miscellaneous

Question 1

variceal bleed (dilated veins cause bleeding most likely oesophagus)

Answer 1

1) ABCDE
2) Terlipressin - vasoconstrictor
3) Endoscopic band ligation
4) Sclerotherapy - injection
5) Balloon tamponade
6) TIPSS

Question 2

variceal bleed prevention

Answer 2

Beta blocker- propranolol

Question 3

peptic ulcer disease (open sore in lining of stomach or upper small intestine duodenum)

Answer 3

Peptic ulcer disease
1) Antacids and stop NSAIDs
2) PPI
3) H2 antagonists
4) H. Pylori eradication – PPI + Amoxicillin or Metronidazole + Clarithromycin
5) Mucosal straighteners – Sucralfate, Bismuth chealate

Question 4

obesity

Answer 4

1) Orlistat – reduces fat absorption
2) Surgery – gastric by-pass

Question 5

C.Diff

Answer 5

ORAL Vancomycin

Question 6

C.Diff 4 NO’s

Answer 6

No antibiotics, no motility agents, no SAIDS, notify public health

Question 7

C.Diff causative organisms

Answer 7

Fluoroquinolones
Cephalosporins
Penicillins
Clindamycin

Question 8

STI

Answer 8

Fluoroquinolones
Cephalosporins
Penicillins
Clindamycin

Question 9

autoimmune hepatitis

Answer 9

Type 1 – HLA gene, anti-nuclear antibodies (ANA) + anti-smooth muscle antibodies
Type 2 – teens, early 20s, anti-LKM1, F>M
1) Corticosteroids (budenoside) + Azathioprine

Question 10

chronic hep b

Answer 10

1) Suppressive antiviral drug
2) Peg-interferon monotherapy
Serology:
- Immunised – Anti HBs +
- Previous Hep B, not carrier – anti HBc +, HBsAg
- Previous Hep B, is carrier anti HBc +, HBsAg +

Question 11

pancreatitis investigation

Answer 11

Ix: Raised serum amylase

Question 12

acute pancreatitis

Answer 12

1) Fluid resuscitation, correct electrolytes, oxygen
2) Pancreatic pseudocysts – drainage
3) Abscess – drainage to control sepsis
4) Necrosis – Percutaneous drain

Question 13

chronic pancreatitis

Answer 13

1) Symptom control
2) Creon as enzyme replacement if pancreas insufficient
3) Surgery – [Pustow procedure, Frey procedure]

Question 14

Pancreatic cancer (exocrine – adenocarcinoma):

Answer 14

1) ERCP stent
2) Resection / Surgery (Whipples)
3) Chemotherapy / Radiotherapy

Question 15

appendicitis

Answer 15

Laparoscopic appendectomy + Analgesia + Antibiotics

Question 16

Peritonitis/ Biliary Tract/ Intra-abdominal

Answer 16

IV amoxicillin + Metronidazole + Gentamicin
-Cotrimoxazole, gentamicin, metronidazole if penicillin allergic

Question 17

Sepsis

Answer 17

1) High flow oxygen
2) IV fluid resuscitation
3) Take blood cultures
4) IV antibiotics
5) Measure Lactate and FBC
6) Monito accurate hourly urine output

Question 18

abscesses

Answer 18

• Can’t be treated by antibiotics as blood supply
• Incision and drainage instead

Question 19

H.pylori

Answer 19

PPI (omeprazole)
+amoxicillin (metronidazole if pen allergic)+clarithromycin