MLA Gastroenterology Flashcards
1
Q
Which cancer biomarker is associated with colorectal cancer?
A
Carcinoembryonic antigen
2
Q
What type of resection is associated with the distal transverse, descending colon?
A
Left hemicolectomy
3
Q
What type of resection is associated with cancer located in the caecum, ascending or proximal transverse colon?
A
Right hemicolectomy
4
Q
What type of surgical resection is associated with the sigmoid colon, upper rectum, and lower rectum?
A
High anterior resection
5
Q
What type of resection is associated with anal verge cancer?
A
Abdominoperineal excision of the rectum
6
Q
Continuous superficial inflammation of the colonic mucosa from the rectum is diagnostic of what disease?
A
ulcerative colitis
7
Q
Which IBD condition is associated with smoking as a protective factor?
A
Ulcerative colitis
8
Q
Bloody diarrhoea is associated with which type of IBD?
A
Ulcerative colitis
9
Q
What is the definition of mild ulcerative colitis?
A
4 or fewer stools/day - no signs of systemic toxicity
10
Q
What is the definition criteria of moderate ulcerative colitis?
A
> 4 stools/day (frequent, bloody, loose) + mild anaemia.
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.
12
Q
Which skin extraintestinal manifestation is associated with ulcerative colitis (related to disease activity)?
A
Erythema nodosum
13
Q
Which extraintestinal ocular manifestation is associated with ulcerative colitis (related to disease activity)?
A
Episcleritis
14
Q
Which dermatological condition characterised by deep violaceous ulcers is associated as an extraintestinal manifestation of ulcerative colitis?
A
Pyoderma gangrenosum
15
Q
What investigation is indicated as an active inflammatory marker for IBD?
A
Faecal calprotectin
16
Q
What is the definitive investigation to confirm ulcerative colitis?
A
Colonoscopy with biopsy
17
Q
Crypt abscesses and goblet cell depletion is associated with which type of IBD?
A
Ulcerative colitis
18
Q
Pseudopolyps are associated with which type of IBD?
A
Ulcerative colitis
19
Q
Which investigation is indicated for suspected toxic megacolon in patients with ulcerative colitis?
A
Plain abdominal X-ray
20
Q
Which severity scoring system is used for ulcerative colitis?
A
Truelove and Witts’ severity index
21
Q
How many bowel movements per day is associated with severe ulcerative colitis?
A
6 or more
22
Q
What is the first-line management for mild to moderate proctitis?
A
Rectal mesalazine
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
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
25
what is the third line management of proctitis?
Oral corticosteroids
26
What is the maintenance therapy for proctitis?
Topical aminosalicylates
27
What is the first line management for extensive disease ulcerative colitis?
Topical aminosalicylates and high-dose oral aminosalicylates.
28
If remission is not achieved within 4 weeks of starting combination therapy for extensive ulcerative colitis, what is the second line of management?
Stop topical treatments and add an oral corticosteroid
29
What is the first line management of severe ulcerative colitis?
Intravenous hydrocortisone 100 mg
30
What is the alternative to hydrocortisone for the immediate management of severe ulcerative colitis?
IV ciclosporin
31
If there is no improvement following IV hydrocortisone after 72 hours for severe UC, what is the next line of management?
add IV ciclosporin to IV corticosteroids or consider surgery.
32
What is the maintenance management for severe ulcerative colitis?
Oral azathioprine or oral mercaptopurine
33
What are the indications of oral azathioprine or oral mercaptopurine?
After TWO or more inflammatory exacerbations in 12 months requiring treatment with systemic corticosteroids
34
What is the class drug of infliximab?
anti-TNF-alpha monoclonal antibody
35
Non-caseating transmural inflammation of the gastrointestinal tract is associated with what IBD diagnosis?
Crohn's disease
36
Smoking has what effect on symptoms associated with Crohn's disease?
Worsens symptoms
37
What is the characteristic appearance observed on colonoscopy in Crohn's disease?
Skip lesions - cobblestone appearance
38
What is the first lesion observed in Crohn's disease?
Aphthous ulcer
39
What is the complication associated with terminal ileal inflammation in Crohn's disease?
- Bile salt malabsorption due to an inflamed terminal ileum
- Steatorrhoea related to bile salt loss
40
What ocular pathology is observed in Crohn's disease?
