Colon Flashcards
(524 cards)
1
Q
For HOW LONG do symptom have to EXIST for the diagnosis of CHRONIC CONSTIPATION?
A
3 MONTHS
2
Q
A CONGENITAL disorder of OBSTIPATION and COLONIC DILATION PROXIMAL to a SPASTIC, NON-PROPULSIVE segment of DISTAL BOWEL resulting in ARREST of CAUDAL MIGRATION?
A
HIRSCHPRUNG’s DISEASE
3
Q
ANTICHOLINERGICS (antispasmodics, antidepressants, antipsychotics); IRON SUPPLEMENTS, ALUMINUM (antacids, sucralfate), OPIATES, ANTIHYPERTENSIVES, CALCIUM CHANNEL BLOCKERS, 5H3-AGONISTS?
A
CONSTIPATING DRUGS
4
Q
WITHOUT ALARM SYMPTOMS (hematochezia, weight loss >10 lbs, FH of colon cancer or IBD, ANEMIA, positive FOBT and ACUTE ONSET of constipation), are flex sig, colonoscopy, barium enema, thyroid tests, etc. warranted for CHRONIC CONSTIPATION?
A
NO
5
Q
What is the FIRST and most PHYSIOLOGIC approach to treating CHRONIC CONSTIPATION?
A
Dietary FIBER (WHEAT BRAN, PSYLLIUM) DAILY - if fiber intollerant, use stimulant laxatives 2-3 times per week or osmotic laxatives daily
6
Q
Which are the PREFERRED SAFE LAXATIVES to use in PREGNANCY?
A
PEG and LACTULOSE
7
Q
Is CHRONIC use of STIMULANT LAXATIVES harmful to the COLON?
A
NO (goal of 2-4 stools/week)
8
Q
In patients who do NOT RESPOND to CONSERVATIVE therapy AFTER DEFECATION studies have been performed, what is the NEXT TEST?
A
COLONIC TRANSIT STUDY (SITZ markers) - normal is NO MARKERS on days 4 and 7 on x-ray
9
Q
Delayed PASSAGE of radiopaque markers through the PROXIMAL COLON with a NORMAL COLON DIAMETER and NORMAL ANORECTAL FUNCTION is known as?
A
COLONIC INERTIA
10
Q
SLOW RECTOSIGMOID colon transit with or without MEGARECTUM?
A
OUTLET DELAY (dyssynergia, weak force, short-segment Hirschprung’s, rectocele)
11
Q
These parameters (rectal sensation and compliance, relaxation of the internal rectal sphincter and expulsion of a water-filled balloon) are checked for the FUNCTION of the RECTUM in what exam?
A
ANORECTAL MANOMETRY
12
Q
In the ABSENCE of DELAYED BALLOON EXPULSION, can DYSSYNERGIC DEFECATION be diagnosed based on ANORECTAL MOTILITY?
A
NO
13
Q
Barium thickened to the consistency of stool is monitored and evacuation monitored by imaging. This test can be used to test for DEFECATION DISORDERS where ANORECTAL MANOMETRY is NOT AVAILABLE?
A
DEFACOGRAPHY
14
Q
FAILURE to RELAX of the PUBORECTALIS and EXTERNAL ANAL SPHINCTER, or INAPPROPRIATE CONTRACTION of these muscles are found in what DEFECATION DISORDER?
A
DYSSYNERGIC DEFECATION (narrows the ANORECTAL ANGLE)
15
Q
When TWO of the following studies are positive (ANORECTAL MANOMETRY, DEFECOGRAPHY, INNABILITY to EXPEL a water BALLOON within 2 MINUTES), ONLY then this can be DIAGNOSED?
A
DYSSYNERGIC DEFECATION treat with BIOFEEDBACK - habit training
16
Q
What treatments should be AVOIDED in the treatment of CHRONIC MEGACOLON?
A
FIBER SUPPLEMENTS and OSMOTIC LAXATIVES (often need surgery)
17
Q
How is INTRACTABLE CONSTIPATION treated?
A
Manual disimpaction, then either BID ENEMAS or PEG until cleared bowles, then PEG to produce stool every other day, with HABIT TRAINING - if no defecation in 2 days, glycerin suppositry or enema
18
Q
What is the FIRST STUDY to perform when evluating a patient for REFRACTORY CONSTIPATION?
A
ANORECTAL MANOMETRY and BALLOON EXPULSION (before ANY other study such as colonic transit studies or biofeedback)
19
Q
What can be done for a patient that has CHRONIC, SEVERE and DISABLING SYMPTOMS from CONSTIPATION UNRESPONSIVE to medical therapy; has SLOW COLONIC TRANSIT of the INERTIA PATTERN; and does NOT HAVE INTESTINAL DYSMOTILITY?
A
SUBTOTAL COLECTOMY with ILEORECTAL ANASTOMOSIS
20
Q
What TEST should be performed BEFORE REPAIR of a RECTOCELE thought to cause CONSTIPATION?
A
IMPROVED RECTAL EVACUATION after pressure is placed on the POSTERIOR VAGINAL WALL
21
Q
What is the TREATMENT of CHOICE for Hirschprung’s Disease?
A
SURGERY - excision of affected segment of bowel
22
Q
What FINDING demonstrates END-STAGE COLON FAILURE?
A
CHRONIC MEGACOLON
23
Q
NALOXONE, NALOXEGOL, NALDEMEDINE and NALTREXONE are all what types of meds?
A
OPIOID ANTAGONISTS used in reversing the CONSTIPATION effect of opioid analgesics
24
Q
In OPIOID-INDUCED CONSTIPATION, what are the FIRST-LINE agents recommended?
A
LAXATIVES followed by OPIOID ANTAGONISTS (naltrexone, etc.)
25
**BEFORE** performing a **COLON TRANSIT STUDY** (markers), what **TESTING** should be done first, to **EXCLUDE DEFECATION** problems **FIRST**?
**BALLOON EXPULSION TEST** and **ANORECTAL MANOMETRY**
26
In a patient with **CHRONIC CONSTIPATION**, **REGARDLESS** of **OPIOID** use, what **MUST** **BE TRIED FIRST** before using **OPIOID ANTAGONISTS** and other measures to relieve the constipation?
**TRADITIONAL LAXATIVES** (PEG)
27
If **ANY TWO** of the following are present: straining during defecations, lumpy, hard stools, incomplete evacuation, sense of anorectal obstruction, manual disimpaction the **DIAGNOSIS** of this can be made?
**FUNCTIONAL CONSTIPATION**
28
**SLOW PROXIMAL COLON TRANSIT** that best reponds to **PEG** and **MISOPROSTOL** is called what?
**COLONIC INERTIA**
29
**Intractable** or disabling symptoms of **COLONIC INERTIA** (proximal colon), **NO** intestinal **PSEUDOOBSTRUCTION**, **NORMAL ANORECTAL FUNCTION** (abdominal pain is NOT predominant feature). What can be done for treatment?
**SUBTOTAL COLECTOMY**
30
MEGACOLON and MEGARECTUM, besides in children with retentive soiling, can be seen in?
Institutionalized **ELDERLY**, those with **PARKINSON's** disease and **SCHIZOPHRENIA** and other **PSYCHOTIC DISORDERS** (treat with LOW fiber diet, enemas, PEG or surgery)
31
Is **PAIN** (progressive, awakens or prevents sleep) associated with **ANOREXIA**, **WEIGHT LOSS** or **MALNUTRITION** a finsing in **IBS**?
**NO**
32
**EXAGERRATED MOTOR RESPONSE** to **MEALS**, **STRESSORS**, **CCK**, and **IMPAIRED** **HANDLING** of **INTESTINAL** **GAS** are seen in what condition?
**IBS**
33
This can be seen in **4-30%** of patients after a **BACTERIAL** or **VIRAL ENTERITIS** with **DIARRHEA** predominance (women, anxiety, deoression, use of antibiotics)?
**POST-INFECTIOUS IBS**
34
Does **PSYCHIATRIC DISTRESS CAUSE** symptoms of **IBS**?
**NO** (but it can **INFLUENCE THEM**)
35
Is there a **RELIABLE BREATH TEST** for **SIBO**?
**NO**
36
Post **LACTULOSE** administration, what constitutes a **POSITIVE HYDROGEN BREATH TEST** for **SIBO**?
An **INCREASE of \>20 ppm** by **90 min or 180 min** (early or late)
37
What strategy results in **FEWER IBS-RELATED FOLLOW-UP** visits?
Physician-Patient relationship with **REALISTIC EXPECTATIONS** and **CONSISTENT LIMITS** - normal life span, FODMAP DIET, reduction of GAS-PRODUCING foods
38
Is **FOOD ALLERGY** testing **HELPFUL** for patients with **IBS**?
**NO**
39
In which patients should the **IBS-D** medication **ELUXADOLINE** **NOT** be used in?
Those S/P **CHOLECYSTECTOMY**, **KNOWN PANCREATICO-BILIARY DISEASE**, **CIRRHOSIS** or **HEAVY ALCOHOL USE**
40
**LINACLOTIDE**, **LUBIPROSTONE**, **PLECANATIDE**, **PEG**, **TEGASEROD** (in women \<65 when **ALL ELSE FAILS**) are **ALL** used to treat this condition?
**IBS-C**
41
**RIFAXIMIN**, **ALOSETRON**, **LOPERAMIDE** and **ELUXADOLIN** are all used to treat what?
**IBS-D**
42
Which **SMOOTH MUSCLE** relaxants and **ANTI-SPASMODICS** work best in **IBS** (short-term use)?
**DICYCLOMINE**, **PEPPERMINT OIL** (good placebo effect)
43
Do **TCAs** and **SNRIs** work better than placebo in **IBS**?
**YES**
44
**FRUCTANS** (onions, wheat, artichokes); **GALACTANS** (legumes, cabbage, Brussles sprouts); **LACTOSE**, **SORBITOL**, **XYLITOL**, **MANNITOL** and **SUCRALOSE**?
**FODMAP** (Fermentable Oligo, Di, Mono And Polyols) - **AVOID THESE** (low-FODMAP diet) in **IBS** patients
45
What is the **BEST DIET** for improving the **QUALITY** of **LIFE** in **IBS** patients?
**LOW-FODMAP**
46
For **MODERATE** to **SEVERE IBS**, what **ELSE** helps **SIGNIFICANTLY** besides medications (rifaximin, etc.)?
**Cognitive Behaviroal Therapy** (self-administered)
47
What should be considered **FIRST** in **IBS-D** before other treatment options?
**FECAL CALPROTECTIN** and if **POSITIVE**, **COLONOSCOPY** with **BIOPSY**
48
What treatment for **IBS** has shown the **GREATEST** value over **PLACEBO**?
**PHYSICIAN-PATIENT RELATIONSHIP**
49
In a patient with **IBS-D**, if intolerant to one **TCA**, what should be done?
**SWITCH** to another **TCA**
50
If **LINACLOTIDE** (or PLECANATIDE - same mechanism) are ineffective in treating **IBS-C**, what should be tried next?
**LUBIPROSTONE** (approved for IBS-C)
51
**CBC**, **FOBT**, **COLORECTAL CANCER SCREENING**, **CRP**, **FECAL CALPROTECTIN**, **STOOL CULTURES** and **COLONOSCOPY** are tests that should be done when working up what?
**IBS** with **NO ALARM SYMPTOMS**
52
This class of meds **Ondansetron**, **Alosetron**, **Prucalopride** are used to treat **IBS**?
**SNRIs**
53
Which **ADENOMAS** of the colon are **DYSPLASTIC**?
**ALL**, by definition (hence, all must be removed)
54
What is considered an **ADVANCED COLON ADENOMA**?
**\>1 cm** and with **HIGH-GRADE DYSPLASIA**
55
**HYPERPLASTIC** polyp, **SESSILE SERRATED** polyp and **SERRATED ADENOMA**s are all types of what?
**SERRATED** colon polyps (hyperplastic is the only benign polyp)
56
Distinguishing features of a polyp that has even **A SINGLE** **DILATED** or **DISTORTED CRYPT** designates it as what type of polyp?
**SESSILE SERRATED** polyp rather than a hyperplastic polyp
57
When a colon lesion **INVADES** into the **SUBMUCOSA**, only then is it termed what?
**CANCER** (carcinoma in situ and intramucosal adenocarcinoma are NOT cancer)
58
Which **COLON POLYPS** have the **HIGHEST** prevalence of **HIGH-GRADE DYSPLASIA**?
**DEPRESSED** lesions (usually **RIGHT** colon, whereas pedunculated lesions are predominantly in the left colon)
59
What differentiates **SUPERFICIAL** from **DEEP SUBMUCOSAL INVASION** of a dysplastic colon polyp?
Lesions with **≥1,000 microns** of **SUBMUCOSAL INVASION**
60
On **ENDOSCOPY** with **NBI**, the appearance of a polyp with **DISRUPTED** or **AMORPHIC** **VASCULAR** and **PIT** structure is suggestive of what?
A polyp with features of **DEEP SUBMUCOSAL INVASION** and **NOT** removable **ENDOSCOPICALLY**
61
What are the **THREE** most common **MOLECULAR PATHWAYS** to **COLON CANCER**?
**1. CHROMOSOMAL INSTABILITY** (**ADENOMAS** tubular and villous, accumulating mutations - APC, K-ras, p53)
**2. HYPERMETHYLATION** pathway - **SERRATED** polyps (BRAF, MLH1 genes)
3. **LYNCH** - germline mutations in mismatch repair genes (MLH1, MSH2, MLH6, PMS2) microsatellite instability
62
In a patient in which **1 - 2 CONVENTIONAL ADENOMAS** have been found on colonoscopy, **WHEN** should they be **SCREENED** next?
**5-10 YEARS**
63
In a patient found to have **≥3 ADENOMAS** of **ANY SIZE** **or** **ONE ≥10 mm** in size **WITH** **VILLOUS** elements **or HIGH-GRADE DYSPLASIA**, when should **SURVEILLANCE** be done next?
In **3 YEARS**
64
In a patient found to have **≥10 ADENOMAS**, when should **SURVEILLANCE** be done next?
In **LESS** than **\<3 YEARS**
65
In a patient found to have an **ADENOMA ≥2 cm** in **SIZE** resected in a **PIECEMEAL** fashion, when should **SURVEILLANCE** be done next?
**3 - 6 MONTHS**, then **1 YEAR**
66
In a patient found to have **1 - 2 SESSILE SERRATED POLYPS \<10 mm** in **SIZE**, when should **SURVEILLANCE** be done next?
**5 YEARS**
67
In a patient found to have **≥3 SESSILE SERRATED POLYPS** **or** **ONE ≥10 mm** in **SIZE** **or** a **SESSILE SERRATED POLYP** with **DYSPLASIA**, when should **SURVEILLANCE** be done next?
**3 YEARS**
68
How should a **SINGE HYPERPLASTIC POLYP** be treated if **≥10 mm** in **SIZE**?
As **ONE SESSILE SERRATED POLYP**
69
Are **SERRATED** type polyps **PEDUNCULATED**?
