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MRCP > Gastroenterology > Flashcards

Gastroenterology Flashcards

MRCP

1
Q

GERD

GERD increase risk of which cancer?

A

Adenocarcinoma after transform to Barret

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2
Q

gerd

Screening interval of barret?

A

1) No dysplasia: every 3-5 years
2) Low grade dysplasia: every year
3) High grade: every 3 months + RFA

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3
Q

What are the different types of SBP?

A

Neutrophil > 250 + positive or negative culture
Neutrophil < 250 + positive culture

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4
Q

Preferred agent for SBP?

A

Cefotaxime.
Other: CTX can be used

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5
Q

What can decrease the mortality if added in SBP management?

A

Day 1 albumin 1.5 g per Kg and Day 3 1g per Kg

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6
Q

Indications for 1ry ppx in SBP?

A

1) GI bleeding with cirrhosis: give ppx CTX Or norfloxacin for 7 days or
2) Ascites + renal or heaptic insuffiecency

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7
Q

Next step if patient had neutrophil < 250 + positive culture?

A

Symptomatic? treat
Asymptomatic? usually resolve by its own. next step is to repeat paracentesis within 48 hours

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8
Q

Mention three Non-selelctive BB used in variceal bleed ppx?

A

NPC
Nadolol, propranolol, Carvidelol.

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9
Q

Most significant risk factor for anal cancer?

A

HPV infection (16 and 18)
Other risk factors:
- MSM, Smoking, pelvic CIN

It is more common in females 2 to 1

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10
Q

Most common type of anal cancer?

A

SCC

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11
Q

Patient uses pentamidine for PJP Developed abdominal pain. What is the possible complication?

A

Acute pancreatitis
Other medications:
- Thiazide, Valproic acid, Azathioprine, mesalazine, didanoside.

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12
Q

Patient with Crohn’s disease and Hx of pancreatitis. You decided to start mesalazine or Sulfasalazine. Which one you will avoid?

A

Both will cause acute pancreatitis but mesalazine has 7X risk in comparison to sulfasalazine

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13
Q

CCK action?
Produced from?

A

GB contraction, from upper part of S. Intestine

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14
Q

Which cell produce CCK?

A

I cells

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15
Q

What are the components of MELD-Na?

A
  • You have 2 labs related to liver + 2 labs related to RFT
    Na 2) Cr 3) Bilirubin. 4) INR
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16
Q

What does MELD-Na tells us?

A

1) 90 D’s mortality
2) Stratify the patient on transplant list

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17
Q

What are the component of child-pugh?

A

3 labs + 2 pic
INR, Bili, Albumin and ascites + HE

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18
Q

Management of Variceal bleed after ABC?

A

1) Terlipressin “preferred over octreotide:
2) Endoscopic variceal ligation “preferred over sclerotherapy”
3) Antibiotic “FLQ”

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19
Q

Next step if ligation failed in variceal bleed?

A

Blakemore tube
if failed go for TIPS

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20
Q

Options for primary prophylaxis against VB in cirrhotic patient?

A

Non-selective BB (NPC)
Nadolol
Propranolol
Carvidelol
Or
Endoscopic ligation: used in larger vessels

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21
Q

Risk factors for variceal bleed

A

1) Cirrhosis severity.
2) Tense ascites.
3) > 5 mm vessel.
4) Red wale sign,
5) HVPW > 12

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22
Q

MOA of terlipressin?

A

Vasopressin analogue causes splanchnic vasoconstriction

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23
Q

Octreotide MOA?

A

somatostatin analogue

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24
Q

Colon cancer

Most common type of polyp?

A

Hyperplastic

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25
Q

Most common pre-malignant type of polyp?

A

Adenamotous

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26
Q

What are the types of benign polyp?

A

1) Hyperplastic polyp: no risk of malignancy.
2) Juvenile polyp: solitary polyp (disorganized hamartouma)
3) Juvenile polyposis: 100’s of polyp in colon. (Increase risk of colon, gastric, pancreas cancer)

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27
Q

What is the most common inherited type of colon cancer?

A

Lynch syndrome (Autosomal dominant)

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28
Q

Most common genes involved in Lynch syndrome?

