Passme Flashcards
A 45-year-old woman presents to her GP with a 2-month history of fatigue, intermittent diarrhoea, and abdominal discomfort. She reports no blood in her stool but does state she has unintentionally lost some weight recently. Her past medical history is unremarkable and she has no allergies.
Her blood results are as follows:
Hb 105 g/L Female: (115 - 160)
MCV 90 fl (82-100)
Ferritin 16 ng/mL (20 - 230)
Vitamin B12 195 ng/L (200 - 900)
Folate 2.3 nmol/L (> 3.0)
What would be the most appropriate next investigation?
Perform an endoscopic intestinal biopsy
Refer via 2-week wait referral for suspected colorectal cancer
Serum intrinsic factor antibodies
Stool microscopy and culture
Tissue transglutaminase antibodies
Coeliac disease is associated with iron, folate and vitamin B12 deficiency
Refer via 2-week wait referral for suspected colorectal cancer is incorrect. NICE guidelines state the criteria for a suspected colorectal cancer pathway referral in patients under the age of 50 is the following: rectal bleeding + any one of the following: abdominal pain, change in bowel habit, weight loss, iron deficiency anaemia. This patient does not have any rectal bleeding. The underlying cause of the patient’s condition is more likely related to malabsorption and nutritional deficiencies, which align with the potential diagnosis of coeliac disease. It is more appropriate to test for tissue transglutaminase antibodies to test for this.
A 70-year-old man is admitted to the Emergency Department after vomiting blood earlier in the day. Which one of the following factors best indicates a significant upper gastrointestinal bleed?
raised urea as protein meal of blood
autoimmune conditons are associatded with
other autoimmune conditions
Sister Mary Joseph nodule – sign of metastasis to periumbilical lymph nodes, classically from what cancer
gastric cnacer
lateral to the umbilicus - swelling painless mass
Pyogenic liver abscess tx and what abx
Management
drainage (typically percutaneous) and antibiotics
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin
staph aureus in kids and e coli in adults
what laxative do you not give in IBS because it increases gas therefore making symptoms worse
lactulose
normal transferrin saturation
high ferritin
negative hep virus
differntials
Inflammation (due to ferritin being an acute phase reactant)
Alcohol excess
Liver disease
Chronic kidney disease
Malignancy
in high tansferrin so iron overad
Primary iron overload (hereditary haemochromatosis)
Secondary iron overload (e.g. following repeated transfusions)
High urea levels can indicate an upper GI bleed versus lower GI bleed
upper gi such as dudoenal ulcer
SAAG > 11g/L inidcates what
portal hypertension
cx of asicities over 11g
Liver disorders are the most common cause
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
Cardiac
right heart failure
constrictive pericarditis
Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
ascites under 11g/l
Hypoalbuminaemia
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)
Malignancy
peritoneal carcinomatosis
Infections
tuberculous peritonitis
Other causes
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases
what contraceptive can cause cholestasis
COCP
Transjugular Intrahepatic Portosystemic Shunt commonly causes an exacerbation of hepatic encephalopathy how
Inadequate metabolism of nitrogenous waste products by the liver
sigmoidoscopy reveals yellow plaques. What is the most likely diagnosis?
Pseudomembranous colitis
PPIs can cause whar electrolyte imbalance
low sodium deu to retention of fluid secondary to an inappropriate ADH secretion
Long term proton pump inhibitor therapy can cause hypomagnesaemia
