MSRA Gastro

Question 1

Diagnosis of SBP

Answer 1

neutrophil count >250 cells/ul

Question 2

Management of SBP

Answer 2

IV cefotaxime

Question 3

Indications for antibiotic prophylaxis in SBP

Answer 3

• Previous SBP
• Fluid protein <15 g/l AND Child-Pugh >=9 OR hepatorenal syndrome

Question 4

Antibiotic prophylaxis in SBP

Answer 4

oral ciprofloxacin/norfloxacin until ascites has resolved

Question 5

Antibodies in autoimmune hepatitis type I
(affects adults and children)

Answer 5

Anti-nuclear antibodies (ANA)

and/or

Anti-smooth muscle antibodies (SMA)

Question 6

Antibodies in autoimmune hepatitis type II
(affects children only)

Answer 6

Anti-liver/kidney microsoma type 1 antibodies (LKM1)

Question 7

Antibodies in autoimmune hepatitis type III
(affects middle-aged)

Answer 7

Soluble liver-kidney antigen

Question 8

Management of autoimmune liver disease

Answer 8

Steroids
Immunosuppressants eg azathioprine
Liver transplantation

Question 9

Management of c.diff: 1st line

Answer 9

Oral metronidazole 10-14 days

Question 10

Management of c.diff: severe or not responding to 1st line

Answer 10

Oral vancomycin

Question 11

Management of c.diff: not responding, multiple co-morbidities

Answer 11

Fidaxomicin

Question 12

Management of c.diff: life-threatening

Answer 12

Oral vancomycin + IV metronidazole

Question 13

Drugs causing acute pancreatitis

Answer 13

azathioprine, mesalazine, didanosine
bendroflumethiazide
furosemide
pentamidine
steroids
sodium valproate

Question 14

Inducing remission in Crohns - 1st line

Answer 14

Glucocorticoids (oral, topical, IV)

Budesonide = alternative

Question 15

Inducing remission in Crohns - 1st line (non-drug)

Answer 15

Enteral feeding with elemental diet

Stop smoking!

Question 16

Inducing remission in Crohns - 2nd line

Answer 16

5-ASA drugs

azathioprine or mercaptopurne or methotrexate as add-on

Question 17

Inducing remission in Crohns - refractory disease/fistulating disease

Answer 17

Infliximab

Continue azathioprine/methotrexate

Question 18

Inducing remission in Crohns - isolated peri-anal disease

Answer 18

Metronidazole

Question 19

Maintaining remission in Crohn’s - 1st line

Answer 19

Azathioprine or mercaptopurine

Stop smoking!

Question 20

Maintaining remission in Crohn’s - 2nd line

Answer 20

Methotrexate

Question 21

Maintaining remission in Crohn’s - previous surgery

Answer 21

5-ASA drugs

Question 22

Features of Peutz-Jeghers

Answer 22

-hamartomatous polyps
-pigmented lesions on lips, oral mucosa, face, palms and soles
-intestinal obstruction
-GI bleeding

Question 23

Acute treatment of variceal haemorrhage

Answer 23

-ABC
-Correct clotting
-Vasoactive agents
-Prophylactic antibiotics
-Endoscopy

-Sengstaken-Blakemore tube if uncontrolled haemorrhage

-TIPSS - transjugular intrahepatic portosystemic shunt

Question 24

Prophylaxis of variceal haemorrhage

Answer 24

Propanolol

Endoscopic variceal band ligation