GI

Question 1

What is the best lab test for chronic pancreatitis?

Answer 1

Low fecal elastase

Question 2

Tumor marker for hepatocellular carcinoma?

Answer 2

AFP

Question 3

What are the two lymph node findings associated with gastric cancer (location and name)?

Answer 3

• Left supraclavicular=Virchow’s

- Periumbilical=Sister Mary Joseph

Question 4

Treatment for Ulcerative colitis?

Answer 4

5-ASA (Mesalamine for small bowel disease and Sulfasalazine for large bowel disease)

exacerbations=steroids

Question 5

Bug associated with diarrhea and pseudo-appendicitis?

Answer 5

Yersinia

Question 6

Marker for Primary Biliary Cholangitis? Who gets it?

Answer 6

-Anti-mitochondrial antibodies
-Bitches get it
(pBc=Bitches, ladies also carry the mitochondria, which helps with remembering the antibodies…you’re welcome)

Question 7

What is the treatment for PBC?

Answer 7

Ursodeoxycholic acid

Question 8

What marker is associated with PSC? What does imaging show?

Answer 8

• pANCA.
• beads on a string

(p=penis, beads=balls, men get this more)

Question 9

What disease is associated with PSC?

Answer 9

Ulcerative colitis

Question 10

What patient population is more likely to get fulminant hepatic failure if they have hepatitis E?

Answer 10

Preggos

Question 11

What types of viral hepatitis increase your risk of hepatocellular carcinoma?

Answer 11

Hep B and C

Question 12

What meds are used for outpatient treatment of diverticulitis?

Answer 12

• Cipro and flagyl
• Bactrim and flagyl
• amoxicillin-clavulonate

Question 13

Treatment for hepatic encephalopathy?

Answer 13

Lactulose and Rifaximin (kills bacteria that produce ammonia)

Question 14

When are alcoholic cirrhosis patients eligible for liver transplant?

Answer 14

-abstinence from booze for 6 months

Question 15

What is Budd-Chiari Syndrome? Symptoms? What is the most sensitive and specific test to diagnose it?

Answer 15

• thrombosis and occlusion of the hepatic vein or supra hepatic portion of the IVC
• Symptoms: ascites, jaundice, hepatomegaly +/- RUQ pain
• Hepatic venography is the most sensitive and specific (Ultrasound is the best initial test)

Question 16

What SAAG score indicates portal HTN?

Answer 16

SAAG >= 1.1

Question 17

Treatment of SBP?

Answer 17

• Cefotaxime or third generation cephalosporin x 5 days.

- Albumin =helps prevent hepatorenal

Question 18

Lab test for suspected hemochromatosis (bronze diabetes)? Tx?

Answer 18

• Ferritin and Transferrin

- Tx: phlebotomy

Question 19

Lab test for Wilson’s? What foods should these people avoid?

Answer 19

• Low ceruloplasmin

- high copper food: shellfish, organ meats, chocolate, nuts, mushrooms

Question 20

Markers associated with autoimmune hepatitis?

Answer 20

-Anti-smooth muscle Ab, Liver kidney microsomal (LKM) antibodies

Question 21

Risk for hepatic adenoma?

Answer 21

OCP

Question 22

Ranson criteria?

Answer 22

GA LAW, C HOBBS
Glucose
AST
LDH
Age
WBC

Ca2+
Hematocrit
Oxygen
BUN 
Base deficit
Sequestration of fluid

Question 23

What is the treatment for Entamoeba histolytica?

Answer 23

Metronidazole or paromomycin

Question 24

What is the treatment for Giardia lamblia?

Answer 24

Metronidazole

Question 25

What is the treatment for Trichinella spiralis

Answer 25

Albendazole or mebendazole

Question 26

What is the treatment for Cryptosporidium parvum?

Answer 26

Nitazoxanide

Question 27

What tests are used to evaluate for celiac disease?

Answer 27

- anti-tissue transglutaminase Ab - Anti-gliadin Ab - Anti-endomysial Ab -EGD with duodenal biopsy--> blunting of villi and hypertrophic crypts

Question 28

What is the triad associated with Plummer-vinson syndrome?

Answer 28

Esophageal webs, dysphagia, and iron deficiency anemia

Question 29

"Corkscrew" on Barium Swallow? Tx?

Answer 29

Diffuse Esophageal Spasm | -Tx: CCB and nitrates or TCA

Question 30

What is Barrett's esophagus?

Answer 30

Metaplasia of the columnar cells of the distal esophagus

Question 31

Pt with bad breath and regurgitating food that was eaten several days ago?

Answer 31

Zener's Diverticulum (right above the UES)

Question 32

Treatment of H. pylori?

