GI

Question 1

Sudan Stain?

Answer 1

Fat in stool - pancreatic insufficiency

Question 2

D xylose test?

Answer 2

tests for problems absorbing carbs. Abnl in sprue, whipples, bacterial overgrowth

Question 3

How/why to confirm UC/crohns before starting tx?

Answer 3

Abd XR. Look for toxic megacolon if patient is looking toxic

Question 4

Breast ‘non feeding’ jaundice

Answer 4

First week or so of life. Hyperbili and dehydration. Low stool and OUP. Red urate xtals in diaper. Tx - optimizing lactation and increase feeding frequency

Question 5

Physical sign typical of acute mesenteric ischemia?

Answer 5

Pain OOP for exam

Question 6

Fecal elastase?

Answer 6

Decreased in chronic panc

Question 7

Elevated Cr, UNa<10 in setting of cirrhosis

Answer 7

Hepatorenal synd (renal hypoperfusion)

Question 8

Tx of ascities

Answer 8

Lasix and spironolactone

Question 9

Tx for SBP

Answer 9

Albumin and cefotaxime

Question 10

Cancers with high EPO?

Answer 10

"Potentially Really High Hct"
Pheo
RCC
HCC
Hemangioblastoma (CNS)

Question 11

Campylobacter diarrhea tx

Answer 11

eryhtromycin

Question 12

shigella diarrhea tx

Answer 12

bactrim

Question 13

M-W bleeds are from what vessels?

Answer 13

submucosal ARTERY bleeds

Question 14

Vitiligo, atrophic glossitis/thyroid dz/neuro problems

Answer 14

Pernicious anemia (Anti IF abs)

Question 15

INH AE?

Answer 15

Other than neuropathy - can also cause liver damage similar looking to viral hepatitis

Question 16

Rapid emptying of hypertonic gastric content into small bowel. Fluid shifts from intravascular space to lumen, increase vasoactive peptide secretions and stim autonomic reflexes. s/p gastrectomy.

Answer 16

dumping syndrome. tx with diet mods

Question 17

Acalculous cholecystitis patient population, presentation

Answer 17

Critically ill patients. Presents like calculous cholecystitis. Imaging will show distended gallbladder with wall thick and pericholecystic fluid. Tx is I/D and cholecystectomy

Question 18

Most worrisome complication of pneumatic dilation of esoph?

Answer 18

Esophageal rupture - which can lead to mediastinitis

Question 19

Prevent Gallstones in gastretomy patients?

Answer 19

Ursodeoxyxholic Acid

Question 20

PTH changes in renal failure?

Answer 20

Typically hyperplasia because of low calcium and renal failure

Question 21

SIADH changes to urine sodium?

Answer 21

Elevated. It retains water and exchanges sodium

Question 22

Hyperbili with pancreatic cancer. Tx?

Answer 22

Palliative - stent placement, usually

Question 23

corkscrew shaped duodenum abnormally located in right abdomen. Seen in infants with bilious emesis

Answer 23

Midgut volvulus/malro

Question 24

What vaccine should all patients with chronic liver disease get?

Answer 24

HAV

Question 25

Lamivudine. Works on what hepatitis virus?

Answer 25

B

Question 26

Extra hepatic manifestations of HCV?

Answer 26

Essential mixed cryoglobulinemia, porphiria cutanea tarda, MPGN.

Question 27

Chronic HCV can be asx or present with nonspecific sxs like fatigue, arthralgias, etc. Can also have normal or elevated LFTs

Answer 27

Don't let normal LFTs throw you off from HCV

Question 28

Liver abscess plus travel to endemic area. Tx?

Answer 28

Think amebic liver abscess. tx with oral metronidazole. dont aspirate

Question 29

CXR shows wide mediastinum, pleural effusion, subQ emphysema. Effusion has high level of amylase

Answer 29

Think boerhaave.

Question 30

Treatment for asymptomatic gallstones?

Answer 30

NOPE! dont.

Question 31

when do we use ursodeoxycholic acid?

Answer 31

Sx gallstones but poor surgical candidates

Question 32

When do we manage SBO conservatively vs operatively?

Answer 32

Depends on how stable patient is. If hemodynamic instability - do surgery (metabolic acid/alk, fever, leukocytosis, tachy, bp messed up)

Question 33

Sphincter of Oddi dysfunction. Treatment?

Answer 33

ERCP and sphincterotomy.

