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AMC MCQ > Gastroenterology & GI Surgery > Flashcards

Gastroenterology & GI Surgery Flashcards

1
Q

Autosomal dominant

A
  • Familial adenomatous polyposis
  • Peutz Jeghers syndrome
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2
Q

Autosomal recessive

A

Gilbert’s syndrome

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3
Q

Liver damage enzymes

A
  • ALT
  • ALP
  • AST
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4
Q

Liver function enzymes

A
  • Bilirubin
  • Albumin
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5
Q

Category 1 Colorectal cancer risk

A
  • Near average risk if they have no family history of colorectal cancer
  • Above-average risk 1 1st degree relative > 60 years at dx
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6
Q

Category 1 Colorectal cancer screening

A
  • iFOBT every 2 years after 45 years to 74
  • low-dose (100 mg) aspirin daily should be considered from age 45 to 70
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7
Q

Category 2 Colorectal cancer risk

A

Moderate risk
2x-4x higher than average risk
One 1st degree relative < 60 years at dx
OR
One 1st degree relative AND >One 2nd degree diagnosed at any range
OR
Two 1st degree relatives diagnosed at any age

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8
Q

Category 2 Colorectal cancer screening

A
  • Colonoscopy every 5 years starting at 10 years younger than the earliest age of diagnosis in 1st degree relative

OR age 50, whichever is earlier, to age 74.

  • CT colonography if clinically indicated
  • Low dose aspirin (100mg)
  • Update history
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9
Q

Category 3 Colorectal cancer risk

A

High risk
Two 1st degree relatives AND One 2nd degree relative diagnosed < 50
OR
Two 1st degree relatives + > Two 2nd degree relative diagnosed at ANY age
OR
> Three 1st degree relatives diagnosed at ANY age

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10
Q

Category 3 Colorectal cancer screening

A
  • Colonoscopy every 5 years starting at 10 years younger than the earliest age of diagnosis of colorectal cancer in a first-degree relative
    OR
    age 40, whichever is earlier, to age 74.
  • CT colonography if clinically indicated
  • Low dose aspirin (100mg)
  • Update history
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11
Q

migratory superficial thrombophlebitis + deep vein
thrombosis

A

Trousseau’s syndrome

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12
Q

hix of gastric bypass + discomfort, including nausea, vomiting, cramps, and diarrhea

A

Dumping syndrome

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13
Q

Dumping syndrome management

A
  • Diet modification (high fibre + protein)
  • -Hydrogen breath test positive
  • Barium fluoroscopy
  • radionuclide scintigraphy reoperation if diet fails
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14
Q

Trousseau’s syndrome associated tumours

A

1-Pancreas 24%
2-Lung 20%
3-Prostate 13%
4-Stomach12%
5-Acute leukaemia 9%
6-Colon 5%

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15
Q

Small bowel obstruction investigation

A

initial: Abdominal X-ray
Best: CT abdomen/gastograffin meal (dx & tx)

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16
Q

Elective non-cardiac surgery following PCI

A

Defer surgery for 6 weeks - 3 months

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17
Q

Elective surgery with history of drug eluding stents

A

Defer for 12 months

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18
Q

emergency surgery with history of rug eluding stents

A

Withhold clopidogrel for 5-7 days
- continue aspirin

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19
Q

most common cause of large bowel obstruction

A

Colon cancer

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20
Q

upper GIT endoscopy 🚩’s

A

▪ anaemia (new onset)
▪ dysphagia (difficulty swallowing)
▪ odynophagia (painful swallowing)
▪ haematemesis or melaena
▪ unexplained weight loss >10%
▪ vomiting older age >50 yrs
▪ chronic NSAID use
▪ severe frequent symptoms including hiccoughs, hoarseness
▪ family history of upper GIT or colorectal cancer
▪ short history of symptoms
▪ neurological symptoms and signs

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21
Q

Oropharyngeal dysphagia causes

A

Neuro-muscular disease:
* Stroke
* Parkinson’s disease
* Brain stem tumour
* Degenerative conditions: ALS
MS
* Myasthenia gravis
* Peripheral neuropathy

Obstructive lesion:
* Tumour
* Inflammatory masses: abscess
* Pharyngeal pouch (Zenkers)
* Anterior mediastinal mass

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22
Q

Oesophageal dysphagia causes

A

Neuro-muscular disease:
* Achalasia
* Scleroderma
* GORD

Obstructive lesion:
* Tumour
* Strictures:
Peptic (reflux oesophagitis)
Radiation
Chemical (caustic Ingestion)
Medication
* Oesophageal webs (Plummer
Vinson)
* Foreign Bodies

Extrinsic Structural Lesions:
* Vascular compression (enlarged or Left Atrium)
* Mediastinal masses:
lymphadenopathy or retrosternal
thyroid.

