1
Q
what malignant condition does ceoliac disease increase the risk of?
A
Non-Hodgkin lymphoma
2
Q
antibody associated with crohns disease?
A
ASCA
3
Q
antibody associated with ulcerative colitis?
A
p-ANCA
4
Q
Signet ring cells
A
Gastric adenocarcinoma
5
Q
oesophageal rupture secondary to vomiting
A
Boerhaave syndrome
6
Q
cause of gastritis that is Gram negative bacillus transmitted via oral-oral or faecal-oral
A
H.pylori
7
Q
rapid urease test (positive = red)
A
H.pylori postive
8
Q
what is Troisier’s sign
A
Presence of palpable lymph node in the left supraclavicular fossa
May be a sign in gastric cancers
9
Q
mouth to anus
A
Crohn’s Disease
10
Q
Skip lesions
A
Crohn’s Disease
11
Q
Bird beak appearance (and distended oesophagus)
A
Achalasia; if in lower GI imaging is a sign of bowel obstruction
12
Q
Mnemonic for causes of acute pancreatitis
A
GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Mumps,
Autoimmune
Scorpion bites/stings, Hyperlipidaemia/hyperthermia/hypercalcaemia, Hypothermia
ERCP
Drugs- azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, sodium valproate)
13
Q
Murphy’s sign positive
A
Cholecystitis
14
Q
Pale stools, jaundice, abdo pain
A
biliary obstruction
15
Q
Abdo distension, caput medusae, shifting dullness
A
portal hypertension + ascites
16
Q
Virchow’s node (left supra-clavicular)
A
gastric cancer
17
Q
“Rice-water”-like stools
A
vibrio cholera
18
Q
Presence of AMA (Anti mitochondrial antibodies)
A
Primary Biliary Cirrhosis
19
Q
Presence of ASMA (anti smooth muscle antibodies)
A
Autoimmune hepatitis
20
Q
Cobblestone mucosa
A
Crohn’s Disease
21
Q
Corkscrew oesophagus on barium swallow
A
diffuse oesophageal spasm
22
Q
evere abdo pain + D&V after raw milk
A
Campylobacter
23
Q
Onion skinning fibrosis, beading of bile ducts
A
Primary Sclerosing Cholangitis
24
Q
Signet RIng” cells seen on biopsy
A
Linitis plastica - diffuse stomach cancer
25
Thumb-printing on X-ray commonly at splenic flexure
Ischaemic colitis
26
fever, jaundice and abdominal pain
Charcot’s triad → Acute cholangitis- secondary to cholelithiasis
27
deficiency of UDP glucuronosyltransferase
Gilbert's syndrome
28
unconjugated hyperbilirubinaemia
Gilbert's syndrome
29
grossly black liver in a jewish person
Dubin-Johnson syndrome
30
what are the two inherited causes of Unconjugated hyperbilirubinaemia
Gilbert's syndrome
Crigler-Najjar syndrom
31
What are the two inherited causes of Conjugated hyperbilirubinaemia
Dubin-Johnson syndrome
Rotor syndrome
32
defect in the ATP7B gene located on chromosome 13
Wilson's disease
33
what inheritenc pattern is wilson disease
autosomal recessive
34
what neurological problems can result from wilsons disease
basal ganglia degeneration- Parkinsonism symetrical
asterixis, chorea, dementia, + especially psychiatric problems
35
blue nails
Wilsons disease
36
copper in descemets corneal membrane
Kayser-Fleischer rings- in Wilsons disease
37
whats the management of Wilsons?
penicillamine (chelates copper)
or
trientine hydrochloride
38
what is the first line investigation for wilsons disease
reduced serum caeruloplasmin
39
mutations in the HFE gene on both copies of chromosome 6*
Haemochromatosis
40
'bronze' skin pigmentation
Haemochromatosis - iron storage disorder
41
how to disagnose Haemochromatosis
serum ferritin
transferrin saturation- will be high
42
Management of Haemochromatosis?
venesection
desferrioxamine may be used second-line
43
viilous atrophy
coeliac disease
44
hyperplastic crypts
coeliac disease
45
dermatitis herpetiformis + GI symptoms
coeliac disease
46
coeliac disease investigations
tissue transglutaminase (TTG) antibodies (IgA)
+
Endoscopic intestinal biopsy
47
epigastric pain typically worse 15 to 30 minutes following a meal
may be relieved by sitting forward
Chronic pancreatitis
48
what type of pancreatic cancer is the most common and where is it usually located?
adenocarcinoma at the head of the pancreas
49
painless jaundice
pale stools, dark urine, and pruritus
Pancreatic cancer
50
double duct' sign
simultaneous dilatation of the common bile and pancreatic ducts in Pancreatic cancer
51
what are the fot soluble vitamins
A, D, E, K
pancreATEK insufficiency
51
CA19-9 is a tumor marker in what cancers?
