giii

Question 1

• Nerve that supplies the rectum

Answer 1

inferior rectal nerve

Question 2

treatment for achalasia

Answer 2

hellers cardiomyotomy or balloon dilatation

Question 3

• Treatment of oesophageal varices and acute presentation!

Answer 3

o Treatment – resuscitation (correct clotting abnormalities), IV terlipressin, banding, sengstaken blakermore tube

Question 4

give features of crohn’s disease

Answer 4

cobblestone mucosa, recurrent oral stomatitis, deep fissuring ulceration of mucosa, anywhere from mouth to anus, weight loss, strictures, cobble stone, rose thorn ulcers, granulomas, mouth ulcers

Question 5

what cell changes can you see in barretts oesophagus

Answer 5

replacement of normal stratified squamous epithelium by simple columnar epithelium with goblet cells

Question 6

• Treatment of ascites

Answer 6

spironolactone – can cause gynaecomastia and hyperkalaemia (risk of arrhythmias)

Question 7

• Thumb printing at splenic flexure

Answer 7

ischaemic colitis

Question 8

excess copper, kayser-fleischer rings

Answer 8

• Wilsons disease

Question 9

• Alphafeto protein

Answer 9

hepatocellular carcinoma

Question 10

• Abdominal pain and diarrhoea after sour milk or shellfish

Answer 10

campylobacter

Question 11

• Charcots triad – fever, jaundice, abdominal pain

Answer 11

ascending/acute cholangitis

Question 12

• Short bowel syndrome

Answer 12

<2m due to surgery ect

Question 13

gastrin secreting tumour – overproduction of gastric acid – recurrent peptic ulcers

Answer 13

• Zollinger Ellison syndrome

Question 14

• Treatment for haemochromatosis

Answer 14

phlemotomy, blood letting

Question 15

– hypoalbuminaemia – white nails

Answer 15

• Leukonychia

Question 16

nail spooning – iron deficiency anaemia

Answer 16

• Koilonychias

Question 17

give prehepatic causes of jaundice

Answer 17

gilberts, haemolytic anaemia, newborn, trauma

Question 18

give intra hepatic causes of jaundice

Answer 18

viral hepatitis, alcoholic hep, autoimmune hep, decompensated cirrhosis

Question 19

give post hepatic causes of jaundice

Answer 19

gall stone, head of pancreas cancer, gallbladder cancer, psc, pbc

Question 20

• Mallory hyaline bodies

Answer 20

alcoholic liver disease

Question 21

• Pelvic floor muscle that is important in urination and defecation

Answer 21

levator ani muscle – it must relax

Question 22

• Onion skinning fibrosis, beading of bile ducts

Answer 22

primary sclerosing cholangitis

Question 23

Anti-mitochondrial antibody (AMA)

Answer 23

Primary biliary cirrhosis

Question 24

Anti-smooth muscle antibody (ASMA)

Answer 24

Autoimmune hepatitis

Question 25

Signet ring cells seen on biopsy

Answer 25

Diffuse stomach cancer

Question 26

Anti-transglutaminase antibody, anti endomysial antibody

Answer 26

Coeliac disease

Question 27

perinuclear-ANCA (pANCA)

Answer 27

Ulcerative colitis, PSC

Question 28

Antineutrophil Cytoplasmic Antibodies (ANCA) (cANCA)

Answer 28

Primary sclerosing cholangitis

Question 29

Raised amylase, lipase, vomiting, pain

Answer 29

Pancreatitis

Question 30

CA-125

Answer 30

Ovarian cancer

Question 31

colicky loin pain radiating to groin

Answer 31

ureteric colic

Question 32

give features of UC

Answer 32

diarrhoea with blood and mucus, toxic megacolon, loss of haustrations, tenesmus, no inflammation beyond submucosa, pseudopolyps, crypt abscesses

Question 33

what is the most common cause of vitamin B12 deficiency

Answer 33

pernicous anaemia

Question 34

The coffee-bean sign is visible on abdominal x-ray

Answer 34

sigmoid volvulus

Question 35

Degenerative loss of ganglia from Auerbach’s plexus

Answer 35

achalasia

Question 36

Hepatic stellate cells found in the space of Disse are activated and transformed into myofibroblasts under the influence of cytokines. These activated cells synthesise collagen leading to fibrosis

Answer 36

mechanism of cirrhosis

Question 37

ursodeoxycholic acid

Answer 37

treatment for PBC

Question 38

McBurney’s point

Answer 38

1/3 between the umbilicus and ASIS

Question 39

lymphoid hyperplasia or a faecolith → obstruction of appendiceal lumen → gut organisms invading the appendix wall → oedema, ischaemia +/- perforation

Answer 39

acute appendicitis

Question 40

serum-ascites albumin gradient SAAG > 11g/L

Answer 40

(indicates portal hypertension) cirrhosis/alcoholic liver disease acute liver failure liver metastases

Question 41

``` Serology tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE endomyseal antibody (IgA) needed to look for selective IgA deficiency, which would give a false negative coeliac result ``` Endoscopic intestinal biopsy the 'gold standard' for diagnosis - this should be performed in all patients with suspected coeliac disease to confirm or exclude the diagnosis

Answer 41

coeliac investigations

Question 42

______ are the commonest reason for fresh blood on toilet paper when wiping.

Answer 42

Haemorrhoids

Question 43

HBsAg - anti HBsAg - anti HBcAg -

Answer 43

susceptible

Question 44

HBsAg - anti HBsAg + anti HBcAg -

Answer 44

immune Vaccine

Question 45

HBsAg - anti HBsAg + anti HBcAg +

Answer 45

immune (previous infection)

Question 46

HBsAg + anti HBsAg - anti HBcAg + IgM +

Answer 46

acute infection

Question 47

HBsAg + anti HBsAg - anti HBcAg + IgM -

Answer 47

chronic infection

Question 48

``` Features cholestasis jaundice, pruritus raised bilirubin + ALP right upper quadrant pain fatigue ```

Answer 48

PSC

Question 49

antacids + exercise Omeprazole + amoxicillin + metronidazole

Answer 49

H.pylori

Question 50

cCEA

Answer 50

colorectal cancer