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ABIM 2015 > ABIM 2015 - Gastro > Flashcards

ABIM 2015 - Gastro Flashcards

1
Q

Condition which presents with oropharyngeal dysphagia with aspiration, neck mass and regurgitation of foul-smelling food?

A

Zenker diverticulum

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2
Q

Condition which presents with oropharyngeal dysphagia with aspiration, neck mass and regurgitation of foul-smelling food?

A

Zenker diverticulum

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3
Q

What does recurrent pneumonia signal in an elderly patient or a patient suffering from a neurological or muscular disorder?

A

Dysphagia with aspiration

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4
Q

What is the diagnostic first-line test of choice for oropharyngeal dysphagia?

A

Video fluoroscopy (modified barium swallow)

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5
Q

What is the diagnostic test of choice for esophageal dysphagia?

A

EGD

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6
Q

What is the diagnostic test of choice for esophageal dysphagia?

A

EGD

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7
Q

When a patient with possible GERD c/o chest pain, what must be done first?

A

Rule out cardiac cause

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8
Q

What is the diagnostic test of choice for odynophagia?

A

EGD

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9
Q

What is the diagnostic test of choice for odynophagia?

A

EGD

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10
Q

What is the innervation of the esophagus and what is the resting state of the sphincters?

A

Vagus nerve; Tonically closed

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11
Q

What is the primary screening test for achalasia? What test is REQUIRED for confirmation?

A

Barium radiography (barium swallow); Manometry

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12
Q

What is the condition called when there is an obstruction at the distal esophagus due to malignancy?

A

Pseudoachalasia

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13
Q

After a myotomy performed for achalasia, what other procedure is often performed to prevent GERD?

A

Nissen fundoplication

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14
Q

What are two non-surgical options for the treatment of achalasia?

A

Repeated balloon dilation or BOTOX

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15
Q

What is the first line treatment for diffuse esophageal spasm?

A

Calcium Channel Blockers

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16
Q

What meds are most successfully used to treat symptoms of diffuse esophageal spasm (dysphagia, chest pain)?

A

Trazodone, imipramine, BOTOX

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17
Q

What meds are most successfully used to treat symptoms of diffuse esophageal spasm (dysphagia, chest pain)?

A

Trazodone, imipramine, BOTOX

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18
Q

What type of motility disorder do meds like narcotics and diseases like scleroderma cause?

A

HYPOmotility disorders

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19
Q

The COMBINATION of manometrically-determined aperistalsis of the esophagus AND a HYPOtensive lower esophageal sphincter is?

A

Scleroderma esophagus

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20
Q

The COMBINATION of manometrically-determined aperistalsis of the esophagus AND a HYPOtensive lower esophageal sphincter is?

A

Scleroderma esophagus

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21
Q

What is the treatment for scleroderma esophagus?

A

Treatment of underlying disease and GERD

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22
Q

What is the treatment for scleroderma esophagus?

A

Treatment of underlying disease and GERD

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23
Q

What are the three most common types of infectious esophagitis?

A

Candida, HSV and CMV

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24
Q

Why can the use of corticosteroids, azathioprine and TNF-alpha inhibitors cause esophagitis?

A

These cause immunosuppression in immunocompetent individuals

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25
Q

Infectious esophagitis with isolated ulcer(s)? How is diagnosis made?

A

CMV esophagitis, biopsy of ulcer BASE

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26
Q

Infectious esophagitis with multiple superficial ulcers? How is diagnosis made?

A

HSV esophagitis, biopsy of ulcer edges

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27
Q

Infectious esophagitis with multiple superficial ulcers? How is diagnosis made?

A

HSV esophagitis, biopsy of ulcer edges

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28
Q

How is HSV esophagitis treated? CMV esophagitis?

A

HSV: acyclovir; CMV: gancyclovir

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29
Q

What portion of the heart makes an indentation on the esophagus?

A

LEFT atrium

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30
Q

Tetracycline, Iron Sulfate, bisphosphonates, NSAIDS, potassium and quinidine all have this potential esophageal disorder in common?

A

Pill-induced esophagitis

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31
Q

What disease MUST be excluded prior to initiation treatment for Eosinophilic Esophagitis?

A

GERD (by pH monitoring or lack of therapeutic response to 6-week trial of BID PPI), because it too can present with >15 eosinophils/hpf

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32
Q

Excessive number of LES relaxations not initiated by swallowing and formation of a hiatal hernia can cause?

A

GERD

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33
Q

What do Xerostomia (decreased formation of saliva), Scleroderma, Nicotine use and Obesity have in common?

A

These can all exacerbate GERD

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34
Q

What combination of symptoms is sufficient to diagnose GERD?

A

Heartburn, regurgitation or both

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35
Q

Dysphagia, Anemia, Vomiting, Weight loss?

A

ALARM symptoms of GERD indicating EGD work-up

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36
Q

What is the next diagnostic step for a patient who had no response to PPI for GERD and had a negative EGD?

A

Ambulatory pH monitoring/impedance monitoring

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37
Q

What should be recommended to ALL patients with long-term PPI therapy (daily or BID dosing regimens)?

A

Adequate calcium + Vitamin D intake

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38
Q

After successful anti-reflux surgery, GERD symptoms usually return within how many years?

A

5-10 (repeat surgery success rates are much lower)

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39
Q

Does anti-reflux surgery reduce risk of GERD-related adenocarcinoma?

A

NO

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40
Q

Does anti-reflux surgery reduce risk of GERD-related adenocarcinoma?

A

NO

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41
Q

When should cough, laryngitis and asthma be treated with PPI’s?

A

ONLY when associated with GERD

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42
Q

What epithelial types are changed in Barrett’s esophagus?

A

NORMAL squamous changes to ABNORMAL columnar

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43
Q

If a patient has had GERD symptoms for 11 years but no alarm symptoms, should you do EGD to evaluate for Barrett’s esophagus?

A

NO (not currently recommended)

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44
Q

What two medications/medication types confer a decreased risk of esophageal adenocarcinoma?

A

Aspirin and other NSAIDS

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45
Q

What is REQUIRED for histologic diagnosis of Barrett’s Esophagus?

A

Intestinal metaplasia AND presence of Goblet Cells

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46
Q

What is REQUIRED for histologic diagnosis of Barrett’s Esophagus?

A

Intestinal metaplasia AND presence of Goblet Cells

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47
Q

Although esophageal ADENOCARCINOMA is the predominant type of esophageal cancer, what are the risks for SQUAMOUS CELL CARCINOMA of the esophagus that are NOT found with adenocarcinoma type?

A

Alcohol, Nitrosamines (hot dogs, etc.), Zinc & Selenium deficiency, Achalasia, Tylosis (keratosis of palms and soles), HPV.

