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Yr4--5 Gastro > Passmed yr5 first > Flashcards

Passmed yr5 first Flashcards

1
Q

what is nissen fundoplication and when is it used

A

used for chronic gastro-oesophageal reflux disease. This procedure tightens the lower oesophageal sphincter to reduce reflux of acid back out of the stomach.

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2
Q

low serum copper and reduced serum caeruloplasmin - what is this

A

Ceruloplasmin is a protein that carries copper to the parts of your body that

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3
Q

features of wilsons disease

A

liver - hepatitis and cirrhosis
neuroloigcal - basal ganglia degeneration
speech and psych problems
asterixis , chorea, dementia and parkinsonism
green brown rings of iris
blue nails
hemolysis
renal tubular acidosis - fanconi

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4
Q

diagnosis of wilsons disease conirmed by what

A

the diagnosis is confirmed by genetic analysis of the ATP7B gene

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5
Q

what can help oesophageal spasm

A

CCB

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6
Q

vomiting and aspiration prodcue what kind of abg picture

A

metabolic alkalosis and low chlorine

things like peptic ulcer leading to pyloric or nasogastric tube suction

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7
Q

drug cause of metabolic alk

A

diuretics

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8
Q

mech of met alk

A

activation of renin-angiotensin II-aldosterone (RAA) system is a key factor
aldosterone causes reabsorption of Na+ in exchange for H+ in the DCT
ECF depletion (vomiting, diuretics) → Na+ and Cl- loss → activation of RAA system → raised aldosterone levels
in hypokalaemia, K+ shift from cells → ECF, alkalosis is caused by shift of H+ into cells to maintain neutrality

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9
Q

1st line mx of NAFLD

A

weight loss

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10
Q

1st line for achalasia

A

pneumatic balloon dilation

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11
Q

6 red flags for gastic CA

A

new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain

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12
Q

apple core sign

A

o ca

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13
Q

dyspepsia over dysphagia think

A

barrets

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14
Q

plummer vinson triad and oesophageal featires

A

Plummer-Vinson syndrome presents as a triad of iron deficiency anaemia, atrophic glossitis and oesophageal webs or strictures. Oesophageal webs are mostly located in the upper oesophagus and consist of multiple concentric narrowings. In contrast, this patient’s barium swallow shows one moderate-large narrowing of the lower oesophagus, making oesophageal webs unlikely

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15
Q

severe flare of UC

A

IV steriods

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16
Q

UC mx summary for inducing remission

A

start with topical aminosalicylae
no remission in 4w add oral one
then add oral steriod

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17
Q

maintaining mild UC - proctitis and proctosigmoiditis

A

topical /oralaminosalicylate daily

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18
Q

maintaining left sided and extensive UC

A

oral amino

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19
Q

if severe relapse or over 2 exacerbations in one year what do you give

A

oral azathioprine or oral mercaptopurine

probiotics can prevent relapse

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20
Q

severe diarrhoea will show what electrolyte inbalances and abg reading

A

Severe diarrhoea, particularly in elderly patients may results in renal impairment, hypokalaemia and hyponatraemia

metabolic acidosis

significant loss of bicarbonate and potassium through the gastrointestinal tract,

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21
Q

Which of the following is the most appropriate for post-eradication therapy h-pylori testing?

A

Urea breath test

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22
Q

first line hepatic encephalopathy

A

oral lactulose

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23
Q

how does lactulose work in HE

A

lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria

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24
Q

retrosternal CP , radiating back and epiG , dyspnea , episode of vomiting caused this - alcohoic , crackles in lung fields showing RS pleural effusion what is it

A

Oesophagela perforation - boergaave

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25
Q

how does rifaximin work in HE

A

antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production

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26
Q

what is the mackler triad-boeeherave

A

vomiting
severe retrosternal chest pain, typically radiating to the back
subcutaneous emphysema

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27
Q

lethargy, puritis , ALP and yGT up

A

PBC

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28
Q

aziathiopurine class and moa

A

immunsuppresssant

Azathioprine’s mechanism of action is not entirely understood but it may be related to inhibition of purine synthesis, along with inhibition of B and T cells.

