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Primary GI > Knowmedge - GI > Flashcards

Knowmedge - GI Flashcards

1
Q

If a patient with inflammatory bowel disease is found to have dysplasia on colonoscopy, what is the best next step in management?

A

Proctocolectomy

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2
Q

Which extra-intestinal manifestions can mirror inflammatory bowel disease?

A

Arthritis and Erythema Nodosum

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3
Q

What 2 steps should be performed after patients undergo cholecystectomy and still complain of right upper quadrant pain?

A

Liver function tests and a Right upper quadrant (RUQ) ultrasound

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4
Q

What is the pattern of dysphagia with mechanical causes?

A

Solids initially and can progress to liquids later

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5
Q

What is the most common cause of death in patients with hemochromatosis?

A

Liver cirrhosis

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6
Q

OCPs are associated with which hepatic pathology?

A

Hepatic adenoma

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7
Q

What should be checked in individuals with refractory hypothyroidism, despite being compliant on medication?

A

Celiac panel

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8
Q

What are treatment options for achalasia?

A

Pneumatic dilatation or Surgical myotomy or Botulinum toxin

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9
Q

Patients with hepatitis C who have undergone a liver transplant and have never been treated for HCV are at an increased risk of what diagnosis immediately after surgery?

A

Recurrent HCV infection immediately after surgery

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10
Q

Cigarette smoking is associated with which type of esophageal cancer?

A

Squamous cell carcinoma of the esophagus

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11
Q

What are the red flag symptoms that should be ruled out before a diagnosis of irritable bowel syndrome is made?

A

Unintentional weight loss, fevers, nocturnal symptoms, and blood in the stool

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12
Q

HbSAg is positive. Which hepatitis B marker will indicate chronicity or carrier state of infection?

A

HB core IgG being positive

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13
Q

What are 5 major causes of elevated Transferrin saturation?

A

Hemochromatosis, Excessive alcohol use, Fatty liver disease, Neoplasm, Hepatitis C infection

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14
Q

How long does 6-mercaptopurine usually take to exert an effect?

In benign postoperative cholestasis, is direct bilirubin elevation greater or indirect bilirubin elevation?

A

Direct biliru
Three months
bin elevation

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15
Q

What is the next step for patients presenting with uncontrolled reflux symptoms (despite medical therapy) and progressive dysphagia?

A

What is the next step for patients presenting with uncontrolled reflux symptoms (despite medical therapy) and progressive dysphagia?

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16
Q

What is the class of anti-hypertensive medications used to treat Raynaud’s phenomenom?

A

Calcium channel blockers

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17
Q

What is the oral antihypertensive of choice in patients presenting with hypertension & Raynaud’s syndrome?

A

Calcium channel blockers

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18
Q

What is the gold standard for diagnosing small intestinal bacterial overgrowth?

A

Endoscopy with jejunal aspirate

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19
Q

If the transaminase level is greater than what number is a non-alcohol process at play?

A

AST > 500 U/L

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20
Q

What are the most and 2nd most common tumors of the liver?

A

Hepatic hemangioma is the most common tumor of the liver. Focal nodular hyperplasia is the second most common tumor of the liver.

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21
Q

What anti-hypertensive treatment can be used in the treatment of diffuse esophageal spasm (DES)?

A

Calcium channel blockers

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22
Q

Which is NOT an indication for repeat colonoscopy in 3 years: 2 Adenomas, Polyp size >1cm, High grade dysplasia, or Villous component?

A

Which is NOT an indication for repeat colonoscopy in 3 years: 2 Adenomas, Polyp size >1cm, High grade dysplasia, or Villous component?

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23
Q

What prophylactic antibiotic is recommended for infective endocarditis patients undergoing GI or GU procedures?

A

No prophylactic antibiotic is recommended for patients undergoing GI or GU procedures

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24
Q

What test can be performed to confirm eradication of Helicobacter pylori?

A

Stool antigen or Urea breath test (not H. pylori serology)

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25
Q

What is the most common cause of fulminant hepatic failure in US?

A

Acetaminophen toxicity

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26
Q

Which cancer are patients with primary sclerosing cholangitis (PSC) at greater risk of developing?

A

Cholangiocarcinoma

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27
Q

How long does 6-mercaptopurine usually take to exert an effect?

A

Three months

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28
Q

If symptoms persist after 6 weeks of proton pump inhibitor therapy in a patient suspected of having GERD but without alarm symptoms, what is the appropriate next step?

A

If symptoms persist after 6 weeks of proton pump inhibitor therapy in a patient suspected of having GERD but without alarm symptoms, what is the appropriate next step?

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29
Q

At what portal vein pressure does clinically significant portal hypertension occur?

A

HVPG is ≥10

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30
Q

What broad spectrum antibiotic can cause discoloration of teeth in children?

A

Doxycycline

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31
Q

Cryoglobulinemia can be associated with what hepatitis infection?

A

Hepatitis C infection

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32
Q

Patient is found to have positive antibodies to soluble liver antigen (SLA). What condition does this patient likely have?

A

Autoimmune hepatitis (which also has anti-smooth muscle antibodies)

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33
Q

How can chronic pancreatitis lead to gastric varices?

A

Chronic pancreatitis can lead to inflammation of the nearby splenic vein leading to thrombosis, which subsequently causes portal hypertension and gastric varices.

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34
Q

Is H. pylori infection more often associated with gastric or duodenal ulcers?

A

Duodenal ulcers

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35
Q

Patient has hepatitis C and is being treated with IFN therapy. LFTs are re-checked and are worsening. What undiagnosed condition does the patient also likely have?

A

Autoimmune hepatitis

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36
Q

What medication is best used to manage pain associated with chronic pancreatitis?

A

Pain medication begins with nonopioids (like acetaminophen, ibuprofen, or both).
If nonopioids do not relieve pain, mild opioids (like codeine) are given.
If mild opioids do not relieve pain, strong opioids (like morphine) are given.

  • See more at: http://www.pancreasfoundation.org/patient-information/chronic-pancreatitis/chronic-pancreatitis-pain-management-and-treatment/#sthash.PsyxYJcP.dpuf
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37
Q

What part of the stomach is usally excluded in Type A chronic gastritis?

A

Antrum of stomach

Type A gastritis primarily affects the body/fundus of the stomach, and is more common with pernicious anemia.

Type B gastritis (most common overall) primarily affects the antrum, and is more common with H. pylori infection.

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38
Q

Along with percutaneous drainage as a treatment for infected pancreatic necrosis, which antibiotic is most commonly recommended?

A

Imipenem or other carbapenem

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39
Q

What complication of pancreatitis is related to the interference of ductal function and is asymptomatic in the majority of patients?

A

Pseudocysts

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40
Q

The hepatitis A vaccine is an inactivated virus that is given in two doses usually separated by ___ months.

A
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41
Q

Post bariatric surgery, which of the following likely indicates an anastomotic leak: Fever, Leukocytosis, Heart rate greater than 120/min or Abdominal tenderness?

A

HR greater than 120/minute

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42
Q

What is the preferred treatment for Giardiasis?

A

Metronidazole orally three times daily for 5-7 days

What is the most common cause of drug induced liver failure in US?

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43
Q

What is the most common cause of drug induced liver failure in US?

A

Acetatinophen

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44
Q

Which antibody test is often associated with Primary Biliary Cirrhosis?

A

AMA (Anti-Mitochondrial Antibody)

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45
Q

What gene mutation is associated in patients who have Familial Adenomatous Polyposis (FAP)?

A

APC germline mutation

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46
Q

The transferrin saturation is a sensitive test for hemochromatosis in the setting of elevated transaminase levels. Transferrin saturation greater than ____% is suggestive of hemochromatosis.

A

The transferrin saturation is a sensitive test for hemochromatosis in the setting of elevated transaminase levels. Transferrin saturation greater than 45% is suggestive of hemochromatosis.

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47
Q

What is the most common composition of salivary gland stones?

A

Calcium phosphate

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48
Q

How much reduction of hepatitis C viral load should be seen at 12 weeks to continue treatment?

A

2 log reduction. If this occurs, chances of sustained viral response is high. If not, chances of sustained viral response is low.

