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Royal College Exam > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

Who should be screened for Barrett’s esophagus?

A

Men with 5+ years of GERD and 2+ risk factors (age>50, white, obese, smoker, FHx BE/esophageal Ca).

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2
Q

What method of endoscopic ablation is indicated for low grade non-nodular Barrett’s esophagus?

A

Radiofrequency ablation.

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3
Q

Name 3 surgical and 3 non-surgical treatments for achalasia.

A

Surgical: pneumatic dilatation, myotomy (e.g. POEMS), esophagectomy.
Medical: botulinum toxin, nitrates, calcium channel blockers.

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4
Q

What clinical features suggest eosinophilic esophagitis?

A

Young male with atopy and solid food dysphagia +/- food boluses.

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5
Q

How do you treat eosinophilic esophagitis?

A

Dietary elimination (eggs, soy, cow’s milk, wheat, tree nuts, seafood), topical steroids with water rinse.

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6
Q

How do you work someone up for celiac disease if they are IgA deficient?

A

Anti-gliadin (DGP) antibody and anti-TTG IgG, if positive then duodenal biopsy.

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7
Q

What features suggest severe ulcerative colitis?

A

> 6 movements per day, urgency, frequent blood, anemia, ESR>30, elevated CRP and fecal calprotectin.

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8
Q

What are maintenance options for moderate to severe ulcerative colitis?

A

Azathioprine, anti-TNFs, tofacitinib (JAK2 inhibitor), vedolizumab (Entyvio, anti-integrin)

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9
Q

How do you diagnose toxic megacolon?

A
  1. Colon > 6cm AND
  2. 3+ fever, HR>120, anemia, neutrophils >10.5 AND
  3. 1+ of dehydration, electrolyte abnormalities, hypotension, altered LOC.
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10
Q

Which therapies are not indicated for Crohn’s?

A

5-ASA (but can use sulfasalazine) and tofacitinib.

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11
Q

What are induction options for Crohn’s disease?

A

IV steroids, methotrexate, anti-TNFs.

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12
Q

How do you treat strictures in Crohn’s disease?

A 
Cold stricture: conservative (NGT, IV fluids, pain management), dilatation or surgery.
Hot stricture (mesenteric adenopathy, fat stranding, elevated inflammatory markers): steroid bridge to anti-TNF.
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13
Q

Describe Type 1/pauciarticular IBD arthritis.

A

More common than type 2, <5 joints affected, usually large joints, flare lasts <10 weeks, flare parallels IBD activity.

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14
Q

Who gets 72 hours IV PPI post-endoscopy?

A

Bleeding vessels, visible vessels, non-removable adherent clot.

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15
Q

Who should get indefinite PPI therapy after a non-variceal bleed?

A

On ASA for secondary prevention, on anticoagulation, unclear etiology of peptic ulcer disease.

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16
Q

Who should you screen for H. pylori?

A

PUD, MALT lymphoma, gastric cancer, long term ASA or NSAID use, unexplained iron deficiency, ITP.

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17
Q

What are two first line therapies for H. pylori infection?

A

PBMT or PAMC for 14 days.

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18
Q

What is the window period in hepatitis B?

A

Viral is clearing and HBsAg is negative, but HBsAb has not become positive yet.

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19
Q

Which chronic Hep B patients get HCC screening with U/S every 6 months?

A
  1. Asian men, HIV+, family Hx HCC > 40 years.
  2. Asian women > 50 years.
  3. Black patients > 20 years.
  4. All cirrhotics.
20
Q

If HBeAg is negative, what is the HBV DNA cut-off for starting treatment?

A

> 2000 IU/mL (>20,000 if HBeAg positive).

21
Q

What are two first line treatments for hepatitis B and how long do you treat for?

A

Tenofovir and entecavir. Treat for life usually.

22
Q

List three extrahepatic manifestations of hepatitis B.

A

Aplastic anemia, membranous nephropathy, polyarteritis nodosum.

23
Q

What are four disease-specific risk factors for hepatitis B becoming either cirrhosis or hepatocellular carcinoma?

A
  1. High liver enzymes.
  2. Prolonged time to eAg seroconversion
  3. eAg negative mutant.
  4. Genotype C.
24
Q

What metric is used to determine hepatitis C cure?

A

SVR12 = sustained viral response at 12 weeks after completing therapy.

25
Q

Name two direct-acting antivirals used for hepatitis C.

