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GI > GI: Multiple Choice & Other Questions > Flashcards

GI: Multiple Choice & Other Questions Flashcards

1
Q

What results would be expected on imaging if a patient has cholecystitis?

  1. CT of abdomen reveals edema of gallbladder
  2. MRI of abdomen demonstrates multiple gallstones
  3. U/S of abdomen reveals thickening of gallbladder wall
  4. All are of equal diagnostic value
A
  1. U/S of abdomen shows gallbladder wall thickening

NOTE: This is the Gold Standard for diagnosis of cholecystitis

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2
Q

Interpretation of these Hepatitis A labs:

a. + Anti-HAV IgG = ___________
b. + Anti-HAV IgM = ___________
c. - Anti-HAV IgM & - Anti-HAV IgG = ___________

A

a. Recovered & immune
b. Acute infection
c. Not infected & not immune

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3
Q

Interpretation of these Hepatitis B labs:

+ HBsAg
- Anti-HBs
+ IgM Anti-HBc
+ Anti-HBc

A

Acute Hepatitis B infection ≤ 6 mo duration
(immunity not yet developed)

+ HBsAg = infection
- Anti-HBs ≠ immunity
+ IgM Anti-HBc = acute ≤ 6 months
+ Anti-HBc = infection

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4
Q

Interpretation of these Hepatitis B labs:

  • HBsAg
  • Anti-HBs
  • Anti-HBc
A

Never infected, never vaccinated for Hepatitis B

  • HBsAg ≠ infection
  • Anti-HBs ≠ immunity
  • Anti-HBc ≠ infection
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5
Q

Interpretation of these Hepatitis B labs:

  • HBsAg
    + Anti-HBs
  • Anti-HBc
A

Immunity from Hepatitis B vaccination

  • HBsAg ≠ infection
    + Anti-HBs = immunity
  • Anti-HBc ≠ infection
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6
Q

Interpretation of these Hepatitis B labs:

+ HBsAg
- IgM Anti-HBc
+ Anti-HBc
- Anti-HBs

A

Chronic Hepatitis B infection

+ HBsAg = infection
- IgM Anti-HBc ≠ acute (≤ 6 months)
+ Anti-HBc = infection
- Anti-HBs ≠ immunity

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7
Q

Interpretation of these Hepatitis B labs:

  • HBsAg
    + Anti-HBs
    + Anti-HBc
A

Immunity due to prior Hepatitis B infection

  • HBsAg ≠ infection
    + Anti-HBs = immunity
    + Anti-HBc = infection
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8
Q

A 64 year-old man will be treated outpatient for acute diverticulitis. What should be part of his plan of care?

  1. Referral for colonoscopy since his last one was 2 years ago
  2. Repeat CT scan about 1 month after becoming asymptomatic
  3. Repeat his CBC in 2 - 3 days to assess degree of leukocytosis
  4. Follow up with office visit 1 week after initiation of antibiotics
A
  1. Referral for colonoscopy since his last one was 2 years ago
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9
Q

A 64 year-old man has uncomplicated diverticulitis based on symptoms, labs, and abdominopelvic CT scan. Choose all symptoms and results you’d expect:

  1. Fistula
  2. Low-grade fever
  3. Leukocytosis
  4. LLQ abdominal pain
  5. Nausea/vomiting
  6. Severe abdominal pain
  7. Intolerance of oral intake
A
  1. Low-grade fever
  2. Leukocytosis
  3. LLQ abdominal pain
  4. Nausea/vomiting

NOTE: These are classic s/s. #1, #6 and #7 would indicate complicated diverticulitis.

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10
Q

A 24 year-old woman presents with RLQ tenderness. Which findings are associated with recent onset acute appendicitis?

  1. White count > 10,000
  2. Bands present
  3. Fever 103F
  4. Onset of pain after intercourse
  5. More likely during menses
A
  1. White count > 10,000
  2. Bands present
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11
Q

Which finding is least likely in a patient who has uncomplicated acute cholecystitis?

  1. A positive Murphy sign
  2. Fever
  3. Elevated ALT, AST, amylase
  4. Thickening of gallbladder wall
A

1 and #4 = classic signs of acute cholecystitis

  1. Elevated ALT, AST, amylase

NOTE:
#3 indicates complicated cholecystitis (ALT & AST = liver involvement, amylase = pancreas involvement)

#2 = possible sign of acute cholecystitis

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12
Q

A 48 year-old woman with obesity present with a positive Murphy’s sign. What laboratory abnormalities are commonly expected in this patient?

  1. Lymphocytosis
  2. Anemia
  3. Elevated LFTs
  4. Elevated amylase
A
  1. Lymphocytosis

NOTE: Lymphocytosis = increased WBCs

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13
Q

A 48 year-old presents with acute cholecystitis. Select all answers that describe the patient’s demeanor in the exam room:

  1. Lying on the exam table, moving from side to side from pain
  2. Lying on the exam table very still
  3. Sitting in a chair waiting for you
  4. Has inspiratory arrest with palpation of RUQ
A
  1. Lying on the exam table very still
  2. Has inspiratory arrest with palpation of RUQ

NOTE: #4 = classic sign!!

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14
Q

A 56 year-old man is a past smoker (quit 5 years ago), has an elevated BMI, and has taken OTC PPIs for 5 years. He has tried to stop PPIs but couldn’t. What should be part of his plan of care?

  1. Prescribe PPIs indefinitely
  2. Referral to GI MD for upper endoscopy
  3. Attempt to wean off PPIs and use H2 blockers
  4. Prescribe prescription-strength PPIs
A
  1. Referral to GI MD for upper endoscopy

NOTE: Patient has many risk factors for Barrett’s esophagitis

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15
Q

A 35 year-old male smoker presents with typical symptoms of GERD. What are these symptoms? Select all that apply.

  1. Heartburn
  2. Pyrosis
  3. Regurgitation
  4. Dysphagia
    5 Hoarseness
  5. Coughing with eating
  6. Globus sensation
A
  1. Heartburn
  2. Pyrosis
  3. Regurgitation
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GI (4 decks)

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