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MKSAP Board Basics Gastroenterology Flashcards

1
Q

What test is used to evaluate suspected oropharyngeal dysphagia?

A

Videofluoroscopy with liquid and solid phases.

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2
Q

What is the first test to order when suspected achalasia is causing dysphagia?

A

Barium swallow

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3
Q

What are GI alarm features?

A
  • Vomiting
  • Anemia
  • Weight loss
  • Dysphagia
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4
Q

How is the diagnosis of GERD confirmed in patients without alarm features?

A

Relief of symptoms with a PPI (proton pump inhibitor)

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5
Q

What should you do if GERD symptoms are refractory of PPI treatment?

A

Upper endoscopy

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6
Q

Should barium X-rays be used to diagnose GERD?

A

No

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7
Q

In men over 50 with GERD symptoms, are nocturnal reflux symptoms a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?

(Yes/No)

A

Yes

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8
Q

In men over 50 with GERD symptoms, is intra-abdominal distribution of fat a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?

A

Yes

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9
Q

In men over 50 with GERD symptoms, is tobacco use a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?

A

Yes

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10
Q

In men over 50 with GERD symptoms, is elevated BMI a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?

A

Yes

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11
Q

In men over 50 with GERD symptoms, is hiatal hernia a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?

A

Yes

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12
Q

What is the treatment of patients with Barrett’s esophagus without dysplasia?

A

Proton pump inhibitor

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13
Q

What is the treatment of patients with Barrett’s esophagus with low- to high grade dysplasia?

A

Endoscopic ablation
(RFA, photodynamic therapy, endoscopic mucosal resection, and esophagectomy)

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14
Q

How often is surveillance done for patients with Barrett’s esophagus without dysplasia?

A

Every 3 - 5 years

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15
Q

How often is surveillance done for patients with Barrett’s esophagus with mild dysplasia who do not get it ablated?

A

Every 6 - 12 months

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16
Q

Do women with GERD require screening for Barrett’s esophagus?

A

No

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17
Q

What are the most common infectious causes of esophagitis?

A
  • Candida albicans
  • CMV
  • HSV
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18
Q

What is the diagnosis in patients with AIDS, odynophagia and oral candidiasis?

A

Esophageal candidiasis

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19
Q

What should you do in patients who are immunocompromised with odynophagia?

A

Empiric therapy for esophageal candidiasis

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20
Q

Do patients with viral esophagitis have associated ulcerative oropharyngeal lesions?

A

Rarely

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21
Q

Can tetracyclines cause pill-induced esophagitis?

A

Yes

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22
Q

Can NSAIDS cause pill-induced esophagitis?

A

Yes

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23
Q

Can potassium chloride cause pill-induced esophagitis?

A

Yes

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24
Q

Can iron pills cause pill-induced esophagitis?

A

Yes

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25
Q

Can alendronate cause pill-induced esophagitis?

A

Yes

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26
Q

What is the diagnosis in young adults who present with extreme dysphagia and food impaction?

A

Eosinophilic esophagitis (EE)

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27
Q

What should you do if empiric therapy for presumed esophagitis is unsuccessful?

A

Perform upper endoscopy with biopsy/brushing

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28
Q

Patient has upper endoscopy showing mucosal furrowing, stacked circular rings, white specks, and mucosal friability.
Endoscopic biopsies show marked infiltration with eosinophils.

Diagnosis?

A

Eosinophilic esophagitis (EE)

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29
Q

Is GERD associated with esophageal eosinophilia?

A

Yes

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30
Q

Does esophageal eosinophilia respond to an 8-week trial of proton pump inhibitor?

A

No

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31
Q

Should you do barium esophagography to evaluate suspected esophagitis?

A

No

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32
Q

Does the absence of oral Candida lesions rule out esophageal candidiasis?

A

No

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33
Q

What is the treatment for esophageal candidiasis?

A
  • Fluconazole
  • Itraconazole
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34
Q

What is the treatment for HSV esophagitis?

