PAEA General Surgery EOR
What are the 2 conditions under the inflammatory bowel disease umbrella? -
CORRECT ANSWER-1. ulcerative colitis
2. crohn's dz
in comparing ulcerative colitis and crohn's dz, which is:
-limited to the colon w/ rectum always involved *VS* mouth to anus
-transmural *VS* mucosa/submucosa involved
-LLQ *VS* RLQ pain
-bloody diarrhea *VS* non
-complications of perianal dz, strictures, fistulas & granulomas *VS* colon cancer
& toxic megacolon
-colonoscopy showing "skip lesions" & cobblestoning *VS* ulceration &
pseudopolyps
-barium studies showing "stovepipe sign" (loss of haustral markings) *VS* "string
sign" narrowing through scarred areas
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces cerevisiae Ab)
-curative *VS* noncurative - CORRECT ANSWER-1. *ulcerative colitis*-
colon/rectum, mucosa/submucosa, LLQ pain, bloody diarrhea, comps of colon
cancer & toxic megacolon, colonoscopy w/ ulcerations & pseudopolyps,
"stovepipe sign" (loss of haustral markings), (+)P-ANCA, curative
2. *crohn's dz*- mouth to anus, transmural, RLQ pain, nonbloody diarrhea,
comps of perianal dz, strictures, fistulas, granulomas, "skip lesions" &
"cobblestoning", "string sign", (+)ASCA, noncurative
what are the best studies of choice for ulcerative colitis vs crohn's dz in acute dz?
- CORRECT ANSWER--UC: *flex sigmoidoscopy* in acute dz (colonoscopy and
barium enema CONTRAINDICATED in acute dz bc can cause perf or toxic
megacolon)
-crohn's dz: *upper GI series* (barium swallow) in acute dz
what medications are used to treat ulcerative colitis and crohn's dz? - CORRECT
ANSWER-1. 5-aminosalicylic acids (anti-inflammatory) *oral mesalamine* best
for maintenance, topical mesalamine (rectal suppositories & enemas),
,*sulfasalzine* (give w/ folic acid); *all of these work best in the colon- so are
better for tx'ing UC*
2. *corticosteroids* in *acute flares* only
3. immune modifying agents: 6-mercaptopurine, azathioprine and MTX
4. anti-TNF agents- adalimumab, infliximab certolizumab
barrett's esophagus (from prolonged/untreated GERD) involves transition of
_________ cells to _________ cells (nml to precancerous); what kind of cancer
can GERD => barrett's turn into? - CORRECT ANSWER--*squamous* epithelium
to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - CORRECT ANSWER-besides
lifestyle changes (food/drink avoidance, avoiding recumbency, wt loss, smoking
cessation
-int/mild: OTC antacids (tums, MOM, maalox, mylanta) & H2 receptor
antagonists/blockers (ranitidine, cimetidine, famotidine)
-mod/severe: H2RAs, PPIs (omeprazole, esomeprazole, pantoprazole), &
prokinetic agents (cisapride), nissen fundoplication if refractory
DDx for hematemesis - CORRECT ANSWER-MC is *PUD* (gastric > duodenal),
varices, angiodysplasia, masses (adenocarcinoma, polyps), & mallory-weiss
tears
dx/tx? vomiting blood after a night of heavy drinking or in a bulimic pt; what is
seen on EGD? - CORRECT ANSWER--dx: mallory-weiss syndrome/tears (d/t
sudden rise in intragastric pressure)
-tx: supportive unless severe bleeding may need epi inj, band ligation or balloon
tamponade
-EGD: superficial longitudinal mucosal erosions/lacerations
dx? dysphagia, esophageal webs, IDA, glossitis, angular cheilitis, koilonychias -
CORRECT ANSWER-plummer-vinson syndrome
test of choice is barium swallow
tx: dilation
,dx? lower esophageal webs/constrictions at squamocolumnar junctions MC
associated w/ sliding hiatal hernias but also can be s/p corrosive injury -
CORRECT ANSWER-schatzki ring
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - CORRECT
ANSWER--cirrhosis as a complication of portal venous HTN
-long term tx:
1. nonselective BB: *propranolol, nadolol* 1st line (reduces portal pressure) but
not used in acute bleeds bc pt may already be hypovolemic
2. *isosorbide*: long acting nitrate (vasodilator)
tx of an acute esophageal varices bleed? these have a 30-50% mortality rate w/
1st bleed and 70% recurrence rate w/i 1st yr! - CORRECT ANSWER-1. 2 large
bore IV lines, IVF, +/- blood transfusion
2. *endoscopic ligation* is tx of choice
