GI Questions Flashcards
A 54-year-old female presents one week following a hip replacement with profuse diarrhoea. What is the most likely diagnosis?
camplyobacter e.coli c. difficile salmonella staph aureus
c. difficile
as she has just been in hospital and c.diff is hospital acquired
A 55-year-old woman with a history of alcoholic liver disease is reviewed in clinic. She has advanced cirrhosis and has started to accumulate ascites. An ascitic tap was recently performed and showed a protein concentration of 12 g/L but no evidence of any organisms. What is the most appropriate management with respect to the risk of spontaneous bacterial peritonitis?
oral penicillin
oral ciprofloxacin
oral doxycycline
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against apontaneous bacterial peritonitis
A 60-year-old man has blood tests after presenting with vague symptoms of anorexia and weight loss. His liver function tests are shown below. He comes back to discuss his results and you notice he looks slightly yellow.
Bilirubin 168 µmol/l3 - 17 µmol/l
ALP 1149 u/l 30-130u/l
ALT 71 u/l 5 - 65 u/l
Gamma-GT 583 u/l 11 - 50 u/l
What is the likely diagnosis?
pancreatic cancer
HCC
gall stones
haemolysis
pancreatic cancer
This man has painless jaundice. Pancreatic cancer needs to be excluded in all adults presenting with painless jaundice.
The liver function tests show an obstructive cause for the jaundice (bigger raise in ALP and GGT than ALT).
A 66-year-old woman comes to see you as she has ongoing symptoms of dyspepsia which are relieved by omeprazole. She has been using omeprazole 20 mg once a day for the past 2 years.
Which one of the following is a disadvantage of using a proton-pump inhibitor (PPI) long-term?
increased risk of MI
increased risk of stroke
increased risk of fractures
increased risk of liver impairment
fractures
Long-term use of PPI’s can mask the symptoms of gastric cancer. They can also increase the risk of osteoporosis and fractures -due to malabsorption of calcium and magnesium
A 34-year-old woman presents with slowly progressive difficulty in swallowing both solids and fluids. This has developed over six months. Over the same time she has had intermittent retrosternal pain, occasional regurgitation of food, and has lost 3kg. She has no other symptoms and no relevant past medical history.
A range of investigations are performed which reveal the diagnosis. She undergoes definitive surgical management.
Which of the following options is it most important to do after the surgery?
provide long term PPI
perform PCR
chemotherapy
prescribe H. pylori eradication therapy
long term PPI
PPIs are required after definitive management of achalasia
A 35-year-old former intravenous drug user is reviewed in the liver clinic. He has recently been diagnosed with hepatitis C after being found to have abnormal liver function tests. It is decided as part of his work-up that he should be assessed for liver cirrhosis. What is the most appropriate test to perform?
MRI liver
Liver biopsy
Transient elastography
Transient elastography is now the investigation of choice to detect liver cirrhosis
Which one of the following is most suggestive of Wilson’s disease?
low hepatic copper conc
increased skin pigmentation
low serum caeruloplasmin
high serum copper
Wilson’s disease - serum caeruloplasmin is decreased
Primary biliary cirrhosis is most characteristically associated with:
ANA
Rheumatoid factor
Anti-mitochondrial antibodies
Primary biliary cirrhosis - the M rule
IgM
anti-Mitochondrial antibodies,
Middle aged females
Which one of the following is least associated with Crohn’s disease?
fistulae kantor's string sign crypt abscess cobblestone appearance involvement of all layers of bowel wall
crypt abscesses
