Gastrointestinal

Question 1

A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

Answer 1

Emergent laparotomy to repair a perforated viscus.

Question 2

The most likely cause of acute lower GI bleed in patients > 40 years of age.

Answer 2

Diverticulosis.

Question 3

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Answer 3

HIDA scan.

Question 4

Risk factors for cholelithiasis.

Answer 4

Fat, female, fertile, forty, flatulent.

Question 5

Inspiration arrest during palpation of the RUQ.

Answer 5

Murphy’s sign, seen in acute cholecystitis.

Question 6

The most common cause of small bowel obstruction (SBO) in patients with no history of abdominal surgery.

Answer 6

Hernia.

Question 7

The most common cause of SBO in patients with a history of abdominal surgery.

Answer 7

Adhesions.

Question 8

Identify key organisms causing diarrhea.
Most common.
Recent antibiotic use.
Camping.
Traveler's diarrhea.
Church picnics/mayonnaise.
Uncooked hamburgers.
Fried ride.
Poultry/eggs.
Raw seafood.
AIDS.
Pseudoappendicitis.

Answer 8

Campylobacter.
Clostridium difficile.
Giardia.
ETEC.
S. Aureus.
E coli O157:H7.
Bacillus cereus.
Salmonella.
Vibrio, HAV.
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC).
Yersinia.

Question 9

A 25 year old Jewish man presents with pain and watery diarrhea after meals. Examination shows fistulas between the bowel and skin and nodular lesions on this tibias.

Answer 9

Crohn’s disease.

Question 10

Inflammatory disease of the colon with an increased risk of colon cancer.

Answer 10

Ulcerative colitis (greater risk than Crohn’s).

Question 11

Extraintestinal manifestations of IBD.

Answer 11

Uveitis, ankylosing sondylitis, pyoderma gangrenosum, erythema nodusum, primary sclerosing cholangitis.

Question 12

Medical treatment for IBD.

Answer 12

5-ASA agents and steroids during acute exacerbations.

Question 13

Difference between Mallory-Weiss and Boerhaave tears.

Answer 13

Mallory-Weiss - superficial tear in the esophagus mucosa.

Boerhaave - full thickness esophageal rupture.

Question 14

Charcott’s triad.

Answer 14

RUQ pain, jaundice, and fever/chills - signs of ascending cholangitis.

Question 15

Reynold’s pentad.

Answer 15

Charcott’s triad plus shock and mental status changes - signs of suppurative ascending cholangitis.

Question 16

Medical treatment for hepatic encephalopathy.

Answer 16

Decreased protein intake, lactulose, rifaximin.

Question 17

The first step in the management of a patient with an acute GI bleed.

Answer 17

Manage ABCs.

Question 18

A 4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Answer 18

Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7.

Question 19

Post-HBV exposure treatment.

Answer 19

HBV immunoglobulin.

Question 20

Classic causes of drug-induced hepatitis.

Answer 20

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.

Question 21

A 40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Answer 21

Biliary tract obstruction.

Question 22

Hernia with highest risk of incarceration - indirect, direct, or femoral?

Answer 22

Femoral hernia.

Question 23

A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forwards. Management?

Answer 23

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time.”