Gastrointestinal_RR

Question 1

A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and AXR reveals free air under the diaphragm. What is the best next step in management?

Answer 1

Emergent laparotomy to repair a perforated viscus

Question 2

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

Answer 2

Diverticulosis

Question 3

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Answer 3

HIDA scan

Question 4

Risk factors for cholelithiasis

Answer 4

Fat, Female, Fertile, Forty, Flatulent

Question 5

Inspiratory arrest during palpation of the RUQ

Answer 5

Murphy’s sign, seen in acute cholecystitis

Question 6

The most common cause of small bowel obstruction (SBO) in patients with no history of abdominal surgery.

Answer 6

Hernia

Question 7

The most common cause of small bowel obstruction in patients with a history of abdominal surgery.

Answer 7

Adhesions

Question 8

What is the most common organism to cause diarrhea?

Answer 8

Campylobacter

Question 9

What organism causes diarrhea in patients with recent antibiotic use?

Answer 9

Clostridium difficile

Question 10

What organism causes diarrhea in patients with recent history of camping?

Answer 10

Giardia

Question 11

What organism causes traveler’s diarrhea?

Answer 11

ETEC

Question 12

What organism causes diarrhea in patients who have recently attended a Church picnic, where they may have consumed mayo?

Answer 12

S. aureus

Question 13

What organism causes diarrhea in patients who have recently consumed uncooked hamburgers?

Answer 13

E. coli O157:H7

Question 14

What organism causes diarrhea in patients who have recently eaten (re-heated) fried rice?

Answer 14

Bacillus cereus

Question 15

What organism is most likely to cause diarrhea in patients who have eaten raw poultry and/or eggs?

Answer 15

Salmonella

Question 16

What organism causes diarrhea in patients who have recently eaten raw seafood?

Answer 16

Vibrio, HAV

Question 17

What organisms cause diarrhea in patients with AIDS?

Answer 17

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Question 18

What organism causes diarrhea in patients with pseudoappendicitis?

Answer 18

Yersinia

Question 19

A 25-year-old Jewish man presents with pain and watery diarrhea after meals. Examination shows fistulas between the bowel and skin, and nodular lesions on his tibias. What is the diagnosis?

Answer 19

Crohn’s disease

Question 20

An inflammatory disease of the colon that is associated with an increased risk of colon cancer

Answer 20

Ulcerative colitis (greater risk than Crohn’s)

Question 21

Extraintestinal manifestations of inflammatory bowel disease

Answer 21

Uveitis,
Ankylosing Spondylitis,
Pyoderma Gangrenosum,
Erythema Nodosum,
Primary Sclerosing Cholangitis

Question 22

Medical treatment for inflammatory bowel disease

Answer 22

5-ASA agents and steroids during acute exacerbations

Question 23

Difference between Mallory-Weiss and Boerhaave tears

Answer 23

Mallory-Weiss: Superficial tear in the esophageal mucosa;

Boerhaave: Full-thickness esophageal rupture

Question 24

Charcot’s Triad.

What condition is this associated with?

Answer 24

RUQ pain, Jaundice, Fever/chills

Signs of Ascending Cholangitis

Question 25

Reynold’s Pentad.

What conditions is this associated with?

Answer 25

Charcot’s Triad + Shock, Mental Status Changes

Signs of Suppurative Ascending Cholangitis

Question 26

Medical treatment for hepatic encephalopathy

Answer 26

Decrease protein intake, lactulose, rifaximin

Question 27

The first step in the management of a patient with an acute GI bleed

Answer 27

Manage ABC’s

Question 28

A 4-year-old presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. What is the most likely diagnosis? Cause?

Answer 28

Hemolytic-Uremic Syndrome (HUS)

E. coli O157:H7

Question 29

Post-HBV exposure treatment

Answer 29

HBV immunoglobulin

Question 30

Classic causes of drug-induced hepatitis

Answer 30

TB medications (isoniazid, rifampin, pyrazinamide)
Acetaminophen
Tetracycline

Question 31

A 40-year-old obese women presents with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools. What is the most likely diagnosis?

Answer 31

Biliary tract obstruction

Question 32

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

Answer 32

Femoral hernia

Question 33

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. What is the next step in management?

Answer 33

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase.
Make the patient NPO, and give IV fluids, O2, analgesia, and “tincture of time.”