MKSAP Board Basics Gastroenterology Flashcards
(150 cards)
1
Q
What test is used to evaluate suspected oropharyngeal dysphagia?
A
Videofluoroscopy with liquid and solid phases.
2
Q
What is the first test to order when suspected achalasia is causing dysphagia?
A
Barium swallow
3
Q
What are GI alarm features?
A
- Vomiting
- Anemia
- Weight loss
- Dysphagia
4
Q
How is the diagnosis of GERD confirmed in patients without alarm features?
A
Relief of symptoms with a PPI (proton pump inhibitor)
5
Q
What should you do if GERD symptoms are refractory of PPI treatment?
A
Upper endoscopy
6
Q
Should barium X-rays be used to diagnose GERD?
A
No
7
Q
In men over 50 with GERD symptoms, are nocturnal reflux symptoms a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?
(Yes/No)
A
Yes
8
Q
In men over 50 with GERD symptoms, is intra-abdominal distribution of fat a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?
A
Yes
9
Q
In men over 50 with GERD symptoms, is tobacco use a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?
A
Yes
10
Q
In men over 50 with GERD symptoms, is elevated BMI a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?
A
Yes
11
Q
In men over 50 with GERD symptoms, is hiatal hernia a risk factor for Barrett’s esophagus or esophageal adenocarcinoma?
A
Yes
12
Q
What is the treatment of patients with Barrett’s esophagus without dysplasia?
A
Proton pump inhibitor
13
Q
What is the treatment of patients with Barrett’s esophagus with low- to high grade dysplasia?
A
Endoscopic ablation
(RFA, photodynamic therapy, endoscopic mucosal resection, and esophagectomy)
14
Q
How often is surveillance done for patients with Barrett’s esophagus without dysplasia?
A
Every 3 - 5 years
15
Q
How often is surveillance done for patients with Barrett’s esophagus with mild dysplasia who do not get it ablated?
A
Every 6 - 12 months
16
Q
Do women with GERD require screening for Barrett’s esophagus?
A
No
17
Q
What are the most common infectious causes of esophagitis?
A
- Candida albicans
- CMV
- HSV
18
Q
What is the diagnosis in patients with AIDS, odynophagia and oral candidiasis?
A
Esophageal candidiasis
19
Q
What should you do in patients who are immunocompromised with odynophagia?
A
Empiric therapy for esophageal candidiasis
20
Q
Do patients with viral esophagitis have associated ulcerative oropharyngeal lesions?
A
Rarely
21
Q
Can tetracyclines cause pill-induced esophagitis?
A
Yes
22
Q
Can NSAIDS cause pill-induced esophagitis?
A
Yes
23
Q
Can potassium chloride cause pill-induced esophagitis?
A
Yes
24
Q
Can iron pills cause pill-induced esophagitis?
A
Yes
25
Can alendronate cause pill-induced esophagitis?
Yes
26
What is the diagnosis in young adults who present with extreme dysphagia and food impaction?
Eosinophilic esophagitis (EE)
27
What should you do if empiric therapy for presumed esophagitis is unsuccessful?
Perform upper endoscopy with biopsy/brushing
28
Patient has upper endoscopy showing mucosal furrowing, stacked circular rings, white specks, and mucosal friability.
Endoscopic biopsies show marked infiltration with eosinophils.
Diagnosis?
Eosinophilic esophagitis (EE)
29
Is GERD associated with esophageal eosinophilia?
Yes
30
Does esophageal eosinophilia respond to an 8-week trial of proton pump inhibitor?
No
31
Should you do barium esophagography to evaluate suspected esophagitis?
No
32
Does the absence of oral Candida lesions rule out esophageal candidiasis?
No
33
What is the treatment for esophageal candidiasis?
- Fluconazole
- Itraconazole
34
What is the treatment for HSV esophagitis?
- Acyclovir
- Famciclovir
- Valacyclovir
35
What is the treatment for CMV esophagitis?
Ganciclovir and/or foscarnet
36
What is the treatment for eosinophilic esophagitis?
Swallowed fluticasone or budesonide
37
What is the treatment for pill-induced esophagitis?
Supportive care
38
What should all patients with peptic ulcer disease be tested for?
Helicobacter pylori infection
39
What are non-invasive strategies for diagnosing Helicobacter pylori infection?
- Urea breath tests
- Stool test for H. pylori antigens
40
What medications cause false-negative rapid urease tests, urea breath tests, and stool antigen results for H. pylori?
