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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_40_библиотеки_им_акад_М_И_Перельмана
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NORMAL RANGES
Immunology/ Rheumatology
serum complement C3 mg/ dL (65– 90)
serum complement C4 mg/ dL (5– 50)
total serum haemolytic complement activity CH50 U/ L (50– 250)
serum C- reactive protein mg/ L (< 0)
serum immunoglobulin G g/ L (6.0– 3.0)
serum immunoglobulin A g/ L (0.8– 3.0)
serum immunoglobulin M g/ L (0.4– 2.5)
serum immunoglobulin E kU/ L (< 20)
serum immunoglobulin D mg/ L (20– 20)
serum immunoglobulin G4 g/ L (0.08– .30)
serum β2- microglobulin mg/ L (< 3)
serum mast cell tryptase ( hour post- reaction) μg/ L (2– 4)
Autoantibodies
anti- acetylcholine- receptor antibodies
anti- adrenal antibodies (negative at :0 dilution)
anticentromere antibodies (negative at :40 dilution)
anticardiolipin antibodies:
immunoglobulin G U/ mL (< 23)
immunoglobulin M U/ mL (< )
anti- cyclic citrullinated peptide antibodies
anti- double- stranded DNA antibodies (ELISA) U/ mL (< 73)
anti- glomerular basement membrane antibodies
anti- lactoferrin antibodies
anti- neutrophil cytoplasmic antibodies:
c- ANCA
p- ANCA
PR3- ANCA U/ mL (< 0)
MPO- ANCA U/ mL (< 0)
antinuclear antibodies (negative at :20 dilution)
extractable nuclear antigen
gastric parietal cell antibodies (negative at :20 dilution)
intrinsic factor antibodies
interstitial cells of testis antibodies (negative at :0 dilution)
anti- Jo- antibodies
anti- La antibodies
antimitochondrial antibodies (negative at :20 dilution)
anti- RNP antibodies
anti- Scl- 70 antibodies
anti- Ro antibodies
anti- skeletal muscle antibodies (negative at :60 dilution)
anti- Sm antibodies
anti- smooth muscle antibodies (negative at :20 dilution)
anti- thyroid colloid and microsomal antibodies (negative at :0 dilution)
anti- gliadin antibodies IU/ L (< 0)
anti- endomysial antibodies
NORMAL RANGES
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anti- tissue transglutaminase antibodies U/ mL (< 5)
rheumatoid factor kIU/ L (< 30)
antistreptolysin titre IU/ mL (< 200)
Hepatitis virus serology
HBs Ag IU/ mL (lower detection limit 50)
HBV DNA IU/ mL (lower detection limit 250)
Hepatitis B genotype A– H
HCV RNA IU/ mL (lower detection limit 5)
Hepatitis C genotype – 6
Tumour markers
serum α- fetoprotein kU/ L (< 0)
serum carcinoembryonic antigen μg/ L (< 0)
serum neuron- specic enolase μg/ L (< 2)
serum prostate- specic antigen
males < 40years of age μg/ L (< 2)
males > 40years of age μg/ L (< 4)
serum β- human chorionic gonadotropin U/ L (< 5)
serum CA 25 U/ mL (< 35)
serum CA 9– 9 U/ mL (< 33)
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Viral loads
cytomegalovirus viral load copies/ mL (lower detection limit 400)
Epstein– Barr viral load copies/ mL (lower detection limit 250)
hepatitis B viral load IU/ mL (lower detection limit 250)
hepatitis C viral load IU/ mL (lower detection limit 5)
HIV viral load copies/ mL (lower detection limit 40)
human herpesvirus- 6 viral load copies/ mL (lower detection limit 50)
human herpesvirus- 8 viral load copies/ mL (lower detection limit 50)
Therapeutic drug concentrations
plasma carbamazepine μmol/ L (34– 5)
blood ciclosporin nmol/ L (00– 50)
blood tacrolimus
≤2months following transplant nmol/ L (8– 2)
> 2months following transplant nmol/ L (5– 0)
plasma digoxin (taken at least 6 hours post- dose) nmol/ L (.0– 2.0)
serum gentamicin (peak) mg/ L (5– 7)
pre- dose mg/ L (< )
hour post- dose mg/ L (3– 5)
serum vancomycin (trough) mg/ L (0– 5)
serum lithium mmol/ L (0.5– .2)
serum phenobarbital μmol/ L (65– 72)
serum phenytoin μmol/ L (40– 80)
serum primidone μmol/ L (23– 55)
plasma theophylline μmol/ L (55– 0)
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NORMAL RANGES
Cerebrospinal uid
opening pressure
total protein
albumin
chloride
glucose
lactate
cell count
white cell count
red cell count
lymphocyte count
neutrophil count
immunoglobulin G:albumin ratio
immunoglobulin index
Synovial uid
white cell count / mL (< 200)
Pulmonary function
