INTERNAL MEDICINE EOR EXAMS EVALUATION
QUESTIONS AND ANSWERS 2025/2026 ALL RATED A+
✔✔What are the 4 types of acute mesenteric ischemias? - ✔✔A) arterial embolism--
emboli are cardiac in oriign such as A.fib, MI, valvular disease ; presentation is more
sudden and painful then other causes
B) Arterial thrombosis-- pts often have preexisting atherosclerotic disease ; presentation
is more gradual and less severe
C) nonoclusive mesenteric ischemia--splanchnic vasocontriction due to low cardiac
output; occurs in crticall ill pts
D) venous thrombosis--- infection, hypercoagulable states, oral contraceptives, portal
HTN, malignancy
✔✔Signs of intestnal infarction: - ✔✔- HYPOtension
-tachypnea
-lactic acidosis
-AMS
✔✔Abd. pain out of proportion of physical exam finding indicates what? - ✔✔Acute
mesenteric ischemia
✔✔Definitive dx test for acute mesenteric ischemia: - ✔✔mesenteric angiography
✔✔What do you want to avoid in the tx for acute mesenteric ischemia? -
✔✔vasopressors
✔✔What is the tx of choice for all arterial causes of acute mesenteric ischemia? -
✔✔infusion of papaverine ( vasodilator)
✔✔What is th tx of choice for embolic acute mesenteric ischemia ? - ✔✔thrombolytics
and embolectomy
✔✔What is the tx for venous thrombosis? - ✔✔Heparin anticoagulants
✔✔What causes chronic mesenteric ischemia? - ✔✔Atherosclerotic occlusive disease
of main mesenteric vessels: celiac arteri, superior and inferior mesenteric arteries
✔✔Sxs of chronic mesenteric ischemia? - ✔✔-abd. angina - typically postprandial
-weight loss
✔✔What confirms chronic mesenteric ischemia? - ✔✔mesenteric arteriography
,✔✔What is the tx for chornic msesenteric ischemia? - ✔✔Surgical revascularization
✔✔Ogilvies syndrome: - ✔✔-pts are usually very ill and have a hx of recent surgery or
medical illness
- radiograph shows large bowel obstruction but there is NO mechanical obstruction
✔✔Tx for ogilvies syndrome" - ✔✔-stop the offending agents: narcotics etc
-IV fluids, electrolyte repletion
- decompression with gentle enemas and nasogastric suction
-surgical decompression is last resort
✔✔What is pseudomembranitis colitis? - ✔✔antibiotics assocaited colitis
-caused by: overgrowth of C.diff
✔✔When there is colonic distension and when the colon diameter exceeds 10 cm ,
what is the immediate tx? - ✔✔decompression immediately
✔✔S and sxs of abx assocaited colitis? - ✔✔watery diarrhea w/o blood
crampy, abd. pain
✔✔Tx for abx assocaited colitis? - ✔✔Metrondiazole
✔✔What are 3 complications of severe pseudo membranous colitis? - ✔✔Toxic
megacolon
Colonic perforation
Anasaraca/electrolyte disturbances
✔✔What is the tx for abx assocaited colitis? - ✔✔-Stop the abx
-metronidiazole is drug of choice
-cholestyramine - can be used as adjuvant tx to improve diarrhea
✔✔What is colonic volvulus? - ✔✔twisting of a loop of intestine about its mesenteric
attachment site --> can cause obstruction or vascular compromise--> can lead to
necrosis or perforation
✔✔What is the most common site for a colonic volvulus to occur? - ✔✔SIgmoid colon
✔✔S and sxs of colonic volvulus? - ✔✔Acute onset of colicky abd pain
obstipation/abd. distension
anorexia
N/V
, ✔✔What is the test of choice for colonic volvulus? - ✔✔sigmoidoscopy- both dx and
therapeutic
✔✔What are the x-ray findings for colonic volvulus? - ✔✔Sigmoid volvulus --> omega
loop sign
Colonic volvulus --> coffee bean sign
✔✔What will a barium enema show for colonic volvulus? - ✔✔"birds beak"
✔✔What is the tx for colonic volvulus? - ✔✔Sigmoid volvulus --> non-operative
reduction
colonic volvulus --> emergent surgery
✔✔What is the m/c cause of cirrhosis ? - ✔✔Alcoholic liver disease followed by chronic
viral infection
✔✔T/F: Cirrhosis is irreversible when advanced. - ✔✔TRUE
✔✔What is the gold standard for diagnosing cirrhosis? - ✔✔Liver biopsy
✔✔What is the child's assessment used for? - ✔✔Assess the severity of liver disease
✔✔two methods of distortion of liver anatomy: - ✔✔A) decreased blood flow to the liver
causes subsequent hypertension --> portal hypertension: ascites, peripheral edmea,
splenomegaly, varicosity of veins
B) Decreased albumin synthesis and decreased clotting factor synthesis
✔✔Childs classification of liver disease severity: 1, 2, 3, - ✔✔
✔✔Once a pt develops complications of cirrhosis, they are considered to be
__________________________________. - ✔✔Decompsensated --> HIGH
MORBIDITY and HIGH MORTALITY
✔✔What are the classic signs of chronic liver disease? - ✔✔Ascites, varices,
gynectomastia, testicular atrophy, palmary erthema, spider angiomas of skin,
hemorrhoids, caput medusae
✔✔What are complications of cirrhosis? - ✔✔A) Portal HTN
B) Varices
C) ascites
D)Hepatic encephalopathy
E) Hepatorenal syndrome