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48
Q

Although esophageal ADENOCARCINOMA is the predominant type of esophageal cancer, what are the risks for SQUAMOUS CELL CARCINOMA of the esophagus that are NOT found with adenocarcinoma type?

A

Alcohol, Nitrosamines (hot dogs, etc.), Zinc & Selenium deficiency, Achalasia, Tylosis (keratosis of palms and soles), HPV.

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49
Q

What portions of the esophagus are generally affected by SQUAMOUS CELL CARCINOMA and ADENOCARCINOMA?

A

Squamous Cell - PROXIMAL; Adenocarcinoma - DISTAL

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50
Q

BE on EGD, no dysplasia, surveillance?

A

1-yr, if no dysplasia, every 3 yrs.

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51
Q

BE on EGD, LOW-grade dysplasia, surveillance?

A

6-mo, then YEARLY.

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52
Q

BE on EGD, HIGH-grade dysplasia, surveillance?

A

EMR or Surgery, EGD every 3 months after.

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53
Q

BE on EGD, HIGH-grade dysplasia, surveillance?

A

EMR or Surgery, EGD every 3 months after.

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54
Q

How is esophageal cancer staged?

A

CT (metastases) + EUS (regional) + PET

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55
Q

What differentiates a gastric ulcer from an erosion?

A

Ulcer is >5 mm

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56
Q

Stomach pain shortly after meals NOT relieved by antacids?

A

Gastric Ulcer

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57
Q

Stomach pain 2-5 hours after a meal relieved by antacids?

A

Duodenal Ulcer

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58
Q

Stomach pain 2-5 hours after a meal relieved by antacids?

A

Duodenal Ulcer

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59
Q

Multiple ulcers beyond duodenal bulb with esophagitis and diarrhea?

A

Gastrinoma

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60
Q

A deep duodenal/gastric ulcer can affect what organ?

A

Pancreas

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61
Q

A deep duodenal/gastric ulcer can affect what organ?

A

Pancreas

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62
Q

Pt with KNOWN NSAID use and PUD, what should you still ALWAYS test for?

A

H.pylori

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63
Q

If H.pylori is POSITIVE in patient with PUD with ulcer 1 cm?

A

NONE (however some prescribe 4-8 weeks); Until H.pylori eradication testing is confirmed

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64
Q

If perforation is suspected in a patient with PUD, is EGD indicated?

A

NO!

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65
Q

If perforation is suspected in a patient with PUD, is EGD indicated?

A

NO!

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66
Q

If perforation is suspected in a patient with PUD, is EGD indicated?

A

NO!

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67
Q

When should you perform an EGD in a patient with family h/o gastrointestinal malignancy?

A

If they are symptomatic (dyspepsia, etc.) because this is considered an ALARM feature

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68
Q

When should you perform an EGD in a patient with family h/o gastrointestinal malignancy?

A

If they are symptomatic (dyspepsia, etc.) because this is considered an ALARM feature

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69
Q

In a patient younger than 50, from an area with low-risk for H.pylori infection, should you test for H.pylori if symptoms of dyspepsia are present BEFORE treating with PPI?

A

NO

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70
Q

In a patient younger than 50, from an area with low-risk for H.pylori infection, should you test for H.pylori if symptoms of dyspepsia are present BEFORE treating with PPI?

A

NO

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71
Q

What is MALT-lymphoma associated with?

A

H.pylori

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72
Q

How do PPIs, H2-blockers, antibiotics and bismuth affect H.pylori tests (except?)?

A

Decrease sensitivity, EXCEPT for Serology (IgG)

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73
Q

How do you treat H.pylori infection? PCN allergy?

A

Clarithromycin+Amoxicillin+BID PPI 10-14 days; Metronidazole

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74
Q

When post H.pylori treatment should you test for eradication when indicated (PUD, h/o gastric cancer, MALT lymphoma)?

A

4-6 weeks

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75
Q

Would you prescribe a COX-2 inhibitor in a patient with cardiovascular risk, why?

A

No (increased risk for cardiovascular ischemic events)

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76
Q

What should patients older than 50 who require chronic NSAID therapy be tested for?

A

H.pylori

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77
Q

What is compulsive hot-water bathing associated with?

A

Cannabinoid hyperemesis syndrome

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78
Q

What constitutes a POSITIVE gastric emptying study for diagnosis of gastroparesis?

A

> 60% retained food at 2 hours or >10% at 4 hours

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79
Q

What two meds can cause false-positive results with gastroparesis?

A

Opioids and Anticholinergics

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80
Q

What endoscopic therapy is available for refractory gastroparesis?

A

BOTOX injection into pylorus

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81
Q

What should you do NEXT in a patient

A

Colonoscopy to rule out FAP

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82
Q

What is the best follow-up for pts who underwent EGD and were found to have extramural lesions/compression on upper gi tract structures?

A

CT/MRI

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83
Q

CD117(c-kit protein) and CD34 expression are seen in what GI tumors? Treatment?

A

GIST; Resection +/- chemothreapy

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84
Q

How do you treat Type I, II and III gastric carcinoid tumors?

A

Types I & II with EMR if 2 cm; Type III with gastrectomy

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85
Q

What is the surveillance required after resection of a carcinoid tumor?

A

EGD in 6-12 months for 3 years

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86
Q

Ionizing radiation, heavily salted foods and a high-carbohydrate diet in the Asian population carry a hight risk of what?

A

Gastric adenocarcinoma

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87
Q

Most common bariatric procedure?

A

Roux-En-Y

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88
Q

What is the most RELIABLE indicator of an anastomotic leak after gastric bypass surgery?

A

HR >120bpm

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89
Q

The two most common causes of post-op mortality in patients who undergo bariatric surgery?

A

Venous thromboembolism and anastomotic leaks

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90
Q

What are the common vitamin and mineral deficiencies after gastric bypass surgery?

A

Iron, Vitamin A, B12, D & E and Calcium, Thiamine, Folate

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91
Q

Gastric bypass patient presents post-prandially, with abdominal distenstion, nausea, diarrhea, sweating, tremulousness and comfusion? Why?

A

Dumping syndrome; due to osmotic load from rapid emptying of refined sugars from stomach

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92
Q

What is a good predictor of severity in acute pancreatitis?

A

Persistent organ failure (hypoxemia, hypotension, renal failure)

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93
Q

How high must the elevation of amylase/lipase be for acute pancreatitis to be diagnosed?

A

3x UPPER limit of normal

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94
Q

What single lab value is the best in acute pancreatitis for prediction of severity?

A

BUN

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95
Q

What should be done with a patient with documented necrotizing pancreatitis to guide further therapy?

