MKSAP GI IV

Question 1

Medications that decrease kidney perfusion such as ____ and _____ should be discontinued in patients with ascites (even with PMHx HTN)

Answer 1

NSAIDS, ACEI/ARBs

Question 2

Mesalamine suppository v enema

Answer 2

Suppository only treats UC in rectum. Enema will help up to the splenic flexure of the colon.

Question 3

Patients younger than age 60 years presenting with dyspepsia should first undergo a ______.

Answer 3

Noninvasive test for Helicobacter pylori followed by eradication therapy if testing is positive. (EGD is for adults > 60)

Question 4

The mainstay of therapy for amebic liver abscesses is _____.

Answer 4

Antibiotic therapy, such as metronidazole, plus a luminal agent, such as paromomycin, to eradicate the coexisting intestinal infection.

Amebic liver abscess usually resolve without surgical intervention.

Question 5

CMV colonoscopy findings

Answer 5

1. well-demarcated ulcerations
2. multinucleated giant cells with eosinophilic inclusions

(can present with diarrhea, fever, abdominal pain and 50% with grossly bloody stools)

Question 6

___________ infection can mimic IBD which is why it’s important to get stool studies in addition to colonoscopy.

Answer 6

Entamoeba histolytica

Question 7

_____ should be considered in all patients younger than age 40 years who have unexplained liver disease.

Answer 7

Wilson disease

Question 8

Patients with achalasia who are at high surgical risk should be treated with ______.

Answer 8

Endoscopic botulinum toxin injection (NOT endoscopic pneumatic dilation or laparoscopic surgical myotomy. CCBs aren’t really effective either and are 3rd line therapy)

Question 9

_____ in a pregnant woman with pruritus are considered diagnostic for cholestasis of pregnancy in the absence of an alternative diagnosis.

Answer 9

Elevated levels of total serum bile acid

Treatment with ursodeoxycholic acid

Question 10

Isolated right-colon ischemia may be a warning sign of ___.

Answer 10

Acute mesenteric ischemia caused by embolism or thrombosis of the superior mesenteric artery and should be evaluated using CT angiography.

(Patients with left-sided colonic ischemia tend to heal well with conservative therapy alone, whereas isolated right-colon ischemia can be the harbinger of acute mesenteric ischemia caused by a focal thrombus or embolus of the superior mesenteric artery.)

Question 11

_____ causes medication-induced enteropathy that can mimic refractory celiac disease.

Answer 11

Olmesartan

Question 12

Barrett esophagus with low-grade dysplasia should be treated with _____ in patients without significant comorbidities.

Answer 12

Endoscopic ablation therapy

Question 13

Risk factors for Giardia lamblia infection in healthy people

Answer 13

1. Children
2. Child care workers
3. Backpackers/campers who drink untreated water

Question 14

What does a 24-hour 5-hydroxyindoleacetic acid measure?

Answer 14

Carcinoid tumors

Question 15

Do you give antibiotics (cipro) for 7 days after a variceal bleed even if there is no mention of ascites?

Answer 15

Yes. (TIPS is only performed if hemostasis is unable to be achieved by endoscopic therapy.)

Question 16

Lactulose is first-line treatment and should be titrated to produce ____ stools per day. _____ is added to lactulose for prevention of recurrent episodes after a second episode of hepatic encephalopathy. Due to its expense, it is not a first-line therapy for hepatic encephalopathy.

Answer 16

three; Rifaximin

Question 17

Pts with a first-degree relative with colon cancer/advanced adenoma diagnosed at age younger than _____ or two or more first-degree relatives with colon cancer/advanced adenoma diagnosed at any age should begin colon cancer at age ____ or 10 years earlier than the youngest age in a first degree relative (whichever is first)

Answer 17

60 years; 40 years