GI

Question 1

Nutritional deficiency associated with carcinoid syndrome

Answer 1

Niacin/B3 deficiency (pellagra: diarrhea, dermatitis, dementia). Because tryptophan (niacin precursor) is converted to serotonin.

Question 2

Medication useful in carcinoid syndrome

Answer 2

Octreotide

Question 3

Triple therapy for H pylori

Answer 3

PPI, clarithromycin, amoxicillin

Question 4

Patient with dysphagia has barium swallow suggestive of achalasia. Next step?

Answer 4

Endoscopy to rule out malignancy (pseudoachalasia)

Question 5

Bowel obstruction with air in the biliary tree

Answer 5

Likely gallstone ileus (air in biliary tree due to biliary-enteric fistula in this case)

Question 6

Antibody associated with autoimmune hepatitis?

Antibody associated with primary biliary cholangitis?

Answer 6

AIH: anti-smooth muscle (ASMA)
PBC: anti-mitochondrial (AMA)

Question 7

3 extrahepatic manifestations of hepatitis C

Answer 7

1. Porphyria cutanea tarda
2. Membranoproliferative GN
3. Mixed cryoglobulinemia syndrome

Question 8

Labs in mixed cryoglobulinemia

Answer 8

Low complement, positive rheumatoid factor (also likely positive HCV and anti-HCV IgG, although can also be seen in other inflammatory diseases)

Question 9

Fatigue, arthralgia, palpable purpura, glomerulonephritis, and low complement levels

Answer 9

Mixed cryoglobulinemia (classically associated with Hep C, but can be seen with other chronic infectious/inflammatory diseases)

Question 10

Criteria for acute liver failure

Answer 10

1. Severe acute liver injury (e.g. AST/ALT > 1,000)
2. Hepatic encephalopathy
   and
3. Synthetic dysfunction (e.g. INR > 1.5)

Question 11

Areas of colon vulnerable to watershed infarcts in general hypotension

Answer 11

1. Splenic flexure (SMA and IMA)

2. Rectosigmoid junction (IMA and superior rectal artery)

Question 12

Management of minimal bright red blood per rectum by age

Answer 12

> 50: colonoscopy
40-49: flex sig or colonoscopy
<40: Anoscopy first, if no hemorrhoids then flex sig or colonoscopy

Question 13

Cancers seen in HNPCC

Answer 13

Colon, endometrial, ovarian