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MRCP Gastroenterology Flashcards

1
Q

Typical biochemical picture with pregnancy-related cholestasis?

A

Elevated serum bile acids, normal urate, fat soluble vitamin malabsorption (resulting in prolonged PT)

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2
Q

Lab findings in Wilson’s disease (serum copper, serum caeruloplasmin, urine copper, uric acid)

A

LOW serum copper, LOW serum caeruloplasmin, LOW serum uric acid (increased excretion)
RAISED urinary copper excretion

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3
Q

How is Peutz-Jeghers syndrome usually inherited?

A

Autosomal dominant

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4
Q

Test to confirm H Pylori eradication

A

13C urea breath test

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5
Q

Investigation of bile acid malabsorption

A

SeHCAT test

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6
Q

Most sensitive test for confirming diagnosis of haemochromatosis

A

Transferrin sats

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7
Q

Barrett’s oesophagus increases risk of which cancer?

A

Adenocarcinoma of oesophagus

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8
Q

IDA + aortic stenosis

A

Angiodysplasia (Heyde syndrome)

Common site is caecum & ascending colon (77%) - need colonoscopy

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9
Q

Ulcerative colitis is a risk factor for developing which biliary tract pathology?

A

Primary sclerosing cholangitis (PSC)

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10
Q

Periodic acid-Schiff within macrophages on histology

A

Whipple’s disease

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11
Q

Middle aged woman, itch, AMA +ve

A

Primary biliary cholangitis (PBC) (prev known as primary biliary cirrhosis)

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12
Q

Which vitamin type is thiamine?

A

Vitamin B1

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13
Q

First virological marker to become abnormal in hep B infection?

A

HBsAg

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14
Q

Venesection in haemochromatosis can improve which feature?

A

Cardiomyopathy

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15
Q

Mode of action of PPIs

A

Inhibit the hydrogen-potassium-ATP proton pump

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16
Q

OGD showing ‘watermelon stomach’ (tortuous vessels in the stomach)

A

Gastric antral vascular ectasia (GAVE)

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17
Q

First-line investigation for coeliac disease?

A

Anti-TTG antibodies

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18
Q

Features of zinc deficiency

A

Dermatitis and alopecia

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19
Q

Hypervascular lesion liver, young woman on OCP

A

Hepatic adenoma

Benign & usually asymptomatic

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20
Q

Treatment of symptomatic bile salt malabsorption (following ileal resection)

A

Cholestyramine

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21
Q

What drug can be given to reduce incidence of colon ca in people with HNPCC?

A

Aspirin

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22
Q

Lab test for monitoring response to venesection in haemochromatosis

A

Serum ferritin

transferrin sats are screening test for diagnosis

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23
Q

Kings college criteria for liver transplant following paracetamol OD:

A

Arterial pH <7.3, 24h after ingestion

OR ALL of the following:
PT >100 / INR >6.5
Creatinine >300
Grade III or IV encephalopathy

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24
Q

Difference in transaminases with alcohol vs para OD liver failure

A

Alcohol: rarely exceed 500, AST:ALT ratio >2

Para OD: AST & ALT can reach 1000s

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25
Vitamin C and collagen synthesis
Hydroxylation of procollagen proline and lysine
26
Type of hyperbilirubinaemia in Gilberts
Unconjugated
27
Two possible diagnoses in case of isolated raised bilirubin
Gilberts | Haemolytic anaemia
28
Describe features of mild UC flare
<4 stools per day +/- blood No systemic disturbance CRP & ESR normal
29
Describe features of moderate UC flare
4-6 stools per day, minimal systemic upset
30
Describe features of severe UC flare
>6 stools per day containing blood | Systemic disturbance eg fever, tachycardia, abdo tenderness, anaemia
31
Diagnosis of C Diff
C Diff stool toxin Antigen only shows exposure to bacteria rather than current infection
32
Treatment for itch in liver disease
Cholestyramine (reduces bile acid accumulation)
33
Most sensitive imaging for pancreatic pathology
CT
34
Lipaemic sample in acute pancreatitis is most likely to be caused by what?
Chylomicrons
35
Most effective therapy for NAFLD?
Weight loss Pioglitazone or vitamin E for advanced fibrosis
36
Mycofenolate can cause what GI upset?
Chrons-like enterocolitis, raised calprotectin & skip lesions. Symptoms resolve with discontinuation of drug
37
What size on AXR signifies toxic megacolon?
Colon dilated to 6cm or more
38
Causes of a protein-losing enteropathy
Sarcoidosis, IBD, CMV colitis, pseudomembranous colitis, TB, CTDs
39
What substances are released in carcinoid syndrome?
Serotonin and prostaglandins
40
Symptoms of Whipples disease
Malapsorption eg bulky smelly stool Pleuritic chest pain Fever, arthralgia
41
Test for confirming pancreatic insufficiency as cause of diarrhoea?
Faecal elastase
42
Most effective long-term therapy for achalasia?
Balloon dilatation of LOS
43
AST and ALT ratios with ALD & NAFLD
AST:ALT ratio > 2 - Alcoholic liver disease ALT:AST ratio >2 - NAFLD
44
Pharmacological management of hepatorenal syndrome
Terlipressin (splanchnic vasoconstrictor)
45
Treatment for relapsed IBD in pregnancy
First line: corticosteroids
46
Treatment of pyoderma gangrenosum
Systemic/topical steroids
47
Treatment for intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid | - improves liver enzymes and itch
48
Histology: intracytoplasmic/intranuclear inclusion bodies in epithelial cells of intestinal mucosa
CMV associated colitis | treat with ganciclovir
49
Commonest electrolyte abnormality in anorexia
Hypokalaemia
50
Describe features of Zieve syndrome
Alcoholics, haemolysis, hypercholesterolaemia, abdo pain, raised bilirubin. Resolves once alcohol consumption stopped
51
Treat GORD in pregnancy
Sodium alginate
52
What does a positive SeHCAT test signify?
Bile acid malabsorption (commonly following ileal recection)
53
Arthralgia followed by diarrhoea & malabsorption
Whipple's disease | - treat with co-trimoxazole
54
Which immunoglobulin is most markedly raised in AI hepatitis?
IgG | a small rise in IgM is sometimes also seen
55
Triad of symptoms seen in pellagra | What vitamin deficiency causes pellagra
1. dermatitis 2. diarrhoea 3. dementia | Nicotinic acid deficiency
56
Initial investigation for Zollinger-Ellison syndrome
Fasting gastrin levels on three different days (pulsatile release) Followed by basal acid output estimation and secretin stimulation test
57
Histological appearance of gastric MALToma
Lymphocytes with irregular nuclear contours and abundant cytoplasm
58
Kantor's string sign on barium follow-through is pathognomonic of which condition?
Crohn's disease
59
Liver biopsy showing concentric periductal fibrosis (like an onion skin) is seen in which condition?
Primary sclerosing cholangitis | the one associated with IBD
60
Treatment/prevention of familial Mediterranean fever
Colchicine

MRCP (14 decks)

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