Gastroenterology

Question 1

GERD

GERD increase risk of which cancer?

Answer 1

Adenocarcinoma after transform to Barret

Question 2

gerd

Screening interval of barret?

Answer 2

1) No dysplasia: every 3-5 years
2) Low grade dysplasia: every year
3) High grade: every 3 months + RFA

Question 3

What are the different types of SBP?

Answer 3

Neutrophil > 250 + positive or negative culture
Neutrophil < 250 + positive culture

Question 4

Preferred agent for SBP?

Answer 4

Cefotaxime.
Other: CTX can be used

Question 5

What can decrease the mortality if added in SBP management?

Answer 5

Day 1 albumin 1.5 g per Kg and Day 3 1g per Kg

Question 6

Indications for 1ry ppx in SBP?

Answer 6

1) GI bleeding with cirrhosis: give ppx CTX Or norfloxacin for 7 days or
2) Ascites + renal or heaptic insuffiecency

Question 7

Next step if patient had neutrophil < 250 + positive culture?

Answer 7

Symptomatic? treat
Asymptomatic? usually resolve by its own. next step is to repeat paracentesis within 48 hours

Question 8

Mention three Non-selelctive BB used in variceal bleed ppx?

Answer 8

NPC
Nadolol, propranolol, Carvidelol.

Question 9

Most significant risk factor for anal cancer?

Answer 9

HPV infection (16 and 18)
Other risk factors:
- MSM, Smoking, pelvic CIN

It is more common in females 2 to 1

Question 10

Most common type of anal cancer?

Answer 10

SCC

Question 11

Patient uses pentamidine for PJP Developed abdominal pain. What is the possible complication?

Answer 11

Acute pancreatitis
Other medications:
- Thiazide, Valproic acid, Azathioprine, mesalazine, didanoside.

Question 12

Patient with Crohn’s disease and Hx of pancreatitis. You decided to start mesalazine or Sulfasalazine. Which one you will avoid?

Answer 12

Both will cause acute pancreatitis but mesalazine has 7X risk in comparison to sulfasalazine

Question 13

CCK action?
Produced from?

Answer 13

GB contraction, from upper part of S. Intestine

Question 14

Which cell produce CCK?

Answer 14

I cells

Question 15

What are the components of MELD-Na?

Answer 15

• You have 2 labs related to liver + 2 labs related to RFT
  Na 2) Cr 3) Bilirubin. 4) INR

Question 16

What does MELD-Na tells us?

Answer 16

1) 90 D’s mortality
2) Stratify the patient on transplant list

Question 17

What are the component of child-pugh?

Answer 17

3 labs + 2 pic
INR, Bili, Albumin and ascites + HE

Question 18

Management of Variceal bleed after ABC?

Answer 18

1) Terlipressin “preferred over octreotide:
2) Endoscopic variceal ligation “preferred over sclerotherapy”
3) Antibiotic “FLQ”

Question 19

Next step if ligation failed in variceal bleed?

Answer 19

Blakemore tube
if failed go for TIPS

Question 20

Options for primary prophylaxis against VB in cirrhotic patient?

Answer 20

Non-selective BB (NPC)
Nadolol
Propranolol
Carvidelol
Or
Endoscopic ligation: used in larger vessels

Question 21

Risk factors for variceal bleed

Answer 21

1) Cirrhosis severity.
2) Tense ascites.
3) > 5 mm vessel.
4) Red wale sign,
5) HVPW > 12

Question 22

MOA of terlipressin?

Answer 22

Vasopressin analogue causes splanchnic vasoconstriction

Question 23

Octreotide MOA?

Answer 23

somatostatin analogue

Question 24

Colon cancer

Most common type of polyp?

Answer 24

Hyperplastic

Question 25

Most common pre-malignant type of polyp?

Answer 25

Adenamotous

Question 26

What are the types of benign polyp?

Answer 26

1) Hyperplastic polyp: no risk of malignancy.
2) Juvenile polyp: solitary polyp (disorganized hamartouma)
3) Juvenile polyposis: 100’s of polyp in colon. (Increase risk of colon, gastric, pancreas cancer)

Question 27

What is the most common inherited type of colon cancer?

Answer 27

Lynch syndrome (Autosomal dominant)

Question 28

Most common genes involved in Lynch syndrome?

Answer 28

MSH2, MLH1
DNA Mismatch lead to microsattalite unstability

Question 29

What criteria used for Lynch syndrome?

Answer 29

Amesterdam
1) At least three family member with colon Cx.
2) At least one of them diagnosed at age < 50
3) Cases span in at least 2 generations

Question 30

Which syndrome associated with APC gene mutation?

Answer 30

Familial adenomatousis polyposis (APS)
- AD, Chromosome 7
- 100’s of polys at age of 30-40

Question 31

FAP has riks for what type of cancer?

Answer 31

Duedenum
Note: Gardner is a subtype of FAP has risk of:
Skull, mandible, retina, thyroid cancer and epidermoid cyst on the skin

Question 33

Known case of UC + High ALP. How to confirm the diagnosis?

Answer 33

This is PSC
MRCP or ECRP. shows multiple beaded bile structure pattern.
If unclear?? liver biopsy (onion skin shape)

Question 34

Antibody associated with PSC?

Answer 34

P-ANCA

Question 35

Next step after diagnosing PSC?

Answer 35

Colonoscopy

Question 36

Female 40, itching, jaundice, and dry eyes?

Answer 36

PBC.
+ AMA
+ MC autoimmune disease associaton is sjogren.

Question 37

Liver biopsy shows flouride duct lesion?

Answer 37

PBC