ClinMed GI quiz Part 1

1.

1 point

What is the most common finding in gastric adenocarcinoma?

frank blood in stool

WBC in stool

Elevated liver enzymes

Iron deficiency anemia

2.

1 point

Risk for gastric lymphoma is greater by sixfold if what is present?

HP

HIV

gastric adenocarcinoma

non-Hodgkin's lymphoma

3.

1 point

Your patient presents with difficulty swallowing both liquids and solids. You decide you need to ask the patient more history taking questions to determine if they have what differential diagnosis?

Neurogenic dysphagia

Esophageal stenosis

Zenker's diverticulum

Achalasia

4.

1 point

What symptoms make up Charcot's triad and it describes what disease?

RUQ tenderness

Primary sclerosing cholangitis (PSC)

Acute cholangitis

fever

jaundice

confusion

LUQ tenderness

Hepatitis

nausea/vomitting

5.

1 point

A patient presents to the clinic with Jaundice. You run a series of tests and results show unconjugated hyperbilirubinemia (elevated indirect bilirubin). This indicates what?

Hepatitis

Cirrhosis of the Liver

Gilbert's Syndrome, no real concern

Cholecystitis

6.

1 point

Painless jaundice, until proven otherwise is_______.

7.

1 point

To diagnose a bowel obstruction what is the best diagnostic test and what will it show you?

CMP, electrolyte imbalance

Upright radiograph, demonstrates air-fluid level

Abdominal plain film

D-xylose test, distinguishes malabsorption

8.

1 point

A homeless patient presents to your ER with symptoms of confusion, ataxic gait, nystagmus, and lack of coordination. You decide to treat them for what vitamin deficiency?

Thiamin

B6 pyridoxine

Pantothenic acid

Niacin

9.

1 point

Portal Hypertension gastritis is classified by?

HP

Esophageal varices

Elevated liver enzymes

Tachycardia

10.

1 point

Aminotransferase elevations are seen in all types of acute hepatitis, including hepatocellular damange?

True

False

11.

1 point

The borders of the Hesselbach's triangle? (common site of direct hernias) (there are 3 correct answers)

Femoral ligament

Lateral border of rectus sheath

Inferior epigastric vessels

Superior epigastric vessels

Inguinal ligament

Medial border of rectus sheath

12.

1 point

The most sensitive diagnostic tool for an Upper GI bleed?

Esophageal manometry

US

UGI (Upper Gastrointestinal Series)

Endoscopy

13.

1 point

Lab findings for alcoholic hepatitis include which of the following? Pick all that apply

High bilirubin

Leukocytosis

Elevated Alk phos

Anemia (microcytic)

Anemia (macrocytic)

Low AST

Low bilirubin

Leukopenia

14.

1 point

Most common bacterial causes of infection of cholangitis are all of the following EXCEPT?

Enterococcus

E. coli

H. Pylori

Enterobacter

Klebsiella

15.

1 point

Most ascites is secondary to what?

chronic liver disease with portal hypertension

nephrotic syndrome with protein loss

malnutrition

protein-losing entropathy

16.

1 point

HAV IgG on lab results indicates what?

they are a carrier for Hepatitis A

the patient has a resolved case of Hepatitis A

the patient has an ongoing infection of Hepatitis A

the patient is currently infected with Hepatitis A

17.

1 point

A patient presents with malaise, weight loss, abdominal swelling, weakness, jaundice and hepatomegaly. You diagnose hepatic carcinoma. Which laboratory finding proved this diagnosis?

Needly biopsy of the tumor

A-fetoprotein, which will be elevated if cancerous

Liver transplant

hepatic angiography

18.

1 point

A patient diagnosed with Peptic Ulcer disease had a CBC panel taken. Results show leukocytosis. You are concerned about which of the following complications? Pick all that apply

Ulcer penetration

anemia

gastric perforation from alcohol use

bacterial infection

19.

1 point

A patient was recently diagnosed with Cholelithiasis. They return to the clinic and present with a small bowel obstruction that has lead to a gallstone ileus. This is called?

Ranson's criteria

Acalculous cholecystitis

Bouveret syndrome

cryptosporidiosis

20.

1 point

A patients lab results for hepatitis are positive for anti-HBc. What do you tell the patient about their hepatitis status?

they are immune to Hepatitis C

they have chronic Hepatitis B

they have received the Hepatitis B vaccine

they have acute hepatitis

22.

1 point

Signs of metastatic spread in gastric adenocarcinoma include?

