Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase3 Specialties - Imperial College London MBBS > MLA Gastroenterology > Flashcards

MLA Gastroenterology Flashcards

1
Q

Which cancer biomarker is associated with colorectal cancer?

A

Carcinoembryonic antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of resection is associated with the distal transverse, descending colon?

A

Left hemicolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of resection is associated with cancer located in the caecum, ascending or proximal transverse colon?

A

Right hemicolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of surgical resection is associated with the sigmoid colon, upper rectum, and lower rectum?

A

High anterior resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of resection is associated with anal verge cancer?

A

Abdominoperineal excision of the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Continuous superficial inflammation of the colonic mucosa from the rectum is diagnostic of what disease?

A

ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which IBD condition is associated with smoking as a protective factor?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bloody diarrhoea is associated with which type of IBD?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of mild ulcerative colitis?

A

4 or fewer stools/day - no signs of systemic toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the definition criteria of moderate ulcerative colitis?

A

> 4 stools/day (frequent, bloody, loose) + mild anaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition criteria of severe ulcerative colitis?

A

≥6 stools/day + severe cramps.
- Symptomatic presentation: Fever, tachycardia, anaemia, raised ESR + weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which skin extraintestinal manifestation is associated with ulcerative colitis (related to disease activity)?

A

Erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which extraintestinal ocular manifestation is associated with ulcerative colitis (related to disease activity)?

A

Episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which dermatological condition characterised by deep violaceous ulcers is associated as an extraintestinal manifestation of ulcerative colitis?

A

Pyoderma gangrenosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigation is indicated as an active inflammatory marker for IBD?

A

Faecal calprotectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the definitive investigation to confirm ulcerative colitis?

A

Colonoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Crypt abscesses and goblet cell depletion is associated with which type of IBD?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pseudopolyps are associated with which type of IBD?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which investigation is indicated for suspected toxic megacolon in patients with ulcerative colitis?

A

Plain abdominal X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which severity scoring system is used for ulcerative colitis?

A

Truelove and Witts’ severity index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many bowel movements per day is associated with severe ulcerative colitis?

A

6 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the first-line management for mild to moderate proctitis?

A

Rectal mesalazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should oral aminosalicylates be added once rectal mesalazine is trialled for mild ulcerative colitis?

A

Within 4 weeks if remission is not achieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the second line management of mild ulcerative colitis if remission is not achieved within 4 weeks following rectal mesalazine?

A

add an oral aminosalicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the third line management of proctitis?

A

Oral corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the maintenance therapy for proctitis?

A

Topical aminosalicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the first line management for extensive disease ulcerative colitis?

A

Topical aminosalicylates and high-dose oral aminosalicylates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If remission is not achieved within 4 weeks of starting combination therapy for extensive ulcerative colitis, what is the second line of management?

A

Stop topical treatments and add an oral corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the first line management of severe ulcerative colitis?

A

Intravenous hydrocortisone 100 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the alternative to hydrocortisone for the immediate management of severe ulcerative colitis?

A

IV ciclosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If there is no improvement following IV hydrocortisone after 72 hours for severe UC, what is the next line of management?

A

add IV ciclosporin to IV corticosteroids or consider surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the maintenance management for severe ulcerative colitis?

A

Oral azathioprine or oral mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the indications of oral azathioprine or oral mercaptopurine?

A

After TWO or more inflammatory exacerbations in 12 months requiring treatment with systemic corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the class drug of infliximab?

A

anti-TNF-alpha monoclonal antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Non-caseating transmural inflammation of the gastrointestinal tract is associated with what IBD diagnosis?

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Smoking has what effect on symptoms associated with Crohn’s disease?

A

Worsens symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the characteristic appearance observed on colonoscopy in Crohn’s disease?

A

Skip lesions - cobblestone appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the first lesion observed in Crohn’s disease?

A

Aphthous ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the complication associated with terminal ileal inflammation in Crohn’s disease?

A
  • Bile salt malabsorption due to an inflamed terminal ileum
  • Steatorrhoea related to bile salt loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What ocular pathology is observed in Crohn’s disease?

A

Anterior uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which vitamin deficiency is associated with Crohn’s disease?

A

Vitamin B12 due to ileal diseae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the first-line induction management of Crohn’s disease?

A

Prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the second line management for Crohn’s disease if there are two or more inflammatory exacerbation in 12 months?

A

Thiopurines (azathioprine, mercaptopurine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which biologic therapies are available for the management of refractory disease and fistulating Crohn’s?

A

Anti-TNF alpha monoclonal antibodies e.g., infliximab and adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What enzyme should be measured first prior to starting Azathioprine or mercaptopurine ?