Almost **NEVER**
70
A colon **POLYP's** features such as **GRANULAR** (bumpy) **LATERAL SPREADING** are different than non-granular lesions in what **IMPORTANT** manner?
These have a **LOWER RISK** of invasive **CANCER** and **SUBMUCOSAL FIBROSIS** - can be **EASILY** removed **ENDOSCOPICALLY** even if **LARGE** (4 cm, etc.)
71
What do **STAGES** **0-4** in **COLORECTAL CANCER** represent?
Stage 0 - **mucosa** only
Stage 1 - **submucosa**
Stage 2 - **invades MP**
Stage 3 - **LN** involvement
Stage 4 - **near** or **distant** **organs**
72
Which portrends a worse outcome, a **POORLY DIFFERENTIATED** lesion or a **WELL** **DIFFERENTIATED** one?
**POORLY DIFFERENTIATED** (also distance from resection margin 1-2 mm, tangential resection)
73
What do these terms (**CARCINOMA-IN-SITU** and **INTRAMUCOSAL ADENOCARCINOMA**) mean?
**HIGH-GRADE DSYPLASIA**
74
What part of the colon is at **HIGHEST RISK** for **MISSED** lesions?
**RIGHT COLON**
75
What is the **RECOMMENDED ADR** (Adenoma Detection Rate) by **ASGE** - % of patients \>50 yo undergoinf first time screening colonoscopy who have one or more conventional adenomas detected and removed?
**25%** (but goal should be **50%**) (if **FIT POSITIVE**, its **40%** with goal of **70%**)
76
What is Lynch Syndrome?
**Inherited** **Colorectal Cancer Syndrome** (hereditary **non-polyposis** colon cancer)
77
Is **NBI** better than **WHITE LIGHT** for **ADR** (adenoma detection rate)?
**YES!**
78
**APC GENE** mutation, **HUNDREDS** of **POLYPS**, **50%** of those affected develop **ADENOMAS** by age **15** (colon, duodenum, stomach), lipomas, fibromas, sebaceous cysts, tumors everywhere..
**FAP** (5q21)
79
By what age on average would a patient with **FAP** develop colon cancer unless the had a **TOTAL** **COLECTOMY**?
**39**
80
**FIRST DEGREE RELATIVES** (at risk) of patients with **FAP** should be **SCREENED** with **APC GENE TESTING** (not colonoscopy)at what age?
**10-12**
81
If a **FIRST DEGREE RELATIVE** is screened for **APC GENE** testing and found to be **NEGATIVE**, what **MUST** be done next?
Test for the **MUTYH GENE** (the autosomal recessive variant)
82
What is recommended for **SCREENING** and **SURVEILLANCE COLONOSCOPY** for a patient with **FAP**?
**SCREENING YEARLY** at **PUBERTY** or the age of **12 - 24**, then **EVERY 2 YEARS** from **25 - 34**, then **EVERY 3 YEARS** from **35 - 44** and then evry **3-5 YEARS**
83
What are the **REALTIVE** indications for **COLECTOMY** in pt's with **FAP**?
**Too many polyps**
84
What is **CRAIL's SYNDROME**?
A variant of **FAP** also with an **APC GENE** mutation which results in a **BRAIN MEDULOBLASTOMA** associated with **ADENOMATOUS POLYPOSIS**
85
A condition in **FAP** where the mutation is in the **MUTYH GENE** and presents with **LESS** polyps than **FAP**, similar surveillance but colon cancer develops **LATER** (**51**) if no colectomy rather than (**39**) as in **FAP**?
**ATTENUATED FAP**
86
What **MUTATION** in **ASHKENAZI JEWS** causes an **INCREASED RISK** of colorectal cancer?
**I1307K MUTATION**
87
What are the **DIFFERENCES** between **MAP** and **FAP**?
**MAP** - **MUTYH GENE** affected - presents like **ATTENUATED FAP**, autosomal **RECESSIVE**, and **WITHOUT** osteomas, dermoid tumors or thyroid cancer. At risk for **BREAST**, **OVARIAN** and **URINARY** cancers. Colonoscopy every 1-2 years starting at 25-30 yo and EGD at 30-35 every 6 mo - 4 years depending on findings
**FAP** - **APC** **GENE** affected, autosomal **DOMINANT**, multiple tumors
88
Newly-diagnosed disease, affecting **POLE** and **POLD1** **GENES** with **OLIGOADENOMATOUS** **POLYPOSIS** (\<100 colorectal adenomas) with **ENDOMETRIAL**, **BRAIN** and **DUODENAL** cancers?
Polymerase Proofreading Associated Polyposis (**PPAP**)
89
Autosomal **Dominant** condition caused by mutation of the **STK11 GENE** on chromosome **19p** with **ARBORIZING** polyps in the **COLON**, **SMALL INTESTINE** and **STOMACH** with **MELANIN** on the **LIPS**, **BUCCAL** mucosa, **FINGERS**, **FEET**, **EYELIDS**?
**PEUTZ-JEGHER's** Syndrome (breast, colon, pancreas, testicular, ovarian, lung cancers)
90
**When** should you test **AT-RISK** (1st degree relatives of affected individual) patients for **PEUTZ-JEGHER's** Syndrome and how?
Test for **STK11 GENE** mutations at **AGE 8** and **EGD/COLONOSCOPY** every **1-3 YEARS**
91
Autosomal **DOMINANT**, **HAMARTOMAS** of the SKIN, **THYROID**, **BREAST**, GIT, and **ADNEXA**, **PTEN GENE** affected on chromosome **10q**, with multiple FACIAL **TRICHILEMMOMAS** around **MOUTH**, **NOSE** and **EYES** (\>90% of patients) with **GI** **LIPOMAS**, **GANGLIONEUROMAS**?
**COWDEN SYNDROME** (**breast** and **thyroid** cancer, ovary, uterus and **urinary**)
92
Present in **INFANCY** or **EARLY CHILDHOOD** (age **4**) with **ONE** or **TWO** polyps in the **RECTOSIGMOID** colon, with **RECTAL BLEEDING** or **ANAL PROLAPSE**
**SOLITARY JUVENILE POLYPS** - **NOT INHERITED**, **NO INCREASED RISK** of **COLON CANCER**
93
At **LEAST** **3-5** but usually **HUNDREDS** of polyps in the **COLORECTUM**, **SMALL INTESTINE** or **STOMACH** (**HAMARTOMAS** with edematous mucosa and **MUCUOUS-FILLED CYSTS**) with mutations in the **TGF/SMAD** pathway and **BMPR1A** on chromosome 10q22-23 and **DIAGNOSIS** **\<6 yo** with **RECTAL BLEEDING**, **ANEMIA**, **FAILURE TO THRIVE**?
**JUVENILE POLYPOSIS** (**39%** lifetime risk of colorectal cancer) - AVMs, cardiovascular complications
94
Multiple **NEVOID BASAL CARCINOMAS**, **SKELETAL ABNORMALITIES**, **MACROCEPHALY**, and **CRANIOFACIAL ABNORMALITIES** associated with **JUVENILE POLYPS with PTCH GENE** affected?
**GORLIN SYNDROME**
95
**≥5 SERRATED** (hyperplastic) **POLYPS PROXIMAL** to the **SIGMOID COLON**, with **TWO** of these **\>1 CM** or in a patient with this **FAMILIAL** DISEASE or **≥20** such polyps?
**SERRATED POLYPOSIS** (HYPERPLASTIC POLYPS) - HIGH (**56%**) lifetime risk of **COLON CANCER** - **ANNUAL** (or 1-3 years) **COLONOSCOPY** surveillance
96
A **VARIANT** of **COWDEN** **SYNDROME** with **PIGMENTED MACULES** on **GLANS** and **SHAFT** of **PENIS**?
**Bannayan-Zonana Syndrome**
97
**NON-FAMILIAL**, multiple **JUVENILE POLYPS** with **EDEMATOUS MUCOSA** in **BETWEEN** polyps, mean age of onset is **59 YO**, **CUTANEOUS HYPERPIGMENTATION**, **HAIR LOSS**, **NAIL BREAKDOWN**, with **DIARRHEA**, **MALABSORPTION**, **WEIGHT** **LOSS** and **EDEMA**?
**CRONKHITE-CANADA** Syndrome
98
**COLITIS CYSTICA PROFUNDA**, is found in **IBD** - polypoid regenerated mucosa, sessile, **NON-NEOPLASTIC** and require **NO TREATMENT**?
**INFLAMMATORY POLYPS** (pseudopolyps)
99
Found in the **TERMINAL ILEUM** of patients with **FAP** or **COMMON VARIABLE IMMUNODEFFICIENCY** **1-3 mm** polyps, **BENIGN**?
**Nodular Lymphoid Hyperplasia** (also associated with **GIARDIA**)
100
How is **COLON** **CANCER** ranked as far as leading causes of **DEATH**?
**2nd** (after lung cancer)
101
What **UROLOGICAL** procedure increases the risk of **COLON CANCER**?
**URETEROSIGMOIDOSTOMY**
102
What do these **STAGES** (T0, Tis, T1, T2, T3, T4a, T4b) mean in **COLON** **CANCER**?
T0 - **NO TUMOR**
Tis - confined to **MUCOSA** (HG dyplasia)
T1 - confined to **SUBMUCOSA**
T2 - Invaded **MP** but not into the serosa
T3 - Invaded the **SEROSA**
T4a - direct invasion of **ORGANS** or **STRUCTURES**
T4b - **PERITONEUM**
103
What do these (Nx, N0, N1, N2) **LYMPH** designations mean in **COLON CANCER STAGING**?
Nx - lymph node involvement **CANNOT BE ASSESSED**
N0 - **NO LN** involvement
N1 - **1-3 REGIONAL LNs**
N2 - **\>4 REGIONAL LNs**
**SHOULD DISSECT** at least **7 LNs**
104
What do (Mx, M0 and M1) mean in **COLORECTAL** **CANCER** **STAGING**?
Mx - distant metastases **CANNOT BE ASSESSED**
M0 - **NO DISTANT METS**
M1 - **YES DISTANT METS** (non-regional LNs - common iliac, external iliac, paraaortic and supraclavicular are considered mets)
105
What are the American College of Gastroenterology recommendations for **COLORECTAL CANCER SCREENING**?
**STARTING** at age **45-50**, **ENDING** at age **75-85**
**COLONOSCOPY** every **10 YEARS** (**ANNUAL FIT** if refuses)
**OR**
**FLEX SIG** every **5-10 YEARS** OR **CT COLOGRAPHY** every **5 YEARS** OR **ANNUAL HEMOCCULT** OR **FECAL DNA** every **3 YEARS**
106
What is the **SEROLOGIC TEST** for **COLORECTAL CANCER SCREENING**?
**SEPTIN-9**
107
People with **COLORECTAL CANCER** or **ADVANCED ADENOMA** in **TWO** 1st degree **RELATIVES** (**any age**) or **COLORECTAL CANCER** or **ADVANCED ADENOMA** in **ONE** 1st degree **REALTIVE \<60** yo, **WHEN** should colorectal cancer **SCREENING BEGIN**?
**COLONOSCOPY** every **5 YEARS** beginning **10 YEARS BEFORE** the age of diagnosis of the **YOUNGEST AFFECTED** **or age 40**, whichever is **EARLIER**
108
In patients who are **GENETIC FAP** (APC) **CARRIERS**, **WHEN** should they get **SCREENED** for colon cancer?
Beginning at **PUBERTY** (age **10-12**)and offered a **FLEX SIG YEARLY**
109
People with colorectal cancer in **MULTIPLE** **1st DEGREE** relatives, accross generations, young age, etc. should be handled **HOW** as far as **SCREENING** is concerned?
**GENETIC COUNSELING** and **SCREENING** **COLONOSCOPY** every **1-2 YEARS** beginnig at **AGE 20-25** or **2-5 YEARS EARLIER** if youngest was **BEFORE** age **20**
110
Which type of colon **POLYP** has the **HIGHEST** incidence of cancer according to **SIZE**?
**VILLOUS** (HIGHEST) \> tubulovillous \> tubular
111
In patients with **IBD**, what is the colon cancer **SCREENING** consensus?
Start **8-10 YEAR**S after diganosis (15 years if only LEFT SIDED) and perform every **1-2 YEARS** with **4-QUADRANT** biopsies every **10 CM**
112
What is the **STANDARD** in testing **ALL** patients found to have **COLORECTAL CANCER**?
Test for **LYNCH SYNDROME** (immunohistochemistry for the abence of the **MISMATCH REPAIR GENE** or **MICROSATELLITE INSTABILITY** - MLH1, BRAF) and if **POSITIVE**, genetic **COUNSELING**
113
What is the **STANDARD** for **SCREENING AFTER COLORECTAL CANCER SURGERY** if **STAGE I, II, III**?
**STAGE I** At **1 YEAR** and the **3 YEARS** and **5 YEARS**
**STAGE II & 3** **PHYSICAL EXAM & CEA** every **3-6 MONTHS** for **2 YEARS** then every **6 MONTHS** for **5 YEARS**; **CT C/A/P** every **6 mo - 1 year** for **5 YEARS** and **COLONOSCOPY** at **1 YEAR**, **3 YEARS**, **5 YEARS** after **SURGERY**
114
In what patients with **STAGE III COLON CANCER** are the drugs 5-FU + LEUCOVORIN, FOLFOX, CAPECITBINE + OXALIPATIN, CETUXIMAB (EGFR), PENITUMUMAB (EGFR), BEVACIZUMAB (VEGF), PEMBROLIZUMAB (PD-L1)
**Post-OP ADJUVANT CHEMOTHERAPY**
115
**EPCAM** gene mutation results in what **SYNDROME**?
**Lynch Syndrome** (**HNPCC** if same syndrome but **NO MUTATION**)
116
**AD** disorder, **3%** of all **COLON CANCER** cases, **80%** of lifetime risk of **COLON CANCER**, younger age at onset (**44**), **RIGHT** side of colon, polyps are **VILLOUS**, **MUCIONOUS**, **POORLY DIFFERENTIATED** and with a **LYMPHOID** host-response to the tumor?
**Lynch Syndrome**
117
**Lynch** Syndrome is **ASSOCIATED** with which extra-intestinal **CANCERS**?
**ENDOMETRIAL**, **OVARIAN**, stomach, small bowel, ovary, ureter and bilairy
118
What is **REQUIRED** to diagnose **HNPCC**?
**≥3 relative**s with **COLON CANCER** (**one** has to be a **1st degree** relative); **COLORECTAL CANCER** involving at least **2 GENERATIONS** and at least one case diagnosed **BEFORE AGE 50**
119
Which **MISMATCH REPAIR GENES** are associated with **LYNCH** **SYNDROME**?
**MSH1**, **MSH2**, **MLH1** (MSH6 and PMS2 have less risk, "attenuated" form - but higher risk of ENDOMETRIAL cancer)
120
What is the **advantage** in **MSI-positive** (microsatellite inatability) tumors in **HNPCC**?
