passmed

Question 1

misoprostol does what to msucosa

Answer 1

prevents damage as stabalises mast cells

Question 1

in zoling - recurrent ulcers what can you not give

Answer 1

nsaid , steriods, bisphosphonates

Question 2

laxative abuse leads to what

Answer 2

melancoliss coli - cell necrosis and apop

Question 3

tx of ith and lft

Answer 3

itch - cholestryamine and uacid for lft

Question 4

signs of Acute intermittent porphyria

Answer 4

classically urine turns deep red on standing
raised urinary porphobilinogen (elevated between attacks and to a greater extent during acute attacks)
assay of red cells for porphobilinogen deaminase
raised serum levels of delta aminolaevulinic acid and porphobilinogen

Question 5

what is gallstone ileus

Answer 5

This patient has patient has a small bowel obstruction and pneumobilia. This is a typical picture for gallstone ileus. He also gives a history that reflects chronic cholecystitis. In gallstone ileus, a gallstone enters the small intestine where it lodges in the ileocaecal valve. It is usually on a background of chronic cholecystitis. A rarer condition is Bouveret’s syndrome which is similar but the gallstone lodges in the duodenum.

Question 6

gallstone ileus usually forms on background of what

Answer 6

chornic cholecystitis

Question 7

why do you give oral vanc over IV

Answer 7

Oral vancomycin has low systemic absorption, making it effective at managing intestinal infections

Question 8

ascites, low urine output, and a significant increase in serum creatinine - hepaotrenal syndroem what si first line

Answer 8

terlipressin, a vasopressin analogue, is the recommended first-line treatment for HRS according to UK guidelines. It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

Question 9

how does terlipressin work

Answer 9

terlipressin, a vasopressin analogue works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

Question 10

In order to see the typical villous atrophy on OJD biopsy, the inflammation must be ongoing and therefore the patient must have been consuming gluten for at least - how long?

Answer 10

6 weeks

Question 11

before upper GI endoscopy how long should omeprazole be stopped before and why

Answer 11

Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy

Proton pump inhibitors (PPIs) such as omeprazole can reduce the size of ulcerative gastro-oesophageal malignancy, which can make them unidentifiable during endoscopic examination

Question 12

A long history of watery green diarrhoea post cholecystectomy is caused

Answer 12

by bile-acid malabsorption, a condition which can also be idiopathic, or seen in patient’s with Crohn’s disease

Question 13

The initial treatment of bile acid malabsorption is with

Answer 13

bile acid sequestrants such as cholestyramine

Question 14

bile acid malabsoprtion can lead to

Answer 14

It can lead to steatorrhoea and vitamin A, D, E, K malabsorption.

Question 15

in chronic liver disease suspecting a dx of liver cirrhosis what is the most sensitive lab finding

Answer 15

thrombocytopenia

Patients with cirrhosis often develop a rise of >2.5 in the ratio of the AST to ALT,