Esophagus
A patient who was a recipient of a heart transplant presents with painful swallowing. What test are you ordering to confirm a diagnosis?
EGD with biopsy
What is the main component of the pathogenesis of non-alcoholic fatty liver disease?
Insulin resistance continually increasing.
What are the 2 main differences in stool presentation between secretory and osmotic diarrhea?
Osmotic is less voluminous stool that goes away with fasting; Secretory has larger volume and doesn't change with fasting
40y F pt presents with RUQ pain and rt shoulder pain lasting the past 6 hrs. She states she ate McDonald's for dinner and the pain onset shortly after and has not gone away. What PE finding would help confirm suspected diagnosis?
Positive Murphy's sign
What are the fat soluble and water soluble vitamins?
F: A, D, E, K
W: B and C
70yo F Pt presents with difficulty swallowing for 3 months. She states she has noticed bad breath for this time, and has had a cough for a couple of days now and just isn't feeling right. What 2 diagnostic tests are you ordering?
CXR- check for pneumonia
Barium swallow
50y old alcoholic present with ascites, RUQ pain, jaundice, and confusion. His discriminant function score is 34. What is your treatment plan?
Banana bag, no ETOH, etc.
Prednisolone 40mg/day for 4 wks with 2 week taper
Pt presents with bloating, flatulence, cramps, and diarrhea after eating ice cream. What are 2 confirmatory diagnostic methods for your suspected diagnosis?
Hydrogen breath test
Small bowel biopsy
Pt presents with acute onset epigastric pain that they describe as constant and if someone is punching a hole through them. They are feeling nauseous and have puked once. Labs reveal elevated lipase, amylase, and leukocytosis. What is the MCC of your suspected diagnosis and what is the most important tx aspect?
Gallstones
Pancreatic rest/IV fluids
An anorexic patient presents to the ER. You decide to start enteral nutrition. What is the most common electrolyte imbalance to avoid due to its fatal consequences?
Hypophosphatemia
A 58 yo male with a BMI of 32 presents to the clinic with complaints of difficulty swallowing. His hx is significant for 25 pack years of smoking. He states this has been going on "for a while now", but only seems to happen when he is trying to eat breakfast after his morning pot of coffee. What is your order, tx plan, and future screening?
EGD- ensure there is no malignancy
PPI daily
EGD every 3y for barrett's
Pt presents with increased vomiting, abd pain, tremors, and depression. On physical exam, you notice changes to the iris. What labs are you ordering and what are your expected findings?
Urine copper (high), serum copper (high), and ceruloplasmin (low)
35yo M presents with complaints of wt loss x 4mo. Upon further questioning, he notes that he has been more depressed and just not feeling himself. He recalls infrequent diarrhea, and an itchy rash on his elbow.
What is your diagnostic choice and tx?
Either serum ttG IgA antibodies or intestinal biopsy
Gluten removal, assess vitamin deficiencies
What is Reynold's pentad and what is it associated with?
Fever, chills, jaundice, confusion, and hypotension
Acute cholangitis
A patient who recently underwent gastric bypass surgery and has switched to a vegetarian diet presents to your office fatigued. You run a CBC and find a hemoglobin of 9.2. What is your treatment?
Vitamin B12 administration
A 67 yo M pt present with acute hematemesis and confusion. His hx is significant for chronic pancreatitis and cirrhosis. His BP is 98/64 and HR is 130, and PT is 16. What is your pharmaceutical treatment for this patient? (4)
Vasoactive drugs (Octreotide)
Vitamin K
Lactulose
Abx (FQL)
An alcoholic with known cirrhosis presents with jaundice, ascities, and pruritis. What is a useful diagnostic tool to assess liver stiffness?
Transient elastography
Pt presents with crampy abdominal pain not localized, wt loss, and diarrhea. He notes a sore on his gums that has been there for a couple weeks now that he thought would go away. You decide to order a colonoscopy that confirms your diagnosis. What is your best, most effective treatment plan for an acute flair?
Corticosteroids
55yo pt with a history of ETOH abuse presents with complaints of flatulence, wt loss, post-prandial pain and "gross" looking stools. They also complain of constant thirst and lack of sensation in their feet. What are your medical treatment options for your suspected diagnosis?
Low fat diet, Pancreatic supplements, No ETOH, and tx the new onset diabetes.
A pregnant lady presents to your office who eats an adequate amount of fruits and vegetables. Which vitamin should you warn her to not supplement with?
Vitamin A
A 30yo M pt presents with dysphagia, heartburn, and upper abd pain. He endorses having a history of puking when he was younger. He has tried PPIs and tums with no relief. You have ordered an EGD with biopsy that confirms your suspicion. What is your treatment plan/options for this patient?
PPI
Biologic options
Swallowed steroids
Diet change (find suspect)
Ursodiol > counteracts toxicity of retained bile salts
Tx secondary elevated cholesterol, malabsorption/fat soluble vitamin deficiencies
Pt presents with bloody diarrhea x 2 months. He reports wt loss, constipation, and intermittent abd pain. Labs show elevated ESR and + fecal RBC. After imaging, he is classified as E2. What is your initial tx to induce remission?
Topical amino salicylates
HIDA scan + CCK
Laparoscopic cholecystectomy
A 70yo F presents to your office with confusion, vomiting, muscle weakness, and polyuria. She was told to take a supplement once a week and has been taking it once a day. Her BMP shows a creatinine of 2.2 and GFR of 40. What is your treatment?
Stop daily vitamin D
IV Fluids
Dialysis (kidneys are hurting)