Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RACP Written Exam 2021 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Indications for treatment in Haemachromatosis either with;

  • Phlebotomy
  • Chelation (if unable to undergo phlebotomy)
A

Ferritin persistently > 500 (Absolute if >1000)
End Organ involvement
- Liver: LFT derangement, biopsy or MRI
- Cardiac: MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications for Liver Biopsy in Haemachromatosis

A

Abnormal LFTs
Ferritin >1000
Hepatomegaly or other signs of CLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications for chelation

A

Phelbotomy contraindicated

  • Severe Anaemia
  • Haemodynamic Compriomise
  • Limited life expectancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Findings of NASH on liver biopsy

A

Hepatic Steatosis
Hepatic Ballooning
Hepatic lobular degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Findings of NAFL on liver biopsy

A

Steatosis with hepatocyte balling or portal inflammation (but not both)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Findings of Cirrhosis on liver biopsy

A

Bridging fibrosis

Stellate cell activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Findings of PBC on liver biopsy

A

Peri-portal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Findings of ASH on liver biopsy

A

Steatosis

Mallory Hyaline bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Findings of AIH on liver biopsy

A

Interface hepatitis

Portal tract inflammation (lymphocytic, plasma cells and multinucleate giant cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HCC screening surveillance benefit

A 
Hepatitis B carriers
 - Asian males >40 
 - Asian females > 50 
 - Family hx of HCC 
 - With cirrhosis 
African/North American blacks with Hep B 
Cirrhosis 
 - Hepatitis C cirrhosis 
 - Genetic Haemachromatosis
- Alpha 1 antitrypsion 
Stage 4 PBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HCC screening algorithm

A

6 monthly ultrasound +/- AFP
Lesion found of US
<1cm: Repeat U/S in 3 months
>1cm: CT or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Primary Billiary Cirrhosis diagnostic criteria

A

2/3

  • ALP elevated
  • AMA elevated
  • Histology of biopsy (Peri-portal inflammation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment for PBC

A

Urosodeoxycholic Acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Main side effects of PPI’s (eight)

A

1) Pneumonia
2) Gastroenteritis
3) Osteoperosis
4) Hypomagnasaemia
5) Interstitial nephritis
6) Microscopic colitis
7) C Diff Colitis (more likely to get recurrent C Diff colitis if on PPI)
8) Hypergastrinaemia - unknown clinical effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnosis of Zollinger Ellison Syndrome

A

1) Fasting Gastrin >10000
2) Gallium 68 Dotate CT-PET

Note: 1/3 patients with ZE have MEN 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic test for chronic pancreatitis

A

Faecal elastase

Note Faecal elastase is not disrupted by creon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hereditary pancreatitis

A

Autosomal dominant
Recurrent mild attacks of pancreatitis age > 5
Chromosone 7q35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pre-malignant pancreatic cysts

A

1) IPMN: Location - head of pancreas
2) MCN: Tail of pancreas.

Both Mucin producing and pre-malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for pancreatic cancer

A 
1) Modifiable 
> Smoking 
2) Non-modifiable 
> Cystic Fibrosis 
> BRCA1/2
> Lynch Syndrome 
> FAMMM
> Hereditary pancreatitis
> Peutz-Jeghers syndrome 
> Familial history of pancreatic cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Findings of Esophageal Eosinophilia on histology

A

> or equal to 15 intraepithelial eosinophils per high powered field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Finding on biopsy of IBD

A

Architectural change

Lymphoplasmacit infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which gene is associated with chrons disease

A

NOD2

They have more fibrostenotic complications of the bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Smoking effect on CD vs UC

A

CD:

  • Refractory
  • Fistulising disease
  • Surgical recurrence

–> smoking cessation is a therapy for CD

UC
- protective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which subset of IBD has the worst risk of cancer?

A

Patients with PSC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Colonoscopy’s in patient sixth IBD

A

3 yearly baseline (Commence 8 years after diagnosis)

Annually

  • PSC
  • Fhx CRC in first degree relative <50 yo
  • Colonic stricture or multiple pseudopolyps
  • Active Disease
  • Prvious dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ASCA vs ANCA for differentiating UC from CD

A 
pANCA+/ASCA- = Ulcerative Colitis 
ASCA+/pANCA- = Chrons Disease
27
Q

Therapy for UC

A

First line: 5ASA (oral + rectal)
Second line: Thiopurines (if patients need more than 1 Course of steroids in a year)
Third line: Infliximab/Vedolizumab

Can use corticosteroids

28
Q

Chron’s Disease therapy

A

Individualised approach
Treat to target approach

Steroids: Induction
Steroid sparing agents: Thiopurines, methotrexate

ASA not effective

29
Q

Adverse effects of ASA

A

Intersitial nephritis (annual UEC)
Diarrhoea
Azospermia (reversible)

30
Q

Steroids in IBD

A

Only for induction, not for maintenance

Prednisolone 40mg/day with slow taper

Nb Budesonide good in mild ileocolonic CD or UC - releases at the ileum with high first pass metabolism (not on the PBS)

31
Q

Risk of elevated 6MMPR metabolite

A

Hepatoxicity (measure metabolites)

Measure TPMT prior to commencement, rationale being that if there are low TPMT they are at risk of rapid leukopenia.
Heterozygotes - half the dose

32
Q

Which metabolites of Azathioprine has a therapeutic effect in IBD

A

TGN

33
Q

Adverse effects of thiopurines

A

1) Myelo suppression
2) Hepatitis
3) Pancreatitis
4) Nausea/Vomiting
5) Lymphoma - hepatosplenic t-cell lymphoma
6) Non-melanoma skin cancers

34
Q

Thiopurine metabolite testing

A

High MMP, Low TGN = shunter

Given allopurinol

35
Q

Which drugs are responsible for hepatosplenic t-cell lymphoma in young males with IBD?

