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PANCE_GI/nutrition 9% Flashcards

1
Q

(CME)
“A 60 y/o male with a 20 yr hx of ETOH abuse presents with complaints of vomitus containing significant frank blood. This retching has occurred twice in two days. What is the likely diagnosis?
a) infectious esophagitis
b) Mallory-Weiss syndrome
c) scleroderma
d) Zenker’s diverticulum
e) esophageal cancer”

A

B) MALLORY-WEISS SYNDROME

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2
Q

(CME)
“What is the best diagnostic test for Zollinger-Ellison syndrome?
f) u/s
g) sniff test
h) CBC/electrolytes
i) urease testing for H. pylori
j) gastrin level”

A

G) GASTRIN LEVEL

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3
Q

(CME)
“A 29 y/o female complains of dysphagia to both solids and liquids and nocturnal cough. Barium swallow reveals delayed esophageal emptying and a bird’s beak deformity. What is the diagnosis?
a) GERD
b) esophageal carcinoma
c) achalasia
d) Boerhaave’s syndrome
e) esophageal webs”

A

C) ACHALASIA

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4
Q

(CME)
“Meckel’s Divericulum is a congenital condition of the alimentary canal. Near which anatomic site would you find this deformity?
f) cardiac sphincter
g) splenic flexure
h) ileocecal juncture
i) proximal duodenum
j) pyloric sphincter”

A

H) ILEOCECAL JUNCTURE

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5
Q

(CME)
“which of the following is LEAST likely to be associated with gastroparesis?
a) hyperthyroidism
b) diabetes mellitus
c) scleroderma
d) hydroxymorphone
e) metoclopramide”

A

A) HYPERTHYROIDISM

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6
Q

(CME)
list 6 RF for gastroparesis

A

DM
scleroderma
hypothyroidism
Parkinson’s disease
opioids
anticholinergic agents

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7
Q

(CME)
s/s of gastroparesis

A

n/v
feeling full soon after beginning to eat
abd bloating/pain
heartburn

(this was Q on NCCPA practice exam)

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8
Q

(CME)
define gastroparesis

A

“delayed gastric emptying w/ weak muscular contractions not caused by an obstruction”

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9
Q

(CME)
what prokinetic agents are used in treatment of gastroparesis? what are the two other treatments for gastroparesis?

A

metoclopramide (Reglan)
domperidone
erythromycin
- - - - - -
treat cause
dietary modifications (sm meals, low fiber diet)

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10
Q

“Which of the following should a pt with celiac sprue NOT eat?
f) oats
g) corn
h) rice
i) arrowroot
j) potatoes”

A

F) OATS

foods not allowed:
WORMs & Bees:
Wheat
Oats
Rye
MaltS
& Barley

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11
Q

(CME)
“What is a pt considered if they are serologically positive for ONLY anti-HBs?
a) vaccinated status
b) active immunity status
c) chronic and active status
d) chronic and infectious status”

A

A) VACCINATED STATUS

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12
Q

(CME)
“a healthy 30 yr woman who has not been vaccinated has been exposed to Hep A. Which of the following should she do according to CDC guidelines?
f) receive one prophylactic dose of vaccine as soon as possible within two weeks of exposure
g) receive two doses with one dose now and one in 2 months
h) receive one dose of immune globulin only
i) receive immune globulin + one dose of vaccine in four weeks
j) do nothing - it’s a mild disease”

A

F) RECEIVE ONE PROPHYLACTICE DOSE OF VACCINE AS SOON AS POSSIBLE WITHIN TWO WEEKS OF EXPOSURE

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13
Q

(CME)
treatment for Hep A

A

“supportive, postexposure prophylaxis”

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14
Q

(didactic module, Taggart)
how long does recovery take for Hep A?

