gastrointestinal

Question 1

hematemesis or melena

Answer 1

upper GI bleed

Question 2

diagnostic study for upper GI bleed?

Answer 2

endoscopy and erythromycin IV to help gastric emptying/improve quality of endoscopy

Question 3

labs to get if GI bleed

Answer 3

CBC, PT INR, creatinine, liver enzymes, blood type and cross

Question 4

when might you suspect a stricture?

Answer 4

gradual development of solid food dysphagia

Question 5

most common cause of gastritis

Answer 5

Hpylori

Question 6

hpylori tx

Answer 6

PPI BID plus clarithromycin 500mg BId plus amoxil 1g po BID x 10-14 days

Question 7

jaundice differential

Answer 7

acute cholangitis, viral hepatitis, extrahepatic biliary obstruction, unconjugated or congugated hyperbilirubinemia, alcoholism

Question 8

fever, chill, RUQ pain and maybe hx prior biliary surgery

Answer 8

acute cholangitis

Question 9

portal htn, hepatomegaly, ascites, abdominal pain, fatigue, anorexia, skin telangectasis, clubbing, jaundice

Answer 9

cirrhosis

Question 10

definitive tx cirrhosis

Answer 10

liver transplant

Question 11

fatigue, malaise, anorexia, nausea, tea colored urine, abdominal discomfort

Answer 11

acute hepatitis

Question 12

HBsAb

Answer 12

antibody (immunity)

Question 13

HBcAb

Answer 13

core antibody (window period) prior or current infection

Question 14

HBsAg

Answer 14

surface antigen (carrier state)

Question 15

IgM HAVAb

Answer 15

acute hepatitis A

Question 16

HAVIgG

Answer 16

resolved Hep A

Question 17

anti-HBc, HBsAG, HBeAg

Answer 17

active infection

Question 18

dull steady abdominal then suddently becomes epigastric and worse, may radiate to back, N&V, anorexia, diarrhea, tachy, fever, abd tenderness//guarding

Answer 18

acute pancreatitis

Question 19

you suspect pancreatitis. next step?

Answer 19

serum lipase and amylase, CB with diff, CMP, CRP, abdominal US to r/o gallstones, CT if needed

Question 20

pancreatic calcifications, steatorrhea, DM is a classic triad of what?

Answer 20

chronic pancreatitis

Question 21

test of choice for chronic pancreatitis

Answer 21

MRCP to demonstrate duct obstruction and calcifications

Question 22

tx chronic pancreatitis

Answer 22

low fat diet, surgical removal, no alcohol

Question 23

tenesmus, bloody diarrhea, LLQ pain, weight loss, malaise

Answer 23

UC

Question 24

toxic megacolon and malignancy complications of what?

Answer 24

UC

Question 25

skip lesions, diarrhea and abd cramps, low grade fever, anemia

Answer 25

chrons

Question 26

most common place for chrons and what is spared

Answer 26

terminal ileum and right colon....rectum spared

Question 27

tx chrons

Answer 27

prednisone for acute attacks, metronidazole and cipro if perianal disease/fissures, infliximab or mesalamine, segmental resection

Question 28

tx UC

Answer 28

aminosalicyclates and corticosteroids...surgery can be curative

Question 29

tx UC

Answer 29

aminosalicyclates and corticosteroids...surgery can be curative

Question 30

labs to get during appendicitis

Answer 30

CBC, amylase and lipase, pelvic US

Question 31

insidious onset of low grade fever, diarrhea, RLQ pain, abdominal mass...hx prior surgery

Answer 31

bowel obstruction

Question 32

you suspect bowel obstruction. dx step?

Answer 32

CT

Question 33

causes of lower GI bleed

Answer 33

diverticulosis, angioectasis, neoplasms, IBD, anorectal disease, ischemic colitis

Question 34

tx giardia

Answer 34

metronidazole and fluid resuscitation

Question 35

dx of giardia

Answer 35

3 stool samples on 3 different days

Question 36

severe pain during bm with pain lasting several hours after. bleeding

Answer 36

anal fissure

Question 37

tx anal fissure

Answer 37

fiver supplements and stool softeners, sitz baths. second line nitroglycerine ointment...botox....surgery if sxs remain after a month with no resolution of conservative therapy

Question 38

itching or irritation of anal region...painless bleeding or painful BM

Answer 38

hemorrhoids

Question 39

grade of hemorrhoids:

Answer 39

1--projects to anal canal does not prolapse 2--protrude with straining but spontaneously reduce 3--protrude spontaneously and need manual reduction 4--chronic prolapse and cant reduce/strangulated

Question 40

tx hemorrhoids

Answer 40

fiber supplements, increase water intake, sitz baths, topical steroids...hemorrhoidectomy if grade 4 or incarcerated

Question 41

when is surgery on hernia for sure indicated?

Answer 41

incarcerated

Question 42

hiatal hernia tx

Answer 42

PPIs or surgery

Question 43

dx hiatal hernia

Answer 43

barium contrast study, upper GI

Question 44

40 yo obese woman with elevated alk phos, bilirubin, and pruritis, dark urine, and clay colored stool

Answer 44

biliary tract obstruction

Question 45

causes of drug induced hepatitis

Answer 45

tylenol, TB medications, tetracycline

Question 46

charcot's triad and what is it a sign of?

Answer 46

RUQ pain, jaundice, fever/chills. sign of ascending choangitis

Question 47

4yo presents with oliguria, petechiae, jaundice following illness with bloody diarrhea

Answer 47

hemolytic uremic syndrome due to E coli

Question 48

epigastric pain that radiates to back and relieved by sitting forward. managment?

Answer 48

get amylase and lipase levels/confirm acute pancreatitis and make patient NPO with iv fluids, o2 and analgesia