First Aid

Question 1

Cause of primary achalasia and 2 causes of secondary achalasia

Answer 1

Loss of myenteric Auerbach plexus (high LES pressure)

Chagas disease (T. cruzi)
Extraesophageal malignancies (mass effect-paraneopl)

Question 2

4 causes of esophagitis

Answer 2

Reflux
Infection (Candida, HSV1, CMV)
Caustic ingestion
Medications

Question 3

Plummer-Vinson syndrome (symptoms and complication)

Answer 3

Triad: dysphagia, iron deficiency anemia, esophageal webs

Risk of esophageal squamous cell carcinoma

Question 4

4 symptoms of toxic megacolon

Answer 4

Abdominal pain/distension
Bloody diarrhea
Fever
Shock (hypotension, tachycardia)

Question 5

5 medications for Crohn disease

Answer 5

Corticosteroids
Azathioprine
Antibiotics (Ciprofloxacin, Metronidazole)
Infliximab
Adalimumab

Question 6

4 medications for ulcerative colitis

Answer 6

5-aminosalicylic preparations (mesalamine)
6-mercaptopurine
Infliximab
Colectomy

Question 7

Ileus associated with 4 conditions

Answer 7

Abdominal surgeries
Opiates
Hypokalemia
Sepsis

Question 8

Treatment of ileus

Answer 8

Bowel rest
Electrolyte correction
Cholinergic drugs

Question 9

Colorectal cancer presentation

Answer 9

Rectosigmoid>ascending>descending
Right side bleeds
Left side obstructs

Question 10

6 causes of cirrhosis

Answer 10

Alcohol
Nonalcoholic steatohepatitis
Chronic viral hepatitis
Autoimmune hepatitis
Biliary disease
Genetic/metabolic disorders

Question 11

3 causes of portal hypertension

Answer 11

Cirrhosis
Vascular obstruction (thrombosis, Budd-Chiari sd)
Schistosomiasis

Question 12

4 conditions with elevated ALP

Answer 12

Cholestasis
Infiltrative disorders
Bone disease
From placenta

Question 13

6 findings in Reye syndrome (fatal childhood hepatic encephalopathy)

Answer 13

Mitochondrial abnormalities
Fatty liver
Hypoglycemia
Vomiting
Hepatomegaly
Coma

Question 14

5 consequences of hyperestrinism from alcoholic liver cirrhosis

Answer 14

Gynecomastia
Spider angiomata
Loss of sexual hair
Testicular atrophy
Palmar erythema

Question 15

Treatment of hepatic encephalopathy

Answer 15

Lactulose +

Rifaximin or Neomycin

Question 16

Budd-Chiari syndrome associated with 4 conditions

Answer 16

Hypercoagulable states
Polycythemia vera
Postpartum state
HCC

Question 17

4 causes of unconjugated hyperbilirubinemia

Answer 17

Hemolytic
Physiologic (newborns)
Crigler-Najjar
Gilbert syndrome

Question 18

3 causes of conjugated hyperbilirubinemia

Answer 18

Biliary tract obstruction (gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke)
Biliary tract disease (1* sclerosing cholangitis, 1* biliary cirrhosis)
Excretion defect (Dubin-Johnson sd, Rotor sd)

Question 19

2 causes of mixed hyperbilirubinemia

Answer 19

Hepatitis

Cirrhosis

Question 20

Treatment of Crigler-Najjar syndromes, type I and II

Answer 20

Type I: plasmapheresis and phototherapy

Type II: phenobarbital

Question 21

6 manifestations of Wilson disease (before age 40)

Answer 21

Liver disease
Neurologic disease
Psychiatric disease
Kayser-Fleischer rings
Hemolytic anemia
Renal disease

Question 22

Treatment of Wilson disease

Answer 22

Penicillamine or Trientine

Oral zinc

Question 23

6 organs where iron accumulates in Hemochromatosis (after age 40)

Answer 23

Liver (cirrhosis)
Pancreas (diabetes mellitus)
Skin (pigmentation)
Heart (dilated cardiomyopathy/HF)
Pituitary (hypogonadism)
Joints (arthropathy)

Question 24

Common cause of death + treatment of Hemochromatosis

Answer 24

Hepatocellular carcinoma

Repeated phlebotomy
Chelation (deferasirox, deferoxamine, oral deferiprone)

Question 25

Primary sclerosing cholangitis: epidemiology + 3 complications

Answer 25

Middle-aged men with Ulcerative colitis Secondary biliary cirrhosis Cholangiocarcinoma Gallbladder cancer

Question 26

Secondary biliary cirrhosis: epidemiology and 1 complication

Answer 26

Known obstructive lesions Ascending cholangitis

Question 27

3 causes of gallstones

Answer 27

High cholesterol and/or bilirubin Low bile salts Gallbladder stasis

Question 28

8 associations with cholesterol gallstones

Answer 28

``` Obesity Crohn disease Advanced age Estrogen therapy Multiparity Rapid weight loss Glucose intolerance Hypomotility ```

Question 29

4 complications of gallstones

Answer 29

Cholecystitis +++ Acute pancreatitis Ascending cholangitis (Charcot triad) Fistula (Gb/GI - pneumobilia and gallstone ileus)

Question 30

3 causes of cholecystitis

Answer 30

Cholelithiasis +++ Ischemia and stasis Primary infection (CMV)

Question 31

1 treatment and 1 complication of porcelain gallbladder

Answer 31

Prophylactic cholecystectomy Cancer (esp. adenocarcinoma)

Question 32

12 causes of acute pancreatitis

Answer 32

``` Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion sting Hypercalcemia Hypertriglyceridemia (>1000 mg/dL) ERCP Drugs (sulfa, NRTIs, protease inhibitors) ```

Question 33

Diagnosis of acute pancreatitis

Answer 33

2 of 3 criteria Acute epigastric pain (to back) Amylase or lipase (specific) 3x upper limit Characteristic imaging findings

Question 34

5 complications of acute pancreatitis

Answer 34

``` Pseudocyst Necrosis Hemorrhage Infection Organ failure Hypocalcemia ```

Question 35

3 manifestations of pancreatic insufficiency

Answer 35

Steatorrhea Fat-soluble vitamin deficiency Diabetes mellitus

Question 36

6 risk factors for pancreatic adenocarcinoma

Answer 36

``` Male >50 yo Tobacco use Diabetes Chronic pancreatitis (>20y) Jewish / African-American ```

Question 37

5 adverse effects of Cimetidine (H2 blocker)

Answer 37

``` Potent inhibitor of CYP450 Antiandrogenic effects Cross blood-brain barrier (confusion, dizziness, headaches) Cross placenta Reduce renal excretion of creatinine ```

Question 38

4 indications of Octreotide

Answer 38

Acute variceal bleeds Acromegaly VIPoma Carcinoid tumors

Question 39

3 GI infections by protozoa: difference + treatment

Answer 39

``` Giardia lamblia (fatty diarrhea)/Metronidazole Entamoeba histolytica (bloody diarrhea)/Metronidazole Cryptosporidium (watery diarrhea / severe in AIDS)/ Nitazoxanide ```