Gastroenterology

Question 1

What is plummer-vinson syndrome?

Answer 1

Oesophageal web causing dysphagia. May occur with iron-deficiency anaemia.

Question 2

What is the difference between oesophageal dysmotility (seen in CREST syndrome) and achalasia?

Answer 2

In achalasia, there is failure of relaxation of the lower oesophageal sphincter causing there to be an increased pressure, whereas in CREST there is a decrease of pressure within the oesophagus.

Question 3

Investigations for dysphagia

Answer 3

All patients require an upper GI endoscopy unless there are compelling reasons for this not to be performed. Motility disorders may be best appreciated by undertaking fluoroscopic swallowing studies.

Question 4

Which hepatitis is most commonly spread by undercooked pork?

Answer 4

Hep E

Question 5

Rash associated with coeliac disease?

Answer 5

Dermatitis herpetiformis

Question 6

Isolated raised alk phos- what conditions cause this?

Answer 6

Pagets & Primary biliary cirrhosis

Question 7

How do you treat primary biliary cirrhosis?

Answer 7

Cholescystramine

NB don’t forget that PBC can cause a varicael bleed so be careful

Question 8

Treatment of C.diff?

Answer 8

2 weeks of oral metronidazole

Second line = IV vancomycin

Question 9

If you are giving someone fluids, what must you say?

Answer 9

I will monitor fluids carefully by regularly checking blood pressure lying and standing, looking at the JVP, listening to the lung bases and monitoring urine output.

Question 10

How do you treat cerebral odema?

Answer 10

Sit patient up, O2, Iv dex/IV mannitol.

Question 11

In a diarrhoea history what is it important to check in the social history?

Answer 11

Always check occupation, incase they handle food and then they should be excluded from work

Question 12

If a patient presents with bloody diarrhoea, what investigations are you going to do?

Answer 12

Stool MC & S as always, then check FBC and U&es (for e-coli 0157).

Question 13

In which patients might you suspect ischaemic colitis to be causing their diarrhoea?

Answer 13

In arteriopaths/history will always involve IHD

Question 14

What condition is important to rule out in chronic diarrhoea?

Answer 14

Hyperthyroid- they will commonly present with this. DON’T FORGET TO CHECK TFTs

Question 15

What does diarrhoea at night indicate?

Answer 15

An autonomic neuropathy (at night our bowels should rest). (diabetes etc can cause this)

Question 16

If you suspect wilsons disease, how should you view the eyes?

Answer 16

With a slit lamp to look for keisher flesher rings.

Question 17

Virchows node on the left, whats the sign?

Answer 17

Troissiers sign (indicating gastric or pulmonary malignancy/ can be other malignancys)