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Clinical: General Surgery > Gastrointestinal and Nutritional > Flashcards

Gastrointestinal and Nutritional Flashcards

1
Q

Where does referred pain for Cholecystitis go

A

Right Subscapular pain (also epigastric)

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2
Q

Where does referred pain for appendicitis go?

A

Early: periumbilical
Rarely: testicular pain

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3
Q

Where does referred pain for Diaphragmatic irritation go

A

Shoulder pain (+ Kehrs sign on the left)

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4
Q

Where does referred pain for Pancreatitis/cancer

A

back pain

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5
Q

Where does referred pain for Rectal disease go

A

pain in the small of the back

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6
Q

Where does referred pain for Nephrolithiasis

A

testicular/flank pain

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7
Q

Where does referred pain for rectal pain go

A

midline small of the back pain

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8
Q

Where does referred pain for small bowel pain go?

A

periumbilical pain

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9
Q

Where does referred pain for uterine pain go?

A

midline small of back pain

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10
Q

what needs to be ruled out with “abdominal pain out of proportion to exam”?

A

Mesenteric ischemia

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11
Q

what presents with fever, LLQ pain and change in bowel habits

A

Diverticulitis

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12
Q

What is an “acute abdomen”?

A

acute abdominal pain so severe that the pt seeks medical attention (not the same as a “surgical abdomen”)

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13
Q

what are peritoneal signs?

A

extreme tenderness
percussion tenderness
rebound tenderness
voluntary guarding
motion pain
involuntary guarding/rigidity (late)

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14
Q

What conditions can mask abdominal pain?

A

Steroids
Diabetes
Paraplegia

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15
Q

what are potential diagnoisis/conditions associated with epigastric pain

A

PUD
gastritis
MI
pancreatitis
biliary colic
gastric volvulus
mallory-weiss

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16
Q

What is the most common cause of acute abdominal surgery in the US?

A

Acute Appendicitis

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17
Q

what are potential diagnoisis/conditions associated with RUQ pain

A

cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis. cholangitis, pyelonephritis, nephrolithiasis, appendicitis
thoracic causes: PE, pericarditis, MI

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18
Q

what are potential diagnoisis/conditions associated with LUQ pain

A

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, hiatal hernia, boerhaaves syndrome, mallory weiss tear, splenic artery aneurysm, colon disease

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19
Q

what are potential diagnoisis/conditions associated with LLQ pain

A

Diverticulitis, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic cuases, appendicitis (rare)

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20
Q

what are potential diagnoisis/conditions associated with RLQ pain

A

Appendicitis
same as LLQ
mesenteric lymphadenitis, cecal diverticulitis, meckels diverticulum, intussusception

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21
Q

what is the population for presentation of acute/chronic cholecystitis

A

5 F’s: Female, Fat, Forty, Fertile, Fair

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22
Q

What is the preferred initial imaging for acute/chonic cholecystitis

A

Ultrasound

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23
Q

what is the gold standard test for acute/chornic cholecystitis

A

HIDA scan

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24
Q

what is a porcelain gallbladder

A

chronic cholecystitis

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25
Q

what is the treatment of acute/chronic cholecystitis

A

cholecystectomy

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26
Q

how is acute pancreatitis described

A

epigastric abdominal pain with radiation to the back and elevated lipase

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27
Q

what are the common etiologies of acute/chronic pancreatitis

A

cholelithiasis
alcohol abuse

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28
Q

what is Grey Turner sign

A

flank bruising seen with acute/chronic pancreattisis

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29
Q

what is cullens sign

A

brusing near the umbilicus with acute/chronic pancreatitis

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30
Q

what is the treatment of acute pancreatitis

A

IV fluids (best), analgesics, bowel rest

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31
Q

what are complications of acute pancreatitis

A

pancreatic pseudocysts

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32
Q

what is a pancreatic pseudocyst

A

circumscribed collection of fluid rich in pancreatic enzymes, blood and necrotic tissue

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33
Q

what is the classic triad of chronic pancreatitis

A

pancreatic calcification (plain abd XR), steatorrhea (high fecal fat) and diabetes mellitus

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34
Q

what is the treatment of chronic pancreatitis

A

no alcohol, low-fat diet

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35
Q

what is the difference from anorectal abscess and anorectal fistula

A

anorectal abscess is a result of infection
fistula is a chornic complication of an abscess

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36
Q

what is an anorectal fistula

A

open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses

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37
Q

what is the treatment of anorectal fistula

A

surgical treatment

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38
Q

what is an anal fissure

A

tearing rectal pain and bleeding which occurs with or shortly after defecation, bright red blood on toilet paper

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39
Q

what is the treatment of anal fissures

A

sitza baths, increased dietary fiber and water intake, stool softeners or laxatives

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40
Q

what are symptoms of gastric ulcers

A

epigastric pain
vomiting
anorexia
nausea

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41
Q

what are symptoms of duodenal ulcers

A

epigastric pain - burning or aching usually several hours after meals
bleeding
back pain
nausea
vomiting
and decreased appetite

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42
Q

what are symptoms of gastric cancer

what is the acronym

A

WEAPON
Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea

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43
Q

what are symptoms of lower GI bleed

A

hematochezia with or w/o abdominal pain
melena
anorexia
fatigue
syncope
SOB
shock

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44
Q

what are symptoms of carcinoma of the GB

A

biliary colic
weight loss
anorexia
many pts are asymptomatic until late

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45
Q

what are symptoms of pancreatic carcinoma

A

painless jaundice from obstruction of the common bile duct
weight loss
abdominal pain
back pain
weakness
pruruitis from bile salt on skin
anorexia
courvoisiers sign
acholic stools
dark urine
diabetes

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46
Q

what medications commonly cause anorexia

A

sedatives
digoxin
laxatives
thiazide diuretics
narcotics
antibiotics

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47
Q

what is the first symptom of appendicitis

A

crampy or “colicky” pain around the navel (periumbilical)

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48
Q

what are the three signs/special tests of appendicitis

A

Rovsing
Obturator
Psoas

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49
Q

what is the most common cause of small bowel obstruction in adults

A

post operative adhesions

hernias, cancer, IBD, volvulus

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50
Q

what is the most common cause of small bowel obstruction in children

A

intussusception

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51
Q

where are SBO ususally located

A

ileium or jejunum

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52
Q

how are SBO diagnosed

A

plain XR (KUB) or CT of the abdomen and pelvis

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53
Q

with is the treatment of SBO

A

Decompression with an NGT, surgery if a mechanical obstruction is suspected

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54
Q

what are the most common causes of LBO

A

Cancer
strictures
hernias
voluvulus
fecal impaction

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55
Q

where are LBO usually found

A

colon or rectum

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56
Q

how are SBO and LBO differentiated on physical exam

A

SBO: more vomiting and periumilical pain that is internmittent
LBO: vomiting less common, pain is lower in abdomen and longer and less frequent bouts of pain

