Questions on diarrhoea

Diarrhoea

• Define diarrhea? H30, 1e460, am140
• Classification
• What are the causes of acute diarrhea? 1e460, am104
• What are the electrolyte imbalances occurring in acute watery diarrhea? h, 1e461
• Patient presented with acute watery diarrhea, how will you manage the patient?
• What are the causes of chronic diarrhea? ie462
• What is the most common cause of chronic diarrhea? h, ie462
• Diagnose a case of chronic diarrhora. 1e463
• Classification and signs/ assessment of dehydration. am104,105
• What is steatorrhea? h
• What are the mechanisms responsible for malabsorption? h

Dysentery

• What is dysentery? e18, am105, h76i
• What are the causes of bloody diarrhea?
• Management
  • Amoebic. e19
  • Bacillary. e18, am108, h79i
• Amoebic vs. bacillary. e20, h78i

Questions on presenting problems in gastrointestinal disease

Dyspepsia

• What is dyspepsia? H10
• What are the alarm features of dyspepsia?

Vomiting

• What are the neurological causes of vomiting? H12
• Give the description of vomiting of gastric outlet obstruction, e.g. pyloric stenosis. H13
• Give the description of vomiting in raised intracranial pressure, e.g. brain tumor.

Hematemesis and melena

• What is hematemesis? H15
• What is melena?
• How can you differentiate between hematemesis and hemoptysis?
• What are the common causes of hematemesis?
• What are the clinical features of upper GI bleeding?
• How much blood is lost to cause postural hypotension?
• How much blood is lost to produce shock?
• What are the investigations done in acute upper GI bleeding?
• What is the management of acute upper GI bleeding?
• Which etiologies bear the worst prognosis?
• Mention the criteria of stool in melena?
• How much blood is required to cause melena?
• Why is stool black?
• What are the usual sites for hematemesis and melena?
• What are the causes of lower GI bleeding?

Diarrhoea

• Define diarrhea? H30
• What are the causes of acute diarrhea?
• What are the electrolyte imbalances occurring in acute watery diarrhea?
• What are the causes of bloody diarrhea?
• Patient presented with acute watery diarrhea, how will you manage the patient?
• What are the causes of chronic diarrhea?
• What is the most common cause of chronic diarrhea?
• What is steatorrhea?
• What are the mechanisms responsible for malabsorption?

Constipation

• Define constipation. H39
• What is the most common cause of constipation?
• What are the neurological causes of constipation?
• What are the metabolic/endocrine causes of constipation?
• What are the types of laxative?

Pathological weight loss

• Tell five common causes of pathological weight loss. h44
• What do you mean by significant weight loss?
• What are the causes of weight loss with increased appetite?

Acute abdomen

• What are the causes of acute abdominal pain (acute abdomen)? H47
• What are the medical causes of acute abdominal pain (acute abdomen)?
• What are the causes of abdominal distension?

GERD

• Define GERD. Hl/223
• What are the clinical features of GERD? Hl
• What are the complications of GERD? Hl
• How can you treat GERD? Hl

Barrett’s esophagus

• What is Barrett’s esophagus? Hl/223

Carcinoma of stomach

• What are the common presentations of carcinoma of stomach? Hl/223
• Tell the sites of carcinoma of the stomach. hl
• What are the paraneoplastic features of carcinoma of the stomach? Hl
• How can you confirm the diagnosis? hl
• What are the modalities of treatment? Hl

Intestinal TB

• Name some diseases which affect the terminal ileum? H112
• What are the presentations of intestinal TB? h113
• What are the pathological types of intestinal TB? h114
• What are the indications of steroid in TB? h115

Oral ulcer

• What are the causes of oral ulcer? H116
• What are aphthous ulcers? H117

Definition and classification

• Q

Epidemiology

• Q

Etiology and Pathophysiology

• Mention the common causes of acute pancreatitis? H80
• What is the most common cause of chronic pancreatitis? H87
• What are the causes of chronic/recurrent pancreatitis? H88

Clinical manifestations

• Describe the pain of acute pancreatitis. H78
• What are the cardinal features of chronic pancreatitis? H89

Examinations

• What are the characteristic findings on examination? H79

Investigations

• How can you investigate acute pancreatitis? H82
• What are the causes of raised serum amylase other than acute pancreatitis? H83
• What is the role of serum lipase in diagnosis of acute pancreatitis? H84

