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Medicine - Finals > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Most common inheritable form of colorectal cancers

A

1 - HNPCC

2 - FAP

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2
Q

Features of ascending cholangitis

A

Reynolds Pentad (jaundice, right upper quadrant pain, fever/rigors, shock and altered mental status)

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3
Q

Ix for acute cholecystitis

A

Abdo USS

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4
Q

Diagnosing Pernicious Anaemia

A

Intrinsic factor antibodies are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies

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5
Q

Initial Ix for IBD

A

faecal calprotectin

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6
Q

How can response to colorectal cancer treatment be monitored?

A

CEA

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7
Q

Positive anti-HBc IgG,
Negative anti-HBc IgM
Negative anti-HBc
Positive HBsAg

A

chronic HBV infection

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8
Q

Define the symptom “waterbrush”

A

bitter taste in mouth commonly found in GORD

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9
Q

Dietry advice in GORD

A

avoid late night meals
avoid caffeine and alcohol
avoid spicy food
weight loss

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10
Q

Diagnosis of H.pylori

A

stool antigen test

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11
Q

Management of H.pylori

A

Amoxicillin
Clarithromycin/Metronidazole
PPI

Avoid NSAIDs

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12
Q

What increases the risk of oesophageal and gastric adenocarcinoma?

A

GORD -> Barrett’s

H.pylori -> Dyspepsia

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13
Q

Which cell releases intrinsic factor?

A

Parietal cells

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14
Q

Gene associated with Crohn’s

A

NOD2

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15
Q

Gene associated with UC

A

HLA-B27

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16
Q

Diagnosis of irritable bowel syndrome

A

Abdominal discomfort for ≥ 3 days per week + ≥2 of:

  • improvement on defaecation
  • change in bowel frequency
  • change in stool form
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17
Q

Biochemistry seen in acute pancreatitis

A

elevated serum amylase
high glucose
low calcium
high lipase

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18
Q

Drugs associated with pancreatitis

A 
Corticosteroids 
Alcohol 
Valproic Acid 
Azathiprine 
Diuretics

Remember: Drugs Causing A Violent Abdominal Distress

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19
Q

Signs of retroperitoneal bleeding

A

Cullen -> periumbilical bruising

Grey Turner -> flank bruising

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20
Q

Management of motion sickness

A

Cyclizine

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21
Q

Which condition is associated with pigmented gallstones?

A

Sickle Cell Anaemia

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22
Q

Risk factors for gallstones

A

The 4 F’s

Fertile 
Fourty 
Female 
Female
Fat
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23
Q

What is Primary Sclerosing Cholangitis associated with?

