GI mc 1

Question 1

what does tahycard and hypovol suggest with GI bleed

Answer 1

2L blood loss

Question 2

what is stage 3 shock

Answer 2

2L blood loss

Question 3

why is RR elevated in GI blood loss

Answer 3

increase oxygen delivery to the circulation and prevent tissue hypoxia

Question 4

good measurement for severity of GI blood loss ilness

Answer 4

RR

Question 5

what happens to CRT in GI blood loss

Answer 5

longer

Question 6

immediate treatment for stage 3 blood loss

Answer 6

500 mL IV crystalloid containing 130-154 mmol/L Na over 15 minutes or less is indicated

Question 7

what blatchford score = endoscopy urgent

Answer 7

above 6

Question 8

what dosent blatchford include

Answer 8

endoscopy

Question 9

what follows IV fluid in GI blood loss

Answer 9

transfusion of two units of cross-matched packed red cells

Question 10

what significantly reduces rate of rebleeding in peptic ulcers

Answer 10

PPI

Question 11

advantages of PPI

Answer 11

decrease the length of hospital stay, rebleeding rate, and need for blood transfusion in patients with high-risk ulcers treated with endoscopic therapy

Question 12

how do PPIs work

Answer 12

inhibiting the parietal cell H+/K+ ATP pump

Question 13

what to withold in GI bleed

Answer 13

amlodipine and ramipril

- hypotensives

Question 14

four major risk factors for bleeding peptic ulcers are

Answer 14

Helicobacter pylori infection
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Physiologic stress
Excess gastric acid

Question 15

what is it when yperacidity causes the ulcer

Answer 15

ZES

Question 16

essential in UGIB

Answer 16

control of acid

Question 17

what is mucosal damage by NSAIDs and aspirin method

Answer 17

inhibition of COX-1

Question 18

what does inhibition of COX-1 do

Answer 18

reduces mucosal generation of protective prostaglandins (PG) such as PGE2

Question 19

what increases risk of complications with GUD

Answer 19

duration and dose of NSAIDs
age
PMH
glucocorticoids, anticoagulants, clopidogrel, bisphosphonates SSRIs

Question 20

prostaglandin E analog

Answer 20

misoprostol

Question 21

what bad thing is COX-2 associated with

Answer 21

risk of cardiovascular disease

Question 22

how to test for h pylori

Answer 22

CLO
faecal test
urea breath tests

Question 23

what is the CLO test

Answer 23

biopsy on agar containing urea and pH → alkaline pH and colour change if present

Question 24

what to avoid with metronidazole

Answer 24

alcohol - as risk of disulfiram interaction

Question 25

what to avoid with calrithromycin

Answer 25

simvastatin = myositis

Question 26

severe UC management

Answer 26

oral glucocorticoids and combination therapy with high dose oral 5-ASA, suppository- 5ASA or steroid, steroid enema or foam

Question 27

if a patient with UC is improving what do you give instead of IV hydrocortisone

Answer 27

oral prednisolone

Question 28

Fulminant colitis treatment

Answer 28

IV glucocorticoids + broad spectrum antibiotics

Question 29

Azathioprine is converted to

Answer 29

6-mercaptopurine

Question 30

how is azathioprine converted

Answer 30

nonenzymatic nucleophilic attack by sulfhydryl-containing compounds

Question 31

what to do before giving azathioprine

Answer 31

TPMT test needed to make sure its active

Question 32

Infliximab

Answer 32

Monoclonal antibody binding to tumor necrosis factor alpha

Question 33

when do you get high TNF alpha

Answer 33

rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn’s disease and UC

Question 34

what does TNF alpha do x6

Answer 34

``` induces proinflammatory cytokines enhancement of leukocyte migration activation of neutrophils and eosinophils leukocyte migration neutrophil/ eosinophil activation apoptosis of T cells ```

Question 35

how to end steroids

Answer 35

gradually so you dont get addisons