GI lectures 1-3 practice questions Flashcards by Morgan Evans

If a pt has isolated thrombocytopenia, what is your main differential?
a) Cirrhosis
b) Cholecystitis
c) Cholangitis
d) Gallstones

(will be on exam)

a) Cirrhosis

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CA19-9 tests for ______; AFP tests for _______
a) HCC; pancreatic CA
b) Pancreatic cancer; HCC
c) Colon cancer; pancreatic cancer
d) Colon cancer; HCC

b) Pancreatic cancer; HCC

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EGD is the diagnostic study of choice for which of the following? Select 2.
a) PUD
b) Esophagitis
c) Mallory-Weiss tears
d) Crohn’s disease

a) PUD
c) Mallory-Weiss tears

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Which of the following should you use with caution in renal patients?
a) Laxatives
b) H2 blockers
c) PPIs
d) Antacids
e) Stool softeners
f) Hemorrhoidal preparations

d) Antacids

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Clindamycin works best on what?
a) Escherichia Coli O157:H7
b) Campylobacter
c) Clostridioides difficile
d) Salmonella & Shigella

c) Clostridioides difficile

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Which of the following may be an indicator of upper GI bleeding?
a) Lower hematocrit
b) Elevated BUN-to-creatinine ratio (BUN/Cr > 36:1)
c) Lower hGB
d) Elevated AST:ALT ratio
e) Elevated creatinine-to-BUN ratio (Cr/BUN > 36:1)

b) Elevated BUN-to-creatinine ratio (BUN/Cr > 36:1)

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Which of the following are the most common causes of acute lower GI bleeding in people <50 y/o? Select all that apply.
a) Infectious colitis
b) Anorectal disease
c) Angioectasias
d) Diverticulosis
e) IBD
f) Malignancy
g) Ischemia

a) Infectious colitis
b) Anorectal disease
e) IBD

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Which of the following statements about acute lower GI bleeding is FALSE?
a) Large volume bright red blood predicts colon origin
b) Maroon suggests right colon or small intestine origin
c) Maroon suggests left colon or large intestine origin
d) Melena suggests origin proximal to ligament of Treitz
e) Painless large volume suggests diverticular bleeding

c) Maroon suggests left colon or large intestine origin

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Massive active [lower GI] bleeding calls for evaluation with ___________, followed by upper endoscopy+/- angiography
a) MRI
b) CT angiography
c) CT with oral & IV contrast
d) Colonoscopy

b) CT angiography

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Crohn’s disease in people under 40 is a common cause of what?
a) Overt or occult small bowel bleeding
b) Overt or occult upper GI bleeding
c) Massive active lower GI bleeding
d) Massive active upper GI bleeding

a) Overt or occult small bowel bleeding

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Disproportionate elevation in AST & ALT compared with alkaline phosphatase is a sign of what?
a) Acute pancreatitis
b) Gilbert’s syndrome
c) Cholestatic liver disease
d) Hepatocellular liver disease

d) Hepatocellular liver disease

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Which of the following is most indicative of acute hepatic failure?
a) AST:ALT > 2:1
b) AST & ALT > 50xULN (LDH also often markedly elevated)
c) AST & ALT > 10xULN + prolonged PT (INR >1.5)
d) AST & ALT >25xULN

c) AST & ALT > 10xULN + prolonged PT (INR >1.5)

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Your patient with hyperbilirubinemia has predominant ALP elevation. What is this most suggestive of?
a) Not likely hepatic injury or biliary tract disease
b) Biliary obstruction or intrahepatic cholestasis
c) Jaundice caused by intrinsic hepatocellular disease
d) Hepatocellular disease with impaired synthetic function

b) Biliary obstruction or intrahepatic cholestasis

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Which of the following organs may cause referred back pain? Select all that apply.
a) Gallbladder
b) Appendix
c) Stomach
d) Kidney
e) Pancreas
f) Ureters

a) Gallbladder
b) Appendix
c) Stomach
d) Kidney
e) Pancreas

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A 27 year old man with a Hx of atopic dermatitis and asthma presents with dysphagia with solids and recent food impaction when eating. He has no dysphagia when drinking his daily protein shakes. What is the probable Dx and Tx?
a) Drug-induced esophagitis; PPIs and take medications with water
b) Esophageal motility disorder; dupilumab and/ or PPIs
c) Eosinophilic esophagitis (EoE); dupilumab and/ or PPIs
d) Infectious esophagitis; PO or IV antibiotic x 14-21 days
e) Candidiasis esophagitis; PO or IV antifungal (ie, fluconazole) x 14-21 days

