Gastroenterology

Question 1

Treatment for Diffuse esophageal spasms

Answer 1

1. trial of PPI
2. CCB
3. Antispasmodics
4. anti anxiety
5. reassurance

Question 2

Causes of odynophagia

Answer 2

1. infection (candida, cmv, hsv)

2. esophagitis (meds)

Question 3

SE PPI

Answer 3

osteo
vitamin d
hypomag
b12
c diff

Question 4

Management of ulcerative esophagitis

Answer 4

PPI BID

repeat EGD to assess for healing and to exclude barrels (can’ two in setting of active ulcerations)

Question 5

management of GERD

Answer 5

patents with atypical sx take longer to respond to tx
hoarseness (PPI BID for 3 months)
h pylori (does not cause reflux)
sucralfate (doesn't do anything )

Question 6

EGD finding of Barrets

Answer 6

salmon colored patch

Question 7

Pathology of Barrets

Answer 7

specialized intestinal epithelium

symptoms - usually 2ndary complications- stricture/esophagitis

Question 8

Barrets relation to esophageal Ca

Answer 8

adenocarcinoma

Question 9

surveillance of Barrets

Answer 9

No dysplasia: repeat EGD 3-5 years
Low grade: 6-12 months
high grade in the absence of eradication therapy; 3 months

Question 10

Endoscopic tx of Barret high grade dysplasia

Answer 10

RFA
PDT
endoscopic mucosal resection

Question 11

Treatment of H pylori

Answer 11

Generally 10-14 days
1. PPI , bismuth, metro tetra
P{I, amor, clarithro (some number of ppl resistant)
PPI, metro + clarithro (if pen allergy)
PPI should be bid

Question 12

h pylori eradication

Answer 12

testing is recommmended
no earlier than 4 weeks after completing therapy
PPI should be stopped 2 weeks prior to testing

Question 13

Atrophic gastritis etiology

Answer 13

1. h pylori
2. AI (a/w pernicious anemia)
3. EOS
4. lymphocytic
5. Intestinal metaplasia - a/w H pylori

Question 14

Treatment of delayed gastric emptying

Answer 14

1. metoclopramide 10mg before meals

Question 15

ZE syndrome

Answer 15

Stop PPI before testing for gastrin

Question 16

Gastrinoma labs worku

Answer 16

elevated gastrin

Question 17

suscpitous for ZE

Answer 17

recurrent ulcers
complicated ulcers
ulcer and diarrhea

Question 18

Gastric subepithelial lessions etiology

Answer 18

lipoma, pancreatic rest, duplication cyst

also gist, lymphoma, carcinoid

Question 19

GIST

Answer 19

<1 % of all tumors
Interstitial cell of Cajal
have KIT mutation

Question 20

Gastric Carcinoid

Answer 20

gastric neuroendocrine tumor
gastrin is usually elevated
arise from enterochromaffin cells of stomach
<1 cm polypectomy is curative
rarely causes carcinoid syndrome

Question 21

Gastric lymphoma

Answer 21

malt lymphoma

Question 22

Complicatison of gastric surgery

Answer 22

sibo
nutritional deficiencies
dumping syndrome
staple line leak
stenosis

Question 23

Symptoms of crohns

Answer 23

abdominal pain, diarrhea, weight loss

Question 24

UC symptoms

Answer 24

bloody diarrhea, tenesmus, abdominal discomfort, incontinence

Question 25

UC findings

Answer 25

uniform, continuous inflammation (start at rectum and up)

Question 26

Crohns

Answer 26

focal, patchy, deep ulcers granulomas perianal abscess, fistula

Question 27

UC

Answer 27

shallow ulcers | always has rectal involvement

Question 28

IBD extraintestinal manifestations

Answer 28

``` PSC episleritis/uveitis erythema nodosum pyoderma gangreosum SI ```

Question 29

PSC

Answer 29

intrahepatic bedding

Question 30

MC extraintestingal manifestation of IBD

Answer 30

VTE

Question 31

Suspicious h/o Lynch syndrome

Answer 31

3 family members are affected w a Lynch associated cancer

Question 32

Chronic ulcerating infections presenting with IBD like symptoms

Answer 32

CMV, entamoeba histolytica

Question 33

s/s entamoeba histolytica

Answer 33

IBD like symptoms | liver abscesses

Question 34

mixed cryo

Answer 34

hep C

Question 35

Tx of Hep C

Answer 35

Ledipasvir | sofosbuvir

Question 36

typical presentation of mixed cryo

Answer 36

asthenia, arthralgia, palpable Purpura

Question 37

path of microscopic colitis collagen type

Answer 37

lymphocytic infiltrates + sub epithelial collagen band

Question 38

management of asymptomatic hepatic adenoma

Answer 38

if <5 cm, d/c ocp w follow up imaging q 6 months for 2 years

Question 39

associations for hepatic adenoma

Answer 39

ocp steroid use obesity metabolic syndrome

Question 40

malignant transformation risk of hepatic adenomas

Answer 40

10%

Question 41

management of hepatic adenoma >5cm

Answer 41

surgical resection | also if found in males