Diagnosis

• Q

Treatment

• Write down the treatment of acute pancreatitis? H85
• What are the adverse prognostic factors in acute pancreatitis (Glasgow criteria)? H81

Complications

• What are the complications of acute pancreatitis? H86

Definition

• What is primary biliary cirrhosis? A
• What is secondary biliary cirrhosis? A
• What are the diseases associated with PBC? A, hs
• What is anti-mitochondrial antibody (AMA)? A, hs
  • What are the types? Hs
  • Which is specific for PBC? hs

Epidemiology

• Q

Etiology and Pathophysiology

• What are the causes? A
• Why itching in PBC? A
• What are the causes of granuloma in liver? A
• What are the causes of anemia in PBC? Hs
• Why bleeding tendency (patichae and ecchymosis) occurs in PBC? hs

Clinical manifestations

• How the patient with PBC usually presents? a

Examinations

• Q

Investigations

• What investigations are done in PBC? A, hs

Diagnosis

• Why it is PBC? A, hs
• Why is portal hypertension? hs
• What are your differential diagnoses? A
• Why not this is a case of cirrhosis of liver? A
• Why not hemochromatosis? A
• Why do you consider lymphoma as differential diagnosis? hl

Treatment

• How to treat this patient? A, hs
  • How cholestyramine works? a
• What is the prognosis of PBC? a
  • What is the best indicator for prognosis in PBC? A
• What are the indications of liver transplantation in PBC? a

Complications

• What is the risk of hepatobiliary malignancy in PBC? a

Definition and classification

• What are the types of liver abscess? A, hl

Epidemiology

• Q

Etiology and Pathophysiology

• What are the causes of pyogenic liver abscess? a
• Mention organisms causing pyogenic liver abscess. A, hl
• What is the organism of amebic liver abscess? Hl
  • How does it enter into the liver? Hl
• In which lobe of liver, abscess is more common and why? Hl

Clinical manifestations

• How does the patient usually present? A
  • What are the causes of hectic rise of temperature (fever with chills and rigor)? H132
• What are the common presentations of amebic liver abscess? H123

Examinations

• What would be your examination findings? H124
  • What are the causes of enlarged tender liver? Hl

Investigations

• What investigations do you suggest in liver abscess? A, hl
  • What is the character of pus in amebic liver abscess? A, hl
  • What do you mean by anchovy sauce? Hl
• Mention one single investigation for the diagnosis. A

Diagnosis

• What are your differential diagnoses? A
• Why not viral hepatitis? A, hl
• Why not congestive cardiac failure? A, hl
• Why is not acute cholecystitis? hl
• What are the differences between pyogenic and amebic liver abscess? A, hl

Treatment

• How to treat liver abscess? A
• How can you treat amebic liver abscess? Hl
• How can you assess response? Hl
• What are the indications of therapeutic aspiration of liver abscess? Hl
• How can you treat pyogenic liver abscess? Hl

Complications

• Q

Definition

• Name some tumors of the liver. H111
• Which tumor is the most common and why? H112

Epidemiology

• Q

Etiology and Pathophysiology

• What are the risk factors/causes for HCC? H113
• Why secondary carcinoma is more common in liver? hl

Clinical manifestations

• Q

Examinations

• What findings do you expect examining the liver? H114

Investigations

• What investigations will you do in HCC? Hl
• How can you screen HCC in cirrhotic patients? H116
• How will you screen CLD patient to detect hepatoma earlier? Hl
• What are the indications of screening? Hl
• What are the metabolic abnormalities which may be found in hepatoma? hl

Diagnosis

• What is your diagnosis? Hl
• Why do you consider hepatoma? Hl
  • When will you suspect that hepatoma has developed in cirrhosis of liver? hl
• Why do you consider CLD with portal hypertension? Hl
• Why are these not hepatic metastasis? hl
• How can you differentiate HCC from secondary tumor? H

Treatment

• What is the treatment of HCC? H118
• What treatment modalities are available for hepatoma? hl

