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ABIM IM Recert > Board Vitals Gastroenterology > Flashcards

Board Vitals Gastroenterology Flashcards

1
Q

Is Barrett esophagus more common in Black or White patients?

A

White

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2
Q

Does Helicobacter pylori infection predispose to Barrett esophagus?

A

No
(It appears to be protective)

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3
Q

Are patients with dyspepsia and H. pylori infection at risk of getting Barrett esophagus?

A

No

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4
Q

What is the mean age at time of diagnosis of Barrett esophagus?

A

55 years

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5
Q

Is Barrett esophagus associated with a family history of gastric cancer?

A

No

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6
Q

Is Barrett esophagus more common in Asian or White patients?

A

White

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7
Q

Is Barrett esophagus more common in Hispanic or Non-Hispanic patients?

A

Non-Hispanic

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8
Q

Does H. pylori protect against Barrett esophagus and esophageal adenocarcinoma?

A

Yes

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9
Q

What is the treatment of mild ulcerative colitis?

A

5-aminosalicylic (ASA) agent (mesalazine)

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10
Q

Which lab value is characteristic of primary biliary cholangitis?

A

Elevated alkaline phosphatase

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11
Q

What are the aminotransferase levels in primary biliary cholangitis?

A

May be normal and are usually lower than 5 times upper limit of normal.

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12
Q

Is primary biliary cholangitis associated with increased risk of hepatocellular carcinoma?

A

Yes

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13
Q

What is the treatment of primary biliary cholangitis?

A

Ursodeoxycholic acid

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14
Q

What should you do if alkaline phosphatase remains elevated after treating primary biliary cholangitis with ursodeoxycholic acid?

A

Obeticholic acid

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15
Q

Does hepatitis C increase the risk of hepatocellular carcinoma?

A

Yes

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16
Q

Does hepatitis C increase the risk of lymphoma in HIV-negative patients?

A

Yes

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17
Q

Which patients have an increased risk of developing cryoglobulinemia and clonal proliferation of B-cells?

A

Patients with hepatitis C and t(14;18) translocation

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18
Q

Which model determines whether patients with alcoholic hepatitis will benefit from pharmacologic therapy?

A

Maddrey discriminant function

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19
Q

Which levels are used in the calculation of the Maddrey discriminant function?

A

Bilirubin
Prothrombin time

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20
Q

What should the Maddrey discriminant score be for patients who will most likely benefit from pharmacological therapy for alcoholic hepatitis?

A

32 or more (those with high short term mortality risk)

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21
Q

Which model assesses the risk of non-shunt operations in cirrhosis patients?

A

Child-Pugh classification

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22
Q

Which model helps predict 90-day mortality in alcoholic hepatitis patients and requires a biopsy?

A

Hepatic histology score

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23
Q

Which model determines if patients with alcoholic hepatitis are responding to therapy?

A

Lille score

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24
Q

What diagnosis should be considered in patients with iron deficiency anemia that does not respond to therapy?

A

Celiac disease

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25
Q

What is the next step in ulcerative colitis patients who are refractory to rectal mesalamine?

A

Rectal budesonide

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26
Q

In patients diagnosed with colon cancer - what is the best next step to determine if they have Lynch syndrome?

A

Immunochemistry staining of tumor

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27
Q

What is the most important intervention in diabetic gastroparesis?

A

Blood glucose control

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28
Q

Do tricyclic antidepressants result in improved gastric emptying in gastroparesis?

A

No

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29
Q

What criteria is used to assess prognosis of patients with pancreatitis?

A

Ransen criteria

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30
Q

What calcium level within 48 hours is associated with worse prognosis in patients with acute pancreatitis?

A

Less than 8 mg/dL

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31
Q

What hematocrit decrease within 48 hours is associated with worse prognosis in patients with acute pancreatitis?

A

More than 10%

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32
Q

What baseline AST is associated with worse prognosis in patients with acute pancreatitis?

A

More than 250

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33
Q

What baseline leukocyte count is associated with worse prognosis in patients with acute pancreatitis?

