GASTRO

Question 1

Difference between acid stricture and plummer vinson

Answer 1

plummer = proximal, acid = distal

Question 2

Treatment of non-infectious esophagitis (drugs: doxy, KCl, eosinophilic)

Answer 2

Steroid inhaler (swallow), PPI

Question 3

Most accurate test for achalasia ________

Answer 3

Mannometry : huge pressures at GE junction

Question 4

Indications for Scoping for Barrett’s Surveillance Among GERD patients

Answer 4

1) Alarm symptoms: Anemia, weight loss, FOBT +
2) Reflux symptoms for 5 - 10 years
3) Previous endoscopy positive: q2-3 years surveillance

Question 5

_______ is usually beneficial to treat when there is ulcerative disease or gastric inflammation

Answer 5

H Pylori

Question 6

Risk of PPI

Answer 6

Ca2+/Mg2+ malabsorption, bacterial invasion, interstitial nephritis

Question 7

Indication for stress ulcer prophylaxis (PPI)

Answer 7

1) Head Trauma/Burns
2) Intubated
3) Sepsis
3) Coagulopathy
4) Steroid Use

Question 8

Zollinger Ellison ulcers are usually present _______

Most accurate test _____

Answer 8

distal duodenum

Secretin suppression, but usually you get a hint with the serum gastrin level

Question 9

_____ kidney stones are common among IBD patients

Answer 9

calcium oxalate (oxalate re-absorption failure)

Question 10

Markers for Crohns _____, _____

Answer 10

ASCA, c-ANCA

Question 11

When to start TNF in Crohns_____

Answer 11

Fistulized disease (Infliximab, Adalimumab)

Question 12

Treatment Paradigm

Mesalamine—> AZT/6MP –> ______

Answer 12

Vedolizumab (Integrin a4b7 inhibitor, gut specific anti-inflammatory)

Question 13

Salvage therapy for EHEC HUS ________

Answer 13

Eculizumab (complement inhibitor, hemolysis stop)

Question 14

True/False : Drain amoeba liver abscess ______

Answer 14

False

Question 15

______ GI infection is associated with Reiters syndrome

Answer 15

Shigella

Question 16

diarrhea, wheezing after eating fish _______

Answer 16

Scramboid; Tx: Antihistamine

Question 17

Bezlotoxumab is a salvage therapy for _____

Answer 17

C.diff (following dose escalated Vanc, fidaxomixin)

You can re-use vancomycin if it worked the first time, for re-infection

Question 18

_____ is a hallmark of lactose intolerance

Answer 18

increased stool osmolarity

Question 19

____ is a GI tumor, characterized by episodes of hypotension, wheezing, flushing, diarrhea. Treatment is _____

Answer 19

Carcinoid , Octreotide

Question 20

D xylose test is used to assess _____

Answer 20

Celiac disease, malabsorption indicated by low serum/urine D xylose

Question 21

______ is an idiopathic malabsorption condition suspected to be due to infectious disease, results in villi flattening and nutritional deficiencies (folate, ADEK). Treatment ________

Answer 21

Tropical Sprue

Metronidazole 3 - 6 months

Question 22

PAS + stain organism, classic for _____

Answer 22

Whipple Disease (Male, Age 50, arthralgia)

Question 23

_____ test helps diagnose chronic pancreatitis

Answer 23

Secretin challenge (like in Zollinger Ellison), high fecal bicarb

Question 24

When antibiotics during pancreatitis_____

Answer 24

necrotizing, needs surgery

Question 25

____ and ___ markers indicate PBC (primary billiard cirrhosis), this antibody helps in diagnosis ____

Answer 25

IgM, ALP (isolated), Anti-mitochondrial

Question 26

Treatment of Wilsons_____

Answer 26

Penicilamine, Trientine

Question 27

Bronze diabetes is pathopnemonic for _____. Treated with ____

Answer 27

Hemachromatosis , Deforoxamine Hint: high iron, low TIBC

Question 28

_____ is a marker for auto-immune hepatitis

Answer 28

anti-smooth muscle

Question 29

Shigella, Campylobacter, ________ EHEC, Salmonella are examples of bloody diarrhea

Answer 29

Entaemeba histolytica

Question 30

Common cause of chronic diarrhea in children _______

Answer 30

Fruit Juice

Question 31

_______ is a stain used to test feces for fat malabsorption

Answer 31

Sudan Black, most accurate = 72hr fecal fat

Question 32

Best initial test for pyloric stenosis ______

Answer 32

US Abdomen

Question 33

Best initial test for mal-rotation, volvulus _____

Answer 33

US Abdomen with Doppler

Question 34

Best initial test for esophageal atresia _____

Answer 34

Gastrograffin esophogram, choking when eating due to TE fistulization

Question 35

CHARGE association

Answer 35

``` C : Coloboma/CNS H: Heart defect A: Choanal Atresia R: retarded growth G: GU (hypogonadism) E: Ear (Deaf) ```

Question 36

Window Period

Answer 36

This patient has acute hepatitis B. The “window period” refers to that period in infection when neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient. It is an immunologically mediated phenomenon caused by the precipitation of antigen-antibody complexes in their zone of equivalent concentrations and, thereby, their removal from the circulation. Because of this, the first thing that will happen in the window period is that the serum will become negative for the surface antigen (HBsAg) as that antigen is precipitated out of the serum by developing levels of its specific antibody (HBsAb). Serologic tests conducted during the window period will be positive for HBcAb and HBeAb.

Question 37

hemachromatosis characterized by High serum iron/ferritin , _____TIBC (inverse of iron deficiency)

Answer 37

Low, pretend like anemia of chronic disease

Question 38

45+ with epigastric pain ______

Answer 38

Automatic endoscopy EGD consult

Question 39

Zollinger Ellison wit hypercalcemia ____

Answer 39

MEN syndrome

Question 40

Zollinger Ellison Diagnosis ____

Answer 40

Secretin suppression test Somatostatin Scan EUS

Question 41

Indication for antibiotics in Crohns____

Answer 41

Perianal Crohns

Question 42

How to treat Cryptosporidium GI infection____

Answer 42

HAART,

Question 43

Hepatitis A post-exposure prophylaxis 1) Age<12 months_____ 2) Age> 12 months_____

Answer 43

Ig Vaccine Give both if immunocompromised

Question 44

Hep B post exposure prophylaxis 1) Naive vaccine_____ 2) Child_____ 3) Vaccinated_____

Answer 44

Ig + Vaccine Ig + Vaccine Check serology, then vaccinate

Question 45

Cirrhotics should get ultrasound q_____ for HCC screening

Answer 45

6 months

Question 46

Treatment of PBC 1) Ursodeoxycholic acid 2) _____ Common complication____

Answer 46

Obeticholic acid Osteoporosis

Question 47

____ _disease is characterized by pseudogout, bronze diabetes, panhypo-pit (infiltration), cirrhosis Dx_______

Answer 47

Hemachromatosis Iron panel: High Iron/Ferritin low TIBC, high iron Sat ---> MRI/HFe gene mutation

Question 48

_____ associated with young woman with auto-immune disease (ITP, thyroiditis, hemolytic anemia), ANA + , Anti smooth muscle + , SPEP; Hypergamma

Answer 48

Autoimmune hepatitis