- Antibiotics
- Bismuth-containing compounds
- PPIs
41
How long do antibiotics need to be stopped before testing for H. pylori?
28 days
42
How long do PPIs need to be stopped before testing for H. pylori?
2 weeks
43
Should you use serum antibody testing to test for H. pylori?
No - cannot differentiate between past and present infection.
44
When should duodenal ulcers be biopsied?
When they are refractory to therapy
45
Should duodenal ulcers be biopsied?
No (unless refractory to therapy)
46
Is the risk of malignancy in duodenal ulcers low or high?
Low
47
What is the treatment for H. pylori infection?
- Clarithromycin-based triple therapy (if no clarithromycin resistance suspected)
- Bismuth quadruple therapy (if resistance to clarithromycin probable)
48
When first-line therapy fails for H. pylori infection, which antibiotics should not be used?
A salvage regimen should avoid previously used antibiotics.
49
When is surgery done for peptic ulcer disease?
When patients have complications
50
What is the follow-up after treating H. pylori infection?
Follow-up noninvasive testing to document H. pylori eradication should be performed at least 4 weeks after completion of
therapy in any patient with a positive H. pylori test result.
51
When is a follow-up upper endoscopy for gastric ulcers indicated?
- If patient remains symptomatic after treatment
- Cause is uncertain
- Biopsies were not performed during initial upper endoscopy
52
Does a selective COX-2 inhibitor provide better gastric protection than a nonselective NSAID plus a PPI?
No
53
Does duodenal peptic ulcer disease without complication need a follow-up upper endoscopy?
No
54
Should serologic testing (ELISA test for IgG antibodies) be used to confirm H. pylori eradication?
No (remains positive in the absence of active infection)
55
What should be used as the initial treatment of H. pylori infection in patients who are allergic to penicillin?
Bismuth quadruple therapy
56
What should you do for patients with refractory symptoms of dyspepsia?
Upper endoscopy
57
What diagnosis should be considered in patients with recurrent nausea, early satiety, bloating, and weight loss?
Gastroparesis
58
What is important to check in diabetes mellitus patients prior to doing a gastric emptying study?
Blood glucose should be less than 275 mg/dL during testing because marked hyperglycemia can acutely impair gastric emptying.
59
What are the dietary recommendations for gastroparesis?
Small low-fat meals consumed four to five times per day
60
What is the treatment of acute gastroparesis?
IV erythromycin
61
What is the treatment of chronic gastroparesis?
Oral metoclopramide
62
What is a serious side effect of metoclopramide?
Tardive dyskinesia
63
What should you do if a patient develops tardive dyskinesia as a result of metoclopramide?
Stop the medication immediately
64
Is tardive dyskinesia due to metoclopramide reversible?
May be irreversible
65
Which bariatric surgery procedure most often causes small intestinal bacterial overgrowth (SIBO)?
Roux-en-Y gastric bypass
66
Patient has abdominal cramps, nausea, and loose stools 15 minutes after eating followed within 90 minutes by lightheadedness, diaphoresis, and tachycardia following gastric resection or bypass surgery.
Diagnosis?
Dumping syndrome
67
What is the treatment of dumping syndrome?
Treat with small frequent feedings and low-carbohydrate meals.
68
A patient has loose stools and malabsorption following bypass surgery.
Diagnosis?
Small intestinal bacterial overgrowth (SIBO)
69
What is the treatment of small intestinal bacterial overgrowth (SIBO)?
- Antibiotics
- Nutritional supplements
70
Abdominal pain, bloating, difficulty belching following fundoplication (bariatric surgery).
Diagnosis?
Gas-bloat syndrome
71
What is the treatment of gas-bloat syndrome in bariatric surgery patients?
Diet modification; most treatments are untested.
72
What imaging study is essential to do in patients with acute pancreatitis to evaluate etiology?
Abdominal ultrasonography to rule out biliary tract obstruction
73
What imaging study is essential in all patients with acute pancreatitis?
Abdominal ultrasonography to evaluate the biliary tract for obstruction.
74
When is a CT abdomen indicated in patients with acute pancreatitis?
- Severe pancreatitis
- If it lasts longer than 48 hours
- If complications are suspected
75
Should you routinely obtain a CT abdomen for acute pancreatitis?
No
76
Is uncomplicated pancreatitis typically associated with rebound abdominal tenderness, absent bowel sounds, high fever, or melena?
No
77
What are (three) complications of acute pancreatitis?
