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MRCP Part 1 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What serology is present in acute Hep B infection?

A

HbsAg (hep B surface antigen)

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2
Q

What does anti HBs?

A

Implies immunity to hep B either by infection or vaccination - it is negative in chronic disease

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3
Q

What does anti-HBc imply

A

previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists

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4
Q

what does amylase do

A

breaks down starch to sugars

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5
Q

what does maltase do

A

cleaves disaccharide maltose to glucose + glucose

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6
Q

what does sucrase do

A

cleaves sucrose to fructose and glucose

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7
Q

what does lactase do

A

cleaves disaccharide lactose to glucose + galactose

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8
Q

what is the inheritance of haemochromatosis

A

autosomal recessive

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9
Q

what antibiotics is most strongly associate with c diff

A

cephalosporins

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10
Q

what is the second line treatment of hepatic encephalopathy

A

rifaximin

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11
Q

what drug can help prevent recurrent c.diff

A

Bezlotoxumab

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12
Q

what drugs can cause a hepatocellular picture

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
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13
Q

what drugs cause a cholestatic picture

A

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

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14
Q

name medications that cause cirrhosis

A

methotrexate
methyldopa
amiodarone

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15
Q

what HLA is associated with coeliac disease

A

HLA DQ2

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16
Q

what supplementation will likely be required following gastric bypass surgery

A

iron - as most surpass the duodenum where iron is absordbed

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17
Q

when is prophylaxis for SBP given

A

if ascited with protein level less than 15

choice is cipro

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18
Q

what is a rare complication of pancreatitis causing cotton wool spots on fundoscopy

A

ischaemic (Purtscher) retinopathy

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19
Q

what causes carcinoid synrome

A

release of serotinin

usually once carcinoid tumours have metastasised to liver

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20
Q

how can u treat carcinoid syndrome

A

ocreatide

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21
Q

what is used to treat SBBOS

A

rifaximin is now the treatment of choice due to relatively low resistance. Co-amoxiclav or metronidazole are also effective in the majority of patients.

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22
Q

what is whipple’s disease

A

rare multi-system disorder caused by Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.

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23
Q

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules is diagnostic of

A

whipples disease

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24
Q

how is whipples disease treated

A

co-trimox

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25
Q

how does teripressen work

A

causes contriction of the splanchnic vessels

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26
Q

older person, diarrhea, lots of mucus, hypokalaemia

A

villous adenoma

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27
Q

where is most likely affected in ischaemic colitis

A

splenic flexure

28
Q

what rheumatological disease is most commonly associated with primary bilary cirrhosis

A

sjrogens

29
Q

what is the triad of budd chairi

A

abdo pain
ascites
hepatomegaly

30
Q

give causes of budd chiari

A

polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
oral contraceptive pil

31
Q

describe the difference between type 1 and type 2 hepatorenal syndrome

A

type 1 -fast onset

type 2 - slower onset (slightly better prognosis)

32
Q

what scoring system can be uses to estimate the likelihood of someone having appendictis

A

alvarado

33
Q

what primary prevention is given for oesophageal varices

A

propranolol: reduced rebleeding and mortality compared to placebo
endoscopic variceal band ligation (EVL)

34
Q

what is the risk of endosopic variceal band ligation

A

ulcers - PPI given to prevent

35
Q

what is dubin johnson syndrome

A

benign autosomal recessive disorder resulting in hyperbilirubinaemia (conjugated, therefore present in urine). It is due to a defect in the canillicular multispecific organic anion transporter (cMOAT) protein. This causes defective hepatic bilirubin excretion

36
Q

what heart problem is angiodysplasia assoiciate with

A

aortic stenosis

37
Q

what are the chances of having bowel cancer from a positive FOB test

A

5-15 percent

about 40 percent chance of having an adenoma

38
Q

what gene mutations are most common in HNPCC

A

MSH2 (60 percent)
MLH1

they are DNA mismatch repair genes

39
Q

what other cancer is most commonly associated with HNPCC

A

endometrial cancer

40
Q

how is vertical tranmission of hep B in pregncnay prevented

A

give newborn hep B vaccine AND immunoglobulin

41
Q

what is the mode of inheritance of peutz jehgers

A

autosomal dominant

42
Q

what blood group is associated with gastric cancer

A

A

43
Q

what needs to be checked before commencing azathioprine

A

TPMT activity

if deficient cannot metalobise azathioprine well and more prone to side effects

44
Q

what can be used for resitant c diff

A

fidaxomicin

45
Q

what are cardiac complications of carcidnoid

A

tricuspid insufficiency and pulmonary stenosis.

46
Q

what is zollinger ellson syndrome

A

is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome

47
Q

what is the diagnostic test for zollinger ellson syndrome

A

gastrin levels (fasting)

48
Q

what is associated with gastric cancer on a pathology vlevel

A

signet ring cells

49
Q

what blood test can be used to assess for chronic pancreatitis

A

faecal elastase

50
Q

what conditions are associate with primary sclerosisng chonlangitis

A

UC
HIV

(also crohns)

51
Q

what is the diagnostic investigation for PSC

A

ERCP

52
Q

what cancers are you at increased risk from in PSC

A

cholangiocarcinoma (10 percent)

colon cancer

53
Q

at what BMI can u be referred for bariatric surgery

A 
no risk factors (>40)
rish factors (>35)
54
Q

what antibody is associated with primary biliary cholangitis

A

antimitochondrial

55
Q

what is the gold standard investigation for GORD

A

24 hour oesophageal pH monitoring

56
Q

what can be seen on imaging in pancreatic cancer

A

‘double duct’ sign - dilation of both the pancreatic and CBD

57
Q

what biochemical marker is used to monitor efficacy of treatment in haemochromatosis

A

ferritin and transferin saturation

58
Q

what investigation can confirm a diagnosis of gilberts syndrome

A

investigation: rise in bilirubin following prolonged fasting or IV nicotinic acid

59
Q

for oesophageal/gastric cancer - what is the best method to assess for mural invasiion

A

endoscopic ultrasound

60
Q

what is the carrier rate of CF

A

1 in 25

61
Q

what clotting factor is paradoxically raised in liver failure

A

factor 8

62
Q

what is the investigation of choice for bile acid malabsoption

A

the test of choice is SeHCAT
nuclear medicine test using a gamma-emitting selenium molecule in selenium homocholic acid taurine or tauroselcholic acid (SeHCAT)
scans are done 7 days apart to assess the retention/loss of radiolabelled 75SeHCAT

63
Q

where do VIPomas usually originate

A

pancreas

64
Q

which type of colonic polyps are more strongly associate with malignancy

A

flat or ‘sessile’ polyps

65
Q

what medical therapy can help prevent cancer in lynch syndrome

A

apirin 600mg

MRCP Part 1 (12 decks)

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