GI

Question 1

hemochromatosis diagnosis

treat with

Answer 1

elevated transferrin sat, ferritin>1000

phlebotomy

Question 2

chronic diarrhea 2/2 malabsorption of artificial sweeteners

Answer 2

diarrhea, bloating, elevated osmotic gap

Question 3

SAAG 1.1 or greater+ ascitic protein of 2.5 or greater

cirrhosis/portal htn

Answer 3

cardiac cause of ascites

ascitic protein <2.5

Question 4

SBP treatment

Answer 4

3rd gen cephalosporin and albumin (1.5g/kg on day of diagnosis, 1g/kg on day 3)

Question 5

dyspepsia + alarm features

Answer 5

age>50 yo, anemia, dysphagia, odynophagia, vomiting, weight loss, family history of cancer, PUD, gastric surgery->scope

Question 6

No alarm features, endemic h. pylori

not endemic h. pylori
partial response to PPI
if still refractory with normal scope

Answer 6

test for h. pylori, treat

PPI
increase dose to twice daily
ph monitoring->fundoplication

Question 7

AKI in the setting of cirrhosis

Answer 7

25% albumin challenge, then midodrine and octreotide (rule out ATN with urinalysis first)

Question 8

ulcer with arterial spurting or a nonbleeding visible vessel

Answer 8

clips, thermal therapy or sclerosants

clean based ulcers don’t need to be treated

Question 9

primary sclerosing cholangitis
diagnosis

look for

Answer 9

ANA, anti-smooth muscle
MRCP-beads on a string

ulcerative colitis (colonoscopy)

Question 10

chronic NSAID use

Answer 10

start omeprazole 20mg or misoprostol

Question 11

chronic pancreatitis

Answer 11

clinical features (pain, recurrent attacks of pancreatitis, weight loss) with objective findings of steatorrhea and pancreatic calcifications

Question 12

chronic diarrhea, abdominal pain, and malabsorption

confirm with

Answer 12

test for celiac with tissue transglutaminase antibodies
small bowel biopsy: intraepithelial lymphocytosis, crypt hyperplasia, and villous blunting
also elevated LFTs

Question 13

irritable bowel syndrome studies

Answer 13

no testing/imaging/procedures

Question 14

unexplained liver disease in patient <40 yo (+hemolytic anemia)
screen
diagnosis

Answer 14

consider Wilson disease
low alk phos, elevated ASTs
low ceruloplasmin , elevated urine copper excretion
liver biopsy

Question 15

Budd-chiari

Answer 15

ascites

Question 16

gallbladder polyp> 1cm

any polyp+ symptomatic OR PSC OR gallstones

Answer 16

cholecystectomy

chole

Question 17

pancreatitis + presence of gallstones (obstructing or not, cholecystitis or not)

Answer 17

chole

Question 18

Crohns flare while preggo

Answer 18

certolizumab (preferred), infliximab, adalimumab (anti-TNF agents)
5-aminosalicylates for UC, not Crohns

Question 19

functional dyspepsia

treatment

Answer 19

epigastric pain/discomfort, postprandial fullness, and/or early satiety in the absence of a structural explanation

treat h. pylori/ ppi/ ranitidine->TCA

Question 20

nonalcoholic fatty liver disease treatment

Answer 20

weight loss

surveillance is necessary only when cirrhosis is present

Question 21

IBD (UC/Crohns) surveillance colonoscopy

PSC+ IBD

Answer 21

every 1 to 2 years beginning after 8 to 10 years of disease.

as soon as PSC diagnosis is made

Question 22

large (≥10 mm) or dysplastic sessile serrated polyps or traditional serrated adenomas, repeat colonoscopy in

an adenoma 10 mm or larger, (2) three to ten adenomas, (3) an adenoma with a villous component or high grade dysplasia

> 20mm polyp/ removed in pieces

Answer 22

3 years

3 years

3-6 months

Question 23

calcified asymptomatic incidental gallstones

Answer 23

observe

Question 24

chronic diarrhea+ exposure to young kids/ water

Answer 24

giardia (O &P)