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57
Q

what is seen on xray with LBO

A

Haustra that do not transverse bowel

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58
Q

what is Haustra

A

small pouches cuased by sacculation, which give the colon its segmented appearance

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59
Q

What is the presentation of cholangitis

A

RUQ pain, jaundice and fever
(aka charcots triad)

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60
Q

what is cholangitis

A

complication of gallstones with symtpoms secondary to an infected obstruction of the common bile duct

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61
Q

what is the most common cause of cholangitis (pathogen)

A

E. coli (#1 cause)

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62
Q

what is Charcots triad

A

RUQ tenderness, jaundice, fever (for cholangitis)

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63
Q

what is Reynolds Pentad

A

charcots triad (RUQ pain, jaundice, fever) + AMS and Hypotension

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64
Q

what is the treatment for Cholangitis

A

ERCP is optimal procedure for both diagnosis and treatment

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65
Q
A
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66
Q

what is seen on enema with colorectal cancer

A

apple core lesion

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67
Q

what is the most common type of colorectal cancer

A

adenoma

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68
Q

what is the tumor marker for colorectal cancer

A

CEA

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69
Q

what are colon cancer screening tests and when should they begin?

A

stool tests:
* Guaiac-based fecal occult blood -1/y
* Fecal immunochemical test -1/y
* FIT-DNA test - 1/1-3y
flexible sigmoidosocopy- 1/5-10y
colonoscopy - 1/10y
CT colonography - 1/5y
Average risk pts should begin screenings at 45yo and end at 75

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70
Q

how is constipation defined?

A

less than 2 BM / week

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71
Q

How does SBO present

A

colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, obstipation, hyperactive bowel sounds

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72
Q

how is LBO present

A

gradually increasing abdominal pain with longer intervals btwn episodes of pain, abdominal distention, obstipation, less vomiting, more common in elderly.

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73
Q

what is the primary sign of illeus

A

absent bowel sounds

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74
Q

what is an ileus

A

a painful obstruction of the ileum or other part of the intestine.

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75
Q

what is the imagine of choice for an ileus

A

CT with Gastrografin - must exclude mechanical obstruction

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76
Q

what is gastroparesis

A

condition that affects the stomach mucscles and prevents proper stomach emptying

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77
Q

what is the most common cause of gastroparesis

A

Diabetes

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78
Q

what is pseudomembranous colitis

A

inflammation of colon caused by c.diff

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79
Q

what is the cause of pseudomambranous colitis

A

c.diff occurs secondary to treatment with braod-spectrum abx

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80
Q

what are signs of pseudomembranous colitis

A

mild watery, foul smelling diarrhea (>3 but <20 stools/day)

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81
Q

what is the treatment of pseudomembranous colitis

A

IV metronidazole
OR
PO vanco (only use for oral vanco)

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82
Q

what is inflammation of an abnormal puch in intestinal wall

A

diverticular disease (diverticulitis)

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83
Q

where is the most common location of diverticulitis

A

sigmoid colon

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84
Q

how is diverticulitis diagnosed

A

abdominal and pelvic CT with oral, rectal and IV contrast

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85
Q

how long after acute flare of diverticulitis can colonoscopy be done

A

1-3 months to assess for cancer

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86
Q

what does CT of diverticulitis show

A

fat stranding and bowel wall thickening

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87
Q

what is the treatment of divericulitis

A

depends on severity - conservative management (Pain control and liquid diet x 2-3 days), sometimes abx, and sometiems percutaneous/endoscopic US guided drainage

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88
Q

what is the most common type of esophageal cancer

A

squamous cell (m/c world wide)
adenocarcinoma (m/c in US)

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89
Q

what type of esophageal cancer is a complication of Barretts esophagus

A

adenocarcinoma

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90
Q

what type of esphageal cancer is associated with smoking and alcohol use

A

squamous cell carcinoma

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91
Q

what are symptoms of esphageal strictures

A

difficulty and painful swallowing, weight loss and regurgitation of food

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92
Q

what is esophageal achalasia

A

primary esophageal motility d/o characterized by the absence of lower esophageal peristalsis

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93
Q

how are esophageal strictures diagnosed

A

barium swallow - “birds beak” or “rats tail” appearance

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94
Q

what is the treatment for esophageal strictures

A

EDG dilation of esophagus or myotomy

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95
Q

what is an esophageal web

A

thin membranes in the mid-upper esophagus. may be acquired or congenital

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96
Q

what is Plummer-Vinson

A

esophageal webs + dysphagia + iron deficiency anemia

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97
Q

what is a schatzki ring

A

diaphragm like mucosal ring that forms at the esophagogastric juntion (B ring).

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98
Q

what are risk factors for gastic cancer

A

family history of gastric cancer
gastric ulcers
H. pylori
pernicious anemia

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99
Q

what are signs of gastric cancer

A

loss of appetite
difficulty swallowing (increasing over time)
vague abdominal fullness
N/V/weight loss

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100
Q

what are three causes of heartburn and dyspepsia

A
  1. autoimmune or hypersensitivity reaction
  2. infection - H.pylori (m/c)
  3. inflam of stomach lining (NSAIDs and Alcohol)
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101
Q

what is the treatment of H.pylori

A

PPI (omeprazole) + clarithromycin + amoxicillin +/- metronidazole

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102
Q

what are the common etiologies of PUD

A

H.pylori (M/c), NSAID use, Zollinger-Ellison syndrome

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103
Q

What is Zollinger-Ellison syndrome

A

refractory PUD - rare digestive condition that cuases the stomach to produce too much acid

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103
Q

what are signs of PUD

A

hematemesis, abdominal discomfort, dull pain

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104
Q

what is the gold standard for diagnosis of PUD

A

endoscopy with bx

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105
Q

what are signs of esophageal varicies

A

hematemesis
bleeding
difficulty swallowing

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106
Q

what is a Mallory-Weiss syndrome

A

tearing in lining of the stomach just above the esophagus cuased by violent retching and vomiting

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107
Q

45yo woman with hemorrhoids that bulges into the anal canal during BM..what type and degree of hemorrhoid is this?

A

1st degree internal hemorrhoids

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108
Q

56yo woman with hemorrhoids that prolapse with defecation but then retract by themselves..what type of hemorrhoids is this?

A

2nd degree internal hemorrhoids

109
Q

34yo woman with hemorrhoids that prolapse after defecation and that she has to “push it back in”..what type and degree of hemorrhoids is this?