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49
Q

True or False: Leukocytosis is commonly seen with diverticulitis

A

True; On laboratory studies, more than half of patients with diverticulitis have leukocytosis.

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50
Q

If metastasis is ruled out in a patient with esophageal cancer, what is the next step?

A

Endoscopic ultrasound to assess for local spread

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51
Q

When should a screening coloscopy be repeated in a patient with a polyp having a tubular component on biopsy?

A

5 years

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52
Q

What pill characteristics are at increased risk of causing pill-induced esophagitis?

A

Larger, round-shaped, and extended-release formulations

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53
Q

What tests may be performed if ultrasound is normal but there is high suspicion that a patient has choledocholithiasis?

A

MRCP, ERCP, or Endoscopic ultrasound

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54
Q

Name three reasons to start antibiotic prophylaxis in cirrhotic patients.

A

History of Spontaneous Bacterial Peritonitis, Esophageal varices, and Ascites protein level less than 1 gram/dl

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55
Q

Thumbprinting is characteristically seen on a kidney-ureter-bladder xray in what condition?

A

Ischemic colitis

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56
Q

Pancreatic necrosis should be considered in patients with pancreatitis not improving within what timeframe?

A

Five or more days

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57
Q

What is the most common location of colonic diverticula ?

A

Sigmoid colon

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58
Q

Skip lesions are seen in which form of inflammatory bowel disease?

A

Crohn’s disease

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59
Q

Young patients who have intermittent dysphagia to solid foods such as bread or meats are likely to have what condition?

A

Schatzki or lower esophageal ring

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60
Q

How is Mallory-Weiss tear managed?

A
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61
Q

How do you differentiate chronic hepatitis B infection from the carrier state?

A
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62
Q

What are the top two causes of pancreatitis in the United States?

A

1 Alcoholism #2 Gallstones

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63
Q

Patient less than 40 is found to have numerous fundus gastric polyps. What syndrome needs to be ruled out in this patient?

A

Familial Adenomatous Polyposis Syndrome

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64
Q

What are common signs and symptoms seen in esophageal cancer?

A

Signs and symptoms of esophageal cancer include dysphagia (difficulty swallowing), odynophagia (painful swallowing), weight loss, cough or hoarseness.

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65
Q

Patient is found to have a 8mm villous adenoma in the transverse colon. When should a colonosopy be repeated?

A

3 years from now. Any polyp that is 1cm or greater or is a villous adenoma should have a repeat colonosopy in 3 years

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66
Q

Patient has a condition in which the lower esophageal sphincter (LES) fails to relax. What is the likely condition and the initial diagnostic test to perform?

A

Condition is achalasia and the initial diagnostic test is a barium swallow, which will show “bird beak” sign.

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67
Q

Where is hepatitis E endemic?

A

Mexico, the Indian subcontinent and Southeast Asia

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68
Q

Treatment of MALT requires eradication of what organism?

A

Heliobacter Pylori (H. pylori)

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69
Q

What is the treatment for MILD factor VIII deficiency?

A

Desmopressin

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70
Q

Achalasia can be associated with what disease?

A

Chagas Disease

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71
Q

What is the most common clinical presentation of autoimmune pancreatitis?

A

Painless, obstructive jaundice is the most common clinical presentation of autoimmune pancreatitis.

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72
Q

A young patient has chronic, unresponsive iron deficiency anemia and bulky, foul smelling stools. What is the likely diagnosis?

A

Celiac Disease or Hookwork Infection

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73
Q

What does the PMN or WBC count in the ascites fluid need to be in order to diagnose SBP?

A
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74
Q

What is the weak point from where protrusion of mucosa takes place in diverticulosis?

A
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75
Q

Of the three major forms of hepatitis, which does not currently have a vaccine against it?

A
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76
Q

In alcoholic hepatitis, which is greater: AST or ALT and by what ratio?

A

AST in a 2:1 ratio or greater

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77
Q

Patient with chronic diarrhea that does not improve with fasting is found to have a high stool osmolar gap. What is the likely diagnosis?

A

Laxative abuse

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78
Q

Rectal bleeding is a common symptom in (Diverticulitis or Diverticulosis?)

A
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79
Q

What is the most likely diagnosis in diabetic patient with diarrhea, weight loss, flatulence and vitamin A, D, B12 deficiencies?

A

Small intestinal bacterial overgrowth

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80
Q

What is the prefered treatment for microscopic colitis?

A
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81
Q

What demographic is most commonly affected by primary biliary cirrhosis (PBC): young males, young females, middle-aged males, middle-aged females, elderly males, elderly females?

A

Middle-aged females

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82
Q

Decreased or absent glucoronyl transferase level in the liver–often resulting from infection, trauma, stress, starvation, or surgical procedures–indicates what condition?

A

Gilbert syndrome

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83
Q

If a small bowel biopsy cannot be performed, what is another way to diagnose Whipple’s disease?

A

CSF fluid analysis with PCR

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84
Q

How are the vitamin B12, vitamin D, and folate levels affected in bacterial overgrowth syndrome?

A

Vitamin B12 low, Vitamin D low, Folate high (due to production by bacteria)

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85
Q

What type of a diet is recommended for patients with chronic pancreatitis?

A

Patient is HCV RNA+, Upcoming travel to endemic area, Patient with chronic liver disease, Male patients who have sex with men, Users of illicit drugs, Patients with blood clotting disorders

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86
Q

What medication that can worsen depression is also contraindicated in autoimmune hepatitis?

A
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87
Q

Approximately what percentage of patients with gallstones will develop cholangiocarcinoma?

A

1-3%

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88
Q

Bluish discoloration around the umbilicus in pancreatitis patients is known as what sign?

A
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89
Q

Which hepatitis infection can’t exist on its own and requires active hepatitis B infection?

A
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90
Q

With what condition are anti-mitochondrial antibodies often associated?

A
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91
Q

What type of triglycerides may be recommended in the diet for a patient with chronic pancreatitis?

A
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92
Q

Which type of glomerulonephritis is common in patients with hepatitis B?

A

Membranous glomerulonephritis

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93
Q

What are the extrahepatic manifestations of hepatitis B infection?

A

Serum sickness like syndrome, glomerulonephritis, polyarthritis, polyarteritis nodosa, dermatologic manifestations (bullous pemphigoid, lichen planus, Gianotti-Crosti syndrome), cryoglobulinemia, neurological manifestations like Guillian Barre syndrome, psychological conditions like depression & psychosis

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94
Q

Which is LEAST likely a risk factor for adenocarcinoma of the esophagus: Uncontrolled GERD, Smoking, or Obesity?

A

Smoking. This increases chances of squamous cell carcinoma of the esophagus.

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95
Q

What kind of anemia are patients with celiac disease at an increased risk of developing and why?

A
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96
Q

What are indications for receiving Hepatitis A vaccine?

A

Patient is HCV RNA+, Upcoming travel to endemic area, Patient with chronic liver disease, Male patients who have sex with men, Users of illicit drugs, Patients with blood clotting disorders

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97
Q

What is the treatment of choice in patients with hemochromatosis?

A

Phlebotomy

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98
Q

When should we consider iron chelation therapy for patients with hemochromatosis?

A

In patients who cannot be managed with phlebotomy, and in anemic patients who have hemochromatosis from overtransfusion (eg. Thalassemia)

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99
Q

Which gender is more at risk of progression of hepatitis C infection to cirrhosis?

A

Male gender

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100
Q

Which genetic abnormality is associated with Wilson’s disease?

A

ATP7B

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101
Q

What is the definition of Transferrin saturation?

A

Ratio of serum iron and total iron binding capacity, multiplied by 100

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102
Q

What is the AST:ALT ratio typically in alcoholic hepatitis?

A

Greater than 2:1

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103
Q

Prior to performing pneumatic dilatation for achalasia, what needs to be performed?

A

EGD for biopsy to rule out lymphoma or cancer (Pseudoachalasia)

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104
Q

What on labwork may be an earlier inidcator of Vitamin B12 deficiency than a low B12 level?

A

Elevated methylmalonic acid and homocysteine levels

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105
Q

What marker is associated with ovarian cancer?

A

Cancer antigen (CA) 125

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106
Q

What are 5 main scenarios in which a surgery referral should be considered in a patient with diverticulitis?

