FES Flashcards
1
Q
(blank) are designed to view the lumen either in a front or side viewing manner
A
Flexible scopes
2
Q
(blank) allow for optimal access to certain areas of the stomach and duodenum and are most commonly utilized during ERCP
A
side-viewing
3
Q
What is a charge coupled device or complementary metal oxide semioconducter chip based camera?
A
sends digital message to a digital processor
4
Q
the suction button and the biopsy cap share a **
A
common channel
5
Q
The suction/biopsy channel is usually between what position on a clock face
A
5 and 7 oclock
6
Q
The (blank) cable connects to the video processing unit either wirelessly or via a separate cable.
A
umbilical
7
Q
Can you use saline in your water channel?
A
NO it can crystalize
8
Q
Do not activate (blank) until the functioning end of the device is fully exited from the endoscope channel.
A
energy sources
9
Q
What scope is a side viewing scope?
A
A duodenoscope
10
Q
What are external sources of endoscopic illumination?
A
Xenon Arc, halogen filled tungsten filament lamp, LED
11
Q
What happens when the blue button of the scope handle is depressed?
A
Provides water to clear the lens
12
Q
If the endoscope does not have a dedicated auxillary channel for irrigation, what channel can be used?
A
The suction/biopsy channel
13
Q
Informed consent is based on what 2 ethical principles?
A
Autonomy and self-determination
14
Q
Is routine testing recommended prior to endoscopy?
A
No
15
Q
When should you do a pregnancy test?
A
All females of child bearing age
16
Q
Who should get coag tests?
A
active bleeding, history of bleeding, acquired coagulopathy
17
Q
Who should get a CXR?
A
Patients with a suspected pulmonary or cardiac decompensation
18
Q
Who should get a chem panel?
A
pts with impaired renal, hepatic or endocrine function
19
Q
Is there a perfect bowel prep?
A
nope
20
Q
What would be an ideal prep?
A
Reliable empties colon No effect on mucosa Short time for ingestion and evacuation No discomfort or signif SE No fluid or electrolyte shifts
21
Q
What is a split dose bowel regiment?
A
half fluid given in the evening and then half in the morning of the colonoscopy completing at least 3 hours prior to procedure.
22
Q
If you are doing rectum and sigmoid colon endoscopy what can be the prep?
A
1 or 2 enemas morning of procedure
23
Q
If your patient is older than 65, what type of bowel prep should you use?
A
PEG solutions to avoid electrolyte and fluid shifts
24
Q
(blank) are osmotically balanced, non-absorbable electrolyte solutions that effect bowel cleansing by washing out the ingested fluid without producing significant fluid or electrolyte shifts
A
Isosmotic preparations
25
What fragile patient populations can use isosmotic preps?
Liver and renal failures, CHF, and electrolyte imbalances
26
(Blank) draw plasma water into the bowel lumen to promote the evacuation of colonic contents. They are better tolerated due to lower volume, resulting in better patient compliance.
Hyperosmotic preparations.
27
What is the downside to hyperosomotic solutions?
cause fluid loss, dehydration and are costly. Cant give it to people with any type of failure, ileus, malabsorption or ascites
28
Antibiotics (are vs Are not?) generally recommended before most endoscopic procedures.
Are NOT
29
Who should you give antibiotic prophylaxis to?
- All patients before PEJ or PG
- Peritoneal dialysis
- Cirrhotic patients with Gi bleed
- Endocarditis or prosthetic valves
- Liver transplant or suspected biliary obstructions
30
Many endoscopic procedures may be performed safely in the setting of antithrombotics. Cold forceps mucosal biopsies may be obtained while patient is on anticoagulation. T or F?
True
31
When anticoagulation is temporary (e.g. warfarin for VTE), elective endoscopic procedures should be delayed when possible until anticoagulation is no longer necessary.
