GI

Question 1

-The psoas (patient lie on his or her left side while the right thigh is flexed backward. Pain may indicate an inflamed appendix )
and obturator signs are positive.
-Classic exam findings include low-grade fever and right lower quadrant (RLQ) pain (McBurney’s point) with rebound and guarding.

Answer 1

Acute Appendicitis

Question 2

Signs of acute abdomen are rebound, positive Rovsing’s sign, and a boardlike abdomen

Answer 2

Acute Diverticulitis

Question 3

Abdominal exam reveals guarding and tenderness over the epigastric area or the upper abdomen, as well as -positive Cullen’s sign (blue discoloration around umbilicus) and -Grey Turner’s sign (blue discoloration on the flanks).

Answer 3

Acute pancreatitis
Or
may indicate retroperitoneal hemorrhage).

Question 4

Antibiotics to most likely cause C-diff

Answer 4

clindamycin (Cleocin), fluoroquinolones
cephalosporins
and penicillins

Answer 5

Crohn’s Disease

Question 6

-Fistula formation and anal disease occur only with
-non bloody diarrhea
-weight loss
-mouth (aphthous) and anal FISSURES
RLQ PAIN
-Higher risk of toxic megacolon and colon cancer.
-Risk of development of lymphoma is also increased, especially for patients treated with azathioprine. More common in Ashkenazi Jews.

Answer 6

Crohn’s Disease

Question 7

IBD that affects the colon/rectum. Bloody diarrhea with mucus (hematochezia) more common
-tenesmus
-LLQ pain

Answer 7

Ulcerative Colitis

Question 8

The most common viral pathogens of viral gastroenteritis

Answer 8

rotavirus and noroviruses.

Question 9

Indicative of active H. pylori infection and is commonly used to document eradication of H. pylori after treatment. Use of PPIs within 2 weeks of the test can interfere with results.

Answer 9

Urea breath test

Question 10

Hepatitis A virus still present (infectious); no immunity yet.
Screening test for hepatitis A

Answer 10

IgM Antibody Hepatitis A Virus (IgM Anti-HAV)

Question 11

Presence means lifelong immunity.
No virus present and patient is not infectious.

Answer 11

IgG Antibody Hepatitis A Virus (IgG Anti-HAV)

Question 12

Screening test for hepatitis B
If positive, patient has the virus and is infectious.
-How: Presence of antigen means either an acute infection or chronic hepatitis B infection.

Answer 12

Hepatitis B Surface Antigen (HBsAg)

Question 13

Antibodies present and patient is immune.
Presence may be due to either a past infection or vaccination with hepatitis B vaccine

Answer 13

Hepatitis B Surface Antibody (Anti-HBs)

Question 14

Marker for actively replicating hepatitis B virus; highly infectious.
Persistence of the “e” antigen indicates chronic hepatitis.

Answer 14

Hepatitis B “e” Antigen (HBeAg)

Question 15

• Appears at onset of symptoms in acute hepatitis B and persists for life.

Answer 15

Total Hepatitis B Core Antibody (Anti-HBc)

Question 16

Hepatitis C Virus Antibody (Anti-HCV)

Answer 16

Screening test for hepatitis C
• Up to 85% of cases become carriers.
• Unlike hepatitis A and B, a positive anti-hepatitis C virus (HCV; antibody) does not always mean that the patient has recovered from the infection and developed immunity; it may instead indicate current infection because up to 85% of cases become carriers.
• If test is positive:
• Order HCV RNA to rule out chronic infection.
• If positive, then patient has hepatitis C; refer to GI specialist for liver biopsy / treatment.

Question 17

the most common site for the development of diverticula?

Answer 17

Sigmoid colon

Question 18

LLQ palpation causes RLQ pain

Answer 18

Rovsing sign

Question 19

pain with passive extension of the right hip

Answer 19

psoas sign

Question 20

pain with internal rotation of flexed right hip

Answer 20

obturator sign