**SURVIVAL ADVANTAGE**
121
**ALL** patients diagnosed with **COLORECTAL CANCER** are screened for what?
**LYNCH SYNDROME** (absence of **MISMATCHED GENE PROTEINS**)
122
Besides **COLORECTAL CANCER SCREENING** **yearly** beginning at age **20-25** in pts with **LYNCH SYNDROME**, and **EGD** every **2 years** with **GASTRIC BIOPSIES** starting at age **30-35**, what **ELSE** should be screened for?
At age **30**, **ANNUAL ENDOMETRIAL CANCER** screening and **TV US** for **OVARIAN CANCER**, **URINALYSIS** **annualy** and **HYSTERECTOMY** at age **40** or when childbearing is complete
123
What is a **VARIANT** of **LYNCH SYNDROME** with **SEBACEOUS** tumors?
**Muir-Torre** Syndrome
124
A **VARIANT** of **LYNCH SYNDROME** with **BRAIN TUMORS** (glioblastoma and astrocytoma)?
**TURCOT SYNDROME**
125
This **VARIANT** of **LYNCH SYNDROME** is **AR** and occurrs with tumors and polyps everywhere including the **BRAIN** and occurs in **CHILDREN**, such as **SCREENING** starts at **8 YO**?
**BMMRD** (Biallelic Mismatch Repair Defficiency)
126
In this **SYNDROME**, there is **MICROSATELLITE** **STABILITY** in the **COLON** (only colon tumors) tumors?
**Familial Colorectal Cancer Syndrome Type X**
127
In a patient with **FAP**, what **ANNUAL SCREENING** must they have besides **ANNUAL SIGMOIDOSCOPY** for retained **RECTUM** as they are **NOT** at an increased risk of **GYN** or gastric cancers (**LOW**)?
**ANNUAL THYROID CANCER SCREENING** (4-10% risk)
128
At **WHAT AGE** is it recommended for women with **LYNCH SYNDROME** (**MSH2**) to have **PROPHYLACTIC** removal of the **OVARIES** and **UTERUS**?
**40** (colonoscopy at age 20-25) - no associated increased breast cancer risk
129
Polyposis with polyps containing **EDEMATOUS MUCOSA** and **DILATED CYSTIC CRYPTS** (colon and stomach)?
**JUVENILE POLYPOSIS** (SMAD4 or BMPR1a)
130
A patient was found on colonoscopy to have 21 **SESSILE SERRATED** (hyperplastic) polyps, waht is the **INHERITANCE RISK** of this condition?
131
What do patients with **JUVENILE POLYPOSIS** (SMAD4 or BMPR1a) demonstrated by polyps with **EDEMATOUS MUCOSA** and **DILATED CYSTIC CRYPTS** have to be **SCREEND** for besides colonoscopy and EGD?
Hemorrhagic **Telangiectasia** Syndrome (**AV** malformations in **LUNG** and **BRAIN**)
132
What **EXTRA-COLONIC** manifestations are there in **SERRATED POLYPOSIS SYNDROME** (multiple hyperplastic polyps)?
133
Genetic **MUTATIONS** in the **POLE** and **POLD** genes are found in **WHICH POLYPS**?
**ADENOMATOUS POLYPS** (not in serrated ones)
134
**OSTEOMAS** (skull and long bones), **FIBROMAS**, **LIPOMAS**, **EPIDERMOID CYSTS** (skin), **EYE**, **THYROID**, **SMALL BOWEL**, **LIVER** (hepatoblastoma) and **ANGIOFIBROMAS** are all associated with this **SYNDROME**?
**FAP** (APC gene)
135
How **OFTEN** and at what **AGE** is **SCREENING** (colonoscopy) performed in patients with **FAP**?
Starting at **AGE 12 - YEARLY**
then **EVERY 2 YEARS at 25**
then **EVERY 3 YEARS at 35**
136
**AFTER SURGERY** (colectomy) in patients with **FAP**, what is still **SCREENED** for **YEARLY**?
**RECTUM** (ileorectal anastomosis)
**EGD** (upper GI)
**THYROID**
Desmoids
137
**\<100 POLYPS** found, **LATER** onset of **COLORECTAL CANCER** (51 vs 39) **HETEROGENEOUS**?
**ATTENUATED FAP** (**MUYTH** gene, also in **MAP** - MUYTH-associated polyposis)
138
How is **MAP** (MUYTH-associated polyposis) different than **FAP**?
**NO OSTEOMAS**, **NO THYROID CANCER**, **NO EYE** involvement, **NO DESMOIDS**
139
What do **CRALI'S** (APC) and **TURCOT's** (MMR) **SYNDROMES** have in common?
**POLYPOSIS** and **BRAIN TUMORS**
140
Associated with the **STK11 GENE** and **SPARES** this part of the **GI** tract?
**PEUTZ-JEGHER's**
141
Which **POLYPOSIS SYNDROME** causes **CANCERS** in the **STOMACH** (remove small bowel polyps \>15 mm), **COLON** (remove polyps \>5 mm), **BREAST**, **PANCREAS**, **OVARY**, **TESTICULAR** and **LUNG**?
**PEUTZ-JEGHER'S**
142
On **COLONOSCOPY**, if you find **\>10 TUBULAR ADENOMAS**, what is the recommended **SCREENING INTERVAL**?
**\<3 YEARS**
143
**AD**, **SMAD4** and **BMPR1A**, **GASTRIC**, **DUODENAL**, **PANCREATIC** tumors, **SCREENING** starting at **AGE 12** and associated with **LUNG** and **BRAIN AVMs**, polyps are **EDEMATOUS** and have **CYSTIC CRYPTS**?
**JUVENILE POLYPOSIS**
144
Mutation in the **PTEN** gene, **BREAST**, **THYROID**, **RENAL**, **CEREBELLAR** cancers, **HAMARTOMAS** of the **SKIN**, **MUCOUS MEMBRANES**, **THYROID**, **BREAST** and COLON (**GANGLIONEUROMAS**), **MACROCEPHALY** and **PAPILLOMATOSIS**?
**COWDEN DISEASE**
145
On **COLONOSCOPY**, if you find **NO POLYPS** or **HYPERPLASTIC POLYPS \<10 mm**, what is the recommended **SCREENING INTERVAL**?
**10 YEARS**
146
On **COLONOSCOPY**, if you find **1-2 TUBULAR ADENOMAS \<10 mm**, what is the recommended **SCREENING INTERVAL**?
**5-10 YEARS**
147
On **COLONOSCOPY**, if you find **3-10 TUBULAR ADENOMAS**, what is the recommended **SCREENING INTERVAL**?
**3 YEARS**
148
On **COLONOSCOPY**, if you find **TUBULAR ADENOMA \>10 mm**, what is the recommended **SCREENING INTERVAL**?
**3 YEARS**
149
On **COLONOSCOPY**, if you find a **VILLOUS ADENOMA**, what is the recommended **SCREENING INTERVAL**?
**3 YEARS**
150
On **COLONOSCOPY**, if you find an **ADENOMA** with **HIGH-GRADE DYSPLASIA**, what is the recommended **SCREENING INTERVAL**?
**3 YEARS**
151
**AVERAGE RISK COLORECTAL CANCER SCREENING TEAR 1**?
**Colonoscopy every 10 YEARS**, **ANNUAL FIT**
152
**AVERAGE RISK COLORECTAL CANCER SCREENING TEAR 2**?
**Virtual Colonoscopy** every **5 YEARS**
Flexible **Sigmoidoscopy** every **5-10 YEARS**
**FIT/FECAL DNA** every **3 YEARS**
153
**AVERAGE RISK COLORECTAL CANCER SCREENING TEAR 3**?
**CAPSULE Colonoscopy** every **5 YEARS**
154
What is the **FDA-APPROVED SERUM** test for **COLORECTAL CANCER SCREENING**?
**SEPTIN-9**
155
If a patient has a **RELATIVE \>60 YO**, that was found to have **COLON CANCER** or an **ADVANCED ADENOMA**, wehn should they be **SCREENED** and **HOW OFTEN**?
Starting at **AGE 40** and **ROUTINE INTERVAL** (not every 5 years)
156
What **PART** of th **COLON** do **SPORADIC COLON CANCERS** develop in, what about **LYNCH SYNDROME CANCERS**?
**SPORADIC** - **LEFT** COLON
**LYNCH** - **RIGHT** COLON
157
**COLON CANCER** arising from **MISMATCH REPAIR GENE** failure?
**LYNCH SYNDROME** (microsattelite, BRAF)
158
If **COLORECTAL CANCER** is found and you performe **IMMUNOHISTOCHEMICAL TESTING** (**IHC**) and **ALL PROTEINS ARE PRESENT**, what is done **NEXT**?
**NOT LYNCH SYNDROME** - no further testing
159
If **COLORECTAL CANCER** is found and you performe **IMMUNOHISTOCHEMICAL TESTING** (**IHC**) and there is **LOSS** of **MLH1** and **PMS2**, what is done **NEXT**?
**PROMOTER** hypermethylation or **BRAF TESTING** - if **PRESENT**, **NOT LYNCH**, no further testing
160
If **COLORECTAL CANCER** is found and you performe **IMMUNOHISTOCHEMICAL TESTING** (**IHC**) and there is **LOSS** of **MLH1** and **PMS2**, what is done **NEXT**?
**PROMOTER** hypermethylation or **BRAF TESTING** - if **NOT PRESENT**, **POSITIVE** for **LYNCH SYNDROME** - **REFER TO GENETIC COUNSELING** for germline mutation testing
161
If **COLORECTAL CANCER** is found and you performe **IMMUNOHISTOCHEMICAL TESTING** (**IHC**) and there is **LOSS** of **OTHER PROTEINS** (not MLH1 or PMS2) what is done **NEXT**?
**POSITIVE** for **LYNCH SYNDROME** - **REFER TO GENETIC COUNSELING** for germline mutation testing
162
In a patient with **SESSILE SERRATED POLYPOSIS** (not hyperplastic) with finding of **POLYPS \<10 mm PROXIMAL** to **SIGMOID** and **NO DYSPLASIA**, what is the **SCREENING INTERVAL**?
**EVERY 5 YEARS**
163
In a patient with **SESSILE SERRATED POLYPOSIS** (not hyperplastic) with finding of **POLYPS \>10 mm** **OR** with **DYSPLASIA** **OR TRADITIONAL SERRATED ADENOMA**, what is the **SCREENING INTERVAL**?
**3 YEARS**
164
In a patient with **SERRATED POLYPOSIS** (\>20 hyperplastic), what is the **SCREENING INTERVAL**?
**YEARLY**
165
What is the **RISK** of **RELAPSE** of **CROHN'S** disease at **1 year** and **5 years** **POST-SURGERY**?
**53%** at **1 YEAR**
**85%** at **5 YEARS**
166
What is considered a **HIGH-RISK** patient with **CHROHN'S DISEASE**?
A patient who developed **CROHN'S** after the age of **40**, has **ILEAL INVOLVEMEN**T, is a **SMOKER**, requires **STEROIDS** or has a **FISTULA** in the **FIRST FEW MONTHS** of **DIAGNOSIS**
167
What **CANCER** are **CROHN'S** disease patients susceptible to besides **COLON** **CANCER**?
**NON-HODGKINS LYMPHOMA**
168
What role does the **APPENDIX** play in **ULCERATIVE COLITIS**?
An **APPENDECTOMY** performed for **APPENDICITIS** rather than abdominal pain has a **PROTECTIVE** role **AGAINST DEVELOPMENT** of **UC**
169
A patient with **ULCERATIVE COLITIS** that is **\>40** years old, has **EXTENSIVE COLITIS**, **DEEP ULCERS**, **HIGH CRP** and **ESR**, requires **STEROIDS**, **HOSPITALIZATIONS**, history of **C. DIFF** and **CMV** are at **HIGH RISK** for what?
Requiring a **COLECTOMY**
170
What **AGE** of **ONSET** is considered **HIGH-RISK** for a **CROHN'S DISEASE** patient?
**Age \<30** (young)
171
What **GENETIC DEFECT** is associated with **IBD**?
**CARD15** (used to be **NOD2**)
172
What are genetic markers **DNAse SENSITIVE** **pANCA**, **ASCA**, **OmpC** and **CBir-1** associated with?
**IBD** (**DNAse sensitive pANCA** is for **UC & CD**; whereas **ASCA** is for **CD**); **OmpC** (**CD**); **CBir-1** (**CD**)
173
What is the **REMAINING** risk when a patient with **UC** has a total colectomy?
**POUCHITIS** (ileal pouch-anal anastomosis)
174
**HIGH LEVELS** of **ASCA** and **DNAse** **SENSITIVE** **pANCA** in a patient with **CROHN'S** **DISEASE** portrends what?
Aggressive **SMALL INTESTINAL DISEASE**
175
What is the recommended **INITIAL THERAPY** for **ULCERATIVE COLITIS**?
**TOPICAL + ORAL 5-ASA** drugs
176
**6-MP** is broken down by the **TPMT** enzyme into a therapeutically-active metabolite and one that is not, which is which?
**6-MMPN** is **INACTIVE** - can cause **HEPATOTOXICITY**
6-TGN is active - can cause **MYELOTOXICITY**
177
What should be done **PRIOR** to initating **6-MP** or **AZA** treatment for **IBD**?
Test for the **TPMT** enzyme to determine **MUTATIONS** causing **RAPID 6-TGN** production and **MYELOTOXICITY** (neutropenia)
178
Which agent is **HELPFUL** in **INDUCTION** and **MAINTENANCE** of **REMISSION** as well as reduce **IMMUNOGENICITY** in **CROHN'S** disease (does **NOT** WORK in **UC**)?
**METHOTREXATE**
179
**Infliximab** (fistulas), **Adalimumab** (if failed infliximab), **Certolizumab** (CD only), **Golimumab** (UC only) are what tye of agents?
anti-TNF-alpha
180
What **MUST** be done **BEFORE** using **anti-TNF-alpha** agents?
Test for **TB** and **HEPATITIS B** for possible **REACTIVATION**
181
If a patient on an **anti-TNF-alpha** agent presents with **FEVER** and **COUGH**, what **MUST** be **SUSPECTED**?
**INFECTION** (**FUNGAL**)
182
In a patient on an **anti-TNF-alpha** agent presents with a **PSORIAFORM** rash, what should be done?
**STOP THERAPY**
183
What **CANCER RISK** exists with the **anti-TNF-alpha** agents?
**LYMPHOMA** (especially patients with **RHEUMATOID ARTHRITIS**)
184
Which **anti-TNF-alpha** agent does **NOT** have a **RISK** of **LYMPHOMA** nor **JC-VIRUS REACTIVATION** (pml)?
**VEDOLIZUMAB** (used for UC and CD)
185
What should **IBD** patients be treated with **IMMEDIATELY** **POST-OP** for **BEST RATES** of **REMISSION**?
