what is FALSE of Giardia, the #1 parasitic cause of diarrhea?

Stool ova and parasite one time is sufficient for dx

which statement is TRUE?

cystic lesions include esoph duplication cysts & bronchogenic/enterogenous, glycogen acanthosis are flat lesions, round, may be asso w celiac dz, an inlet patch are typically in proximal esophagus and asymptomatic, Esophagitis dissecans superficialis: sloughing off of esoph mucosal eipthel

what is FALSE of a diverticular bleed?

Typically associated with diverticulitis

hemobilia (bleeding from/into biliary tree) is usually caused by invasive procedures of the liver & has a triad of what?

RUQ pain, jaundice, overt upper GI bleeding

which is a peripheral cause of vomiting?

most GI or intra-abdominal problems

Which of the following are symptoms of celiac's but NOT gluten sensitivity?

vitamin deficiencies and fertility issues

what is true of achalasia?

inadequate peristalsis in lower esophagus with tight LES, barium esophagram will show characteristic bird beak sign, key sx is progressive dysphagia with solids and liquids with chest pain, surgical myotomy if candidate- risk of post op reflux (concurrent fundoplic

which of the following is an H1 antihistamine used to treat acute causes of nausea and vomiting?

Promethazine (Phenergan), Meclizine (Bonine, Antivert)

what is FALSE of H2 blockers

decrease acid secretion by blocking the gastric H, K-ATPase pump

what contains the area postrema in the floor of the fourth ventricle?

Chemoreceptor Trigger Zone (CTZ)

what are risk factors for rebleeding and and mortality with GI bleeds?

age > 60 years, more than one comorbidity, bright red hematemesis with hypotension, large ulcers, recurrent hemorrhage, coagulopathy from severely impaired liver function/loss of clotting factors, severe blood loss, shock on admission

what is FALSE of Barrett's esophagus?

Usually sx such as progressive dysphagia

what is true of C. diff?

may cause toxic megacolon (dilated colon), recent abx is the biggest risk factor followed by health care exposure, can occur up to 60 days after abx use, Only oral abx work: fidaxomicin or vancomycin