c) Eosinophilic esophagitis (EoE); dupilumab and/ or PPIs

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Which of the following is NOT one of the most common causes of infectious esophagitis?
a) Esophageal candidiasis
b) HSV
c) Cytomegalovirus (CMV)
d) HPV

d) HPV

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“Corkscrew” esophagus on a Barium-esophagram is a sign of what condition? How is this condition diagnosed?
a) GERD; EGD
b) Achalasia; manometry
c) Lower esophageal spasm; manometry
d) Lower esophageal spasm; EGD

c) Lower esophageal spasm; manometry

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How do you diagnose Barrett’s esophagus?
a) Upper endoscopy with biopsy of the proximal esophagus
b) Upper endoscopy with biopsy of the distal esophagus
c) Esophageal manometry + biopsy of the proximal esophagus
d) Esophageal manometry

b) Upper endoscopy with biopsy of the distal esophagus

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A 35 year old African American female has a hiatal hernia. Should she be screened for Barrett’s esophagus?
a) Yes
b) No

b) No

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A 55 year old white male has central obesity and smokes 2ppd. Should he be screened for Barrett’s esophagus?
a) Yes
b) No

a) Yes

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Heartburn (pyrosis) & regurgitation are the classic Sx of what?
a) GERD
b) Esophagitis
c) Barrett’s esophagus
d) Dysphagia

a) GERD

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What is the first line treatment for GERD in pregnancy?
a) Antacids followed by sucralfate
b) H2RAs followed by PPIs
c) Sodium bicarbonate & magnesium trisilicate (Gaviscon)
d) Lifestyle & dietary modification

d) Lifestyle & dietary modification

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You are a primary care PA. Your patient has had GERD for the past 3 years and it has been well controlled with PPIs. They wish to discontinue therapy. What should you tell them?
a) You may taper off your PPI any time you wish.
b) You may d/c your PPI at any time without a taper.
c) I would like to refer you to a GI specialist before you d/c your PPI.
d) You should not d/c your PPI

c) I would like to refer you to a GI specialist before you d/c your PPI.

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Iron or opioids may cause which of the following?
a) GERD
b) Esophagitis
c) Dysphagia
d) Dyspepsia

d) Dyspepsia

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You have a 40 year old patient with suspected dyspepsia. What should be your first test(s)? a) EGD b) CBC + CMP c) Urea breath test d) Thyroid function test

c) Urea breath test

Increased acid secretion and diminished mucosal defenses may be caused by what? a) H. pylori-induced injury b) GERD c) Esophagitis d) Dyspepsia

a) H. pylori-induced injury

Which of the following may cause esophageal strictures? a) Adenocarcinoma b) Squamous cell carcinoma c) Peptic stricture secondary to GERD d) Radiation therapy e) Eosinophilic esophagitis f) All of the above

f) All of the above

__% of those who bleed from esophageal varices will die from the bleed

15%

True or false: Hemorrhoidal preparations may cause skin atrophy and/ or dermatitis

True

True or false: Acute upper GI bleeding usually requires an NG tube.

False (usually self-limiting)

True or false: Conjugated hyperbilirubinemia (direct) is more likely to cause pruritus than unconjugated (indirect)

True

True or false: NSAIDs and Warfarin increase risk of acute lower GI bleeding

True

True or false: GERD is more likely to cause odynophagia than non-reflux esophagitis

False (it's the opposite)

True or false: Antibiotics and NSAIDs are among the most likely medication to cause esophagitis

True

True or false: Asymptomatic patients with Barrett’s esophagus should take a daily PPI

True

True or false: You do not need the classic Sx of GERD to receive a diagnosis.

False; classic Sx are required

True or false: 325 mg ASA QOD increases risk of duodenal ulcers

True

A patient has PUD, and their symptoms get worse with food. Where is the likely location of their PUD? a) Duodenal b) Gastric c) Jejunal d) Esophageal

b) Gastric

Which of the following is NOT one of the 3 main types of gastritis? a) Erosive b) Hemorrhagic c) Infectious d) Drug-induced

d) Drug-induced

Which of the following hemorrhoid grade(s) can be treated with Fiber & Sitz baths +/- rubber band ligation (RBL)? Select all that apply a) Grade 1 b) Grade 2 c) Grade 3 d) Grade 4

a) Grade 1 b) Grade 2

What is the most common type of anorectal fissure, and what is the primary Sx? a) Anterior midline; intense pain b) Posterior midline; profuse bleeding c) Posterior midline; intense pain with defecation d) Lateral; intense pain with defection

c) Posterior midline; intense pain with defecation

Which of the following is NOT an osmotic laxative? a) Lactulose b) Bisacodyl (Dulcolax) c) Miralax (PEG) d) Magnesium citrate

b) Bisacodyl (Dulcolax)

What should you do to diagnose acute diverticulitis? a) Colonoscopy b) CT with oral and IV contrast c) EGD d) CT scan without contrast

b) CT with oral and IV contrast

What is the typical duration of antibiotics for acute diverticulitis? a) 3-5 days b) 5-10 days c) 7-10 days d) 7-14 days

c) 7-10 days

Smoking increases risk for _______ but may lower risk of developing _________ a) Crohn’s; Ulcerative Colitis b) Ulcerative Colitis; Crohn’s c) IBS; IBD d) IBD; constipation

a) Crohn’s; Ulcerative Colitis

True or false: You should prophylactically treat critically ill and mechanically ventilated patients at risk for gastritis with a PPI.