3. pharmacologic vasoconstrictors- *octreotide* 1st line (somatostatin analog),
vasopressin
4. balloon tamponade
5. surgical decompression *TIPS* (transjugular intrahepatic portosystemic shunt)
connects portal vein to hepatic vein to drain to IVC
what is the tx for type I/sliding hiatal hernia vs type II/rolling hiatal hernias? -
CORRECT ANSWER--type I/sliding: (MC type 95%) tx: none except manage
GERD it causes
-type II/rolling: (paraesophageal) tx: surgical repair to avoid complications
(strangulation)
in comparing squamous cell vs adenocarcinoma of the esophagus, which is:
-MC worldwide (90%) *VS* MC in the US
-MC in upper 1/3 of esophagus *VS* lower 1/3
-RF of untreated GERD/barrett's *VS* tobacco/EtOH use, exposure to noxious
stimuli, AA - CORRECT ANSWER--squamous cell: MC worldwide (90%), upper
1/3, RF: tobacco/EtOH use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF: untx'd GERD/barrett's
, what are the 2 most common causes of gastritis? how are they diagnosed and
treated? - CORRECT ANSWER-1. H. pylori MC- stool antigen or urea breath
test; tx: triple therapy: "CAP" *clarithromycin + amoxicillin + PPI* or
metronidazole if PCN allergic; if macrolide resistance suspected do quad
therapy: PPI + bismuth subsalicylate + tetracycline + metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std; tx: acid suppression (PPI, H2RA,
antacids)
is a *gastric* or *duodenal* ulcer more associated with relief of epigastric pain
(dyspepsia) with eating? which type always needs a Bx and endoscopic
monitoring 2-3 mos later to r/o malignancy and document healing? - CORRECT
ANSWER--duodenal ulcer (area becomes more basic when you eat in
preparation for acid/food later on); these are 4x more common that GUs
-gastric ulcer bc higher risk of malignancy
PPIs block the _______ pump of the ________ cell reducing acid secretion;
taken _____ min before meals and can result in diarrhea, HA, hypomagnesemia,
_____ deficiency, and hypocalcemia; which PPI causes CP450 inhibition? -
CORRECT ANSWER--H/K ATPase pump
-parietal cells
-30 min
-B12 deficiency
-omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin,
phenytoin, etc.)
which H2RA/H2 blocker causes CP450 inhibition (can inc levels of theophyllin,
warfarn, phenytoin, etc.) and can also cause anti-androgen s/e (gynecomastia,
impotence, dec libido)? - CORRECT ANSWER-cimetidine/Tagamet
what PUD tx is best for treating NSAID induced ulcers because it is a
prostaglandin E1 analog that increases bicarb & mucus secretion? what pts is
this drug contraindicated in? - CORRECT ANSWER--misoprostol
-CI: premenopausal women bc abortifacent and causes cervical ripening
what PUD treatments are cytoprotective (forms viscous adhesive ulcer coating
that promotes healing and protects stomach mucosa)? what s/e can they have? -
What are the 2 conditions under the inflammatory bowel disease umbrella? -
CORRECT ANSWER-1. ulcerative colitis
2. crohn's dz
in comparing ulcerative colitis and crohn's dz, which is:
-limited to the colon w/ rectum always involved *VS* mouth to anus
-transmural *VS* mucosa/submucosa involved
-LLQ *VS* RLQ pain
-bloody diarrhea *VS* non
-complications of perianal dz, strictures, fistulas & granulomas *VS* colon cancer
& toxic megacolon
-colonoscopy showing "skip lesions" & cobblestoning *VS* ulceration &
pseudopolyps
-barium studies showing "stovepipe sign" (loss of haustral markings) *VS* "string
sign" narrowing through scarred areas
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces cerevisiae Ab)
-curative *VS* noncurative - CORRECT ANSWER-1. *ulcerative colitis*-
colon/rectum, mucosa/submucosa, LLQ pain, bloody diarrhea, comps of colon
cancer & toxic megacolon, colonoscopy w/ ulcerations & pseudopolyps,
"stovepipe sign" (loss of haustral markings), (+)P-ANCA, curative
2. *crohn's dz*- mouth to anus, transmural, RLQ pain, nonbloody diarrhea,
comps of perianal dz, strictures, fistulas, granulomas, "skip lesions" &
"cobblestoning", "string sign", (+)ASCA, noncurative
what are the best studies of choice for ulcerative colitis vs crohn's dz in acute dz?
