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Pass Med finals pack > Medicine - Gastroenterology > Flashcards

Medicine - Gastroenterology Flashcards

1
Q

Patient with

  • HTN
  • T2DM
  • AF

acute 12 hr hx severe abdominal pain + bloody diarrhoea

Pain out of proportion to sign

this strongly suggests :

A

acute mesenteric ischaemia

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2
Q

intestinal angina is classically characterised by triad of…

aka chronic mesenteric ischaemia

A
  1. severe
  2. colicky post prandial abdominal pain
  3. weight loss
  4. abdominal bruit
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3
Q

DKA treated with

A

IV saline and insulin infusion

patient with DKA would present with hyperglycaemia

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4
Q

alcoholic ketoacidosis is managed how

A

managed with infusion of saline and thiamine

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5
Q

smoking cessation has been shown to increase flares of what condition..

A

ulcerative colitis

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6
Q

presentation of

  • painless jaundice
  • anti-smooth muscle antibodies
  • raised IgG levels

charactersitic of:

A

autoimmune hepatitis

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7
Q

histology of Crohn’s disease?

A
  • inflammation in all layers from mucosa to serosa
  • goblet cells
  • granulomas
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8
Q

The splenic flexure marks the point where

A

the majority of blood supplied changes from the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA).

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9
Q

The rectum itself gets an excellent supply of blood from

A

collaterals due to branches from the internal iliac artery.

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10
Q

The rectum itself gets an excellent supply of blood from

A

collaterals due to branches from the internal iliac artery.

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11
Q

A 52-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination, there is some mild crepitus in the epigastric region. What is the likely diagnosis?

A

oesophageal perforation

The Mackler triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema. It typically presents in middle aged men with a background of alcohol abuse.

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12
Q

new onset dysphagia is a red flag symptom therefore requires what…

A

urgent endoscopy

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13
Q

patient with:

  • history of heart burn
  • odynophagia but no weight loss
  • systemically well
A

oesophagitis

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14
Q

odynophagia definition

A

painful swallowing

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15
Q

what is achalasia ?

A

dysphagia of both liquids and solids

heart burn

regurgitation of food

may lead to cough, aspiration pneumonia

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16
Q

transverse colon being >6cm in diameter in combination with signs of systemic upset

may indicate

A

toxic megacolon

needs aggressive medical therapy for 24-72 hrs

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17
Q

what kind of tube may be used to stop an uncontrolled variceal haemorrhage

A

sengstaken-blakemore tube

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18
Q

SSRIs are major risk factors for duodenal ulcers

A

SSRIs such as sertraline are major risk factors for duodenal ulcers

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19
Q

What is Zollinger-Ellison syndrome?

A
  • excessive levels of gastrin

- usually from a gastrin secreting tumour

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20
Q

correct investigations for testing for coeliac’s disease

A
  • paired tissue transglutaminase (TTG)

- IgA

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21
Q

H-pylori eradication regime

A

PPI + amoxicillin + clarithromycin

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22
Q

barium enema of a patient with ulcerative colitis may show

A
  • loss of haustrations
  • superficial ulceration ‘pseudopolyps’
  • colon is narrow and short
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23
Q

presentation of the following symptoms is characteristic of what:

  • bloody diarrhoea
  • urgency
  • tenesmus
  • abdo pain esp LLQ
  • extra-intestinal features
A

ulcerative colitis

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24
Q

vitamin C deficiency leads to

A
  1. scurvy
    - aar defective synthesis of collagen
  2. bleeding
    - capillary fragility
  3. poor wound healing
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25
Q

signs of liver decompensation

A

jaundice

confusion

occurs due to build up of toxic products within the body

26
Q

gilberts syndrome is an unconjugated or conjugated hyperbilirubinaemia

A

unconjugated hyperbilirubinaemia

hence would not cause dark urine or pale stools

as conjugation enables water solubility

27
Q

long term use of PPI can lead to…

A
  • osteoporosis and fractures

- due to malabsorption of calcium and magnesium

28
Q

how do PPIs work

A
  • cause irreversible blockade of H+/k+ ATPase

- in gastric parietal cell

29
Q

what should always be examined in young males presenting with RIF pain

A
  • examine scrotum

- testicular problems: infection and torsion

30
Q

patient presents with dysphagia.

came on gradually, initially only with solid food but now with soft foods

has vomitted on a few occasions

no nausea or change in appetite

previously fit and well

does not smoke or drink

likely cause of symptoms?

A

oesophageal malignancy

  • progressive nature of symptoms suggests growing obstruction
31
Q

what severity index is used to assess severity of ulcerative colitis in adults ?

A

Truelove and Witt’s severity index

32
Q

how is flare of ulcerative colitis treated?