A

TPMPT activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Low TPMPT activity results in what effect with concurrent thiopurine use?

A

increased risk of myelosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the management of bile acid diarrhoea?

A

Cholestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the management for fistulae and strictures associated with Crohn’s disease?

A
  • Ileocecal resection for stricturing terminal ileal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the investigation of choice for perianal fistulae in Crohn’s disease?

A
  • MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which antibiotic is prescribed for perianal fistulae in Crohn’s disease?

A

Oral metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the adverse effects associated with azathioprine?

A
  • Bone marrow suppression (FBC count)
  • Nausea/vomiting
  • Pancreatitis
  • Increased risk of non-melanoma skin cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Azathioprine interacts with what drug?

A

Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which haplotype is associated with Coeliac disease?

A

DQ2, DQ8 HLA haplotypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which cutaneous manifestation is associated with Coeliac disease?

A
  • Dermatitis herpetiformis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the first line of investigation for suspected Coealic disease?

A

Total IgA with serum IgA Tissue Transglutaminase antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the confirmatory diagnostic investigation for Coeliac disease?

A

Duodenal biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What histological findings are observed in Coeliac disease?

A

villous atrophy, crypt hyperplasia and increased intra-epithelial lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which type of cancer is associated with Coeliac disease?

A

enteropathy-associated T cell lymphoma (EATL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which immunisations should be offered for patients with Coeliac disease (with hyposplenism)?

A

influenza, meningococcal and pneumococcal (every 5 years) immunisations for people with Hyposplenism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What investigation is indicated in patients with Coeliac disease to assess for the risk of osteoporosis?

A

DEXA scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the life-long management of Coeliac disease?

A

Gluten-free diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the most common cause of acute pancreatitis?

A

Gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the second most common cause of acute pancreatitis?

A

Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which drugs are associated with potentiating acute pancreatitis?

A

Thiazides, ACEi, statins, fenofibrate, azathioprine, tetracyclines, oestrogens, corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What electrolyte derangement is associated with a poor prognosis of acute pancreatitis?

A

Hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which sign denotes peri-umbilical discolouration?

A

Cullen’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which sign denotes flank discolouration in acute pancreatitis?

A

Grey–Turner’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the characteristic pain description associated with acute pancreatitis?

A
  • Severe epigastric pain radiating to the back, relieved by sitting forward.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What serum investigation is raised in patients with acute pancreatitis?

A

Plasma amylase >3 upper limit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which serum investigation is a more sensitive test for acute pancreatitis?

A

Serum lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the preferred radiological imaging of choice for acute pancreatitis?

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is associated with a raised amylase?

A

Pancreatic pseudocyst, mesenteric infarct, perforated viscus, acute cholecystitis, and diabetic ketoacidosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which scoring criteria is used to assess acute pancreatitis?

A

Modified Glasgow Criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the parameters of the Modified Glasgow Criteria ?

A
  • Age >55 years
  • White cell count - >15 x 109/L
  • Blood glucose >10 mmol/L
  • Serum lactate dehydrogenase >600 U/L
  • Serum urea >16 mmol/L
  • Serum-adjusted calcium <2.00 mmol/L
  • Serum albumin <32 g/L
  • Po2 > 7.9 kPa.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

A score of x is associated with severe pancreatitis?

A

Score ≥3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the first line management of severe pancreatitis?

A

Intravenous fluids

IV antibiotics and analgesia

Consider enteral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the main pancreatic complication associated with acute pancreatitis?

A

Pancreatic pseudocyst formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which high hepatitis vaccine is mandated for travel to India?

A

Hepatitis A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which vitamin deficiency is associated with dry skin, ocular dryness and night blindness?

A

Vitamin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which investigation is recommended for assessing peritoneal metastatic nodules in the gastric carcinoma before major abdominal surgery?

A

Diagnostic laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are NICE referral guidelines for an urgent 2-week wait pathway (for upper endoscopy)?

A

Age >55 years with weight loss and upper abdominal pain, reflux or dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

A negative nitroblue tetrazolium test is suggests which diagnosis?

A

Chronic granulomatous disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the two most common presenting features of chronic mesenteric ischaemia?

A

Postprandial pain and weight loss with an otherwise unremarkable examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the gold-standard diagnostic test for chronic mesenteric ischaemia?

A

Arteriography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Which characteristic feature is observed in the iris, in patients with Wilson’s disease?

A

Kayser–Fleischer rings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Intermittent dysphagia with a history of atopy is associated with which diagnosis?

A

Eosinophilic oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Which chronic disease commonly leads to cirrhosis among IV drug abusers?

A

Hepatitis C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which syndrome is associated with neutrophil dermatosis associated with systemic upset in a patient with a background of IBD?