F)Hyperestrenism
QUESTIONS AND ANSWERS 2025/2026 ALL RATED A+
✔✔What are the 4 types of acute mesenteric ischemias? - ✔✔A) arterial embolism--
emboli are cardiac in oriign such as A.fib, MI, valvular disease ; presentation is more
sudden and painful then other causes
B) Arterial thrombosis-- pts often have preexisting atherosclerotic disease ; presentation
is more gradual and less severe
C) nonoclusive mesenteric ischemia--splanchnic vasocontriction due to low cardiac
output; occurs in crticall ill pts
D) venous thrombosis--- infection, hypercoagulable states, oral contraceptives, portal
HTN, malignancy
✔✔Signs of intestnal infarction: - ✔✔- HYPOtension
-tachypnea
-lactic acidosis
-AMS
✔✔Abd. pain out of proportion of physical exam finding indicates what? - ✔✔Acute
mesenteric ischemia
✔✔Definitive dx test for acute mesenteric ischemia: - ✔✔mesenteric angiography
✔✔What do you want to avoid in the tx for acute mesenteric ischemia? -
✔✔vasopressors
✔✔What is the tx of choice for all arterial causes of acute mesenteric ischemia? -
✔✔infusion of papaverine ( vasodilator)
✔✔What is th tx of choice for embolic acute mesenteric ischemia ? - ✔✔thrombolytics
and embolectomy
✔✔What is the tx for venous thrombosis? - ✔✔Heparin anticoagulants
✔✔What causes chronic mesenteric ischemia? - ✔✔Atherosclerotic occlusive disease
of main mesenteric vessels: celiac arteri, superior and inferior mesenteric arteries
✔✔Sxs of chronic mesenteric ischemia? - ✔✔-abd. angina - typically postprandial
-weight loss
✔✔What confirms chronic mesenteric ischemia? - ✔✔mesenteric arteriography
,✔✔What is the tx for chornic msesenteric ischemia? - ✔✔Surgical revascularization
✔✔Ogilvies syndrome: - ✔✔-pts are usually very ill and have a hx of recent surgery or
medical illness
- radiograph shows large bowel obstruction but there is NO mechanical obstruction
✔✔Tx for ogilvies syndrome" - ✔✔-stop the offending agents: narcotics etc
-IV fluids, electrolyte repletion
- decompression with gentle enemas and nasogastric suction
-surgical decompression is last resort
✔✔What is pseudomembranitis colitis? - ✔✔antibiotics assocaited colitis
-caused by: overgrowth of C.diff
✔✔When there is colonic distension and when the colon diameter exceeds 10 cm ,
what is the immediate tx? - ✔✔decompression immediately
✔✔S and sxs of abx assocaited colitis? - ✔✔watery diarrhea w/o blood
crampy, abd. pain
✔✔Tx for abx assocaited colitis? - ✔✔Metrondiazole
✔✔What are 3 complications of severe pseudo membranous colitis? - ✔✔Toxic
megacolon
Colonic perforation
Anasaraca/electrolyte disturbances
✔✔What is the tx for abx assocaited colitis? - ✔✔-Stop the abx
-metronidiazole is drug of choice
-cholestyramine - can be used as adjuvant tx to improve diarrhea
✔✔What is colonic volvulus? - ✔✔twisting of a loop of intestine about its mesenteric
attachment site --> can cause obstruction or vascular compromise--> can lead to
necrosis or perforation
✔✔What is the most common site for a colonic volvulus to occur? - ✔✔SIgmoid colon
✔✔S and sxs of colonic volvulus? - ✔✔Acute onset of colicky abd pain
obstipation/abd. distension
anorexia
N/V
, ✔✔What is the test of choice for colonic volvulus? - ✔✔sigmoidoscopy- both dx and
therapeutic
✔✔What are the x-ray findings for colonic volvulus? - ✔✔Sigmoid volvulus --> omega
loop sign
Colonic volvulus --> coffee bean sign
✔✔What will a barium enema show for colonic volvulus? - ✔✔"birds beak"
✔✔What is the tx for colonic volvulus? - ✔✔Sigmoid volvulus --> non-operative
reduction
colonic volvulus --> emergent surgery
✔✔What is the m/c cause of cirrhosis ? - ✔✔Alcoholic liver disease followed by chronic
viral infection
✔✔T/F: Cirrhosis is irreversible when advanced. - ✔✔TRUE
✔✔What is the gold standard for diagnosing cirrhosis? - ✔✔Liver biopsy
✔✔What is the child's assessment used for? - ✔✔Assess the severity of liver disease
✔✔two methods of distortion of liver anatomy: - ✔✔A) decreased blood flow to the liver
causes subsequent hypertension --> portal hypertension: ascites, peripheral edmea,
splenomegaly, varicosity of veins
B) Decreased albumin synthesis and decreased clotting factor synthesis
✔✔Childs classification of liver disease severity: 1, 2, 3, - ✔✔
✔✔Once a pt develops complications of cirrhosis, they are considered to be
__________________________________. - ✔✔Decompsensated --> HIGH
MORBIDITY and HIGH MORTALITY
✔✔What are the classic signs of chronic liver disease? - ✔✔Ascites, varices,
gynectomastia, testicular atrophy, palmary erthema, spider angiomas of skin,
hemorrhoids, caput medusae
✔✔What are complications of cirrhosis? - ✔✔A) Portal HTN
B) Varices
C) ascites
D)Hepatic encephalopathy
E) Hepatorenal syndrome
F)Hyperestrenism
