Kgi 400-450

Front 1

Q400. which side of colon is melena more common in?; hematochezia?

Back 1

A400. right; left

Front 2

Q401. most common presentation of rectal cancer

Back 2

A401. hematochezia

Front 3

Q402. when should CEA levels be obtained in colorectal cancer

Back 3

A402. before surgery

Front 4

Q403. use of radiation tx in colorectal cancer

Back 4

A403. used in rectal ca but not in colon ca

Front 5

Q404. frequency of colonoscopies in patients with history of colorectal cancer

Back 5

A404. colonoscopy at 1 yr, then q3y

Front 6

Q405. in addition to colonoscopy, what other f/u is required in patients with colorectal cancer

Back 6

A405. CT scan of abdomen and pelvic; CXR; do these for up to 5 yrs; check CEA q 3-6 months

Front 7

Q406. recurrence rate of colorectal cancer

Back 7

A406. 90% within 3 yrs of surgery

Front 8

Q407. what types of polyps are associated with UC

Back 8

A407. pseudopolyps

Front 9

Q408. pathogenesis of diverticuli

Back 9

A408. outpouching at area of weakness in colon wall, which is at the site of a bv penetration --> bleeding

Front 10

Q409. risk factors for diverticulosis

Back 10

A409. constipation increases intralumenal pressure; family history

Front 11

Q410. #1 location of diverticuli

Back 11

A410. sigmoid colon

Front 12

Q411. test of choice for diverticulosis

Back 12

A411. barium enema

Front 13

Q412. tx of diverticulosis

Back 13

A412. high fiber food to increase stool bulk psyllium

Front 14

Q413. complications of diverticulosis

Back 14

A413. painless rectal bleeding; diverticulitis

Front 15

Q414. complications of diverticulitis

Back 15

A414. bowel obstruction; fistula; abscess

Front 16

Q415. how to manage bleeding in diverticulosis

Back 16

A415. usually stops on its own - no tx for these patients; if it continues, then colonoscopy should be performed to locate site of bleeding, if persistent or recurrent, surgery may be needed

Front 17

Q416. dx of diverticulitis

Back 17

A416. ct abdomen and pelvis; abdominal XR to rule out other causes, ileus, obstruction, and perforation

Front 18

Q417. tx of diverticulitis for first episode

Back 18

A417. NPO; antibiotics; surgery may be necessary if persists x 3-4 days

Front 19

Q418. examples of angiodysplasia of the colon

Back 19

A418. AV malformation; vascular ectasia

Front 20

Q419. dx of angiodysplasia of the colon

Back 20

A419. colonoscopy

Front 21

Q420. tx of angiodysplasia of the colon

Back 21

A420. colonoscopic coagulation; if bleeding persists, right hemicolectomy (cecum is most common location)

Front 22

Q421. types of acute mesenteric ischemia; which is most common

Back 22

A421. arterial embolism *; venous thrombosis (rarest); arterial thrombosis; nonoclusive mesenteric ischemia

Front 23

Q422. random association with angiodysplasia of the colon

Back 23

A422. aortic stenosis

Front 24

Q423. clinical history of patient with mesenteric arterial thrombosis

Back 24

A423. patients with history of atherosclerotic disease at other sites; acute occlusion occurs over preexisting atherosclerotic disease (acute event can be a decrease in CO or plaque rupture); collateral circulation has usually developed; SYMPTOMS are gradual and less severe than embolic causes

Front 25

Q424. clinical history of a patient with nonocclusive mesenteric ischemia

Back 25

A424. splanchnic vasoconstriction secondary to low CO; typically seen in elderly

Front 26

Q425. overall mortality of all causes of acute mesenteric ischemia

Back 26

A425. 60%

Front 27

Q426. presentation of patient with venous thrombosis as a cause for mesenteric ischemia

