FARR Gastrointestinal

Question 1

A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

Answer 1

Emergent laparotomy to repair perforated viscus.

Question 2

he most likely cause of acute lower GI bleed in patients > 40 years of age.

Answer 2

Diverticulosis.

Question 3

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Answer 3

HIDA scan.

Question 4

Risk factors for cholelithiasis.

Answer 4

Fat, female, fertile, forty, flatulent.

Question 5

Inspiratory arrest during palpation of the RUQ.

Answer 5

Murphy’s sign, seen in acute cholecystitis.

Question 6

The most common cause of SBO in patients with no history of abdominal surgery.

Answer 6

Hernia.

Question 7

The most common cause of SBO in patients with a history of abdominal surgery.

Answer 7

Adhesions.

Question 8

Identify key organisms causing diarrhea:
■ Most common organism
■ Recent antibiotic use
■ Camping
■ Traveler’s diarrhea
■ Church picnics/mayonnaise
■ Uncooked hamburgers
■ Fried rice
■ Poultry/eggs
■ Raw seafood
■ AIDS
■ Pseudoappendicitis

Answer 8

Campylobacter 
Clostridium difficile 
Giardia
ETEC
S. aureus
E. coli O157:H7
Bacillus cereus
Salmonella
Vibrio, HAV
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Yersinia

Question 9

A 25-year-old Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

Answer 9

Crohn’s disease.

Question 10

Inflammatory disease of the colon with ↑ risk of colon cancer.

Answer 10

Ulcerative colitis (greater risk than Crohn’s).

Question 11

Extraintestinal manifestations of IBD.

Answer 11

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis.

Question 12

Medical treatment for IBD.

Answer 12

5-ASA agents and steroids during acute exacerbations.

Question 13

Difference between Mallory-Weiss and Boerhaave tears.

Answer 13

Mallory-Weiss—superficial tear in the esophageal mucosa; Boerhaave—full-thickness esophageal rupture.

Question 14

Charcot’s triad.

Answer 14

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis.

Question 15

Reynolds’ pentad.

Answer 15

Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis.

Question 16

Medical treatment for hepatic encephalopathy.

Answer 16

↓ protein intake, lactulose, rifaximin.

Question 17

First step in the management of a patient with an acute GI bleed.

Answer 17

Establish the ABCs.

Question 18

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Answer 18

Hemolytic-uremic syndrome (HUS) due to E. coli O157: H7.

Question 19

Post-HBV exposure treatment.

Answer 19

HBV immunoglobulin.

Question 20

Classic causes of drug-induced hepatitis.

Answer 20

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.

Question 21

A 40-year-old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Answer 21

Biliary tract obstruction.

Question 22

Hernia with highest risk of incarceration—indirect, direct, or femoral?

Answer 22

Femoral hernia.

Question 23

A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Answer 23

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time.”