Bug hunting
Oh my RUQ hurts!(gallstones)
Oh my belly hurts! (PUD)
Oh my liver!
(Hepatitis)
Grab Bag
100
Name the type of ulcer more commonly associated with H. pylori infection
Duodenal ulcer. H pylori associated in 95-99% of duodenal ulcer versus 90% of gastric ulcers.
100
What is test of choice for evaluation of suspected acute cholecystitis?
Ultrasound of gallbladder and biliary tree
100
Name the prototypical acid hypersecretory condition resulting in ulcer formation
Zollinger-Ellison syndrome
100
What will be positive in patient who is immune to Hep B due to immunization (what lab test)?
Hepatitis B surface antibody
100
What organ was known at the "seat of life" to early Mesopotamians? Hint: You have a 1 in 3 chance of guessing right...
Liver
200
The cancer curable with treatment of H. pylori infection.
Mucous associated lymphoid tissue lymphoma (MALT).
200
What does MRCP stand for and what is the sensitivity of it?
Magnetic resonance cholangiopancreatography which has a sensitivity of greater than 90% and is great study for noninvasive evaluationof biliary tree.
200
Which type of ulcer is more prevalent and when is its peak prevalence?
Duodenal which accounts for 80% of cases peaks in prevalence between age 45 and 54.
200
Which of the following have beneficial effect on course of acute viral hepatitis: corticosteroids, dietary manipulation, bedrest
None of them have been proven to have any beneficial effect on course or prognosis of acute viral hepatitis.
200
What is third largest class of medications sold in USA?
proton pump inhibitors
300
Name the four ways you can test for H pylori.
Endoscopic tissue sampling, serologic testing, C urea breath test, stool antigen test.
300
What is a medication that can be used to treat gallstones if patient is a poor surgical candidate or reluctant to have surgery?
Ursodiol- which is a bile acid effective in dissolving cholesterol stones with limited side effects.
300
Name a few things to avoid (limiting precipitants) during management of PUD.
Smoking, Aspirin, NSAIDs, alcohol, steroids, emotional stress. No strong evidence to support diet changes aside from limiting eating before bedtime.
300
What is the only intervention with life saving potential for fulminant acute hepatitis?
Liver transplantation
300
We all know october is breast cancer awareness month but it is also awareness month for what else?
October is domestic violence awareness month.
400
Which of the tests for H pylori are best to look for eradication and why.
C urea breath test (costly and not widely available), and stool antigen test because they will not remain positive despite no active disease like the serologic test will. Also not invasive like endoscopy.
400
Which medications should be avoided to prevent gallstones (or which have increased risk of stone development)?
Clofibrate, estrogen, thiazide diuretics.
400
When should you consider adding sucralfate according to Goroll?
To aid in healing of a large, non nsaid induced ulcer if resolution is slow.
400
When is hospital admission indicated in those with chronic hepatitis?
When mental status worsens, GI bleeding, refractory ascites, coagulopathy, or poor home environment.
400
How did the gallbladder get its name?
Medieval people believed in health as a balance of 4 fluids, and inbalance affected mood and health. An excess of "yellow bile" found in the gallbladder was thought to produce aggression or "gall". So a hot tempered patient would naturally have a gallbladder issue!
500
In the treatment of h pylori infection, what are the general components of treatment and why are they necessary.
Two different antibiotics- due to increased resistance when using only one type. Anti-secretory/acid suppression agent- To decrease gastric acidity which can limit efficacy of antibiotics needed for eradication
500
How does performing non elective open cholecystectomy effect mortality rate?
It increases it four fold (up to 10% in the elderly)
500
What should you do for persistent or recurrent disease unresponsive to treatment?
Refer for endoscopy/biopsy to rule out malignancy and/or complicated disease
500
What combination of medicines is used to treat Hepatitis C?
Interferon (alfa or pegylated) and ribavirin are used in combination.
500
Most commonly used hepatotoxic drug?
Acetaminophen- but only when taken in massive doses or inappropriately.
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