Anterior uveitis
41
Which vitamin deficiency is associated with Crohn's disease?
Vitamin B12 due to ileal diseae
42
What is the first-line induction management of Crohn's disease?
Prednisolone
43
What is the second line management for Crohn's disease if there are two or more inflammatory exacerbation in 12 months?
Thiopurines (azathioprine, mercaptopurine)
44
Which biologic therapies are available for the management of refractory disease and fistulating Crohn's?
Anti-TNF alpha monoclonal antibodies e.g., infliximab and adalimumab
45
What enzyme should be measured first prior to starting Azathioprine or mercaptopurine ?
TPMPT activity
46
Low TPMPT activity results in what effect with concurrent thiopurine use?
increased risk of myelosuppression
47
What is the management of bile acid diarrhoea?
Cholestyramine
48
What is the management for fistulae and strictures associated with Crohn's disease?
- Ileocecal resection for stricturing terminal ileal disease
49
What is the investigation of choice for perianal fistulae in Crohn's disease?
- MRI
50
Which antibiotic is prescribed for perianal fistulae in Crohn's disease?
Oral metronidazole
51
What are the adverse effects associated with azathioprine?
- Bone marrow suppression (FBC count)
- Nausea/vomiting
- Pancreatitis
- Increased risk of non-melanoma skin cancer
52
Azathioprine interacts with what drug?
Allopurinol
53
Which haplotype is associated with Coeliac disease?
DQ2, DQ8 HLA haplotypes
54
Which cutaneous manifestation is associated with Coeliac disease?
* Dermatitis herpetiformis
55
What is the first line of investigation for suspected Coealic disease?
Total IgA with serum IgA Tissue Transglutaminase antibodies
56
What is the confirmatory diagnostic investigation for Coeliac disease?
Duodenal biopsy
57
What histological findings are observed in Coeliac disease?
villous atrophy, crypt hyperplasia and increased intra-epithelial lymphocytes
58
Which type of cancer is associated with Coeliac disease?
enteropathy-associated T cell lymphoma (EATL)
59
Which immunisations should be offered for patients with Coeliac disease (with hyposplenism)?
influenza, meningococcal and pneumococcal (every 5 years) immunisations for people with Hyposplenism.
60
What investigation is indicated in patients with Coeliac disease to assess for the risk of osteoporosis?
DEXA scan
61
What is the life-long management of Coeliac disease?
Gluten-free diet
62
What is the most common cause of acute pancreatitis?
Gallstones
63
What is the second most common cause of acute pancreatitis?
Ethanol
64
Which drugs are associated with potentiating acute pancreatitis?
Thiazides, ACEi, statins, fenofibrate, azathioprine, tetracyclines, oestrogens, corticosteroids
65
What electrolyte derangement is associated with a poor prognosis of acute pancreatitis?
Hypocalcaemia
66
Which sign denotes peri-umbilical discolouration?
Cullen’s sign
67
Which sign denotes flank discolouration in acute pancreatitis?
Grey–Turner’s sign
68
What is the characteristic pain description associated with acute pancreatitis?
* Severe epigastric pain radiating to the back, relieved by sitting forward.
69
What serum investigation is raised in patients with acute pancreatitis?
Plasma amylase >3 upper limit
70
Which serum investigation is a more sensitive test for acute pancreatitis?
Serum lipase
71
What is the preferred radiological imaging of choice for acute pancreatitis?
CT scan
72
What is associated with a raised amylase?
Pancreatic pseudocyst, mesenteric infarct, perforated viscus, acute cholecystitis, and diabetic ketoacidosis.
73
Which scoring criteria is used to assess acute pancreatitis?
Modified Glasgow Criteria
73
What are the parameters of the Modified Glasgow Criteria ?
* 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.
74
A score of x is associated with severe pancreatitis?
Score ≥3
75
What is the first line management of severe pancreatitis?
Intravenous fluids
IV antibiotics and analgesia
Consider enteral nutrition
76
What is the main pancreatic complication associated with acute pancreatitis?
Pancreatic pseudocyst formation
77
Which high hepatitis vaccine is mandated for travel to India?
Hepatitis A
77
Which vitamin deficiency is associated with dry skin, ocular dryness and night blindness?
