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1MRCP Part 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Features of Whipple’s Disease (7)
Gene association

A

Steatorrhoea
Malabsorption
Abdominal Pain
Polyarthralgia
Hyperpigmentation
Petechiae
Photosensitivity
Gene = HLAB27

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2
Q

Factors for liver transplant - paracetamol overdose (4)

A

pH <7.3 after 24 hours
Cr >300
PT >100
Grade III or IV encephalopathy

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3
Q

Determining cause of ascites
- albumin

A

Serum: ascites albumin gradient
serum - ascites albumin value = gradient
SAAG >11 = portal hypertension
- Infectious or malignant ascites results in low gradient (albumin values are approx same because different pathology)

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4
Q

Marker of severity in pancreatitis

A

CRP
- associated rise with pancreatic necrosis

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5
Q

Check for h.pylori following eradication therapy

A

Urea breath test
- ideally wait 4 weeks after finishing treatment

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6
Q

Treatment of pyoderma gangrenosum in IBD

A

Oral prednisolone

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7
Q

Difference between Type 1 and Type 2 Hepatorenal Syndrome

A

Type 1 = rapid, Cr >250
Type 2 = more insidious

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8
Q

Acute alcohol intake in paracetamol overdose - good or bad?

A

May be protective - chronic alcohol excess worse

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9
Q

Best anti-emetic for travel sickness

A

Hyoscine

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10
Q

Blood results in haemochromatosis

A

Raised iron
Raised ferritin
Low or normal transferrin

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11
Q

Management of UC
- >= 2 exacerbations in 12 months

A

PO azathioprine or mercaptupurine as maintenance

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12
Q

Management of UC
- disease beyond L side of colon

A

PO 5ASA + rectal 5ASA
Enemas only go so far

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13
Q

Management of UC
- flare

A

IV steroids
If not improving 72 hours then consider ciclosporin

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14
Q

What is normal oesophageal mucosa made up of?
What happens in Barrett’s?

A

Normal = squamous
Barrett’s = metaplasia from squamous to columnar

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15
Q

HELPP vs Acute Fatty Liver of pregnancy

A

Hypertension VS normotension
Haemolysis VS no haemolysis

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16
Q

Investigation of hepatic vein thrombosis
- initial
- definitive

A

Initial = US with doppler flow
Definitive = hepatic venography

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17
Q

Pathogenesis of achalasia

A

Loss of ganglia of Auerbach’s plexus
= loss of peristalsis and increased tone at lower oesophageal sphincter

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18
Q

Investigation of choice in achalasia

A

Manometry +- barium swallow

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19
Q

Pathogenesis of pharyngeal pouch

A

Posteromedial herniation of pharynx

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20
Q

Management of eosinophilic oesophagitis

A

Dietary modification
(topical steroids are 2nd line)

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21
Q

Plummer Vinson

A

= glossitis, IDA, oesophageal webs

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22
Q

Boerhave’s Syndrome =

A

= complete transmural oesophageal rupture

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23
Q

Monitoring for Barrett’s oesophagus

A

Endoscopy
- at least every 3-5 years

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24
Q

Staging investigation for oesophageal cancer

A

Endoscopic US

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25
Q

Risk factors for Gastric Cancer (2)
Investigation sign

A

Blood Group A, Smoking
= signet ring sign

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26
Q

Why is angiodysplasia associated with aortic stenosis?

A

= theory is turbulence of flow at the aortic valve results in loss of vWF

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27
Q

Gene loci associated with Coeliac disease
Disease association

A

HLA DQ2/HLA DQ8
T cell lymphoma

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28
Q

Bilirubin metabolism

A

Haem > iron + bilverdin
(haem oxygenase)
iron + bilverdin > unconjugated bilirubin
(bilverdin reductase)
> conjugated bilirubin
(UDP-GT)

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29
Q

Causes of unconjugated hyperbilirubinaemia (2)
Genetic inheritance

A

Gilbert’s Syndrome
Crigler-Najjar Syndrome
Autosomal recessive

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30
Q

Prophylaxis of c.difficile

A

Bezotoxumab

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31
Q

Investigation for small bowel overgrowth
Management for small bowel overgrowth

A

H breath test
Rifaximin

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32
Q

Organism implicated in Whipple’s Disease
Management

A

Tropheryma whipplei
Need long duration of antibiotics - IV penicillin then PO co-trimoxazole for at least 1 year

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33
Q

Biopsy finding in tropical sprue

A

Mononuclear cell infiltrates
6 months of tetracyclines

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34
Q

Gastroenteritis - severe vomiting immediately after eating food

A

Staph aureus

35
Q

Colorectal cancer screening

A

Between 60-74 years
Every 2 years, send FIT, if FIT positive then invited for colonscopy

36
Q

What criteria is used for staging colorectal cancer?