Question 34

BRBPR if less than 50 y and no rf's

Answer 34

can monitor with anoscopy/sigmoidoscopy

Question 35

Persistent abd pain/dyspepsia s/p chole.

Answer 35

postchole syndrome/ get ercp

Question 36

Watery, frequent diarrhea. Bx of colon shows brown discoloration of colon with lymph follicles shining thru as pale patches. melanosis coli

Answer 36

LAxative abuse

Question 37

What metabolic abnormality can iron tox give you?

Answer 37

Met acidosis

Question 38

liver with fatty vacuolization, diffuse mitochondrial injury.

Answer 38

Reyes syndrom. tx ffp, glucose and mannitol

Question 39

When d o you start UC colon CA surveillance?

Answer 39

8 yrs s/p dx - then do cscope every 1-2 years

Question 40

How do you treat non bleeding esoph varicies?

Answer 40

BBLOX. no sclerotherapy

Question 41

Noncaseating granulomas are seen with which IBD?

Answer 41

Chrons

Question 42

what antibodies do you look for UC? Chrons?

Answer 42

PANCA for UC. Anti Saccharomyces cerevisiae for chrons

Question 43

what sex abnormalities do we see in chronic liver dz?

Answer 43

test atrophy, gynecomastia, hypogonadism

Question 44

Mild DM, necrolytic migratory erythema, wt loss, diarrhea. dx?

Answer 44

Think glucagonoma

Question 45

Ductopenia is seen with?

Answer 45

PBC, liver failure, tplant (called vanishing bile duct synd)

Question 46

How can systemic sclerosis cause malapsorption?

Answer 46

Low gi motility leads to bact overgrowth

Question 47

suspected achalasia. What else do you need to rule out?

Answer 47

Malignancy obvs/. so do endoscopy

Question 48

What raises your suspicion for angiodyplasia over diverticulosis?

Answer 48

Aortic stenosis or ESRD

Question 49

What meds can we use to treat HBV?

Answer 49

even though none actually cures dz - INFa along with a bunch of HIV drugs, like lamivudine (Epivir), adefovir (Hepsera), tenofovir (Viread), telbivudine (Tyzeka) and entecavir

Question 50

Alopecia, abnormal taste, bullous/pustules on orifices, poor wound healing. Seen in TPN and IBD

Answer 50

Zinc def

Question 51

Best imaging for diverticulitis?

Answer 51

Abd CT

Question 52

How does severe acute panc lead to severe hypotension?

Answer 52

systemic vascular injury and permeability

Question 53

How does bowel ischemia lead to met acidosis?

Answer 53

because increase lactate

Question 54

Corn based diets are deficient in?

Answer 54

Niacin - pellagra

Question 55

If urine dipstick is positive for bili, what type (UCB, CB) of hyperbili are we thinking?

Answer 55

Conjugated

Question 56

Pathophys of rotors?

Answer 56

benign. defect in hepatic storage of bili. Conj bili leaks to plasma

Question 57

Why can antiTTG sometimes be negative in celiac?

Answer 57

Because celiac is also assoc with concurrent IgA def.

Question 58

Most common complication of PUD?

Answer 58

Hemorrhage > Perforation

Question 59

Mechanism of NASH?

Answer 59

insulin resistance leads to hepatic uptake of fatty acids

Question 60

PAtient with HCV. What should you do prior to starting antiviral tx?

Answer 60

Do liver bx - best indicator of clinical disease progression.

Question 61

Patient looks like he has pancreatitis. What test should you get to evaluate underlying cause of patient's condition?

Answer 61

RUQ US. Even if it doesn't look like he has gall stones. ETOH and stones account for 75% of cases.

Question 62

Elevated liver enzymes with tremor, rigidity, abnormal gait?

Answer 62

Wilson's dz. COpper can affect basal ganglia. SLit lamp tests. decreased serum ceruloplasmin

Question 63

periorbital edema, eosinophilia, and myositis. splinter hemorrhages/conjunctival or retinal hemorrhages. dx?

Answer 63

trichinella infection

Question 64

ARF in HCV patient. Does not respond to bolus, no urinary retention. DX? Tx?

Answer 64

This patient has hepatorenal syndrome prolly. Only way to tx is with liver tplant. Very quick mortality.

Question 65

Suspected esoph perforation. How do you diagnose?

Answer 65

Barium swallow

Question 66

Jet black liver?

Answer 66

Dubin Johnson. Not Rotor. Johnson = Jet Black