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FES Exam questions latest upload
- (blank) are designed to view the lumen either in a front or side viewing manner: Flexible scopes
- (blank) allow for optimal access to certain areas of the stomach and duode- num and are most commonly utilized during ERCP: side- viewing
- What is a charge coupled device or complementary metal oxide semiocon- ducter chip based camera?: sends digital message to a digital processor
- the suction button and the biopsy cap share a ****: common channel
- The suction/biopsy channel is usually between what position on a clock face: 5 and 7 oclock
- The (blank) cable connects to the video processing unit either wirelessly or via a separate cable.: umbilical
- Can you use saline in your water channel?: NO it can crystalize
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- Do not activate (blank) until the functioning end of the device is fully exited from the endoscope channel.: energy sources
- What scope is a side viewing scope?: A duodenoscope
- What are external sources of endoscopic illumination?: Xenon Arc, halogen filled tungsten filament lamp, LED
- What happens when the blue button of the scope handle is depressed?: Pro- vides water to clear the lens
- If the endoscope does not have a dedicated auxillary channel for irrigation, what channel can be used?: The suction/biopsy channel
- Informed consent is based on what 2 ethical principles?: Autonomy and self-determi- nation
- Is routine testing recommended prior to endoscopy?: No
- When should you do a pregnancy test?: All females of child bearing age
- Who should get coag tests?: active bleeding, history of bleeding, acquired coagulopathy
- Who should get a CXR?: Patients with a suspected pulmonary or cardiac decompensation
- Who should get a chem panel?: pts with impaired renal, hepatic or endocrine function
4 / 35 No discomfort or signif SE No fluid or electrolyte shifts
- What is a split dose bowel regiment?: half fluid given in the evening and then half in the morning of the colonoscopy completing at least 3 hours prior to procedure.
- If you are doing rectum and sigmoid colon endoscopy what can be the prep?: 1 or 2 enemas morning of procedure
- If your patient is older than 65, what type of bowel prep should you use?: PEG solutions to avoid electrolyte and fluid shifts
- (blank) are osmotically balanced, non-absorbable electrolyte solutions that effect bowel cleansing by washing out the ingested fluid without producing significant fluid or electrolyte shifts: Isosmotic preparations
- What fragile patient populations can use isosmotic preps?: Liver and renal failures, CHF, and electrolyte imbalances
- (Blank) draw plasma water into the bowel lumen to promote the evacuation of colonic contents. They are better tolerated due to lower volume, resulting in better patient compliance.: Hyperosmotic
5 / 35 preparations.
- What is the downside to hyperosomotic solutions?: cause fluid loss, dehydration and are costly. Cant give it to people with any type of failure, ileus, malabsorption or ascites
- Antibiotics (are vs Are not?) generally recommended before most endoscopic procedures.: Are NOT
- Who should you give antibiotic prophylaxis to?: All patients before PEJ or PG People undergoing peritoneal dialysis Cirrhotic patients with Gi bleed High risk cardiac conditions like endocarditis or prosthetic valves In patients with liver transplant or suspected biliary obstructions
- Many endoscopic procedures may be performed safely in the setting of antithrombotics. Cold forceps mucosal biopsies may be obtained while patient is on anticoagulation. T or F?: True
- T or F When anticoagulation is temporary (e.g. warfarin for VTE), elective endoscopic procedures should be delayed when possible until anticoagulation is no longer necessary.: True
7 / 35 have a risk of thromboembolism of (blank) per year in the absence of anticoagulation. The risk is higher in the presence of dilated cardiomyopathy, valvular heart disease, or recent thromboembolic events: 5% to 7%
- The absolute risk of any embolic event in a patient with a low- risk condition in whom anticoagulation is stopped for 4 to 7 days is (blanK) per 1000 patients.: 1 to 2
- Pre-procedural management of antithrombotic therapy for procedures with low risk of significant bleed are as follows: •Endoscopic procedures may be per- formed in patients taking antithrombotic therapy (WITH OR WITHOUT***)any alterations.: Without
- Pre-procedural management of antithrombotic therapy for procedures with high-risk of significant bleed are as follows: • (blank) does not need to be stopped. • Patients on a single antiplatelet drug, should be switched to (blank) 5-7 days before. • Patients on dual antiplatelet drugs, (blank) should be con- tinued and the second drug should be stopped 5-7 days before. • Patients at high-risk for a thromboembolic event on long-acting
8 / 35 anticoagulants should be given (blank).: Aspirin Aspiri n Aspiri n Bridge Therapy
- When should you resume antithrombotic therapy?: No consensus
