GI (Pearls of Wisdom)

Question 1

A patient presents with chronic, progressive dysphagia of SOLIDS & LIQUIDS. A barium study shows a dilated esophagus with a distal “BIRD BEAK” appearance. What is the likely dx?

Answer 1

Achalasia

Question 2

What study is the gold standard for diagnosing achalasia?

Answer 2

Esophageal manometry

Question 3

MC sx of esophageal dz:

Answer 3

heartburn

Question 4

What is the single, best dx study for evaluating a pt w/ GERD?

Answer 4

EGD

Question 5

Barrett esophagitis is assoc. w/ which type of cancer?

Answer 5

Esophageal adenocarcinoma

Question 6

What is the most predominant type of cancer of the PROXIMAL esophagus?

Answer 6

squamous cell carcinoma

• distal = adenocarcinoma

Question 7

MC benign esophageal neoplasm:

Answer 7

Leiomyoma

Question 8

MCC of infectious esophagitis:

Answer 8

Candida albicans

Question 9

MC viral cause of infectious esophagitis:

Answer 9

HSV

Question 10

A diverticular outpouching usually located posteriorly in the hypopharynx

Answer 10

Zenker’s diverticulum

Question 11

Repeated violent bouts of vomiting that results in a tear involving the submucosa and mucosa, typically in the right posterolateral wall of the gastroesophageal jxn

Answer 11

Mallory-Weiss tear

Question 12

Repeat violent bouts of vomiting that results in a full-thickness tear, usu in the unsupported L posterolateral wall of the distal esophagus

Answer 12

Boerhaave syndrome

Question 13

air in the mediastinum following an esophageal perforation

Answer 13

Hamman sign

Question 14

MC type of gastric carcinoma?

Answer 14

Adenocarcinoma

Question 15

gastric carcinoma that has metastasized to the ovary

Answer 15

Krukenberg tumor

Question 16

Stomach cancer is assoc. w/ the enlargement of what LNs?

Answer 16

Supraclavicular nodes (Virchow’s node)

Question 17

After the fluid and blood resuscitation of a bleeding ulcer, what is the most useful diagnostic test?

Answer 17

upper endoscopy

Question 18

Name 2 endocrine problems that can cause PUD:

Answer 18

1. Zollinger-Ellison syndrome

2. hyperparathyroidism

Question 19

A 48-yo female diabetic pt presents with a multimonth h/o chronic nausea, early satiety, & postprandial bloating. What is the most likely dx?

Answer 19

Diabetic gastroparesis

Question 20

What is the diagnostic TOC to evaluate a pt suspected to have gallstones?

Answer 20

Abdominal US

Question 21

What is the diagnostic TOC to evaluate a pt suspected to have gallstones?

Answer 21

Abdominal US

Question 22

A 54-yo man, 2 days postop for a R knee replacement, presents with RUQ abd pain, nausea, & low-grade fevers. His US fails to reveal any gallstones or other obvious GB abnormality. What is the probable dx?

Answer 22

Acalculous cholecystitis

Question 23

Name the sign: pain on inspiration w/ palpation of the RUQ

Answer 23

Murphy sign

- seen in cholecystitis

Question 24

Name the sign: pain on inspiration w/ palpation of the RUQ

Answer 24

Murphy sign

- seen in cholecystitis

Question 25

An 11 yo child w/ sickle cell anemia presents w/ fever, RUQ abdominal pain, and jaundice. What is the most likely dx?

Answer 25

ascending cholangitis

Question 26

Charcot's triad

Answer 26

1. Fever 2. RUQ abd pain 3. jaundice

Question 27

Gallstones w/in the GB sac

Answer 27

Cholelithiasis

Question 28

Inflammation of the common bile duct, often caused by infxn or choledocholithiasis

Answer 28

Cholangitis

Question 29

Inflammation of the GB

Answer 29

Cholecystitis

Question 30

Gallstones that have migrated from the GB sac into the common bile duct

Answer 30

Choledocholithiasis

Question 31

What is the most likely dx for a pt who presents with epigastric pain that radiates to the back & is partially relieved by sitting up?