A

Recurrent bouts of diverticulitis, CT abdomen reveals obstruction, Abscess formation, Fistula, or Perforation

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107
Q

Which is LEAST likely when a patient has a SAAG of 2.1 g/dL: Liver cirrhosis, Budd-Chiari Syndrome, or Nephrotic syndrome?

A

Nephrotic syndrome

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108
Q

What does anti-Hepatitis A virus IgG (+) indicate?

A
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109
Q

What advantage does ERCP have over MRCP in patients with choledocholithiasis?

A

ERCP allows removal of the stone

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110
Q

Which antiretroviral is associated with nephrolithiasis?

A
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111
Q

Post-gastrectomy patients experiencing diarrhea, bloating, nausea and tachycardia after eating most likely have what condition?

A

Dumping syndrome

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112
Q

Which would NOT require a repeat colonoscopy in 3 years: Greater than three adenomas, Villous morphology, or Tubular morphology?

A

Tubular morphology would not require repeat colonoscopy in 3 years.

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113
Q

Blood transfusion occurring before what year can be a risk factor for hepatitis C?

A

Blood transfusion prior to 1992

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114
Q

What are some common symptoms seen in diverticulitis?

A

● Lower left sided abdominal pain (often severe and sudden)
● Fever
● Change in bowel habits
● Constipation
● Diarrhea
● Bloating

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115
Q

What is the best diagnostic modality to order when diverticulitis is suspected?

A

CT scan of the abdomen with IV contrast

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116
Q

What is the best initial test to diagnose spontaneous bacterial peritonitis?

A

Ascitic fluid neutrophil count (> 250 neutrophils)

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117
Q

What is the mechanism by which patients with Zollinger-Ellison syndrome develop steatorrhea?

A
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118
Q

Which agent is not used in the management of Ulcerative Colitis: Mesalamine, Methotrexate, Corticosteroids, or 6-MP?

A

Methotrexate can be used for Crohn’s Disease but does not work for Ulcerative Colitis

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119
Q

What class of anti-depressant medication used to treat urge incontinencecan also cause constipation?

A

Tricyclic antidepressants

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120
Q

What are the 4 main conditions that can result from compromised blood flow to the gastrointestinal tract?

A

Ischemic colitis, Acute mesenteric ischemia, Chronic mesenteric ischemia and Mesenteric vein thrombosis

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121
Q

In patients with short bowel syndrome, what causes greasy and foul-smelling stools?

A

Bile acid malabsorption

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122
Q

When should colonoscopies be initiated for colorectal cancer screening in patients with ulcerative colitis?

A

Surveillance begins eight years after diagnosis

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123
Q

Enteral feedng for patients with severe acute pancreatitis consists of a tube that passes what anatomical landmark?

A

The Ligament of Treitz, avoiding pancreatic stimulation

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124
Q

Which is LEAST likely to be seen in Wilson Disease: Elevated aminotransferases, Decreased ceruloplasmin, Increased alkaline phosphate, or Hemolytic anemia?

A

Increased alkaline phosphate is least likely to be seen. The alkaline phosphatase level is generally either normal or decreased.

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125
Q

________ years after diagnosis of ulcerative colitis, patients should have a colonoscopy done every ____ to _____ years.

A

Eight years after diagnosis of disease, it is recommended the patient get a colonoscopy every one to two years

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126
Q

What malignancy are patients with celiac disease at an increased risk of developing?

A

Lymphoma

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127
Q

What is an effective medication with low side effect profile used against Crohn’s disease?

A

Mesalamine

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128
Q

What is the likely diagnosis when foamy macrophages on a Periodic acid-Schiff (PAS) stain of small bowel biopsy?

A

Tropheryma whipplei infection causing Whipple’s disease

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129
Q

Not being vaccinated against which organism is a risk factor for parotitis?

A

Mumps virus

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130
Q

What is the likely diagnosis in a patient who has long standing history of GERD and dysphagia to solids first and liquids later?

A

Esophageal stricture

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131
Q

True or False: Patients with hemochromatosis can develop arthropathy involving the 2nd and 3rd DIP joints

A

False; The arthropathy that you can see in hemochromatosis involves the 2nd and 3rd MCP joints.

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132
Q

Patient found to have 3 adenomas on colonoscopy. When should repeat test be performed?

A

3 years

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133
Q

Patient has Kayser-Fleischer rings. What would you expect serum copper, ceruloplasmin, and urine copper levels to be? (High, low or unchanged)

A

KF rings = Wilson’s disease. Low serum copper, Low ceruloplasmin, and High urinary copper.

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134
Q

What condition should be considered if a patient with primary sclerosing cholangitis develops clinical signs of decompensation?

A

Cholangiocarcinoma

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135
Q

Patient has bloody diarrhea, tenesmus, and abdominal pain. Colonscopy shows superficial ulcerations with crypt abscesses. Likely diagnosis?

A

Ulcerative colitis

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136
Q

The genetic form of hemochromatosis has an autosomal recessive inhertiance pattern and is due to _____ and ______ mutations in the HFE gene.

A

The genetic form of hemochromatosis has an autosomal recessive inhertiance pattern and is due to C282Y and H63D mutations in the HFE gene.

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137
Q

What is the most common screening test for Wilson Disease?

A

Serum ceruloplasmin levels (these levels will be decreased)

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138
Q

Hypertensive patient has esophageal varices. Of the following, which medication can be used: Nadolol, Lisinopril, or Verapamil?

A

Nadolol

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139
Q

In which gender is eosinophilic esophagitis more common?

A

Male

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140
Q

What lab test is the hallmark of autoimmune hepatitis?

A

Anti-smooth muscle antibodies

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141
Q

What does HBsAg(+) indicate and in what 3 states is it positive?

A

Infection. It will be positive in Acute hepatitis, Chronic hepatitis, Carrier state.

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142
Q

How often should colonoscopies be performed in patients with colorectal cancer?

A

Every 1-2 years

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143
Q

Which hepatitis is the only one to be DNA-based?

A

Hepatitis B is a DNA-based virus. Hepatitis A, hepatitis C, hepatitis D, and hepatitis E are all RNA-based viruses.

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144
Q

Which of the following is not a known cause of pancreatitis: Azathioprine, Steroids, Gallstones or TG level of 450mg/dL?

A
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145
Q

Anti-soluble liver antigen, anti-smooth muscle or anti-LKM can be associated with what condition?

A

Autoimmune hepatitis

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146
Q

What do you expecte on labs in Wilson’s disease: (High/low) Ceruloplasmin, (High/low) Urine copper?

A

Low ceruloplasmin, High urine copper

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147
Q

How do you differentiate HDV coinfection & superinfection?

A

Both conditions will have anti HDV antibodies but in addition coinfection will have anti-HBc IgM antibody while superinfection will have anti-HBc IgG antibody.

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148
Q

What marker is used to check for the recurrence of colon carcinoma?

A

Carcinoembryonic antigen (CEA)

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149
Q

True or False: Any female with a hepatic adenoma who is pregnant or is seeking pregnancy should have the adenoma resected.

A

True; Hepatic adenoma can cause intraperitoneal bleeding especially in females seeking pregnancy or who are pregnant.

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150
Q

Which is incorrect for autoimmune hepatitis: Affects younger women, Anti-smooth muscle antibodies can be positive, Can progress to cirrhosis, or Responds well to IFN?

A

Responds well To IFN

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151
Q

Middle aged female is found to have positive anti-mitochondrial antibodies. What is the best management for this condition at this time?

A

Ursodeoxycholic acid (Ursodiol)

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152
Q

What 3 main molecules cause the secretion of gastric acid from parietal cells?

A

Acetylcholine, Gastrin, and Histamine

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153
Q

HbsAg (+), Hbc Ab IgG (+) and HbeAg (+). How can this be interpreted?

A

Chronic hepatitis B infection in replicative state

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154
Q

What type of diet should be tried in post-gastrectomy patients with diarrhea, bloating, nausea and tachycardia after eating?

A

Trial of high fat and protein diet (with low carbohydrates) and several small meals, which will delay gastric emptying

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155
Q

Which condition that is a risk factor for parotitis is associated with antibodies to SSA (Ro) and antibodies to SSB (La)?

