Gastrointestinal

Question 1

diagnostic modality used when US is equivocal for choledystitis

Answer 1

HIDA scan

Question 2

risk factors for cholelithasis

Answer 2

fat, female, fertile, forty, and flatulent

Question 3

inspiratory arrest during palpation of the RUQ

Answer 3

murphy’s sign - seen in acute cholecytisis

Question 4

most common causes of small bowel obstructions

Answer 4

ABCs - adhesions; bulge (hernia); cancer

Question 5

IBD w/ increased risk of colon cancer

Answer 5

UC

Question 6

extraintestional manifestions of IBD

Answer 6

uveitis, anklyosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis

Question 7

medical tx for IBD

Answer 7

5-ASA agents and steroids during acute exacerbations

Question 8

difference between mallory-weiss and boerhaave tears

Answer 8

mallory weiss = superficial tear in the esophageal mucosa

boerhaave = full-thickness esophageal rupture

Question 9

charcot’s triad - signs of ascending cholangitis

Answer 9

RUQ pain, jaundice, and fever/chills

Question 10

reynold’s pentad - signs of suppurative ascending cholangitis

Answer 10

charcot’s triad plus shock (hypotension) and AMS

Question 11

medical tx for hepatic encephalopathy

Answer 11

decreased protein intake, lactulose, and rifaximin

Question 12

first step in the mgmt of a pt w/ an acute GI bleed

Answer 12

manage ABCs

Question 13

post-HBV exposure tx

Answer 13

HBV immunoglobulin

Question 14

classic causes of drug-induced hepatitis

Answer 14

TB meds (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline

Question 15

hernia w/ the highest risk of incarceration - indirect, direct, or femoral

Answer 15

femoral

Question 16

most likely cause of acute lower GI bleed in pts > 40 yo

Answer 16

diverticulosis

Question 17

describe the three distinct categories of liver function…

Answer 17

1. synthetic (synthesis of clotting factors, cholesterol, and proteins)
2. metabolic (metabolism of drugs and steroids, including detoxification)
3. excretory (bile excretion)

Question 18

hyperestrogenism in cirrhosis leads to…

Answer 18

gynecomastia, testicular atrophy, decreased body hair, spider angiomas, and palmar erythema

Question 19

most common etiology of bacterial diarrhea. pt frequently presents w/ bloody diarrhea. cause? tx?

Answer 19

camplyobacter. tx w/ erythromycin

Question 20

diarrhea associated w/ recent abx (PCN, quinolones, clindamycin) that presents w/ fever, abdominal pain, and watery diarrhea. lab? dx? tx? complications?

Answer 20

labs - c diff toxin assay
dx - c. diff
tx - cessation of inciting abx, tx w/ PO metronidazole or vanc; give IV metronidazole if pt cannot tolerate
complications - toxic megacolon

Question 21

pt traveling to developing country (w/in 3 months) presents w/ severe abdominal pain, diarrhea, and fever. + fecal RBCs and WBCs. dx? tx?

Answer 21

entamoeba histolytica. tx w/ metronidazole (avoid steroid as can lead to fatal perforation)

Question 22

child recently eaten meat presents w/ severe abdominal pain, low grade fever, vomiting, and diarrhea. dx? tx? complication?

Answer 22

e coli 0157:H7. tx w/ supportive care. avoid abx or anti-diarrhea meds as can increase complication of HUS

Question 23

pt ingested poultry or eggs presents w/ prodromal HA, fever, myalgia, abdominal pain and diarrhea. dx?

Answer 23

salmonella

Question 24

pt w/ severe diarrhea. + fecal RBCs and WBCs. spread fecal-oral route. dx? tx?

Answer 24

shigella. tx w/ TMP-SMX

Question 25

HIV pt w/ bloody diarrhea, normal stool exam, colonoscopy shows multiple ulcers and mucosal erosions, biopsy demonstrates characteristic cells w/ inclusion bodies. dx? tx?

Answer 25

CMV colitis. tx of choice is ganciclovir. foscarnet is alternative.

Question 26

pt returning from developing country or camping trip w/ symptoms of malabsorption (s/s including foul smelling stools, fatty stools, bloating, flatulence, nausea, malaise, and abdominal cramps). dx? tx?

Answer 26

giardiasis. tx w/ metronidazole.

Question 27

pt w/ epigastric pain that improves upon eating? cause?

Answer 27

duodenal ulcer. most commonly H pylori or NSAIDs

Question 28

zenker diverticulum develops due to…

Answer 28

due to posterior herniation between the fibers of the cricopharyngeal muscle

Question 29

distinguish between crohns and UC - s/s, location, morphology, complications, tx

Answer 29

crohns:
s/s = diarrhea (+/- bloody) w/ IBD associated symptoms;
location = any portion of GI tract except rectum w/ skip lesions;
morph = transmural inflammation –> fistulas, cobblestoning, non-caseating granulomas
complications = strictures, fistulas
tx = corticosteroids, azathioprine, methotrexate, infliximab, adalimumab

UC:
s/s = bloody diarrhea w/ IBD associated symptoms;
location = colon, continuous, always involving the rectum;
morph = mucosal and submucosal inflammation only, loss of haustra - lead pipe appearance, ulcers
complications = increased colon cancer risk, PSC, toxic megacolon
tx = ASA preparations (sulfasalazine), 6-MP, infliximab, colectomy

Question 30

pt w/ recurrent abdominal pain associated w/ 2 of more: pain improves w/ defecation, change in stool freq, change in stool appearance, alternating between loose and constipation

Answer 30

IBS

Question 31

marked elevations in AST and ALT (> 25 x ULN). ddx?

Answer 31

ddx includes toxin-induced (ie tylenol), ischemic, or viral hepatitis

Question 32

LFTs in alcoholic hepatitis

Answer 32

elevated AST and ALT (AST: ALT is 2:1) usually with levels less than 300 (def no more than 500) + increased GGT