GI misc 2

Question 1

Involves protrusion of the stomach through the diaphragm via the esophageal hiatus.

It can cause symptoms of GERD

Answer 1

Hiatal hernia

Question 2

Cause of travelers diarrhea

Answer 2

e-coli

Question 3

cause of diarrhea after a picnic and egg salad

Answer 3

staph aureus

Question 4

cause of diarrhea from shellfish

Answer 4

vibrio cholerea

Question 5

cause of diarrhea from poultry or pork

Answer 5

salmonella

Question 6

cause of diarrhea from poorly canned home foods

Answer 6

C. perfringens

Question 8

cause of diarrhea breakout in daycare

Answer 8

Rotavirus

Question 9

cause of diarrhea on a cruise ship

Answer 9

Norovirus

Question 10

Diarrhea after drinking fresh mountain stream water?

Incubation time?

Answer 10

Giardia lamblia

incubation: 1-3 wks

Question 11

Diarrhea caused by what?

foul-smelling bulky stool and may wax and wane over weeks before resolving

Question 12

What composition is recommended by WHO for oral rehydration therapy?

Na, K, Cl, Citrate, glucose?

Answer 12

90mmol Na

20mmol K

80mmol Cl

10mmol citrate

111mmol glucose

Rehydralyte is closest to this recommendation!

Question 13

What is the MCC bacterial gastroenteritis in children and adults

Answer 13

Campylobacter jejuni

(starts with fever and malaise, followed by N/V/D, fever and abdominal pain. D may contin blood)

Question 15

3 classic sxs of enterohemorrhagic E. coli

Answer 15

no fever

bloody stool

+abdominal tenderness

Question 16

What is hemolytic uremic syndrome and what is it a/w

Answer 16

Enterohemorrhagic E. coli a/w hemolytic uremic syndrome

• Hemolytic anemia
• Renal failure
• Thrombocytopenia

Question 17

MC type of rectal cancer

Answer 17

adenocarcinoma

Question 18

MC site for blood borne mets of rectal cancer is where

Answer 18

liver

Question 19

sxs of what

hematochezia, tenesmus, rectal mass, feeling of incomplete evacuation of stool

Answer 19

rectal cancer

Question 20

6 risk factors of rectal cancer

Answer 20

receptive anal intercourse

1. HPV
2. Chronic fistulas
3. Irradiated anal skin
4. Leukoplakia
5. lymphogranuloma venereum
6. condyloma acuminatum

Question 21

painless rectal bleeding and a change in bowel habits in a pt 50-80 y/o

Question 22

When is colon cancer screening recommended

What are screening options

Answer 22

50-75y/o

• Stool tests: guaic based fecal occult blood (gFOBT), Fecal immunochemic test (FIT)–> both once a year
• FIT-DNA test- q1-3yrs
• colonoscopy q10yrs
• flex sig q5yrs or q10yrs w/ a FIT yearly

Question 23

carcinoma of the colon most commonly originates from what

Answer 23

adenomatous polyp

Question 24

What is the role of CEA in colon cancer

Answer 24

Not diagnostic for colorectal cancer

elevated preop CEA levels correlate wtih postop recurrance rate

Help detect recurrance after surgical resection

Question 25

Apple core lesion on barium enema

Answer 25

adenocarcinoma of the colon

Question 26

What is the MC GI cancer and 2nd MC cancer in US

Answer 26

colorectal cancer

Question 27

What is the second MCC of cancer deaths

Answer 27

colorectal cancer

Question 28

risk factors for colorectal cancer

Answer 28

low fiber, high fat diets FHx Lynch syndrome h/o IBD

Question 29

Grey Turners sign and cullens sign

Answer 29

acute panreatitis

Question 30

2 etiologies of acute pancreatitis

Answer 30

cholelithiasis alcohol abuse

Question 31

What is Ranson's criteria for poor prognosis of acute pancreatitis (\>3= severe prognosis)

Answer 31

At admit: * Age \>55 * Leukocyte \>16k * Glucose \>200 * LDH \>350 * AST \>250 At 48 hrs: * Arterial PO2 \<60 * HCO3 \<20 * Ca \<8 * BUN: inc by 1.8+ * Hct: decr by \>10% * Fluid sequestration \>6L

Question 32

Tx for acute pancreatitis

Answer 32

IVF analgesics bowel rest

Question 33

What is the classic triad of chronic pancreatitis

Answer 33

pancreatic calcification steatorrhea DM

Question 34

Tx for chronic pancreatitis

Answer 34

no alcohol low fat diet

Question 35

Tumor marker for pancreatic cancer

Answer 35

CA 19-9

Question 36

What criteria is used to predict mortality in acute pancreatitis

Answer 36

Ransons

Question 37

Painless jaundice and a palpable non-tender GB (Courvoisier's sign)

Answer 37

pancreatic cancer

Question 38

Pancreatic cancer is MC located at which part of pancreas

Answer 38

head

Question 39

What is the most sensitive test for chronic pancreatitis

Answer 39

ERCP

Question 40

MC etiology of appendicitis

Answer 40

Fecalith

Question 41

Sxs of small bowel obstruction

Answer 41

**_colicky abd pain_** N **_bilious vomiting_** obstipation abdominal distention

Question 42

6 MCC small bowel obstruction

Answer 42

adhesions hernias cancer IBD volvulus intussusception

Question 43

Are polyps in the distal or proximal colon more likely benign

Answer 43

distal colon are commonly benign

Question 44

Colonic polyps: \_\_\_\_ adenomas have a 30-70% risk of malignant transformation

Answer 44

villous

Question 45

Once a colonic polyp is identified, how often should you follow-up with colonoscopy

