Upper GI

Question 1

Give 7 indications for 2 week referral to oral surgery

Answer 1

Unexplained ulceration/mass >3weeks
Unexplained painful/swollen/bleeding patches
Unexplained unilateral head/neck pain >4weeks with earache but normal otoscopy
Unexplained recent neck lump or change in neck lump
Unexplained persistent sore throat
Signs/symptoms in oral cavity>6weeks not definitively benign

Question 2

Give 5 signs of scurvy

Answer 2

Gingivitis
Easy bruising
Curly hair
Eye bulging
Brown flaky skin

Question 3

Give 4 causes of gingival hyperplasia

Answer 3

Phenytoin
Ciclosporin
Calcium channel blockers especially nifedipine
AML (myelomonocytic/monocytic types)

Question 4

What is the most common cause of leukoplakia?

Answer 4

Smoking

Question 5

What is the cause of erythroplakia?

Answer 5

Irritation

Question 6

What is the management of oral candidiasis?

Answer 6

Nystatin

Question 7

What antibodies are associated with limited systemic sclerosis?

Answer 7

Anti-centromere

Question 8

What antibodies are associated with diffuse systemic sclerosis?

Answer 8

Anti-Scl70

Question 9

Which type of oesophageal cancer is associated with smoking?

Answer 9

Squamous cell carcinoma

Question 10

What is the management of Barrett’s oesophagus?

Answer 10

Endoscopy and biopsy every 3-5 years

High dose PPI therapy

Question 11

What is the first line antibiotic in suspected variceal bleeding?

Answer 11

Ceftriaxone

Question 12

What are the indications for fluconazole in suspected variceal bleeding?

Answer 12

If at risk of fungal sepsis e.g. jaundice or renal impairment

Question 13

What does the Glasgow-Blatchford score take into account?

Answer 13

Blood urea, Hb, pulse, systolic BP, comorbidities (melaena, syncope, heart failure, hepatic disease)

Question 14

What is the first line management of gastric varices?

Answer 14

Endoscopic injection of N-butyl-2-cyanoacrylate

Question 15

Give 3 contraindications of TIPSS

Answer 15

Portal vein thrombosis
Severe systemic infection
Severe pulmonary hypertension

Question 16

What is the definitive management of acute non-variceal upper GI bleeds (e.g. Mallory-Weiss tears, bleeding peptic ulcers)?

Answer 16

Endoscopic clipping with/without adrenaline, thermal coagulation + adrenaline or fibrin/thrombin + adrenaline

Question 17

What is the key investigation for Boorhaeve syndrome?

Answer 17

CT chest with oral contrast

Question 18

What is Mackler’s triad?

Answer 18

Vomiting
Chest pain
Subcutaneous emphysema

Question 19

Give 6 side effects of PPIs

Answer 19

Hyponatraemia
Hypomagnesaemia
Osteoporosis
Diarrhoea
Increased risk of C difficile infection
Microscopic colitis

Question 20

Give 2 indications for hiatus hernia repair

Answer 20

Severe disease refractory to medical management

Complications e.g. Barrett’s oesophagus

Question 21

What blood group is at increased risk of gastric cancer?

Answer 21

A

Question 22

What is Sister Mary Joseph’s node?

Answer 22

Painful palpable umbilical node due to metastatic abdominal or pelvic cancer

Question 23

How soon should PPIs be stopped before endoscopy?

Answer 23

2 weeks

Question 24

What type of stomach cancer has signet ring cells?

Answer 24

Gastric adenocarcinoma

Question 25

What is the management of T1A gastric cancers?

Answer 25

Endoscopic mucosal resection

Question 26

Give 7 types of drugs that increase risk of peptic ulcers

Answer 26

``` NSAIDs SSRIs TCAs Steroids Bisphosphonates Nitrates Anticholinergics ```

Question 27

What are Cushing's ulcers?

Answer 27

Peptic ulcers secondary to neurosurgery

Question 28

What are Curling's ulcers?

Answer 28

Erosions secondary to hypovolaemic shock in burns

Question 29

What are the key investigations for Zollinger-Ellison syndrome?

Answer 29

Fasting gastrin level | Secretin stimulation test (causes paradoxical increase in gastrin)

Question 30

What are the components of triple therapy for H. pylori?

Answer 30

Lansoprazole, clarithromycin, amoxicillin

Question 31

Give 1 neurological complication of Campylobacter infection

Answer 31

Guillaine-Barre syndrome

Question 32

What is the management of Campylobacter infection?

Answer 32

Erythromycin/ciprofloxacin

Question 33

When does pyloric stenosis present?

Answer 33

2-8 weeks

Question 34

How does duodenal atresia present?

Answer 34

Vomiting straight after birth before feeding

Question 35

What condition is associated with duodenal atresia?

Answer 35

Down's syndrome

Question 36

What is the first line antibiotic for cholecystitis?

Answer 36

IV co-amoxiclav

Question 37

What is the first line antibiotic for cholecystitis (allergic to penicillin)?

Answer 37

Ciprofloxacin

Question 38

What are the first and second most common causes of ascending cholangitis?

Answer 38

E. coli | Klebsiella

Question 39

What are the indications for gallbladder polyp removal?

Answer 39

``` >1cm PSC Certain ethnic minorities Adjacent wall thickening Symptomatic ```

Question 40

Name 9 drugs that can cause pancreatitis

Answer 40

``` Azathioprine Mesalazine Didanosine Bendroflumethiazide Furosemide Mentamidine Steroids Valproate Cytotoxics ```

Question 41

What are the 8 factors in the modified Glasgow score for pancreatitis?

Answer 41

``` PaO2<8kPa Age>55 WCC>15 Calcium<2mM Urea>16mM LDH>600/AST>200 Albumin<32g/l Glucose>10mM ```

Question 42

How does a trypsin R122H mutation lead to chronic pancreatitis?

Answer 42

Cationic trypsin produced and prematurely activated

Question 43

How is faecal elastase altered in chronic pancreatitis?

Answer 43

Low

Question 44

What is the gold standard investigation for chronic pancreatitis?

Answer 44

CT with IV contrast

Question 45

What is the management of pancreatic pseudocysts?

Answer 45

Initially conservative | If non-resolved after 12 weeks, endoscopic or surgical cystogastrostomy or aspiration