A

Sweet syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What two serum tests are raised and consistent with a diagnosis of primary biliary cholangitis?

A

Serum IgM
Anti-mitochondrial antibodies (M2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the first line management for PBC?

A

Ursodeoxycholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which grade of haemorrhoids protrudes from the anal canal with defecation/straining and shrinks spontaneously?

A

Grade 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which antibiotic is recommended for patients with campylobacter associated bacterial gastroenteritis?

A

Macrolide e.g., oral clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Pigment laden macrophages within the mucosa on periodic acid Schiff staining and incidental colonic polyps is consistent with which diangosis?

A

Melanosis coli secondary to laxative abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the most common cause of melanosis coli?

A

laxative abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the eponymous sign or law that states that in the presence of a palpable gallbladder, painless jaundice is unlikely to be caused by gallstones?

A

Courvoisier’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which anti-emetic is contraindicated in Parkinson’s disease?

A

Metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How frequent should endoscopic surveillance be performed in patients with Barrett’s oesophagus?

A

Every 2-3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the most common cause of acute cholangitis?

A

Gallstones

Other causes:
* Infection post-ERCP
* Tumours (pancreatic cholangiocarcinoma)
* Bile duct strictures or stenosis
* Parasitic infection (ascariasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What surgical intervention predisposes patients to developing acute cholangitis?

A

ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the most common enteric bacterial cause of acute cholangitis?

A

Escherichia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Which triad of symptoms is associated with acute cholangitis?

A

Charcot’s triad:
1. Right upper quadrant pain (with tenderness, may refer to shoulder)
2. Fever with rigors
3. Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is Reynold’s Pentad?

A
  1. Right upper quadrant pain (with tenderness, may refer to shoulder)
  2. Fever with rigors
  3. Jaundice

Reynold’s Pentad:
* Mental confusion
* Septic shock – hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the first line imaging investigation for suspected acute cholangitis?

A

Abdominal ultrasound – stones and dilatation of the common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the first line management for acute cholangitis?

A

Intravenous broad-spectrum antibiotics until blood and bile cultures are obtained.
o Cefuroxime + metronidazole (gram-negative and anaerobic cover).
o Rehydration using saline bolus fluid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is the definitive management for acute cholangitis?

A

Remove obstruction using ERCP–suction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Which sign is positive in a patient with acute cholecystitis?

A

Murphy’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is the gold standard investigation of choice for acute cholecystitis?

A

Abdominal ultrasound of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the first line management for acute cholecystitis?

A

Bed rest, IV fluids, and antibiotics + analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is the definitive management for acute cholecystitis?

A

Laparoscopic cholecystectomy and common bile duct stone removal with ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

When should a laparoscopic cholecystectomy be performed following a diagnosis of acute cholecystitis?

A

Within 1 week of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What complication of acute cholecystitis is associated with gallbladder pus distension?

A

empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the management of a gallstone empyema?

A

Percutaneous drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is the most common composition of gallstones?

A

cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the risk factors for gallstone development?

A

Female, fair, fat fertile, forty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is the presentation of gallstones?

A
  • Biliary colic: Steady non-paroxysmal biliary pain – epigastrium/RUQ >30 minutes <8 hours; associated with nausea and vomiting.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is the first line investigation for gallstones?

A

Abdominal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is the gold standard investigation for acute cholangitis?

A

MRCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is the first line analgesic option for severe biliary colic pain?

A

Diclofenac 75 mg IM (second 75 mg dose after 30 minutes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Which serum marker is raised in patients with an upper gastrointestinal bleed?

A

Raised urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What risk assessment tool is used as first assessment for upper GI bleeding?

A
  • Blatchford Score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What risk assessment tool is used post endoscopy for upper GI bleeding?

A
  • Rockall score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is the first line management for stable patients presenting with an upper GI bleeding?

A

Endoscopic treatment (clips, thermal coagulation, fibrin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is the first line medical management for variceal bleeding?

A

Terlipressin and prophylactic antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the definitive management for varcieal bleeding?

A

Band ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the main risk factor for an anal fissure?

A

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the characteristic clinical presentation of an anal fissure?

A
  • Anal pain (on defecation)
  • Sharp and severe, followed by a deep burning pain that persists for several hours.
  • Bleeding (bright red blood on the stool or toilet paper)
  • Tearing sensation on passing stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Most anal fissures are found where?

A

In the posterior midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is the first line management for patients with anal fissures?

A

Increase fibre and fluid intake

Stool softening laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the first line analgesia for anal fissures?

A

Simple analgesia e.g., paracetamol/ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is the preferred management step for patients with persistent anal fissure symptoms >1 week?

A

Rectan GTN 0.4% for 6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is the most common cause of large bowel obstruction?

