OME - Day 15

Question 1

PUD etiology, Curling ulcer

Answer 1

Burnt Patient

Question 2

PUD tx

Answer 2

• Stop smoking, ETOH, NSAIDs

- Give PPI

Question 3

Cancer in H. Pylori

Answer 3

MALToma

Question 4

H. Pylori Triple therapy

Answer 4

• Clarithromycin
• Amoxicillin (MTZ if allergic)
• PPI

Question 5

H. Pylori dx

Answer 5

• Serology
• Urea breath test
• Stool Ag
• EGD with biopsy

Question 6

Best initial test for H. Pylori

Answer 6

Urea breath test

Question 7

Gastroparesis Pt

Answer 7

• Chronic nausea vomiting
• Abdominal pain with eating
• Peripheral neuropathy (diabetes, effects distal before proximal)

Question 8

Gastroparesis dx

Answer 8

• EGD to r/o other diseases

- Emptying study

Question 9

Gastroparesis tx

Answer 9

• No opiates or anticholinergics
• Small meals
• Good glucose control
• Prokinetics
  
  • Metoclopramide long term
  • Erythromycin for flares

Question 10

Cyclical vomiting syndrome etiology

Answer 10

Habitual marijuana

Question 11

Document H. Pylori with:

Answer 11

Stool studies

Question 12

Gastrin level 700, next best step

Answer 12

Secretin stimulation test, looking for gastrin increase

Question 13

Gnawing epigastric pain that radiates to the back, and changes with food. Diagnosis

Answer 13

Peptic Ulcer Disease

Question 14

How do you diagnose H. Pylori (best test)?

Answer 14

EGD with biopsy

Question 15

How do you diagnose peptic ulcer disease?

Answer 15

EGD with biopsy

Question 16

How do you localize a gastrinoma?

Answer 16

Somatostatin Receptor Scintillography

Question 17

Multiple shallow gastric ulcers, you’re thinking?

Answer 17

NSAID’s (px with chronic arthritis)

Question 18

Multiple refractory ulcers, H. Pylori negative. Diagnosis?

Answer 18

Gastrinoma (Zollinger-Ellison)

Question 19

Options for a patient that needs NSAID’s but has ulcers.

Answer 19

Add misoprostol (cardiac risk) and then switch to celecoxib (no cardiac risk)

Question 20

Prophylaxis for a stress ulcer for a patient in the ICU on the ventilator.

Answer 20

PPI

Question 21

Diagnosis for Japanese man with early satiety and weight loss.

Answer 21

Gastric cancer

Question 22

MALToma treatment

Answer 22

Treat H. Pylori

Question 23

Supraclavicular lymph node gastric association

Answer 23

Gastric cancer (Virchow’s node)

Question 24

AIDS and diarrhea, diagnosis?

Answer 24

Cryptosporidium

Question 25

Bloody diarrhea after uncooked hamburgers, diagnosis?

Answer 25

E. Coli O157:H7

Question 26

Bloody diarrhea and renal failure in a child, diagnosis?

Answer 26

TTP/HUS and Shiga-like toxin

Question 27

Diarrhea after a picnic, diagnosis?

Answer 27

Staph Aureus

Question 28

Diarrhea after ABX use, diagnosis?

Answer 28

C. Diff

Question 29

Diarrhea and camping, diagnosis?

Answer 29

Campylobacter

Question 30

Diarrhea from Chinese food buffet line, diagnosis?

Answer 30

Bacillus Cereus

Question 31

Diarrhea travel to Mexico or Caribbean, diagnosis?

Answer 31

Traveler's diarrhea (E. Coli enterotoxic)

Question 32

Poultry, eggs and diarrhea, diagnosis?

Answer 32

Salmonella

Question 33

Most common cause of diarrhea with no risk factors

Answer 33

Viral gastroenteritis

Question 34

Treatment for refractory C. Diff

Answer 34

Fidaxomycin

Question 35

Treatment for regular C. Diff

Answer 35

Oral Metronidazole

Question 36

Treatment for severe C. Diff

Answer 36

Oral Vancomycin + IV Metronidazole

Question 37

25 year old man with watery diarrhea, weight loss and fistulas, diagnosis?

Answer 37

Crohn's disease

Question 38

Flushing, wheezing, diarrhea, and right sided cardiac fibrosis, diagnosis?

Answer 38

Carcinoid tumor

Question 39

Foul smelling, difficult to flush diarrhea that slows down at night, diagnosis?

Answer 39

Osmotic diarrhea

Question 40

How do you diagnose a carcinoid tumor?

Answer 40

5-HIAA in the urine

Question 41

How do you localize a carcinoid tumor?

Answer 41

Somatostatin receptor scintillography

Question 42

If you suspect lactase deficiency, what should you do?

Answer 42

Eliminate dairy (not breath test)

Question 43

To confirm lactase deficiency, what would you do?

Answer 43

Lactose breath hydrogen test

Question 44

Watery diarrhea with no change in frequency with sleeping or NPO, diagnosis?

Answer 44

Secretory diarrhea

Question 45

RBC and WBC in diarrhea that lasts over 8 weeks, diagnosis?

Answer 45

Inflammatory diarrhea, get a colonoscopy