Rosh Review: Gastroenterology Questions With 100 % Correct Answers | latest

A 75-year-old woman with a history of hypertension presents to the ED with right upper quadrant pain that has been gradually worsening over the past day. Her vital signs are: T 103°F, BP 100/60, HR 100, RR 22, and oxygen saturation 97% on room air. Physical exam reveals scleral icterus and right upper quadrant tenderness without rebound or guarding. A bedside right upper quadrant ultrasound demonstrates a common bile duct measuring 1 cm. Laboratory results are pending. What is the definitive management of this condition? - Ascending Cholangitis! TX: ERCP (Endoscopic retrograde cholangiopancreatography) Charcot's triad (fever, jaundice, and right upper quadrant pain); Does an alkaline button battery that passes into the stomach need to be emergently removed endoscopically? - No, if it has passed to the stomach it can be radiographically followed Most FBs that pass pylorus pass spontaneously Emergent endoscopy indicated if FB is battery, sharp, or signs of obstruction present During endoscopy, what hemostatic agent can be injected to control bleeding caused by a Mallory-Weiss tear? - Epinephrine How is the diagnosis of HIV confirmed? - Initial: ELISA Confirmatory: Western Blot Seroconverts 3-12 weeks post exposureIf a previously vaccinated hospital worker tests negative for HBsAb and is exposed to a HBsAg positive source, what is the recommended postexposure prophylaxis? - Hepatitis B immune globulin and hepatitis B vaccine. In a patient with right-sided pelvic pain, what is the imaging modality of choice? - Pelvic ultrasound with Doppler flow! It is sensitive for many GYN disorders and, in the hands of an experienced technician, compressive ultrasound can diagnose appendicitis. In patients with appendicitis, what physical sign occurs when right lower quadrant pain is elicited by passive right hip extension? - Psoas Sign! Irritable bowel syndrome is a common example of which subclass of chronic diarrhea? - Motility disorder, in which stool osmotic gap is normal Is an NG tube required in acute pancreatitis? - No, it is recommended for patients with intractable vomiting or ileus. Name another common risk factor for gallstones, especially in a patient post abdominal surgery. - TPN (Total parenteral nutrition) Prevention of polyps, and therefore colon cancer, involves which strategies? - Maintaining an appropriate weight, a diet high in fiber and low in fat, and tobacco and alcohol cessation. What are complications that can make hepatic encephalopathy worse? - Constipation, Increasing ammonia levels, renal failure, Gi bleeding, infection, diuretic therapy leading to hypokalemia and alkalosis What are Irremovable white lesions on lateral tongue associated with HIV diagnosis? - Oral Hairy Leukoplakia!What are longitudinal mucosal lacerations of the distal esophagus usually including the gastroesophageal junction? - Mallory Weiss Tear! What are Ranson's five predictors of complications from acute pancreatitis upon admission? - Age >55 years Glucose >200 WBC >16,000 AST>250 LDH>350. What are risk factors for developing Hepatitis C? - IV drug use, transplant surgeries, intranasal cocaine use, tattoos, and blood transfusions What are some extracolonic findings associated with ulcerative colitis? What extraintestinal manifestations may be seen with inflammatory bowel disease? - Hepatitis and cirrhosis, uveitis and episcleritis, and erythema nodosum and pyoderma gangrenous. IBD: Uveitis, arthritis, or liver disease. What are the 3 most common complications of diverticulitis? - Perforation ObstructionAbscess What are the classic "Red Flag" symptoms of esophageal cancer? - Dysphagia, vomiting, anorexia, weight loss, and symptoms of gastrointestinal-related blood loss. What are the classic barium swallow findings in a patient with achalasia? - "Bird-beak" narrowing of the lower esophageal sphincter and proximal esophageal dilation. What are the most common cancers associated with small bowel obstruction? - Colonic and ovarian malignancies! What are the most common causes of travelers diarrhea? Tx? - Enterotoxigenic E. coli (ETEC) Salmonella Shigella species TX: Oral rehydration a three-day course of CIPROFLOXACIN and antimotility agents, such as LOPERAMIDE What are the most common locations for anal fissures? When does it cause for concern of considering systemic association? - Most common:Posterior Midline Concern: Lateral fissure--> associated with Crohns, HIV, leukemia, syphilis, TB What are the nerves most commonly affected during hernia surgery? - Ilioinguinal Iliohypogastric Genitofemoral nerves These nerves provide sensation to the L1 DERMATOME , aka the belt line What are the physical exam findings of someone with cirrhosis? - Jaundice, Spider Angiomas, Finger Clubbing, Esophageal Varices, Palmar Erythema (impaired breakdown of sex hormones) Leukonychia (thickened nails), Icterus, Asterixis, Caput Medusae (dilated veins around the umbilicus), gynecomastia What are the physical exam findings typically seen in pancreatic cancer? - Painless Jaundice, Icterus , Dark colored urine (direct bilirubin increased), fatigue, weight loss Trousseaus: Migratory thrombophlebitis (hyper coagulability that accompanies most cancers) Courvoisier sign: Palpable nontender gallbladder Virchow's Node & Sister Mary Joseph NodeWhat are the proper guidelines for Colorectal Cancer Screening? - Routine: FOBT, Sigmoidoscopy or Colonoscopy in adults 50-75 1 relative with colon cancer: Screen at age 40 or 10 years before their onset of cancer Familial Adenomatous Polyposis: Sigmoidoscopy at age 12, then every 1-2 years Colonoscopy every 10 years, starting age 50 FOBT- annually starting at age 50 Sigmoidoscopy- every 3-5 years instead of colonoscopy starting at age 50