A

majority make complete recovery in 2-3 months, may take up to 6-9 months

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15
Q

(didactic module, Taggart)
treatment for Hep A

A

supportive

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16
Q

(didactic module, Taggart)
s/s of Hep A

A

1st: abrupt onset of fever, anorexia, malaise, abd pain, diarrhea
then –> dark urine and pale stools
finally - jaundice and pruritis
PE: jaundice, scleral icterus, hepatomegaly, RUQ tenderness to palpation

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17
Q

(didactic module, Taggart)
lab findings for Hep A

A

ALT>AST
both >1,000 IU/dL

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18
Q

(CME)
“what is the leading cause of ascites in the US?
a) chronic pancreatitis
b) chronic hemodialysis
c) fulminant hepatitis
d) portal hypertension due to CHF
e) cirrhosis of the liver”

A

E) CIRRHOSIS OF THE LIVER

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19
Q

(CME)
“which serum tumor marker is most closely associated with hepatocellular carcinoma?
f) alpha fetoprotein (AFP)
g) CA 125
h) carcinoembryonic antigen (CEA)
i) human chorionic gonadotropin (HCG)
j) prostate specific antigen (PSA)”

A

F) ALPHA FETOPROTEIN (AFP)

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20
Q

(CME)
“which bilirubin level is most likely to be the highest in patients with biliary obstruction?
a) conjugated bilirubin
b) unconjugated bilirubin”

A

A) CONJUGATED BILIRUBIN

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21
Q

(CME)
“A 75 y/o male presents with confusion, decreased reflexes, edema and tachycardia. To which nutritional deficiency is this condition most attributed?
f) Vit B3
g) Vit B1
h) Vit A
i) Vit B6
j) Vit C”

A

G) VITAMIN B1

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22
Q

(NCCPA Practice Exam)
“A 24 y/o woman who is a marathon runner comes to the office because she has had severe HA during the past 3 wks. She says the pain usually begins upon awakening each a.m. The pt is otherwise healthy and takes no medications other than daily megavitamins. V/S are WNL, and PE shows no abnormalities. Ophthalmologic exam shows papilledema. The most likely dx is toxicity of which of the following vitamins?
a) A
b) B3
c) D
d) E
e) K”

A

A) VITAMIN A

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23
Q

(CME)
what vitamin deficiency is a common cause of blindness?

A

VITAMIN A DEFICIENCY

common cause of blindness, usually starts with night blindness

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24
Q

(CME)
What vitamin deficiencies are connected to poor wound healing?

A

Vitamin A
and
Vitamin C

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25
Q

(CME)
symptoms of Vit A toxicity

A

dry scaly skin
hair loss
hepatomegaly
HA
papilledema
vomiting

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26
Q

(RR)
six RF for acute cholecystitis

A

FAMILY HX (I missed this)
old age
obesity
F>M
multiparity
rapid wt loss

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27
Q

(RR)
two imaging modalities for diagnosis of cholecystitis

A

initial: U/S

gold std: HIDA

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28
Q

(RR)
is cholecystitis pain steady/constant or intermittent?

A

it’s steady

also, located in RUQ or epigastric area

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29
Q

(RR)
“what is MC type of gallstone?”

A

“cholesterol gallstone”

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30
Q

(RR)
what area of the intestine is most likely to suffer ischemia leading to ischemic colitis?

A

the SPLENIC FLEXURE

This area of the large intestine is prone to ischemia due to the marginal artery of Drummond-artery’s small caliber and potential lack of vasa recta along this portion of the colon

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31
Q

(RR)
what arteries supply the splenic flexure of the large intestine?

A

this is the SUPERIOR and INFERIOR MESENTERIC ARTERY watershed area

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32
Q

(RR)
what arteries supply the sigmoid colon area?

A

the INFERIOR MESENTERIC and HYPOGASTRIC ARTERY watershed

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33
Q

(RR)
“Why do patients with right-sided colonic ischemia have a higher rate of mortality and surgical intervention?”

A

“This more likely involves the superior mesenteric arteries which also supply the small intestine and cause widespread intestinal ischemia.”

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34
Q

(RR)
common PE presentation of ischemic colitis -

A

abdominal pain out of proportion to the PE

hematochezia

tenesmus

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35
Q

(RR)
common lab presentation of ischemic colitis -

A

increased serum lactate
LDH
creatine phosphokinase
amylase levels

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36
Q

(RR)
what does CT imaging show for ischemic colitis?

A

bowel wall edema

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37
Q

(RR)
how do we treat ischemic colitis?

