GI

Question 1

MCC of upper GI bleed

Answer 1

peptic ulcer disease

Question 2

what are some complications we worry about with untreated GERD?

Answer 2

• Barrett’s esophagus - body changes esophageal mucosa from squamous to columnar cells (incr cancer risk)
• stricture
• aspiration pneumonia

Question 3

Esophogeal cancer - risk factors, presentation

Answer 3

RF: tobacco, alcohol, chronic GERD, age 40-75, men

px: progressive dysphagia to solids and weight loss

Question 4

what is the MC tye of esophageal cancer

Answer 4

adenocarcinoma > squam

Question 5

Achalasia - who gets it, how to they present, what to r/o, how to we treat?

Question 6

“bird’s beak” finding on barium esophagram is seen in

Answer 6

Achalasia

Question 7

Mallory-weiss tear vs Boerhave

Question 8

how does the presentation of esophageal rings/webs differ from achalasia/esophageal cancer?

Answer 8

non-progressive, intermittent dysphagia to solids

Question 9

iron deficiency anemia, esophageal web and dysphagia

Question 10

peptic ulcer dz - who gets it, presentation, dx

Question 11

aside from things on cbc, what other lab findings are elevated in B12 deficiency?

Answer 11

MMA abd homocysteine

Question 12

gastric lymphomas - what infection is associated with MALToma?

Answer 12

H. pylori –> *tx of h. pylori can result in tumor regression

Question 13

what skin finding is associated with celiac dz

Answer 13

dermatitis herpetiformis
*rash that looks similar to shingles but crosses midline

Question 14

what labs are seen in celiacs dz?
what is the gold standard for diagnosis?

Question 15

acute paralytic ileus - when do ppl get this, how do they present, tx?
how can we differentiate from SBO?

Answer 15

loss of peristalsis in the intestines with no obstruction present

precipitants: recent abdominal surgery, severe illness, elecrtolyte imbalance, meds (opiods, anticholinergics)

*bowel sounds decr or absent!!

tx underlying cause, bowel rest

Question 16

PE findings of appendicitis

Question 17

appenditicitis - dx and tx

Answer 17

labs: CBC with leukocytosis
imaging: ultrasound (young, preg), CT scan
Tx: surgery, abx

Question 18

what dx criteria is used to dx irritable bowel syndrome (IBS)

Answer 18

Rome IV criteria

• recurrent abdominal pain
• pain is related to defecation
• associated with change in form/frequency of stool

Question 19

pt presents with intense diarrhea after tx with clindamycin for a skin infection. what is going on and what are tx options

Question 20

crohn’s vs ulcerative colitis

Question 21

non-continuous inflammation (“skip lesions”) affecting the GI tract from the mouth to anus sparing the rectum, worse in terminal ileus

Question 22

what area of GI tract is most commonly involved in crohn’s? what is the associated nutritional problem

Answer 22

terminal ileus –> can see B12 deficiency

Question 23

erythema nodosum, episcleritis, non-erosive arthris are extra-intestinal manifestations of what GI condition?

??? mb reword bc uc also has erythema nodosum

Answer 23

crohn’s

Question 24

how do we dx crohn’s

Question 25

ulcerative colitis only affects what area of the bowel?

Answer 25

colon

Question 26

bloody diarrhea is more commonly seen in crohn's or ulceratice collitis?

Answer 26

ulcerative collitis

Question 27

what are some extracolonic manifestations that can be seen un crohn's and US

Question 28

UC diagnosis

Question 29

what is the important complication of ulcerative colitis? what screening is needed and when?

Question 30

what abx are used in tx for diverticulitis?

Answer 30

cipro AND flagyl (metronidazole) or Augmentin

Question 31

pt was tx for diverticulitis with antibiotics, what if any, further screening should be done and why?

Answer 31

colonoscopy to r/o cancer if they have not had on in the past year *must be at least 8 weeks post flare, do NOT want to do during flare

Question 32

risk factors for colon cancer

Question 33

colon cancer screening guidelines

Question 34

pt found to have colon cancer on colonoscopy and will start tx. what tumor marker is used to assess response tx?

Answer 34

CEA

Question 35

what is the most common location for an anal fissure

Answer 35

posterior midline *if lateral, think Crohn's

Question 36

perianal abscess/fistula

Question 37

external vs internal hemorrhoids

Question 38

how do we manage thrombosed hemorrhoids?

Question 39

acute mesenteric ischemia - who gets it, how do they present, how do we dx and tx?

Question 40

CHRONIC mesenteric ischemia - who gets it, how do they present, how do we dx and tx?

Question 41

inflammatory vs non-inflammatory diarrhea

Question 42

what empiric antibiotics would you consider for inflammatory diarrhea pending cultures?

Answer 42

fluoroquinolone (cipro) or azithromycin

Question 43

what supportive care measures are used for acute diarrhea?

Answer 43

HYDRATION, bland diet *loperamide only if non-inflammatory

Question 44

what are common causes of acute pancreatitis?

Answer 44

gallstones !!! alcohol hypertriglyceridemia ( > 1,000) other less commonL hypercalcemia, abdominal trauma, drugs, post ERCP, viral infections (MUMPS), scorpion bite

Question 45

what labs are elevated in acute pancreatitis? which is more sensitive

Answer 45

amylase and lipase *lipase is more sensitive

Question 46

dx of acute pancreaitits and severity scale

Question 47

acute pancreatitis tx

Question 48

chronic pancreatitis - who gets it, how do they present, dx and tx

Question 49

MC type and location of pancreatic cancer?

Answer 49

type - ductal adenocarcinoma location - head of pancreas

Question 50

what are risk factors for pancreatic cancer?

Question 51

what is the first thing you should r/o in a patient presenting with painless jaundice?

Answer 51

pancreatic cancer

Question 52

what is charcot's triad? reynald's pentad? what does it indicate?

Answer 52

charcot's triad - fever, RUQ pain, jaundice reynold's pentad - charcot's + **AMS and hypotension** ***cholangitis***

Question 53

how do we dx cholecystitis?

Answer 53

RUQ US *HIDA scan only us US unequivical

Question 54

hepatitis and liver stuff