Board Vitals Gastroenterology Flashcards
Is Barrett esophagus more common in Black or White patients?
White
Does Helicobacter pylori infection predispose to Barrett esophagus?
No
(It appears to be protective)
Are patients with dyspepsia and H. pylori infection at risk of getting Barrett esophagus?
No
What is the mean age at time of diagnosis of Barrett esophagus?
55 years
Is Barrett esophagus associated with a family history of gastric cancer?
No
Is Barrett esophagus more common in Asian or White patients?
White
Is Barrett esophagus more common in Hispanic or Non-Hispanic patients?
Non-Hispanic
Does H. pylori protect against Barrett esophagus and esophageal adenocarcinoma?
Yes
What is the treatment of mild ulcerative colitis?
5-aminosalicylic (ASA) agent (mesalazine)
Which lab value is characteristic of primary biliary cholangitis?
Elevated alkaline phosphatase
What are the aminotransferase levels in primary biliary cholangitis?
May be normal and are usually lower than 5 times upper limit of normal.
Is primary biliary cholangitis associated with increased risk of hepatocellular carcinoma?
Yes
What is the treatment of primary biliary cholangitis?
Ursodeoxycholic acid
What should you do if alkaline phosphatase remains elevated after treating primary biliary cholangitis with ursodeoxycholic acid?
Obeticholic acid
Does hepatitis C increase the risk of hepatocellular carcinoma?
Yes
Does hepatitis C increase the risk of lymphoma in HIV-negative patients?
Yes
Which patients have an increased risk of developing cryoglobulinemia and clonal proliferation of B-cells?
Patients with hepatitis C and t(14;18) translocation
Which model determines whether patients with alcoholic hepatitis will benefit from pharmacologic therapy?
Maddrey discriminant function
Which levels are used in the calculation of the Maddrey discriminant function?
Bilirubin
Prothrombin time
What should the Maddrey discriminant score be for patients who will most likely benefit from pharmacological therapy for alcoholic hepatitis?
32 or more (those with high short term mortality risk)
Which model assesses the risk of non-shunt operations in cirrhosis patients?
Child-Pugh classification
Which model helps predict 90-day mortality in alcoholic hepatitis patients and requires a biopsy?
Hepatic histology score
Which model determines if patients with alcoholic hepatitis are responding to therapy?
Lille score
What diagnosis should be considered in patients with iron deficiency anemia that does not respond to therapy?
Celiac disease
What is the next step in ulcerative colitis patients who are refractory to rectal mesalamine?
Rectal budesonide
In patients diagnosed with colon cancer - what is the best next step to determine if they have Lynch syndrome?
Immunochemistry staining of tumor
What is the most important intervention in diabetic gastroparesis?
Blood glucose control
Do tricyclic antidepressants result in improved gastric emptying in gastroparesis?
No
What criteria is used to assess prognosis of patients with pancreatitis?
Ransen criteria
What calcium level within 48 hours is associated with worse prognosis in patients with acute pancreatitis?
Less than 8 mg/dL
What hematocrit decrease within 48 hours is associated with worse prognosis in patients with acute pancreatitis?
More than 10%
What baseline AST is associated with worse prognosis in patients with acute pancreatitis?
More than 250
What baseline leukocyte count is associated with worse prognosis in patients with acute pancreatitis?
More than 16,000 cells/mm3
What age is associated with worse prognosis in patients with acute pancreatitis?
More than 55 years
Should you test for H. pylori infection while the patient is on a proton pump inhibitor?
No
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?
Yes
Can patients with upper GI bleed with low-risk clinical and endoscopic features be discharged on PPI if their hemoglobin and vitals are stable?
Yes
Which antibodies do patients vaccinated against hepatitis B have?
anti-HBs
Which antibodies do patients with previous hepatitis B infection have?
anti-HBs and anti-HBc
Which test shows current infection with hepatitis B?
HbsAg
What are the most common causes of liver abscesses in the United States?
Staphylococcal or streptococcal infections
If a patient has been to India, Mexico, South America, or Africa, and they develop a liver abscess - what organism should you think of?
Entamoeba histolytica
If an immunocompromised patient presents presents with multiple liver abscesses - what organism should you think of?
Candida
If a patient presents with multiple very small, nodular appearing liver abscesses - what organism should you think of?
Bartonella
Are liver abscesses caused by mycobacterium tuberculosis usually single or multiple?
