GI

Question 1

Red flags for GI Ca

Answer 1

ALARMS:
anaemia
loss of weight
anorexia
recent onset of progressive sx
masses/ melena
swallowing difficulties

> 55y/o

Question 2

oesophageal disease differentials: haematemesis

Answer 2

Mallory Weiss
oesophageal varices
oesophageal Ca

Question 3

oesophageal disease differentials: swallowing difficulties

Answer 3

achalasia
oesophageal Ca
Zenker’s diverticulum
systemic sclerosis
strictures

Question 4

oesophageal disease differentials: pain

Answer 4

Mallory Weiss
oesophageal varices
GORD

Question 5

Exam technique: difference between Mallory Weiss and oesophageal varices

Answer 5

MW: ‘continuously retching’, ‘vomiting blood’
OV: PMH liver, ‘coughing up blood’

Question 6

What is Zenker’s diverticulum?

Answer 6

outpouching of pharynx causing pseudo-choking, bad breath and infection

Question 7

Exam technique: difference between oesophageal ca and achalasia?

Answer 7

oesophageal ca: can’t swallow solids, then liquids
achalasia: can’t swallow either (occurs at the same time)

Question 8

ix and result for achalasia

Answer 8

endoscopy
barium swallow- bird’s beak sign
manometry (gold)

Question 9

histological change in Barrett’s oesophagus

Answer 9

stratified squamous to simple columnar epithelium

Question 10

potential bacterial cause of gastritis

Answer 10

helicobacter pylori infection- gram -ve spiral bacterium
oral-oral or faecal-oral transmission

Question 11

where is vit B12 absorbed

Answer 11

terminal ileum

Question 12

how do NSAIDs cause acute gastritis?

Answer 12

COX-inhibitor -> inhibits prostaglandin synthesis -> less mucus secretion

Question 13

helicobacter pylori infection gastritis ix

Answer 13

urea breath test
stool antigen test

stop PPI for 2 weeks, abx for 4 weeks before

Question 14

How does eating affect gastric/ duodenal ulcer pain?

Answer 14

duodenal: gets better as duodenal sphincter closes
gastric: gets worse as increased stomach acid production

Question 15

What is triple therapy for h pylori?

Answer 15

PPI, clarithromycin, amoxicillin/ metronidazole

Question 16

Which artery could a gastric/ duodenal ulcer perforate?

Answer 16

gastric: gastroduodenal
duodenal: left gastric

Question 17

Signs of gastric ulcer perforation

Answer 17

haematemesis + melena

Question 18

Signs of duodenal ulcer perforation

Answer 18

hematochezia + melena

Question 19

IBS s+s

Answer 19

ABC

abdominal pain (relieved by defecation)
bloating
change in bowel habits

Question 20

path of UC inflammation

Answer 20

rectum to ileum

so abdo pain starts in left lower quadrant

Question 21

IBD extraintestinal signs

Answer 21

A PIE SAC

Ankylosing spondylitis
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Aphthous ulcers/ amyloidosis
Clubbing

Question 22

flow chart of diagnostic markers for UC and Crohn’s

Answer 22

+ve faecal calprotectin for IBD (-ve for IBS)

pANCA is +ve for UC, -ve for Crohn’s

Question 23

mild UC tx

Answer 23

1. mesalazine (to maintain remission)
2. • steroid (prednisolone)

Question 24

moderate/ severe UC tx

Answer 24

1. fluid resus
2. IV steroid (hydrocortisone)
3. • TNF-alpha inhibitor (infliximab)

Question 25

UC gold tx

Answer 25

colectomy

Question 26

location of Crohn's abdo pain

Answer 26

right lower quadrant (mostly affects ileum)

Question 27

tropical sprue GOLD ix

Answer 27

jejunal tissue biopsy

Question 28

difference between tropical sprue and Crohn's

Answer 28

tropical sprue: incomplete villous atrophy Crohn's: complete villous atrophy

Question 29

3 histological changes in coeliac disease

Answer 29

villous atrophy crypt hyperplasia intraepithelial lymphocytes

Question 30

skin sx present in coeliac

Answer 30

dermatitis herpetiformis angular stomatitis

Question 31

dude is just feeling ill bro

Answer 31

duodenum: iron jejunum: folate ileum: B12

Question 32

1st and 2nd line and gold ix for coeliac

Answer 32

raised anti-tTG raised anti-EMA endoscopy and duodenal biopsy (villous atrophy, crypt hyperplasia, intraepithelial lymphocytes)

Question 33

chronic mesenteric ischaemia s+s (classic triad)

Answer 33

central colicky abdo pain after eating weight loss abdominal bruit (due to turbulent blood flow)

Question 34

diverticular disease sx

Answer 34

BBL bowel habits change bloating/ flatulence left lower quadrant pain N+V

Question 35

diverticulitis sx

Answer 35

diverticular disease sx + fever + blood in stool

Question 36

what is Rovsing's sign?

Answer 36

sign of acute appendicitis- palpation of LIF causes pain in the RIF

Question 37

most common viral causes of diarrhoea

Answer 37

rotavirus: leading cause in children norovirus: leading cause in adults Traveller's diarrhoea

Question 38

most common bacterial cause of diarrhoea

Answer 38

campylobacter jejuni E coli salmonella enterica shigella

Question 39

difference between salmonella and shigella on XLD plate

Answer 39

salmonella: pink w black centre shigella: pink

Question 40

how is diarrhoea caused by c diff treated?

Answer 40

metronidazole, vancomycin, stop abx

Question 41

mc cause + tx for parasitic diarrhoea

Answer 41

giardia lamblia metronidazole

Question 42

where does oesophageal adenocarcinoma affect?

Answer 42

lower 1/3 of the oesophagus

Question 43

where does oesophageal squamous cell carcinoma affect?

Answer 43

upper 2/3 of the oesophagus

Question 44

What is CA19-9 a marker for?

Answer 44

cholangiocarcinoma and pancreatic cancer

Question 45

what is alpha fetoprotein (AFP) a marker for?

Answer 45

HCC and testicular cancer

Question 46

what is beta-hCG a marker for?

Answer 46

pregnancy

Question 47

what is CA-125 a marker for?

Answer 47

ovarian cancer

Question 48

what is carcinoembryonic antigen (CEA) a marker for?

Answer 48

colorectal cancer