A
  • Acyclovir
  • Famciclovir
  • Valacyclovir
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35
Q

What is the treatment for CMV esophagitis?

A

Ganciclovir and/or foscarnet

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36
Q

What is the treatment for eosinophilic esophagitis?

A

Swallowed fluticasone or budesonide

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37
Q

What is the treatment for pill-induced esophagitis?

A

Supportive care

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38
Q

What should all patients with peptic ulcer disease be tested for?

A

Helicobacter pylori infection

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39
Q

What are non-invasive strategies for diagnosing Helicobacter pylori infection?

A
  • Urea breath tests
  • Stool test for H. pylori antigens
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40
Q

What medications cause false-negative rapid urease tests, urea breath tests, and stool antigen results for H. pylori?

A
  • Antibiotics
  • Bismuth-containing compounds
  • PPIs
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41
Q

How long do antibiotics need to be stopped before testing for H. pylori?

A

28 days

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42
Q

How long do PPIs need to be stopped before testing for H. pylori?

A

2 weeks

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43
Q

Should you use serum antibody testing to test for H. pylori?

A

No - cannot differentiate between past and present infection.

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44
Q

When should duodenal ulcers be biopsied?

A

When they are refractory to therapy

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45
Q

Should duodenal ulcers be biopsied?

A

No (unless refractory to therapy)

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46
Q

Is the risk of malignancy in duodenal ulcers low or high?

A

Low

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47
Q

What is the treatment for H. pylori infection?

A
  • Clarithromycin-based triple therapy (if no clarithromycin resistance suspected)
  • Bismuth quadruple therapy (if resistance to clarithromycin probable)
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48
Q

When first-line therapy fails for H. pylori infection, which antibiotics should not be used?

A

A salvage regimen should avoid previously used antibiotics.

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49
Q

When is surgery done for peptic ulcer disease?

A

When patients have complications

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50
Q

What is the follow-up after treating H. pylori infection?

A

Follow-up noninvasive testing to document H. pylori eradication should be performed at least 4 weeks after completion of
therapy in any patient with a positive H. pylori test result.

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51
Q

When is a follow-up upper endoscopy for gastric ulcers indicated?

A
  • If patient remains symptomatic after treatment
  • Cause is uncertain
  • Biopsies were not performed during initial upper endoscopy
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52
Q

Does a selective COX-2 inhibitor provide better gastric protection than a nonselective NSAID plus a PPI?

A

No

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53
Q

Does duodenal peptic ulcer disease without complication need a follow-up upper endoscopy?

A

No

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54
Q

Should serologic testing (ELISA test for IgG antibodies) be used to confirm H. pylori eradication?

A

No (remains positive in the absence of active infection)

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55
Q

What should be used as the initial treatment of H. pylori infection in patients who are allergic to penicillin?

A

Bismuth quadruple therapy

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56
Q

What should you do for patients with refractory symptoms of dyspepsia?

A

Upper endoscopy

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57
Q

What diagnosis should be considered in patients with recurrent nausea, early satiety, bloating, and weight loss?

A

Gastroparesis

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58
Q

What is important to check in diabetes mellitus patients prior to doing a gastric emptying study?

A

Blood glucose should be less than 275 mg/dL during testing because marked hyperglycemia can acutely impair gastric emptying.

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59
Q

What are the dietary recommendations for gastroparesis?

A

Small low-fat meals consumed four to five times per day

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60
Q

What is the treatment of acute gastroparesis?

A

IV erythromycin

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61
Q

What is the treatment of chronic gastroparesis?

A

Oral metoclopramide

62
Q

What is a serious side effect of metoclopramide?

A

Tardive dyskinesia

63
Q

What should you do if a patient develops tardive dyskinesia as a result of metoclopramide?

A

Stop the medication immediately

64
Q

Is tardive dyskinesia due to metoclopramide reversible?

