Other Flashcards
Which investigation for coeliac disease has the highest negative predictive value?
HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.
What is the most sensitive investigation for coeliac disease?
HLA DR3 - close to all patients with coeliac disease carry this HLA type. However not usually useful for diagnosis.
A patient present with an itchy, vesicular rash over shoulders, elbows and knees. What gastrointestinal condition is this most likely associated with?
Coeliac disease
Dermatitis herpetiformis
What serology would you send to investigate potential coeliac disease?
tTG-IgA + total IgA level +/- DGP-IgG
Why is it particularly important for patients with coeliac disease to be up to date with vaccinations?
Due to hyposplenism are at increased risk for pneumococcal sepsis
Hereditary non-polyposis colorectal cancer is caused a mutation in (1), and inheritance is in a (2) pattern.
Mismatch repair gene e.g. MLH2, MSH2, MSH6
Autosomal dominant inheritance
Apart from CRC, what other malignancy are patients with HNPCC most at risk of developing?
Endometrial cancer
How do you know when to pursue genetic testing for diagnosis of HNPCC in patients with CRC?
Use Amsterdam criteria
3 relatives and 2 generations with assoc ca, one a first degree relative of others, FAP excluded, tumous verified on pathoogy
In patients with familial adenomatous polyposis, what is the risk of developing CRC?
100% in classic FAP
What is the underlying cause of familial adenomatous polyposis?
Mutated TSG (adenomatous polyposis coli/APC) gene
When should CRC screening begin for those with known FAP? What other form of cancer screening is recommended?
Flexi sig annually from age 10-12, progress to colonoscopy if adenomas detected
Annual thyroid ultrasound also recommended
What is the main physiological mechanism causing GORD?
Transient lower oesophageal sphincter relaxation
Which autoantibodies are associated with primary biliary cirrhosis?
ANA, AMA
Does primary biliary cirrhosis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?
Intrahepatic
Does primary sclerosing cholangitis affect intrahepatic bile ducts, extrahepatic bile ducts, or both?
Both
What is the main pharmacological management of primary biliary cirrhosis?
Ursodeoxycholic acid
What is the LFT pattern usually found in those with primary biliary cirrhosis?
Elevated ALP
What LFT pattern is seen in primary sclerosing cholangitis?
Cholestatic LFTs
How is PSC diagnosed?
MRCP/ERCP to view bile ducts - wall thickening, dilatation, strictures
What is the most common autoantibody present in PSC?
pANCA
What are the three main indications for H pylori testing?
MALT lymphoma
Peptic ulcer disease
Early gastric cancer
What is the treatment for H pylori?
PPI + amoxi + clarithromycin for 7 days
What factors can interfere with H pylori testing?
PPI or recent UGIB can cause false negatives
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) It is INCREASED gastric acid secretion which inactivates pancreatic enzymes and causes fat malabsorption
Allocate the below trait to either the jejunum or the ileum:
Able to adapt better post small bowel resection
Ileum
Allocate the below trait to either the jejunum or the ileum:
Location of vitamin B12 absorption
Ileum
Allocate the below trait to either the jejunum or the ileum:
Primary site for absorption of most macro and micronutrients
Jejunum
Allocate the below trait to either the jejunum or the ileum:
Secretes a large amount of fluid
Jejunum
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?
HELLP syndrome
Best management is early delivery, if <34/40 and stable can give betamethasone first
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?
Intrahepatic cholestasis of pregnancy
Mx is ursodeoxycholic acid
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?
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!