**anti-TNF-alpha** (adalimumab best)
186
This **CROHN'S DISEASE** antibiologic targets **INTERLUKINS IL-12** and **IL-23** and is an **INFUSION** given every **8 WEEKS**?
**USTEKINUMAB**
187
An antibiologic used for **moderate to severe** active **ULCERATIVE COLITIS** that targets **JAK 1, 2, 3** and acts **VERY RAPIDLY** to stop bleeding is?
**TOFACITINIB** (adverse effects are **HERPES ZOSTER** and elevated **CHOLESTEROL**)
188
In what **IBD** cases is an **ELEMENTAL DIET** as **EFFICACIOUS** as **STEROIDS**?
**CROHN'S DISEASE** with **SMALL BOWEL** involvement
189
What **INFECTION** are **IBD** patients **SUSCEPTILE** to by virtue of the disease itself not treatment?
**CLOSTRIDIUM DIFFICILE**
190
What **PREVENTS POUCHITIS** and what is used to **TREAT IT**?
**PROBIOTICS** **prevent** it
**METRONIDAZOLE** **treats** it (or ciprofloxacin)
191
Flat **SKIN** lesions in **IBD** patients on the **EXTENSOR** surfaces of **LOWER EXTREMITIES** which turn painful and parallel GI symptoms
**Eryhtema Nodosum**
192
This lesion sarts out as a **NODULE** or **ULCER** in **IBD** patients on the **EXTENSOR** surfaces of **LOWER** **EXTREMITIES** which turns bigger with manipulation and time.
**Pyoderma Gangrenosum**
193
Joint **arthralgias**, **arthritis**, **ankylosing spondylitis**, **uveitis** and **episcleritis** (immediate ophthalmologist attention) are all extra-intestinal manufestations of what?
**IBD** (erythema nodosum and pyoderma gangrenosum as well)
194
**PRE-MALIGNANT** condition associated with **IBD** that can cause liver cirrhosis and need for transplantation, no other treatment available, what is this?
Primary Sclerosing Cholangitis (**PSC**) - persistently elevated alk phos
195
What is the **INCREASED RISK** for **COLORECTAL** **CANCER** in patients with **UC** over the general population?
**INCREASE** of **10%** after **30 YEARS** of **DISEASE**
196
Does **IBD** result in **INFERTILITY**?
**UC** - **ONLY** if had **POUCH PROCEDURE**
**CD** - **scarring of fallopian tubes** due to pelvic inflammation
**BEST OUTCOMES** - **CONCEPTION** when in **REMISSION**
197
What medication **CANNOT** be used in **PREGNANCY** to treat **IBD**?
**METHOTREXATE** (all other meds ok in **LOWEST EFFECTIVE DOSE**)
198
What is the **RECOMMENDATION** for **VACCINATION** of infants born to mothers actively treated for **IBD**?
**NO LIVE VACCINATIONS** (rotavirus, BCG) for the first **6 MONTHS** of life)
199
In how many patients with **UC** is the **RECTUM** involved?
**\>99%**
200
Which **IBD** disease is **MORE COMMON** in **NON-SMOKERS** or **EX-SMOKERS**?
**ULCERATIVE COLITIS** (smoking can induce remission but **NEVER** recommended)
201
Can **REGULAR USE** of **HIGH-DOSE NSAIDs** lead to disease flares in **IBD**?
**YES**
202
What is the **BEST** mode of treatment of **LEFT-SIDED** (most common) **ULCERATIVE** **COLITIS** and what is done for more **ACTIVE** disease?
**TOPICAL** (enemas, suppositories) meds, **ADD ORAL** ones for more active disease
203
**THIOPURINES** (azathioprine and 6-MP) have an **INCREASED** **RISK** of what?
**NON-MELANOMA** skin cancers (make the skin photosensitive), and **LYMPHOMA**, HPV
204
The **RISK** of **WHAT** returns to **BASELINE** if **THIOPURINES** (azathioprine and 6-MP) are **DISCONTINUED**?
**LYMPHOMA**
205
In patients with **GOOD BLOOD LEVELS** of **anti-TNF-alpha** inhibitors like **INFLIXIMAB** who **DO NOT RESPOND** to therapy, how **MUST** treatment be **CHANGED**?
Use of **NON** **anti-TNF-alpha inhibitors** such as vedolizumab, ustekinumab, natalizumab
206
How **MUST** treatment be **CHANGED** in a patient who **PREVIOUSLY RESPONDED** but developed **ANTIBODIES** to one **anti-TNF-alpha inhibitor**?
**COMBINATION** therapy with **another** **anti-TNF-alpha inhibitor**
207
Which **IBD** medications cause **PALMAR PLANTAR PUSTULOSIS** as an adverse effect?
**anti-TNF-alpha inhibitors** (adalimumab, infliximab) - change class of drug
208
Peripheral **ARTHRITIS** and **ARTHRALGIAS** are noted in **IBD** usually with what? How is it treated?
Active and more bothersome with **ACTIVE DISEASE**
Treat by **TREATING ACTIVE DISEASE** and **INCREASE DOSAGE** as needed
209
What drug is a **CHIMERIC** **IgG1** Ab to TNF-alpha?
**INFLIXIMAB**
210
What drug is a **FULLY HUMANIZED IgG1** Ab to TNF-alpha?
**ADALIMUMAB**
211
What drug is a **HUMANIZED PEGYLATED FAB IgG1 FRAGMENT** to TNF-alpha?
**CERTOLIZUMAB**
212
What drug is a **alpha-1-INTEGRIN inhibitor IgG4** Ab?
**NATALIZUMAB**
213
What is the **10-YEAR risk** from diagnosis of **SURGERY** need in **Crohn's** disease?
**40%**
214
What has been proven as **SUPERIOR** for identification of **NEOPLASIA** in **ULCERATIVE** **COLITIS**?
**DYE SPRAY CHROMOENDOSCOPY** (methylene blue or indigo carmine) with **STANDARD DEFINITION** colonoscopes is superior to white lite standard definition colonoscopes
215
What should be done in a patient who develoops an **anti-TNF-alpha PSORIAFORM RASH** (palmar erythema with pruritus and peeling)?
**HOLD the anti-TNF-alpha DRUG**
216
When suspecting **INITIAL** episode of **POUCHITIS** (not recurrent), what is the recommended approach?
**METRONIDAZOLE** or **CIPROFLOXACIN**
217
In **PREGNANT** patients with **CROHN's** disease, what occurs with the infants **REGARDLESS** of treatment?
**PREMATURE** babies, **SMALL** for **GESTATIONAL AGE** (more likely to have a C-SECTION)
218
In a patient with **CROHN's DISEASE** who was **NON-COMPLIANT** with **INFLIXIMAB** **INFUSION** therapy and presnts with **MYALGIAS**, **ARTHRALGIAS** and **FEVERS** following his **INFUSIONS** likely because of what?
Developed **DRUG-INDUCED IMMUNE HYPERSENSITIVITY** to infliximab so **START** **STEROIDS**
219
If **AZATHIOPRINE** or **6-MP** are **NOT YET STARTED** during a **PREGNANCY**, why should these **NOT** be started if possible?
Because of the risk of **PANCREATITIS** (which can severely affect pregnancy)
220
Which **anti-TNF-alpha inhibitor** does **NOT CROSS** the **PLACENTA**?
**CERTOLIZUMAB PEGOL**
221
**THIOPURINES** (azathioprine and 6-MP) increase the **RISK** of what type of cancers?
**NON-MELANOMA** skin cancers (**BASAL CELL** and **SQUAMOUS**)
222
Histomogically, **NO EDEMA**, **CRYPT ABSCESSES**, **SHORT-BRANCHED CRYPTS**, **LESS SURFACE DAMAGE** and **DECREASED MUCIN** are found in what condition?
**ULCERATIVE COLITIS**
223
In a patient with **UC** with **EXTENSIVE COLITIS**, **DEEP ULCERS**, **AGE \<40**, **HIGH CRP** & **ESR**, **STEROID-REQUIRING**, **HOSPITALIZATION** history, **C. DIFF** and **CMV** infections all indicate a **HIGH-RISK** for what?
**COLECTOMY**
224
Is it **RECOMMENDED** to use **FECAL CALPROTECTIN** to assess the **EFFECT** of **STRESS** on **IBD**?
**NO** (no effect)
225
**DNAse** **SENSITIVE** **pANCA**?
**ULCERATIVE COLITIS**
226
**ASCA**, **OmpC**
**CROHN's DISEASE**
227
What is the significance of **HIGH IgG** and **IgA ASCA** in **Crohn's** Disease?
More **AGGRESSIVE** **Small Bowel** Disease
228
Are **SEROLOGIC MARKERS** recommended in **DIAGNOSIS** or **PROGNOSTICATION** of **IBD**?
**NO**
229
In which **IBD** is **ABDOMINAL PAIN** noted?
**CROHN's** **DISEASE** (in UC its bleeding)
230
In which **IBD** condition is **METHOTREXARTE** used as it can **INDUCE** **REMISSION** and is effective for **MAINTENANCE** therapy as well as prevent **ANTI-DRUG Ab's** when used in **COMBINATION** therapy?
**CROHN's DISEASE** (does NOT WORK in UC) - **NEEDS FOLIC ACID** supplementation
231
What can be used as a **SURROGATE** to determine **DISEASE** **ACTIVITY** in an **IBD** patient whe **ENDOSCOPY** is not feasible to assess mucosal healing and disease activity?
Fecal **CALPROTECTIN**
232
What does "**HISTOLOGIC** **REMISSION**" in **IBD** refer to (as opposed to endoscopic remission)?
**ABSENCE** of **NEUTROPHILS**
233
What **SIMPLE** medication is **EFFECTIVE** for **INDUCTION** and **MAINTENANCE** of **MILD** to **MODERATE ULCERATIVE COLITIS**?
**5-ASA** (aminosalycilates)
234
What **CORTICOSTEROID** is **EFFICACIOUS** for achieving **INDUCTION** of **REMISSION** in **MILD** to **MODERATE UC**?
**BUDESONIDE** (enteric coated - ileum and cecum; extended release - throughout colon)
235
How should **STEROIDS** be used in treating **IBD**?
Use **NON-SYSTEMIC** first (budesonide), check **VIT D** and **BONE DENSITY**
236
What does having the **NUDT15** mutation mean?
**INCREASED** **SENSITIVITY** to **6-MP** (leukopenia)
237
Which **IBD** treatments **INCREASE** the **RISK** of **LYMPHOMA**?
**THIOPURINES** (azathioprine and 6-MP) and **anti-TNF-alpha** inhibitors
238
In a patient on **6-MP** with **SUB-THERAPEUTIC 6-TGN** levels and elevated **LFTs**, what can be done?
Start **ALLOPURIONOL** (xanthine oxidase pathway rescue)
239
When using **METHOTREXATE** (never in pregnant women), what must be **SUPPLEMENTED**?
**FOLIC ACID** (monitor LFTs every 6 months)
240
**BONE MARROW SUPPRESSION**, **MUCOSITIS**, **HYPERSENSITIVITY PNEUMONITIS**, **CIRRHOSIS** are all adverse effect of this medication used to treat **CROHN's** **DISEASE**?
**METHOTREXATE**
241
What is **SWAPPING** vs **CYCLING** when speaking of IBD drugs?
**SWAPPING** - using a completely DIFFERENT CLASS drug (ustekinumab for infliximab)
**CYCLING** - using a different drug within the SAME CLASS (adalimumab for infliximab)
242
What is **ROUTINELY RECOMMENDED** to guide **THIOPURINE DOSE** therapy in **IBD** patients?
**TPMT** testing and reactive thiopurine **METABOLITE** testing to guide therapy (**TGN**, **MMPN**)
243
What **TESTS** can be used to **PREDICT RELAPSE** in a patient with **CROHN's DISEASE** if **INFLIXIMAB** therapy is **WITHDRAWN**?
**CRP** (**\>6**) and **FECAL** **CALPROTECTIN** (**\>300**)
244
In a patient with **SURGICAL-INDUCED** remission of **CROHN's** **DISEASE**, what is the post-surgical surveillance recommendation?
**COLONOSCOPY** every **6-12 months**
245
In a patient with **SURGICAL-INDUCED** remission of **CROHN's** **DISEASE**, what is the post-surgical **TREATMENT** recommendation?
**anti-TNF-alpha inhibitor** (infliximab) +/- additional agent (methotrexate, etc)
246
What treatment for **IBD** is **HIGH-RISK** for **POST-OPERATIVE** complications?
**STEROIDS**
247
Are the **DISEASE OUTCOMES** modified in **ULCERATIVE COLITIS**, when the **STEP-UP** approach is used and **5-ASA** is **ADDED** to **BIOLOGICS**?
**NO** (no need to add the 5-ASA)
248
Which are the **ANTI-INTEGRIN DRUGS** (still need to check for **TB** and **HBV** before use - insurance issues no elevated risk) used in **IBD** treatment?
**NATALIZUMAB** (**CROHN's** **ONLY**) and **VEDOLIZUMAB** (**CROHN's** & **UC**) no PML danger, LOW malignancy risk)
249
This is an **anti-INTERLUKIN** (IL12/23) medication **APPROVED** for **CROHN's** **DISEASE** (induction and maintenance of remission for **MODERATE-SEVERE** and **REFRACTORY** **DISESE**) only?
**USTEKINUMAB** (for **CROHN's** **ONLY**)
250
This **JAK-INHIBITOR** was approved for **MODERATE-SEVERE UC** and can flare **HERPES** **ZOSTER**?
**TOFACITINIB**
251
What is the **BEST** therapeutic indicator in **IBD** therapy that utilizes **INFLIXIMAB** whether monotherapy or combination?
**INFLIXIMAB LEVELS**
252
When **ESCALATING** therapy to **anti-TNF-alpha inhibitors**, does the addition of **5-ASA** make a difference?
**NO**
253
Do **USTEKINUMAB** and **VEDOLIZUMAB** benefit from **COMBINATION** therapy?
**NO**
254
What **DIET** has been shown in **CROHN's DISEASE** to be as beneficial as **STEROID** treatment?
**ELEMENTAL DIET**
255
Any patient presenting with a **FLARE** of **IBD** should be tested for what initially?
**C. DIFF** (if positive, treat with PO vancomycin)
256
What should be offered to patients with **IBD** and **RECURRENT** **C. DIFF** infections?
**Fecal Microbiota Transplant** (FMT)
257
What can be used as **MAINTENANCE** therapy for patients with **POUCHITIS**?
**PROBIOTICS**
258
**MALE** gender, longer **DURATION** of disease, **YOUNGER** age of diagnosis, **GREATER** **EXTENT** of colonic involvement, **FAMILY HISTORY**, **PSC** are all risk factors in **UC** for what?
**COLORECTAL CANCER**
259
If **DYSPLASIA** is found on **SURVEILLANCE** colonoscopy in a patient with **IBD**, what is the recommendation?
**COLECTOMY** or **CLOSE** surveillance very **6 months** with biopsies
260
Can **PREGNANCY** cause **RELAPSE** of **UC** in an **INACTIVE** patient?