Pancreatic cancer + cholangiocarcinoma
52
abdominal pain, diarrhoea and flushing
carcinoid syndrome
53
+ murphy sign constant RUQ pain and fever
cholecystitis
54
What is the management for acute cholecystitis?
IV antibiotics
Laparoscopic cholecystectomy within 1 week
55
where is the obstruction in cholecystitis?
cystic duct
56
where is the obstruction in choledocolithiasis?
common bile duct
57
RUQ pain Fever, Jaundice
Charcots triad- Ascending cholangitis
58
RUQ pain Fever, Jaundice + hypotension + confusion
Reynolds' pentad- Ascending cholangitis
59
what antibody is associated with primary sclerosing cholangitis?
p-ANCA
60
what antibody is associated with primary biliary cholangitis?
AMA- anti mitochondiral antibody
61
what medicine can relieve itching?
cholestyramine
62
what medication is first-line in primary biliary cholangitis?
ursodeoxycholic acid
63
triad of CVD, high lactate and soft but tender abdomen
Mesenteric ischaemia
64
What's a major cause of drug-induced pancreatitis?
Mesalazine
65
what are you most worried about in pancreatitis?
hypocalcaemia
66
whats the most common association of HNPCC after colorectal cancer
endometrial cancer
67
pain when hungry, and are relieved by eating
Duodenal ulcers
68
pain worse with food
gastric ulcer
69
what cancer are coeliacs at incresed risk of
enteropathy-associated T cell lymphoma
70
loss of haustrations
Ulcerative colitis
71
how long should PPIs be stopped before an upper endoscopy
2 weeks
72
causes of ASCITES with high SAAG
indicates portal hypertension
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
Cardiac
right heart failure
constrictive pericarditis
Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
73
causes of ASCITES with low SAAG
TB
peritoneal carcinomatosis
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases
74
TREATMENT OF ASCITES FOR HIGH SAAG
Salt restricion
aldosterone antagonists: e.g. spironolactone
Add: Furosemide if needed
Large volume paracentesis (if tense ascites)
Give albumin replacement
75
TREATMENT OF ASCITES FOR LOW SAAG
paracentesis + underlying cause
76
Ascitic fluid analysis with neutrophils > 250 cells/ul indicates?
spontaneous bacterial peritonitis
77
Management of spontaneous bacterial peritonitis?
Prophylaxis: oral ciprofloxacin
Management: IV cefotaxime
78
What is the definitive management for ascites caused by cirrhosis?
Transjugular intrahepatic portosystemic shunt (TIPS)
79
transjugular intrahepatic portosystemic shunt procedure connects which two vessels?
connects the hepatic vein to the portal vein
80
Management of a chronic anal fissure
1st topical GTN
not worked after 8 weeks:
surgery (sphincterotomy)
81
what is the treatmeny for ulcerative colitis Following a severe relapse or >=2 exacerbations in the past year?
oral azathioprine or oral mercaptopurine
82
In a mild-moderate flare of distal ulcerative colitis, what the first-line treatment?
topical (rectal) aminosalicylates
83
what is the issue in achalasia?
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from the myenteric (Auerbach's) plexus
84
what is the first line test for diagnosis of small bowel overgrowth syndrome
Hydrogen breath testing
84
what is the Helicobacter pylori eradication regime
first-line: PPI + amoxicillin + (clarithromycin OR metronidazole)
if ongoing symptoms after first line treatment: PPI + amoxicillin+ (clarithromycin OR metronidazole, whichever was not used first line)
if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin
85
what cells in the epithelium of the stomach secrete mucus?
foveolar cells
86
what cells in the epithelium of the stomach secrete HCL?
parietal cells
87
what cells in the epithelium of the stomach secrete pepsinogen?
cheif cells
88
what cells in the epithelium of the stomach secrete gastrin and what does gastrin do?
