Stomach, H. pylori & GI hormones flashcards
18 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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What are the first-line tests for Helicobacter pylori in a patient with dyspepsia?
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Carbon-13 urea breath test or stool antigen test.
Why? Both detect current infection. H. pylori makes urease, which splits the labelled urea into labelled CO2 that is breathed out.
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Before testing for H. pylori, stop PPIs for ______ and antibiotics for 4 weeks.
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2 weeks
Why? Both suppress the organism and cause false-negative breath and stool tests.
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Before testing for H. pylori, stop PPIs for 2 weeks and antibiotics for ______.
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4 weeks
Why? Both suppress the organism and cause false-negative breath and stool tests.
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What is the first-line H. pylori eradication regimen in a patient without penicillin allergy?
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7 days of a PPI plus amoxicillin plus either clarithromycin or metronidazole (all twice daily).
Why? Two antibiotics reduce resistance and the PPI raises gastric pH so the antibiotics work better.
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What is the first-line H. pylori eradication regimen in a penicillin-allergic patient?
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7 days of a PPI plus clarithromycin plus metronidazole.
Why? Amoxicillin is replaced so that two non-penicillin antibiotics are still used together.
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If a test of cure for H. pylori is needed after eradication, which test is used?
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Carbon-13 urea breath test.
Why? It shows whether live organisms remain. Stop the PPI for 2 weeks beforehand.
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What is the first-line treatment for low-grade gastric MALT lymphoma?
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H. pylori eradication therapy.
Why? The lymphoma is driven by chronic H. pylori antigen stimulation; most early tumours regress once the organism is cleared.
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Which histological cell type is characteristic of diffuse-type gastric adenocarcinoma ('linitis plastica')?
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Signet ring cells.
Why? Mucin pushes the nucleus to the edge of the cell. Diffuse infiltration makes the stomach rigid, like a 'leather bottle'.
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Gastric cancer can spread to the left supraclavicular node (______), the umbilicus (Sister Mary Joseph nodule) and the ovaries (Krukenberg tumour).
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Virchow's node
Why? These eponymous metastases are classic exam clues. The liver is the most common site of metastasis overall.
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Gastric cancer can spread to the left supraclavicular node (Virchow's node), the umbilicus (Sister Mary Joseph nodule) and the ovaries (______).
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Krukenberg tumour
Why? These eponymous metastases are classic exam clues. The liver is the most common site of metastasis overall.
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What is the first-line blood test for suspected Zollinger–Ellison syndrome?
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Fasting serum gastrin (markedly raised, often more than 10 times the upper limit of normal).
Why? A gastrinoma secretes gastrin autonomously, causing parietal cell hyperplasia, massive acid output and multiple or refractory ulcers.
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Which dynamic test confirms Zollinger–Ellison syndrome?
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Secretin stimulation test: gastrin RISES after IV secretin.
Why? Secretin normally suppresses gastrin release; gastrinoma cells respond paradoxically.
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Which type of hiatus hernia carries a risk of gastric volvulus and strangulation?
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Para-oesophageal (rolling) hiatus hernia.
Why? The fundus rolls up beside the oesophagus while the GO junction stays in place, so it can twist. Sliding hernias mainly cause reflux and Barrett's.
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Which antibody is the most specific test for pernicious anaemia?
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Anti-intrinsic factor antibody.
Why? Anti-parietal cell antibodies are more common (more sensitive) but much less specific. Serum gastrin is raised because acid is low.
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What is the B12 regimen for pernicious anaemia WITH neurological involvement?
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IM hydroxocobalamin 1 mg on alternate days until no further improvement, then 1 mg every 2 months for life.
Why? Neurological damage (subacute combined degeneration) needs more intensive replacement than anaemia alone.
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Gut hormone cells: gastrin from ______ of the antrum; CCK from I cells of the duodenum/jejunum; secretin from S cells of the duodenum.
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G cells
Why? Gastrin drives acid; CCK contracts the gallbladder and releases pancreatic enzymes; secretin releases pancreatic bicarbonate.
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Gut hormone cells: gastrin from G cells of the antrum; CCK from ______ of the duodenum/jejunum; secretin from S cells of the duodenum.
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I cells
Why? Gastrin drives acid; CCK contracts the gallbladder and releases pancreatic enzymes; secretin releases pancreatic bicarbonate.
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Gut hormone cells: gastrin from G cells of the antrum; CCK from I cells of the duodenum/jejunum; secretin from ______ of the duodenum.
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S cells
Why? Gastrin drives acid; CCK contracts the gallbladder and releases pancreatic enzymes; secretin releases pancreatic bicarbonate.