A

3rd degree internal hemorrhoids

110
Q

56yo woman with hemorrhoids that are “stuck out” after BM

A

4th degree internal hemorrhoid

111
Q

what are hemorroids

A

varicose veins of the anus and rectum

112
Q

what are risk facotrs for hemorrhoids

A

constipation/straining
pregnancy
portal HTN
obesity
prolonged sitting/standing
anal intercourse

113
Q

what are the etiologies of Hepatic carcinoma

A

Cirrhosis
hep B, C, D
aflatoxin from aspergillus

114
Q

what is the most common inguinal hernias

A

indirect: through internal inguinal ring with inguinal canal

115
Q

what is a direct inguinal hernia

A

passage of intestine through external inguinal ring at Hesselbachs triangle

115
Q

what makes up hesselbachs triangle

A

aka inguinal triangle
medial- lateral border of rectus abdominis muscle
lateral - inferior epigastric vessels
inferior - inguinal ligament

116
Q

what is a ventral hernia

A

often from previous abdominal surgery, obesity.
abdominal mass noted at the site of previous incision

117
Q

what is an obstructed hernia

A

irreducible hernia containing intestine that is obstructed from without or within, but no interference of blood supply to the bowel.

118
Q

what is a hiatal hernia

A

diaphragmatic - protrustion of stomach through the diaphragm via esophageal hiatus

119
Q

what portion of the bowel is affected with Ulcerative colitis

A

isolated tothe colon - starts at the rectum and moves proximally.

120
Q

what portion of the bowels are affected by Crohns disease

A

from mouth to anus, transmural, skip lesions and cobblestoning.
m/c in terminal ileum

121
Q

what is the treatment for Crohns flares

A

prednisone +/- Mesalamine +/- Metronidazole or Ciprofloxacin

122
Q

what is the maintenance medication for crohns

A

mesalamine

123
Q

what is melena

A

black, tarry stools
(usually indicating Upper GI bleed)

124
Q

what is hematochezia

A

bright red blood per rectum (BRBPR) - lower GI bleed

125
Q

what is pathognomonic of pancreatic carcinoma

A

painless jaundice

126
Q

what type and where is pancreatic carcinoma usually located

A

ductal adenocarcinoma located at the pancreatic head

127
Q

what is the presentation of pancreatic carcinoma

A

weight loss/epigastric pain, clay-colored stools
Courvoisiers sign
Virchows node

128
Q

what is courvoisiers sign

A

jaundice + palpable non-tender gallbladder

129
Q

what is Virchows node

A

lymph node in the left supraclavicular fossa

130
Q

what is a pancreatic pseudocyst

A

cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas

131
Q

when does pancreatic pseudocyst occur

A

typically occurs 2-3 weeks after acute pancreatitis

132
Q

what is the presentation of pancreatic pseudocyst

A

abdominal pain and a palpable epigastric mass

133
Q

what is the treatment for pancreatic pseudocyst

A

if pseudocysts persists for 4-6 weeks or continues to enlarge.. surgical decompression, percutaneous drainage and can become infected and lead to peritonitis

134
Q

what is pyloric stenosis

A

congenital condition where newborns pylorus undergoes hyperplasia and hypertrophy, leading to obstruction of pyloric valve which causes vomiting as well as dehydration and metabolic alkalosis

135
Q

when does pyloric stenosis present

A

<3 months of age

136
Q

how is pyloric stenosis diagnosed

A

Ultrasound - double track
barium studies - “string sign” or “shoulder sign”

137
Q

what is toxic megacolon

A

a complication of UC (m/c), Crohns, hirschprungs etc that is a life-threatening form of colon distention

138
Q

how is toxic megacolon diagnosed

A

clinical signs of systemic toxicity in combo with xray evidence

139
Q

what is the treatment of toxic megacolon

A

decompression of colon is required
- in some cases colostomy or even complete colonic resection may be required

140
Q

Which of the following is most commonly associated with acute cholecystitis?
A. grey-turner sign
B. Murphy’s sign
C. Psoas sign
D. Rovsings sign
E. Cullen’s sign

A

B. Murphy’s sign

elicited by asking the pt to take a deep breath while the examiners fingers are placed just below the right costal margin causing pain due to inflamed peritoneum

141
Q

A 55yo male persents wtih recurrent RUQ abdominal pain and bloating, especially after fatty meals. He has a hx of gallstones but no fever or jaundice. Which imaging modality is most appropriate to diagnose chronic cholecystitis in the patient?
A. Abdominal XR
B. CT scan of the abdomen
C. US of the abdomen
D. MRCP
E. ERCP

A

C. US of the abdomen

imaging modality of choice for dx of chronic cholecystitis.

142
Q

60 yo female is dx with acute cholecystitis, confirmed by imagine. she has mild symptoms and no signs of complications. what is the most appropriate initial treatment for this patient?
A. immediate cholecystectomy
B. conservative management with analgesics and abx
C. ERCP
D. Percutaneous cholecystosomy
E. oral cholecystography

A

B. Conservative management with analgesics and abx

143
Q

a 62 yo male with CHF and emphysema has sympotms of substernal chest pain and regurgitation after meals and at bedtime. He obtains incomplete relief of symptoms with famotidine. an endoscopy confirms mild esophagitis. which of the following is the most appropriate next step?
a. reassure him that continued occurance of symtpms while receiving therapy is normal
b. prescribe omeprazole 20mg/day
c. schedule him for 24 hour pH monitoring, manometry and barium esophagogram for further eval
d. schedule him for a laparoscopic nissen fundoplication
e. recommend dietary changes

A

b. prescribe him omeprazole 20mg/day

given the pts comorbidities (CHF and emphysema) he isnt a good surgical candidate. important part of hx is partial relief with H2 blocker as oppposed to no respoonse at all, therefore the hx suggests dx of GERD is a correct one and pts may simply have an ascalation of GERD tx. this pt should be switched to PPI b/c the relapse rate associated with H2 blockers is much higher than that associated with PPIs.

