GI practice

Question 1

Tx moderate GERD with _________ and severe with ________
a) Lifestyle modifications; PPIs
b) Lifestyle modifications; H2 blockers
c) PPIs; H2 blockers
d) H2 blockers; PPIs

Answer 1

d) H2 blockers; PPIs

Question 2

Progressive dysphagia, first with solids then including liquids, is the main symptom of what?
a) GERD
b) Esophageal Neoplasms
c) Gastritis
d) Peptic Ulcer Disease

Answer 2

b) Esophageal Neoplasms

Question 3

Portal vein thrombosis leading to esophageal varices is defined as?
a) Boerhaave syndrome
b) Ogilvie syndrome
c) Budd-Chiari syndrome
d) Blind Loop Syndrome

Answer 3

c) Budd-Chiari syndrome

Esophageal Varices Classic Sxs = painless upper GI bleed with “coffee ground” appearance

Question 4

Which are correct about gastritis? Select all that apply
a) Often asymptomatic
b) Sometimes confirmed on endoscopy/biopsy performed for other issues
c) Testing does not incl: B12 level, CBC, H pylori testing
d) Address underlying cause and control gastric risk factors (NSAIDs, alcohol, etc.)

Answer 4

a) Often asymptomatic
b) Sometimes confirmed on endoscopy/biopsy performed for other issues
d) Address underlying cause and control gastric risk factors (NSAIDs, alcohol, etc.)

(these are all underlying conditions)

Question 5

Which is incorrect about PUD?
a) EGD usually for patients who have bleeding, or do not respond to treatment, or have been taking meds that suppress H. pylori (PPI, high-dose H2, antibiotics, bismuth)
b) Zollinger-Ellison Syndrome may be caused by MEN-1
c) Fasting serum gastrin level (>10x normal) and gastric pH (<2) are the first line testings for ZES
d) Gastric adenocarcinoma is twice as common in females, and almost never occurs before 40 years

Answer 5

d) Gastric adenocarcinoma is twice as common in females, and almost never occurs before 40 years

(twice as common in males, not females)

Question 6

Your pt has opioid-induced constipation. Which would you recommend to them? Select all that apply
a) Psyllium (Metamucil)
b) Polyethylene glycol (MiraLAX)
c) Bisacodyl (Dulcolax)
d) Docusate (Colace)

Answer 6

a) Psyllium (Metamucil)
c) Bisacodyl (Dulcolax)
d) Docusate (Colace)

Question 7

Serum anti-tissue transglutaminase (anti-tTG) antibodies are the best initial test for what? (hint: f/u w small bowel biopsy)
a) Lactose intolerance
b) Crohn’s
c) Celiac
d) Pancreatic insufficiency

Answer 7

c) Celiac

Question 8

Your pt just quit nicotine and has experienced a sudden onset of bloody, pus-filled diarrhea. They’ve lost weight and been experiencing fatigue. After their exacerbation ends, you do a colonoscopy and note eosinophils, erosions of the mucosa, & continuous involvement of the rectum that extends proximally. What is the first line Tx?

a) Mesalamine, sulfasalazine, or steroids
b) Azathioprine, infliximab, or adalimumab
c) Surgical resection

Answer 8

a) Mesalamine, sulfasalazine, or steroids

(Describing UC; B is second line and C is third line)

Question 9

Abdominal pain relieved by defecation is a key symptom of what?
a) Crohns
b) Celiac
c) UC
d) IBS

Answer 9

d) IBS

Question 10

Your pt presents with sudden severe pain out of proportion with subsequent guarding, rebound, heme-positive stool. You do an XR and CT to rule out other causes, and angiography shows mesenteric edema and stranding. Their labs show elevated lactate. What is the Tx?
a) IV antibiotics
b) Biologics
c) Surgical resection
d) Emergent surgical revascularization

Answer 10

d) Emergent surgical revascularization
(describing acute ischemic bowel disease)

Question 11

Which are correct about colonic polyps? Select all that apply
a) Hyperplastic are lowest risk; single q10y & multiple q5y.
b) Tubular polyps are increased risk; q5y
c) Villous polyps are highest risk; q3y
d) Polyps are not typically asymptomatic

Answer 11

a) Hyperplastic are lowest risk; single q10y & multiple q5y.
b) Tubular polyps are increased risk; q5y
c) Villous polyps are highest risk; q3y

Question 12

Which are appropriate options for acute pancreatitis Tx? Select all that apply
a) Carbapenem
b) Doxycycline + vancomycin
c) Ceftazidime + metronidazole
d) Cefepime + metronidazole

Answer 12

a) Carbapenem
c) Ceftazidime + metronidazole
d) Cefepime + metronidazole

Question 13

Change in bowel habits + obstruction are typical signs of ________ sided CRC
a) left
b) right

Answer 13

a) left

(Right-sided = bleeding and anemia)

Question 14

Which was NOT mentioned as a a complication of gallstones?
a) Cholecystitis
b) Pancreatitis
c) Cholangitis
d) All of the above were mentioned

Answer 14

d) All of the above were mentioned

Question 15

Your pt presents with RUQ tenderness, jaundice, AMS and hypotension. Their temperature is 103.2 and they have a left shift + incr bilirubin and liver enzymes. What is the most likely Dx, and what is the best imaging for this once the pt is stable?

a) Choledocolithiasis; RUQ US
b) Viral Hepatitis; ERCP
c) Cholangitis; ERCP
d) Cholecystitis; RUS US

Answer 15

c) Cholangitis; ERCP

Question 16

Tenofovir is typically preferred for the Tx of __________
Hep A
Hep B
Hep C
Hep D

Answer 16

Hep B

Question 17

List what the Hep B antibodies mean

Answer 17

HBsAg: ongoing infection. Persistence indicates chronic infection.
Anti-HBc: suggest exposure
Anti-HBs: follows disappearance of HBsAg (suggests vaccination or recovery from exposure)