A

Epclusa and Maviret.

26
Q

Name 4 autoimmune and 4 hematologic extrahepatic manifestations of hepatitis C.

A

Autoimmune: diabetes, myastenia gravis, sjogren’s, thyroid disease.
Hematologic: hemolytic anemia, cryoglobulinemia, lymphoma, ITP.

27
Q

What are the Maddrey discriminant function and Lille score cut-offs in treating alcoholic hepatitis?

A

If Maddrey score >32 - start prednisolone 40 mg po daily x 28 days. If Lille score <0.45 on day 7 then continue therapy, otherwise stop (Lille low = lucky).

28
Q

Name 3 interventions for treatment of NAFLD/NASH.

A
  1. Lose 3-5% body weight, may require bariatric surgery.
  2. Pioglitazone and vitamin E in NASH only.
  3. Aggressive cardiovascular risk reduction.
29
Q

What MELD score should be referred for liver transplant?

A

MELD>15

30
Q

What three screening tests should be performed upon diagnosis of cirrhosis?

A

Endoscopy for varices, U/S for HCC, paracentesis if ascites) for SBP.

31
Q

Who gets non-selective beta blocker therapy for varices?

A

Primary prophylaxis: small varices that are high risk (Child Pugh C, red wale, red spot), medium to large varices (can do EVL instead).
Secondary prophylaxis: along with EVL.

32
Q

What causes SAAG>11?

A

Portal hypertension: cirrhosis, liver mets, portal vein thrombosis.

33
Q

What are two contraindications to TIPS?

A

Hepatocellular carcinoma, encephalopathy.

34
Q

How do you diagnose spontaneous bacterial peritonitis?

A

Ascitic neutrophils>250 OR positive culture and no other secondary causes.

35
Q

Who gets SBP prophylaxis?

A
  1. Prior SBP.
  2. Cirrhosis with variceal bleed.
  3. Ascitic albumin < 15 and either renal (Cr>106, BUN>8.9, Na<130) or liver (bili>51 AND Child-Pugh>9) impairment.
36
Q

What are the two types of autoimmune pancreatitis?

A

Type 1: IgG4-mediated (older men, sausage-shaped pancreas, biliary strictures, other IgG4 organs involved).
Type 2: isolated pancreatic disease, associations with IBD.

37
Q

Who do you screen for hereditary hemochromatosis?

A

First degree relatives of a diagnosed HH case (homozygous at C282Y).

38
Q

What are the phlebotomy targets for hemochromatosis treatment?

A

Ferritin < 100 in men and < 50 in women.

39
Q

How do you diagnose primary biliary cholangitis?

A

PBC - middle aged woman with jaundice, pruritis, fatigue.

Diagnose with 2+ of ALP elevated >6 months, AMA>1:40, liver biopsy.

40
Q

How do you diagnose hepatorenal syndrome?

A

Patients with chronic liver disease with:

  • Rising Cr and oliguria
  • Bland sediment and proteinuria <0.5 g/d
  • Urine sodium < 20
  • Ruled out ATN, nephrotoxins, obstruction
  • No response to stopping diuretics and trialling albumin for 2d
41
Q

What are complications of PPI?

A 
C diff, pneumonia
HypoMg, Low B12
AIN/CKD
Dementia
Low BMD
Gastric Ca
42
Q

What is the management of indefinite esophageal dysplagia on OGD for Barrett’s?

A

Optimize PPI, then EGD.

If still indefinite, repeat bx in 1 year
If histology changed, manage per new histology

43
Q

When and how long do you do SBP prophylaxis in UGIB?

A

Both non variceal and variceal bleed in setting of cirrhosis.

Ceftriaxone 1g Q24h x up to 7 days or till when octreotide stops

44
Q

Who should you screen for Hep C?

A

Risk factor based screening:

IVDU/incarceration/sexual contact/HIV/MSM
Healthcare worker
Transfusion prior to 1992
Born to mother with Hep C or endemic areas

45
Q

How do you manage scope-proven esophagitis?

A

PPI and lifestyle changes, monitor lifestyle changes, increase to BID if refractory, switch PPI if refractory past 8 weeks.

46
Q

What are the findings of hemochromatosis:

A

Tan, arthralgias, chondrocalcinosis of 2nd and 3rd MCP, neuropathy, cardiomyopathy, diabetes, hypopituitarism, hypogonadism

Royal College Exam (15 decks)

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