**YES**
261
Does **PREGNANCY** significantly affect **DISEASE** **ACTIVITY** in **ACTIVE UC**?
NO
262
Is there a risk for **CONGENITAL** abnormalities in patients with **IBD**?
**NO** (only prematurity and small gestational age with or without thiopurines)
263
Which **anti-TNF-alpha** drugs can be detected in infant up to **6-MONTHS** postpartum?
**INFLIXIMAB** and **ADALIMUMAB**
264
Can **METHOTREXATE** or **THALIDOMIDE** be used in **PREGNANCY**?
**NO**
265
Which **VACCINES** are **PREFERRED** before starting **anti-TNF-alpha inhibitor** therapy?
**PNEUMOVAX** and **ZOSTER**
266
Which **VACCINES** must be **AVOIDED** once on **IMMUNOSUPPRESSION** therapy?
All **LIVE** vaccines (**MMR**, **ROTAVIRUS**, SMALLPOX, CHICKENPOX, YELLOW FEVER)
267
**ANNUAL DERMATOLOGIC** screening and **PAP** smears, **HPV** vaccination and **COLORECTAL CANCER** screening, **BONE** health, **SMOKING CESSATION** are recommeneded for all patients being treated for what?
**IBD** (especially if on immunosuppressants)
268
**WANING INFLIXIMAB** effect with **LOW ATI** (anti-infliximab antibodies) and **LOW** **TROUGH** levels indicate what?
**UNDER-DOSING** of INFLIXIMAB
269
**POOR INFLIXIMAB** effect with **LOW ATI** (anti-infliximab antibodies) and good **TROUGH** levels indicates what?
**MECHANISTIC ESCAPE** (immune system override of drug)
270
What is the **HIGHEST-RISK** with **INFLIXIMAB**?
**INFECTION** (by far and way over non-melanoma skin cancer)
271
What **RISK** factor with **METHOREXATE THERAPY** can occur at **ANY TIME** during treatment?
**HYPERSENSITIVITY PNEUMONITIS**
272
What should be done when a patient on an **anti-TNF-alpha inhibitor** therapy develops **PSORIATIC LESIONS**?
**CHANGE AGENT** (**50%** chance of recurrence with next agent)
273
**ACTIVE IBD** is associated with what **THREE** main **RISKS** in **PREGNANCY**?
**LOW BIRTH WEIGHT**
**PREMATURE BIRTH**
**SPONTANEOUS ABORTION**
274
In a patient with **STEROID-RESISTENT UC**, what should be thought of?
**CMV** or **C. DIFF** infection
275
Can **C. DIFF** present in patients with **IBD** without **PSEUDOMEMBRANES** on colonoscopy?
**ABSOLUTELY YES**
276
When should you perform a **SURVEILLANCE** **COLONOSCOPY** for a patient who underwent **SURGERY** for **CROHN's DISEASE**?
Within **6-12 MONTHS** after the **SURGERY** (look for evidence of recurrence)
277
In a patient with **SYMPTOMS** of **POUCHITIS** but they have a **NROMAL-APPEARING** **POUCH**, what is the issue?
**IRRITABLE POUCH SYNDROME** (IPS)
278
Where is **POUCHITIS** normally located?
**DISTAL POUCH ONLY**
279
If **POUCHITIS TRACKS** up the **AFFERENT LIMB**, what is the issue?
**CROHN's DISEASE**, not UC
280
If **POUCHITIS** is **LIMITED** to the **ANAL TRANSITION ZONE**, what is the issue?
**CUFFITIS**
281
What **VACCINATIONS** should patients with **IBD** get?
**MENINGOCOCCAL**, **Tdap**, **HPV**, etc.
282
Which **TWO** agents are responsible for the **HIGHEST INCIDENCE** of **DEATH** related to **INFECTIOUS DIARRHEA**?
**C. DIFF** and **NOROVIRUS**
283
How do **ENTEROTOXINS** (**VIBRIO** cholera, **ENTEROTOXIGENIC E. COLI**) cause diarrhea?
Secrete toxin which causes villi that **IMPAIR** **SECRETION** or **ABSORPTION**
284
This common enteric bacteria makes **CYTOTOXIN** which causes **CELL INJURY** and inflammation?
**C. DIFF**
285
These bacteria produce **PREFORMED TOXINS** causing diarrhea?
Staph **AUREUS** and Bacillus **CEREUS**
286
These organisms produce **ENTEROADHERENT** **TOXINS** which adhere to the intestinal mucosa and **EFFACE MUCOSAL CELLS**?
**ENTEROPATHOGENIC**, **ENTEROHEMORRHAGIC**, **ENTEROAGGREGATIVE** and **DIFFUSELY ADHERENT E. COLI**
287
These organisms result in **MUCOSAL** **INVASION**, with **INFLAMMATION** and **ULCERATION** as they penetrate to mucosa and cause erosions and ulcerations?
**SHIGELLA**, **ENTEROINVASIVE E. COLI**, **CAMPYLOBACTER JEJUNI**
288
These organisms **PENETRATE** the **MUCOSA** and **PROLIFERATE** in the **SUBMUCOSA**?
**SALMONELLA**, **YERSINIA** **ENTEROCOLITICA**
289
**ARACHIDONIC ACID**, metabolites and **KININS**, as well as **VASOACTIVE** substances are all what types of agents?
Inflammatory **SECRETOGOGUES**
290
What is the **MOST COMMON** vehicle for **FOOD POISONING**?
**GREEN LEAFY** vegetables
291
When a patient presents with **INITIAL** and **PREDOMINANT NAUSEA** and **VOMITING**, what type of substance were they exposed to as far as **FOOD POISONING**?
**PREFORMED TOXIN** (staph aureus, bacillus cereus)
292
When a patient presents with **INITIAL** and **PREDOMINANT WATERY DIARRHEA**, what type of organism were they exposed to as far as **FOOD POISONING**?
**NON-INVASIVE** pathogen
293
When a patient presents with **INITIAL** and **PREDOMINANT** **BLOODY DIARRHEA**, what type of organism were they exposed to as far as **FOOD POISONING**?
**INVASIVE** pathogen
294
For agents that have **PREFORMED TOXINS**, what is the presentation **TIMELINE** post **INGESTION**?
**1-12 HOURS** for **bacteria** (staph aureus - protein rich, creamy foods, bacillus cereus - starchy foods, rice) - food sits at **ROOM TEMP**
**24-48 HOURS** for **VIRUSES**
295
**FOOD POISONING** with this agent results in **INCUBATION** period of **12-24 hours**, **SYMPTOMS** of **NAUSEA**, **VOMITING**, **WATERY DIARRHEA**, **FEVER** that last from **1-3 DAYS** and pt can be **INFECTIOUS** from **5 DAYS to 4 WEEKS**?
**NOROVIRUS**
296
**WATERY** **DIARRHEA** from food poisoning can be either **INFLAMMATORY** or **NON-INFLMMATORY**, which are the **NON-INFLAMMATORY AGENTS**?
**CLOSTRIDIUM PERFRINGENS** (spores in meat, gravy), **ENTEROTOXIGENIC E. COLI**, **NOROVIRUS** and **ROTA VIRUS** as well as **PARASITES** (giardia, cryptosporidium, cyclospora - water, produce, milk - diarrhea can last a month)
297
How can you **DIAGNOSE PARASITES** as the food poisoning agents?
**ACID-FAST STOOL** test (giardia - daycare, streams or rivers - stool antigen test, cryptosporidium, cyclospora)
298
**WHICH** individuals are more susceptible to **GIARDIA** infections (fresh water streams and rivers, daycare workers)?
Those with an **IgA DEFICIENCY**
299
When **BLOOD** and **MUCOUS** is noted in **DIARRHEA**, severe **ABDOMINAL** **PAIN** and **FEVER**, what type of diarrhea is this?
**INFLAMMATORY** - stool **LEUKOCYTES** or **LACTOFERRIN**
300
**INFLAMMATORY** diarrhea (BLOOD and MUCOUS) is generally caused by these agents in which the **INCUBATION** period is **3-5 DAYS**?
**SALMONELLA**, **SHIGELLA**, **CAMPYLOBACTER** (poultry)- undercooked **MEAT** and contaminated **PRODUCE**
301
This **TOXIN** is found in **UNDERCOOKED** **MEAT**, **UNPASTEURIZED JUICES**, **CONTAMINATED FRUITS** and **VEGETABLES** and has an **INCUBATION** period of **1-7 DAYS**, starts out with **WATERY** diarrhea that **TURNS BLOODY**?
**SHIGATOXIN** produced by **E. coli 0157:H7** (Hemolytic Uremic Syndrome - HUS)
302
What toxin is associated with **WATERY** diarrhea that **TURNS BLOODY** and causes **Hemolytic Uremic Syndrome** (**HUS**)?
**SHIGATOXIN** caused by **E. coli 0157:H7**
303
This organism can cause **ILEO-COLITIS**, is found in **UNDERCOOKED PORK** and **PORK INTESTINES**, as well as **UNPASTEURIZED MILK** and causes an **INFLAMMATORY** (**BLOODY**) **DIARRHEA**?
**YERSINIA ENTEROCOLITICA**
304
These **TWO** organisms are known to cause **CHRONIC ILEO-COLITIS**?
**PLESIOMONAS** and **AEROMONAS**
305
**48 HOURS** after ingesting **SHELLFISH**, a patient develops **DIARRHEA** and these can be **DEADLY** in patients who are **IMMUNOCOMPROMISED** or have **LIVER DISEASE**?
**VIBRIO** (**parahaemolyticus**; vulnificus - associated skin infection)
306
**Achlorhydria**, **Sickle Cell Disease**, **RAW EGGS**, **PETS** (reptiles, chicks, ducklings, hamsters) predispose to an **INFECTION** with this bacteria and treatment is **ONLY** **RECOMMENDED** in those **IMMUNOCOMPROMISED**?
**SALMONELLA**
307
An **INFECTION** with this bacteria causes COLONIC INFLAMMATION and **DYSENTERY** and **ALL CASES SHOULD BE TREATED**?
**SHIGELLA** (**QUINOLONES**, CEPHALOPSPORINS, AZITHROMYCIN)
308
An **INFECTION** with this bacterial agent causes **WATERY** to **BLOODY** diarrhea, is most **COMMONLY** contracted from **POULTRY** and presents with **ILEOCOLITIS** (can mimic appendicitis) and can cause **GUILLAIN-BARRE SYNDROME**?
**CAMPYLOBACTER**
309
Which **FOUR** (**4**) **E. coli** bacteria types affect the **SMALL INTESTINE**?
**ENTEROTOXIGENIC**
**ENTEROPAHTOGENIC**
**ENTEROADHERENT**
**DIFFUSELY ADHERENT**
310
Which are the **TWO** (**2**) **E.coli** baterial types that affect the **COLON**?
**ENTEROINVASIVE**
**ENTEROHEMORRHAGIC** (shiga, 0157:H7)
311
How must **ENTEROHEMORRHAGIC** (shiga, 0157:H7 - undercooked beef, salad, sprouts, unpasteurized cider) **E.coli NEVER** be **TREATED**?
**NEVER TREAT** with **ANTIBIOTICS** or **ANTIDIARRHEALS**
312
The **INCREASE** in use of what **ANTIBIOTICS** can select for a very **VIRULENT** strain of **C. DIFF** (NAPI/B1)?
**QUINOLONES** (as well as **CLINDAMYCIN**, CEPHALOSPORINS)
313
Which **MEDICATION** **TYPES** are **CONTRAINDICATED** in the treatment of **C. DIFF**?
**ANTIDIARRHEALS** (decreased stool transit times lengthen the illness course)
314
**ONLY** which patients should be tested by **PCR** for **C. DIFF** as this is the **BEST** test but also **VERY SENSITIVE** (can detect carriers)?
**ONLY** patients with **DIARRHEA**
315
**HOW** is **C. DIFF** best treated and for how long?
**ORAL** **METRONIDAZOLE** or **VANCOMYCIN** or **FIDAXOMICIN** for **10 DAYS**
316
Do **PROBIOTICS** help in treatment of **C. DIF**F?
**NO**
317
Which **ANTIBIOTIC** is the **BEST** for the treatment of **SEVERE** **C. DIFF**?
**ORAL VANCOMYCIN** (125 mg PO QID)
318
How are **CRITICALLY ILL** (pseudomembranes, high leukocytosis, colon wall thickening ascites) patients with **C. DIFF** treated?
**ORAL VANCOMYCIN** at 500 mg PO QID **and** **IV METRONIDAZOLE** 500 TID
319
**WHEN** is a **TOTAL COLECTOMY** with **ILEOSTOMY** required for **C. DIFF** infection?
When there is a **HIGH-RISK** of **DEATH** (marked **leukocytosis**, serum **lactate** \>5, rising **Cr**)
320
What **DETERMINES** whether an episode of **C. DIFF** is **MILD** or **SEVERE**?
**MILD** C. DIFF (WBC \<15,000; Cr \<1.5)
**SEVERE** C. DIFF (WBC ≥15, 000; CR ≥ 1.5)
321
How do you treat **C. DIFF** in patient has an **ILEUS**?
**VANCOMYCIN ENEMAS**
322
In **HOW** mant patients will **C. DIFF** recur?
**10-20%** (low IgG to TOXIN A) and occurs **5-8 DAYS** after antibiotics are stopped
323
How is **RECURRENT** **C. DIFF** treated?
Repeat Vancomycin 125 mg PO 4x/day for **10 DAYS**, t**hen 125 mg PO every 3 DAYS for 10 more DAYS**
324
When is the **TREATMENT** with **FECAL MICROBIOTA TRANSPLANT** (**FMT**) appropriated for **C. DIFF**?
When there has been at lease **THREE RECURRENCES**
325
When **SHOULD** a **PROBIOTIC** (and **WHICH ONE**) be used in **C. DIFF** treatment?
**Saccharomyces boulardii** and **ONLY** in **COMBINATION** with **HIGH-DOSE VANCOMYCIN**
326
Should **IVIG** be used to treat **C. DIFF**?
**NO** (not efficacious)
327
Which **BACTERIAL** agent acts like **C. DIFF** (antibiotic-associated colitis), C. DIFF **NEGATIVE**, **BLOODY** diarrhea involving the **RIGHT** colon and **CECUM** with **RECTAL SPARING** and **NO PSEUDOMEMBRANES**?
**Klebsiella oxytoca**
328
This organism **MIMICS APPENDICITIS** and **CROHN's** disease with **ACUTE** or **CHRONIC COLITIS**, with **ESENTERIC ADENITIS** and is grown on **COLD ENRICHMENT MEDIUM**, it is usually transmitted from undercooked **PORK** and **PORK INSTETINES**?
**YERSINIA**
329
These **TWO** organisms are transmitted from **RAW SHELLFISH** or **WATER**, they can cause **CHRONIC COLITIS** as well as **TRIGGER IBD** in **SUSCEPTIBLE** patients?
