MTB Gastro

Question 1

pain while swallowing.

Answer 1

Odynophagia

Question 2

Alarm symptoms indicating endoscopy include:

Answer 2

• Weight loss
• Blood in stool
• Anemia

Question 3

Achalasia diagnostic finding

Answer 3

Barium esophagram will show a “bird’s beak”

Question 4

Achalasia treatment

Answer 4

Pneumatic dilation

Botulinum toxin injection

Question 5

Esophageal Spasm presentation

Answer 5

sudden onset of chest pain that is not related to exertion. Therefore, at first it is impossible to distinguish them from some form of atypical coronary artery spasm or unstable angina.

Question 6

Zenker is

Answer 6

an outpocketing of the posterior pharyngeal constrictor muscles. There is dysphagia, halitosis, and regurgitation offood particles. Some patients suffer from aspiration pneumonia when the contents of the diverticulum end up in the lung.

Question 7

Mallory-Weiss tear presents with

Answer 7

upper gastrointestinal bleeding after prolonged or severe vomiting or retching. Repeated retching is followed by hematemesis of bright red blood, or by black stool.

Question 8

GORD presentation

Answer 8

The patient also complains of sore throat, bad taste in the mouth (metallic), hoarseness, or cough.

Question 9

GORD treatment

Answer 9

All patients should:
• Lose weight if obese.
• Avoid alcohol,nicotine,caffeine,chocolate,and peppermint.
•Avoid eating at night before sleep (within 3hours of bedtime).
• Elevate head of bed 6 to 8inches.
PPis.

Question 10

Stress ulcer prophylaxis Is Indicated In:

Answer 10

• Mechanical ventilation
• Burns
• Head trauma
• Coagulopathy

Question 11

Less common causes of peptic ulcers are:

Answer 11

• Burns
• Head trauma
• Crohn disease
• Gastriccancer
• Gastrinoma(Zollinger-Ellisonsyndrome)

Question 12

“best initial therapy” of H, pylori is

Answer 12

a PPI combined with clarithromycin and amoxicillin.

Question 13

Gastrinoma aka

Answer 13

Gastrinoma (Zollinger-Ellison Syndrome)

Question 14

Diabetic Gastroparesis

Answer 14

Look for a diabetic patient with chronic abdominal discomfort, “bloating,” and constipation. There is also anorexia, nausea, vomiting, and early satiety.

Question 15

Variceal bleeding, look for

Answer 15

• Vomiting blood+/- black stool
• Spiderangiomataandcaputmedusa
• Splenomegaly
• Palmar erythema
• Asterixis

Question 16

Chronic pancreatitis diagnostic finding

Answer 16

AXR calcification

Abdo CT calcification

Question 17

Carcinoid syndrome

Answer 17

• Flushing
• Wheezing
• Cardiac abnormalities of the right side of the heart

Question 18

The pain of IBS is:

Answer 18

IBS is not associated with weight loss.
• Relieved by a bowel movement
• Less at night
• Relieved by a change in bowel habit such as diarrhea

Question 19

Crohn disease

Answer 19

skip lesions
transmural glanulomas
fistula and abscess
masses and obstruction
perianal disease

Question 20

Ulcerative colitis

Answer 20

curable by surgery
entirely mucosal
no fistula, no abscess 
no obstruction
no perineal disease

Question 21

Acute epigastric pain + tenderness + nausea/vomiting = pancreatitis

Answer 21

Acute pancreatitis

Question 22

All forms of chronic liver disease can produce:

Answer 22

• Ascites
• , Coagulopathy (all clotting factors except VIII are made in liver)
• Asterixis and encephalopathy
• Hypoalbuminemia and edema
• Spider angiomata and palmar erythema
• Portal hypertension leading to varices
• Thrombocytopenia from splenic sequestration
• Renal insufficiency (hepatorenal syndrome)
• Hepatopulmonary syndrome

Question 23

Treat PBC with

Answer 23

ursodeoxycholic acid.

Question 24

Nonalcoholic Steatohepatitis (NASH) or Nonalcoholic Fatty liver Disease

Answer 24

This disorder is associated with:
• Obesity
• Diabetes
• Hyperlipidemia
• Corticosteroiduse

Question 25

The single word progressive (or “from solids to liquids”) is the most important
clue to the diagnosis of

Answer 25

esophageal cancer.

Question 26

Plummer-Vinson syndrome is associated with

Answer 26

iron deficiency anemia and can rarely transform into squamous cell cancer.

Question 27

GERD is the answer when you see

Answer 27

“epigastric burning pain radiating up into the chest.”

Question 28

Testing for H.pyroli

Answer 28

Endoscopic biopsy
Serology
Urea C13 or C14 breath testing
H. pylori stool antigen

Question 29

There is no way to diagnose PUD without

Answer 29

endoscopy or barium studies.
Radiologic testing such as an upper GI series can detect ulcers, but cannot detect the presence of either cancer or H. pylori.

Question 30

If there is no response to DU therapy with PPis, clarithromycin, and amoxi- cillin, the first thought should be

Answer 30

antibiotic resistance of the organism.

C13 urea breathing test

Question 31

All forms of fat malabsorption present with

Answer 31

deficiency of fat-soluble vitamins such as vitamins A, D, E, and K.
Fat malabsorption frequently presents with weight loss.

Question 32

ANCA and ASCA results in IBD

Answer 32

ANCA only positive in UC

ASCA positive in Crohn

Question 33

Colonoscopy and barium enema are dangerous in

Answer 33

acute diverticulitis because of increased risk of perforation. Infection weakens the colonic wall.

Question 34

Diverticulitis Abx

Answer 34

Ciprofloxacin combined with metronidazole

cover the E. coli and anaerobes

Question 35

MRCP is diagnostic; ERCP is for

Answer 35

therapy.

Question 36

Early PSC can look just like PBC. Look for:

Answer 36

• Pruritus
• Elevated alkalinephosphatase and GGTPas well as elevated bilirubin level
Early PSC can look just like PBC. The bilirubin level can be normal in early disease.

Question 37

Look for the combination ofliver disease and emphysema (COPD) in a young patient (under 40) who is a nonsmoker.

Answer 37

Alpha !-Antitrypsin Deficiency