144
Q

A 51-year-old woman has a 6-month history of substernal chest pain and vague upper abdominal discomfort. She has been taking antacid therapy with minimal relief and has had a negative upper endoscopy. Which of the following is the best next step in her workup?
A. barium esophagogram to evaluate for a hiatal hernia
B. performing manometry to r/o motility disorder such as diffuse esophageal spasm or achalasia
C. referring the patient to cardiac workup as a potential cause of her chest pain
D. referring to psychiatrist for possible conversion disorder
E. performing a CT of chest and abdomen

A

C. referring pt for cardiac workup as potential cause of her chest pain

When chest or epigastric pain does not respond to antacid therapy, and especially with a negative upper endoscopy, etiologies other than GERD (such as cardiac pain) should be considered. This patient’s history qualifies as atypical chest pain and may benefit from an exercise stress test. Documentation of a hiatal hernia does not necessarily correlate causally to her symptoms. Cardiac disease would be the most concerning disease, and that is why this disorder should be ruled out first. CT of the abdomen and chest may be helpful to identify other potential anatomic causes of her chest and abdominal pain but should only be done after appropriate cardiac evaluations

145
Q

a 45yo male has been dx with GERD for 3 years with tx with H2-blocking agents. recently he has complained of epigastric pain. an Upper endoscopy was performed showing barrett esophagus at the distal esophagus. which of the following is the best next step in the treatment of teh individual?
A. initiate PPI
B. Advise the pt to continue to take the H2 blocker
C. Perform a laparoscopic Nissen fundoplicaiton
D. Advise surgical therapy involving gastrectomy and esophageal bypass
E. discontiue the Hblocker and initiate antacids

A

A. Initiate PPI

The next step in medical therapy for GERD is the addition of a PPI, which is a more effective medication for GERD. The patient has been symptomatic and developed Barrett esophagitis on an H2 blocker, and therefore additional therapy is needed for relief of symptoms and to decrease the progression of the Barrett esophagitis to adenocarcinoma. An antireflux surgery (such as the Nissen fundoplication) is an option but not gastrectomy and esophageal bypass. In general, most practitioners would elect to place the patient on the more appropriate medical treatment at this time rather than proceed with fundoplication. This patient also needs endoscopic surveillance of the Barrett esophagus.

146
Q

A 24yo man with long standing GERD, currently taking PPis, is being evaluated for possible surgical threapy. which fo the following is an indication for surgery?
A. inability to tolerate PPIs
B. Inability to afford PPIs
C. incomplete relief of sympotms despite a maximum dosage of medical therapy
D. the pts desire to d/c medications
E. All of the above

A

E. all of the above

The indications for surgery are relative and determined in part by the patient; thus, inability to tolerate, inability to pay for, or a desire to discontinue medical therapy is a consideration for operative management.

146
Q

What is GERD?

A

Excessive reflux of gastric contents into the esophagus, “heartburn”

147
Q

What are the causes of GERD?

A

decreased lower esophageal sphincter (LES) tone
decreased esophageal motility to clear refluxed liquid
gastric outlet obstruction
Hiatal hernia

148
Q

What disease must be ruled out when the symptoms of GERD are present?

A

Coronary Artery Disease

149
Q

What is Barretts Esophagus

A

columnar metaplasia from the normla squamous epithelium as a result of chronic irritation from reflux

150
Q

What is the major concern with Barretts esophagus?

A

developing cancer

151
Q

what type of cancer develops in Barretts esophagus

A

Adenocarcinoma

152
Q

What is the treatment of Barretts esophagus with dysplasia?

A

Non surgical: endoscopic mucosal resection and photo therapy. readio frequency ablation, cryoablation

153
Q

a 36yo male presents with sudden onset severe epigastric pain following an alcohol binge. pain is referred to his back. pain is alleviated when he sits and leans forward. there is also N/V. PE revealed upper abdomnal tenderness, bluish discoloration around umbilicus and bowel sounds are absent. what is the most likely dx?
A. acute pancreatitis
B. acute appendicitis
C. acute cholecystitis
D. acute gastroenteritis

A

A. acute pancreatitis

Sudden severe epigastric pain (following alcohol binge) that is referred to the back and relieved by sitting and leaning forward with Cullen’s sign (periumbilical ecchymosis) strongly suggest acute pancreatitis.

154
Q

a 36yo male presents with sudden onset severe epigastric pain following an alcohol binge. pain is referred to his back. pain is alleviated when he sits and leans forward. there is also N/V. PE revealed upper abdomnal tenderness, bluish discoloration around umbilicus and bowel sounds are absent. all of the following tests hsould be ordered next except

a. CBC with diff
B. serum amylase and lipase level
C. CT of abdomen with contrast
D. CMP
E. ABG

A

C. CT abdomen with contrast

The initial laboratory evaluation should include a complete blood count with differential, amylase and lipase levels, metabolic panel (blood urea nitrogen, creatinine, glucose, and calcium levels), liver function tests, and arterial blood gas analysis. Results from these tests should be used to guide further evaluation. CT scan of the abdomen would help in diagnosis of pancreatitis and pseudocyst formation but should be done after the initial laboratory investigations and stabilization of the patient

155
Q

Which of the radiologic imaging techniques is the most sensitive in diagnosis of acute pancreatitis and pancreatic pseudocyst?
A. transabdominal US
B. contrast enhanced CT of abdomen
C. MRCP
D. Plain radiograph (adominal series)

A

B. Contrast enhanced CT of the abdomen

Question 3 Explanation: Contrast-enhanced CT has become the standard imaging technique for detection of acute pancreatitis and pseudocyst formation. Not only does it help in diagnosis, but some studies have shown that a CT severity index is helpful in predicting the severity of acute pancreatitis compared with the Ranson criteria and the APACHE II scale.

156
Q

Fullness in the epigastric region and a palpable mass in this patient are most likely due to
A. Pancreatic psuedocyst formation
B. palpable gallbladder
C. enlarged spleen
D. enlarged liver

A

A. Pancreatic pseudocyst formation

The palpable mass in this patient is most likely due to pancreatic pseudocyst formation. These patients are jaundiced and do not present with such acute symptoms and pain.

157
Q

What is acute pancreatitis

A

suddend inflammation that develops quickly and lasts a short time. usually settles in a few days but sometimes it becomes severe

158
Q

what are the causes and risk factors of acute pancreatitis

A

caused by gallstones and alcohol consuption
RF: autoimmune disease, infxn, meds, surgery, trauma, metabolic d/o

159
Q

What are symptoms of acute pancreatitis

A

pain in epigastrum that radiates to the back. typically lessens when pt leans forward or lies in fetal positon. eating may make it worse.
severe abd pain, N/V,abd distention

159
Q

what are symptoms of chronic pancreatitis

A

epigastric pain, malabsorption
(diarrhea and weight loss), diabetes, upset stomach, vomiting

160
Q

what are causes of chronic pancreatitis causes

A

90% caused by alcohol abuse
- cystic fibrosis, gallstones, high triglycerides and medications

161
Q

what is the mnemonic for common causes of acute pancreatitis

A

GET SMASHHED

162
Q

what is the mnemonic GET SMASHHED

A

most common causes of acute pancreatitis
- gallstones
- ethanol
- trauma
- steroids
- mumps
- autoimmune disease
- scorpion stine
- hypercalcemia
- hyperlipidemia
- ERCP
- Drugs

163
Q

What is the treatment of acute pancreatitis

A

fluid resuscitation, pain control and nutrition
abx if pancreas is infected
ERCP to remove gallstones

164
Q

what is the treatment of chronic pancreatitis

A

water
abstaining from alcohol
eating small low-fat meals

165
Q

what is Ransons Criteria

A

form a clinical prediction rule for predicting the severity of acute pancreatitis.