Vitamin A
78
Which investigation is recommended for assessing peritoneal metastatic nodules in the gastric carcinoma before major abdominal surgery?
Diagnostic laparoscopy
79
What are NICE referral guidelines for an urgent 2-week wait pathway (for upper endoscopy)?
Age >55 years with weight loss and upper abdominal pain, reflux or dyspepsia
79
A negative nitroblue tetrazolium test is suggests which diagnosis?
Chronic granulomatous disease
80
What are the two most common presenting features of chronic mesenteric ischaemia?
Postprandial pain and weight loss with an otherwise unremarkable examination
81
What is the gold-standard diagnostic test for chronic mesenteric ischaemia?
Arteriography
82
Which characteristic feature is observed in the iris, in patients with Wilson's disease?
Kayser–Fleischer rings
83
Intermittent dysphagia with a history of atopy is associated with which diagnosis?
Eosinophilic oesophagitis
84
Which chronic disease commonly leads to cirrhosis among IV drug abusers?
Hepatitis C
85
Which syndrome is associated with neutrophil dermatosis associated with systemic upset in a patient with a background of IBD?
Sweet syndrome
86
What two serum tests are raised and consistent with a diagnosis of primary biliary cholangitis?
Serum IgM
Anti-mitochondrial antibodies (M2)
87
What is the first line management for PBC?
Ursodeoxycholic acid
88
Which grade of haemorrhoids protrudes from the anal canal with defecation/straining and shrinks spontaneously?
Grade 2
89
Which antibiotic is recommended for patients with campylobacter associated bacterial gastroenteritis?
Macrolide e.g., oral clarithromycin
90
Pigment laden macrophages within the mucosa on periodic acid Schiff staining and incidental colonic polyps is consistent with which diangosis?
Melanosis coli secondary to laxative abuse
91
What is the most common cause of melanosis coli?
laxative abuse
92
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?
Courvoisier’s
93
Which anti-emetic is contraindicated in Parkinson's disease?
Metoclopramide
94
How frequent should endoscopic surveillance be performed in patients with Barrett's oesophagus?
Every 2-3 years
95
What is the most common cause of acute cholangitis?
Gallstones
Other causes:
* Infection post-ERCP
* Tumours (pancreatic cholangiocarcinoma)
* Bile duct strictures or stenosis
* Parasitic infection (ascariasis)
96
What surgical intervention predisposes patients to developing acute cholangitis?
ERCP
97
What is the most common enteric bacterial cause of acute cholangitis?
Escherichia coli
98
Which triad of symptoms is associated with acute cholangitis?
Charcot’s triad:
1. Right upper quadrant pain (with tenderness, may refer to shoulder)
2. Fever with rigors
3. Jaundice
99
What is Reynold's Pentad?
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
100
What is the first line imaging investigation for suspected acute cholangitis?
Abdominal ultrasound – stones and dilatation of the common bile duct
101
What is the first line management for acute cholangitis?
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.
102
What is the definitive management for acute cholangitis?
Remove obstruction using ERCP–suction
103
Which sign is positive in a patient with acute cholecystitis?
Murphy's sign
104
What is the gold standard investigation of choice for acute cholecystitis?
Abdominal ultrasound of the biliary tree
105
What is the first line management for acute cholecystitis?
Bed rest, IV fluids, and antibiotics + analgesia
106
What is the definitive management for acute cholecystitis?
Laparoscopic cholecystectomy and common bile duct stone removal with ERCP
107
When should a laparoscopic cholecystectomy be performed following a diagnosis of acute cholecystitis?
Within 1 week of diagnosis
108
What complication of acute cholecystitis is associated with gallbladder pus distension?
empyema
109
What is the management of a gallstone empyema?
Percutaneous drainage
110
What is the most common composition of gallstones?
cholesterol
111
What are the risk factors for gallstone development?
Female, fair, fat fertile, forty
112
What is the presentation of gallstones?
* Biliary colic: Steady non-paroxysmal biliary pain – epigastrium/RUQ >30 minutes <8 hours; associated with nausea and vomiting.
113
What is the first line investigation for gallstones?
Abdominal ultrasound
114
What is the gold standard investigation for acute cholangitis?
