INTERNAL MEDICINE BOARD REVIEW FLASHCARDS

Gastroenterology
Includes 50 Flashcards for Board Exam prep

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KNOWMEDGE

INTERNAL MEDICINE BOARD REVIEW FLASHCARDS

Gastroenterology

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Question 1

What are some common symptoms seen

in diverticulitis?

Answer 1
- Lower left sided abdominal pain (often severe and
sudden)
- Fever
- Change in bowel habits
- Constipation
- Diarrhea
- Bloating

Question 2

Rectal bleeding is a common symptom in

(Diverticulitis or Diverticulosis?)

Answer 2

Rectal bleeding is rarely seen in patients

with diverticulitis. It is much more
common in patients with diverticulosis.

Question 3
After a night of heavy drinking, patient
begins to retch and cough violently
before seeing blood in his emesis. Likely
diagnosis?

Answer 3

Extreme retching and violent coughing

preceding hematemesis is a clue for
Mallory-Weiss tear.

Question 4

What are the two most common causes

of lower GI bleed in the elderly?

Answer 4

Diverticular bleeding and Angiodysplasia

are the most common causes of lower GI
bleed in the elderly (age greater than 60)

Question 5

Definitive diagnosis of a Mallory-Weiss

tear is made by __________.

Answer 5

Definitive diagnosis of a Mallory-Weiss

tear is made by
Esophagogastroduodenoscopy (EGD)

Question 6

What are common signs and symptoms

seen in esophageal cancer?

Answer 6
Signs and symptoms of esophageal
cancer include dysphagia (difficulty
swallowing), odynophagia (painful
swallowing), weight loss, cough or
hoarseness.

Question 7

How do gastric and duodenal ulcers

differ based on their most common
cause?

Answer 7
Gastric ulcers are generally caused by
excessive NSAID use. Duodenal ulcers
are generally caused by Helicobacter
pylori (H. pylori)

Question 8

How do gastric and duodenal ulcers

differ in terms of their relation to food
intake?

Answer 8

Gastric ulcers typically worsens with

food intake. Duodenal ulcers typically
improve with food intake.

Question 9

Which medication class can lead to

peptic ulcers independently: Steroids or
NSAIDs?

Answer 9
NSAIDs can induce ulcers by themselves
but steroids alone are not ulcerogenic.
The combination of NSAIDs and steroids
are ulcerogenic and can increase the
bleeding risk of ulcers significantly.

Question 10

Young patients who have intermittent

dysphagia to solid foods such as bread or
meats are likely to have what condition?

Answer 10

Schatzki or lower esophageal ring

Question 11

Systemic sclerosis (or scleroderma)

causes dysphagia to solids, liquids or
both?

Answer 11

It is a motility problem that is expected

to cause dysphagia to both solids and
liquids.

Question 12

What is the initial test to be ordered

when "Steakhouse syndrome" is
suspected?

Answer 12

Barium swallow

Question 13
In Nissen fundoplication, what part of
the stomach is used to wrap around the
lower esophageal sphincter to increase
its tone?

Answer 13

The fundal portion of the stomach

Question 14

In osmotic diarrhea, what is the stool

osmotic gap?

Answer 14

Greater than 100mOsm/kg

Question 15

What are the 4 main categories of

chronic diarrhea?

Answer 15

Secretory, Osmotic, Exudative, Increased

motility

Question 16

What is the most likely symptom is

patients experiencing VIPoma?

Answer 16

Voluminous, watery diarrhea

Question 17

In secretory forms of diarrhea, how does

fasting affect the large/frequent bowel
movements?

Answer 17

Little/No effect

Question 18

How is the stool osmotic gap calculated?

What number is it less than in secretory
diarrhea?

Answer 18
Stool osmotic gap = 290 - 2 (Stool
Potassium + Stool Sodium).
Value < 50mOsm/kg in secretory
diarrhea

Question 19

Diet containing what sugar-like

compounds can cause diarrhea?

Answer 19

High sorbitol or fructose diet

Question 20

Diet containing what sugar-like

compounds can cause diarrhea?

Answer 20

Metformin

Question 21

What type of a diet is recommended for

patients with chronic pancreatitis?

Answer 21

Low-fat diet with addition of fat-soluble

vitamins (A, D, E, K).

Question 22

What type of triglycerides may be

recommended in the diet for a patient
with chronic pancreatitis?

Answer 22

Medium-chain triglycerides (MCTs)

Question 23

30,000 units of what enzyme is

recommended for patients with chronic
pancreatitis?