A

Colorectal adenocarcinoma

130
Q

What are the intraluminal causes of bowel obstruction (3)?

A
  • Gallstone ileus
  • Ingested foreign body
  • Faecal impaction
131
Q

What are the mural causes of bowel obstruction?

A
  • Cancer
  • Inflammatory strictures
  • Intussusception
  • Diverticular strictures
  • Meckel’s diverticulum
  • Lymphoma
132
Q

What are the extra-mural causes of bowel obstruction (4)?

A
  • Hernias
  • Adhesions
  • Peritoneal metastasis
  • Volvulus
133
Q

Which clinical feature differentiates between small and large bowel obstruction?

A

Colicky abdominal pain with initial bilious vomiting progressing to feculent vomiting

134
Q

On auscultation of the bowel, what finding is observed in bowel obstruction?

A

Tinkling bowel sounds

135
Q

What is the first line radiological investigation for patients with suspected bowel obstruction?

A

Erect abdominal X-ray

136
Q

What is the definitive radiological investigation for patients with bowel obstruction?

A

CT scan of abdomen and pelvis

137
Q

What diameter threshold x >cm is suggestive of small bowel obstruction?

A

> 3 cm

138
Q

What radiological findings are consistent with a diagnosis of small bowel obstruction?

A
  • Dilated bowel >3cm
  • Central abdominal location
  • Valvulae conniventes visible (lines completely crossing the bowel)
139
Q

What radiological findings are consistent with a diagnosis of large bowel obstruction?

A
  • Dilated bowel (>6.5 cm for recto-sigmoid diameter; >10-12 cm for caecum; >8 cm for the ascending column).
  • Peripheral location
  • Haustral lines visible
140
Q

What is the first line management of bowel obstruction?

A

Drip and suck for up to 72 hours e.g., IV fluids, nil by mouth and nasogastric decompression to decompress the bowel

141
Q

What is the immediate management for peritonitic bowel in bowel obstruction?

A

Exploratory laparatomy

142
Q

Which criteria is used to diagnose functional constipation?

A

Rome IV criteria

143
Q

Fewer than x number of spontaneous bowel movements/week is diagnostic of constipation?

A

3

144
Q

What is the first line medical management for constipation?

A

Bulk-forming laxative (ispaghula husk, fybogel) - increases stool mass + peristalsis.

145
Q

What is the second line drug management for constipation?

A

Macrogol (osmotic laxative) – retains fluid in the bowel (Bloating).

146
Q

Name a bulk forming laxative?

A

ispaghula husk, fybogel

147
Q

What type of laxative is macrogol?

A

Osmotic laxative

148
Q

Which drug is considered if at least two laxatives from two different classes have been tried at the highest tolerated recommended dose for at least 6 months, with persistent constipation?

A

Prucalopride (a selective, high-affinity serotonin 5HT4 receptor agonist)

149
Q

What is the first line drug management for opioid-induced constipation?

A

Osmotic laxative and a stimulant laxative

150
Q

What is the main cause of appendicits?

A

Faecolith

151
Q

Which anatomical location is 2/3rd of the way from the umbilicus to the anterior superior iliac spine?

A

McBurney’s point

152
Q

What is the characteristic pain presentation for appendicits?

A
  • Abdominal pain (periumbilical/epigastric)
  • Migratory to the RLQ (within 24-48 hours)
153
Q

What clinical feature is suggestive of appendiceal perforation?

A

Sudden relief in pain

154
Q

Which eponymous sign describes the following:
‘Palpation of the LLQ, increases pain felt in the RLQ’

A

Rovsing’s sign

155
Q

Which eponymous sign describes the following:
‘Passive extension of the right thigh in the left lateral position –> pain in the RLQ’.

A

Psoas sign

156
Q

What FBC finding is consistent with appendicitis?

A

Neutrophil-predominant leucocytosis

157
Q

What is the preferred line of imaging for appendicitis?

A

Ultrasound

158
Q

What is the 1st line of management for appendicitis?

A

IV fluids and antibiotics

159
Q

What is the gold-standard management for appendicitis?

A

Laparoscopic appendicectomy and prophylactic antibiotics

160
Q

Which anatomical triangle is used to define inguinal hernias?

A

Hesselbach’s triangle

161
Q

What are the three borders of Hesselbach’s triangle?

A

Inferior: Inguinal ligament
Lateral: Inferior epigastric vessels
Medial: Rectus abdominis muscles

162
Q

Which type of hernia is medial to the inferior epigastric vessels?

A

Direct inguinal hernia

163
Q

Which type of hernia passes directly through a weakness in the posterior wall of the canal?

A

Direct inguinal hernia

164
Q

Which type of hernia protrudes at the internal inguinal ring and is lateral to the inferior epigastric vessels?

