GI disorders

Question 1

which cells produce acid in stomach?

a) chief cells
b) mucinus cells
c) parietal cells
d) pyloric cells
e) g cells

Answer 1

parietal cells

Question 2

which molecule is key in mucus production in the GI system?

a) gastrin
b) histamine
c) acetyl choline
d) bicarbonate ions
e) prostaglandin E2

Answer 2

prostaglandin E2

Question 3

omeprazole has what MOA when treating PUD?

a) it is an antacid
b) it inhibits gastrin
c) it is an antihistamine
d) it is an anticholinergic
e) it is a PPI

Answer 3

it is a PPI

Question 4

for gastric acid secretion in GORD what would you give?

Answer 4

antacids; H2RAs; PPIs

Question 5

for antifoam/gas dispersal in GORD what would you give?

Answer 5

simeticone

Question 6

for oesophageal mucosal resistance in GORD what would you give?

Answer 6

alginates; sucralfate, bismuth subsalicylate

Question 7

compare and contrast Crohn’s disease and ulcerative colitis

Answer 7

crohns: anywhere from mouth to anus, skip lesions, deep fissures and damage

ulcerative colitis: confined to colon/rectum, continuous (no skip lesions) confined to mucosa

Question 8

what is the MOA of azathioprine + methotrexate in IBD?

a) anti-inflammatory
b) analgesic
c) immunosuppressant
d) anti-pyretic
e) TNF inhibitor

Answer 8

immunosuppressant

Question 9

29 yr pt w hx of crohns. Experienced 3 exacerbations during past 12 months + unable to taper most recent course of prep. Consultant initiates azathioprine.

What is the rationale for prescribing azathioprine to pt + outline monitoring requirements.

Answer 9

Immunosuppressant that is used when there are 2 or more exacerbations in the past 12 months.

Monitor TPMT and FBC before treatment and FBC during treatment every week for 4 or 8 weeks.

Question 10

pt recently diagnosed with active peptic ulceration associated w H. pylori. which is 1st line?

a) omep 20mg, amox 1g and clarithro 500mg TDS for 7 days
b) omep 20mg, amox 1g and clarithro 500mg BD for 7 days
c) omep 20mg, amox 1g and clarithro 500mg BD for 14 days
d) omep 20mg, amox 1g and clarithro 500mg OD for 14 days
e) omep 20mg, amox 1g and clarithro 500mg OD for 7 days

Answer 10

omep 20mg, amox 1g and clarithro 500mg BD for 7 days

Question 11

36 yr pt started on lansoprazole 30mg OD for tx peptic ulcer. Which of the following is NOT a side effect of lansoprazole?

a) osteoporosis
b) hypermagnesaemia
c) hyponatraemia
d) inc risk of clostridioles difficile infection
e) may mask symptoms of gastric cancer

Answer 11

don’t know

Question 13

which of the following drugs most likely to contribute to development of dyspepsia?

a) atorvastatin
b) azathioprine
c) digoxin
d) mesalazine
e) prednisolone

Answer 13

prednisolone

Question 14

which of the following meds most likely to interact with warfarin?

a) atorvastatin
b) furosemide
c) naproxen
d) nicorandil
e) theophylline

Answer 14

theophylline

Question 15

what is the most appropriate description of the interaction between carbamazepine and theophylline?

a) cimetidine inc metabolism of theophylline and results in a sub-therapeutic response
b) cimetidine dec metabolism of theophylline and results in a sub-therapeutic response
c) cimetidine inc renal excretion of theophylline and results in sub-therapeutic response
d) cimetidine dec metabolism of theophylline and results in inc risk of toxicity
e) cimetidine inc metabolism of theophylline and results in inc risk of toxicity

Answer 15

cimetidine reduces metabolism of theophylline and results in increased risk of toxicity

Question 16

what is the most likely electrolyte imbalance associated with the patient’s presenting symptoms (tachycardia + palpitations) after theophylline?

a) hyperkalaemia
b) hypokalaemia
c) hypernatraemia
d) hyponatraemia
e) hypocalcaemia

Answer 16

hypokalaemia

Question 17

44 yrs started on rifampicin. Patient also takes warfarin for stroke prevention.

a) what is the mechanism of interaction between rifampicin + warfarin?
b) explain the risks the patient would have if co-administrated
c) suggest appropriate management plan for pt to reduce risk of interaction.

