GI

Question 1

What are the most common causes of acute diarrhea?

Answer 1

Viral infections (norovirus, rotavirus), bacterial infections (Salmonella, Shigella, E. coli, Campylobacter), and parasites (Giardia).1

Question 2

When is testing indicated for a patient with acute diarrhea?

Answer 2

If diarrhea is severe (>6 stools/day), bloody, associated with fever >101.3°F (38.5°C), or lasting >7 days.2

Question 3

What is the first-line treatment for most cases of acute diarrhea?

Answer 3

Oral rehydration therapy, symptomatic treatment (loperamide if no red flags), and antibiotics only if severe bacterial infection is suspected.3

Question 4

What is the most common cause of traveler’s diarrhea?

Answer 4

Enterotoxigenic Escherichia coli (ETEC).4

Question 5

What is the treatment for moderate to severe traveler’s diarrhea?

Answer 5

Azithromycin or ciprofloxacin, with loperamide for symptom relief.5

Question 6

How can traveler’s diarrhea be prevented?

Answer 6

Avoid contaminated food and water, eat only cooked foods, and consider bismuth subsalicylate (Pepto-Bismol) prophylaxis.6

Question 7

What are the most common causes of acute nausea and vomiting?

Answer 7

Gastroenteritis, food poisoning, pregnancy, motion sickness, migraine, or medication side effects.7

Question 8

What are the red flags associated with nausea and vomiting?

Answer 8

Severe dehydration, persistent vomiting, altered mental status, hematemesis, or severe abdominal pain.8

Question 9

What are the best antiemetic treatments for nausea and vomiting?

Answer 9

Ondansetron (Zofran), promethazine (Phenergan), or metoclopramide (Reglan).9

Question 10

What are the most common causes of acute gastroenteritis?

Answer 10

Viral (norovirus, rotavirus), bacterial (Salmonella, Shigella, Campylobacter, E. coli), and parasitic (Giardia, Cryptosporidium).10

Question 11

How is viral gastroenteritis differentiated from bacterial gastroenteritis?

Answer 11

Viral gastroenteritis has watery diarrhea without blood, while bacterial gastroenteritis can present with bloody stools and fever.11

Question 12

What is the primary treatment for viral gastroenteritis?

Answer 12

Oral rehydration therapy and supportive care.12

Question 13

What are the most common causes of constipation?

Answer 13

Low-fiber diet, dehydration, inactivity, opioid use, hypothyroidism, and IBS.13

Question 14

What is the first-line treatment for chronic constipation?

Answer 14

Increase fiber intake, hydration, and physical activity; bulk-forming laxatives (psyllium).14

Question 15

When is further workup needed for constipation?

Answer 15

If symptoms are persistent (>4 weeks), associated with weight loss, hematochezia, or new onset in older adults.15

Question 16

What are the Rome IV criteria for diagnosing IBS?

Answer 16

Recurrent abdominal pain at least 1 day per week for 3 months associated with stool frequency, form, or relief with defecation.16

Question 17

What are the major subtypes of IBS?

Answer 17

IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), IBS-M (mixed type).17

Question 18

What are the first-line treatments for IBS?

Answer 18

Dietary modifications (low FODMAP), fiber supplements, antispasmodics (dicyclomine), and antidepressants (TCAs or SSRIs).18

Question 19

What are the common causes of dyspepsia?

Answer 19

GERD, peptic ulcer disease, H. pylori infection, functional dyspepsia, and medication side effects (NSAIDs, antibiotics).19

Question 20

What is the first-line treatment for functional dyspepsia?

Answer 20

Proton pump inhibitors (PPIs) for 4-8 weeks and lifestyle modifications.20

Question 21

When is endoscopy indicated in a patient with dyspepsia?

Answer 21

If age >60, weight loss, anemia, early satiety, dysphagia, or persistent symptoms despite treatment.21

Question 22

What are the hallmark symptoms of GERD?

Answer 22

Heartburn, regurgitation, chronic cough, and dysphagia.22

Question 23

What are the first-line treatments for GERD?

Answer 23

Lifestyle changes (weight loss, avoiding trigger foods, elevating the head of the bed) and PPIs (omeprazole).23

Question 24

What are complications of untreated GERD?

Answer 24

Esophagitis, Barrett’s esophagus, esophageal stricture, and adenocarcinoma.24

Question 25

What are the most common causes of esophagitis?

Answer 25

GERD, infections (Candida, HSV, CMV), pill-induced (NSAIDs, bisphosphonates), and eosinophilic esophagitis.25

Question 26

What is the classic presentation of infectious esophagitis?

Answer 26

Odynophagia (painful swallowing), dysphagia, and retrosternal pain, often in immunocompromised patients.26

Question 27

What are the most common causes of gastritis?

Answer 27

H. pylori infection, NSAIDs, alcohol, stress (ICU patients).27

Question 28

How does the presentation of gastric ulcers differ from duodenal ulcers?

Answer 28

Gastric ulcers worsen with food, while duodenal ulcers improve with food.28

Question 29

What is the treatment for H. pylori infection?

Answer 29

Triple therapy: PPI + clarithromycin + amoxicillin (or metronidazole if allergic).29

Question 30

What are the common causes of upper GI bleeding?

