GI

Question 1

What is the most sensitive and what is the most specific test for pancreatic cancer?

Answer 1

sensitive is CT

specific is ECRP

Question 2

What is the type of bilirubin increased in each disease and what is the underlying problem?
Crigler?
Gilbert?
Dubin Johnson?
Rotor?

Answer 2

unconjugated, UGT don’t work
un, UGT don’t work, but only when the body is stressed
direct or conjugated, cant transport out of liver
direct or conjugated, cant store in liver

Question 3

When I want to make a diagnosis of viral infection like the flu, what test to do?

Answer 3

PCR

Question 4

diagnostic test and treatment for volvulus?

Answer 4

sigmoidoscopy diagnosis it and treats it

Question 5

what is a late sign of liver disease?

Answer 5

fetor hepaticus which is a sweet, fecal odor of breath

Question 6

what med closes the PDA and which med keeps it open?

Answer 6

NSAIDS close it

prostaglandins open it

Question 7

What is the finding on pulmonary function test for restrictive lung disease?

Answer 7

deceased DLCO

Question 8

what is the difference between primary sclerosing cholangitis and primary biliary cirrhosis?

Answer 8

PSC is stricture and dilation of both intra and extra hepatic ducts
PBC is only intrahepatic ducts

Question 9

What is the most common hereditary cause of colon cancer? How do we screen these folks? What is another cancer these people get?

Answer 9

hereditary non poly colorectal cancer or lynch syndrome
colonoscopy started at 20-25 or ten years earlier than family diagnosis
endometrial cancer

Question 10

Best treatment for hemochromatosis?

Answer 10

phlebotomy

Question 11

What is the most common type of benign liver tumor?

What will they look like on CT?

Answer 11

cavernous hemangioma

complete opacification on delayed image

Question 12

How do we treat these hemangiomas?

Answer 12

is asymptomatic and less than 5cm, nothing. grater than 5cm, image it in 6-12 months.
symptomatic, surgery,

Question 13

What is the most common cause of lower GI bleeding in people around 60? What is the classic presentation?

Answer 13

diverticulosis

painless rectal bleeding

Question 14

Dysphagia caused by circumferential membrane in the distal esophagus?

Answer 14

schatzkis rings

Question 15

what are the two MAJOR risk factors for peptic ulcer disease?

Answer 15

NSAIDS and H pylori

stress and alcohol are only minor

Question 16

most common complication of diverticulitis is?

Answer 16

fistula

Question 17

2 main causes of cirrhosis to see on exam?
4 major clinical signs?
What is the underling mechanism of the disease causing problems?

Answer 17

alcohol or chronic viral hepatis with C and B
jaundice, gynecomastis, spider angiomata, ascities
portal vein htn

Question 18

What liver tumor is associated with contraceptive use?

Answer 18

hepatic adenoma

Question 19

Under what three circumstances will you remove the adenoma?

Answer 19

symptomatic, over 5 cm, or stopped OCs and the tumor didn’t shrink or go away.

Question 20

What will be the differentiating factor between dubin Johnson syndrome and rotor syndrome?

Answer 20

coproportphryn 1 is greater than 80% in urine for dubin and less than 20% in rotor

Question 21

what is angiodysplasia?
Another name for it?
common association?

Answer 21

AV malformation in the GI tract and one of the most common vascular anomalies in the gut causing painless lover GI bleeds
AV malformations
von Willebrand

Question 22

Explain how we determine what the cause of ascites is and the two results and options?

Answer 22

we use the serum to fluid albumin gradient
if it is greater than 1.1, we are confident it is because of portal hypertension. This increases the hydrostatic pressure causing fluid to leak out and leave protein in the vessel. this would be things like, portal vein thrombosis, cirrhosis, heptic carcinoma, CHF, budd chiari)
If the gradient is less than 1.1 we are not thinking portal htn. more like infection, rheumatoid conditons, cancers lsewhere.

Question 23

What condition am I thinking with antimitochondrial antibodies?
What can we use to treat the itching from the increased bile acids?

Answer 23

primary biliary cirrhosis

chlestyramine or colestipol

Question 24

first line treatment for c diff?

second line?

Answer 24

vancomycin

fidaxomicin or pulse tapered vancomycin

Question 25

when diverticulosis is diagnosed incidentally and is asymptomatic, how do we manage?

Answer 25

high fiber diet

Question 26

What do I always need to have in mind when someone has history of chronic pancreatitis and sudden ab pain?

Answer 26

acute mesenteric ischemia

Question 27

5 lab values for wislons dz?

Answer 27

low albumin
low ceruloplasmin
low total serum 
increased free serum copper
increased urine excretion of copper

Question 28

2 lab values for primary biliary cholangitis?

Answer 28

antimitochondrial antibodies

high alkaline phosphatase

Question 29

what is diagnostic test for zenkers and how to treat?

Answer 29

barium swallow

myotomy

Question 30

What is the diagnostic test for acute diverticulitis?

Answer 30

CT with contrast

Question 31

two types of hiatal hernias?

how to treat?

Answer 31

sliding and paraesophageal.
usually sliding is associated with gerd so treat the gerd.
symptomatic para need surgery

Question 32

What is a complication of diverticulitis and how will it present?

Answer 32

fistula

air in the urine on imaging

Question 33

what cancer is found at the confluence of the hepatic ducts?

Answer 33

cholangiocarcinoma, called a klatskin tumor

Question 34

association and identifying symptom for primary sclerosing cholangitis?

Answer 34

UC

pruritis

Question 35

Identifying symptom of primary biliary cirrhosis?

Answer 35

xanthomata with pruritis

Question 36

charcots triad is for which disease?

Answer 36

cholangitis

Question 37

what are the two initial and confirming tests for cholecystitis?

Answer 37

US

HIDA

Question 38

triad of hereditary hemochromatosis?

Answer 38

skin hyperpigmentation, hepatic cirrhosis, and diabetes from iron depositing all over.
“Bronze Diabetic”

Question 39

what is diagnostic of spontaneous bacterial peritonitis?

Two most common bugs causing it?

Answer 39

Paracentesis of the ascites showing polys leukocytes greater than 250
E coli
Klebsiella

Question 40

diagnostic test of choice for diverticulitis?

Answer 40

CT