GI 8 practice

Question 1

Which of the following should NOT be done with IBS-D patients?
a) Fecal calprotectin or lactoferrin
b) Stool test for giardia
c) Celiac serologies
d) CRP (if calprotectin or lactoferrin not available)
e) Colonoscopy if over 35

Answer 1

e) Colonoscopy if over 35

(just do colonoscopy at normal age of 45)

Question 2

The intestinal ____________ is most sensitive to mesenteric ischemia
a) Serosa
b) Muscularis
c) Submucosa
d) Mucosa

Answer 2

d) Mucosa

Question 3

Which are the 3 arteries that supply the intestines? Select three
a) Celiac artery
b) Anterior mesenteric artery (AMA)
c) Posterior mesenteric artery (PMA)
d) Superior mesenteric artery (SMA)
e) Inferior mesenteric artery (IMA)

Answer 3

a) Celiac artery
d) Superior mesenteric artery (SMA)
e) Inferior mesenteric artery (IMA)

Question 4

Which of the following etiologies of acute mesenteric ischemia is more likely to be caused by cirrhosis?
a) SMA embolism
b) SMA thrombosis
c) Strangulating obstructions
d) Vasculitis
e) Venous thrombosis

Answer 4

a) SMA embolism

Question 5

A patient is experiencing nausea, vomiting, and has been passing maroon stools. This sounds like the characteristics of what form of mesenteric ischemia?
a) Acute mesenteric ischemia
b) Chronic mesenteric ischemia
c) Colonic ischemia
d) Rectal ischemia

Answer 5

c) Colonic ischemia

Question 6

What is the most common cause of large bowel obstruction?
a) Sigmoid prolapse
b) Sigmoid volvulus
c) Colonic prolapse
d) Colonic volvulus
e) Stricture due to prior colorectal resection

Answer 6

b) Sigmoid volvulus

Question 7

70% of polyps removed during colonoscopy are adenomatous, which are _____________.
a) Completely benign
b) Precancerous
c) Cancerous
d) Serrated

Answer 7

b) Precancerous

Question 8

Toxic megacolon is a potentially lethal complication of IBDs, particularly ________.
a) Crohn’s
b) IBS
c) UC
d) None of the above

Answer 8

c) UC

Question 9

What is the most common presenting symptom of toxic megacolon?
a) Malaise
b) Distention
c) Severe abdominal pain
d) Severe bloody diarrhea

Answer 9

d) Severe bloody diarrhea

Question 10

Toxic megacolon begins with the severe inflammation of the ____________ layer, leading to paralysis and dilation.
a) Serosa
b) Submucosa
c) Smooth muscle
d) Mucosa

Answer 10

c) Smooth muscle

Question 11

A patient presents with a temperature of 100.2 and a HR of 130bpm. Labs show dehydration, anemia, and neutrophilic leukocytosis (>10,500/microL). Plain films show colonic distention.

Do they meet the diagnostic criteria for toxic megacolon?

Answer 11

Yes

Criteria:
1) Radiographic evidence of colonic distention
2) PLUS at least 3: fever (>38C, >100.4F), HR >120 BPM, neutrophilic leukocytosis (>10,500/microL), anemia
3) PLUS at least 1: dehydration, AMS, electrolyte disturbances, hypotension

Question 12

Colonic dilation is defined as >________cm

Answer 12

> 6cm

Question 13

T/F: Mesenteric ischemia can involve the small bowel or colon

Answer 13

True

Question 14

T/F: Colonic polyps are usually asymptomatic

Answer 14

True

Question 15

T/F: Toxic megacolon doesn’t always involve systemic toxicity

Answer 15

False (always does)

Question 16

T/F: Hyperkalemia is a precipitating risk factor for toxic megacolon

Answer 16

False (Hypokalemia is)

Question 17

T/F: You should admit toxic megacolon pts to the ICU and send them for surgical consult

Answer 17

True