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1
Q

If a patient who is on opiates has constipation despite multiple laxatives, what is the next step?

A

oral naloxegol

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2
Q

Patient with HBV since birth, normal LFTs, positive HBeAg and DNA >20k

what’s the next step?

A

This is the immune tolerant phase

Do not need to treat

Tx: serial LFT checks, if LFTs increase to >2x ULN, THEN you would treat

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3
Q

Should you hold ASA for patient with CAD having a colo?

A

No, do not need to discontinue ASA prior to a colo for any reason

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4
Q

65M with dysphagia to solids and liquids, 16lb weight loss in 3 months..what is the most likely dx?

A

pseudoachalasia from a tumor!

Pseudoachalasia is caused by a tumor at the gastroesophageal junction infiltrating the myenteric plexus causing esophageal motor abnormalities; symptoms, barium-imaging and manometric findings, and endoscopic appearance are similar to achalasia.

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5
Q

Cirrhotic with a drop in sat from sitting to standing - dx and evaluation?

A

Likely hepatopulmonary syndrome - echo with saline to rule out intracardiac shunt

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6
Q

Patient with gallbladder polyp and gallstones - what is the next step?

A

Cholecystectomy is indicated for this patient with a gallbladder polyp and gallstones because of the increased risk for gallbladder cancer when the two conditions coexist. Doesn’t matter if patient is symptomatic or not.

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7
Q

What are appropriate ways to confirm eradication of H Pylori?

A

Stool Ag or urea breath testing

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8
Q

Patient with dyspepsia > 60 yo, what should be part of their mgmt?

A

upper endoscopy

high value care

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9
Q

patient with asymptomatic pancreatic necrosis that is walled off - next step in mgmt?

A

nothing!

high value care

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10
Q

what intervention improves rates of gallstone complications in patients with gallstone pancreatitis?

A

same admission cholecystectomy

high value care

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11
Q

Does acute diverticulitis require imaging?

A

usually not

high value care

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12
Q

patient with small hyperplastic polyps - what should their colo screening interval be?

A

no sooner than 10 years

high value care

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13
Q

What is the treatment for uncomplicated diverticulitis

A

oral abx

high value care

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14
Q

what is the mgmt for asymptomatic hepatic cysts?

A

no follow up needed

high value care

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15
Q

What is the diagnosis?

Positive Anti–smooth muscle antibody

A

Autoimmune hepatitis

also associated with anti-LKM1 Ab

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16
Q

diagnostic workup for suspected achalasia

A
  1. barium swallow

2. endoscopy to rule out cancer and esophageal manometry

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17
Q

What is the treatment for achalasia

A

laparaoscopic myotomy of LES and endoscopic pneumatic dilation of the esophagus

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18
Q

what should patients undergo before surgery for GERD?

A

pH monitoring to demonstrate true reflux with symptom correlation and manometry to rule out a motility disorder before surgery

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19
Q

Who needs screening for Barrett’s

A

men > 50 with GERD sx for >5 years and add’l risk factors:

  • noctural reflux
  • hiatal hernia
  • elevated BMI
  • active tobacco use
  • intra abdominal distribution of fat
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20
Q

What is the treatment for Barrett’s

A

no dysplasia -> PPE, surveillance q 3-5 years with EGD

endoscopic ablation if low or high grade dysplasia

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21
Q

do women with GERD require routine screening for Barrett’s

A

no

don’t be tricked!

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22
Q

patients who are immunosuppresed and have odynophagia - best next step?

A

start empiric therapy for esophageal candidiasis

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23
Q

young adult with extreme dysphasia and food impaction

What is the diagnosis?

A

eosinophilic esophagitis

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24
Q

how diagnose eosinophilic esophagitis?

