GI

Question 1

Dysphagia to B solid and liquid is a motility prob. Differentials?

Answer 1

Progressive w/ cough- achalasia
Progressive w/Heartburn- scleroderma

Intermittent w/ chest pain- DES

Question 2

Dxtix for DES

Answer 2

Barium swallow showing corkscrew appearance

Tx: trial of PPI; CCB

Question 3

First bite dyaphagia

Answer 3

Lower esophageal ring/ schatzki’s ring

Tx: pneumatic dilatation

Question 4

Findings in achalasia

Answer 4

Birds beak appearance
Manometry showing dec peristalsis and inc LES tone

Tx: surgical myotomy

Question 5

Egd reveals concentric rings

Answer 5

Eosinophilic esophagitis

Tx: trial of PPI; budesonide

Question 6

Regurgitation of food eaten several days before

Answer 6

Zenker’s diverticulum

Question 7

HIV with odynophagia, what to do?

Answer 7

Trial of fluconazole/ itraconazole

If persistent, EGD to r/o HSV or CMV

Question 8

Dysphagia to solids is an obstruction problem. Differentials?

Answer 8

Progressive and Age > 50- r/o CA
Progressive w/ heartburn: peptic stricture

Intermittent: eosinophilic esophagitis

Question 9

Indications for EGD

Answer 9

Anemia
Melena
Weight loss
Dysphagia or odynophagia
Poor response to PPI for 4-8 weeks
GERD sx > 5 yrs

Question 10

T/F tx of barrett’s esophagus w/ PPI or fundoplication reverses the epithelial changes

Answer 10

F

Question 11

EGD for Barretts

Answer 11

If no dysplasia, rpt in 3 yrs
If w/ low grade dysplasia, rpt in 6 mos. if still dysplasia, rpt in 1 yr; if already metaplasia, repeat in 3yrs
If high grade dysplasia, endoscopic radiation ablation and repeat egd in 1 yr

Question 12

Dxtic for esophageal rupture

Answer 12

Gastrograffin study

Question 13

Difference bet type A and B chronic gastritis

Answer 13

Type A: (AAA)
more common in fundus
Atrophic gastritis
Anemia - Pernicious 
adenoCA-- 3x risk (no need for surveillance)
Inc gastrin

Type B:
H pylori associated
More common in antrum

Question 14

T/F diet, personality, occupation play a role in PUD

Answer 14

F

Question 15

Tx of maltoma?

Answer 15

H pylori tx

After tx repeat biopsy before annpuncing cure bec t (8,11) has poor response to tx

Question 16

Best test for h pylori diagnosis when px is on PPI

Answer 16

Ab testing

Question 17

Tx regimen for PUD

Answer 17

PAC: PPI + amox + clarithro
MOC: Metro + Omep + clarithro

Question 18

Tx failure w/ PUD regimen

Answer 18

Tetracycline + bismuth + metro + PPI

Question 19

Zollinger ellison syndrome

Answer 19

Gastrinomas; associated w: men 1

Presents w/ diarrhea/ steatorrhea

Question 20

Dxtic for ZES

Answer 20

Fasting gastrin level
If not dxtic, IV secretin w/c inc gastrin to > 1000
CT or somatostatin scintigraphy to localize

Question 21

Tx for ZES

Answer 21

PPI, resection

Life expectancy normal if surgery curative; otherwise it’s 2 yrs

Question 22

What to do w/ clean based ulcer on egd

Answer 22

If

Question 23

If bleeding ulcer, visible vessel, bleedinb varices on egd what to do?

Answer 23

Monitor for 72hrs

Question 24

What meds to give for esophageal varices

Answer 24

Nonselective BB- propranolol, nadolol, carvedilol

Question 25

T/F banding is better than sclerotherapy

Answer 25

T

Question 26

ReBleeding after banding/sclerotherapy?

Answer 26

MELD 24 - transplant

Question 27

Gastric varices w/o esophageal varices on EGD

Answer 27

Do CT -- consider splenic vein thrombosis

Question 28

Dumping syndrome etiology/tx?

Answer 28

Sx: palpitations, tachycardia, sweating, hypotension Early (15min): rapid emptying Delayed (90 min postprandial): hypoglycemia Tx: small frequent feeds Low carbo diet

Question 29

Afferent loop syndrome?

Answer 29

Postgastrectomy there is postprandial bloating/pain relieved with bilious vomiting

Question 30

Blind loop syndrome

Answer 30

Postgastrectomy -- bacterial overgrowth (low B12, normal folate) --- steatorrhea

Question 31

Extrinsic compression of cbd

Answer 31

Mirrizzi's syndrome | Tx: cholecystectomy

Question 32

Gb sludge & pancreatitis? | What to do

Answer 32

Ercp w/ biliary sampling --- cholecystectomy

Question 33

Why do yearly US for ulcerative colitis?