A

More than 16,000 cells/mm3

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34
Q

What age is associated with worse prognosis in patients with acute pancreatitis?

A

More than 55 years

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35
Q

Should you test for H. pylori infection while the patient is on a proton pump inhibitor?

A

No

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36
Q

In patients with peptic ulcer disease on proton pump inhibitors, with negative biopsy for H. pylori, should testing for H. pylori be repeated once the PPI has been discontinued?

A

Yes

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37
Q

Can patients with upper GI bleed with low-risk clinical and endoscopic features be discharged on PPI if their hemoglobin and vitals are stable?

A

Yes

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38
Q

Which antibodies do patients vaccinated against hepatitis B have?

A

anti-HBs

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39
Q

Which antibodies do patients with previous hepatitis B infection have?

A

anti-HBs and anti-HBc

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40
Q

Which test shows current infection with hepatitis B?

A

HbsAg

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41
Q

What are the most common causes of liver abscesses in the United States?

A

Staphylococcal or streptococcal infections

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42
Q

If a patient has been to India, Mexico, South America, or Africa, and they develop a liver abscess - what organism should you think of?

A

Entamoeba histolytica

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43
Q

If an immunocompromised patient presents presents with multiple liver abscesses - what organism should you think of?

A

Candida

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44
Q

If a patient presents with multiple very small, nodular appearing liver abscesses - what organism should you think of?

A

Bartonella

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45
Q

Are liver abscesses caused by mycobacterium tuberculosis usually single or multiple?

A

Multiple

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46
Q

What is the treatment of asymptomatic gallstones?

A

Observation

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47
Q

What is bright red blood per rectum without abdominal pain most consistent with?

A

Diverticular bleed

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48
Q

What is the first line treatment for eosinophilic esophagitis?

A
  • Proton pump inhibitor
  • Swallowed steroids
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49
Q

Biopsies of the colon reveal an abnormally thickened subepithelial collagen band in the lamina propria.

Diagnosis?

A

Collagenous colitis

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50
Q

Can NSAIDS cause collagenous colitis?

A

Yes

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51
Q

Biopsies of the colon reveal villous atrophy, intraepithelial lymphocytosis, and inflammation of the lamina propria.

Diagnosis?

A

Celiac disease

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52
Q

What is the first step in treating microscopic colitis?

A

Discontinue medications that can potentially cause this.

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53
Q

What are collagenous colitis and lymphocytic colitis?

A

Microscopic colitis

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54
Q

What should you think of in patients with melanosis coli on colonoscopy?

A

Laxative abuse

55
Q

Patient has pigmented macules and GI hamartomas.

Diagnosis?

A

Puetz-Jeghers syndrome

56
Q

What is the inheritance pattern of Puetz-Jeghers syndrome?

A

Autosomal dominant

57
Q

Patients with Puetz-Jeghers syndrome are at greatest risk of which malignancy?

A

Colon cancer

58
Q

What is the screening age for colonoscopy in patients of average risk?

A

45 years

59
Q

What is the screening age for colonoscopy in patients with first degree relative with colon cancer before age 60 years?

A

Age 40 years or 10 years before age of youngest affected member, whichever comes first.

60
Q

What should you do before anti-virals/treatment for hepatitis C?

A

(Viral) genotype testing

61
Q

What is the treatment of spontaneous bacterial peritonitis?

A

Third generation cephalosporins (ceftriaxone or cefotaxime)

62
Q

Can hepatitis B or C cause hepatic steatosis?

A

Yes

63
Q

Should patients with NAFLD be evaluated for other causes of hepatic steatosis?

A

Yes

64
Q

Can GERD cause chronic cough?

A

Yes

65
Q

Which medication for hepatitis C is most commonly associated with hemolytic anemia?

A

Ribavirin

66
Q

Is glecaprevir-pibrentasvir for the treatment of hepatitis C safe to use in chronic kidney disease?

A

Yes

67
Q

In patients’ with a family history of colon cancer - when should the next colonoscopy be done if the first screening colonoscopy is normal?

A

In 5 years.

68
Q

Can celiac disease cause secondary lactose malabsorption?