A

Indirect inguinal hernia

165
Q

In relation to the pubic tubercle, define the location of an inguinal hernia?

A

Superior and medial

166
Q

An irreducible tender tense hernia is suggestive of what?

A

Strangulated hernia

167
Q

For patients <18 years with an inguinal hernia, what is the 1st line management?

A

Urgent referral to a paediatric surgeon within 2 weeks

168
Q

What is the first line of routine management for adult inguinal hernia?

A

Routine referral to general surgery for surgical management
- Surgical intervention:
o Mesh repair (lowest recurrence rate)
 Unilateral inguinal hernias – open approach
 Bilateral and recurrent hernias – laparoscopic.
o Hernia truss – indicated in patients unfit for surgery.

169
Q

Which hernia resides inferior and lateral to the pubic tubercle?

A

Femoral hernia

170
Q

What is the first line management for femoral hernia?

A

Surgical repair (due to increased risk of strangulation)

171
Q

When does the NHS bowel screening begin?

A

Aged 50 to 74 years

172
Q

How frequently is the NHS bowel screening programme?

A

Every 2 years

173
Q

What test is used for bowel screening by the NHS?

A

Faecal Immunochemical Test (FIT)

174
Q

An abnormal FIT test on bowel screening warrants what further investigation?

A

colonoscopy

175
Q

What is the main underlying cause of postoperative ileus?

A
  • Deranged electrolytes
176
Q

What is the first line management of post-operative ileus?

A

NBM + IV fluids (to maintain normovolaemia) + correction of electrolyte derangement.
- Consider nasogastric tube insertion if vomiting

177
Q

Which type of hepatic shunting is responsible for oesophageal varices?

A

Extrahepatic shunting

178
Q

What are the features of decompensated cirrhosis?

A

jaundice, ascites, hepatic encephalopathy and/or variceal bleeding

179
Q

What is the most common cause of liver cirrhosis?

A

Alcohol

180
Q

Which hepatitis infections are associated with liver cirrhosis?

A

Hepatitis B and C

181
Q

Which three drugs are commonly associated with causing liver cirrhosis?

A

Long-term amiodarone, methotrexate or methyldopa use

182
Q

What are the signs of chronic liver diseaes?

A
  • Hepatosplenomegaly
  • Clubbing
  • Ecchymosis
  • Spider naevi
  • Palmar erythema – caused by raised oestrogen levels.
  • Nail changes (proximal nail-bed pallor; leukonychia)
  • Muscle wasting (cachexia)
  • Gynaecomastia
  • Testicular atrophy
183
Q

What test (s) are a marker of synthetic liver function?

A

Serum albumin (low)
INR/prothrombin time

184
Q

What is the tumour marker for hepatocellular carcinoma?

A

Alpha-fetoprotein (AFP)

185
Q

What is the first radiological investigation for liver cirrhosis?

A

liver ultrasound

186
Q

What is the gold-standard investigation for assessing the degree of fibrosis in a patient with liver cirrhosis?

A

Transient elastography

187
Q

Which serum test is performed in patients with Wilson’s disease?

A
  • Caeruloplasmin
188
Q

Which auto-immune markers are associated with autoimmune hepatitis?

A

ANA, SMA, AMA, LKM-1

189
Q

Which classification system is used to assess the prognosis in liver cirrhosis?

A

Child-Pugh classification

190
Q

What are the parameters of the Child-Pugh classification system (ABCDE)?

A

Albumin

Bilirubin

Clotting (prothrombin time)

Distension (ascites)

Encephalopathy

191
Q

Which score is used every 6 months to calculate the 3-monthly mortality as a percentage?

A

MELD Score

192
Q

What are the features of decompensated liver disease that warrant a liver transplant? (AHOY)

A

Ascites

Hepatic encephalopathy

Oesophageal varices bleeding

Yellow (jaundice)

193
Q

What is the prophylactic drug for variceal bleeding in the context of portal hypertension?

A

Propranolol

194
Q

What two drugs are prescribed in patients as first line in patients with bleeding oesophageal varices?

A

Terlipressin and prophylactic antibiotics

195
Q

What is the first line drug for ascites?

A

Spironolactone

196
Q

What is the definitive management for ascites following spironolactone?

A

Paracentesis

197
Q

What is the first line drug for SBP?

A

piperacillin with tazobactam.

198
Q

What is the first line drug for the management of hepatic encephalopathy?

A

Lactulose

199
Q

What prophylactic drug is indicated to reduce the risk of developing hepatic encephalopathy?

A
  • Rifaximin
200
Q

What is the major risk factor for diverticular disease?

A

Low fibre diet

201
Q

Tenderness in which abdominal quadrant is associated with diverticular disease?