Answer 33

To look for GB polyps | If + and > 1cm, cholecystectomy bec of high risk of CA

Question 34

Marker for autoimmune pancreatitis?

Answer 34

IgG4 Tx: steroids

Question 35

Finding in pancreatic divisum

Answer 35

Dilated dorsal duct

Question 36

In pancreatitis, marker for biliary etiology?

Answer 36

ALT 2x elevated; alkphos rises later

Question 37

Soap bubble sign in pancreatitis

Answer 37

Abscess; abx and drainage | For persistent fever > 72 hrs, open drainage

Question 38

Persistently elevated amylase in pancreatitis?

Answer 38

Consider pseudocyst

Question 39

Worrisome features of pancreatic cysts

Answer 39

``` Solid component Enhancing thickened wall Nodule RBCs or inflammatory cells Size 3cms or more Dilated pancreatic duct > 1cm + cea + pathology ```

Question 40

What to do if pancreatic cyst has worrisome features

Answer 40

Confirm with EUS

Question 41

3cm panc cyst w/ no worrisome features on eus

Answer 41

MRI or EUS every 3-6mos

Question 42

2cm panc cyst w/ no worrisome features on eus

Answer 42

MRI or EUS every 2-3 yrs

Question 43

Dx for steatorrhea

Answer 43

Stool fat > 40g

Question 44

Tx for chronic pancreatitis

Answer 44

Pancrealipase x 6 wks; if no response, pregabalin

Question 45

Path in IBD

Answer 45

UC: shallow ulcers w/ crypt abscess CD: deep ulcers w/ granuloma

Question 46

Xray in IBD

Answer 46

UC + CD: toxic megacolon | CD: string sign

Question 47

Extraintestinal manifestations are common in which IBD?

Answer 47

UC They mirror UC activity except for Ankylosing spondylitis and PSC

Question 48

When to do colonoscopy for IBD

Answer 48

8 yrs after diagnosis then every 1-3 yrs after

Question 49

Labs for IBD

Answer 49

UC: p anca CD: Asca

Question 50

Tx for IBD

Answer 50

Mesalamine +/- metronidazole

Question 51

What to do for flares of IBD

Answer 51

Steroids

Question 52

Steroid sparing drugs for IBD?

Answer 52

6 mercaptopurine and azathioprine

Question 53

In IBD unresponsive to 6 MP or azathioprine

Answer 53

Infliximab (anti-TNF)

Question 54

Px with IBD presents with diarrhea and leukocytosis

Answer 54

R/o c diff

Question 55

Ca oxalate stones common in which IBD

Answer 55

Chrons

Question 56

Which diarrhea stops with eating

Answer 56

Osmotic

Question 57

How to differentiate secretory fr osmotic diarrhea

Answer 57

Stool osmotic gap Na + K x 2 Secretory: 50

Question 58

Most common cause of invasive diarrhea

Answer 58

Campylobacter (undercooked poultry)

Question 59

Tx of ETEC

Answer 59

Loperamide; azithro x 5 days

Question 60

How to culture O157:H7 e coli

Answer 60

McConkey + sorbitol agar

Question 61

Diarrhea after eating soft cheese

Answer 61

Listeria

Question 62

Frothy stool after camping

Answer 62

Giardia Dx: stool ELISA Tx: metronidazole

Question 63

Most common viral cause of age in adults

Answer 63

Norovirus

Question 64

Ate fish, had perioral paresthesias

Answer 64

Ciguatera toxin

Question 65

Ate fish had flushing

Answer 65

Scombroid

Question 66

Ate fish, had ascending paralysis

Answer 66

Tetradotoxin

Question 67

Flask shaped ulcers

Answer 67

Amoebic colitis

Question 68

Tx for cryptosporidium

Answer 68

Nitazoxanide

Question 69

Rule out what dse in pxs with irritable bowel syndrome

Answer 69

Celiac with TTG ab

Question 70

Osmotic diarrhea turns red with NaOH

Answer 70

Laxative abuse

Question 71

Flow of drugs in c diff

Answer 71

Flagyl -- flagyl again -- vanco po -- vanco pulsed tx -- vanco po + iv flagyl -- fidaxomicin

Question 72

What nutrients absorbed in duodenum

Answer 72

Ca, mg, fe, fa

Question 73

What nutrients absorbed in ileum

Answer 73

B12, fat soluble vit (adek)

Question 74

Mucosal causes of malabsorption will be positive for what test?

Answer 74

D xylose test

Question 75

Dxtic for celiac sprue

Answer 75

TTG Ab

Question 76

Diarrhea + iron def + rash

Answer 76

Think celiac sprue

Question 77

Rash of celiac sprue

Answer 77

Dermatitis herpetiformis

Question 78

Tx of Dermatitis herpetiformis

Answer 78

Dapsone

Question 79

Brother of px w/ celiac dse wants to be tested

Answer 79

HLA DQ 2 or 8

Question 80

Tropical sprue diff of carribean and asian types

Answer 80

Caribbean: normal folic, low b12 Asian: low folic, normal b12 Vs bacterial overgrowth; high folic, low b12

Question 81

Pathology of tropical sprue

Answer 81

Flattened villi with lymphocytes or plasma cells Fr klebsiella or e coli

Question 82

Tx of tropical sprue

Answer 82

Tetracycline + folic

Question 83

Tx for whipples dse

Answer 83

Bactrim or tetracycline x 1 yr

Question 84

Dxtic for bacterial overgrowth

Answer 84

Hydrogen breath test, xylose 14c breath test

Question 85

Tx for bacterial overgrowth

Answer 85

Cipro, flagyl

Question 86

Short bowel syndrome: | Postoperative diarrhea tx

Answer 86

PPI

Question 87

Short bowel syndrome: | Persistent diarrhea tx

Answer 87

Cholestyramine Defect: dec bile acid absorption

Question 88

Short bowel syndrome: | Greasy stools tx

Answer 88

Med chain triglycerides Defect: dec bile acids

Question 89

Microscopic colitis tx

Answer 89

Budesonide po

Question 90

Recurrent LLQ pain w/o fever or WBCs in px known to have diverticulosis

Answer 90

Symptomatic diverticular dse Tx: mesalamine, rifaximine

Question 91

Med known to cause diverticulitis w/ perforation

Answer 91

Tocilizumab

Question 92

Tx for acute vs chronic mesenteric ischemia

Answer 92

Acute: thrombolysis, surgery Chronic: angioplasty, revasc

Question 93

Tx for ischemic colitis

Answer 93

Hydration and abx

Question 94

AVMs in all organs

Answer 94

Osler-weber-rendau Tx: cautery, laser coagulation, sclerotherapy

Question 95

Chronic constipation unresponsive to laxatives

Answer 95

Polyethylene glycol

Question 96

CA px w/ constipation unresponsive to golytely

Answer 96

IV methylnatrexone

Question 97

Acute pseudocolonic obstruction

Answer 97

Ogilvie's syndrome Dxtic: CT w/ water soluble enema Tx: rectal tube, neostigmine

Question 98

Whirl sign on xray, what to do

Answer 98

Sigmoid volvulus Flexible sigmoidoscopy

Question 99

Needlestick injury, what to do?

Answer 99

Hep b titers 10: reassurance

Question 100

Who to treat for hep b

Answer 100

ALT x 2 normal | Compensated cirrhosis

Question 101

Tx for hep b

Answer 101

