OME - Day 17

Question 1

40 year old man with ulcerative colitis and jaundice, diagnosis?

Answer 1

Primary Sclerosing Cholangitis, get an MRCP

Question 2

40 year old woman with jaundice and no alcohol or viruses, diagnosis?

Answer 2

Primary Biliary Cirrhosis

Question 3

Beads on a string on MRCP, diagnosis?

Answer 3

Primary Sclerosing Cholangitis

Question 4

Cirrhosis and COPD, diagnosis?

Answer 4

Alpha-1 Anti-Trypsin Deficiency

Question 5

Diabetes, Diastolic CHF, Hyperpigmentation, and Cirrhosis, diagnosis and next step?

Answer 5

Hemochromatosis, get a ferritin

Question 6

Fatty liver on ultrasound but no alcohol or viral hepatitis, diagnosis?

Answer 6

NASH, NAFL

Question 7

See a picture of someone’s eye and the vignette is about cirrhosis, diagnosis and next step?

Answer 7

Wilson’s disease, get a urinary copper

Question 8

Serology associated with Primary Sclerosing Cholangitis, diagnosis?

Answer 8

p-ANCA

Question 9

Treatment for Hemochromatosis (before cirrhosis)

Answer 9

Phlebotomy or Deferoxamine/Deferasirox

Question 10

What is the diagnostic step for primary biliary cirrhosis?

Answer 10

Biopsy only (Microductal intrahepatic disease)

Question 11

Flapping tremor, altered mental status, cirrhosis, diagnosis and next step?

Answer 11

Hepatic Encephalopathy, asterixis, give lactulose

Question 12

How do you diagnose Hepatocellular Carcinoma?

Answer 12

Triple Phase CT Scan (NOT a biopsy)

Question 13

How do you treat Spontaneous Bacterial Peritonitis?

Answer 13

Ceftriaxone

Question 14

Paracentesis is done and there are 1000 white cells, 75% white blood cells, what is it?

Answer 14

Spontaneous bacterial peritonitis

Question 15

Prophylaxis for Spontaneous bacterial peritonitis?

Answer 15

Fluoroquinolone

Question 16

Screening for Hepatocellular Carcinoma?

Answer 16

Ultrasound and AFP q6 months

Question 17

You do a large volume paracentesis, what should you do immediately after?

Answer 17

IV albumin

Question 18

First step in a GI Bleed?

Answer 18

2 large bore IVs - manage the ABCs

Question 19

Superficial mucosal tear, self limiting GI bleed, diagnosis?

Answer 19

Mallory-Weiss

Question 20

There is a GI bleed not seen on endoscopy, and they require transfusions every 3 hours, diagnosis and treatment?

Answer 20

Brisk bleed, arteriogram

Question 21

There was a GI bleed last week and it stopped, EGD was negative, next step?

Answer 21

Colonoscopy

Question 22

There was a GI bleed two weeks ago, both the EGD and colonoscopy were negative, next step?

Answer 22

Pill-cam endoscopy

Question 23

Transmural tear, mediastinitis, diagnosis?

Answer 23

Boerhaave’s

Question 24

What do you add to the usual 5 things in gi bleed if they are cirrhotic?

Answer 24

Octreotide (for varices) and Ceftriaxone (for SBP prophylaxis)

Question 25

What FIVE things do you do for someone with a GI bleed?

Answer 25

2 large bore IVs, IV fluids, type and cross, call GI, IV PPI

Question 26

What is the treatment of a peptic ulcer disease causing bleeding?

Answer 26

PPI

Question 27

You suspect Boerhaave's, what's the first step?

Answer 27

Gastrografin (usually it is barium)

Question 28

Currant jelly diarrhea in a child, pain relieved by knee-to-chest position. What's the diagnosis?

Answer 28

Intussusception

Question 29

What is the treatment for Intussusception?

Answer 29

Air-enema

Question 30

What three things should you look for in a patient with necrotizing enterocolitis?

Answer 30

Intraventricular hemorrhage (ultrasound with Doppler), Retinopathy of prematurity (Ophtho exam), Bronchopulmonary Dysplasia

Question 31

X-ray findings in Necrotizing Enterocolitis?

Answer 31

Pneumatosis Intestinalis, air in the wall of the bowel

Question 32

Diagnostic step for a Meckel's Diverticulum?

Answer 32

Technetium-99 scan (it won't be called a Meckel's scan)

Question 33

Painful bloody bowel movement in a child, relieved by knee-chest position - diagnosis?

Answer 33

Intussusception

Question 34

Sausage-shaped mass and currant-jelly diarrhea - diagnosis?

Answer 34

Intussusception

Question 35

What do you do about an anal fissure in a child?

Answer 35

Treat constipation if present. Check for IBD if older child.

Question 36

What do you get if you're worried about a GI bleed in a healthy term neonate right after delivery?

Answer 36

Apt Test

Question 37

What test do you do to investigate Intussusception?

Answer 37

Air Enema

Question 38

What are the imaging keywords you're looking for to diagnose necrotizing enterocolitis?

Answer 38

Pneumatosis Intestinalis (air in the wall of the bowel)

Question 39

You're worried about a GI bleed in a premature neonate, what do you get?

Answer 39

X-ray

Question 40

Epigastric pain boring to the back, better with leaning forward, diagnosis?

Answer 40

Pancreatitis

Question 41

Flank ecchymosis and pancreatitis, diagnosis?

Answer 41

Grey-Turner Sign

Question 42

How do you diagnose acute pancreatitis?

Answer 42

Lipase

Question 43

How do you manage a pancreatic pseudocyst?

Answer 43

6cm and 6 weeks, if > drain, if < watch

Question 44

How do you treat Pancreatitis?

Answer 44

NPO, IVF, Pain control

Question 45

Two most common causes of pancreatitis?

Answer 45

Alcohol and Gallstones

Question 46

Umbilical ecchymosis and pancreatitis, look for what sign?

Answer 46

Cullen's

Question 47

What is the treatment of gallstone pancreatitis?

Answer 47

ERCP

Question 48

When do you get a CT scan in pancreatitis?

Answer 48

When you're really sure it is pancreatitis, but Lipase is normal

Question 49

When do you give antibiotics to pancreatitis?

Answer 49

Meropenem if an FNA / Biopsy grows an organism