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29
Q

ascites why do we use aldosterone antagonist - moa

A

lower sodium and hence, water retention. In general, where sodium goes, water follows.

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30
Q

when do you consider fluid restriction in ascites

A

when sodium is under 125

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31
Q

mx barrets

A

high dose PPI

32
Q

barrets with metaplasia only what mx now

A

endoscoppy 3-5yrly

33
Q

dysplasia of any grade what is offered in barrets

A

endoscopic intervention is offered. Options include:
radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
endoscopic mucosal resection

34
Q

difference between metaplasia and dysplasia

A

Metaplasia is the term used to describe the transformation of one mature type of cell into another mature type of cell. Dysplasia is a term used to describe an increased amount of immature cell types, often abnormal

35
Q

When treating dyspepsia, if either a PPI or ‘test and treat’ approach has failed what should you do

A

try the other

so ppi for month or eradication therapy if positiv e

36
Q

fidaxomicin moa

A

Blocks Clostridium difficile B toxin (TcdB)

37
Q
A
37
Q

main ascites mx

A

reducing dietary sodium
fluid restriction is sometimes recommended if the sodium is < 125 mmol/L
aldosterone antagonists: e.g. spironolactone
driangae if tense - paracentesis with albumin cover
prophylacitc abx cover reduce risk of SBP
TIPS considered

38
Q

top diff of this - This patient has osteomalacia, symptoms of diarrhoea and fatigue, and a history of autoimmune thyroid disease.

A

coeliac

39
Q

how does coeliac lead to osteomalacia

A

impaired vitamin D absorption secondary to villous atrophy.

40
Q

haemochromatosis IX

A

transferrin saturation - gold
ferritin -not abnormal if caught early

ferritin can be raised in inflmmaotry states

41
Q

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

why is TIBC high in IDA and not in chronic anaeia

A

high TIBC is because the body still has the capability to transport iron around the body since there is not a high concentration of iron currently.

In because, in anaemia of chronic disease, there is not a lack of iron, but the iron is trapped elsewhere and not able to be used. For example, it is trapped in inflammatory tissue. However, since it is therefore still in the body, the capability of the body to attach to free iron and transport it around is reduced (or normal), represented by TIBC.

42
Q

second most common association of HNPCC after colorectal cance

A

endometrial

43
Q

malnutrition dx weight loss

A

Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition

44
Q

his patient’s presentation is suggestive of hepatorenal syndrome (HRS), a type of functional kidney impairment that occurs in patients with advanced liver disease. The key features include ascites, low urine output, and a significant increase in serum creatinine

first line to treat this

A

erllipressin - vasopressin analgoue

45
Q

how does vasopressin work

A

It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

46
Q

firm smooth tender pulsatile liver edge what is most likley cause

A

Right heart failure is associated with a firm, smooth, tender and pulsatile liver edge

copd cause RHSF

47
Q

what is a must score

A

MUST (Malnutrition Universal Screen Tool)

48
Q

what gastro drug increased risk of OP

A

omeprazole - osteoporosis → increased risk of fractures

49
Q

stopping mediciations before OGD and breath test
gaviscon
PPI
ranitidine - H2
abx
how long for all

A

topping medications before OGD (1-4):
1 day = gaviscon
2 weeks = PPIs
3 days = ranitidine
4 weeks = antibiotics

50
Q

pt with ascities 2ndary to liver cirrhosis with abdo p and fever and distension

how would you confrim most likely dx and what is it

A

SBP
neutrophil count under 250 from paracentesis

Prescribe prophylactic ciprofloxacin

51
Q

when do you treat stones in the biliary tree

A

Asymptomatic gallstones which are located in the gallbladder are common and do not require treatment. However, if stones are present in the common bile duct there is an increased risk of complications such as cholangitis or pancreatitis and surgical management should be considered.

