GI cards

Question 1

Drugs that cause cholecystatic pic? PASS FOR?

Answer 1

phenothiazides (prochloperazide, chlorpromazine), anabolic steroids/ abx (erythromycin, co-amox, fluclox), sulfonylureas, fibrates, OCP, rare -nifedipine

Question 2

Alcoholic vs fatty LD AST/ALT ratio?

Answer 2

alcoholic - AST:ALT >2
NAFLD: ALT :AST >2
salt before lime in tquila

Question 3

true love and witt’s criteria?

Answer 3

admission crtieria for UC flare. severe: Hb <105, wcc 15+, CRP 45+/ stools 6+ admit for IV

Question 4

young hepatitis, psych symptoms?

Answer 4

wilson’s disease tx penicillamine

Question 5

gall bladder palpable painless jaundice?/ new diabetes

Answer 5

do CT abdo, panc cancer
other signs: migratory thrombophlebitis, double duct,

Question 6

C diff tX?

Answer 6

PO van 10 days (1st time)
if not, PO metronidazole, then IV metro and PO vanc.
CX: PPI, abx
urea breath test is guideline
if recurring - PO fidaxomicin

Question 7

Oesophageal cancer - which is more common in developing world? where is is?

Answer 7

SCC (upper 2/3), AF: plummer vinson dsyndrome,
A/C - in uk/US (AF GORD, barrets, lower 1/3)
barium - apple core appearance

Question 8

spontaneous bacterial peritonitis when to give proph abx? how do we confirm dx

Answer 8

when protein ascites i <15, give ciproflox/ norflox
DX: paracentesis neutrophils 250+

Question 9

DM, cirrhosis, skin pigmentation?

Answer 9

haemochromatosis. risk of HCC. most common recessive disorder. need TS/ ferritin

Question 10

HCC RF?

Answer 10

Hep B (worldwide), Hep C (europe), Alpha 1 antitrypsin, DM, male, OCP

Question 11

hepatitis cx with pulmonary sx?

Answer 11

alpha 1 antitrypsin

Question 12

Liver cirrhosis drug causes? (MAM’s liver)

Answer 12

methyldopa, methotrexate, amiodarone

Question 13

drugs causing hepatocellular pic?

Answer 13

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

Question 14

suspected variceal bleed tx before?

Answer 14

terlipressin and abx

Question 15

SE of PPI?

Answer 15

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

Question 16

c urea breath test should be clear of abx and ppi for how long?

Answer 16

no abx for 4 weeks and no ppi for 2 weeks

Question 17

Features of crohns?

Answer 17

crow’s have less blood (non blood diarrhoea), skip lesions (skip through street), goblet cells,all layers, episleritis more common, bowel obstruction/ fistula
N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)

Question 18

UC features?

Answer 18

bloody diarrhoea (sir has more blood), continuous lesions (downt he street), likely to make a mark/ scar (PSC), and get colorectal cancer, more common to get uveitis,
C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

Question 19

features common to both UC and crohns (IBD)

Answer 19

pyoderma gangrenosum, arthritis, erythema nodosum, arthritis

Question 20

surgical options for UC?

Answer 20

ileostomy/ J pouch (ileoanal anastomosis)

Question 21

What is plummer-vinson

Answer 21

iron deficiency anaemia, atrophic glossitis and oesophageal webs or strictures. AF - SCC

Question 22

bird beak’s sign, dysphagia with both solids and liquids from day 1?

Answer 22

achalasia: narrowing of the distal oesophagus

Question 23

why do endomesial antibody in coelaic testing?

Answer 23

IGA antibody needed to exclude IGA deficiency or else a false negative result could arise

Question 24

Acute liver disease features?

Answer 24

jaundice, raised PT, low albumin, renal failure
CX: Hep A/B, alcohol, paracetmaol (most common), acute fatty liver of pregnancy

Question 25

72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa

Answer 25

diverticulitis

Question 26

haematemesis/ melena with epigastric pain hours after eating. relieved by eating?

Answer 26

duodenal ulcer.
Anteriorly sited ulcers may perforate and result in peritonitis, posteriorly sited ulcers may erode the gastroduodenal artery and present with haematemesis and/ or malaena.

Question 27

brisk haematemesis with finding of: prominent blood vessel is identified in the mucosa approximately 6 cm from the O-G junction on the lesser curve of the stomach?

Answer 27

Dieulafoy lesion (rare type of vascular malformation)

Question 28

profuse painless UGIB. malnourished, gynaecomastia, spider naevi, (signs of liver failure)

Answer 28

Variceal bleeds

Question 29

Child-pugh score?

Answer 29

prognosis of cirrhosis. severity. (1 - 3 points for each)
Albumin
Biliburin
Clotting
Ddilatation (ascites)
Encephalopathy

Question 30

sulphasalazine SE?
Mesalasine SE

Answer 30

rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

mesalazine: has more gI upset SE, pancreatitis, interstitial neohritis, agranulocytosis, headache

Question 31

metaclopramide SE?

Answer 31

extrapyramidal effects
acute dystonia e.g. oculogyric crisis
this is particularly a problem in children and young adults
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism

Question 32

Ascending cholangitis triad?

Answer 32

RUQ pain, jaundice, fever, infection of bile duct secondary to gall stones

Question 33

A woman who is know to have gallstones presents with pain in her right upper quadrant. On examination she is not jaundiced and has a temperature of 37.8ºC. Palpating under the right costal margin causes her to catch her breath.

Answer 33

acute cholecystitis

Question 34

RUQ intermittent pain after eatign?

Answer 34

biliary colic

Question 35

HX of scleroderma, has pale bulky stools, bloods would show?

Answer 35

low ferritin, B12, malabsortopion. scleroderma is RF for small intestine bacterial overgrowth syndrome

Question 36

young woman, seconday amernohhroea, raised ALT?

Answer 36

autoimmune hepatitis

Question 37

Fatty stools, diarrhoea after travelling i swimming pools?

Answer 37

giardia lamblia ( resistant to chlorine)

Question 38

PBC?

Answer 38

inflammation and damage to small bile ducts autoimmune.
AF: systemic sclerosis, RAm thyoid, sojrens,
IG M, middle ages white woman, AMA antibody