GI/Hepatology

Question 1

Initial treatment for type 1 autoimmune pancreatitis

Answer 1

High-dose PO prednisone

Question 2

Treatment for severe alcoholic hepatitis, defined as Maddrey score > 32 or the presence of hepatic encephalopathy

Answer 2

Prednisolone

Question 3

Appropriate colon cancer surveillance with colonoscopy for patients with 1 or 2 sessile serrated polyps < 10 mm without dysplasia

Answer 3

Every 5 to 10 years

Question 4

Diagnostic study for Budd-Chiari syndrome

Answer 4

US with doppler

Question 5

Post exposure prophylaxis for hepatitis A virus in nonimmune person

Answer 5

Hepatitis A virus vaccine

+ HAV immune globulin if > 40 y/o

Question 6

Diagnosis associated with insulinoma in patients <40 years old

Answer 6

MEN type 1

Question 7

Management for localized Ulcerative proctitis

Answer 7

Topical/suppository 5-ASA

Question 8

Elevated serum ferritin level and transferring saturation

Answer 8

Hereditary hemochromatosis

Question 9

Study of choice for active lower GI bleeding with associated hemodynamic instability

Answer 9

CT angiography

Question 10

Treatment of choice for familiar adenomatous polyposis

Answer 10

Colectomy

Question 11

Recommend surveillance for cervical cancer screening in patients with IBD receiving immuno suppressive therapy

Answer 11

Pap testing annually

Question 12

Dysphasia and food bolus obstruction usually found in younger men with a topic conditions

Answer 12

Eosinophilic esophagitis

Question 13

Recommend surveillance for patients with cirrhosis who have undergone virologic cure for Hepatitis C virus infection

Answer 13

US every 6 months for evaluation of HCC

Question 14

Recommended imaging modality for the diagnosis of acute mesenteric ischemia

Answer 14

CT angiography

Question 15

Equation for fecal osmotic gap

Answer 15

290 - (2 x [stool Na + stool K])

Question 16

Evaluation for suspected oropharyngeal dysphasia

Answer 16

Videofluoscopy with liquid and solid phases

Question 17

Degeneration of the myenteric plexus with failure of the lower esophageal sphincter to relax in response to swallowing and absent peristalsis

Answer 17

Achalasia

Question 18

Diagnostic evaluation for Achalasia in the following order

Answer 18

1) barium swallow
2) Esophageal manometry
3) Upper endoscopy

Question 19

First line therapies for achalasia

Answer 19

Laparoscopic surgical myotomy of the LES and endoscopic pneumatic dilation of the esophagus

Question 20

Appropriate evaluation for GERD refractory to empiric therapy with PPI

Answer 20

Upper endoscopy

If normal, ambulatory esophageal pH monitoring or impedance pH testing

Question 21

Surveillance for Barret esophagus and no dysplasia

Answer 21

Every 3 to 5 years

Question 22

Surveillance for Barret esophagus with low-grade dysplasia in those that do not choose endoscopic ablation

Answer 22

Every 6 to 12 months

Question 23

Evaluation for eosinophilic esophagitis

Answer 23

8 week trial of PPI

If symptoms refractory, this confirms diagnosis

If symptoms resolved, this indicates GERD-associate eosinophilia

Question 24

Timing of follow-up H. pylori testing After completion of therapy

Answer 24

4 weeks

Question 25

First line therapy for dumping syndrome

Answer 25

Smaller, more frequent meals

Question 26

Most common cause of recurrent celiac disease symptoms

Answer 26

Gluten exposure

Question 27

Management for esophageal hypomotility disorder

Answer 27

Lifestyle changes + PPI

Question 28

Painless obstructive jaundice with cross-sectional imaging revealing sausage-shaped pancreatic enlargement with and without elevated IgG4 levels

Answer 28

Type 1 Autoimmune pancreatitis (elevated IgG4) Type 2 AIP (normal IgG4)

Question 29

1) Osmotic gap > 100 mOsm/kg H2O | 2) Osmotic gap < 50 mOsm/kg H2O

Answer 29

1) osmotic diarrhea | 2) secretory diarrhea

Question 30

Appropriate surveillance for patients with larger adenomas (>10 mm), 5-10 tubular adenomas <10 mm, Adenomas with tubulovillous histology, or other adenomas with high-grade dysplasia

Answer 30

Colonoscopy every 3 years

Question 31

Diagnosis of Puetz Jeghers syndrome requires 2 of the following 3 criteria:

Answer 31

1) >2 PJS-type hamartomatous polyps in the G.I. tract 2) Multiple melanogic macules in the mouth, bucc mucosa, nose, Eyes, fingers, genitalia 3) Family history of PJS

Question 32

Age at which patients with Lynch syndrome should be screened for colon and stomach/small bowel cancer

Answer 32

Colon: colonoscopy beginning at ages 20 to 25 years (or 2-5 years before the earliest cancer diagnosis in family) Stomach/small bowel: Upper endoscopy beginning at age 30 to 35 years

Question 33

Surveillance for ulcerative pancolitis or Crohn disease

Answer 33

Colonoscopy beginning 8 years after diagnosis then performed every 1 to 2 years after Proctocolectomy if dysplasia is found

Question 34

Poorly localized severe abdominal pain, often out of proportion to physical findings; peritoneal signs signify infarction Diagnostic evaluation Treatment

Answer 34

Acute mesenteric ischemia CTA or selective mesenteric angiography Peritoneal: urgent laparotomy Not peritoneal: angiography

Question 35

Postprandial abdominal pain, Fear of eating, and weight loss; often signs and symptoms of atherosclerosis in other vascular beds Diagnostic evaluation Treatment

Answer 35

Chronic mesenteric ischemia CTA, selective angiography, or MRA Surgical reconstruction or angioplasty with stenting

Question 36

LLQ abdominal pain and self-limited bloody diarrhea Diagnostic evaluation Treatment

Answer 36

Ischemic colitis Colonoscopy: patchy segmental ulcerations Supportive care with IV fluids and bowel rest

Question 37

Management for gallbladder polyps > 1cm

Answer 37

Cholecystectomy

Question 38

Treatment for functional dyspepsia refractory to PPI

Answer 38

Tricyclic antidepressant

Question 39

Management for Canada esophagitis

Answer 39

PO fluconazole

Question 40

Appropriate management for dermatitis herpetiformis after resolution of celiac symptoms

Answer 40

Testing for G6PD deficiency prior to initiating dapsone

Question 41

Hepatitis A prophylaxis in 1) healthy persons <40 years old 2) Older adults and those who are immune compromised or half chronic liver disease

Answer 41

1) hepatitis A vaccine | 2) Vaccine + immunoglobulin

Question 42

Hepatitis B prevention for postexposure prophylaxis after needlestick injury and for sexual and household contacts of patients with HBV

Answer 42

Hepatitis B vaccine + HBIG

Question 43

Recommended indications for treatment in patients with hepatitis B infection

Answer 43

1) acute liver failure or cirrhosis 2) Infection in the immune active phase 3) Infection in the reactivation phase (immune escape) 4) Immunosuppression or planned immunosuppression

Question 44

Treatment for hepatitis B virus

Answer 44

entecavir or tenofovir

Question 45

Indications for US Surveillance every 6 months in patients with HBC anD increased risk for HCC

Answer 45

1) cirrhosis 2) Asian men > 40 years and Asian women >50 years 3) Black patients > 20 years 4) Elevated ALT level and HBV DNA levels > 10,000 U/mL 5) Family history of HCC

Question 46

Initial diagnostic study for hepatitis C infection

Answer 46

Anti-HCV antibody If positive, test for HCV RNA

Question 47

Patients with HCV who are candidates for liver transplantation

Answer 47

HCV + decompensated disease Localized HCC

Question 48

HCC Ultrasound surveillance for patients with HCV cirrhosis

Answer 48

Every 6 months

Question 49

Indication for initiation and discontinuation of prednisolone in alcoholic hepatitis

Answer 49

Inititation: MDF > 32, MELD > 18, or encephalopathy and ascites Discontinuation: If bilirubin level does not improve by day 7

Question 50

Most appropriate screening test for Hemochromatosis

Answer 50

Fasting serum transferrin saturation

Question 51

Diagnostic studies of Hemochromatosis

Answer 51

C282Y homozygous or C282Y/H63D compoubd heterozygous

Question 52

The diagnosis of Peutz-Jeghers syndrome is based on the presence of 2 of the following 3 criteria:

Answer 52

1) 2 or more PJS type hamartomatous polyps in G.I. tract 2) Multiple melanotic macules in the mouth, buccal mucosa, nose, eyes, genitalia, or fingers 3) Family history of PJS