A

Sampling of collection

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96
Q

When should feedings begin in patient with acute pancreatitis and how?

A

ASAP; Nasojejunal

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97
Q

Why can some patients after acute pancreatitis present with gastric varices?

A

Splenic vein thrombosis (DO NOT treated with anticoagulation!)

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98
Q

How is chronic pancreatitis treated?

A

Enzyme supplements and fat-soluble vitamins

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99
Q

What type of pancreatic enzymes should be used to treat pain in chronic pancreatitis?

A

NON-enteric coated + PPIs (because otherwise they’ll be denatured by gastric acid)

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100
Q

Most important risk factor for pancreatic adenocarcinoma?

A

Age >50

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101
Q

When do patients with pancreatic cancer present with pain?

A

When tumor arrises in the BOP or TOP

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102
Q

Migratory thrombophlebitis and palpable gallbladder?

A

Pancreatic cancer

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103
Q

Is tissue sampling for pancreatic cancer necessary if imaging (CT/EUS) is characteristic of a resectable tumor?

A

NO

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104
Q

How do you treat local pancreatic adenocarcinoma without vascular invasion or mets?

A

Surgical resection + chemotherapy

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105
Q

How do you treat pancreatic adenocarcinoma with vascular invasion?

A

Neo-adjuvant chemotherapy with re-staging after therapy

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106
Q

Affected organs have a lyphoplasmacytic infiltrate rich in IgG4 and the disease responds to corticosteroid therapy or corticosteroids with 6MP or azathioprine?

A

Autoimmune Hepatitis (AIP)

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107
Q

What are all pancreatic cystic neoplasms associated with ?

A

von Hippel-Lindau disease

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108
Q

Which pancreatic cystic neoplasms have the highest malignant potential? what’s the treatment?

A

Main and combined (main and side-branch) IPMN’s; surgical resection (regardless of size)

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109
Q

When do you NOT resect a pancreatic cystic neoplasm?

A

When SIDE-branch only or not connected to duct, are LESS than 3 cm (

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110
Q

Where are mucinous cystadenomas and cystadenocarcinomas of the pancreas typically found?

A

Body and Tail of pancreas

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111
Q

What is the recommendation when pancreatic mucinous cystadenomas and cystadenocarcinomas are found?

A

Resection

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112
Q

When should pseudocysts of the pancreas be drained or resected?

A

When they cause localized symptoms or are infected

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113
Q

A pancreatic cyst HIGH in CEA is what?

A

IPMN or MUCINOUS cyst

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114
Q

Tumors of the pancreas associated with MEN-I and von Hippel-Lindau disease?

A

Pancreatic neuroendocrine tumors

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115
Q

Which is the most common pancreatic neuroendocrine tumor?

A

Gastrinoma

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116
Q

How are gastrinomas treated? What if they are metastatic?

A

Resection; Acid suppression (PPI) + Octreotide (to suppress diarrhea)

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117
Q

What imaging technique can be used to detect pancreatic neuroendocrine tumors EXCEPT Insulinomas?

A

Octreotide Scan (Scintigraphy)

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118
Q

Since Octreotide Scan (Scintigraphy) cannot find pancreatic neuroendocrine tumors of the Insulinoma type, what can be used?

A

EUS

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119
Q

What should be done with ALL pancreatic neuroendocrine tumors?

A

Resection

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120
Q

What pancreatic neuroendocrine tumor can cause DM with dermatitis?

A

Glucagonoma

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121
Q

What pancreatic neuroendocrine tumor can cause diarrhea with low potassium and low chloride?

A

VIP tumor

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122
Q

What is the duration of diarrhea to be considered acute? Chronic?

A

Acute 4 weeks

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123
Q

What type of diarrhea results in the loss of fat, carbohydrates and protein in the stool?

A

Malabsorptive diarrhea

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124
Q

Most common cause of acute diarrhea?

A

Infection (self-limited)

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125
Q

Diarrhea with arthralgia, lymphadenopathy and neurologic symptoms?

A

Whipple disease (PAS+ macrophages, acid-fast negative)

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126
Q

Pancreatic insufficiency, small bowel bacterial overgrowth and celiac disease can all cause what type of diarrhea?

A

Steatorrhea (fat-malabsorption)

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127
Q

Diarrhea with edema, ascites and anasarca is due to what?

A

Protein malabsorption (C.diff, IBD, Celiac, Whipple)

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128
Q

How is protein malabsorption diagnosed?

A

Stool Alpha-1 Antitrypsin clearance

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129
Q

Besides autoimmune diseases, what other condition is associated with celiac disease?

A

Down syndrome

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130
Q

Baseline bone densitrometry testing, vitamin and mineral survey and vaccination against encapsulated organisms should be recommended to all patients with this GI condition?

A

Celiac disease

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131
Q

What can cause a false positive in hydrogen breath testing for small bowel bacterial overgrowth?

A

Rapid bowel transit and recent antibiotic use

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132
Q

Short bowel syndrome is less than how much small bowel left?

A
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133
Q

What is the best chance for adaptation for a patient with short bowel syndrome?

A

If the COLON remains connected to the small bowel

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134
Q

What population subtype is know to have a high prevalence for IBD?

A

Ashkenazi (Eastern European) Jews

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135
Q

If a colonic stricture is noted in a patient presumed to have UC, what does this mean?

A

Wrong diagnosis or malignancy

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136
Q

IS abdominal pain a common occurrence in UC?

A

No

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137
Q

What is the most SEVERE complication associated with UC?

A

Toxic Megacolon (>6 cm)

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138
Q

What are indications for surgery with toxic megacolon?

A

Progressive abdominal distention and tenderness in spite of medical therapy (antibiotics, steroids, bowel rest and IVFs) and hemodynamic instability.

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139
Q

Which IBD disease is acute in onset and which is indolent?

A

UC - acute; Crohn’s - indolent

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140
Q

Episcleritis, iritis, uveitis, symmetric arthritis, oral aphthous ulcers, sacroileitis and HLA B27-associated ankylosing spondylitis, erythema nodosum and pyoderma gangrenosum and primary sclerosing cholangitis are what?

A

Extra-intestinal manifestations of IBD

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141
Q

A patient with UC and primary sclerosing cholangitis is at an increased risk of what?

A

Colon cancer

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142
Q

What gastrointestinal procedures should be done if Chron disease is suspected?

A

BOTH colonoscopy and EGD to determine small bowel and upper GI involvement

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143
Q

What should you suspect in a patient whose IBD has BECOME refractory to corticosteroid therapy?

A

CMV infection

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144
Q

What medication can be used to treat Crohn disease in a patient who cannot tolerate 6MP or azathioprine?