- Abscess
- Pseudocyst
- Necrotizing pancreatitis
78
Can kidney disease cause mildly elevated amylase values?
Yes
79
Can intestinal ischemia cause mildly elevated amylase values?
Yes
80
Can appendicitis cause mildly elevated amylase values?
Yes
81
Can parotitis cause mildly elevated amylase values?
Yes
82
What should you do in acute pancreatitis patients who are found to have ascending cholangitis or biliary obstruction?
ERCP within 24 hours of presentation
83
How are symptomatic pancreatic pseudocysts treated?
Transgastric or transduodenal drainage
84
When is fluid resuscitation for acute pancreatitis most beneficial?
In the first 12 - 24 hours of presentation
85
Should you withhold oral feeding on the basis of persistent elevations in pancreatic enzyme levels in acute pancreatitis when the abdominal pain, nausea and vomiting has resolved?
No
86
Should you treat interstitial (nonnecrotizing) pancreatitis with antibiotics?
Not without evidence of infection
87
Should you treat cholangitis, infected pancreatic necrosis, and infected pseudocysts with antibiotics?
Yes
88
What is the common cause of chronic pancreatitis?
Chronic alcohol abuse
89
What should you do in young patients with chronic pancreatitis?
Sweat chloride testing for cystic fibrosis
90
Do normal amylase and lipase levels rule out chronic pancreatitis?
No
91
Should opioids be used in chronic pancreatitis?
No
92
What is the initial therapy for malabsorption in chronic pancreatitis?
Pancreatic enzymes
93
What should you look for in persistent or refractory pain in chronic pancreatitis?
- Dilated pancreatic duct
- Intraductal calcifications
94
What treatment options should you consider in case of a dilated pancreatic duct and/or intraductal calcifications?
- Endoscopic stenting
- Lithotripsy
- Surgical drainage (pancreaticojejunostomy)
95
How many types of autoimmune pancreatitis are they?
2 types (type 1 and type 2)
96
Which type of autoimmune pancreatitis is more likely to have elevated IgG4 levels?
Type 1
97
Patient presents with painless obstructive jaundice or acute pancreatitis (rare). Cross-sectional imaging reveals “sausage-shaped” pancreatic enlargement with an indistinct border.
Diagnoses?
Autoimmune pancreatitis
Possible pancreatic cancer
98
What is the treatment of autoimmune pancreatitis?
Glucocorticoids
99
When do patients need antibiotics for acute diarrhea?
- Diarrhea lasting > 7 days
- Patients with fever, abdominal pain or hematochezia
100
Should you order stool cultures for diarrhea of less than 1 week duration?
No
101
Should you choose antibiotics for enterohemorrhagic Escherichia coli (EHEC) colitis?
No
102
Should you give loperamide for acute diarrhea with fever or blood in the stool?
No
103
Should you give diphenoxylate for acute diarrhea with fever or blood in the stool?
No
104
What may happen if you give loperamide or diphenoxylate in enterohemorrhagic Escherichia coli (EHEC) colitis?
Hemolytic uremic syndrome
105
What may happen if you give loperamide or diphenoxylate in C. difficile infection?
Toxic megacolon
106
How long does chronic diarrhea last?
More than 4 weeks
107
What investigation should usually be done in most chronic diarrhea patients?
Colonoscopy
108
What investigation should usually be done in chronic diarrhea patients if colonoscopy is nondiagnostic?
A 48- to 72-hour stool collection with analysis of fat content.
109
What fat excretion is diagnostic of steatorrhea?
>14 g/d
110
What do you measure to calculate fecal osmotic gap?
Stool electrolytes (sodium and potassium)
111
What is the most common cause of chronic infectious diarrhea?
Giardia lamblia
112
In a patient with chronic diarrhea and bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features...
What's the most likely diagnosis?
Irritable bowel syndrome
113
In a patient with chronic diarrhea and bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features...
What should you do next?
Test for celiac disease
114
In a female aged 45 - 60 years with chronic diarrhea which is unrelated to food intake (nocturnal diarrhea), normal colonoscopy...
What's the most likely diagnosis?
Microscopic colitis
115
In a female aged 45 - 60 years with chronic diarrhea which is unrelated to food intake (nocturnal diarrhea), normal colonoscopy...
What should you do next?
- Stop NSAIDS or PPIs
- Biopsy
116
In a patient with chronic diarrhea with diary products...
What's the most likely diagnosis?
Lactose intolerance
117
In a patient with chronic diarrhea with diary products...
What should you do next?