Back 27

A426. symptoms may be present for several days or weeks with gradual worsening

Front 28

Q427. clinical feature of acute mesenteric ischemia

Back 28

A427. severe abdominal pain disproportionate to physical findings

Front 29

Q428. complications of acute mesenteric ischemia

Back 29

A428. peritonitis; sepsis; shock

Front 30

Q429. dx of acute mesenteric ischemia

Back 30

A429. mesenteric angiography; plain film of abdomen to rule out other causes

Front 31

Q430. tx of acute mesenteric ischemia

Back 31

A430. IVF; broad spectrum antibiotics; papaverine (vasodilator) into superior mesenteric artery during arteriograph to relieve occlusion and vasospasm; direct infusion of thromboloytics in patients with embolism; heparin for venous thrombosis

Front 32

Q431. signs of intestinal infarction

Back 32

A431. hypotension, tachycardia, tachypnea, lactic acidosis, fever, change in ms, shock; CHECK LACTATE LEVEL

Front 33

Q432. causes of chronic mesenteric ischemia

Back 33

A432. atherosclerotic occlusive disease of celial artery and sma, ima

Front 34

Q433. symptoms of chronic mesenteric ischemia

Back 34

A433. abdominal angina (postprandially)

Front 35

Q434. tx of chronic mesenteric ischemia

Back 35

A434. surgical revasularization

Front 36

Q435. tx of ogilvie's syndrome

Back 36

A435. decompression with gentle enemas or ng suction; if not, colonoscopic decompression; surgical decompression is last resort

Front 37

Q436. complication of pseudomembranous colitis

Back 37

A436. toxic megacolon with risk of perforation; amasarca; electrolyte disturbances

Front 38

Q437. tx of pseudomembranous colitis

Back 38

A437. metronidazole; (oral vancomycin if metronidazole is contraindicated - infants and pregnancy)

Front 39

Q438. most common cause of upper GI bleeding

Back 39

A438. pud (duodenal ulcer, gastric ulcer, gastritis)

Front 40

Q439. pertinent history in a patient with aorticoenteric fistula

Back 40

A439. distant history of aortic graft surgery, in a patient with a small GI bleed, involving the duodenum; massive, fatal hemorrhage occurs hours to weeks later

Front 41

Q440. tx of aortoenteric fistula

Back 41

A440. endoscopy or surgery

Front 42

Q441. where is the bleeding from? test to order?; hematemesis

Back 42

A441. Upper GI; endoscopy

Front 43

Q442. where is the bleeding from? test to order?; hematochezia

Back 43

A442. Lower GI; first rule out hemorrhoids; colonoscopy

Front 44

Q443. where is the bleeding from? test to order?; melena

Back 44

A443. Upper GI or right side of colon; do endoscopy first, if negative, do colonoscopy

Front 45

Q444. where is the bleeding from? test to order?; occult blood

Back 45

A444. Lower GI; colonoscopy; upper endoscopy if colonoscopy is -

Front 46

Q445. type of pain: vague, dull, poorly localized, usually midline due to bilateral innervation of organs based on embryologic origin

Back 46

A445. Visceral Pain; (Visceral is Vague); ex: early appendicitis

Front 47

Q446. type of Pain: sharp, well-localized and involves the peritoneum and is associated with rebound and guarding

Back 47

A446. Parietal Pain (Parietal is PiNPOint); ex: late appendicitis

Front 48

Q447. Referred pain: Ureteral obstruction in man

Back 48

A447. Ipsilateral testicle

Front 49

Q448. Dx: 45-yo obese woman complains of fever, RUQ pain and nausea that worsens when she eats fatty foods

Back 49

A448. Cholecystitis

Front 50

Q449. Diff Dx: Epigastric Pain; GI (3); Pancreatic (2); Aortic (2); Cardiac (3)

Back 50

A449. Gastritis; Peptic Ulcer; GERD; Acute/Chronic Pancreatitis; Ruptured Aortic Aneurysm; Dissecting Aorta; Angina, MI, Pericarditis

Front 51

Q450. Diff Dx: RUQ Pain; Hepatobiliary (4); GI (1)

Back 51

A450. Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis; Peptic Ulcer