A

upper endoscopy and biopsy

empiric trial of PPI x 8 weeks -> diagnose EE if symptoms persist

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25
does the absence of oral candida rule out esophageal candida?
no! don't be tricked!
26
What is the treatment for eosinophilic esophagitis
swallowed fluticasone or budesonide
27
All patients with PUD should be tested for what?
H Pylori
28
how long before testing for H Pylori should you stop antibiotics and PPIs
28 days for antibiotics 2 weeks for PPIs don't be tricked!
29
do duodenal ulcers need biopsies
no, little risk of malignancy don't be tricked!
30
when should you test for H Pylori eradication
at least 4 weeks after treatment
31
what is the workup for gastroparesis
nuclear medicine solid phase gastric emptying study
32
when reglan is used for gastroparesis what signs shuld prompt abrupt cessation of reglan?
dystonia and parkinsonian-like tardive dyskinesia
33
What is the diagnosis? loose stools and malabsorption following bypass surgery
blind loop syndrome (SIBO) tx with antibiotics and nutritional supplements
34
all patients with acute pancreatitis require what?
RUQUS to evaluate for obstructed biliary tract
35
if there are no calcifications on CT of pancreas and you suspect chronic pancreatitis, what's the next step?
MRI, MRCP or EUS to detect abnormalities of the main and branch pancreatic ducts
36
sausage shaped pancreas on imaging What is the diagnosis?
autoimmune pancreatitis
37
how can you distinguish between type I and II autoimmune pancreatitis
Serum IgG4 is increased in type 1
38
What is the treatment for autoimmune pancreatitis
steroids
39
workup for chronic diarrhea?
Select colonoscopy for most patients with chronic diarrhea. The terminal ileum should be viewed to assess for Crohn disease; random biopsies of the colonic mucosa should be performed to assess for microscopic colitis.
40
What is the diagnosis? Bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features
IBS, test for celiac dz
41
What is the diagnosis? Diarrhea mainly in women aged 45-60 years, unrelated to food intake (nocturnal diarrhea), normal colonoscopy
Microscopic colitis; stop NSAIDs/PPIs, biopsy
42
What is the diagnosis? diarrhea associate with Use of artificial sweeteners or fructose
carbohydrate intolerance, dietary exclusion or hydrogen breath test
43
What is the diagnosis? Diarrhea with dairy products
Lactose intolerance; dietary exclusion or hydrogen breath test
44
What is the diagnosis? Nocturnal diarrhea and diabetes mellitus or SSc
SIBO, hydrogen breath test or empiric Abx trial
45
What is the diagnosis? Somatization or other psychiatric syndromes, history of laxative use
self induced diarrhea obtain tests for stool osmolality, electrolytes, magnesium, and laxative screen
46
What is the diagnosis? Severe secretory diarrhea and flushing
Carcinoid syndrome; obtain test for 24-hour urinary excretion of 5-HIAA
47
what are the 4 most common malabsorptive disorders?
celiac SIBO short bowel syndrome pancreatic insufficiency
48
What is the diagnosis? Travel to India or Puerto Rico, malabsorption, weight loss, malaise, folate or vitamin B12 deficiency, steatorrhea
Diagnose tropical sprue. Order a small bowel biopsy. Treat with a sulfonamide or tetracycline and folic acid.
49
What is the diagnosis? History of resection of <100 cm of distal ileum, with voluminous diarrhea, weight loss, and malnutrition
Diagnose short-bowel syndrome with bile acid enteropathy. Order empiric trial of cholestyramine.
50
How do you diagnose celiac disease?
Diagnostic tests include an IgA anti-tTG antibody assay with small bowel biopsy for those with a positive antibody assay.
51
what test do all celiac patients need
DEXA
52
Celiac adherent patients with recurrent malabsorption should be evaluated for what?
intestinal lymphoma.
53
Why is it important that all celiac patients adhere to a gluten free diet
to prevent intestinal lymphoma
54
how often should patients wtih IBD have screening colonoscopies?