A

Methotraxate + Folic acid

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145
Q

What medication is effective for pts with Crohn disease when anti-TNF agents failed but carries a risk of PML due to JC-virus reactivation?

A

Natalizumab

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146
Q

Is methotrexate effective for UC?

A

NO

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147
Q

What are elements of general health care maintenance for patients treated for IBD?

A

Calcium and Vitamin D supplementation, baseline DEXA scan, yearly influenza immunization and pneumococcal vaccination every 5 years

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148
Q

What vaccinations MUST be avoided in immunosuppressed patients (IBD therapy and otherwise)?

A

LIVE vaccinations (varicella, MMR and intranasal influenza)

149
Q

When are patients with Crohn disease and UC at an increased risk of colorectal cancer and what should be done?

A

IF at least 1/3 of colon is involved and >8 years post diagnosis; colonosocopy every 1-2 years

150
Q

Hospitalized patients with IBD are at an increased risk particularly for this condition?

A

DVT

151
Q

Microscopic colitis is associated with systemic disease, medications and this disease?

A

Celiac disease

152
Q

What features of constipation require anorectal manometry testing?

A

Sensation of blockage in anorectal region and paradoxical contractions of the puborectalis or external anal sphincter

153
Q

Magnesium-containing antacids should be avoided in these patients due to the risk of hypermagnesemia?

A

Renal impairment

154
Q

What agent can be used in opiate-induced constipation WITHOUT negating the effects of analgesia?

A

Methylnaltrexone

155
Q

Treatment for patients with dyssynergic defecation?

A

BIOFEEDBACK

156
Q

What are the ROME III criteria for IBS?

A
  1. Recurrent abdominal pain for at least 3 DAYS/month for the past 3 months beginning >6 months ago.
  2. Symptoms IMPROVE with defecation.
  3. Onset associated with change in frequency of stool.
  4. Onset associated with change in form of stool.
157
Q

Family history, h/o sexual abuse, low birth weight, h/o infectious gastroenteritis in women

A

IBS

158
Q

What is the ONLY serologic test necessary in a pt in whom IBS is suspected without alarm symptoms and is IBS-D or IBS-M?

A

Celiac serology

159
Q

How are IBS-D/M treated?

A

FIRST-high-fiber diet, SSRI’s, TCA’s ; SECOND- loperamide, Alosetron

160
Q

What must women prescribed lubiprostone do?

A

Use contraception

161
Q

What is the best diagnostic test for diverticulitis if not obvious?

A

CT of abd/pelv

162
Q

When should immunocompromised patients be offered surgery after an episode of diverticulitis?

A

AFTER their FIRST episode

163
Q

What is mesenteric ischemia?

A

Ischemia of the small bowel

164
Q

What are the 3 most common cause of mesenteric ischemia?

A
  1. SMA embolus (left atrium)
  2. Ventricular mural thrombi
  3. Non-occlusive, from MI
165
Q

Young patient (

A

Cocaine, triptans

166
Q

What labs are elevated in pt with mesenteric ischemia?

A

WBC, lactate, metabolic acidosis

167
Q

When is “thumbprinting” found on abdominal x-rays and interstitial pneumatosis with bowel wall thickening on CT?

A

Mesenteric ischemia

168
Q

What is the gold standard diagnostic modality for mesenteric ischemia?

A

Angiography (renal risk)

169
Q

How is mesenteric ischemia treated?

A

Cardiovascular resuscitation, antibiotics and papaverine

170
Q

Do you treat mesenteric ischemia with anticoagulation?

A

NO! (hemorrhage)

171
Q

Abdominal pain ~30 min after eating leading to fear of eating and weight loss, eventually pain without eating?

A

CHRONIC mesenteric ischemia (at least 2 major splanchnic arteries are occluded on angiography)

172
Q

How is CHRONIC mesenteric ischemia treated?

A

Surgical revascularization

173
Q

How does COLONIC ischemia present and how is it diagnosed?

A

Abdominal pain, rectal bleeding; colonoscopy

174
Q

How is COLONIC ischemia treated?

A

IVF and antibiotics

175
Q

Pain out of proportion to examination?

A

MESENTERIC (small bowel) ischemia

176
Q

What is CHRONIC mesenteric ischemia caused by?

A

Mesenteric atherosclerosis

177
Q

The most common mechanism through which 66% of all colorectal cancers develop is?

A

Chromosomal Instability (CIN)

178
Q

Aside from hereditary factors, what are the two highest risk factors for colon cancer?

A

Alcohol and obesity

179
Q

Cholecystectomy, DM, ureterosigmoidostomy are risk factors for what?

A

Colorectal cancer

180
Q

What is the risk for colorectal cancer in family h/o colon cancer and family h/o adenomatous polyps?

A

SAME

181
Q

Early adenomatous colon polyps (20’s-30’s), progress to colon cancer more quickly, PROXIMAL colon, poorly-differentiated histology and MSI-genotype (microsatellite instability)?

A

HNPCC

182
Q

What other high-risk of cancer besides colon are HNPCC pt’s at risk for?

A

Endometrial

183
Q

100’s to 1000’s of colon polyps, diagnosed at 16, mean cancer age 39, duodenal adenomas, APC gene?

A

Familial Adenomatous Polyposis (FAP)

184
Q
A

Attenuated Familial Adenomatous Polyposis (AFAP)

185
Q

Abdominal pain, bleeding, intussusception, small intestinal polyps, colorectal adenomas, young pt, gastric, pancreatic, small bowel, esophageal, breast, ovary lung cancers?

A

Peutz-Jehgers Syndrome

186
Q

SOLITARY, SPORADIC hamartomatous polyps in children

A

Juvenile Polyposis Syndrome

187
Q

Large hyperplastic polyps proximal to sigmoid colon or >30 hyperplastic polyps throughout colon?

A

Hyperplastic Polyposis

188
Q

What is considered a POSITIVE fecal occult blood test for risk of colorectal cancer?

A

Collection of TWO samples from THREE CONSECUTIVE stools (6 samples) ALL positive

189
Q

If using flex sig for colorectal cancer screening, what finding constitutes the need for a full colonoscopy?

A

ANY polyp >5 mm

190
Q

What is the average bowel perforation risk for a colonoscopy?

A

1 in 1000 patients

191
Q

What is the recommended screening colonoscopy frequency for a patient with IBD (other than proctitis) that has been diagnosed >8 years ago?

A

EVERY 1-2 years

192
Q

What is the recommended screening colonoscopy age and frequency for a patient with Lynch syndrome?

A

Start at 20-25 and EVERY 1-2 years

193
Q

What is the recommended screening colonoscopy frequency for a patient with family history of colon cancer?