True
32
Procedures with a high risk of significant bleeding include:
* Polypectomy
* Biliary sphincterotomy
* Pneumatic or bougie dilation
* Percutaneous endoscopic gastrostomy (PEG) placement
* Endoscopic mucosal resection / endoscopic submucosal dissection (EMD/ESD)
* Endosonographic-guided fine needle aspiration and pseudocyst drainage
* Laser ablation and coagulation
* Treatment of varices
33
Low-risk conditions for embolic event
- Deep vein thrombosis
- Uncomplicated or paroxysmal nonvalvular atrial fibrillation
- Bioprosthetic valve
- Mechanical valve in the aortic position
34
High-risk conditions for embolic event
* Atrial fibrillation associated with valvular heart disease
* Mechanical valve in the mitral position
* Mechanical valve and prior thromboembolic event
35
The risk of major embolism in patients with mechanical heart valves without anticoagulation is(Blank) per 100 person-years, and is reduced to (blank) per 100 person-years in patients with antiplatelet therapy, and to (blank) per 100 person-years in patients with warfarin.
4
2.2
1
36
Patients with atrial fibrillation but without valvular disease have a risk of thromboembolism of (blank) per year in the absence of anticoagulation. The risk is higher in the presence of dilated cardiomyopathy, valvular heart disease, or recent thromboembolic events
5% to 7%
37
The absolute risk of any embolic event in a patient with a low-risk condition in whom anticoagulation is stopped for 4 to 7 days is (blanK) per 1000 patients.
1 to 2
38
Endoscopic procedures may be performed in patients taking antithrombotic therapy (WITH OR WITHOUT***) any alterations.
Without
39
Pre-procedural management of antithrombotic therapy for procedures with high-risk of significant bleed are as follows:
• (blank) does not need to be stopped.
• Patients on a single antiplatelet drug, should be switched to (blank) 5-7 days before.
• Patients on dual antiplatelet drugs, (blank) should be continued and the second drug should be stopped 5-7 days before.
• Patients at high-risk for a thromboembolic event on long-acting anticoagulants should be given (blank).
Aspirin
Aspirin
Aspirin
Bridge Therapy
40
When should you resume antithrombotic therapy?
No consensus
41
In patients with (CIED) Cardiovascular Implantable Electronic Device, what type of device are preferred?
Bipolar and ultrasonic devices
42
How do you know if a patient has a pacemaer?
there should be pacing spikes on EKG in front of P waves
43
When do you place a magnet?
- In non pacing patients to prevent arrythmia detection
- In non pacing depending but has pacing ability patients, do need but should be available
- in pacing dependent without ICD, place a magnet if procedure above umbilicus
- in pacing dependent with an ICD
44
If patients have an CIED, what else should you do besides have a magnet handy?
monitored with either plethysmography or an arterial line and should have transcutaneous patches for emergent defibrillation and/or emergent transcutaneous pacing.
Make sure CIED is working before they leave
45
```
NPO guidelines:
CLD?
Breast milk?
Infant formula?
Non human Milk?
Light meal?
Fried food, fatty foods, meat?
```
```
CLD?- 2
Breast milk?- 4
Infant formula?- 6
Non human Milk?- 6
Light meal?- 6
Fried food, fatty foods, meat?- 8
```
46
Which are isomostic bowel preps?
| Hyperosomolar?
polyethylene base and triLyte (movi prep, golytelY)
| Mag citrate, sodium phosphate
47
Which of the following is considered a high-risk procedure for bleeding?
a. EUS assessment of vessel encasement for pancreatic cancer
B. Colonoscopy with cold forceps biopsy
C. Push enteroscopy
D. Balloon dilation of esophageal stricture
D. balloon dilation of esophageal stricture
48
What characterizes moderate sedation?
- Mildly depressed level of consciousness
- Patient response to verbal commands
- maintenance of patients own airway
- Intact airway reflexes
- hemodynamic equilibrium
49
Deep sedation is characterized by:
* Significant depression of level of consciousness
* Painful stimulus is necessary to evoke a withdrawal response
* Airway protective reflexes cannot be relied upon
* Hemodynamics are usually preserved although instability can occur
50
Updated Practice Guidelines for Sedation and Analgesia for Non-Anesthesiologists set forth by the American Society of Anesthesiology Task Force in 2002 recommend that all patients undergoing moderate sedation and analgesia be monitored with:
* Pulse oximetry
* Verbal stimulation to track level of consciousness
* Observation and auscultation of pulmonary ventilation
* Blood pressure and heart rate at five-minute intervals during the procedure
* Continuous electrocardiography (ECG) for patients with significant cardiovascular disease
51
(blank) should be considered for patients receiving deep sedation, for patients with certain medical conditions (sleep apnea) and for patients whose ventilation cannot be directly observed during moderate sedation.