G-cells
stimulates parietal cells to secrete HCL
Promotes Pepsinogen secretion: Triggers chief cells to release pepsinogen, which is converted to pepsin for protein digestion.
Encourages mucosal growth: Stimulates the growth and replenishment of the gastric mucosa (lining).
Increases gastric motility: Enhances stomach and antral contractions to aid digestion.
89
where does Gastric adenocarcinoma arise from?
glandular epithelium of the stomach lining.
90
what blood group is most associated with gastric cancer
Type A
91
signet ring cells?
gastric cancer
92
Sister Mary Joseph's node
periumbilical nodule in gastric cancer
93
Krukenberg tumour
ovarian mets from gastric cancer
94
Leser trelat sign
sudden, explosive eruption or rapid increase in size and number of seborrheic keratoses (warty, "stuck-on" brown spots), often accompanied by itching
95
melanotic macules- ie pigmented lesions on lips, oral mucosa, face, palms and soles + GI obstruction
Peutz-Jeghers syndrome
96
what are the treatment options for achalasia?
pneumatic (balloon) dilation
Heller cardiomyotomy
or botox
97
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
Plummer-Vinson syndrome
98
treatment of c diff
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
99
Dermatitis, diarrhoea, dementia/delusions
Pellagra
100
what is Pellagra?
Vitamin B3 (niacin) deficiency
101
anaemia, bleeding gums and bruising/petechiae of the skin.
scurvy
102
what is scurvy
vitamin C deficiency
103
what is adenocarcinoma of the oesophagus most associated with?
GORD, Barretts oesophagus
104
What type of oesophageal cancer is seen with a history of smoking and drinking?
Squamous cell carcinoma
105
where is adenocarcinoma of the oesophagus most likely to be located?
Lower third - near the gastroesophageal junction
106
where is small cell cancer of the oesophagus most likely to be located?
Upper two-thirds of the oesophagus
107
anti-nuclear antibodies (ANA) ± anti-smooth muscle antibodies (SMA)
Typically women in their late 40s/50s but can affect all ages
type 1 autoimmune hepatitis
108
anti-liver kidney microsomal-1 (LKM-1) or anti-liver cytosolic-1 (LC-1)
occurs in younger patients but can affect all ages
type 2 autoimmune hepatitis
109
how to treat Alcoholic ketoacidosis?
infusion of saline & thiamine
110
what does Metoclopramide do
Blocks D2 receptors in the chemorecptor trigger zone to preduce vomitting
111
what does odansetron do?
5-HT3 receptor antagonist, blocking the action of serotonin in the vagus nerve and central nervous system that triggers vomiting.
112
What does Cyclizine do?
blocking histamine and cholinergic receptors in the brain that trigger sickness. good for vertigo induced vomitting
113
how does loperamide work?
stimulation of µ-opioid receptors in the submucosal neural plexus of the intestinal wall. This, in turn, reduces peristalsis of the intestines decreasing gastric motility.
114
what do you use for the prophylaxis of oesophageal bleeding?
carvedilol- non-cardioselective beta-blockers (NSBBs)
115
management of wilsons
penicillamine (chelates copper)
or
trientine hydrochloride
116
what will the TIBC be in iron deficiency anaemia
high
117
what will the TIBC be in anaemia of chronic disease
low/ normal
118
in wilsons disease is serum caeruloplasmin is decreased or increased?
decreased
119
First-line treatment for mild–moderate proctitis flare?
Topical (rectal) aminosalicylate (mesalazine)
120
If no remission after 4 weeks (mild–moderate proctitis)?
Add oral aminosalicylate- mesalazine
121
If still no remission in mild–moderate proctitis after rectal and oral aminosalicylate?
Add topical or oral corticosteroids
122
First-line treatment of Proctosigmoiditis (left sided) in ulcerative colitis- mild to moderate flare?
Topical (rectal) aminosalicylate
123
treatment of Proctosigmoiditis (left sided) in ulcerative colitis- mild to moderate flare if no remission after 4 weeks?
Add high-dose oral aminosalicylate OR
Switch to oral aminosalicylate + topical steroid
124
treatment of Proctosigmoiditis (left sided) in ulcerative colitis- mild to moderate flare if no respose after adding oral aminosalicylate and topical steroid?
