Colon

Question 1

Answer 1

intussusception

in adults, managed operatively

Question 2

Patient with diarrhea

Answer 2

lymphocytic colitis

1st line therapy- budesonide 9mg/day for 8 weeks, then 6mg for 2 weeks, then 3mg for 2 weeks
for recurrence give 6mg taper over 6 months

Question 3

Answer 3

Collagenous colitis

1st line therapy- budesonide 9mg/day for 8 weeks, then 6mg for 2 weeks, then 3mg for 2 weeks
for recurrence give 6mg taper over 6 months

Question 4

Answer 4

Thumbprinting of the bowel
concerning for severe colitis
ischemic colitis, UC, c. diff, etc

Question 5

Answer 5

Single stripe sign of ischemic colitis

Question 6

Answer 6

Sigmoid volvulus

Coffee bean sign

Question 7

Answer 7

volvulus

Whirl sign

Question 8

Answer 8

Cecal volvulus

Question 9

Answer 9

cecal volvulus

Question 10

Answer 10

intussusception

target sign

Question 11

Answer 11

intussusception

target sign or bulls eye

Question 12

what is the anorectal inhibitory reflex?

Answer 12

when stool reaches rectum,
involuntary relaxation of internal anal sphincter

voluntary contraction of external anal sphincter to maintain continence

RAIR is absent in hirschprung’s

Question 13

What are the mechanism of actions for and doses in CIC and IBS-C?
-linaclotide
-plecanitide
-lubiprostone
-prucalopride

Answer 13

-linaclotide - increase Cl secretion via GC-C/ CFTR (max 145microgm in CIC, 290microgm in IBS-C)

-plecanitide- CFTR pathway - 3mg daily

-lubiprostone - increase CL secretion via CCL2 pathway -24microgm in CIC vs 8microgm in IBS-c

-prucalopride - 5HT agonist 1-2mg daily in CIC, not approved for IBS-C

Question 14

Pathology seen in GVHD

Answer 14

epithelial cell apoptosis with apoptotic bodies, as well as loss of crypts and crypt necrosis

Question 15

SMAD4
CHD1
CHEK2

Answer 15

SMAD4 - juvenile polyposis syndrome; CRC, stomach

CHD1- diffuse gastric cancer, lobular breast cancer

CHEK2- breast cancer, low risk of CRC

Question 16

Who should be screened for pancreatic cancer and when do you start?

Answer 16

2 family members with pancreatic cancer including 1 FDR
ATM
BRCA 1 or 2
STK11 (Peutz-Jeghers syndrome) 35yo
PALB2
mismatch repair genes (Lynch syndrome) +one FDR with pancreatic cancer
CKDN2A mutation 40
hereditary pancreatitis -PRSS1*40

otherwise age 50 or 10 years before youngest relative was diagnosed.

Question 17

What is necessary to diagnosed dyssynergistic defecation?

Answer 17

2 of 3
ARM
balloon expulsion test
imaging (like defacography)

Question 18

Severe abdominal pain in patient with CKD, HTN, DM

Answer 18

Acute mesenteric ischemia
LLQ fat stranding
portal venous gas

Question 19

Seen in the rectum

Answer 19

rectal NET
if <1cm remove with polypectomy

Question 20

antibiotic-associated hemorrhagic colitis ; not c. diff

Answer 20

Klebsiella oxytocain
will not respond to PO vanc
treat by removing the antibiotic

Question 21

how do you test for c. diff?

Answer 21

sensitive test (GHD, NAAT) –> followed by specific test (ELISA)

Question 22

treatment of thrombosed external hemorrhoid?

Answer 22

<72hour- incision and drainage
>72hours conservative measures