Transcript Gastrointestinal Blueprint

Gastrointestinal Blueprint
Questions, Answers and Explanations
Question 1
1. Your patient is a 25 year old male that presents with RLQ pain, WBC
14.5, and voluntary guarding in the RLQ. His scrotal exam is
unremarkable. He has no abdominal distension and his bowel sounds
are normal. Which of the following is the best imaging modality to
evaluate this patient.
A. Abdominal Ultrasound
B. CT scan of Abdomen and Pelvis
C. 3 view Abdominal Series
D. Intravenous Pyelogram
Answer 1
1. Choice B is the correct answer. CT scan of the abdomen and
pelvis is the imaging study of choice. This study has the highest
yield. Abdominal ultrasound can be attempted but often the
appendix is not visualized especially if their is a lot of bowel gas.
Intravenous Pyelogram is for kidney stones. A three view
abdomen is useful when there is a suspicion of a bowel
obstruction or perforation. Air fluid levels would be seen in the
case of a bowel obstruction on the upright films and
pneumoperitoneum would be seen in the case of perforation.
Question 2
2. All of the following are common causes of
large bowel obstructions except?
A. Volvulus
B. Adhesions
C. Cancer
D. Diverticulitis
Answer 2
2. Choice B is the correct answer. Adhesions
are not a common cause of large bowel
obstruction. Adhesions are a common cause of
a small bowel obstruction. Tumors are the most
common cause of large bowel obstructions.
Diverticulitis and Volvulus can cause large
bowel obstructions.
Question 3
3. Which of the following is true regarding Meckel's
Diverticulum?
A. It is congenital remnant of the omphalomesenteric duct
B. It affects 15 percent of the population
C. It usually presents with abdominal pain
D. The hematochezia is painful
Answer 3
3. Choice A is the correct answer. Meckel's
Diverticulum has the rule of two's. It occurs in in
2% of the population. It is found about two feet
from the ileocecal valve, and is about two
inches long. Meckel's diverticulum is typically
painless until it becomes inflamed.
Question 4
4. The most common cause of acute diarrhea
is?
A. Campylobacter
B. Shigella
C. E. Coli
D. Viruses
Answer 4
4. Choice D is the correct answer. Acute
diarrhea is defined as diarrhea lasting less than
14 days. Viruses are the most common cause.
Campylobacter, Shigella, and E.Coli are all
causes of acute diarrhea but occur with much
less frequency than viral infections.
Question 5
5. Which of the following is not true regarding
Crohn's Disease?
A. Crohn's is a recurrent disorder
B. Most common involves the terminal ileum
C. Granulomatous Process
D. Always begins at the rectum
Answer 5
5. Choice D is the correct answer. Crohn's
disease is a disorder that is transmural and can
affect any where from the mouth to the anus. It
affects the terminal ileum mostly. Crohn's
causes skip lesions, unlike ulcerative colitis that
starts at the rectum and tracts proximally.
Question 6
6. All of the following are risk factors for
esophageal cancer except?
A. Poor oral hygiene
B. Obesity
C. Herpes Simplex Virus
D. Barrett's Esophagus
Answer 6
6. Choice C is the correct answer. Herpes simplex virus is
not a risk factor for esophageal cancer. Human
papillomavirus is a risk factor for esophageal cancer. Poor
oral hygiene, obesity, Barrett's Esophagus, caustic
strictures, atrophic gastritis, achalasia, family history, and
certain medications put you at risk for esophageal cancer.
Question 7
7. Your patient is a 45 year old female that presents with epigastric
discomfort improved with eating. You have sent her for outpatient labs
and she has a positive H. Pylori antibody. She has never had H. Pylori
in the past. Which of the following is an acceptable antibiotic regimen
for H. Pylori eradication?
A. azithromycin and amoxicillin
B. metronidazole and clindamycin
C. clarithromycin and metronidazole
D. ciprofloxacin and tetracycline
Answer 7
7. Choice C is the correct answer. Acceptable
antibiotic regimens for H. Pylori eradication
include: clarithromycin and metronidazole,
metronidazole and tetracycline, or amoxicillin
plus clarithromycin. Azithromycin, clindamycin,
and ciprofloxacin are not helpful in H. Pylori
eradication.
Question 8
8. Your patient is a 5 week old caucasian male that presents with
vomiting, and weight loss. This has been going on for approximately 2
days. Physical exam reveals a "olive like" mass at the rectus
abdominus muscle. Which of the following tests would be most helpful
in confirming the diagnosis?
A. KUB
B. Ultrasound
C. CT scan of Abdomen and Pelvis
D. 24 hour pH probe
Answer 8
8. Choice B is the correct answer. This patient
has pyloric stenosis. An "olive like" mass is
consistent with pyloric stenosis. Pyloric
stenosis typically presents at 3-6 weeks.
Usually is the first born caucasian male. A 24
hour pH probe would be helpful for determining
if reflux was present.
Question 9
9. Which serotype of Hepatitis requires
Hepatitis B to replicate?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
Answer 9
9. Choice D is the correct answer. Hepatitis D
requires the serotype Hepatitis B to be present
in order to replicate.
Question 10
10. The most common cause of cirrhosis other
than alcohol in the United States is?
A. Hemochromatosis
B. Hepatitis C
C. Autoimmune hepatitis
D. Fatty Liver Disease
Answer 10
10. Choice B is the correct answer. The most common
causes of cirrhosis is the US are alcoholism and Hepatitis
C. Other causes of cirrhosis include hepatitis B,
hemochromatosis, autoimmune hepatitis, non alcoholic
fatty liver disease, primary sclerosing cholangitis,
medications, Wilson's Disease, alpha 1 antitrypsin
deficiency, portal fibrosis, infections, right heart failure, and
venous occlusive disease.