Gastrointestinal

Question 1

Most likely cause of acute LGIB in pts >40 yo

Answer 1

Diverticulosis

Question 2

Dxic modality when U/S is equivocal for cholecystitis

Answer 2

HIDA scan

Question 3

RFs for cholelithiasis

Answer 3

Fat, female, fertile, forty, flatulent

Question 4

Inspiratory arrest during palpation of the RUQ

Answer 4

Murphy’s sign, seen in acute cholecystitis

Question 5

MCC of SBO in pts with no h/o abdominal surgery

Answer 5

Hernia

Question 6

MCC of SBO in pts with a h/o abdominal surgery

Answer 6

Adhesions

Question 7

Diarrhea: MC organism

Answer 7

Campylobacter

Question 8

Diarrhea: recent abx use

Answer 8

Clostridium difficile

Question 9

Diarrhea: camping

Answer 9

Giardia

Question 10

Diarrhea: traveler’s diarrhea

Answer 10

ETEC

Question 11

Diarrhea: church picnics/mayo

Answer 11

S. aureus

Question 12

Diarrhea: uncooked hamburgers

Answer 12

E. coli O157:H7

Question 13

Diarrhea: fried rice

Answer 13

Bacillus cereus

Question 14

Diarrhea: poultry/eggs

Answer 14

Salmonella

Question 15

Diarrhea: raw seafood

Answer 15

Vibrio, HAV

Question 16

Diarrhea: AIDS

Answer 16

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Question 17

Diarrhea: pseudoappendicitis

Answer 17

Yersinia

Question 18

25 yo Jewish M presents with pain and watery diarrhea after meals
Exam: fistulas btwn the bowel and skin, nodular lesions on tibias

Answer 18

Crohn’s dz

Question 19

Inflammatory dz of the colon with increased risk of colon CA

Answer 19

Ulcerative colitis (greater risk than Crohn’s)

Question 20

Extraintestinal manifestations of IBD

Answer 20

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1˚ sclerosing cholangitis

Question 21

Medical tx for IBD

Answer 21

5-ASA agents and steroids during acute exacerbations

Question 22

Difference btwn Mallory-Weiss and Boerhaave tears

Answer 22

• Mallory-Weiss: superficial tear in the esophageal mucosa

- Boerhaave: full-thickness esophageal rupture

Question 23

Charcot’s triad

Answer 23

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis

Question 24

Reynolds’ pentad

Answer 24

Charcot’s triad (RUQ pain, jaundice, fever) + shock + mental status ∆s, with suppurative ascending cholangitis

Question 25

Medical tx for hepatic encephalopathy (HE)

Answer 25

• Decrease protein intake
• Lactulose
• Rifaximin

Question 26

1st step in managing a pt with an acute GIB

Answer 26

Establish the ABCs

Question 27

4 yo presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely dx and cause?

Answer 27

Hemolytic uremic syndrome (HUS) d/t E. coli O157:H7

Question 28

Post-HBV exposure tx

Answer 28

HBV immunoglobulin

Question 29

Classic causes of drug-induced hepatitis

Answer 29

• TB meds (INH, rifampin, pyrazinamide)
• Acetaminophen
• Tetracycline

Question 30

40 yo obese F with elevated alk phos, elevated bili, pruritus, dark urine, and clay-colored stools

Answer 30

Biliary tract obstruction

Question 31

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

Answer 31

Femoral hernia

Question 32

50 yo M with h/o alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Answer 32

Confirm the dx of acute pancreatitis with elevated amylase and lipase. Make sure pt is NPO. Give IVF, O2, analgesia, and “tincture of time.”

Question 33

Pt presents with sudden onset of severe, diffuse abd pain
Exam: peritoneal signs
AXR: free air under the diaphragm
Management?

Answer 33

Emergent laparotomy to repair perforated viscus