- CORRECT ANSWER--UC: *flex sigmoidoscopy* in acute dz (colonoscopy and
barium enema CONTRAINDICATED in acute dz bc can cause perf or toxic
megacolon)
-crohn's dz: *upper GI series* (barium swallow) in acute dz
what medications are used to treat ulcerative colitis and crohn's dz? - CORRECT
ANSWER-1. 5-aminosalicylic acids (anti-inflammatory) *oral mesalamine* best
for maintenance, topical mesalamine (rectal suppositories & enemas),
,*sulfasalzine* (give w/ folic acid); *all of these work best in the colon- so are
better for tx'ing UC*
2. *corticosteroids* in *acute flares* only
3. immune modifying agents: 6-mercaptopurine, azathioprine and MTX
4. anti-TNF agents- adalimumab, infliximab certolizumab
barrett's esophagus (from prolonged/untreated GERD) involves transition of
_________ cells to _________ cells (nml to precancerous); what kind of cancer
can GERD => barrett's turn into? - CORRECT ANSWER--*squamous* epithelium
to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - CORRECT ANSWER-besides
lifestyle changes (food/drink avoidance, avoiding recumbency, wt loss, smoking
cessation
-int/mild: OTC antacids (tums, MOM, maalox, mylanta) & H2 receptor
antagonists/blockers (ranitidine, cimetidine, famotidine)
-mod/severe: H2RAs, PPIs (omeprazole, esomeprazole, pantoprazole), &
prokinetic agents (cisapride), nissen fundoplication if refractory
DDx for hematemesis - CORRECT ANSWER-MC is *PUD* (gastric > duodenal),
varices, angiodysplasia, masses (adenocarcinoma, polyps), & mallory-weiss
tears
dx/tx? vomiting blood after a night of heavy drinking or in a bulimic pt; what is
seen on EGD? - CORRECT ANSWER--dx: mallory-weiss syndrome/tears (d/t
sudden rise in intragastric pressure)
-tx: supportive unless severe bleeding may need epi inj, band ligation or balloon
tamponade
-EGD: superficial longitudinal mucosal erosions/lacerations
dx? dysphagia, esophageal webs, IDA, glossitis, angular cheilitis, koilonychias -
CORRECT ANSWER-plummer-vinson syndrome
test of choice is barium swallow
tx: dilation
,dx? lower esophageal webs/constrictions at squamocolumnar junctions MC
associated w/ sliding hiatal hernias but also can be s/p corrosive injury -
CORRECT ANSWER-schatzki ring
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - CORRECT
ANSWER--cirrhosis as a complication of portal venous HTN
-long term tx:
1. nonselective BB: *propranolol, nadolol* 1st line (reduces portal pressure) but
not used in acute bleeds bc pt may already be hypovolemic
2. *isosorbide*: long acting nitrate (vasodilator)
tx of an acute esophageal varices bleed? these have a 30-50% mortality rate w/
1st bleed and 70% recurrence rate w/i 1st yr! - CORRECT ANSWER-1. 2 large
bore IV lines, IVF, +/- blood transfusion
2. *endoscopic ligation* is tx of choice
3. pharmacologic vasoconstrictors- *octreotide* 1st line (somatostatin analog),
vasopressin
4. balloon tamponade
5. surgical decompression *TIPS* (transjugular intrahepatic portosystemic shunt)
connects portal vein to hepatic vein to drain to IVC
what is the tx for type I/sliding hiatal hernia vs type II/rolling hiatal hernias? -
CORRECT ANSWER--type I/sliding: (MC type 95%) tx: none except manage
GERD it causes
-type II/rolling: (paraesophageal) tx: surgical repair to avoid complications
(strangulation)
in comparing squamous cell vs adenocarcinoma of the esophagus, which is:
-MC worldwide (90%) *VS* MC in the US
-MC in upper 1/3 of esophagus *VS* lower 1/3
-RF of untreated GERD/barrett's *VS* tobacco/EtOH use, exposure to noxious
stimuli, AA - CORRECT ANSWER--squamous cell: MC worldwide (90%), upper
1/3, RF: tobacco/EtOH use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF: untx'd GERD/barrett's
, what are the 2 most common causes of gastritis? how are they diagnosed and
treated? - CORRECT ANSWER-1. H. pylori MC- stool antigen or urea breath
test; tx: triple therapy: "CAP" *clarithromycin + amoxicillin + PPI* or
metronidazole if PCN allergic; if macrolide resistance suspected do quad
therapy: PPI + bismuth subsalicylate + tetracycline + metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std; tx: acid suppression (PPI, H2RA,
antacids)
is a *gastric* or *duodenal* ulcer more associated with relief of epigastric pain
(dyspepsia) with eating? which type always needs a Bx and endoscopic
monitoring 2-3 mos later to r/o malignancy and document healing? - CORRECT
ANSWER--duodenal ulcer (area becomes more basic when you eat in
preparation for acid/food later on); these are 4x more common that GUs
-gastric ulcer bc higher risk of malignancy
PPIs block the _______ pump of the ________ cell reducing acid secretion;
taken _____ min before meals and can result in diarrhea, HA, hypomagnesemia,
_____ deficiency, and hypocalcemia; which PPI causes CP450 inhibition? -
CORRECT ANSWER--H/K ATPase pump
-parietal cells
-30 min
-B12 deficiency
-omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin,
phenytoin, etc.)
which H2RA/H2 blocker causes CP450 inhibition (can inc levels of theophyllin,
warfarn, phenytoin, etc.) and can also cause anti-androgen s/e (gynecomastia,
impotence, dec libido)? - CORRECT ANSWER-cimetidine/Tagamet
what PUD tx is best for treating NSAID induced ulcers because it is a
prostaglandin E1 analog that increases bicarb & mucus secretion? what pts is
this drug contraindicated in? - CORRECT ANSWER--misoprostol
-CI: premenopausal women bc abortifacent and causes cervical ripening
what PUD treatments are cytoprotective (forms viscous adhesive ulcer coating
that promotes healing and protects stomach mucosa)? what s/e can they have? -