Multiple
What is the treatment of asymptomatic gallstones?
Observation
What is bright red blood per rectum without abdominal pain most consistent with?
Diverticular bleed
What is the first line treatment for eosinophilic esophagitis?
- Proton pump inhibitor
- Swallowed steroids
Biopsies of the colon reveal an abnormally thickened subepithelial collagen band in the lamina propria.
Diagnosis?
Collagenous colitis
Can NSAIDS cause collagenous colitis?
Yes
Biopsies of the colon reveal villous atrophy, intraepithelial lymphocytosis, and inflammation of the lamina propria.
Diagnosis?
Celiac disease
What is the first step in treating microscopic colitis?
Discontinue medications that can potentially cause this.
What are collagenous colitis and lymphocytic colitis?
Microscopic colitis
What should you think of in patients with melanosis coli on colonoscopy?
Laxative abuse
Patient has pigmented macules and GI hamartomas.
Diagnosis?
Puetz-Jeghers syndrome
What is the inheritance pattern of Puetz-Jeghers syndrome?
Autosomal dominant
Patients with Puetz-Jeghers syndrome are at greatest risk of which malignancy?
Colon cancer
What is the screening age for colonoscopy in patients of average risk?
45 years
What is the screening age for colonoscopy in patients with first degree relative with colon cancer before age 60 years?
Age 40 years or 10 years before age of youngest affected member, whichever comes first.
What should you do before anti-virals/treatment for hepatitis C?
(Viral) genotype testing
What is the treatment of spontaneous bacterial peritonitis?
Third generation cephalosporins (ceftriaxone or cefotaxime)
Can hepatitis B or C cause hepatic steatosis?
Yes
Should patients with NAFLD be evaluated for other causes of hepatic steatosis?
Yes
Can GERD cause chronic cough?
Yes
Which medication for hepatitis C is most commonly associated with hemolytic anemia?
Ribavirin
Is glecaprevir-pibrentasvir for the treatment of hepatitis C safe to use in chronic kidney disease?
Yes
In patients’ with a family history of colon cancer - when should the next colonoscopy be done if the first screening colonoscopy is normal?
In 5 years.
Can celiac disease cause secondary lactose malabsorption?
Yes
Where is lactase located?
On the small intestine brush border.
Which criteria is used to diagnose irritable bowel disease?
Rome IV criteria
What is Charcot’s triad?
- Fever
- Abdominal pain
- Jaundice
What is the initial imaging of choice in suspected acute cholangitis in patients who don’t fulfill Charcot’s triad?
Abdominal ultrasonography
Liver transplant patient: CD8+ and CD4+ T lymphocytes against donor major histocompatibility complex (MHCs).
Liver failure symptoms.
What is this?
Acute transplant rejection
Liver transplant patient: CD4+ T lymphocytes against recipient antigen-presenting cells.
Liver failure symptoms.
What is this?
Graft versus host disease
Liver transplant patient: Pre-existing recipient antibodies.
Liver failure symptoms.
What is this?
Hyperacute rejection
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?
CMV esophagitis
What is the mechanism of action of erythromycin when it’s used to treat gastroparesis?
Motilin receptor agonist
What is the induction therapy for moderate to severe Crohn’s disease with fistula formation?
Infliximab and azathioprine
What would be the most likely cause of painless bright red blood per rectum in a very young person?
Meckel’s diverticulum
What is the first line treatment of esophageal eosinophilia?
- Proton pump inhibitor
- Swallowed/topical glucocorticoids (not oral)
What are the transaminase levels typically in alcoholic hepatitis?
AST > ALT (2:1)
< 300 IU/L
Which layer of the gastrointestinal tract is affected in ulcerative colitis?
Mucosa
Which layer of the gastrointestinal tract is affected in Crohn’s disease?
All layers
Does the alkaline phosphatase rise early in common bile duct obstruction?
No
Does the GGT rise early in common bile duct obstruction?
No
Does the AST and ALT rise early in common bile duct obstruction?
Yes
Does the bilirubin rise early in common bile duct obstruction?
Yes
How high can the transaminases be if a person intentionally overdoses on acetaminophen?
> 3500
When should patients get a colonoscopy if they have a first degree relative with colon cancer diagnosed before the age of 60 years?
Age 40 years or 10 years before the age at which relative was diagnosed; whichever is sooner.