ETCO2
52
The following should be available for all procedures to be performed under sedation:
* Advanced life support
| * A resuscitation cart with appropriate equipment, medications, and instructions
53
T or F
| Morbidity and mortality rates for moderate sedation are higher than for general anesthesia.
True
54
Risk factors associated with desaturation include:
Age greater than 60
ASA 3 or higher
Lengthy, more complex procedures
55
In (blank) only painful or repeated physical stimulation elicits a purposeful withdrawal response.
deep sedation
56
(blank) can be used to measure the depth of sedation. In relatively healthy subjects, deep sedation appears to be well tolerated for brief periods
The Modified Observer's Assessment of Alertness/Sedation Score (MOAA/S)
57
According to the ASA, the primary causes of sedation-related morbidity in patients undergoing endoscopy stem from (blank and blank)
respiratory depression (hypoventilation) and airway obstruction.
58
For patients with (blank) in whom monopolar energy is being considered, ECG monitoring should be available.
pacemaker
59
Guidelines published by the ASGE recommend considering the assistance of an anesthesia specialist when:
- Airway abnormalities
- complex procedures
- intolerance to sedatives
- severe comorbidities
60
Benefits of midazolam?
- short duration of action
- minimal venous irritation
- anterograde amnesia
61
What is the starting dose of midazolam?
Onset of action?
When can you increase the dose?
0.5 mg to 2 mg IV
3-5 minutes
after 2 minutes
62
Who should you reduce midazolam doses?
- elderly
- liver disease
- renal failure
- in combination with narcotics
63
Benzos can cause what complications?
- hypoventilation
- hypotension
- paradoxical agitation
64
What is the starting dose of flumazenil?
- 0.2 mg IV
| - titrate up to 1 mg
65
What is the dosage for fentanyl?
1 to 2 microgram/kg (usually about 75-150 micrograms)
66
How quickly does naloxone work?
2 minutes
67
What are the cardiovascular effects of propofol?
* Decrease in cardiac output
* Decrease in systemic vascular resistance
* Decrease in arterial pressure
* Negative cardiac inotropy
* Respiratory depression
68
Potential adverse effects of topical anesthetics include
* Aspiration
* Anaphylactoid reactions
* Methemoglobinemia
69
While in recovery, patients are still at risk for complications related to sedation. Delayed presentation of undesirable side effects can be due to:
* Lack of procedural stimulation
* Variable drug absorption
* Slow drug elimination
70
DC criteria?
VSS, alert, Scoring system OAA or MOAA, dc to an adult
71
The overall complication rate related to sedation and endoscopy
1 in 10,000
72
The ASGE recommends considering the assistance of an anesthesia specialist when...
Risk of complications is increased because of severe comorbidities
73
The main effect of midazolam during moderate sedation for endoscopy is?
amnesia
74
What is the half life of naloxone?
1 to 1.5 hours
75
What are NOT indications for diagnostic EGD?
- Atypical, non-progressive and chronic abdominal discomfort or pain due to a functional problem
- Uncomplicated reflux responsive to medical therapy in non-high risk patients
- Evaluation of asymptomatic benign findings on a radiologic study
- End stage malignant disease when the results of the procedure will not alter management or when there is no therapeutic benefit
76
History of gastrectomy for benign disease...... Is surveillance endoscopy recommended or not?
NOT
77
Patients with (Blank) should have a single endoscopy with no follow up if there is no evidence of malignancy
pernicious anemia
78
Who should get screening for barretts esophagus?
GERD with multiple RF's:
| - Men, white race, age greater than 50, GERD >5 years, hiatal hernia, obesity
79
Timing of barretts endosopy surveillance
- No dysplasia?
- Low grade?