transfer factor for CO (TLCO)
transfer coecient (KCO)
mmH2O (50– 80)
g/ L (0.5– 0.45)
g/ L (0.066– 0.442)
mmol/ L (6– 22)
mmol/ L (3.3– 4.4)
mmol/ L (.0– 2.0)
/ μL (≤5)
/ μL (≤5)
/ μL ( 0)
/ μL (≤3.5)
/ μL ( 0)
(≤0.26)
(≤0.88)
% (80– 20) mmol/ minute/ kPa % (00)
mmol/ minute/ kPa
Cardiac pressures
mean arterial pressure
mean right atrial pressure
mean pulmonary arterial pressure
mean pulmonary arterial wedge pressure
mean cardiac output
Hepatic venous pressures
portal venous pressure
hepatic venous pressure
hepatic venous pressure gradient
ECG measurements
PR interval
QRS complex
Ascites
white cell count < 250 cells/ mm
3
mmHg (96)
mmHg (3)
mmHg (5)
mmHg (9)L/ min (5)
mmHg (4– 8)
mmHg (2– 4)
mmHg (< 5)
ms (20– 200)
ms (40– 20)
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chapter
GASTROINTESTINALHAEMORRHAGE
1. A 52- year- old man presented to the emergency department reporting
QUESTIONS
black, tarry stools. He had a history of gastric bypass surgery seven years
ago for obesity but no other comorbidities. He had been using ibuprofen
for back pain. Pulse was 110 beats per minute and blood pressure 100/
58mmHg.
Investigations:
Haemoglobin 95 g/ L
Mean corpuscular volume (MCV) 78 fL
Platelet count 395 × 109/ L
Serum urea 14mmol/ L
Serum creatinine 80 µmol/ L
Prothrombin time 13 seconds
Which of these contributes to the Glasgow- Blatchford score (GBS)?
A. Platelet count
B. Presentation with melaena
C. Previous gastric bypass surgery
D. Prothrombin time
E. Use of non- steroidal anti- inammatory drugs (NSAIDs)
Best of Five MCQs for the European Specialty Examination in Gastroenterology and Hepatology. Thomas Marjot, Colleen G C McGregor,
Tim Ambrose, Aminda N De Silva, Jeremy Cobbold, and Simon Travis, Oxford University Press (2021). © Oxford University Press.
DOI: 10.1093/oso/9780198834373.003.0001
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CHAPTER | GASTROINTESTINALHAEMORRHAGE
2. A 23- year- old woman presented after her housemate noticed blood-
stained vomit in the bathroom. She had been drinking heavily the night
before but was no longer intoxicated. She reported a few episodes of
loose, brown stools and nausea, but was able to tolerate oral uids.
Physical examination was unremarkable. She was afebrile with blood
pressure of 122/ 74mmHg and pulse 86 beats per minute.
Investigations:
Haemoglobin 133 g/ L
Platelet count 289 × 109/ L
Serum sodium 143mmol/ L
Serum potassium 3.6mmol/ L
Serum urea 5.4mmol/ L
Serum creatinine 115 µmol/ L
What is the most appropriate management?
A. Admit for overnight observation
B. Discharge with outpatient gastroscopy
C. Intravenous uids and anti- emetic
D. Intravenous proton pump inhibitor (PPI) infusion
E. Urgent inpatient gastroscopy
CHAPTER | QUESTIONS
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3. A 42- year- old man presented to the emergency department with
haematemesis and melaena. He had a past medical history of gout and
had recently increased his dose of ibuprofen.
Investigations:
Gastroscopy See Fig. 1.1
3
Fig.1.1 Endoscopic image of the second part of the duodenum. See also Plate 1
Which Forrest classication best describes this lesion?
A. Ia
B. Ib
C. IIa
D. IIc
E. III
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CHAPTER | GASTROINTESTINALHAEMORRHAGE
4. A 45- year- old man presented with melaena. He smoked 20 cigarettes
per day. He was otherwise t and well, and not taking any regular
medication.
Investigations:
Gastroscopy Duodenal ulcer with a clean base (Forrest III)
With regard to duodenal ulcers, which of the following statements
is true?
A. Duodenal ulcers are an infrequent cause of gastrointestinal bleeding
B. Gastric ulcers have a higher risk of perforation
C. PPI infusion given before endoscopy reduces risk of re- bleeding
D. Routine follow- up gastroscopy is required because of high risk of malignancy
E. Most duodenal ulcers are associated with Helicobacter pylori
5. A 63- year- old woman underwent urgent gastroscopy for weight loss,
dyspepsia, and melaena. She had a history of type 2 diabetes but with
good performance status.
