Practice Tests

Question 1

Pouchitis vs ischemic pouchitis appearance

Answer 1

Pouchitis is diffuse erythema, ischemic pouchitis is asymmetric with sharp demarkation

Question 2

How to treat jackhammer esophagus?

Answer 2

Poem if unresponsive to ca channel blockers?

Question 3

How can pantoprazole cause diarrhea?

Answer 3

Can cause lymphocytic colitis

Question 4

Pancreatic solid pseudopapillary neoplasm features

Answer 4

Mixed solid and cystic spaces, seen in young women, in head of pancreas, ultimately need to be removed given malignant potential

Question 5

Mucinous cystic neoplasm features

Answer 5

Can be seen in younger women, usually in tail, cystic with thick wall, unilocular

Question 6

Mycophenolate GI side effect?

Answer 6

Colitis and diarrhea

Question 7

Risk for resecting type 1 carcinoids/

Answer 7

Perforation given thin gastric wall 2/2 atrophic gastritis

Question 8

Remember the appearance of anal warts on retroflexion

Answer 8

Treat with cryotherapy

Question 9

What is the time course for acute pancreatic fluid collection or necrosis vs pseudocyst/walled off necrosis?

Answer 9

<4 weeks is acute

Question 10

How to tell difference between pseudocyst and walled off necrosis?

Answer 10

Walled off necrosis has a discrete wall — has solid necrosis and fluid

Question 11

Difference between EGJOO and achalasia? Workup?

Answer 11

EGJOO has normal peristalsis but increased IRP. EGJOO with EUS to make sure no malignant obstruction

Question 12

Varices in upper esophagus in patient with ? lung cancer?

Answer 12

Possible SVC syndrome

Question 13

How to treat psoriasis 2/2 TNF inhibitor?

Answer 13

Switch agent

Question 14

How to treat budesonide-refractory microscopic colitis?

Answer 14

Infliximab

Question 15

EUS appearance of lipoma

Answer 15

Third layer, bright! (GIST, etc are dark)

Question 16

Appearance of SCA and tx?

Answer 16

Microcystic (honeycomb) with central scar with calcifications. Just needs observation

Question 17

Cowden syndrome highest cancer risk?

Answer 17

Breast

Question 18

Serious side effect of tofacitinib?

Answer 18

GI perforation, cardiac issues

Question 19

TNF inhibitor contraindication?

Answer 19

Heart failure, increases risk of death. TB, untreated HBV

Question 20

Mutation that is a specific marker for mucinous cysts of the pancreas?

Answer 20

KRAS

Question 21

Management and surveillance of Barrett’s without dysplasia?

Answer 21

EGD q3y and PPI daily

With low grade or high grade dysplasia, need ablative therapy

Question 22

Sign of vitamin E deficiency?

Answer 22

Ataxia, falls, hyporeflexia

Question 23

Sign of vitamin C deficiency?

Answer 23

Petechiae, bleeding gums, impaired wound healing

Question 24

Sign of Selenium deficiency?

Answer 24

Cardiomyopathy

Question 25

Critical medication after extensive small bowel resection?

Answer 25

PPI for acid suppression to prevent ulceration with increased gastric acid after resection

Question 26

Difference between SOD1 (biliary sphincter of oddi stenosis) and SOD2 (functional biliary SOD), how to distinguish, how to treat?

Answer 26

SOD1 = biliary sphincter of oddi stenosis has biliary pain, dilated CBD AND periodically abnormal LFTs. Treat with biliary sphincterotomy (ensure PD stent is placed and indomethacin given) SOD2 = functional biliary SOD May have dilated duct OR periodically abnormal LFTs. If one or the other, then do SO manometry. If <40, then functional pain, if >40 =biliary SO stenosis and go to ERCP.

Question 27

What causes AIDS cholangiopathy? How does it look on biliary tree? How to treat the abdominal pain?

Answer 27

Caused by organisms like cryptosporidium. Intrahepatic and extra hepatic bile duct strictures and CBD dilation due to papillary stenosis (which distinguishes it from PSC). Treat abdominal pain with sphincterotomy, but mostly just needs HAART

Question 28

Severe pain after ERCP with precut papillotomy or large sphincterotomy with normal lipase? How to diagnose

Answer 28

Possibly retroperitoneal perforation. Need CT to diagnose (too small to see on XR). Conservative management. Can be normal after ERCP if no pain.

Question 29

Severe pain and free air after shortening duodenoscope to short position? Risk factors?

Answer 29

Lateral wall perforation -- needs closure and often surgical consult. Risk factors are bilroth II and duodenal stricture

Question 30

Cardiovascular or neurologic collapse during ERCP without free air on Fluoro?

Answer 30

Suspect air embolism and put patient into trendelenberg.

Question 31

Large pancreatic tumor with severely elevated lipase and erythema nodosum?

Answer 31

Acinar cell carcinoma of the pancreas.

Question 32

How to treat metastatic HCC in healthy(ish) patient?

Answer 32

Atezolizumab or bevacizumab is better than sorafenib