A

Sjogren’s syndrome

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156
Q

What is the staging system used to classify perforated diverticulitis?

A

Hinchey classification system

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157
Q

When should colonoscopy be performed after an episode of diverticulitis?

A

4 to 6 weeks later

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158
Q

What stain is used to detect fecal fat?

A

Sudan stain

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159
Q

Definitive diagnosis of a Mallory-Weiss tear is made by __________.

A

Definitive diagnosis of a Mallory-Weiss tear is made by Esophagogastroduodenoscopy (EGD)

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160
Q

Diet containing what sugar-like compounds can cause diarrhea?

A

High sorbitol or fructose diet

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161
Q

A clue to upper GI bleed would be an abnormally high BUN:creatinine ratio greater than ___:___.

A

30:1

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162
Q

Ascitic fluid containing polymorphonuclear leukocytes (PMNs) greater than this number indicates spontaneous bacterial peritonitis (SBP)?

A

Greater than 250/mm3

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163
Q

What do you expect the urine anion gap to be in cases of diarrhea (positive or negative)?

A

Negative urine anion gap

Usually the most important unmeasured ion in urine is NH4+ since it is the most important form of acid excretion by the kidney.[4] Urine NH4+ is difficult to measure directly, but its excretion is usually accompanied by the anion chloride. A negative urine anion gap can be used as evidence of increased NH4+ excretion. In a metabolic acidosis without a serum anion gap:

A positive urine anion gap suggests a low urinary NH4+ (e.g. renal tubular acidosis).
A negative urine anion gap suggests a high urinary NH4+ (e.g. diarrhea).

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164
Q

What demographic has an increased risk of developing autoimmune hepatitis: Young females, Young males, Middle-aged males, Middle-aged females, Elderly males, Elderly females?

A

Young females

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165
Q

What osmotic agents may be used to treat opioid-induced constipation?

A

Magnesium hydroxide, Lactulose and Polyethylene glycol

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166
Q

What genetic testing is mandatory before starting patient on abacavir?

A

Before initiating treatment with abacavir, patients should undergo testing for HLA B-5701. If positive, then patients are at increased risk of having life threatening hypersensitivity with abacavir

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167
Q

What should be the rate of caloric intake on first day of the refeeding regimen?

A

10 kcal/kg/day

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168
Q

What class of antibiotics can cause Achilles tendon rupture?

A

Fluoroquinolones (e.g. ciprofloxacin or levofloxacin)

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169
Q

What is the name of the congenital anomaly in which the pancreatic duct is not one whole entity but forms the ventral and dorsal duct?

A

Pancreatic divisum

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170
Q

In cases of refractory GERD despite lifestyle modifications and high dose proton pump inhibitors, what is the next step?

A

EGD and Helicobacter pylori testing

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171
Q

What electrolyte abnormality most commonly can cause constipation?

A

Hypercalcemia

172
Q

What would you expect the folate and vitamin B12 levels to be in pts who are diagnosed with bacterial overgrowth?

A

Increased folate levels, decreased Vitamin B12 levels

173
Q

What is the most common cause of hematochezia in patients greater than 60 years of age?

A
174
Q

Triglycerides typically need to exceed what level in order to cause pancreatitis?

A
175
Q

What does anti-Hepatitis A virus IgM (+) indicate?

A

Acute infection; it typically persists for 2-6 months

176
Q

Which is reserved to manage Crohn’s but not ulcerative colitis‎: Corticosteroids, Adalimumab, or Methotrexate?

A

Methotrexate

177
Q

Given that endoscopic retrograde cholangiopancreatography (ERCP) can sometimes worsen acute pancreatitis, when is it indicated in setting of pancreatitis?

A

Evidence of common bile duct dilatation

178
Q

What test is ordered before a patient undergoes Nissen fundoplication for the treatment of GERD?

A

Manometry study to confirm good motility of the esophagus before Nissen is done. If poor motility, achalasia can result.

179
Q

If a patient with ulcerative colitis experiences worsening of symptoms originally controlled on mesalamine now requiring higher steroid doses, what is the best next step in treatment?

A
180
Q

What procedure can be performed in patients with resectable cancers localized to the head of the pancreas?

A

Whipple procedure (also known as pancreaticoduodenectomy)

181
Q

What is the specific antibody blood test for celiac disease?

A

Tissue transglutaminase antibody

182
Q

Post-gallbladder removal, patient has right upper abdominal pain and still has elevated LFTs. What is the next best step in management?

A

Check manometery studies to rule out sphincter of oddi function

183
Q

Patient being treated with IFN for hepatitis C has reduction in HCV RNA but worsening LFTs. What condition has been overlooked?

A

Autoimmune hepatitis. IFN therapy can exacerbate autoimmune hepatitis.

184
Q

What is the lesion caused by constant sliding of hiatal hernia leading to erosions of the crest of gastric folds?

A

Cameron lesion

185
Q

What causes the “Bird’s beak” finding on barium swallow and what is the diagnosis?

A

Dilated esophagus with tapered gastroesophageal junction due to increased lower esophageal sphincter tone; seen in Achalasia

186
Q

Patient with Ulcerative Colitis is found to have elevated alkaline phosphatase levels and total bilirubin levels. What is the likely diagnosis?

A

Primary Sclerosing Cholangitis (PSC)

187
Q

What symptoms are typically associated with Giardiasis?

A

Foul-smelling fatty stools, abdominal cramps, and nausea, which can be so profound that weight loss may occur

188
Q

Which of the following medications is least likely to cause pill-induced esophagitis: Tetracycline, Iron supplements, Bisphosphonate, Levothyroxine, Potassium supplements?

A

Levothyroxine

189
Q

Which antigen is prevalent during replicative phase of hepatitis B in patient sera?

A

HBeAg

190
Q

How does hypergastrinemia occur in Type A atrophic gastritis?

A

The low chloride and gastric acid level from the parietal cells cause a feedback mechanism to increase gastrin levels.

191
Q

Which class of antiretrovirals have dyslipidemia as predominant side effects?

A

Protease inhibitors (although other classes of antiretrovirals can also change lipid profile of patients on HAART)

192
Q

Patient with Crohn’s disease is complaining of a new limp. What complication could this be?

A

Psoas (Iliopsoas) abscess that can occur because of transmural inflammation which occurs with Crohn’s Disease

193
Q

When should a colonoscopy be done after a bout of diverticulitis?

A

About 6 weeks later to prevent perforation of colon

194
Q

Patient has had GERD for 6 weeks on PPI treatment. No alarm features but symptoms are not improving. What is the next best step?

A

24 hour PH ambulatory monitoring

195
Q

Dysphagia to liquids, difficulty in initiating a swallow, coughing and gagging suggest which anatomical category of dysphagia?

A

Oropharyngeal dysphagia

196
Q

Any patient with Crohn’s disease and a new limp must be ruled out for what complication?

A

Psoas (or iliopsoas) muscle abscess

197
Q

What are the drugs used in treatment of HCV infection?

A

Peg-interferon plus ribavarin, telapravir, bocepravir

198
Q

What does IgG Anti-HBc(+) indicate?

A

Hepatitis B Chronic infection, Carrier state, or Cleared state

199
Q

What 2 main molecules inhibit the secretion of gastric acid from parietal cells?

A

Somatostatin and Secretin

200
Q

In Gilbert syndrome, is direct bilirubin elevation greater or indirect bilirubin elevation?

A

Indirect bilirubin elevation

201
Q

What psych medication category can increase the risk of developing salivary gland stones?

A

Phenothiazine antipsychotics

202
Q

Which conditions result in a SAAG < 1.1 g/dl?

A

Infections (except SBP), Cancer, Nephrotic Syndrome

203
Q

What are the two most common causes of acute mesenteric ischemia?

A

Superior Mesenteric Artery (SMA) embolism from the left atrium or Ventricular mural thrombi

204
Q

What is the cell metaplasia that occurs in Barrett’s esophagus?

A

Squamous to columnar metaplasia of the esophageal epithelium

205
Q

What liver lesion is characterized on CT or MRI with appearance of anomalous artery as a “central scar”?