``` Tenofovir Entecavir Adefovir Lamivudine Alpha interferon Telbivudine ```

Question 102

Pregnant woman with hep b, how to prevent transmission

Answer 102

Treat mother with telbivudine, give immunoglobulin and vaccine to baby

Question 103

Who to check for hep c ab

Answer 103

Born bet 1945-1965

Question 104

Needlestick fr hep c + px what to do

Answer 104

Hcv RNA now then 12 wks after

Question 105

Tx for hep c

Answer 105

Sofusbuvir + ribavirin + ifn

Question 106

Tx for hep c if depressed

Answer 106

Sofusbuvur + simeprivir x | 12 wks

Question 107

Serology of hep d superinfection

Answer 107

Hbs IgG + HDV

Question 108

Primary biliary cirrhosis findings

Answer 108

*hypercholesterolemia with high HDL Dec vit adek AMA ab + Liver biopsy- granulomas/ lymphocytic destruction of bile ducts

Question 109

Tx for PBC

Answer 109

Liver transplant Ursodeoxycholic acid slows down progression

Question 110

Autoimmune hepatitis most specific finding

Answer 110

Antismooth muscle ab Biopsy: piecemeal necrosis Tx: pred +/- azathioprine

Question 111

Tx for alcoholic hepatitis

Answer 111

Steroids Discriminant factor > 32

Question 112

Contraindication to steroids in alcoholic hepatitis

Answer 112

GI bleed | SBP

Question 113

What to use if steroids cannot be used in alcoholic hepatitis

Answer 113

Pentoxyfylline

Question 114

How to diagnose nASH

Answer 114

Biopsy

Question 115

Contraindications for liver transplant

Answer 115

Active alcohol or illegal drug use Extrahepatic CA Unresolved sepsis

Question 116

Relative contraindications to luver transplant

Answer 116

HIV | Hep B e ag +

Question 117

Tx for wilsons

Answer 117

Penicillamine + pyridoxine; trientine