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Year 1 Incorrect Questions > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Signs of acute porphyria

A

Intermittent worsening abdo pain, nausea, lethargy

Recent course of nitrofuratoin (UTI)

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2
Q

Treatment of acute alc withdrawal

A

Reducing regimen of chlordiazepoxide and Pabrinex

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3
Q

Vit defic causing Wernicke’s encephalopathy

A

B1

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4
Q

High/Low SAAG caused by…

A

High - Portal HT

Low - Peritoneal cancers

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5
Q

First line ascites treatment

A

Spironolactone

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6
Q

Absolute contraindications to ascitic tap

A

Disseminated intravasc coag (bleeding gums, raised D-dimer, low fibrinogen)

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7
Q

First line for AI hepatitis

A

Immunosuppressants (azathioprine!!!!!!)

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8
Q

Management for Barrett’s w high-grade dysplasia

A

Endoscopic ablation/resection

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9
Q

Oeso cancer most assoc w Barrett’s

A

Adenocarcinoma

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10
Q

Treatment of carcinoid crisis

A

Octreotide

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11
Q

Abrupt onset watery diarrhoea

A

Cholera

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12
Q

Cholera treatment

A

Doxycycline or co-trimoxazole

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13
Q

Chronic pancreatitis on AXR/CT

A

Pancreatic calcification

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14
Q

Name for scratches from constant itching

A

Excoriations

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15
Q

First line for C.diff

A

Oral vancomycin

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16
Q

Colonoscopy appearance of pseudomembraneus colitis from C. diff

A

Raised yellow plaques across mucosa

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17
Q

What type of cancer are Coeliacs most at risk of?

A

Small bowel lymphoma

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18
Q

In which disease must you also test for Coeliac?

A

Grave’s (thyroid)

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19
Q

What can you see on buttocks in Coeliac?

A

Pruritic papulovesicular lesions

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20
Q

What is alpha-feto protein a marker of?

A

Hepatocellular cancer

Also testicular/germ cell cancer

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21
Q

Management of fistulae

A

Trans-sphincteric - drainage seton
Low/submucosal - fistulotomy
Perianal - insertion of fistula plug

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22
Q

Crohn’s on endoscopic biopsy

A

Non-caseating granulomas

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23
Q

Test to definitively distinguish Crohn’s and UC

A

Ileocolonoscopy and biopsy

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24
Q

Investigation for sepsis in Crohn’s

A

Urgent MRI pelvis

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25
Q

What drugs can commonly cause dyspepsia?

A

Clarithromycin

Risedronate

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26
Q

New onset dyspepsi + WL + >55 + H.pylori pos = which investigation?

A

Endoscopy within 2w

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27
Q

Liver foci and bloody diarrhoea from gastroenteritis?

A

Entamoeba histolytica

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28
Q

Campylobactor (gm- rod) treated w…

A

Erythromycin (macrolide)

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29
Q

What gastroenteritis pathogen is GBS associated with?

A

Campylobacter jejuni

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30
Q

What is the cause of abdo discomfort, bloating and flatulence after giardia treatment?

A

Lactose intolerance

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31
Q

Hep B serology seen w previous vaccination?

A

HbSAg negative, Anti-HbS positive, Anti-HbC negative

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32
Q

Pharma treatment for haemochromatosis

A

Desferrioxamine

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33
Q

Diag of hernia

A

Barium swallow !!!!!!
Endoscopy
Oeso manometry

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34
Q

Management of hernia

A

Conservative (WL, raise bed head, avoid large meals before sleep, avoid alc/acid foods/smoking/spec drugs etc)

Meds (PPI for 4-8w then review)

Surgery (Nissen’s fundiplication if med-resistance, urgent is haem/necrosis/volvulus/obs)

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35
Q

What drugs can affect hernia?

A

Calcium channel blockers e.g. amlodipine

Beta blockers

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36
Q

Drugs causing diarrhoea

A 
Magnesium
Antibiotics - penicillins
Chemotherapy
Omeprazole
Cimetidine
Ranitidine
NSAIDs
Metformin
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37
Q

Drugs causing constipation

A 
Anti-depressant agents
Anti-psychotic agents
Levodopa
Aluminium
Iron
Opiates
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38
Q

Inv for flow over diarrhoea

A

Rectal exam

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39
Q

Indication for TIPSS

A

Secondary prophylaxis for oesophageal variceal bleeding
Treatment of refractory ascites
Treating portal hypertension in Budd-Chiari syndrome

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40
Q

How can TIPSS cause hepatic encephalopathy?

A

Diverts blood flow away from liver and reduces ammonia breakdown

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41
Q

When is pain relieved in IBS?