beginning 8 years after diagnosis -> every 1-2 years if dysplasia is found -> protocolectomy
55
What is the treatment for microscopic colitis
bismuth or loperamide
56
What is the diagnosis? LLQ abdominal pain and self limited bloody diarrhea
ischemic colitis dx colonoscopy: patchy segmental ulcerations can also see thumbprinting on barium x ray
57
how do you diagnose Gilbert's disease?
elevated indirect (>80% indirect bili), normal AST and ALT and lack of hemolysis
58
post exposure prophylaxis for Hep A?
vaccine if <40yo | immune globulin if older or immunocompromised
59
how vaccine for Hep A prior to travel
1 dose if <40 and healthy 1 dose vaccine + immune globulin if older or immunocompromised or have chronic liver dz
60
Post-exposure prophylaxis for Hep B?
vaccine + HBIG after needle stick injury, for sexual and household contacts of patients with HBV
61
Which patients with HBV need monitoring for HCC
``` asian women >50 asian men >40 cirrhotics black patients >20 elevated ALT and HBV DNA >10k family history of HCC ```
62
What is the diagnostic work-up for HCV
anti HCV ab then HCV RNA HCV genotyping if infected
63
Can normal LFTs exclude a diagnosis of HCV?
no don't be tricked!
64
What should you test for before treating for HCV?
HBV, can be reactivated iso HCV don't be tricked!
65
What is the treatment for HBV iso pregnancy
pegylated interferon
66
What is the treatment for hemochromatosis
monitoring if positive for HFE gene but normal serum ferritin levels phlebotomy if elevated ferritin
67
patients with hemochromatosis and cirrhosis should be screened for HCC how often
q 6 months
68
Can patients with fatty liver and elevated LFTs be treated wtih statins
yes don't be tricked!
69
What is the management of PBC
biliary US to rule out extrahepatic bile duct obstruction
70
What is the treatment for PBC
ursodeoxycholic acid
71
what Ab is associated with PBC
antimitochondrial
72
PSC is associated with what other illness?
IBD, found in 80% of patients, mostly UC
73
granulomatous inflammation centered on the septal bile duct What is the diagnosis?
PBC
74
What screening do patients with PSC need
colonoscopy q1-2 years starting at diagnosis with PSC annual MRCP and carb 19-9 level for cholangiocarcinoma surveillance if have cirrhosis - q6 month screening for HCC with US
75
what is the neutrophil cut off for SBP
250
76
what is the SAAG cut off for cirrhosis or R sided HF or budd chiari
> 1.1
77
cirrhosis patients with varices should receive what form of bisphosphonates
IV don't be tricked!
78
What is the treatment for SBP in board basics
cefotaxime and albumin infusions
79
how treat acute wilson's dz
trientine or penicillamine
80
pregnant patient with ithing, ALT 5x ULN, elevated bile acids and alk phos What is the diagnosis?
intrahepatic cholestasis of pregnancy tx: ursodiol
81
What is the diagnosis? pregnant woman in 3rd trimester with HTN, edema, proteinuria and mild ALT elevation
preeclampsia tx: delivery
82
What is the diagnosis? pregnant woman in 3rd trimester with HTN, edema, proteinuria and mild ALT elevation also with lab abnormalities: hemolysis, elevated ALT, thrombocytopenia
HELLP syndrome tx: delivery
83
What is the diagnosis? pregnant woman with HTN, edema, abd pain, nausea, ALT 200-1000, hemolysis, low platelets, encephalopathy, prolonged INR
Acute fatty liver of pregnancy tx: delivery
84
What is the diagnosis? RUQ pain, diarrhea and obstructive jaundice in advanced HIV
AIDS cholangiopathy cryptosporidium infection
85
What is the treatment for biliary cholic
NSAIDs elective chole if gallstones seen on imaging
86
What is the treatment for acute cholecystitis
antibiotics and surgery before hospital discharge
87
What is the treatment for ascending cholangitis
antibiotics and ERCP to remove common bile duct stones elective chole within 6 weeks
88
What is the Hgb transfusion threshold for patients with colonic bleeding?
Hgb 9.0
89
First step in undiagnosed GI bleeding
repeat EGD or colo

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