Gastrointestinal

Question 1

C.difficile treatment

Answer 1

First line: oral vancomycin for 10 days
Second line: oral fidaxomicin
third-line and life-threatening: oral vancomycin + IV metronidazole

Question 2

Wilson’s disease treatment

Answer 2

Penicillamine

Question 3

Painless jaundice and enlarged gallbladder - most likely diagnosis?

Answer 3

Pancreatic cancer

Question 4

Features of primary biliary cholangitis:

Answer 4

Middle aged woman
IgM
Anti-mitochondrial antibodies

Question 5

Spontaneous bacterial peritonitis: diagnosis

Answer 5

paracentesis: neutrophil count >250 cells/ul

E.coli found in ascitic fluid culture (most common)

Question 6

What is the characteristic ratio in alcoholic hepatitis?

Answer 6

AST:ALT = 2:1

Question 7

Management of alcoholic hepatitis:

Answer 7

Prednisolone [determined by Maddrey’s discriminant function].
Pentoxyphylline sometimes used.

Question 8

Features of a carcinoid tumour:

Answer 8

flushing, diarrhoea, bronchospasm, hypotension, right heart valvular stenosis

Question 9

Management of carcinoid tumour:

Answer 9

somatostatin analogues: octreotide

Question 10

investigations for achalasia:

Answer 10

oesophageal manometry : diagnostic test
barium swallow
chest x-ray

Question 11

Criteria for urgent endoscopy referral:

Answer 11

1. All patients with dysphagia
2. All patients with abdominal mass consistent with stomach cancer
3. All patients >55 with weight loss and one of: dyspepsia, reflux, upper abdominal pain