A

Yes

69
Q

Where is lactase located?

A

On the small intestine brush border.

70
Q

Which criteria is used to diagnose irritable bowel disease?

A

Rome IV criteria

71
Q

What is Charcot’s triad?

A
  • Fever
  • Abdominal pain
  • Jaundice
72
Q

What is the initial imaging of choice in suspected acute cholangitis in patients who don’t fulfill Charcot’s triad?

A

Abdominal ultrasonography

73
Q

Liver transplant patient: CD8+ and CD4+ T lymphocytes against donor major histocompatibility complex (MHCs).

Liver failure symptoms.

What is this?

A

Acute transplant rejection

74
Q

Liver transplant patient: CD4+ T lymphocytes against recipient antigen-presenting cells.

Liver failure symptoms.

What is this?

A

Graft versus host disease

75
Q

Liver transplant patient: Pre-existing recipient antibodies.

Liver failure symptoms.

What is this?

A

Hyperacute rejection

76
Q

Patient presents with CD4 count of 78 cells/microliter and painful swallowing. Endoscopy shows linear ulcerations of the lower esophageal sphincter and a biopsy shows eosinophilic intranuclear inclusions and basophilic intracytoplasmic inclusions.

Diagnosis?

A

CMV esophagitis

77
Q

What is the mechanism of action of erythromycin when it’s used to treat gastroparesis?

A

Motilin receptor agonist

78
Q

What is the induction therapy for moderate to severe Crohn’s disease with fistula formation?

A

Infliximab and azathioprine

79
Q

What would be the most likely cause of painless bright red blood per rectum in a very young person?

A

Meckel’s diverticulum

80
Q

What is the first line treatment of esophageal eosinophilia?

A
  • Proton pump inhibitor
  • Swallowed/topical glucocorticoids (not oral)
81
Q

What are the transaminase levels typically in alcoholic hepatitis?

A

AST > ALT (2:1)
< 300 IU/L

82
Q

Which layer of the gastrointestinal tract is affected in ulcerative colitis?

A

Mucosa

83
Q

Which layer of the gastrointestinal tract is affected in Crohn’s disease?

A

All layers

84
Q

Does the alkaline phosphatase rise early in common bile duct obstruction?

A

No

85
Q

Does the GGT rise early in common bile duct obstruction?

A

No

86
Q

Does the AST and ALT rise early in common bile duct obstruction?

A

Yes

87
Q

Does the bilirubin rise early in common bile duct obstruction?

A

Yes

88
Q

How high can the transaminases be if a person intentionally overdoses on acetaminophen?

A

> 3500

89
Q

When should patients get a colonoscopy if they have a first degree relative with colon cancer diagnosed before the age of 60 years?

A

Age 40 years or 10 years before the age at which relative was diagnosed; whichever is sooner.

90
Q

Reduction of activity of which enzyme predisposes to formation of gallstones?

A

Cholesterol 7-alpha hydroxylase

91
Q

What kind of work-up should painless jaundice trigger?

A

Malignancy work-up

92
Q

What is mild to moderate ileocecal Crohn’s disease treated with?

A

Ileal-release budesonide

93
Q

Patient with Roux-en-Y admitted for muscle weakness, peripheral paresthesia, ataxia, and confusion. Which nutritional deficiency does the patient have?

A

Thiamine

94
Q

What is the treatment of cricopharyngeal spasms?

A

Botulinum toxin type A

95
Q

What is the treatment of porcelain gallbladder (calcified gallbladder)?

A

Laparoscopic removal

96
Q

If a patient on sulfasalazine for ulcerative colitis is planning to be pregnant or is pregnant what should you do?

A

Continue sulfasalazine and add folic acid 2 mg orally daily

97
Q

Should treatment with 5-ASA compounds for ulcerative colitis continue during pregnancy?

A

Yes

98
Q

What is the next stop in a unstable patient with an upper GI bleed?

A

Immediate endoscopy

99
Q

What is the first line treatment for gastroparesis?

A

Small, frequent meals

100
Q

Which immunoglobulin deficiency are patients with celiac disease at risk for?

