PAEAGeneralSurgeryEORexamwith
correctanswers
whatarethe2conditionsundertheinflammatory boweldisease umbrella?-correct answer✔✔1.
ulcerativecolitis
2.crohn'sdz
incomparingulcerativecolitisandcrohn'sdz,whichis:
-limitedtothecolonw/rectumalwaysinvolved*VS*mouthtoanus
-transmural *VS*mucosa/submucosainvolved
-LLQ*VS*RLQpain
-bloodydiarrhea*VS*non
-complications ofperianaldz,strictures, fistulas&granulomas*VS*coloncancer&toxicmegacolon
-colonoscopyshowing"skiplesions"&cobblestoning*VS*ulceration&pseudopolyps
-bariumstudiesshowing"stovepipesign"(lossofhaustral markings)*VS*"stringsign"narrowing
throughscarredareas
-(+)P-ANCA*VS*(+)ASCA(antisaccharomycescerevisiae Ab)
-curative *VS*noncurative-correct answer✔✔1.*ulcerative colitis*- colon/rectum,
mucosa/submucosa,LLQpain,bloodydiarrhea, compsofcoloncancer&toxicmegacolon,
colonoscopyw/ulcerations&pseudopolyps, "stovepipesign"(lossofhaustral markings),(+)P-ANCA,
curative
2.*crohn'sdz*-mouthtoanus,transmural,RLQpain,nonbloodydiarrhea, compsofperianal dz,
strictures, fistulas,granulomas, "skiplesions"&"cobblestoning","stringsign",(+)ASCA,noncurative
whatarethebeststudiesofchoiceforulcerative colitisvscrohn'sdzinacutedz?-correct answer✔✔-
UC:*flexsigmoidoscopy* inacutedz(colonoscopyandbariumenemaCONTRAINDICATEDinacutedz
bccancauseperfortoxicmegacolon)
,-crohn'sdz:*upperGIseries* (bariumswallow)inacutedz
whatmedicationsareusedtotreatulcerative colitisandcrohn'sdz?-correct answer✔✔1.5-
aminosalicylicacids(anti-inflammatory)*oral mesalamine*bestformaintenance, topical
mesalamine (rectalsuppositories &enemas),*sulfasalzine* (give w/folicacid);*all oftheseworkbest
inthecolon-soarebetterfortx'ingUC*
2.*corticosteroids*in*acuteflares*only
3.immunemodifyingagents:6-mercaptopurine, azathioprine andMTX
4.anti-TNFagents-adalimumab, infliximab certolizumab
barrett'sesophagus(fromprolonged/untreated GERD)involvestransitionof_________ cellsto
_________ cells(nmltoprecancerous);whatkindofcancercanGERD=>barrett'sturninto?-correct
answer✔✔-*squamous* epitheliumtometaplastic*columnar*
-esophageal*adenocarcinoma*
txforintermittent/mild vsmod/severeGERD-correct answer✔✔besideslifestylechanges
(food/drinkavoidance,avoidingrecumbency, wtloss,smokingcessation
-int/mild:OTCantacids(tums,MOM,maalox,mylanta)&H2receptorantagonists/blockers
(ranitidine, cimetidine, famotidine)
-mod/severe:H2RAs,PPIs(omeprazole,esomeprazole,pantoprazole),&prokineticagents
(cisapride),nissenfundoplicationifrefractory
DDxforhematemesis -correct answer✔✔MCis*PUD*(gastric>duodenal),varices, angiodysplasia,
masses(adenocarcinoma,polyps),&mallory-weiss tears
dx/tx? vomitingbloodafteranightofheavydrinkingorinabulimicpt;whatisseenonEGD?-correct
answer✔✔-dx:mallory-weisssyndrome/tears(d/tsuddenriseinintragastric pressure)
-tx:supportiveunlesssevere bleedingmayneedepiinj,bandligationorballoontamponade
-EGD:superficiallongitudinal mucosalerosions/lacerations
,dx?dysphagia,esophagealwebs,IDA,glossitis, angularcheilitis,koilonychias-correct
answer✔✔plummer-vinsonsyndrome
testofchoiceisbariumswallow
tx:dilation
dx?loweresophagealwebs/constrictions atsquamocolumnar junctionsMCassociatedw/sliding
hiatalherniasbutalsocanbes/pcorrosive injury-correct answer✔✔schatzkiring
testofchoiceisbariumsallow
tx:dilation
esophagealvaricesareMCd/t?txtopreventrebleeds? -correct answer✔✔-cirrhosisasacomplication
ofportalvenousHTN
-longtermtx:
1.nonselective BB:*propranolol, nadolol*1stline(reducesportal pressure)butnotusedinacute
bleedsbcptmayalreadybehypovolemic
2.*isosorbide*:longactingnitrate(vasodilator)
txofanacuteesophageal varicesbleed? thesehavea30-50%mortalityratew/1stbleedand70%
recurrence ratew/i1styr!-correct answer✔✔1.2large boreIVlines,IVF,+/-bloodtransfusion