A

MSH2, MLH1
DNA Mismatch lead to microsattalite unstability

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29
Q

What criteria used for Lynch syndrome?

A

Amesterdam
1) At least three family member with colon Cx.
2) At least one of them diagnosed at age < 50
3) Cases span in at least 2 generations

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30
Q

Which syndrome associated with APC gene mutation?

A

Familial adenomatousis polyposis (APS)
- AD, Chromosome 7
- 100’s of polys at age of 30-40

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31
Q

FAP has riks for what type of cancer?

A

Duedenum
Note: Gardner is a subtype of FAP has risk of:
Skull, mandible, retina, thyroid cancer and epidermoid cyst on the skin

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32
Q
A
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33
Q

Known case of UC + High ALP. How to confirm the diagnosis?

A

This is PSC
MRCP or ECRP. shows multiple beaded bile structure pattern.
If unclear?? liver biopsy (onion skin shape)

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34
Q

Antibody associated with PSC?

A

P-ANCA

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35
Q

Next step after diagnosing PSC?

A

Colonoscopy

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36
Q

Female 40, itching, jaundice, and dry eyes?

A

PBC.
+ AMA
+ MC autoimmune disease associaton is sjogren.

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37
Q

Liver biopsy shows flouride duct lesion?

A

PBC

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38
Q

Patient with dysphagia for l + S for 3 months + CXR shows air-fluid level

A

Achalasia.
CXR shows: Retrocardiac Air-fluid level + wide mediastinum

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39
Q

familial adenomatous polyposis mode of inheritance + chromosome involved

A

Chromosome 5 + AD
Notes:
- Both lynch syndrome and FAP Are AD
- Lynch syndrome is the most common inherited cause for colon cancer

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40
Q

Second most common cancer involved with FAP after colon cancer?

A

Endometrial cancer

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41
Q

Crypt abcess seen in?

A

UC

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42
Q

Goblet cell depletion seen in?

A

UC

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43
Q

ulceration mimic pseudopolyp. (Which IBD?

A

uc

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44
Q

Hepatitis

Type of HBV? DNA or RNA?

A

All Hepaitits viruses are RNA except HBV (DNA)

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45
Q

Interpretation:
Hbsag negative and Hbsab positive, Hbc negative?

A

Immunization. If he has previous infection core will be positive

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46
Q

What is the first Ag appear after hepatitis infection?

A

HbsAg
- If positive for 6 months this is acute
- If positive for more than 6 months this is chronic infection

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47
Q

(Watery Diarrhea, Hypokalemia, Achlorhydria

A

VIPOMA
Most of the tumors appear from the pancreas

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48
Q

Hepatitis

Risk of infection by needly stick injury

A

HBV: 0.3 % HCV: 3 % HIV: 30 %

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49
Q

Hepatitis

4 INDICATIONS TO TREAT HBV infection

A

as the pic

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50
Q

biliary diseases

Which immunoglobulin will be high in PBC?

A
  • IgM
  • AMA M2 type (highly specific)
    Note:
  • IgA seen in celiac and Alcoholic liver disease
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51
Q

biliary

Antibodies associated with PSC?

A

P-ANCA

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52
Q

Mention three medication can cause high Triglyceride

A

Cyclosporine, estrogen and steroid.

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53
Q

liver abscess

Most common cause of pyogenic liver abscess

A

Adult: E coli
Children: Staph aureus

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54
Q

live abscess

Managemnet pf pyogenic liver abscess

A

Amoxicillin + Cipro + metro
If amoxi allergy:
Cipro and clinda

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55
Q

Esophagus

Criteria of esonophilic esophagitis diagnosis

A

more than 15 hpf esonophil in Bx
trial of PPI
Exclusion of other esonophilia causes

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56
Q

nutrition

Which option has highest calori content
Butter, rice, red meat, white bread, Pasta

A

Butter (fat has the highest calories per gram)

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57
Q

Nutrition

Electrolytes in re-feeding synrome

A

All low (K, Mg, PO)

While in TLS (High K, PO, Low Ca)

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58
Q

Parasitology

Tipworm causes anal itching and outbreaks.
Name of the warm is? management?

A

Enterobius vermicularis
Treat with one dose of mebendazole

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59
Q

Worms

What nematode causes IDA and GI bleed after penetration of the skin?