A

“most cases resolve with supportive care”

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38
Q

(RR)
pathogenesis of duodenal ulcer

A

inhibition of cyclooxygenase-1 leading to prostaglandin deficiency

(prostaglandins protect gastric and duodenal mucosa and are synthesized by enzyme cyclooxygenase (COX))

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39
Q

(RR)
where do COX-1 and COX-2 have effects (in general)?

A

GI mucosa
kidney
CV

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40
Q

(RR)
where do COX-1 and COX-2 have effects, specifically?

A

GI mucosa: COX-1
kidney: COX - 1 & 2
CV: COX - 1 & 2

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41
Q

(RR)
“Which NSAID is a selective cyclooxygenase-2 (COX-2) inhibitor?”

A

Celecoxib

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42
Q

(RR)
what cholescintigraphy findings are diagnostic of acute cholecystitis?

A

“NONVISUALIZATION OF THE GALLBLADDER ON DELAYED IMAGES”

(if not visualized within 4 hours, the duct is likely obstructed)

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43
Q

(RR)
what cholescintigraphy findings indicate no disease?

A

gallbladder visualized within 1 hour after injection of radioactive tracer

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44
Q

(RR) BUZZWORDS
foul-smelling, watery diarrhea and abdominal cramping following pneumonia tx

A

think C. diff

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45
Q

(RR)
what is the treatment of choice for children with C. diff?

A

ORAL VANC or ORAL METRONIDAZOLE

“The treatment of choice for mild-to-moderate C.difficile infection in children is oral vancomycin, an alternative is oral metronidazole, however oral vancomycin is more effective.”

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46
Q

(RR)
what is the treatment of choice for adults with C.diff?

A

nonsevere or severe: ORAL VANC or ORAL FIDAXOMICIN

fulminant: ORAL VANC with PARENTERAL METRONIDAZOLE

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47
Q

(RR)
what strange thing do we do for pts with at least two C. Diff infection recurrences treated with appropriate abx?

A

fecal transplant

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48
Q

(RR)
MC cause of impacted esophageal food boluses

A

Schatzki rings

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49
Q

(RR)
what are Schatzki rings?

A

fibrous structures found in 15% of the population

    • associated with hiatal hernia
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50
Q

(RR)
“What medication may be used to facilitate passage of a lower esophageal foreign body prior to endoscopy?”

A

glucagon

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51
Q

(RR) BUZZWORDS

AST>ALT
2:1

A

alcoholic hepatitis

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52
Q

(RR)
“What is the difference between unconjugated and conjugated bilirubin?”

A

“Unconjugated bilirubin is unable to be excreted in the bile and rises in cases of hemolysis and liver disease.

Conjugated bilirubin is excreted into the bile and rises in cases of biliary obstruction.”

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53
Q

(RR)
treatment for alcoholic hepatitis

A

supportive

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54
Q

(RR)
“How does the presentation of abd pain differ in pts of advanced age?”

A

“more likely to need an emergent surgical procedure”

(NOT “more likely to present with an elevated WBC”)

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55
Q

(RR)
three statistics about abd pain for older population

A

50% are admitted
33% have surgery
10% mortality

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56
Q

(RR)
what arteries are most likely involved in an infarct of the descending colon and recto-sigmoid junction?

A

INFERIOR mesenteric artery

“The left “half” of the large intestine, sigmoid colon and rectum are supplied by the inferior mesenteric artery”

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57
Q

(RR)
“small intestine infarction usually occurs from which etiologies?”

A

“Superior mesenteric arterial embolism or thrombosis, and abdominal venous thrombosis.”

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58
Q

(RR)
“sudden onset left-sided abdominal pain and bloody diarrhea. Abdominal CT demonstrates thickening of the bowel wall and free peritoneal fluid. What is the most likely diagnosis?”

A

ICHEMIC COLITIS

key finding = CT imaging of bowel wall edema

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59
Q

(RR)
what is the treatment for ischemic colitis?

A

“most cases resolve with supportive care”

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60
Q

(RR)
“When evaluating for ischemic colitis, in what condition should a colonoscopy not be performed?”

A

“acute peritonitis”

61
Q

(RR)
Charcot triad for acute cholangitis….what do we add for Reynolds pentad?

