third-MKSAP

Question 1

In a patient with hepatitis C, what indicates an ACTIVE infection?

Answer 1

Positive hep C RNA

Question 2

Is a___chance that the hep C virus will spontaneously resolve Within this ___time

Answer 2

20 to 50% chance
First 6 months(Keep monitoring hep C RNA during this time)

Question 3

When should you start treatment for hep C?

Answer 3

After 6 months when you have monitored during this time and it has not went away

Because there is a chance that hep C may spontaneously resolve within the first 6 months

Question 4

If patient has iron deficiency anemia, EGD/colonoscopy negative, what is the next diagnostic step?

Answer 4

Capsule endoscopy for small bowel bleed eval

Question 5

To evaluate for bowel bleed, CTA or tagged red cell scintigraphy or good options if there is___bleed

Answer 5

Active

Question 6

There is a gallstone polyp 5 mm in size in a patient with gallstones, management should be cholecystectomy versus repeat ultrasound/monitoring in 6 months or 12mo?

Answer 6

Cholecystectomy

Because even though gallstone polyp <1 cm, is associated alongside gallstones which increases the chances of malignancy

Question 7

Lifestyle modifications recommended for GERD

Answer 7

-If obese, lose weight
-Quit smoking
-Avoid late evening meals and eat 3 hours before bedtime
-Elevate head of bed
-Eliminate triggers if recognized i.e. alcohol, Tomato
-Avoid large meals

Question 8

In this patient you see Charcot’s triad and CBD obstruction with stone on ultrasound, what the next step?

Answer 8

Urgent ERCP, sphincterotomy and stone extraction

Obviously alongside antibiotics targeting and Enterobacter

Question 9

Gallbladder polyp size___is a risk factor for malignancy, and treatment is___

Answer 9

> 1 cm
Cholecystectomy

Question 10

Gallbladder polyps associated with___disease are likely to be malignant alongside___of ____size

Answer 10

Associated with PSC-primary sclerosing cholangitis
gallstones
Any size

Question 11

Discontinuing___helps with chronic pancreatitis pain

This is a substance

Answer 11

Tobacco

Question 12

Patient on aspirin for primary prevention now
Has a gastrointestinal bleed, at time of discharge aspirin should be___resumed/discontinued

Answer 12

Discontinued indefinitely

Question 13

Patient on aspirin for secondary Prevention now
Has a gastrointestinal bleed, at time of discharge aspirin should be___resumed/discontinued

Answer 13

Resumed as soon as bleeding has been controlled

Question 14

What is considered aspirin use for primary prevention?

Answer 14

-Aged 40-60 who have ASCVD risk of 10% or greater
- 40 or older with DM
- LDL>190

Question 15

What is considered aspirin use for Secondary prevention?

Answer 15

You have stroke or MI

Question 16

Antibody/serological test for celiac disease must occur while patient is___

Answer 16

Actually on a gluten diet

Being on a gluten-free diet can reduce sensitivity of the tissue transglutaminase IgA antibody test, Therefore place him back on a gluten diet and then test again 1 to 3 months in

Question 17

Normal CBD size

Answer 17

1.5-6-ish millimeter

Question 18

In a patient with gallstone pancreatitis where gallstone has passed, this cholecystectomy have to be done in hospital or upon follow-up?

Answer 18

Must be done before discharge

Question 19

___Pancreatic cystadenoma has malignant potential

Answer 19

Mucin producing cysts, including intraductal papillary mucinous neoplasm and mucinous cystic neoplasms

Question 20

___Pancreatic cystadenoma does not have malignant potential

Answer 20

Non mucin producing cysts

Likely serous cystadenoma-They look like lobulated bunch of grapes on imaging

Question 21

For Peutz-Jeghers syndrome, the presence of 2 out of 3 is a diagnostic criteria

Answer 21

-Peutz-Jeghers type hematoma polyps, in GI tract
-Multiple melanotic macules on mouth, buccal mucosa, nose, genitalia, eyes, fingers
-Family history of PJS

Question 22

What are some symptoms of eosinophilic esophagitis?

Answer 22

Dysphagia
Food bolus obstruction

Question 23

What is diagnosis criteria of the Eosinophilic esophagitis

Answer 23

-Esophageal biopsy with >15 Eosinophil counts
-No other causes of eosinophilia Of the esophagus
-Dysphagia

Question 24

What is the treatment of eosinophilic esophagitis?

Answer 24

-PPI
-Swallowed topical glucocorticoids like fluticasone, budesonide
-Biologics
-Endoscopic dilation

Question 25

What are other causes of eosinophilia of the esophagus?

Answer 25

GERD Hypereosinophilic syndrome Infections Autoimmune or connective tissue disorder Crohn's disease with esophageal involvement Drug hypersensitivity reaction

Question 26

What conditions are associated with eosinophilic esophagitis?

Answer 26

Atopy like asthma, rhinitis, dermatitis, Food allergies or seasonal allergies

Question 27

What is the surveillance for hepatitis C virus? What are you looking for?

Answer 27

Every 6 months of U/S, alpha-fetoprotein Hepatocellular carcinoma

Question 28

Pancreatic pseudocyst do not require drainage unless___and___

Answer 28

Pseudocyst becomes infected Patient is symptomatic

Question 29

Definition of pancreatic pseudocyst

Answer 29

Peripancreatic fluid collections that persist beyond 4 weeks And has no epithelial layer to the wall--made of fiber(the significance of this is NO epithelial layer means NO malignant potential)

Question 30

Name all 4 types of fluid collections that can be seen in acute pancreatitis

Answer 30

-Pancreatic pseudocyst -after4wk -Acute peripancreatic fluid collections -Acute necrotic collections -Walled off necrosis(Necrotic area liquefies, and becomes encapsulated within a well-defined wall surrounding the necrotic area)-after4wk

Question 31

Acute necrotic collections develop in___timeline of acute pancreatitis

Answer 31

Within first 4 weeks, Of acute pancreatitis

Question 32

Patient has Pancreatic pseudocyst with abdominal pain, what is the treatment?

Answer 32

Endoscopic drainage with FNA We are treating it only because it is symptomatic-Otherwise no intervention necessary

Question 33

Patient has walled off necrosis around pancreas, with the next step for treatment?

Answer 33

Cystogastrostomy and necrosectomy Definitely not endoscopic fine-needle aspiration!!!