Lower GI + Hepatobillary

Question 1

Glasgow score for pancreatitis

Answer 1

PaO2 <8kPa
Age >55years
Neutrophilia (White cell count >15 x 10^9/L)
Calcium <2mmol/L
Renal function (urea >16mmol/L)
Enzymes (LDH >600iu/L or AST >200iu/L)
Albumin <32g/L
Sugar (blood glucose >10mmol/L)
Score >3 = severe pancreatitis therefore CDU/ITU

Question 2

Rare eye sign in pancreatitis

Answer 2

Ischaemic (Purtscher) retinopathy - may cause temporary or permanent blindness

Question 3

H’s in Get Smashed

Answer 3

Hypertriglyceridaemia
Hyperchylomicronaemia
Hypercalcaemia
Hypothermia

Question 4

M in Get Smashed

Answer 4

Mumps
Other infections:
- Coxsackie B virus

Question 5

D’s in Get Smashed

Answer 5

• Azathiprine
• Mesalazine
• Didanosine
• bendroflumethizide
• Furosemide
• pentamidine
• steroids
• sodium valproate

Question 6

Breast cancer management

Answer 6

Surgery
Radiotherapy
Hormonal therapy
Biological therapy
Chemotherapy

Question 7

Breast cancer surgery

Answer 7

Mastectomy
 - Multifocal tumour 
 - Central tumour
 - large lesion in small breast
 - DCIS >4cm 
Wide local excision
 - Solitary lesion
 - peripheral tumour
 - small lesion in large breast
 - DCIS <4cm

Question 8

Radiotherapy for breast cancer

Answer 8

• Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
• For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes

Question 9

Hormonal therapy for breast cancer

Answer 9

• Tamoxifen is still used in pre- and peri-menopausal women.
• Post-menopausal women, aromatase inhibitors such as anastrozole are used for this purpose

Question 10

Side effects of Tamoxifen

Answer 10

Increased risk of endometrial cancer
VTE
menopausal symptoms

Question 11

Biological therapy for breast cancer

Answer 11

Herceptin (trastuzumab) in HER2 +ve Cancers

cant be used if they have history of heart disorders

Question 12

Chemotherapy in breast cancer

Answer 12

Used to down stage a primary lesion or after surgery depending on the stage of the tumour (eg if there is axillary node disease)

Question 13

Ascending cholangitis features and mx

Answer 13

Bacterial infection of billary tree - gallstones predispose

Features:

• fever
• RUQ pain
• jaundice
• hypotension and confusion

Mx:

• IV antibiotics
• ERCP after 24-48 hrs