GI System

Question 1

Jejunal ulcers

Answer 1

R/o Zollinger-Ellison syndrome by checking gastrin level

Question 2

Main cause of duodenal ulcers

Answer 2

H pylori

Question 3

Main cause of gastric ulcers

Answer 3

NSAIDs, ASA

Question 4

Triple therapy

Answer 4

PPI, clarithromycin, amoxicillin

Question 5

Pernicious anemia

Answer 5

Lack of intrinsic factor necessary for absorption of Vitamin B12 2/2 autoantibodies to parietal cells in the FUNDUS of stomach, associated with Type A gastritis

Question 6

Curling ulcers

Answer 6

Stress ulcers associated with burn injuries

Question 7

Cushing ulcers

Answer 7

Stress ulcers associated with traumatic brain injury

Question 8

How to NOT test if H pylori infection cleared?

Answer 8

H pylori antibodies

Question 9

How to test if H pylori infection cleared?

Answer 9

Urea breath test or repeat stool antigen

Question 10

Krukenberg tumor

Answer 10

gastric adenocarcinoma that metastasizes to ovary

Question 11

Virchow node

Answer 11

Enlarged left supra-clavicular lymph node in setting of gastric cancer

Question 12

Dumping syndrome

Answer 12

Delivery of hyper-osmotic chyme to small intestine causing massive fluid shifts into the bowel, seen particularly in procedures that bypass the pylorus; p/w:
-Bloating
-Cramping
-Diarrhea
-Vasomotor sxs (weakness, flushing, palpitation, diaphoresis)
all after ingestion of meal

Question 13

Achlorhydia

Answer 13

Absence of HCl secretion most commonly caused by pernicious anemia , where anti-parietal cell antibodies destroy acid-secreting parietal cells

Question 14

Radiologic imaging studies used to detect slow or intermittent GI bleeds.

Answer 14

Isotope- labeled (Technetium 99m) RBC scan using nuclear medicine

Question 15

Radiologic imaging studies used to detect rapid bleeds and embolization of bleeding vessels.

Answer 15

Mesenteric CT angiography

Question 16

Antibiotic treatment for diverticulitis

Answer 16

Fluoroquinolone + metronidazole

Question 17

Osmotic diarrhea

Answer 17

Non-absorbable solutes (e.g. lactose or other sugar intolerance) remain in bowel and retain water

Question 18

Secretory diarrhea

Answer 18

Associated with excess bowel secretion of fluid 2/2:

• Bacterial toxins (E Coli, cholera)
• VIPoma
• Bile acids (after ileal resection)

Question 19

Infectious diarrhea

Answer 19

Associated w/:

• Invasive bacteria (Shigella, Salmonella, Yersinia, Campylobacter, ETEC, stream-drinkers Giardia)
• p/w: fever, WBCs

Question 20

First line treatment of C difficile.

Answer 20

PO metronidazole

Question 21

Young woman with completely benign exam, GI complaints, h/o anxiety, psychosocial stressors

Answer 21

Irritable bowel syndrome

Question 22

HUS

Answer 22

Hemolytic uremic syndrome 2/2 E. coli or Shigella diarrhea in children p/w:

• Thrombocytopenia
• Hemolytic anemia (schistocytes, helmet cells, fragmented RBCs on blood smear)
• Acute renal failure

Question 23

Fistulas, abscesses, Transmural inflammation, non-caseating granulomas, cobble-stoning, string sign on barium XR

Answer 23

Crohn’s disease

Question 24

Crypt-abscess, bleeding ulcers, Pseudo-polyps, lead-pipe colon on barium XR

Answer 24

Ulcerative colitis

Question 25

Surgical tx for UC

Answer 25

Protocolectomy with ileoanal anastomosis

Question 26

Toxic megacolon

Answer 26

UC

Question 27

Ulcerative colitis is associated to what autoimmune biliary disease

Answer 27

Primary sclerosing cholangitis

Question 28

Pyoderma gangrenosum

Answer 28

UC

Question 29

In an active Hepatitis B infection, what antibody is the first to appear?

Answer 29

IgM Hepatitis core antibody (HBcAb)

Question 30

Management of acute exposure to Hepatitis B?

Answer 30

Hep B immunoglobulin, Hep B vaccine

Question 31

What does a positive Hep C antibody mean?

Answer 31

It means pt had infection in the past but it does NOT mean it is cleared. Many patients become chronic carriers t/f test for Hep C virus RNA.

Question 32

Hep E and pregnant women?

Answer 32

Hep E in pregnant women is fatal.

Question 33

Anti-smooth muscle antibody

Answer 33

Autoimmune hepatitis seen in young women, tx with steroids

Question 34

Hematochromatosis

Answer 34

Excessive iron reabsorption by intestine and deposited in: -Liver (cirrhosis, hepatocellular carcinoma) -Pancreas (diabetes) -Heart (dilated cardiomyopathy) -Skin (bronze pigmentation) -Joints (arthritis) Tx: Phlebotomy

Question 35

Hepatolenticular degeneration

Answer 35

Wilson diseases: characterized by liver disease with CNS/psychiatric manifestations (caused by copper deposits in the basal ganglia)

Question 36

Treatment of Hyperammonemia 2/2 liver failure?

Answer 36

Decreased protein intake | Lactulose (prevents absorption)

Question 37

Signs ans symptoms of Biliary tract obstruction

Answer 37

- Elevated conjugated bilirubin - Elevated Alk Phos - Pruritis - Clay-colored stools - Dark urine (strongly positive for conjugated bilirubin since unconjugated is not excreted in the urine, it's tightly bound to albumin)

Question 38

Imaging modality used to visualize a gallstone?

Answer 38

Ultrasound

Question 39

Courvoisier sign

Answer 39

Jaundice with a palpably enlarged gallbladder, seen in Pancreatic cancer

Question 40

Positive anti-mitochondrial antibodies in a woman c/o jaundice, pruritis, xanthelesma

Answer 40

Primary biliary cholangitis

Question 41

Primary sclerosing cholangitis

Answer 41

Young adult with inflammatory bowel disease (UC) with fever, chills, pruritis, RUQ pain

Question 42

"Onion skin" bile duct

Answer 42

Primary sclerosing cholangitis

Question 43

Charcot triad (for cholangitis)

Answer 43

- Fever - RUQ pain - Jaundice

Question 44

Treatment for achalasia

Answer 44

Dx: Esophageal manomatery Tx: CCB, balloon dilatation, botulism toxin injection

Question 45

CREST syndrome

Answer 45

``` Calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactylyl Telangiectasia ``` Anticentremere

Question 46

Grey Turner sign

Answer 46

Blue-black flanks 2/2 hemorrhagic pancreatic exudate

Question 47

Cullen sign

Answer 47

Blue-black umbilicus 2/2 hemorrhagic pancreatic exudate

Question 48

Common cause of Chronic pancreatitis

Answer 48

Alcoholism

Question 49

Smoking vs. Alcohol is a greater risk factor for pancreatic cancer?

Answer 49

Smoking

Question 50

Crigler-Najjar syndrome

Answer 50

severe unconjugated hyperbilirubin from birth

Question 51

Gilbert syndrome

Answer 51

mild unconjugated hyperbilirubin 2/2 stress

Question 52

Treatment of pathologic jaundice with unconjugated bilirubin > 15

Answer 52

Phototherapy to convert unconjugated bilirubin to water-soluble form that can be excreted

Question 53

Treatment of pathologic jaundice with unconjugated bilirubin is >20

Answer 53

Exchange transfusion