GI

Question 1

What is alternative regime when a patient fails triple therapy for eradication of H. Pylori?

Answer 1

PP, Bismuth, tetracycline and metronidazole.

Question 2

A patient with low risk of malignancy comes in with dyspepsia and fails PPI therapy, next step in management?

Answer 2

Test and treat: Offer H. Pylori testing and treat. If patient negative then next step would be invasive endoscopy testing.

Question 3

What is the management of constipation in children?

Answer 3

1. First Dietary modification 2. Mild laxative (Magnesium )

Question 4

What is the next step in management for a patient with toxic megacolon w/ no perforation from UC ?

Answer 4

Steroidal therapy, along with aggressive fluid and electrolyte repletion. Avoid opioids and anticholingerics.

Question 5

What test confirms eradication of H. Pylori?

Answer 5

Urea breath test or stool antigen test 4 weeks after therapy. Serology will remain positive for 1 year.

Question 6

Pt presents with fever, RUQ pain, elevated Bili and alk phos but normal LFTs. Ddx? Management?

Answer 6

Acute cholangitis (Charcot triad) fever, RUQ pain and jaundice. IV fluids, Abx (amp +gent, imipenem, levaquin) and elective ERCP

Question 7

What is the difference btw oropharyngeal dysphagia and esophageal dysphagia? What is the first diagnostic test of dysphagia?

Answer 7

1. Oro associated with coughing and drooling. Esophageal associated with food sticking in upper and lower chest. Nasopharyngeal laryngoscopy

Question 8

Pt presents with abdominal pain, diarrhea, hematochezia, metabolic acidosis and elevated lactate. Dx? Test? Rx?

Answer 8

Acute Colonic Ischemia (occurs in setting of nonocclusive disease, watershed areas - splenic flexure and rectosigmoid junction). CT Scan. IVF, bowel rest(NPO), colonic resection if necrosis develops

Question 9

First step in management for gastroparesis? Rx

Answer 9

Endoscopy to r/o obstruction then gastric emptying study. Frequent small meals. If unsuccessful then reglan, erythromycin. Feeding tubes for refractory.

Question 10

What is considered high rick when screening for colon CA?

Answer 10

One First degree relative with CA or advanced adenomatous polyps ( size > 1cm, villous, high grade dysplasia) < 60 2. Two first degree relatives of any age. screen by 40 or 10 years younger then age diagnosed.

Question 11

Intervals for follow up colon: 1. Small rectal hyperplastic polyp? 2. 1 or 2 small tubular <1cm
3. 3-10 Adenomas, >1cm, High grade with villous features 4. More than 10 5. >2cm sessile polyp

Answer 11

1. 10 yrs 2. 5yrs 3. 3 years 4. <3 years 5. 2-6months

Question 12

Management of diagnosing some one with GERD? What is a common complication of GERD?

Answer 12

PPI if equivocal or no improvement then 24 hr pH monitoring. Peptic Stricture.

Question 13

Fever, Jaundice, RUQ pain? What consist of the pentad Test? Rx?

Answer 13

Cholangitis. Hypotension and AMS. Abdominal US. Abx coverage. Biliary drainagedecompression ERCP w/in 24 hrs.

Question 14

Difference btw complete and partial small bowel obstruction? Management? What are the complications?

Answer 14

Partial obstruction will have air in the distal colon. intervention is supportive/ observation. Monitor for signs of strangulaiton and ischemia which would warrant surgical intervention. IV hydration, NG tube suctioning, replete electrolytes.

Question 15

For patients with systemic sclerosis, what is important to rx at time of diagnosis?

Answer 15

PFTs. Complications are pulmonary HTN and ILD.

Question 16

Test and Rx for mallory weis tear?

Answer 16

EGD (shows single longitudinal tear GE junction) Observation.

Question 17

Describe Management for each: 1. Dyspepsia + typical GERD symptoms? 2. Dyspepsia + NSAID use? 3. Dyspepsia and no NSAID use?

Answer 17

1. Acid suppression 2. Stop drug 3. Alarm systems and > 55 then EGD 3. < 55, check for H. P prevalence. If high test and rx, if low PPI trial for 4-8 weeks.

Question 18

RUQ pain, nausea, vomiting now WBC, no fevers Dx? Test? Management ?

Answer 18

Biliary colic, US, elective cholecystectomy

Question 19

Splenic vein thrombosis is a common complication of what? Test? Rx?

Answer 19

Pancreatitis (inflammation destroys the vein that runs behind it and causes it to thrombose.) CT w/ contrast. Splenectomy.

Question 20

Difference btw colonic ischemia and mesenteric?

Answer 20

Colonic associated with mild pain.

Question 21

What consist of the MELD score?

Answer 21

(Model for endstage liver disease determines 90 day mortality in patients with cirhosis) Bili, INR, Cr

Question 22

What is the initial diagnostic test for celiac dz? What is the malignancy associated with celiac?

Answer 22

Anti-tissue transglutaminase, Anti-endomysial antibodies. Biopsy showing flattening villi is the definitive test. Enteropathy associated celiac dz.

Question 23

Pt w/ cirrhosis p/w temp of 100.4, abdominal pain, AMS, hypotension. Dx? Test? Rx? When do you use rifaxamin?

Answer 23

SBP. SAAG < 1, positive culture, Protein < 1, PMNS > 250. Cefotaxime. Give flouroquinolone for prophylaxis. Hepatic encelopathy.

Question 24

Dysphagia associated with collagen and fibrin deposition?

Answer 24

Systemic Sclerosis. (hymotility low amplitude on manometry)

Question 25

Dysphagia associated with Asthma and allergy?

Answer 25

Eosinophilic Eosphagitis.

Question 26

Failure of the LES sphincter to relax ?

Answer 26

Achalasia (degeneration of ganglia in aurbech plexus)

Question 27

Chest pain and dysphagia immediately after eating or drinking. Dx? First Test? Gold Standard? Rx?

Answer 27

DES (simultaneous premature contractions of the distal esophagus.) First test Barium Swallow “ Corkscrew” . Manometry will show simultaneous contractions.