Answer 23

Lipase

Question 24

Any patient with Crohns disease and a

new limp must be ruled out for what
complication?

Answer 24

Psoas (or iliopsoas) muscle abscess

Question 25

What is the anatomic landmark which

differentiates upper & lower GI bleeds?

Answer 25

Ligament of Treitz

Question 26

What is the most common location of

colonic diverticula?

Answer 26

Sigmoid colon

Question 27

______________ is the formation of

outpouchings in the lining of the bowel
and can cause rectal bleeding

Answer 27

Diverticulosis is the formation of

outpouchings in the lining of the bowel
and can cause rectal bleeding

Question 28

Diverticuli can be seen in the context of

what four main conditions?

Answer 28

Asymptomatic diverticulosis, Painful

diverticulosis, Diverticular bleed,
Diverticulitis

Question 29

A clue to upper GI bleed would be an

abnormally high BUN:Creatinine ratio
greater than ___:___.

Answer 29

A clue to upper GI bleed would be an

abnormally high BUN:Creatinine ratio
greater than 30:1

Question 30

What test is ordered before a patient

undergoes Nissen fundoplication for the
treatment of GERD?

Answer 30
Manometry study to confirm good
motility of the esophagus before Nissen
is done. If poor motility, achalasia can
result.

Question 31

What test must any patient with GERD

experiencing alarm features undergo?

Answer 31

EGD with biopsy to rule out

adenocarcinoma of the esophagus

Question 32

What are alarm features associated with

GERD?

Answer 32

Dysphagia, Hematemesis or
Unintentional weight loss

Question 33

What causes the "Bird's beak" finding on

barium swallow and what is the
diagnosis?

Answer 33
Dilated esophagus with tapered
gastroesophageal junction due to
increased lower esophageal sphincter
tone; seen in Achalasia

Question 34
Dysphagia to liquids, difficulty in
initiating a swallow, coughing and
gagging suggest which anatomical
category of dysphagia?

Answer 34

Oropharyngeal dysphagia

Question 35

What is the appropriate test for

diagnosing oropharyngeal dysphagia?

Answer 35

Modified barium swallow

(videofluoroscopy)

Question 36
Barium swallow, Manometry, or EGD
with biopsy are studies that may be
involved in the work up which
anatomical category of dysphagia?

Answer 36

Esophageal dysphagia

Question 37

The hepatitis A vaccine is an inactivated

virus that is given in two doses usually
separated by ___ months.

Answer 37

Question 38

OCPs are associated with which hepatic

pathology?

Answer 38

Hepatic adenoma

Question 39

Which anaesthetic gas is associated with

idiosyncratic hepatotoxicity & high
mortality rates?

Answer 39

Halothane

Question 40

What are the two main side effects

associated with amlodipine?

Answer 40

Peripheral edema and headaches

Question 41

What is the hepatotoxic metabolite

derived from acetaminophen by CytP450
CYP2E1?

Answer 41

N-acetyl-benzoquinone-imine (NAPQI)

Question 42

What are the autoantibodies found in

patient with autoimmune hepatitis?

Answer 42
ANA, anti smooth muscle antibody, anti
LKM, antibodies to "soluble liver
antigen/liver pancreas antigen",
antibodies to hepatic lectin

Question 43

Which specific antiviral therapy is

contraindicated in patients with
autoimmune hepatitis?

Answer 43

Interferon is contraindicated in patients

with autoimmune hepatitis as it can
worsen the disease

Question 44

What is the mainstay of treatment of

autoimmune hepatitis?

Answer 44

Glucocorticoid therapy

Question 45

Enteral feeding for patients with severe

acute pancreatitis consists of a tube that
passes what anatomical landmark?

Answer 45

The Ligament of Treitz, avoiding

pancreatic stimulation

Question 46

What osmotic agents may be used to

treat opioid-induced constipation?

Answer 46

Magnesium hydroxide, Lactulose and

Polyethylene glycol

Question 47
What complication of chronic
pancreatitis, seen in about 5-10% of
cases can present as postprandial
abdominal pain and early satiety?

Answer 47

Duodenum obstruction

Question 48
In the stepwise approach to preventing
constipation in patients using opioid
medications, what is the first medication
to try?

Answer 48

Stool softeners (e.g. docusate) with the

initiation of the opioid medication

Question 49

What are the colonic stimulants that may

be used against opioid-induced
constipation when all other options fail?

Answer 49

Bisacodyl and Senna

Question 50

What is the class of anti-hypertensive

medications used to treat Raynaud's
phenomenom?

Answer 50

Calcium channel blockers

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