Gastrointestinal

Question 1

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

Answer 1

Emergent laparatomy to repair a perforated viscus.

Question 2

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

Answer 2

Diverticulosis

Question 3

Risk factors for cholelithiasis

Answer 3

Fat, female ,fertile, forty, flatulent

Question 4

Inspiratory arrest during palpation of the RUQ

Answer 4

Murphy sign, seen in acute cholecystitis

Question 5

The most common caurse of small-bowel obstruction (SBQ) in patients with no history of abdominal surgery

Answer 5

Hernia

Question 6

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

Answer 6

Adhesions

Question 7

Identify key organisms causing diarrhea:
Most common bacterial organism
Recent antibiotic use
TRaveler's diarrhea
Poultry/eggs
Raw seafood

Answer 7

Campylobacter
Clostridium difficile
Enterotoxigenic Escherichia Coli (ETEC)
Salmonella
Vibrio, hepatitis A (HAV)

Question 8

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

Answer 8

Crohn disease

Question 9

Inflammatory disease of the colo with a raised risk of colon cancer

Answer 9

Ulcerative colitis (greater risk than Crohn)

Question 10

Extraintestinal manifestations of IBD

Answer 10

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

Question 11

Difference betwwen Mallory-Weiss and Boerhaave tears

Answer 11

Mallory - Weiss__ superficial tear in the esophageal mucosa; Boerhaave ___ full-thickness esophadeal rupture

Question 12

Charcot triad

Answer 12

RUQ pain, jaundice, and fever/chills

Question 13

Reynolds pentad

Answer 13

Charcot triad plus shock and mental status changes

Question 14

Medical treatment for hepatic encephalopathy

Answer 14

Lowered protein intake, lactulose, rifaximin

Question 15

The first step in the management of a paitent with an acute GI bleeding episode

Answer 15

Manage ABCs

Question 16

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

Answer 16

Hemolytic-uremic syndrome (HUS° due to E Coli Q157:H7

Question 17

Treatment after exposure to hepatitis B virus (HBV)

Answer 17

HBV immunoglobin

Question 18

Classic cause of drug-induced hepatitis

Answer 18

TB medications (INH, rifampicine, pyrazinamide) acetaminophen, and tetracycline

Question 19

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

Answer 19

Biliary tract obstruction

Question 20

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

Answer 20

Femoral hernia

Question 21

Severe abdominal pain out of proportion to the examination

Answer 21

Mesenteric ischemia.

Question 22

Diagnosis of ileus

Answer 22

Abdominal radiographs (could also perform CT scan)

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 forward . Management?

Answer 23

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

Question 24

Colon cancer region based on symptoms:

• Anemia from chronic disiase, occult blood loss, vague abdominal pain.
• Obstructive symptoms, change in bowel movements

Answer 24

Right sided: rare to have an obstriction

Left- sided : “apple-core” lesion

Question 25

Presents with watery diarrhea, dehydration, muscle weakness, and flushing

Answer 25

VIPoma (replace fluids and elctrolytes, may need to surgically resect tumor, or use octreotide)

Question 26

Presents with palpable nontender gallbladder

Answer 26

Courvoisier sign (suggests pancreatic cancer)