Gastroenterology

Question 1

Test of choice for:

1) Oropharyngeal dysphagia
2) Esophageal dysphagia
3) Odynophagia

Answer 1

1) Videofluoroscopy / modified barium swallow
2) Upper endoscopy
3) Upper endoscopy

Question 2

Quadruple Therapy (the preferred treatment) for H. Pylori consists of:

Answer 2

1) Bismuth QID
2) Metronidazole QID
3) Tetracycline (or doxycycline 100mg BID)
4) PPI BID

Treat for 14 days.

Question 3

Imatinib is sometimes used to treat what type of GI malignancy?

Answer 3

Gastrointestinal stromal tumors (c-kit positive).

Question 4

Describe Trousseau syndrome and Courvoisier sign:

Answer 4

Trousseau syndrome = migratory thrombophlebitis

Courvoisier sign = palpable gallbladder

Question 5

Antibody associated with autoimmune pancreatitis:

Answer 5

IgG4

Question 6

4 kinds of pancreatic neuroendocrine tumors:

Answer 6

1) Gastrinoma -> Zollinger-Ellison syndrome
2) Insulinoma
3) VIPoma -> Verner-Morrison syndrome
4) Glucagonoma

Question 7

Colorectal cancer surveillance intervals for IBD:

1) UC, pancolitis or distal colitis
2) UC, proctitis only
3) Chron disease, >1/3 of colon involved

Answer 7

1) IBD duration >8 years, 1-2 year interval
2) IBD duration >8 years, 10 year interval
3) IBD duration >8 years, 1-2 year interval

Question 8

Amsterdam Criteria II for HNPCC / Lynch syndrome:

Answer 8

1) 3 or more relatives with an HNPCC-associated cancer
2) 2 or more generations affected
3) 1 more more cancer diagnosed before age 50
“3 relatives, 2 generations, 1 person younger than 50”.

Question 9

Colorectal cancer surveillance interval for Lynch syndrome:

Answer 9

Start at age 20-25, repeat every 1-2 years.

Also remember: transvaginal ultrasound annually for women, urine cytology annually

Question 10

Colorectal cancer surveillance interval for FAP:

Answer 10

Start at age 10-12, repeat every year.
(Also remember: upper endoscopy every 1-3 years [increased risk of duodenal adenomas/cancer], palpation of thyroid annually [increased risk of papillary thyroid cancer])

Question 11

All patients with IBS-D and IBS-M should be tested for:

Answer 11

Celiac disease (anti-tTG IgA)

Question 12

Surveillance colonoscopy intervals after definitive treatment of colorectal cancer:

Answer 12

1 year, 3 years, and 5 years

Question 13

Two extrahepatic manifestations of HBV:

Answer 13

1) Polyarteritis nodosa

2) Membranous glomerulonephritis

Question 14

Three extrahepatic manifestations of HCV:

[Hint: blood, kidneys, skin]

Answer 14

1) Mixed cryoglobulinemia
2) Membranoproliferative glomerulonephritis
3) Porphyria cutanea tarda

(Others: NHL, MGUS)

Question 15

What goes into the MELD score?

Answer 15

1) Creatinine
2) Bilirubin
3) INR

Question 16

What goes into the Child-Pugh score?

Answer 16

1) Bilirubin
2) Albumin
3) PT/INR
4) Ascites (none, controlled, refractory)
5) Encephalopathy (none, grade I-II, grade III-IV)

Question 17

What pancreatic neuroendocrine tumor will generally not be seen w/ octreotide scanning due to lack of adequate numbers of somatostatin receptors?

Answer 17

Insulinoma.

EUS is the best study if no tumor seen on CT

Question 18

Antibodies associated with:

1) Primary biliary cirrhosis (PBC)
2) Primary sclerosing cholangitis (PSC)

Answer 18

1) Antimitochondrial antibody

2) ANA and anti-smooth muscle antibody

Question 19

Treatment of acute variceal hemorrhage:

Answer 19

1) Octreotide (50 ug bolus followed by infusion of 50 ug /h for 2-5 days)
2) Ceftriaxone 1g/day (or a fluoroquinolone)
3) Endoscopic therapy (ligation preferred over sclerotherapy)

Question 20

PMN count that defines SBP:

Answer 20

> 250 cells/microliter

[and/or positive culture]

Question 21

Interpretations of serum-ascites albumin gradient (SAAG):

Serum albumin minus ascites albumin

Answer 21

1.1 or greater with total ascites protein <2.5 g/dL = portal hypertension
1.1 or greater with total ascites protein >2.5 g/dL = cardiac ascites
< 1.1 = not portal hypertension