GI

Question 1

PBC (+ antimitochondrial Ab) increases risk of (3 things)?

Answer 1

Osteomalacia (d/t malabsorption of fat soluble vits)
Hepatocellular carcinoma
Xanthelasmas
Tx - Ursodeoxycholic acid delays progression

Question 2

Lynch syndrome is associated with which 3 cancers?

Answer 2

Colorectal
Endometrial
Ovarian

Question 3

Familial adenomatous polyposis is associated with which 3 cancers?

Answer 3

Colorectal
Desmoids/Osteomas
Brain tumors

Question 4

von Hippel-Lindau syndrome is associated with which 3 cancers?

Answer 4

Hemangioblastomas
Clear cell RCC
Pheo

Question 5

MEN type 1, 3 cancers?

Answer 5

Parathyroid adenoma
Pituitary adenoma
Pancreatic adenoma

Question 6

MENT type 2, 2 cancers?

Answer 6

Medullary thyroid cancer
Pheo
Parathyroid hyperplasia (type 2 A)

Question 7

BRCA1/2 is associated with?

Answer 7

Breast

Ovarian

Question 8

How do you screen for endometrial cancer in a pt with Lynch syndrome?

Answer 8

Annual endometrial bx (age 30-35)

Prophylactic hysterectomy

Question 9

Middle aged male
Diarrhea, abd pain weight loss
Steatorrhea
Skin hyperpigmentation, arthralgia
Small bowel bx - villous atrophy s/ PAS-positive material in the lamina propria

Answer 9

Whipple’s

Infection with Tropheryma whippelii

Question 10

Pt has dysphagia with regurgitation through his nose and frequent RLL PNA. Dx and workup?

Answer 10

Oropharyngeal dysphagia

Get a videofluoroscopic modified barium swallow to see swallowing mechanics/dysfxn/aspiration

Question 11

Colon cancer tends to metastasis to?

Answer 11

The liver

RUQ pain, firm hepatomegaly

Question 12

Most common cause of lower GI bleed in adults?

Answer 12

Diverticulosis

Question 13

Why do acute pancreatitis pts become hypotensive?

Answer 13

Intravascular volume loss d/t vascular endotelial injury ( leads to vasodilation, increased permeability, plasma leak into the retroperitoneum)

Question 14

Tx for hematemesis d/t esophageal varices?

Answer 14

Octreotide

Question 15

Older pt with recurrent painless lower GI bleed

Answer 15

Angiodysplasia
Dilated submucosal v. and AVM's
Dx'd on colonoscopy but often missed
If asyx - no tx
If anemic, bleeding - cauterize

Question 16

IBD w/ spared rectum, perianal dz, noncaseating granulomas

Answer 16

Crohn dz

Question 17

Pt w/ ascities presenting with low grade fever, AMS

Answer 17

always need to r/o SBP

Question 18

Does a negative guiac r/o nee for colonoscopy in a pt with high suspicion for GI bleed?

Answer 18

Nope

Question 19

Dermatitis (of sun exposed skin)
Dementia
Diarrhea

Answer 19

Pellagra d/t niacin deficiency
Isoniazid use can cause pellagra
Synthesized from tryptophan, so vegetarian diet high in corn is a strong RF

Question 20

GERD pt gets MALT. How?

Answer 20

H. pylori

Give quad therapy

Question 21

SBP diagnostic criteria on paracentesis?

Answer 21

PMN > 250

+ Culture

Question 22

Jaundice, scleral icterus
+ urine bili
NL LFTs, AP

Answer 22

Rotor’s syndrome

Benign, inherited defect in hepatic secretion of bilirubin

Question 23

Mineral deficiency w/:

Alopecia, pustular rash, hypogonadism, impaired wound healing, impaired taste, immune dysfunction

Answer 23

Zinc

Question 24

Mineral deficiency w/:

Brittle hair, skin depigmentation, Neurologic dysfunction, sideroblastic anemia, osteoporosis

Answer 24

Copper

Question 25

Mineral deficiency S/: | thyroid dysfunction, cardiomyopathy, immune dysfunction

Answer 25

Selenium

Question 26

Management of upper GI bleed that is losing consciousness

Answer 26

Intubate | EGD can wait until after the airway is secured

Question 27

Cardiac finding in Carcinoid

Answer 27

Tricuspid regurg

Question 28

Tx for esophageal spasm

Answer 28

CCB's | corkscrew on esophagram

Question 29

GI manifestations of a cholesterol embolism

Answer 29

Pancreatitis, mesenteric ischemia

Question 30

Hematemesis following repeated vomiting in an alcoholic

Answer 30

Mallory-Weiss tear Longitudinal tear at the GE junction Dx on EGD Tx - resolves spontaneously or endoscopy

Question 31

Major modifiable RF's for pancreatic cancer?

Answer 31

Smoking (most sig) Obesity Non hereditary pancreatitis (ie alcohol)

Question 32

Cirrhosis pt develops SOB and dullness over one lung field. Why?

Answer 32

Hepatic hydrothorax | Transudative pleural effusion through small defects in the diaphragm

Question 33

IBD pseudopolyps Mucosal ulcerations crypt ascesses

Answer 33

Ulcerative colitis | Increases risk for PSC (+ p-ANCA)

Question 34

How do you manage a non bleeding varices in a cirrhosis pt?

Answer 34

Beta Block - prophylactic tx to reduce the likelihood of progression to large varices and hemorrhage EGD ligation is second line in those when BBlock is contra

Question 35

epigastric pain and weight loss in pt w/ PMH sig for chronic pancreatitis

Answer 35

Pancreatic cancer | Get a CT

Question 36

How do you define acute liver failure?

Answer 36

Severe liver injury w/ encephalopathy, impaired synthetic fxn (INR>1.5) Drugs and virus is most common

Question 37

What is recommended in addition to CCB's in newly dx'd achlasia

Answer 37

EGD to r/o malignancy | Especially if they have red flags

Question 38

Which path finding following colonoscopy bx would need to most intensive follow up?

Answer 38

Villous adenoma Adenomatous polyps have the highest malignancy potential If the adenomatous polyp is > 1cm, high grade dysplasia, or villous features this is even higher grade

Question 39

Younger male has perianal skin tags, fistulas, aphthous ulcers Bx woud reveal?

Answer 39

Focal ulcers w/ transmural inflammation | Crohn's dz