GI (35)

Question 1

source of epigastric pain temporarily relieved by eating v. not relieved

Answer 1

relieved - duodenal ulcer (perforation = gastroduodenal a)

not relieved - gastric ulcer (perforation = left gastric a)

Question 2

guarding and rigidity indicate

Answer 2

peritonitis

Question 3

referred pain to shoulder means…

Answer 3

diaphragm irritation, causing phrenic n irritation to C3/4 dermatome

Question 4

pANCA, lead pipe appearance (loss of haustra) in left colon), young male, mucosal and submucosal ulcerations

Answer 4

UC

Question 5

chronic non-bloody diarrhea, abd pain relieved by defecation, ASCA, skip lesions, transmural, fistula formation, string sign terminal ileum seen on barium, granuloma MC in terminal ileum (RLQ), FHx of HLA-B27/autoimmune (psoriasis)

Answer 5

Crohn’s

Question 6

bloody diarrhea with a fever in a child - next dx step?

Answer 6

bacterial stool sample –> test for bacterial enteritis

Question 7

MCC of bacterial diarrhea dt food poisoning. Motile, spiral, non spore forming, gram negative.

Answer 7

Campylobacter jejuni

Question 8

triple therapy for HPylori

Answer 8

14 days of PPI (omepr or lanospr), amoxicillin, clarithromycin

(OAC, LAC, BMT - bismuth/metro/tetracyclin)

Question 9

Tx for moderate C diff (no leukocytosis, AKI, fever, sepsis, megacolon)

Answer 9

metronidazole

Question 10

Tx for severe C diff (leukocytosis, AKI, fever, sepsis, megacolon) OR elderly/@risk pts with moderate Cdiff

Answer 10

po vancomycin

Question 11

tx for acute onset of excruciating pain wiht thrombosed external hemorrhoids

Answer 11

surgical elliptical excision

Question 12

tx for internal hemorrhoids

Answer 12

rubber band ligation

Question 13

pt with ascites, fever, chills, jaundice, abd pain, tenderness and fluid wave on exam, and paracentesis fluid analysis with over 250 neuts per microliter

dx?

Answer 13

spontaneous bacterial peritonitis

Question 14

tx of spontaneous bacterial peritonitis

Answer 14

cefotaxime

Question 15

what can mumps cause?

Answer 15

acute pancreatitis (i.e. floating stool), parotid gland sialadenitis, orchitis

Question 16

causes of pancreatitis

Answer 16

GET SMASHED - gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion, hyperTG, (start statin) ERCP, drugs

Question 17

test to dx enterobius vermicularis

Answer 17

pinworm - scotch tape test

Question 18

CEA tumor marker for…

Answer 18

colorectal cancer

Question 19

MCC of isolated unconjugated hyperBr in asx adults. Br UGT activity

Answer 19

gilbert syndrome

Question 20

CA19-9 most useful for

Answer 20

assessment of whether tx for pancreatic cancer is working, GI malignancies, and pancreatitis

Question 21

raw fish and B12 deficiency (neuro LCST/cerebellar/DC sx), think…

Answer 21

diphllobothrium latum - can be latent for a long time

Question 22

MCC of bowel obstruction in infancy. Best dx test

Answer 22

pyloric stenosis.

US - show thickened pylorus muscle. Barium shows “double track” sign

Question 23

medication ost associated with pyloric stenosis

Answer 23

azithromycin

Question 24

infant presents wtih bilious nonbloody, nonprojectile vomiting withing first d-mo of life. intermittent, but progressive food intolerace, FTT, currant jelly stool (dt SMA ischemia) - dx and test?

Answer 24

malrotation (Around SMA), dx with upper GI barium endoscopy

see “birds-beak” and spiral/corkscrew duodenal configuration

Question 25

hematochazia (BRB) v. melena (Dark) landmark

Answer 25

bleed below v. above ligament of treiz

Question 26

cirrhotic patient with painless hematochazina - bleeding from where?

Answer 26

superior rectal vein

Question 27

first week of life, presents with new onset jaundice, pale colored stool, hyperBr with elevated direct Br

associated with CMV, neovirus, rotavirus (and no palpable abdominal mass)

Answer 27

biliary atresia - surgically tx

if there is an abdominal mass, thing choledochal cyst

Question 28

diagnostic and therapeutic for meconium ileus in CFTR-508 neonates

Answer 28

gastrografin enema

Question 29

entamoeba histolytica-kind of diarrhea

Answer 29

bloody

Question 30

anti-endomysial and anti-tissue transglutaminase IgA antibodies can est
Celiac dx, but require what?

Answer 30

normal IgA

Question 31

fasting lipid panels are only viable if pt refrains from….

Answer 31

calories for 12 hrs and alcohol for 24 hours