OME - Day 16

Question 1

Anemia in a gastric bypass patient, what’s the diagnosis?

Answer 1

B12 deficiency

Question 2

Best test for celiac sprue?

Answer 2

EGD with biopsy showing blunting of intestinal villi

Question 3

Caribbean farmer, negative antibodies, and blunting of intestinal villi, diagnosis?

Answer 3

Tropical Sprue

Question 4

Foul flatulence, diarrhea with dairy products, diagnosis?

Answer 4

Lactase deficiency, give lactase or avoid dairy

Question 5

Palpable rash on buttocks and legs, related to malabsorption, diagnosis?

Answer 5

Dermatitis Herpetiforme

Question 6

You see a picture of an electron microscopy on a malabsorption question. What is the diagnosis?

Answer 6

Whipple’s disease

Question 7

You suspect Celiac Sprue, what is the first test to perform?

Answer 7

Anti-endomysial antibody (not anti-gliadin)

Question 8

Px with diverticulitis and a CT scan shows an abscess, what is the next step?

Answer 8

Antibiotics and drainage

Question 9

LLQ abdominal pain, fever, leukocytosis, >50 years old, diagnosis?

Answer 9

Diverticulitis

Question 10

Painless rectal bleeding in a patient >50 years old, diagnosis?

Answer 10

Diverticular hemorrhage

Question 11

Refractory Diverticulitis (more than one episode), what do you do?

Answer 11

Resection

Question 12

What antibiotics do you use for diverticulitis?

Answer 12

Ciprofloxacin+Metronidazole or Ampicillin+Gentamicin+Metronidazole for gram negative rods and anaerobes

Question 13

When do you do a colonoscopy for diverticulitis?

Answer 13

2-6 weeks after resolution

Question 14

“Apple-core” lesion on a barium enema, diagnosis?

Answer 14

Colon cancer

Question 15

3 cancers, 2 generations, 1 premature, diagnosis?

Answer 15

HNPCC (Hereditary Non-polyposis Colorectal Cancer)

Question 16

Alternate bowel habits with pencil thin stools, diagnosis?, what is the next best step?

Answer 16

Colon cancer. Start with colonoscopy

Question 17

Colon cancer and Brain tumor, diagnosis?

Answer 17

Turcot’s syndrome

Question 18

Colon cancer and jaw bone cancer, diagnosis?

Answer 18

Gardner’s syndrome

Question 19

When does colon cancer screening start?

Answer 19

Everyone starting at 50 years of age, or 10 years from diagnosis of any first degree relative

Question 20

Familial Adenomatous Polyposis progression? Treatment?

Answer 20

1000’s of polyps at 18, cancer at 28, dead at 38. Treat with prophylactic colectomy.

Question 21

Iron deficiency in a man or post-menopausal woman, diagnosis and next step?

Answer 21

Colon cancer, start with colonoscopy

Question 22

Picture of pigmented dots ion their lips and vignette is about colon cancer, what’s the diagnosis?

Answer 22

Peutz-Jegherz

Question 23

What are the screening options for colon cancer?

Answer 23

• Colonoscopy every 10 years
• FOBT every year
• FOBT + Sigmoidoscopy every 3 years and 5 years respectively

Question 24

Bloody diarrhea and weight loss in a young man, diagnosis?

Answer 24

Ulcerative colitis

Question 25

Continuous lesions, crypt abscesses, diagnosis?

Answer 25

Ulcerative colitis

Question 26

How do you treat a Crohn's flare?

Answer 26

Steroids

Question 27

How do you treat severe refractory Crohn's?

Answer 27

Rituximab

Question 28

How do you treat severe refractory Ulcerative Colitis?

Answer 28

Colectomy

Question 29

Skipped lesions, transmural inflammation, and non-caseating granulomas, diagnosis?

Answer 29

Crohn's Disease

Question 30

Watery diarrhea, weight loss, fistula formation, diagnosis?

Answer 30

Crohn's Disease

Question 31

What is special about Rectal Ulcerative Colitis?

Answer 31

No risk of colon cancer, so it doesn't need the screening colonoscopy or colectomy

Question 32

When do you start colon cancer screening for Ulcerative Colitis?

Answer 32

8 years from diagnosis