3 GI

Question 1

Esophageal food impaction

-when to do endoscopy

Answer 1

if food not passed within 12-24h

can try glucagon 1-2mg

Question 2

hepatitis A,B,C

incubation times

Answer 2

A: 15-50 days, think 1month

B: 1-3 months

C: 2 months

Question 3

If patient has/is exposed to Hep A, do what?

Answer 3

can give Hep A immune globulin within 2 weeks of exposure

Question 4

Pt in ED with Hep B exposure, and not vaccinated, do what?

Answer 4

If within 14 days, give IG

Also can give the vaccination

Question 5

RUQ US:

normal CBD diameter

Answer 5

5mm, add 1mm for each 10y above 50

Question 6

scombroid vs ciguatera

-what kind of fish

Answer 6

tuna, mackerel, bonito

ciguatera: grouper, snapper, barracuda

Question 7

Pt in ED has water diarrhea and took abx 2 months ago.

Can they have C Diff? what is C Diff time course

Answer 7

usu 7-10d

however up to 60d after abx

Question 8

What do irreducible hernias get mistaken for the most?

Answer 8

enlarged lymph nodes

Question 9

Hernias:

direct, indirect

Answer 9

direct: older people, acquired
indirect: younger people, congenital opening

Question 10

spigelian hernia

Answer 10

Lateral ventral hernia, lateral to rectus

high rates of incarceration

Question 11

obturator hernia

Answer 11

Elderly female with Medial thigh pain from obturator nerve compression (howship romberg sign)

perf 50%, death 20%

Rare.

Question 12

appendicitis

What diameter on ultrasound?

Answer 12

more than 6mm

also check for perappendiceal fluid, fat stranding, appendicolith

Question 13

causes of SBO

Answer 13

HANG IV
hernia, adhesions

neoplasm, gallstone ileus

intussuception, volvulus

Question 14

Sigmoid vs Cecal volvulus

• who gets what
• appearances

Answer 14

look at the picture

Question 15

perirectal abscess

you drained and are sending pt home

How to teach proper hygiene?

Answer 15

WASH regimen

Warm water (sitz baths 15min tid)

Anesthetic–eg topical lidocaine

Stool softener

High fiber

Question 16

Perirectal abscess

who to image first?

Answer 16

People higher risk for fistulas and deep space infections

Elderly, diabetes, systemic sxs, leukocytosis, immunocompromised

Question 17

anal fissure:

if not midline, think what?

Answer 17

autoimmune (eg crohns), malignancy, STI, trauma/abuse

Question 18

Spleen issues

-what to remember

Answer 18

Too big or too small

Asplenia: sickle cell, post-trauma

Splenomegaly: “BIG”

Backed up (cirrhosis)

Infection (eg EBV)

Genetic (sickle cell sequestration, hematologic cancer)

Question 19

Pt with mono

how long to not play sports

Answer 19

3 weeks

Question 20

Splenic sequestration

-what to expect to see on labs

Answer 20

Hgb drop>2

low platelets

high retic count