- High grade?
no dyplasia- 3-5 years
low grade 6-12 months
high grade 3 months
80
Complications of topical pharyngeal sprays
methemoglobinemia, aspiration and anaphylaxis
81
Patients with a RNYGB may need what type of endoscope?
Pediatric colonoscope or device assisted enteroscope
82
What is a vertical banded gastroplasty
resistrictive procedure with band/mesh at bottom of pouch
83
How far back should you hold the scope with your right hand?
about 12 inches (30 cm from the tip)
84
What should you measure during an EGD?
- Distance of incisiors to Z line- squamous/columnar junction
- GE junction- upper limit of gastric folds
- Diaphragmatic pinch- contraction on the lower esophagus
85
What is considered a hiatal hernia?
if the GE junction (end of gastric folds) is more than 2 cm above the pinch of the diaphragm
86
If there is a lesion on the lesser curve of the stomach or periampullary region of the duodenum that is difficult to see, or cannot be approached directly, repeat endoscopy using a (blank) might be of value.
side-viewing endoscope
87
(blank) is a false diverticulum occurring in the posterior hypopharynx that is sometimes associated with foreign body sensation, throat irritation, dysphagia or halitosi
Zenker's diverticulum (ZD)
88
If the majority of the stomach is intrathoracic and you are having difficulty intubating the pylorus. What maneuver can you do to get access to it?
retroflexion
89
```
Which classification do you use for the following pathologies?
Erosive esophagitis?
Esophageal varices
Barretts
Neoplasms
Bleeding ulcers
```
- Erosive esophagitis- LA
- Esophageal varices- Size classification
- Barretts- Prague C
- Neoplasm- Paris
- Bleeding ulcer- Forest
90
In normal anatomy the Z line is usually located where?
| Hiatal hernia?
distal esophagus
| The Z line, the GE junction are proximal to pinch of diaphragm
91
What do you use to classify hiatal hernias?
hill grading
92
In the presence of columnar metaplasia of the esophagus. the Z line is proximal to the EGJ (end of rival folds)
Esophagogastric Junction
93
Hill grades?
1 good ridge, tight around scope
2 sort of good fold, opens with respiration
3 ridge is poor, hiatus patulous
4, no ridge, hiatus wide open
94
LA reflux grades?
A. Mucosal breaks < 5 mm
B. Break > 5 mm
C. continous between tops of mucosal folds, less than 75% circumference of esophagus
d. involves at least 75% of esophageal circumference
95
steps of the prague classification?
1. identify GE junction
2. Look for hiatal hernia
3. identify the most proximal circumferentially columnar mucosa in cm above GE junction, define as C value
4. identify most proximal vertical columnar mucosa in cm above GE junction, define as M value
5. Subtract the GE junction in cm from the C number and then do the same for the M number to get your classifcation.
96
Complication rate of EGD?
0.13%
97
MC complication from upper endoscopy
Cardiopulmonary
98
Bite blocks are not helpful in regards to oxygenation... why?
They are basically a reverse jaw thrust because they push the jaw and tongue posteriorly.
99
What areas of the esophagus are prone to iatrogenic perforation?
Pharynx, cricopharyngeus, duodenum
100
What to do if you suspect esophageal perforation?
water soluble upper GI or CT
101
Which of the following is an indication for surveillance with upper endoscopy?
A. Intestinal metaplasia of the stomach without metaplasia
B. Pernicious anemia with prior normal upper endoscopy
c. History of gastrectomy for benign disease
d. baretts esophagus
D. Barretts
102
A patient was found to have Barretts esophagus on upper endoscopy. Pathology reports metaplasia with no dysplasia. The recommendation for repeat endoscopy is?
3 years.
103
Which hill grade classification best describes a patient found to have a hiatus that is wide open all the time and a sphincter this is displaced axially?
Hill grade IV
104
The American cancer society lowered their colorectal cancer screening recommendation starting at age ***
45
105
People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of ***
75
106
Increased risk patients for colonoscopy screening are?
| What age should they start getting colonoscopies?
1st degree releatives with CRC, Adenomas or serrated lesions before 60. or 2 first degree relatives with CRC at any age.
40 y/o or 10 years before 1st diagnosis
107
Patients with no polyps seen at index colonoscopy require their next colonoscopy in (blank)
10 years.