A

left lower quadrant

202
Q

What is the characteristic finding associated with acute diverticulitis?

A

Severe abdominal pain, fever, rectal bleeding

203
Q

What is the investigation of choice for diverticular disease?

A

Abdominal CT with oral and IV contrast

204
Q

What is the drug of choice for acute diverticulitis?

A

co-amoxiclav

205
Q

What is the management for diverticular disease?

A
  • Lifestyle advice, smoking cessation, weight loss
  • Bulk-forming laxatives e.g., ispaghula husk.
  • Simple analgesia – paracetamol (do not prescribe NSAIDs or opioid analgesia)
206
Q

Ganglia from which plexus is absent in achalasia?

A

myenteric plexus

207
Q

Dysphagia to what is characteristic of achalasia?

A

liquids and solids

208
Q

What is the diagnostic investigation of choice for achalasia?

A

Oesophageal manometry

209
Q

What is the characteristic appearance on barium swallow that is consistent with achalasia?

A

Bird’s beak’ appearance

210
Q

What is the first line management for achalasia?

A

Pneumatic ballon dilatation.

211
Q

Which surgical intervention is indicated for Achalasia?

A

Heller cardiomyotomy

212
Q

Which antibiotics potentiate c.difficile infection?

A

clindamycin, cephalosporin, and co-amoxiclav

213
Q

What is the first line investigation for identifying active infection of c. difficile?

A

C difficile toxin test

214
Q

Which investigation is falsely positive representing exposure to the bacteria as opposed to current infection in c diff?

A

Antigen

215
Q

What are the markers/criteria for severe C difficile infection?

A
  • WCC > 15 x 109/L;
  • Increased serum creatinine (>50% increase above baseline)
  • Temperature >38.5
  • Severe colitis
216
Q

What is the first line antibiotic for Clostridioides difficile infection?

A

Vancomyin

217
Q

What is the second line antibiotic for Clostridioides difficile infection?

A

Oral fidaxomicin

218
Q

What are the two antibiotics indicated for life threatening Clostridioides difficile infection?

A

Oral vancomycin and IV metronidazole

219
Q

What is the antibiotic indicated for recurrent Clostridioides difficile infection?

A

Oral fidaxomicin

220
Q

What is the minimum duration of symptoms to diagnose IBS?

A

6 months

221
Q

What are three features of IBS?

A
  1. Abdominal pain/discomfort
  2. Bloating
  3. Change in bowel habit
222
Q

How is pain relieved in IBS?

A

Relieved on defecation

223
Q

What is the first line management for IBS?

A

lifestyle advice and trigger identification

224
Q

What is the drug of choice to manage diarrhoea symptoms in IBS?

A

Loperamide

225
Q

What is the drug of choice to manage constipation symptoms in IBS?

A

Ispaghula husk

226
Q

What is the drug of choice to manage abdominal pain in IBS?

A

Mebeverine hydrochloride

227
Q

What is the preferred antibiotic for small intestinal bacterial overgrowth?

A

Rifaximin

228
Q

What is the first line investigation for suspected GORD (no alarm symptoms)?

A

Helicobacter pylori test

229
Q

What is the definitive investigation for GORD if ALARM symptoms are present?

A

Endoscopy

230
Q

What are the ALARM symptoms in the context of GORD?

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent progressive dysphagia
  • Melaena/haematemesis
  • Upper abdominal mass
231
Q

What is the first line management for non-investigated dyspepsia?

A

4 weeks of full dose PPI test

232
Q

For H-pylori positive GORD, what is the first line management?

A

Triple therapy for 7 days e.g., amoxicillin clarithromycin and PPI

233
Q

What is the second line management for non-investigated GORD following PPI?

A

H2-receptor antagonist e.g, famotidine

234
Q

What is the dose duration for proven erosive GORD?

A

8 weeks

235
Q

What is the gold standard management for proven erosive GORD?

A

Laparoscopic fundoplication

236
Q

What metaplastic change is observed in Barrett’s oesophagus?

A

squamous epithelium to columnar epithelium

237
Q

Barrett’s oesophagus predisposes to which type of oesophageal carcinoma?

A

Adenocarcinoma

238
Q

What is the 1st line Ix for Barrett’s oesophagus?

A

Endoscopy with biopsies

239
Q

Which type of ulcer is most attributed to H pylori?

A

Duodenal ulcer

240
Q

Which type of ulcer is better after eating?

A

Duodenal ulcer

241
Q

Which type of ulcer is worse after eating?

A

Gastric ulcer

242
Q

What is the following diagnosis?

Painless, white patches on the side of the tongue that CANNOT be scraped off

A

Oral Hairy Leucoplakia

243
Q

What is the topical management for Oral Hairy Leucoplakia?

