Gastroenterology Flashcards
MRCP
1
Q
GERD
GERD increase risk of which cancer?
A
Adenocarcinoma after transform to Barret
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
3
Q
What are the different types of SBP?
A
Neutrophil > 250 + positive or negative culture
Neutrophil < 250 + positive culture
4
Q
Preferred agent for SBP?
A
Cefotaxime.
Other: CTX can be used
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
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
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
8
Q
Mention three Non-selelctive BB used in variceal bleed ppx?
A
NPC
Nadolol, propranolol, Carvidelol.
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
10
Q
Most common type of anal cancer?
A
SCC
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.
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
13
Q
CCK action?
Produced from?
A
GB contraction, from upper part of S. Intestine
14
Q
Which cell produce CCK?
A
I cells
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
16
Q
What does MELD-Na tells us?
A
1) 90 D’s mortality
2) Stratify the patient on transplant list
17
Q
What are the component of child-pugh?
A
3 labs + 2 pic
INR, Bili, Albumin and ascites + HE
18
Q
Management of Variceal bleed after ABC?
A
1) Terlipressin “preferred over octreotide:
2) Endoscopic variceal ligation “preferred over sclerotherapy”
3) Antibiotic “FLQ”
19
Q
Next step if ligation failed in variceal bleed?
A
Blakemore tube
if failed go for TIPS
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
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
22
Q
MOA of terlipressin?
A
Vasopressin analogue causes splanchnic vasoconstriction
23
Q
Octreotide MOA?
A
somatostatin analogue
24
Q
Colon cancer
Most common type of polyp?
A
Hyperplastic
25
Most common pre-malignant type of polyp?
Adenamotous
26
What are the types of benign polyp?
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)
27
What is the most common inherited type of colon cancer?
Lynch syndrome (Autosomal dominant)
28
Most common genes involved in Lynch syndrome?
MSH2, MLH1
DNA Mismatch lead to microsattalite unstability
29
What criteria used for Lynch syndrome?
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
30
Which syndrome associated with APC gene mutation?
Familial adenomatousis polyposis (APS)
- AD, Chromosome 7
- 100's of polys at age of 30-40
31
FAP has riks for what type of cancer?
Duedenum
Note: Gardner is a subtype of FAP has risk of:
Skull, mandible, retina, thyroid cancer and epidermoid cyst on the skin
32
33
Known case of UC + High ALP. How to confirm the diagnosis?
This is PSC
MRCP or ECRP. shows multiple beaded bile structure pattern.
If unclear?? liver biopsy (onion skin shape)
34
Antibody associated with PSC?
P-ANCA
35
Next step after diagnosing PSC?
Colonoscopy
36
Female 40, itching, jaundice, and dry eyes?
PBC.
+ AMA
+ MC autoimmune disease associaton is sjogren.
37
Liver biopsy shows flouride duct lesion?
PBC
38
Patient with dysphagia for l + S for 3 months + CXR shows air-fluid level
Achalasia.
CXR shows: Retrocardiac Air-fluid level + wide mediastinum
39
familial adenomatous polyposis mode of inheritance + chromosome involved
Chromosome 5 + AD
Notes:
- Both lynch syndrome and FAP Are AD
- Lynch syndrome is the most common inherited cause for colon cancer
40
Second most common cancer involved with FAP after colon cancer?
Endometrial cancer
41
Crypt abcess seen in?
UC
42
Goblet cell depletion seen in?
UC
43
ulceration mimic pseudopolyp. (Which IBD?
uc
44
# Hepatitis
Type of HBV? DNA or RNA?
All Hepaitits viruses are RNA except HBV (DNA)
45
Interpretation:
Hbsag negative and Hbsab positive, Hbc negative?
Immunization. If he has previous infection core will be positive
46
What is the first Ag appear after hepatitis infection?
HbsAg
- If positive for 6 months this is acute
- If positive for more than 6 months this is chronic infection
47
(Watery Diarrhea, Hypokalemia, Achlorhydria
VIPOMA
Most of the tumors appear from the pancreas
48
# Hepatitis
Risk of infection by needly stick injury
HBV: 0.3 % HCV: 3 % HIV: 30 %
49
# Hepatitis
4 INDICATIONS TO TREAT HBV infection
as the pic
50
# biliary diseases
Which immunoglobulin will be high in PBC?
