Gastrointestinal

Question 1

Classic symptoms of ascending cholangitis

Answer 1

Charcot’s triad: fever, RUQ pain, jaundice.

Can progress to Reynolds’ pentad: add shock and altered mental status.

Question 2

Risk factors for cholelithiasis

Answer 2

Fat
Female
Fertile (multiparity, OCP)
Forties
(Fair)

Question 3

Common Abx for intra-abdominal infections

Answer 3

Cipro+Flagyl
Ceftri+Flagyl

Question 4

Indications for surgery for diverticulitis

Answer 4

Unstable pt
Peritonitis
Abscess, fistula, rupture
Immunosuppressed
2+ attacks

Question 5

Causes of pancreatitis

Answer 5

I get smashed:
Idiopathic
Gallstones
Ethanol
Tumor
Scorpion
Microbes (TB, mumps, rubella, VZV, hepatits, HIV, CMV)
Autoimmune (SLE, Crohn’s, polyarthritis nodosa)
Surgery/trauma
Hyperlipidemia (TG), hyperCa, hypothermia
Emboli/ischemia
Drugs (Lasix, estrogen, H2 blockers, valproate, Abx, ASA)

Question 6

Risk factors for / conditions associated with celiac

Answer 6

Family Hx
T1DM
Autoimmune thyroiditis/liver disease
Down syndrome
Turner syndrome
IgA deficiency

Question 7

Classic non-GI manifestation of celiac disease

Answer 7

dermatitis herpetiformis:
intensely itchy, chronic papulovesicular eruptions, usually distributed symmetrically on extensor surfaces (buttocks, back of neck, scalp, elbows, knees, back, hairline, groin, or face).

Question 8

w/u and management for bone health in pts with celiac disease

Answer 8

Assess malabsorption (Ca, vit D, PTH, calcitonin)
BMD (if malabsorption or high risk)
Treat: gluten-free diet, Ca, vit D
Lifestyle (exercise, stop smoking, reduce EtOH)

Question 9

Deficiencies to look for in celiac pts

Answer 9

Iron
Folate
B12
(anemia)

Ca
Vit D
(osteoporosis)

Question 10

Non-serology tests to confirm Dx of celiac

Answer 10

HLA-DQ2/DQ8 gene.
Intestinal biopsy (before gluten-free diet)
Biopsy of dermatitis herpetiformis lesions