GI 3

Question 1

GERD alarming features include
9

Answer 1

1. New onset of dyspepsia in patient ≥60 years
2. Evidence of gastrointestinal bleeding (hematemesis, melena, hematochezia, occult blood in stool)
3. Iron deficiency anemia
4. Anorexia
5. Unexplained weight loss
6. Dуsрhаgiа
7. Оԁуոοрhagiа
8. Persistent vomiting
9. Gastrointestinal cancer in a first-degree relative

Question 2

GERD - classic symptoms can be a clinical dx, what are they
2

Answer 2

regurgitation
heart burn

Question 3

GERD - risk for Barret’s esophagus starts w/ 5 years or more of GERD symptoms + three additional parameters - do what

Answer 3

hold off on tx, need GI w/u

Question 4

GERD - mild mod sx, fewer than 2 episodes a week tx initially

Answer 4

lifestyle changes
low H2RA as needed i.e. famotidine 10 mg PO daily x 4 weeks +/- antacids

Question 5

GERD - mod severe sx, 2 or more episodes a week or severely impairing life tx initially

Answer 5

lifestyle changes
standard dose PPI - pantoprazole 40 mg daily x 8 weeks

Question 6

GERD - when do you see them again after starting H2RA (histamine 2 receptor antagonist)

Answer 6

4 weeks - if failed, move onto PPI

Question 7

GERD - when do you see them again after starting PPI

Answer 7

8 weeks

Question 8

PUD lifestyle changes include
2

Answer 8

1. quit smoking
2. limit alcohol to one drink/day

Question 9

PUD is suspected in patients w/
3

Answer 9

dyspepsia
hx of h. pylori
NSAID use

Question 10

GERD - when to send to ER
2

Answer 10

1. aucte abd
2. NV w/ signs of dehydration or inability to tolerate PO

Question 11

hematochezia

Answer 11

bright red blood, generally present in LGIB

Question 12

bright red blood, generally present in LGIB

Answer 12

hematochezia

Question 13

melena is an indicator of

Answer 13

UGIB

Question 14

indicator of UGIB

Answer 14

melena

Question 15

LGI bleed - patients may c/o
2

Answer 15

blood or black stools
streaking on toilet paper

Question 16

LGI bleed - hx may include
3

Answer 16

1. GI malignancy
2. recent GI procedure
3. GI disorder

Question 17

LGI bleed - always ask about ____ of sx

Answer 17

duration

Question 18

LGI bleed - indications of ongoing hemorrhage or severe bleed
4

Answer 18

1. abd aortic aneurysm repair
2. previous hx of GI bleed
3. hx of bleeding for > 4 hours prior to presentation
4. anticoags or antiplts

Question 19

LGI bleed - VS and skins
5

Answer 19

1. skin normal to pale
2. diaphoretic
3. tachycardia
4. bradycardia
5. hypotension may indicate severe bleeding

Question 20

LGI bleed - PE abd/GI/GU
2

Answer 20

1. +/- tenderness
2. +/- distention

Question 21

LGI bleed - rectal PE
2

Answer 21

1. +/- bleeding
2. hemorrhoids or fissure may be evident

Question 22

LGI bleed - img/testing

Answer 22

none usually in UC
-fecal occult blood test
-consider anoscopy
-consider EKG if unstable
-consider CBC and PT/INR

Question 23

LGI bleed - fissures tx and f/u
3

Answer 23

stool softeners
topical analgesia
f/u w/ PCP, GI, surgery

Question 24

LGI bleed - when to refer to ER
3

Answer 24

1. hemodyn unstable
2. acute abd
3. active bleeding

Question 25

cholecystitis

Answer 25

infection or inflammation of gallbladder caused by obstruction of cystic duct

Question 26

biliry colic

Answer 26

intermittent obstruction causing episodic pain (< 6 hrs; once per week) defined as pain in the abdomen, due to obstruction usually by stones in the cystic duct or common bile duct of the biliary tree

Question 27

cholecystitis risk factors 5

Answer 27

5 F's 1. female 2. fat 3. fertile 4. forty 5. fair skinned

Question 28

cholecystitis/biliary colic - sx typically occur when

Answer 28

soon after eating a fatty meal

Question 29

cholecystitis sx include

Answer 29

severe, constant RUQ pain that may radiate to right should/scapula

Question 30

severe, constant RUQ pain that may radiate to right should/scapula

Answer 30

cholecystitis sx

Question 31

biliary colic sx

Answer 31

dull, achy, RUQ abd pain, lasting < 6 hrs

Question 32

dull, achy, RUQ abd pain, lasting < 6 hrs

Answer 32

biliary colic sx

Question 33

cholecystitis/biliary colic - s/sx can include (besides abd pain) 4

Answer 33

1. fever 2. anorexia 3. NV 4. jaundice

Question 34

what sign is most sensitive to cholecystitis

Answer 34

Murphy's sign - push in around ribcage/liver area and have them take deep breath, pain is positive sign as gallbladder is shifted down and pressed by hand during this

Question 35

cholecystitis/biliary colic - PE may show 5

Answer 35

1. jaundice 2. positive Murphy's sign 3. rebound tenderness 4. guarding 5. NV +/-

Question 36

cholangitis

Answer 36

inflammation of the bile ducts

Question 37

inflammation of the bile ducts

Answer 37

cholangitis

Question 38

suspected cholangitis when 2

Answer 38

1. Charcot's triad - fever, RUQ pain, jaundice 2. Reynold's pentad - Charcot's triad + hypotension and AMS

Question 39

cholecystitis/biliary colic - img/testing

Answer 39

none usually in UC setting

Question 40

cholecystitis/biliary colic - DD 4

Answer 40

1. pancreatitis 2. hepatitis 3. Gastritis 4. PUD

Question 41

biliary colic tx 3

Answer 41

1. consider antiemetics 2. consider IV fluids 3. consider NSAIDs

Question 42

biliary colic - if pain resolves, may d/c w/ (f/u)

Answer 42

PCP or surgical f/u

Question 43

cholecystitis/biliary colic - when to refer to ER

Answer 43

all suspected cases of cholecystitis