A

Duke’s criteria
e.g. Grade C = lymph node spread (A/B to do with wall thickness spread)

37
Q

HNPCC
- inheritance
- gene
- presentation

A

= Lynch syndrome
Autosomal dominant
Mismatch repair gene - MSH2
Proximal colorectal, endometrial

38
Q

FAP
- inheritance
- gene
- management

A

= familial adenomatous polyposis
Autosomal dominant
APC gene on chromosome 5
Total colectomy + ileo-anal pouch

39
Q

Gardener’s Syndrome

A

FAP
with
facial osteomas, thyroid cancer

40
Q

Peutz-Jegher’s Syndrome
- inheritance
- gene
- presentation (3)

A

Autosomal dominant
STK11/LKB1
Harmatous polyps, GI bleeding, intusseption

41
Q

Cowden’s Syndrome
- gene
- presentation
- associated cancers (3)

A

PTEN (tumour suppressor gene)
Harmatomous polyps
Breast, uterine, thyroid cancer

42
Q

Mechanism of action of 5-ASA

A

Inhibits prostaglandin synthesis

43
Q

Mechanism of action of azathioprine

A

Inhibits purine synthesis

44
Q

Mechanism of action of methotrexate

A

Inhibits dihydrofolate reductase

45
Q

Management of refractory Crohn’s disease

A

Infliximab

46
Q

Medications used for maintaining remission in Crohn’s disease
Need to check?

A

Azathioprine/Mercaptopurine
Need to check TPMT status prior to commencing

47
Q

Biopsy appearance of Crohn’s disease (2)

A

Transmural
Cobblestoning appearance

47
Q

Definition of severe flare of ulcerative colitis

A

> 6 stools/day with blood
+- fever, tachycardia, pain

48
Q

Investigation findings of ulcerative colitis (4)

A

Submucosal
Crypt abscesses
Pseudopolyps
Drainpipe colon

49
Q

Topical 5-ASA, when not to use?

A

If inflammation extends beyond splenic flexure, need PO as well: enemas can only go so far

50
Q

EEG findings in encephalopathy

A

Triphasic slow waves

50
Q

Monitoring in ulcerative colitis

A

All need colonoscopy
- either every 1, 3 or 5 years depending on risk

51
Q

Anti-HbC
- acute vs chronic infection?

A

IgM - acute
IgG - cleared or chronic infection
(HBsAg will be positive in active infection)

52
Q

Associations with hepatitis B (4)

A

Chronic infection
Polyarteritis nodosa
Cryoglobulinaemia
Hepatocellular Carcinoma

52
Q

Associations with hepatitis C (5)

A

Chronic hepatitis C
Hepatocellular carcinoma
Type II cryoglobulinaemia
Sjogren’s syndrome
Porphyria

53
Q

Medical management of HCC

A

Sorafenib

53
Q

Contra-indications for liver biopsy (5)

A

INR >1.4
PLT <60
Ascites
Anaemia
Hydatid cyst disease

54
Q

Pathophysiology of hepatic encephalopathy

A

Accumulation of ammonia and glutamine

54
Q

SAAG
>1.1g/dl

A

Reflects portal hypertension causing ascites

55
Q

Investigation for pancreatitis

A

CT with contrast
US - determine aetiology e.g. gallstones

56
Q

Most common cause of SBP in alcoholic liver disease

A

E.coli

56
Q

Gene implicated in Wilson’s disease

A

ATP7B gene on chromosome 13

57
Q

Pathogenesis of hepato-renal syndrome

A

Vasoactive mediators produced by liver = vasodilation
= hypoperfusion of kidneys
Activation of RAAS to try and compensate
= fluid overload - continuous cycle

57
Q

Investigation findings in Wilson’s Disease

A

Reduced caeruloplasmin levels
Decreased total copper levels (reduced transport)

58
Q

Gene locus associated with autoimmune hepatitis

A

HLA DR3

59
Q

Type 1 autoimmune hepatitis

A

Adults/kids
ANA/smooth muscle antibody

60
Q

Type 2 autoimmune hepatitis

A

Children
Anti-liver kidney microsomal antibody8

61
Q

Type 3 autoimmune hepatitis

A

Anti-soluble liver antibody

62
Q

Antibody associated with PBC

A

anti-mitochondrial antibodies subtype M2
- may also see raised IgM and anti-SMA

63
Q

Investigation of PSC
- finding

A

ERCP/MRCP
Beaded appearance of the ducts

64
Q

Where is the most common site for pancreatic adenocarcinoma?

A

Head of pancreas

65
Q

Presentation of pancreatic cancer (3)
Investigation of pancreatic cancer

A

New diabetes, steatorrhoea, migratory thrombophlebitis
HRCT

66
Q

C urea breath test
- rules around medications

A

No antibiotics in the last 4 weeks
PPI stopped for 2 weeks

67
Q

Barium swallow - oesophageal stricture with apple core effect =

A

= oesophageal cancer

68
Q

Hepatic vein thrombosis =

A

Budd Chiari Syndrome
Hepatic portal vein thrombus has a more indolent course

69
Q

Gold standard test for bile acid malabsorption

A

SEHCAT test
- nuclear medicine test using selenium: swallow as a capsule

70
Q

Gold standard investigation for GORD

A

Oesophageal 24 hour pH monitor

71
Q

Ca125 can also be used as marker in…

A

Peritoneal cancer

72
Q

Pigment laden macrophages on GI biopsy

A

Laxative abuse

73
Q

What feature of IBD is not associated with disease activity?

A

Primary sclerosing cholangitis

74
Q

Electrolyte abnormality associated with ileostomy

A

= hypomagnesaemia
(there is impaired PTH secretion which then results in hypocalcaemia = mechanism by which ileostomy causes hypocalcaemia)

75
Q

What cells are responsible for liver fibrosis?

A

Stellate cells

76
Q

Icthyosis + pancreatic cancer - what associated mutation?

A

KRAS mutation

77
Q

What is related to the risk of re-feeding syndrome?

A

BMI

1MRCP Part 1 (20 decks)

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