A

May be irreversible

65
Q

Which bariatric surgery procedure most often causes small intestinal bacterial overgrowth (SIBO)?

A

Roux-en-Y gastric bypass

66
Q

Patient has abdominal cramps, nausea, and loose stools 15 minutes after eating followed within 90 minutes by lightheadedness, diaphoresis, and tachycardia following gastric resection or bypass surgery.

Diagnosis?

A

Dumping syndrome

67
Q

What is the treatment of dumping syndrome?

A

Treat with small frequent feedings and low-carbohydrate meals.

68
Q

A patient has loose stools and malabsorption following bypass surgery.

Diagnosis?

A

Small intestinal bacterial overgrowth (SIBO)

69
Q

What is the treatment of small intestinal bacterial overgrowth (SIBO)?

A
  • Antibiotics
  • Nutritional supplements
70
Q

Abdominal pain, bloating, difficulty belching following fundoplication (bariatric surgery).

Diagnosis?

A

Gas-bloat syndrome

71
Q

What is the treatment of gas-bloat syndrome in bariatric surgery patients?

A

Diet modification; most treatments are untested.

72
Q

What imaging study is essential to do in patients with acute pancreatitis to evaluate etiology?

A

Abdominal ultrasonography to rule out biliary tract obstruction

73
Q

What imaging study is essential in all patients with acute pancreatitis?

A

Abdominal ultrasonography to evaluate the biliary tract for obstruction.

74
Q

When is a CT abdomen indicated in patients with acute pancreatitis?

A
  • Severe pancreatitis
  • If it lasts longer than 48 hours
  • If complications are suspected
75
Q

Should you routinely obtain a CT abdomen for acute pancreatitis?

76
Q

Is uncomplicated pancreatitis typically associated with rebound abdominal tenderness, absent bowel sounds, high fever, or melena?

77
Q

What are (three) complications of acute pancreatitis?

A
  • Abscess
  • Pseudocyst
  • Necrotizing pancreatitis
78
Q

Can kidney disease cause mildly elevated amylase values?

79
Q

Can intestinal ischemia cause mildly elevated amylase values?

80
Q

Can appendicitis cause mildly elevated amylase values?

81
Q

Can parotitis cause mildly elevated amylase values?

82
Q

What should you do in acute pancreatitis patients who are found to have ascending cholangitis or biliary obstruction?

A

ERCP within 24 hours of presentation

83
Q

How are symptomatic pancreatic pseudocysts treated?

A

Transgastric or transduodenal drainage

84
Q

When is fluid resuscitation for acute pancreatitis most beneficial?

A

In the first 12 - 24 hours of presentation

85
Q

Should you withhold oral feeding on the basis of persistent elevations in pancreatic enzyme levels in acute pancreatitis when the abdominal pain, nausea and vomiting has resolved?

86
Q

Should you treat interstitial (nonnecrotizing) pancreatitis with antibiotics?

A

Not without evidence of infection

87
Q

Should you treat cholangitis, infected pancreatic necrosis, and infected pseudocysts with antibiotics?

88
Q

What is the common cause of chronic pancreatitis?

A

Chronic alcohol abuse

89
Q

What should you do in young patients with chronic pancreatitis?

A

Sweat chloride testing for cystic fibrosis

90
Q

Do normal amylase and lipase levels rule out chronic pancreatitis?

91
Q

Should opioids be used in chronic pancreatitis?

92
Q

What is the initial therapy for malabsorption in chronic pancreatitis?

A

Pancreatic enzymes

93
Q

What should you look for in persistent or refractory pain in chronic pancreatitis?

A
  • Dilated pancreatic duct
  • Intraductal calcifications
94
Q

What treatment options should you consider in case of a dilated pancreatic duct and/or intraductal calcifications?

A
  • Endoscopic stenting
  • Lithotripsy
  • Surgical drainage (pancreaticojejunostomy)
95
Q

How many types of autoimmune pancreatitis are they?