A

At the age of 40 or 10 years earlier than the age of the relative at time of diagnosis, whichever is younger

194
Q

Next screening colonoscopy for patient with 1-2 adenomatous polyps (tubular) and

A

5-10 years

195
Q

Next screening colonoscopy for patient with ≥3 adenomatous polyps (villous) and ≥1 cm OR high-grade dysplasia?

A

3 years

196
Q

Pt is found to have colorectal cancer on colonoscopy, when do you repeat screening?

A

1 year post-op, 3 years, 5 years

197
Q

What sites does colorectal cancer typically metastasize to?

A

Liver, peritoneum, lungs

198
Q

What are the ONLY patients in which NSAIDS and estrogen therapy are recommended for prevention of colorectal cancer?

A

HEREDITARY cancer syndromes

199
Q

Conjugated (direct) bilirubin abnormality suggests what?

A

Disease of the liver

200
Q

What is considered ACUTE hepatitis?

A
201
Q

When is someone infected with Hep A infectious?

A

During incubation period (time before symptoms occur: 2-6 weeks or ~28 days) and for a week after onset of jaundice (jaundice develops 1-2 weeks after symptoms)

202
Q

What is the difference between HBV acquired in adulthood vs childhood?

A

HBV acquired in adulthood is acute and commonly resolves. HBV acquired in childhood becomes chronic

203
Q

HBV acquired perinatally, with high levels of HBV DNA, no hepatic inflammation and at risk for conversion to active HBV?

A

IMMUNE-TOLERANT STATE (monitor, don’t treat)

204
Q

Low levels of HBV DNA, no hepatic inflammation (normal LFTs), at risk for conversion to active HBV, low risk for progression to liver disease?

A

INACTIVE CARRIER (monitor, don’t treat)

205
Q

What patients with HBV should receive anti-viral therapy?

A

Chronic Active HBV patients and those with developing liver failure from severe, acute HBV

206
Q

What HBV patients respond to PEG-Interferon therapy?

A

Those with ELEVATED LFTs (at least 2x nl) and with low viral loads

207
Q

What are the two (2) main antiviral agents used against HBV due to less resistance?

A

Entecavir and Tenofovir

208
Q

Do inactive carriers of HBV and immune-tolerant HBV patients benefit from antiviral therapy?

A

NO

209
Q

Polyarteritis Nodosa and Membranous Glomerulonephritis re associated with which GI disease?

A

HBV

210
Q

How do you treat a newborn that has been born to an HBV positive mother?

A

Vaccinate + IgG

211
Q

Blood transfusions prior to what YEAR are considered hight risk for HBV infection?

A

1992

212
Q

Mixed Cryoglobulinemia, Porphyria Cutanea Tarda, non-Hodgkin Lymphoma and Membranoproliferative Glomerulonephritis are associated with what GI disease?

A

HCV

213
Q

How is HCV Genotype 1 treated in patient with significant inflammation and fibrosis?

A

PEG-Interferon + Ribavirin + Protease Inhibitor

214
Q

What should ALL HIV patients be tested for?

A

HCV

215
Q

When do you treat an HIV+ pt for HCV?

A

ALWAYS, unless CD4 count is

216
Q

MDF (discriminant function) of > 32 / MELD score of >18 mean what for an alcoholic hepatitis patient?

A

Short-term mortality risk of 50%

217
Q

What meds can be given to a patient with ACUTE alcoholic hepatitis with an MDF >32 / MLED >18?

A

Corticosteroids or Pentoxifylline

218
Q

Most common cause of liver injury REQUIRING transplant?

A

Drug-induced

219
Q

Augmentin, phenytoin, valproic acid, statins all have this in common?

A

Hepatotoxic

220
Q

What agent should be used for ANY drug-induced liver injury?

A

N-acetylcysteine

221
Q

What does “Interface Hepatitis” suggest on biopsy?

A

Autoimmune Hepatitis

222
Q

In autoimmune hepatitis, what else can be tested for if ANA, anti Sm Ab and g-globulin (GGT) are all negative?

A

p-ANCA

223
Q

When do you treat autoimmune hepatitis?

A
  1. AST >10 x nl
  2. AST >5 x nl AND g-globulin (GGT) is >2 x nl
  3. Liver biopsy with bridging or confluent necrosis
  4. Pt is symptomatic (jaundice, fever, n/v)
224
Q

What agents are used to treat autoimmune hepatitis?

A

Azathioprine and corticosteroids

225
Q

What is the “Metabolic Syndrome?”

A

HTN, DM, Obesity, Dyslipidemia

226
Q

What causes NAFLD?

A

Insulin resistance and the metabolic syndrome

227
Q

Inflammation & fibrosis in NAFLD is?

A

NASH

228
Q

How is hemochromatosis treated?

A

Phlebotomy and iron chelation

229
Q

How is alpha1-antitrypsin deficiency treated when it affects the liver and lung?

A

Liver - transplant (when cirrhosis develops)

Lung - IV alpha1 antitrypsin

230
Q

Elevated liver enzymes, ANEMIA (hemolytic), normal Alk Phos?

A

Wilson Disease

231
Q

What two tests are used for Wilson Disease?

A

Serum Ceruloplasmin (LOW) & Urine Copper (HIGH)

232
Q

Trientine; Penicillamine are what?

A

Copper chelating agents

233
Q

Pan-acinar emphysema of the lungs?

A

Alpha1-antitrypsin defficiency

234
Q

> 50 yo, woman, fatigue, dry eyes/mouth, pruritus, elevated Alk Phos (1.5 x normal), normal T.bili, elevated LFTs (>5 x normal) and positive AMA?

A

Primary Biliary Cirrhosis (PBC)

235
Q

Focal duct obliteration with granuloma formation on liver biopsy?

A

Primary Biliary Cirrhosis (PBC)

236
Q

What are the best 2 therapeutic agents for pruritus caused by hyperbilirubinemia?

A

Cholestyramine and Rifampin

237
Q

For patients with esophageal varices and osteoporosis, what is used to treat?

A

INTRAVENOUS bisphosphonate therapy (NOT oral)

238
Q

What is the ONLY medication that has been proven to provide a SURVIVAL benefit to patients with Primary Biliary Cirrhosis?

A

Ursodeoxycholic acid

239
Q

40 yo man with a chronic inflammatory disorder affecting intra and extra hepatic bile ducts with Jaundice, pruritus and abdominal pain, associated with IBD?

A

Primary Sclerosing Cholangitis (PSC)

240
Q

Elevated alk phos (3-10 x normal), elevated LFTs (2-3 x normal), T.bili normal, positive ANA and Anti-sm-Ab with abnormal CHOLANGIOGRAPHY?