A

fever or chills
RUQ pain
jaundice

add AMS
and
hypOtension

62
Q

(RR)
acute (ascending) cholangitis is a biliary tract infection due to obstruction of what duct?

A

COMMON BILE DUCT

63
Q

(RR)
acute (ascending) cholangitis is a biliary tract infection due to obstruction of what duct?

A

COMMON BILE DUCT(RR)

64
Q

(RR)
treatment for acute ascending cholangitis

A

broad-spectrum antibiotics such as piperacillin-tazobactam

maybe “ drainage of the biliary ducts via ERCP.”

65
Q

(RR)
dx of acute cholangitis usually made by?

A

RUQ u/s
CT scan
or
ERCP

66
Q

(RR)
MC cause of acute cholangitis

A

choledocholithiasis that leads to bac infection (E. coli)

67
Q

(RR)
a pt presnts with abd cramping, nonbloody diarrhea, wt loss (no travel or recent abx use or consumption of well water)…also has a pruritic rash, vesicular in nature….what are you thinking for dx?

A

CELIAC DISEASE (not Crohn’s)

this rash is “dermatitis herpetiformis”

“Rare cutaneous malformations such as erythema nodosum and pyoderma gangrenosum are some of the extraintestinal manifestions of Crohn’s however these do not have the same presentation of the rash that is seen in celiac disease. “

68
Q

(RR)
diagnosis for celiac disease

A

made by SMALL BOWEL BIOPSY (duodenal villous atrophy seen on endoscopy)

69
Q

(RR)
multiple, small ulcers in the distal esophagus

A

HSV infectious esophagitis

“HSV ulcers are well-circumscribed and usually less than 2 cm in diameter.” “CMV ulcers tend to be linear and deeper”

70
Q

(RR)
three types of infectious esophagitis and the treatment of each

A

candida: fluconazole
CMV: ganciclovir
HSV: acyclovir

71
Q

(RR)
MC cause of traveler’s diarrhea

A

ETEC

72
Q

(RR)
five common causes for traveler’s diarrhea

A

E. coli
Shigella
Campylobacter
norovirus
rotavirus

73
Q

(RR)
first line treatment for traveler’s diarrhea in pregnant women and children

A

azithromycin

74
Q

(RR)
abrupt onset of watery diarrhea, nausea, abd cramping

A

think traveler’s diarrhea

replace fluids

azithromycin, cipro, rifaximin only in severe disease

75
Q

(RR)
MC type of gastric carcionma

A

adenocarcinoma

76
Q

(RR)
MC RF for gastric carcinoma

A

H. pylori

77
Q

(RR)
“What tumor marker is increased in about 50 percent of individuals with gastric cancer?”

A

CEA
(carcinoembryonic antigen)

78
Q

(RR)
what is this:
“Endoscopic findings typically show stacked circular rings that can be transient or fixed along with white nodules with granularity.”

A

eosinophilic esophagitis

79
Q

(RR)
worsening vision in dim or dark environments
bilaterally dry conjunctivae with small white patches
diffusely dry skin

what is wrong?

A

Vitamin A deficiency

80
Q

(RR)
“A 77-year-old man presents to his primary care provider with progressive jaundice for the past 2 weeks. He also reports a 15 lb unintentional weight loss. The man has a 50 pack-year smoking history. On physical exam, jaundice and hepatomegaly are noted. Additionally, his gallbladder is able to be palpated but is nontender.” What is most likely diagnosis?

A

PANCREATIC CANCER

81
Q

(RR)
MC presenting symptoms of pancreatic cancer

A

pain
progressive PAINLESS jaundice
wt loss

(jaundice is 2/2 obstruction of the CBD by a mass in the head of the pancreas)

82
Q

(RR)
what is Courvoisier sign?

A

palpable, nontender gallblader

(an infrequent finding of pancreatic cancer)

83
Q

(RR)
diagnosis of pancreatic cancer is usually made via

A

u/s
ERCP or MRCP
CT
endoscopic u/s (RR lists all four, equally (?))

84
Q

(RR)
preferred diagnostic testing (when indicated) for GERD

A

EGD (aka “upper endoscopy”)

85
Q

(RR)
“Which medications are the most powerful agents used in the treatment of gastroesophageal reflux disease?

