GI 2

Question 1

Rx for Hep B?

Answer 1

Entecavir or Tenofovir

Question 2

Management of acute liver failure (Encephalopathy within 26 weeks of developing jaundice(symptoms of liver dz)?

Answer 2

Liver Transplantation

Question 3

Common causes of Hepatic Encephalopathy ?

Answer 3

GI bleeding, infection, Opiods/Benzos.

Question 4

Who requires SBP ppx with Cipro?

Answer 4

Pt who had it once before, low sodium, low protein, elevated Cr, Bili ( Evidence of worsening liver failure)

Question 5

Pt with liver dz who has a rise in Cr of atleast 0.3 or 50% from baseline within 48 hrs, bland urinalysis, negative Renal US.

Dx?
What medications to avoid?

Answer 5

Hepatorenal Syndrome

NSAIDs, ACE, ARBs

Question 6

Test to diagnosis Hepatopulmonary syndrome.

Pt presents with playtpnea, orthodeoxia, (hypoxemia in upright position) ?

Answer 6

Echo with agitated Saline (bubble study) to r/o cardiac shunt (ASD)

Question 7

Management of Hepatic Adenomas smaller than 5cm in size?

Answer 7

Discontinue OCP and follow up every 6 months

Question 8

Management of Amebic Liver Abscess ( Mexico) ?

Answer 8

Metronidazole and Paromoycin

Question 9

Treatment for Intrahepatic Cholestasis (pruritus and abnormal LFTs) of pregnancy?

Answer 9

Urosodexycholic Acid - the conditions improves 48 hrs after pregnancy

Question 10

Late in 3rd trimester women develops pruritus and erythematous plaques in distribution of striae?

Answer 10

Pruritic Urticarial Papules and Plaques of Pregnancy

Question 11

ED, Destructive Arthropathy, DM.
Dx?
Test?
Test to confirm?
Rx?

Answer 11

Hemochromatosis

Fasting Serum Transferrin Saturation

HFE gentotype to confirm

Rx with phelobotomy

Question 12

Positive ANA and Anti-Smooth Muscle antibody, Anti-Liver Kidney Anti-body, Anti-Liver-cytosol antibody.
Dx?
Rx?

Answer 12

Autoimmune hepatitis

Most pt have another autoimmune dz.

Prednisone and Azathiorine

Question 13

Women aged 40-60, Cholestatic Liver Pattern, Positive Anti-mitochondrial Antibody Titer.
Dx?
Test?
Rx?

Answer 13

PBC

ALP elevated 1.5 x normal with positive antibodies, Anti-mitochondria, sp100, gp210

Urosodeoxycholic acid

Question 14

Management of Intrahepatic Biliary Dilatation of PSC with bacterial cholangitis?

Answer 14

ERCP

Question 15

1. Initial Management of Acute Cholecystitis?
2. Next Step after initial management?
3. Rx for an Older Patient with Acute Cholecystitis who has Failed conservative therapy (Pain meds, IV fluids and Abx)?

Management of Acalculous cholecystitis?

Answer 15

1. IVF, Pain medication, Bowel Rest, Abx (Zosyn or Ceftriaxone + Metronidazole)
2. Laproscopic Cholecystectomy
3. Percutaneous Cholecystostomy.
   (Not a Candidate for Surgery)
4. Laproscopic Cholecystectomy

Question 16

Name that GI bleed:

1. Painless, self limited, massive hematochezia?
2. Chronic blood loss or acute painless hematochezia in older adult patient
3. Recent Colonic polypectomy
4. Evidence of vascular disease in an older adult pt, typical LLQ abdominal pain
5. Aortic Stenosis
6. Younger patient with hx of bloody diarrhea, tenesmus, abdominal pain and fever
7. Aortic aneurysm repair
8. Painless hematochezia in young patient and normal upper endoscopy and colonoscopy
9. Mucoutaneous telangiectasia

Answer 16

1. Diverticular bleeding
2. Colonic Tumor, polyp or angiodysplasia
3. Post-polypectomy
4. Ischemic Colitis
5. Angiodysplasia (Heyde Syndrome)
6. IBD
7. Aortoenteric fistula (UGI bleeding)
8. Meckel diverticulum
9. Hereditary hemorrhagic telangiectasia

Question 17

1. Management of Severe Acute Gallstone Pancreatitis or Cholangitis?
2. Management of Mild to Moderate gallstone pancreatitis?
3. Which liver function study is significant for an acute attack?
4. When is a CT-guided percutaneous aspiration done?
5. Management of Walled-off pancreatic necrosis?

Answer 17

1. ERCP THEN cholecystectomy to reduce risk of recurrence
2. Supportive care
   (IV fluids + pain management)
3. ALT > 150 U/L
4. Infected Pancreatic Necrosis
5. Observe

Question 18

For modest elevations in LFTs, what common disorders need to be excluded before NAFLD is diagnosed?

Answer 18

1. ETOH or metabolism related
2. Viral
3. Medication
4. Hemachromatosis

Question 19

What is the Next Step in Management for a patient with Anal Fissures with no improvement for > 8 weeks?

Answer 19

Colonoscopy to evaluate for Crohn Disease

Question 20

1. What study is important to do for Newly diagnosed Cirrhosis?
2. What study is important after diagnosis of ascites ?
3. What is the treatment for patients with Active Variceal Bleeding?

