Mksap 16 Q&a Gi

Front 1

When is further evaluation with endoscopy required or GERD warning signs?

Back 1

Symptoms of weight loss, dysphagia, odynophagia, bleeding, or anemia and in men with long-standing symptoms (>5 years) or refractory to acid-suppression therapy.

Front 2

Bleeding rate required for angiography.

Back 2

>1 mL/min

Front 3

Bleeding rate detected by nuclear scintigraphy.

Back 3

0.1 to 0.5 mL/min

Front 4

Endoscopy should not be delayed for anticoagulation reversal unless the INR is:

Back 4

>3.0

Front 5

Surveillance endoscopy if Barrett's is identified:

Back 5

-Endoscopy with multiple biopsies at diagnosis and at 1 year; if no dysplasia found, defer next surveillance for 3 years

Front 6

Most common cause of acute mesenteric ischemia?

Back 6

Embolus to superior mesenteric artery from left atrium or ventricular mural thrombus.

Front 7

Second most common cause of acute mesenteric ischemia:

Back 7

nonocclusive mesenteric ischemia due to cardiovascular event (s.a. hypotension post MI)

Front 8

When to repeat colonoscopy in patients with 3-10 adenomas on initial colonoscopy?

Back 8

in 3 years

Front 9

When to repeat colonoscopy in patients with 1 or 2 small (<1cm) tubular adenomas, with low-grade dysplasia?

Back 9

in 5 years

Front 10

When to repeat colonoscopy in patients with small rectal hyperplastic polyps?

Back 10

in 10 years

Front 11

Treatment of eosinophilic esophagitis:

Back 11

The first step in treatment of suspected eosinophilic esophagitis is exclusion of GERD by an ambulatory pH study (to detect excessive esophageal acid exposure) or a 6-week therapeutic trial of a high-dose PPI

Front 12

Medications that cause pill-induced esophagitis

Back 12

-Tetracycline

-Iron sulfate

-Bisphosphonates

-Potassium

-NSAIDs

-Quinidine

Front 13

What is lubiprostone?

Back 13

C2 chloride channel activator that causes secretion of salt water into the intestine and may improve colonic motility - for constipation-predominant IBS

Front 14

NOTE: If CT and MRI radiologic criteria are typical of hepatocellular cellular carcinoma, a

Back 14

Biopsy is NOT necessary and the lesion should be treated as HCC.

Front 15

Clinical features of thiamine deficiency manifesting as Wernicke encephalopathy

Back 15

-Nystagmus

-Ophthalmoplegia

-Ataxia

-Confusion

Front 16

Formula for stool osmotic gap

Back 16

290 - 2(stool Na + stool K):

>100 indicates osmotic diarrhea, most commonly lactose intolerance

Front 17

Preferred diagnostic test for acute cholangitis

Back 17

ERCP

Front 18

Indications for ERCP:

Back 18

ERCP should be performed ONLY if a patient with gallstone pancreatitis has worsening liver chemistry tests in the setting of clinical instability or has documented ascending cholangitis.

Front 19

Maddrey Score for severe alcoholic hepatitis

Back 19

>/= 32

Front 20

Drug of choice in severe ETOH hepatitis with contraindications to steroids (s.a. bleeding)

Back 20

pentoxyfilline

Front 21

Definitive therapy for acute acalculous cholecystitis?

Back 21

cholecystectomy OR percutaneous drainage if surgery not possible

Front 22

Fusiform dilatation of the common bile duct in the absence of obstruction or stones

Back 22

Type 1 biliary cyst

Front 23

Octreotide inhibits the hormone secretion of these tumors by binding to somatostatin receptors:

Back 23

1. Carcinoid

2. Insulinomas

3. Gastrinomas

Front 24

Most reliable routine laboratory test to predict mortality in acute pancreatitis?

Back 24

Serial BUN measurements

Front 25

Causes of erythema nodosum (EN) fall into 3 broad categories

Back 25

-Infections

-Drugs, and

-Systemic diseases (ulcerative colitis or sarcoidosis).

Front 26

Treatment of large varices

Back 26

offer beta blocker vs ligation (if BB contraindicated)

Front 27

What is chronic HBV infection in the immune-tolerant state?

