Pre-Pros MEQ prep

Question 1

Mx of Intestinal Obstruction?

Answer 1

Stool culture/C. Diff (if 설사)
Daily AXR
Strict I/O charting
NBM, NGT, Rectal Tube

Treat underlying condition
Review meds
Replace electrolyte problems

Question 2

1st line invx for acute appendicitis?

Answer 2

CTAP

Question 3

Mx of appendicitis?

Answer 3

IV Ceftriaxone + Metronidazole
Symptomatic relief
NBM, IV hydration, electrolytes

Question 4

Invx for achalasia?

Answer 4

Esophageal manometry
OGD

CXR
EUS
CT TAP

Question 5

Mx of Achalasia?

Answer 5

Pneumatic balloon dilatation(1st line non-surgical tx)
Botulinum toxin endoscopic injection (Medical tx)
Heller Esophagomyotomy (Surgical tx)
Lifestyle e.g. Antacid, H2 receptor blockers, eat when sitting up, eat slowly, dont lie down after meals

Question 6

Invx of GERD?

Answer 6

Ambulatory 24hr pH probe (GS)
OGD tro esophagitis, Barrett
Manometry (tro motility disorder)

Question 7

Mx of GERD?

Answer 7

Lifestyle:
- weight loss
- cut 술, 카페인, 매운 맛, fatty foods
- Smoking cessation
- Elevate head when sleeping
- Dont lie down after eating

Meds:
PPIs
Antacids
H2 blockers

Question 8

Prophylaxis for variceal bleeding?

Answer 8

Band ligation 3 weeks
+
Propranolol

If BB contraindicated, go for Isosorbide Mononitrate

Question 9

Mx of active variceal bleed?

Answer 9

Resuscitation
Pharm: Abx, somatostatin, omeprazole, Vit K
Definitive tx is endoscopic variceal band ligation.

Ceftriaxone for abx

Question 10

Therapeutic mx for active PUD bleeding?

Answer 10

Adrenaline injection + Clip/heater probe
through endoscope

Question 11

Mx of uncomplicated PUD?

Answer 11

PPI + Clarithromycin + Metro/Amoxicillin for 10-14 days.
Re-scope in 6 weeks to document healing.

Dont forget lifestyle mx

Question 12

Invx for ischemic colitis?

Answer 12

Endoscopy is GS.
AXR supine
CTAP with contrast (can localize site)

Question 13

Mx of ischaemic colitis?

Answer 13

NBM, Analgesia, fluid hydration, abx
Consider NGT decompression

hydration is to optimize perfusion to ischemic colon

Question 14

Imaging for Diverticulitis?

Answer 14

CTAP

Gold standard to diagnose + stage severity

Question 15

Mx of uncomplicated diverticulitis?

Answer 15

NBM > liquid diet > high fibre low residue diet
Analgesia
IV Ceftriaxone & Metro 10-14d

Question 15

Invx for Crohn’s disease?

Answer 15

Endoscopic + biopsy best
CT/MRI with contrast 2nd line

Look for non-caseating granulomas in colon

Question 16

Invx for ulcerative colitis?

Answer 16

flexible sigmoidoscopy + biopsy

Do not scope during acute flare - risk of perforation

Question 17

Mx of haemorrhoids?

Answer 17

Grade 1 = Lifestyle modi + stool softeners + daflon
Grade 2 = Above + Rubber band ligation
Grade 3 + 4 = Above + Haemorrhoidectomy

Question 18

Mx of anal fissure?

Answer 18

High fibre diet
Bulking agents
Stool softener
Warm sitz baths
Lidocaine jelly
Topical nifeidipine/diltiazem
GTN ointment

Question 19

Mx of anal fistulas?

Answer 19

Intersphincteric = Fistulotomy
Suprasphincteric = Fistulotomy / seton cutting
Trans-sphincteric = Seton / endorectal advancement flap / sphincter reconstruction
Extrasphincteric = Endorectal advancement flap / laparotomy

Question 20

Invx for anal fistulas?

Answer 20

Endoanal Ultrasound easiest
MRI is gold standard

CT / fistulography in emergency

Question 21

Mx for anal fistulas?

Answer 21

High fistula = require seton + endorectal advancement flap
Low fistula = Fistulotomy

Puborectalis is key to future continence

Question 22

Invx for acute pancreatitis?

Answer 22

US HBS 1st line
Erect CXR
Supine AXR
CTAP

Question 23

Mx of acute pancreatitis?

Answer 23

Fluid resus
Monitoring
Opioid analgesics
Enteral nutrition
IV Ceftriaxone/Metronidazole

NSAIDs banned cuz can worsen pancreatitis + cause renal failure

Question 24

Invx of chronic pancreatitis?

Answer 24

**MRCP best** CT/MRI/US 2nd choice Pancreatic Secretin Stimulation Test is GS but invasive

Question 25

Invx for gallstones?

Answer 25

**US HBS** 1st line **MRCP** if pt doesnt need therapeutic intervention **ERCP** if therapy needed CTAP tro other differentials Perc biliary drainage last resort

Question 26

Mx of cholecystitis?

Answer 26

**Lap chole** is definitive tx Perc cholec | Keep NBM, IV Ceftriaxone + Metronidazole

Question 27

Imaging for choledocholithiasis?

Answer 27

**US HBS** 1st line MRCP ERCP EUS

Question 27

Mx of choledocholithiasis?

Answer 27

**Lap chole** **ERCP **with sphincterotomy

Question 28

Invx for urolithiasis?

Answer 28

**CT KUB non contrast** 1st line KUB XR (usu for follow-up/screening) US kidneys/bladder (evidence of stone/comp)

Question 29

Mx of urolithiasis?

Answer 29

<5mm can wash out. **Tamsulosin** to relax ureter tone Lower protein and salt intake Surgical = **Perc nephrolithotomy** (PCNL) 1st line | ESWL not commonly done cuz too pain, and success rate not high

Question 30

Invx for prostatic cancer?

Answer 30

Prostate-specific Antigen **Trans-rectal Ultrasound** with biopsy (TRUS) **MRI** to stage | CT or MRI to stage? pls check

Question 30

Invx for testicular tumour?

Answer 30

**Ultrasound scrotum** to diagnose. **CT TAP** for staging | Seminoma shows hypoechoic intratesticular mass. ## Footnote Non-seminoma shows inhomogenous lesion e.g. teratoma

Question 31

Invx for hernia?

Answer 31

Dynamic Ultrasound if clinically inconclusive AXR supine if suspect IO