GI

Question 1

What among the following is a common cause of pancreatitis?

Answer 1

cholelithiasis

A question wanted to know the most common complication of ERCP. I picked pancreatitis.

Question 2

Your pat is s/p liver transplant. He develops fever and his bile production decreases to 20 from 300. What should you do next?

Answer 2

Consider liver bx

Question 3

Which of the following displays a current or recent Hepatitis A infection?

Answer 3

Anitbody-specific to IgM

Question 4

Your patient is post-op cardiothoracic surgery. She develops nausea, periumbilical abdominal pain, moderate Lipase, LDH, ALT, ↓BS. What is the diagnosis?

Answer 4

Mesenteric Infarct

Question 5

Your patient complains of tarry stools, change in stool caliper, and constipation. What intervention is appropriate?

Answer 5

Order more testing

Question 6

Your pt has been on peritoneal dialysis long term, and develops a fever and cloudy peritoneal fluid. What do you order first?

Answer 6

Culture of the dialysis tube

Question 7

Most critical symptom for diagnosing peritonitis/bowel perforation?

Answer 7

Rigidity

Question 8

What is GI angioplasty used to diagnose?

Answer 8

Hemorrhage of unknown cause

Question 9

Your pt with Sickle Cell Anemia is complaining of nausea and lack of sleep. What med is best?

Answer 9

Phenergan

Question 10

Pt presents with RLQ pain, 1-2 episodes of vomiting, and + Psoas sign. What dx are confirmatory of appendicitis?

Answer 10

ABD US and WBC 10-20 (key is WBC. A CT would also work)

Question 11

36 yo with h/o Crohn’s disease arrives in the ER with c/o ABD pain, freq. vomiting and water bowel movements. You notice high-pitched, tinkling bowel sounds and transabdominal US reveals partial SBO. Which is not necessary?

Answer 11

immediate surgical consult

Question 12

A Nurse experiences a needle stick from a patient who has Non-A, Non-B hepatitis. She has already had the HepB vaccine series. What is the next step?

Answer 12

Obtain blood samples from the pt and the RN.

Question 13

42 y M with epigastric pain that is better after he eats:

Answer 13

duodenal ulcer

Question 14

65 yr ETOH use + 25 yr smoking. S/s: dysphagia and epigastric pain. What is Dx:

Answer 14

GERD

Question 15

XR identification

Answer 15

Pneumoperitoneum. Note air under the diaphragm (d/t perforated bowel)

Question 16

Avoid Diverticulitis flare ups:

Answer 16

quit smoking (also increased risk for perf/abcess)

Question 17

Tx for diverticulitis

Answer 17

NPO dependent upon condition, IVF, IV abx (flagyl,Cipro, ceftazidime, clinda, ampicillin), Tx GI bleed

Question 18

True/False: Barium enema is indicated in the conservative management of diverticulitis?

Answer 18

False

Question 19

Lab values and acute pancreatitis

Answer 19

GWGLA HBCABE

Question 20

Which disorder worsens epistaxis?

Answer 20

Cirrhosis, HIV

Question 21

Bowel obstruction antibiotic

Answer 21

zosyn (piperacillin-tazobactam)

Question 22

49 yo M presents with c/o abdominal swelling that progressed over 2 days. Patient also reports mucous-filled diarrhea and ABD pain. Exam is significant for profound ABD distention. You suspect an SBO. What type of bowel sounds are associated?

Answer 22

High pitched, tinkling bowel sounds

Question 23

Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis?

Answer 23

Proximal SBO

Question 24

tx and presentation for Crohns

Answer 24

diarrhea, abd p, abscess/fistulas, abx: flagyl/Cipro

Question 25

Who is at risk for Toxic megacolon

Answer 25

pts with both crohns and UC

Question 26

48 yo with fever, ABD pain and bloody diarrhea with h/o chronic sinusitis, arthritis and recent DVT Which represents the most likely dx and test to order?

Answer 26

Ulcerative colitis, sigmoidoscopy

Question 27

17 year old with UC, what is the worst complication

Answer 27

Toxic megacolon

Question 28

young male with UC, what would be a probable finding?

Answer 28

Rectosigmoid stricture

Question 29

Ulcerative colitis meds

Answer 29

Canasa (mesalamine) suppositories or enemas for 3-12 weeks, hydrocortisone suppositories and enemas.

Question 30

What abx do you use for UC?

Answer 30

IV ciprofloxacin and metronidazole in severe colitis and high grade fever, leukocytosis with extreme numbers of immature neutrophils (bands > 700/microL), and peritoneal signs or megacolon. There is no role of antibiotics in patients with severe colitis without signs of systemic toxicity

Question 31

When would you find “thumb printing sign” on abd XRAY?

Answer 31

Mesenteric ischemia (ischemic colitis), pseudomembranous colitis, and IBD (ulceratve colitis) = radiologic sign of thickening of the bowel wall

Question 32

Woman ETOH has liver dz but husband does not:

Answer 32

Women are likely to get liver disease while drinking less than men

Question 33

What causes GI bleed in elderly?

Answer 33

Thin gastric membranes (However, per Medscape: PUD in UGIB. Diverticulosis and colitis in LGIB. Both exacerbated by NSAID/ASA/Anticoag use)

Question 34

When to not use protonix drip

Answer 34

increased risk of hip fx. Increase vitamin D

Question 35

Why would you pick a PPI over phenergan for treatment:

Answer 35

PPI Can be used in combo with other drugs to control symptoms

Question 36

Patient on PD Dialysis has an infected dialysis catheter:

Answer 36

Remove the catheter