A

2 types (type 1 and type 2)

96
Q

Which type of autoimmune pancreatitis is more likely to have elevated IgG4 levels?

97
Q

Patient presents with painless obstructive jaundice or acute pancreatitis (rare). Cross-sectional imaging reveals “sausage-shaped” pancreatic enlargement with an indistinct border.

Diagnoses?

A

Autoimmune pancreatitis
Possible pancreatic cancer

98
Q

What is the treatment of autoimmune pancreatitis?

A

Glucocorticoids

99
Q

When do patients need antibiotics for acute diarrhea?

A
  • Diarrhea lasting > 7 days
  • Patients with fever, abdominal pain or hematochezia
100
Q

Should you order stool cultures for diarrhea of less than 1 week duration?

101
Q

Should you choose antibiotics for enterohemorrhagic Escherichia coli (EHEC) colitis?

102
Q

Should you give loperamide for acute diarrhea with fever or blood in the stool?

103
Q

Should you give diphenoxylate for acute diarrhea with fever or blood in the stool?

104
Q

What may happen if you give loperamide or diphenoxylate in enterohemorrhagic Escherichia coli (EHEC) colitis?

A

Hemolytic uremic syndrome

105
Q

What may happen if you give loperamide or diphenoxylate in C. difficile infection?

A

Toxic megacolon

106
Q

How long does chronic diarrhea last?

A

More than 4 weeks

107
Q

What investigation should usually be done in most chronic diarrhea patients?

A

Colonoscopy

108
Q

What investigation should usually be done in chronic diarrhea patients if colonoscopy is nondiagnostic?

A

A 48- to 72-hour stool collection with analysis of fat content.

109
Q

What fat excretion is diagnostic of steatorrhea?

110
Q

What do you measure to calculate fecal osmotic gap?

A

Stool electrolytes (sodium and potassium)

111
Q

What is the most common cause of chronic infectious diarrhea?

A

Giardia lamblia

112
Q

In a patient with chronic diarrhea and bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features…

What’s the most likely diagnosis?

A

Irritable bowel syndrome

113
Q

In a patient with chronic diarrhea and bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features…

What should you do next?

A

Test for celiac disease

114
Q

In a female aged 45 - 60 years with chronic diarrhea which is unrelated to food intake (nocturnal diarrhea), normal colonoscopy…

What’s the most likely diagnosis?

A

Microscopic colitis

115
Q

In a female aged 45 - 60 years with chronic diarrhea which is unrelated to food intake (nocturnal diarrhea), normal colonoscopy…

What should you do next?

A
  • Stop NSAIDS or PPIs
  • Biopsy
116
Q

In a patient with chronic diarrhea with diary products…

What’s the most likely diagnosis?

A

Lactose intolerance

117
Q

In a patient with chronic diarrhea with diary products…

What should you do next?

A
  • Dietary exclusion
  • Hydrogen breath test
118
Q

In a patient with chronic diarrhea with use of artificial sweeteners or fructose…

What’s the most likely diagnosis?

A

Carbohydrate intolerance

119
Q

In a patient with chronic diarrhea with use of artificial sweeteners or fructose…

What should you do next?

A
  • Dietary exclusion
  • Hydrogen breath test
120
Q

In a patient with diabetes mellitus or systemic sclerosis and nocturnal chronic diarrhea…

What should you do next?

A
  • Hydrogen breath test
  • Empiric antibiotic trial
121
Q

In a patient with diabetes mellitus or systemic sclerosis and nocturnal chronic diarrhea…

What’s the most likely diagnosis?

A

Small bowel bacterial overgrowth

122
Q

In a patient with chronic diarrhea coexistent pulmonary diseases and/or recurrent Giardia infection…

What’s the most likely diagnosis?

A

Chronic venous insufficiency and selective IgA deficiency

123
Q

In a patient with chronic diarrhea coexistent pulmonary diseases and/or recurrent Giardia infection…

What should you do next?