Peri-umbilical or flank ecchymosis(Cullen & Grey Turner’s Sign)

ovary tumor (Krukenberg tumor)

umbilical nodule (Sister Mary Joseph)

Left supraclavicular lymphadenopathy (Virchow's node)

23.

1 point

Treatment for alcoholic cirrhosis of the liver include all of the following EXCEPT:

Methylprednisone

Ursodiol

Banana bag (thiamine, folate)

Spironolactone

Pentoxyfylline

24.

1 point

Patient presents with a gnawing pain that radiates to the back. Patient has lost a lot of weight recently due to pain when eating. You suspect what?

PUD with a gastric ulcer

H pylori secondary to PUD

PUD with gastric malignancy

PUD with a duodenal ulcer

25.

1 point

First line treatment for pancreatitis?

surgical resection (modified Whipple's procedure) in those without metastitis

NPO, fluid volume restoration, parenteral hyperalimentation

low-fat diet

address the underlying cause, most likely alcohol

26.

1 point

A HIDA scan would be used to detect what and is used when? Pick all that apply:

False positives can result from hepatitis

Used to demonstrate an obstructed cystic duct

Used to demonstrate tumors only in the cystic duct

False positives can result from prolonged fasting, liver disease

Use when gallbladder ejection fraction is suspect

27.

1 point

The most specific test to diagnose pancreatitis:

serum amylase

serum lipase

elevated WBC

elevated LFT's

28.

1 point

A patient was infected with Hepatitis B 5 months ago. You order a panel on the patient and expect to find what test result?

anti-HBc

anti-HAV

HBsAg

anti-HBs

29.

1 point

A patient presents with ascites. You discover the patient has recently moved to the country from Africa. You are most concerned about what possible cause of ascites based on patient history?

Tuberculosis peritonitis

liver failure

Jaundice

Hepatitis C

30.

1 point

For a patient with chronic Hepatitis B, what lab results would you expect to see? Pick all that apply

Hepatocellular damage on biopsy

Elevated ALT

negative HBsAg

positive anti-HBc

positive HBsAG

Elevated AST

31.

1 point

A patient presents with constant GI ulcer pain despite medication. You suspect Zollinger-Ellison syndrome (ZES). In order to confirm this diagnosis you must run what test to confirm the presence of ZES? and what results will you see?

Give patient secretin 2 U/kg (IV). Gastrin levels will lower by more than 200 pg/ml

give patient secretin 2 U/kg (IV). Gastrin will increase by more than 200 pg/ml

Give the patient 2 U/kg of gastrin. Levels should hover around 150 pg/mL

no labs are required for this diagnosis. Perform a CT or MRI to localize the tumor

32.

1 point

What medication should be avoided by a patient diagnosed with GERD?

None of the answers are correct

A-adrenergic antagonist

Diazepam

B-agnoist

Theophylline

Nitrates

All of the answers are correct

CCB

33.

1 point

A patient presents with RUQ pain, fever, jaundice, altered mental status and shock. You know these symptoms are classic findings for?

Reynolds's pentad-- toxic ascending cholangitis

Charcot's triad- cholangitis

Asterixis secondary to hepatic encephalopathy

Hepatic vein occlusion (Budd-Chiari syndrome)

34.

1 point

Treatment for Primary sclerosing cholangitis (PSC) includes all of the following EXCEPT?

Ursodeoxycholic acid

Corticosteroids

Methotrexate

Salicylates

Long-term antibiotics

35.

1 point

What test is used to identify cause, location and extent of a biliary obstruction?

US

HIDA scan

ERCP- endoscopic retrograde cholangiopancreatography

CT scan with contrast

36.

1 point

Empiric 2-4 week trial of PPI's can be used to treat upper gastritis, especially in those patients whom NSAID used is required?

True

False

37.

1 point

Which test can indicate both the location of gastritis as well as presence of HP?

Endoscopy with biopsy

Barium radiography

Urea Breath Test

Ultrasound with contrast

38.

1 point

Hepatitis D is only seen in conjunction with Hep B and is associated with a more severe course?

True

False

39.

1 point

Gastropathy denotes conditions in which there is epithelial or endothelial damage with inflammation, whereas Gastritis denotes there is no histological inflammation?

True

False

40.

1 point

50 year old woman presents to clinic with new onset of GERD-like symptoms, including heartburn and chest pain. What studies do you perform at this time for diagnosis? Pick all that apply

Endoscopy

ambulatory 24-hour pH

Barium swallow

ECG

esophageal manometry