A

Necator (Strawberry nectar juice on the beach)

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60
Q

What worm can cause esonophilic lung disease?

A

Ascaris

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61
Q

Young male have pshycosis, Hx of ingestion uncooked pork. CT:

A

Tinea solium neurocysticercosis. Swiss cheese appearance

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62
Q

Liver

Mode of inheritance of hemochromatosis?

A

AR Chromosome 6

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63
Q

T\F arthopathy in hemochromatosis is irreversible

A

True. The only reversibly features are
dilated CMP + Skin pigmentation

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64
Q

GI bleed

High BUN level suggest Upper or LGI bleeding

A
  • High BUN suggest UGIB
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65
Q

Management of alcoholic ketoacidosis?

A

Thiamine and NS
To avoid Wernicke encephalopathy or Korsakoff psychosis.

66
Q

Hepatology

INR higher than .. is CI for liver biopsy

A

1.4

67
Q

Hepatology

Mention 4 medication causes cholestatic liver disease

A

1) Metabolic diseases: Fibrate + SFU
2) Antibiotics: Except NFU And anti-TB
3) Steroids

68
Q

Which one is better to diagnose acute pancreatitis. Amylase or lipase?

A

Lipase
1) Higher Sp and Sn.
2) Longer half-life “can detect late pancreatitsi presentation > 24 h)

69
Q

First line management of isolated peri-anal disease in Crohns

A

Metronidazole

70
Q

Management option for complex peri-anal fistula in crohns disease

A

Seton placement

71
Q

Way of transmission of C difficile

A

Fecal-oral by ingestion of spores (not toxins)

72
Q

Management option for first-time C difficile infection

A

Oral vancomycin for 10 days.

73
Q

Monoclonal antibody treat C difficile infection

A

Bezlotoxumab (against toxin b)

74
Q

Features of severe C difficile infection

A

1) HD unstable
2) ileus
3) Toxic megacolon

75
Q
A
75
Q

What medication used to slow the progression of PBC

A

UDXA
While cholestramine used to relive pruritis only

76
Q

Somatostatin produced from which cell?

A

D cells in pancreas and stomach

77
Q

True or false
Osteoporosis is associated with IBD activity

A

True

78
Q

Eye manifestation associated with disease activity in IBD

A

Episcleritis while uveitis is not associated with disease activity

79
Q
A
80
Q

HLA Associated with celiac disease

A

HLD DQ-2 In 95 % of patients + DQ-8

81
Q

Hepatology

Phenytoin and sodium valproate effect on LFT

A

Causes hepatocellular pattern. Not cholestatic.

82
Q

Diarrhea in patient with CD post ileal resection. How to manage?

A
  • If CRP normal + no evidence of disease flare.
  • Cholestramine is indicated.

Bile acid malabsorbtion post ileal resection

83
Q

Steatorrhea, migratory arthritis, sacro-ilitis, HLA-B27 positive, hyperpigmentation

A

Whipple disease.
Dx: Jejunal biopsy. PAS +

84
Q
A
85
Q

Management of Whipple disease

A
  • 2 weeks IV CTX then 1 year bactrim
86
Q

If patient treated for C diff with vanc and cameback after 2 months with same symptoms. Treatment option is?

A

Fidoxamycin. (Recurrent, he came within 12 weeks after treatment)

87
Q

Why patient with celiac need to be uptodate with vaccination?

A

Functional hyposplenism.

88
Q

Break

A
89
Q

Vaccines in celiac disease?

A
  • Pneumococcal every 5 years
90
Q

Mention four factors in severe pancreatitis, might prompt ICU admission

A

1) Hypocalcemia < 2
2) High RBS > 200
3) Hypoxia
4) LDH > 600

91
Q

MOA of which paracetamol causes hepatocellular damage

A

Necrosis.
While in hepatitis it causes apoptosis

92
Q

Causes of villius atrophy in intestinal biopsy

A

Celiac, lymphoma, hypogammaglobenemia, tropical sprue, Whipple disease

93
Q

Multiple gastric ulcers, diarrhea and malabsorbtin. Diagnosis? cell responsible?