Complications

• Q

Definition

• CLD
  • What is chronic liver disease (CLD) and chronic liver failure? A
  • What do you mean by CLD? H46
  • Which diseases are included in CLD? Hl
• Cirrhosis of liver
  • Define cirrhosis? H48
  • What are the histological components of cirrhosis? H49
  • Classify cirrhosis. H50
  • What is cirrhosis of liver? What are the types? A
  • What are the types of cirrhosis of liver clinically? hl
• What is ascites? A, hl
• What is spontaneous bacterial peritonitis (SBP)? a
• What is hepatorenal syndrome? A
• What is hepatopulmonary syndrome? A
• What is portopulmonary hypertension? A
• What are the vitamin K-dependent coagulation factors? A
• What is fetor hepaticus? A
• What is diabetic cheiroarthropathy? A
• What is fulminating hepatic failure? A
• What is constructional apraxia? How to test for it? A
• What do you mean by serum ascites albumin gradient (SAAG)? a335/350, hl
• What is hepatic encephalopathy? Hl
• What is constructional apraxia? Hl
• What is hepatic facies? Hl
• What is spider nevi? Hl
  • What is the usual sites of spider nevi? Hl
• What is refractory ascites and mention its type? Hl
• Define portal hypertension? Hl

Etiology and Pathophysiology

• Cirrhosis of liver
  • What are the causes of cirrhosis of liver? A, h51, hl
  • What are the commonest causes of cirrhosis of liver? A
  • What is the pathogenesis of clinical features of cirrhosis of liver? Hl
• Why itching in liver disease? A
• What are the causes of bad breath (halitosis)? A
• Why does hepatic facies occur/ hl
• Ascites
  • What are the causes of abdominal distension? A
  • What are the causes of ascites? A, h64
  • What are the most common causes of ascites? Hl
  • What is the mechanism of ascites in cirrhosis of liver? A
  • What is the type of ascites in cirrhosis of liver? Hl
  • What are the causes of transudative ascites? Hl
  • What are the causes of exudative ascites? Hl
  • What are the common causes of cirrhotic ascites? Hl
  • How much fluid is required to detect ascites clinically? A, hl
• Hepatic encephalopathy
  • What are the predisposing factors of hepatic encephalopathy? Hl
• Portal hypertension
  • When do clinical features or complications develop in portal hypertension? Hl
  • What are the mechanisms of developing portal hypertension? Hl
  • What are the common causes of portal hypertension? Hl

Clinical manifestations

• What are the presentations of cirrhosis of liver? Hl
• Describe hepatic facies. H58
• Tell the grading of hepatic encephalopathy. H85
• What are the clinical features of portal hypertension? Hl

Examinations

• What specific signs you would look for to fins out underlying cause? hs
  • What are the features of alcohol abuse? hs
• What are the stigmata of CLD or cirrhosis? A
• What are the cutaneous stigmata of cirrhosis? Hl
  • Tell the common causes of gyneocomastia. Hl
  • Tell the name of some drugs which may cause gynecomastia. Hl
• Tell the finding on testis. Hl
• How to confirm ascites clinically? a
• What specific findings will you see in CLD or cirrhosis of liver in a young patient? A
• What are the features of hepatocellular insufficiency? Hl
• What are the signs of portal hypertension? A, hl
• If the patient has SBP, what features will you observe? hl
• What are the signs of decompensated cirrhosis? A, hl
• Which signs will you expect in hepatic encephalopathy? Hl
  • Is flapping tremor present in every case? H87
  • Show flapping tremor. hl

Investigations

• How will you investigate this patient? Hl
  • Tell the use of USG in CLD. Hl
  • What are the liver function tests? Hl
  • What will you observe in LFT? Hl
  • If there is any need of endoscopy? Hl
• Ascities
  • What investigations are done in ascites? A
  • What is the character of ascitic fluid in CLD? A
  • What is the single best investigation to detect ascites? A
  • How will you differentiate exudative and transudative ascites? Hl
• What investigations should be done in cirrhosis of liver? A, h60
• What investigations are done to see the severity of liver disease? A
• Name a single test in poor patient to find out the prognosis? Hl
• What are the components of scoring in Child-Pugh classification of prognosis in cirrhosis? hl