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Questions 98

Answers

1
what inflam bowel dz has a hallmark of blood diarrhea and moves in a continuous fashion proximally?
Crohn's disease
Ulcerative colitis
2
what is FALSE of neurokinin receptor antagonists?
work best when used in conjunct. with serotonin receptor antags & dexametha
primarily used in prevention of chemotherapy induced n/v
all the above are TRUE
prevent acute but also delayed emesis
3
what is FALSE of Giardia, the #1 parasitic cause of diarrhea?
from contaminated water supplies (drinking from streams)
treat with hydration and metronidazole
fatty diarrhea, flatulence, bloating
Stool ova and parasite one time is sufficient for dx
4
borders of the triangle of calot include all of the following except...
cystic duct
common bile duct
cystic artery
common hepatic duct
5
what agent for Crohn's disease has the risk of developing progressive multifocal lueukoencephalopathy?
IV vedolizumab
Certolizumab
IV cyclosporine
Natalizumab
6
Angiodysplasia is an acquired vascular ectasia usually in the distal colon. Self limiting, but rebleeding is common
False
True
7
Primary Sclerosing Cholangitis labs show hypergammaglobulinemia and cholestatic LFT pattern
True
False
8
what is the first line drug for gastroparesis?
Cisapride
Reglan (metoclopramide)
Domperidone
Macrolides
9
Iron deficiency anemia with (+) hemoccult in the elderly is CANCER until proven otherwise
False
True
10
What is the imaging study of choice for pancreatitis?
ERCP
Abdominal U/S
CT abdomen with contrast
CT abdomen without contrast
11
which is NOT a complication of NGTs?
gastritis or gastric bleeding
coiling/knotting of tubing
nasal ulceration or necrosis, sinusitis
small bowel perforation
12
which of the following is an OPEN drain?
Round blake
Penrose
Jackson Pratt
Hemovac
13
Primary bile acids are cholic acid and chendoxycholic acid which are conjugated to form bile salts
True
False
14
NGTs are used in treating an ileus or bowel obstruction
True
False
15
NGTs are used as prophylactic placement (abd/thoracic surgery), gastric lavage, long term enteral nutrition
False
True
16
what is the best diet for weight loss and obesity?
low-carb diets
Mediterranean diet
Fad diets
low-fat diets
17
which statement is TRUE?
cystic lesions include esoph duplication cysts & bronchogenic/enterogenous
glycogen acanthosis are flat lesions, round, may be asso w celiac dz
an inlet patch are typically in proximal esophagus and asymptomatic
Esophagitis dissecans superficialis: sloughing off of esoph mucosal eipthel
18
Adenomas (raised lesion) arise in segments of Barretts almost always (biopsy surrounding areas for intestinal metaplasia
True
False
19
which of the following is predominately used as prophylaxis against motion sickness w/ SEs of dry mouth, drowsiness?
Butyrophenones
antihistamines (Diphenhydramine)
Phenothiazines
Scopolamine
20
what is FALSE of a diverticular bleed?
most common cause of overt LGIB
typically painless
both left and right colon bleed, but right (ascending) more common (80%)
Typically associated with diverticulitis
21
hemobilia (bleeding from/into biliary tree) is usually caused by invasive procedures of the liver & has a triad of what?
RUQ pain, jaundice, occult upper GI bleeding
RUQ pain, elevated total bilirubin, overt upper GI bleeding
RUQ pain, elevated total bilirubin, occult upper GI bleeding
RUQ pain, jaundice, overt upper GI bleeding
22
____ is the most common esophageal cancer in the world ; _____ is the most common esophageal cancer in the US
SCC ; adenocarcinoma
adenocarcinoma ; SCC
23
which is a peripheral cause of vomiting?
anxiety/depression
infection
most GI or intra-abdominal problems
food and medication
24
which of the following causes black pigmented stones in cholelitiasis?
colonization of bile with bacteria
liver fluke infestation
high heme turnover
intraductal stasis
25
Which of the following are symptoms of celiac's but NOT gluten sensitivity?
excessive gas and diarrhea
vitamin deficiencies and fertility issues
bloating
anxiety/depression and headaches and fatigue
26
First line drugs for weight loss
Orlistat (lipase inhibitor)
Bupropion-naltrexone
GLP-1 agonists
Phentermine-topiramate
27
what serotonin receptor antagonist is very effective for both acute and delayed emesis?