Answer 17

idk

Question 18

which of the following pt groups would NOT be eligible for annual influenza vaccine?

a) 39 yrs w T2-DM
b) 58 yrs w hx of COPD
c) 47 yrs MI 6 months ago
d) 38 yrs w depression
e) 24 yrs w hypothyroidism
f) 33 yrs pregnant
g) 87 yrs w CKD
h) 45 yrs taking azathioprine for crohns

Answer 18

45 yrs taking azathioprine for crohns ?

Question 19

which of the following blood tests would you perform to assess for the cause of yellowing of the eyes and skin?

a) ALT
b) ALP
c) AST
d) albumin
e) prothrombin time

Answer 19

ALP ?

Question 20

18 month old pt with itchy swollen eyes present for a week on and off. Diagnosed with allergic rhinitis.

which of the following tx most appropriate?

a) cetirizine 1mg/mL oral solution
b) chlorphenamine 1mg/mL oral solution
c) loratidine 1mg/mL oral solution
d) sodium cromoglycate 2% eye drops
e) sodium chloride 0.9% eye drops

Answer 20

loratadine or cetirizine

Question 21

32 yr pregnant pt with constipation. Complaining of hard stools for 3 days and tried inc fibre intake to no effect/

which of the following laxatives most appropriate?

a) bisacodyl
b) decussate sodium
c) ispaghula husk
d) lactulose
e) Senna

Answer 21

lactulose

Question 22

36 yrs started on lansoprazole 30mg OD for peptic ulcer. Which of the following is NOT a side effect of lansoprazole?

a) osteoporosis
b) hypermagnesaemia
c) hyponatraemia
d) increased risk of C. difficile infection
e) may mask the symptoms of cancer

Answer 22

hypermagnesaemia

Question 23

which class of enzymes is responsible for the bioactivation of aminosalicylates?

a) azoreductases
b) dihydrofolate reductase
c) oxidoreductases
d) nitroreductases
e) ribonucleotide reductase

Answer 23

azoreductases

Question 24

which of the following best represents the physiological function of the colon?

a) absorption of nutrients
b) reabsorption of water from waste material
c) secretion of strong acid that are used in breakdown of food
d) secretion of enzymes that are used in the breakdown of food
e) to ensure efficient mixing of food to enhance the breakdown of food

Answer 24

reabsorption of water from waste material

Question 25

which metabolic pathway is the most common for systemic 5-aminosalicylic acid?

a) acetylation
b) glucoronidation
c) methylation
d) oxidation
e) reduction

Answer 25

acetylation

Question 26

65 yrs female presenting with abdominal pain and indigestion for 2 weeks which coincided with tx for back pain. she currently takes these medications:

amiodarone
bumetanide
hyoscine butyl bromide
mebeverine
naproxen

which is most likely contributing to their symptoms?

Answer 26

naproxen

Question 27

22 yr male diagnosed with UC 6 months ago. Started on reducing course of pred with unsuccessful tapering. Despite a second course of pred, pt could not have remission induced so azathioprine was recommended. Prior to initiation of azathioprine, which enzyme do we need to assess levels for?

a) cytochrome p450
b) thiopurine methyltransferase (TPMT)
c) xanthine oxidase

Answer 27

TPMT

Question 28

77 yrs with oral thrush 3 days ago after doxycycline to treat COPD exacerbation. Pt takes these meds:

atenolol
atorvastatin
candesartan
warfarin

which of the following is the most appropriate management for the pt?

a) refer to prescriber
b) sell daktarin (miconazole) 2% oral gel
c) sell daktacort (miconazole 2%/hydrocortisone 1%) cream
d) sell clotrimazole 1% cream
e) sell hydrocortisone 1% cream

Answer 28

refer to prescriber

Question 29

which of the following is INCORRECT about prescribing of methotrexate?

a) pts should report signs of blood toxicity such as sore throat, bruising and mouth ulcers.
b) the risk of bone marrow suppression is increased if the patient is prescribed other medications with anti-folate activity.
c) methotrexate can cause liver toxicity
d) methotrexate can cause pulmonary toxicity
e) methotrexate should be taken daily

Answer 29

Methotrexate should be taken daily