Gastrointestinal and Nutrition

Question 1

IVF in dehydrated young children

Answer 1

normal saline

Question 2

GGT and ferritn - classify how?

Answer 2

both acute phase reactants seen in alcoholic liver disease

Question 3

preggo with s/s of appy - what next?

Answer 3

ultrasound

Question 4

unconjugated hyperbilirubinemia + positive urine urobilinogen indicative of what process?

Answer 4

hemolysis

Question 5

Serum-to-Ascites Albumin Gradient (SAAG) differentiates ascites fluid origin from portal or non-portal HTN etiologies.
Equation: SAAG = peritoneal fluid albumin concentration - serum albumin concentration. ____ or greater = portal HTN (i.e. cirrhosis, cardiac ascites, etc).

Answer 5

1.1

Question 6

mgmt of pyloric stenosis

Answer 6

wait for surgery, manage with IVF and potassium replacement

Question 7

MCC of esophageal reupture

Answer 7

endoscopy

Question 8

abdominal pain after cardiac event (even weeks ago) + elevated amylase and/or metabolic acidosis –> dx?

Answer 8

–> Acute Mesenteric Ischemia

Question 9

diagnstic test for (test and dx): upper esoph sphincter dysfunction and esophageal dysmotility.
herniation forms superior to the UES and posteriorly between cricopharyngeal muscle.

Answer 9

Zenker

-contrast esophagram

Question 10

painless GI bleeding Associated/dx in advanced RENAL DISEASE and vWD and AORTIC STENOSIS.

Answer 10

angiodysplasia

Question 11

Rim enhancing perisigmoid fluid collection with n/abd pain/f. after sigmoid divertcula and
perisigmoid stranding found on CT.

Answer 11

acute diverticuitis

Question 12

Pt with Hemophilia A needs surgery - give what pre-operatively?

Answer 12

DDAVP (desmopressin) to increase factor 8 by causing vWF release from endothelial cells.

Question 13

Emergent laparotomy needed. Pt is on warfarin with INR of 2.1. Do what?

Answer 13

FFP or concentrated vitK factors

Question 14

Blunt abdominal trauma in stable pts - next step if: (a) Alert? (b) not alert

Answer 14

Alert? (a) Yes, then FAST exam. (b) No, then serial abd

exams +/- Ct scan.

Question 15

Pts with cirrhosis and portal HTN and ascites and peripheral edema - may develop _____, which causes a pleural effusion.

Answer 15

hepatic hemothorax. pleural effusio ndue to hemodiaphragm defect MC on right side

Question 16

Post-op or critically ill patient with unexplained fever and RUQ tenderness and leukocytosis. Possible jaundice or abnormal LFTs.

Answer 16

Think ACALCULOUS CHOLECYSTITIS due to GB stasis or ischemia from local inflammation.

Question 17

Rapid, massive increase in transaminases (in thousands) with mild elevation in Br and alk phos post-hypotension

Answer 17

shock liver or ischemic hepatic injury

Question 18

Jaundice and sustect pancreatic cancer - location and first test

Answer 18

head of pancreas, do us

Question 19

No jaundice, suspect pancreatic cancer - location and first test

Answer 19

body and tail. do abd CT

Question 20

What immune deficiency assoc with celiac?

Answer 20

IgA

Question 21

What test needs to be done to dx celiac if pt is also IgA decient

Answer 21

IgA anti-ttG and IgA anti-endomysial ab will be ENGATIVE. NEed to do small bowel bx to see villous atrophy. DONT TRUST IgA DIAGNSTIC TESTS IN CELIAC FOR RULING OUT.

Question 22

RF for adenocarcinoma esophageal cancer v. SqCCa of esophagus

Answer 22

AdenoCa = obesity, GERD

SqCCa = smoking, alcohol, caustic injury

Question 23

succussion splash indicates?

Answer 23

gastric obstruction - astric malignancy, peptic ulcer disease, crohn disease, strictures (with pyloric stenosis) secondary to ingestion of caustic agents, and gastri bezoars.

Question 24

Achalasia and esophageal stricture sx VS gastric outlet obstruction sx

Answer 24

Symtoms of GOO = postprandial pain and early satiety and vomting. VS Achalasia and esophagea stricture = dysphagia.

Question 25

suspect alcohol cirrhosis- next best test

Answer 25

upper endoscopy to look for varices

Question 26

ABG in laxative abuse

Answer 26

metabolic alkalosis

laxative abuse gives diarrhea with a METABOLIC ALKALOSIS - dt loos o fK, so hypoK impair
chlroide reaps = decr Cl-bicarb exchanger = incr bicarb [] in serum.

Question 27

P AS-positive in lamina propria of SI on bx +arthralgia + wt loss + diarrhea + abd pain + steatorhea + dementia (later stage) + supranuclear ophthalmoplega/myoclonus/valve/LAD and hyperpigmentation (later) =

Answer 27

Whipples disease

Question 28

pruritis, fatigue, HM, elevated Br –
assocaited with hepatocellular carcinma and OSTEOMALACIA (dt malabsoprtion).

+antimitochondrial ab =

Answer 28

primary biliary cholangitis

Question 29

Post cholecystectomy pain due to …?

Answer 29

Sphincter of ODDI dysfunciton.

Question 30

Meconium v. Hirschsprung in location: which is ileum level obstruction v. rectosigmoid level?

Answer 30

MEconium is obstruction at the level of the ileum and a NARROW underdeveloped COLON. [Inspissated = (viscous) meconoium)]. Hirschspring has obstruction at rectosigmoid region with transition zone be aganglionic rectum and PROXIMAL DILATED COLON.

Question 31

dx: LES lack of relaxation dt LOSS OF PERISTALSIS/DENERVATOIN)

Answer 31

primary achalasia

Question 32

calcium laden GB wall due to chromic cholecystisis –> name and incr risk for what?

Answer 32

porcelain GB

INCREASES RIS FOR GB ADENOCARCINOMA. Treat with cholecystectomy.