Gastrointestinal

Question 1

Diagnosis of achalasia

Answer 1

Barium swallow and manometry

Question 2

Rx for achalasia

Answer 2

Pneumatic dilation, surgical sectioning/ myotomy, botox- required every 3-6 months

Question 3

Esophadeal spasm- radiology finding, treatment

Answer 3

Corkscrew appearance
High amplitude non peristaltic contractions
Rx- CCB, TCS, nitrates, PPI at times

Question 4

Gastritis, hypercalcemia with weight loss. Diagnosis. Management

Answer 4

Zollinger Ellison syndrome- gastrinoma. Screen for MEN syndrome as well. Do serum gastrin levels. Do secretin stimulation test. Secretin inhibits gastrin. If still increased, ZES confirmed.
Rx- high dose PPI, surgery if no mets.

Question 5

Malabsorption, arthritis, lymphadenopathy, PAS positive lamina propria. Diagnosis? Rx?

Answer 5

Whipple disease. Long term antibiotics

Question 6

Initial test for carcinoid tumor. Treatment

Answer 6

Urine levels of 5-HIAA. Octreotide and surgery

Question 7

Diagnosis of SBO. Rx?

Answer 7

1st x ray, accurate- CT abdomen
Fluid resuscitation
Partial SBO- supportive, NPO, NG, etc
Complete- Explorative laparotomy

Question 8

Causes of ileus

Answer 8

Recent surgery, medical illness, electrolyte imbalance, hypothyroidism, DM, hypokalemia,

Question 9

Most accurate test for mesenteric ischemia

Answer 9

CT angiography. Best initial- CT abdomen

Question 10

Tests for diverticulosis and diverticulitis

Answer 10

Diverticulosis- colonoscopy, diverticulitis- CT abdomen

Question 11

Causes of LBO

Answer 11

MCC- colon cancer
Diverticulosis, volvulus, fecal impaction, benign tumors

Question 12

CF Cholangitis- triad

Answer 12

Fever, jaundice, RUQ pain

Question 13

What indicated ascites is associated with portal hypertension?

Answer 13

SAAG >1.1- splenic or portal vein thrombosis, schistosomiasis, cirrhosis, RHF, constrictive pericarditis, BCS

Question 14

Primary sclerosing cholangitis associated with ?

Answer 14

UC, P anca and onion skinning sclerosis

Question 15

Med slowing progression of PBC

Answer 15

Ursodeoxycholic acid, cholestyramine, liver transplant

Question 16

Gold standard for Wilson’s disease

Answer 16

24 hr urinary copper after penicillamine

Question 17

Chain of lakes helps in diagnosis of ?

Answer 17

Chronic pancreatitis

Question 18

Courvoisier sign associated with which cancer?

Answer 18

Pancreatic cancer

Question 19

C diff treated with vancomycin developed C diff again. Next step?

Answer 19

Retreat with oral vancomycin. If that too doesn’t work, switch to fidaxomicin

Question 20

Diarrhoea with urine showing low levels of D xylose. Diagnosis?

Answer 20

Celiac disease

Question 21

Dx and Mx of TEF

Answer 21

Dx- NG tube, x ray
Mx- surgical correction, VACTERL screening

Question 22

Syndromes associated with congenital umbilical hernia

Answer 22

Beckwith weidemann, ehlers danlos, Down’s syndrome

Question 23

Tx of umbilical granuloma

Answer 23

Silver nitrate

Question 24

Complications of gastroschisis. Mx?

Answer 24

Necrotising enterocolitis, bowel obstruction, SBO, FGR, oligohydramnios
Manage with sterile saline dressing and plastic wrap

Question 25

Complications of Beckwith weidemann. Dx

Answer 25

Wilms tumor, hepatoblastoma. Monitor for hypoglycaemia Dx- serum AFP, USG Abdomen- done from birth to age 4 yrs, USG renal - 4-8 yrs

Question 26

Double and triple bubble sign seen in ?

Answer 26

Double- duodenal atresia, triple- jejunal atresia in x ray abdomen

Question 27

Squirt sign positive on DRE in? Gold standard diag?

Answer 27

Hirschsprung disease. Rectal suction biopsy

Question 28

Micro colon diagnostic of ?