2.*endoscopicligation*istxofchoice
3.pharmacologic vasoconstrictors- *octreotide* 1stline(somatostatinanalog),vasopressin
4.balloontamponade
5.surgicaldecompression *TIPS*(transjugular intrahepatic portosystemic shunt)connectsportal
veintohepatic veintodraintoIVC
, whatisthetxfortypeI/slidinghiatal herniavstypeII/rollinghiatalhernias? -correct answer✔✔-type
I/sliding:(MCtype95%)tx:noneexceptmanageGERDitcauses
-typeII/rolling:(paraesophageal)tx:surgicalrepairtoavoidcomplications(strangulation)
incomparingsquamouscellvsadenocarcinomaoftheesophagus,whichis:
-MCworldwide(90%)*VS*MCintheUS
-MCinupper1/3ofesophagus*VS*lower1/3
-RFofuntreatedGERD/barrett's*VS*tobacco/EtOHuse,exposuretonoxiousstimuli,AA-correct
answer✔✔-squamouscell:MCworldwide(90%),upper1/3,RF:tobacco/EtOHuse,exposureto
noxiousstimuli,AA
-adenocarcinoma: MCinUS,lower1/3,RF:untx'dGERD/barrett's
whatarethe2mostcommoncausesofgastritis? howaretheydiagnosedandtreated? -correct
answer✔✔1.H.pylori MC-stoolantigenorureabreathtest;tx:triple therapy:"CAP"*clarithromycin +
amoxicillin+PPI*ormetronidazole ifPCNallergic;ifmacrolide resistance suspecteddoquadtherapy:
PPI+bismuthsubsalicylate +tetracycline +metronidazole
2.NSAIDs/ASA-clinicallydxbutEGDgoldstd;tx:acidsuppression(PPI,H2RA,antacids)
isa*gastric* or*duodenal* ulcermoreassociatedwithrelief ofepigastric pain(dyspepsia)witheating?
whichtypealwaysneedsaBxandendoscopicmonitoring2-3moslatertor/omalignancyand
documenthealing? -correct answer✔✔-duodenal ulcer(areabecomesmorebasic whenyoueatin
preparationforacid/foodlateron);theseare4xmorecommonthatGUs
-gastriculcerbchigherrisk ofmalignancy
PPIsblockthe_______ pumpofthe________ cell reducingacidsecretion;taken_____minbefore
mealsandcanresultindiarrhea, HA,hypomagnesemia, _____deficiency, andhypocalcemia;which
PPIcausesCP450inhibition? -correct answer✔✔-H/KATPasepump
-parietalcells
-30min
-B12deficiency
correctanswers
whatarethe2conditionsundertheinflammatory boweldisease umbrella?-correct answer✔✔1.
ulcerativecolitis
2.crohn'sdz
incomparingulcerativecolitisandcrohn'sdz,whichis:
-limitedtothecolonw/rectumalwaysinvolved*VS*mouthtoanus
-transmural *VS*mucosa/submucosainvolved
-LLQ*VS*RLQpain
-bloodydiarrhea*VS*non
-complications ofperianaldz,strictures, fistulas&granulomas*VS*coloncancer&toxicmegacolon
-colonoscopyshowing"skiplesions"&cobblestoning*VS*ulceration&pseudopolyps
-bariumstudiesshowing"stovepipesign"(lossofhaustral markings)*VS*"stringsign"narrowing
throughscarredareas
-(+)P-ANCA*VS*(+)ASCA(antisaccharomycescerevisiae Ab)
-curative *VS*noncurative-correct answer✔✔1.*ulcerative colitis*- colon/rectum,
mucosa/submucosa,LLQpain,bloodydiarrhea, compsofcoloncancer&toxicmegacolon,
colonoscopyw/ulcerations&pseudopolyps, "stovepipesign"(lossofhaustral markings),(+)P-ANCA,
curative
2.*crohn'sdz*-mouthtoanus,transmural,RLQpain,nonbloodydiarrhea, compsofperianal dz,
strictures, fistulas,granulomas, "skiplesions"&"cobblestoning","stringsign",(+)ASCA,noncurative
whatarethebeststudiesofchoiceforulcerative colitisvscrohn'sdzinacutedz?-correct answer✔✔-
UC:*flexsigmoidoscopy* inacutedz(colonoscopyandbariumenemaCONTRAINDICATEDinacutedz
bccancauseperfortoxicmegacolon)
,-crohn'sdz:*upperGIseries* (bariumswallow)inacutedz
whatmedicationsareusedtotreatulcerative colitisandcrohn'sdz?-correct answer✔✔1.5-
aminosalicylicacids(anti-inflammatory)*oral mesalamine*bestformaintenance, topical
mesalamine (rectalsuppositories &enemas),*sulfasalzine* (give w/folicacid);*all oftheseworkbest
inthecolon-soarebetterfortx'ingUC*
2.*corticosteroids*in*acuteflares*only
3.immunemodifyingagents:6-mercaptopurine, azathioprine andMTX
4.anti-TNFagents-adalimumab, infliximab certolizumab
barrett'sesophagus(fromprolonged/untreated GERD)involvestransitionof_________ cellsto
