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Session 8 GI Questions - University of Nevada School of Medicine

By Russell Campbell,2014-09-26 03:54
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Session 8 GI Questions - University of Nevada School of MedicineSess

    REMEDIATION

    Gastroenterology Remediation Questions

    Instructions

    Remediation this year will be done twice a month at a noon seminar time. It is MANDATORY for you to attend ALL of these

    sessions. The only exceptions are if you are on vacation, night shift, or actively participating in an ER shift. You are required to attend if you are in the ER for the month but not working on the day of remediation.

    This year’s program will consist of board style review questions to be discussed by the group. Approximately 1 week prior to the session you will each be assigned to a question. Your job is to research the answer and present teaching points related to the

    question assigned to the group. Please send us a written explanation of the question 2 days before the remediation session so we can provide everyone with the answers and explanations after the session. We encourage you guys to bring pictures, mnemonics,

    etc. to help teach your question. Attending physicians and the chief residents will be present to facilitate added discussion, however the responsibility of education is on you as a group. We expect each of you to arrive prepared and willing to contribute.

    Question assignments

    February 16th

    RESIDENT QUESTION

    Adair, Jennifer 1

    Asif, Aisha 2

    Brady, Sean 3

    Caliri, Erin 4

    Chin, Aleen 5

    Collazos, Juan 6

    Cox, Melissa 7

    Gordon, Robert 8

    Jack, Ineada 9

    Kharrubi, Rani 10

    Kochav, Margalit 11

    Merhi, Reema 12

    Rao, Shoba 13

    Temple, Israel 14

    Trompeta, Andree 15

    Vangala, Nivruthi 16

    1. A 16 year old boy presents with the “flu” and jaundice. The parents seem unconcerned by the jaundice. They relate that this happens every time he becomes ill. In fact, his father and uncle do the same thing. You convince them to check a bilirubin, which comes back with indirect bilirubin of 4mg/dL; the remainder of the liver tests are normal, as is a complete blood count. The next appropriate step is

    a. Liver biopsy

    b. Reassurance that this is a benign condition

    c. Liver ultrasound

    d. Hepatitis panel

    2. A 4 week old infant presents with fever and explosive stools. The child was diagnosed shortly after birth with Down syndrome. In your history, you find that the child did not stool until the third day of life. A rectal suction biopsy is performed. The expected diagnostic finding is:

    a. Absence of ganglion cells

    b. Hypertrophied nerve fibers

    c. Decreased muscle fibers

    d. Increased ganglion cells

    3. A 20 month old male presents with bloody stools. Although on complete blood count, the patient is anemic, he has no apparent abdominal pain and no feeding intolerance. Which of the studies is most likely to be diagnostic?

    a. Colonoscopy

    b. Upper GI series

    c. Upper endoscopy

    d. Meckel’s scan

    4. For the following answers which indicates remote Hepatitis B infection that has resolved? Choice HBsAg HBcAb HBsAb

    A Negative Positive Positive

    B Negative Negative Positive

    C Positive Positive Negative

    D Negative Negative Negative

    E Positive Positive Positive

    5. Which of the following is true about intussusception?

    a. Intussusception usually occurs within the first week of life

    b. Intussusception rarely present with vomiting

    c. Air contrast enema is not the diagnostic procedure of choice

    d. “Currant jelly” bowel movements may occur hours or days after the abdominal pain has begun

    e. Most intussusception have a definable etiology

    6. Which of the following is true about acute appendicitis?

    a. Appendicitis is the most common surgical emergency in children

    b. In children, fatigue and anorexia are rare in the initial presentation

    c. Periumbilical discomfort is rarely seen in children

    d. Right lower quadrant pain of the abdomen is the first sign

    e. Pain that suddenly relieves is usually indicative of self-resolution of the appendicitis and no need for

    further evaluation

    7. You are seeing a 1 month old female for a well-child visit. Mother reports that things are going well. The infant is nursing every 3 hours. She is having regular gray or pale yellow stools several times per day. She has noticed that she has been jaundiced for the past 1-2 weeks.

    PMH: Born term without complications. Birth weight was 7 pounds, 6 ounces

    Family History: Grandmother with ulcerative colitis, grandfather with hypertension, otherwise negative. PE: Weight 8lbs, 1 ounce, Temp 99.1 rectal. The patient is moderately jaundiced over entire body. The liver is palpable approximately 3cm below the costal margin. No murmur. Lungs are clear. Femoral pulses are normal.