A
  • iv corticosteroids

- e.g. prednisolone

33
Q

state some of the Truelove and Witt’s severity index

A
  • temperature greater than 37.8
  • HR > 90bpm
  • anaemia, Hb < 105g/L
  • erythrocyte sedimentation rate greater than 30 mm/hour
34
Q

clostridium difficile is gram positive or gram negative

A

gram positive

35
Q

72 y/o female

  • being treated for recent infection with oral cefuroxime
  • presents to ED with abdominal pain and diarrhoea
  • hypotensive 95/47
  • t.cardic 120 bpm
  • fever 38.1
  • RR 18

what is likely diagnosis

A

life-threatening clostridium difficile

presentation of abdominal pain and diarrhoea associated with second generation cephalosporin antibiotics

36
Q

42 y/o male with jaundice, pruritus and abdominal pain

PMH- ulcerative colitis, biliary colic, DM

Bloods reveal - raised ALP , positive ANCA

likely diagnosis

A

primary sclerosing cholangitis

37
Q

in spontaneous bacterial peritonitis: what is the most common organism found in ascitic fluid culture?

A

Escherichia coli

38
Q

diffuse hepatic injury resulting from acute hypo perfusion is known as

A

ischaemic hepatitis

  • marked increase in aminotransferase
39
Q

what type of cells would be found on biopsy of patient with gastric adenocarcinoma ?

A

signet ring cells

40
Q

woman with gallstones present with pain in RUQ

examination

  • not jaundiced
  • temp of 37.8

palpating under right costal margin causes her to catch her breath

what sign is ellicted?

what condition is this?

A

acute cholecystitis

scenarios - Murphy’s sign

41
Q

72 y/o male presents with heart failure, T2DM & persistent dull ache in RUQ

blood tests show mild elevation of alanine aminotransferase level

patient most likely has?

A
  • congestive hepatomegaly
42
Q

23 y/o student recently returned from trip to North Africa, presents with anorexia, nausea, mild RUQ and lethargy

bloods show marked elevation of AAT

suggestive of:

A

viral hepatitis

43
Q

ascending cholangitis presents with which triad

A
  • fever
  • ruq pain
  • jaundice
44
Q

10 y/o presents with 2 day history of abdominal pain + anorexia

  • tender over mcburneys point
  • rebound and percussion tenderness

diagnosis ?

A

acute appendicitis

prophylactic IV antibiotics should be given prior to appendicectomy

45
Q

pseudomembranous colitis most likely caused by

A

clostridium difficile

46
Q

trans jugular intra-hepatic portosystemic shunt (TIPS) procedure connects what two veins

A

hepatic vein to portal vein

47
Q

what is first line antibiotic fo patients with clostridium difficile infection

A

metronidazole

48
Q

what part of the bowel is most likely affected by ulcerative colitis?

A

the rectum

49
Q

71 y/o pt with 2 year hx of intermittent problems with swallowing.

he has halitosis and is coughing at night.

PMH T2DM, otherwise well.

weight stable, good appetite,

most likely diagnosis?

A

pharyngeal pouch

50
Q

27 y/o male.

rigidity, cog wheeling, bradykinesia, ataxia, slurred speech.

OE

  • lack of coordination
  • ascites
  • splenomegaly
  • oesophageal varices

memory loss, slow thinking processes, possible psychosis

likely diagnosis

A

Wilsons disease

51
Q

68 y/o

  • t2dm
  • features of septic shock
  • ruq tenderness
  • not jaundiced
  • no stones in gall bladder
  • normal calibre bile duct

most likely diagnosis

A

acalculous cholecystitis

52
Q

patient with known gallstones, admitted with high fever and jaundice.

OE

  • extremely unwell
  • abdomen soft
  • mild RUQ tenderness

characteristic of:

A

cholangitis

- features of jaundice, fever and systemic sepsis

53
Q

34 y/o 3 day hx colicky ruq pain radiating to back.

pain now constant.

temp 38.5

localised peritonism in RUQ

characteristic of:

A

acute cholecystitis

  • fever
  • ruq pain
  • Murphy’s sign
54
Q

anti-dsNA primarily associated with

A

SLE

- systemic lupus erythematous

55
Q

anti-ccp highly specific for

A

rheumatoid arthritis

56
Q

ANCA antibodies are associated with

A

small vessel vasculitides

57
Q

c-ANCA primarily associated with

A

granulomatosis with polyangitis and eosinophilic granulomatosis with polyangitisi

58
Q

50 y/o presenting with

  • fatigue
  • erectile dysfunction
  • arthralgia

earliest signs of:

A

haemochromatosis

59
Q

budd-chiari syndrome occurs due to

A

obstruction of the hepatic vein

60
Q

budd-chiari syndrome typically presents with

A

RUQ pain

painful ascites

61
Q

PPIs can cause hyponatraemia

A

PPIs can cause hyponatraemia

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