A

PPIs

86
Q

(RR)
treatment options/progression for GERD

A

first - lifestyle modifications

“H2 receptor antagonists for mild or intermittent symptoms,

PPIs (most effective) for frequent (two or more times weekly) or debilitating symptoms

87
Q

(RR)
Intussusception in adults is _____ but when present, involves the _______________________.

A

RARE

SMALL BOWEL IN 80% OF CASES

“Intussusception in adults is rare but when present, involves the small bowel in 80% of cases.”

88
Q

(RR) BUZZWORDS
ultrasound target sign

A

intussusception

89
Q

(RR)
treatment MC appropriate for intussusception

A

air or hydrostatic (contrast or saline) enema

90
Q

(RR)
radiologically, where do Zenker diverticula usually appear?

A

ABOVE THE CRICOPHARYNGEAL MUSCLE

91
Q

(RR)
anatomically, where do Zenker diverticula occur?

A

Killian triangle

(“a weak point defined on the sides by the bilateral inferior pharyngeal constrictor muscles and at the base by the cricopharyngeal muscle, which comprises a vital part of the upper esophageal sphincter”)

92
Q

(RR)
“What diagnostic test, besides esophagogram, can identify motility disorders of the esophagus?”

A

“manometry”

93
Q

(RR)
If a patient’s laboratory testing reveals iron deficiency anemia, elevated stool osmotic gap and positive anti-endomysial antibodies

A

celiac disease

“These altered intestinal mechanics lead to malabsorption, which may lead to osteoporosis, iron deficiency anemia, and elevated liver enzymes, as well as a high stool osmotic gap. Diagnosis requires a serologic search for specific markers, namely anti-endomysial and anti-tissue transglutaminase antibodies”

IgA EMA and anti-tTG

94
Q

(RR)
“What are some complications of celiac disease if left untreated?”

A

T-cell lymphoma and sm intestine adenocarcinoma

95
Q

(RR)
“Which of the following describes the most common presentation of an acute bowel obstruction?
a) Colicky abdominal pain, distention, and emesis
b) Fever, crampy abdominal pain, nausea, vomiting, and diarrhea
c) Nausea, anorexia, and pain in the right lower quadrant
d) Watery diarrhea with diffuse abdominal pain and weight loss

A

A) COLICKY ABD PAIN, DISTENTION, AND EMESIS

96
Q

(RR)
Xray findings of small bowel obstruction

A

dilated bowel,
air-fluid levels,
stack of coins, or
string of pearls sign

97
Q

(RR)
MC causes of sm bowel obstruction

A

post op adhesions (60%)
hernia
malignancy
Crohn’s
radiotherapy

98
Q

(RR)
“venom from which organisms can cuse pancreatitis?”

A

brown recluse spiders
scorpions
Gila monster lizard

99
Q

(RR)
causes of acute pancreatitis, in descending order of commonality

A

gallstones > ETOH

then hypertriglyceridemia
or
drugs

100
Q

(RR)
at what level of total bilirubin does someone begin to appear jaundiced?

A

5 mg/dL

101
Q

(RR)
what is the MC cause of significant lower GI bleeding?

A

divericulosis

102
Q

(RR)
systemic s/s are more common than with ulcerative colitis….what is this?

A

Crohn’s

103
Q

(RR)
ASCA positive, pANCA negative…think…

A

Crohn’s

104
Q

(RR)
two lab findings of Crohn’s

A

ASCA positive

pANCA negative

105
Q

(RR)
what should you do if you discover a lateral anal fissure?

A

look for pathologic etiologies such as
Crohn disease
malignancy
communicable disease
other granulomatous disease

106
Q

(RR)
“what is the MC adverse effect of nitroglycerin ointment?”

A

HA

107
Q

(RR)
“where in the esophagus do most iatrogenic injuries occur?”

A

“pharyngoesophageal junction b/c the wall is thinnest in this area”

108
Q

(RR)
a loss of esophageal wall ganglion cells resulting in failure of LES relaxation which leads to obstruction

A

achalasia

109
Q

(RR)
hallmark of achalasia

A

progressive solid and liquid dysphagia

(with commonly associated symptoms of regurgitation, CP, dyspepsia)

110
Q

(RR)
how is dx made for suspected achalasia

A

esophageal manometry (increased LES pressure findings)

111
Q

(RR)
“what are the MC presenting signs of colorectal cancer?”

