GI

Question 1

How does metoclopramide work?

Answer 1

D2 receptor anatagonist

Question 2

Side effects of metoclopramide

Answer 2

Extra pyramidal movements (e.g. tardive dyskinesia, oculogyral crisis)
Hyperprolactinaemia
Parkinonism

Question 3

Management of variceal bleeding

Answer 3

Terlipressin and prophylactic antibiotics at presentation (i.e. before endoscopy)

Then do band ligation

Question 4

Treatment of gastric varices

Answer 4

Injections of N-butyl-2-cyanoacrylate

Question 5

If initial management of varices does not work, what should you do?

Answer 5

Transjugular intrahepatic shunt

Question 6

Hereditary haemochromatosis inheritance pattern

Answer 6

Autosomal recessive

Question 7

Liver failure triad

JEC

Answer 7

Jaundice
Encephalopathy
Coagulopathy

Question 8

First line test for coeliac disease

Answer 8

Tissue transglutaminase antibodies

Question 9

What is coeliac disease

Answer 9

A sensitivity to gluten

-repeated exposure leads to villous strophy, which in turn causes malabsorption

Question 10

What are patients with primary sclerosing cholangitis at risk of?

Answer 10

Around 10% of patients with primary sclerosing cholangitis will develop cholangiocarcinoma
Also have an increased risk of colorectal cancer

Question 11

What is primary sclerosing cholangitis?

Answer 11

Inflammation of the intra- and extra hepatic bile ducts

Question 12

Which other conditions are associated with primary sclerosing cholangitis?

Answer 12

Ulcerative colitis
Crohn’s
HIV

(10% of patients with PSC will develop cholangiocarcinoma)

Question 13

What might you see on liver biopsy in primary sclerosing cholangitis?

Answer 13

Would see onion skin fibrosis

Question 14

First line investigation for primary sclerosing cholangitis, and what will investigation show?

Answer 14

ERCP - will show beaded appearance (from multiple biliary strictures)

Question 15

A young man with RIF pain, what must you do?

Answer 15

MUST always examine the testicles

In young men with RIF pain, could be appendicitis or testicular problems (infection/torsion)

Question 16

Which type of peptic ulcers are more common? and clinical feature?

Answer 16

Duodenal ulcers more common, epigastric pain relieved by eating

Question 17

Colicky pain, typically in the LLQ
Diarrhoea, sometimes bloody
Fever, raised inflammatory cells and white cells

Answer 17

Acute diverticulitis

Question 18

Tinkling bowel sounds

Answer 18

Intestinal obstruction

Question 19

How does mesenteric ischaemia present?

Answer 19

Central abdominal pain - patients typically have a history of AF or other cardiovascular disease
-Diarrhoea, rectal bleeding may be seen
A METABOLIC ACIDOSIS IS OFTEN SEEN (due to tissue ‘dying’)

Question 20

What type of ABG would you see in mesenteric ischamia

Answer 20

Often see a metabolic acidosis

Question 21

When is mesenteric ischaemia worse?

Answer 21

Worse after eating - as gut is having to work and digest food
- Do MR angiogram

Question 22

Investigation for mesenteric ischaemia

Answer 22

MR angiogram

Question 23

Thumb printing

Answer 23

Ischaemic colitis

Question 24

Risk factors for mesenteric ischaemia?

Answer 24

Atrial fibrillation

Other causes of emboli include endocarditis, malignancy

Question 25

What drug might predispose to bowel ischaemia?

Answer 25

Cocaine - ischaemic colitis is sometimes seen in young patients following cocaine use

Question 26

Management of ischaemic colitis

Answer 26

Usually supportive - surgery may be required in a minority of cases (e.g. if generalised peritonitis or perforation or on-going haemorrhage)

Question 27

Treatment of overflow diarrhoea?

Answer 27

Treat with high dose osmotic laxatives

Question 28

May cause confusion in old people

Answer 28

Constipation

Question 29

Characteristic presentation of feacal impaction?

Answer 29

Loose stools intermixed with solid or hard stools and abdominal pains

Question 30

Treatment for clostridium difficile infection?

Answer 30

Metronidazole

Question 31

Budd-chiari triad?

