GI/GU

Question 1

What is the most common cause of a palpable, painless testicular mass in a young man?

Answer 1

Testicular cancer.

possible symptoms include a heavy ache in the scrotum, perianal area, or lower abdomen.

Do U/S

Question 2

After medical management, what is the next best step in a patient who has ingested a strong acid or alkali solution?

Answer 2

After medical management, make sure that you do an EGD. You want to check out the extent of the damage to the esophagus and the gastrum and you can really only do this by looking at it.

Question 3

what commonly helps to differentiate Crohn’s disease from UC?

Answer 3

Crohn’s disease can present with perianal disease: fissures, fistulas, or abscesses. UC does not.

Crohn’s commonly presents with crampy abdominal pain, low-grade fevers, non-bloody diarrhea, and heme-positive stool.

Dx: colonsocopy and mucosal biopsies

Question 4

What do you do wit ha symptomatic hepatic adenoma?

hint: a hepatic adenoma is going to be a well circumscribed hyperechoic mass on US

Answer 4

Any hepatic adenoma that is symptomatic or > 5cm

=

surgery

Question 5

How do you treat ascending cholangitis?

Answer 5

ERCP

Question 6

What is a common complication of abdominal repair surgery that causes abdominal tenderness and bloody diarrhea?

Answer 6

Ischemic colitis

Question 7

What do you suspect is going on in a patient who develops fluid overload, decreased urine output, and has numerous dark brown casts in his urine after surgery?

Answer 7

Obviously this patient has acute tubular necrosis.

In patients with refractory volume overload, hyperkalemia, and symptoms of uremia the next best step in treatment is hemodialysis

Question 8

What is the best step in management in a patient who presents with GERD but is also over 60?

Answer 8

in a patient over 60 with s/s of GERD do an EGD.

EGD is also indicated in patients with upper gastrointestinal symptoms who fail empiric therapy with a proton pump inhibitor

Question 9

What is the most common cause of pancreatitis?

Answer 9

pancreatitis is most commonly caused by

GALLSTONES

when they obstruct the ampulla opening from the pancreas into the small intestine.

Question 10

what is the most likely cause of profuse watery diarrhea with a pancreatic mass?

Answer 10

VIPoma

Question 11

unspecified LUQ pain, nausea, unexplained weight loss, fetid breath.

Answer 11

gastric bezoar (foreign body in the stomach) resulting from the accumulation of ingested material (most commonly hair).

Look for a patient with patchy areas of broken hairs and alopecia on the scalp (signs of trictillomania)

Question 12

LLQ pain

fever

no nausea or diarrhea

Answer 12

Diverticulitis

you will also see leukocytosis

Diagnosis is made using an abdominal CT scan

treatment includes a clear liquid diet (for bowel rest) and abx to cover anaerobic and gram (-) bugs.

Question 13

What is the treatment of choice for a painful, thrombosed hemorrhoid?

Answer 13

Surgery is the treatment of choice for painful, thrombosed hemorrhoids

rubber band ligation is the most common treatment for symptomatic internal hemorrhoids that do not respond to conservative management

Question 14

what type of esophageal cancer has a strong correlation with alcohol and cigarettes?

Answer 14

squamous cell carcinoma of the esophagus

patients present with progressive dysphagia and significant weight loss

Question 15

This type of hernia occurs when only the antimesenteric wall of a hollow abdominal organ becomes incarcerated in an inguinal hernia

Answer 15

Richter’s hernia

Question 16

what type of hernia has contents of the bladder wall within the hernia sac?

Answer 16

sliding inguinal hernia is defined as a hernia containing a hollow retroperitoneal organ which is ususally the bladder or the colon.

Question 17

What are signs and symptoms of toxic mega colon?

Answer 17

Signs and symptoms of toxic mega colon:

leukocytosis

fevers

tachycardia

abdominal distention

History of C. diff colitis

Question 18

what is the appropriate treatment for toxic mega colon?

Answer 18

subtotal colectomy with end-ileostomy in the procedure of choice for urgent or emergent surgery associated with toxic mega colon.

this procedure involves the removal of the entire colon with ileostomy (without removing the rectum) and diverting loop ileostomy with colonic lavage.

Question 19

What is the appropriate surgical management for an NSAID related gastric perforation?

Answer 19

NSAID-related perforations and patients who have never been treated for peptic ulcer disease whould have a simple patch closure of the omentum.

Question 20

What is the first line medical treatment for Crohn’s disease?

Answer 20

5-ASA drugs (sulfasalazine and mesalamine) are good for treating flares and maintaining remission of Crohn’s disease

you may also choose to add abx (cipro and metro) in addition to the 5-ASA drugs if there is perianal involvement.

Question 21

Crohn’s patient already on sulfasalazine.

disease flares.

what do you do?

Answer 21

corticosteroids are used to treat acute flare ups of Crohn’s disease.

Question 22

treatment of refractory Crohn’s?

Answer 22

immunomodulators:

6-mercaptopurine

azathioprine

infliximab (anti-tNF alpha)

Question 23

what generation of cephalosporins have anaerobic coverage?

Answer 23

2nd generation (cefotetan and cefoxitin)

2nd gen cephalosporins are indicated as a single drug treatment for gram-negative and anaerobic coverage and can be used prophylactically during colorectal surgery.

Other options include ampicillin/sulbactam,

sefazolin + metro, slindamycin plus floroquinolon/aztreonam

Question 24

What is blind loop syndrome?

what are complications?

Answer 24

blind loop syndrome occurs after chronic obstruction to a portion of the intestines causing bacterial overgrowth.

The bacteria will bind to vitamin B12 leading to megaloblastic anemia and peripheral neuropathy. Patients may also develop vit A deficiency leading to xerophthalmia and night blindness.

Question 25

What is the test of choice if you suspect colon cancer?

Answer 25

The test of choice is a colonoscopy

Look for an elderly patient with s/s of iron deficiency anemia:, weightloss, blood in the stool, microcytic anemia

The reason you choose a colonoscopy is because you can take a biopsy of a suspicious lesion while you’re there.

Question 26

What is the chapman point for the stomach?

Answer 26

The chapman’s points for the stomach are the 5th and 6th intercostal spaces on the right

Question 27

What is the most appropriate test to confirm achalasia?

Answer 27

The most appropriate test to confirm achalasia is an esophageal motility study (manometry).

Classic findings of achalasia on manometry include inccomplete relaxation of the LES and lack of peristalsis