166
Q

which of the following surgical procedures is Not associated with increase risk of PONV and POV?
A. cholecystectomy
B. gynecologic procedures
C. Laparoscopy
D. Stabismus surgery
E. total hip replacement

A

E. total hip replacemement

Some surgical procedures are associated with an increased risk of PONV and POV, including the following:
Adults – Cholecystectomy, gynecologic procedures, laparoscopy
Children – Strabismus surgery, adenotonsillectomy

167
Q

Which of the following dx studies is indicated in the evaluation of an upper GI bleed?
A. esophageal manometry
B. bleeding scan
C. upper endoscopy
D. barium swallow

A

C. upper endoscopy

168
Q

define upper GI bleed

A

bleeding into lumen of proximal GI tract. proximal to ligament of treitz

169
Q

what is the most comon cause of significant UGI bleeding?

A

PUD - duodenal and gastric ulcers

170
Q

A 26-year old female presents with colicky abdominal pain which was initially at the periumbilical region, then after about 3 hours radiated to the right iliac fossa. She also has nausea and anorexia and has had two episodes of vomiting. On examination, she’s acutely ill looking, has low grade pyrexia (99.8oF), localized abdominal tenderness over McBurney’s point with muscle guarding and rebound tenderness. Blood test reveals Leucocytosis and a shift to left. Which of the following is the most likely diagnosis?

a. ruptured ectopic pregnancy
b. salpingitis
c. torsion of an ovarian cyst
d. acute appendicitis

A

D. acute appendicitis

The classic presentation of acute appendicitis is colicky abdominal pain frequently first noticed in the periumbilical region, then at the right iliac fossa. There is usually nausea, anorexia, fever and 1 or 2 episodes of vomiting. Examination findings usually show tenderness, muscle guarding and rebound tenderness over the McBurney’s point.

171
Q

Which of the following signs is not associated with acute appendicitis?
A. murphys
B pointing
C Rovsings
D obturator

A

A. murphys

this is for acute cholecystitis

172
Q

Deep palpation of left iliac fossa causing pain in right iliac fossa is
a. rovsings
b. psoas
c. obturator
d. dunphys

A

A. Rovsings

Rovsing’s sign, named after the Danish surgeon Niels Thorkild Rovsing (1862 -1927), is a sign of appendicitis. If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.

172
Q
A
173
Q

Which lab marker is most helpful in supporting dx of acute appendicitis?
a. amylase
b. WBC count
C. CRP
D. UA

A

B. WBC count

A WBC count is often elevated. In acute appendicitis, the average leukocyte count is 15,000/mm3, and 80% of patients have a leukocyte count greater than 11,000/mm3. The differential count will often show a left shift. A leukocytosis can be helpful in supporting a diagnosis of appendicitis but does not differentiate it from other intra-abdominal processes.

174
Q

the test with the highest sensitivty in dx of appendicitis is
a. US
b. barium enema
c. abdominal xr
d. CT with IV and oral contrast agents

A

D. CT with IV and oral contrast

The sensitivity of CT is 94%. The sensitivity of ultrasonography is 83% to 88% and is operator dependent. Barium enema is 80% to 90% sensitive but is no longer recommended because up to 40% of studies can be equivocal secondary to only partial filling of the appendix. Abdominal radiography is not routinely recommended because of very low sensitivity and specificity. Note that although imaging can be helpful, the diagnosis of appendicitis is primarily made by history and physical examination, and imaging study results can be equivocal!

175
Q

what is the m/c cause of acute abdomen

A

appendicitis

176
Q

Following bariatric surgery, a patient is at increased risk for which of the following nutritional deficiencies?
A. Vitamin C
B. Calcium and vitamin D
C. Potassium
D. Vitamin B12
E. Vitamin A

A

B. Calcium and Vitamin D

Patients who undergo bariatric surgery, especially malabsorptive procedures like Roux-en-Y gastric bypass, are at increased risk for calcium and vitamin D deficiencies due to altered gastrointestinal anatomy and reduced absorption. This can lead to bone demineralization and increased risk of fractures.

177
Q

What is the formula for BMI?

A

Body weight (Kg) divided by height (meters squared)

178
Q

What medical conditions are associated with morbid obesity?

A

sleep apnea
CAD
Pulmonary disease
DM
venous stasis ulcers
arthritis
infections
sex-hormone abnormalities
HTN
breast cancer
colon cancer

179
Q

what is the most common sign of an astomotic leak after gastric bypass?

A

tachycardia

180
Q

What is Ghrelin?

A

Hormone produced in stomach fundus that stimulates hunger.

181
Q

which of the following is the most common cause of esophageal stricture?
A. corrosive ingestion
B. GERD
C. Post op scarring
D. esophageal cancer

A

B. GERD

GERD accounts for aprox 70-80% of all cases of esophageal stricutre

182
Q

Which of the following is not a cause of distal esophageal stricture?
A. GERD
B. Adenocarcinoma
C. Scleroderma
D. Infectious esophagitis

A

D. infectious esophagitis

infectious esophagitis causes stricture mostly at the proximal and mid esophagus

183
Q

60yo man has had GERD for 2 years. for about 13 months now, he has noticed an increaseing difficulty with swallowing his food. which of the following is the most likely diagnosis:?
A. Achalasia
B. diffuse esophageal spasm (DES)
C. Pyloric stenosis
D. esophageal stricture

A

D. esophageal stricture

184
Q

which of the following is not a treatment modality for esophageal stricture?
A. PPI
B. endoscopic dilation
C. endoscopic intralesional steroid
D. endoscopic sclerotherapy

A

D. endoscopic sclerotherapy

this is the treatment of bleeding esophageal varices.