Answer 31

Pancreatitis

Question 32

What are the major causes of acute pancreatitis?

Answer 32

Alcoholism | gallstone dz

Question 33

Name 2 metabolic causes of acute pancreatitis

Answer 33

1. hypertriglyceridemia | 2. hypercalcemia

Question 34

MCC of chronic pancreatitis in Western society:

Answer 34

chronic alcohol abuse

Question 35

What are the laboratory abnormalities assoc. w/ pancreatitis?

Answer 35

- leukocytosis - hyperglycemia - elevated amylase - elevated lipase - hepatic enzyme elevation

Question 36

What are some abdominal XR findings assoc. w/ acute pancreatitis?

Answer 36

- sentinel loop | - calcification of the pancreas

Question 37

What are some abdominal XR findings assoc. w/ acute pancreatitis?

Answer 37

- sentinel loop | - calcification of the pancreas

Question 38

Name the sign: Periumbilical ecchymosis indicative of pancreatitis, severe upper GI bleeding, or ruptured ectopic pregnancy

Answer 38

Cullen sign

Question 39

Name the sign: A palpable, distended GB in the RUQ of pts w/ jaundice. It is usu the result of a malignant bile duct.

Answer 39

Courvoisier sign

Question 40

Where is the MC site of pancreatic cancer?

Answer 40

the pancreatic duct system found in the HEAD OF THE PANCREAS

Question 41

What is the tumor marker that can assist in diagnosing pancreatic cancer?

Answer 41

CA 19-9

Question 42

What are the 2 MCCs of ascites?

Answer 42

1. Chronic liver dz | 2. Peritoneal carcinomatosis

Question 43

How are hepatitis viruses transmitted?

Answer 43

- A & E = fecal, oral route | - B, C, D = blood borne

Question 44

A dz of IRON OVERLOAD in the liver & other organs w/ the most likely defect occurring in a regulatory mechanism for iron absorption in the small intestine. Name the condition.

Answer 44

Hemachromatosis

Question 45

A dz of IRON OVERLOAD in the liver & other organs w/ the most likely defect occurring in a regulatory mechanism for iron absorption in the small intestine. Name the condition.

Answer 45

Hemachromatosis

Question 46

What is the MC screening test for hemochromatosis?

Answer 46

Serum ferritin

Question 47

A 52-yo pt presents w/ tremor, ataxia, dementia, cirrhosis, and GRAY-GREEN rings around the edge of the cornea. What is the dx?

Answer 47

Wilson dz

Question 48

What is looked at to accurately diagnose Wilson dz?

Answer 48

Diminished serum ceruloplasmin levels

Question 49

MC vascular tumors of the liver:

Answer 49

hemangiomas

Question 50

MCC of jaundice in pregnancy

Answer 50

Viral hepatitis

Question 51

MC liver disorder related to pregnancy

Answer 51

Intrahepatic cholestasis

Question 52

A 43-yo pt presents w/ a 6-wk h/o frequent, malodorous diarrhea that leaves an oily sheen to the surface of the toilet water. You suspect a malabsorption disorder. What is the best study to screen for fat malaborption?

Answer 52

A microscopic stool examination using Sudan stain

Question 53

A 43-yo pt presents w/ a 6-wk h/o frequent, malodorous diarrhea that leaves an oily sheen to the surface of the toilet water. You suspect a malabsorption disorder. What is the best study to screen for fat malaborption?

Answer 53

A microscopic stool examination using Sudan stain

Question 54

What is the best test to differentiate malabsorption caused by small bowel vs pancreatic etiology?

Answer 54

d-Xylose test

Question 55

What is the most sensitive & specific serum marker for celiac dz?

Answer 55

Tissue transglutaminase (tTG)

Question 56

Name the dz assoc. w/ the following sx: - Wt. loss - diarrhea - Arthralgias - Cardiac involvement

Answer 56

Whipple dz

Question 57

What GI dz is MCly assoc. w/ Dermatitis Herpetiformis?

Answer 57

Celiac dz

Question 58

What GI dz is MCly assoc. w/ Dermatitis Herpetiformis?