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23
Q

Iron deficiency anaemia in elderly

A

colon cancer

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24
Q

high INR + low calcium + hypochromic microcytic anaemia

A

malabsorption syndrome

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25
Q

malabsorption syndrome investigation

A

Anti-gliadin antibodies

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26
Q

Coeliac disease Symptoms:

A

Chronic diarrhoea

Steatorrhoea

Weight loss

Anorexia

Abdominal distension

Nutritional deficiency: folate, calcium, zinc or iron (in particular)

Grouped blisters around the knees, elbows and buttocks (dermatitis herpetiformis)

Hair loss

Mouth ulcers

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27
Q

Coeliac vitamin deficiencies

A
  • iron (most common)
  • B12
  • ADEK
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28
Q

Coeliac disease investigation

A

Serum transglutaminase antibodies

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29
Q

conditions is associated with an increased risk of coeliac disease

A
  • Type I diabetes mellitus
  • Hashimoto’s thyroiditis
  • autoimmune diseases
  • Down’s syndrome
  • Turner’s syndrome
  • IgA deficiency
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30
Q

long hx of vomiting after food + reduced appetite

A

Gastro-oesophageal reflux disease (GORD)

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31
Q

Most common complication of GORD

A

Oesophagitis

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32
Q

Gastro-oesophageal reflux disease (GORD) investigation

A

Initial: Intraoesophageally pH probe monitoring
diagnostic: oesophageal endoscopy with multiple biopsies

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33
Q

GORD management

A

Therapeutic trial of proton pump inhibitor

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34
Q

high age + progressive dysphagia + decreased contractions + increased tertiary wave activity

A

Presbyoesophagus

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35
Q
  • Dysphagia to solids and liquids
  • Heartburn unresponsive to a trial of proton pump inhibitor therapy for 4weeks
  • Retained food in the oesophagus on upper endoscopy
  • Unusually increased resistance to passage of an endoscope through the oesophagogastric junction
A

achalasia

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36
Q

Most important diagnostic feature of achalasia?

A

Dysphagia for both solids and liquids

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37
Q

Barrett’s oesophagus monitoring

A

2-5 years by endoscopy and biopsy depending on segment length

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38
Q

bariatric surgery indications

A

– BMI above 40 with no co-morbidities
– BMI above 35 with co-morbidities such as hypertension
– BMI above 30 with poorly controlled type 2 diabetes
– BMI above 30 with increased cardiovascular risk due to multiple risk factors such as hypertension, hyperlipidemia, strong family history of cardiovascular disease at a young age

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39
Q

bariatric surgery contraindications

A

– Irreversible end-organ dysfunction.
– Cirrhosis with portal hypertension.
– Medical problems precluding general anaesthesia.
– Centrally mediated obesity syndromes such as Prader-Willi syndrome or Craniopharyngioma.

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40
Q

PUD risk factors

A

-Male sex.
-Family history of peptic ulcer disease.
-Smoking.
-Stress.
-NSAIDs.
-H.pylori.

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41
Q

H. Pylori

A

Gram -ve
- corkscrew-shaped, motile bacillus with three to seven flagella
- rapid urease test
- Eradication with colloidal bismuth (Pepto-Bismol), an antibiotic (amoxicillin or ampicillin), and a nitroimi-dazole such as metronidazole.