Answer 31

Ascites Abdominal pain Enlarged liver

Question 32

Who is Budd Chiari most likely to occur in?

Answer 32

More likely to occur in a patient with hypercoagulative state e.g. anti-phospholipid syndrome (can also occur as a result of physical obstruction e.g. tumour)

Question 33

What is Barrett's osesophagus?

Answer 33

When squamous epithelium is replaced by columnar epithelium

Question 34

Risk factors for Barrett's

Answer 34

GORD (biggest risk factor) Male (7:1) Smoking Central obesity

Question 35

Management of Barrett's

Answer 35

endoscopic surveillance with biopsies | high-dose proton pump inhibitor

Question 36

How often should you scope someone with Barrett's?

Answer 36

Scope every 3-5 years | -if they develop dysplasia then will need endoscopic mucosal resection or radiofrequency ablation

Question 37

Features of achalasia

Answer 37

Dysphagia of both solids and liquids | Regurgitation of food - may lead to cough, aspiration pneumonia etc

Question 38

CREST

Answer 38

``` Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasia ```

Question 39

Lower oesophageal sphincter pressure in achalasia/systemic sclerosis

Answer 39

Increased pressure in achalasia | Decreased pressure in systemic sclerosis

Question 40

When is myasthenia gravis better?

Answer 40

Better in the morning

Question 41

Villous atrophy Raised intraepithelial lymphocytes Crypt hyperplasia

Answer 41

Coeliac disease

Question 42

Treatment for giardia lamblia

Answer 42

Metronidazole

Question 43

Biopsy findings of a gastric adenocarcinoma

Answer 43

Signet ring cells

Question 44

Signet ring cells

Answer 44

Gastric adenocarcinoma

Question 45

Side effects of 5-ASAs e.g. mesalazine

Answer 45

``` Diarrhoea, nausea, vomiting, exacerbation of colitis ACUTE PANCREATITIS (7 times more common inpatients taking mesalazine rather than sulfasalazine) ```

Question 46

"severe epigastric pain which radiates through to the back"

Answer 46

Acute pancreatitis

Question 47

Side effects of sulphasalazine

Answer 47

``` Rashes Oligospermia Headache Heinz body anaemia Megaloblastic anaemia Lung fibrosis ```

Question 48

What should you give patients with ascites and protein <15g/dl

Answer 48

Give them oral ciprofloxacin or nofloxacin as prophylaxis against spontaneous bacterial peritonitis

Question 49

Management of spontaneous bacterial peritonitis

Answer 49

IV cefotaxime

Question 50

Antibiotics for pyogenic liver abscess

Answer 50

MAC Metronidazole Amoxicillin Ciprofloxacin

Question 51

What is Peutz Jeghers syndrome

Answer 51

Autosomal dominant Polyps in the GI tract (may lead to intussusception) Pigmented lesions on lips, oral mucosa, face, palms and soles GI bleeding

Question 52

You want to screen someone for hep B infection what should you look for?

Answer 52

HBsAg

Question 53

What is Mirizzi syndrome?

Answer 53

When the common hepatic ducts become obstructed because of extrinsic compression e.g. impacted stone in cystic duct/hartmann's pouch of gallbladder

Question 54

What is gallstone ileus?

Answer 54

Obstruction of the bowel due to impaction of gallstones

Question 55

Treatment with clindamycin is associated with high risk of what

Answer 55

C. diff

Question 56

diarrhoea abdominal pain a raised white blood cell count is characteristic if severe toxic megacolon may develop

Answer 56

C diff.

Question 57

Diagnosis of C diff.

Answer 57

C. diff toxin in stool

Question 58

Endoscopy when someone has a pharyngeal pouch

Answer 58

Will probably be poorly tolerate - also quite hazardous and may result in iatrogenic perforation

Question 59

Increased goblet cells

Answer 59

Crohn's

Question 60

How long should you reintroduce gluten for, before testing for coeliac?

Answer 60

Reintroduce for 6 weeks

Question 61

Test for H. pylori

Answer 61

Carbon-13 urea breath test or stool antigen

Question 62

Test of h. pylori cure

Answer 62

Carbon-13 urea breath test