108
Patients with small (< 10mm) hyperplastic polyps in the rectum or sigmoid require their next colonoscopy in (blank)
10 years.
109
Patients with one or two small (< 10mm) adenomatous polyps completely excised require their next colonoscopy in 5 years
5-10 years.
110
Patients with three or more adenomatous polyps or patients with one 10mm or greater than polyp completely excised require their next colonoscopy in at least (blank)
three years
111
Patients with serrated adenomas require specialized follow-up in (blank) based on degree of dysplasia and extent of polyp burden.
one to five years
112
post-polypectomy screening
- 2-6m: piecemeal removal
- 1 year: > 10 adenomas
- 3 years: 3+ adenomas, HGD, > 1cm, villous elements
- 5 years: 1-2 tubular adenomas (< 1cm)
- 10 years: hyperplastic polyps (<20)
113
Colonoscopy should be performed every (blank) years for patients with either colorectal cancer or adenomatous polyps in a first-degree relative before age 60 years or in two or more first-degree relatives at any age.
five years
114
Generally, if a luminal obstruction is traversable with a (blank) diameter flexible endoscope and the patient is having bowel movements, emergent intervention is not required. However, these patients should be monitored closely for obstruction.
10mm
115
Immunocompromised patients are at risk for opportunistic infections such as cytomegalovirus (CMV), which macroscopically produces nonspecific colitis with ulcerations, but contains microscopic(blank) seen in mucosal biopsy.
inclusion bodies
116
(blank) refers to inflammation of the ileocecum on cross-sectional abdominal imaging.
Typhilitis
117
Preoperative localization of colorectal lesions may be required. Endoscopic tattooing facilitates intra-operative identification of pathology that may otherwise be difficult to localize intra-operatively. Non-soluble materials such as carbon particles should be used. (blank) dissipate quickly and should not be use.
Methylene blue or indigo carmine
118
The tattooing agent is injected into the (blank) plane. Transmural injection should be avoided as it may result in diffuse peritoneal staining.
submucosal
119
Water immersion techniques can assist traversing the rectosigmoid colon and advance the colonoscope. Water immersion is performed by filling the lumen with (blank) and may open the lumen and reduce the acuity of sigmoid angulation.
250-500cc of water
120
```
What is the Boston bowel prep score?
0?
1?
2?
3?
```
0 unprepared colon with solid stool
1 can see some mucosa but not all
2 minor amount of stool staining
3 entire mucosa seen
121
```
Paris classification of polyps?
Is
Isp
Is
IIa
IIb
IIc
III
```
Is, Isp, Is= protruding
Ia, Ib, Ic= non protruding
III excavated
122
Distinguishing features used to discriminate malignant from benign polyps include:
```
Necrosis
Fungation
Firmness
Central ulceration or depression
"Non-lifting sign" during saline lift polypectomy
```
123
Lipomas can be distinguished from other submucosal lesions by the (blank) test which shows the lesion dimples easily when pushed with endoscopic instruments.
"pillow test"
124
Chronic anthraquinone laxative use (e.g. senna) can cause permanent (blank) of the colonic mucosa.
dark staining
125
Perforations arising from scope advancement typically occur at the (blank) where enlarging loops may traumatize the colonic wall.
rectosigmoid colon
126
leukocytosis following cautery-assisted polypectomy.
Post-polypectomy syndrome
127
Postpolypectomy syndrome occurs in less than 1% of cautery assisted polypectomies and may develop between (blank and blank) days following the procedure.
12 hours and five
128
Currently, ASGE society quality indicators call for adenoma detection rates to be at least (blank) percent for men and (blank) % for women.
30% and 20%
129
A minimum withdrawal time of (blank) minutes has been recommended to improve ADR, although an absolute minimum time remains somewhat controversial.
six
130
The most accurate way of localizing colonic pathology is...?
tattooing
131
In adults the length of the small bowel is variable, usually (blank) meters. The duodenum is about 20-30cm long. The jejunum is about 40% and the ileum about 60% of the length of the small bowel.
5 meters
132
(blank) is considered the optimal screening tool for suspected small bowel disorders.
