gastrointestinal

Question 1

a younger patient typically has what type of ulcer

Answer 1

duodenal ulcer - age 30-55

Question 2

older people have what type of ulcer typically

Answer 2

gastric ulcer

Question 3

this type of ulcer pain is better with eating

Answer 3

duodenal

Question 4

his type of ulcer has increased pain with eating

Answer 4

gastric

Question 5

s/s of ulcer perforation

Answer 5

severe epigastric pain, “board like” abdomen , quiet bowel sounds, rigidity, acute abdomen

Question 6

air under diaphragm

Answer 6

pneumoperotenium

Question 7

types of H2 receptor antagonists

Answer 7

cimetidine
famotidine
nizatidine

Question 8

types of PPI and when to take

Answer 8

30 minute before a meal
lansoprazole
rabeprazole
pantoprazole
omeprazole
dexlansoprazole
esomeprazole

Question 9

do antacids decrease gastric acidity

Answer 9

no

Question 10

treatment for H. pylori eradication

Answer 10

two antibiotics + PPI with or without bismuth for 10-14 days

a. ECA: PPI BID + clarithromycin BID + amoxicillin BID
b. EBMT: PPI BID _ bismuth QUID+ metronidazole _ tetracycline
c. ECAM: PPI BID+ clarithromycin + amoxicillin + metronidazole

Question 11

guidelines for 1st line therapy for suspected PUD

Answer 11

PPI

Question 12

what medication is associated with decrease in nosocomial pneumonia

Answer 12

sucralfate

Question 13

black box warning associated with PPI

Answer 13

increased risk of hip fx

increase Vitamin D

Question 14

elderly pt presents with dysphagia and belchign that typically occurs at night and is relieved by sitting up what do you think

Answer 14

GERD

Question 15

precursor for esophageal cancer

Answer 15

barretts esophagus

Question 16

mtg of GERD

Answer 16

non-pharmacologic: elevate HOB, avoid alcohol, caffeine, spices, peppermint, stop smoking, decrease weight
Antacids PRN
H2blockers
PPI if H2blockers ineffective
GI/surgical consult prn

Question 17

oral fecal route of hepatitis

Answer 17

hep A

Question 18

Anti-HAV and IgM

Answer 18

acute hepatitis A

Question 19

hepatitis associated with injection drug use

Answer 19

hep C

Question 20

Anti-HAV , IvG

Answer 20

recovered hep A

Question 21

HBsAg, HBeAg, Anti-HBc, Igm

Answer 21

hep b active

Question 22

HBsAG, Anti-HBc, Anti-HBe, IGM, IgG

Answer 22

chronic hep B

Question 23

anti-HBc, Anti-HBs

Answer 23

recovered hep b

Question 24

anti-HCV, HCV RNA

Answer 24

acute/chornic hep C

Question 25

Mtg of hepatitis

Answer 25

supportive increase fluids 3000-4000 ml/day avoid alcohol/meds by liver no/low protein diet lactulose

Question 26

what is in all three hep b serology

Answer 26

anti-HBc

Question 27

education to patient for decreasing diverticulitis flare ups

Answer 27

quit smoking

Question 28

tx for diverticulitis

Answer 28

NPO IV fluids if GI bleeding - treat surgical eval

Question 29

Murphys sign

Answer 29

deep pain on inspiration while fingers are placed under right rib cage - present in cholecystitis

Question 30

why do you obtain KUB on pt with diverticulitis

Answer 30

to r/o pneumoperitoneum (air under diaphragm)

Question 31

what bowel sounds are associated with SBO

Answer 31

tinkling high pitched

Question 32

what bowel sounds are associated with peritonitis

Answer 32

quiet bowel sounds

Question 33

what is common cause of pancreatitis

Answer 33

HEAVY alcohol use cholelithiasis

Question 34

gold standard for diagnosis of cholecystitis

Answer 34

Ultrasound

Question 35

major complications of ERCP

Answer 35

pancreatitis

Question 36

what is GI angioplasty used to diagnose

Answer 36

hemorrhage of unknown cause

Question 37

pt with abrupt abdominal pain upon inspection the upper abdomen is tender to palpation and is with out guarding , rigidity or rebound. What do you suspect

Answer 37

acute pancreatitis

Question 38

Flank discoloration

Answer 38

grey turner sign (in pancreatitis if hemorrhagic)

Question 39

umbilical discoloration

Answer 39

Cullens sign (in pancreatitis if hemorrhagic)

Question 40

labs r/t acute pancreatitis

Answer 40

elevated serum amylase (50-180) elevated lipase (14-280) hypocalcemia <7

Question 41

ransons critera mortality risk

Answer 41

5-6 40% >87 100%

Question 42

ransons criteria

Answer 42

assess pancreatitis George - greater than 55 y/o Washington - WBC >16000 Got - glucose > 200 Lazy - LDH >350. After - AST >250

Question 43

management of ulcerative colitis

Answer 43

mesalamine suppositories or enemas x 3-12 weeks hydrocortisone suppositories and enemas

Question 44

48 y/o presents with abdominal swelling and bloody diarrhea with a history of choric sinusitis, and resent DVT. Which represents the most likely dx and test to order

Answer 44

UC, sigmoidoscopy

Question 45

what is a major complication associated with UC

Answer 45

toxic megacolon

Question 46

where is UC

Answer 46

involves the rectum and may extend upward involving the whole colon

Question 47

when would you find "thumb print sign" on abdominal xray

Answer 47

mesenteric ischemia, colitis, IBD

Question 48

Icteric stage

Answer 48

in hepatits C /second state after pre-icteric weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine

Question 49

DX and MTG of mesenteric ischemia

Answer 49

abdominal xray first then CT emergent surgical intervention

Question 50

Rovsings sign

Answer 50

RLQ pain when pressure applied to LLQ in appy

Question 51

Obturator sign

Answer 51

pain with internal rotation of flexed right thigh in appy

Question 52

psoas sign

Answer 52

pain with right thigh extension - in appy

Question 53

mcburneys point

Answer 53

associated with appy one-third the distance from anterior superior iliac spine to the umbilicus

Question 54

how to dx appendicits

Answer 54

CT or ultrasound WBC 10-20, 000