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42
Q

Left supraclavicular lymph node cancer

A
  • abdominal or pelvic
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43
Q

Acute pancreatitis investigation

A
  • serum lipase (elevated)
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44
Q

acute pancreatitis surgery indications

A
  • Uncertainty of clinical diagnosis
  • Worsening clinical condition despite optimal supportive car2
  • Infected pseudocysts
  • Gallstone-associated pancreatitis
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45
Q

Pancreatic pseudocyst management

A
  • size > 6cm ERCP
  • Present for > 6 weeks
  • Wall thickness for > 6 mm

NOTE: if ERCP fails, then move on to laporotomy

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46
Q

Pancreatic cancer risks

A

-Smoking.
-Long-standing diabetes mellitus.
-Chronic pancreatitis.
-Obesity.
-Inactivity (high cholesterol/obesity?
-Non–O blood group

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47
Q

freckling + gastrointestinal polyposis (polyps in small bowel) + intussusception + pigmented macules (1–5mm) on lips, buccal mucosa and fingers

A

Peutz Jeghers Syndrome

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48
Q

Peutz Jegers Syndrome complications

A

high risk of specific cancers:
intestine
colon
pancreas
breasts
cervix
ovaries
testes

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49
Q

Diverticultis highest mortality rate complication

A

Perforation 20%

  • Bleeding especially in elderly
    – Intra-abdominal abscess.
    – Peritonitis.
    – Fistula formation.
    – Intestinal obstruction.
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50
Q

Meckel diverticulum investigation

A
  • painless large-volume intestinal hemorrhage
    Technetium-99m pertechnetate scintigraphic study
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51
Q

– Severe colicky epigastric and periumbilical pain
– Absolute constipation.
– Nausea and vomiting.
– Abdominal distension

A

small bowel obstruction

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52
Q

jaundice, dark urine, and pale stool + palpable gall bladder

A

Periampullary tumor

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53
Q

GI bleed with weight loss and decreased appetite

A

colon adenocarcinoma

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54
Q

5 F’s of cholecystitis

A
  • Fair
  • Fat
  • Female
  • Fertile
  • Forty
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55
Q

infective cholecystitis pathogen

A

E. Coli

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56
Q

hx of cholecystectomy + abdominal pain + dyspepsia + increased liver enzymes abd cholesterol

A

post-cholecystectomy syndrome

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57
Q

post-cholecystectomy syndrome investigation

A

Perform ERCP

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58
Q

gall stone investigation

A

initial:
diagnostic: US/ERCP

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59
Q

Gallstone surgery indication

A

size > 3 cm
- calcified/porcelain gallbladder

60
Q

abdominal surgical interventions

A

D1. iffuse peritonitis(localized peritonitis is not always an indication).
2-Severe or increasing localized tenderness.
3-Progressive abdominal distension.
4-Tender mass with fever or hypotension (abscess).
5-Septicemia and abdominal findings.
7-Bleeding and abdominal findings.
8-Suspected bowel ischemia (acidosis,fever,tachycardia).
9-Massive bowel dilatation more than 12cm.

61
Q

diarrhoea + abdominal pain + bloating + belching + flatus + nausea and vomiting

A

Giardiasis

62
Q

Giardiasis investigation

A

stool examination for ova and cyst

63
Q

most common cause of constipation

A

Dietary

64
Q

dysphagia + hoarseness + hx of achalasia + thoracic inlet mass

A

Oesophageal cancer

65
Q

dysphagia + chest discomfort +
weight loss ± hiccoughs

A

oesophageal cancer

66
Q

oesophageal malignant lesions surgical contraindication

A
  • Invasion of tracheobronchial tree
  • Invasion of great vessels
  • lesion more than 10 cm
67
Q

hoarseness + dysphagia + neck mass

A

Laryngeal cancer

68
Q

paraesophageal/hiatus hernia investigation

A

Diagnostic: Barium swallow

69
Q

fever + jaundice, + pain in the right upper quadrant + chills

A

Acute cholangitis
Harcot’s triad

70
Q

Acute cholangitis poor prognostic determinants

A

1- Age more than 70.
2- Female gender.
3- Failure to respond to conservative management.
4- Concurrent medical conditions:
- liver abscess
- cirrhosis
- hypoalbuminaemia
- thrombocytopenia
- IBD
- malignant strictures

71
Q

abdominal pain + diarrhoea + Tenderness on DRE

A

Acute appendicitis

72
Q

Left iliac fossa pain + Fever + Tenderness and rebound tenderness + Guarding + Per rectal bleeding + hypotension

A

Acute diverticulitis

73
Q

hx of ascites+ fever + altered mental status + increased WBC + abdominal pain/discomfort

A

spontaneous bacterial peritonitis

74
Q

Splenectomy measures

A
  • Vaccination against:
    streptococcus pneumoniae
    meningococcus
    H. influenza
  • Antibiotics (Penicillin) from 6 months - 2 years
  • target cells (deformed RBCs)
75
Q