A
206
Q

What conditon would you expect with decreased glucoronyl transferase levels and elevated indirect bilirubin levels?

A
207
Q

How do you diagnose esophageal rupture?

A

Gastrografin swallow study

208
Q

Which is the most common HCV genotype prevalent in US?

A

Genotype 1

209
Q

Which is a motility dysphagia problem: Eosinophilic esophagitis, Strictures, achalasia, or Esophageal cancer?

A

Achalasia is a motility dysphagia problem. The others are examples of mechanical dysphagia problems.

210
Q

How do gastric and duodenal ulcers differ in terms of their relation to food intake?

A
211
Q

30,000 units of what enzyme is recommended for patients with chronic pancreatitis?

A
212
Q

Which of the hepatitis virsuses is the most common cause of fulminant hepatic failure?

A

Hepatitis B virus

213
Q

How does alpha 1-antitrypsin deficiency present?

A

Liver disease and emphysema in a young non-smoking patient

214
Q

What is the most common location of angiodysplasia?

A

Cecum & ascending colon

215
Q

What are the two main side effects associated with amlodipine?

A

Peripheral edema and headaches

216
Q

What anti-diabetic medication has diarrhea as one of its more common side effects?

A

Metformin

217
Q

Barium swallow, Manometry, or EGD with biopsy are studies that may be involved in the work up which anatomical category of dysphagia?

A

Esophageal dysphagia

218
Q

NS3/4A protease inhibitors, when combined with IFN and Ribavarin Rx, can improve the success of what HCV genotype?

A

HCV genotype 1

219
Q

Oral candidal infection can result from incorrect use of inhaled steroids. How should ptatients starting inhaled steroid therapy be counseled?

A

Rinse the mouth out well with water after using the inhaler

220
Q

What is the likely diagnosis in a patient with a history of dysphagia to solids and liquids concurrently and with chest pain, especially after drinking cold beverages?

A

Diffuse esophageal spasm

221
Q

Foamy macrophages on PAS stain on a small bowel biopsy is seen in what condition?

A

Whipple’s Disease

222
Q

Patient with UC is found to have elevated alkaline phosphatase and bilirubin levels. Likely diagnosis?

A

Primary sclerosing cholangitis (PSC)

223
Q

What is the best initial test in diagnosis of hemochromatosis?

A

Transferrin saturation (usually elevated at 45% or more)

224
Q

Which will give a high stool osmolal gap: Zollinger-Ellison syndrome, Carcinoid, or Pancreatic insufficiency?

A

Pancreatic insufficiency is an example of osmotic diarrhea and will give an increased stool osmolal gap

225
Q

On plain film, what area of the colon is most often affected in setting of toxic megacolon from ulcerative colitis?

A

Transverse colon

226
Q

What are the two main sub-types of microscopic colitis?

A

Lymphocytic colitis and collagenous colitis

227
Q

How is abdominal pain in irritable bowel syndrome affected by defecation?

A

Abdominal pain improves with defecation

228
Q

Which conditions present with SAAG > 1.1 g/dL?

A

Liver cirrhosis, Portal HTN, Hepatic vein thrombosis, CHF, Constrictive pericarditis

229
Q

In a patient suspected of having gastroparesis, what test should be performed to rule out obstruction?

A

EGD

230
Q

Sphincter of Oddi dysfunction can be ruled out with what test?

A

Manometric studies

231
Q

After a night of heavy drinking, patient begins to retch and cough violently before seeing blood in his emesis. Likely diagnosis?

A

Extreme retching and violent coughing preceding hematemesis is a clue for Mallory-Weiss tear.

232
Q

Which protease inhibitor is not associated with dyslipidemia?

A

Atazanavir (darunavir also causes only mild changes in lipid profile)

233
Q

Which isn’t used to determine eradication of H. pylori after treatment: Urea breath test, Fecal antigen test, or Serological test?

A

Serological testing

234
Q

In non-alcohol fatty liver disease (NALFD), which transaminase is usually greater?

A

ALT

235
Q

How is the calcium level changed in cases of pancreatitis leading to multi-organ failure?

A
236
Q

Which autoantibodies are associated with primary biliary cirrhosis?

A

Anti-mitochondrial antibody

237
Q

What are some extra-intestinal manifestations that do NOT mirror ulcerative colitis?

A

Pyoderma gangrenosum, Sacroilitis, and Primary sclerosing cholangitis do not mirror ulcerative colitis. If the ulcerative colitis improves, primary sclerosing cholangitis, pyoderma gangrenosum, and sacroilitis will not necessarily improve.

238
Q

What is the most common cause of jaundice in pregnancy?

A

Viral hepatitis

239
Q

What is the most likely symptom is patients experiencing VIPoma?

A

Voluminous, watery diarrhea

240
Q

Any patient experiencing an osmotic diarrhea that persists during fasting periods should be asked what question?

A

Do you use laxatives and, if so, how frequently?

241
Q

What would you expect the Vitamin B12 and folate level to be in Caribbean tropical sprue?

A

Vitamin B12 level is decreased and folate will be normal

242
Q

What is the most common cause of fulminant hepatic failure in pregnant women?

A

Hepatitis E infection

243
Q

How long after Rx for H.pylori should a fecal antigen test or urea breath test be performed to confirm eradication of infection?

A

4-6 weeks after treatment

244
Q

What is the most important risk factor determining progression of liver disease in a patient of chronic hepatitis C?

A

Longer duration of illness

245
Q

Diffuse esophageal spasm, systemic sclerosis, and achalasia are examples of which type of dysphagia?

A

Motility. Dysphagia to solids and liquids concurrently

246
Q

Digestion of which toxin from reef fish can cause for peri-oral parasthesias to occur?

A

Ciguatera toxin

247
Q

What complication of chronic pancreatitis, seen in about 5-10% of cases can present as postprandial abdominal pain and early satiety?

A

Duodenum obstruction

248
Q

With bacterial overgrowth, what would you expect the vitamin B12 and folate levels to be (elevated, decreased, normal)?

A

Increased folate levels, decreased vitamin B12 levels

249
Q

What are alarm features associated with GERD?

A

Dysphagia, Hematemesis or Unintentional weight loss

250
Q

Globally, which two hepatitis infections can cause fulminant hepatitis?

A

Hepatitis A and Hepatitis E

251
Q

Long term use of what comonly prescribed medication can cause bacterial overgrowth?

A

Proton pump inhibitors

252
Q

What are the two most common causes of lower GI bleed in the elderly?

A

Diverticular bleeding and Angiodysplasia are the most common causes of lower GI bleed in the elderly (age greater than 60 years).

253
Q

What are the indications based on BMI for gastric bypass surgery consideration?

A

BMI greater than 40kg/m2 or greater than 35kg/m2 with co-morbidities

254
Q

Which is true of chronic mesenteric ischemia: Sitophobia is present, SMA embolus is the main cause, or Lower gastrointestinal bleed is common?

A

Sitophobia present is true. SMA embolus is the main cause of acute mesenteric ischemia

255
Q

In osmotic diarrhea, what is the stool osmotic gap?

A

Greater than 100mOsm/kg

256
Q

How is the Hepatitis A virus transmitted?

A

Fecal-oral route

257
Q

In patients with chronic pancreatitis, how many units of lipase is recommended daily?

A
258
Q

What is the mainstay of treatment of autoimmune hepatitis?

A

Glucocorticoid therapy

259
Q

What is Charcot’s triad?

A

Fever, Right upper quadrant abdominal pain, and Jaundice

260
Q

What 3 main surgical procedures can lead to the development of blind loop syndrome?

A
261
Q

What are the 4 A’s associated with Type A non-erosive gastritis?

A

Autoantibodies, Achlorhydia, Atrophic, Anemia (pernicious)

262
Q

Which hepatitis infection can cause fulminant hepatitis in the third trimester of pregnancy?

A

Hepatitis E

263
Q

What hepatitis B marker indicates active replication?

A

HbeAg

264
Q

What is typically seen on biopsy from endoscopic ultrasound (EUS) in patients with autoimmune pancreatitis?

A

Lymphoplasmacytic infiltrate

265
Q

What condition is commonly associated with gnawing abdominal pain after eating, seen more often in smokers and is treated with surgical bypass or angioplasty?