A

R-sided colon CA: presents w/ bleeding ranging from a positive fecal occult blood test to HEMATOCHEZIA

L-sided colon CA: presents w/ changes in bowel habits

112
Q

(RR)
what percentage of pts with cholelithiasis will develop acute cholecystitis?

A

~20%

113
Q

(RR)
“in which organ is 90% of the body’s vitamin A stored?”

A

“the liver”

114
Q

(RR)
“MC cause of intussusception in adults”

A

65% of adult cases are due to tumors (either benign or malignant)

115
Q

(RR)
name a GI reason for worsening hepatic encephalopathy

A

constipation due to an increase in intestinal ammonia production and subsequent absorption

116
Q

(RR)
what’s an electrolyte reason for worsening (hepatic?) encephalopathy?

A

hypokalemia

“With decreased serum potassium and the alkalosis that may be associated with this, there is increased conversion of NH4+ to NH3 leading to increased serum levels of ammonia”

117
Q

(RR)
“ In addition to lactulose, what is another treatment for hepatic encephalopathy?”

A

rifaximin
neomycin

118
Q

(RR)
“what is the MC cause of rectal bleeding in an adult?”

A

hemorrhoids

119
Q

(RR)
“What is the most common cause of nonvariceal upper GI bleeding?”

A

PUD

120
Q

(RR)
define encopresis

A

fecal incontinence, involuntarily passing stool in underwear in children 4 yrs or under w/o underlying neuromuscular anorectal dysfunction, classified as retentive or nonretetentive

121
Q

which type of encopresis in children is most common?

A

80% of children have RETENTIVE encopresis, associated w/ functional constipation.

122
Q

(RR)
if hard stool is present in a child with encopresis, what is the cause of the chronic fecal soiling?

A

OVERFLOW OF LOOSE STOOL

123
Q

(RR)
What is the management of postop ileus?

A

“The management of postoperative ileus consists of BOWEL REST, SUPPORTIVE CARE, and SERIAL ABDOMINAL EXAMINATIONS”

124
Q

(RR)
What is most appropriate pharmacotherapy for external hemorrhoids?

A

“A short course of a topical steroid cream (e.g. hydrocortisone) or suppositories used twice daily has been shown to improve pain and diminish swelling associated with external hemorrhoids”

125
Q

(RR)
If a GERD pt is on a PPI, and symptoms do not resolve, what is the next step in treatment?

A

increase the PPI to twice daily (after trying one dose for 2 mo.)

2nd dose - 30 minutes before evening meal, avoid laying down for 3 hours

126
Q

(RR)
where is an esophageal cancer mass most likely located if the integrity of the RLNs are affected?

A

upper 2/3 of esophagus

127
Q

(RR)
“What portion of the esophagus is adenocarcinoma most likely to involve?”

A

“distal third”

128
Q

(RR)
“what lab results point to an acute Hep A infection?”

A

anti-hepatitis A virus IgM positive

129
Q

(RR)
“what are the most important markers of impaired liver function?”

A

altered synthetic function
decreased SERUM ALBUMIN and ELEVATED PROTHROMBIN TIME

130
Q

(RR)
“You diagnose a 43-year-old man with alcohol withdrawal. Lab results reveal a hemoglobin of 12 g/dL and an MCV of 115 fL” What is the most likely cause of these findings?”

A

direct ethanol toxicity

“the most likely cause of macrocytic anemia is due to direct ethanol toxicity. Macrocytosis is present in the majority of patients with heavy alcohol use even before significant anemia appears.”

131
Q

(RR)
if a pt has recurrent postprandial abd pain, n/v/d, “food fear” and subsequent wt loss w/ a hx of cardiac disease or AFib and an abdominal bruit, think about what dx?

A

chronic mesenteric ischemia
(aka “intestinal angina”)

132
Q

(RR)
After pts with bleeding esophageal varices are initially stablized, what should be administered next?