Peritonitis investigation

A
  • Ascitic analysis
    (fluid neutrophil count more than 250 cells/mm3)
76
Q

Malignant cells in ascites will spread to

A

Left supraclavicular lymph nodes

77
Q

spontaneous bacterial peritonitis transmission

A

Bacterial translocation from gut to mesenteric lymph node Bacterial translocation from gut to mesenteric lymph node

78
Q

bacterial peritonitis treatment

A

Cefotaxime and albumin
- albumin to reduce the rate of renal failure

79
Q

screening for hepatoma or primary liver cancers with chronic hepatitis

A

Alpha fetoprotein

80
Q

Hepatic hydatid cyst pathogen

A

Echinococcus tape worm

81
Q

Hepatic hydatid cyst investigation

A

Initial: USG
Best: Triphasic abdominal CT (confirmatory)
- Cyst aspiration

82
Q
A

Hepatic hydatid cyst USG

83
Q
A

Hepatic hydatid cyst USG

84
Q
A

Hepatic hydatid cyst CT

85
Q
A

Hepatic hydatid cyst CT

86
Q

Hepatic hydatid cyst management

A

Albendazole
Surgery
Praziquantel followed by albendazole if spilled cyst

87
Q

autoimmune hepatitis predictor of poor clinical response to therapy

A

Anti-liver-kidney microsomal antibody (Anti-LKM antibody)

88
Q

Elevated liver enzymes with normal bilirubin

A

Ischemic hepatitis

89
Q

Indicator for chronic liver disease

A
  • Alanine aminotransferase
  • Aspartate aminotransferase
90
Q

Child-Pugh classification

A

The severity of portal hypertension
1-Increased total bilirubin.
2-Prolonged INR.
3-Low serum albumin.
4-Presence of hepatic encephalopathy.
5-Presence of ascites.

91
Q

Best predictor of patient livelihood

A

Hypoalbumin
- decrease in osmotic pressure, therefore ANSARCA that leads to CHF

92
Q

Best indicator for chronic liver disease

A

Albumin

93
Q

Longstanding cirrhosis or Hep C

A

Form hepatocellular carcinioma

94
Q

Cirrhosis findings

A

PE: spider naevi, palmar erythema, gynecomastia and splenomegaly

LAB:
- Thrombocytopenia
Abnormal coagulation studies including INR and PT
Hypoalbuminemia

95
Q

Pilonidal sinus prevention

A

1-Keep the area clean and dry.
2-Avoid sitting for a long time on hard surfaces.
3-Remove hair from the area

96
Q

Acute confusion post surgery

A

Atelectasis, PR, chest infection
- check pulse oximetry

97
Q

Encephalopathy grades

A

Grade-I involves altered mood/behaviour, sleep disturbance including reversal of sleep cycle.
Grade-II involves increasing drowsiness, confusion and slurred speech
Grade-III involves stupor, incoherence, restlessness and significant confusion
Grade IV is an
ultimate coma

98
Q

Dilated abdominal veins flowing towards head + hepatomegaly

A

Inferior Vena Cava Obstruction

99
Q

Dilated abdominal veins flowing towards legs+ hepatomegaly

A

Caput medusae from cirrhosis and portal hypertension

100
Q

History of recent myocardial infarction. + acute onset of abdominal pain + Metabolic
acidosis.

A

mesenteric ischemia

101
Q

chronic gastrointestinal bleeding prevention

A

BB (Propranolol or nadolol)

102
Q

most likely to strangulate hernia

A

indirect inguinal hernia

103
Q

least likely to strangulate hernia

A

Direct inguinal hernia

104
Q

gastroenteritis in Australia?

A

Norovirus

105
Q

Repeated unconjugated hyperbilirubinemia + No evidence of haemolysis, with normal findings on complete blood count, reticulocyte count, and blood smear. + Normal liver function tests except for the bilirubin.