- IgM
- AMA M2 type (highly specific)
Note:
- IgA seen in celiac and Alcoholic liver disease
51
# biliary
Antibodies associated with PSC?
P-ANCA
52
Mention three medication can cause high Triglyceride
Cyclosporine, estrogen and steroid.
53
# liver abscess
Most common cause of pyogenic liver abscess
Adult: E coli
Children: Staph aureus
54
# live abscess
Managemnet pf pyogenic liver abscess
Amoxicillin + Cipro + metro
If amoxi allergy:
Cipro and clinda
55
# Esophagus
Criteria of esonophilic esophagitis diagnosis
more than 15 hpf esonophil in Bx
trial of PPI
Exclusion of other esonophilia causes
56
# nutrition
Which option has highest calori content
Butter, rice, red meat, white bread, Pasta
Butter (fat has the highest calories per gram)
57
# Nutrition
Electrolytes in re-feeding synrome
All low (K, Mg, PO)
| While in TLS (High K, PO, Low Ca)
58
# Parasitology
Tipworm causes anal itching and outbreaks.
Name of the warm is? management?
Enterobius vermicularis
Treat with one dose of mebendazole
59
# Worms
What nematode causes IDA and GI bleed after penetration of the skin?
Necator (Strawberry nectar juice on the beach)
60
What worm can cause esonophilic lung disease?
Ascaris
61
Young male have pshycosis, Hx of ingestion uncooked pork. CT:
Tinea solium neurocysticercosis. Swiss cheese appearance
62
# Liver
Mode of inheritance of hemochromatosis?
AR Chromosome 6
63
T\F arthopathy in hemochromatosis is irreversible
True. The only reversibly features are
dilated CMP + Skin pigmentation
64
# GI bleed
High BUN level suggest Upper or LGI bleeding
- High BUN suggest UGIB
65
Management of alcoholic ketoacidosis?
Thiamine and NS
To avoid Wernicke encephalopathy or Korsakoff psychosis.
66
# Hepatology
INR higher than .. is CI for liver biopsy
1.4
67
# Hepatology
Mention 4 medication causes cholestatic liver disease
1) Metabolic diseases: Fibrate + SFU
2) Antibiotics: Except NFU And anti-TB
3) Steroids
68
Which one is better to diagnose acute pancreatitis. Amylase or lipase?
Lipase
1) Higher Sp and Sn.
2) Longer half-life "can detect late pancreatitsi presentation > 24 h)
69
First line management of isolated peri-anal disease in Crohns
Metronidazole
70
Management option for complex peri-anal fistula in crohns disease
Seton placement
71
Way of transmission of C difficile
Fecal-oral by ingestion of spores (not toxins)
72
Management option for first-time C difficile infection
Oral vancomycin for 10 days.
73
Monoclonal antibody treat C difficile infection
Bezlotoxumab (against toxin b)
74
Features of severe C difficile infection
1) HD unstable
2) ileus
3) Toxic megacolon
75
75
What medication used to slow the progression of PBC
UDXA
While cholestramine used to relive pruritis only
76
Somatostatin produced from which cell?
D cells in pancreas and stomach
77
True or false
Osteoporosis is associated with IBD activity
True
78
Eye manifestation associated with disease activity in IBD
Episcleritis while uveitis is not associated with disease activity
79
80
HLA Associated with celiac disease
HLD DQ-2 In 95 % of patients + DQ-8
81
# Hepatology
Phenytoin and sodium valproate effect on LFT
Causes hepatocellular pattern. Not cholestatic.
82
Diarrhea in patient with CD post ileal resection. How to manage?
- If CRP normal + no evidence of disease flare.
- Cholestramine is indicated.
## Footnote
Bile acid malabsorbtion post ileal resection
83
Steatorrhea, migratory arthritis, sacro-ilitis, HLA-B27 positive, hyperpigmentation
Whipple disease.
Dx: Jejunal biopsy. PAS +
84
85
Management of Whipple disease
- 2 weeks IV CTX then 1 year bactrim
86
If patient treated for C diff with vanc and cameback after 2 months with same symptoms. Treatment option is?
Fidoxamycin. (Recurrent, he came within 12 weeks after treatment)
87
Why patient with celiac need to be uptodate with vaccination?
Functional hyposplenism.
88
Break
89
Vaccines in celiac disease?
- Pneumococcal every 5 years
90
Mention four factors in severe pancreatitis, might prompt ICU admission
1) Hypocalcemia < 2
2) High RBS > 200
3) Hypoxia
4) LDH > 600
91
MOA of which paracetamol causes hepatocellular damage
Necrosis.
While in hepatitis it causes apoptosis
92
Causes of villius atrophy in intestinal biopsy
Celiac, lymphoma, hypogammaglobenemia, tropical sprue, Whipple disease
93
Multiple gastric ulcers, diarrhea and malabsorbtin. Diagnosis? cell responsible?
- Gastrinoma (ZES)
- G-cell.
- MOA: Increase H secretion by gastric cells
94
HCC + Good functional status + 2 lesions each lesion measured 2 cm. Next step?
TACE then transplant
95
T/F: Avoid lactoluse in patient with IBS-C
Yes, use other laxatives. If the patient did not improve. Use TCA it is preferred in comparison to SSRI
96
What would you recommend for dietary modification for patient with IBS and bloating
Increase Oat
97
Most common cause of HCC in UK
HCV In europe and HBV worldwide
98
Patient diagnosed with adenocarcinoma. What is the best modality to detect mural extension of the disease?
Endoscopic US.
Better than CT, PET or MRI. To detect lovcoregional extension in gastric and esophageal cancer
99
Achalasia is a risk factor for SCC or adenocarcinoma?
SCC
Plummer vinson and achalasia assoicated with SCC
100
Diarrhoea, weight, arthralgia, lymphadenopathy, ophthalmoplegia
Diagnosis and management
Whipple disease
Dx: Jejunal Bx shows PAS
Rx: Bactrim for 1 year
101
Medication associated with dyspepsia by reducing LES pressure
calcium channel blockers*
nitrates*
theophyllines
Other medications associated with Dyspepsia:
Bisphophonate, NSAID's and steroid
102
# Bowel
SeHCAT (Selenium-75-labelled homocholic acid taurine) test used to diagnose?
Bild acid malabsorption
103
Management of carcinoid?
Somatostaitin analgue (Octreotide)
104
105
Malignancy associated with celiac disease
Rare: esophageal cancer,
Other like: T-cell lymphoma of small intestine
106
Malignancy associated with celiac disease
Rare: esophageal cancer,
Other like: T-cell lymphoma of small intestine
107
Mention the two types of Autoimmune hepatitis
1) Type I: more in adult
- ANA, ASMA
2) Type II: More in children
- Anti-LKM And anti cytosol
108
Which immunoglobulin will be high in autoimmune hepatitis?
IgG
IgM will be high in PBC
IgA in Alcoholic liver diseases
109
Blood group associated with gastric cancer?
Type A, diagnosis based on biopsy shows signet ring cells
110
Is it safe for a mother with HBV to breastfed?
Yes, unlike HIV.
111
First line management of SIBO?
Rifaximin
112
What tool can be used to assess for malnutrition ?
Malnutrition universal screening tool (MUST)
113
% of having cancer if the patient has positive FOBT?
10 %
114
Gold standard test to diagnose achalsia?
Esophageal manometry
115
Break: )
116
Follow up tool for patient with hemochromatosis post venosection
Transferrin saturation should be less than 45 % and ferritin < 50
117
What is the most adequate test to check for H pylori eradication?
Urea breath test according to BTS. Better than stool Ag
118
What are the types of hepatorenal syndrome
I: Acute within 2 weeks. Poor prognosis.
II: Chronic, less severe form. Gradual progression of RFT.
119
What are the types of hepatorenal syndrome
I: Acute within 2 weeks. Poor prognosis.
II: Chronic, less severe form. Gradual progression of RFT.
120
Treatment options for hepatorenal syndrome
1) Vasopressin, NE
2) Midodrine.
3) Octreotide
121
Diarrhea, with pigment laiden macrophage on colon biopsy.