Palonosetron (Aloxi) - IV
Ondansetron (Zofran) – PO, IV
Granisetron (Sustol, Sancuso) – IV, transdermal patch
Dolasetron (Anzemet) – PO, IV
28
Adverse effects of long term PPI use includes all the following except...
hypomagnesemia
rebound acid secretion
B12 deficiency
hyponatremia
29
what is true of achalasia?
inadequate peristalsis in lower esophagus with tight LES
barium esophagram will show characteristic bird beak sign
key sx is progressive dysphagia with solids and liquids with chest pain
surgical myotomy if candidate- risk of post op reflux (concurrent fundoplic
30
which of the following is an H1 antihistamine used to treat acute causes of nausea and vomiting?
Promethazine (Phenergan)
transdermal scopolamine (Transderm Scop)
Meclizine (Bonine, Antivert)
Metoclopramide (Reglan) and Ondansetron (Zofran)
31
what is FALSE of H2 blockers
inhibit acid secretion by blocking H2 receptors on the parietal cells
AEs: gynecomastia, impotence, B12 deficiency, CNS effects
decrease acid secretion by blocking the gastric H, K-ATPase pump
initial treatment of GERD
32
what contains the area postrema in the floor of the fourth ventricle?
visceral nervous system
CNS
Chemoreceptor Trigger Zone (CTZ)
vestibular system
33
which of the following neurotransmitters are involved in vomiting?
dopamine (D2) and 5-Ht3 serotonin
histamine (H1) and muscarinic (M1)
neurokinin 1 (NK1)
all the above
34
pancreatic cancer is typically from an adenocarcinoma of the endocrine cells lining the pancreatic duct
False
True
35
what are risk factors for rebleeding and and mortality with GI bleeds?
age > 60 years, more than one comorbidity
bright red hematemesis with hypotension, large ulcers, recurrent hemorrhage
coagulopathy from severely impaired liver function/loss of clotting factors
severe blood loss, shock on admission
36
what is the minimum amount of biopsies needed for Celiac's disease?
3
1
6
4
37
what is FALSE of Barrett's esophagus?
Usually sx such as progressive dysphagia
shorter segments have a lower risk of developing esophageal caner
diagnosis made with endoscopy with biopsy
Replacement of strat squamous epithelium in distal esophagus w columnar epi
38
Orogastric tubes are used in intubated patients and nasal ulcerations and sinusitis are not concerns
False
True
39
what is the m/c dopamine receptor antagonist that has SEs of extrapyramidal rxns (tardive dyskinesia) and hypotension?
Benzamides
Butyrophenones
all the above
Phenothiazines
40
what is true of C. diff?
may cause toxic megacolon (dilated colon)
recent abx is the biggest risk factor followed by health care exposure
can occur up to 60 days after abx use
Only oral abx work: fidaxomicin or vancomycin
41
what type of ulcer may have nocturnal pain and pain that is diminished with eating and antacids?
Gastric
Duodenal
42
Contraindications to nasogastric tubes include all of the following except...
Esophageal stricture, varices, and diverticulum
unilateral choanal atresia
Hx of bariatric surgery (roux-en-Y or sleeve gastrectomy)
basilar skill/facial fracture
43
what describes UC beyond the splenic flexure and involves the cecum? Proximal to splenic flexure but spares cecum?
left sided UC ; pancolitis
proctitis ; proctosigmoiditis
extensive colitis ; pancolitis
pancolitis ; extensive colitis
44
what are normal gas patterns of the small bowel, large bowel, and cecum respectively?
4-8-12 cm
3-6-9 cm
2-4-6 cm
1-2-3 cm
45
Celiac's disease is associated with HLA-DQ2 and HLA-DQ8 gene loci which result in genetic predisposition
False
True
46
Reynold's Pentad is Charcot's triad plus what two other things (associated with acute cholangitis)?
hepatic encephalopathy and hypotension
AMS and hepatic encephalopathy
hypotension and AMS
hypertension and tachycardia
47
A HIDA scan is the imaging done id U/S is non-diagnostic when suspicion of acute cholecystitis remains high
False
True
48
which of the following is not included in an obstruction series?
prone
erect
supine
CXR
49
Acute pancreatitis presents with sudden onset of epigastric or LUQ pain that may radiate. Pain is knifelike & intense
False
True
50
Acute dysphagia is typically from a FB impaction in the esophagus (m/c site). Other causes include infxn, stroke, trauma
False
True
51
