MKSAP-GI

Question 0

Patient with acute abdomen – test?

Answer 0

Supine and upright abdominal radiographs (Although CT scan will be likely be necessary eventually)

Question 1

Suspect nephrolithiasis – test?

Answer 1

Noncontrast helical abdominal CT

Question 2

Typical initial symptoms of ruptured AAA? CBC findings?

Answer 2

Sudden, severe pain and near syncope

Leukocytosis and anemia

Question 3

Clinical criteria for IBS?

Answer 3

Rome III criteria:

1. Pain relieved with defecation
2. Change in stool frequency
3. Change in stool consistency

Also need no alarm indicators (old age, male, nocturnal awakenings, bleeding, weight loss, family history of colon cancer)

Question 4

Patient with constipation due to IBS – first and second line treatment?

Answer 4

1. High-fiber diet

2. Laxative (poly ethylene glycol)

Question 5

Patient with suspected ischemic colitis – important history? Typical colonoscopy finding?

Answer 5

Atherosclerosis

Thickening of the bowel wall in segmental pattern

Question 6

Patient with suspected diverticulitis – test?

Answer 6

Contrast enhanced CT scan

Question 7

Suspected HUS – test? Tx?

Answer 7

Peripheral blood smear; supportive

Question 8

Suspected radiation proctitis – Sx? test and confirmatory findings?

Answer 8

Diarrhea and tenesmus Six weeks after radiation treatment

Flexible sigmoidoscopy sees mucosal telangiectasia, submucosal fibrosis and arterial Endarteritis

Question 9

Suspect chronic pancreatitis – test?

Answer 9

Abdominal CT

Question 10

Marker for celiac disease?

Answer 10

Anti-endomysial antibodies

Question 11

Symptoms of Clostridium diff?

Answer 11

Diarrhea 10 to 15 times daily, fever, leukocytosis, abdominal pain

Question 12

Treatment for salmonella gastroenteritis?

Answer 12

Supportive - Antibiotics slow clearance of salmonella from the stool and antidiarrheal agents increase chance of invasion

Question 13

When to treat salmonella gastroenteritis?

Answer 13

1. Age 50
2. Patients with severe illness requiring hospitalization
3. Patients with atherosclerotic plaques or bone prosthesis (possible seeding)
4. Immunocompromised

Question 14

Hepatocellular injury versus cholestatic injury?

Answer 14

Elevations in AST, ALT, and conjugated bilirubin

Elevation in alkaline phosphatase and small elevations in AST and a penalty

Question 15

Diseases that can cause a mixed hepatocellular and cholestatic injury?

Answer 15

Hepatitis B and C

Question 16

Gilbert syndrome a.k.a.?

Answer 16

Constitutional hepatic dysfunction and familial nonhemolytic jaundice

Question 17

Effect of OCP on liver function?

Answer 17

Conjugated hyperbilirubinemia and elevated alkaline phosphatase

Question 18

When to use cholecystectomy versus ursodeoxycholic acid?

Answer 18

If previously symptomatic vs if cannot undergo surgery (can only prevent new stone formation)

Question 19

Acute cholangitis - tx?

Answer 19

Immediate broad spectrum antibiotics followed by ERCP-sphincterotomy

Question 20

Gallstone pancreatitis - tx?

Answer 20

ERCP

Question 21

Pt with pancreatitis - general management?

If pancreatic necrosis?

Answer 21

Jegunal Enteral tube feeds > TPN

Imipenem and debridement

Question 22

GERD - tx? Test if unresponsive? Tx with alarm symptoms?

Answer 22

PPI; esophageal pH monitoring; EGD

Question 23

Errosive esophagitis - tx?

Answer 23

PPI > H2-blocker

Question 24

Pt with gastric ulcer - next step?

Answer 24

Biopsy

Question 25

Functional dyspepsia? Tx?

Answer 25

Discomfort in epigastrum without organic cause.

PPI

Question 26

Acute mesenteric colitis vs ischemic colitis? And tx?

Answer 26

Small bowl, very painful, caused by embolic event

Vs

Large bowl, bloody stool an cramping, caused by hypoperfusion

Question 27

How to diagnose a hepatocellular CA without a biopsy?

Answer 27

Suggestive Ultrasound with AFP>500

Question 28

Typical pt with non-alcoholic steatohepatitis? Diagnose with?

Answer 28

Obese woman with hx of HTN, HLD

US, CT, MRI

Question 29

Treatment of hepatic encephalopathy?

Answer 29

Lactulose titrated to achieve 2 to 3 stools per day with a pH<6

Question 30

UC - all treatments?

Answer 30

1. Masalamine
2. Other 5-aminosalicylates (-salazines)
3. Oral prednisone
4. Azathioprine and 6MP
5. Infliximab

Question 31

Upper GI bleed - steps?

Answer 31

1. Fluid
2. EGD
3. If variceal veins - octreotide
   Or if arterial, arteriography

Question 32

NG tube is reliable in ruling out upper G.I. bleed if?

Answer 32

Aspirate contains bile (indicates tube went beyond pylorus)

Question 33

What exposures Increase risk of acute hepatitis A?

Answer 33

Traveling, daycare, homosexual sex, raw shellfish

Question 34

AST/ALT levels in acute hepatitis? Alcoholic hepatitis?

Autoimmune hepatitis?

Answer 34

> 1000

<500

In the thousands

Question 35

Most common blood-borne infection in the United States? Tests?

Answer 35

Hepatitis C

Screening test – anti-HCV antibody test
Extent of active infection – HCV RNA test

Question 36

Definition of hepatorenal syndrome?

Answer 36

Kidney dysfunction in patients with portal hypertension

Also must have excluded prerenal azotemia, renal parenchymal disease and obstruction

Question 37

Eruption of erythema nodosum preceded by?

Answer 37

Prodrome of fever and arthralgia

Question 38

Findings of microscopic colitis? (Symptoms, colonoscopy, biopsy) treatment?

Answer 38

Symptoms – nonbloody diarrhea

Colonoscopy – normal mucosa

Biopsy – increased lymphocytes (lymphocytic colitis) or increased submucosal collagen (collagenous colitis)

Antidiarrheals - Loperamide, diphenoxylate, bismuth subsalicylate