Answer 58

Celiac dz

Question 59

MC cancer arising in the colon:

Answer 59

adenocarcinoma

Question 60

What is the gold standard for identifying colorectal cancer?

Answer 60

Colonoscopy

Question 61

A benign disorder of pigmentation that develops w/in the walls of the colon

Answer 61

Melanosis coli

Question 62

What laxatives are MCly assoc. w/ melanosis coli?

Answer 62

Anthraquinones | aloe and senna

Question 63

A 72-yo female pt presents w/ a 2-day h/o progressively worsening LLQ abdominal pain assoc. w/ constipation & chills. What is the most likely dx?

Answer 63

Diverticulitis

Question 64

MC tumor of the appendix:

Answer 64

carcinoid tumor

Question 65

What Abs are commonly assoc. w/ C. diff colitis?

Answer 65

Clindamycin, ampicillin, & 3rd gen. cephalosporins

Question 66

What Abs are commonly assoc. w/ C. diff colitis?

Answer 66

Clindamycin, ampicillin, & 3rd gen. cephalosporins

Question 67

What is the 1st line tx of C. diff colitis?

Answer 67

Metronidazole (Flagyl)

Question 68

What is the most likely source of acute hematemesis in a 43-yo male pt w/ a h/o cirrhosis?

Answer 68

Esophageal varices

Question 69

MCC of hematochezia or lower GI bleeding in adults

Answer 69

Internal hemorrhoids

Question 70

MCC of lower GI bleeding in children:

Answer 70

Meckel diverticulum

Question 71

MCC of lower GI bleeding in children:

Answer 71

Meckel diverticulum

Question 72

An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal "thumbprinting" changes.

Answer 72

Ischemic colitis

Question 73

An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal "thumbprinting" changes. Dx?

Answer 73

Ischemic colitis

Question 74

An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal "thumbprinting" changes. Dx?

Answer 74

Ischemic colitis

Question 75

An umbilical metastasis manifesting as periumbilical LAD from an internal malignancy.

Answer 75

Sister Mary Joseph node

Question 76

What is a common cause of acute abdominal pain in illicit drug users?

Answer 76

Acute mesenteric ischemia

Question 77

What is a common cause of acute abdominal pain in illicit drug users?

Answer 77

Acute mesenteric ischemia

Question 78

MCC of gastroenteritis in U.S.:

Answer 78

viruses

Question 79

MCC of childhood diarrhea

Answer 79

Rotavirus

Question 80

MCC of childhood diarrhea

Answer 80

Rotavirus

Question 81

MC bacterial source to infectious diarrhea in the U.S.

Answer 81

Campylobacter jejuni

Question 82

MC parasitic diarrhea infxn in the U.S.:

Answer 82

Giardia lamblia

Question 83

MC parasitic diarrhea infxn in the world?

Answer 83

Amebiasis | Entamoeba histolytica

Question 84

MC parasitic diarrhea infxn in the world?

Answer 84

Amebiasis | Entamoeba histolytica

Question 85

Pellagra is caused primarily by a deficiency of what nutrient?

Answer 85

Niacin

Question 86

What are the 3 Ds of pellagra?

Answer 86

Dermatitis Dementia Diarrhea

Question 87

Rickets is assoc. w/ a deficiency of what vitamin?

Answer 87

Vitamin D

Question 88

Rickets is assoc. w/ a deficiency of what vitamin?

Answer 88

Vitamin D

Question 89

A 38-yo male pt presents w/ anorexia, lethargy, arthralgias, & swollen gums. What vitamin deficiency may be present?

Answer 89

Vitamin C (scurvy)

Question 90

Deficiencies in either of these 2 micronutrients may cause paresthesias, tetany, seizures, or arrhythmia:

Answer 90

Calcium or magnesium

Question 91

Deficiencies in either of these 2 micronutrients may cause paresthesias, tetany, seizures, or arrhythmia:

Answer 91

Calcium or magnesium

Question 92

Night blindness may be assoc. w/ what vitamin deficiency?

Answer 92

Vitamin A

Question 93

What is the MC digestive complaint in the U.S.?

Answer 93

Constipation