Reduction of activity of which enzyme predisposes to formation of gallstones?
Cholesterol 7-alpha hydroxylase
What kind of work-up should painless jaundice trigger?
Malignancy work-up
What is mild to moderate ileocecal Crohn’s disease treated with?
Ileal-release budesonide
Patient with Roux-en-Y admitted for muscle weakness, peripheral paresthesia, ataxia, and confusion. Which nutritional deficiency does the patient have?
Thiamine
What is the treatment of cricopharyngeal spasms?
Botulinum toxin type A
What is the treatment of porcelain gallbladder (calcified gallbladder)?
Laparoscopic removal
If a patient on sulfasalazine for ulcerative colitis is planning to be pregnant or is pregnant what should you do?
Continue sulfasalazine and add folic acid 2 mg orally daily
Should treatment with 5-ASA compounds for ulcerative colitis continue during pregnancy?
Yes
What is the next stop in a unstable patient with an upper GI bleed?
Immediate endoscopy
What is the first line treatment for gastroparesis?
Small, frequent meals
Which immunoglobulin deficiency are patients with celiac disease at risk for?
IgA deficiency
Which autosomal dominant disease has a high risk of colon cancer?
Lynch syndrome
At what age should individuals at risk for Lynch syndrome start getting colonoscopies?
20 - 25 years
What is the treatment of chronic immune-active hepatitis B?
Tenofovir or entecavir
What is the treatment of Zenker’s diverticulum?
Surgical correction
What disease does interferon alpha plus lamivudine treat?
Hepatitis B
What is the treatment of hepatitis C?
Ledipasvir-sofosbuvir
Which two bacteria should you think of if there is rapid onset of nausea and vomiting following food exposure?
- Staphylococcus aureus
- Bacillus cereus
E. Coli causes diarrhea; but is this immediately after ingestion of contaminated food?
No
What should you do when you suspect GERD?
Trial of PPI
Is Peutz-Jeghers syndrome associated with an increased risk of gynecological cancers?
Yes
Can metaplasia similar to that occurring in Barret’s esophagus also occur in the stomach?
Yes
How often should a colonoscopy be done in left-sided ulcerative colitis, or Crohn’s colitis involving more than one third of the colon?
Every 1 - 2 years
How long after treatment of H. pylori should patients be tested for eradication?
4 weeks (regardless of symptoms)
Is total colectomy recommended in Peutz-Jeghers syndrome?
No
What test is specific for autoimmune pancreatitis?
Elevated serum IgG4 levels
Should beta blockers be given in acute variceal hemorrhage?
No - they are used as prophylaxis after the acute illness
When is TIPS attempted?
When variceal bleed cannot be controlled pharmacologically or endoscopically; or it recurs despite therapy
What should you do after resuscitation in variceal bleed?
IV ceftriaxone
What is the stage of Barret’s esophagus in which dysplastic mucosal cells do not penetrate the basement membrane?
T1 in situ
When should you repeat the colonoscopy if there is inadequate bowel prep?
1 year
What is the treatment of bloody diarrhea caused by Escherichia coli O157:H7?
Supportive care
What organism has stool examination showing cysts and trophozoites with ingested erythrocytes?
Entamoeba histolytica
Does regular soy sauce contain wheat/gluten?
Yes
What other GI disease is primary sclerosing cholangitis associated with?
Ulcerative colitis
What is the most appropriate diagnostic procedure when a pancreatic ampullary or periampullary mass is suspected?
Side viewing EGD (esophagogastroduodenoscopy) with multiple biopsies
What is the first-line treatment of inflammatory bowel disease associated arthritis?
NSAIDS
What is the second-line treatment of inflammatory bowel disease associated arthritis?
Sulfasalazine
Is further testing needed if the patient obviously has hypertriglyceridemia related pancreatitis?
No
Which organism that causes bloody diarrhea is a comma-shaped, single-flagellated rod with corkscew motility?
Campylobacter jejuni
Is there is a viable vessel identified on EGD that may have been bleeding then what is the treatment?
- IV proton pump inhibitor
- Electrocoagulation of vessel with or without epinephrine or use of a hemoclip.
What is the pathophysiology of achalasia?
Degeneration of inhibitory neurons of the esophagus
What can patients do to reduce their risk of recurrent diverticulitis?
Maintain normal body weight
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?
True
