Ward round/clinics

Question 1

what is Enlers danlos syndrome?

Answer 1

genetic condition affecting the connective tissue

Question 2

why do HIV patients get diarrhoea?

Answer 2

infectious causes of diarrhoea in HIV are CMV infection, cryptosporidiosis, microsporidiosis and MAC infection

Question 3

why is pain in Ulcerative colitis an alarm sign?

Answer 3

in UC usually only the mucosa is involved so if pain is present there is probably deeper nerve damage.

Question 4

what are the causes of pain in Ulcerative Colitis?

Answer 4

toxic dilatation
microperforaton
opposite side foecal load

Question 5

what pain relief can be used in a patient with ulcerative colitis?

Answer 5

paracetamol and morphine

Question 6

what is the management of acute severe colitis?

Answer 6

• monitor and replace electrolytes
• FBC (with CRP)
• stop anticholinergics, antidiarrheals, NSAIDs, opioids
• LMWH prophylaxis
• IV corticosteroids
• infliximab infusion

Question 7

what is the role of lactulose in encephalopathy?

Answer 7

• reduce nitrogen absorption
• stop nitrogen conversion to ammonia
• increases motility so stagnant bacteria can’t translocate over gut mucosa and less ammonia producing bacteria available.
• as ammonia causes encephalopathy lactuose can be used to prevent it

Question 8

what are the 5 P’s of ischaemia?

Answer 8

pain
pulseless
parathesia 
paralysis
perishingly cold

Question 9

why should oral iron only be give once a day?

Answer 9

hepcidin produced in the liver as soon as iron enters the body and released to blood and regulates amount of iron absorbed. its activity peaks 6-8 hours after initial iron intake

Question 10

what do blue areas on colonoscopy indicate?

Answer 10

liver/spleen (hepatic/splenic flexure)

Question 11

what sedatives are given for colonoscopY?

Answer 11

medazalan
phenytoin
oxygen given via nasal cannula

Question 12

what is seen in the small bowel on colonoscopy

Answer 12

villi

Question 13

what do blue veins on colonoscopy suggest?

Answer 13

haemorrhoids

Question 14

what ‘sign’ is seen at the appendix on colonoscopy

Answer 14

mercedes sign

Question 15

what parts of the bowel are passed through on colonoscopy in order?

Answer 15

anus
rectum
sigmoid
descending colon
splenic flexure
transverse colon
hepatic flexure
ascending colon
cecum (appendix)

Question 16

what would blood results show in a patient with iron deficiency anaemia?

Answer 16

• low Hb, Low MCH, low MCV, RCDW may be raised
• ferritin test, transferrrin test, serum iron decreased
• total iron binding capacity increased

Question 17

what are the causes of microcytic anaemia?

Answer 17

iron deficiency due to

• bleeding
• malabsorption
• genetic
• malnutrition
• thalasemia
• SIT (sideroblastic, iron deficiency, thalasemia)

Question 18

what are the causes of normocytic anaemia?

Answer 18

acute blood loss
haemolysis
renal failure

Question 19

what are the causes of macrocytic anaemia?

Answer 19

folate, B12 deficiency

alcohol

Question 20

what are the GI causes of anaemia??

Answer 20

blood loss
coeliac
alcohol
B12
folate
liver disease

Question 21

when should you consider thalassemia/

Answer 21

young patient, iron deficiency, asian and otherwise well

Question 22

what are the investigations in a patient with iron deficiency anaemia/

Answer 22

dipstick
Hb electrophoresis
pregnancy
coeliac

Question 23

when should blood transfusion be considered in a patient with anaemia?

Answer 23

levels lower than 60/70

Question 24

what do gastric cardia secrete?

Answer 24

mucus

Question 25

what do cells in the gastric fundus secrete?

Answer 25

parietal->HCl

Chief->pepsinogen

Question 26

what do cells in the gastric pylorus secrete?

Answer 26

G cells->gastrin
endocrine cells
D cells (somatostatin)

Question 27

what is the management for acute diarrhoea?

Answer 27

• sodium, potassium, urea, creatinine
• if Hb and albumin is low may be a chronic cause
• if acute diarrhea test results will be normal
• don’t drink milk as temporarily lactose intolerant