Answer 30

Peptic ulcer disease, esophageal varices, Mallory-Weiss tears, and gastritis.30

Question 31

How is an upper GI bleed managed?

Answer 31

IV fluids, proton pump inhibitors (PPIs), endoscopy, and possible blood transfusion if severe.31

Question 32

What are the most common causes of lower GI bleeding?

Answer 32

Diverticulosis, hemorrhoids, colorectal cancer, and inflammatory bowel disease.32

Question 33

What is the classic presentation of acute appendicitis?

Answer 33

Periumbilical pain that migrates to the right lower quadrant (McBurney’s point), nausea, vomiting, fever.33

Question 34

What physical exam signs suggest appendicitis?

Answer 34

Rovsing’s sign, psoas sign, obturator sign.34

Question 35

What is the gold standard for diagnosing appendicitis?

Answer 35

CT scan (ultrasound in children or pregnant women).35

Question 36

What are the risk factors for gallstones (cholelithiasis)?

Answer 36

Female, fat, forty, fertile (4 F’s).36

Question 37

How does acute cholecystitis present?

Answer 37

RUQ pain, fever, positive Murphy’s sign, nausea after fatty meals.37

Question 38

What is the best initial imaging test for cholecystitis?

Answer 38

Right upper quadrant ultrasound.38

Question 39

What are the two most common causes of acute pancreatitis?

Answer 39

Gallstones and alcohol use.39

Question 40

What are the classic symptoms and physical exam findings of acute pancreatitis?

Answer 40

Severe epigastric pain radiating to the back, nausea, vomiting, Cullen’s sign (periumbilical ecchymosis), and Grey Turner’s sign (flank ecchymosis).40

Question 41

What is the first-line treatment for acute pancreatitis?

Answer 41

Supportive care with IV fluids, pain control (opioids), NPO (bowel rest), and treatment of underlying cause.41

Question 42

What causes motion sickness?

Answer 42

Mismatch between visual, vestibular, and proprioceptive sensory inputs, leading to nausea and dizziness.42

Question 43

What is the first-line treatment for motion sickness?

Answer 43

Antihistamines (meclizine, dimenhydrinate) or scopolamine patches.43

Question 44

What non-pharmacologic strategies can help prevent motion sickness?

Answer 44

Fixing gaze on the horizon, avoiding reading in a moving vehicle, staying in the front seat of a car, and controlled breathing.44

Question 45

What are the differences between direct and indirect inguinal hernias?

Answer 45

Indirect hernias pass through the inguinal ring (lateral to the inferior epigastric vessels), while direct hernias protrude through Hesselbach’s triangle (medial to the vessels).45

Question 46

How does a femoral hernia differ from an inguinal hernia?

Answer 46

Femoral hernias occur below the inguinal ligament and have a higher risk of incarceration/strangulation.46

Question 47

What are the indications for surgical repair of a hernia?

Answer 47

Strangulation (severe pain, discoloration), incarceration (cannot be reduced), or symptomatic hernias.47

Question 48

What are the most common causes of hepatitis?

Answer 48

Viral hepatitis (A, B, C, D, E), alcohol, autoimmune hepatitis, drug-induced liver injury.48

Question 49

What are the major differences between hepatitis A, B, and C?

Answer 49

Hepatitis A is acute and self-limited, Hepatitis B can be chronic but has a vaccine, and Hepatitis C is often chronic with no vaccine.49

Question 50

What are the two broad categories of jaundice, and what causes each?

Answer 50

Prehepatic (hemolysis, Gilbert syndrome) and posthepatic (biliary obstruction, cholestasis, pancreatic cancer).50

Question 51

How can conjugated vs. unconjugated hyperbilirubinemia be differentiated?

Answer 51

Unconjugated bilirubin is increased in hemolysis and Gilbert’s syndrome, while conjugated bilirubin is seen in liver disease and bile duct obstruction.51

Question 52

What imaging test is indicated for painless jaundice in an older patient?

Answer 52

Abdominal ultrasound or CT to rule out pancreatic cancer.52

Question 53

What is the difference between diverticulosis and diverticulitis?

Answer 53

Diverticulosis is the presence of colonic diverticula without inflammation, while diverticulitis is inflammation and possible infection of the diverticula.53

Question 54

What are the clinical signs of acute diverticulitis?

Answer 54

LLQ pain, fever, leukocytosis, and possibly changes in bowel habits.54

Question 55

What is the first-line treatment for uncomplicated diverticulitis?

Answer 55

Oral antibiotics (ciprofloxacin + metronidazole or amoxicillin-clavulanate) and a low-fiber diet during acute episodes.55

Question 56

What are the key differences between internal and external hemorrhoids?

Answer 56

Internal hemorrhoids are painless but can cause rectal bleeding, while external hemorrhoids are painful and can thrombose.56

Question 57

What is the best initial treatment for mild hemorrhoids?

Answer 57

High-fiber diet, increased fluid intake, sitz baths, and topical hydrocortisone.57

Question 58

When is surgical intervention indicated for hemorrhoids?

Answer 58

Severe, persistent, or thrombosed hemorrhoids unresponsive to conservative treatment.