Answer 45

q3-5yrs

Question 46

* What is characterized by the development of hundreds to thousands of adenomatous polyps * Colorectal polyps develop by age 15 and cancer at 40 * Fam should undergo yearly sigmoidoscopy at 12 y/o * 1st deg rel should undergo genetic screening after 10

Answer 46

Familial adenomatous polyposis

Question 48

Which of the following is NOT a cause of paralytic ileus a. GI surgery b. hypokalemia c. intra-abdominal sepsis d. hyperkalemia

Answer 48

d. hyperkalemia

Question 49

large or small bowel obstruction? distention is early and pronounced. Pain is mild and vomiting and dehydration are late

Answer 49

Large bowel obstruction

Question 50

What is the MCC small bowel obstuction

Answer 50

postoperative adhesions

Question 51

What is the MCC of small bowel obstruction in children

Answer 51

intussusception

Question 52

MC location of large bowel obstruction

Answer 52

sigmoid colon due to neoplasms, fecal impaction and diverticulitis

Question 53

currant jelly stool

Answer 53

intussuception

Question 54

physical exam: abdominal distention and tenderness **_sausage shaped abd mass in RUQ_**

Answer 54

Intusussception

Question 55

What can be used for both dx and treatment for intussusception in children

Answer 55

barium or air enema (barium enema should not be used in adults)

Question 56

Target sign on abdominal ultrasound

Answer 56

intussusception

Question 57

in adults, intussusception is almost always caused by what

Answer 57

neoplasm

Question 58

Causes of lower GI bleed (6)

Answer 58

1. **_Hemorrhoids_** (painless bleeding with wiping) 2. **_Anal fissures_** (severe rectal pain w/ defecation 3. **_Proctitis_** (rectal bleeding and abdominal pain 4. **_Polyps_** (painless rectal bleeding, no red flag signs 5. **_Colorectal cancer_** (painless rectal bleeding and chnage in bowel habits in 50-80y/o 6. rectal ulcers

Question 59

5 causes of upper GI bleed

Answer 59

1. Peptic ulcer 2. Esophageal ulcer 3. Mallory-Weiss tear 4. Variceal hemorrhage or portal hypertensive gastropathy (jaundice, abd. distention) 5. Malignancy

Question 61

What diagnostic studies do you use to evaluate hematochezia vs melena

Answer 61

hematochezia= colonoscopy melena= EGD

Question 62

What are the 4 cardinal signs of strangulated bowel?

Answer 62

1. Fever 2. Tachycardia 3. Leukocytosis 4. Localized abdominal tenderness

Question 63

what lab abnormalities (renal and electrolytes, etc) are ssen in bowel obstruction

Answer 63

ongoing emesis and third spacing lead to dehydration, prerenal azotemia hypochloremic hypokalemic metabolic acidosis

Question 64

Causes of SBO "GIVES BAD CRAMPS"

Answer 64

* Gallston Ileus * Intussusception * Volvulus * External Compression * SMA syndroms * Bowel wall hematoma * Abscess * Diverticulosis * Chrons * Radiation enteritis * Annular pancreas * Meckel's diverticulum * Peritoneal adhesions * Stricture

Question 65

When does Gilbert syndrome cause jaundice

Answer 65

during stress like severe infection, otherwise asxs

Question 66

Causes of biliary tract obstruction

Answer 66

gallstones pancreatic carcinoma liver fluke cholangiocarcinoma

Question 67

Signs of biliary tract obstruction

Answer 67

* JAUNDICE * incr alk phos * decr urine urobilinogen * dark urine * pale stool * pruritis

Question 68

What is charcot's triad

Answer 68

COLANGITIS fever jaundice RUQ

Question 69

What is Reynold's pentad?

Answer 69

CHOLANGITIS Charcot's tirad (fever, jaundice, RUQ pain) + mental confusion + hypotension

Question 71

What is the gold standard for imaging the biliary system

Answer 71

ERCP

Question 72

Cholangitis is commonly caused by what bacteria

Answer 72

E. coli

Question 73

pruritis w/ progressive jaundise= ? cholangiography will show fibrosis of the bile ducts w/ dilation b/w strictures

Answer 73

Primary sclerosing cholangitis (common in pt w/ h/o ulcerative colitis)

Question 74

What 4 conditions are cholangitis associated with

Answer 74

IBD Cholangiocarcinoma pancreatic cancer Colorectal cancer

Question 75

which 2 GI pathogens can cause appendicitis-like presentation

Answer 75

Entamoeba histolytica Yersiniosis enterocolitica

Question 76

Which bacteria can cause ileocecitis | (can get from pork)

Answer 76

Yersinia enterocolitica

Question 77

Which 3 HIV meds commonly cause pancreatitis

Answer 77

Tenofovir didanosine stavudine

Question 78

What is the MCC of bacterial foodborne dz in US? #2?

Answer 78

#1- salmonella (milk products, poultry, eggs) #2- Campylobacter (undercooked pork)

Question 79

Salmonellosis is affected with what type of arthritis

Answer 79

reactive arthritis