Wheat, rye and barley are main sources of gluten and should be absolutely avoided in Celiac's disease
False
True
52
what is TRUE of IV contrast used with CT?
barium or water soluble iodine-based contrast used for bowel opacification
Not nephrotoxic
useful to identify intraluminal suspicions
Useful to identify extraluminal suspicions or solid organ etiologies
53
"Villous atrophy" on small intestine biopsy is associated with what?
Hirschsprung's disease
gastric cancer
Celiac's disease
IBD
54
what is the first line treatment for moderate to severe Crohn's disease?
Steroids such as budesonide
TNF inhibitors
immunomodulators
oral 5-ASA such as mesalamine
55
what is the BMI of class I obesity?
25 - 29.9
30 - 34.9
35 - 39.9
20 - 24.9
56
What mimics appendicitis or Crohn's disease and may present with fever, diarrhea and RLQ pain?
salmonella enterica
Yersinia enterocolitica
shigella
campylobacter jejuni
57
Serum lipase is more sensitive than serum amylase when eval pancreatitis. It's elevated 3x ULN & stays elevated longer
True
False
58
what is FALSE of osmotic diarrhea?
Celiac sprue and lactose intolerance are causes
electrolyte absorption are NOT impaired
Often nocturnal
subsides if person fasts or stops ingesting
59
what is the gold standard diagnosis of Zenker diverticulum?
Barium swallow
CXR
barium swallow with video fluoroscopy
EGD
60
what is a herniation of the esophageal mucosa that presents w/ halitosis and regurg of undigested food/pills?
esophageal cancer
Zenker diverticulum
Nutcracker esophagus
diffuse esophageal spasm
61
what is NOT associated with Plummer Vinson Syndrome?
anemia
jaundice
cervical esophageal web
dysphagia
62
what is FALSE of E-coli H7:)157 enterohemorrhagic e coli (SHIGA producing toxin)?
does not spread person to person
may cause hemolytic uremic syndrome
abx are not used because they can caused increased risk of HUS
sx range from mild diarrhea to life threatening hemorrhagic colitis
63
what is FALSE of caustic esophageal injury?
alkaline (liquefactive necrosis) is less severe than acidic (coag necrosis)
All patients need upright chest x-ray and airway protection is key
vomiting should NOT be induced
Risk of stricture long-term due to remodeling of scar tissue
64
what is true of primary sclerosing cholangitis?
site of involvement is intrahepatic only
Tx w ursodeoxycholic acid to slow progression, steroids, liver transplant
potential development of cholangiocarcinoma & assoc w IBD (ulcerat colitis)
gradual destruction of bile ducts due to inflammation and cholestasis
65
which is considered an emergency when it comes to swallowing FBs?
objects greater than 6cm in length above the duodenum
not sharp-pointed objects
coins in esophagus
inability to handle oral secretions
66
what is important to recognize early as it can progress to gangrenous cholecystitis?
Acute cholecystitis
Choledocholithisis
Acalculous cholecystits
Cholelitiasis
67
what produces detailed images of the hepatobiliary & pancreatic system (liver, gallbladder, bile ducts, pancreas)?
Contrast enhanced CT
endoscopic retrograde cholangiopancreatography (ERCP)
magnetic resonance cholangiopancreatography (MRCP)
HIDA scan
68
Lead pipe sign and collar button ulcers are seen in what?
Ulcerative colitis
Crohn's disease
69
which of the following results in sudden, overt, major bleeding if a rupture occurs, and can be fatal?
Esophageal varices
Mallory-Weiss tear
Boerhaave syndrome
Peptic ulcer disease
70
what is true of primary biliary cholangitis?
hallmark is the presence of antimitochondrial antibodies
level of involvement is intrahepatic and extrahepatic
MRCP to eval biliary tree & tx with immunosuppresion and steroids initially
fibrosis destroying bile ducts
71
Benzamines (metoclopramide- Reglan) has a BBW for irreversible tardive dyskinesia with higher dosing and long-term use
True
False
72
what is the most common condition causing acute episodes of vomiting?
acute pancreatitis
appendicitis
viral gastroenteritis
Peritonitis
73
which is a cause of functional diarrhea?
Crohn's
Irritable bowel disease
Ulcerative colitis
giardia, pancreatic exocrine insufficiency
74
which is NOT included in acute classification diarrhea (at least one of the following and < 3 weeks)?
at least one bloody stool
sudden onset of 3 or more water stools
passage of greater than 200 grams of stool
