Mehlman. Diagnostic modalities 10-26 (1)

Question 1

NG tube insertion?

Answer 1

answer for tracheoesophageal fistula and choanal
atresia (discussed in HY Pulm PDF).

Question 2

answer for tracheoesophageal fistula and choanal
atresia (discussed in HY Pulm PDF)?

Answer 2

NG tube insertion

Question 3

Barium swallow. upper eso?

Answer 3

For suspected Zenker; shows outpouching.

Question 4

Barium swallow. first step in what?

Answer 4

First step in achalasia (before monometry); shows bird’s beak.

Question 5

Barium swallow. dont use in what?

Answer 5

Do not use for esophageal perforation. Can cause mediastinitis if it leaks out through a hole in the esophagus.

Question 6

Barium swallow. can be used in what specific case?

Answer 6

Can be used for patients with aspiration risk, since it doesn’t cause pneumonitis.

Question 7

Gastrografin swallow. solubility?

Answer 7

water-soluble contrast swallow.

Question 8

Gastrografin swallow. used in what case and why?

Answer 8

Used for esophageal perforations because it doesn’t cause mediastinitis.

Question 9

Gastrografin swallow. dont use in what case?

Answer 9

Do not use if patient has aspiration risk; causes pneumonitis. Use barium instead.

Question 10

Esophageal manometry. answer in what condition?

Answer 10

Answer for achalasia after barium swallow shows bird’s beak.

Question 11

Esophageal manometry. A pressure study of the esophagus

Answer 11

.

Question 12

Endoscopy. immediate answer for what patient?

Answer 12

For any patient with new-onset dysphagia and Hx of GERD or heavy smoking/alcohol (for esophageal cancer). Then biopsy any lesion/stricture.

Question 13

Endoscopy. varices treatment?

Answer 13

Endoscopy + banding for esophageal varices emergent management.

Question 14

Endoscopy. hernia?

Answer 14

Diagnosis of hiatal hernia (asked on NBME).

Question 15

Endoscopy. done in what specific patients (age and condition)?

Answer 15

Done in patients over 50 who have H. pylori positivity (on newer 2CK form).

Question 16

Capsule endoscopy?

Answer 16

Always wrong fucking answer on USMLE

Question 17

Upper GI series. in peds what cases?

Answer 17

Congenital midgut volvulus in pediatrics; will show a corkscrew.

Question 18

Upper GI series. how performed?

Answer 18

This is a contrast swallow followed by X-rays to visualize the upper GI tract

Question 19

abdominal UG. cholecyst condition what?

Answer 19

Cholelithiasis.

Question 20

abdominal UG. first step to diagnose what? -> what next step?

Answer 20

First step to diagnose cholecystitis; if negative, do HIDA scan.

Question 21

abdominal UG. what other condition also first step diagnosis? –> then what next step?

Answer 21

First step for choledocholithiasis, then do ERCP.

Question 22

abdominal UG. what common condition esp in peds, also first step –> then what?

Answer 22

Intussusception Dx, then do enema (definitively diagnostic and therapeutic)

Question 23

abdominal UG. kokia dvylikapirstes zarnos diagnoze?

Answer 23

Pyloric stenosis

Question 24

HIDA scan. answer for confirmatory diagnosis ….?

Answer 24

Answer for confirmatory diagnosis of cholecystitis (not cholelithiasis alone) IF UG IS NEGATIVE.

Question 25

HIDA scan. how is performed?

Answer 25

Radiocontrast is injected + secreted into bile. If gallbladder lights up, there is no obstruction of the cystic duct and it is negative; if gallbladder doesn’t light up, we know there’s an obstruction by a stone and it confirms cholecystitis

Question 26

CT of abdomen. USMLE won’t force you to choose, but just assume contrast CT is always used.

Answer 26

.

Question 27

CT of abdomen. what are two cases when non-contrast CT is answer in general? 2

Answer 27

The only times non-contrast CT will be an answer is for urolithiasis and intracranial bleeds.

Question 28

CT of abdomen. higher yield indication in usmle?

Answer 28

Diagnosis of pancreatic cancer

Question 29

CT of abdomen. liver cases?

Answer 29

Diagnosis of liver cancer and focal nodular hyperplasia.

Question 30

CT of abdomen. kidney?

Answer 30

Renal injury (ultra-HY; discussed in HY Renal PDF).

Question 31

CT of abdomen. trauma?

Answer 31

Blunt force trauma to abdomen in patient who is stable.

Question 32

CT of abdomen. storžarnė?

Answer 32

Diverticulitis.

Question 33

Abdominal xray. bowel gas in what case?

Answer 33

Used to look for bowel gas in suspected obstruction (e.g., sigmoid volvulus showing coffee bean sign).

Question 34

Abdominal xray. duodenal atresia. what seen?

Answer 34

Duodenal atresia (double bubble sign).

Question 35

Abdominal xray. diaphragma?

Answer 35

Congenital diaphragmatic hernia (bowel gas in left hemithorax).

Question 36

Abdominal xray. what necrotizing condition?

Answer 36

Necrotizing enterocolitis (pneumatosis intestinalis).

Question 37

Abdominal xray. what colon condition?

