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Quesmed GI Flashcards

1
Q

What will cool so y show for Crohn’s?

A

Rose thorn ulcers due to transmural inflammation
Non-caesating granuloma
Cobblestone mucosa

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2
Q

What should be assessed prior to Azathriopine therapy for Crohn’s?

A

Tiopurine methyltransferase activity, as under activity will increase the risk of bone marrow suppression

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3
Q

What causes a high AST:ALT ratio, elevated GGT and hypoalbuminaemia?

A

Alcoholic liver disease

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4
Q

What are the features of carcinoid tumour?

A

Diarrhoea, hypotension, wheezing and flushing from tumour of endocrine cells

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5
Q

Which cardiac pathology occurs with carcinoid tumours?

A

Pulmonary stenosis due to right sided valvular stenosis from the effect of serotonin. Tricuspid regurgitation is a less likely slide effect

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6
Q

What is carcinoid syndrome assocated with?

A

Pellagra which causes the 4 D’s:
Dermatitis on sun exposed areas on the skin as a red rash
Diarrhoea
Dementia with confusion
Death

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7
Q

What is a low SAAG?

A

Less than 11 g/l

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8
Q

What is the best prognostic indicator for fulminant hepatitis due to paracetomol overdose?

A

INR
Represents the synthetic function of the liver

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9
Q

What does albumin indicate

A

It has a half life of three weeks and is a better indicator of subacute liver function

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10
Q

Does the PTT change with liver damage?

A

No
-> PT is prolonged but PTT is relatively unaffected

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11
Q
A
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12
Q

What condition causes dysphagia, fatigue, paleness, brittle nails, pale and glossitis?

A

Plummer Vinson Syndrome

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13
Q

How does Budd-chairing present?

A

Severe abdominal pain
Ascites
Tender hepatomegaly

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14
Q

What is the gold standard for diagnosis of Budd chairi?

A

Abdominal ultrasound
Doppler

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15
Q
A
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16
Q

What should be avoided in toxic megacolon?

A

NSAIDs
Opiates
Anticholinergic
-> reduce motility and increase risk of perforation

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17
Q

What is an emergency complication of ulcerative colitis?

A

Toxic megacolon with abdominal distention and pain

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18
Q
A
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19
Q

What is first line for gastroparesis?

A

Metoclopramide and domperidone

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20
Q

What is a dermatological manifestation of Crohn’s disease?

A

Pyoderma gangrenosoum with large painful ulcers in the elgs

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21
Q

Which medication causes acute pancreatitis?

A

Furosemide and thiazide diuretics
Azathriopine
Sodium valproate
Tetracycline
ACE inhibitors

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22
Q

What can cause a false negative anti-TTG result with coeliac?

A

IgA deficiency

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23
Q

What test should confirm diagnosis of coeliac?

A

Jejunum biopsy

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24
Q

What is first line for ascites in liver cirrhosis?

