Test 2 - Created June 23

Question 1

Mallory-Weiss vs Boerhaave

Answer 1

MW: mucosal tear, hematemesis, do upper GI
Boerhaave: transmural (bores through), crepitus and crunching sound (Hamman sign), do esophagography with water-soluble contrast, surgery consult

Question 2

GI clinical findings of celiac

Answer 2

D, steatorrhea, wt loss, abd. pain, flatulence, bloating, ulcerative jejunitis, T-cell lymphoma

Question 3

non-GI findings of celiac: skin, endo, bone, heme, neuropsych

Answer 3

skin: dermatitis herpetiformis, atrophic glossitis
endo: vit.D def, 2* hyperPTH
bone: osteomalacia, osteoporosis, rickets
heme: Fe def
neuropsych: peripheral neuropathy, depr, anx

Question 4

antibodies for celiac disease

Answer 4

anti-endomysial

anti-tissue transglutaminase

Question 5

when higher doses needed for levothyroxine

Answer 5

malabsorption (celiac for ex.), iron, calcium, sucralfate, CYP450 drugs (phenytoin, carbamazepine, rifampin), obesity, pregnancy, overt proteinuria

Question 6

when to give RBC transfusion in pt with upper GI bleed

Answer 6

Hgb < 7 g/dL, hemodynamically unstable, OR sxs of severe anemia (CP, syncope)

Question 7

when to give octreotide in setting of upper GI bleed

Answer 7

with variceal hemorrhage

Question 8

when to give albumin infusion for GI issue

Answer 8

spontaneous bacterial peritonitis or large-volume paracentesis

Question 9

when to give platelet transfusion

Answer 9

life-threateing bleed and plt’s < 50k OR in those taking anti-plt agents

Question 10

sxs/signs of PBC

Answer 10

fatigue, itchy, infl. arthritis, tan, RUQ discomfort, xanthelasmata or xanthomata

Question 11

dx and tx of PBC

Answer 11

dx: elev alk phos; +anti-mitochondrial Ab
tx: ursodiol, liver transplant

Question 12

complications of PBC

Answer 12

osteopenia and osteoporosis

Question 13

antibody for type 1 autoimmune hepatitis

Answer 13

anti-smooth muscle

Question 14

sxs/signs of hemochromatosis

Answer 14

tan, DM, arthropathy, CMP

Question 15

B2 deficiency

Answer 15

angular cheilosis and stomatitis

Question 16

B1 deficiency

Answer 16

wet beriberi (CMP, polyneuropathy) and Wernicke-Korsakoff

Question 17

B3 deficiency

Answer 17

dermatitis, D, dementia

Question 18

chronic mesenteric ischemia: presentation and dx test

Answer 18

dull, crampy epigastric pain after eating; h/o of atherosclerotic dz; “intestinal angina”; need angiography

Question 19

sxs of Dyspepsia

Answer 19

burning epigastric pain, N/V, epigastric fullness, heartburn

Question 20

workup for Dyspepsia

Answer 20

over 60: upper endoscopy

< 60: H. pylori test; scope if high risk (bleed, wt loss, more severe sxs)

Question 21

biliary colic presentation and workup

Answer 21

EPISODES of epigastric or RUQ discomfort with radiaiton to the back and R shoulder; N/V, sweaty; < 6h; benign PE; do U/S

Question 22

when to do CCK cholescintigraphy on biliary colic patient

Answer 22

having typical biliary colic sxs but NO gallstones on prior imaging; CCK cholescintigraphy looks for functional GB disorder