Gastroenterology

Question 1

First-line to third-line treatment for c.diff?

Answer 1

1: Oral Vancomycin
2: Recurrence within 12/52: fidaxomicin
3/life-threatening: oral vanc + IV metro

Vancomycin is always oral. It doesn’t have efficacy as an IV drug.

Question 2

In Barret’s oesophagus, what is the indication for Endoscopic mucosal resection (EMR)?

Answer 2

High-grade dysplasia (HGD). This has a high risk of progression to adenocarcinoma of the oesophagus.

Question 3

What is used for primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices

Answer 3

Endoscopic variceal band ligation

Question 4

What investigation can be used for the diagnosis of small intestinal bacterial overgrowth (SIBO)?

Answer 4

Hydrogen breath test

Question 5

Most common extra-intestinal feature in both Crohn’s and UC?

Answer 5

Arthritis

Question 6

What is the name of surgical thread used in management of complex perianal fistulae in patients with Crohn’s disease?

Answer 6

Seton

Question 7

What are the GI complications of scleroderma?

Answer 7

SIBO -> malabsorption syndrome
Psuedo-obstruction
Digestive issues: Heartburn, difficulty swallowing, bloating, cramps, constipation, diarrhea, nausea, and vomiting

Question 8

Outline the diagnostic criteria for IBS.

Answer 8

The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:
Abdominal pain, and/or
Bloating, and/or
Change in bowel habit

A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
altered stool passage (straining, urgency, incomplete evacuation)
abdominal bloating (more common in women than men), distension, tension or hardness
symptoms made worse by eating
passage of mucus

Question 9

What is the investigation of choice for suspected perianal fistulae in patients with Crohn’s?

Answer 9

MRI Pelvis

Question 10

Which laxatives are used to treat constipation associated with IBS?

Answer 10

Ispaghula husk & Linaclotide

As per NICE guidelines, lactulose is not recommended to treat constipation in IBS as it can increase gas production, thereby making symptoms worse in some patients.

Question 11

Which PPI is best used for patients taking clopidogrel?

Answer 11

Lansoprazole

Omeprazole and esomeprazole are known to decrease the efficacy of clopidogrel due to its inhibition of the CYP2C19 enzyme

Question 12

What is the TIBC in IDA vs anaemia of chronic disease?

Answer 12

TIBC is high in IDA, and low/normal in anaemia of chronic disease

Question 13

Which commonly used drug which is not an antibiotic is also associated with C-diff infection?

Answer 13

PPI like omeprazole

Question 14

For urea breath test, how long should drug x and y be stopped for? And what is x and y.

Answer 14

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI or H2a) in past 2 weeks

Question 15

In patients with non-alcoholic fatty liver disease, what is recommended to aid diagnosis of liver fibrosis

Answer 15

enhanced liver fibrosis (ELF) testing

Question 16

What are treatment steps for Crohn’s flare?

Answer 16

1. Glucocorticoids to induce remission
2. 5-ASA drugs (e.g. mesalazine) as second line
3. azathioprine or mercaptopurine (if TPMT activity is okay) may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine
4. Infliximab

Question 17

Treatment for mild-moderate flare of UC vs moderate-severe?

Answer 17

Usually just starts with topical PR aminosalicylates (5-ASA). If no remission in 4 weeks then add oral 5-ASA. If still no remission then stop topical and use oral 5-ASA + steroids
If extensive disease throughout the colon then you start with topical and oral
If severe disease requiring admission then start with steroids and consider ciclosporin if severe or steroid contraindicated.

Question 18

What type of cancer does achalasia increase the risk of?

Answer 18

squamous cell carcinoma of oesophagus

Question 19

What can be used for prophylaxis of oesophageal bleeding?

Answer 19

A non-cardioselective B-blocker (NSBB) - propanolol

Question 20

What activity should be checked before starting someone on azathioprine or mercaptopurine for Crohn’s disease and why?

Answer 20

The enzyme thiopurine methyltransferase (TPMT) needs to be assessed before starting a patient on azathioprine because a deficiency in this enzyme (present in 1% of the population) could lead to bone marrow suppression with potentially deadly consequences.

Question 21

First line treatment to maintain remission in Crohn’s flare?

Answer 21

Azathioprine or mercaptopurine

Question 22

A patient on 5-ASA becomes unwell with sore throat and fever, what must you think of?

Answer 22

Agranulocyutosis. Do an FBC.

Question 23

What neutrophil count confirms SBP from paracentesis?
When and which antibiotic indicated based on ascitic fluid protein count?

Answer 23

> 250 cells/ul
Ciprofloxacin; protein count less than 15 g/L

Question 24

Should IV PPI be given in an acute UGI bleed before endoscopy?

Answer 24

No. IV PPI should be given after endoscopy.
The use of PPI may obscure the endoscopic appearance of ulcers by reducing visible stigmata of bleeding, potentially complicating diagnosis and management. and it hasn’t been shown to confer significant better mortality rate.

Question 25

A rare cause of GI bleeding characterised by a tortuous arterial malformation?

Answer 25

Dieulafoy’s lesion

Question 26

How many units of alcohol are in a 750ml bottle of red wine with an alcohol by volume of 12%?

Answer 26

9 Units

Helpful simple way for me is: If a drink says 12% alcohol.
It means that in a 1Litre drink (1000ml), there is 12 units.

i.e. % alcohol on a bottle = number of units if you drank 1 litre of it.