A

Pribary Sclerosing Cholangitis (PSC)

241
Q

What should you suspect when T.bili is elevated in patients with Primary Sclerosing Cholangitis (PSC)?

A

Advanced disease vs obstructing stone/cancer

242
Q

Gold Standard for diagnosis of Primary Sclerosing Cholangitis (PSC)?

A

Cholangiography

243
Q

MRCP with finding of “Beads on a String”?

A

Primary Sclerosing Cholangitis

244
Q

If cholangiography is negative in PSC, what is the required diagnostic test?

A

Liver Biopsy

245
Q

Histologic finding of FIBRO-OBLITERATIVE Cholangiopathy?

A

Primary Sclerosing Cholangitis (PSC)

246
Q

What are Primary Sclerosing Cholangitis (PSC) patients at highest risk for?

A

Cholangiocarcinoma

247
Q

Patient with Primary Sclerosing Cholangitis (PSC) with acute change in LFTs or symptoms, you MUST suspect what?

A

Cholangiocarcinoma

248
Q

What is the only treatment for PSC besides supportive?

A

Liver TRANSPLANTATION

249
Q

Cirrhosis causes ascites, hepatic encephalopathy and varices (esophageal & gastric) how?

A

Portal Hypertension (>8-10 mm Hg)

250
Q

What should be done for large esophageal varices?

A

Prophylactic ß-blocker or endoscopic ligation

251
Q

How often should you screen cirrhotic pt with no esophageal varices??

A

Every 2-3 years

252
Q

How often should you screen cirrhotic pt with small esophageal varices??

A

YEARLY

253
Q

What must be done on a patient with NEW ascites diagnosis?

A

DIAGNOSTIC paracentesis (cell count w/diff, albumin, total protein, ± culture AT BEDSIDE)

254
Q

What antibiotic is used for SBP treatment? Prophylaxis?

A

CEFTRIAXONE (IV); NORFLOXACIN (PO)

255
Q

Explain SAAG

A

Serum-Ascites Albumin Gradient (Subtract the ascites fluid albumin concentration FROM the serum albumin concentration; if the SAAG ≥ 1.1g/dL and total ASCITES protein is 2.5 g/dL = cardiac disease is the cause

256
Q

What must be replaced at the rate of 8 g per L of ascitic fluid removed?

A

ALBUMIN

257
Q

What constitutes SBP?

A

POSITIVE bacterial culture of ascites fluid AND PMN (neutrophils/basophils/eosinophils/granulocytes) >250 cells/µL

258
Q

Besides antibiotics, what else MUST be given to an inpatient with SBP and significant liver/kidney dysfunction?

A

Albumin

259
Q

How can you determine if medical therapy is effective for SBP?

A

Repeat paracentesis in 48 hours and determine if drop in PMN count

260
Q

If large esophageal varices are found and treated, when is repeat EGD needed for continued treatment until eradication and thereafter?

A

Every 2-4 weeks (usually 2-4 sessions) then FIRST surveillance EGDin 1-3 months Followed by every 6-12 months

261
Q

What does an increased frequency and severity of hepatic encephalopathy predict?

A

Increased risk of death

262
Q

Should dietary protein be restricted for patients with cirrhosis or hepatic encephalopathy?

A

ABSOLUTELY NOT (increased mortality)

263
Q

A patient with cirrhosis is experiencing a Cr ≥2.5 mg/dL and a 50% reduction in their Cr clearance in a 24-hr urine sample over the past TWO (2) WEEKS without significant histologic renal biopsy changes, is diagnosed with?

A

Type -I Hepato-Renal Syndrome (HRS)

264
Q

A patient with cirrhosis is experiencing a Cr ≥2.5 mg/dL and a 50% reduction in their Cr clearance in a 24-hr urine sample over the past MONTH with REFRACTORY ASCITES, without significant histologic renal biopsy changes, is diagnosed with?

A

Type -II Hepato-Renal Syndrome (HRS)

265
Q

In the ABSENCE of ANY renal disease (toxic meds, shock, hypotension), a serum Cr >1.5 mg/dL WITHOUT improvement after 48 hours of diuretic withdrawal and albumin supplementation?

A

Hepato-Renal Syndrome (HRS)

266
Q

A patient with cirrhosis has hypoxemia on ABG, digital clubbing and cyanosis without any identified COPD or other lung disease is diagnosed with?

A

Hepato-Pulmonary Syndrome (HPS)

267
Q

When is a cirrhotic patient with Hepato-Pulmonary Syndrome (HPS) considered a high-priority candidate for liver transplantation?

A

When PO2 ≤60 mm Hg!!!

268
Q

Elevated pulmonary artery pressure (≥25 mm Hg), elevated right ventricular systolic pressure (≥50 mm Hg) and primary portal HTN (>8-10 mm Hg) with progressive exertional dyspnea requires what?

A

Liver transplantation for Porto-Pulmonary HTN (POPH)

269
Q

Cirrhosis, chronic Hep B & C, hemochromatosis and alpha-1 antitrypsin deficiency cause 80% of these?

A

Hepatocellular Carcinoma (HCC)

270
Q

Can alpha-fetoprotein (AFP) alone be used for HCC surveillance every 6 months in a patient at risk?

A

NO! need US/CT/MRI as well OR two (2) imaging studies

271
Q

What AFP value is concerning for HCC?

A

> 400

272
Q

When is HCC biopsy necessary for diagnosis?

A

When radiology, radiology+AFP (>400) combo is inconclusive

273
Q

What is the best treatment for HCC in early-stage disease?

A

Liver Transplantation

274
Q

What is used to treat patient with advanced HCC?

A

Sorafenib (hand-foot syndrome, HTN)

275
Q

Hepatic encephalopathy after onset of jaundice (

A

Fulminant Hepatic Failure (hyperacute, acute, subacute)

276
Q

What is the most common cause of fulminant hepatic failure?

A

Acetaminophen toxicity

277
Q

What is used to treat fulminant hepatic failure due to Amanita mushroom poisoning?

A

Penicillin G

278
Q

What two treatments can be used to reduce cerebral edema in setting of fulminant hepatic failure?

A

Mannitol and Induced hypothermia

279
Q

What MUST be done once Fulminant Hepatic Failure is diagnosed?

A

Transfer patient to facility that can do liver transplant (the ONLY treatment)

280
Q

Coagulopathy due to liver dysfunction/failure is best measured by what?

A

Prothrombin Time (PT)

281
Q

Liver transplantation can be considered in a patient with HCC depending on tumor configuration which is?