A

Spironolactone

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25
What is second line for ascites in sin liver cirrhosis?
Furosemide
26
How does campylobacter jejuni infection present?
spiral or comma-shaped gram-negative organism, which commonly presents with a flu-like prodrome, crampy abdominal pain, and bloody diarrhoea. It is a common cause of food poisoning and can have an incubation period as long as five days
27
What is campylobacter jejuni infection associated with?
Guillan barre syndrome, with ascending bilateral weakness in lower limbs
28
What organism causes diarrhoea and rose coloured spots on the periumbilical region?
Typhoid fever which has a high risk of intestinal perforation and GI ulceration. Initial symptoms are diarrhoea and fever and progressses to delirium and abdominal pain.
29
What cases bloody diarrhoea?
Campylobacter jejuni E.Coli Shigella Salmonella enteric typhi and paratyphi Norovirus
30
What is the management of patients with low grade dysplasia fo oesophagus?
High dose Omeprazole and SIX monthly endoscopic surveillance
31
What is the management of patients with high grade dysplasia of oesophagus?
Endoscopic ablation
32
How does acute porphyria present?
Abdominal pain Muscle weakness confusion Seizures
33
What is a common side effect following treatment of giardiasis?
Lactose intolerance with bloating, abdominal discomfort and flatulence
34
Which systems are mainly affected in Wilson’s disease?
Liver and Brian
35
What causes GGT to be raised?
Diabetes Pancreatic disease Cholestasis liver disease
36
What causes a metallic taste in the mouth as part of H.pylroi treatment?
Metronidazole
37
What is a side effect of bismuth?
Blac stools and occasional constipation
38
What is the syndrome with haemochromatosis?
Erectile dysfunction Type 1 diabetes Painful joint presenting as pseudo gout
39
What is the best initial investigation of haemochromtosis?
Transferrin saturation
40
What is the genetic test for haemochromtosis?
C282Y mutation in the HFE gene
41
What maintains remission of Cron’s?
Azathriopine -> patients should have thipurine methyltransferase levels checked
42
What is the gold standard for NAFLD?
Liver biopsy for staging -> fibroscan is a preferable non invasive method
43
How does coeliac disease affect FBC?
Causes Macrocytic anaemia with hyposplenism (Howell-jolly bodies) and thrombocytosis
44
What causes epigastric pain worst on waking and relieved by eating?
Duodenal ulcers
45
What does HBeAg indicate?
Viral load -> when it is positive, there is a high viral load
46
What does anti-HBc mean?
Past or current ensure to hepatitis B It is seroconversion with chronic infection with resolution
47
Which drug for NAFLD?
Piagitazone which activates PPAR for anti-inflammatory and insulin-sensitising effect
48
What predicts poor prognosis for acute liver failure?
King’s college criteria based on
49
What predicts poor prognosis for acute liver failure?
INR over 6.5 PT over 100 Serum creatinine over 300 Grade III or IV hepatic encephaloapthy Arterial pH less than 7.3 24 hours post araceotmol overdose
50
How does Duputren’s contracture present?
Tender nodule with flexed flexion of little and ring finger. Related to chronic alcohol intake or repeated hand trauma
51
What is the most common hepatits in the uK?
Hepatitis C
52
How does Alcohlic hepatitis present?
Fever and confusion with: jaundice, elevated liver enzymes with an AST>ALT ratio typically greater than 2
53
What is given for mild flare of ulcerative colitis?
Mesalsalazine enema
54
When is prednisolone given for UC?
Second INR to mesasalazine Severe flare -> anaemia and raised inflammatory markers Passing more than 4 stools per day
55
What is the appropriate intervention after fluids and blood transfusion for variceal bleeding?
Terlipressin, a vasopressin analogue for spinach IC vasoconstriction Antibiotics regardless of infection confirmation that cover gram negative bacteria
56
What is an alternative to Terlipressin?
Ocreotide
57
58
What condition occurs with UGT1A1 gene mutation?
Gilbert;;s syndrome
59
What condition occurs with UDP-glucuronosyltransferase enzyme deficiency?
Crigler-Najjar syndorme
60
What is given as an anti-emetic for chemotherapy?
5HT3 antagonist like ondansetron
61
5
62
What is the criteria for 2 week endoscopy to rule out gastric cancer?
Patients over 55 with weight loss and: Upper abdominal pain OR Reflux OR Dyspepsia
63
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65
What type of ulcer is most common with H. Pylori?
90% cause of Duodenal ulcer -> gastric ulcers is 80% and can have other causes but at least
66
What is the management of uncomplicated sliding hiatal hernia?
PPI and lifestyle advice in the absence of: Haemorrhage Volvos/ischameia/necrosis
67
What his the gold standard for coeliac?
Endoscopy wit duodenal biopsy
68
What is the cause of gastric MALTOMA?
Helicobacter Pylori Chronic inflammation
69
What promotes smooth muscle relaxation in digestive system including oesophagus?
PROGESTERONE
70
What i the first line for hepatitis C?
Direct acting antivirals like sofosbuvir, ledipasvir and velpatasivir -> pegylated interferons are not recommended for hep C
71
What is pegylated interferon used for?
Hepatitis B
72
What is Whipple’s disease?
Tropheryma Whipple I bacteria infection causing joint pain, diarrhoea and abdominal pain. There will be positive acid-Schaffer antibodies.
73
How is Whipple’s disease managed?
Co-trimozazole
74
What causes Mucosal oedema and erythema, widespread ulceration, spontaneous bleeding?
Ulcerative colitis
75
Multiple epithelial growths across the colonic mucosa
FAP
76
What causes an inflamed opening in the skin surrounding the anus?
Peri anal fistula which is the most common type of fistula
77
What are the risk factors for Whipple’s disease?
Male over 50 Genetic predisposition
78
How is a perianal fistula managed?
Metronidazole antibiotic or ciprofloxacin
79
80
What is an enterococci fistula?
Abnormal tract between two parts of the bowel
81
What causes blueish bulging vessels?
Haemorrhoid
82
What s the first line treatment for gastroparesis?
Domperidone D2 antagonist AVOID in patient with prolonged QT interval
83
What is a sensitivity GI agnostic for hiatus hernia?
barium swallow for upper GI
84
What causes gurgling sound on palpation and dysphagia?
Pharyngeal pouch
85
What
86
What is the cause of dark brown pigment macrophages in lamina propia of coon?
Melanonosis coli,a sscoiated with laxatives containing senna
87
What is the cause of pyoderma gangrenosium?
Crohn’s disease Ulcerative colitis
88
What are the physical findings of oestrogen at high levels?
Palmar erythema Spider naevi Gynaecomastia
89
What is used for primary prophylaxis of variceal bleeding?
Non selective beta blocker Variceal band ligation
90
Which organisms cause spontaneous bacterial peritonitis?
Kliebsella pneumonia E.Coli
91
What is the most important indicator for urgent liver transplant?
PT over 100 seconds
92
What is given for bowel obstruction?
Metacloprmide which stimulates bowel movements and is an anti-emetic
93
What should be avoided in bowel obstruction?
Isphagala husk
94
Which medication is given for carcinoid?
Ocreotide
95
What are common systemic effects of haemochromatosis?
diabetes type 2 Hypogonadism Ophir hypogonadism Arthritis Cardiac fialure
96
What is the calcium value in Gaslgow imrie score?
Calcium less than 2.0
97
How should patients be managed with dyspepsia and failure to relive with PPI in the absence of weight loss?
Urea breath test for H.pylori
98
What does CA19-9 indicate?
pancreatic cancer Gall bladder cancer Bile duct cancer Gastric cancer
99
What does CA15-3 indicate?
Breast cancer screening
100
What is used to screen hepatitis C?
CA15-3
101
How do patients present with giardiasis?
non-bloody diarrhoea and pale, floating stools after an incubation period of 1-3 weeks

Year 3 (224 decks)

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