MKSAP GI V

Question 1

How do you treat a patient with cirrhosis and meet the Milan criteria (up to 3 hepatocellular carcinoma tumors <3cm or one tumor <5cm) are best treated with:

Answer 1

Liver transplantation

Question 2

Gastrointestinal bleeding occurring in patients following aortic graft surgery should raise the possibility of aortoenteric fistula; _____ is the initial test in appropriate patients.

Answer 2

CT with contrast

Question 3

Randomized controlled trials have not shown a _____ in clinical outcomes or cost with rapid bowel preparation and colonoscopy within 8 to 12 hours compared with a standard oral bowel preparation and colonoscopy within 24 hours for patients with LGIB.

Answer 3

benefit

Question 4

What do you use to diagnose overflow incontinence?

Answer 4

KUB

Question 5

Colonoscopy with sharply demarcated pale mucosa with petechial bleeding.

Left colon inflammatory changes on colonoscopy or abdominal CT.

Answer 5

Ischemic colitis (gradual L-sided moderate-intensity abdominal pain)

(Acute mesenteric ischemia is ischemia of small bowel and is caused by embolism 50% of the time and classically present with central abdominal pain out of proportion to exam)

Question 6

Anti–tumor necrosis factor agents such as _____ are effective in inducing and maintaining remission in moderate to severe Crohn disease.

Answer 6

infliximab

Question 7

Lynch syndrome CRC screening

Answer 7

1. start at age 20 and 25 yrs or 2-5 years before earliest cancer in family
2. repeat every 1-2 years if baseline is normal

Question 8

A history of multiple family members with gastric cancer (before age 50), or multiple family members with lobular breast suggest _____ and the need for EGD and testing for mutations of the ________.

Answer 8

hereditary diffuse gastric cancer; CDH1 gene.

Question 9

In patients with well-preserved liver function, drug-induced liver injury should be managed with ___.

Answer 9

1. Discontinuation of the offending medication

2. Observation until resolution of symptoms occurs (no steroids needed)

Question 10

Centrally mediated abdominal pain syndrome is characterized by near-constant abdominal pain lasting longer than _____, involving a ____ anatomic distribution, and without ____ or ____.

Answer 10

1. 6 months
2. large
3. initiating triggers
4. alarm features

Question 11

When does EGD start for FAP?

Answer 11

Screening for duodenal cancer should begin at onset of colonic polyposis or at age 25-30 years (whichever first)

Question 12

Diagnostic criteria for function dyspepsia

Answer 12

1. bothersome postprandial fullness
2. early satiety
3. epigastric pain and/or
4. epigastric burning for at least 3 days per week

For at least 6 months with no evidence of structural disease.

Treatment is with 4 weeks of once daily omeprazole then TCA

Question 13

Treatment of microscopic colitis

Answer 13

1. DC a potentially causative medication (like NSAIDS, SSRI, PPI)
2. supportive treatment with loperamide, etc
3. budesonide if does not respond to the above

Question 14

Colonoscopy with lymphocytic infiltration and subepithelial collagen band

Answer 14

Collagenous colitis (subtype of microscopic colitis)

Question 15

Size cut off for hepatic adenoma in woman on estrogen containing OCPs.

Answer 15

<5cm (with follow-up imaging every 6 months for at least 2 years) after DC OCP

Question 16

What is a push enteroscopy?

Answer 16

Advancement of endoscope beyond ligament of Treitz into jejunum

Question 17

What is CT enterography used for?

Answer 17

CT enterography is a way to get good imaging of small bowel. Used for working-up small-bowel obstruction where a lesion or mass is suspected

Question 18

Risk factors for SIBO

Answer 18

1. small-bowel disease
2. previous bowel resection
3. primary/secondary GI motility disorder