MRCP
115
What is the first line analgesic option for severe biliary colic pain?
Diclofenac 75 mg IM (second 75 mg dose after 30 minutes)
116
Which serum marker is raised in patients with an upper gastrointestinal bleed?
Raised urea
117
What risk assessment tool is used as first assessment for upper GI bleeding?
* Blatchford Score
118
What risk assessment tool is used post endoscopy for upper GI bleeding?
* Rockall score
119
What is the first line management for stable patients presenting with an upper GI bleeding?
Endoscopic treatment (clips, thermal coagulation, fibrin)
120
What is the first line medical management for variceal bleeding?
Terlipressin and prophylactic antibiotics
121
What is the definitive management for varcieal bleeding?
Band ligation
122
What is the main risk factor for an anal fissure?
Constipation
123
What is the characteristic clinical presentation of an anal fissure?
* 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
124
Most anal fissures are found where?
In the posterior midline
125
What is the first line management for patients with anal fissures?
Increase fibre and fluid intake
Stool softening laxatives
126
What is the first line analgesia for anal fissures?
Simple analgesia e.g., paracetamol/ibuprofen
127
What is the preferred management step for patients with persistent anal fissure symptoms >1 week?
Rectan GTN 0.4% for 6-8 weeks
128
What is the most common cause of small bowel obstruction?
Adhesions
129
What is the most common cause of large bowel obstruction?
Colorectal adenocarcinoma
130
What are the intraluminal causes of bowel obstruction (3)?
* Gallstone ileus
* Ingested foreign body
* Faecal impaction
131
What are the mural causes of bowel obstruction?
* Cancer
* Inflammatory strictures
* Intussusception
* Diverticular strictures
* Meckel’s diverticulum
* Lymphoma
132
What are the extra-mural causes of bowel obstruction (4)?
* Hernias
* Adhesions
* Peritoneal metastasis
* Volvulus
133
Which clinical feature differentiates between small and large bowel obstruction?
Colicky abdominal pain with initial bilious vomiting progressing to feculent vomiting
134
On auscultation of the bowel, what finding is observed in bowel obstruction?
Tinkling bowel sounds
135
What is the first line radiological investigation for patients with suspected bowel obstruction?
Erect abdominal X-ray
136
What is the definitive radiological investigation for patients with bowel obstruction?
CT scan of abdomen and pelvis
137
What diameter threshold x >cm is suggestive of small bowel obstruction?
>3 cm
138
What radiological findings are consistent with a diagnosis of small bowel obstruction?
* Dilated bowel >3cm
* Central abdominal location
* Valvulae conniventes visible (lines completely crossing the bowel)
139
What radiological findings are consistent with a diagnosis of large bowel obstruction?
* 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
What is the first line management of bowel obstruction?
Drip and suck for up to 72 hours e.g., IV fluids, nil by mouth and nasogastric decompression to decompress the bowel
141
What is the immediate management for peritonitic bowel in bowel obstruction?
Exploratory laparatomy
142
Which criteria is used to diagnose functional constipation?
Rome IV criteria
143
Fewer than x number of spontaneous bowel movements/week is diagnostic of constipation?
3
144
What is the first line medical management for constipation?
Bulk-forming laxative (ispaghula husk, fybogel) - increases stool mass + peristalsis.
145
What is the second line drug management for constipation?
Macrogol (osmotic laxative) – retains fluid in the bowel (Bloating).
146
Name a bulk forming laxative?
ispaghula husk, fybogel
147
What type of laxative is macrogol?
Osmotic laxative
148
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?
Prucalopride (a selective, high-affinity serotonin 5HT4 receptor agonist)
149
What is the first line drug management for opioid-induced constipation?
Osmotic laxative and a stimulant laxative
150
What is the main cause of appendicits?
Faecolith
151
Which anatomical location is 2/3rd of the way from the umbilicus to the anterior superior iliac spine?
McBurney's point
152
What is the characteristic pain presentation for appendicits?
* Abdominal pain (periumbilical/epigastric)
- Migratory to the RLQ (within 24-48 hours)
153
What clinical feature is suggestive of appendiceal perforation?
