practical classes

Question 1

Risk factors for Barrett oesophagus

Answer 1

High BMI
alcohol
Smoking
Drugs which relax LOS
Genetic

Question 2

How does a patient with oesophageal cancer present

Answer 2

Asymptomatic or

Heart burn, chest pain, dyspepsia, blood in stool, iron deficient anaemia

Question 3

Diverticular disease

Answer 3

Outpouchings as a result of herniation of the mucosa and submucosa through the bowel wall at sites of weakness
Sigmoid colon most commonly affected
Can be present with intestinal obstruction

Question 4

Complications of diverticular disease

Answer 4

Diverticulitis and perforation

-> peritonitis

Question 5

Alcohol toxicity

Answer 5

350mg/dl to 600mg/dl

No antidote for alcohol toxicity

Question 6

Chronic alcoholic liver disease progression

Answer 6

Fatty change - steatosis
Cirrhosis
Fibrosis
- hepatitis

Question 7

What enzyme is raised in chronic alcohol misuse

Answer 7

Gamma-glutamyltransferase

Question 8

Liver function tests

Answer 8

Bilirubin, albumin, total protein
ALT, AST, ALP
GGT
PT

Question 9

Why do patients with chronic liver disease have a tendency to bleed

Answer 9

Dynamic disequilibrium between procoagulant and anti-coagulant states in individuals with cirrhosis

Question 10

Other causes of steatosis - non alcoholic steatohepatitis

Answer 10

Obesity
Insulin resistance
Hyperglycaemia
High levels of fat

Question 11

Symptoms/signs of acute hepatitis

Answer 11

Jaundice

Polymorphs/neutrophils in liver

Question 12

Risks of a liver biopsy

Answer 12

Bleeding
Pain 
Infection
Collapsed lung/haemothorax
Injury to other organs

Question 13

Causes of cirrhosis

Answer 13

Alcohol
Viral hepatitis
Primary biliary cirrhosis (autoimmune)
Primary haemocromatosis (genetic - iron overload)
Wilson’s disease (genetic - Cu build up)
Alpha-1 antitrypsin deficiency (genetic increased risk of COPD and liver disease - inflammation of blood vessels)
Cryptogenic (unknown cause)

Question 14

Complications of cirrhosis

Answer 14

Portal hypertension (cirrhosis, oesophageal varices, splenomegaly, encephalopathy)
Liver failure (jaundice, hypoproteinaemia, bleeding, hepatic encephalopathy)
Ascites
Hepatocellular carcinoma

Question 15

Causes of bleeding in an alcoholic patient

Answer 15

Oesophageal varices
Peptic ulcer
Mallory Weiss tear (when a patient vomits against a closed cardiac sphincter - NSAIDS and Helicobacter - alcohol irritates gastric mucosa and exacerbates effects above)
Haemorrhagic gastritis
Reflux oesophagitis with ulceration

Question 16

Alcohol related deaths

Answer 16

Sudden death in fatty liver due to metabolic acidosis - cardia arrhythmias
Haemorrhage - oesophageal varices, acute gastritis and peptic ulcers
Liver failure

Question 17

What is hepatocellular carcinoma associated with

Answer 17

Alpha feto protein

Question 18

Causes of acute renal failure

Answer 18

Hypovolaemic shock
Drugs
Congestive cardiac failure

Question 19

Causes of chronic renal failure

Answer 19

Glomerlunephritis
Chronic use of drugs (aspirin)
Chronic pyelonephritis
Hypertension
Diabetes mellitus
Autoimmune diseases
Obstruction of urinary tract

Question 20

Causes of urinary tract obstruction

Answer 20

Calculi/stones
Stricture in ureter/urethra
Benign prostatic hyperplasia
Cancer of bladder/prostate

Question 21

Renal cell cancer

Answer 21

Yellow/pale variegated appearance

Patient may present with haematuria/loin discomfort

Question 22

Symptoms of cystitis

Answer 22

Pain or burning when peeing
Needing to pee more often/urgently
Urine that's dark, cloudy, smells
Pain low down in stomach
Achy, sick tired feeling

Question 23

Benign Prostatic Hyperplasia

Answer 23

Affects 50% of men over 60 years

Symptoms due to urethral obstruction: frequency in micturition, nocturne, poor stream, UTIs, bladder outlet obstruction

Question 24

Prostatic cancer

Answer 24

Raised prostatic specific antigen, MRI, Needle core biopsies for diagnosis, CT
Radical prostatectomy

Question 25

Complications of Radical prostatectomy

Answer 25

Bleeding, UTI, incontinenct, ED, narrowing of urethra or bladder neck, cysts