**AEROMONAS** hydrophila and **PLESIOMONAS** shigelloides
330
These **TWO** organisms have a **PREDILECTION** for the **ILEO-COLONIC** area, **BIOPSY**, **CULTURE** and **PCR** are best and only **50%** of patients also have the **PULMONARY** manifestations?
**TUBERCLOSIS** and **HISTOPLASMOSIS**
331
Often found in **OUTBRAKES** of **WATERY DIARRHEA** with **FEVER**, **HEADACHE** and **MENINGITIS** and found in **LUNCH MEAT**, **UNPASTEURIZED CHEESE**, **CANTALOUPES** and **ICE CREAMS** and can be **FATAL** in **IMMUNOCOMPROMISE** as well as cause **FETAL DEATH** in pregnant women?
**LISTERIA MONOCYTOGENES**
332
What **PHASES** of **ENTAMOEBA HISTOLYTICA** (abd pain and watery diarrhea) **MUST** be **TREATED**?
**TISSUE** and **LUMINAL PHASES** (diagnose with **SEROLOGY**)
333
**WATERBORNE** parasite that affects the **SMALL INTESTINE** and **BILIARY TRACT** and is treated with **NITAZOXANIDE**?
**CRYPTOSPORIDIUM**
334
Parasite transmitted from imported **RASPBERRIES** and **BASIL**, and causes **WATERY** diarrhea for **4-6 WEEKS**?
**CYCLOSPORA**
335
What is the **MOST COMMON** finding in parasitic infection with **WORMS**?
**EOSINOPHILIA**
336
What **WORM** parasite can cause **APPENDICITIS** and **BILIARY OBSTRUCTION** and is the **MOST COMMON** worldwide?
**ASCARIS**
337
This **WORM** parasite causes **IRON DEFFICIENCY ANEMIA** and **OCCULT GI BLOOD LOSS**?
**HOOKWORMS**
338
Stepping on contaminated animal **FECES** when this parasite makes contact with the **SKIN**, the larvae penetrate the skin and travel to the **LUNGS**, up the bronchial tree and are **SWALLOWED**, burrow into the **SMALL BOWEL** mucosa and live for years. The eggs are passed in the stool and can also **AUTOINFECT** the **HOST**?
**STRONGYLOIDES** STERCORALIS - SKIN, PULMONARY and GI manifestations - **IVERMECTIN** or **ALBENDAZOLE**
339
Infection with this **PARASITE** causes **ANAL ITCHING** but **NOT DIARRHEA**?
**PINWORM**
340
What is the **MOST COMMON CAUSE** of **DIARRHEA** world-wide?
**ROTAVIRUS** (children) and **NOROVIRUS** (everyone) - vaccines (rotavirus), **WASHING** **HANDS** (preventative), **REHYDRATION** (treatment)
341
What should be done for **ALL** patients presenting with **DYSENTERIC** **DIARRHEA** (**BLOOD** and **MUCOUS**)?
**STOOL TESTING**
342
What should be done **ALL** patients presenting with **DYSENTERIC DIARRHEA** (**BLOOD** and **MUCOUS**) who have **RECENTLY TRAVELLED**?
**EMPIRIC AZITHROMYCIN** (can use RIFAXIMIN too)
343
What should be done with a patient infected with these agents SHIGELLA, CHOLERA, C. DIFF, PARASITES, SEVERE TRAVELLER's DIARRHEA, VIBRIO, YERSINIA, CAMPYLOBACTER, AEROMONAS and PLESIOMONAS?
Pathogens that **SHOULD BE TREATED**
344
How should a patient be **TREATED** if presenting with **MILD WATERY DIARRHEA** or **MODERATE TO SEVERE DIARRHEA WITHOUT FEVER** (EXCEPT 0157:H7 or C. DIFF)?
**REHYDRATION** and **LOPERAMIDE** (EXCEPT 0157:H7 or C. DIFF)
345
What is the **MOST COMMON CAUSE** of **DEATH** from **GI INFECTIONS** in the **US**?
**C. difficile**
346
Which **FOOD** is the most **COMMON CAUSE of EPIDEMICS**?
**GREEN LEAFY VEGETABLES**
347
**HIGHLY-CONTAGIOUS** agent with **NO LIFELONG IMMUNITY**, transmitted via fecal-oral route, aerosolized vomitus and fomites. This can spread quickly especially in institutionalized patients with **MALAISE**, **LOW-GRADE FEVER**, **WATERY DIARRHEA**?
**NOROVIRUS**
348
How **LONG** does an ilness from a **PREFORMED TOXIN** last?
**6-24 HOURS** (nor days)
349
In a patient with **TRAVELER's DIARRHEA** watery at first, then with mucous and blood, whether **PREGNANT** or not, what is the best empiric treatment?
**AZITHROMYCIN** (NOT quinolones - resistence and pregnancy contraindication)
350
**DELAYED INCUBATION PERIOD 4-7 DAYS**, **WATERY DIARRHEA** and **BLOATING**, **STOOL TEST** is **DIAGNOSTIC**?
**CYCLOSPORA** (raspberries)
351
A patient with **CHRONIC DIARRHEA** tests **POSITIVE** for **BLASTOCYSTIS HOMINIS** and **ENDOLIMAX NANA** in stool **O&P**, what do you do?
These are **NOT PATHOGENS** but **CAN BE TREATED** (to get rid of symptoms)
352
**TRABELERS** who develop **WATERY** or **BLOODY** diarrhea are treated how?
**EMPIRICALLY** with **AZITHROMYCIN**
353
**BLOODY DIARRHEA** in the **USA** (not treveler's) indicates what **TYPE** of **PATHOGEN** and what must be done?
**INVASIVE** pathogen requiring a **STOOL CULTURE** and **NOT EMPIRIC THERAPY**
354
In the **USA** (not traveler), **WHEN** is a **STOOL CULTURE** required for **WATERY** (non-bloody) **DIARRHEA** rather than empiric treatment?
When there is **FEVER \>101F** and **DURATION \>72 HOURS**
355
Eating **FISH** that is **NOT FRESH** can cause a **HISTAMINE RASH** (scombroid fish poisoning) that manifests as a **PAINLESS** red rash on the **FACE** and **UPPER CHEST**, how do you **TREAT**?
**ANTIHISTAMINES** (increase dose until they work)
356
What **HISTOLOGIC** feature **DISTINGUISHES** **UC** from **INFECTIOUS COLITIS**?
**BRANCHING** of the **BASE** of the **CRYPTS**
357
What can occur after **FMT** is used to treat **C. diff** in a patient with **CROHN's** (or **UC**) **DISEASE**?
**IBD FLARE**
358
Which **E. coli** species **AFFECT THE COLON** (not small bowel)?
**EIEC** (ENTERO **INVASIVE**) - DYSENTERY
**EHEC** (ENTERO **HEMORRHAGIC**) - 0157:H7
Severe abdominal pain, bloody stools with mucus, causes **HUS** - **DO NOT** USE **ANTIBIOTICS** or **ANTIDIARRHEALS**
359
Caused by **TROPHERYMA WHIPPLEI** - **CADIAC**, **JOINT** and **NEUROLOGIC SYMPTOMS** (memory loss) with small bowel biopsies that show **ACID-SCHIFF** (**PAS**) - positive **FOAMY MACROPHAGES**?
**WHIPPLE's DISEASE** (treat with IV PCN/Ceftriaxone and **ORAL METRONIDAZOLE** for **1 YEAR**)
360
Diarrhea that is **WATERY**, **LARGE VOLUME**, with **MID-ABDOMIAL PAIN**, can have **MALABSORPTION** without **INVASION** or **INFLAMMATION** of the mucosa?
**SMALL BOWEL INFECTIOUS DIARRHEA**
361
**CRUISE** ship diarrhea, with **ABRUPT** onset of N/V/Abd pain, fever and **MYALGIAS**, lasts **\<72 hours**, **VERY INFECTIOUS**, **CONTAGIOUS** for **3 WEEKS** and **NO LIFE-LONG IMMUNITY**?
**NOROVIRUS**
362
**ALCOHOL HAND-GEL** does **NOT PREVENT** transmission of these **TWO DIARRHEA-CAUSING** agents?
**ROTAVIRUS**, **C. DIFF**
363
What is available **PREVENTATIVELY** for **ROTAVIRUS** for infants?
**VACCINE**
364
What are the **RECOMMENDED** attributes of **ORAL REHYDRATION** therapy for **DIARRHEA**?
**LOW OSMOLARITY** (245), **LESS GLUCOSE** and **SALT**, and **RICE CEREAL**, diluted **APPLE JUICE**
365
What **DOES NOT** work as **ORAL REHYDRATION THERAPY**?
**SPORTS DRINKS**, **SODA**, **COFFEE** (recommend salty crackers, pretzels, mineral water, chicken broth, yogurt, fruit juices)
366
What bacterial **E.coli** organism is involved in **TRAVELER's DIARRHEA**?
**ETEC** (EnteroToxigenic E. Coli) - **1-3 DAYS** incubation, **\<3 WEEKS** and treat with **RIFAXIMIN** (**MILD**) or **AZITRHOMYCIN** (cipro too) if **SEVERE** or **DYSENTERY**
367
What can be used as **PROPHYLAXIS** for **TRAVELER's DIARRHEA** (65% effective)?
**BISMUTH SUBSALYCILATE** (pepto-bismol)
368
What are the **BEST TESTS** for **SMALL INTESTINAL PARASITES**?
**STOOL Giardia** and **ACID-FAST TEST**
369
**RECURRENT GIARDIA** episodes?
**HYPOGAMMAGLOBULINEIA** (**IgA**)
370
**WATERBORNE** parasite, causes **WATERY DIARRHEA**?
**CRYPTOSPORIDIUM** - treat with **NITAZOXANIDE**
371
Transient **EOSINOPHILIA**, check **BEFORE TRANSPLANT**, **ENDEMIC** areas (AFRICA), with **ITCHING**, **COUGH** and abdominal pain?
**STRONGYLOIDES STERCORALIS** (eosinophils, **SEROLOGY**, ELISA, STOOL cultures)- **TREAT** with **IVERMECTIN**
372
**SOLID ORGAN TRANSPLANT**, **HTLV-1**, **HIV** and **HIGH-DOSE STEROIDS** all increase the **RISK** of this **PARASITIC** infection?
**STRONGYLOIDES STERCORALIS**
373
Which **VIRUS** can cause **INFECTIOUS COLONIC DIARRHEA**?
**CMV**
374
Campylobacter, Salmonella, Shigella, E.coli 0157:H7 (EIEC), C. diff, Yersinia, Aeromonas, Plesiomonas, Vibrio and Listeria all have what in **COMMON**?
These are **ALL INFECTIOUS** agents that cause **INVASIVE ILEO-COLONIC DIARRHEA**
375
Entamoeba Histolytica, Trichuris (whipworm) and Schistosomiasis are all parasites that cause what in **COMMON**?
**INVASIVE ILEO-COLONI**C infectious **DIARRHEA**
376
**RAW CHICKEN**, **N/V/WATERY** to **BLOODY DIARRHEA**, causes **ILEOCOLITIS** and **GUILLAIN-BARRE**?
**CAMPYLOBACTER** - erythromycin, cipro
377
**REPTILES**, **CHICKEN** or **DUCK EGGS** are associated with this **DIARRHEA-CAUSING** agent?
**SALMONELLA**
378
**ALWAYS TREAT DIARRHEA** (watery-to-bloody) with **FEVER** caused by this organism as it is **HIGHLY-INFECTIOUS**?
**SHIGELLA** (azithromycin)
379
**INCUBATION** period of **1-3 DAYS**, **WATERY DIARRHEA** - to - **BLOODY DIARRHEA** and **SEVERE CRAMPS**, **FEVER**, similar symptoms to ischemic colitis and causes **HUS**?
**STEC** (ShigaToxin E. coli) - **0157:H7**
380
Hemolytic **ANEMIA**, **RENAL FAILURE**, **THROMBOCYTOPENIC PURPURA**, what is it and what is it caused by?
**HUS** (hemolytic uremic syndrome) caused by **STEC** (**0157:H7**)
381
If **STEC** is suspected (shiga-toxin E.coli) whether 0157:H7 or not, what is **RECOMMENDED**?
**CULTURE** for **SHIGA TOXIN**
382
In **STEC** (shiga-toxin E. coli) why are **ANTIBIOTICS** and **ANTIDIARRHEALS CONTRAINDICATED**?
Because they can precipitate **HUS**
383
**ILEITIS**, **MESENTERIC ADENITIS**, **GRANULOMATOUS APPENDICITIS**, **DIARRHA** and **2-3 WEEKS** later with **REACTIVE ARTHRITIS**?
**YERSINIA** (cold enrichment medium) - **NO TREATMENT** needed
384
Which **DIARRHEA**-causing **ORGANISMS** can result in **REACTIVE ARTHRITIS 2-3 WEEKS** post infection?
**YERSINIA**, **CAMPYLOBACTER**, **SALMONELLA** and **SHIGELLA**
385
Usually from **RAW SHELLFISH**, with **COLON INVASION**, **N/V/D x 1 DAY**, **SELF-LIMITED** and sometimes with **BULLOUS SKIN LESIONS**?
**VIBRIO** (vulnificus - skin lesions)
386
**UNPASTEURIZED CHEESE**, **LUNCH MEAT**, **HOT DOGS**, **DELI MEAT**, **CANTALOUPES**, **ICE CREAM**, resists salt, acid and cold (multiplies in refrigerator)?
**LISTERIA** - WATERY DIARRHEA, FEVER, HEADACHE, SELF-LIMITED
387
**PREGNANT WOMEN** are at **HIGH-RISK for FETAL LOSS** and **MORTALITY** if infected with this **WATERY-DIARRHEA** causing organism?
**LISTERIA**
388
**90%** are **ASYMPTOMATIC CARRIERS**, with **INFECTIOUS CYSTS** and **INVASIVE TROPHS** and cause colon **ULCERS**?
**ENTAMOEBA HISTOLYTICA** - **STOOL ANTIGEN** (best)
389
On colonoscopy you find **THIS** which causes **CHRONIC DIARRHEA**, **COLITIS** and **DYSENTERY**, how do you treat?
**TRICHURIS TRICHURIA** (whipworm) - **ALBENDAZOLE**
390
Campylobacter, Salmonella, Yersinia (can mimic appendicitis and Crohn's), TB and Amoebas are found usually **WHERE** in the colon?
**ILEO-CECAL**
391
**WHERE** in the **COLON** is **STEC** (shiga-toxin producing E.coli - 0157:H7) found and it **MIMICS ISCHEMIC COLITIS**?
**RIGHT COLON**
392
**WHERE** in the **COLON** is **SHIGELLA** found and it **MIMICS UC**?
**DISTAL COLON**
393
How do you **TREAT MILD DIARRHEA**?
Oral **REHYDRATION** Therapy (ORT) and **LOPERAMIDE**
394
How do you **TREAT MODERATE TO SEVERE TRAVELER's DIARRHEA**?