Sudden relief in pain
154
Which eponymous sign describes the following:
'Palpation of the LLQ, increases pain felt in the RLQ'
Rovsing’s sign
155
Which eponymous sign describes the following:
'Passive extension of the right thigh in the left lateral position --> pain in the RLQ'.
Psoas sign
156
What FBC finding is consistent with appendicitis?
Neutrophil-predominant leucocytosis
157
What is the preferred line of imaging for appendicitis?
Ultrasound
158
What is the 1st line of management for appendicitis?
IV fluids and antibiotics
159
What is the gold-standard management for appendicitis?
Laparoscopic appendicectomy and prophylactic antibiotics
160
Which anatomical triangle is used to define inguinal hernias?
Hesselbach’s triangle
161
What are the three borders of Hesselbach’s triangle?
Inferior: Inguinal ligament
Lateral: Inferior epigastric vessels
Medial: Rectus abdominis muscles
162
Which type of hernia is medial to the inferior epigastric vessels?
Direct inguinal hernia
163
Which type of hernia passes directly through a weakness in the posterior wall of the canal?
Direct inguinal hernia
164
Which type of hernia protrudes at the internal inguinal ring and is lateral to the inferior epigastric vessels?
Indirect inguinal hernia
165
In relation to the pubic tubercle, define the location of an inguinal hernia?
Superior and medial
166
An irreducible tender tense hernia is suggestive of what?
Strangulated hernia
167
For patients <18 years with an inguinal hernia, what is the 1st line management?
Urgent referral to a paediatric surgeon within 2 weeks
168
What is the first line of routine management for adult inguinal hernia?
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
Which hernia resides inferior and lateral to the pubic tubercle?
Femoral hernia
170
What is the first line management for femoral hernia?
Surgical repair (due to increased risk of strangulation)
171
When does the NHS bowel screening begin?
Aged 50 to 74 years
172
How frequently is the NHS bowel screening programme?
Every 2 years
173
What test is used for bowel screening by the NHS?
Faecal Immunochemical Test (FIT)
174
An abnormal FIT test on bowel screening warrants what further investigation?
colonoscopy
175
What is the main underlying cause of postoperative ileus?
* Deranged electrolytes
176
What is the first line management of post-operative ileus?
NBM + IV fluids (to maintain normovolaemia) + correction of electrolyte derangement.
- Consider nasogastric tube insertion if vomiting
177
Which type of hepatic shunting is responsible for oesophageal varices?
Extrahepatic shunting
178
What are the features of decompensated cirrhosis?
jaundice, ascites, hepatic encephalopathy and/or variceal bleeding
179
What is the most common cause of liver cirrhosis?
Alcohol
180
Which hepatitis infections are associated with liver cirrhosis?
Hepatitis B and C
181
Which three drugs are commonly associated with causing liver cirrhosis?
Long-term amiodarone, methotrexate or methyldopa use
182
What are the signs of chronic liver diseaes?
- 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
What test (s) are a marker of synthetic liver function?
Serum albumin (low)
INR/prothrombin time
184
What is the tumour marker for hepatocellular carcinoma?
Alpha-fetoprotein (AFP)
185
What is the first radiological investigation for liver cirrhosis?
liver ultrasound
186
What is the gold-standard investigation for assessing the degree of fibrosis in a patient with liver cirrhosis?
Transient elastography
187
Which serum test is performed in patients with Wilson's disease?
* Caeruloplasmin
188
Which auto-immune markers are associated with autoimmune hepatitis?
ANA, SMA, AMA, LKM-1
189
Which classification system is used to assess the prognosis in liver cirrhosis?
Child-Pugh classification
190
What are the parameters of the Child-Pugh classification system (ABCDE)?
Albumin
Bilirubin
Clotting (prothrombin time)
Distension (ascites)
Encephalopathy
191
Which score is used every 6 months to calculate the 3-monthly mortality as a percentage?
MELD Score
192
What are the features of decompensated liver disease that warrant a liver transplant? (AHOY)
Ascites
Hepatic encephalopathy
Oesophageal varices bleeding
Yellow (jaundice)
193
What is the prophylactic drug for variceal bleeding in the context of portal hypertension?
Propranolol
194
What two drugs are prescribed in patients as first line in patients with bleeding oesophageal varices?
Terlipressin and prophylactic antibiotics
195
What is the first line drug for ascites?