True

True or false: Perianal abscesses are the least common form of perirectal abscess.

False (most common)

True or false: A woman with depression + anxiety is at high risk for secondary constipation

False (she’s at high risk for primary constipation)

True or false: Hypothyroidism can cause constipation

True

True or false: Opioid receptor antagonists are a type of laxative

True

True or false: Seeds, nuts, popcorn, caffeine, & alcohol are associated with increased risk of diverticular disease

False

True or false: Diverticulosis is usually asymptomatic and is not evident on physical exam

True

Villous atrophy is a primary characteristic of what condition? a) Crohn’s disease b) Celiac disease c) Ulcerative colitis d) SBO

b) Celiac disease

Mechanical SBO results in progressive dilation _______ to obstruction & decompression _____________ to the obstruction. a) Proximal; distal b) Distal; proximal c) Proximal; proximal d) Distal; distal

a) Proximal; distal

Which of the following is the most common cause of mechanical SBO? a) Crohn's disease b) Tumors c) Gallstones d) Intraperitoneal adhesions

d) Intraperitoneal adhesions

A patient presents with a Hx of Crohn’s presents with acute abdominal pain, tachycardia, and dullness to percussion. You get some labs and their serum lactate is elevated. **What is the most likely diagnosis, and what is your next step?** a) Acute mechanical SBO; CT with PO and IV contrast, then plain radiographs b) Acute mechanical SBO with bacteremia; CT scan. c) Acute mechanical SBO with ischemia; plain radiographs, then CT with PO and IV contrast d) Acute functional SBO with ischemia; CT with PO and IV contrast

c) Acute mechanical SBO with ischemia; plain radiographs, then CT with PO and IV contrast

Tissue transglutaminase (tTG)-IgA is the single preferred test for what? a) Crohn’s disease b) Celiac disease c) Ulcerative colitis d) SBO

b) Celiac disease

What is the gold standard for the diagnosis of Celiac disease? a) Mucosal intestinal biopsy of duodenal bulb, distal duodenum or proximal jejunum + clinical response to dietary withdrawal of gluten b) Tissue transglutaminase (tTG)-IgA + clinical response to dietary withdrawal of gluten c) EGD + clinical response to dietary withdrawal of gluten d) CT scan with PO & IV contrast

a) Mucosal intestinal biopsy of duodenal bulb, distal duodenum or proximal jejunum + clinical response to dietary withdrawal of gluten

A 55 year old alcoholic presents with sudden onset severe, steady, boring epigastric pain that radiates to his back. On PE, his abdomen is tender. His serum lipase is >3x ULN he has elevated bilirubin, BUN & ALP. What is the likely diagnosis, and what imaging do you need to do? a) Alcoholic hepatitis; CT abdomen with IV contrast b) Alcoholic hepatitis; EGD c) Acute pancreatitis; EGD d) Acute pancreatitis; CT abdomen with IV contrast

d) Acute pancreatitis; CT abdomen with IV contrast

Steatorrhea is a Sx of what? a) Acute cholecystitis b) Acute pancreatitis c) Chronic pancreatitis d) Acute gastritis e) Acute appendicitis

c) Chronic pancreatitis

A patient presents with acute RLQ pain that they report began as periumbilical, indigestion, and low grade fever. Upon PE, the region is non-compressible. **What should you suspect, and how do you Dx?** a) Acute cholecystitis; CT abdomen & pelvis (pref. IV contrast) b) Acute pancreatitis; U/S focused in RLQ c) Chronic pancreatitis; U/S focused in RLQ d) Acute gastritis; CT abdomen & pelvis (pref. IV contrast) e) Acute appendicitis; CT abdomen & pelvis (pref. IV contrast)

e) Acute appendicitis; CT abdomen & pelvis (pref. IV contrast)

True or false: Proximal SBO may cause hypervolemia

False; may cause hypovolemia

True or false: Most patients with mechanical SBO present acutely

True

True or false: Celiac can lead to osteopenia

True

True or false: Gallstones and alcohol can’t cause pancreatitis; they primarily affect the liver

False