A
266
Q

What is the best way to differentiate chronic hepatitis B from carrier state of hepatitis B?

A
267
Q

True or False: Hepatitis A and Hepatitis E are both RNA-based viruses.

A
268
Q

Watermelon stomach is also known as what condition?

A
269
Q

Which specific antiviral therapy is contraindicated in patients with autoimmune hepatitis?

A
270
Q

What two HLA alleles are often seen in patients with celiac disease?

A

HLA DQ-2 and HLA DQ-8

271
Q

What two antibiotics are often prescribed for uncomplicated diverticulitis?

A
272
Q

Surgical post operation patient has elevated total bilirubin levels with direct > indirect and normal alkaline phosphate level. What is the likey diagnosis?

A

Benign post operative cholestasis that is a result of massive blood transfusion during surgery.

273
Q

When should a colonoscopy be repeated in an individual found to have hyperplastic polyp?

A

10 years later

274
Q

Which part of the stomach does Type A non-erosive gastritis typically affect?

A

Usually Type A affects body or fundus of stomach. Type B non-erosive gastritis affects antrum of stomach

275
Q

Which autoantibodies are associated with autoimmune hepatitis?

A

Anti-smooth muscle antibody, Anti-LKM1, Anti-soluble liver antigen

276
Q

Systemic sclerosis (or scleroderma) causes dysphagia to solids, liquids or both?

A

It is a motility problem that is expected to cause dysphagia to both solids and liquids.

277
Q

What are major risk factors for esophageal cancer?

A

Smoking history, excessive alcohol use, obesity, low socioeconomic status, and GERD with or without Barrett esophagus.

278
Q

Which is example of osmotic diarrhea: Celiac disease, ViPoma, ZE syndrome, or carcinoid syndrome?

A

Celiac disease is an example of osmotic diarrhea. Others are examples of secretory diarrhea

279
Q

What is the difference in likely location within the stomach between Type A and Type B atrophic gastritis?

A

Type A gastritis primarily affects the body and fundus of the stomach. Type B gastritis primarily affects the antrum.

280
Q

A patient has dysphagia to solids and liquids and chest pain that occurs especially after drinking cold beverages. What is the likely diagnosis?

A

DIffuse esophageal spasm (DES)

281
Q

ATP7B gene mutation is associated with which condition?

A

Wilson’s Disease

282
Q

What study should be ordered prior to treating achalasia and why?

A

EGD with biopsy to rule out pseudoachalasia in which lymphoma/other cancer causes obstructive symptoms. Pneumatic dilatation should not be performed; appropriate management is to treat the underlying malignancy.

283
Q

What is the estimated average blood glucose level for a patient with a HGBA1c of 7%?

A

154 mg/dL

284
Q

Which of the following is an example of secretory diarrhea: Celiac disease, Pancreatic insufficiency, or VIPoma?

A

VIPoma

285
Q

What type of inheritance is seen in Wilson’s disease?

A

Autosomal recessive

286
Q

What is the most common cause of infectious esophagitis in immunocompetent individuals?

A

Candia albicans

287
Q

What is the most common cause of fulminant hepatic failure in the US?

A

Acetaminophen overdose

288
Q

Gastroesophageal reflux disease (GERD) is a risk factor for what type of esophageal cancer?

A

Adenocarcinoma of the esophagus

289
Q

What is the most common risk factor for the development of cholangiocarcinoma?

A

Gallstones

290
Q

Porphyria cutanea tarda and cryoglobulinemia can often be associated with what hepatitis infection?

A

Hepatitis C

291
Q

What medication helps chelate copper in Wilson’s disease?

A

Penicillamine

292
Q

Which of the following is most likely associated with women on OCPs: Hepatic cysts, Focular nodular hyperplasia, Hepatic adenoma, or Hepatic abscess?

A

Hepatic adenoma

293
Q

Which is the most sensitive indicator of HCV infection?

A
294
Q

In secretory forms of diarrhea, how does fasting affect the large/frequent bowel movements?

A

Little/No effect

295
Q

What are 2 major risk factors of acalculous cholecystitis?

A

Critical illness in the ICU (who often have an underlying infection) and Total parenteral nutrition (TPN) use

296
Q

What is the anatomic landmark which differentiates upper & lower GI bleeds?

A

Ligament of Treitz

297
Q

What does IgM Anti-HBc(+) indicate?

A

Acute Hepatitis B infection

298
Q

How is the stool osmotic gap calculated?

What number is it less than in secretory diarrhea?

A

Stool osmotic gap = 290 - 2 (Stool Potass ium + Stool Sodium).

Value <50mOsm/kg in secretory diarrhea

299
Q

Which agent used for the treatment of ulcerative colitis should not be used for maintenance?

A

Steroids

300
Q

Which anaesthetic gas is associated with idiosyncratic hepatotoxicity & high mortality rates?

A

Halothane

301
Q

What are 4 main classes of medications that can promote reflux symptoms?

A

Calcium channel blockers, Tricyclic antidepressants, Anti-histamines, and Anti-cholinergics

302
Q

In the stepwise approach to preventing constipation in patients using opioid medications, what is the first medication to try?

A

Stool softeners (e.g. docusate) with the initiation of the opioid medication

303
Q

For at least how long does an individual need to be in a tropical country to be considered for a diagnosis of tropical sprue?

A

1 month

304
Q

Mucosal break less than what size is considered an erosion?

A

Less than 5mm is considered an erosion. Greater than 5mm is considered peptic ulcer

305
Q

What are 2 major complications of choledocholithiasis?

A

Ascending cholangitis and sepsis

306
Q

If a polyp larger than 1cm or one with a villous component on biopsy is found, when should repeat screening be performed?

A

3 years

307
Q

What is the treatment of symtpoms resulting from short bowel syndrome?

A

Medium chain triglycerides and antacids

308
Q

What is the most common indication for liver transplantation in US?

A

HCV mediated liver cirrhosis

309
Q

What are the potential late complications of gastric bypass surgery?

A

Anastamosis stricture, Bacterial overgrowth, Marginal ulceration, Incisional hernia, Nutritional deficiencies (including iron and vitamin B12 deficiency)

310
Q

What test helps distinguish a hepatobiliary versus bone cause to an elevated alkaline phosphatase?

A

Gamma-glutamyl transferase (GGT), which is elevated in hepatobiliary and low/normal in bone disease

311
Q

AST is typically less than what value in cases of alcoholic hepatitis?

A

Less than 500 U/L

312
Q

What is the treatment of autoimmune pancreatitis?

A

Steroids

313
Q

For localized esophageal cancer, what are treatment options?

A

For localized esophageal cancer, surgical esophagectomy or chemoradiation with fluorouracil (5-FU), cisplatin and external beam radiotherapy can be used.

314
Q

Which gender presents earlier with hemochromatosis?

A

Males (menstruation delays onset of liver cirrhosis in females)

315
Q

What is typically used to manage triglyceride-induced pancreatitis?

A

Insulin drip

316
Q

What vitamin is typically checked when a patient presents with gastrointestinal malabsoprtion?

A

Vitamin D

317
Q

What is the best way to detect primary sclerosing cholangitis?

A

Endoscopic retrograde cholangiopancreatography (ERCP)

318
Q

Which two extra-intestinal manifestations mirror IBD?

A

Arthritis and erythema nodosum

319
Q

Which hepatitis B marker indicates active replication?

A

HBeAg

320
Q

What is the approximate annual rate of hepatocellular carcinoma in cirrhotic patients with hepatitis C?

A

1-4%, occuring mainly in patients having HCV infection for 30 years or more

321
Q

What is the minimum timeframe of symptoms in irritable bowel syndrome?

A

Continuous or recurrent for at least three months

322
Q

How is chronic hepatitis differentiated from chronic carrier state?

A

Chronic hepatitis will have deranged liver function test unlike in case of chronic carrier state

323
Q

What malignancy is a patient at an increased risk for with positive tissue transglutaminse antibodies?

A

Lymphoma (condition is celiac disease)

324
Q

What are 5 agents involved in ulcerative colitis treatment?

