Gastro

Question 1

Most sensitive for diagnosis of GERD

Answer 1

24 hour pH monitoring

Question 2

Indication for endoscopy in GERD (5)

Answer 2

1. Reflux unresolved by antisecretory therapy
2. Alarm symptoms: Weight loss, GI bleed, dysphagia
3. Recurrence dyspepsia after treatment that is not clearly due to reflux from clinical ground —> Increase Barrett’s esophagus
4. Reflux and dysphagia to look for stricture and malignancy
5. > /= 10 years of GERD

Question 3

Triad of Plummer-Vinson Syndrome

Answer 3

IDA
Esophageal Web
Dysphagia

Question 4

Risk factors of esophageal scquaCA (4)

Answer 4

1. Smoking
2. Cigarette smoking
3. Caustic injury
4. HPV infection

Question 5

Most consistent clinical feature of IBS

Answer 5

Altered bowel habits

Question 6

Most common location of diverticular disease

Answer 6

Left and sigmoid colon with sparing of the rectum

Question 7

Most common cause of hematochezia in patients > 60

Answer 7

Colonic diverticulum hemorrhage

Question 8

Most common location of mesenteric venous thrombosis

Answer 8

Watershed areas
1. Splenic flexure : Griffith’s point
2. Descending / sigmoid colon: Sudeck’s point

Question 9

Most important indicatory of survival in acute mesenteric ischemia

Answer 9

Timeliness of diagnosis and tx

Question 10

Most prevalent gastrointestinal disease
complicating cardiovascular surgery

Answer 10

Nonocclusive mesenteric ischemia

Question 11

Drug of choice in pregnant patients with chronic hepatitis B

Answer 11

Tenofovir

> IFN (C): antiproliferative properties and should be avoided during pregnancy
Adefovir (C): risk of spontaneous abortion may be increased
Entacavir (C)
Telvibudine (not first line) and Tenofovir (B)
Tenofovir is the current drug of choice in pregnancy

Question 12

Treatment for HBV-HIV co-infection

Answer 12

Tenofovir
Tenofovir + emtricitabine

TAF > TDF

** NO MONOTHERAPY FOR LAMIVUDINE –> Resistance

Question 13

Treatment for Hepatitis B post - Liver transplant

Answer 13

> Prevention : short-term (5–7 days) IV HBIG + lifelong low-resistance oral entecavir or TDF or TAF
Low-risk for recurrence: newer, more potent, and less resistance-prone oral agents use instead of HBIG
HR for recurrence and progression: lifelong combination HBIG-oral agent
Livers from anti-HBc-positive donors, lifelong oral-agent therapy is recommended (without HBIG)

Question 14

Current standard of care therapy for chronic hepatitis C

Answer 14

3rd gen. NS5A Inhibitors + 4th gen. Protease Inhibitors

* Sofosbuvir-velpatasvir-voxilaprevir

Question 15

Simplified treatment algorithms that can be prescribed for all treatment-naïve patients with or without cirrhosis

Answer 15

Glecaprevir-Pibrentasvir (8 weeks) and Sofosbuvir- Velpatasvir (12 weeks)

Question 16

Extraesophageal syndromes with association to GERD (4)

Answer 16

1. Chronic cough
2. Asthma
3. Dental erosions
4. Laryngitis