Spironolactone
196
What is the definitive management for ascites following spironolactone?
Paracentesis
197
What is the first line drug for SBP?
piperacillin with tazobactam.
198
What is the first line drug for the management of hepatic encephalopathy?
Lactulose
199
What prophylactic drug is indicated to reduce the risk of developing hepatic encephalopathy?
- Rifaximin
200
What is the major risk factor for diverticular disease?
Low fibre diet
201
Tenderness in which abdominal quadrant is associated with diverticular disease?
left lower quadrant
202
What is the characteristic finding associated with acute diverticulitis?
Severe abdominal pain, fever, rectal bleeding
203
What is the investigation of choice for diverticular disease?
Abdominal CT with oral and IV contrast
204
What is the drug of choice for acute diverticulitis?
co-amoxiclav
205
What is the management for diverticular disease?
- Lifestyle advice, smoking cessation, weight loss
- Bulk-forming laxatives e.g., ispaghula husk.
- Simple analgesia – paracetamol (do not prescribe NSAIDs or opioid analgesia)
206
Ganglia from which plexus is absent in achalasia?
myenteric plexus
207
Dysphagia to what is characteristic of achalasia?
liquids and solids
208
What is the diagnostic investigation of choice for achalasia?
Oesophageal manometry
209
What is the characteristic appearance on barium swallow that is consistent with achalasia?
Bird’s beak’ appearance
210
What is the first line management for achalasia?
Pneumatic ballon dilatation.
211
Which surgical intervention is indicated for Achalasia?
Heller cardiomyotomy
212
Which antibiotics potentiate c.difficile infection?
clindamycin, cephalosporin, and co-amoxiclav
213
What is the first line investigation for identifying active infection of c. difficile?
C difficile toxin test
214
Which investigation is falsely positive representing exposure to the bacteria as opposed to current infection in c diff?
Antigen
215
What are the markers/criteria for severe C difficile infection?
- WCC > 15 x 109/L;
- Increased serum creatinine (>50% increase above baseline)
- Temperature >38.5
- Severe colitis
216
What is the first line antibiotic for Clostridioides difficile infection?
Vancomyin
217
What is the second line antibiotic for Clostridioides difficile infection?
Oral fidaxomicin
218
What are the two antibiotics indicated for life threatening Clostridioides difficile infection?
Oral vancomycin and IV metronidazole
219
What is the antibiotic indicated for recurrent Clostridioides difficile infection?
Oral fidaxomicin
220
What is the minimum duration of symptoms to diagnose IBS?
6 months
221
What are three features of IBS?
1. Abdominal pain/discomfort
2. Bloating
3. Change in bowel habit
222
How is pain relieved in IBS?
Relieved on defecation
223
What is the first line management for IBS?
lifestyle advice and trigger identification
224
What is the drug of choice to manage diarrhoea symptoms in IBS?
Loperamide
225
What is the drug of choice to manage constipation symptoms in IBS?
Ispaghula husk
226
What is the drug of choice to manage abdominal pain in IBS?
Mebeverine hydrochloride
227
What is the preferred antibiotic for small intestinal bacterial overgrowth?
Rifaximin
228
What is the first line investigation for suspected GORD (no alarm symptoms)?
Helicobacter pylori test
229
What is the definitive investigation for GORD if ALARM symptoms are present?
Endoscopy
230
What are the ALARM symptoms in the context of GORD?
* Anaemia
* Loss of weight
* Anorexia
* Recent progressive dysphagia
* Melaena/haematemesis
* Upper abdominal mass
231
What is the first line management for non-investigated dyspepsia?
4 weeks of full dose PPI test
232
For H-pylori positive GORD, what is the first line management?
Triple therapy for 7 days e.g., amoxicillin clarithromycin and PPI
233
What is the second line management for non-investigated GORD following PPI?
H2-receptor antagonist e.g, famotidine
234
What is the dose duration for proven erosive GORD?
8 weeks
235
What is the gold standard management for proven erosive GORD?
Laparoscopic fundoplication
236
What metaplastic change is observed in Barrett's oesophagus?
squamous epithelium to columnar epithelium
237
Barrett's oesophagus predisposes to which type of oesophageal carcinoma?