A

After defaecation

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42
Q

Mirrizi’s disease

A

Causes obs jundice due to compression of common bile duct secondary to gallstones

Produces conjugated hyperbilirubinaemia

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43
Q

Features of primary sclerosing cholangitis

A

Fatigue, itch etc
Deranged LFTs
AMA +ve

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44
Q

Hepatic jaundice LFTs…

A

Raised bilirubin
Raised AST and ALT
Maybe slightly raised ALP
Low albumin

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45
Q

Classification of cirrhosis w Child-Pugh score

A

A <7 points
B 7-9 points
C >9 points

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46
Q

Cirrhosis complications

A 
Ascites 
SBP
Liver failure
Hepatocellular carcinoma
Oeso varices +/- haemorrhage
Renal failure
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47
Q

Features of Budd-Chiari

A

Hepatic vein obs in patients w underlying haem conditions or pro-coag state e.g. polycythaemia rubra vera
Classic triad of abdo symptoms (pain, ascites, tender hepatomegaly)
Abdo US or Doppler

48
Q

SBP Presentation

A

Background of cirrhosis
Generally unwell w tense ascites!!!!
Infection symptoms like fever

49
Q

What is an essential first line test for patients w chronic liver disease?

A

Cap blood glucose

They are esp susceptible to hypoglycaemia

50
Q

High AST:ALT ratio plus high GGT…

A

Alchohol related liver disease

51
Q

Jaundice, plus SOB and wheeze, plus lack of benefit from inhalers?

A

Alpha-1 antitrypsin defic

52
Q

3 key features of Budd-Chiari

A

Hepatomegaly
Hypercoagulability
Worsening ascites

53
Q

Caus eof gynaecomastia in cirrhosis

A

Altered oestrogen metabolism

54
Q

Management of perforated peptic ulcer w signs of peritonitis

A

Laparotomy

55
Q

What drug is indometacin?

56
Q

Risk factor for types oeso cancer

A

Squamous - achalasia, genetics, smoking, alcohol

Adenocarcinoma - GORD, obsety and reflux, caucasian

57
Q

Signet rings on biopsy…

A

Stomach cancer

58
Q

Phases of gastric acid secretion

A

Cephalic (smell/taste of food) - secretion of HCl and gastrin
Gastric (stomach distension) - low pH/peptides cause gastrin release
Intestinal (food in duodenum) - inhibits secretion via enterogastrones

59
Q

Pale stool and dark urine…

A

Obs cholestasis (confirmed by ALP and GGT)

60
Q

Pos AMA plus deranged LFTs

A

Primary biliary cholangitis/cirrhosis

61
Q

Absent urobilirubin + strong pos bilirubin

A

Obs jaundice - panc e.g. adenocarcinoma

62
Q

White cells in SBP

A

White cells >250

Neutrophils >40%

63
Q

INR suitable for liver biopsy

63
Q

INR suitable for liver biopsy

64
Q

Rise n which enzyme indicates pancreatitis

A

Usually serum lipase/amylase

65
Q

How can sickle cell affect the gallbladder?

A

Sickle cell anemia leads to hemolysis with increased bilirubin that favors formation of pigmented gallstones

66
Q

4 stages of hepatic encephalopathy

A
  1. Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
  2. Drowsiness, confusion, slurring of speech and personality change
  3. Incoherency, restlessness, asterixis
  4. Coma
67
Q

Drug to reduce cerebral oedema in encephalopathy

A

IV mannitol

68
Q

Criteria for paracetamol liver transplant

A

Arterial pH <7.3 24h after ingestion OR
Pro-thrombin time >100s
AND creatinine >300µmol/L
AND grade III or IV encephalopathy.

69
Q

Criteria for non-paracetamol liver failure

A 
Prothrombin time >100s OR
Any three of:
Drug-induced liver failure
Age under 10 or over 40 years
1 week from 1st jaundice to encephalopathy
Prothrombin time >50s
Bilirubin ≥300µmol/L.
70
Q

Asterixis (hepatic flap) in liver failure is sign of…

A

Grade 2/3 hepatic encephalopathy

Dute to paracetamol induced failure

71
Q

What condition causing grey skin pigmentation, joint pains, erectile dysfuncton in middle aged men can cause liver failure?

A

Haemochromatosis

test for ferritin and transferrin

72
Q

Oral or IV lactulose for hepatic encephalopathy

A

Oral - it can alter gut environment and reduce ammonia

73
Q

Common resp infection causing harsh breath sounds after liver failure

A

Pneumonia - treat w IV antibios

74
Q

Cancer assoc w H. pylori, chronic inflam and AI conditions

A

MALT

- treat w H. pylori eradication and if this fails then chemo/radio

75
Q

What can cause different oral lesions?

