Gastrointestional

Question 1

A pt presents w/ sudden onset of severe, diffuse abd pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

Answer 1

Emergent laparotomy to repair a perforated viscus.

Question 2

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

Answer 2

Diverticulosis

Question 3

Diagnostic modality used when U/S 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 MCC of small bowel obstruction (SBO) in pts w/ no hx of abd surgery

Answer 6

Hernia

Question 7

The MCC of SBO in pts w/ a hx of abd surgery

Answer 7

Adhesions

Question 8

Most common organism causing diarrhea

Answer 8

Campylobacter

Question 9

Diarrhea in recent abx use

Answer 9

Clostridium difficile

Question 10

Diarrhea and camping

Answer 10

Giardia

Question 11

Traveler’s diarrhea

Answer 11

ETEC

Question 12

Diarrhea and church picnics/mayonnaise

Answer 12

S aureus

Question 13

Diarrhea and uncooked hamburgers

Answer 13

E coli O157:H7

Question 14

Diarrhea and Fried rice

Answer 14

Bacillus cereus

Question 15

Diarrhea and poultry/eggs

Answer 15

Salmonella

Question 16

Diarrhea and raw seafood

Answer 16

Vibrio, HAV

Question 17

Diarrhea and AIDS

Answer 17

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Question 18

Diarrhea and pseudoappendicitis

Answer 18

Yersinia

Question 19

A 25 y/o Jewish man presents w/ pain and watery diarrhea after meals. Examination shows fistulas b/w the bowel and skin and nodular lesions on his tibias

Answer 19

Crohn’s dz

Question 20

Inflammatory dz of colon w/ an increased risk of colon cancer

Answer 20

Ulcerative colitis (greater risk than Crohn’s)

Question 21

Extraintestinal manifestations of IBD

Answer 21

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis

Question 22

Medical tx for IBD

Answer 22

5-ASA agents and steroids during acute exacerbation

Question 23

Difference b/w 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

Answer 24

RUQ pain, jaundice, and fever/chills - signs of ascending cholangitis

Question 25

Reynolds' pentad

Answer 25

Charcot's triad plus shock and mental status changes - signs of suppurative ascending cholangitis

Question 26

Medical tx for hepatic encephalopathy

Answer 26

Decreased protein intake, lactulose, rifaximin

Question 27

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

Answer 27

Manage ABCs

Question 28

A 4 y/o child presents with oliguria, petechiae, and jaundice following an illness w/ bloody diarrhea. Most likely diagnosis and cause?

Answer 28

Hemolytic- uremic syndrome (HUS) due to E coli O157:H7

Question 29

Post-HBV exposure tx

Answer 29

HBV immunoglobulin

Question 30

Classic causes of drug-induced hepatitis

Answer 30

TB medications (INH, rifampin, pyrazinaminde), acetaminophen, and tetracycline

Question 31

A 40 y/o obese woman with elevated alk phos, elevated bilirubin, pruritus, dark urine, and clay-colored stools

Answer 31

Biliary tract obstruction

Question 32

Hernia w/ highest risk of incarceration - indirect, direct or femoral?

Answer 32

Femoral hernia

Question 33

A 50 y/o man w/ a hx of alcohol abuse presents w/ boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Answer 33

Confirm the dx of acute pancreatitis w/ elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and "tincture of time"