GI

Question 1

Management of achalasia

Answer 1

Laproscopic myotomy is the 1st line treatment. Endoscopic dilation is the second line option but carries risk of rupture. Can also do botulinum if can not tolerate surgery or if high risk of perforation with dilation.

Question 2

Screening in FAP or peutz-jegher syndrome

Answer 2

Once collectomy is performed still need upper endoscopy as at risk for ampullary cancer (evaluate duodenum)

Question 3

Autoimmune pancreatitis

Answer 3

See diffusely enlarged pancreas with narrowed duct and painless jaundice. Can have an elevated IgG4 level. Treatment is steroids

Question 4

Colon cancer screening in UC and ulcerative proctitis

Answer 4

In UC need it yearly. If limited to the rectum there is NO increase in colon cancer risk and they are okay with screenings every 10 years.

Question 5

Screening after removal of a colon cancer?

Answer 5

Should be done in 1 year.

Question 6

High risk patients requiring a 3 year interval colonoscopy are defined as?

Answer 6

≥3 adenomas
≥1 cm
villous morphology
high-grade dysplasia

Question 7

Unclear source of GIB

Answer 7

Repeat endoscopy or colonoscopy before going for capsule or push enteroscopy

Question 8

H pylori testing

Answer 8

In the setting of PPI use or recent GIB histology, urea breath test and stool antigen test is REDUCED. Need to use serology testing as a second test if the others are negative.

Question 9

Colonoscopy for relatives of patients with CRC

Answer 9

First screen should occur at age 40 or 10 years younger than earliest diagnosis, whichever comes first

Question 10

Primary biliary cirrhosis

Answer 10

Presents with elevated alk phos.
Will likely have + antimitochrondrial antibodies.
Treat with ursodeoxycholic acid

Question 11

Primary sclerosing cholangitis

Answer 11

Intra and extra hepatic ducts.
Associated with inflammatory bowel disease.
Look for antinuclear and smooth muscle antibodies.
Cholangiography (beads on a string).
Risk of malignancy

Question 12

Stool osm gap

Answer 12

290- 2[Stool Na+ Stool K]

If >100 then osmotic cause. If

Question 13

Small intestinal bacterial overgrowth

Answer 13

Presents with diarrhea, bloating and wt loss. Find B12 deficiency with high folate levels (bacteria consume and make). Hydrogen breath testing can confirm

Question 14

Biliary cyst

Answer 14

Presents as fusiform dilation of the common bile duct. High risk for cholangitis and biliary cancer

Question 15

Treatment of SBP

Answer 15

Give 3rd gen cephalosporin, but ALSO give albumin if Cr >1.5, BUN>30 or bilirubin >4 to help prevent HRS

Question 16

Imaging for GIB

Answer 16

Tagged RBC scan is more sensitive for slow bleeds, angio requires at least >1 ml/min

Question 17

EE treatment

Answer 17

Try PPI for 6 weeks first, then can progress to swallowed corticosteroids

Question 18

Management of gallbladder polyp

Answer 18

If >10 mm or porcelain GB should be removed, if it is

Question 19

Anterior mediastinum tumors

Answer 19

Thyroid, thymic, lymphoma

Question 20

Middle mediastinum tumors

Answer 20

Bronchogenic cysts, pericardial cysts and lymphadenopathy

Question 21

Posterior mediastinal tumors

Answer 21

neural tissues, esophageal tumors or cysts

Question 22

Marker of lymphoid origin

Answer 22

TdT+

Question 23

B cell markers

Answer 23

CD10 and CD20

Question 24

Diarrhea after small bowel resection

Answer 24

• only use cholestryramine if

Question 25

Agents that can cause microscopic colitis?

Answer 25

Lansoprazole
NSAIDS
Sertraline
Ranitidine
Ticloipinde 
Acarbose