A 31-year-old man with ulcerative colitis presents with a worsening of his symptoms. He is passing around four loose stools a day which do not contain blood. He has also experienced some urgency and tenesmus but is otherwise systemically well.
What is the most appropriate management?
Correct Answer A:
Ulcerative colitis: management:
Treatment can be divided into inducing and maintaining remission: Inducing remission:
Maintaining remission:
A 65-year-old man with liver cirrhosis of unknown cause is reviewed in clinic.
Which one of the following factors is most likely to indicate a poor prognosis?
Correct Answer C:
Child-Pugh classification of liver cirrhosis:
The Child-Pugh classification is a scoring system to assess the severity of liver cirrhosis:
Summation of the scores allows the severity to be graded either A, B or C:
A 25-year-old female currently under investigation for secondary amenorrhoea presents with jaundiced sclera.
On examination spider naevi are present along with tender hepatomegaly. Blood tests show:
What is the most likely diagnosis?
Correct Answer D: The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest autoimmune hepatitis.
Autoimmune hepatitis: Autoimmune hepatitis is condition of unknown aetiology which is most commonly seen in young females. Recognized associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3. Three types of autoimmune hepatitis have been characterized according to the types of circulating antibodies present:
Features:
Management:
Which of the following statements is true regarding the genetics of colon cancer?
Correct Answer E:
Colorectal cancer: genetics:
It is currently thought there are three types of colon cancer:
Studies have shown that sporadic colon cancer may be due to a series of genetic mutations. For example, more than half of colon cancers show allelic loss of the APC gene. It is believed a further series of gene abnormalities e.g. activation of the K-ras oncogene, deletion of p53 and DCC tumour suppressor genes lead to invasive carcinoma.
HNPCC, an autosomal dominant condition, is the most common form of inherited colon cancer. Around 90% of patients develop cancers, often of the proximal colon, which are usually poorly differentiated and highly aggressive. Currently seven mutations have been identified, which affect genes involved in DNA mismatch repair leading to microsatellite instability. The most common genes involved are:
The Amsterdam criteria are sometimes used to aid diagnosis:
FAP is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30- 40 years. Patients inevitably develop carcinoma. It is due to a mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5. Genetic testing can be done by analyzing.
DNA from a patients white blood cells. Patients generally have a total colectomy with ileo-anal pouch formation in their twenties.
Patients with FAP are also at risk from duodenal tumours. A variant of FAP called Gardner's syndrome can also feature osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin.
You wish to screen a patient for hepatitis B infection.
Which one of the following is the most suitable test to perform?
Correct Answer B: A positive anti-HBs would imply immunity through either previous immunization or disease.
A positive HBsAg implies either acute or chronic hepatitis B.
Hepatitis B serology:
Interpreting hepatitis B serology is a dying art form which still occurs at regular intervals in medical exams. It is important to remember a few key facts:
Example results:
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