A

Measure immunoglobulins

124
Q

In a patient with chronic diarrhea and somatization or other psychiatric syndromes, history of laxative use…

What’s the most likely diagnosis?

A

Self-induced diarrhea

125
Q

In a patient with chronic diarrhea and somatization or other psychiatric syndromes, history of laxative use…

What should you do next?

A
  • Obtain tests for stool osmolality,
    electrolytes, magnesium
  • Laxative screen
126
Q

In a patient with severe secretory diarrhea and flushing…

What should you do next?

A

24-hour urinary excretion of 5-HIAA

127
Q

In a patient with severe secretory diarrhea and flushing…

What’s the most likely diagnosis?

A

Carcinoid syndrome

128
Q

In a patient with chronic diarrhea and history of irritable bowel syndrome and iron deficiency anemia…

What’s the most likely diagnosis?

A

Celiac disease

129
Q

How do you diagnose celiac disease?

A

IgA anti-tTG antibody assay and small bowel biopsy if positive.

130
Q

What is the treatment for celiac disease?

A

Gluten free diet

131
Q

In a patient with chronic diarrhea and chronic pancreatitis, hyperglycemia, history of pancreatic resection, cystic fibrosis…

What’s the most likely diagnosis?

A

Pancreatic insufficiency

132
Q

If you suspect pancreatic insufficiency, what should you do?

A
  • Test for excess fecal fat
  • X-rays for pancreatic calcifications
133
Q

What is the treatment of pancreatic insufficiency?

A

Pancreatic-enzyme replacement therapy

134
Q

In a patient with chronic diarrhea and previous surgery, small bowel diverticulosis, dysmotility (systemic sclerosis or diabetes mellitus), combination of vitamin B12 deficiency and elevated folate level…

What’s the most likely diagnosis?

A

Bacterial overgrowth

135
Q

What should you do after diagnosing bacterial overgrowth?

A

Empiric trial of antibiotics or hydrogen breath test

136
Q

In a patient with chronic diarrhea and resection of >200 cm of distal small bowel (or viable small bowel <180 cm)…

What’s the most likely diagnosis?

A

Short-bowel syndrome.

137
Q

What is the treatment of short-bowel syndrome?

A

Replace nutrient and electrolyte deficiencies.

138
Q

In a patient with history of resection of <100 cm of distal ileum, with voluminous diarrhea, weight loss, and malnutrition…

What’s the most likely diagnosis?

A

Short-bowel syndrome with bile acid enteropathy

139
Q

What should you do in patients with short-bowel syndrome with bile acid enteropathy?

A

Empiric trial of cholestyramine

140
Q

In a patient with chronic diarrhea and arthralgia; fever; neurologic, ocular, or cardiac disease…

What’s the most likely diagnosis?

A

Whipple disease or tropical sprue

141
Q

What should you do if you suspect Whipple disease?

A

Small bowel biopsy and PCR for Tropheryma whippelii

142
Q

What is the treatment for Whipple disease?

A

Antibiotics for 12 months

143
Q

What investigation should you do when you suspect tropical sprue?

A

Order a small bowel biopsy

144
Q

What is the treatment of tropical sprue?

A

Sulfonamide or tetracycline and folic acid

145
Q

In a patient with prolonged traveler’s diarrhea, diarrhea after a camping trip, outbreak in a day-care center…

What’s the most likely diagnosis?

A

Giardiasis

146
Q

What should you do if you suspect giardiasis?

A

Giardia parasites or Giardia antigen in the stool

147
Q

What is the treatment of giardiasis?

A

Metronidazole

148
Q

What will happen if you use cholestyramine if ileal resection is >100 cm?

A

Will worsen bile salt deficiency and steatorrhea

149
Q

What should you do if diarrhea begins after cholecystectomy?

A

Cholestyramine

150
Q

What test confirms esophageal perforation?

A

Gastrografin contrast esophagram

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