GI history and examination

Question 1

alarm features

Answer 1

• persistent vomiting
• dysphagia
• fever
• weight loss
• GI bleeding
• anaemia
• painless, watery, high volume diarrhoea
• nocturnal symptoms disturbing sleep

Question 2

how can you confirm subjective assessment of weight loss?

Answer 2

• ask about how clothes fit

- reviewing case records

Question 3

cause of difficulty swallowing liquids

Answer 3

neuromuscular disorder

Question 4

cause of difficulty swallowing solids?

Answer 4

oesophageal obstruction due to cancer, peptic stricture, achlasia

Question 5

what should you ask about vomiting?

Answer 5

relation to meaks

associated symptoms such as abdo pain, weight loss and haematemesis

Question 6

what is reflux like dyspepsia

Answer 6

heartburn predominant dyspepsia

Question 7

ulcer like dyspepsia

Answer 7

epigastric pain relieved by food or antacids

Question 8

dysmotility like dyspepsia

Answer 8

nausea, belching, bloating

Question 9

risk factors for viral hepatitis

Answer 9

• IV drugs use
• tattoos
• foreign travel
• blood transfusion
• too much SEX

Question 10

what should you ask about haematemesis

Answer 10

recent ingestion of aspirin, NSAIDs and alcohol

Question 11

what medical condition is primary biliary cirrhosis and auto-immune hepatitis associated with?

Answer 11

thyroid disease

Question 12

what medical condition is non-alcoholic fatty liver disease associated with?

Answer 12

diabetes

obesity

Question 13

IBD is more common in patients with a family history of what?

Answer 13

crohns

UC

Question 14

what are smokers at an increased risk of?

Answer 14

• oesophageal cancer
• colorectal cancer
• crohns
• peptic ulcer

Question 15

signs associated with chronic liver disease?

Answer 15

• palmar erythema
• spider naevi (5 normal)
• gynaecomastia
• loss of body hair
• testicular atrophy

Question 16

what is finger clubbing associated with?

Answer 16

liver cirrhosis
IBD
malabsorption syndromes

Question 17

signs of liver failure

Answer 17

asterisks

fetor hepaticus

Question 18

what is fetter hepaticus

Answer 18

-mousy odour on the breath

Question 19

what is dupytrens contracture?

Answer 19

linked with alcohol-related chronic liver disease

Question 20

what happens to the organs during inspiration?

Answer 20

liver, spleen and kidneys move downwards

Question 21

what do abnormally prominent veins on the abdo wall suggest?

Answer 21

portal hypertension

vena caval obstruction

Question 22

how can you make an incisional hernia more obvious

Answer 22

patient raises the head off the bed or coughs

Question 23

what can a pulsatile mass indicate?

Answer 23

• normal aortic pulsation
• gastric or pancreatic tumour transmitting underlying aortic pulsation
• AAA

Question 24

causes of epigastric mass

Answer 24

• gastric cancer
• pancreatic cancer
• aortic aneurysm

Question 25

causes of generalised distention

Answer 25

- fat (obesity) - fluid (ascites) - flatus (obstruction) - faeces (constipation) - fetus (pregnancy)

Question 26

causes of right iliac fossa mass

Answer 26

- caecal cancer - crohns - appendix

Question 27

what does a patient with right upper quadrant pain and a positive Murphy's sign suggest?

Answer 27

acute cholecystitis

Question 28

what is a palpable gallbladder likely to be in a patient with jaundice?

Answer 28

extra-hepatic obstruction

Question 29

causes of splenomegaly

Answer 29

- leukaemias - portal hypertension - infection (glandular fever) - RA (Gettysburg syndrome)

Question 30

what is ascites?

Answer 30

accumulation of intraperitoneal fluid

Question 31

causes of ascites?

Answer 31

- intra-abdominal malignancy - chronic liver disease - severe heart failure - nephrotic syndrome

Question 32

what does the absence of bowel sounds imply?

Answer 32

- paralytic ileus | - peritonitis

Question 33

what does an indirect inguinal hernia do?

Answer 33

bulges through the internal ring and follows the course of the inguinal canal

Question 34

where does a direct inguinal hernia form?

Answer 34

site of muscle weakness in the posterior wall of the inguinal cancal

Question 35

where does. femoral hernia project?

Answer 35

through the femoral ring and into the femoral canal

Question 36

what are haemorrhoids?

Answer 36

congested venous plexuses around the anal canal

Question 37

what is Grey Turners sign?

Answer 37

bruising over the flanks

Question 38

what is Cullens sign?

Answer 38

bruising around the umbilicus

Question 39

what is Grey Turners sign?

Answer 39

bruising over the flanks

Question 40

what is Cullens sign?

Answer 40

bruising around the umbilicus