GI

Question 1

Which 2 hepatitis are transmitted by faecal-oral route

Answer 1

Eat Ass

Hep E + Hep A

Question 2

Acute management of variceal bleeding?

Answer 2

Terlopressin + prophylactic IV antibiotics

then endoscopy

Question 3

Spontaneous bacterial peritonitis - most common causative organism?

Answer 3

E. coli

Question 4

Most common inherited colorectal cancers?

Answer 4

HNPCC (Lynch syndrome): 3-5% chance of malignancy

FAP: 100% chance of malignancy

Question 5

What to monitor in haemochromatosis?

Answer 5

Ferritin and transferrin saturations

Question 6

Atrial fibrillation + acidosis + abdo pain =

Answer 6

Mesenteric ischaemia

Question 7

Why prescribe albumin for large volume ascites?

Answer 7

Reduce risk of circulatory dysfunction following paracentesis

Question 8

What should be checked before starting azathioprine or mercaptopurine?

Answer 8

TPMT activity

(enzyme involved in the metabolism of azathioprine and mercaptopurine)

Question 9

Which drug to induce remission of Crohn’s?

Which drug to maintain remission of Crohn’s?

Answer 9

Prednisolone to induce remission

Azathioprine to maintain remission

Question 10

Crohn’s vs UC in a running race: who wins?

Answer 10

Crohn’s wants to win BY ANY MEANS POSSIBLE.

It finds the quickest possible way to the top, by skipping lesions. However, because it does that skipping, its feet fall deeper with every skip, so it causes transmural inflammation. 



On the other hands, UC is a more meticulous runner who takes its time….ensures the environment is doing ok…so covers all the surface, and superficial mural inflammation.

Unfortunately, this effort causes it to be tired, and it never reaches beyond the Caecum.

Question 11

Treatment of UC - to maintain remission

Answer 11

Topical aminosalicylates e.g. mesalazine suppositories

Question 12

AMA M2 positive + raised ALP = ?

Answer 12

Primary biliary cholangitis

Question 13

Low creatinine =

Answer 13

Low muscle mass, e.g. malnutrition or chronic illness

Question 14

Cause of hepatic encephalopathy?

What to prescribe?

Answer 14

Increasing circulating ammonia

Give lactulose
(increases ammonia excretion)

Question 15

2 commonest oesophageal cancers = ?

Answer 15

Squamous cell = upper 2/3, associated with smoking/alcohol

Adenocarcinoma = Barrett’s oesophagus, GORD

Question 16

What are metanephrines?

Answer 16

Breakdown product of adrenaline

Used to measure adrenaline levels as their half-life is much longer

(24-hour urine catecholamines also used)

Question 18

What does lactulose do?

When should it be prescribed?

Answer 18

Pulls water into colon to soften poo

Prescribed for constipation AND hepatic encephalopathy

Question 19

Alpha-1 antitrypsin deficiency - primary problems?

Answer 19

Lungs lose elasticity (bronchiectasis + emphysema)

Liver fibrosis - cirrhosis - hepatocellular carcinoma

Question 20

Test used to assess for cirrhosis when FIB-4 score indicates ‘advanced fibrosis’

Answer 20

Transient elastography

Question 21

Key risk factors for PSC

Answer 21

Male
Aged 30-40
Ulcerative colitis (70% have UC)
Family history

Question 22

Beading on MRCP and pANCA +ve =

Answer 22

Primary SCLEROSING cholangitis

Beading = strictures

Question 23

Diagnostic test for H. pylori ?

Answer 23

Rapid urease test

Question 24

Anti-nuclear antibodies + anti-smooth muscle antibodies =

Answer 24

Autoimmune hepatitis

Investigation = Liver biopsy

Question 25

What do these Hepatitis B viral markers indicate? 1. Surface antigen (HBsAg) 2. E antigen (HBeAg) 3. Core antibody (HBcAb) 4. Surface antibody (HBsAb) 5. Hepatitis B virus DNA (HBV DNA)

Answer 25

Surface antigen (HBsAg) = active infection E antigen (HBeAg) = high infectivity Core antibody (HBcAb) = past or current infection Surface antibody (HBsAb) - vaccination or past or current infection Hepatitis B virus DNA (HBV DNA) - direct count of the viral load

Question 26

Test for IBD in primary care =

Answer 26

Faecal calcoprotein

Question 28

Crohn's or UC: which gives you gallstones?

Answer 28

Crohn's gives you stones Reduced bile absorption causes gallstones

Question 29

Tell me about the SAAG!

Answer 29

SAAG = Serum-ascites albumin gradient Serum albumin - ascitic albumin If the answer is >11g/L, the cause is portal hypertension.

Question 30

UC poorly controlled by mesalazine - what to do?

Answer 30

Add a thiopurine, e.g. azathioprine (Don't stop the aminosalicylate) (also, must check TPMT before starting azathioprine)

Question 31

What is a raised lactate? What does it mean?

Answer 31

>2 is raised >4 is bad bad bad Shows: - Sepsis - Shock - Ischaemia

Question 32

Severe C. difficile infection

Answer 32

Oral vancomycin + IV metronidazole (Mild = just oral vancomycin)

Question 33

How to confirm C. difficile infection?

Answer 33

CDT (Clostridium difficile toxin) in stool sample

Question 34

Spontaneous bacterial peritonitis - treatment + prophylaxis medications = ?

Answer 34

Treat = CefoTaxime PROphylaxis = ciPROfloxacin (also, PROphylaxis for meningococcal meningitis for exposed close contacts)

Question 35

Hepatitis IgM vs IgG

Answer 35

IgM = in the Moment (you have it rn) IgG = Grandpa (old infection)

Question 36

Which vaccine should coeliacs receive?

Answer 36

Pneumococcal vaccine Due to risk of pneumococcal sepsis due to hyposplenism

Question 37

Initial iron screening results in haemochromatosis =

Answer 37

Raised transferrin saturation Raised ferritin Low TIBC

Question 38

What to give for a recurrent episode of C. difficile infection?

Answer 38

Oral fidaxocimin

Question 39

What is "double duct" sign?

Answer 39

Simultaneous dilatation of the common bile duct and the pancreatic duct. Shows pancreatic cancer.

Question 40

Scoring system for malnutrition

Answer 40

MUST score (Malnutrition Universal Screening Tool)

Question 41

Primary biliary cholangitis - the M rule

Answer 41

IgM AMA-M2 (anti-Mitochondrial antibodies, M2 subtype) Middle-aged females

Question 42

Large volume paracentesis - what must be prescribed?

Answer 42

IV human albumin solution