- Dietary exclusion
- Hydrogen breath test
118
In a patient with chronic diarrhea with use of artificial sweeteners or fructose...
What's the most likely diagnosis?
Carbohydrate intolerance
119
In a patient with chronic diarrhea with use of artificial sweeteners or fructose...
What should you do next?
- Dietary exclusion
- Hydrogen breath test
120
In a patient with diabetes mellitus or systemic sclerosis and nocturnal chronic diarrhea...
What should you do next?
- Hydrogen breath test
- Empiric antibiotic trial
121
In a patient with diabetes mellitus or systemic sclerosis and nocturnal chronic diarrhea...
What's the most likely diagnosis?
Small bowel bacterial overgrowth
122
In a patient with chronic diarrhea coexistent pulmonary diseases and/or recurrent Giardia infection...
What's the most likely diagnosis?
Chronic venous insufficiency and selective IgA deficiency
123
In a patient with chronic diarrhea coexistent pulmonary diseases and/or recurrent Giardia infection...
What should you do next?
Measure immunoglobulins
124
In a patient with chronic diarrhea and somatization or other psychiatric syndromes, history of laxative use...
What's the most likely diagnosis?
Self-induced diarrhea
125
In a patient with chronic diarrhea and somatization or other psychiatric syndromes, history of laxative use...
What should you do next?
- Obtain tests for stool osmolality,
electrolytes, magnesium
- Laxative screen
126
In a patient with severe secretory diarrhea and flushing...
What should you do next?
24-hour urinary excretion of 5-HIAA
127
In a patient with severe secretory diarrhea and flushing...
What's the most likely diagnosis?
Carcinoid syndrome
128
In a patient with chronic diarrhea and history of irritable bowel syndrome and iron deficiency anemia...
What's the most likely diagnosis?
Celiac disease
129
How do you diagnose celiac disease?
IgA anti-tTG antibody assay and small bowel biopsy if positive.
130
What is the treatment for celiac disease?
Gluten free diet
131
In a patient with chronic diarrhea and chronic pancreatitis, hyperglycemia, history of pancreatic resection, cystic fibrosis...
What's the most likely diagnosis?
Pancreatic insufficiency
132
If you suspect pancreatic insufficiency, what should you do?
- Test for excess fecal fat
- X-rays for pancreatic calcifications
133
What is the treatment of pancreatic insufficiency?
Pancreatic-enzyme replacement therapy
134
In a patient with chronic diarrhea and previous surgery, small bowel diverticulosis, dysmotility (systemic sclerosis or diabetes mellitus), combination of vitamin B12 deficiency and elevated folate level...
What's the most likely diagnosis?
Bacterial overgrowth
135
What should you do after diagnosing bacterial overgrowth?
Empiric trial of antibiotics or hydrogen breath test
136
In a patient with chronic diarrhea and resection of >200 cm of distal small bowel (or viable small bowel <180 cm)...
What's the most likely diagnosis?
Short-bowel syndrome.
137
What is the treatment of short-bowel syndrome?
Replace nutrient and electrolyte deficiencies.
138
In a patient with history of resection of <100 cm of distal ileum, with voluminous diarrhea, weight loss, and malnutrition...
What's the most likely diagnosis?
Short-bowel syndrome with bile acid enteropathy
139
What should you do in patients with short-bowel syndrome with bile acid enteropathy?
Empiric trial of cholestyramine
140
In a patient with chronic diarrhea and arthralgia; fever; neurologic, ocular, or cardiac disease...
What's the most likely diagnosis?
Whipple disease or tropical sprue
141
What should you do if you suspect Whipple disease?
Small bowel biopsy and PCR for Tropheryma whippelii
142
What is the treatment for Whipple disease?
Antibiotics for 12 months
143
What investigation should you do when you suspect tropical sprue?
Order a small bowel biopsy
144
What is the treatment of tropical sprue?
Sulfonamide or tetracycline and folic acid
145
In a patient with prolonged traveler’s diarrhea, diarrhea after a camping trip, outbreak in a day-care center...
What's the most likely diagnosis?
Giardiasis
146
What should you do if you suspect giardiasis?
Giardia parasites or Giardia antigen in the stool
147
What is the treatment of giardiasis?
Metronidazole
148
What will happen if you use cholestyramine if ileal resection is >100 cm?
Will worsen bile salt deficiency and steatorrhea
149
What should you do if diarrhea begins after cholecystectomy?
Cholestyramine
150
What test confirms esophageal perforation?
Gastrografin contrast esophagram
