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Passmed wrong > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

HNPCC associated with what cancers

A

Colorectal
pancreatic
endometrial

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2
Q

Carcinoid tumours secrete what hormones

A

Bradykinin and serotonin –> flushing, diarrhoea, bronchoconstriction

ACTH –> Cushingoid features

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3
Q

carcinoid syndrome associated with what cardiac features

A

R. sided valvular - TIPS

tricuspid insufficiency
pulmonary stenosis

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4
Q

gene mutations associated with HNPCC

A

MSH2/MLH1

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5
Q

gallstone ileus

A

SBO + air in biliary tree

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6
Q

acute liver failure triad

A

encephalopathy
jaundice
coagulopathy

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7
Q

Strongest RF for Barretts oesophagus

A

GORD

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8
Q

Pellagra

A

Niacin deficiency (B3)

Dermatitis
diarrhoea
dementia/delusions
leading to death

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9
Q

metoclopramide side effects

A

acute dystonia e.g. oculogyric crisis
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism

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10
Q

Metoclopramide should be avoided in X, but may be helpful in Y

A

Metoclopramide should be avoided in bowel obstruction, but may be helpful in paralytic ileus.

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11
Q

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?

A

hepatic vein to portal vein

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11
Q

Sister Mary Joseph node

A

palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

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12
Q

Risk of rebleeding and mortality

A

Rockall score

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13
Q

Patients with GORD being considered for fundoplication surgery require what investigations

A

oesophageal pH and manometry studies

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14
Q

AI hepatitis LFTs

A

ALT/AST»ALP

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15
Q

gold standard diagnostic investigation for SBP

A

paracentesis confirmed by neutrophil count >250 cells/ul

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16
Q

1st line management of Achalasia

A

pneumatic (balloon) dilation

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17
Q

Severe UC

A

At least 6 stools per day PLUS at least one of:

  • Temperature greater than 37.8°C
  • Heart rate greater than 90 beats per minute
  • Anaemia (Hb less than 105g/ L)
  • Erythrocyte sedimentation rate greater than 30 mm/hour
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18
Q

Gastric vs Duodenal ulcer

A

Gastric ulcer= immediately after meals
Duodenal ulcer= few hours after meals

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19
Q

Zollinger-Ellison syndrome

A

Gastrinoma presents with multiple gastroduodenal ulcers causing abdominal pain and diarrhoea.

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20
Q

Plummer Vinson Syndrome

A

triad of dysphagia, glossitis and iron-deficiency anaemia (some definitions additionally include cheilitis in the syndrome).

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21
Q

Carcinoid tumour- tumour marker

A

Urinary 5-Hydroxyindoleacetic acid

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22
Q

liver cirrhosis poor prognosis

A

ascites

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23
Q

Hepato-renal syndrome

A

ascites
low urine output
significant increase in serum creatinine

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24
Q

Hepato-renal syndrome Tx

A

Terlipressin

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25
Q

The most common type of inherited colorectal cancer:

A

HNPCC

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26
Q

1st line to stop oesophageal variceal bleed

A

endoscopic variceal band ligation

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27
Q

pharyngeal pouch

A

Dysphagia, aspiration pneumonia, halitosis

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28
Q

Peutz Jeghers syndrome features

A

hamartomatous polyps in the gastronintestinal tract (mainly small bowel)

–>small bowel obstruction is a common presenting complaint, often due to intussusception

–>gastrointestinal bleeding

pigmented lesions on lips, oral mucosa, face, palms and soles

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29
Q

perianal fistula Tx

A

metronidazole

if complex–> draining seton

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30
Q

pharyngeal pouch Ix

A

barium swallow combined with dynamic video fluoroscopy

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31
Q

secondary prophylaxis of hepatic encephalopathy

A

Lactulose and rifaximin

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32
Q

Budd-Chiari syndrome triad

A

sudden onset abdominal pain, ascites, and tender hepatomegaly

33
Q

H.pylori most associated with

A

duodenal ulceration

also:
gastric adenocarcinoma
atrophic gastritis

34
Q

Barrett’s oesophagus Tx:
if dysplasia of any grade is identified

A

endoscopic intervention is offered. Options include:
radiofrequency ablation
endoscopic mucosal resection

35
Q

Barrett’s oesophagus Tx:

A

high-dose proton pump inhibitor

endoscopic surveillance with biopsies
for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

