fifth-MKSAP

Question 1

• Causes of achalasia?

Answer 1

Viral or parasitic i.e. Chagas’s disease
Autoimmune
Neurodegenerative disorders

Question 2

• What is the first-line diagnostic test for achalasia? And what will you see?

Answer 2

Barium esophagram or EGD

You will see dilation of esophagus with narrowing at GE junction

Question 3

• Hepatic adenomas are malignant/benign___, and can be differentiated from focal nodular hyperplasia by imaging___

Answer 3

Benign
Abdominal MRI

Question 4

• Hepatic adenomas are found typically in this demographic___, using this medication___

Answer 4

Women
Oral contraceptives

Question 5

• Malignant transformation of hepatic adenoma includes size of___or greater, and adenoma with___activation

Answer 5

> 5 cm
Beta-catenin

Question 6

• Treatment of non-suspicious hepatic adenoma includes___and follow-up in___time interval with___imaging

Answer 6

Discontinuation of any hormone medication
6-month follow-up
MRI

Question 7

• Focal nodular hyperplasia are typically malignant/benign___

Answer 7

benign

Question 8

• Simple hepatic cyst are typically malignant/benign___

Answer 8

Benign

Question 9

• Hepatic hemangioma are typically malignant/benign___

Answer 9

Benign

Question 10

• Is PPI commonly used as part of treatment for Mallory-Weiss tear?

Answer 10

Not really

Question 11

• This electrolyte issue can occur from unnecessary and prolonged use of PPI

Answer 11

Hypomagnesemia, with subsequent hypokalemia and hypocalcemia

Question 12

• This vitamin deficiency can be a result of PPI overuse

Answer 12

Vitamin B12 deficiency

Question 13

• First-line treatment for dumping syndrome

Answer 13

Smaller more frequent meals

Question 14

• What is the pathophysiology behind dumping syndrome

Answer 14

Rapid gastric emptying–>a lot of release of gastrointestinal hormones with vasoactive properties-which explains the vasomotor symptoms like diaphoresis, tachycardia, flushing, syncope

Question 15

• What causes dumping syndrome?

Answer 15

Gastric surgery i.e. Roux-en-Y bypass, sleeve gastrectomy, esophagectomy, vagotomy

Question 16

• What are the symptoms of dumping syndrome?

Answer 16

1 hour after eating: Abdominal pain, bloating, fullness, nausea/vomiting, diarrhea
Classic vasomotor symptoms to: Tachycardia, flushing, diaphoresis, syncope, pallor
(Happening because vasoactive hormones are released when food is suddenly pushed into the small intestines)

Question 17

• How do you treat colon cancer in a patient with familial adenomatous polyposis?

Answer 17

Colectomy-subtotal, and follow-up with sigmoidoscopy annually

Question 18

• Familial adenomatous polyposis has___mutation in the gene

Answer 18

APC gene

Question 19

• The patient with hepatitis C recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment? Cirrhosis is not diagnosed yet

Answer 19

Surgical resection if there is no decompensated cirrhosis or portal hypertension

Question 20

The patient with PMH of Cirrhosis is diagnosed also and is well compensated, hepatitis C
recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment?

Answer 20

Surgical resection, because there is no decompensated cirrhosis

Question 21

• The patient with PMH of Cirrhosis is not the best compensated, there may be portal hypertension as well, hepatitis C

comes to your clinic because recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment?

Answer 21

Liver transplant because patient does not have well compensated cirrhosis, and there is portal hypertension

Question 22

• If patient has hepatocellular cancer,___is when you do surgical resection versus___is when you do liver transplant************

Answer 22

Surgical resection if: Well compensated cirrhosis, no portal hypertension, normal liver function markers
Liver transplant if: Portal hypertension present, decompensated cirrhosis, abnormal liver function markers

Question 23

• What is the definitive way to diagnose PSC-primary sclerosing cholangitis?

Answer 23

Liver biopsy!

Question 24

• What diseases PSC associated with?

Answer 24

Ulcerative colitis

Question 25

* If he had to use an imaging test for PSC, which would be? And if this was not showing PSC, does that rule out PSC?

Answer 25

MRCP, not not not ultrasound If MRCP negative-and there is still cholestatic liver enzyme levels, do liver biopsy, MRCP alone does not rule it out in this case

Question 26

* What is the colonoscopy screening needed for Crohn's/UC?

Answer 26

Screen with colonoscopy 8 to 10 years after disease is diagnosed AFTER negative screening, the SURVEILLANCE every 1 to 5 years depending on risk factors: Burden of colonic inflammation, family history of colon cancer, PSC

Question 27

* Having PSC with__IBD puts you at a risk for___

Answer 27

Ulcerative colitis Colon cancer

Question 28

* If patient has GERD, with these risk factors___, they be screened for Barrett's esophagus: You must have at least 3 of the following:

Answer 28

-Male -White race -Obesity -Tobacco use -Family history of Barrett's -Esophageal adenocarcinoma in a first-degree relative -Over the 50 years of age

Question 29

* A duration of___years or more, and__or more risk factors, is an indication for screening of Barrett's esophagus with EGD

Answer 29

5 or more years of GERD symptoms 3 or more risk factors i.e. race, age, family history of Barrett's etc.

Question 30

* What is the histology of Barrett's esophagus?

Answer 30

Intestinal metaplasia Low-grade dysplasia Intramucosal carcinoma Acid mucin containing goblet cells on slide

Question 31

what will you see on EGD for Barrett's esophagus?

Answer 31

Salmon colored mucosa