A
  • Gastrinoma (ZES)
  • G-cell.
  • MOA: Increase H secretion by gastric cells
94
Q

HCC + Good functional status + 2 lesions each lesion measured 2 cm. Next step?

A

TACE then transplant

95
Q

T/F: Avoid lactoluse in patient with IBS-C

A

Yes, use other laxatives. If the patient did not improve. Use TCA it is preferred in comparison to SSRI

96
Q

What would you recommend for dietary modification for patient with IBS and bloating

A

Increase Oat

97
Q

Most common cause of HCC in UK

A

HCV In europe and HBV worldwide

98
Q

Patient diagnosed with adenocarcinoma. What is the best modality to detect mural extension of the disease?

A

Endoscopic US.
Better than CT, PET or MRI. To detect lovcoregional extension in gastric and esophageal cancer

99
Q

Achalasia is a risk factor for SCC or adenocarcinoma?

A

SCC
Plummer vinson and achalasia assoicated with SCC

100
Q

Diarrhoea, weight, arthralgia, lymphadenopathy, ophthalmoplegia
Diagnosis and management

A

Whipple disease
Dx: Jejunal Bx shows PAS
Rx: Bactrim for 1 year

101
Q

Medication associated with dyspepsia by reducing LES pressure

A

calcium channel blockers*
nitrates*
theophyllines
Other medications associated with Dyspepsia:
Bisphophonate, NSAID’s and steroid

102
Q

Bowel

SeHCAT (Selenium-75-labelled homocholic acid taurine) test used to diagnose?

A

Bild acid malabsorption

103
Q

Management of carcinoid?

A

Somatostaitin analgue (Octreotide)

104
Q
A
105
Q

Malignancy associated with celiac disease

A

Rare: esophageal cancer,
Other like: T-cell lymphoma of small intestine

106
Q

Malignancy associated with celiac disease

A

Rare: esophageal cancer,
Other like: T-cell lymphoma of small intestine

107
Q

Mention the two types of Autoimmune hepatitis

A

1) Type I: more in adult
- ANA, ASMA
2) Type II: More in children
- Anti-LKM And anti cytosol

108
Q

Which immunoglobulin will be high in autoimmune hepatitis?

A

IgG
IgM will be high in PBC
IgA in Alcoholic liver diseases

109
Q

Blood group associated with gastric cancer?

A

Type A, diagnosis based on biopsy shows signet ring cells

110
Q

Is it safe for a mother with HBV to breastfed?

A

Yes, unlike HIV.

111
Q

First line management of SIBO?

A

Rifaximin

112
Q

What tool can be used to assess for malnutrition ?

A

Malnutrition universal screening tool (MUST)

113
Q

% of having cancer if the patient has positive FOBT?

A

10 %

114
Q

Gold standard test to diagnose achalsia?

A

Esophageal manometry

115
Q

Break: )

A
116
Q

Follow up tool for patient with hemochromatosis post venosection

A

Transferrin saturation should be less than 45 % and ferritin < 50

117
Q

What is the most adequate test to check for H pylori eradication?

A

Urea breath test according to BTS. Better than stool Ag

118
Q

What are the types of hepatorenal syndrome

A

I: Acute within 2 weeks. Poor prognosis.
II: Chronic, less severe form. Gradual progression of RFT.

119
Q

What are the types of hepatorenal syndrome

A

I: Acute within 2 weeks. Poor prognosis.
II: Chronic, less severe form. Gradual progression of RFT.

120
Q

Treatment options for hepatorenal syndrome

A

1) Vasopressin, NE
2) Midodrine.
3) Octreotide

121
Q

Diarrhea, with pigment laiden macrophage on colon biopsy.

A

Laxative abuse (Melanosis coli)

122
Q

For how long, celiac disease patient need to be on gluten free diet to turn serology test to negative?

A

At least 6 months before conversion of the serology test.

123
Q

Management option for patient with C difficile did not respond to vancomycin + Fidoxomycin

A

Try oral vancomycin + IV metronidazole not Bezlotoxumab

124
Q

Definitive management of hydated cyst?

A

Surgery. Not albendazole

125
Q

For how long you need to stop antibiotics before urea breath test?