decreased stool consistency
75
which is a characteristic of salmonella enterica?
progressive fever and may have rose spots
treat with cipro or ceftriaxone
life threatening infection (Typhoid fever)
common in picnic months, may have reactive arthritis, and is self limiting
76
what is FALSE regarding acute cholecystitis?
pts may have fever and tachycardia due to GB inflam from cystic duct obstru
RUQ pain that may radiate to scapula, (+) Murphy
U/S will show pericholecystic fluid, GB wall thickening
percutaneous transhepatic cholecystotomy is the preferred standard of care
77
which dopamine receptor antagonist are major tranquilizers that potentiate the actions of opiods? SEs= QT prolongation
Benzamides
Butyrophenones
Phenothiazines
78
what is not included in bismuth quadruple therapy?
tetracylcine
metronidazole
PPI
clarithromycin
79
what is the landmark that determines an upper GI bleed versus a lower GI bleed?
sphincter of oddi
ligament of treitz
ileocecal valve
transverse colon
80
If lab studies show (+) p-ANCA and (-) ASCA, which inflammatory bowel disease is more likely the diagnosis?
Ulcerative colitis
Crohn's disease
81
Surgery is the primary treatment and the only potential curative treatment of pancreatic cancer
True
False
82
A LBO will not result in a dilated small bowel because the ileocecal valve is a one way valve
False
True
83
If the stomach contains air, where may it be visible on xray?
right upper quadrant
left upper quadrant
left hypochondriac
right hypochondriac
84
which is NOT a common presentation of pancreatic cancer?
Epigastric abdominal tenderness/pain
dark urine, pale stool
painful jaundice
Non tender but palpable gallbladder (Courvoisier's sign)
85
What are mucosal folds of the small intestine that start from the 2nd part of the duodenum & disappear in distal ileum?
plicae circulares
Kerckring folds/valves
Valvulae conniventes
small bowel folds
86
what is the gold standard test of a lower GI bleed that is both diagnostic and therapeutic?
CT angiography
EGD
radionuclide imaging
colonoscopy
87
what is the most common congenital abnormality of the gallbladder that involves intraserosal fold in GB fundus?
aberrant cytic duct
gallbladder agenesis
choledochal cyst
phrygian cap
88
what inflam bowel dz is transmural & may involve anywhere from mouth to anus, most often distal ileum?
ulcerative colitis
Crohn's disease
89
which is an indication of Non contrast enhanced CT?
cancer staging
Diverticulitis, inflammatory bowel disease
suspected kidney stone, head trauma and acute stroke
acute appendicitis
90
what is an outpouching that occurs at the junction of the lower part of the throat & the upper portion of the esophagus
Achalasia: "bird beak sign"
Zenker's diverticulum
Schatzki's ring
91
what is NOT true regarding the diagnosis of Celiac's disease?
testing should be done while the patient is practicing a gluten free diet
If pt on GF diet but high suspicion for celiac disease, check HLA DQ2/DQ8
check total IgA first then check TgG TTG is low
IgA tissue transglutaminase is the single preferred test
92
what inflam bowel dz has complications of severe bleeding, fulminant colitis, toxic megacolon, and perforation?
Ulcerative colitis
Crohn's disease
93
which medications are associated with weight gain?
valproic acid and carbamazepine
all the above
antidepressants and antipsychotic drugs
corticosteroids and inslin/oral hypoglycemic agents
94
Large bowel mechanical obstruction is a surgical emergency
True
False
95
pt w/ heartburn not improving w/ antacids, solid food dysphagia, & impacted food bolus, hx of atopic derm. ML dx?
Eosinophilic esophagitis
severe erosive esophagitis
esophageal stricture
early stages of esophageal cancer
96
which are Upper GI bleed causes?
diverticular bleed and ischemic colitis
PUD, Mallory-Weiss tear, Boerhaave syndrome
IBD and hemorrhoids
colon cancer and angiodysplasia
97
How do you measure the estimated depth of a nasogastric tube?
tip of the nose to mastoid process to xyphoid
middle of the forehead to mastoid process to xyphoid
level of opposite eye to ear lobe to xyphoid
tip of the the nose to ear lobe to xyphoid
98
A barium enema is when contrast is inserted via the rectum and fluro is performed
True
False

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