A

5-ASA, 6-Mercaptopurine, Azathioprine, Infliximab, Steroids

325
Q

What will the folate and vitamin B12 levels be in patients with Caribbean tropical sprue?

A

Normal folate, decreased vitamin b12 levels

326
Q

How is the diagnosis of eosinophilic esophagitis made?

A

EGD reveals a scalloped appearance to the esophagus with ridges or rings. Also, eosinophils in esophageal epithelium on mucosal biopsy

327
Q

Anti-smooth muscle antibodies are associated with which condition?

A

Autoimmune hepatitis

328
Q

In which gender is primary sclerosing cholangitis (PSC) more common?

A

Male

329
Q

Which hepatitis C treatment medication may exacerbate autoimmune hepatitis?

A

Interferon

330
Q

What lab test is the hallmark of primary biliary cirrhosis (PBC)?

A

Anti-mitochondrial antibodies

331
Q

Distal to what location lowers Gastrointestinal bleeding to occur?

A

Ligament of Treitz

332
Q

What two antibiotics are most commonly used for the treatment of diverticulitis?

A

Ciprofloxacin and Metronidazole

333
Q

What procedure is considered in resectable pancreatic cancers of the body and tail?

A

Distal pancreatectomy

334
Q

Discriminant function greater than or equal to what predicts short term mortality as high as 50% in alcoholic patients?

A

Greater than equal to 32

335
Q

What diagnosis needs to be ruled out when a patient presents with unintentional weight loss, decreased appetite, and progressive dysphagia to solids?

A

Esophageal cancer

336
Q

What is the appropriate test for diagnosing oropharyngeal dysphagia?

A
337
Q

What are the two most common HLA markers associated with a condition that has positive antibodies to tissue transglutaminase?

A

HLA DQ-2 and HLA DQ-8

338
Q

What medication requiring bedside atropine to be present may be used in the treatment of Ogilvie’s syndrome?

A
339
Q

What is the classic presentation of a patient experiencing diffuse esophageal spasm (DES)?

A

Chest discomfort after drinking cold or carbonated drinks

340
Q

What is the drug of choice for treatment of acetaminophen toxicity?

A

N-acetylcysteine by replenishing body stores of hepatic glutathione and binding to toxic metabolite

341
Q

What are the potential early complications of gastric bypass surgery?

A

Anastamosis leak, Bowel obstruction, Hemorrhage, Venous thromboembolism, Wound infection

342
Q

What is the oral antihypertensive of choice in patients presenting with hypertension & esophageal varices?

A

Beta blockers

343
Q

How do Caribbean tropical sprue and Asian tropical sprue differ on labwork?

A
344
Q

What is the hepatotoxic metabolite derived from acetaminophen by CytP450 CYP2E1?

A

N-acetyl-benzoquinone-imine (NAPQI)

345
Q

What is the initial test to be ordered when “Steakhouse syndrome” is suspected?

A

Barium swallow

346
Q

If sphincter of Oddi dysfunction is confirmed to be causing a patient’s symptoms, what is the best next step?

A

The approach to a patient with suspected sphincter of Oddi dysfunction (SOD) depends upon the patient’s clinical presentation as well as the results of laboratory testing and abdominal imaging. In general, only patients fulfilling the Rome III criteria should undergo invasive evaluation for SOD. This decreases the chance of patients being inappropriately subjected to invasive testing for SOD that is associated significant complications (primarily pancreatitis). (See ‘Rome III criteria’ above and ‘Sphincter of Oddi manometry’ below.)

To determine if patients fulfill the Rome III criteria, liver tests (transaminases, alkaline phosphatase, bilirubin) and pancreatic enzymes (amylase, lipase) should be checked, and structural abnormalities need to be excluded. Transabdominal ultrasound is typically the initial imaging study obtained for suspected biliary SOD. It can look for structural abnormalities such as gallstones while also providing an estimate of the common bile duct diameter. However, transabdominal ultrasound may not adequately visualize the pancreas because of overlying bowel gas, so alternate imaging techniques, such as magnetic resonance cholangiopancreatography (MRCP), may be required for evaluation of the pancreatic duct. Additional testing that may help to rule out structural abnormalities includes abdominal computed tomography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP).

In appropriately selected patients, the diagnosis of SOD is established by sphincter of Oddi manometry (SOM), which is performed during ERCP. Several less invasive methods have also been evaluated for establishing the diagnosis, but none has been shown to approach the diagnostic accuracy of SOM [28,30]. (See ‘Sphincter of Oddi manometry’ below.)

347
Q

What 2 commonly prescribed antibiotics has been shown to lead to cases of drug-induced pancreatitis?

A

Metroniadazole, tetracycline, Bactrim

348
Q

Diverticuli can be seen in the context of what 4 main conditions?

A
  • Asymptomatic diverticulosis
  • Painful diverticulosis
  • Diverticular bleed
  • Diverticulitis
349
Q

Patient with heartburn, diarrhea and increased gastrin levels. What is the likely diagnosis?

A

Zollinger-Ellison

350
Q

What is the procedure of choice in a patient who has obstruction of the common bile duct by a pancreatic mass causing jaundice and abdominal pain?

A

ERCP with stent placement

351
Q

What would be first line quadruple treatment of H. pylori infection?

A

Tetracycline, Bismuth, Metronidazole, and Proton pump inhibitor twice daily

352
Q

What is the most common cause of infectious esophagitis?

A

Candida albicans

353
Q

Any female not seeking pregnancy and having a hepatic adenoma less than ___cm in diameter can discontinue OCPs and see if the size of adenoma decreases. If the size of the hepatic adenoma is greater than this, what is the best next step?

A

Any female not seeking pregnancy and having a hepatic adenoma less than 5cm in diameter can discontinue OCPs and see if the size of adenoma decreases. If the size of the hepatic adenoma is greater than 5cm in diameter, resection should be performed.

354
Q

What is the most common side effects of efavirenz?

A

Dysphoria, abnormal dreams, teratogenicity

355
Q

If esophageal cancer is diagnosed, what is the next step?

A

CT of the chest and abdomen to rule out metastasis

356
Q

What are the Iron studies like in a patient with hemochromatosis?

A

Increased iron, increased ferritin, decreased TIBC

357
Q

Which vitamin is administered before initiating treatment in patients at risk of developing refeeding syndrome?

A

Thiamine

358
Q

In Nissen fundoplication, what part of the stomach is used to wrap around the lower esophageal sphincter to increase its tone?

A

The fundal portion of the stomach

359
Q

What hepatitis A marker indicates chronic infection?

A

None. Hepatitis A only has an acute form, no chronic infection seen in hepatitis A

360
Q

How does autoimmune pancreatitis resemble pancreatic cancer?

A

Both may feature jaundice and CT scan that shows a mass in the pancreas

361
Q

What antibody can be associated in individuals who have Crohn’s Disease?

A

Anti-Saccharomyces cerevisiae antibodies (ASCA)

362
Q

What are the 3 main pancreatitis complications for which a CT scan is ordered?

A

Necrosis, Pseudocyst, or Abscess formation

363
Q

Approximately what percentage of patients with cholangiocarcinoma have gallstones?

A

65-90%

364
Q

What antibody (and subytpe) is often associated with autoimmune pancreatitis?

A

IgG4 subytpe

365
Q

What PMN and WBC value in ascitic fluid indicates an SBP infection?

A

PMN greater than 250/uL and WBC greater than 500/uL

366
Q

Patient has isolated elevated alkaline phosphatase level. What blood test will help distinguish bone from liver pathology?

A

GGT (Elevated with liver pathology and normal with bone pathology)

367
Q

How do gastric and duodenal ulcers differ based on their most common cause?

A

Gastric ulcers are generally caused by excessive NSAID use. Duodenal ulcers are generally caused by Helicobacter pylori (H. pylori)

368
Q

Which virus–hepatitis B or hepatitis C–has a greater chance of chonicity?

A

Hepatitis C

369
Q

What conditions is microscopic colitis associated with?

A

Autoimmune conditions such as rheumatoid arthritis, diabetes mellitus and hypothyroidism

370
Q

Which is NOT a likely complication of fulminant hepatic failure: Hyperglycemia, Infection, Cerebral edema or Coagulopathy?

