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Gastroenterology
Internal Medicine
| Question | Answer |
|---|---|
| 1. Progressive dysphagia to both solids and liquids simultaneously. 2. Dysphagia to solids that progresses to liquids. | 1. achalasia 2. esophageal cancer (usually also has long hx of smoking/EtOH) |
| Diagnostic workup of a patients with progressive dysphagia to both solids and liquids simultaneously. | Achalasia 1. barium swallow followed by esophageal manometry 2. EGD for alarm symptoms (age 60+, weight loss, +hemoccult) |
| 1. Patient with crushing chest discomfort and dysphagia. 2. Diagnostic workup. 3. Treatment | 1. Diffuse esophageal spasm 2. barium swallow may reveal nutcracker esophagus; manometric studies are diagnostic 3. Ca2+ blockers and nitrates |
| 1. Patient with dysphagia reveals, ringed constrictions in the lower esophagus on barium swallow 2. Treatment | 1. Schatzki rings 2. pneumatic dilation |
| 1. Patient with dysphagia reveals, constrictions in the upper esophagus on barium swallow 2. Treatment | 1. Plummer-Vinson syndrome 2. pneumatic dilation |
| 1. Odynophagia in HIV positive patient 2. Odynophasia in diabetic patients 3. Treatment for both | 1. Candida albicans esophagitis 2. Candida albicans esophagitis 3. fluconazole (Diflucan) |
| 2. Odynophagia in young patient taking medications for acne. | Pill esophagitis (doxycycline) |
| 1. What is a Zenker diverticulum? 2. How is a diagnosis made? | 1. outpocketing of the posterior pharyngeal constrictor muscles at the back of the pharynx 2. barium swallow |
| How is a diagnosis of Mallory-Weiss tear found?studys | upper endoscopy |
| Common etiology of epigrastric pain in which all tests are found to be normal. | nonulcer dyspepsia |
| What are the causes of epigastric pain related to the GI system (5) | 1. pancreatitis 2. GERD 3. gastritis 4. gastric cancer 5. peptic ulcer |
| What are alarm symptoms that require an endoscopy in patients with epigastric pain? | 1. dysphagia, odynophagia 2. weight oss 3. anemia, + hemoccult |
| What is the main physiologic problem of Zollinger-Ellison syndrome? | excessive production and release of gastrin from G cells |
| How does the diagnostic workup differ for epigastric pain in a patient younger that 45 than a patient older than 45? | 1. younger can be given a trial of H2 blockers of PPIs 2. older should be given an endoscopy |
| What are the four tests for H. pylori and which test does not distinguish new vs old disease? | 1. serology (does not distinguish new vs old disease) 2. urea breath test 3. stool antigen 4. CLO test of the biopsy |
| First choice in treatment therapy for H. pylori | 1. PPI 2. clarithromycin 3. amoxicillin |
| 1. Which type of gastritis is caused by an autoimmune process? 2. Does alcohol cause gastritis, ulcers or both? | 1. Type A 2. only gastritis |
| How do you distinguish vitamin B12 deficiency from folate deficiency in anemia? | vitamin B 12 deficiency has low B12 and increased methylmalonic acid |
| Patient with remitting peptic ulcers and hypercalcemia. | MEN1 with gastrinoma and hyperparathyroidism |
| How is the diagnosis of gastrinoma confirmed? | 1. secretin stimulation tests (gastrin will ↑) 2. elevated gastrin levels when patient is off PPIs and H2 blockers |
| 1. Patient with poorly controlled diabetes presents with abdominal pain and bloating. 2. Treatment | 1. Gastroparesis 2. erythromycin or metoclopramide |
| Which antibodies are associated with: 1. Crohn's Disease 2. Ulcerative Colitis | 1. anti-saccharomyces cerevisiae antibodies (ASCA) 2. anti-neutrophil cytoplasmic antibody (ANCA) |
| 1. Main therapy for inflammatory bowel disease 2. Treatment for acute exacerbations of inflammatory bowel disease. | 1. mesalamine derivatives 2. budesonide (high dose steroids) |
| What is the cause of a rash in carinoid syndrome? | the overproduction of serotonin leads to a tryptophan deficiency and subsequently a niacin deficiency |
| 1. Patient with diarrhea, flushing, tachycardia. 2. How do you confirm diagnosis? 3. Treatment | 1. carcinoid syndrome 2. urinary 5-HIAA 3. octreotide controls diarrhea, surgical resection if tumor is localized |
| Where are the following absorbed: 1. iron 2. vitamin B12 | 1. duodenum 2. ileum |
| Two most common causes of fat malabsorption | 1. celiac disease 2. chronic pancreatitis |
| Steatorrea with arthralgias | Whipple disease |
| What test confirms the diagnosis of: 1. celiac disease 2. chronic pancreatitis | 1. antigliadin, antiendomysial, antitransglutaminase antibodies may be present but biopsy with flattening of the villi is diagnostic 2. calcifications of the pancreas on x-ray and CT scan; secretin test is most accurate |