**ANTIBIOTICS** (azithromycin)
395
How do you **TREAT MODERATE** to **SEVERE NON-TRAVELER's DIARRHEA** with **NO** or **LOW** grade **FEVER** (\<101 F)?
Oral **REHYDRATION** Therapy (ORT) and **LOPERAMIDE**
396
How do you **TREAT MODERATE** to **SEVERE NON-TRAVELER's DIARRHEA** with **FEVER** (**\>101 F**) and **\<72 HOURS DURATION**?
Oral **REHYDRATION** Therapy (ORT) and **LOPERAMIDE**
397
How do you **TREAT MODERATE** to **SEVERE NON-TRAVELER's DIARRHEA** with **FEVER** (**\>101 F**) and **\>72 HOURS DURATION**?
**STOOL CUTURES**
398
How do you **TREAT NON-TRAVELER's DYSENTERY** (**BLOODY DIARRHEA**) with or without **FEVER**?
**STOOL CULTURES + ANTIBIOTICS** (azithromycin)
399
How do you **TREAT TRAVELER's DYSENTERY** (**BLOODY DIARRHEA**)?
**EMPIRIC ANTIBIOTICS** (azithromycin)
400
What **COLONIC** manifestations does **HSV** cause?
**DISTAL PROCTITIS**
401
What is found on **COLON BIOPSY** in patients with **COLITIS** (vs. **IBD**)?
**NORMAL ARCHITECTURE** (distorted in IBD)
**ACUTE INFLAMMATION** (acute and chronic in IBD)
**NO BASAL INFLAMATION** (present in IBD)
402
What is the **GOLD STANDARD DIAGNOSTIC TEST** for **C. DIFF**?
**PCR**
403
How many adults are **HEALTHY CARRIERS** of **C. DIFF**?
**3-7%** and if **HOSPITAL** EXPOSED (**4-15%**) - test **ONLY** patients with **DIARRHEA**
404
How **LONG** do **CULTURES** and **TOXINS** stay **POSITIVE** after treatment of **C. diff**?
**ONE MONTH** (so **DON'T TEST** for **CURE**)
405
**ELDERLY** patient **\>75** with **LACTATE \>5**, **WBC \>20**, **SHOCK**, on **PRESSORS** due to **C. diff** colitis, what do you do?
**COLECTOMY** (survival benefit) or **LOOP ILEOSTOMY** with **PEG** and **VANCOMYCIN LAVAGE** - colon preserving
406
In a patient **ON IBD THERAPY** and diagnosed with **C. diff DIARRHEA**, what should be done for treatment?
**HOLD IBD TREATMENT** while C. diff is being treated (if IBD severe, treat BOTH)
407
**WHEN** do you use **FMT** for treatment of **RECURRENT C. diff**?
After the **THIRD RECURRENCE**
408
What can develop **CHRONICALLY** in patients with **DIVERTICULOSIS**?
**IBS-LIKE SYMPTOMS**
409
**OBESITY**, **SMOKING**, **NSAIDs**, **CORTICOSTEROIDS** and **OPIATES** are risk factors for this condition of the **COLON**?
**DIVERTICULITIS**
410
What is the **STANDARD** of **CARE** for **DIVERTICULITIS**?
**ANTIBIOTICS**
411
What is **RECOMMENDED** after a **DIVERTICULITIS EPISODE**?
In a patient who has **NOT HAD** a **RECENT COLONOSCOPY**, one is recommended 6-8 weeks **AFTER** the **EPISODE**
412
When is the **ONLY** time **SURGERY** is recommended after **DIVERTICULITIS**?
**ONLY** if **COMPLICATIONS** like **PERFORATION** or **PERITONITIS**
413
An inflammatory-appearing colon polyp with **CYSTIC** architecture and **MUCUS-FILLED** **GLANDS** on histology and usually occurr in patients **\<10 years of age** and present with **PAINLESS BLEEDING**. These are **NOT** associated with **SYNDROMES** and if **COMPLETELY REMOVED** do not **NEED SPECIAL SURVEILLANCE**?
**JUVENILE POLYP** (if \>5 of these polyps - JUVENILE POLYPOSIS SYNDROME)
414
A **HAMARTOMATOUS** (AD) polyposis syndrome with **50% risk of CANCER** by **AGE 30** (**COLON**, **STOMACH**, **DUODENUM**, **PANCREAS**) - **BMPR1A**, **DPC4** and **SMAD4**
**JUVENILE POLYPOSIS SYNDROME** (\>5 JUVENILE POLYPS)
415
What is the **RECOMMENDED SURVEILLANCE** for **JUVENILE POLYPOSIS SYNDROME**?
**COLONOSCOPY** every **3 YEARS** from **SYMPTOM OCCURRENCE** (or **EALY TEENS** if family histroy but no symptoms) and **EGD** every **2 YEARS**
416
What is the **DIFFERENCE** in **SURVEILLANCE** between post-treatment **COLON CANCER** and **RECTAL CANCER**?
**RECTAL CANCER** requires more **FREQUENT SURVEILLANCE** due to **HIGHER RATE** of **LOCAL RECURRENCE** (especially with **TRANSANAL** surgery)
417
What is the **GOLD STANDARD** treatment of **APPENDICITIS**?
**APPENDECTOMY** (**HIGH CRP** and **WBCs**)
418
What are the **PREFERRED IMAGING** modalities for diagnosing **APPENDICITS** in a **CHILD** and in an **ADULT**?
**CHILD** - **US**
**ADULT** - **LOW-DOSE**, **NON-CONTRAST CT**
**PREGNANCY** - **MRI**
419
What **MEDICATIONS** can cause **MICROSCOPIC COLITIS**?
**NSAIDs** (**STOP** THE NSAIDs)
420
What is the **RECOMMENDATION** for **ANTIBIOTIC PROPHYLAXIS** for pts undergoing **COLONOSCOPY** with **PERITONEAL DIALYSIS**?
**AMPIILLIN 1g + AMINOGLYCOSIDE** with or without **METRONIDAZOLE IV IMMEDIATELY** before procedure **AND** that the abdomen be **EMPTIED** of **FLUID BEFORE** procedure
421
What is the **RECOMMENDED** treatment for **VOLVULUS** after fluids and antibiotics if **NO PERITONEAL SIGNS**?
FLEXIBLE **SIGMOIDOSCOPY** (only then followed by surgical repair)
422
**PAIN** focally, at site of **ABDOMINAL HERNIA REPAIR** that can be **REPRODUCED** by tensing the **RECTUS SHEETH** (situp) is **CAUSED** by what and **TREATED HOW**?
Caused by **ENTRAPMENT** (by scar tissue) of the **ANTERIOR CUTANEOUS NERVE** - **LIDOCAINE/XYLOCAINE INJECTION** followed by long-acting steroid like TRIAMCINOLONE
423
Intussusception usually caused by a **POLYP**, **LYMHADENOPATHY** or **CANCER** (focal area of traction) or infections, adhesions, Crohn's or ulcers with resulting **EDEMA** and **ISCHEMIA** resulting in **NECROSIS** or **PERFORATION**. **HOW** is the **TREATED**?
**SURGERY** (gas between segments on imaging, with CRESCENT, TARGET or DONUT sign) - **NO ENDOSCOPIC REDUCTION** as can cause **PERFORATION**
424
What **TYPE** of **INTUSUSSCEPTION** is **ALWAYS** caused by a **MALIGNANCY**?
**ILEO-COLIC INTUSUSSCEPTION** (cecal adenocarcinoma)
425
**EXCESSIVE STRAINING** and **EXCESSIVE** time sitting on the toilet with **SINGLE** **ULCER**?
**SOLITARY RECTAL ULCER SYNDROME** (**HIGH**-**FIBER** diet with **LAXATIVES**)
426
What is the **RECOMMENDED** **INITIAL** **EVALUATION** for acute **LOWER GI BLEEDS** usually caused by **DIVERTICULI**, with **SUDDEN** **HEMATOCHEZIA** with **CLOTS** (not likely UGIB source if clots and RED blood)?
**COLONOSCOPY** - after RAPID BOWEL PURGE and REUSSCITATION within **24 HOURS** and **INR 1.5-2.5** (if INR \>2.5, reverse FIRST)
427
**HEMATOCHEZIA** presenting with **HEMODYNAMIC** **INSTABIITY**, what is the likely **SOURCE**?
**UGIB** (HIGH **BUN:Cr**) - ENDOSCOPY or LAVAGE first
428
For **OBSCURE-OVERT GIB**, what is the **BEST** initial modality to **LOCALIZE** the **BLEED**?
**CT ANGIOGRAPHY** (over bleeding scan)
429
What is the **RECOMMENDED** **INITIAL** **TREATMENT** for **OPIOID-INDUCED CONSTIPATION**?
**TRADITIONAL LAXITIVES** (**PEG**), PAMORA's (Peripherappy Acting Mu Opioid Receptor Antagonists) are SECOND LINE THERAPY
430
**CHLAMYDIA TRACHOMATIS** can cause a proctitis-type picture especially in **GAY MEN** with **SYSTEMIC INFECTION**, what **MUST BE DONE** for **DIAGNOSIS**?
LYMPHOGRANULOMA VENERUM (**LGV SEOLOGY**) - tenesmus, proctitis - **DOXYCYCLINE** 100 mg PO BID x **21 DAYS**
431
What is a classic **CROHN's DISEASE MIMIC** (**DIARRHEA**, abdominal pain, **SORE THROAT,** arthralgias, erythema nodosum, TI inflammation, **MESENTERIC ADENOPATHY**, fecal leukocytes) and **HOW** is it **TREATED**?
**YERSINIA** ENTEROCOLITICA - **TMP-SMX** or DOXYCYCINE, aminoglycosides or fluoroquinolones (PROLONGED **DIARRHEA** - 4 WEEKS) - DEVELOPS **REACTIVE ARTHRITIS** when **DIARRHEA SUBSIDES**
432
What is the **PREFERRED TREATMENT** for **PELVIC FLOOR DYSFUNCTION** (constipation, incomplete evacuation, straining, WEAK PUSH)?
Pelvic Floor **RETRAINING** and **BIOFEEDBACK**
433
Which **TYPE** of **ISCHEMIC COLITIS** is the most **SERIOUS** and why?
ISOLATED **RIGHT-COLON** ISCHEMIA (IRCI) - A-fib, CAD, CKD - assess RISK for MESENTERIC ISCHEMIA before SURGERY with **CT ANGIOGRAPHY**
434
What is the **INITIAL RECOMMENDED** therapy for **MILD**-to-**MODERATE** **C. diff DIARRHEA**?
**VANCOMYCIN** 125 mg PO 4x/day **OR** **FIDAXOMYICIN** 200 mg PO BID x 10 days
435
Colonic **MUCOSA** and **SUBMUCOSA** **HERNIATE** through **MUSCULARIS PROPRIA**?
**DIVERTICULOSIS**
436
What is the **RECOMMENDED SURVEILLANCE** for **RECTAL CANCER** once surgically removed?
**FLEXIBLE SIGMOIDOSCOPY** or **EUS** every **3-6 MONTHS** for the **FIRST 2-3 YEARS** after surgery
437
What **BACTERIAL DIARRHEA** can cause **ULCERS** of the **COLON** which can result in **INTUSUSSCEPTION**?
**YERSINIA**
438
Single **1 cm** **ANTERIOR RECTAL WALL ULCER** within **10 cm** of the **rectal verge**, mucosal thickening with elongation and gland distortion, edema of the lamina propria and fibrosis and extention of the smooth muscle fibers between the crypts?
**SINGLE RECTAL ULCER SYNDROME** (HIGH-FIBER DIET + LAXATIVES)
439
In a patient with **GIB**, if **CT ANGIOGRAPHY** (preferred over bleeding scan) demonstrates bleed, what is **RECOMMENDED** to be done **NEXT**?
**INITIAL** or **REPEAT ENDOSCOPY**; IR; or SURGERY
440
**PROLONGED DIARRHEA** (3-4 weeks) and **PHARYNGITIS**?
**YERSINIA** enterocolitica
441
What **ARTERY** is **OBSTRUCTED** in **RIGHT-COLON ISCHEMIA**?
**SMA** (evident on CTA)
442
What **MEDICATION** should **NOT** be used with **NEW-ONSET BLOODY** diarrhea?
**LOPERAMIDE** or **ANY** **ANTI**-**DIARRHEALS**
443
What should **ANY YOUNG WOMAN** be tested for when presenting with **ABDOMINAL PAIN**?
**PREGNANCY TEST**
444
In **ALL** patients with **CROHN's** disease, where **\>⅓ of the colon** is involved, **WHEN** should they get their **FIRST** colonoscopy?
After **8-10 years** from **DIAGNOSIS**
445
At what **AGE** do patients develop **CROHN's** disease?
**YOUNG**, **\<30**
446
In which **IBD** disorder are non-caseating **GRANULOMAS** found?
**CROHN's** Disease
447
What is **INCREASING** in **INCIDENCE** among **IBD** patients and should be **TESTED** for when they present with **INCREASED** bowel movements, even without recent antibiotics, etc.?
**C.diff**
448
What is **CT ENTEROGRAPHY** used for in **CROHN's DISEASE**?
Assessment of **SMALL BOWEL CROHN's** disease
449
This **TEST** used in diagnosis of **CROHN's DISEASE** provides **TRANSMURAL DISEASE ASSESSMENT**, detects **PENETRATING** **DISEASE** and to diagnose **EXTRAINTESTINAL** **MANIFESTATIONS** where **MANAGEMENT** of the disease is altered by the results?
**CT ENTEROGRAPHY** (used mainly to assess **SMALL BOWEL INVOLVEMENT**)
450
What happens to **WOMEN** who are in **REMISSION BEFORE PREGNANCY** once they become **PREGNANT**?
They are **MORE LIKELY** to **REMAIN** in **REMISSION** during their pregnancy
451
In a woman with **CROHN's** who wants to become **PREGNANT**, when should **METHOTREXATE** be **DISCONTINUED**?
**3 MONTHS** before **CONCEPTION**
452
**WHEN** throughout **PREGNANCY** are **IBD** **FLARES** most common?
**FIRST TRIMESTER** and **POSTPARTUM**
453
What is the **PREGNANCY** course like for a woman with **INACTIVE** **IBD** who have **NOT** had **ABDOMINAL** or **PELVIC OPERATIONS**?
**NORMAL**
454
What **DIETARY RESTRICTIONS** do **IBD** patients have?
**NONE**
455
In a patient with **SMALL BOWEL STRICTURES**, what would be the most appropriate **DIET**?
**LOW**-**RESIDUE** (low fiber) diet
456
Which **SEX** has a **HIGHER RISK** for **CROHN's** disease?
**WOMEN**
457
What **DIETARY** intolerance is **COMMON** among **CROHN's** patients?
**LACTOSE** intolerance
458
What are **ALL REASONABLE** tests in a patient suspected to have a **CROHN's** **FLARE**?
