FES WRITTEN EXAM | 139 QUESTIONS | WITH
COMPLETE SOLUTIONS.
Time frames for upper endoscopy - Familiar polyposis Answer - 1-2 years
Patient positioning for ERCP Answer - prone position with the head turn
toward the right shoulder
patient positioning for upper endoscopy Answer - left side down, head slightly
up.
Maneuver to look at the GE junction Answer - J maneuver (tip up), rotate the
shaft of the scope CCW and withdraw, pulling the scope into the proximal body
and cardia, rotate the scope 360 around the GE jx,
techniques to decrease post ERCP pancreatitis Answer - selective bile duct
cannulation w/ guidewire, stenting pancreatic dut w/ stent or guidewire for
difficult CBD cannulation, limiting contrast injection into the pancreatic duct
Technique for billiary sphincterotomy Answer - apply pressure w/ cutting wire
toward 11 o'clock direction, continue the sphincterotomy until the intramural
portion is cut. Use blended current with cutting and coag at 15-20J. Alt: can use
balloon dilation but a/w higher rate of post-ECRP pancreatitis
Direction of pancreatic cannulation during ERCP Answer - 1 to 3 o'clock
position
,When to stop warfarin before ERCP Answer - stop 5 days before and switch to
heparin or lovenox if peri-procedural anticoagulation is required. This can be
stopped a day prior to the procedure
rate of post ERCP pancreatitis Answer - 3-5%
Timing of colonoscopy for first degree relative w/ CRC or adenomas prior to
age 60 Answer - colonoscopy at age 40 or 10 years before the youngest
affected relative, whichever is earlier. Then repeat every 5 yrs
Indications for ECRP Answer - Tissue sampling - bile duct, pancreatic duct,
ampulla bx
chronic pancreatitis/divisum
pancreatic malignancy
billiary malignancy
Benign strictures
Ductal disruption/injury
Jaundice
cholangitis
gallstone pancreatitis
dilated CBD
maneuvers to enter IC valve Answer - rotate the scope until the valve is at the
bottom of the visual field, look down into the valve, gently insufflate air to
open up the valve, OR retroflex the tip in the cecum and shorten the scope
(hook the IV valve)
cancer detection rate of brush biopsy Answer - 20-60%
, band ligation vs sclerotherapy for esophageal varices Answer - equal efficacy
but baldn ligation has lower complication rate.
cancer detection rate of needle aspiration Answer - 6-30%
how long after sphincterotomy can the bleeding complication manifest?
Answer - immediate up to 14 days
relative contraindications for colonoscopy Answer - anal fissure, recent MI, PE,
large bowel obstruction
Time frames for upper endoscopy - esophageal varices s/p sclerotherapy and
banding Answer - q6-8weeks
Indications for screening colonoscopies Answer - over 50 y/o, repeat every 10
years
Time frames for upper endoscopy - pernicious anemia Answer - single
endoscopy w/o f/u
complication rate of diagnostic colonoscopy Answer - 1:1500
Time frames for upper endoscopy - Barett's esophagus (high risk) Answer - >3
cm, circumferential - yearly
low grade dysplasia - every 6 mo
Factors a/w rebleeding after endoscopic procedures Answer - endoscopic
stigmata w/ active bleeding and visible vessles having the highest rebleeding
COMPLETE SOLUTIONS.
Time frames for upper endoscopy - Familiar polyposis Answer - 1-2 years
Patient positioning for ERCP Answer - prone position with the head turn
toward the right shoulder
patient positioning for upper endoscopy Answer - left side down, head slightly
up.
Maneuver to look at the GE junction Answer - J maneuver (tip up), rotate the
shaft of the scope CCW and withdraw, pulling the scope into the proximal body
and cardia, rotate the scope 360 around the GE jx,
techniques to decrease post ERCP pancreatitis Answer - selective bile duct
cannulation w/ guidewire, stenting pancreatic dut w/ stent or guidewire for
difficult CBD cannulation, limiting contrast injection into the pancreatic duct
Technique for billiary sphincterotomy Answer - apply pressure w/ cutting wire
toward 11 o'clock direction, continue the sphincterotomy until the intramural
portion is cut. Use blended current with cutting and coag at 15-20J. Alt: can use
balloon dilation but a/w higher rate of post-ECRP pancreatitis
Direction of pancreatic cannulation during ERCP Answer - 1 to 3 o'clock
position
,When to stop warfarin before ERCP Answer - stop 5 days before and switch to
heparin or lovenox if peri-procedural anticoagulation is required. This can be
stopped a day prior to the procedure
rate of post ERCP pancreatitis Answer - 3-5%
Timing of colonoscopy for first degree relative w/ CRC or adenomas prior to
age 60 Answer - colonoscopy at age 40 or 10 years before the youngest
affected relative, whichever is earlier. Then repeat every 5 yrs
Indications for ECRP Answer - Tissue sampling - bile duct, pancreatic duct,
ampulla bx
chronic pancreatitis/divisum
pancreatic malignancy
billiary malignancy
Benign strictures
Ductal disruption/injury
Jaundice
cholangitis
gallstone pancreatitis
dilated CBD
maneuvers to enter IC valve Answer - rotate the scope until the valve is at the
bottom of the visual field, look down into the valve, gently insufflate air to
open up the valve, OR retroflex the tip in the cecum and shorten the scope
(hook the IV valve)
cancer detection rate of brush biopsy Answer - 20-60%
, band ligation vs sclerotherapy for esophageal varices Answer - equal efficacy
but baldn ligation has lower complication rate.
cancer detection rate of needle aspiration Answer - 6-30%
how long after sphincterotomy can the bleeding complication manifest?
Answer - immediate up to 14 days
relative contraindications for colonoscopy Answer - anal fissure, recent MI, PE,
large bowel obstruction
Time frames for upper endoscopy - esophageal varices s/p sclerotherapy and
banding Answer - q6-8weeks
Indications for screening colonoscopies Answer - over 50 y/o, repeat every 10
years
Time frames for upper endoscopy - pernicious anemia Answer - single
endoscopy w/o f/u
complication rate of diagnostic colonoscopy Answer - 1:1500
Time frames for upper endoscopy - Barett's esophagus (high risk) Answer - >3
cm, circumferential - yearly
low grade dysplasia - every 6 mo
Factors a/w rebleeding after endoscopic procedures Answer - endoscopic
stigmata w/ active bleeding and visible vessles having the highest rebleeding