A

Gilbert’s syndrome

106
Q

most common gastrointestinal complication seen after cholecystectomy

A

Diarrhoea

107
Q

infliximab for inflammatory bowel disease

A

Crohn’s disease with perianal fistulas

108
Q

erythematous + well define + fluctuant mass at the anal orifice

A

Perianal abscess

109
Q

sulfasazine side effects

A
  • agranulocytosis
  • haemolytic anaemia
    rash -
110
Q

presence of eosinophils + dysphagia

A

eosinophilic esophagitis

111
Q

eosinophilic esophagitis management

A
  1. PPI
  2. Swallowed budesonide
  3. Systemic corticosteroids
112
Q

CEA

A

glycoprotein found in colon - cancer
- CEA assay is a sensitive serologic tool for identifying recurrent disease

113
Q

infant + volvulus + duodenal obstruction + intermittent or chronic + abdominal pain

A

malrotation

114
Q

hernia that follows the path of the spermatic cord within the cremaster muscle

A

Indirect inguinal

115
Q

hernia passes directly beneath the inguinal
ligament at a point medial to the femoral vessels

A

femoral

116
Q

hernia passes through a weakness in the floor of the inguinal canal medial to the inferior epigastric
artery

A

direct inguinal

117
Q

hernia that protrude through an anatomic defect that can occur along the lateral border of
the rectus muscle at its junction with the linea semilunaris

A

Spigelian

118
Q

thiazide diuretic + beta
blocker

A

hypokalemia

119
Q

haemorrhoiids investigation

A

Proctoscopy

120
Q

Recurrent pneumonia + dysphagia + undigested food regurgitation

A

Zenker diverticulum (pharyngeal puch)

121
Q

Zenker diverticulum investigation (pharyngeal puch)

A

Initial: Contrast esophagography
Best: Upper gastrointestinal endoscopy

122
Q

Zenker diverticulum management (pharyngeal puch)

A

Surgery: cricopharyngeal myotomy ± diverticulectomy

123
Q

dysphagia + coughing and choking + recurrent aspiration pneumonia + stroke

A

Oropharyngeal dysphagia

124
Q

Oropharyngeal dysphagia investigation

A

Videofluoroscopic modified barium swallow study

125
Q

middle-aged women + hyperlipidemia + fatigue + pruritus + elevated alkaline phosphatase

A

cholestasis

126
Q

constipation + fecal ncontinence + hematochezia + hx of pelvic radiation therapy

A

Radiation proctitis

127
Q

Acute pancreatitis worse prognosis

A

Blood urea nitrogen level
- reflect intravascular volume depletion

128
Q

Ursodeoxycholic acid is used to treat

A

Primary biliary cirrhosis
- increases bile acid output and bile flow while reducing
cholesterol absorption

129
Q

primary lymphoma predisposing factors

A

Celiac disease

130
Q

solids dysphagia + breathlessness, cough +
heartburn + wheezing

A

Congenital anomaly of the aortic arch
- presses against the oesophagus causing dysphagic, compression isn’t too harsh as liquids can still pass through

131
Q

long hx of constipation + sudden cut-off + dilated proximal colon + abdominal distension + empty rectum on DRE

A

sigmoid volvulus

132
Q

sigmoid volvulus investigation

A

diagnostic: CT abdomen
NOTE: barium if perforation is suspected

133
Q

mild tenderness on rectal exam + pain localized in the pelvis

A

pelvic appendicitis

134
Q

Disease with strongest association with colorectal cancer

A

Familial adenomatous polyposis
- cancer can develop as early as 20

135
Q

Somalian + anal fissure predisposing factor

A

Rectal schistosomiasis

136
Q

most common cause of treatment failure in PUD

A

metronidazole/clarithromycin resistance

137
Q

dyspepsia + belching + abdominal pain + post cholesytectomy

A

Post- cholecystectomy syndrome (PCS)

138
Q

Most common cause of post-cholecystectomy syndrome (PCS)

A

Choledocholithiasis

139
Q

Radiologic study of choice for oesophagus

A

Barium swallow

140
Q

Radiologic study of choice for oesophagus + stomach + duodenum

A

Barium meal

141
Q

Radiologic study of choice for oesophagus + stomach + duodenum + small intestine

A

Barium follow-through

142
Q

Radiologic study of choice for colon

A

Barium enema

143
Q

Radiologic study of choice for suspected perforations/ volvulus/ bowel obstructions

A

Gastrogaffin

144
Q

Oesophagogastroduodenoscopy
(OGD) indications

A

Haematemesis or Melena

145
Q

Colonoscopy indications

A
  • Diarrhoea
  • Dark red blood in rectal bleeding
146
Q

OGD + colonoscopy indications

A

Iron deficiency anaemia

147
Q

flexible sigmoidoscopy indications

A

Rectal bleeding bright red blood

AMC MCQ (56 decks)

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