Pass Med

Question 1

Condition causing small bowel obstruction usually following acute cholecystitis

Answer 1

Gallstone Ileus

Question 2

Primary Biliary Cholangitis

- Sx

Answer 2

Fatigue, pruitis, jaundice

Question 3

PBC

- Bloods

Answer 3

High ALP and high cholesterol

Question 4

PBC - Mx

Answer 4

Ursodeoxycholic Acid lifelong to prevent hepatic damage

Question 5

Chrons: non-gastro signs

Answer 5

Arthritis, erythema nodosum, pyoderma gangrenosum

Question 6

UC: non-gastro signs

Answer 6

Arthritis, erythema nodosum, pyoderma gangrenosum

PLUS:
Primary sclerosing cholangitis, uveitis

Question 7

VIPoma?

Sx

Answer 7

Vasoactive Intestinal Peptide tumour = pancreatic mass and watery diarrhoea w/ low K+ and low Cl

Question 8

B3 Niacin deficiency

Answer 8

Pellagra
- dermatitis, diarrhoea and cognitive deficit

e.g. Vegan

Question 9

B1 Thiamine

Answer 9

Beri Beri

• Wernicke’s is a sub type of dry BeriBeri

Question 10

Vit C

Answer 10

Scurvy: anaemia, bleeding gums, petichaie or bruising

Question 11

Non-alcoholic fatty liver disease - who gets it? what test?

Answer 11

Obese w/ T2DM

Use enhanced liver fibrosis blood test

Question 12

Aminosylicilates? Side effects?

Answer 12

Mesalazine/sulfasalazine
5-ASA

SE pancreatitis (mesal), nausea, vomiting, diarrhoea, exacerbation of colitis

Question 13

Anti-scl-70 antibody

Answer 13

Scleroderma

Question 14

ASMA antibody or P-ANCA

Answer 14

Primary sclerosing cholangitis

Question 15

Anti-mitochrondrial antibody

Answer 15

Primary Biliary Cirrhosis

Question 16

Anti CCP

Answer 16

Rheumatoid (with Rheumatoid factor)

Question 17

Anti-saccharomyces cervisiaese

Answer 17

Present in Chron’s, not diagnostic

Question 18

Urgent Endoscopy referral (2 week)

Answer 18

Dysphagia
Upper abdo mass

> 55 years with Weight loss and any of the following
- Upper abdo pain, reflux, dyspepsia

Question 19

Non-urgent Endoscopy

Answer 19

Haematemesis

> 55 years

• treatment resistent dyspepsia,
• abdo pain + low Hb
• high platelet count
• N&V with weight loss/ GORD/dyspepsia/pain

Question 20

Management if no need for referral

Answer 20

• Review meds
  -life style advice
• Full dose PPI for 1 month
  OR
• test and treat for H.pylori (before give PPI)

Question 21

Anti-GBM antibody

Answer 21

Goodpasture’s disease

Question 22

Anti-dsDNA

Answer 22

SLE

Question 23

Primary sclerosing Cholangitis

Answer 23

80% UC patients will have PSC
- RUQ pain, fatigue, jaundice and pruritis

• ERCP diagnostics (beaded appearance)

Question 24

Coeliac Disease - Complications

Answer 24

• Anaemia, folate, B12, iron deficiency,
• enteropathy-associated T-cell lymphoma
  Osetoporosis, osteomalacia

Question 25

Carcinoid Tumours What? Test?

Answer 25

Seretonin releasing liver metasteses Test with 24 hour urine collection - 5 Hydroxindoleacetic acid

Question 26

IgM anti-HBc antibody

Answer 26

Negative = Chronic infection Positive = acute infeciton (in last 6 months)

Question 27

Haemochromatosis: - What is it? - Mx

Answer 27

Autosomal recessive disorder = iron accumulation Transferrin saturation and ferritin levels to monitor Mx = Regular venesection

Question 28

Spontanous Bacterial Peritonitis | - Prophlatic abx criteria

Answer 28

``` Give ciprofloxacin to patients with acites AND - previous ep of SBP - fluid protein <15g/l - Child pugh score >9 - Hepatorenal syndrome ```

Question 29

Acute Pancreatitis | I GET SMASHED

Answer 29

Idiopathic Gall stones Ethanol (alcohol) Trauma ``` Steroids Mumps Autoimmune Scorpion Hypercalcaemia ERCP Drugs - Mesalazine, sodium valproate, furosomide, azathioprine ```

Question 30

Complication of Tracheo-oesophageal fistula repair

Answer 30

Benign oesophageal stricture - large bolus of food in oesophagus

Question 31

Dysphagia - Cancer - Sx - Risk Factors

Answer 31

Weight loss, anorexia, vomiting during eating RF: - Barret's, GORD, smoking and drinking

Question 32

Dysphagia - Oesophagitis

Answer 32

Hx Reflux, odynophagia but systemically well

Question 33

Dysphagia - Candidiasis

Answer 33

HIV/steroid inhaler use

Question 34

Dysphagia - Achalasia

Answer 34

Liquids and solids from the start | - Reflux, regurgitation

Question 35

Dysphagia - Pharyngeal Pouch

Answer 35

Elderly men - dysphagia, regurgitation, aspirarion, chronic cough

Question 36

Dysphagia - Systemic Sclerosis - CREST FEATURES

Answer 36

``` Calcinosis Reynaud's Oesophagel dysmotility Sclerodactyl Telangectasia ```

Question 37

Dysphagia - Myasthenia Gravis

Answer 37

Weakness or ptosis (worse at end of day) Both solids and liquids

Question 38

Dysphagia - Globus Hystericus

Answer 38

Hx of anxiety, releived by swallowing, painless lump in throat

Question 39

Dysphagia - Investifations

Answer 39

Upper GI endoscopy Fluroscopic study for motility disorder Check hb

Question 40

Bowel Ischaemia - RF

Answer 40

``` Age AF (mesenteric) Embolic predisposition CVD risk factors Cocaine ```

Question 41

Bowel Ischaemia - PC

Answer 41

Abdo pain not inkeeping with examination Rectal bleeding Diarrhoea Fever Bloods = high white cell count, lactic acidosis

Question 42

Lanz Incision

Answer 42

RIF - appendectomy

Question 43

Kocher's Incision

Answer 43

R subcostal - cholecystectomy (open)

Question 44

Pfannenstiels incision

Answer 44

Transverse supra pubic e.g. C section

Question 45

Rutherford-Morison Incision

Answer 45

Extraperitoneal approach to L or R lower quadrant. - Renal transplant scar

Question 46

Liver Cirrhosis - Investigation?

Answer 46

Transient Elastography

Question 47

Coeliac Disease - Investigations

Answer 47

TTG and IgA Jejunal biopsy - Villous atrophy - Crypt hyperplasia - High lymphocytes

Question 48

Hepatocellular Carcinoma - Risk factors

Answer 48

Cirrhosis (2nd to) - Hep B and C (5% chance) - Alcohol - Haemochromatosis - Primary biliary cirrhosis

Question 49

Alcohol Unit Calculation

Answer 49

Volume ml x ABV /1000 = units

Question 50

Hepatitis: | Positive Anti-Hbs

Answer 50

Immunity through previous immunisation or disease

Question 51

Achalasia - Barium Swallow

Answer 51

Bird's Beak appearance | Air fluid level due to lack of peristalsis

Question 52

Plummer-Vinson (oesophageal web)

Answer 52

Dysphagia Glossitis Ion deficiency anaemia