Gastroenterology and renal

Question 1

Serum ascites albumin ratio to diagnose cirrhosis

Answer 1

1.5

Question 2

Bacteria causing D&V after eating pre-prepared food?

Answer 2

Listeria

Question 3

Presence of Hepatitis B surface antigen (HBsAg)

Answer 3

it is the first serum marker to be detected following initial infection.

Question 4

Presence of Anti-HBc IgM means?

Answer 4

The presence of anti-HBc IgM indicates recent infection within the last six months

Question 5

Presence of antibodies against HBeAg means?

Answer 5

HBeAg seroconversion is the development of antibodies against HBeAg (anti-HBe); it marks a transition from active disease to an inactive ‘carrier’ state.5 Anti-HBe remains in serum for life and indicates acquired, natural immunity (i.e. immunity from a previous infection only).

Question 6

Main source of listeria

Answer 6

Cold pre-prepared food

Question 7

Mild c.diff infection

Answer 7

Mild infection: not associated with an increased white cell count (WCC). Typically associated with fewer than 3 episodes of loose stools per day.

Question 8

Moderate c.diff infection

Answer 8

associated with an increased WCC (but less than 15 × 109 per litre). Typically associated with 3 to 5 loose stools per day.

Question 9

Severe c.diff infection

Answer 9

associated with a WCC greater than 15 × 109 per litre, or an acutely increased serum creatinine concentration (greater than 50% increase above baseline), or a temperature higher than 38.5 degrees Celsius, or evidence of severe colitis (abdominal or radiological signs). The number of stools may be a less reliable indicator of severity.

Question 10

Life threatening c.diff infection

Answer 10

symptoms and signs include hypotension, partial or complete ileus, toxic megacolon or CT evidence of severe disease.

Question 11

Diagnose SBP on an ascitic tap

Answer 11

> 250 polymorphonuclear cells (neutrophils) per cubic millimetre

Question 12

Incubation period for Hep A

Answer 12

28-30 days

Question 13

Treatment for Hep A

Answer 13

Supportive

Question 14

Key facts re Hep A infection

Answer 14

No chronic carrier state
Nil chronic infection
Life long immunity after contracting

Question 15

Skin sign in UC

Answer 15

Erythema nodosum

Question 16

Skin sign in coeliac disease

Answer 16

Dermatitis herpetiformis

Question 17

What is most helpful in diagnosing HUS

Answer 17

Peripheral blood smear with schistocytes

Question 18

When to use calcium chloride in hyperkalaemia

Answer 18

Any severity with ECG changes

Question 19

Moderate hypokalaemia

Treatment

Answer 19

2.5-2.9

Oral

Question 20

Layers affected in

UC

Crohns

Answer 20

Mucosa and sub mucosa

Transmural

Question 21

Which antibiotics used in patients with travellers diarrhoea who are at risk of developing an invasive infection

Answer 21

Ciprofloxacin

Question 22

Which type of E.coli does NOT cause bloody diarrhoea

Answer 22

Enterotoxigenic (non invasive)

Question 23

Primary biliary cirrhosis, primary sclerosing cholangitis and chronic active hepatitis are recognised associations of…

Answer 23

UC

Question 24

What type of bacteria is Clostridium difficile

Answer 24

Gram-positive, anaerobic, spore-forming bacteria

Question 25

primary sclerosing cholangitis vs primary biliary cholangitis

Answer 25

One major difference is that primary biliary cholangitis (PBC) affects only your intrahepatic bile ducts, the bile ducts within your liver. Primary sclerosing cholangitis (PSC) affects all of your bile ducts, including your extrahepatic ducts.

Question 26

1st line for typhoid fever

Answer 26

Cefotaxime

Question 27

Ovarian mets most often come from

Answer 27

Gastric Ca

Question 28

Pabrinex contains the following vitamins:

Answer 28

Thiamine (vitamin B1)
Riboflavin (vitamin B2)
Nicotinamide (Vitamin B3, niacin and nicotinic acid)
Pyridoxine (vitamin B6)
Ascorbic acid (vitamin C)

Question 29

Which two drugs have UK marketing authorisation for the management of acute alcohol withdrawal symptoms.

Answer 29

diazepam and chlordiazepoxide

Question 30

Which screening tool is recommended by NICE for the identification of alcohol misuse.

Answer 30

AUDIT

Question 31

First two choices in rapid tranq according to NICE

Answer 31

IM Lorazepam

IM haloperidol + promethazine

Question 32

Wernicke’s encephalopathy triad

Answer 32

Acute confusion
Ophthalmoplegia
Ataxia

Question 33

When is IM haloperidol + promethazine contraindicated in rapid tranq

Answer 33

If there is evidence of cardiovascular disease, including a prolonged QT interval, or no electrocardiogram has been carried out, then intramuscular haloperidol combined with intramuscular promethazine should be avoided, and intramuscular lorazepam used instead.

Question 34

Define AKI stage 1 (based on blood results / UO)

Answer 34

A rise in serum creatinine of 26 μmol/L or greater within 48 hours.

50% or greater increase in serum creatinine (1.5 fold from baseline) within the preceding seven days.

A fall in urine output to less than 0.5 mL/kg/hour for more than six hours.

Question 35

NSAID impact on

Renal plasma flow
Filtration fraction
eGFR

Answer 35

Decreased renal plasma flow, no change in filtration fraction, decreased GFR

Question 36

Define AKI stage 2 (based on blood results / UO)

Answer 36

Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),

or

Urine output <0.5 mL/kg/hour for more than 12 hours

Question 37

Define AKI stage 3 (based on blood results / UO)

Answer 37

Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), or

Creatinine rise to 354 micromol/L or more with acute rise of 26 micromol/L or more within 48 hors or 50% or more rise within 7 days, or

Urine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours

Question 38

At what eGFR should dialysis be started?

Answer 38

Patients generally begin dialysis when their GFR reaches 10 ml/min or 15 ml/minute if they are diabetic.