Gastroenterology Flashcards
What is triple therapy for H. pylori infection?
Which option is most likely to be resistant?
If found to be resistant what is the next line?
proton pump inhibitor (PPI), amoxicillin, and clarithromycin. Resistant = clarithromycin
Next line = 14-day course of quadruple therapy with a PPI, amoxicillin, clarithromycin, and metronidazole or tinidazole is recommended.
What are the two roles of Leptin in the body?
Where is it produced?
Where does it act?
If someone is leptin resistant what will their levels be?
Leptin inhibits food intake and increases energy expenditure
Produced in fat cells
Acts on the hypothalamus
High
What does melanosis coli on colonic biopsy imply?
Crohn disease.
Giardia infection.
Cryptosporidium infection.
Laxative abuse.
Hyperthyroidism
Why does this occur?
Laxative abuse
Certain laxatives cause damage to the bowel wall, damaging melanocytes causing release of melanin
What are the osmotic gap and pH of secretory vs osmotic diarrhoea?
Secretory diarrhea if osmotic gap <50, pH >6.0
Osmotic diarrhea if osmotic gap >125 pH <5.5
Which of the following is more likely to occur in primary biliary cirrhosis (PBC) vs primary sclerosing cholangitis (PSC);
Female predominance?
AMA +ve?
Risk of cancer?
Beaded appearance of bile ducts?
Linked to Sjogrens syndrome?
Linked to Ulcerative colitis?
URSO improves survival?
Female = PBC
AMA +ve = PBC
Cancer risk = PSC
Beaded appearance = PSC
Sjogrens = PBC
UC = PSC
URSO = improves symptoms in both but survival only in PBC
What are the 5 parts to the Child-Pugh score?
ABCDE
What does a score of 10-15 indicate in regards to mortality?
Albumin level
Bilirubin level
(Coagulation) Prothrombin time
(Drain the) Ascites
Encephalopathy
10-15 = 45% of mortality within one year
What medication is likely to be most effective when used as prophylaxis against post ERCP pancreatitis (PEP)?
NSAID
A Cag A negative H.pyori is mostly associated with which condition?
Gastric ulcer
Hepatic drug clearance is reduced in old age. Which of the following ageing changes is currently believed to have the biggest impact on hepatic drug metabolism?
Diminished hepatic blood flow.
Reduced expression of CYP (cytochrome P450) genes.
Oxidative (post-translational) injury to drug metabolizing enzymes.
Impaired protein binding and reduced serum albumin.
Diminished hepatic volume
Diminished hepatic blood flow
A 46-year-old man has had pancolonic ulcerative colitis since age 23.
Biopsies show chronic active mucosal inflammation with high grade epithelial dysplasia.
The most appropriate management is:
endoscopic polypectomy
total colectomy
sigmoid colectomy
regular sulphasalazine in increased dose.
regular sulphasalazine and prednisone.
Total colectomy
High-grade dysplasia in the context of ulcerative colitis is a significant risk factor for the development of colorectal cancer.
The lab finding that is most specific for the diagnosis of pernicious anaemia is:
Which one is seen elevated in B6 and folate deficiencies?
positive gastric parietal cell antibody
positive intrinsic factor antibody
elevated serum gastrin level
low serum vitamin B12 level
elevated fasting homocysteine level
Pernicious = positive intrinsic factor antibody
B6/folate = elevated homocysteine level
Low serum vitamin B12 levels are least likely to be seen in which one of the following?
Crohn disease.
Severe folate deficiency
Short bowel syndrome
Transcobalamin II deficiency
Pernicious anaemia
Severe folate deficiency
Which of the following nutrients is predominantly absorbed in the duodenum and upper small intestine?
Vitamin E.
Calcium
Linoleic acid
Bile salts.
Vitamin B12
Calcium
What serology is the most accurate for diagnosing Coeliac disease?
Tissue transglutaminase Ab (IgA-tTG)
Endomysial Ab (IgA-EMA).
Anti-gliadin Ab
Tissue transglutaminse Ab
Which of the following is the most appropriate medication to maintain remission in ileo-colonic Crohn’s disease?
Which one is used to induce remission?
Azathioprine
Nicotine
Mesalazine
Budesonide
Cyclosporin
Maintain = Azathioprine
Induce = Budesonide
