Module 5 GI

Question 1

Which of the following is not a bacterial cause of gastroenteritis?

a) campylobacter jejuni
b) salmonella
c) C. diff
d) enterobacteriaceae
e) C. perfringens

Answer 1

Answer: d) enterobacteriaceae

Other bacteria include: S. aureus, shigella (most common in kids), and E. coli

Question 2

Which bacteria responsible for gastroenteritis is reportable?

a) campylobacter jejuni
b) salmonella
c) C. diff
d) enterobacteriaceae
e) shigella

Answer 2

Answer: shigella

Question 3

True or false, to diagnose gastroenteritis, usually no diagnostic testing is needed?

Answer 3

True. A stool culture can be done to determine causative organism if needed.

Question 4

Match the bacteria involved with gastroenteritis with the onset period:

a) campylobacter jejuni
b) salmonella
c) C. diff
d) S. aureus
e) C. perfringens
f) shigella
g) Giardia (protozoan)

1) 30 min-6 hours
2) 12-26 hours
3) 2-4 days
4) 10 hours-6 days
5) 1-7 days
6) 1-4 weeks
7) n/a

Answer 4

S. aureus: 30 min-6 hours

Salmonella: 12-26 hours

Shigella: 2-4 days

E.coli: 10 hr-6 days

Campylobacter: 1-7 days

Giardia: 1-4 week

C. Diff: n/a

“SSSECGC”= Sally sells seashells every corner grocery case?”

Question 5

Treatment is not recommended for which of the following bacteria involved in gastroenteritis (choose all that apply):

a) Campylobacter
b) Shigella
c) Salmonella
d) Giardia
e) S. aureus

Answer 5

Answer: c& e

Treatment with antibiotics of S. aureus and salmonella is generally not recommended

Note: salmonella in at risk patients can be treated with Bactrim or Cipro

Question 6

Which causative organisms of gastroenteritis are treated with bactrim or cipro (choose all that apply)?

a) Campylobacter
b) Shigella
c) Salmonella
d) E. coli
e) S. aureus

Answer 6

Answer: b& d

Shigella and E. coli

Shigella-Bactrim BID q3-5 days; if outside US (cipro Q10days)

E. Coli-Bactrim BID q3days; cipro alternative

Note: at risk patients with Salmonella can be treated with bactrim or cipro also

Question 7

Treatment of choice for campylobacter is:

a) Bactrim
b) Erythromycin
c) Metronidazole
d) Ciprofloxacin

Answer 7

Answer: b) erythromycin or cipro

Erythromycin QID for 5 days or Cipro BID q7days

Question 8

Which organisms involved with gastroenteritis are treated with metronidazole?

a) C. diff
b) Shigella
c) Salmonella
d) Giardia
e) S. aureus

Answer 8

Answer: A&D

C. diff is treated with metronidazole 500 mg TID or 250 mg QID+vancomycin 125 mg QID

Giardia is treated with metronidazole 250 mg TID q5-7days

Question 9

Which medication can be used for nausea and vomiting in pregnant patients (choose all that apply):

a) diclegis (Doxylamine-pyridoxine)
b) promethazine (phenergan)
c) ondansetron (zofran)
d) prochlorperazine (Compazine)

Answer 9

Answer: a & c

Diclegis is the only one approved for this in pregnancy & ondansetron.

Note: ondansetron is a 5-HT3 receptor antagonist

Prochlorperazine is contraindicated in pregnancy
Phenergan is a teratogen

Question 10

What medications are safe for kids to treat nausea and vomiting, choose all that apply:

a) metoclopramide (Reglan)
b) promethazine (phenergan)
c) ondansetron (zofran)
d) prochlorperazine (Compazine)

Answer 10

Answer: b, c, d

Metoclopramide is the only one NOT safe for children.

Note: scopolamine is not recommended for kids.