Question 25

type 1 autoimmune pancreatitis treatment

Answer 25

``` imaging features (focal pancreatic enlargement with a featureless rim and a nondilated pancreatic duct), increased serum IgG4 level, and extrapancreatic organ involvement (sclerosing cholangitis or IgG4-associated cholangitis) steroids ```

Question 26

GI bleed with neg EGD/colonoscopy OR pos capsule | endoscopy

Answer 26

push enteroscopy

Question 27

IBS with constipation treatment | IBS diarrhea

Answer 27

fiber->polyethylene glycol->linaclotide, Lubiprostone | rifaximin

Question 28

primary biliary cholangitis/cirrhosis treatment

Answer 28

cholestatic liver enzyme profile in the setting of a positive antimitochondrial antibody test fatigue, dry mouth/eyes, itching ursodiol

Question 29

complicated pancreatitis management

Answer 29

enteral feeding

Question 30

hepatocellular adenoma >5 cm or β-catenin nuclear reactivity positive otherwise

Answer 30

resection CT q6months-1 year

Question 31

CMV esophagitis treatment

Answer 31

ganciclovir

Question 32

GI bleeding + pain

Answer 32

some sort of colitis

Question 33

suspected esophageal cancer

Answer 33

scope

Question 34

Type I (not assoc with MEN or Zollinger-Elinson) gastric neuroendocrine tumor that's <1cm, <5 of them

Answer 34

endoscopic removal, no further management

Question 35

Roux en Y + diarrhea, bloating, flatulence, and weight loss

Answer 35

treat for SIBO (abx)

Question 36

comm acquired diarrhea <72 hours

Answer 36

supportive care, no cultures

Question 37

sporadic (no fam hx) solitary juvenile polyp

Answer 37

no future health risk once the polyp is removed and do not require surveillance endoscopy

Question 38

oropharyngeal dysphagia diagnosis

Answer 38

videofluoroscopy

Question 39

maintaining remission in ulcerative colitis

Answer 39

taper steroid, azathioprine, 6-mercaptopurine (only in high TPMT) , or an anti−tumor necrosis factor agent (infliximab)

Question 40

African, >20 yo with chronic Hep B infection | Asian men > 40 yo, women >50 yo

Answer 40

u/s of liver q 6months

Question 41

Peptic ulcers at low risk for bleeding (clean based or with a nonprotuberant pigmented spot)

Answer 41

oral PPI, early d/c

Question 42

Barrett with high grade dysplasia no dysplasia

Answer 42

radiofrequency ablation, photodynamic therapy, or endoscopic mucosal resection repeat endoscopy in 3-5 years

Question 43

insulinoma imaging when CT fails | workup

Answer 43

endoscopic u/s | 72 hour fast, then imaging

Question 44

microscopic collagenous colitis | treatment

Answer 44

may be drug induced loperamide or diphenoxylate for mild persistent disease, bismuth subsalicylate for moderate disease, or budesonide for severe disease

Question 45

cirrhotic HCC up to three hepatocellular carcinoma tumors ≤3 cm or one tumor ≤5 cm angiolymphatic or extrahepatic involvement, doesn't meet Milan criteria

Answer 45

no need for biopsy, lesions larger than 1 cm that enhance in the arterial phase and have washout of contrast in the venous phase transplant sorafenib

Question 46

MYH-associated polyposis inheritance pattern

Answer 46

AR

Question 47

Variceal hemorrhage+ cirrhosis

Answer 47

antibiotics (fluoroquinolones)

Question 48

sphincter of oddi dysfunction vs choledocholithiasis

Answer 48

nothing vs h/o stones

Question 49

non–acetaminophen-related acute liver failure causes treatment LFTs in multiple thousands + low bilirubin

Answer 49

drug induced : augmentin among others N-acetylcysteine and transplant eval herpes hepatitis

Question 50

young man with solid-food dysphagia that requires endoscopy for removal endoscopy findings treatment

Answer 50

eosinophilic esophagitis rings, longitudinal furrows, and sometimes strictures swallowed aerosolized topical glucocorticoids (fluticasone or budesonide)

Question 51

FAP surveillance s/p total colectomy and ileorectal anastomosis.

Answer 51

upper endoscopy q1-5 years

Question 52

Acute hep B

Answer 52

self-resolves in 90% of adults serial monitoring of LFTs if protracted (>6 months) or fulminant (marked dysfunction)->lamivudine, entecavir, or tenofovir

Question 53

chronic pancreatitis pain

Answer 53

Tylenol, ibuprofen->tramadol->pregabalin | Extracorporeal shock wave lithotripsy for pancreatic duct stones

Question 54

``` refractory UC (to steroids) mild to moderate disease ```

Answer 54

IV steroids or anti-TNF (-mabs) | 5-aminosalicylate

Question 55

UGI bleed and CVD aspirin

Answer 55

resume before d/c+ daily PPI

Question 56

serrated polyposis syndrome

Answer 56

(1) five or more serrated polyps proximal to the sigmoid colon, two or more of which are 10 mm in diameter or greater, (2) any number of serrated polyps proximal to the sigmoid colon in an individual with a first-degree relative who has SPS, or (3) more than 20 serrated polyps distributed throughout the colon. (can be found over multiple scopes) ANNUAL SCOPE

Question 57

H. pylori primary therapy | salvage therapy

Answer 57

omeprazole, clarithromycin, amoxicillin | 10 days of replace clarithromycin OR BIMT

Question 58

unconjugated hyperbilirubinemia + normal rec count

Answer 58

gilbert syndrome

Question 59

history of colorectal cancer screening

Answer 59

1 year post op, 3 years post op, q5 years after

Question 60

painless watery diarrhea without bleeding

Answer 60

microscopic colitis lymphocytic colitis: intraepithelial lymphocytosis (>20 intraepithelial lymphocytes per 100 epithelial cells) collagenous: subepithelial collagen thickening

Question 61

Nonocclusive mesenteric ischemia

Answer 61

jejunal wall thickening and dilation, ongoing hypotension, fever, and abdominal pain in low flow state

Question 62

cirrhosis + MELD >15

Answer 62

transplant eval

Question 63

Most common cause of UGIB

Answer 63

PUD

Question 64

Acalculous cholecystitis

Answer 64

percutaneous cholecystostomy (draining tube), abx

Question 65

sporadic fundic gland polyps (1-5 mm, <10) without dysplasia

Answer 65

associated with PPI | no excision/ surveillance

Question 66

lynch syndrome colonoscopy

Answer 66

25 yo : q1-2 years | OR 2-5 years earlier than family member if he/she was <25 yo

Question 67

treat chronic hep b if

Answer 67

HBV DNA or LFTs are elevated

Question 68

IBS diarrhea, test for

Answer 68

celiac

Question 69

chest pain eval

Answer 69

rule out cardiac causes before evaluating GERD