Gastrointestinal

Question 1

A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and abdominal radiograph reveals free air under the diaphragm. Management?

Answer 1

Emergent laparotomy to repair a perforated viscus

Question 2

The most likely cause of acute lower GI bleeding in patients >40 years of age

Answer 2

Diverticulosis

Question 3

Diagnostic modality used when ultrasonography is equivocal for cholecystitis

Answer 3

Hepatobiliary IminoDiacetic Acid (HIDA) scan

Question 4

Risk factors for cholelithiasis

Answer 4

Fat, female, fertile, forty (or older), fair (white)

*First Aid says flatulent instead of fair, not sure where they got that from or what that is supposed to mean.

Question 5

Inspiratory arrest during palpation of the RUQ. Likely diagnosis?

Answer 5

Murphy sign, seen in acute cholecystitis

Question 6

The most common cause of small bowel obstruction (SBO) in patients with no history of abdominal surgery? With a history of abdominal surgery?

Answer 6

Without surgical hx: hernia

With surgical hx: adhesions

Question 7

Most common bacterial organism causing diarrhea

Answer 7

Campylobacter

Question 8

Organism causing diarrhea associated with recent antibiotic use

Answer 8

Clostridium difficile

Question 9

Organism causing diarrhea associated with camping.

Answer 9

Giardia

Question 10

Organism causing diarrhea associated with traveler’s diarrhea

Answer 10

Enterotoxigenic E. coli (ETEC)

Question 11

Organism causing diarrhea associated with church picnics / mayonnaise

Answer 11

Staph aureus

Question 12

Organism causing diarrhea associated with uncooked hamburgers

Answer 12

E coli. O157:HY (EHEC)

Question 13

Organism causing diarrhea associated with fried rice

Answer 13

Bacillus cereus

Question 14

Organism causing diarrhea associated with poultry/eggs

Answer 14

Salmonella

Question 15

Organisms causing diarrhea associated with raw seafood

Answer 15

Vibrio, hepatitis A virus

Question 16

Organisms causing diarrhea associated with AIDS

Answer 16

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Question 17

Organisms causing diarrhea associated with pseudoappendicitis.

Answer 17

Yersinia, Campylobacter

Question 18

A 25 year-old Jewish man presents with pain and water diarrhea after meals. Examination shows fistulas between the bowel and skin, and nodular lesions on his tibias. Likely diagnosis?

Answer 18

Crohn’s disease

Question 19

Inflammatory disease of the colon with n increased risk of colon cancer

Answer 19

Ulcerative colitis (greater risk than Crohn’s)

Question 20

Extraintestinal manifestations of IBD

Answer 20

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis

Question 21

Medical treatment for IBD

Answer 21

5-ASA agents and steroids during acute exacerbations

Question 22

A 30 year old man with ulcerative colitis presents with fatigue, jaundice, and pruritis. Likely diagnosis?

Answer 22

Primary sclerosing cholangitis

Question 23

Difference between Mallory-Weiss and Boerhaave tears

Answer 23

Mallory-Weiss: superficial tear in the esophageal mucosa

Boerhaave: full-thickness esophageal rupture

Question 24

Signs of and condition indicated by Charcot triad?

Reynolds’ pentad?

Answer 24

Charcot: RUQ pain, jaundice, and fever/chills. Acute cholangitis.
Reynold’s: Triad plus shock and AMS. Obstructive ascending cholangitis.

Question 25

Medical treatment for hepatic encephalopathy

Answer 25

Decreased protein intake, lactulose, rifamixin

Question 26

The first step in the management of a patient with an acute GI bleeding episode

Answer 26

ABCs

Question 27

A 4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloodny diarrhea. Most likely diagnosis and cause?

Answer 27

Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7 (or alternatively, other E. coli serotypes, Shigella, or Campylobacter)

Question 28

Treatment after exposure to hepatitis B virus?

Answer 28

Hepatitis B Immune Globulin (HBIG)

Question 29

Classic causes of drug-induced hepatitis

Answer 29

TB medications (isoniazid/INH, rifampin, pyrazinamide), acetaminophen, and tetracycline

Question 30

A 40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritis, dark urine, and clay-colored stools. Likely diagnosis?

Answer 30

Biliary tract obstruction

Question 31

Hernia with highest risk of incarceration: indirect, direct, or femoral?

Answer 31

Femoral

Question 32

Severe abdominal pain out of proportion to the examination suggests...?

Answer 32

Mesenteric ischemia

Question 33

Diagnosis of ileus

Answer 33

Abdominal radiographs (could also perform CT scan)

Question 34

A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Likely diagnosis? Management?

Answer 34

Confirm the diagnosis of pancreatitis with elevated amylase and lipase. Make the patient NPO, give IV fluids, oxygen, analgesia, and "tincture of time"

Question 35

Anemia from chronic disease, occult blood loss, vague abdominal pain.

Answer 35

Right-sided colon cancer (rarely causes obstruction)

Question 36

Obstructive symptoms and changes in bowel movements

Answer 36

Left-sided colon cancer: "apple-core" lesion

Question 37

What presents with watery diarrhea, dehydration, muscle weakness, and flushing? Management?

Answer 37

VIPoma. Replace fluids and electrolytes, may need to surgically resect tumor or use octreotide

Question 38

What presents with palpable, nontender gallbladder? Name of sign?

Answer 38

Courvoisier sign, suggests pancreatic cancer