Diagnosis

• What is your diagnosis? Hs
• Why portal hypertension? A
• What are the differential diagnosis? Hl
  • Why not abdominal tuberculosis? hl
• What are the other possible causes of ascites in this case? A
• Is there any importance of family history? hl
• If a patient of CLD with ascites complains of fever and abdominal pain, what is the likely diagnosis? A
• If there is associated fever, what is your diagnosis? Hl
• If the patient has cirrhosis and ascites, what does it indicate? a
• If patient with CLD deteriorates, what are the possibilities? A
• Which criteria should be present to diagnose hepatic encephalopathy? H83
• What are the differential diagnoses of hepatic encephalopathy? H91

Treatment

• What are the principles of management of cirrhosis? Hl
• CLD
  • How can you treat a case of CLD? Hl
  • What types of diuretics are used in CLD? Why? H75
  • When diuretics should be stopped? Hl
  • When fluid will be restricted in case of CLD? H77
  • Why constipation and diarrhea is avoided in CLD? hl
  • What are the bad prognostic signs of CLD? A
• In which liver disease, vitamin K therapy is helpful? A
• What are the principles of treatment of cirrhotic ascites? Hl
• Ascites
  • How to treat ascites in cirrhosis of liver? A, hl
  • What are the rationalities of treatment of ascites? Hl
  • Will you prefer paracentesis or TIPSS in refractory ascites? A
  • What is the treatment of refractory ascites? Hl
• Hepatic encephalopathy
  • What are the principles of management of hepatic encephalopathy? Hl
  • Tell the management of hepatic encephalopathy? Hl
  • What is the mechanism of action of lactulose in hepatic encephalopathy? Hl
• Portal hypertension
  • What is the management of portal hypertension? hl
  • What is the emergency management of variceal bleeding? Hl
  • How can you prevent recurrent bleeding? Hl
  • How can you prevent initial variceal bleeding? Hl

Complications

• What are the complications of cirrhosis of liver? A
• What are the complications of CLD? hl
• What are the complications of ascites in CLD? A, h56
• What are the complications of ascites? Hl
• What is the management of portal hypertension? Hl

Related topics a

• Portosystemic anastomosis
• Spider angioma
• Venous stars
• Palmar erythema (liver palm)

Portosystemic encephalopathy (PSE) or hepatic precoma

• What are the differential diagnoses of PSE? A
• How to diagnose PSE in early stage? A
• What is the mode of action of lactulose? a

Definition

• Define hepatitis. H4
• What is HBsAg carrier? H34
• What are the hepatotropic viruses? Hl
• What is acute (fulminating) hepatic failure? Hl
  • Tell the classification of acute liver failure. Hl
• What is fulminant hepatic failure? H106

Epidemiology

• How many patients with hepatitis B virus infection develop chronicity? Hl

Etiology and Pathophysiology

• What are the common causes of hepatitis? Hl
  • Name the drugs causing hepatitis. Hl
  • What are the viruses causing hepatitis? A, h7
  • What are the hepatotropic viruses? H8
• Classify viral hepatitis./ What is the clinical classification of viral hepatitis? H9,hl
  • What are the genomic types of hepatitis viruses? Hl
  • What are the common causes of acute viralhepatitis? hl
  • Can HDV itself cause disease? H13
  • What is the mode of transmission of each virus? Hl
  • What is feco-oral route? Hl
  • How HBsAg is transmitted vertically? H35
  • Does hepatitis C virus cause acute hepatitis? H44
• What are the causes of acute hepatitis? A
• Which hepatitis viruses cause acute viral hepatitis? H10
• What are the causes of chronic hepatitis? A
• Which hepatitis viruses cause chronicity? Hl
• What are the causes of acute liver failure? Hl

Clinical manifestations

• What is the classical patterns of acute viral hepatitis? H16
• What is the classical presentations of acute viral hepatitis? hl
• What is the presentation of hepatitis C virus infection? H43
• What are the features of FHF? Hl

Examinations

• Q

Investigations

• What investigations do you suggest in acute viral hepatitis? A, hl
• What are the markers of HBV infection? A
• Can you tell significance of antigen and antibody of HBV? H18
• What are the markers of B virus replication? A
• What are the components of liver function tests? H19
• What is window period? Which marker will be found in this period? H20