Answer 37

Toxic megacolon if patient is stable

Question 38

Abdominal xray. + chest xray, what case?

Answer 38

“X-rays of chest and abdomen” used for duodenal ulcer perforation to look for
air under the diaphragm

Question 39

ERCP. Endoscopic retrograde cholangiopancreatography; type of EGD that can also
enter the biliary tree, remove stones there, and inject contrast if necessary

Answer 39

.

Question 40

ERCP. answer in what case as next step?

Answer 40

Answer on USMLE for choledocholithiasis (including gallstone pancreatitis) after
ultrasound is performed

Question 41

ERCP.
Answer for diagnosis of cholangitis.

Answer for drainage of pancreatic pseudocyst.

Answer 41

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Question 42

MRCP. Magnetic resonance cholangiopancreatography.

Answer 42

.

Question 43

MRCP.
Never seen this as correct answer on NBME, but I observe that students always pick it when they don’t know what’s going on, maybe because it sounds weird and specific

Answer 43

.

Question 44

MRCP.
Can visualize biliary tree much more safely than ERCP, but unlike ERCP, it isn’t a form of treatment (ERCP is both diagnostic and therapeutic).

Answer 44

.

Question 45

Endoscopic ultrasound.
Never seen this as correct answer, only wrong answer.

Answer 45

.

Question 46

Endoscopic ultrasound.
Can be done to diagnose pancreatic cancer if CT is negative or to drain pancreatic fluid collections in place of ERCP. But once again, never seen this as correct.

Answer 46

.

Question 47

Paracentesis. used in what HY case?

Answer 47

SBP

Question 48

Paracentesis.
As mentioned earlier, choose “white cell count and differential” before “gram
stain and culture of the fluid.” Do not confuse with pericardiocentesis.

Answer 48

.

Question 49

Meckel scan.
Radiocontrast uptake scan that localizes to the diverticulum at terminal ileum.

Answer 49

.

Question 50

Colonoscopy. diagnose what? 3

Answer 50

Done for diagnosis of colorectal cancer, IBD, pseudomembranous colitis

Question 51

Colonoscopy. do NOT do in what cases?

Answer 51

Do not do in diverticulitis (can cause perforation; do CT instead).

Question 52

Colonoscopy. what case about anal cancer?

Answer 52

Do if patient has anal cancer prior to excision in order to first see if there’s greater extent of cancer (might change management).

Asked on 2CK form, where
they say there is cancer at anal verge, and excision is wrong; answer is colonoscopy.

Question 53

Colonoscopy. screening in what population?

Answer 53

Commence at age 45-50 (guidelines are evolving) and then do every 10 years.

USMLE will not force you into a position where ohemgee is it 45 or 50. If they force you to choose 45 as a new guideline, it will be obvious the other answer choices are wrong

Question 54

Colonoscopy. if first-degree relative have colon cancer?

Answer 54

If first-degree relative (parent or sibling) has colon cancer, commence at age 40 or 10 years prior to diagnosis in that family member, whichever is earlier.

In other words, NEVER LATER than 40.

For example, if dad was diagnosed at 58, commence
at age 40. If dad was diagnosed at 44, commence at age 34.

Then do every 5 years

Question 55

Colonoscopy. if patient has IBD, what commence years for screening?

Answer 55

If patient has IBD (UC or Crohn), commence 8 years after the diagnosis was made and then do every 2-3 years.
2CK NBME is real slick about this. T

Question 56

Colonoscopy. IBD case.

They give mid-30s patient with IBD diagnosed in 20s + also has dad diagnosed with colon cancer in 50s;

wrong answer = colonoscopy at age 40;

correct answer is
“colonoscopy now,” since patient has IBD and should have had one done 8 years
after his/her diagnosis.

Answer 56

.

Question 57

Colonoscopy.
Patients who have history of dysplastic polyps need repeat colonoscopies every …

Answer 57

2-5 years, depending on size/morphology of polyp(s).

Question 58

Colonoscopy. HNPCC (Lynch syndrome), when start?

Answer 58

If patient has HNPCC (Lynch syndrome), start at 20-25, then do every 1-2 years.

Question 59

Colonoscopy. if has FAP? when do? what prophylaxis for this case?

Answer 59

For FAP, start at age 10-12 and do every 1-2 years.
Then do prophylactic proctocolectomy at age 18 (on NBME).

Question 60

Colonoscopy.
For Peutz-Jeghers?

Answer 60

For Peutz-Jeghers, start at age 8, then every 1-2 years

Question 61

Sigmoidoscopy. for what diagnosis?

Answer 61

“Sigmoidoscopy-guided insertion of rectal tube” is answer on NBME for treatment of sigmoid volvulus.

Question 62

Sigmoidoscopy.

I’ve never seen sigmoidoscopy as a diagnostic tool. I make this point because there are alternative theoretic regimens to colon cancer screening – i.e.,
sigmoidoscopy + barium enemas, etc., but I’ve never seen these assessed.

Answer 62

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Question 63

Anoscopy. 2CK diagnosis for what?

Answer 63

Shows up on newer 2CK form as answer for diagnosis of hemorrhoids before banding is performed. This will help determine extent of hemorrhoids.