General

Question 1

A 42 yr old obese type 2 DM pt on his 3rd pod after Roux-en-Y surgery comes with acute onset epigastric pain, severe n worsening overtime. He also has chills, rigors, SOB
T 38.5, epigastric tenderness n distention, leukocytosis
Best next step( to make the dx)
Most likely Dx?

Answer 1

Abdominal CT scan with oral contrast
Dx- anastomotic leak
- endoscopy is contraindicated in a suspected anastomotic leak

Question 2

RUQ pain, nausea, vomiting , crepitus in the abdominal wall adjacent to the gall bladder in a pt with DM. Most likely Dx?
Diagnostic tests?

Answer 2

Emphysematous gall bladder
Dx- abdominal X-ray showing air fluid levels in the GB
- abdominal U/S
- CT when others r not clear

Question 3

The commonest complication of pud

Answer 3

Hemorrhage

Question 4

A 60 yr old pt presented with anemia, painless gi bleeding, murmur of AS. The most likely dx is?

Answer 4

Angiodysplasia (AV malformation of the GIT)

Question 5

Scleroderma: manometer shows, including sphincter tone

Answer 5

Esophageal dysmotylity

Decreased LES pressure

Question 6

Cause of diarrhea in zollinger Ellison syndrome

Answer 6

Inactivation of pancreatic enzymes by increased acid production

Question 7

Failure to relax of the LES

Answer 7

Achalesia

Question 8

Esophageal perforation Dx?

Answer 8

Water soluble contrast esophagogram

Question 9

Zenker diverticulum is?
Best dxed with?
Cause is?

Answer 9

Outpocketing of the posterior pharyngeal constrictor mm
Dx- barium studies
Cause- upper esophageal dysfunction and esophageal dysmotility

Question 10

Dysphagia for both at onset, diagnostic investigation, exceptions

Answer 10

Motility disorders

barium swallow followed by Manometery. In cases of pseudoachalesia, do endoscopy

Question 11

GERD initial Rx, exceptions( endoscopy needed), 4reasons

Answer 11

PPI

Age>50, >5yr sxs, alarm sxs, cancer risk factors

Question 12

Mallory Weiss tear: the bleeding is from

Answer 12

Ruptured submucosal arteries of distal esophagus n proximal stomach

Question 13

Dysphagia first to solids then liquid, diagnostic tests, exceptions

Answer 13

Mechanical obstruction
Endoscopy
Exceptions: caustic injury, surgery for ca, complex stricture… do barium swallow first followed by possible endoscopy

Question 14

Sudden chest pain, normal ECG , ^contraction with normal tone of LES
Dx?
Rx?

Answer 14

Diffuse esophageal spasm
Manometery shows the above pattern (see question). Esophagogram shows corkscrew pattern.
CCBs r first line

Question 15

Acute appendicitis: peri umbilical Vs RLQ pain

Answer 15

Peri umbilical- referred, visceral in nature

RLQ- parietal peritonium involvement, somatic in nature

Question 16

Drugs that increase serum digoxin levels n might cause digoxin toxicity

Answer 16

Amiodarone, verapamil, quinidine, propafenone

Question 17

Melanosis coli is cxc of?

Answer 17

Laxative abuse eg. In cases of factitiuous diarrhea. It’s dark brown discoloration of the colon with lymph follicles

Question 18

The most accepted therapy of MALTOMA without any metastasis (other than chemo)?

Answer 18

H-pylori eradication therapy (abx)

Question 19

Alopecia, abnormal taste, bullous n pustulous lesions around body orifices, impaired wound healing in a pt on parenteral nutrition for a long time

Answer 19

Zinc deficiency

Question 20

Porphyria cutanea tarda, essential mixed cryoglobulinemia, membranoproliferative GN r highly associated with?

Answer 20

Hepatitis C infection

Question 22

Chest/back pain, fever, pleural effusion( usually left) in the setting of self induced vomiting eg in a pt with achalasia, crepitus or crunching sound on chest auscultation r suggestive of

Answer 22

Esophageal perforation