A

vasoactive substances such as octreotide, somatostatin, terlipressin…to reduce splenic and hepatic blood flow and portal venous pressures

133
Q

(RR)
three common causes for esophageal varices

A

portal hypertension
hx of chronic liver disease or
alcohol use

134
Q

(RR)
what are the chronic GERD cellular changes that lead to Barrett esophagus?

A

“Chronic GERD changes the cellular makeup of the distal esophagus from stratified squamous epithelium to columnar-lined epithelium with goblet cells and is diagnosed via endoscopy with biopsy.

Goblet cells represent intestinal metaplasia and are not typically seen in distal esophagus”

135
Q

(RR)
25 y/o F presents after being diagnosed with Lynch syndrome. She has a germline mutation in the MSH2 DNA mismatch repair gene, and her mother was diagnosed with colon cancer at 43 years of age. What is her recommended colorectal screening approach?

A

annual colonoscopy starting immediately

Lynch Syndrome –> Hereditary NonPolyposis Colorectal Cancer (HNPCC)

136
Q

(RR)
if a pt presents w/ s/s of ascites, what is the first step in dx?

A

abdominal u/s to confirm the presence of ascites and look for evidence of cirrhosis or malignancy

137
Q

(RR)
what lymph nodes are most likely to reveal malignant cells for gastric carcinoma?

A

supraclavicular nodes

“Supraclavicular lymphadenopathy suggests cancer in the chest or abdomen”

138
Q

(RR)
how should suspected pancreatitis be confirmed (imaging)?

A

” Confirmation should be obtained with an ultrasound of the right upper quadrant focused on the liver, gall bladder, and biliary tree.”

139
Q

(RR)
“Which of the following represents appropriate management of a thrombosed external hemorrhoid in the acute 48-hour setting?

a) excision
b) reduction
c) Sitz baths
d) surgery referral

A

A) EXCISION

“Thrombosed external hemorrhoids presenting within 48 - 72 hours of symptom onset should be excised”

“…by complete evacuation of the clot. Failure to fully remove the clot results in rebleeding, swelling, and skin tag formation. If the thrombosed external hemorrhoid is not excised, it will go on to ulcerate over the next several days.”

140
Q

(CME)
“A 9 mo old boy comes to the ER w/ acute spasms of abd pain followed by vomiting and diarrhea containing blood and mucus. On exam the abd is distended w/ a small mass in the LLQ. What is the recommended tx?”

A

“BARIUM ENEMA”

141
Q

(CME)
“which of the following is best to eat if a patient has celiac disease?
- wheat
- rye
- arrowroot
- malt
- barley”

A

ARROWROOT

142
Q

(CME)
“which of the following organisms is LEAST likely to cause bloody diarrhea in severe infections?
- salmonella
- giardia
- shigella
- campylobacter
- E. coli - O157-H7”

A

GIARDIA

143
Q

(CME)
“which of the following is usually the first line treatment for a pt with hepatic encephalopathy?
- high-dose aspirin
- corticosteroids
- ceftriaxone
- metronidazole
- lactulose”

A

LACTULOSE

144
Q

(CME)
“Where is the gallstone usually located in a pt who has choledocholithiasis?
- cystic duct
- common bile duct
- common hepatic duct
- pancreatic duct”

A

COMMON BILE DUCT

145
Q

(NCCPA practice exam)
a 4 y/o boy swallowed a watch battery, has no pain, is not in distress…this child needs to go to the ER immediately b/c of risk of what?

A

burn of mucosal tissue

“Always remove button/disc batteries as soon as possible for their risk of causing corrosive burns or tissue damage to the GI tract (unless it has already passed the pylorus and is making swift progress through GI tract)” (SmartyPance)

146
Q

(RR)
“Carcinoid tumors are most likely to develop in which other organ system besides the pulmonary system?”

A

“these tumors tend to develop in the GI tract and produce similar symptoms of carcinoid syndrome”

147
Q

(RR)
how does carcinoid syndrome present?

A

skin flushing
wheezing
diarrhea

148
Q

(RR)
how is dx of carcinoid syndrome made?

A

24-hr excretion of 5-hydroxyindoleacetic acid (5-HIAA) in the pt’s urine

PANCE (13 decks)

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