Question 11

What medication is used for nausea and vomiting related to chemotherapy?

a) metoclopramide (Reglan)
b) promethazine (phenergan)
c) ondansetron (zofran)
d) prochlorperazine (Compazine)
e) dolasetron mesylate

Answer 11

Answer: e) dolasetron mesylate

Can be given to adults and children 1 hour prior to chemo

SE: diarrhea, HA, QT prolongation, serotonin syndrome

Question 12

Match the age appropriate for the indicated medication (if applicable):

a) metoclopramide (Reglan)
b) promethazine (phenergan)
c) ondansetron (zofran)
d) prochlorperazine (Compazine)

1) ages 2+
2) ages 4+
3) not safe at any age

Answer 12

A) metoclopramide: not safe at any age
B) promethazine: ages 2+
C) ondansetron: ages 4+
D) prochlorperazine: ages 2+

Question 13

What nausea/vomiting medications are on the Beer’s list:

a) metoclopramide (Reglan)
b) promethazine (phenergan)
c) ondansetron (zofran)
d) prochlorperazine (Compazine)
e) dolasetron mesylate

Answer 13

Answer: b & d

Promethazine & Proclorperazine are on Beer’s list for those ages 65+

Question 14

True or false, constipation in anyone aged 50+ is a red flag for colorectal neoplasm?

Answer 14

True

Question 15

What is the stepwise approach to GERD management:

Phase 1:
Phase 2:
Phase 3:

Answer 15

Phase 1: lifestyle+antacids
Phase 2: H2 blockers
Phase 3: PPI, if symptoms persist refer to endoscopy

Question 16

First line pharmacologic treatment for GERD is?

a) antacids
b) PPIs
c) H2 blockers
d) barrier agents
e) prokinetics

Answer 16

Answer: b&c

H2 blockers (ranitidine and famotidine)

PPIs are also first line “prazoles”

Note: PPIs are also 1st line and more effective than H2 blockers

Question 17

Side effects of PPIs include:

a) B12 deficiency
b) hip fracture
c) hypermagnesemia
d) C. diff
e) blood dyscrasias

Answer 17

Answer: a,b,d

PPIs can cause: hip fractures, B12 deficiency, C. diff, community acquired pneumonia, and hypomagesemia

Question 18

Side effects of H2 blockers include:

a) B12 deficiency
b) hip fracture
c) decreased renal clearance
d) QT prolongation
e) blood dyscrasias

Answer 18

Answer: a)B12 deficiency and d) QT prolongation

Note: H2 blockers dosage needs to be decreased if CrCl<50

Question 19

2nd line pharmacologic treatment for GERD is:

a) antacids
b) PPIs
c) H2 blockers
d) barrier agents
e) prokinetics

Answer 19

Answer: a, d, e

Second line agents: antacids, barrier agent (sucralfate) and prokinetics (metoclopramide)

Note: Metoclopramide can cause blood dyscrasias if given with PPI/H2; also has risk of tardive dyskinesia

Question 20

What drugs can PPIs/H2 blockers interact with:

a) metoclopramide
b) warfarin
c) phenytoin
d) digoxin
e) lasix

Answer 20

Answer: a,b,c,d

PPIs/H2 blockers are metabolized in P450 so they will prolong diazepam, warfarin, phenytoin,

Note: when given with metoclopramide they can cause blood dyscrasias

Question 21

True or false, pediatric patients can take liquid PPIs/H2 blockers?

Answer 21

True

Question 22

Which of the following is not a cause of peptic ulcer disease:

a) NSAIDS
b) corticosteroids
c) radiation
d) H. pylori
e) stress

Answer 22

Answer: e) stress

PUD is NOT caused by stress, spicy foods, or emotional distress

Question 23

Duodenal ulcers are (relieved/exacerbated) by food and (relieved/exacerbated) by antacids. Whereas gastric ulcers are (relieved/exacerbated) by food and (relieved/exacerbated) by antacids.

Answer 23

Answer:

Duodenal ulcers are RELIEVED by food and RELIEVED by antacids. Whereas gastric ulcers are EXACERBATED by food and RELIEVED by antacids.