A

ONE tumor ≤5 cm OR ≤3 tumors ≤3 cm

282
Q

INH (isoniazid), sulfonamides, tetracycline, MDMA (ecstasy), NSAIDS, cocaine, CMV, EBV, Parvovirus B19, Varicella-Zoster Virus (VZV), Bacillus cereus, Budd-Chiari syndrome, Acute Fatty Liver of Pregnancy (AFLP), HELLP syndrome, autoimmune hepatitis can all cause?

A

Fulminant Hepatic Failure

283
Q

How is a large, symptom-causing (RARE) simple hepatic cyst best treated?

A

Fenestration

284
Q

What hepatic cysts require resection?

A

Symptomatic cysts [(Cystadenomas (complex cyst)]

285
Q

Hypertrophic tissue reaction to an anomalous artery in the liver with the lesions characteristically demonstrating a “central scar” on CT/MRI?

A

Focal Nodular Hyperplasia (FNH)

286
Q

What is the recommended management of a BENIGN-appearing hepatic lesion

A

Observation every 6 months with US, NO BIOPSY necessary

287
Q

Sheets of BENIGN hepatocytes without biliary structures?

A

Hepatic adenoma (women, oral contraceptives, risk for malignant transformation)

288
Q

Who gets hepatic adenomas most commonly and are these dangerous?

A

Women who use oral contraceptive pills; YES, risk of malignant transformation

289
Q

What is the management of a

A

Cessation of oral contraceptives and monitoring with US

290
Q

What is the management of a ≥5 cm hepatic adenoma or ANY sized hepatic adenoma in a woman considering pregnancy?

A

Surgical Resection (because these are hormonally responsive)

291
Q

Liver lesion that demonstrates PERIPHERAL nodular enhancement followed by CENTRIPETAL filling?

A

Hemangioma

292
Q

How is ANY abscess treated?

A

Drainage and antibiotics

293
Q

Amebiasis positive stool can lead to what complication without treatment?

A

Amebic liver abscess with fatal rupture

294
Q

1st trimester, prolonged vomiting with elevated LFTs and fluid/electrolyte imbalances?

A

Hyperemesis gravidarum

295
Q

A woman in her second or third trimester, or one who is not pregnant but on supplemental hormonal therapy, presenting with JAUNDICE, PRURITUS and elevated serum BILE ACIDS?

A

Interhepatic Cholestasis of Pregnancy (ICP)

296
Q

How do you treat Interhepatic Cholestasis of Pregnancy (ICP)?

A

Ursodeoxycholic acid

297
Q

What is HELLP?

A

A complication of pre-eclampsia: Hemolysis-Elevated LFTs-Low-Platelets?

298
Q

A woman in her third trimester presents with abdominal pain, new-onset nausea and vomiting, jaundice and pruritus?

A

HELLP syndrome (20% mortality)

299
Q

What is the definitive therapy for HELLP syndrome?

A

Delivery

300
Q

What’s the risk of HELLP syndrome in subsequent pregnancies?

A

25%

301
Q

What is the risk with Interhepatic Cholestasis of Pregnancy (ICP)?

A

Fetal complications and intra-uterine death

302
Q

Similar to HELLP syndrome but with HYPOGLYCEMIA and worse coagulopathy requiring prompt delivery and management by hepatologist at liver transplant center?

A

Acute Fatty Liver of Pregnancy (AFLP)

303
Q

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency is associated with what condition?

A

Acute Fatty Liver of Pregnancy (AFLP)

304
Q

What are the two most serious pregnancy-related liver conditions requiring URGENT delivery?

A

HELLP and AFLP

305
Q

What testing and treatments are used for metabolic bone disease in cirrhotic patients?

A

Bone density testing; Calcium+Vitamin D, bisphosphonates or raloxifene (IV if esophageal varices) & weight-bearing exercises

306
Q

Male cirrhotic patients with hypogonadism can be treated with transdermal testosterone except when?

A

If HCC is a concern

307
Q

Alcoholic hepatitis with discriminant function ≥32 or significantly severe with ascites and SBP with fever and leukocytosis as well as varices, besides albumin and octreotide/nadolol should be treated with what specifically and why?

A

Pentoxifylline and NOT prednisone (because of the active SBP infection, otherwise ok to use)

308
Q

After resection of a Type I or II carcinoid tumor, what is the recommended EGD surveillance?

A

EGD every 6-12 months for 3 years

309
Q

What are the ONLY immunizations cirrhotic patients should NOT receive?

A

LIVE attenuated vaccines (MMR, Varicella, intranasal-Influenza)

310
Q

In patients with esophageal varices and ascites, what medications should be avoided?

A

NSAIDS and Aspirin

311
Q

I patients with cirrhosis, what medications should be avoided?

A

Amoxicillin-clavulanate (augmentin) and Isoniazid (INH)

312
Q

Obesity, Dyslipidemia, Pregnancy, DM, Cirrhosis, Crohn disease, resection of the terminal ileum and gastric bypass surgery are all risk factors for what?

A

Gallstone formation

313
Q

What is the recommendation for a patient with a porcelain GB or with GB stones ≥3 cm?

A

Cholecystectomy

314
Q

Severe episodic abdominal pain in epigastric/RUQ area that intensifies over 15 minutes then lasts approximately 3 hours and slowly resolves associated with nausea and vomiting?

A

Biliary colic

315
Q

When biliary colic lasts >6 hours it is most likely?

A

Cholecystitis

316
Q

What is different about elderly patients, immunosuppressed patients or those with DM when it comes to cholecystitis?

A

They may NOT have symptoms nor fever

317
Q

Murphy’s sign clues you in on what diagnosis?

A

Cholecystitis

318
Q

How is cholecystitis diagnosed?

A

US

319
Q

What test can be done ONLY if US is indeterminate for cholecystitis?

A

HIDA scan

320
Q

How is ACUTE cholecystitis treated?

A

IVF, antibiotics and laparoscopic cholecystectomy within 48-96 hours of hospitalization

321
Q

Fever with elevated amylase due to hospitalization for critical illness, burns, advanced age, atherosclerotic vascular disease, AIDS, salmonella, CMV, polyarteritis nodosa and SLE?

A

Acalculous Cholecystitis

322
Q

What should be done after an ERCP for a patient with choledocholithiasis whom may not be a surgical candidate?

A

Sphincterotomy

323
Q

How long after ERCP for stone clearance should cholecystectomy be performed?

A

Within 6 weeks

324
Q

Choledocholithiasis with development of fever is?

A

Cholangitis

325
Q

Fever, Jaundice, RUQ pain?

A

Charcot triad (cholangitis)

326
Q

Chronic salmonella infection can lead to what?

A

Gallbladder cancer

327
Q

Primary Sclerosing Cholangitis (PSC), biliary atresia, liver flukes and biliary cysts are all risk factors for?

