Infection, nutrition & pregnancy flashcards
14 high-yield MRCP Part 1 cards from the Intellect Medicos Gastroenterology & Hepatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Profuse vomiting starts 1–6 hours after a meal of reheated fried rice. Which organism is most likely?
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Bacillus cereus.
Why? Its spores survive cooking and make a preformed emetic toxin when rice is left warm. Staphylococcus aureus toxin also causes vomiting within 1–6 hours.
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If antibiotics are needed for Campylobacter enteritis, which is first-line?
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Clarithromycin (a macrolide).
Why? Most cases settle with fluids alone. Campylobacter often has a flu-like prodrome, bloody diarrhoea and RIF pain.
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What is the first-line treatment for a FIRST episode of C. difficile infection (mild, moderate or severe) under NICE?
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Oral vancomycin 125 mg four times a day for 10 days.
Why? Oral vancomycin is not absorbed, so it reaches high concentrations in the colon. Stop the causative antibiotic if possible.
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What is used for C. difficile if vancomycin is ineffective, or for a relapse within 12 weeks?
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Fidaxomicin 200 mg twice a day for 10 days.
Why? Fidaxomicin is a narrow-spectrum macrocyclic antibiotic that spares the normal flora, so it lowers recurrence.
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What antibiotic regimen is used for life-threatening C. difficile infection?
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Oral vancomycin 500 mg four times a day plus IV metronidazole 500 mg three times a day, with urgent surgical review.
Why? IV metronidazole reaches the colon even when ileus stops oral drugs getting there; rectal vancomycin may be added with ileus.
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Name three classes of drug that increase the risk of C. difficile infection.
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Any three of: clindamycin, cephalosporins (2nd/3rd generation), co-amoxiclav, quinolones, PPIs.
Why? Broad-spectrum antibiotics destroy normal colonic flora; PPIs reduce the acid barrier to spores.
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What is the hallmark biochemical abnormality of refeeding syndrome?
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Hypophosphataemia (with hypokalaemia and hypomagnesaemia).
Why? Carbohydrate triggers an insulin surge that drives phosphate, potassium and magnesium into cells, where phosphate is used to make ATP.
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In a patient at HIGH risk of refeeding syndrome, how should feeding start (NICE)?
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Give thiamine and vitamin B complex before feeding, then start at no more than 10 kcal/kg/day and build up to full needs over 4–7 days.
Why? Slow introduction limits electrolyte shifts; thiamine prevents Wernicke's as carbohydrate metabolism restarts. Extremely high risk (BMI under 14 or no intake for over 15 days): 5 kcal/kg/day with cardiac monitoring.
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NICE: offer bariatric surgery referral for BMI of ______, or 35–39.9 with a significant condition likely to improve with weight loss; expedite assessment for BMI 35 or more with type 2 diabetes diagnosed within the last 10 years.
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40 or more
Why? Surgery gives the largest, most durable weight loss and can put type 2 diabetes into remission. Sleeve gastrectomy is the most common UK procedure.
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NICE: offer bariatric surgery referral for BMI of 40 or more, or 35–39.9 with a significant condition likely to improve with weight loss; expedite assessment for BMI 35 or more with type 2 diabetes diagnosed within the last ______.
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10 years
Why? Surgery gives the largest, most durable weight loss and can put type 2 diabetes into remission. Sleeve gastrectomy is the most common UK procedure.
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Late dumping syndrome (1–3 hours after meals) after gastric bypass causes which problem, and which drug can help?
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Reactive hypoglycaemia; acarbose, which delays carbohydrate absorption.
Why? Rapid glucose absorption triggers an exaggerated insulin release. Early dumping (10–30 minutes) is due to fluid shifts and causes vasomotor and GI symptoms.
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A 34-week primigravida with twins has vomiting, RUQ pain and jaundice. Glucose is 2.8 mmol/L, INR is 2.1 and ALT is 350 IU/L. What is the diagnosis and the definitive treatment?
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Acute fatty liver of pregnancy – prompt delivery of the baby (with supportive care: IV glucose, correct coagulopathy).
Why? Microvesicular fatty infiltration causes liver failure; hypoglycaemia and coagulopathy/DIC are key clues that separate it from HELLP.
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Intrahepatic cholestasis of pregnancy = itching (palms and soles, worse at night, no rash) with bile acids of ______; planned birth at 35–36 weeks is considered when peak bile acids reach 100 µmol/L or more.
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19 µmol/L or more
Why? The risk is to the fetus (stillbirth), which rises with bile acid levels; maternal risk is low and it resolves after delivery.
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Intrahepatic cholestasis of pregnancy = itching (palms and soles, worse at night, no rash) with bile acids of 19 µmol/L or more; planned birth at 35–36 weeks is considered when peak bile acids reach ______.
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100 µmol/L or more
Why? The risk is to the fetus (stillbirth), which rises with bile acid levels; maternal risk is low and it resolves after delivery.