     You tell this mother:

    a. Lab work must be done right away with further radiographic testing most likely

    b. The baby most likely has breast milk jaundice and there is no concern

    c. Stop breastfeeding and give the infant an elemental formula

    d. You will recheck the infant in a month

    e. The infant needs to be started on alpha-interferon immediately

    8. You are ordering screening tests for celiac disease on one of your patients with diabetes. Which of the following should be ordered along with the antiendomysial and tissue trans-glutaminase antibodies?

    a. Hemoglobin A1C

    b. C-peptide level

    c. Quantitative IgG

    d. Islet cell antibodies

    e. Quantitative IgA

    9. A hospitalized 6-year old boy complains of right upper quadrant pain. An abdominal ultrasound shoes prominent noncalculous distention of the gallbladder. Findings of physical examination include a rash. Which of the following best describes the rash most commonly associated with this patient’s findings on abdominal ultrasound?

    a. A maculopapular rash associated with numerous petechiae involving the wrists, palms, ankles and soles

    and, to a lesser extent, the truck.

    b. A rash consisting of petechial and purpuric coalescent lesions involving the buttocks and lower

    extremities.

    c. An erythematous rash in a malar distribution that spares the nasolabial folds.

    d. A widespread morbilliform rash that is particularly prominent in the perineum and intertriginous areas.

    e. Numerous small brownish papules and plaques that react to stroking with a wheel and flare type

    reaction.

    10. A 5-year old female presents with a history of diarrhea for 2 days. She has had fever with the diarrhea to 102 F. her stools this morning had frank blood in them, which prompted her parents to bring her in. she has a new pet puppy, which she received about a month ago. The puppy has not been ill. Cultures of the stool show motile, comma shaped Gram negative bacilli. Which of the following is the most likely organism?

    a. Shigella

    b. Salmonella species

    c. Ameba

    d. Campylobacter jejuni

    e. Bartonella henselae

    11. Which of the following is true with regards to “physiologic jaundice” of the newborn?

    stnda. Serum bilirubin reaches values near 6 mg/dL between the 1 and 2 week in full term infants.

    b. Pigment concentrations decline gradually and reach normal values in 5-7 days in term infants.

    c. The excess bilirubin is due to increased bilirubin in breast milk.

    d. Physiologic jaundice can cause damage in healthy full term neonates approximately 10% of the time.

    ndthe. Serum bilirubin reaches maximum values near 6 mg/dL between the 2 and 4 day in full term infants.

    12. Which of the following is true with regard to organic and functional abdominal pain in children?

    a. Night awakening is not common with function abdominal pain.

    b. Crampy abdominal pain is more likely organic.

    c. Pain farther from the umbilicus is more likely organic.

    d. Associated diarrhea is common in functional abdominal pain.

    e. Duration of pain is helpful in discerning between the two.

    13. Which of the following is NOT true about Meckel diverticulum?

    a. The diagnostic sensitivity of readionucleotide scanning can be improved with prior administration of an

    H2-blocker.

    b. It is usually within 2 cm of the ileocecal valve.

    c. Painless rectal bleeding most often occurs in the 2-year old age group.

    d. Is the most common GI anomaly.

    e. Occurs in 2% of the population.

    14. You are seeing a first born male for this 2-month immunizations and well child checkup. It was noted in the nursery that he had delay in passage of meconium. He is growing well, and his mother notes that he has bowel movements, but that they are intermittent and he may go several days without one. His examination shows a distended abdomen with a palpable stool mass. His anal canal and rectum are empty with no palpable fecal material. Hirschsprung disease is high on you differential. Which of the following is seen in Hirshprung diasease?

    a. A rectal biopsy is always indicated.

    b. On barium enema, the aganglionic segment is the proximal dilated segment and the aganglionic

    segment is the distal narrowed segment.

    c. On barium enema, the aganglionic segment is the distal narrowed segment and the normal ganglionic

    segment is dilated proximally.

    d. On barium enema, the aganglionic segment is the distal dilated segment and the ganglionic segment is

    narrowed proximately.

    e. On barium enema, the aganglionic segment is the proximal narrowed segment and the normal

    ganglionic segment is dilated distally.

    15. A 16 year old Caucasian male with a history of acne is brought in by his mother because of the acute onset of difficulty swallowing this morning. He has had continued difficulty since breakfast. He notes nothing unusual before this and had a good night sleep. He says school is going very well, and he really enjoys being in the band, He did not notice a problem until he tried to eat his breakfast, which consisted of a chocolate pop tart and tortilla chips. Which of the following is the most likely etiology of his swallowing complaint?

    a. Bulimia

    b. Pill-induced esophagitis

    c. Gastreoesophageal reflux

    d. Cocaine abuse

    e. Scleroderma

    16. A 20 month old boy presents to the emergency room after several episodes of bloody diarrhea. His parents deny associated symptoms of fever, appetite change, or decrease in activity. Several months prior to presentation he had several bloody stools, which were thought to be associated with a “bad stomach virus” and cleared

    spontaneously. On physical examination he is afebrile, alert, playful, and interactive. His abdominal exam is positive only for increased bowel sounds. A stool sample is positive for blood. Which of the following is the most likely cause of this patient’s clinical signs and symptoms?

    a. An area(s) of erosion within the gastric mucosa.

    b. Helicobacter pylori located within the stomach and duodenum.

    c. Invagination of a part of the intestine into itself.

    d. Ectopic gastric tissue.

    e. Increased production of gastrin from a duodenal gastrinoma.

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