A

Cholangiocarcinoma

328
Q

When can a hilar cholangiocarcinoma (Klatskin tumor) be resected?

A

When it does NOT extend into BOTH intrahepatic bile ducts

329
Q

Ampullary adenocarcinoma is associated with what hereditary conditions?

A

Familial Adenomatous Polyposis & Peutz-Jehgers syndrome

330
Q

What is the management of an ampullary adenocarcinoma?

A

Excision by Whipple procedure

331
Q

Dilation of bile duct without evidence of obstructing lesion, chronic, intermittent abdominal pain with recurrent bouts of cholangitis, jaundice and carries a very hight risk of cholangiocarcinoma?

A

Biliary cyst

332
Q

Hgb ≤2 g/dL, Hct ≤6% from baseline or ≥2 units PRBC transfusion is needed?

A

SEVERE GI bleed

333
Q

How much blood is needed for melena to occur?

A

50-100 ml

334
Q

Erosions found on the crest of gastric folds within a large hiatal hernia caused by mechanical trauma?

A

Cameron lesions

335
Q

GAVE is associated with what conditions?

A

Cirrhosis and Connective Tissue Disease

336
Q

Acute or chronic GI blood loss, occurs in the setting of epistaxis, facial telangiectasias, which can also involve the lung, liver and brain and there is a family history of the condition?

A

Hereditary Hemorrhagic Telangiectasia (HHT) also called Osler-Weber-Rendu disease

337
Q

Describe the formation of a GI tract pseudoaneurysm?

A

Pancreatitis-pseudocyst formation-erosion into an artery

338
Q

A tachycardia in a patient with GIB indicates how much blood loss? Hypotension?

A

Tachycardia: 15-30%; Hypotension ≥30%

339
Q

Patient with NO OTHER SYMPTOMS other than HEART RATE >120 bmp after bariatric surgery indicates?

A

Anastomotic leak (critical emergency)

340
Q

Macrocytosis (MCV ≥100) and elevated INR in a patient NOT on anticoagulants clue you in on?

A

Liver disease

341
Q

What is the Blatchford Score?

A

Patients with signs of GIB that can be managed as OUTPATIENTS (BUN 109 mm Hg, HR

342
Q

What is the most important thing to measure when dealing with an acute GIB?

A

CONTINUOUS HEMODYNAMIC MONITORING

343
Q

What is the ABSOLUTE indication for transfusion?

A

Hgb

344
Q

In a GIB, within what time frame should EGD be done?

A

Within 24 HOURS of presentation (whether stable or not)

345
Q

Within what time frame should EGD be done for a patient with suspected variceal bleed?

A

Within 12 HOURS of presentation

346
Q

What should be initial management for a suspected variceal bleed?

A

Octreotide & Antibiotics

347
Q

Patients with GIB whom are at high-risk should be treated with a PPI how initially?

A

Bolus PPI followed by IV for 72 hours, then oral PPI (must therefore be hospitalized for at least 72 HOURS)

348
Q

When is a “SECOND LOOK” with EGD recommended?

A

ONLY if poor initial visualization or RE-BLEEDING prior to surgery or IR intervention

349
Q

When should an EGD be repeated for a gastric ulcer to rule out malignancy?

A

ONLY if biopsies of the ulcer were NOT obtained initially (due to EGD for bleeding) and 6-8 weeks after initial EGD

350
Q

When should ASPIRIN used for cardiovascular purposes be restarted after PUD?

A

While on PPI therapy

351
Q

What should you consider when a patient with a lower GIB presents with hypotension?

A

A possible UPPER source of bleeding and perform an EGD as well

352
Q

What is the MOST appropriate diagnostic procedure for a suspected upper GIB?

A

EGD

353
Q

Is NGT placement with gastric lavage an acceptable diagnostic test to rule out upper GIB?

A

NO!!! (50% miss rate)

354
Q

What should be done for a patient presenting with suspected GIB with orthostatic hypotension OR bleeding in the first 4-HOURS of evaluation OR using anticoagulants (aspirin, warfarin, etc.) OR has multiple comorbidities?

A

ADMISSION to the hospital

355
Q

Recurrent GIB (anemia and FOBT+) without a defined source after EGD and colonoscopy?

A

OBSCURE GIB

356
Q

What is the FIRST step for patients who have an OBSCURE GIB (anemia, FOBT+, negative EGD/Colonoscopy)?

A

REPEAT EGD and COLONOSCOPY (30%-50% success)

357
Q

When should angiography be performed for OBSCURE GIB?

A

ONLY when there is active, overt bleeding (requires a bleeding rate ≥1 mL/min)

358
Q

What are the risks of angiography with embolization for the treatment of OBSCURE GIB?

A

Renal failure, necrosis, dissection/aneurysm

359
Q

What radiologic test should be done FIRST because it has the best SENSITIVITY for actively bleeding GI lesions but does not allow intervention nor does it have good specificity (78%, but better than angiography) for localization of source?

A

NM (technetium-99m) labeled RED BLOOD CELL scan

360
Q

What is the bleed rate required for a NM (technetium-99m) RED BLOOD CELL scan?

A

0.1 - 0.5 mL/min

361
Q

Intermittent LARGE-VOLUME bleeding in a patient with negative initial EGD without a hiatal hernia?

A

Dieulafoy lesion (superficial artery)

362
Q

What diagnostic test for OBSCURE GIB can be done which DOES NOT require active bleeding?

A

Small Bowel Video Capsule Endoscopy (SBVCE)

363
Q

What should be done as therapy for a patient with a bleeding Meckel diverticulum?

A

Surgical excision

364
Q

What is the best therapy for a patient with AORTIC-STENOSIS caused angioectasia (Heyde syndrome) with GIB?

A

Aortic Valve REPLACEMENT

365
Q

Howell-Jolly Bodies dictate the necessity of this PREVENTIVE measure?

A

Vaccination for encapsulated organisms (S.pneumonia and H.influenza) due to functional asplenia (any asplenia)

366
Q

What can be used instead of a thiopurine to treat Crohn disease (NOT FOR UC) when thiopurines such as azathioprine or 6MP caused pancreatitis or are not tolerated?

A

Methotrexate + Folic Acid

367
Q

What can be used to treat the pain and bowel dysregulation in IBS-D or IBS-M?

A

TCA’s (amitriptyline) because of the anticholinergic constipating effects and analgesia

368
Q

What can be used to treat the pain and bowel dysregulation in IBS-C?

A

SSRI’s (sertraline) because of their bowel-stimulating effects and analgesia

369
Q

What should ALWAYS be checked for when evaluating a patient for potential IBS-D or IBS-M?

A

CELIAC disease

ABIM 2015 (11 decks)

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