Video capsule endoscopy (VCE)
133
Small bowel endoscopy is good for surveillance for polyposis syndromes affecting the small bowel like ....
Peutz-Jeghers-syndrome or FAP (familial adenomatous polyposis)
134
Patients carrying a video capsule should not undergo (blank)
MRI
135
Absolute and relative contraindications to VCE include:
| Known (blank) of the intestinal tract that can lead to capsule retention and obstruction.
stricture
136
VCE can be performed after fasting for (blank) hours. Visibility of the small intestine can be improved by giving the patient a half or full dose of a colonoscopy preparation and an anti-foam agent (i.e. Simethicone) to reduce air bubbles.
8
137
Push endoscopy reaches further into the small intestine than EGD by using a pediatric colonoscope or an enteroscope that is usually (blank) cm long and has a diameter or about 9mm
200
138
Different types of endoscopes for "deep" enteroscopy are available.(blank) (Fig.1) is considered the gold-standard with regard to deep intubation and complete enteroscopy.
Double-balloon enteroscopy
139
The overall risk for complications during deep enteroscopy is in the range of (blank) %
1-2%
140
The following are potential complications following enteroscopy for choledocholithiasis after Billroth II anastamosis
a. Perforation
b. pancreatitis
c. none
d. both
D. Both
141
How do you position a patient for ERCP?
Prone with head to the right
142
The key anatomic principle of ERCP is the orientation of the biliary and pancreatic ducts to the duodenal lumen. The bile duct comes from a cephalad direction parallel to the duodenal lumen, and typically joins the papilla between the (blank) o clock and (blank) o clock position. The pancreatic duct comes from a more directly perpendicular direction, and joins the papilla between the (blank and blank) o'clock positions.
11 and 1 o'clock positions
| 2 and 4
143
Endoscopic sphincterotomy is performed with (blank) electrosurgery.
monopolar
144
Plastic biliary stents require removal or exchange every xxx because of the risk of cholangitis secondary to occlusion of the stent over time
3 months
145
(blank) have longer patency rates compared to plastic stents, and come in both covered and uncovered varieties. The (blank) stents have longer patency rates and may be removed endoscopically.
Self-expanding metal stents (SEMS)
| Covered
146
(blank) are placed in patients with unresectable malignant obstructions and may provide durable patency avoiding further interventions in settings of limited life expectancy.
SEMS
147
Most common complication of ERCP is?
What is the incidence?
What medication can you give to reduce this risk?
pancreatitis.
3-5%
Indocin
148
Who are at increased risk of post ERCP pancreatitis?
young females who have had their sphincters cut before.
149
What are the absolute contraindications to ERCP?
there are none
150
Partial gastrectomy with Billroth ii reconsutrction require (Blank) access to the papilla from the distal duodenum.
retrograde
151
What are indications for endoscpic sphincterotomy?
facilitation of stent placement
| treatment of duct leaks or disruption
152
Definition of clinical post ERCP pancreatitis?
increased abdominal pain with elevated amylase 3x above normal
153
What can you do to control post-sphincterotomy bleeding?
thermal techniques and endoclips
154
Upper GI bleed.. How do you improve your field of vision
Gastric lavage with NG
Prokinetic agents (reglan/erythromycin) given 20 minutes prior to endoscopy
Reposition paitent
155
Because most LGI bleeding stops spontaneously, there is often an opportunity for the patient to complete (blank) prior to endoscopy. However, when urgent colonoscopy is required for active bleeding, no (blank) is required.
a bowel prep (usually with PEG solution)
| bowel prep
156
What meds do you give during an UGI?
PPI gtt
Octreotide if variceal bleed
Abx if patient is a cirrhotic
157
What is the rockall score?
risk of mortality and rebleed in UGI bleeds
158
What is the best practice for an adherent clot (iiB forest classification) bleeding ulcer?
cold snare to remove clot with endoscopic therapy to ulcer base.
159
Sclerosants must be used with care to avoid (blank) leading to stricture or perforation.
full thickness tissue necrosis
160
(blank) for esophageal varices is more effective than sclerotherapy with a lower complication rate.
band ligation
161
(blank) techniques use a combination of energy and pressure to achieve hemostasis.
coaptive hemostatic
162
(blank) is a contact form of bipolar electrosurgical energy used to treat diffuse mucosal bleeding.