Answer 20

1. EGD to document Varices and Assess for risk of variceal hemorrhage
2. EGD
3. IVF (Hemodynamic Resuscitation)
4. Octreotide
5. Prophylatic Abx (Continued for 7 days despite cultures)
6. Endoscopic Therapy

Question 21

Pt reporting Recurrent Abdominal Discomfort of the last 2 years. Reports moderate epigastric discomfort that last 2-3 days. Reports he DRINKS 8-10 BEERs over the weekend and throughout the week. AXR shows Focal Calcifications. EGD shows Gastric Varices. Dx?

Answer 21

Splenic Vein thrombosis due to Chronic pancreatitis.

Question 22

Pt presenting with new onset Fever, Rash, B/L joint pains and Elevated AST (298) and ALT (355)

Answer 22

Acute Hep B infection ( serum sickness reaction).

Pt presents with rash and joint pains first for 2-3 weeks then the Icteric phase occurs.

Question 23

Ulcerative Colitis is associated with which Biliary Disease?

Which lab test helps to Confirm Diagnosis?

What imaging confirms diagnosis?

Answer 23

Primary Sclerosing Cholangitis. PSC

ALK Phos

MRCP or ERCP (done for patients or Cannot Tolerate MRCP or its done in Early Stages of Disease)

Question 24

HIV patient presenting with Fever, Retrosternal pain, Severe Odynophagia and no Thrush seen on Exam. What is the next step in management?

Answer 24

EGD to diagnosis for Ulcerative Esophagitis which is caused by Viral Infections (HSV and CMV.)

It is also important to r/o cancer due to level of severity with PAIN.

Question 25

Young woman presents with Rapid onset Abdominal Pain and Ascites. Dx? Test? Rx?

Answer 25

Budd-Chiari Syndrome (Hepatic Vein Thrombosis). US w/ Doppler flow or CT scan, MRA. Rx: Blood thinners and if needed Angioplasty, TIPS, Transplant.

Question 26

Rx of Metastatic Colon Cancer to liver?

Answer 26

Hemicolectomy and resection of liver masses followed by chemotherapy.

Question 27

1. Pt presents with abdominal pain, elevated AFP and 2cm mass on US. Next step in management? 2. How often should routine surveillance of Chronic Hep B and C and Cirrhotic patients should be?

Answer 27

1. MRI of liver (Helps to differentiate Malignant nodules from Regenerative nodules) 2. US very 6 months.

Question 28

Rx of PSC? Rx of PBC?

Answer 28

1. Liver Transplant 2. Ursodeoxycholic Acid

Question 29

Pt with Multiple Sexual Partners presents with Fever, Symmetric Polyathritis and Urticarial skin lesions for 1 week. LFTs are elevated. HIV negative. Dx? Test?

Answer 29

1. Acute Hepatitis B infection (Presents with Serum Sickness-like Syndrome). Test: Presence of Hep B Surface Antigen. - Rash and joint problems resolve after 2-3 weeks

Question 30

Pt with liver cirrhosis and progressive SOB. Pulse ox is 88% while sitting and supine is pulse ox is 93%. He has slight bluish discoloration of his toes and digits. What is the best test to diagnosis this condition?

Answer 30

Contrast Echocardiography (Bubble Study) with agitated saline(bubble study-bubbles show passage in pulmonary vasculature). He as orthodexia and platypnea due to hepatopulmonary syndrome. It is associated with portal HTN. These patients have IPVDs (intrapulmonary vascular dilatations) that can cause right to left shunting. Rx for this is liver transplant.

Question 31

56 yo M presents with 45 pack year smoking hx, Active Smoker. He presents wih abdominal pain , bloating, anorexia, jaundice and weightloss over 2 months. RUQ US shows no gallstones but dilated intrahepatic and extrahepatic biliary ducts. What is the next step in management?

Answer 31

Abdominal CT Scan- to Assess for pancreatic Malignancy. If choledocholithiasis was present then you would do ERCP.

Question 32

1. RUQ Pain, Jaundice, Ascites, Muscle weakness, Low albumin, Elevated INR, Increased WBC, Ferritin 1000, AST:ATL ratio >2. Dx? 2. RUQ Pain, Jaundice, AST and ALT > 1000. Dx?

Answer 32

1. Alcoholic Hepatitis 2. Tylenol Toxicity

Question 33

24 yo African American Man complains of abdominal pain while vacationing in the Mountains. 36 hrs after arrial He presents with Acute Upper Abdominal Pain and nausea. It is Sharp and Constant and increased by DEEP Inspiration. He also feels pain at TOP of his LEFT SHoulder. Dx? Rx?

Answer 33

Splenic Infarction in a patient with Sickle Cell Trait. Treatment is Supportive

Question 34

What is the difference between PBC and Autoimmune hepatitis in regards to LFTs and Antibodies?

Answer 34

PBC has predominant Elevation in ALKALINE Phosphatase. Anti-mitochondrial Antibodies can be present in PBC and Autoimmune, but Anti-Smooth Muscle Antibody is ONLY present in Auto-immune.

Question 35

Complications after Roux-en-Y: 1. Malabsorptive diarrhea with nutrient deficiencies, dehydration and weight-loss. 2. Nausea, vomiting, GERD and dysphagia several weeks after procedure? 3. Abdominal pain, diarrhea, nausea, hypotension and tachycardia 15-30 minutes after eating?

Answer 35

1. Short Bowel Syndrome 2. Stomal Stenosis 3. Dumping Syndrome