Question 24

True or false, NSAID-induced ulcers are usually silent.

Answer 24

True.

Question 25

True or false, gastric ulcers are more common than duodenal?

Answer 25

False, duodenal ulcers are 4x more common than gastric.

Question 26

Which of the following is a diagnostic tool used for peptic ulcer disease? a) ultrasound b) H. pylori testing c) stool sample d) CBC

Answer 26

Answer: b & d CBC, H. pylori testing Note: consider endoscopy if no improvement after 8-12 weeks of treatment

Question 27

How long should PUD be treated with either PPIs/H2 blockers initially?

Answer 27

4-8 weeks

Question 28

What is the treatment approach to H. pylori induced ulcers?

Answer 28

Quadruple therapy

Question 29

What does quadruple therapy involve for H. Pylori ulcers?

Answer 29

14 days of "CAMP": clarithromycin BID, amoxicillin BID, metronidazole BID, PPI Or: 14 days of: Bismuth, tetracycline, metronidazole BID, PPI

Question 30

What medication is likely causing the patient to have a black tongue and black stools? a) metronidazole b) clarithromycin c) metoclopramide d) bismuth

Answer 30

Answer: d)bismuth Note: it contains aspirin so use caution

Question 31

What medication can pregnant patients with PUD take? a) H2 blockers b) PPI c) sucralfate d) antacids

Answer 31

Answer: b) PPIs but use caution

Question 32

A patient presents with bloody diarrhea, abdominal pain, weight loss, and fever. What is a likely diagnosis? a) peptic ulcer disease b) diverticulitis c) Crohn's disease d) ulcerative colitis

Answer 32

Answer: b)diverticullitis or d) ulcerative colitis Crohn's disease typically does not present with bloody diarrhea

Question 33

What age range is ulcerative colitis most prevalent in (choose all that apply): a) ages 10-20 years b) ages 15-40 years c) ages 20-55 years d) ages 30-65 years e) ages 50-80 years

Answer 33

Answer: b & e The first peak is at ages 15-40 years and a secondary peak occurs (smaller peak) at ages 50-80 years

Question 34

Which is not a cause of or contributing factor to peptic ulcer disease? a) stress b) NSAIDs c) tobacco & alcohol d) H. pylori e) hypersecretion syndromes f) medications g) radiation g) spicy foods

Answer 34

Answer: a) stress and g) spicy foods All of the other choices can contribute to PUD

Question 35

How do you differentiate ulcerative colitis from Crohn's disease?

Answer 35

See notes

Question 36

Which of the following are consistent with ulcerative colitis: a) involves the rectum b) bleeding c) granulomas d) transmural inflammation e) skip lesions

Answer 36

Answer: a,b UC involves the rectum (usually the colon) and causes bleeding. Granulomas, transmural inflammation and skip lesions are consistent with Crohn's disease

Question 37

Which of the following are consistent with Crohn's disease: a) involves the rectum b) skip lesions c) bleeding d) fissures e) weight loss f) fat soluble vitamin deficiency

Answer 37

Answer: b,d,e,f Crohn's disease involves skip lesions, inflammation which can cause fissures/abscesses, weight loss due to frequent diarrhea/malabsorption, which can also lead to decreased absorption of fat soluble vitamins like D (note: B12 can be decreased and lead to anemia).

Question 38

Which is the treatment of mild to moderate ulcerative colitis? a) steroid enema b) azathioprine c) mesalamine d) Humira e) budesonide

Answer 38

Answer: c) mesalamaine (Pentasa) Treatment of mild-moderate UC is 5-ASA which is Pentasa, Lialda, Apriso. The next option would be rectal 5-ASA

Question 39

If a patient is unresponsive to steroids in managing ulcerative colitis, what is the next treatment option? a) sulfasalazine b) methotrexate c) Remicade d) azathioprine

Answer 39

Answer: d) azathioprine If unresponsive to steroids the next step is immune modulators (azathioprine & 6-mercaptopurine). If unsuccessful treatment there, the next step is biologics (Humira or Remicade)

