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C. Year 3: Gastroenterology Random NOT on MLA Map > Post rectal bleeding > Flashcards

Post rectal bleeding Flashcards

1
Q

Lower GI bleeds can often be a sign of pathophysiology. What is the incidence of lower GI bleeds?

1 - 0.33 - 0.87 / 100,000

2 - 3.3 - 8.7 / 100,000

3 - 33 - 87 / 100,000

4 - 330 - 870 / 100,000

A

3 - 33 - 87 / 100,000

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2
Q

Around 3% of lower GI bleeds are emergency referrals. What is the mortality rate of lower GI bleeds?

1 - 0.34%

2 - 3.4%

3 - 34%

4 - 68%

A

2 - 3.4%

  • generally due to current comorbidities
  • NOT exsanguination (drainage of bodily fluids
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3
Q

What % of the adult population have an episode of PR bleed in any year?

1 - 0.1%

2 - 1%

3 - 10%

4 - 30%

A

3 - 10%

  • likely to be under reported
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4
Q

10% of the adult population have an episode of PR bleed in any year. Which of the 2 below are the most likely causes of PR bleeds?

1 - colorectal cancer

2 - haemorrhoids

3 - fissures

4 - diverticular disease

A

2 - haemorrhoids

3 - fissures

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5
Q

10% of the adult population have an episode of PR bleed in any year. In patients >50 y/o, 2-3% will have what?

1 - colorectal cancer

2 - haemorrhoids

3 - fissures

4 - diverticular disease

A

1 - colorectal cancer

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6
Q

In a patient who is having or has had a PR bleed, or potentially loss of blood elsewhere we would do a FBC, specifically looking at haemoglobin. What is haemoglobulin?

1 - primary protein of RBCs

2 - heme group of RBCs

3 - iron content of RBCs

4 - O2 of RBCs

A

1 - primary protein of RBCs

  • contains 4 globin subunits
  • each globin subunit has 1 heme group
  • each heme group can carry 1 molecule of O2
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7
Q

How many molecules of oxygen is haemoglobin able to bind?

1 - 1

2 - 2

3 - 3

4 - 4

A

4 - 4

  • 4 globin and 4 haem
  • each haem can bind 1 molecule of O2
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8
Q

When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient without cardiac or CKD, where the normal level is between 120-160 g/L?

1 - 60

2 - 70

3 - 80

4 - 90

A

2 - 70

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9
Q

When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient with cardiac disease, where the normal level is between 120-160 g/L?

1 - 60

2 - 70

3 - 80

4 - 90

A

3 - 80

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10
Q

When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient with CKD, where the normal level is between 120-160 g/L?

1 - 60

2 - 70

3 - 80

4 - 90

A

1 - 60

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11
Q

10% of the adult population have an episode of PR bleed in any year. In patients >50 y/o, 2-3% will have what colorectal cancer. Which of the following is NOT a common suspicious feature of PR bleeds?

1 - older age at first onset

2 - melena

3 - change in bowel habits

4 - PR bleed without defection

5 - chronic and continuous

A

2 - Melena

  • generally associated with upper GI bleed (peptic ulcer)
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12
Q

What is the first examination that we would perform in a patient who has PR bleed?

qFIT = Quantitative Faecal Immunochemical Test

1 - sigmoidoscopy

2 - qFIT

3 - digital rectal examination

4 - colonoscopy

A

3 - digital rectal examination

  • exam for masses, fissures and/or haemorrhoids
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13
Q

In a patient who has PR bleed, the first examination is often a digital rectal examination. Which 2 of the following would this normally be followed up by?

qFIT = Quantitative Faecal Immunochemical Test

1 - sigmoidoscopy

2 - qFIT

3 - proctoscopy

4 - colonoscopy

A

1 - sigmoidoscopy (rectum and sigmoid)

3 - proctoscopy (rectum only)

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14
Q

If a patient has a lower GI bleed, what must their Hb drop by before they will be considered for a 2 unit of blood transfusion?

1 - drop of >5g/L

2 - drop of >10g/L

3 - drop of >20g/L

4 - drop of >50g/L

A

3 - drop of >20g/L

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15
Q

If you suspect a patient is losing blood and has colorectal cancer, but there is no clear signs of blood loss, what test can be performed that has a 99.6% negative predictive value? (essentially says you do not have disease)?

1 - Hb

2 - RBCs and Hb

3 - qFIT

4 - faecal calprotectin

A

3 - qFIT

  • measures microscopy blood in stool indicating presence of Hb
  • NOT used if blood is clearly present
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16
Q

What is the gold standard for investigating a lower GI bleed in a patient?

1 - sigmoidoscopy

2 - qFIT

3 - digital rectal examination

4 - colonoscopy

A

4 - colonoscopy

  • can reach the ileocaecal valve
  • can be diagnostic and therapeutic
17
Q

Colonoscopy is the gold standard for investigating a lower GI bleed in a patient. However, this does require a bowel prep and sedation, and has what risk of perforation?

1 - 1 / 2

2 - 1 / 20

3 - 1 / 200

4 - 1 / 2000

A

4 - 1 / 2000

18
Q

In addition to a colonoscopy, patients can have a sigmoidoscopy. Why is sigmoidoscopy, which is able to reach the splenic flexure, often a good choice to diagnose colon cancer?