Diagnosis

• What are the points in favour of your diagnosis? hl
• What are your differential diagnoses? A
• Why is this not obstructive jaundice? A
• Why is ths not CCF? Hl
• Why not hemolytic jaundice? A
• Why is this not liver abscess? Hl
  • When does jaundice occur in liver abscess? Hl
• What history should be taken in acute viral hepatitis? A
• A 15-year-old boy is diagnosed, he is suffering from acute viral hepatitis but HBsAg is negative. Which virus will you think next? H24
  • Why? H25
• A 35-year-old lady is diagnosed, he is suffering from acute viral hepatitis but HBsAg is negative. Which virus will you think next? H27
  • Why? H28
  • Suppose this lady is pregnant, what is your concern? H29
• A patient got admitted in the hospital with jaundice; suddenly he developed unconsciousness, what are the probable causes? H104

Treatment

• How would you treat a patient with acute viral hepatitis? A, hl
• What is the indication of hospital admission? Hl
• What is the prognosis of acute viral hepatitis? A
• What is the prognosis of acute hepatitis due to hepatitis A? hl
• What is the prognosis of acute hepatitis due to hepatitis E? hl
• How to treat chronic HBV infection? A
  • What are the drugs used to treat chronic hepatitis B? h32
  • Tell the indications of antiviral therapy. H33
  • How to treat a patient with incidental finding of positive HBsAg? A
  • How will you manage a case of HBsAg positive pregnancy? H36
• What is the management of hepatitis C virus infection? H45
• What are the principles of management of FHF? Hl
• What are the principles of management of hepatic encephalopathy? Hl

Prevention

• Against which viruses’ vaccine is available? Hl
• How can you prevent HBV infection? H38
• Can you tell about the route of administration, time schedule and booster dose, duration of protection of vaccine? H39
• Tell Ab response after vaccination? H40
• Which group of patient couldn’t achieve the protection? H41
• What are the other causes of ineffectiveness of vaccine? H42

Complications

• What are the complications of acute viral hepatitis? A, hl
• What are the fates of hepatitis B virus infection? Hl

Features of different virus causing hepatitis a

• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)

Discussion on Weil’s Disease (Leptospirosis)

• What is Weil’s disease? What is it’s mode of infection, clinical features, investigation and treatment? a

Definition

• What do you mean by IBD? Hl
• Which diseases are included under IBD? hl
• What is Crohn’s disease? a
• What is ulcerative colitis? A
• What is a pseudopolyp? A
• What are the types of ulcerative colitis? A
• What is toxic megacolon? A
• Name some diseases which affect the terminal ileum? H112

Epidemiology

• Q

Etiology and Pathophysiology

• Crohn’s disease
  • What are the causes of Crohn’s disease? A
  • What are the sites of Crohn’s disease? A, hl
  • What are the characteristics of lesions in Crohn’s disease? Hl
  • What is the relation of smoking in IBD? A
  • What are the types of arthritis in Crohn’s disease? A
  • What are the causes of fistula in abdominal wall? A
• Ulcerative colitis
  • What is the site of involvement in ulcerative colitis? A, hl
  • What are the characteristics of lesions in ulcerative colitis? Hl

Clinical manifestations

• What are the presentations of Crohn’s disease? A
• What are the extra-intestinal manifestations of Crohn’s disease? A
• What extraintestinal features are associated with active disease of IBD? Hl
• What is the most common presentation of ulcerative colitis? Hl

Examinations

• How to assess the activity of Crohn’s disease? A
• What are the features of severe ulcerative colitis? Hl

Investigations

• How will you investigate this patient? hl
• What investigations should be done in Crohn’s disease? A
• How will you investigate a case of ulcerative colitis? a

Diagnosis

• Why do you consider IBD? hl
• What are your differential diagnoses? A
  • Why is this not colorectal carcinoma? hl
• What are the differential diagnoses of Crohn’s disease? A
• What are the differences between ulcerative colitis and Crohn’s disease? A, h108
• How to suspect malignancy in ulcerative colitis? a

Treatment

• How will you treat this patient? hl
• What are the drugs used in the treatment of IBD? Hl
• How to treat Crohn’s disease? A
• How to treat ulcerative colitis? A
• How can you manage severe/fulminant ulcerative colitis? Hl
• How to treat ulcerative colitis in pregnancy? A
• What surgery is done? a
• How to treat toxic megacolon? a

Complications

• What are the complications of inflammatory bowel disease? hl
• What are the complications of Crohn’s disease? A
• What are the complications of ulcerative colitis? A