First Aid

Question 1

Cause of primary achalasia and 2 causes of secondary achalasia

Answer 1

Loss of myenteric Auerbach plexus (high LES pressure)

Chagas disease (T. cruzi)
Extraesophageal malignancies (mass effect-paraneopl)

Question 2

4 causes of esophagitis

Answer 2

Reflux
Infection (Candida, HSV1, CMV)
Caustic ingestion
Medications

Question 3

Plummer-Vinson syndrome (symptoms and complication)

Answer 3

Triad: dysphagia, iron deficiency anemia, esophageal webs

Risk of esophageal squamous cell carcinoma

Question 4

4 symptoms of toxic megacolon

Answer 4

Abdominal pain/distension
Bloody diarrhea
Fever
Shock (hypotension, tachycardia)

Question 5

5 medications for Crohn disease

Answer 5

Corticosteroids
Azathioprine
Antibiotics (Ciprofloxacin, Metronidazole)
Infliximab
Adalimumab

Question 6

4 medications for ulcerative colitis

Answer 6

5-aminosalicylic preparations (mesalamine)
6-mercaptopurine
Infliximab
Colectomy

Question 7

Ileus associated with 4 conditions

Answer 7

Abdominal surgeries
Opiates
Hypokalemia
Sepsis

Question 8

Treatment of ileus

Answer 8

Bowel rest
Electrolyte correction
Cholinergic drugs

Question 9

Colorectal cancer presentation

Answer 9

Rectosigmoid>ascending>descending
Right side bleeds
Left side obstructs

Question 10

6 causes of cirrhosis

Answer 10

Alcohol
Nonalcoholic steatohepatitis
Chronic viral hepatitis
Autoimmune hepatitis
Biliary disease
Genetic/metabolic disorders

Question 11

3 causes of portal hypertension

Answer 11

Cirrhosis
Vascular obstruction (thrombosis, Budd-Chiari sd)
Schistosomiasis

Question 12

4 conditions with elevated ALP

Answer 12

Cholestasis
Infiltrative disorders
Bone disease
From placenta

Question 13

6 findings in Reye syndrome (fatal childhood hepatic encephalopathy)

Answer 13

Mitochondrial abnormalities
Fatty liver
Hypoglycemia
Vomiting
Hepatomegaly
Coma

Question 14

5 consequences of hyperestrinism from alcoholic liver cirrhosis

Answer 14

Gynecomastia
Spider angiomata
Loss of sexual hair
Testicular atrophy
Palmar erythema

Question 15

Treatment of hepatic encephalopathy

Answer 15

Lactulose +

Rifaximin or Neomycin

Question 16

Budd-Chiari syndrome associated with 4 conditions

Answer 16

Hypercoagulable states
Polycythemia vera
Postpartum state
HCC

Question 17

4 causes of unconjugated hyperbilirubinemia

Answer 17

Hemolytic
Physiologic (newborns)
Crigler-Najjar
Gilbert syndrome

Question 18

3 causes of conjugated hyperbilirubinemia

Answer 18

Biliary tract obstruction (gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke)
Biliary tract disease (1* sclerosing cholangitis, 1* biliary cirrhosis)
Excretion defect (Dubin-Johnson sd, Rotor sd)

Question 19

2 causes of mixed hyperbilirubinemia

Answer 19

Hepatitis

Cirrhosis

Question 20

Treatment of Crigler-Najjar syndromes, type I and II

Answer 20

Type I: plasmapheresis and phototherapy

Type II: phenobarbital

Question 21

6 manifestations of Wilson disease (before age 40)

Answer 21

Liver disease
Neurologic disease
Psychiatric disease
Kayser-Fleischer rings
Hemolytic anemia
Renal disease

Question 22

Treatment of Wilson disease

Answer 22

Penicillamine or Trientine

Oral zinc

Question 23

6 organs where iron accumulates in Hemochromatosis (after age 40)

Answer 23

Liver (cirrhosis)
Pancreas (diabetes mellitus)
Skin (pigmentation)
Heart (dilated cardiomyopathy/HF)
Pituitary (hypogonadism)
Joints (arthropathy)

Question 24

Common cause of death + treatment of Hemochromatosis

Answer 24

Hepatocellular carcinoma

Repeated phlebotomy
Chelation (deferasirox, deferoxamine, oral deferiprone)

Question 25

Primary sclerosing cholangitis: epidemiology + 3 complications

Answer 25

Middle-aged men with Ulcerative colitis

Secondary biliary cirrhosis
Cholangiocarcinoma
Gallbladder cancer

Question 26

Secondary biliary cirrhosis: epidemiology and 1 complication

Answer 26

Known obstructive lesions

Ascending cholangitis

Question 27

3 causes of gallstones

Answer 27

High cholesterol and/or bilirubin
Low bile salts
Gallbladder stasis

Question 28

8 associations with cholesterol gallstones

Answer 28

Obesity
Crohn disease
Advanced age
Estrogen therapy
Multiparity
Rapid weight loss
Glucose intolerance
Hypomotility

Question 29

4 complications of gallstones

Answer 29

Cholecystitis +++
Acute pancreatitis
Ascending cholangitis (Charcot triad)
Fistula (Gb/GI - pneumobilia and gallstone ileus)

Question 30

3 causes of cholecystitis

Answer 30

Cholelithiasis +++
Ischemia and stasis
Primary infection (CMV)

Question 31

1 treatment and 1 complication of porcelain gallbladder

Answer 31

Prophylactic cholecystectomy

Cancer (esp. adenocarcinoma)

Question 32

12 causes of acute pancreatitis

Answer 32

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion sting
Hypercalcemia
Hypertriglyceridemia (>1000 mg/dL)
ERCP
Drugs (sulfa, NRTIs, protease inhibitors)

Question 33

Diagnosis of acute pancreatitis

Answer 33

2 of 3 criteria
Acute epigastric pain (to back)
Amylase or lipase (specific) 3x upper limit
Characteristic imaging findings

Question 34

5 complications of acute pancreatitis

Answer 34

Pseudocyst
Necrosis
Hemorrhage
Infection
Organ failure
Hypocalcemia

Question 35

3 manifestations of pancreatic insufficiency

Answer 35

Steatorrhea
Fat-soluble vitamin deficiency
Diabetes mellitus

Question 36

6 risk factors for pancreatic adenocarcinoma

Answer 36

Male
>50 yo
Tobacco use
Diabetes
Chronic pancreatitis (>20y)
Jewish / African-American

Question 37

5 adverse effects of Cimetidine (H2 blocker)

Answer 37

Potent inhibitor of CYP450
Antiandrogenic effects
Cross blood-brain barrier (confusion, dizziness, headaches)
Cross placenta
Reduce renal excretion of creatinine

Question 38

4 indications of Octreotide

Answer 38

Acute variceal bleeds
Acromegaly
VIPoma
Carcinoid tumors

Question 39

3 GI infections by protozoa: difference + treatment

Answer 39

Giardia lamblia (fatty diarrhea)/Metronidazole
Entamoeba histolytica (bloody diarrhea)/Metronidazole
Cryptosporidium (watery diarrhea / severe in AIDS)/ Nitazoxanide