A

Hyperglycemia

371
Q

Long term use of NSAIDS ________ (increases, decreases, has no effect) on the risk of developing colon cancer.

A

Decreases

372
Q

Flask shaped ulcers are seen on a colonoscopy in a patient with chronic diarrhea who traveled to a 3rd world country. What is the likely diagnosis?

A

Amebic colitis

373
Q

With what condition are anti-smooth muscle antibodies often associated?

A

Autoimmune hepatitis

374
Q

What are the three main symptoms of primary sclerosing cholangitis (PSC)?

A

Jaundice, Fatigue, and Pruritis

375
Q

What marker is associated with pancreatic cancer?

A

Cancer antigen (CA) 19-9

376
Q

Why is the folate level increased in patients with bacterial overgrowth syndrome?

A

Bacterial production of folate

377
Q

What is the most severe complication associated with Ulcerative Colitis?

A

Toxic Megacolon

378
Q

Which is LEAST likely associated with hepatitis C: Cryoglobulinemia, MPGN, Porphyria cutanea tarda, or Focal segmental glomerulosclerosis (FSGS)?

A

FSGS (Focal segmental glomerulosclerosis)

379
Q

What condition occurs when submucosal arterioles intermittently protrude into the mucosa to cause UGI bleed?

A

Dieulafoy lesion

380
Q

What disease are patients with Barrett’s esophagus at an increased risk of developing?

A

Adenocarcinoma of the esophagus

381
Q

Female patient in 3rd trimester develops fulminant hepatitis. Which hepatitis infection is the likely cause?

A

Hepatitis E

382
Q

What would you expect the vitamin B12 and folate levels to be in patients with bacterial overgrowth?

A

Low B12 and high folate

383
Q

What is the best next step for any patient with a history of ulcerative colitis having dysplasia on a colonoscopy?

A

Total proctocolectomy

384
Q

What are folate and vitamin B12levels in bacterial overgrowth syndrome?

A

Eleveated Folate and decreased Vitamin B12 levels

385
Q

______________ is the formation of outpouchings in the lining of the bowel and can cause rectal bleeding

A

Diverticulosis

386
Q

What are the autoantibodies found in patient with autoimmune hepatitis?

A

A number of specific antibodies found in the blood (antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), liver/kidney microsomal antibody (LKM-1, LKM-2, LKM-3), anti soluble liver antigen (SLA/LP) and anti-mitochondrial antibody (AMA))

387
Q

What are the 4 main categories of chronic diarrhea?

A

Secretory, Osmotic, Exudative, Increased motility

388
Q

What condition is associated with positive anti-mitochondrial antibodies?

A

Primary biliary cirrhosis

389
Q

What is the name of the sign in which RLQ pain is elicited with LLQ palpation in a patient suspected of having appendicitis?

A

Rovsing sign

390
Q

Blood transfusions before what year are a risk factor for developing hepaitis C?

A

1992

391
Q

What classification is used to classify hepatic encephalopathy?

A

West Haven Criteria

392
Q

Which hepatitis infection is the only type that is a DNA virus?

A

Hepatitis B

393
Q

What are the colonic stimulants that may be used against opioid-induced constipation when all other options fail?

A

Bisacodyl and Senna

394
Q

Which is the most common electrolyte abnormality in refeeding syndrome?

A

Hypophosphatemia

395
Q

What does a RIBA (+) test indicate?

A

The patient had the infection but it spontaneously resolved

396
Q

Of the following, which is a motility problem of dysphagia: Diffuse esophageal spasm, Strictures, Eosinophilic esophagitis, or Schatski rings?

A

DES (Diffuse esophageal spasm). All others are mechanical problems.

397
Q

What hepatitis infection can cause fulminant hepatitis in the 3rd trimester of pregnancy?

A

Hepatitis E infection

398
Q

What is the best test to diagnose diverticulitis?

A

CT scan with IV contrast

399
Q

What are 3 main symptoms that patients with bacterial overgrowth syndrome can develop?

A

Diarrhea, Bloating and Malabsorption

400
Q

Which is LEAST likely to show elevated hepatic copper levels: PSC, PBC, autoimmune hepatitis, or Wilson’s Disease?

A

Autoimmune hepatitis. All other conditions can have elevated hepatic copper levels.

401
Q

A 2004 meta-analysis found that which form of nutrition (enteral or parenteral) is preferable due to a lower mortality rate, including fewer infectious complications?

A

Enteral feeding

402
Q

Which among the two conditions, superinfection & coinfection of Hepatitis D & Hepatitis B virus, can lead to fulminant liver failure?

A

Superinfection

403
Q

When should a screening colonoscopy be repeated in a patient with a hyperplastic polyp?

A

10 years

404
Q

What is the rash that is commonly associated with celiac disease?

A

Dermatitis herpetiformis

405
Q

What are the two most common extrahepatic manifestations of hepatitis B?

A

Polyarteritis nodosa and Membranous nephropathy

406
Q

Which clinical feature is the LEAST common in patients with autoimmune hepatitis: Fatigue, Nausea/vomiting, Jaundice or Pruritis?

A

Nausea and vomiting is the least likely clinical feature among these choices

407
Q

Barrett’s esophagus often occurs in the setting of what chronic condition?

A

GERD

408
Q

What are some atypical presentations of patients experiencing GERD?

A

Nocturnal non-productive cough, Hoarseness of voice, Sour taste, or Urge to constantly clear the throat

409
Q

What are the 3 antibody tests specific for autoimmune hepatitis?

A

A number of specific antibodies found in the blood (antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), liver/kidney microsomal antibody (LKM-1, LKM-2, LKM-3), anti soluble liver antigen (SLA/LP) and anti-mitochondrial antibody (AMA))

410
Q

What is the gallbladder wall measurement that defines gallbladder wall edema?

A

A thickened gallbladder wall measures more than 3 mm, typically has a layered appearance at sonography [1], and at CT frequently contains a hypodense layer of subserosal oedema that mimics pericholecystic fluid [2]

411
Q

What is the best test to rule out pancreatic necrosis?

A

CT

412
Q

What is the next step in the evaluation of a patient whose pill-induced esophagitis persists despite discontinuation of the medication?

A

Upper endoscopy to rule out esophageal stricture

413
Q

What are the three main sub-types of IBS?

A

IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and IBS with mixed constipation and diarrhea (IBS-M)

414
Q

What is the classic presentation of eosinophilic esophagitis?

A

Patient with recurrent bouts of dysphagia and food impaction

415
Q

Who is more likely to have microscopic colitis: young female, young male, elderly female, or elderly male?

A

Elderly females

416
Q

What are the antiretrovirals which can cause pancreatitis?

A

NRTIs (Didanosine, stavudine, zalcitabine); Ritonavir

417
Q

What test is used to confirm delayed gastric emptying?

A

Gastric scintigraphy

418
Q

What is the oral antihypertensive of choice in patients presenting with hypertension & diabetes?

A

ACE inhibitors or ARBs

419
Q

What is the recommendation for initial colonoscopy after inflammatory bowel disease diagnosis and follow up colonoscopies?

A

8 years after diagnosis and then every 1-2 years

420
Q

HbsAg (+), Hbc Ab IgM (+), HbeAg (+). How can this be interpreted?

A

Acute hepatitis B infection in replicative state

421
Q

What cholestatic condition is often seen in patients with inflammatory bowel disease?

A

Primary sclerosing cholangitis (PSC)

422
Q

Which medication class can lead to peptic ulcers independently: Steroids or NSAIDs?

A

NSAIDs can induce ulcers by themselves but steroids alone are not ulcerogenic. The combination of NSAIDs and steroids are ulcerogenic and can increase the bleeding risk of ulcers significantly.

423
Q

What test must any patient with GERD experiencing alarm features undergo?

A

EGD with biopsy to rule out adenocarcinoma of the esophagus

424
Q

What advice can be given to campers to prevent the development of Giardiasis?

A

Either boil, purify, or filter water, rather than drinking it directly from the stream

425
Q

Ranson’s Criteria or APACHE score is used for what condition?

A

Pancreatitis

426
Q

What is the best prognostic indicator in chronic hepatitis C?

A

Features on liver histology

Primary GI (2 decks)

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