UWORLD GI

Question 1

massive increase in AST/ALT with modest increase in bili + alkphos

Answer 1

ischemic hepatic injury (i.e. “shock liver” from septic shock)

Question 2

In management of cirrhotic patient, always check for…

Answer 2

VARICES

it’s a common and potentially deadly complication

Question 3

jaundice, anorexia, fever, RUQ pain, tender hepatomegaly, AST=2xALT

Answer 3

alcoholic hepatitis

Question 4

hematemesis + aspirin/cocaine/alcohol

Answer 4

acute erosive gastropathy

if hx doesn’t mention FREQUENT VOMITING, probably not MW tear

Question 5

pleural effusion (usu. left), acute chest pain, tachypnea, post EGD, subacute emphysema and suprasternal crepitus
DX, how to dx, AND TREATMENT

Answer 5

esophageal rupture

diagnose with contrast esophagram, treat with surgery and drainage of mediastinum

Question 6

how to dx Zenker’s diverticulum?

Answer 6

contrast esophagram

Question 7

calcified rim of gallbladder on CT

Answer 7

porcelain gallbladder (usu. from chronic cholestasis)
associated with gallbladder carcinoma

Question 8

difficulty initiating swalling + cough/choking + nasal regurgitation + aspiration pneumonia

Answer 8

oropharyngeal dysphagia,

dx with videofluorescent barium swallow

Question 9

multiple liver lesions vs single liver lesions

Answer 9

metastases (usu. colon) -> multiple

HCC (single lesion) , dx with AFP

Question 10

feared complication of acetominophen toxicity + treatment

Answer 10

acute liver failure = transaminases (>1000), hepatic encephalopathy, decreased liver synthesis, treat with transplant

Question 11

elevated alk phos, normal RUQ, normal transaminases

positive AMA, diagnosis and treatment?

Answer 11

PBC, treat with ursodoxycholic acid and possibly liver transplant

Question 12

UGIB + HDS + Hgb<7 (what to do)?

Answer 12

transfuse pRBCs, not whole blood or FFP

Question 13

fever + jaundice + RUQ pain? dx, imaging, treatment?

Answer 13

CHARCOT’S triad
acute cholangitis
dx with u/s, CT abd - will show CBD dilation
treat with abx w/ ERCP with drainage/relief of obstruction

Question 14

burning, localized pain + regional hyperesthesia/allodynia esp after physical stress (i.e. chemo)

Answer 14

herpes zoster (shingles)

Question 15

how to dx pancreatic cancer (STEPS)

Answer 15

US, CT, CA 19-9/ERCP

Question 16

common association of non-met gastric MALT lymphoma and how to treat?

Answer 16

h pylori!

treat with triple therapy

Question 17

Increased risk of what 3 cancers in lynch syndrome?

Answer 17

• colon
• ovarian
• endometrial

Question 18

acute pancreatitis + yellow/red papules on skin

Answer 18

hypertriglyceridemia

Question 19

intermittent increase in transaminasess + porphyria tarda (vesicles/erosions on dorsum of hand)

Answer 19

essential mixed cryoglobulinemia (assoc with hepC)

Question 20

abd distension + fever + leukocytosis + hypotension + tachycardia (how to dx and often first presentation of what?)

Answer 20

toxic megacolon

dx with abdominal x-ray; often 1st presentation of IBD

Question 21

complications of PBC

Answer 21

increased risk HCC
severe HLD (xanthelesma)
fat malabsorption
metabolic bone disease (osteoporosis/malacia)

Question 22

another name of Wilson’s disease

Answer 22

hepatolenticular degeneration

Question 23

abdominal pain + microcytic anemia + positive FOBT + hard/firm hepatomegaly

Answer 23

GI malignancy (MCC site of mets to liver)

Question 24

chronic abdominal pain + elevated ESR + anemia + water diarrhea + weight loss + mouth ulcers

Answer 24

Crohn’s disease

Question 25

What features does Chron's have that UC doesn't

Answer 25

- noncaseating granulomas on biopsy - skip lesions (rectal sparing) - fistula formation - transmural inflammation/cobblestoning

Question 26

What two markers are most useful in dx ACUTE hep B

Answer 26

HbsAG and IGM antiHBc | both will remain elevated during window period (anti HbS happens after window period)

Question 27

multiple refractory peptic ulcers (usu. distal to duodenum), chronic diarrhea with bloody and fatty...dx and work up

Answer 27

Zollinger ellison syndrome (fatty diarrhea due to inactivation of pancreatic enzymes due to excess stomach acid)...dx with endoscopy and somatostatin receptor scintigraphy to look for tumor...gastrin level >1000 diagnostic

Question 28

After positive finding for gastric adenocarcinoma on biopsy, what to do next?

Answer 28

CT abdomen for staging...then PET/CT/laparoscopy to determine if resectable or chemo

Question 29

pharmacologic rx for bleeding varices vs non bleeding varices (esophageal(

Answer 29

bleeding - octreotide + abx | non-bleeding - control BP with BETA BLOCKERS

Question 30

first line treatment for diffuse esophageal spasm

Answer 30

CCBs

Question 31

LLQ pain, leukocytosis, fevers/v/v, hx of chronic constipation, urinary frequency...dx and best test

Answer 31

acute diverticulitis, CONTRAST CT ABDOMEN | treat with cipro/metro

Question 32

pica (craving for nonedible objects) is usually associated with...

Answer 32

iron deficiency anemia...check for GI bleed

Question 33

sudden onset epigastric pain, nausea/vomiting, negative murphy sign, no abdominal tenderness on exam...what test to order first

Answer 33

ECG NIGGA | rule out ACS first

Question 34

bulky foul smelling stools, weight loss, occasional joint pains, loss of muscle mass/weight loss, iron def anemia, villous atrophy on biopsy, positive tissue transglut OR NEGATIVE WATCH OUT

Answer 34

celiac

Question 35

bulky foul smelling stools, weight loss, occasional joint pain, generalized lymphadenopathy, fever, skinhyperpigmentation, diastolic murmur in aortic area, PAS POSITIVE materials in lamina propria

Answer 35

whipple disease

Question 36

multiple stomach ulcers (even in the jejunum), thickened gastric folds, diarrhea...what to do next

Answer 36

check gastrin for gastrinoma (ZE snydrome)

Question 37

lab findings in lactose intolerance

Answer 37

increased stool osmolar gap, low stool pH, positive hydrogen breath test

Question 38

positive urobilinogen in urine | positive bilirubin in urine

Answer 38

uro - unconj = intravascular hemolysis bili - conjugated = defect in hepatic secretion of bili (Rotor's syndrome if LFTs are normal)

Question 39

carcinoid syndrome is linked to what vitamin deficiency

Answer 39

pellagra NIACIN....dermatitis, diarrhea, dementia linked with serotonin metabolism