185
Q

A Schatzki ring will cause dysphagia to:
A. solids
B. liquids
C. both solids and liquids

A

A. solids

186
Q

a 45yo caucasian female presents with dysphagia to solids foods with a CBC indicative or iron deficiency anemia. What finding on endoscopy would lead to you a diagnosis of Plummer-Vinson Syndrome?
A. esophageal web
B. Mallory-Weiss Tear
C. Barrett’s esophagus
D. varicies
E. solid tumor

A

A. esophageal webs

Plummer–Vinson syndrome (PVS), also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia, is a rare disease characterized by difficulty in swallowing, iron deficiency anemia, glossitis, cheilosis and esophageal webs. Treatment with iron supplementation and mechanical widening of the esophagus generally provides an excellent outcome.Plummer-Vinson Syndrome has 3 main findings: 1. dysphagia 2. esophageal webs 3. iron deficiency anemia

187
Q

what is Plummer-Vinson syndrome

A

Aka Paterson-Brown-Kelly syndrome or Sideropenic dysphagia
rare disease characterized by difficulty swallowing, iron deficiency anemia, glossitis, cheilosis and esophageal webs

188
Q

what is the treatment of Plummer-Vinsons syndrome

A

iron supplementation and mechanical widening of esophagus

189
Q

what is an esophageal stricture

A

abnormal tightening/narrowing of esophagus making it more difficult for food to travel down the tube

190
Q

What are the types of esophageal strictures?

A

Simple or complex strictures

191
Q

what type of strictures are smaller and lead a wider opening in the esophagus.

A

simple sticture

192
Q

what type of strictures are usually not straight or symmetrical andhave uneven surfaces/margins?

A

Complex strictures

193
Q

what are risk factors for esophageal strictures

A

alcohol use
cancer in the neck area
GERD
hiatal hernia
PUD
hx of dysphagia

194
Q

What is the most common cause of esophageal stricture

A

GERD

195
Q

what is eosinophilic esophagitis

A

allergic reaction/immune system problem causing inflammation in the esophagus, possibly leading to strictures

196
Q

Define esophageal web

A

thin membrane in the mid-upper exsophagus. Mya be congenital or acquired

197
Q

Define Schatzki ring

A

diaphragm like mucosal ring that forms at the esophagogastic junction (B-ring).

198
Q

A 65yo man presents to you with 3 month hx of dysphagia initially to solid food and then 4 weeks later to liquid. hx of tobacco use and higher level of alcohol ingestion over 20 years. He has lost 22lbs in the past 2 months. what is the most likely diagnosis?
A. Zenkers diverticulum
B. Achalasia
C. esophageal cancer
D/ diffuse escophageal spasm

A

C. Esophageal cancer

Esophageal cancer occurs in the elderly population. Presents as dysphagia initially to solids then weeks later to liquid. Prolonged histories of tobacco use and alcohol ingestion are strong risk factors for esophageal cancer.

199
Q

what is the first line investigative modality in a pt with concerns for esophageal cancer?
A. CXR
B. esophagoscopy
C. barium swallow
D. edoscopic US

A

B. esophagoscopy

first line for an elderly pt presenting with dysphagia. used to diagnose esophageal cacner along with bx.

200
Q

60yo man presents with a 4 week hx of dysphagia to only solid foods. he is a non-smoker but has hx of GERD for 20 years. what is the most liekly dx?
A. adenocarcinoma of esophagus
B. SCC of esophagus
C. Kaposi’s sarcoma of esophagus
D. Leiomyoma of esophagus

A

A. adenocarcinoma of esophagus

201
Q

Adenocarcinoma of the esophagus is most likely to occur at what part of the esophagus?
A. upper third
B. Middle third
C. Lower third
D. all of the above

A

C. Lower third

202
Q

what are the two main types of esophageal carcinoma

A

adenocarcinoma at GE junction
SCC (in most of esophagus)

203
Q

what are the 5 common etiologies of esophageal carcinoma?

A
  1. tobacco
  2. alcohol
  3. GERD
  4. barrets esophagus
  5. radiation
204
Q

Which of the following is not a risk facotr for the formation of cholestrol gallstones?
A. pregnancy
B. obesity
C. sickle cell anemia
D. estrogen

A

C. sickle cell anemia

this is a risk factor for the formation of black pigment gallstones

205
Q

which of the statements is false about cholelithiasis?
a. gallstone disease is responsible for about 10,000 deaths per year in the US
b. consuption of caffeinated coffee appears to protect against gallstones in women.
c. acute pancreatitis is a possible complication of cholelithiasis
d. gallstones are more common in men then women

A

D. gallstones are more common in men then women

Women are more likely to develop cholesterol gallstones than men, especially during their reproductive years, when the incidence of gallstones in women is 2-3 times that in men.

206
Q

Gallstones have been classified into all of the following except:
a. cholesterol stones
b. cystine stones
c. pigment stones
e. mixed stones

A

B. cystine stone

these are examples of kidney stones

207
Q

which of the following is not a complication of cholelithiasis?
a. intestinal obstruction
b. acute cholangitis
c. gallbladder empyema
d. pyelonephritis

A

d. pyelonephritis

207
Q

which antibiotic is a major cause of biliary sludge?
a. amoxicillin
b. ciprofloxacin
c. ceftriaxone
d. doxycycline

A

c. ceftriaxone

Ceftriaxone is a major cause of biliary sludge. The mechanism of biliary sludge formation during ceftriaxone therapy appears to be the propensity of ceftriaxone to bind calcium and form insoluble crystals in bile in the gallbladder, resulting in biliary sludge or frank stones.

208
Q

define cholelithiasis

A

gallstones in the gallbladder

209
Q

define choledocholithiasis

A

gallstones in common bile duct

210
Q

define cholecystitis

A

inflammation of gallbladder

211
Q

define cholangitis

A

infection of biliary tract

212
Q

what are the “big 4” risk facotrs of chonelithiasis

A

Female, Fat, Forty, and fertile

213
Q

what are the causes of black pigmented stones?

A

cirrhosis, hemolysis

214
Q

What is Boas’ sign?

A

referred right subscapular pain of biliary colic

215
Q

60yo male with hx of rectal bleeding and change in bowel habits undergoes colonoscopy, whihc reveals a mass in the ascending colon. which of the following is the most appropriate next step inthe management of this patinet?
A. repeat colonoscopy in one year
B. immediate initiation of chemo
C. biopsy of mass during colonoscopy
D. surgical resection of the mass without biopsy
E. prescription of high fiber diet

A

C. biopsy of mass during colonoscopy

216
Q

which of the following is the standard treatment for localized stage 2 colon cancer?
a. palliative care only
b. chemo alone
c. radiation alone
d. surgical resection followed by adjuvant chemo based on risk factors
e. immunotherapy

A

d. surgical resection followed by adjuvant chemo based on risk factors

217
Q

carcinoma of the colon most commonly originates in which of the following?
a. adenomatous polyp
b. inflammatory polyp
c. hyperplastic polyp
d. benign lymphoid polyp
e. hamartomatous poylp

A

a. adenomatous polyp

the majority of colon carcinomas originate from adenomatous polyps through the adenoma-carcinoma sequence, a well-documented pathway in colorectal cancer development. These polyps are considered precancerous, and their transformation into cancer is influenced by various genetic and environmental factors.