Stop topical → use oral aminosalicylate + oral corticosteroid
125
First-line treatment for extensive disease in flare of UC?
topical (rectal) aminosalicylate and a high-dose oral aminosalicylate
126
If no remission after 4 weeks of treatment in extensive disease UC flare?
top topical → high-dose oral aminosalicylate + oral corticosteroid
127
First-line treatment for severe UC?
IV corticosteroids
128
treatment for severe UC if steroids are contraindicated?
IV ciclosporin
129
treatment of severe UC if no improvement after 72 hours?
Add IV ciclosporin OR
Consider surgery
130
Maintenance options for proctitis/proctosigmoiditis?
Topical aminosalicylate (best)
± Oral aminosalicylate
131
Maintenance for left-sided/extensive UC?
Low-dose oral aminosalicylate
132
Who needs immunomodulators for maintenance in UC?
Severe relapse OR
≥2 flares/year
use- Azathioprine or mercaptopurine
133
what is the investigation of choice for suspected carcinoid tumours
Urinary 5-HIAA
134
treatment of Hepatic encephalopathy
Lactulose (traps ammonia)
± rifaximin
135
confusion +asterixis: 'liver flap
Hepatic encephalopathy
136
↑ ALP > ALT
Post-hepatic- obstruction
137
whats happens in Barrett's oesophagus?
metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium
138
what should be assessed before offering azathioprine or mercaptopurine therapy in Crohn's disease
Thiopurine methyltransferase (TPMT)
139
Jaundice after eating seafood (especially shellfish) — most likely cause?
hepatitis A
140
treatment of small bowel bacterial overgrowth syndrome
Rifaximin
141
What serology indicates past (resolved) Hep B infection?
HBsAg ❌
Anti-HBc ✅
Anti-HBs ✅
141
What serology indicates immunity from Hep B vaccination?
HBsAg ❌
Anti-HBc ❌
Anti-HBs ✅
142
what is the hallmark symptom of refeeding syndrome?
hypophosphataemia
can also have-
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
143
goblet cells
Crohn's disease
144
what do you give for IBS is cramping and bloating is the predominant symptom?
Antispasmodic agents such as mebeverine
145
Horseshoe Abscess
Abscess formation within the space between the coccyx and anal canal
146
where are diverticula mose commonly found?
sigmoid colon
147
Pathophysiology of an indirect inguinal hernia?
Failure of processus vaginalis to close
Hernia passes through deep inguinal ring
148
Key clinical feature of indirect hernia?
Can extend into scrotum
149
Pathophysiology of direct inguinal hernia?
Weakness in posterior wall of inguinal canal
Through Hesselbach’s triangle
150
Boundaries of Hesselbach’s triangle?
Lateral: inferior epigastric vessels
Medial: rectus abdominis
Inferior: inguinal ligament
151
Classic LFT pattern in NAFLD?
↑ ALT > AST
adipose liver trouble
152
Classic LFT pattern in alcoholic liver disease?
↑ AST > ALT (2:1 ratio)
alcohol damages the mitochondria and AST is partly mitochondrial
153
First-line pharmacological management of acute constipation
bulk-forming laxative such as isphagula husk
154
If bulk-forming laxatives don’t work in constipation what is the next line treatment?
Osmotic laxative (e.g. macrogol)
155
If still constipated despite osmotic laxative what is the 3rd line treatment?
Stimulant laxative (e.g. senna, bisacodyl)
156
How do you treat opioid-induced constipation?
Stimulant + osmotic laxative together
👉 Do NOT use bulk-forming alone (can worsen)
157
First-line for faecal impaction?
High-dose oral macrogol
next line-
Add stimulant laxative
± suppository/enema
158
how to maintain remsicon in crohns?
Azathioprine or mercaptopurine
159
what is the most likely compilaction of TIPSS?
Hepatitic encephalopathy
160
Vomiting + diarrhoea outbreak in cruise ship/school — cause?
Norovirus
161
Bloody diarrhoea after eating undercooked chicken? + RIF pain
Campylobacter
162
Diarrhoea after eggs/poultry/reptiles?
Salmonella
163
Rapid vomiting after reheated rice?
Bacillus cereus
164
Undercooked beef + Bloody diarrhoea
E. coli O157
165
Diarrhoea after reheated meat/gravy/buffet?
Clostridium perfringens
166
prolonged Fatty, foul-smelling diarrhoea after camping/water exposure?
Giardia
167
Bloody diarrhoea + fever + tenesmus?
Shigella
168
travelers diarrhoea most likly organism?
E. coli
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