Jeopardy questions

Question 1

This ligament separates upper vs lower GI bleed

Answer 1

ligament of Treitz

Question 2

A 68-year-old male presents to the ED with bright red rectal bleeding. Symptoms started about 6 hours ago, and since that time he has passed 6-7 diarrheal stools mixed with bright red blood. He complains of weakness and dizziness but not abdominal pain or vomiting. He had routine colonoscopy about 9 years ago, which he reports as normal. The patient denies any previous gastrointestinal issues. Vital signs are stable. What is the most likely source of his rectal bleeding?

Answer 2

Diverticular bleeding

Question 3

A 67 year old female presents with melena and a fall in hemoglobin. What is the minimal amount of blood lost via the GI tract for melena to be present?


A- 50 ml

B- 100ml

C-150ml

D-300 ml

Answer 3

50 ml

Question 4

A 26-year-old man has hx of ulcerative colitis. He now presents with a 5-day hx of bloody diarrhea and abdominal pain. All of the following are true about this patient condition, EXCEPT:



A. Total parental nutrition is not effective as primary therapy

B. Sulfasalazine can be effective in maintain remission, as well as in acute disease

C. If he responds to a corticosteroid, he should be maintained on it indefinitely

D. Sclerosing choalangitis may be an associated conditions

Answer 4

C. If he responds to a corticosteroid, he should be maintained on it indefinitely

Question 5

A 72 year old patient with a history of PVD comes to the ED with abdominal pain and bloody diarrhea. Abdminal discomfort is diffuse and crampy x 2 days and today the patient had 2-3 diarrheal stoold mixed with bright red blood. The patient denied recent foreign travel and contaminated food exposure. Which of the following conditions is high on the differential dx for this patient?



A. Hemorrhoids

B. Gastroenteritis

C. Mesenteric Ischemia

D. Ischemic Colitis

Answer 5

D. Ischemic Colitis

Question 6

A 25-year-old women presents with recurrent abdominal pain 2-3 days per week for the past 4 months. The patient also notes diarrhea, which seems to improve the abdominal pain. The patient denies any rectal bleeding or relationship between abdominal pain and her diet or exercise. What is the most likely dx?


A. Celiac Disease

B. Ischemic Colitis

C. Ulcerative Colitis

D. Irritable Bowel Syndrome

Answer 6

D. Irritable bowel syndrome

Question 7

TRUE or FALSE


Acute gastritis can be the result of chronic daily intake of NSAIDS?

Answer 7

True

Question 8

You are evaluating a patient with RLQ abdominal pain. On exam the patient has a positive iliopsoas sign. What is the most likely dx?

Answer 8

Acute Appendicitis

Question 9

A patient with epigastric pain that is unrelieved by antacids presents for evaluation by a nurse practitioner. He has a positive urea breath test. The NP prescribes amoxicillin, metronidazole, clarithromycin and omeprazole. How many days should the NP prescribe these for?

Answer 9

14 days

Question 10

Which two antihypertensive agents are recommended for patients with HTN and albuminuria?

Answer 10

ACE-I and ARB’s

Question 11

BECK’s TRIAD consists of the following symptoms/PE findings:



A. Kussmaul sign, pericardial knock and hypotension


B. Hypotension, JVD and muffled heart sounds


C. Dyspnea, tachycardia and pulsus paradoxus 



Answer 11

B. Hypotension, JVD and muffled heart sounds.

Question 12

This non-didhydropyridine CCB has the strongest negative inotropic effect and should be avoided in heart failure

Answer 12

Verapamil or Enapril

Question 13

A 64-year-old male presents with claudication. Ankle-brachial indices are consistent with PAD. Which of the follow is true about risk factors for PAD?



A. Renal insufficiency is a risk factor

B. Smoking is the only known risk factor

C. Diabetes insipidus is a risk factor

D. Liver disease is a risk factor

Answer 13

Renal insufficiency

Question 14


A 75-year-old women presents her cardiology NP with increasing SOB over the past year. Auscultation revelas a 2/6 apical diastolic murmur, a 3/6 systolic murmur at the right upper sternal boarder, and JVD. ECG shows a-fib. What feature in this patients hx explains her presentation?



A. Bicuspid aortic valve

B. Severe aortic stenosis

C. Ebstein anomaly

D. Hx Streptococcal throat infections

Answer 14


D. Hx Streptococcal throat infections

Question 15

A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?


A. Initiate fibrinolytic treatment.

B. Transfer to the PCI-capable institution.

C. Give the patient an oral beta blocker.

D. Administer heparin.

Answer 15

A. Initiate fibrinolytic treatment.

Question 16


When compared to anticoagulation (AC) for patients with intermediate or high-risk pulmonary embolism (PE), what may catheter-directed thrombolysis (CDT) result in?


A. Higher Risk of Death


B. High Risk of Intracranial hemorrhage


C. Lower risk of death


D. Lower risk of GI bleeding

Answer 16

C. Lower risk of death

Question 17

Cardiac function is compromised from a pericardial effusion due to this?

Answer 17

Decreased diastolic filling

Question 18

Mrs. S is a 75 year old women with hx of hypothyrioidms and CHF. She has become very short of breath when doing the dishes and vacuuming. She has been unable to care for the house or cook as a result. She no longer walks to the mailbox. She denies any symptoms at rest. Which New York Heart Association (NYHA) functional class is her heart failure?

Answer 18

Class III

Question 19

A 50 year old male is admitted to the ICU for STEMI post stent placement 2 days ago. On exam he is tachypneic with a BP or 70/40 and 02 saturation of 88% on RA. The patient appears pale, and his extremities are cool to touch. Lung sounds are clear. Cardiac sounds are nml and rhythm is regular. There is no JVD. ESR and c-reactive protein are nml. The monitor reveals ventricular tachycardia and evolves to vfib?
What is the most likely cause of this?

Answer 19

ACS d/t stent thrombosis

Question 20

True or False


In a transplanted organ, chronic rejection is only cell mediated

Answer 20

B. False, usually T cell mediated

Question 21

Tumor lysis syndrome is an oncologic emergent resulting from the breakdown of malignant cells. Rapid accumulation of uric acid often results in AKI leading to which two MAJOR electrolyte abnormalities?

Answer 21

Hyperkalemia and Hyperphosphatemia

Question 22

Your patient, a 62 year old male s/p heart transplant 5 days ago now has a HR of 38 bpm. He c/o feeling lightheaded. What treatment would you order?


A. Atropine

B. High-dose isoproterenol

C. Adenosine 
D. Transcutaneous pacing 


Answer 22

D. Transcutaneous pacing

Question 23

An anastomotic leak is a dreaded complication for patients who undergo colorectal surgery. Which anastomosis has the highest rate of postoperative leakage?


A. Rectal anastomoses

B. Colonic anastomoses

C. Ileocolic anastomoses

D. All anastomoses have equal rates of leakage

Answer 23


A. Rectal anastomosis
Risk for leaks are highest for most distal anastomoses.