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Gastroenterology > Other > Flashcards

Other Flashcards

1
Q

Which investigation for coeliac disease has the highest negative predictive value?

A

HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.

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1
Q

What is the most sensitive investigation for coeliac disease?

A

HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.

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2
Q

A patient present with an itchy, vesicular rash over shoulders, elbows and knees. What gastrointestinal condition is this most likely associated with?

A

Coeliac disease

Dermatitis herpetiformis

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3
Q

What serology would you send to investigate potential coeliac disease?

A

tTG-IgA + total IgA level +/- DGP-IgG

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4
Q

Why is it particularly important for patients with coeliac disease to be up to date with vaccinations?

A

Due to hyposplenism are at increased risk for pneumococcal sepsis

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5
Q

Hereditary non-polyposis colorectal cancer is caused a mutation in (1), and inheritance is in a (2) pattern.

A

Mismatch repair gene e.g. MLH2, MSH2, MSH6

Autosomal dominant inheritance

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6
Q

Apart from CRC, what other malignancy are patients with HNPCC most at risk of developing?

A

Endometrial cancer

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7
Q

How do you know when to pursue genetic testing for diagnosis of HNPCC in patients with CRC?

A

Use Amsterdam criteria
3 relatives and 2 generations with assoc ca, one a first degree relative of others, FAP excluded, tumous verified on pathoogy

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8
Q

In patients with familial adenomatous polyposis, what is the risk of developing CRC?

A

100% in classic FAP

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9
Q

What is the underlying cause of familial adenomatous polyposis?

A

Mutated TSG (adenomatous polyposis coli/APC) gene

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10
Q

When should CRC screening begin for those with known FAP? What other form of cancer screening is recommended?

A

Flexi sig annually from age 10-12, progress to colonoscopy if adenomas detected
Annual thyroid ultrasound also recommended

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11
Q

What is the main physiological mechanism causing GORD?

A

Transient lower oesophageal sphincter relaxation

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12
Q

Which autoantibodies are associated with primary biliary cirrhosis?

A

ANA, AMA

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13
Q

Does primary biliary cirrhosis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?

A

Intrahepatic

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14
Q

Does primary sclerosing cholangitis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?

A

Both

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15
Q

What is the main pharmacological management of primary biliary cirrhosis?

A

Ursodeoxycholic acid

16
Q

What is the LFT pattern usually found in those with primary biliary cirrhosis?

A

Elevated ALP

17
Q

What LFT pattern is seen in primary sclerosing cholangitis?

A

Cholestatic LFTs

18
Q

How is PSC diagnosed?

A

MRCP/ERCP to view bile ducts - wall thickening, dilatation, strictures

19
Q

What is the most common autoantibody present in PSC?

A

pANCA

20
Q

What are the three main indications for H pylori testing?

A

MALT lymphoma
Peptic ulcer disease
Early gastric cancer

21
Q

What is the treatment for H pylori?

A

PPI + amoxi + clarithromycin for 7 days

22
Q

What factors can interfere with H pylori testing?

A

PPI or recent UGIB can cause false negatives

23
Q 
Which of the following is not a cause of fat malabsorption?
A) Reduced gastric acid secretion
B) Reduced bile acid secretion
C) Reduced pancreatic lipase
D) Reduced small bowel surface area
A

A) It is INCREASED gastric acid secretion which inactivates pancreatic enzymes and causes fat malabsorption

24
Q

Allocate the below trait to either the jejunum or the ileum:

Able to adapt better post small bowel resection

A

Ileum

25
Q

Allocate the below trait to either the jejunum or the ileum:

Location of vitamin B12 absorption

A

Ileum

26
Q

Allocate the below trait to either the jejunum or the ileum:

Primary site for absorption of most macro and micronutrients

A

Jejunum

27
Q

Allocate the below trait to either the jejunum or the ileum:

Secretes a large amount of fluid

A

Jejunum

28
Q

A 34 week pregnant woman presents with right upper quadrant pain and nausea. Bloods: bilirubin 25, ALT 150, Hb 90, Plts 75, PT 14 seconds. Likely dx?

A

HELLP syndrome

Best management is early delivery, if <34/40 and stable can give betamethasone first

29
Q

A 34 week pregnant woman presents with significant itching of her palms and soles. Bloods: bilirubin 35, ALT 150, Hb 100, Plts 300. Likely dx? Mx?

A

Intrahepatic cholestasis of pregnancy

Mx is ursodeoxycholic acid

30
Q

A 34 week pregnant woman presents with right upper quadrant pain and nausea. Bloods: bilirubin 25, ALT 1000, AST 1000. Hb 100, WCC 14, Plts 75, INR 2.9. BGL 2.9. Most likely dx?

A

Acute fatty liver of pregnancy
AFLP is most common cause of acute liver failure in pregnancy
Significant overlap between this and HELLP/ preeclampsia. Luckily management is all the same!

Gastroenterology (3 decks)

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