Gastroenterology COPY

Question 1

BBV transmission methods

Answer 1

Sharing needles
Blood transfusion/blood products
Vertical
Uprotected sexual intercourse
Sharing razors/toothbrushes
Bites/cuts/straws
Tattoos, body pericings, acupuncture
Medical/dental treatment

Question 2

Who to test for BBV?

Answer 2

Past or current IVDU
Migrants from high endemic prevalance
Paitnets due to recieve chemo
Ever on chronic haemodialys
Persistently abnormal ALTS
Healthcare workers following needlestick
Household contacts/relatvies
Prisoners

Question 3

What would be seen if past infection hepatitis B

Answer 3

No surface antigen for Hep B

Question 4

Immune tolerance stage of chronic HBV?

Answer 4

High HBV DNA, Normal LFTs, HBeAG positive

Question 5

Immune clearance stage of chronic HBV

Answer 5

High HBV DNA
Abnormal LFTS
HBeAG positive
At risk of progression to cirrhosis annd HCC therfore should be referred for consideration of treatment

Question 6

Immune control stage of chronic HBV

Answer 6

Best stage to be in
Low HBV DNA, Normal LFTS, HBeAG neg, anti-HBe positive

Question 7

Immune escape stage of chronic HBV

Answer 7

High HBV DNA, Abrnomal LFTS

Question 8

Why is hepatoma surveillance done?

Answer 8

The goal of screening is to detect subclinical disease, and when screening is performed at regular intervals, it is called surveillance. Surveillance of at-risk patients with imaging results in detection of HCC at an earlier stage, which has a favorable effect on outcomes.

Question 9

First line for chronic hep B?

Answer 9

Nuceloside analogues

Question 10

If someone gets HCV antibody positive and HCV PCR negative?

Answer 10

Repeat test at 3-6 month to check if cleared

Question 11

If someone tests HCV antibody positive and HCV PCR positive

Answer 11

Repeat genotype test and then start treatment

Question 12

Complications of coeliac

Answer 12

Ulcerative jejunitis
Small bowel lymphoma
Osteoporosis
Functional hyposplenism
Vit D deficinecy

Question 13

What antibodies to look at in gastroenterology?

Answer 13

t-TG antibodies
IgA levels

Question 14

What is calprotectin?

Answer 14

Found in cytosol of neutorphils and macrophages
Released as part of the innate immune response

Question 15

Diagnosis of pancreatic exocrine malabsorption

Answer 15

Gold standard for diagnosis is faecal fat quantification
Measurement of faecal elastases more acceptable

Question 16

Management of pancreatic malabsorpionr

Answer 16

Dietary fat restriciton
Pancreatic enzyme supplements
Supplement fat soluble vitamins
Manage bone disease

Question 17

first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis

Answer 17

Daily rectal +/- oral mesalazine

Question 18

Primary biliary cholangitis - the M rule

Answer 18

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 19

Features of giardia lamblia?

Answer 19

fat malabsorption, therefore greasy stool can occur. It is resistant to chlorination, hence risk of transfer in swimming pools.

Question 20

Management of Barretts oesophagus?

Answer 20

high-dose proton pump inhibitor

endoscopic surveillance with biopsies

if dysplasia of any grade is identified endoscopic intervention is offered. Options include:
radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
endoscopic mucosal resection

Question 21

What letter of the alphabet to antibiotics causing C diff usually begin with?

Answer 21

C

Question 22

What is autoimmune hepatitis?

Answer 22

condition of unknown aetiology which is most commonly seen in young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3. Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present

Question 23

When to offer prophylatic abx in ascities?

Answer 23

Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved’

Question 24

Features of type 1 autoimmune hepatitis?

Answer 24

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Question 25

Features of type II autoimmune hepatitis?

Answer 25

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Question 26

Features of type III autoimmune hepatitis?

Answer 26

Soluble liver-kidney antigen

Question 27

Memory aid for heart defects in carcinoid synrome?

Answer 27

TIPS
tricuspid insufficiency and pulmonary stenosis.

Question 28

Managing severe colitis?

Answer 28

should be treated in hospital
intravenous steroids are usually given first-line
intravenous ciclosporin may be used if steroid are contraindicated
if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery

Question 29

Third line vancomycin?

Answer 29

oral vancomycin +/- IV metronidazole

Question 30

Investigation of choice for suspected perianal fistulae in patients with crohns

Answer 30

MRI