Adenocarcinoma
238
What is the 1st line Ix for Barrett's oesophagus?
Endoscopy with biopsies
239
Which type of ulcer is most attributed to H pylori?
Duodenal ulcer
240
Which type of ulcer is better after eating?
Duodenal ulcer
241
Which type of ulcer is worse after eating?
Gastric ulcer
242
What is the following diagnosis?
Painless, white patches on the side of the tongue that CANNOT be scraped off
Oral Hairy Leucoplakia
243
What is the topical management for Oral Hairy Leucoplakia?
* Topical retinoic acid, gentian violet and 25% podophyllin resin
244
Pain out of proportion to clinical findings associated with nausea and vomiting + AF history?
Acute mesenteric ischaemia
245
What is the definitive investigation for AMI?
CT with intravenous contrast
246
What is the definitive management of AMI?
immediate laparotomy
247
What is steatosis?
- Reversible fatty infiltration; asymptomatic and spontaneously resolves within 6 weeks of abstinence
248
What AST:ALT ratio is consistent with acute alcoholic hepatitis?
* AST:ALT ratio >2
249
What scoring system is used to identify patients with acute decompensation who may benefit from glucocorticoid therapy?
Maddrey’s discriminant function
250
What is the immunisation schedule for alcoholic hepatitis?
Annual influenza and one-off pneumococcal vaccine
251
What is the acute management of alcoholic hepatitis?
Pabrinex and steroids
252
What are the three causes of ascites with a SA-AG <11?
1. Malignancy
2. Pancreatitis
3. Tuberculosis
253
What are the main causes of ascites with a SA-AG >11?
Portal hypertension
Nephrotic syndrome
Cardiac failure
254
What is the first line drug for ascites?
* Spironolactone
255
What are the adverse effects of Spironolactone ?
Decreased libido, impotence and gynaecomastia in men, and menstrual irregularity in women + hyperkalaemia.
256
What is the first non-medical management for ascites?
Dietary salt restriction
257
What is the definitive management for large/refractory ascites?
Therapeutic paracentesis
258
What is prophylactic antibiotic of choice for SBP in patients with ascites?
* Oral ciprofloxacin or norfloxacin
259
What is the most common cause of SBP?
E. coli
260
What neutrophil count is consistent with SBP?
neutrophil count >250 cell/mm3
261
what is the first line drug management for SBP?
cefotaxime
262
What should be administered in patients with SBP + renal impairment?
Albumin infusion
263
Which two genetic syndromes predispose to colorectal cancer?
FAP and Lynch syndrome
264
What is the management of FAP?
Total proctocolectomy with ileal pouch-anal anastomosis
265
Which genes are associated with Lynch syndrome?
MSH2 and MLH1 genes
266
What is the presentation of right-sided colon cancers?
Abdominal pain, IDA, palpable mass in the right iliac fossa
267
What is the presentation of left-sided colon cancers?
Rectal bleeding, change in bowel habit, tenesmus, palpable mass in the left iliac fossa or on PR exam
268
>40 years with what two features warrant an urgent FIT test?
>40 years with unexplained weight loss and abdominal pain
269
What is the NICE urgent FIT test pathway for >50?
>50 years with unexplained rectal bleeding abdominal pain or weight loss
270
IDA or change in bowel habit for patients > x years warrant an urgent FIT?
>60 years
271
How often should a FIT test be performed between 60-75 years?
Every 2 years
272
What is the gold-standard investigation for colorectal cancer?
Colonoscopy with biopsy
273
What tumour marker for colorectal cancer is used to monitor disease progression?
* Carcinoembryonic antigen (CEA)
274
What is the staging criteria for colorectal cancer?
Duke's staging
275
What is the ABCD Duke's criteria?
* A: Confined beneath the muscularis propria
* B: Extension beyond the muscualris propria
* C: Regional lymph node involvement
* D: Distant metastasis
276
What is the first line management for colorectal cancer?
Resection
277
What is an emergency procedure of the sigmoid colon and upper rectum with end colostomy?
- Hartmann’s procedure
278
What radiographic sign is consistent with sigmoid volvulus?
Coffee bean sign
279
What is the definitive investigation for sigmoid vovlulus?
CT abdomen-pelvis scan
280
What are the risk factor associations for sigmoid volvulus?
