GI

Question 1

Additional test to complete after diagnosis with celiac disease

Answer 1

DEXA at time of diagnosis regardless of age or menopausal status as increased risk of bone loss

Question 2

Reasons to go straight to an EGD when evaluating new onset dyspepsia

Answer 2

age >60 OR <60 with alarm features (family history of gastric cancer, unintended weight loss, dysphagia, GI bleeding, iron deficient anemia)

Question 3

Timing of ERCP and Cholecystectomy in gallstone pancreatitis

Answer 3

ERCP within first 24 hours, cholecystectomy after recovery to reduce risk of recurrence

Question 4

Two conditions more commonly associated with arteriovenous malformation lower GI bleeding

Answer 4

Elderly patients with ESRD and aortic stenosis

Question 5

Decreased arterial saturation >5% from supine to upright

Answer 5

Orthodeoxia

Question 6

Increased dypsnea when sitting upright, relieve when supine

Answer 6

Platypnea

Question 7

Triad of liver disease, hypoxemia and intrapulmonary vascular dilatations

Answer 7

Hepatopulmonary syndrome

Question 8

Best diagnostic test to diagnose hepatopulmonary syndrome

Answer 8

Contrast echocardiography

Question 9

Best next step if jaundice and abdominal pain with elevated alk phos and bili, but no gallstones on US

Answer 9

CT scan to look for pancreatic malignancy with extrahepatic obstruction

Question 10

Watery nonbloody diarrhea; fecal urgency and incontinence, abdominal pain, fatigue, weight loss. Colonoscopy on biopsy can demonstrate thickened subepithelial collagen band or high levels of intraepithelial lymphocytes

Answer 10

Microscopic colitis

Question 11

Microscopic colitis triggers

Answer 11

NSAIDs and smoking

Question 12

Diarreha, steatorrhea, abdominal cramps and bloating, weight loss despite good intake

Answer 12

Indicative of malabsorption. Need to first evaluate for infectious causes such as giardia

Question 13

Next steps in patients with dyspepsia without GERD symptoms

Answer 13

if < 60 - stool or breath test for H. Pylori. If > 60, EGD

Question 14

Persistently elevated lipase with abdominal fullness or early statiety 4-6 weeks afteer an episode of acute pancreatitis

Answer 14

Pacnreatic pseudocyst

Question 15

Treatment of locally advanced rectal cancer

Answer 15

preoperative chemoradiation –> surgery –> postop chemotherapy

Question 16

Present > 60 years old with months to years of transient oropharyngeal dysphagia, halitosis, gurgling in the throat, food regurgitation, apeparance of a neck mass and weight loss

Answer 16

Zenker’s diverticulum

Question 17

Preferred diagnostic modality for Zenker’s diverticulum

Answer 17

Barium esophogram

Question 18

Treatment of anorectal fistulas in patients with Crohn’s.

Answer 18

If asymptomatic - observation and heals on own, if mildly symptomatic - cipro/flagyl for prolonged course, if moderately symptomatic - immunomudulator therapy with TNF inhibitors. Surgery if fails medical therapy or have recurrent fistulas

Question 19

Effects of low carb diets

Answer 19

Produce rapid initial weight loss, but long term the weight loss is similar to other diets. They are associated with increased incidence of GI Side effects

Question 20

What should you consider in patients with typical symptoms of achalasia, but are elderly +/- a fast (< 6 months of symptoms) onset?

Answer 20

Pseudoachalasia - should do an EGD to evaluate for a tumor and the LES

Question 21

What is relatively common in women with PBC and needs to be monitored for?

Answer 21

About 50% of women will develop osteopenia or osteoporosis

Question 22

First step in diagnosing gastroparesis?

Answer 22

Need to first rule out causes of gastric outlet obstruction with EGD +/- CT/MRI abdomen. THEN can move on to gastric emptying study

Question 23

Watery diarrhea that can occur at night with associated episodes of fecal incontinence in a diabetic

Answer 23

Diabetic diarrhea - combination of autonomic neuropathy, bacterial overgrowth, and anorectal dysfucntion

Question 24

Most concerning complication of pituitary apoplexy?

Answer 24

Acute adrenal insufficiency - when pituitary apoplexy is suspected should give IV glucocorticoids

Question 25

Skin tags, oily skin, excessive malodorous scent, enlarging hands and sleep apnea

Answer 25

Suggestive of acromegaly

Question 26

Higher risk of what cancers in Klinefelters?

Answer 26

Breast, germ cell tumors, hodgkins lymphoma

Question 27

Monitoring after radioactive iodine ablation?

Answer 27

If TSH low - this can be transient, should also check T3 and T4 before starting levothyroxine replacement