Answer 32

-PPI, amoxicillin, clarithromycin

Question 33

What is a Cushing ulcer associated with?

Answer 33

Increased intracranial pressure -> increased gastric acid secretion

Question 34

How can you determine if a GI bleed is upper or lower?

Answer 34

NG lavage

Question 35

Medication for GI bleed if varices are suspected?

Answer 35

Octreotide (decrease splanchnic blood flow)

Question 36

Most common causes of SBO?

Answer 36

- Adhesions - Bulge (incarcerated hernia) - Cancer

Question 37

Old man with abdominal pain, diarrhea, weight loss, arthralgia and neurological problems....diagnosis?

Answer 37

Whipple disease (Tropheryma whipplei)

Question 38

Intestinal biopsy showing lamina propria filled with fat droplets and PAS + foamy macrophages? Tx?

Answer 38

Whipple disease | -IV ceftriaxone then oral Bactrim for 12 months

Question 39

What is the D-Xylose test used for?

Answer 39

To test for passive absorption of carbohydrates. - Will be NORMAL in pancreatic insufficiency (does not need pancreatic enzymes to absorb). - Will be abnormal in celiac disease

Question 40

How do you calculate a stool osmotic gap? What value is osmotic diarrhea? Secretory?

Answer 40

- Osmotic gap= 290 - 2(Na+stool + K+stool) - >125--> osmotic diarrhea - secretory diarrhea

Question 41

Cause of a caucasian with foul-smelling diarrhea and iron deficiency anemia?

Answer 41

Celiac disease

Question 42

Recent immigrant from the Dominican Republic with foul-smelling chronic diarrhea with macrocytic anemia?

Answer 42

Tropical Sprue

Question 43

Chronic diarrhea + arthralgia + ataxia

Answer 43

Whipple Disease

Question 44

What skin finding is associated with Celiac?

Answer 44

Dermatitis herpetiformis

Question 45

Chronic diarrhea with a positive stool sudan stain and a normal D-xylose test. Cause?

Answer 45

Pancreatic insufficiency

Question 46

Most common food borne bacterial GI infection?

Answer 46

Salmonella

Question 47

"bacterial dysentery"? Treatment?

Answer 47

- Shigella | - FQ, bactrim

Question 48

When should you do further studies for acute diarrhea? What is the workup?

Answer 48

Severe diarrhea: hypovolemia, bloody stools, fever, >6 stools/day, duration >1 week, severe abdominal pain, older age, immunocompromised. -workup: fecal leukocytes, stool culture, +/- ova and parasites if immunocompromised, +/- giardia and E. histolytic if associated with surface water, c. diff toxin

Question 49

Rice water diarrhea

Answer 49

vibrio cholera. Agressive rehydration!!

Question 50

What parasitic infection can cause liver abscesses?

Answer 50

Entamoeba histolytica. Tx: metronidazole

Question 51

Rome Criteria for IBS?

Answer 51

- recurrent abd pain for 3+ days/month/3months and 2 of the following: - Relief with defecation - onset associated with change in frequency of stool - onset associated with change of form of stool

Question 52

What serum lab findings can distinguish Crohn's from UC?

Answer 52

Crohns=ASCA + | UC= pANCA +

Question 53

What unique image can you see on a plain film of a patient with ovules?

Answer 53

Double bubble

Question 54

How can a gallstone obstruct the normal propulsive ability of the bowel?

Answer 54

-can pass through a biliary-enteric fistula and become impacted in the ileum

Question 55

Carcinoid syndrome symptoms?

Answer 55

"Be FDR" - bronchospasm - flushing - diarrhea - right sided valvular disease

Question 56

Outpatient treatment of diverticulitis?

Answer 56

- NPO | - FQ + metronidazole

Question 57

APC gene mutation?

Answer 57

Lynch syndrome (hereditary non-polyposis colon cancer)

Question 58

What is the best initial lab test in a suspected ZES? Then what?

Answer 58

-gastrin level --> if >1000 then do a secretin stimulation test

Question 59

Migratory thrombophlebitis (Trousseaus sign)?

Answer 59

can be a complication of pancreatic adenocarcinoma

Question 60

What is necrolytic migratory erythema associated with?

Answer 60

Glucagonoma

Question 61

What meds can stop insulin production in an insulinoma

Answer 61

Diazoxide and octreotide

Question 62

Best test for acute cholangitis?

Answer 62

ERCP

Question 63

"porcelain gall bladder" (with calcifications) seen on US?

Answer 63

Gallbladder cancer

Question 64

What patients are at risk for acalculous cholecystitis?

Answer 64

- Critically ill patients | - TPN