Investigations:
Haemoglobin 54 g/ L
Gastroscopy Partially obstructing pyloric tumour with active
diuse bleeding
Staging computed tomography (CT) Not yet performed
How should the bleeding be controlled?
A. Adrenaline injection alone
B. Adrenaline injection with placement of multiple clips
C. Bipolar coagulation
D. Haemostatic powder
E. Pyloric stent placement
CHAPTER | QUESTIONS
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6. A 73- year- old man with a history of cirrhosis presented with large-
volume haematemesis. Emergency endoscopy revealed three columns
of Grade 3 oesophageal varices with active bleeding. Despite band
ligation, the patient continued to bleed and was not stable for transfer
to his local hepatology unit for consideration of porto- systemic shunting.
Which one of the following statements about management of refractory
variceal bleeding is true?
A. Balloon tamponade can be safely used for three days
B. Patients must be kept nil by mouth once a self- expanding metal stent (SEMS) has been
inserted and the bleeding controlled
C. SEMS is as eective and safer than balloon tamponade
D. SEMS can be useful for managing refractory gastric variceal bleeding
E. SEMS can only be inserted under direct endoscopic guidance
7. A 54- year- old man with Hepatitis C virus- related cirrhosis presented
with haematemesis and syncope. Following resuscitation, he underwent
urgent gastroscopy.
Investigations:
Gastroscopy Two columns of Grade 2 oesophageal varices, not bleeding, no
red spots. Large varix extending from oesophagus into fundus and
What is the most appropriate next management step?
A. Adrenaline injection + clip placement
B. Cyanoacrylate injection
C. Insertion of a Sengstaken- Blakemore tube
D. Transjugular intrahepatic porto- systemic shunt (TIPSS)
E. Variceal band ligation
towards the greater curvature with active bleeding
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CHAPTER | GASTROINTESTINALHAEMORRHAGE
8. A 69- year- old man presented with breathlessness and a one- week
history of melaena. He had a background of a metallic mitral valve
replacement and was on warfarin. Blood pressure was 110/ 65mmHg
with pulse 88 bpm. He had a similar presentation two months previously
with a normal gastroscopy. Outpatient colonoscopy to the caecum
showed minor sigmoid diverticulosis but no cause of bleeding was found.
Bowel preparation was excellent.
Investigations:
Haemoglobin 75 g/ L
MCV 69 fL
Serum urea 7.6mmol/ L
Serum creatinine 70 µmol/ L
INR 3.2
Repeat gastroscopy Normal
What is the next most appropriate investigation?
A. CT angiogram
B. CT colonoscopy
C. Magnetic resonance enterography
D. Red cell scintigraphy
E. Video capsule endoscopy (VCE)
9. An 83- year- old woman presented with symptomatic anaemia.
Eight units of red blood cells had been transfused in the past two
months. Gastroscopy was normal but colonoscopy revealed bleeding
angiodysplasia in her ascending colon, which was treated with argon
plasma coagulation.
Which of the following investigations would be most important to
arrange?
A. Echocardiogram
B. Factor VIII levels
C. Hepatic elastography
D. HIV test
E. Renal ultrasound
CHAPTER | QUESTIONS
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7
10. An 81- year- old man presented with large- volume rectal bleeding in the
absence of haematemesis. He had a past history of diverticular disease.
On examination, he was tender in the left iliac fossa. Dark red blood
with clots were identied on digital rectal examination. No melaena was
seen. He received 2 litres of intravenous crystalloid and a transfusion of
2 units of red blood cells.
Investigations (after initial resuscitation):
Heart rate 106 bpm
Blood pressure 99/ 64mmHg
What is the most appropriate next investigation?
A. Abdominal radiograph
B. Colonoscopy
C. CT angiography
D. Gastroscopy
E. Magnetic resonance angiography
11. A 19- year- old man presented with recurrent melaena and abdominal
pain. Previous gastroscopies and colonoscopies had been normal. His
heart rate was 128 bpm and blood pressure 114/ 58mmHg.
Investigations:
CT mesenteric
angiography
Regarding the likely diagnosis, which of the following is true?
A. Ectopic pancreatic tissue is most commonly identied
B. Nuclear medicine scanning with 99m technetium pertechnetate can be diagnostic
C. Symptomatic disease can usually be managed medically
D. These lesions are usually found in the middle third of the ileum
E. This is a rare congenital malformation with a prevalence of less than 0.0%
Aberrant branch of the superior mesenteric artery and active
contrast extravasation 40cm upstream of the ileocaecal valve
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