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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
Hepato-renal syndrome Tx
Terlipressin
25
The most common type of inherited colorectal cancer:
HNPCC
26
1st line to stop oesophageal variceal bleed
endoscopic variceal band ligation
27
pharyngeal pouch
Dysphagia, aspiration pneumonia, halitosis
28
Peutz Jeghers syndrome features
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
29
perianal fistula Tx
metronidazole if complex--> draining seton
30
pharyngeal pouch Ix
barium swallow combined with dynamic video fluoroscopy
31
secondary prophylaxis of hepatic encephalopathy
Lactulose and rifaximin
32
Budd-Chiari syndrome triad
sudden onset abdominal pain, ascites, and tender hepatomegaly
33
H.pylori most associated with
duodenal ulceration also: gastric adenocarcinoma atrophic gastritis
34
Barrett's oesophagus Tx: if dysplasia of any grade is identified
endoscopic intervention is offered. Options include: radiofrequency ablation endoscopic mucosal resection
35
Barrett's oesophagus Tx:
high-dose proton pump inhibitor endoscopic surveillance with biopsies for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years
36
osteomalacia in coeliac
reduced absorption of vitamin D in the small intestine high ALP, low calcium
37
New onset dysphagia Ix
OGD in any age group
38
IBS Tx
1. loperamide 2. low dose amitryptiline
39
investigation of choice for suspected perianal fistulae in patients with Crohn's
MRI
40
neurological features of pernicious anaemia
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
oesophageal cancer barium swallow sign
apple core sign- narrowing
42
severe UC Ix
colonoscopy should be avoided due to the risk of perforation --> a flexible sigmoidoscopy is preferred
43
Hypotension + melaena
bleeding peptic ulcer
44
perforated peptic ulcer Sx
Sx of peritonitis e.g. diffuse abdominal pain, abdominal distension, rigidity, and guarding
45
RHF hepatomegaly
firm, smooth, tender and pulsatile liver edge
46
C.diff sigmoidoscopy
yellow plaques on the intraluminal wall of the colon.
47
Metastatic HCC TX
Sorafenib
48
Upper GI bleed bloods
high urea normocytic anaemia
49
prognosis in pancreatitis
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
pigmented gallstones association
SCA
51
drug induced pancreatitis
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
52
post-cholecystectomy jaundice and RUQ pain
gallstone in common bile duct
53
chronic pancreatitis Ix
CT pancreas with IV contrast
54
isolated hyperbilirubinaemia first line test
FBC--> haemolysis or Gilberts
55
pancreatic pseudocyst Tx
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
gallstone present where in biliary system does not cause jaundice
Blockage of the cystic duct or gallbladder does NOT cause jaundice
57
absolute contraindications to laparoscopic surgery
haemodynamic instability/shock raised intracranial pressure acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm) uncorrected coagulopathy
58
Boerhaaves Ix
CT contrast swallow
59
Iron defiency anaemia vs. anaemia of chronic disease
TIBC high in IDA, low/normal in ACD
60
first line Tx for diarrhoea in IBS
loperamide
61
Melanosis coli
pigment laden macrophages --> laxative abuse
62
diarrhoea, fatigue, osteomalacia
coeliac disease
63
ongoing acute bleeding despite repeated endoscopic therapy
referral to general surgery
64
what must be administered prior to endoscopy for suspected vatical haemorrhage
IV ABx and terlipressin
65
pernicious anaemia antibodies
intrinsic factor> gastric parietal cells
66
Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg
chronic Hep B
67
drugs to stop during C. difficile infection
anti-motility and anti- peristaltic drugs due to risk of toxic megacolon e.g. opioids
68
Most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
thrombocytopenia
69
C.diff antigen and toxin
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
abdominal pain and fever in patients with cirrhosis and portal hypertension
Spontaneous bacterial peritonitis
71
HBsAg negative, anti-HBs positive, IgG anti-HBc positive
previous infection
72
mesenteric ischaemia
triad of CVD, high lactate and soft but tender abdomen
73
paracetamol overdose LFTs
hepatocellular: high ALT, normal ALP, high ALT:ALP ratio
74
ERCP shows strictures giving a 'beaded' appearance.
PSC
75
In life-threatening C. difficile infection treatment is with
ORAL vancomycin and IV metronidazole
76
Transjugular Intrahepatic Portosystemic Shunt complications
precipitate hepatic encephalopathy due to inadequate metabolism of nitrogenous waste products by the liver.
77
haemachromatosis bloods
raised transferrin sat, raised ferritin, low TIBC
78
drug induced cholestasis
combined oral contraceptive pill antibiotics: flucloxacillin, co-amoxiclav, erythromycin* anabolic steroids, testosterones phenothiazines: chlorpromazine, prochlorperazine sulphonylureas fibrates rare reported causes: nifedipine
79
The definition of an Upper GI Bleed is
a haemorrhage with an origin proximal to the ligament of Treitz
80
Maddrey's discriminant function is calculated by a formula based on the
prothrombin time and serum bilirubin
81
chronic mesenteric ischaemia triad:
severe, colicky post-prandial abdominal pain, weight loss, abdominal bruit
82
Wilson's disease bloods
serum caeruloplasmin reduced, total serum copper reduced free serum copper raised, urinary copper raised,
83
alcoholic liver disease blood tests
AST:ALT 2:1
84
high SAAG (>11g/L)
portal HTN: liver- cirrhosis, alcoholic liver disease, acute liver failure, liver mets heart- right HF, constrictive pericarditis, other- Budd-chiari, portal vein thrombosis, myxoedema
85
severe C. diff infection may lead to
toxic megacolon
86
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year
they should be given either oral azathioprine or oral mercaptopurine to maintain remission
87
drugs causing liver cirrhosis
methotrexate methyldopa amiodarone

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