GIT 1

Question 1

First line therapy for Diffuse esophageal spasm and Hypertensive peristalsis (Nutcracker Esophagus)

Answer 1

CCB ( Diltiazem)

Question 2

Hepatitis A: ________ correlates with ↑ mortality

Answer 2

a significant prolonged PT

Question 3

Hepatitis A labs
Early changes:
Late chabges:

Answer 3

Early:↑ ALT, AST

Several days later: Bilirubin and ALP increase

Question 4

Hepatitis A jaundice occurs _______

Answer 4

within 2 weeks.

not so early

Question 5

Acute liver failure diagnostic criteria

Answer 5

1. HE
2. Synthetiv liver function INR >1.5
3. ALT, AST >1000

Question 6

Most important prognostic factor for ALF is

Answer 6

PT

Question 7

Diagnosis of acute pancreatitis requires tests….

Answer 7

First: Amylase, lipase
second: CT with contrast

Abdominal USG for identifying cause

Question 8

Precipitating factors of hepatic encephalopathy:

Answer 8

Hypovolemia
Hypokalemia
Infection

Question 9

Hepatic encaph treatment steps

Answer 9

1. Supportive (volume repletion and electrolyte correction)
2. Adequate nutrition without protein-restricted diet
3. Treat precipitating causes
4. Lower serum ammonia —– Lactulose. If no improvement in 48 hours with lactulose then Rifamixin
   Neomycin if unable to take rifamixin

Question 10

SAAG <1.1 indicates?

Conditions?

Answer 10

↑ capillary permeability

TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome

Question 11

Gastric carcinoma evaluation?

Answer 11

1. EGD
2. CT scan of abdomen to reveal mets
3. H. Pylori removal before cancer removal to avoid future adenocarcinoma.

Question 12

Acute cholecystits vs Acute cholangitis:

Answer 12

Acute cholecystitis: No inc. bilirubin and ALP
USG shows thick gallbladder wall and pericholecystic fluid

Acute cholangitis: inc. bilirubin, inc. ALP.
Jaundice, RUQ pain, fever (Charcot triad)
USG shows biliary dilation

Question 13

Bilirubin and aminotransferases in acetaminophen toxicity:

Answer 13

Indirect bilirubin

aminotransferases >3000

Question 14

HEPATIC HYDROTHORAX

Best option for treatment:

Answer 14

liver transplant

Question 15

HEPATIC HYDROTHORAX

Primary treatment:

Answer 15

thoracocentesis followed by diuresis and salt restriction no response→ TIPS→
TIPS contraindicated→ pleurodesis

Question 16

Hepatic transplant is treatment for:

Answer 16

HEPATORENAL SYNDROME
HEPATIC HYDROTHORAX
CRIGGLER NAJJAR SYNDROME - Type 1
BILIARY ATRESIA

Question 17

Mycophenolate is discontinued in _____

Answer 17

patients with active infection due to risk of neutropenia.

Question 18

Ursodeoxycholic acid is treatment of

Answer 18

PBC

Question 19

Surveillance USG in cirrhotic patients

Answer 19

every 6 months to exclude a mass.

Question 20

Eosinophilic esophagitis

treatment:

Answer 20

Dietary modification

± Topical glucocorticoids

Question 21

Eosinophilic esophagitis

Diagnosis:

Answer 21

Endoscopy & esophageal biopsy (≥15 eosinophils per high-power field)

Question 22

Diagnosis of pancreatic cancer is made by

Answer 22

Abdominal ultrasound (if jaundiced) or CT scan with contrast (if no jaundice)

Question 23

Primary biliary cholangitis

Complications:

Answer 23

1. Malabsorption, fat-soluble vitamin deficiencies
2. Metabolic bone disease (osteoporosis, osteomalacia)
3. Hepatocellular carcinoma

Question 24

Packed red blood cell transfusions are recommended in

Answer 24

• acute gastrointestinal bleeding for patients with hemoglobin <7 g/dL.
• A higher threshold of hemoglobin <9 g/dL is considered for unstable patients with acute coronary syndrome or with active bleeding and hypovolemia.

Question 25

Platelet transfusions are typically given for a platelet count

Answer 25

• <10,000/mm3 (increased risk of spontaneous hemorrhage)

or

• for a platelet count <50,000/mm3 with active bleeding.

Question 26

Treatment of Clostridioides difficile infection

• Fulminant
(eg, hypotension/shock,
ileus, megacolon)

Answer 26

• Metronidazole IV plus high-dose vancomycin PO (or PR if ileus is present)
• Surgical evaluation

Question 27

Treatment of Clostridioides difficile infection

• Recurrence

Answer 27

• First recurrence
Vancomycin PO in a prolonged pulse/taper course
OR
Fidaxomicin if vancomycin was used in initial episode
• Multiple recurrences
Vancomycin PO followed by rifaximin (or above regimens)
Fecal microbiota transplant

Question 28

Pancreatic cysts radiographic features are associated with higher risk for malignancy, including:

Answer 28

Large size (≥3 cm)
Solid components or calcifications
Main pancreatic duct involvement (ie, ductal dilation)
Thickened or irregular cyst wall

Question 29

______ is the test of choice for diagnosis of IBD

Answer 29

Colonoscopy with biopsies

Question 30

The diarrhea is typically large in volume and persists while fasting and at night.

Answer 30

Secretory diarrhea occurs due to
1. toxins (eg, produced by Vibrio cholerae),
2. hormones (eg, produced by VIPomas),
3. congenital disorders of ion transport (eg, cystic fibrosis),
or
4. bile acids (in postsurgical patients)
5. Microscopic colitis

Question 31

pH of pleural fluid
• Empyema and pulmonary tuberculosis
• pancreaticopleural fistula (PPF)
• Normal pH

Answer 31

• Empyema and pulmonary tuberculosis low pH (<7.30)
• pancreaticopleural fistula (PPF) 7.3 - 7.5
• Normal pH: 7.6

Question 32

Treatment of microscopic colitis:

Answer 32

withdrawal of triggering medications.

If diarrhea persists, budesonide and antidiarrheal medications (eg, loperamide)