Laxative abuse (Melanosis coli)
122
For how long, celiac disease patient need to be on gluten free diet to turn serology test to negative?
At least 6 months before conversion of the serology test.
123
Management option for patient with C difficile did not respond to vancomycin + Fidoxomycin
Try oral vancomycin + IV metronidazole not Bezlotoxumab
124
Definitive management of hydated cyst?
Surgery. Not albendazole
125
For how long you need to stop antibiotics before urea breath test?
- Stop antibiotics for 4 weeks.
- Stop PPI for 2 weeks.
126
Painless jaundice and CT shows dilation of pancreatic duct and CBD
Pancreatic cancer (Double duct sign) Or cholangiocarcinoma.
If both options there, chose pancreatic cancer as it is more common
127
Reversible manifestation in hemochromatosis?
CMP And Skin pigmentation
128
What is the strongest risk factor to have anal cancer?
Most strongest and most common is HPV
Others:
HIV, MSM, Immunosupressive therapy
129
Patient with abdominal pain + loss of vision. Fundoscopy shows microinfarctions with cotton wall spots.
Most likely diagnosis?
Acute pancreatitis fundoscopy represents Purtscher retinopathy.
130
First line test for patient suscpected to have celiac disease? (Antibodies)
Anti-TTG
Two others are:
- Anti endomysial
- Anti-giliadin (not recommended)
131
Choice of management for UC patient with 5 stool per day with blood + no systemic features.
Oral and rectal ASA. As the disease extended the left sided colon
132
What are the clinical features of carcinoid syndrome ?
Bronchospasm, flushing, diarrhea, right sided heart diseases
133
Which bariatric surgery causes more of malabsorbtion rather than restriction
Biliopancreatic diversion with duedenal switch
134
T or F.
Reflexology is recommended for patient with IBS
False
135
T or F
Acupucture is recommended for patients with IBS
False. Only hypnotherapy recommended for IBS
136
T or F
Acupucture is recommended for patients with IBS
False. Only hypnotherapy recommended for IBS
137
Secretory diarrhea, hypokalemia and microcytic anemia
Villous adenoma
138
90 % of patients with peutz-jugher syndrome will die from GI cancer at age of 60
True or false?
False. 50 %
Remember: Lynch syndrome (lunch) and PJS are AD
139
Mother with chronic hepatitis B infection. What would you recommend to give to the newborn?
Vaccination and Immunoglobulin
140
Tumor marker used for colon cancer?
CEA
141
When you calculated Maddrey score for a patient with alcoholic liver disease. His score was 40. What is your next step?
Start prednisone.
Maddrey > 32 = poor prognosis + start prednisone.
142
What medication you will start in patient with maddrey score 40
Prednisone.
Start if the score more than 32 in patient with alcoholic liver disease.
143
What medication you will start in patient with maddrey score 40
Prednisone.
Start if the score more than 32 in patient with alcoholic liver disease.
144
Earliest symptom of carcinoid tumor
Facial flushing
145
Earliest symptom of carcinoid tumor
Facial flushing
146
Patient with UC, on oral ASA, patient did not improve. What is the next step?
Add oral prednisone.
147
The only approved vasopressor for UGI bleeding in cirrhotic patient?
Terlipressin
148
Gold standards for GERD diagnosis?
24 h esophageal monitoring
149
Interpretation?
Recent hepatitis vaccination.
In early stage after vaccination, patient might get low level of surface antigene after vaccination.
150
Intrepretation
Recent hepatitis B vaccination,
Patient with recent vaccine will get positive sAg initially (low positive or equivocal)
151
152
153
Which antibiotic causes hepatocellular injury? Augmentin or Nitrofurontain?
Nitro.
Augmentin causes cholestatic pattern
154
Patient with UC, had 3 flares in the last year required prednisone. What is the first option to use for remission?
Azathioprine
155
Which enzyme responsible for breakdown of disacharide to glucose + glucose
Maltase (malteser chocolate is sugar and sugar)
156
Which enzyme responsible for cleaving starch to sugar?
Amylase
157
Which on of the following associated with HCC
Hemochromatosis or wilson disease?
Hemochromatosis.
158
First line management for HRS according to BTS
Terlipressin
159
First line management for HRS according to BTS
Terlipressin