52
Q

two ways carcinoid syndrome occurs

A

usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

53
Q

what is the double duct sign and when is it seen

A

the presence of dilatation of both the pancreatic and common bile ducts.

pancreatic cancer

54
Q

difference between pancreatic ca and PBC and PSC on CT abdo

A

pancreatic cancer - double duct - extrahepatic duct dilation

PBC - intraheaptic duct dilation
PSC - intra-hepatic duct dialtion

55
Q

mx of alcoholic hepatitis

A

prednisilone if indicated

56
Q

Bile acid malabsorption occurs when

A

Primary or secondary to cholecystectomy, Crohn’s, coeliac.

57
Q

you get chronic diarrhoea in bile acid malabsorption how do you test for this

A

SeHCAT. - s a diagnostic test to check how well your gut is able to absorb bile acids. If the absorption is poor, this can result in chronic (long term) diarrhoea.

give - Cholestyramine - bile acid sequestrant

58
Q

sliding hiatus hernia.

Which of the following is the first-line management for her condition?

A

Correct, first-line management includes lifestyle changes (weight loss, avoiding lying flat) and PPIs to reduce acid reflux.

59
Q

dx ix for hiatus hernia

A

barium swallow

60
Q

A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended.

what is going on here

A

This patient has developed small bowel obstruction secondary to an impacted gallstone.

61
Q

gallstone ileus what do you see on plain film

A

In gallstone ileus, a plain abdominal film classically shows small bowel obstruction and air in the biliary tree

62
Q

anastamotic leak how long psot surgery

A

Anastomotic leaks can occur up to several weeks after surgery, but most develop within 3 days.

63
Q

sx anastamotic leak

A

Low blood pressure, rapid heart rate, fever, stomach pain, nausea and vomiting, drainage from a surgical wound, pain in the left shoulder area, decreased urine output

64
Q

what is an anastamotic leak

A

An anastomotic leak is a serious complication that occurs when the contents of a reconnected body channel leak after a surgical anastomosis fails:
An anastomosis is a procedure that connects two ends of a channel together by sealing them. The most common type of surgery that involves anastomosis is bowel resection, but other procedures, like a gastric bypass, also involve anastomosis

65
Q

autoimmune hepatitis blood results for ALT AST and ALP what would they show
would you see a raised AMA

A

Autoimmune hepatitis is more likely to show predominantly raised ALT / AST on LFTs than ALP
no AMA raised in PBC

66
Q

hyposlenism for exmaple in coealiac what vaccine every 5 yr

A

pnuemoccoal

67
Q

Bile-acid malabsorption- history of watery diarrhoea which is green in colour, associated with abdominal bloating and cramping- may be treated

A

Cholestyramine

68
Q

lead pipe appearance of the colon

A

uc

69
Q

Total iron-binding capacity reflects the availability of iron-binding sites on transferrin. The levels, therefore, increase in iron deficiency and decrease in iron overload - what would you see in haemachomatois

A

As such you would expect a low total iron-binding capacity in haemochromatosis, leaving option 4 as the correct answer.

70
Q

triad of liver failure

A

Liver failure = triad of encephalopathy, jaundice and coagulopathy

71
Q

ix you should do if someone comes in with intermittent abdo pain, diarrhoea suspecting IBS or IBD

A

In addition to a full blood count (FBC), urea & electrolytes (U&E), coeliac screen, erythryocyte sedimentation rate (ESR) and C-reactive protein (CRP)
faecal calprotectin

72
Q

what node is lateral to the umbilicus raised in malginancy potentially gastric

A

Sister Mary Joseph nodule - sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary

73
Q

plummer vision is triad of -dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

how do you treat

A

Treatment includes iron supplementation and dilation of the webs

74
Q

By which mechanism does loperamide act through to slow down bowel movements?

A

Loperamide is a µ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut

75
Q

low-flow priaprism caused by

A

Low-flow: Urological emergency.
Abnormally sustained erection due to impaired venous outflow. Results in increased pressure which impedes arterial blood flow = Ischaemia.
Causes: Sickle cell.
Clinical features: Very painful, fully rigid erection.
Corporal blood gas: pO2 < 3, lactate raised, CO2 raised

Yr4--5 Gastro (7 decks)

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