**CT ENTEROGRAPHY**, **COLONOSCOPY**, **CRP**, **C.diff**
459
In a patient with **NEW** presentation of **BLOODY DIARRHEA**, with colonoscopy demonstrating **INFLAMMATION** around the **APPENDIX** and sigmoid and rectum with “mild **CHRONIC ACTIVE COLITIS**,” what is the diagnosis?
**ULCERATIVE COLITIS** (appendiceal **PATCH**)
460
**PERIANAL PAIN** with a **BOIL** in a patient with **CROHN's** disease suggests **WHAT**? **HOW** do you test for it?
**FISTULA** and/or **ABSCESS** - **PELVIC MRI**
461
What **IMAGING STUDY** is **NOT** good for assessing **PERIANAL CROHN's** disease such as **FISTULAS** or **ABSCESSES**?
**CT** or **CT ENTEROGRAPHY**
462
What is the **RECOMMENDED** **STARTING DOSE** for **AZATHIOPRINE** in **MANAGEMENT** of **IBD**?
**2.0 - 2.5 mg/kg** **DAILY (NOT 5)**
463
In a patient with **CROHN's** and **ARTHRITIS** (joint pain) **SYMPTOMS**, what is the **BEST OPTION** for a **MEDICATION** **CHOICE** to start?
**METHOTREXATE** **25 mg SC WEEKLY** (best for joint pains)
464
When a patient on an **anti-TNF-alph**a drug begins to require **DOSE ESCALATIONS**, what should be **DONE**?
**CHANGE** to **ANOTHER** **anti-TNF-alpha AGENT**
465
What is the **RISK** of **INCREASING** **AZATHIOPRINE** **DOSAGE**?
**BONE MARROW TOXICITY**
466
How can development of **anti-INFLIXIMAB Ab's** be **PREVENTED** (but once they exist, this will have no effect)?
By **PRE-MEDICATING** with **METHYLPREDNISOLONE** and **DIPHENHYDRAMINE**
467
What is **NATALIZUMAB** (IBD anti-TNF) **DANGEROUS FOR**?
**RE-ACTIVATION** of **JC POLYOMAVIRUS** (do **NOT** use in patients with **antibodies** to JC polyomavirus)
468
What is the **BEST MEDICATION** to start for a patient with **IBD** who is **NOT RESPONDING** to **STEROIDS**?
An **anti-TNF-alpha** agent or **CYCLOSPORINE** (**2-4 mg/kg NOT 5**)
469
Pt with **IBD** and **BACK PAIN** (worse on awakening and improves throughout the day) **HLA-B27 POSITIVE**, is **WHAT**? How do you **BEST TREAT**?
**ANKYLOSING SPONDYLITIS** - **PHYSICAL THERAPY**
470
What **DOES** the **DIAGNOSIS** of **PSC** in a patient with **UC** increase the **RISK** for?
**COLON CANCER** and cholangiocarcinoma
471
How **OFTEN** should patients with **UC** and **PSC** receive **SURVEILLANCE COLONOSCOPY** at time of **PSC DIAGNOSIS**?
**YEARLY**
472
In a patient with **IBD**, who develops **LE EDEMA**, **LOW ALBUMIN**, with **CONGO RED STAINING** will be likely to find **WHAT** on **EXTRACELLULAR TISSUE DEPOSITION**?
Serum **AMYLOID A** protein (secondary amyloidosis)
473
What is the **FIRST LINE THERAPY** for **PYODERMA GANGRENOSUM** (**IBD**) and what should **NEVER** be done?
**CORTICOSTEROIDS** or **TOPICAL TACROLIMUS** - **NEVER SURGERY** (any trauma makes it WORSE)
474
What is the **DIFFERENCE** between a patient with **UC** and **EYE** involvement in **ACTIVE** and **INACTIVE** disease and **HLA-B27** association?
**ACTIVE** DISEASE (**NO HLA**) - **EPISCLERITIS**. SCLERITIS
**INACTIVE or ACTIVE** DISEASE (**HLA-B27** POSITIVE) - **IRITIS**
475
Fecal **LEUKOCYTES**, **WATERY** then **BLOODY DIARRHEA NO DAYCARE** history (shigella)?
**CAMPYLOBACTER**
476
**48 HOURS**, **N**/**V**/**WATERY DIARRHEA**, **CHINESE RESTAURANT**?
**BACILUS CEREUS**
477
**FOOD POISONING** from **SOFT CHEESES** and **LUNCH MEATS** of **HIGH**-**RISK** in **PREGNANT WOMEN** and **IMMUNOCOMPROMISED**?
**LISTERIA**
478
**FOOD POISONING** with **MAIN SYMPTOMS** of **N/V** and **NO RICE** exposure?
**STAPH AUREUS**
479
**FIRST LINE THERAPY** for **C.diff** with **MILD DISEASE** (**WBC \<15**, **Cr \<1.5 x baseline**)?
**METRONIDAZOLE 500 mg PO TID** x **10 DAYS**
480
**FIRST LINE THERAPY** for **C.diff** with **MOD-SEVERE DISEASE** (**WBC \>15**, **Cr \>1.5 x baseline**)?
**VANCOMYCIN 125 mg PO 4x/day** x **10 DAYS**
481
What **MEDICATIONS** are to be **AVOIDED** in **INFECTIOUS DIARRHEA**?
**ANTI-DIARRHEALS**
482
**1 WEEK LARGE-VOLUME WATERY DIARRHEA** and **GAS**, **CAMPING**, **STREAM WATER**?
**GIARDIA** (affects the small bowel)
483
**LARGE-VOLUME WATERY DIARRHEA** with **NAUSEA**, **BLOATING**, **FLATULENCE**, **CRAMPING** and has **RECENTLY EATEN RASPBERRIES**?
**CYCLOSPORA** (raspberries) - **TMP-SMX**
484
**ACUTE-ONSET VOMITING** and **DIARRHEA**, muscle aches, fatigue, **CHILDREN** in **DAYCARE**, **NO FOOD ASSOCIATION**?
**VIRAL GASTROENTERITIS**
485
In **WHAT RACIAL** or **ETHNIC GROUP** is the **INCIDENCE** and **MORTALITY** of **COLORECTAL CANCER** the **HIGHEST**?
**AFRICAN AMERICANS**
486
Can **BOTH BRAF** and **KRAS MUTATIONS EXIST** in the same **COLON CANCER**?
**NO**
487
**WHAT MUTATION** in **COLORECTAL CANCER** is **ASSOCIATED** with **METHYLATION** of **MLH1**?
**BRAF**
488
In a patient with **COLORECTAL CANCER POSITIVE** for **BRAF** **MUTATION WITHOUT MLH1 MUTATION**, **FIRST DEGREE RELATIVES DO NOT** need to be **SCREENED**, **WHY**?
**DOES NOT** meet **DIAGNOSTIC CRITERIA** for **LYNCH SYNDROME**
489
**COLORECTAL CANCER POSITIVE** for **BRAF MUTATION AND MLH1 MUTATION** is considered **WHAT**?
**LYNCH SYNDROME**
490
**METHYLATION** of **MLH1** is **ASSOCIATED** with **WHAT MUTATION**?
**BRAF**
491
Is there a **ROLE** for **SURVEILLANCE** with **COLONOSCOPY** in a patient with **APC** (**FAP**)?
**BEGINNING at AGE 10**, **YEARLY**, **UNTIL COLECTOMY** (hundreds of adenomatous polyps)
492
**SIBLINGS** and **CHILDREN** of those with **APC MUTATIONS** should be **OFFERED** what?
**GENETIC TESTING**
493
Pt presents with **HUNDREDS** of polyps on colonoscopy and biopsies show adenomas, what is the **RECOMMENDATION**?
**GENETIC COUNSELING** for **APC GENE MUTATION** and **COLECTOMY** (FAP)
494
A **SINGLE** (**\<10**) **HAMARTOMATOUS** **POLYP** noted on **COLONOSCOPY** means **WHAT**?
**JUVENILE POLYP** (cancer risk **NOT** increased) - **REASSURANCE ONLY**
495
**MULTIPLE** (**\>10**) **HAMARTOMATOUS** **POLYPS** noted on **COLONOSCOPY** means **WHAT**?
LIKELY **JUVENILE POLYPOSIS** - GENETIC TESTING for **SMAD4**, **BMPR1A**, **ENG** (**SURVEILLANCE** for AT-RISK RELATIVES BETWEEN **AGES 15-70** WITH BOTH **EGD** AND **COLONOSCOPY**)
496
In the **TREATMENT** of **METASTATIC COLON CANCER**, **TESTING** for **WHAT MUTATION** is **DONE** to **GUIDE** the **CHOICE** of **CYTOTOXIC** chemotherapy?
**KRAS**
497
**METASTATIC COLON CANCER** to **WHICH ORGANS** indicates that pt may still be **CURABLE** with **SURGERY** and **CHEMOTHERAPY**?
**LIVER** and **LUNG**
498
In a patient who presents with **COLORECTAL POLYPOSIS** (**1-100** **ADENOMAS**) in the **ABSENCE** of **FAMILY HISTORY** should be **EVALUATED** for what?
**ATTENUATED FAP** (**MYH**-associated polyposis)
499
**WHICH** **PATIENTS** with **ATTENUATED** **FAP** (**MYH**) **REQUIRE** **COLONOSCOPY** and **EGD** **SURVEILLANCE**?
Only **BI-ALLELIC MYH MUTATION** (monoallelic mutations do not require special surveillance)
500
In a patient with **ATTENUATED FAP** (**MYH**), how do you **DETERMINE** the **RISK** of **BI-ALLELIC MYH MUTATIONS** (disease not carrier) in the **CHILDREN**?
**MOTHER** should be tested for **MYH**
501
**DYSSENERGIC DEFECATION** (pelvic floor dysfunction) - lifelong constipation, infrequent **BMs**, excessive straining and difficulty passing stools with manual disimpaction, even with **SOFT STOOLS** with elevated digital anal sphincter pressure and tenderness, how do you **DIAGNOSE**?
**ANORECTAL MANOMETRY** with **BALLOON EXPULSION** (pelvic floor **RETRAINING** with **BIOFEEDBACK** therapy)
502
What are **KEGEL EXERCISES RECOMMENDED** for?
**FECAL INCONTINENCE**
503
**WOMAN \>50 YO** with **2-YEAR** history of **ABD PAIN**, **CRAMPING**, **WATERY DIARRHEA** and **BLOATING** with **NORMAL SCREENING COLONOSCOPY** (for polyps) and **NORMAL LABS**. What is the **NEXT STEP**?
**IBS-D** (**microscopic colitis** can mimic this) - so **REPEAT COLONOSCOPY** with **RANDOM BIOPSIES**
504
How is **MEDICALLY-REFRACTORY SLOW-TRANSIT CONSTIPATION** (sitz-marker study) treated?
**SUBTOTAL COLECTOMY** with **ILEORECTAL ANASTOMOSIS** (**ileorectostomy**) - segmental resection is NOT HELPFUL
505
What is the surgical procedure of **CHOICE** for a patient with **RECTAL PROLAPSE**?
**RECTOPEXY**
506
**WOMAN** **YOUNGER \<50 YO** with a **2-YEAR HISTORY** of crampy lower **ABDOMINAL PAIN** associated with **BLOATING** and **FREQUENT LOOSE STOOLS** (**IBS-D**), what is the **NEXT** **TEST** of **CHOICE** in such a patient?
**SCREEN** for **CELIAC DISEASE** with **IgA TTG Ab**
507
What is the **MECHANISM** of **ACTION** of **LUBIPROSTONE**?
**CHLORIDE-CHANNEL ACTIVATOR**
508
What is the **MECHANISM** of **ACTION** of **LINACLOTIDE**?
**GC-C AGONIST** (guanylate cyclase C agonist) - **increases cGMP**
509
What is the **HIGHEST-RISK** **FACTOR** for developing **POST-INFECTIOUS IBS**?
**PROLONGED DURATION** of **INITIAL ILLNESS**
510
**PELVIC FLOOR DYSFUNCTION** with a **DEFECATORY DISORDER** (constipation, infrequent stools, strains even with soft stools, sense of blockage and incomplete evacuation with defecation, negative flex sig), what's the **NEXT STEP**?
**ANORECTAL MANOMETRY** and **RECTAL BALLOON EXPULSION** test
511
Can **ANORECTAL TESTS** have **FALSE-POSITIVE RESULTS**?
**YES** (due to embarrassment, etc.)
512
What is the **FIRST CHOICE** of treatment for **YOUNG** patients with **CONSTIPATION WITHOUT ALARM SYMPTOMS**?
**OTC LAXATIVES**
513
For patients with **SIGNIFICANT SYMPTOMS** of **FECAL INCONTINENCE** that have **NOT IMPROVED** with **MEDICAL THERAPY**, what is **RECOMMENDED NEXT**?
**SACRAL NERVE STIMULATION**
514
Is **SURGICAL SPHINCTER DEFECT REPAIR** a good **LONG-TERM SOLUTION** for patients with **FECAL INCONTINENCE**?
**NO**, works short-term only
515
Is **PELVIC FLOOR RETRAINING** by **BIOFEEDBACK THERAPY SUPERIOR** to **KEGEL EXERCISES**?
**NO**
516
**SYMPTOMS** of **INCREASED BOWEL FREQUENCY** and **INCONTINENCE** after **CHOLECYSTECTOMY** are treated **HOW**?
**BILE-ACID BINDING RESIN** (cholestyramine)
517
Do **ANAL PRESSURES VARY** with **AGE** and **SEX**?
**YES** (should be compared with NORMAL values with the same technique in age and sex-matched asymptomatic people)
518
Can **ANAL RESTING** and **SQUEEZE** functions be accurately assessed with a **DIGITAL RECTAL EXAM**?
**YES**
519
What is a **SAFE**, **FIRST-LINE** **CATEGORY A MEDICATION** that can be used in **PREGNANCY** in patients with **FIRST-TRIMESTER NAUSEA** (without alarm symptoms)?
**PYRIDOXINE** (Vit B6)
520
Is **SODIUM BICARBONATE** **SAFE** to use in **PREGNANCY**?
**NO** (causes milk-alkali syndrome and electrolyte imbalance in fetus)
521
What **HEARTBURN MEDICATION** is safe to use during **ALL TRIMESTERS** of **PREGNANCY**?
**PPIs**
522
What **SHOULD** a **PREGNANT** **WOMAN** do if she is on **AZATHIOPRINE** or **6MP** for **IBD** which is controlling her disease well, **BEFORE SHE GOT PREGNANT**?
**CONTINUE**, **DO NOT STOP AZATHIOPRINE** or **6MP**
523
In a **PREGNANT** patient on **TACROLIMUS** for a **TRANSPLANT** who is **STABLE**, what is done with the **TACROLIMUS**?
It is **CONTINUED**
524
**FUNCTIONAL** **CONSTIPATION**, a **COMMON OCCURRENCE** during **PREGNANCY** is treated how (first-line treatment)?
**FIBER SUPPLEMENT -THERAPY** (can also use docusate)
