PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
what are the 2 conditions under the inflammatory bowel disease umbrella? - (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 - (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? - (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? - (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
,PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
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? - (answer)
-*squamous* epithelium to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - (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 - (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? - (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 - (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 - (answer) schatzki ring
,PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - (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! - (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? - (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 - (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
, PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
what are the 2 most common causes of gastritis? how are they diagnosed and treated? - (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? - (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? - (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)? - (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? - (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? - (answer) -bismuth compounds (pepto-
bismol, kaopectate): also antibacterial; s/e: darkening of stool/tongue, constipation
-sucralfate/Carafate: s/e: may reduce bioavailability of H2RA
DETAILED ANSWERS
what are the 2 conditions under the inflammatory bowel disease umbrella? - (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 - (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? - (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? - (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
,PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
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? - (answer)
-*squamous* epithelium to metaplastic *columnar*
-esophageal *adenocarcinoma*
tx for intermittent/mild vs mod/severe GERD - (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 - (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? - (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 - (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 - (answer) schatzki ring
,PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
test of choice is barium sallow
tx: dilation
esophageal varices are MC d/t? tx to prevent rebleeds? - (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! - (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? - (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 - (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
, PAEA GENERAL SURGERY EOR EXAM NEWEST 2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS
what are the 2 most common causes of gastritis? how are they diagnosed and treated? - (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? - (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? - (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)? - (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? - (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? - (answer) -bismuth compounds (pepto-
bismol, kaopectate): also antibacterial; s/e: darkening of stool/tongue, constipation
-sucralfate/Carafate: s/e: may reduce bioavailability of H2RA