A

Thipurine + Anti-TNF

36
Q

What does adalimumab target

A

TNF (anti-tif drug)

37
Q

Vedolixumab better in CD or UC?

A

UC

38
Q

Ustekinimab use in Australia

A

CD

39
Q

Anti-TNF drugs for fistulizing CD

A

1) Infliximab or adalimumab

40
Q

Adverse effects of Anti-TNF

A

1) Reactivate TB (need screening prior)
2) Lymphoma
3) Melanoma (!!!)
4) Demyelinating disorders
5) Lupus like syndrome
6) Heart failure in pre-existing NYHA 3-4

41
Q

Vedolizumab mechanism of action

A

Blocks alpa4beta7-MADCAM which stops diapesis of the T cells into the gut tissue

Gut specific = no systemic immunosuppression
UC or CD

42
Q

Ustekinumab mechanism of action

A

Blocks IL12/23 via p40 subunit

43
Q

Biologics in IBD

A

TNF blockers
Vedolizumab
Ustekinumab

44
Q

Only indication for Fecal transplant (FMT)

A

Refractory C.Diff

45
Q

Which treatments for IBD increase risk of skin cancer?

A

1) TNF: Melanoma

2) Thiopurines: Non-melanomatous skin cancer

46
Q

Acute severe ulcerative colitis

A

Initially

1) QID hydrocortisone
2) Clexane
3) IV Fluids
4) Aim HB>100

Flexible sigmoidoscopy for CMV

No response at 3-5 days
1) Surgery

Nb: Mortality = 1%

47
Q

Which treatment do you start in peri-anal disease with CD

A

Anti-TNF (Infliximab)

48
Q

Indication for C-section in patients with CD

A

Active perianal disease

49
Q

Safest biologic during pregnancy

A

Anti-TNF

50
Q

Vaccinations at diagnosis for patients with IBD

A

“the big five”

1) Hep B
2) HPV
3) VZV - note live and therefore not able to be given on immunomodulator
4) Pneumococus
5) Infuenza

51
Q

Indications for 6 monthly ultrasound screening in Hep B

A

1) Cirrhosis
2) Asian male >40
3) Asian female >50
4) African descent
5) HBD +
6) First degree family member with HCC

52
Q

Treatment indications for Chronic Hep B

A

1) HBE Ag+
- HBV >20,000 DNA
- ALT > 2 times ULN
2) HBE Ag-
- HBV >2,000
- ALT >2 times ULN

53
Q

Which is the most suggestive of chron’s disease over ulcerative colitis?

A

Perianal fistula

54
Q

Best first test in patient with chronic diarrhoea?

A

Fecal calprotectin
(released by neutrophils migrating into the lumen)
Early predictor of flares

55
Q

Which extraintestinal manifestation is most highly associated with disease activity in CD

A

large joint arthritis (knees, hands and wrists)

56
Q

Treatment for Pyoderma Gangrenosum

A

Topical steroids

Topical Tacrolimus

57
Q

Treatment for PSC

A

Liver Transplant

58
Q

HLH On azathioprine (thiopurines)

A

Commonly triggered by EBV infection

59
Q

Oxford criteria for failure of treatment for acute sever UC

A
  • > 8 stools per day
  • Ongoing blood in stool
  • CRP > 44
60
Q

How does Vedolizumab act?

A

Binds to and inhibits alpha 4 beta 7 trafficking into the gut

61
Q

Follow up colonoscopy for
> 1-2 adenomas <10mm with no villous/high grade dysplasia
> 3-4 or any with villous, high grade dysplasia or >10mm
> 5-9
> 10+

A 
As per the Cancer Council Guidelines 
> 1-2: 5 years
> 3-4 or concerning features: 3 years
> 5-9: 1 year
> 10+: <1 year
62
Q

Grades of immunotherapy induced colitis (number of stools greater than normal)

A 
> Grade 1: < 4 movements/day 
> Grade 2: 4-6 bowel movements/day
> Grade 3: 7 bowel movements/day 
> Grade 4: Life threatening hypovolaemia or electrolyte disturbance 
> Grade 5: Death
63
Q

Treatment for checkpoint induced colitis

A

Always exclude infectious cause of diarrhoea
Grade 1: Symptomatic management (loperamide), continue ICI
Grade 2: Observation, withhold ICI
Grade 3: Oral prednisone 1mg/kg, withhold ICI (asses response at D5)
Grade 4: IV methylprednisone 1mg/kg, withhold ICI (assess response at D3)
If failure to improve at the discussed reassessment period (usually 72 hours) then consider starting steroid sparing agent, i.e Infliximab at 5mg/kg. There can be two doses of Infliximab given.
For grades 3-4 checkpoint inhibitors should be permanently discontinued.

RACP Written Exam 2021 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions