Passmed - Gastro

Question 1

Metabolic alkalosis + hypokalaemia →

Answer 1

? Prolonged vomiting

Question 2

Metabolic alkalosis causes?

Answer 2

vomiting / aspiration
(e.g. peptic ulcer leading to pyloric stenos, nasogastric suction)
vomiting may also lead to hypokalaemia
diuretics
liquorice, carbenoxolone
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
Bartter’s syndrome

Question 3

Metabolic alkalosis?

Answer 3

Metabolic alkalosis may be caused by a loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract

Question 4

PPI adverse effects?

Answer 4

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

Question 5

Loperamide, a mu-receptor agonist anti-diarrhoeal agent, adverse effects?

Answer 5

dry mouth, constipation and dizziness

Question 6

Beta blocker adverse effects?

Answer 6

bronchospasm, cold peripheries and fatigue

Question 7

Primary sclerosis cholangitis investigation?

Answer 7

MRCP

Question 8

Pancreatic cancer features?

Answer 8

classically painless jaundice (pale stools, dark urine, and pruritus; cholestatic liver function tests)
Abdominal mass
Often non-specific way with anorexia, weight loss, epigastric pain
loss of exocrine function (e.g. steatorrhoea)
loss of endocrine function (e.g. diabetes mellitus)
atypical back pain is often seen
migratory thrombophlebitis (Trousseau sign) more common than with other cancers

Question 9

Pancreatic cancer abdo masses that may be found (in decreasing order of frequency):

Answer 9

hepatomegaly - due to metastases
gallbladder - Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
epigastric mass - from the primary tumour

Question 10

Double duct sign?

Answer 10

Pancreatic cancer

the presence of simultaneous dilatation of the common bile and pancreatic ducts

Question 11

Pancreatic cancer investigations?

Answer 11

USS (60-90% sensitivity)
HRCT scanning is investigation of choice if the diagnosis is suspected
imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

Question 12

Pancreatic cancer management?

Answer 12

less than 20% are suitable for surgery at diagnosis
a Whipple’s resection (pancreaticoduodenectomy) for resectable lesions in the head of pancreas.
adjuvant chemotherapy is usually given following surgery
ERCP with stenting is often used for palliation

Question 13

Whipple’s resection

Answer 13

(pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas.

Side-effects - dumping syndrome and peptic ulcer disease

Question 14

Coeliac disease management?

Answer 14

Avoid gluten
Immunisation (due to hyposplenism)

Question 15

Coeliac disease investigations?

Answer 15

tTG-IgA Test
+ IgA antibody

Question 16

Iron defiency anaemia vs. anaemia of chronic disease

Answer 16

TIBC is high in IDA, and low/normal in anaemia of chronic disease

Question 17

Anaemia of chronic disease bloods?

Answer 17

normochromic/hypochromic, normocytic anaemia
reduced serum and TIBC
normal or raised ferritin

Question 18

Iron deficiency anaemia bloods?

Answer 18

TIBC raised
Ferritin low

Question 19

first line antibiotic for use in patients with C. difficile infection

Answer 19

Oral vancomycin

Question 20

life-threatening C. difficile infection treatment

Answer 20

ORAL vancomycin and IV metronidazole

Question 21

life-threatening C. difficile infection treatment

Answer 21

ORAL vancomycin and IV metronidazole

Question 22

IBS considered if following symptoms for 6 months: ABC

Answer 22

Abdominal pain, and/or
Bloating, and/or
Change in bowel habit

Question 23

A positive diagnosis of IBS should be made if the patient has…

Answer 23

abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
- altered stool passage (straining, urgency, incomplete evacuation)
- abdominal bloating (more common in women than men), distension, tension or hardness
- symptoms made worse by eating
- passage of mucus

Question 24

Primary care investigations for IBS?

Answer 24

full blood count
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies)

Question 25

Primary biliary cholangitis - the M rule

Answer 25

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 26

Most important intervention to stop further Crohn’s episodes?

Answer 26

Smoking cessation

Question 27

A severe flare of ulcerative colitis should be treated…

Answer 27

in hospital with IV corticosteroids

Question 28

Adenocarcinoma is now the most common type of oesophageal cancer and is more likely to develop in patients with a history of…

Answer 28

gastro-oesophageal reflux disease (GORD) or Barrett’s.

Question 29

gold standard for diagnosis of coeliac disease

Answer 29

Endoscopic intestinal biopsy

Question 30

Coeliac -> koilonychia?

Answer 30

Koilonychia = sign of hypochromic anemia (esp iron-def)
Bloating, fatigue, foul-smelling and greasy stools combined with her elevated serum anti-tTG levels = coeliac disease -> malabsorption in the gut due to villous atrophy -> iron-def anaemia because dietary iron is not adequately absorbed. Iron deficiency -> koilonychia.

Question 31

metastatic HCC treatment?

Answer 31

Sorafenib

Question 32

Mesenterio ischaemia triad?

Answer 32

CVD, high lactate and soft but tender abdomen

Question 33

first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis?

Answer 33

A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used
E.g. topical mesalazine

Question 34

first-line medication for primary biliary cholangitis?

Answer 34

Ursodeoxycholic acid

Question 35

mainstay of treatment in haemochromatosis

Answer 35

Regular venesection

desferrioxamine may be used second-line