A
  • Topical retinoic acid, gentian violet and 25% podophyllin resin
244
Q

Pain out of proportion to clinical findings associated with nausea and vomiting + AF history?

A

Acute mesenteric ischaemia

245
Q

What is the definitive investigation for AMI?

A

CT with intravenous contrast

246
Q

What is the definitive management of AMI?

A

immediate laparotomy

247
Q

What is steatosis?

A
  • Reversible fatty infiltration; asymptomatic and spontaneously resolves within 6 weeks of abstinence
248
Q

What AST:ALT ratio is consistent with acute alcoholic hepatitis?

A
  • AST:ALT ratio >2
249
Q

What scoring system is used to identify patients with acute decompensation who may benefit from glucocorticoid therapy?

A

Maddrey’s discriminant function

250
Q

What is the immunisation schedule for alcoholic hepatitis?

A

Annual influenza and one-off pneumococcal vaccine

251
Q

What is the acute management of alcoholic hepatitis?

A

Pabrinex and steroids

252
Q

What are the three causes of ascites with a SA-AG <11?

A
  1. Malignancy
  2. Pancreatitis
  3. Tuberculosis
253
Q

What are the main causes of ascites with a SA-AG >11?

A

Portal hypertension
Nephrotic syndrome
Cardiac failure

254
Q

What is the first line drug for ascites?

A
  • Spironolactone
255
Q

What are the adverse effects of Spironolactone ?

A

Decreased libido, impotence and gynaecomastia in men, and menstrual irregularity in women + hyperkalaemia.

256
Q

What is the first non-medical management for ascites?

A

Dietary salt restriction

257
Q

What is the definitive management for large/refractory ascites?

A

Therapeutic paracentesis

258
Q

What is prophylactic antibiotic of choice for SBP in patients with ascites?

A
  • Oral ciprofloxacin or norfloxacin
259
Q

What is the most common cause of SBP?

A

E. coli

260
Q

What neutrophil count is consistent with SBP?

A

neutrophil count >250 cell/mm3

261
Q

what is the first line drug management for SBP?

A

cefotaxime

262
Q

What should be administered in patients with SBP + renal impairment?

A

Albumin infusion

263
Q

Which two genetic syndromes predispose to colorectal cancer?

A

FAP and Lynch syndrome

264
Q

What is the management of FAP?

A

Total proctocolectomy with ileal pouch-anal anastomosis

265
Q

Which genes are associated with Lynch syndrome?

A

MSH2 and MLH1 genes

266
Q

What is the presentation of right-sided colon cancers?

A

Abdominal pain, IDA, palpable mass in the right iliac fossa

267
Q

What is the presentation of left-sided colon cancers?

A

Rectal bleeding, change in bowel habit, tenesmus, palpable mass in the left iliac fossa or on PR exam

268
Q

> 40 years with what two features warrant an urgent FIT test?

A

> 40 years with unexplained weight loss and abdominal pain

269
Q

What is the NICE urgent FIT test pathway for >50?

A

> 50 years with unexplained rectal bleeding abdominal pain or weight loss

270
Q

IDA or change in bowel habit for patients > x years warrant an urgent FIT?

A

> 60 years

271
Q

How often should a FIT test be performed between 60-75 years?

A

Every 2 years

272
Q

What is the gold-standard investigation for colorectal cancer?

A

Colonoscopy with biopsy

273
Q

What tumour marker for colorectal cancer is used to monitor disease progression?

A
  • Carcinoembryonic antigen (CEA)
274
Q

What is the staging criteria for colorectal cancer?

A

Duke’s staging

275
Q

What is the ABCD Duke’s criteria?

A
  • A: Confined beneath the muscularis propria
  • B: Extension beyond the muscualris propria
  • C: Regional lymph node involvement
  • D: Distant metastasis
276
Q

What is the first line management for colorectal cancer?

A

Resection

277
Q

What is an emergency procedure of the sigmoid colon and upper rectum with end colostomy?

A
  • Hartmann’s procedure
278
Q

What radiographic sign is consistent with sigmoid volvulus?

A

Coffee bean sign

279
Q

What is the definitive investigation for sigmoid vovlulus?

A

CT abdomen-pelvis scan

280
Q

What are the risk factor associations for sigmoid volvulus?

A

Older patients with chronic constipations, and neurological disease e.g., Parkinson’s disease/vascular dementia, antipsychotics

281
Q

What is the first line management for sigmoid volvulus?

A

Sigmoidoscope decompression

282
Q

What is the emergency surgical procedure for a sigmoid volvulus?

A

laparotomy and Hartmann’s procedure

283
Q

What is the radiological sign observed in a caecal volvulus?