A

IgA deficiency

101
Q

Which autosomal dominant disease has a high risk of colon cancer?

A

Lynch syndrome

102
Q

At what age should individuals at risk for Lynch syndrome start getting colonoscopies?

A

20 - 25 years

103
Q

What is the treatment of chronic immune-active hepatitis B?

A

Tenofovir or entecavir

104
Q

What is the treatment of Zenker’s diverticulum?

A

Surgical correction

105
Q

What disease does interferon alpha plus lamivudine treat?

A

Hepatitis B

106
Q

What is the treatment of hepatitis C?

A

Ledipasvir-sofosbuvir

107
Q

Which two bacteria should you think of if there is rapid onset of nausea and vomiting following food exposure?

A
  • Staphylococcus aureus
  • Bacillus cereus
108
Q

E. Coli causes diarrhea; but is this immediately after ingestion of contaminated food?

A

No

109
Q

What should you do when you suspect GERD?

A

Trial of PPI

110
Q

Is Peutz-Jeghers syndrome associated with an increased risk of gynecological cancers?

A

Yes

111
Q

Can metaplasia similar to that occurring in Barret’s esophagus also occur in the stomach?

A

Yes

112
Q

How often should a colonoscopy be done in left-sided ulcerative colitis, or Crohn’s colitis involving more than one third of the colon?

A

Every 1 - 2 years

113
Q

How long after treatment of H. pylori should patients be tested for eradication?

A

4 weeks (regardless of symptoms)

114
Q

Is total colectomy recommended in Peutz-Jeghers syndrome?

A

No

115
Q

What test is specific for autoimmune pancreatitis?

A

Elevated serum IgG4 levels

116
Q

Should beta blockers be given in acute variceal hemorrhage?

A

No - they are used as prophylaxis after the acute illness

117
Q

When is TIPS attempted?

A

When variceal bleed cannot be controlled pharmacologically or endoscopically; or it recurs despite therapy

118
Q

What should you do after resuscitation in variceal bleed?

A

IV ceftriaxone

119
Q

What is the stage of Barret’s esophagus in which dysplastic mucosal cells do not penetrate the basement membrane?

A

T1 in situ

120
Q

When should you repeat the colonoscopy if there is inadequate bowel prep?

A

1 year

121
Q

What is the treatment of bloody diarrhea caused by Escherichia coli O157:H7?

A

Supportive care

122
Q

What organism has stool examination showing cysts and trophozoites with ingested erythrocytes?

A

Entamoeba histolytica

123
Q

Does regular soy sauce contain wheat/gluten?

A

Yes

124
Q

What other GI disease is primary sclerosing cholangitis associated with?

A

Ulcerative colitis

125
Q

What is the most appropriate diagnostic procedure when a pancreatic ampullary or periampullary mass is suspected?

A

Side viewing EGD (esophagogastroduodenoscopy) with multiple biopsies

126
Q

What is the first-line treatment of inflammatory bowel disease associated arthritis?

A

NSAIDS

127
Q

What is the second-line treatment of inflammatory bowel disease associated arthritis?

A

Sulfasalazine

128
Q

Is further testing needed if the patient obviously has hypertriglyceridemia related pancreatitis?

A

No

129
Q

Which organism that causes bloody diarrhea is a comma-shaped, single-flagellated rod with corkscew motility?

A

Campylobacter jejuni

130
Q

Is there is a viable vessel identified on EGD that may have been bleeding then what is the treatment?

A
  • IV proton pump inhibitor
  • Electrocoagulation of vessel with or without epinephrine or use of a hemoclip.
131
Q

What is the pathophysiology of achalasia?

A

Degeneration of inhibitory neurons of the esophagus

132
Q

What can patients do to reduce their risk of recurrent diverticulitis?

A

Maintain normal body weight

133
Q

Aerophilic gram positive bacteria, more commonly found in the large intestine, transform bile salts into deoxycholic acid, a tumor promotor, leading to the higher rate of adenocarcinoma in the large intestine.

True or false?

A

True

ABIM IM Recert (42 decks)

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