36
Q

osteomalacia in coeliac

A

reduced absorption of vitamin D in the small intestine
high ALP, low calcium

37
Q

New onset dysphagia Ix

A

OGD in any age group

38
Q

IBS Tx

A
  1. loperamide
  2. low dose amitryptiline
39
Q

investigation of choice for suspected perianal fistulae in patients with Crohn’s

A

MRI

40
Q

neurological features of pernicious anaemia

A

peripheral neuropathy

subacute combined degeneration of the spinal cord: progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia

neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritabiltiy

41
Q

oesophageal cancer barium swallow sign

A

apple core sign- narrowing

42
Q

severe UC Ix

A

colonoscopy should be avoided due to the risk of perforation –> a flexible sigmoidoscopy is preferred

43
Q

Hypotension + melaena

A

bleeding peptic ulcer

44
Q

perforated peptic ulcer Sx

A

Sx of peritonitis e.g. diffuse abdominal pain, abdominal distension, rigidity, and guarding

45
Q

RHF hepatomegaly

A

firm, smooth, tender and pulsatile liver edge

46
Q

C.diff sigmoidoscopy

A

yellow plaques on the intraluminal wall of the colon.

47
Q

Metastatic HCC TX

A

Sorafenib

48
Q

Upper GI bleed bloods

A

high urea
normocytic anaemia

49
Q

prognosis in pancreatitis

A

Modified Glasgow Imrie scale:

PANCREAS:

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

50
Q

pigmented gallstones association

A

SCA

51
Q

drug induced pancreatitis

A

azathioprine,
mesalazine*,
didanosine,
bendroflumethiazide,
furosemide,
pentamidine,
steroids,
sodium valproate

52
Q

post-cholecystectomy jaundice and RUQ pain

A

gallstone in common bile duct

53
Q

chronic pancreatitis Ix

A

CT pancreas with IV contrast

54
Q

isolated hyperbilirubinaemia first line test

A

FBC–> haemolysis or Gilberts

55
Q

pancreatic pseudocyst Tx

A

observation for up to 12 weeks as 50% resolve spontaneously

active drainage via endoscopic or surgical cystogastrostomy or aspiration if:
signs of infection,
mass effect on abdominal organs
a persisting pseudocyst beyond 12 weeks from it developing

56
Q

gallstone present where in biliary system does not cause jaundice

A

Blockage of the cystic duct or gallbladder does NOT cause jaundice

57
Q

absolute contraindications to laparoscopic surgery

A

haemodynamic instability/shock
raised intracranial pressure
acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
uncorrected coagulopathy

58
Q

Boerhaaves Ix

A

CT contrast swallow

59
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

TIBC high in IDA, low/normal in ACD

60
Q

first line Tx for diarrhoea in IBS

A

loperamide

61
Q

Melanosis coli

A

pigment laden macrophages
–> laxative abuse

62
Q

diarrhoea, fatigue, osteomalacia

A

coeliac disease

63
Q

ongoing acute bleeding despite repeated endoscopic therapy

A

referral to general surgery

64
Q

what must be administered prior to endoscopy for suspected vatical haemorrhage

A

IV ABx and terlipressin

65
Q

pernicious anaemia antibodies

A

intrinsic factor> gastric parietal cells

66
Q

Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg

A

chronic Hep B

67
Q

drugs to stop during C. difficile infection

A

anti-motility and anti- peristaltic drugs due to risk of toxic megacolon
e.g. opioids

68
Q

Most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

A

thrombocytopenia

69
Q

C.diff antigen and toxin

A

positive toxin = bacteria is actively replicating and is likely the cause of the diarrhoea.

positive antigen= bowel is colonised with C. difficile, and not necessarily causing diarrhoea

70
Q

abdominal pain and fever in patients with cirrhosis and portal hypertension

A

Spontaneous bacterial peritonitis

71
Q

HBsAg negative, anti-HBs positive, IgG anti-HBc positive

A

previous infection

72
Q

mesenteric ischaemia

A

triad of CVD, high lactate and soft but tender abdomen

73
Q

paracetamol overdose LFTs

A

hepatocellular:
high ALT, normal ALP, high ALT:ALP ratio

74
Q

ERCP shows strictures giving a ‘beaded’ appearance.

A

PSC

75
Q

In life-threatening C. difficile infection treatment is with

A

ORAL vancomycin and IV metronidazole

76
Q

Transjugular Intrahepatic Portosystemic Shunt complications

A

precipitate hepatic encephalopathy due to inadequate metabolism of nitrogenous waste products by the liver.

77
Q

haemachromatosis bloods

A

raised transferrin sat, raised ferritin, low TIBC

78
Q

drug induced cholestasis

A

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

79
Q

The definition of an Upper GI Bleed is

A

a haemorrhage with an origin proximal to the ligament of Treitz

80
Q

Maddrey’s discriminant function is calculated by a formula based on the

A

prothrombin time and serum bilirubin

81
Q

chronic mesenteric ischaemia triad:

A

severe, colicky post-prandial abdominal pain,
weight loss,
abdominal bruit

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