PASSMED REVIEW KEY CONCEPTS

Question 1

How can you monitor/look for a carcinoid tumour?

Answer 1

Urinary 5-HIAA (as carcinoid tumours release serotonin)

Question 2

What surgery is done for a distal transverse or descending colon cancer?

Answer 2

Left hemicolectomy

Question 3

why do PPIs cause hyponatremia?

Answer 3

As they can cause medication-induced syndrome of inappropriate anti diuretic hormone secretion

Question 4

What conditions is oesophageal adenocarcinoma associated with?

Answer 4

GORD
Barrett’s oesophagus

Question 5

If a pt takes once-daily insulin, how should this be altered on the day before and day of surgery?

Answer 5

Reduce dose by 20%

Question 6

Why does large-volume paracentestsis for the treatment of ascites required albumin cover?

Answer 6

As it reduces paracentesis-induced circulatory dysfunction and mortality

Question 7

How is an unruptured sigmoid volvulus primarily managed?

Answer 7

Flatus tube insertion (inserting a tube into the rectum to relieve flatulance)

Question 8

Which area of the colon is the most likely area to be affected by ischaemic colitis?

Answer 8

Splenic flexure

Question 9

Whats the most common cause of melanosis coli?

Answer 9

Prolonged laxative use

Question 10

How should you treat a severe flare of UC?

Answer 10

In hopsital with IV corticosteroids

Question 11

What is mild UC?

Answer 11

< 4 stools/day, only a small amount of blood

Question 12

What is moderate UC?

Answer 12

4-6 stools/day, varying amounts of blood, no systemic upset

Question 13

What is severe UC?

Answer 13

> 6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 14

How do you induce remission in mild/moderate UC/

Answer 14

Typical aminosalicylates
If remission is not achieved within 4 weeks, add a high-dose oral aminosalicylates

(If extensive disease then start with topical aminosalicylate and a high-dose oral aminosalicylate:)

Question 15

How do you induce remission in severe colitis?

Answer 15

should be treated in hospital
intravenous steroids are usually given first-line
If after 72 hours there is no improvement, consider adding IV Ciclosporin to IV corticosteroids
OR consider surgery

Question 16

How do you maintain remission of mild/moderate UC/

Answer 16

Topical aminosalicylates along or/with an oral aminosalicylate

Question 17

How should you maintain remission of UC following a severe relapse or 2 or more exacerbations in th past year?

Answer 17

oral azathioprine or oral mercaptopurine

Question 18

What features of appendicitis are included in the Alvarado score?

Answer 18

Right lower quadrant tenderness
Elevated temperature
Rebound tenderness
Migration of pain to right lower quadrant
Anorexia
Nausea or vomiting
Leukocytosis
Leukocyte left shift >75% neutrophils

Question 19

If a patient is taking a PPI or H2 receptor blocker, what advice should be given prior to an endoscopy?

Answer 19

To stop taking it at least 2 weeks before to ensure it doesnt mask serious underlying pathology

Question 20

What type of bacteria is c.diff?

Answer 20

Gram positive rod

Question 21

What causes c.diff?

Answer 21

Leading cause is now second and third generation cephalosporins
Clindamycin
PPIs

Question 22

How is c.diff categories into mild, moderate, severe and life threatening?

Answer 22

Mild - normal WCC
Moderate. Raised WCC and 3-5 loose stools a day
Severe - raised WCC over 15x10 9, or an acutely raised creatinine >50% above baseline, or a temperature >38.5, or evidence of severe colitis
Life threatening - hypotension, partial or complete ileus, toxic megacolon, CT evidence of severe disease

Question 23

How is c.diff diagnosed?

Answer 23

C.diff toxin positive test
(Not that c.diff antigen shows exposure to bacteria and not current infection)

Question 24

Outline the pathophysiology of c.diff?

Answer 24

A bacteria that’s often encountered in hospital. When normal gut flora are suppressed by broad spectrum antibiotics -> exotoxin causes intestinal damage -> pseudomembranous colitis

Question 25

How often is c.diff found in the digestive system?

Answer 25

1 in 30 adults

Question 26

Outline treating the first episode of c.diff?

Answer 26

first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

Question 27

How often does a pt with c.diff have a recurrent episode?

Answer 27

20%
50% if after their second epdiese

Question 28

How should you manage a recurrent episode of c.diff?

Answer 28

If within 12 weeks of symptoms resolution then oral fidaxomicin
If after 12 weeks then oral vancomycin or fidaxomicin

Question 29

How should you manage life threatening c.diff infections?

Answer 29

oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered

Question 30

What medications should be stopped during a c.diff infection?

Answer 30

Anti-motility and anti-peristaltic drugs e.g. opioids - Can predispose to toxic megacolon by slowing the clearance of c.diff
Antibiotics (other than ones using to clear c.diff) - to allow normal intestine flora to be re-established

Question 31

How do you manage alcoholic ketoacidosis?

Answer 31

Infusion of saline and thiamine

Question 32

How much does your risk of oesophageal adenocarcinoma increase by if you have Barrett’s oesophagus?

Answer 32

50-100 fold

Question 33

Whats the subdivision of Barrett’s oesophagus?

Answer 33

Short <3cm
Long >3cm

The length of the affected segment correlates strongly with the chances of identifying metaplasia.

Question 34

What should you do if on endoscopy for Barrett’s oesophagus, dysplasia of any grade is identified?

Answer 34

Endoscopic intervention - radio frequency ablation or endoscopic mucosal resection

Question 35

What should you do if on endoscopy for Barrett’s oesophagus, metaplasia is identified?

Answer 35

Endoscopy is recommended every 3-5 years

Question 36

Whats the risk of each cancer with lynch syndrome (HNPCC)?

Answer 36

80% colorectal cancer
60% endometrial cancer
10% Ovarian cancer