1 - camera is more accurate than in colonoscopy

2 - bowel prep is better

3 - requires more sedation

4 - 75% of colon cancers are located in left colon and rectum

A

4 - 75% of colon cancers are located in left colon and rectum

  • depends if the clinician suspects transverse or right sides tumour based on CT
  • requires enema, but often doesn’t need sedation
19
Q

Which imaging techniques offers similar accuracy (except in small polyps <6mm) to colonoscopy for diagnosing colorectal cancer?

1 - MRI

2 - CT with contrast

3 - ultrasound

4 - X-ray

A

2 - CT with contrast

  • requires less sedation than colonoscopy
20
Q

In patients who are unable to have a colonoscopy, which imaging technique us often used with an 80% sensitivity to detecting colorectal cancer?

1 - MRI

2 - CT

3 - ultrasound

4 - X-ray

A

2 - CT

  • MRI and capsule colonoscopy all have a place
21
Q

What scoring tool is used in lower GI bleeds?

1 - Chicago score

2 - CURB score

3 - Modified Glasgow score

4 - Oaklands score

A

4 - Oaklands score

22
Q

What is the incidence of an acute lower GI bleed?

1 - 0.18 - 0.20 / 100,000

2 - 1.8 - 2 / 100,000

3 - 18 - 20 / 100,000

4 - 180 - 200 / 100,000

A

3 - 18 - 20 / 100,000

  • majority of these stop spontaneously
23
Q

When transfusing a unit of blood, how much does Hb rise when patients are given one unit of blood?

1 - 1g/L

2 - 5g/L

3 - 10g/L

4 - 20g/L

A

3 - 10g/L

24
Q

All of the options below are causes of acute lower GI bleeds. Of these which has the highest % for causing hospital admissions?

1 - haemorrhoids

2 - IBD

3 - diverticular disease

4 - ischaemic colitis

5 - colorectal cancer

6 - iatrogenic

7 - rectal ulcer

8 - vascular abnormality

9 - radiation proctitis

10 - other (fissures etc)

A

3 - diverticular disease

  • presence of diverticulosis with symptoms
25
Q

In a patient who has presented with an acute lower GI bleed, what is the first thing we are going to do when they are admitted?

1 - qFIT

2 - colonoscopy

3 - medical history

4 - assess ABCDE

A

4 - assess ABCDE

26
Q

In a patient presenting with an acute lower GI bleed, we will assess ABCDE. Then we will perform some of the following. Which one would NOT be done at this time?

1 - history of known lower GI pathology

2 - associated symptoms (weight loss, change of bowel habits)

3 - qFIT to detect Hb

4 - Previous pelvic radiation

5 - vascular history

6 - anti-coagulant therapy

A

3 - qFIT to detect Hb

27
Q

In a patient presenting with an acute lower GI bleed, we will assess ABCDE and then perform a history if safe to do so. What would be the next 2 main examinations?

1 - colonscopy

2 - X-ray

3 - digital rectal examination

4 - abdominal examination

A

3 - digital rectal examination

4 - abdominal examination

28
Q

When giving a patient fluids, which of the following doesn’t typically rise?

1 - cardiac output

2 - SV

3 - Sats %

4 - Hb

A

4 - Hb

29
Q

All of the following are investigations that can be performed in a patient who continues to have a lower GI bleed. Which 2 of the following have have the best detection rates and even therapeutic effects?

1 - colonoscopy

2 - CT mesenteric angiography

3 - red cell scan (nuclear medicine)

4 - Mesenteric angiography

A

2 - CT mesenteric angiography

  • requires >0.3ml/min bleeding
  • high accuracy

4 - Mesenteric angiography

  • requires >0.5ml/min bleeding
  • can embolize as well
30
Q

Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. A segmental colonic resection of localised bleeding is the optimal surgical choice. What is the mortality and re-bleed rate of this?

M = mortality

RB = Re-bleed

1 - M <5% and RB <20%

2 - M <10% and RB <14%

3 - M <20% and RB <20%

4 - M <30% and RB <10%

A

2 - M <10% and RB <14%

31
Q

Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If a blind colonic resection is required as they cannot identify the bleed, what is the mortality and re-bleed rate of this?

M = mortality

RB = Re-bleed

1 - M <5% and RB <20%

2 - M <60% and RB <75%

3 - M <50% and RB <20%

4 - M <60% and RB <10%

A

2 - M <60% and RB <75%

32
Q

Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If a blind colonic resection is required as they cannot identify the bleed, what is the mortality and re-bleed rate of this?

M = mortality

RB = Re-bleed

1 - M <5% and RB <20%

2 - M <60% and RB <75%

3 - M <50% and RB <20%

4 - M <60% and RB <10%

A

2 - M <60% and RB <75%

33
Q

Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If an emergency blind subtotal colectomy is required what is the mortality?

1 - <10-15%

2 - <10-33%

3 - <25-50%

4 - <25-70%

A

2 - <10-33%

34
Q

Which of the following is NOT typically a red flag in a patient who has had a recent change of bowel habits?

1 - intermittent symptoms

2 - associated symptoms (weight loss, bleeding)

3 - continuous symptoms

4 - onset at old age

A

1 - intermittent symptoms

C. Year 3: Gastroenterology Random NOT on MLA Map (12 decks)

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