GI

Question 1

cause of PUD in 90% of duodenal ulcers & 75% of gastric ulcers

Answer 1

H.pylori

Question 2

PUD is more common in which gender?

Answer 2

men

Question 3

usu age of presentation of duodenal ulcers

Answer 3

30-55

Question 4

usu age of presentation of gastric ulcers

Answer 4

55-65

Question 5

pain a/w duodenal ulcer

Answer 5

relieved by food

Question 6

pain a/w gastric ulcer

Answer 6

worsened by food

Question 7

which class of medication is 1st line of tx of PUD?

Answer 7

H2 antangonist

Question 8

which med is used for prophylaxis against NSAID induced ulcers?

Answer 8

Misoprostol (cytotec)

Question 9

H.Pylori eradication regimen

Answer 9

2 abx + PPI or bismuth /Bismuth regimens (require 4x/d dosing)

MOC (metronidazole, omeprazole, clarithromycin)

AOC (amoxicillin, “ “)

MOA (metronidazole, omeprazole, amoxicillin)

BMT (bismuth, Metronidazole, tetracyn) or BMT + Omeprazole

Question 10

Post-H.Pylori eradication anti-ulcer therapy regimen

Answer 10

duodenal ulcer: omeprazole 40mg QD or Lansoprazole 30mg QD x 7 wks H2 blockers or sucralfate can be given for 6-8wks

Question 11

Drug of choice in treatment of in hospital management of PUD/bleeding ulcers

Answer 11

IV H2 antagonists

Question 12

S&S of GERD

Answer 12

retrosternal “burning”

bitter taste in mouth

belching

hiccups

dsyphagia

excessive salivation

Question 13

Which class of drug should be used first to treat GERD?

Answer 13

H2 antagonist in high doses at night or divided BID

PPIs if H2 blockers are ineffective

Question 14

IVDU cases 50% of what type of hepatitis ?

Answer 14

C

Question 15

pre-icteric sxs of hepatitis

Answer 15

fatigue, malaise, anorexia N/V, HA, aversion to smoking/alcohol

Question 16

icteric sxs of hepatitis

Answer 16

*Low grade fever

weight loss

jaundice

pruritus

RUQ pain

clay colored stool

dark urine

hepatomegaly may be present

Question 17

LABS abnormalities seen in hepatitis

Answer 17

*inc AST & ALT (500-2000IU/L)

UA: proteinuria & bilirubinuria

inc LDH, bilirubin, ALP PT normal or slightly elevated

Question 18

IgM indicates

Answer 18

I=immediate, a.k.a active infection

Question 19

IgG indicates

Answer 19

G= gone, a.k.a indicates previous exposure

Question 20

presence of HBeAg indicates

Answer 20

active infection of Hep B E= virEmia

Question 21

anti-HBe indicates

Answer 21

chronic infection , =diminished viral replication/infectivity

Question 22

Serology for recovered Hep B

Answer 22

anti-HBc & anti-HBsAg

Question 23

first evidence of Hep B infection is seen by what serology?

Answer 23

HBsAg

Question 24

what test is used to differentiate prior exposure from current viremia in Hep C?

Answer 24

PCR

Question 25

When is VIT K indicated in tx of hepatitis?

Answer 25

for PT\>15sec

Question 26

Diverticulitis is more common in which gender?

Answer 26

women

Question 27

IV abx in tx of diverticulitis?

Answer 27

Flagyl, Cipro, Ceftazidime, Clindamycin, Ampicillin

Question 28

S&S of diverticultis

Answer 28

LLQ pain N/V constipation or loose stools

Question 29

cholecystitis is most commonly due to ?

Answer 29

gallstones

Question 30

5 F's of cholecystitis

Answer 30

1. fat 2. forty 3. fertile 4. fair 5. female

Question 31

murphys sign

Answer 31

deep pain on inspiration while palpating under right rib cage

Question 32

murphys sign is indicative of which disease?