Question 40

What is the first line of treatment for mild to moderate Crohn's disease? a) budesonide b) azathioprine c) mesalamine d) Humira e) prednisone

Answer 40

Answer: a) budesonide is given 9 mg daily x 8 weeks

Question 41

What medication is given for acute Crohn's and maintenance? a) budesonide b) azathioprine c) mesalamine d) Humira e) prednisone

Answer 41

Answer: c) mesalamine 5-ASA are given and include Mesalamine & sulfasalazine Remember: in ulcerative colitis only the 5-ASA without sulfa are given such as mesalamine to achieve and maintain remission.

Question 42

Which is not a risk of developing Crohn's disease: a) alcohol b) refined sugar rich diet c) cigarette smoking d) diet rich in animal fat e) age 15-40

Answer 42

Answer: a & e Risks include: a diet rich in refined sugar/fat, cigarette smoking, a bacterial infection (C. diff)

Question 43

Which inflammatory bowel disease process is actually protected by smoking?

Answer 43

Ulcerative colitis Remember: Crohn's risk is almost doubled with smoking

Question 44

Which of the following is not included in the Rome criteria (choose all that apply)? a) improvement/worsening of pain with defecation b) change in stool frequency c) nocturnal pain or passing stools d) change in stool appearance e) GI bleed

Answer 44

Answer: c&e Rome criteria is used to help diagnose IBS. It is recurrent abdominal pain 1+ day/week in the past 3 months plus one of the following: Improvement/worsening of pain with defecation Change in stool frequency Change in stool appearance

Question 45

Which is not a medication used for IBS in women ONLY: a) Alosetron (Lotronex) b) Lubiprostone (Amitiza) c) Tegaserod (Zelnorm) d) Linaclotide (Linzess)

Answer 45

Answer: d) Linaclotide (Linzess) can be used in men and women Note: alosetron (Lotronex) is linked with ischemic colitis and death

Question 46

True or false, SSRIs can be useful in managing IBS?

Answer 46

False. Tricyclic antidepressants can be helpful.

Question 47

Risk factors for diverticulitis include (choose all that apply): a) obesity b) low fiber diet c) smoking d) female gender e) rapid weight loss

Answer 47

Answer: a,b,c Risks include: age 40+, low fiber diet, smoking, sedentary lifestyle, and previous diverticulitis

Question 48

True or false, any type of scope (flex sig, colonoscopy) is appropriate to perform during an acute diverticulitis episode?

Answer 48

False. It is generally contraindicated.

Question 49

What is the bowel rest regimen for managing an acute diverticulitis episode?

Answer 49

NPO-->clear liquid 3 days-->low residue 5-7 days-->high fiber

Question 50

Mainstays of diverticulitis treatment are: a) imipenem b) fluoroquinolone c) rifaximin d) piperacillin/tazobactim

Answer 50

Answer: c) rifaximin 400 mg BID q7days or continuous mesalamine 800 mg BID Note: antibiotic use is controversial

Question 51

What foods should a patient with diverticulosis avoid? a) oatmeal b) popcorn/corn c) nuts d) seeds

Answer 51

Answer: b,c,d These foods should be avoided as they can become lodged and produce diverticulitis

Question 52

What medications are appropriate for the initial management of Alzheimer's? a) Memantine (Namenda) b) Levodopa/Caribdopa (Sinemet) c) SSRIs d) Galantamine (Reminyl) e) Donepezil (Aricept)

Answer 52

Answer: d&e These drugs will increase the level of acetylcholine (which is impaired in Alzeheimer's). Another option is rivastigmine (Exelon) Note: use caution when combining these with beta-blockers

Question 53

What medication can be used for moderate-severe Alzheimer's (or if patients cannot tolerate cholinesterase inhibitors)? a) Memantine (Namenda) b) Levodopa/Caribdopa (Sinemet) c) SSRIs d) Galantamine (Reminyl)

Answer 53

Answer: a) Memantine (Namenda) Note: need to adjust for renal impairment