Answer 28

Meconium ileus

Question 29

Confirmatory diagnosis of malformation due to volvulus, tx, associated congenital anomalies?

Answer 29

Upper GI series, LADD procedure. Omphalocele, diaphragmatic hernia, heterotaxy syndrome

Question 30

X ray findings of necrotising enterocolitis

Answer 30

Pneumatosis intestinalis, pneumoperitoenum

Question 31

Pathogenesis of allergic proctocolitis

Answer 31

Non IgE mediated inflammation

Question 32

Preventive therapy of cyclic vomiting syndrome

Answer 32

Age>5 - amitriptyline, age <5 - cyproheptadine. Risk factors- migraine in family

Question 33

Risk factors of intussusception

Answer 33

Viral illness, rota vaccine Meckels, HSP, Celiac, intestinal tumor, polyps

Question 34

USG findings of intussception

Answer 34

Target sign, crescent sign

Question 35

Diagnosis of mid gut volvulus

Answer 35

X ray, Double bird beak/ corkscrew in upper GI series, treitz on right.

Question 36

Diagnosis of sigmoid volvulus. Mx?

Answer 36

X ray- coffee bean sign CT scan - whirl sign Mx- endoscopic detorsion, sigmoid colectomy

Question 37

What is to be avoided in congenital diaphragmatic hernia?

Answer 37

Bag and mask ventilation, causes lung compression. Only ET to be done

Question 38

Ogilvie syndrome, Dx, Tx?

Answer 38

X-ray- Colonic dilation, non dilated small bowel. CT- colonic dilation without anatomic obstruction Npo, NG/ rectal tube decompression Neostigmine if no improvement

Question 39

Diagnosis of diabetic gastroparesis

Answer 39

Nuclear gastric emptying scan

Question 40

Rx of SIBO

Answer 40

Rifaximin

Question 41

Major risk factors of CRC

Answer 41

Obesity and T2 DM

Question 42

Hyperplastic polyps, colonoscopy screening

Answer 42

Every 10 years, every 5 years if high risk history, more frequent for adenomatous polyps

Question 43

What should be initially done if a patient presents with CRC or adenomas?

Answer 43

Proctocolectomy

Question 44

Lab findings in mesenteric ischemia

Answer 44

Leucocytosis, Hemoconcentration , elevated amylase and phosphate, lactic acidosis

Question 45

Clostridium septicum or bovis increases risk of ?

Answer 45

CRC. Do colonoscopy if organisms positive

Question 46

What is used to reduce anal sphincter pressure in anal fissure

Answer 46

Topical nifedipine

Question 47

Risk factors for GI AVM

Answer 47

Vwf disease, CKD, AS

Question 48

Initial steps of Mx of IBS

Answer 48

Low FODMAP - fermentable oligosaccharides, disaccharides, monosaccharides, polyols

Question 49

When does diarrhoea episodes occur in secretory diarrhoea

Answer 49

Nocturnal , fasting diarrhoea

Question 50

Which imaging is contraindicated in acute diverticulitis

Answer 50

Sigmoidoscopy and colonoscopy

Question 51

Colonoscopy showing Melanosis coil suggests?

Answer 51

Laxative abuse, senna laxative

Question 52

Rx for biliary atresia

Answer 52

Kasai procedure- surgical hepatoenterostomy, liver transplant

Question 53

SBP prophylaxis

Answer 53

Fluoroquinolone

Question 54

Which infectious gastroenteritis presents as pseudoappendicitis

Answer 54

Campylobacter

Question 55

20M trauma to central upper abd- fever, pain, right flank pain, Xray- free air in retroperitoneum. Diag?

Answer 55

Duodenal tear- sx repair

Question 56

2F lehargy, confusion. h/o fever, nasal discharge. Hepatomegaly, elevated LFT, acidosis, ammonia. CT- diffuse cerebral edema. Cause?

Answer 56

Medication effect- Reyes syndrome.

Question 57

Risks of intrahep cholestasis of preg. mx?

Answer 57

IUD, preterm, meconium stained fluid, NRDS. Mx- ursodeoxy, anti histamine, deliver at 37 wks

Question 58

Fecal impaction causes

Answer 58

Elderly- low fiber diet, less fluids, impaired mobility, chronic constipation, decreased sensation- dementia, spinal cord inj Can be associated with urine incontinence