GI

Question 1

Vaccination for hepatitis A and B

Answer 1

• chronic liver disease
• msm
• IVDU
• chronic recipients of blood
• household contacts

Question 2

Specific indications for vaccination

• A
• B

Answer 2

A:
Travelers

B:
Health fcare workers
Ppl on dialysis
DM

Question 3

Colon cancer screening

Dysplastic polyps!!!!

Answer 3

• those over 50
  
  • every 10 year
  • FOBT yearly
  • barium enema

If 1 family member had colon cancer
- start at age 40 or 10 years before the family member

If :3 family member, 2 generations, 1 premature (>50)… aka HNPCS
- colonoscopy every 1-2 years starting at age 25

• . FAP
  
  • sigmoidoscopy every 1-2 years. start screening at age 12
• Colectomy once polyps found

Gardner’s
- multiple bone tumors called osteomas

Dysplastic polyps!!!!
- repeat colonoscopy every 3-5 years

Question 4

When is virtual colonoscopy the answer

Answer 4

What NOT to do!

Question 5

Esophageal cancer treatment

Answer 5

• surgery

- follow surgery with 5- FU

Question 6

Eosomophilic Esophagitis

Answer 6

• Dysphagia
• Hx of allergies
• scope + Bx

Tx
PPTs And budesonide-

Question 7

Stricture syndrome associated with squamous cell esophageal cancer

Answer 7

Plummer- Vinson

Question 8

Strictures treatment

P-V syndrome

Shatzkis ring

Answer 8

Plummer Vinson—> iron replacement

Shatzkis ring —> pneumatic dilation

Question 9

When is 24 hour pH monitoring the answer

Answer 9

When no response to ppi and the diagnosis isn’t clear

Question 10

Action on:

Barrett’s esophagus

Low grade dysplasia

High grade dysplasia

Answer 10

Barrett’s:
Ppi And endoscopy every 2-3 years

Low grade dysplasia:
Ppi and endoscopy in 3-6 months

High grade dysplasia:
- endoscopic mucosal resection
Ablative removal
Distal esophagectomy

Question 11

When to scope

Answer 11

> 45 and epigAstric pain

Question 12

Z-E syndrome

Answer 12

Do gastric level and gastric acid output
- remember, everyone on Ppi And H blockers have an elevated gastrin level

If both are high then look for the gastrinoma… -
EU
- nuclear somatostatin scan
- secretin suppression test ( most accurate )… normally gastrin levels and gastric acid output yo down but not with Z-E

Question 13

Most accurate for diverticulosis

Answer 13

Barium enema

Question 14

When is NG tube the answer

Answer 14

When you don’t know if it’s upper GI bleed or lower

Question 15

Dx testing in acute mesenteric ischemia

Answer 15

Met acidosis because if the elevated lactic acid

Elevated amylase!!!

Most accurate test angiography

Question 16

PPI s/e

Answer 16

• high gastric levels

- C diff

Question 17

Malabsorption

Best initial

Most accurate

Answer 17

Sudan black stain of the stool

72 hour fecal fat

Question 18

Acute pancreatitis blue box

Dx with which tests?

Treat with this

Answer 18

Dx with u/S, ct, or mrcp

Tx with ercp

Question 19

Acute hep C

Best initial

Most accurate

Tx ( same like chronic hep C)

Answer 19

Hep C antibody

Serology

IFN/ribavirin ) + oral protease inhibitor like ledipasvir, simeprevir, sofodbuvir)

Interferon s/e:
Flu like 
Thrombocytopenia 
Fatigue
Myalgia  
Depression 
Arthralgia) 

Ribavirin s/e
Anemia

Question 20

Chronic hep C treatment

Answer 20

Ifn/ ribavirin + oral protease inhibitor

Harvoni—> genotype 1 ( ledipasvir/sofobusvir)

Question 21

Ascites
-SAAG

SBP

Tx of ascites

Answer 21

SAAG>1.1= portal HTN

SAAG<1.1= no portal HTN

SBP > 250 neutrophils

Tx of ascites cefotaxime

Question 22

Wilson’s

Best initial
Most accurate

Answer 22

Kayser Fleisch rings
And
LOW ceruloplasmin

Most accurate liver biopsy

Question 23

Wilson’s Tx

Answer 23

Penicillamine Or trientine

Question 24

Hemochromatosis manifestations

Answer 24

Restrictive cmpthy 
Skin darkening 
Bronze diabetes
Infertility
Joint pain
Hepatoma 
Panhypopituitarism

Question 25

Hemochromatosis

Best initial
Most accurate

Tx

Answer 25

Iron studies ( they look kinda like iron deficiency but this has high iron!

Most accurate test liver biopsy … but you can do mri with HFe mutation to spare a liver biopsy