Passmed Questions

Question 1

Biliary Colic

Answer 1

RUQ
Caused by gallstones lodged in the bile duct.
Provoked by eating a fatty meal.
Has no fever + inflammation

Question 2

Acute Cholecystitis

Answer 2

RUQ
Inflammation / infection of the gall bladder secondary t gall stones.
Murphy’s sigh positive

Question 3

Ascending Cholangitis

Answer 3

RUQ
Ascending cholangitis is a bacterial infection of the biliary tree. MOST common predisposing gallstone.
Charcot’s triad of RUQ pain, fever and jaundice

Question 4

Acute pancreatitis

Answer 4

Epigastric - can radiate to the back.
Due to alcohol / gallstones.
Pain is often very severe.
examination may reveal tenderness, ileus + low grade fever.

Question 5

Peptic Ulcer Disease

Answer 5

Epigastric 
History of NSAID / alcohol excess. 
Most common duodenal ulcer (relieved by food). 
Gastric ulcer worsens by eating. 
Features: Haemorrhage, melena.

Question 6

Appendicitis

Answer 6

Right iliac fossa.
Pain central abdomen before localising to right iliac fossa.
Features: anorexia, Tachycardia, low grade pyrexia, tenderness in RIF.

Question 7

Acute Diverticulitis

Answer 7

LLQ
Colicky pain in LLQ
Features: Diarrhoea, sometimes bloody.
Fever, raised inflammation, WCC.

Question 8

Intestinal Obstruction

Answer 8

Central.
History of malignancy (intraluminal obstruction)
Features: Vomiting

Question 9

Ruptured abdominal aortic aneurysm

Answer 9

Central abdominal pain radiating to the back.
Features: sudden collapse, severe central abdominal pain with developing SHOCK.
Shock: hypotension, tachycardic and history of CVD.

Question 10

Mesenteric Ischeamia

Answer 10

Central Abdominal pain.
History of AF / CVD
Features: Diahoea, rectal bleeding and metabolic acidosis (seen in dying tissues).

Question 11

Cause of acute pancreatitis

Answer 11

Gall stones 
Ethanol 
Trauma 
Steroids
Mumps 
Autoimmune 
Scorpion venom 
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP 
Drugs ( macolides, diuretics, steriods, sodium)

Question 12

On palpation: palpate over the LIF pain bounces to the RIF

Answer 12

Rovsing’s sign

Question 13

Affects between 6 -18 months of age. Boys are effected more than girls.

Answer 13

Intussusception, one portion of bowel into the lumen, commonly around ileo-caecal region.

Question 14

Common in females and pregnant women

Answer 14

Femoral Hernias

Question 15

Familial Adenomatous polyposis

Answer 15

Mutation of APC gene

Feature: colonic adenomas

Question 16

Peutz-Jeghers

Answer 16

STK11 mutation on chromosome 19.

Features: Multiple benign intestinal hamartomas

Question 17

Plummer-Vinson Syndrome

Answer 17

Triad of: dysphagia, glossitis, Fe deficiency anaemia.

Question 18

Mallory Weiss syndrome

Answer 18

Severe vomiting, → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

Question 19

Gilbert’s Syndrome

Answer 19

Autosomal recessive
Due to deficiency of UDP glucuronosyltransferase.

This enzyme conjugates bilirubin in the liver.
Results in build-up of unconjugated bilirubin which cannot be excreted.

Question 20

What must be present for the diagnosis of Barrett’s oesophagus

Answer 20

Goblet cells

Question 21

Pancreatic cancer

Answer 21

Tumour are adenocarcinoma which typically occur at the head.

Associates with BRCA2 gene.

Question 22

Chronic pancreatitis:

Answer 22

Inflammatory condition effecting exocrine + endocrine function.
80% of cases is due to alcohol.

Other issues: Hereditary Haemochromatosis / ducts obstruction due to tumour.

Question 23

Crohns Disease

Answer 23

inflammatory bowel disease, commonly affects the terminal ileum and colon, also mouth to anus.

Inflammation involves all layers down to Serosa = more prone to stricture, fistulas and adhesions.

Question 24

Ulcerative colitis, what to look for ?

Answer 24

Mucosal inflammation, crypt abscess, shallow ulceration, and marked pseudopolyps.

Question 25

Toxic Megacolon

Answer 25

It is greater than 6cm on the AXR.

Occurs in IBD. This is because the colon is unable to remove gas / faeces from the body = build-up in the colon.

Question 26

What is Wilson’s Disease?

Answer 26

A genetic disorder, due to excessive copper deposition in tissues.

Metabolic abnormalities including increased copper absorption from small intestine and decreased hepatic copper excretion..

Combination of neurological disease and liver.

Buzzword: Kayser - Fleischer ring (dark rings ciruclating the iris of the eye).