218
Q

What is Lynch syndrome

A

Hereditary non-polyposis colon cancer (HNPCC)
autosomal-dominant inheritance of high risk for the development of colon cancer

219
Q

what are the current recommendations for colorectal cancer screening if there is a hx of colorectal cancer in a first-degree relative less than 60 years old?

A

colonoscopy at age 40, or 10 years before the age at dx of the youngest first-degree relative, and every 5 years thereafter

220
Q

what is the most common site of distant metastasis from colorectal cancer?

A

liver

221
Q

what are the risk factors for gastric cancer?

A

diet: smoked meats, high nitrates, low fruits/veggies, alochol and tobacco
environment

222
Q

what is sister mary joseph’s sign?

A

periumbilical lymph node - presents as periumbilical mass

223
Q

what finding on barium swallow is associated with pyloric stenosis?
a. string sign
b. birds beak
c. corkscrew esophagus

A

a. string sign

224
Q

which of the following is not a known complication of diverticulitis?
a. fistula
b. colonic stricture
c. abscess
d. colon cancer

A

d. colon cancer

225
Q

which of the following is not a component of Charcots triad?
a. hepatomegaly
b. RUQ pain
c. fever
d. jaundice

A

a. hepatomegaly

226
Q

Which of the following is not a part of Reynolds pentad?
a. metal confusion
b. hypotension
c. fever
d. anorexia
e. jaundice

A

d. anorexia

227
Q

the most common cause of acute cholantitis is:
a. choledocholithiasis
b. ERCP
c. biliary tract tumors
d. parasitic infection

A

a. choledocholithasis

228
Q

which of the following organisms is the most common cause of acute cholangitis?
a. streptococcus
b. e.coli
c. staphylococcus aureus
d. pseudomonas aeruginosa
e. klebsiella pneumonia

A

b. e.coli

229
Q

ascending cholangitis is defined as bacterial infection of what?

A

bile duct

230
Q

what is charcot triad

A

jaundice, fever and RUQ pain with cholangitis

231
Q

what is the initial imaging study for ascending cholangitis?

A

US

232
Q

A 45-year-old man with a history of chronic alcoholism presents with persistent abdominal pain and weight loss for the past two months. He had an episode of acute pancreatitis six months ago. On examination, he has epigastric tenderness. His serum amylase and lipase levels are mildly elevated. An abdominal CT scan reveals a 5 cm cystic lesion in the region of the pancreas without evidence of calcification or solid components. Which of the following is the most likely diagnosis?
a. pancreatic adenocarcinoma
b. pancreatic pseudocyst
c. acute pancreatitis
d. pancreatic serous cystadenoma
e. chronic pancreatitis

A

b pancreatic psuedocyst

233
Q

what are three tx options for pancreatic pseudocysts?

A
  1. percutaneous aspiration/drain
  2. operative drainage
  3. transpapilary stent via ERCP
234
Q

which of the following is a tumor marker elevated in liver cancer?
a. CEA
b. AFP
c. CA-125
d. CA27-29

A

b. alpha-fetoprotein (AFP)

The most abundant plasma protein found in the human fetus is alpha-fetoprotein (AFP). AFP is a protein normally made by the immature liver cells in the fetus. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. Also, pregnant women carrying babies with neural tube defects may have high levels of AFP in both the bloodstream and in the amniotic fluid. In adults, high blood levels (over 500 nanograms/milliliter [or ng/ml]) of AFP are seen in hepatocellular carcinoma.

235
Q

A 69-year old man presents with epigastric pain which radiates to his back, progressive weight loss, jaundice, and pruritus. On physical examination, patient looks cachectic, is icteric, has scratch marks, palpable gallbladder. His fasting blood sugar (FBS) is 13mg/dl. What is the most likely diagnosis?
a. pancreatic cancer
b. gastric cancer
c. gastric ulcer
d. hepatocellular carcinoma

A

a. pancreatic cancer

236
Q

what are risk factors for pancreatic carcinomas?

A

smoking 3x risk
DM
heavy alcohol use
chronic pancreatitis
diet high in fried meats
previous gastrectomy

237
Q

What is Courvoisiers sign?

A

palpable, nontender, distended gallbladder which may indicate pancreatic neoplasm

238
Q

What tumor markers are associated with pancreatic cancer?

A

CA-19-9

239
Q

which medicatiosn is considered the mainstay of therapy for mild to moderate IBD?
a. prednisone
b sulfasalazine
c. metronidazol
d. azathioprine (imuran)

A

b. sulfasalazine

Sulfasalazine and other 5-aminosalicylic acid drugs are the cornerstone of therapy in mild to moderate inflammatory bowel disease as they have both anti-inflammatory and antibacterial properties.

240
Q

Which of the following is not an extraintestinal manifestation of inflammatory bowel disease?
a. uveitis
b erythema nodosum
c. arthritis
d. dermatitits hepetiformis

A

d. dermatitis herpetiformis

Dermatitis herpetiformis (A chronic, very itchy skin rash made up of bumps and blisters) is an extraintestinal manifestation of celiac disease. All other options are correct.

241
Q

A 60-year-old individual presents to your office with persistent abdominal pain, unexplained weight loss, and occasional gastrointestinal bleeding. The patient’s family history reveals a sibling with colorectal cancer. After a series of diagnostic tests, including a CT scan and endoscopy, a small bowel carcinoma is diagnosed. What is the most appropriate initial treatment approach for localized small bowel carcinoma?
a. chemotherapy alone
b. radiation therapy alone
c. surgical resection
d. palliative care only
e. high-dose vitamin therapy

A

c. surgical resection

242
Q

A 58-year-old individual presents to your office with recurrent cramping abdominal pain, fatigue, and melena. Laboratory tests reveal iron-deficiency anemia. A capsule endoscopy is performed, revealing a mass in the jejunum. Biopsy confirms the diagnosis of small bowel adenocarcinoma. What is the most common risk factor associated with small bowel adenocarcinoma?
a. chronic alcohol consuption
b. celiac dissease
c. smoking
d. crohns disease
e. high-fat diet

A

d. Crohn’s disease

Crohn’s disease is the most common risk factor associated with small bowel adenocarcinoma. Chronic inflammation of the small intestine in Crohn’s disease can lead to dysplasia and eventually adenocarcinoma. While small bowel adenocarcinoma is relatively rare, individuals with Crohn’s disease have an increased risk compared to the general population.

243
Q

what are risk factors associated with small bowel carcinoma?

