Gastro

Question 1

What is indicated by bowel change 7-10 years after ulcerative colitis?

Answer 1

Urgent colonoscopy for colonic adenocarcinoma

Question 2

What is the most common gastrointestinal complication of diabetes after 10 years?

Answer 2

Gastroparesis

Question 3

How is diabetes-related gastroparesis diagnosed?

Answer 3

Gamma scintigraphy, gastric emptying study

Question 4

What are the treatments for gastroparesis?

Answer 4

• Prokinetics (domperidone)
• Erythromycin

Question 5

What condition should be suspected in a young patient with recurrent peptic ulcer disease and no obvious explanation?

Answer 5

Gastrinoma (Zollinger-Ellison syndrome)

Question 6

How is gastrinoma diagnosed?

Answer 6

• Serum gastrin levels
• Octreotide scan
• Endoscopic ultrasound

Question 7

What is caput medusa pathognomonic for?

Answer 7

Portal hypertension

Question 8

What are the criteria for a severe ulcerative colitis attack?

Answer 8

• At least 6 stools/day
• Visible blood
• At least one feature of systemic upset (Temp >37.8, heart rate >90 bpm, anaemia, ESR >30 mm the first hour)

Question 9

What does a transverse colon with a diameter of at least 6cm in a patient with ulcerative colitis indicate?

Answer 9

Toxic megacolon

Question 10

What symptoms might young patients with coeliac disease present with?

Answer 10

Recurrent mouth ulcers

Question 11

What are the symptoms of carcinoid syndrome caused by neuroendocrine tumours secreting serotonin?

Answer 11

• Bluish-red facial and neck flushing
• Facial telangiectasia
• Bronchospasm
• Abdominal pain and diarrhoea
• Pedal oedema
• Raised JVP
• Pansystolic murmur (tricuspid regurgitation/pulmonary stenosis)

Question 12

What are the extra-digestive manifestations of Whipple’s disease?

Answer 12

• Fever
• Arthralgia
• Pleuritic chest pain/pericarditis
• Ophthalmoplegia
• Dementia

Question 13

What is observed on biopsy for Whipple’s disease?

Answer 13

Periodic Acid-Schiff macrophages in lamina propria of small intestine

Question 14

What does a raised APTT that doesn’t correct after a 50:50 mix indicate?

Answer 14

Presence of clotting factor VIII inhibitor

Question 15

When does obstetric cholestasis usually occur, and does it require treatment?

Answer 15

Occurs in late pregnancy, usually doesn’t require treatment

Question 16

What are the serum and urinary copper levels in Wilson’s disease?

Answer 16

• Serum copper is low
• Urinary copper is high

Question 17

What genetic mutation causes Wilson’s disease?

Answer 17

Mutation in the ATP7B gene, inherited in an autosomal recessive manner

Question 18

What is the treatment for oropharyngeal candidiasis?

Answer 18

Nystatin mouthwash and encouraging mouth swilling after using inhaled corticosteroids

Question 19

What conditions are associated with megaloblastic anaemia?

Answer 19

• Type 1 diabetes mellitus (T1DM)
• Hypothyroidism
• Pernicious anaemia

Question 20

What is the treatment of choice for spontaneous bacterial peritonitis?

Answer 20

• Cefotaxime
• Oral ciprofloxacin

Question 21

What are the Glasgow criteria for pancreatitis severity?

Answer 21

• PaO2 <8.0,
• Age>55 yo
• Neutrophilia >15000
• Calcium <2.0 mmol
• Renal-urea>16 E
• Albumin<30g/L
• Sugar-glucose>10mmol/L

Question 22

What does NICE recommend for daily potassium (K+) replacement?

Answer 22

1mmol/kg/day

Question 23

What condition can present with Pellagra?

Answer 23

Carcinoid syndrome

Question 24

What is the most common cause of upper GI bleed?

Answer 24

Chronic peptic ulcer

Question 25

What are the symptoms of amoebiasis?

Answer 25

- Gradual-onset bloody diarrhoea - Mucus - High WCC - Colonic mucosal ulceration

Question 26

How is hepatorenal syndrome treated?

Answer 26

Terlipressin

Question 27

What is the hallmark of hepatorenal syndrome?

Answer 27

Oliguria

Question 28

What complication can arise from gastric resection?

Answer 28

Small bowel bacterial overgrowth

Question 29

What vitamin is essential for hydroxylation of procollagen proline and lysine?

Answer 29

Vitamin C

Question 30

What does nocturnal diarrhoea suggest?

Answer 30

Organic disease rather than functional disease

Question 31

What side effect can ribavirin used in hepatitis C cause?

Answer 31

Haemolytic anaemia

Question 32

What symptoms are associated with Gardner's syndrome?

Answer 32

- Familial adenomatous polyposis - Retinal pigmentation - Skull osteomas - Thyroid carcinoma

Question 33

What conditions show paraproteins and pseudohyponatraemia?

Answer 33

MALT lymphomas

Question 34

What are the symptoms of Entamoeba histolytica infection?

Answer 34

- Diarrhoea - Travel history - Leukocytosis in stool

Question 35

What are the side effects of sulfasalazine?

Answer 35

Pancytopaenia

Question 36

What indicates a rolling hiatus hernia and sliding hiatus hernia?

Answer 36

Distance between the diaphragmatic hiatus and gastro-oesophageal junction is more than 2 cm

Question 37

What conditions are associated with systemic sclerosis?

Answer 37

- Oesophageal strictures - Small bowel bacterial overgrowth syndrome - Intestinal pseudo-obstruction - Anal incontinence

Question 38

What is the likely cause of multiple liver abscesses with pus?

Answer 38

- Staph aureus - Enterococci - E. coli

Question 39

What is a solitary non-pyogenic liver abscess associated with?

Answer 39

Entamoeba histolytica

Question 40

What should be done after finding positive 5-HIAA in a patient with a vegetarian diet rich in certain foods?

Answer 40

Redo urinary 5-HIAA after dietary restriction

Question 41

What are the new treatment options for hepatitis C?

Answer 41

Simepravir-sofosbuvir

Question 42

What are the signs of gastric carcinoma in a patient with a history of smoking/drinking?

Answer 42

- Malignancy picture/abdominal mass - Abnormal liver enzymes - Haematemesis

Question 43

What are the serum caeruloplasmin and plasma hepcidin levels in Wilson's disease and haemochromatosis?

Answer 43

- Wilson's disease: Reduced serum caeruloplasmin - Haemochromatosis: Reduced plasma hepcidin