| 1. How is diverticulosis diagnosed? 2. How is diverticulitis diagnosed? | 1. colonoscopy 2. clinically symptoms (LLQ pain, fever, ↑WBC) + CT scan |
| What can cause a fast-negative hemoccult test? | vitamin C |
| What age is colon cancer screening done in: 1. general population 2. FMH of colon cancer 3. FMH of Lynch Syndrome 4. Familial adenomatous polyposis 5. juvenile polyposis syndrome | 1. age 50 2. age 40 or 10 years earlier than the family member 3. age 25 4. age 12 5. normal population |
| What would you do if an x-ray finds osteomas as an incidental finding? | colonoscopy (possibly Gardner syndrome) |
| 1. Rx for acute bleeding of esophageal varices. 2. Rx for long-term management of portal hypertension. | 1. Octreotide 2. propranolol |
| Two most common causes of pancreatitis | 1. alcohol 2. gallstones |
| Sign of severe pancreatitis: 1. blue discoloration around the umbilicus 2. bluish discoloration around the flanks | 1. Cullen sign 2. Turner's sign |
| Most accurate test to determine pancreatitis. | CT scan |
| Management of pancreatitis | 1. NPO, IV fluids, NG tube 2. CT scan monitoring for necrosis → start with imipenem if found |
| Which diuretic is most useful in cirrhosis? Why? | 1. spironolactone 2. cirrhotics have low intravascular volume (b/c it is all in third space) resulting in a high aldosterone |
| Antimitochondrial antibody | primary biliary cirrhosis |
| Treatment of: 1. diverticulosis 2. diverticulitis | 1. increased fiber in the diet 2. ciprofloxacin and metronidazole |
| What is the secretin test for diagnosis of chronic pancreatitis? | 1. place a NG tube into the duodenum and inject secretin into the blood 2. pancreas will not release bicarb or enzymes in chronic pancreatitis |
| What is the most common cause of constipation? | lack of dietary fiber and insufficient fluid intake |
| What is the initial management of a patients with severe GI bleeding? | 1. fluid resuscitation with NS or RL 2. CBC, prothrombin time and crossmatch |
| How do you confirm the diagnosis of alpha-1 antitrypsin deficiency? | low level of the enzyme in a person with COPD |
| What is the appearance of the gallbladder when the common bile duct is obstructed due to: 1. malignancy 2. cholelithiasis | 1. enlarged gallbladder 2. shrunken gallbladder |
| Patient with chronic, intermittent diarrhea and facial flushing develops a rash on his hands. What is causing the problem? | patient has carcinoid syndrome; the overproduction of serotonin is depleting tryptophan and thus niacin resulting in pellagra |
| 1. Which type of Crigler-Najjir is more often fatal? 2. Which type is treated with phenobarbital? | 1. type 1 2. type 2 |
| Does the D-Xylose test distinguish between chronic pancreatitis and celiac disease? | 1. D-Xylose is absorbed y the gut without the need to be digested 2. D-Xylose will not be absorbed in celiac disease because of bowel-wall abnormality |
| What are the alarm symptoms that require EGD in a patient with dysphagia? | 1. age 60+ 2. weight loss 3. +hemoccult 4. anemia 5. > 6 month duration |
| Treatment for achalasia | 1. pneumatic dilation 2. botulinum toxin 2nd 3. surgical myotomy as a last resort |
| What form of mesalamine is used in: 1. Crohn's disease 2. Ulcerative colitis | 1. pentasa (released in both upper and lower bowel) 2. asacol (only released in large bowel) |
| What are the Rome criteria for irritable bowel syndrome: | 1. pain relieved by a bowel movement 2. fewer symptoms at night 3. diarrhea alternating with constipation |
| Treatment for: 1. celiac disease 2. chronic pancreatitis 3. whipple disease 4. tropical sprue | 1. gluten-free diet 2. replace enzymes 3. TMP-SMX 4. TMP-SMX |
| 1. Most common site for colonic diverticula 2. Most common site for bleeding diverticula | 1. sigmoid colon 2. right colon |
| What are the 3 classes of polyps? | 1. hyperplastic 2. hamartomatous 3. adenomatous |
| Upper GI bleeding with a history of abdominal aortic aneurysm repair in past year. | aortoenteric fistula |
| Define orthostasis: | 1. > 10-point rise in pulse upon standing 2. > 20-point drop in BP upon changing position |
| What causes hypocalcemia in acute pancreatitis? | malabsorption of fat allows fat to bind with calcium in the bowel |
| Treatment for spontaneous bacterial peritonitis | cefotaxime or cefriaxone and albumin decreases the risk of hepatorenal syndrome |
| Test you would use for diagnosis of gastroenteritis in AIDs patient. | 1. Cryptosporidiosis 2. modified acid-fast test |
| Treatment for gastroenteritis: 1. when there is hypotension or blood 2. Giargia | 1. ciprofloxacin 2. metronidazole |
Created by:
amichael@siumed.edu
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