Radiofrequency Ablation (RFA)
163
Patients should be counseled to watch for post-procedure bleeding for up to (blank) days
14
164
T or F, you should cold lavage to improve exposure in UGI bleeds?
false, cold fluid causes coagulopathies
165
Endoscopic clips are best used when?
thin walled areas of the GI tract
166
(blank) biopsy forceps are commonly employed because they facilitate taking multiple biopsies during a single pass of the forceps without specimen loss.
spiked
167
Snare polypectomy without energy (cold snare) can safely be used for small sessile polyps, less than (blank) mm in size and reduces the risks of thermal injury and delayed post-polypectomy bleeding.
<7 mm
168
(blank) polyps should be snared using monopolar energy (hot snare polypectomy). Larger sessile lesions may require mucosal elevation prior to resection using a hot snare.
Pedunculated
169
a (blank) sessile polyp may indicate invasive cancer and typically merits proper oncologic surgical resection.
non-lifting
170
What is EMR?
You use suction or banding to create a pedunculated polyp and then remove it
171
Radiofrequency ablative (RFA) techniques have proven to be safe and effective in the treatment of dysplastic (blank)
Barrett's epithelium.
172
After the first endoscopic biopsy, the cold forcep is placed into a specimen cup containing formulin. What is the most appropriate step prior to performing any additional passes?
The biopsy forcep should be rinsed in saline
173
Enteral access is generally NOT indicated in patients who will resume oral feeding within (blank) days. Careful consideration should be given prior to enteral access to those patients with limited life expectancy.
30 days
174
Is ascites a relative or absolute contraindication for PEG and PEJ?
relative
175
Steps for appropriate PEG placement?
Insufflate, transilluminated, palpate a minimum of 2 fingerbreadths below costal margin
176
EUS devices use what angle?
oblique
177
What are the 2 types of endoscopes?
radial (360 view) and curvilinear (biopsy scope)
178
For most tumors the fourth layer, (blank), is the most important layer as it often dictates surgical and medical oncology options.
the muscularis propria
179
For consideration of endoscopic therapy, the first two layers (the superficial and deep mucosa) and the third layer (the submucosa) are critical determinants for safe and effective (blank and blank)
EMR and ESD.
180
Therapeutic EUS procedures can be performed with which type of endoscpe?
curvilinear
181
Diagnostic yield of an EUS guided bx can be increased by (blank)
on site cytopathology
182
Permanent neurolysis can be performed with which injectate?
alcohol
183
Post procedure quality indicator include an EUS-FNA rate of post procedure pancreatitis below which rate?
2 percent
184
Is a triangular shape of a LN benign or malignant?
benign
185
Enhanced magnifying scopes (I.e zoom endoscope) can magnify how mucH?
150 fold
186
T or F , HD colonoscopy detects more adenomas?
True
187
T or F, HD colonoscopy helps identify dysplasia in IBD
True
188
T or F, NBI is better than white light for barretts dysplasia detection?
True
189
T or F, FICE improves detection of colonic polyps compared to standard?
False
190
What is autofluorescene endoscopy?
Normal mucosa appears green, dysplastic/cancerous is magenta (has a lot of false positives though)
191
What is confocal endomicroscopy good for?
in vivo prediction of completeness after endoscopic mucosal resection
192
In barretts esophagus, the identification of irregular microvascular and structural patterns on NBI zoom images indicates high grade dysplasia or early cancer which which sensitivity and specificity?
95%
193
The DISCARD trial demonstrated that optical diagnosis with NBI was reasonably accurate for characterization and histopathology is not required for colonic polyps below which size? (blank)
Based on the NICE classification, a colonic polyp that is lighter than the background on NBI is most likely a (blank)
10mm, hyperplastic polyp
194
The magnification of endoscopic images for a standard high-resolution endoscope is (blank)
30X
195
In patients with long standing colonic IBD, HD scopes increase the rate of dysplasia detection by (blank) fold
3 fold
