Family Med SG14

Question 1

When to consider FIT or FOBT in patients with suspected PUD

Answer 1

Consider if no improvement with PPI test and treat strategy

Question 2

Difference between FOBT and FIT

Answer 2

FIT is more sens and specific than FOBT, but FIT cannot detect blood that came from proximal to ligament of Treitz, so FOBT is best used to check for upper GI bleed.

Question 3

Multiple negative FOBTs or FITs

Answer 3

do NOT exclude upper or lower GI bleed

Question 4

What can cause false pos results in FOBT and FIT?

Answer 4

Diets high in red meat, iron, and vit C

Question 5

Types of H pylori testing

Answer 5

H pylori IgG serology, urease breath test, fecal antigen testing

Question 6

H pylori IgG serology

Answer 6

Confirms past infection but cannot be used to confirm eradication after treatment

Question 7

Urease breath test

Answer 7

Detects active infection. Less active DURING PPI treatment. May be used as a confirmatory test after pos serologic test. Must stop PPI for at least 2 wks and bismuth at least 4 wks prior to breath test

Question 8

Fecal antigen testing

Answer 8

Accurate but more expensive. May be used to evaluate for eradication after medications for h pylori

Question 9

Management of GERD or PUD

Answer 9

Test and treat for both GERD and PUD. Short term trial of PPI. Should be stopped after a successful 4 to 8 week course or used PRN