Medicine

Question 1

3 Criteria to make the dx of acute/fulminant liver failure

— helps to differentiate between ALF n acute hepatitis

Answer 1

1) elevated aminotransferases often >1000
2)impaired synthetic function- INR>|=1.5
3) signs of hepatic encephalopathy
Hepatic encephalopathy helps to differentiate between ALF n acute hepatitis

Question 2

A pt came with UGIB secondary to esophageal varices having hematemesis n altered mental status. While being volume resuscitated n blood being prepared, the pt continued to vomit blood. What should b the best next step in the mx?

Answer 2

Intubation to protect the airway. Endoscopy comes next

Question 3

A non-invasive fecal test with high sensitivity n specificity for severe pancreatic exocrine insufficiency is?

Answer 3

Fecal elastase measurement ( low levels r diagnostic) elastase is a zymogen produced by pancreatic acinar cells and activated by trypsin in the duodenum.
Low serum trypsinogen is a similar test

Question 4

Bone related complications of PBC include(2)

Answer 4

Osteoporosis n osteomalacia

Etiology not clearly understood ( normal levels of Ca n vit D)

Question 5

A patient is diagnosed to have acute acalculus cholecystitis and blood cultures show clostridium septicum bacteremia. The most appropriate test to evaluate for associated conditions is?

Answer 5

Colonoscopy- screen for ca
Clostridium septicum is a colonic bacteria that rarely causes bacteremia n invasive infections like gas gangrene n tissue necrosis. The risk is significantly increased in those with colonic ca. Because tumor cells frequently undergo anaerobic glycolysis, it creates a suitable environment for the bacteria to proliferate n damage the colonic mucosa leading to bacteremia.

Question 6

A 45 yr old obese pt comes with progressive sxs of nausea, postprandial vomiting, GE reflux, dysphagia. 4 months back she underwent Roux-en-Y bypass surgery for wt loss.
The best next step in the mx? The cause of her current condition?

Answer 6

The surgery bypasses the stomach leaving small pouch and anastomosing jejunum with it. As a complication stenosis at the site of anastomoses can occur causing such sxs.
Esophagogastroduodenoscopy should b done. Balloon dilation can b done. If it fails, surgical revision

Question 7

A 54 yr old female presented with epigastric pain radiating to the back, fatigue and wt loss. She was diagnosed with idiopathic chronic pancreatitis 2yrs back and she’s on enzyme replacement therapy. She’s not jaundiced. The best next step in the mx is?

Answer 7

Abdominal CT with contrast. Pancreatic ca in the body or tail is suspected in this case. If the pt had jaundice, abdominal U/S would have been the first choice to rule out pancreatic head tumor

Question 8

What happens to splanchnic circulation in a cirrhotic pt?

Answer 8

Splanchnic vasodilation

Question 9

An elderly patient having chronic constipation, presenting with incontinence for small soft stool most likely has?

Answer 9

Fecal impaction with overflow incontinence

Question 10

A 53 yr old woman comes with rt sided abdominal pain that started 2 days ago. It’s constant, burning. A few doses of ibuprofen n antacid didn’t help. She has breast ca for which she has been on chemotherapy. lightly brushing the skin to the rt of the umbilicus elicits intense pain. No other abnormalities were seen. Dx is?

Answer 10

Herpes zoster infection ( early stage)

Question 11

A 43 yr old man comes for routine medical evaluation. He has intermittent dry cough, otherwise feels well. He has hepatomegaly and tipped spleen on examination. No other abnormalities detected. Na-136, Ca-11.2, K-4.2, ALP-370, AST-87, ALT-74, CXR shows mediastinal fullness with bilateral reticulonodular opacities
The most likely dx?

Answer 11

Sarcoidosis- lung, liver, spleen involvement, hypercalcemia

Question 12

A 34 yr old woman comes with episodic mild abdominal cramps nausea and watery diarrhea for the past 4-5 months. The episodes occur within an hour of eating n also associated with increased flatus n bloating sensation. Over the past several months she has been consuming green leafy vegetable, fruits, low fat diary products in an effort to lose wt.
most likely Dx?

Answer 12

Lactose intolerance ( brush border enzyme deficiency)

Question 13

Chemotherapy related diarrhea is treated with?

Answer 13

Oral rehydration and antidiarrheal agents like loperamide

Question 14

Secretory Vs osmotic diarrhea

Stool osmolar gap…

Answer 14

Secretory - low stool osmolar gap, diarrhea persists while fasting n at night. Eg. A pt can have it after bowel resection or cholecystectomy, when unabsorbed bile acids reach the colon n stimulate luminal ion channels
Osmotic- high SOG, occurs after meals eg lactose intolerance

Question 15

In acute liver failure if the patient has PT>100, Cr>3.4, grade lll or lV hepatic encephalopathy
The best next step in the mx is?

Answer 15

Liver transplantation

Question 16

Common risk factors for C. difficile other than recent abx use r?(3)

Answer 16

PPI use, hospitalization, old age(>65)

Question 17

Women above the age of 60 having chronic secretory diarrhea, colonoscopy reveals grossly normal appearing colonic mucosa. Biopsy demonstrates a mononuclear infiltrate within the lamina propria and a subepithelial collagen band
Dx is?

Answer 17

Microscopic colitis

Question 18

In a pt with IBS, further testing may b indicated in which of the ff findings?
A) episodic nature of the sxs
B) frequent alteration of bowel habit
C) nocturnal diarrhea 
D) postprandial sxs

Answer 18

Nocturnal diarrhea- which is a symptom secretory diarrhea and needs to b investigated

Question 19

In a cirrhotic pt with ascites, initial mx of ascites is?

A) fluid restriction B) furosemide and spironolactone

Answer 19

Furosemide and spironolactone and salt restriction.

- fluid restriction is used to treat hypervolemic hyponatremia