Questions - Random Flashcards
How does N-acetylcysteine work in paracetamol toxicity?
A. Restores hepatic glutathione stores B. Prevents paracetamol absorption C. Depletes hepatic glutathione stores D. Enhances paracetamol metabolism E. Induces hepatic cytochrome p450 action
Ans: A
NAC is a pre-cursor of Glutathione
Paracetamol Metabolism:
- 95% Paracetamol gets conjugated in the liver toboth Sulphate and Glucuronide (these are non-toxic and readily excreted by kidneys)
- 5% Paracetamol is oxidised by CYP450 system
- This oxidisation results in production of N-acetyl-p-benzoquinone imine (NAPQI) which is a very toxic intermediate metabolite. It can induce severe hepatic necrosis
- Glutathione molecules in the liver rapidly conjugate NAPQI molecules to produced non-toxic metabolites that can be readily excreted in the kidneys
n a patient with NASH - what is the most important factor causing progression to fibrosis?
A. Older age B. Moderate EtOH consumption C. Diabetes Mellitus D. Hepatic inflammation on liver biopsy E. BMI > 28kg/m2
C. Diabetes Mellitus
In a patient with cirrhosis, which of the following is most likely to worsen encephalopathy? A) Hypokalemia B) Hypomagnesemia C)Hyponatermia D)Hypocalcaemia E)Hypophosphotaemia
A) Hypokalemia
A serum ascites to albumin gradient of 13 is most likely to be caused by which of the following? A) Malignant ascites B) Nephrotic syndrome C) Pancreatitis ascites D) Portal hypertension E) Tuberculous ascites
Ans: D
SAAG < 11 = exudate
SAAG > 11 = transudate
Coelic disease results in which mineral deficiency? A. Magnesium B. Folate C. Iron D. Calcium E. Vitamin B12
C. Iron
Which of the following hormones leads to weight loss? A. Ghrelin B. Neuropeptide Y C. AgRP D. Gastrin E. Leptin
E. Leptin
PPI in elderly a/w reduced
- bicarb
- ca
- K
- Mg
- Na
Mg
Lactulose MOA
- Bulk forming
- Lubricant
- Osmotic
- Stimulant
- Stool softener
Osmotic
IBS - pain management
Amitriptyline
38‑year‑old male with Chronic Hepatitis B is on Tenofovir. Urinalysis reveals protein ++ and glucose ++. Which of the following laboratory abnormalities is most likely to be present? a) Hypocalcuria b) Hypophosphataemia c) Hypomagnesaemia d) Hyperkalaemia e) Hyperglycaemia
b) Hypophosphataemia
Fanconi Syndrome
A middle-aged patient presents with large volume, non-bloody, watery diarrhoea. Colonoscopy is normal, and a biopsy reveals a lymphocyte infiltration. What is the likely diagnosis? A. Coeliac disease B. Crohn’s disease C. Ulcerative colitis D. Microscopic colitis NSAID colitis
D. Microscopic colitis
What is the role of transcobalamin II in vitamin B12 metabolism?
A. Binds to liberated B12 in the stomach
B. Transport of B12 to the liver
C. Transport of B12 to the peripheral tissues
D. Cooperation with intrinsic factor
C. Transport of B12 to the peripheral tissues
A 65 year old female is usually well aside from taking ibuprofen and codeine a few times a month for headaches. She presents with haematemesis and malaena and goes on to have a gastroscopy. A 3cm antral stomach ulcer is found and treated with adrenaline injection. She is discharged on an appropriate course of proton pump inhibitor therapy. She is reviewed 8 weeks later and is clinically well. What should you do next?
A. Discharge back to GP
B. H. Pylori breath test
C. Methane breath test
D. Gastroscopy
D. Gastroscopy
-A repeat upper endoscopy is indicated in patients with any one of the following:
- Persistent symptoms or recurrent symptoms after discontinuation of PPI therapy
- Complicated ulcer (bleeding) with evidence of ongoing bleeding
- Giant gastric ulcer (>2 cm)
- Ulcer with features of malignancy
- Gastric ulcer that was not biopsied
- Gastric ulcers in a patient with risk factors for gastric cancer
-Gastric ulcer of unclear etiology
Where in the gastrointestinal tract are bile acids actively reabsorbed? a. Colon. b. Duodenum. c. Ileum. d. Jejunum. Rectum.
c. Ileum.
In patients with hepatic encephalopathy, lactulose may be beneficial by increasing the amount of non-absorbable ammonium (NH4) formation in the colon.
Which indirect mechanism of lactulose within the colon likely mediates this effect?
A. Decreases formation of acetic acid. B. Decreases nitrogen excretion. C. DecreasespH. D. Increases disaccharidase activity within enterocytes. IncreasespH.
C. DecreasespH.