A

UC

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24
Q

Presentation of Ascending Cholangitis

A

Charcot’s Triad

  • RUQ pain
  • Fever
  • Jaundice
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25
Gene associated with Coeliac Disease
HLADQ2/Q8 gene
26
Risk factors for squamous cell carcinoma of the oesophagus
Smoking | HPV
27
Duke's staging for GI malignancy
A - confined by muscularis propria B - invaded the muscularis propria C - Metastatic
28
Two main inherited colorectal cancer syndromes
HNPCC (<100 polyps) - most common, late onset, r-sided FAP (>100 polyps) early onset adenocarcinoma Both are autosomal dominant conditions
29
What is Wilson's disease?
Ceruloplasmin deficiency causing copper build-up This can be detected by the increased copper in urine, reduced serum copper (as deposited in tissue) and reduced ceruloplasmin
30
Features of Wilson's disease
Parkinsonism Dementia Kayser-Fleischer rings Cirrhosis
31
Hep B serology. Distinguishing between acute and chronic disease
Acute - HBsAg +ve for 1-6 months | Chronic - HBsAg +ve for >6 months
32
Management of C.difficile
Mild - PO Metronidazole Severe - PO Vancomycin Life-threatening - PO Vancomycin and IV Metronidazole
33
Initial investigation for acute bowel obstruction
Supine AXR - small bowel -> valvulan convientes "coinstacked" appearance - large bowel -> haustra coli
34
What is the "silk" sign associated with?
Inguinal hernia - specifically in paediatrics
35
Raised CA 19-9
Pancreatic Cancer
36
Raised CA 15-3
Breast Cancer
37
Medications associated with hyponatraemia
PPI, ACEI, Thiazides, Sodium valproate, Loops, Ecstacy
38
Management of IBS
First -line pharmacological treatment - pain: antispasmodic agents - constipation: laxatives but avoid lactulose - diarrhoea: loperamide is first-line Second-line pharmacological treatment - low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg) are used in preference to selective serotonin reuptake inhibitors
39
Management of Crohn's
Inducing remission 1. Steroid or Budesonide 2. Consider enteral feeding with elemental diet (especially in children) 3. 5-ASA drugs (e.g. mesalazine) Add-on therapy: azathioprine or mercaptopurine Metronidazole is often used for isolated peri-anal disease Maintaining remission 1. Lifestyle e.g. stopping smoking is a priority (remember: smoking makes Crohn's worse, but may help ulcerative colitis) 2. azathioprine or mercaptopurine is used first-line to maintain remission 3. methotrexate is used second-line 4. 5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery Surgery
40
What should be tested before starting Azathioprine?
thiopurine methyltransferase (TPMT) activity before offering azathioprine or mercaptopurine
41
Management of UC flare
Inducing remission: rectal aminosalicyclate add oral aminosalicyclate if no better in 4 weeks and if serious consider steroids at this point
42
Management of UC - maintaining remission
Following a mild-to-moderate ulcerative colitis flare proctitis and proctosigmoiditis - topical (rectal) aminosalicylate alone (daily or intermittent) - an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent) - an oral aminosalicylate by itself: this may not be effective as the other two options left-sided and extensive ulcerative colitis low maintenance dose of an oral aminosalicylate Following a severe relapse or >=2 exacerbations in the past year oral azathioprine or oral mercaptopurine
43
Features and management of Zollinger-Ellison syndrome
Zollinger-Ellison syndrome typically presents with multiple gastroduodenal ulcers causing abdominal pain and diarrhoea. High-dose proton pump inhibitors are needed to control the symptoms.
44
What tumour syndrome is associated with Zollinger-Ellison syndrome?
MEN1
45
What can be used as a measure of pancreatitis severity?
Mainly: Hypocalcaemia - full list below P - PaO2 (< 7.9 kPa). A - age (>55). N - neutrophils (white cell count > 15x 109/L). C - calcium (calcium < 2 mmol/L). R - renal function (urea > 16 mmol/L). E - enzymes (lactate dehydrogenase > 600 IU/L). A - albumin (albumin < 32 g/L). S - sugar (blood glucose > 10 mmol/L). 3 points and above suggests a high risk for severe pancreatitis.
46
What marker is used to assess exocrine function in chronic pancreatitis?
Faecal elastase
47
Secondary prevention of hepatic encephalopathy
Lactulose and rifaximin
48
What is the best measure of acute liver failure?
Prothrombin time
49
Isolated rise in bilirubin in response to physiological stress
Gilbert's Syndrome
50
Sigmoid Volvulus associations
older patients chronic constipation Chagas disease neurological conditions e.g. Parkinson's disease, Duchenne muscular dystrophy psychiatric conditions e.g. schizophrenia
51
Abdominal X-ray. Coffee Bean Sign
Sigmoid volvulus
52
Management of Campylobacter jejuni gastroenteritis
Watchful waiting | Clarithromycin if complicated or immunosuprressed
53
When should urea breath test not be performed for H.pylori?
Within 4 weeks of antibacterial therapy or within 2 weeks of antisecretory medication (e.g. PPI)
54
What is the only test recommended for testing H pylori eradication?
Urea breath test
55
Vitamin A + Deficiency
Retinoids deficiency causes night-blindness
56
Vitamine B1 + Deficiency
Thiamine deficiency causes: - dry beriberi --> peripheral neuropathy - wet beriberi --> dilated cardiomyopathy - Wernicke's --> nystagmus, ophthalmoplegia and ataxia - Korsakoff --> amnesia and confabulation
57
Vitamine B6 + Deficiency
Pyridoxine deficiency presents with anaemia, irritability and seizures
58
Bitamin B3 + Deficiency
Niacin deficiency causes Pellagra (Remember: Vit B3 deficiency gives you the 3D's) Dermatitis Diarrhoea Dementia
59
Vitamin B7 + Deficiency
Biotin --> dermatitis and seborrhoea
60
Vitamin B9 + Deficiency
Folic Acid --> Megaloblastic Anaemia and Neural Tube defects in early pregnancy
61
Vitamin B12 + Deficiency
Cyanocobalamin --> Megaloblastic Anaemia and Peripheral Neuropathy
62
Vitamin C + Deficiency
Ascorbic Acid --> Scurvy (gingivitis and bleeding)
63
Vitamin D + Deficiency
Cholecalciferol --> Rickets and Osteomalacia
64
Vitamin E + Deficiency
Tocopherol --> Mild haemolytic anaemia in newborns, ataxia and peripheral neuropathy
65
Vitamin K + Deficiency
Naphthoquinone --> Haemorrhagic Disease of the Newborn, bleeding diathesis

Medicine - Finals (21 decks)

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