A
  • Stop antibiotics for 4 weeks.
  • Stop PPI for 2 weeks.
126
Q

Painless jaundice and CT shows dilation of pancreatic duct and CBD

A

Pancreatic cancer (Double duct sign) Or cholangiocarcinoma.
If both options there, chose pancreatic cancer as it is more common

127
Q

Reversible manifestation in hemochromatosis?

A

CMP And Skin pigmentation

128
Q

What is the strongest risk factor to have anal cancer?

A

Most strongest and most common is HPV
Others:
HIV, MSM, Immunosupressive therapy

129
Q

Patient with abdominal pain + loss of vision. Fundoscopy shows microinfarctions with cotton wall spots.
Most likely diagnosis?

A

Acute pancreatitis fundoscopy represents Purtscher retinopathy.

130
Q

First line test for patient suscpected to have celiac disease? (Antibodies)

A

Anti-TTG
Two others are:
- Anti endomysial
- Anti-giliadin (not recommended)

131
Q

Choice of management for UC patient with 5 stool per day with blood + no systemic features.

A

Oral and rectal ASA. As the disease extended the left sided colon

132
Q

What are the clinical features of carcinoid syndrome ?

A

Bronchospasm, flushing, diarrhea, right sided heart diseases

133
Q

Which bariatric surgery causes more of malabsorbtion rather than restriction

A

Biliopancreatic diversion with duedenal switch

134
Q

T or F.
Reflexology is recommended for patient with IBS

A

False

135
Q

T or F
Acupucture is recommended for patients with IBS

A

False. Only hypnotherapy recommended for IBS

136
Q

T or F
Acupucture is recommended for patients with IBS

A

False. Only hypnotherapy recommended for IBS

137
Q

Secretory diarrhea, hypokalemia and microcytic anemia

A

Villous adenoma

138
Q

90 % of patients with peutz-jugher syndrome will die from GI cancer at age of 60
True or false?

A

False. 50 %
Remember: Lynch syndrome (lunch) and PJS are AD

139
Q

Mother with chronic hepatitis B infection. What would you recommend to give to the newborn?

A

Vaccination and Immunoglobulin

140
Q

Tumor marker used for colon cancer?

A

CEA

141
Q

When you calculated Maddrey score for a patient with alcoholic liver disease. His score was 40. What is your next step?

A

Start prednisone.
Maddrey > 32 = poor prognosis + start prednisone.

142
Q

What medication you will start in patient with maddrey score 40

A

Prednisone.
Start if the score more than 32 in patient with alcoholic liver disease.

143
Q

What medication you will start in patient with maddrey score 40

A

Prednisone.
Start if the score more than 32 in patient with alcoholic liver disease.

144
Q

Earliest symptom of carcinoid tumor

A

Facial flushing

145
Q

Earliest symptom of carcinoid tumor

A

Facial flushing

146
Q

Patient with UC, on oral ASA, patient did not improve. What is the next step?

A

Add oral prednisone.

147
Q

The only approved vasopressor for UGI bleeding in cirrhotic patient?

A

Terlipressin

148
Q

Gold standards for GERD diagnosis?

A

24 h esophageal monitoring

149
Q

Interpretation?

A

Recent hepatitis vaccination.
In early stage after vaccination, patient might get low level of surface antigene after vaccination.

150
Q

Intrepretation

A

Recent hepatitis B vaccination,
Patient with recent vaccine will get positive sAg initially (low positive or equivocal)

151
Q
A
152
Q
A
153
Q

Which antibiotic causes hepatocellular injury? Augmentin or Nitrofurontain?

A

Nitro.
Augmentin causes cholestatic pattern

154
Q

Patient with UC, had 3 flares in the last year required prednisone. What is the first option to use for remission?

A

Azathioprine

155
Q

Which enzyme responsible for breakdown of disacharide to glucose + glucose

A

Maltase (malteser chocolate is sugar and sugar)

156
Q

Which enzyme responsible for cleaving starch to sugar?

A

Amylase

157
Q

Which on of the following associated with HCC
Hemochromatosis or wilson disease?

A

Hemochromatosis.

158
Q

First line management for HRS according to BTS

A

Terlipressin

159
Q

First line management for HRS according to BTS

A

Terlipressin

MRCP (6 decks)

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