Back 27

High circulating viral level in the absence of markers of liver inflammation - no pharmacologic treatment, just monitor LFTs

Front 28

Rome III criteria for IBS:

Back 28

Recurrent abdominal pain or discomfort 3 days/month in last 3 months associated with 2 or more of:

-(1) improvement with defecation,

-(2) onset associated with a change in frequency of stool, and

-(3) onset associated with a change in form of stool

Front 29

GI antispasmodic agents:

Back 29

-Dicyclomine (Bentyl)

-Hyoscyamine (Levsin)

-Possibly peppermint oil

Front 30

Extrahepatic manifestations of chronic HCV infection:

Back 30

-Hematologic conditions (mixed cryoglobulinemia, lymphoma)

-Skin diseases

-Autoimmune diseases (thyroiditis)

-Kidney disease

Front 31

How to interpret SAAG?

Back 31

SAAG:

>1.1 indicates portal hypertension;

<1.1 other causes;

Heart failure causes SAAG >1.1 and total ascitic protein >2.5

Front 32

Post colorectal cancer surveillance with colonoscopy

Back 32

1 year

Front 33

Treatment of primary billiary cirrhosis (PBC)

Back 33

Ursodeoxycholic acid (Actigall)

Front 34

Diagnosis of primary billiary cirrhosis is confirmed by:

Back 34

-Cholestatic profile (alkaline phosphatase >1.5x upper limits of normal;

-Increases in ALT AST < 5 x upper limits of normal

-Positive serum antimitochondrial antibody titer >1:40

Front 35

Condition characterized by effortless regurgitation of undigested food and reswallowing of the contents?

Back 35

Rumination syndrome

Front 36

Treatment for rumination syndrome?

Back 36

Postprandial diaphragmatic breathing exercises

Front 37

Initial diagnostic test for Budd Chiari syndrome

Back 37

Ultrasound

Front 38

Initial treatment of mod to severe Crohn's disease:

Back 38

anti-TNF infliximab (Remicade)

Front 39

The syndrom with arterial hypoxemia from pulmonary vascular dilatation in the setting of portal hypertension?

Back 39

Hepatopulmonary syndrome

Front 40

Most efficient method to detect hepatopulmonary syndrome?

Back 40

-Contrast-enhanced transthoracic echocardiography with agitated saline -> microbubbles in the left atrium within three to six cardiac cycles indicate the presence of an abnormally dilated vascular bed.

Front 41

Development of pulmonary arterial hypertension in patients with portal hypertension

Back 41

Portopulmonary hypertension (POPH)

Front 42

Define fulminant hepatic failure

Back 42

Hepatic encephalopathy in the setting of jaundice without preexisting liver disease

Front 43

Classification of liver failure based on time of onset of encephalopathy after onset of jaundice

Back 43

-Hyperacute liver failure: within 1 week

-Acute liver failure is between 1 and 4 weeks

-Subacute liver failure is between 4 and 12 weeks

Front 44

The two types of hepatorenal syndromes?

Back 44

- Type 1 HRS: is typically defined by at least a doubling of the initial serum creatinine to greater than 2.5 mg/dL (221 micromoles/L) in less than 2 weeks.

-Type 2 HRS: is not as rapidly progressive but is a common cause of death in patients with refractory ascites.

Front 45

Major criteria for diagnosis of HRS

Back 45

cirrhosis with ascites, crea >1.5 mg/dL (133 micromoles/L); no improvement of serum creatinine (improvement is defined by a decrease to ≤1.5 mg/dL [133 micromoles/L]) after at least 2 days of diuretic withdrawal and volume expansion with 1.5 L or more of albumin; absence of shock or hypotension; no current or recent treatment with nephrotoxic drugs; and the absence of parenchymal kidney disease (no significant proteinuria [<500 mg/d], hematuria, findings of acute tubular necrosis [pigmented granular casts on urinalysis], or evidence of obstruction on ultrasound)

Front 46

The most promising agent that reverses type 1 hepatorenal syndrome?

Back 46

Terlipressin

Front 47

Recommended for the initial treatment of type 1 HRS?

Back 47

vasopressor agents

Front 48

Second most promising treatment for HRS?

Back 48

albumin

Front 49

The most effective medical treatment for fistulizing Crohn disease?

Back 49

Infliximab (Remicade)

Front 50

Most appropriate management for achalasia?

Back 50

Laparoscopic myotomy

Front 51

Micro-opioid-receptor antagonist, has been found to help with opioid-induced constipation without negating the beneficial effects of the analgesia?

Back 51

Methylnaltrexone

Front 52

Treatment for diffuse esophageal spasm

Back 52

calcium channel blockers

Front 53

Options for the management of high-grade dysplasia in patients with Barrett esophagus (BE)

Back 53

esophagectomy or endoscopic therapy (ablation)

Front 54

Size of bile ducts affected in primary biliary cirrhosis?

Back 54

-Microscopic bile ducts.

-Extrahepatic bile ducts are not dilated in PBC