A

age
family hx
celiac disease
crohns disease
FAP/Lynch syndrome

244
Q

the first manifestation of conjugated hyperbilirubinemia is?
a. scleral icterus
b. jaundice
c. clay-colored stools
d. tea-colored urine
e. pruritis

A

d. tea-colored urine

245
Q

name the causes of prehepatic postop jaundice

A

hemolysis (prosthetic valve)
resolving hematoma
transfusion rxn
post CP bypass
transfusions

246
Q

name the cuases of postop hepatic jaundice

A

drugs
hypotension
hypoxia
sepsis
hepatitis
“sympathetic” hepatic inflammation
etc.

247
Q

name the causes of postop posthepatic jaundice

A

choledocholithiaiss, stricture, cholangitis, cholecystitis, biliary-duct injury, pancreatitis, etc.

248
Q

In colorectal cancer, from which site is melena more common?

A

right-sided colon cancer

249
Q

what are causes of melena

A

gastric cancer
duodenal ulcers
right sided colon cancer
portal HTN with esophageal varicies
severe erosive esophagitis
mallory-weiss syndrome

250
Q

what are causes of hematochezia

A

hemorrhoids
anal fissures
polyps
proctitis
rectal ulcers
colorectal cancer

251
Q

An 83-year-old female patient presents to the ED with abdominal pain and distention. The abdominal radiograph demonstrates multiple air–fluid levels and dilated large-bowel loops consistent with a large-bowel obstruction. What is the most likely cause of the obstruction?
A Inguinal hernia
B Adhesions
C Carcinoma of the colon
D Diverticulitis
E Sigmoid volvulus

A

c. carcinoma of the colon

Colorectal cancer is the most common cause of large bowel obstruction in adults. Tumors can grow to a size that blocks the passage of feces through the colon, leading to obstruction. Diverticulitis can also cause LBOs, and patients often give a history of intermittent left lower quadrant pain. Sigmoid volvulus is a less common cause of LBO. It is seen most often in the elderly with poor bowel habits and chronic constipation.

252
Q

A 72-year-old man presents with abdominal distension, constipation, and vomiting. Abdominal X-ray shows dilated loops of colon with air-fluid levels. Which of the following is the most appropriate next step in the diagnosis?
A Colonoscopy
B CT scan of the abdomen with contrast
C MRI of the abdomen
D Barium enema
E Ultrasound of the abdomen

A

b. CT of the abdomen with contrast

A CT scan of the abdomen with contrast is the most appropriate next step in diagnosing large bowel obstruction. It provides detailed images that can help identify the location and cause of the obstruction, such as a tumor, volvulus, or diverticular disease, and assess for complications like ischemia or perforation.

253
Q

What is the most appropriate initial management for a patient diagnosed with acute large bowel obstruction due to suspected colorectal cancer?
A Immediate surgical resection of the obstructed segment
B Intravenous fluids and bowel rest
C Administration of oral laxatives
D Endoscopic stent placement
E Total parenteral nutrition (TPN)

A

b. IV fluids and bowel rest

The most appropriate initial management for a patient with acute large bowel obstruction, especially due to suspected colorectal cancer, includes stabilization with intravenous fluids and bowel rest. This approach addresses dehydration and electrolyte imbalances while further diagnostic and therapeutic plans are made, such as surgical intervention or endoscopic stent placement for palliation or as a bridge to surgery.

254
Q

what is the most common site for anal fissures?

A

posterior midline (comparatively low blood flow)

255
Q

A patient describes abdominal discomfort that improves with meals and gets worse an hour or so later after eating. What do you suspect?
A duodenal ulcer
B gastric ulcer
C acute cholecystitis

A

a. duodenal ulcer

256
Q

A patient describes abdominal discomfort that is worse with meals and gets better an hour or so later after eating. What do you suspect?
A Duodenal ulcer
B Gastic Ulcer
C Acute pancreatitis

A

b. gastric ulcer

257
Q

Which of the following is not a component of the TRIPLE THERAPY for H. pylori eradication
A Amoxicillin
B Clarithromycin
C A proton pump inhibitor
D Bismuth

A

d. bismuth

258
Q

A 26-year old lady presents at the outpatient clinic with 11 month history of recurrent epigastric pain which is worse when she’s hungry. It is temporarily relieved by food and antacids. It is also worse at night. It sometimes awakens her. Pain occurs for a few weeks, then goes and occurs again after several weeks. There is history of chronic NSAID ingestion, nausea and anorexia. Which of the following is the most likely diagnosis?
A Esophagitis
B Acute pancreatitis
C Peptic ulcer disease
D Gastroesophageal reflux disease

A

C. peptic ulcer disease

the most common presentation of PUD is that of recurrent epigastric pain which has three notable characteristics: localization to the epigastrium, relationship to food and episodic occurrence (periodicity). Chronic NSAID ingestion can cause PUD.

259
Q

Which of the following is the gold standard for definitive diagnosis of Peptic Ulcer Disease(PUD)
A Upper gastrointestinal endoscopy
B Double-contrast barium enema
C Chest radiograph
D None of the above

A

a. upper gastrointestinal endoscopy

260
Q

What type of hernia involves passage of intestine through the external inguinal ring at Hesselbach triangle and rarely enters the scrotum
A Indirect inguinal hernia
B Direct inguinal hernia
C Ventral hernia
D Hiatal hernia

A

B. direct inguinal hernia

261
Q

What type of hernia involves passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one?
A Direct inguinal hernia
B Indirect inguinal hernia
C Umbilical hernia
D Ventral hernia

A

b. indirect inguinal hernia

262
Q

A 45-year old woman being managed for ulcerative colitis, developed abdominal pain, vomiting, diarrhea, passage of blood and mucus per rectum and fever. On examination, she was pale, febrile (temp: 102.20C), moderately dehydrated, heart rate: 124bpm. There was abdominal distention and tenderness, bowel sounds were hypoactive. Lab results showed Hb: 9g/dl, WBC: 14 x 109/L, elevated CRP. Stool was negative for C. difficile. HIV status was negative. Abdominal radiograph showed dilated transverse colon of about 11 cm. What is the most likely diagnosis of this patient?
A Hirschsprung’s disease
B Cytomegalovirus colitis
C Toxic megacolon
D Kaposi’s sarcoma

A

d. toxic megacolon

263
Q

Diagnostic criteria for Toxic megacolon includes all of the following except
A Radiographic evidence of colonic dilatation (>6cm)
B Fever (>101.50F)
C Blood pressure > 150/90
D Heart rate > 120/min

A

C. blood pressure > 150/90

264
Q

Which of the following is not an etiology for toxic megacolon?
A Ulcerative colitis
B Pancreatitis
C Crohn colitis
D Pseudomembranous colitis

A

b. pancreatitis

265
Q

what is a rare yet life threatening complication of severe colon disease or infection that is characterized by non-obstructive segmantal or pancolonic dilation

A

toxic megacolon

Clinical: General Surgery (10 decks)

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