A

Candida/leucoplakia - age/diabetes/immunosuppression/corticosteroids/malig/antibios (treat w anti-fungual e.g. fluconazole)
Hairy leukoplakia - HIV, EBV
Oral ulcers - defic incl iron/B12/folate - e.g. Crohn’s
Glossitis/chelitis - iron defic

76
Q

Courvoisier’s sign

A

Painless palpable gallbladder with jaundice

77
Q

Panc cancer inv

A

CT abdo/pelvis

78
Q

Management of paracetamol overdose

A

> 1h - activ charcoal
Staggered/>15 - N-acetylcysteine
<4h - wait 4h to take level and then N-ace
4-15h - take immediate level then decide treatment (bloods and consider liver unit)

79
Q

Incr risk of paracetamol toxicity

A

Patient on long-term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states: eating disorders, malnutrition and HIV.

80
Q

Signs of pernicious anaemia

A 
Low B12
Low Hb
High MCV and MCH
Normal MCHC
Low/normal folic acid
Low reticulocyte
81
Q

Management of pernicious anaemia

A

Test for anti-intrinsic factor antibodies

Treat w life-long cobalamin

82
Q

Key inv in primary biliary cholangitis

A

Positive AMAs

Liver biopsy also shows fibro-obliterative bil tree scarring

83
Q

Key feature of PSC on MR cholangiopancreatography

A

Multiple beaded biliary strictures

84
Q

Pellagra and its treatment

A 
B3 Defic (the 3 Ds)
Nicotinamide
85
Q

Common causative org in diabetic foot ulcers

A

Gm +
e.g. staph areus, enterococcus

Gm-
e.g. pseudomonas, E coli

86
Q

Diabetes diag if symptomatic

A

Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)

87
Q

Treatment of typhoid

A

Fluoroquinolones or third generation cephalosporins

88
Q

Inv findings in UC

A

Colonoscopy - continuous inflam, red mucosa, loss of haustral markings, pseudopolyps
Biopsy - loss of goblet, crypt abscess, inlam cells

89
Q

Ca19-9 tumour marker of which cancer assoc with UC

A

Cholangiocarcinoma

90
Q

Surgery indication in UC with toxic megacolon

A

Failure to respond to intravenous steroids within 48-72 hours

91
Q

Observations indicating levels of blood loss

A

Resting tachy <15% lost
Ortho hypoT >15%
Supine hypoT >40%

92
Q

Initial man of upper GI bleed

A

IV fluid resus and blood transfusion
Nil by mouth and supplemental O2
Perhaps IV PPI
If variceal, IV terliprssion (to reduce pressure for endo)/antibios

93
Q

Rockall score

A

> 0 inpatient OGD

0 urgent outpatient OGD

94
Q

Upper GI bleed liver related

A

Oeso varices

95
Q

Prophylaxis of variceal bleed

A

Beta blocker e.g. propanolol

96
Q

Prophylaxis of variceal bleed

A

Beta blocker e.g. propanolol

97
Q

First line Whipple inv

A

Jejunal biopsy

97
Q

First line Whipple inv

A

Jejunal biopsy

98
Q

Wilson’s disease causes which anaemia?

A

Coomb’s negative haemolytic anaemia, with transient episodes of low-grade haemolysis and jaundice

99
Q

Inv findings for Wilson’s

A

Normally low ceruruloplasmin and serum copper
High urinary copper
Diag confirmed by genetic analysis of ATP7B

100
Q

Wilson’s treatment

A

Penicillamine and trientine
Zinc salts
Mandatory screening

101
Q

Which drug enhances gastric emptying?

A

Metoclopramide

102
Q

What drug is used to manage alcohol addicted patients in hospital to prevent withdrawal?

A

Clordiazepoxide

103
Q

Which score is used to assess pancreatitis severity?

A

Modified Glasgow score

104
Q

Paraneoplastic syndrome assoc with pacreatic cancer

A

Trousseau syndrome
(aka migratory thrombophlebitis)

105
Q

Hyposplenism associated with anaemia and malabsorption?

A

Coeliac
- anti-TTG antibodies

106
Q

High SAAG in ascites

A

Raised portal pressure
e.g. caused by liver cirrhosis, pericarditis, HF, Budd-Chiari etc

107
Q

Describe Courvoisier’s sign

A

Painless jaundice with palpable gallbladder
- suggests obs pancreatic/biliary neoplasm until proven otherwise

108
Q

Rose coloured spots on abdomen assoc with abdominal pain/constipation and history of South Asia travel

A

Salmonella typhi
- when someone gives you ROSES say thank you (TY)

109
Q

Immediate management of oesophageal varicaeal bleed

A

Terlipressin (vasopressin)

110
Q

Which substances are secreted by G, enterochromaffin, and Chief cells?

A

G = gastrin
Enterochromaffin = histamine
Chief = pepsinogen

111
Q

FL management ascites

A

Spironolactone

112
Q

Targets for diuretic agents

A

Ascites - Aldosterone Antagonists: e.g. spironolactone
Heart Failure - Furosemide
HyperTension - Thiazide diuretics

Year 1 Incorrect Questions (7 decks)

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