Gastroenterology

Question 1

Acute pancreatitis first step in management

Answer 1

Always IV fluid at rate of 250cc/h for the first1-2 days.

Question 2

Acute pancreatitis Xray finding

Answer 2

Sentinel loop (proximal small bowel distention due to focal pancreatic inflammation). Usually doesn’t need NGT decompression

Question 3

Acute diverticulitis AB of choice

Answer 3

• Metrondiazole PLUS cipro/levoFloxacin or Bactrum

Question 4

Duodenal Vs. Gastric ulcer

Answer 4

Gastric: require repeating Upper Endoscopy after PPI
Duedonal: no need

PPI promote ulcer healing

Question 5

Acute mesentric ischemia test of choice

Answer 5

CT angio

Question 6

Coffee bean sign versus Pseudotumor sign

Answer 6

Coffee bean: U shaped bowel
Pseudo-tumor: fluid filled loop resemble a mass

Question 7

Appendicitis incidence age peak

Answer 7

10-14 years

Question 8

Best imaging for Renal stone

Answer 8

• CT Scan without contrast
• Renal U/S can diagnose stones, but may miss distal pathology (distal uretur)

Question 9

Two third of patients with GERD have endoscopic findings?

Answer 9

FALSE, 2/3 have no endoscopic findings

Question 10

GERD treatment sequence

Answer 10

1- Lifestyle and dietary modifications
2- OTC antacids
3- H2 receptor antagonist “rantidine”
4- 8w course of 20mg PPI
5- Double the dose
6- Anti-reflux surgery

Question 11

PPI long term risks?

Answer 11

1- C diff related colitis’
2- Drug induced lupus

2013 meta analysis showed that PPI was not associated with increased risk of hospital admission due to cap

Question 12

Dyspepsia definition

Answer 12

Upper abdominal discomfort and fullness

Red flags:
- Age >60
- bleeding, weight loss, dysphagia, family history of GI cancer

If red flags > Upper endoscopy
If no red flags > test for H.pylori

Positive> treat
Negative> PPI

Question 13

Non alcoholic fatty liver disease

Answer 13

• Cirrhosis is more common with alcoholic than non alcoholic
• Level of AST and ALT are usually high in patient with non alcoholic steatohepatitis
• Liver biopsy is the only way to confirm the diagnosis of non alcoholic steatohepatitis ( suspected in obese, abnormal LFT, DM, Splenomegaly, PE findings )

Question 14

Serology for Hepatitis B?

Answer 14

Negative surface Ag >

1- previous infection (2 AB positive core and surface ), or
2- previous immunity ( only surface AB positive )

Positive surface Ag >

HbcAb (igM) : acute infection
HbcAb (igG) : chronic infection

Question 15

Core antibodies in Hepatitis B ?

Answer 15

• HbcAb total: positive from onset of symptoms, and remain for life
• HbcAb (igM): within the first 6 months of acute infection