_________ cells(nmltoprecancerous);whatkindofcancercanGERD=>barrett'sturninto?-correct
answer✔✔-*squamous* epitheliumtometaplastic*columnar*
-esophageal*adenocarcinoma*
txforintermittent/mild vsmod/severeGERD-correct answer✔✔besideslifestylechanges
(food/drinkavoidance,avoidingrecumbency, wtloss,smokingcessation
-int/mild:OTCantacids(tums,MOM,maalox,mylanta)&H2receptorantagonists/blockers
(ranitidine, cimetidine, famotidine)
-mod/severe:H2RAs,PPIs(omeprazole,esomeprazole,pantoprazole),&prokineticagents
(cisapride),nissenfundoplicationifrefractory
DDxforhematemesis -correct answer✔✔MCis*PUD*(gastric>duodenal),varices, angiodysplasia,
masses(adenocarcinoma,polyps),&mallory-weiss tears
dx/tx? vomitingbloodafteranightofheavydrinkingorinabulimicpt;whatisseenonEGD?-correct
answer✔✔-dx:mallory-weisssyndrome/tears(d/tsuddenriseinintragastric pressure)
-tx:supportiveunlesssevere bleedingmayneedepiinj,bandligationorballoontamponade
-EGD:superficiallongitudinal mucosalerosions/lacerations
,dx?dysphagia,esophagealwebs,IDA,glossitis, angularcheilitis,koilonychias-correct
answer✔✔plummer-vinsonsyndrome
testofchoiceisbariumswallow
tx:dilation
dx?loweresophagealwebs/constrictions atsquamocolumnar junctionsMCassociatedw/sliding
hiatalherniasbutalsocanbes/pcorrosive injury-correct answer✔✔schatzkiring
testofchoiceisbariumsallow
tx:dilation
esophagealvaricesareMCd/t?txtopreventrebleeds? -correct answer✔✔-cirrhosisasacomplication
ofportalvenousHTN
-longtermtx:
1.nonselective BB:*propranolol, nadolol*1stline(reducesportal pressure)butnotusedinacute
bleedsbcptmayalreadybehypovolemic
2.*isosorbide*:longactingnitrate(vasodilator)
txofanacuteesophageal varicesbleed? thesehavea30-50%mortalityratew/1stbleedand70%
recurrence ratew/i1styr!-correct answer✔✔1.2large boreIVlines,IVF,+/-bloodtransfusion
2.*endoscopicligation*istxofchoice
3.pharmacologic vasoconstrictors- *octreotide* 1stline(somatostatinanalog),vasopressin
4.balloontamponade
5.surgicaldecompression *TIPS*(transjugular intrahepatic portosystemic shunt)connectsportal
veintohepatic veintodraintoIVC
, whatisthetxfortypeI/slidinghiatal herniavstypeII/rollinghiatalhernias? -correct answer✔✔-type
I/sliding:(MCtype95%)tx:noneexceptmanageGERDitcauses
-typeII/rolling:(paraesophageal)tx:surgicalrepairtoavoidcomplications(strangulation)
incomparingsquamouscellvsadenocarcinomaoftheesophagus,whichis:
-MCworldwide(90%)*VS*MCintheUS
-MCinupper1/3ofesophagus*VS*lower1/3
-RFofuntreatedGERD/barrett's*VS*tobacco/EtOHuse,exposuretonoxiousstimuli,AA-correct
answer✔✔-squamouscell:MCworldwide(90%),upper1/3,RF:tobacco/EtOHuse,exposureto
noxiousstimuli,AA
-adenocarcinoma: MCinUS,lower1/3,RF:untx'dGERD/barrett's
whatarethe2mostcommoncausesofgastritis? howaretheydiagnosedandtreated? -correct
answer✔✔1.H.pylori MC-stoolantigenorureabreathtest;tx:triple therapy:"CAP"*clarithromycin +
amoxicillin+PPI*ormetronidazole ifPCNallergic;ifmacrolide resistance suspecteddoquadtherapy:
PPI+bismuthsubsalicylate +tetracycline +metronidazole
2.NSAIDs/ASA-clinicallydxbutEGDgoldstd;tx:acidsuppression(PPI,H2RA,antacids)
isa*gastric* or*duodenal* ulcermoreassociatedwithrelief ofepigastric pain(dyspepsia)witheating?
whichtypealwaysneedsaBxandendoscopicmonitoring2-3moslatertor/omalignancyand
documenthealing? -correct answer✔✔-duodenal ulcer(areabecomesmorebasic whenyoueatin
preparationforacid/foodlateron);theseare4xmorecommonthatGUs
-gastriculcerbchigherrisk ofmalignancy
PPIsblockthe_______ pumpofthe________ cell reducingacidsecretion;taken_____minbefore
mealsandcanresultindiarrhea, HA,hypomagnesemia, _____deficiency, andhypocalcemia;which
PPIcausesCP450inhibition? -correct answer✔✔-H/KATPasepump
-parietalcells
-30min
-B12deficiency
