Quiz Flashcards
A 74 year old man presents with a change in bowel habit and anaemia. Colonoscopy and subsequent CT showed below. What is the Duke stage of his cancer?
Dukes D
A - survival high, resectable, limited to lining of bowel (may be in contact with muscularis layer)
B - transversing the whole bowel lining
C - lymph node involvement also
Which one of the following is FALSE regarding colorectal cancer?
Bowel cancer screening is offered to people aged 55 or over
The majority of cancers occur in the proximal colon
FAP and HNPCC are two inherited causes of colon cancer
Proximal cancers usually have a worse prognosis
Patients with PSC and UC have an increased risk of developing colon cancer
The majority of cancers occur in the proximal colon
(mostly in distal colon)
Important that UC or UC and PSC increase risk of CRC
FAP and HNPCC important causes
A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of his disease?
Weight loss
Dysphagia to solids initially then both solids and liquids
Dysphagia to solids and liquids occurring from the start
Anaemia
Recent onset of symptom
Dysphagia to solids and liquids occurring from the start
A 32 year old lady complains of a 6 month history of bloating and diarrhoea. What is the most likely diagnosis based on the small bowel histology - see villus atrophy? Crohn’s disease Ulcerative colitis Microscopic colitis Coeliac disease Irritable bowel syndrome
Coeliac disease
Hypertrophic crypts
villi atrophy
Marsh Stages of Coeliac (see)
A 19 year old girl presents with abdominal pain and loose stool. Which of the features suggest that she has irritable bowel syndrome? Anaemia Nocturnal diarrhoea Weight loss Blood in stool Abdominal pain relieved by defaecation
Abdominal pain relieved by defaecation
Which statement is true regarding Helicobacter pylori?
It is a gram positive bacteria
HP prevalence is similar in developing and developed countries
15% of patients with a duodenal ulcer are infected with H. Pylori
PPIs should be stopped 1 week before a H. Pylori stool antigen test
It is associated with an increased risk of gastric cancer
It is associated with an increased risk of gastric cancer
But patients with a duodenal ulcer can be infected with H. Pylori
A 56 year old man presents with abdominal distension and shortness of breath. Examination revealed fever of 38C, a tense distended abdomen with shifting dullness. He also has dullness to percussion in the right lung base. Several spider naevi are seen on his chest. Which is the most important test in the management of this patient? CXR Ultrasound abdomen Echocardiogram Ascitic tap
Spontaneous bacterial peritonitis (large abdomen swelling)
All correct but
First Test for diagnosis:
Ascitic tap
Temperature means infection. Ascitic tap can be sent to lab
Which of the following features best distinguishes Ulcerative colitis from Crohn’s disease?
Ileal involvement
Continuous colonic involvement on endoscopy
Non-caseatinggranuloma
Transmural inflammation
Perianal disease
Continuous colonic involvement on endoscopy
Granuloma in most Crohns Transmural in UC - colon; Crohns anywhere in GI tract UC - continuous; Crohn's - skip lesions Peri-anal disease: Common in Crohns; Rare in UC
A 68 year old lady presents with abdominal pain and distention. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Examination reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is NOT likely to be the cause of her abdominal pain and distention? Colon cancer Adhesions Ascites Diverticulitis Strangulated hernia
Ascites
Lady has an open bowel (outstruction or perforation)
Obstruction usually due to colon cancer, adhesions, strangulated hernia
Perforation due to diverticulitis
A 71 year old man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean Sea. He was treated with a week of augmentin (co-amoxiclav) for his pneumonia. On day 7 of his admission, he started having diarrhoea 10 times a day without any blood. He feels unwell and dehydrated. He had a flexible sigmoidoscopy which showed this (loads of spots through lumen). What is the likely organism responsible for his diarrhoea? Norovirus Escherichia coli Giardia lamblia Clostridium difficile Salmonella enteritidis
Clostridium difficile
A 52 year old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis? Simvastatin induced liver injury Primary biliary cholangitis Gall stones Autoimmune hepatitis Primary sclerosing cholangitis
Autoimmune hepatitis
A 68 year old unkempt and malnourished homeless man was brought to the hospital with haematemesis. Endoscopy found bleeding varices. Subsequent USS showed a coarse shrunken liver. On day 2 admission he was found to be ataxic, confused with nystagmus. What is the most likely cause of his neurological presentation? Alcohol toxicity Alcohol withdrawal Delirium tremens Wernicke’s encephalopathy Korsakoff syndrome
all answers related to alcohol
Wernicke’s encephalopathy (see slide explaining this)
A 23 year old man was brought in at 2am with RIF pain and was diagnosed with acute appendicitis. He was stable and was scheduled for appendicectomy in the morning. During the ward round, he acutely deteriorated. He was immediately brought to theatre for a perforated appendix. What clinical signs would you NOT expect to see? Fever Bowel sounds Tachycardia Rebound tenderness Guarding
Bowel sounds