Answer 32

cholecystitis

Question 33

gold standard test for cholecystitis

Answer 33

US

Question 34

LAB abnormalities in cholecystits

Answer 34

inc WBC (12-15,000) \*inc serum ALT, AST, LDH, ALK Phos serum bili & amylase may be elevated

Question 35

Causes of pancreatitis

Answer 35

\*\*ETOH - gallbladder disease - HPLD - hypercalcemia

Question 36

S&S of pancreatitis

Answer 36

- abrupt onset of steady, s**evere epigastric pain** -pain worsened by walking & lying supine, relieved by sitting & leaning forward; pain may radiate to back - N/V - weakness, sweating, anxiety if severe

Question 37

Grey turner & cullens sign are indicative of what disease?

Answer 37

hemorrhagic pancreatitis

Question 38

LAB abnormalities in pancreatitis

Answer 38

Inc WBC \*\*\*inc Amylase (\>180U/dL) & inc Lipase (\>280 U/L) inc BG Inc LDH & AST elevated CRP suggests pancreatic necrosis

Question 39

Diagnostic test for pancreatitis

Answer 39

CT

Question 40

Hypocalcemia \< _____ associated with tetany. What Signs should be monitored for?

Answer 40

\<7mg/dL chvosteks (tap cheek) trousseaus (BP cuff and twitch of wrist)

Question 41

Purpose of ransoms criteria

Answer 41

to evaluate prognosis in pancreatitis

Question 42

Greater than 7 risk factors on ransoms criteria is indicative of?

Answer 42

100% mortality

Question 43

Ransoms criteria components

Answer 43

**George washington got lazy after he broke C-A-B-E** _Prognistic signs at admission:_ G: greater than 55 yr W: WBC\>16,000 G: glucose\>200 L: LDH\>350 A: AST\>250 Prognostic signs after 1st 48hr: H: Hct drop \>10 B: BUN inc \>5 C: Ca \<8 A: Arterial O2\<60 B: Base deficit \>4 E: estimated fluid sequestration \>600ml

Question 44

In a patient with pancreatitis, when can a clear liquid diet be started?

Answer 44

when a pt is pain free & has bowel sounds

Question 45

most common cause of bowel obstruction

Answer 45

adhesions

Question 46

A proximal bowel obstruction S&S:

Answer 46

vomiting within minutes of pain/profuse vomiting minimal abd distension

Question 47

A distal bowel obstruction S&S

Answer 47

vomiting within 2 hrs of pain /episodic vomiting \*\*pronounced abd obstruction

Question 48

S&S of bowel obstruction

Answer 48

\*abd distenstion( minimal=proximal; pronounced=distal) mild tenderness, but no peritoneal findings \*\*high pitched, tinkling bowel sounds unable to pass gas/stool

Question 49

hallmark symptom of UC?

Answer 49

bloody diarrhea

Question 50

Diagnostic test for UC?

Answer 50

sigmoidoscopy

Question 51

Management of UC

Answer 51

Mesalamine (canasa) suppositories or enemas x 3-12 wks Hydrocortisone suppositories or enemas

Question 52

diagnostic tests for diverticulitis

Answer 52

sigmoidoscopy shows inflamed mucosa \*\*must do plain abd xray to assess for free air (pneumoperitoneum) may consider CT to eval for abscess

Question 53

Sudden onset of crampy, colicky abdominal pain is likely indicative of what disease process?

Answer 53

mesenteric ischemia

Question 54

LAB abnormalities seen in mesenteric ischemia

Answer 54

elevated amylase leukocytosis

Question 55

Diagnostic tests for mesenteric ischemia

Answer 55

xray, CT

Question 56

Appendicitis most commonly affects?

Answer 56

men, 18-30yrs

Question 57

+ psoas sign

Answer 57

pain w/right thigh extension

Question 58

+ obturator sign

Answer 58

pain w/internal rotation of flexed right thigh

Question 59

+ rovsing sign

Answer 59

RLQ pain when pressure applied to LLQ

Question 60

presentation of chrons

Answer 60

diarrhea