A

embryo sign

284
Q

What is the appearance of an ileostomy?

A

Spouted

285
Q

What are ileostomies spouted?

A

To reduce contact of irritant contents with the skin

286
Q

Where are ileostomies typically found?

A

Right iliac fossa

287
Q

What classic radiological sign is seen in gallstone ileus?

A

Rigler triad

288
Q

Gallstone ileus affects which part of the bowel?

A

Gallstone impaction at the ileocaecal valve

289
Q

Which cancer affects the middle and upper thirds of the oesophagus?

A

Squamous cell carcinoma

290
Q

Which cancer affects the lower third of the oesophagus?

A

Adenocarcinoma

291
Q

What is the first line investigation for oesophageal cancer?

A

Upper GI endoscopy (OGD) with biopsy

292
Q

Intermittent dysphagia to both solids and liquids if consistent with which diagnosis?

A

Diffuse Oesophageal Spasm

293
Q

What characteristic appearance is observed on barium swallow for diffuse oesophageal spasm?

A

corkscrew or ‘rosary bead’ appearance

294
Q

What is the gold-standard investigation for diffuse oesophageal spasm?

A

Manometry

295
Q

What is the first line medical management for diffuse oesophageal spasm?

A

Nitrates and CCBs

296
Q

What is the surgical management for diffuse oesophageal spasm?

A

Heller myotomy

297
Q

What type of hormone is produced from Zollinger-Ellison syndrome?

A

Gastrin

298
Q

What is the first line management for ZES?

A

Fasting serum gastrin

299
Q

What is the definitive management for ZES?

A

Surgical resection

300
Q

What is the most common histological subtype for gastric cancer?

A

Adenocarcinoma

301
Q

What is the primary risk factor for gastric cancer?

A
  • Helicobacter pylori infection
302
Q

What are the metastatic signs of gastric cancer?

A

o Troisier sign (palpable Virchow’s node)
o Acanthosis nigricans
o Sister Joseph nodules (umbilicus)
o Ascites
o Hepatomegaly
o Jaundice

303
Q

What is the diagnostic investigation for gastric cancer?

A

Gastroscopy and biopsy

304
Q

What is the curative management for gastric cancer?

A

Partial gastrectomy (early-stage tumours) – indicated for distal cancers.
- Roux-en-Y reconstruction method
* Total gastrectomy – indicated for proximal cancers.
* Endoscopic mucosal resection for early tumours e.g., T1a.

305
Q

Which is the most common type of hiatus hernia?

A

Sliding hiatus hernia

306
Q

Which type of hiatus hernia is associated with superior herniation of the cardia through the diaphragmatic hiatus?

A

Sliding hernia

307
Q

What are the two types of hiatus hernia?

A

Sliding and rolling

308
Q

What is the gold-standard investigation for hiatus hernia?

A

OGD

309
Q

What is the surgical management of hiatus hernia?

A

Laparoscopic fundoplication

310
Q

What is the most common histological subtype of anal cancer?

A

Squamous cell carcinoma

311
Q

Which HPV strains are associated with anal cancer?

A

HPV 16 and 18

312
Q

What is the first line investigation for anal cancer?

A

Digital anorectal examination AND biopsy

313
Q

Which anatomical line is used to delineate the type of haemorrhoid?

A

dentate line

314
Q

What are first degree haemorrhoids?

A

Project into the lumen of the anal canal (but do not prolapse)

315
Q

Grade 3 haemorrhoids?

A

Haemorrhoids protrude outside the anal canal and reduce manual pressure

316
Q

What is the first line management of haemorrhoids?

A

Increase dietary fibre intake

317
Q

What is the curative management of haemorrhoids?

A

Rubber band ligation

318
Q

What BMI warrants immediate bariatric surgery?

A

> 50

319
Q

What is the most common type of cholangiocarcinoma?

A

Klatskin tumours: The most common site for bile duct cancers is at the bifurcation of the right and left hepatic ducts – hilar cholangiocarcinoma.

320
Q

Which disease predisposes the development of cholangiocarcinoma?

A

PSC

321
Q

Which tumour marker is raised in cholangiocarcinoma?

A

CA-19

322
Q

What is the gold-standard investigation for the diagnosis of Cholangiocarcinoma?

A

MRCP

323
Q

Which auto-antibody is associated with PSC?

A

p-ANCA.

324
Q

What is observed on cholangiography in patients with PSC?

A

Beads on a string appearance

325
Q

What is the first line management of PSC?

A

Ursodeoxycholic acid

326
Q

Bile duct loss with granulomas and anti-m2 antibodies is associated with which disorder?

A

Primary Biliary Cirrhosis

Phase3 Specialties - Imperial College London MBBS (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions