - 6 foods - milk, egg, wheat, soy, peanuts/treenuts, seafood
Consider dilation (may get mucosal tearing)

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17
Q

Components of blatchford score for GI bleeding

A

BUN
Hb
BP
Others: Cardiac failure, hepatic failure, syncope, malaena

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18
Q

Dx of pernicious anaemia

A

intrinsic factor antibodies 100% specific; 50-70% sensitive

elevated fasting serum gastrin level is sensitive but not specific

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19
Q

Hepatic vein pressure gradient HVPG

A

> 12 indicates cirrhosis, ascites devt

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20
Q

H Pylori

A

a/w ulcers, MALT, gastric cancer

not a/w GORD

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21
Q

Drug induced liver disease - hepatocellular

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
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22
Q

Drug induced liver disease - cholestatic

A

oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

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23
Q

Drug induced liver disease - cirrhosis

A

methotrexate
methyldopa
amiodarone

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24
Q

painful red eye

A

dilated pupil - glaucoma

small pupil - uveitis

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25
Q

alpha 1 antitrypsin

A 
alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow
normal = PiMM
homozygous PiSS (50% normal A1AT levels)
homozygous PiZZ (10% normal A1AT levels)
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26
Q

autoimmune hepatitis

A

Features
may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
type 1: ANA/Smooth muscle antibodies, raised IgG levels; respond well to steroids
type 2: LKM (liver kidney microsomal) Abs severe course

liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

27
Q

coeliac diagnosis

A

anti endomysial IgA near 100% sens, spec
anti gliadin IgG, IgA 70-90% sens, spec
HLA DQ2 DQ8 universal

28
Q

SAAG

A

> 11 indicates portal HT
protein > 3g/dL is exudate - heart failure
< 3g/dL is transudate - cirrhosis

29
Q

cryoglobulins

A

type 1: monoclonal a/w lymphoma, hyperviscosity, normal complement levels
type 2: mixed monoclonal; Ab to Fc of IgG (Rh F), HCV, lymphoproflierative disorders, rheumatic disease low complement
type 3: mixed polyclonal HCV, Rh D, low complement
2 + 3: purpura, GN, peripheral neuropathy
Rx; pred, cyclo

30
Q

CAG PAI

A

Virulence factor for H. Pylori

PAI = pathogenicity island

31
Q

H. Pylori

A

Rx: PPI, clarithromycin, amoxicillin (metro if allergy) 7/7
urease breath test 4/52 post treatment completion PPI may cause FN result
clarithro resistance: levofloxacin, bismuth

32
Q

amoxycillin DILI

A

cholestasis

33
Q

methotrexate DILI

A

transaminitis

34
Q

CRC kras mutation

A

40% CRC

predicts lack of response to EGFR inhibitors (cetuximab)

35
Q

Lynch Syndrome

A

BRAF mutation - only in sporadic tumours

36
Q

anti TNF agents in IBD indications

A

fisulising crohns
active crohns: induction / maintenance
salvage therapy in UC: fulminant and other treatments failed; not for UC maintenance (ciclo just as good)

37
Q

paracetamol overdose

A

activated charcoal only in first 2 hours

cimetidine inhibits 2E1 (protective); chronic alcohol induces 2E1 (worse)

38
Q

coeliac disease HLA type

A

HLA DQ2 or DQ8

39
Q

Whipples disease

A

Tropheryma whipplei
worm
eye, CNS, lungs, heart, joints
diarrhoea, LOW, fever, malaise, arthralgias, cognitive impairment, ataxia, eye signs

40
Q

autoimmune enteropathy

A

looks like coeliac disease but does not respond to exclusion diet

41
Q

UGI bleed

A

restart aspirin if for secondary prevention (use PPI cover)

42
Q

HBV

A

treat if DNA load > 106IU/ml at any time during the pregnancy
Precore mutant: HBeAg negative but high viral load
HDV is lamivudine resistant

43
Q

histamine - which cell

A

ECL (enterochromaffin like) cells

most important paracrine stimulator of acid release

44
Q

gastrin

A

G cells

stimulates histamine secretion from ECL cells which stimulates acid secretion from parietal cells

45
Q

somatostatin

A

D cells - inhibit gastric acid secretion
(direct action on parietal cells and decreases histamine and gastrin release too)
released in response to low pH

46
Q

intrinsic factor

A

parietal cells

47
Q

acetylcholine

A

directly stimulates parietal cells to secrete gastric acid

48
Q

ALT: AST

A

AST > ALT - alcoholic liver disease, AI liver disease

ALT > AST - NAFLD

49
Q

Maddreys discriminant function

A

BI (bili + PT above control) X 4.6

> 32 indicates need for pred for 4/52

50
Q

PBC

A

anti mitochondrial Abs 90%

51
Q

HCC surveillance

A 
6 monthly USS, alpha fetoprotein
cirrhotics
HBsAg +ve Asian male > 40yo; female > 50yo
African male > 20yo; female > 50yo
FHx HCC
52
Q

do not recur post liver transplant

A

wilsons disease

alpha 1 antitrypsin

53
Q

abnormality in Wilsons disease

A 
neuro / liver + haemolysis
auto recessive
ATP 7B mutation
Rx: penicillamine, zinc, trientine
tetrathiomolybdate for neuro sxs
54
Q

crohns disease

A

NOD2 card variant predicts severe disease

ASCA anti saccharomyces ceresvisiae in 70%

55
Q

azathioprine active metabolite

A

6TGN

56
Q

neuroendocrine tumours

A

chromogranin A positive in 90%

octreoscan

57
Q

PPI side effects

A

osteoporosis increased; incl hip # in women
decreased iron absorption
increased c diff
increased CAP

58
Q

Zollinger Ellison

A

gastrinoma in pancreas / duodenum
Dx: secretin stimulation test
octreoscan

59
Q

nutrient absorption

A

mostly jejunum
calcium - proximal duodenum
B12, bile - terminal ileum
Fe - duodenum

60
Q

Bloody diarrhoea

A

E Coli 0157:H7, salmonella, shigella, campylobacter

61
Q

diarrhoea < 6/24

A

staph aureus / bacillus cereus

62
Q

HVPG

A 
hepatic vein pressure gradient
= WHVP - FHVP 
wedged hepativ vein pressure minus free hepatic vein pressure
normal 1-5; clin sigt portal HT > 10
risk bleeds > 12
63
Q

Gilbert

A

defect in bilirubin conjugation due to defect in UGT1A1

64
Q

Wilsons

A

cannot put copper into caeruloplasmin
low caeruloplasmin, copper accumulates in bile
auto rec ATP7B

FCRAP (19 decks)

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