GI

Question 1

How is visceral pain described?

Answer 1

Deep, dull, crampy, poorly localized

Question 2

How is parietal pain described?

Answer 2

sharp, localized

Question 3

What does rebound tenderness suggest?

Answer 3

Peritoneal inflammation

Question 4

What does vascular pain look like?

Answer 4

Severe, ripping, radiating to back

Question 5

Lead poisoning pain?

Answer 5

Poorly localized, wandering pain, rigid abdomen

Question 6

What are some causes of referred pain to abdomen?

Answer 6

MI, pneumonia, ovarian problems, urinary tract problems

Question 7

What medication can worsen GERD?

Answer 7

CCB, progestin, estrogens

Question 8

Red flags for Gerd?

Answer 8

Dysphagia, odynophagia, globus, asthma, GI bleeding, weight loss, anemia, gastric cancer, palpable mass, jaundice

Question 9

What’s an important differential diagnoisis for GERD?

Answer 9

Hiatal hernia

Question 10

Step therapy for GERD?

Answer 10

1. Lifestyle modifications, tums, malox, mylanta, cimetidine, rinatidine
2. Prescription medications
3. Increase PPI for 8-12 weeks, possible referral
4. Refferal and possible surgical intervention

Question 11

What’s an important complication of GERD?

Answer 11

Barret’s esophagus, 40x increased risk for esophageal cancer, EGD every 3-5 years to look for cancer

Question 12

Factors for PUD?

Answer 12

NSAIDS, alcohol, tobacco, glucocorticoids, anticoagulants, H. Pylori

Question 13

Differential for PUD from gastric to duodenal?

Answer 13

1. Duodenal is woken up at night, relieved by food.

2. Gastric is worsened by food

Question 14

When do you do endoscopy for PUD?

Answer 14

for alarm signs, including hx of gastric cancer, weight loss, bleeding, anemia, abdominal mass, hematemesis, early saiety

Question 15

Treatments for PUD?

Answer 15

PPIs, H2 blockers, antacids, cytotec, COX-2 inhibitors, Carafate, H.Pylori eradication

Question 16

What is triple and quad therapy for H. Pylori

Answer 16

Triple- Ciprofloxacin, amoxicillin or flagyl, PPI

Quad- Bismuth, PPI, Flagyl + tetracycline

Question 17

What is a side effect of Bismuth?

Answer 17

Hypoglycemia and turning stools black

Question 18

When should you refer for PUD?

Answer 18

> 2 weeks, suspect gastric ulcer, treatment failure, endoscopy

Question 19

Risk factors for gallstones

Answer 19

1. Fat
2. female
3. 40
4. flatulet,
5. fertile
6. fat intolerant
   Rapid weight loss

Question 20

Assessment sign for gallstones and cholecystitis?

Answer 20

Murphy’s Sign

Question 21

Labs suggestive of cholecystitis?

Answer 21

Increase alkaline phosphatase and billiruben, U/S, WBC up to 15K

Question 22

Symptoms of IBS/ Rome Criteria?

Answer 22

1. painless diarrhea
2. Abdominal pain with altered bowel habits
3. Abdominal pain with relief with dedication, mucus in stool

Question 23

Physical exam of IBS?

Answer 23

may have tender sigmoid colon and discomfort on rectal exam

Question 24

Treatment of IBS?

Answer 24

Fiber, antispasmodics (bentyl), antidiarrhea, reglan, antidepressants, probiotics

Question 25

When do you refer IBS?

Answer 25

Patient’s >50y.o. organic disease, treatment failures

Question 26

Important risk factors for colon cancer?

Answer 26

Advanced age, family history, etcetera

Question 27

Main symptom for colon cancer?

Answer 27

Change in BM

Question 28

Systemic signs of Ulcerative Colitis and Crohn Disease?

Answer 28

1. Central Arthropothies- ankylosing spondylitis and sacroiliitis
2. Peripheral arthritis
3. Osteoporosis
4. Erythema nudism
5. Pyoderma gangrenosum
6. Aphthous ulcers
7. Episcleritis
8. Uveitis
   9Gallstones/Primary Sclerosing cholangitis

Question 29

Describe diverticular disease

Answer 29

Greater than 40 y.o., LLQ pain, possible firm mass, CT with oral contrast is best test

Question 30

Assessment findings for pancreatitis?

Answer 30

Relieved by sitting up, worse when laying down

Question 31

Risk factors for bowel obstruction? x4

Answer 31

Hernia, adhesions, cancer, diverticulitis

Question 32

Mediations for diverticulitis?

Answer 32

Flagyl and clindamycin

Question 33

Difference between UC and CD

Answer 33

1. UC is more common in men, continuous, and situated rectum

2. CD is more common in women, can have skip lesions, anywhere in the GI system.

Question 34

What disease can be surgically cured and why? CD or UC?

Answer 34

UC because it’s only limited to the small bowel. Total colectomy is curative.