Older patients with chronic constipations, and neurological disease e.g., Parkinson's disease/vascular dementia, antipsychotics
281
What is the first line management for sigmoid volvulus?
Sigmoidoscope decompression
282
What is the emergency surgical procedure for a sigmoid volvulus?
laparotomy and Hartmann’s procedure
283
What is the radiological sign observed in a caecal volvulus?
embryo sign
284
What is the appearance of an ileostomy?
Spouted
285
What are ileostomies spouted?
To reduce contact of irritant contents with the skin
286
Where are ileostomies typically found?
Right iliac fossa
287
What classic radiological sign is seen in gallstone ileus?
Rigler triad
288
Gallstone ileus affects which part of the bowel?
Gallstone impaction at the ileocaecal valve
289
Which cancer affects the middle and upper thirds of the oesophagus?
Squamous cell carcinoma
290
Which cancer affects the lower third of the oesophagus?
Adenocarcinoma
291
What is the first line investigation for oesophageal cancer?
Upper GI endoscopy (OGD) with biopsy
292
Intermittent dysphagia to both solids and liquids if consistent with which diagnosis?
Diffuse Oesophageal Spasm
293
What characteristic appearance is observed on barium swallow for diffuse oesophageal spasm?
corkscrew or ‘rosary bead’ appearance
294
What is the gold-standard investigation for diffuse oesophageal spasm?
Manometry
295
What is the first line medical management for diffuse oesophageal spasm?
Nitrates and CCBs
296
What is the surgical management for diffuse oesophageal spasm?
Heller myotomy
297
What type of hormone is produced from Zollinger-Ellison syndrome?
Gastrin
298
What is the first line management for ZES?
Fasting serum gastrin
299
What is the definitive management for ZES?
Surgical resection
300
What is the most common histological subtype for gastric cancer?
Adenocarcinoma
301
What is the primary risk factor for gastric cancer?
- Helicobacter pylori infection
302
What are the metastatic signs of gastric cancer?
o Troisier sign (palpable Virchow’s node)
o Acanthosis nigricans
o Sister Joseph nodules (umbilicus)
o Ascites
o Hepatomegaly
o Jaundice
303
What is the diagnostic investigation for gastric cancer?
Gastroscopy and biopsy
304
What is the curative management for gastric cancer?
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
Which is the most common type of hiatus hernia?
Sliding hiatus hernia
306
Which type of hiatus hernia is associated with superior herniation of the cardia through the diaphragmatic hiatus?
Sliding hernia
307
What are the two types of hiatus hernia?
Sliding and rolling
308
What is the gold-standard investigation for hiatus hernia?
OGD
309
What is the surgical management of hiatus hernia?
Laparoscopic fundoplication
310
What is the most common histological subtype of anal cancer?
Squamous cell carcinoma
311
Which HPV strains are associated with anal cancer?
HPV 16 and 18
312
What is the first line investigation for anal cancer?
Digital anorectal examination AND biopsy
313
Which anatomical line is used to delineate the type of haemorrhoid?
dentate line
314
What are first degree haemorrhoids?
Project into the lumen of the anal canal (but do not prolapse)
315
Grade 3 haemorrhoids?
Haemorrhoids protrude outside the anal canal and reduce manual pressure
316
What is the first line management of haemorrhoids?
Increase dietary fibre intake
317
What is the curative management of haemorrhoids?
Rubber band ligation
318
What BMI warrants immediate bariatric surgery?
>50
319
What is the most common type of cholangiocarcinoma?
Klatskin tumours: The most common site for bile duct cancers is at the bifurcation of the right and left hepatic ducts – hilar cholangiocarcinoma.
320
Which disease predisposes the development of cholangiocarcinoma?
PSC
321
Which tumour marker is raised in cholangiocarcinoma?
CA-19
322
What is the gold-standard investigation for the diagnosis of Cholangiocarcinoma?
MRCP
323
Which auto-antibody is associated with PSC?
p-ANCA.
324
What is observed on cholangiography in patients with PSC?
Beads on a string appearance
325
What is the first line management of PSC?
Ursodeoxycholic acid
326
Bile duct loss with granulomas and anti-m2 antibodies is associated with which disorder?
Primary Biliary Cirrhosis