- In patients with (CIED) Cardiovascular Implantable Electronic Device, what type of device are preferred?: Bipolar and ultrasonic devices
- How do you know if a patient has a pacemaer?: there should be pacing spikes on EKG in front of P waves
- When do you place a magnet?: -In non pacing patients to prevent arrythmia detection -In non pacing depending but has pacing ability patients, do need but should be available -in pacing dependent without ICD, place a magnet if procedure above umbilicus -in pacing dependent with an ICD
- If patients have an CIED, what else should you do besides have a magnet handy?: monitored with either plethysmography or an arterial line and should
10 / 35 golytelY) Mag citrate, sodium phosphate
- Which of the following is considered a high-risk procedure for bleeing? a. EUS assessment of vessel encasement for pancreatic cancer B. Colonoscopy with cold forceps biopsy C. Push enteroscopy D. Balloon dilation of esophageal stricture: D. balloon dilation of esophageal stricture
- What characterizes moderate sedation?: Mildly depressed level of consciousness Patient response to verbal commands maintenance of patients own airway Intact airway reflexes hemodynamic equilibrium
- Deep sedation is characterized by:: • Significant depression of level of consciousness • Painful stimulus is necessary to evoke a withdrawal response • Airway protective reflexes cannot be relied upon • Hemody- namics are usually preserved although instability can occur
- Updated Practice Guidelines for Sedation and Analgesia for
11 / 35 Non-Anesthesi- ologists set forth by the American Society of Anesthesiology Task Force in 2002 recommend that all patients undergoing moderate sedation and analgesia be monitored with:: Pulse oximetry • Verbal stimulation to track level of consciousness • Observation and auscultation of pulmonary ventilation • Blood pressure and heart rate at five-minute intervals during the procedure • Continuous electrocardiography (ECG) for patients with significant cardiovascular disease
- (blank) should be considered for patients receiving deep sedation, for pa- tients with certain medical conditions (sleep apnea) and for patients whose ventilation cannot be directly observed during moderate sedation.: ETCO
- The following should be available for all procedures to be performed under sedation:: • Advanced life support • A resuscitation cart with appropriate equipment, medications, and instructions
- T or F Morbidity and mortality rates for moderate sedation are higher than for gen- eral anesthesia.: True
- Risk factors associated with desaturation include:: Age greater than 60 ASA 3 or higher Lengthy, more complex procedures
13 / 35 When can you increase the dose?: 0.5 mg to 2 mg IV 3-5 minutes after 2 minutes
- Who should you reduce midazolam doses?: elderly, liver disease, renal failure, in combination with narcotics
- Benzos can cause what complications?: hypoventilation, hypotension, paradoxical agitation
- What is the starting dose of flumazenil?: 0.2 mg IV, titrate up to 1 mg
- What is the dosage for fentanyl?: 1 to 2 microgram/kg (usually about 75- micrograms)> if used with midazolam start at 50 to 100.
- How quickly does naloxone work?: 2 minutes
- What are the cardiovascular effects of propofol?: Decrease in cardiac output • Decrease in systemic vascular resistance • Decrease in arterial pressure • Negative cardiac inotropy • Respiratory depression
- Potential adverse effects of topical anesthetics include: Aspiration
- Anaphylactoid reactions • Methemoglobinemia
- While in recovery, patients are still at risk for complications related to se- dation. Delayed presentation of undesirable side effects can be due to:: Lack of procedural stimulation • Variable drug absorption • Slow drug
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- DC criteria?: VSS, alert, Scoring system OAA or MOAA, dc to an adult
- The overall complication rate related to sedation and endoscopy: 1 in 10,
- The ASGE recommends considering the assistance of an anesthesia special- ist when...: Risk of complications is increased because of severe comorbidities
- The main effect of midazolam during moderate sedation for endoscopy is?: amnesia
- What is the half life of naloxone?: 1 to 1.5 hours
- What are NOT indications for diagnostic EGD?: Atypical, non- progressive and chronic abdominal discomfort or pain due to a functional problem Uncomplicated reflux responsive to medical therapy in non-high risk patients Evaluation of asymptomatic benign findings on a radiologic study End stage malignant disease when the results of the procedure will not alter management or when there is no therapeutic benefit
- Known gastric atrophy, including intestinal metaplasia of the stomach with- out dysplasia, History of gastrectomy for benign disease Is surveillance endoscopy
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- How far back should you hold the scope with your right hand?: about 12 inches (30 cm from the tip)
- What should you measure during an EGD?: distance of incisiors to Z line GE junction Diaphragmatic pinch
- What is considered a hiatal hernia?: if the GE junction is more than 2 cm above the pinch of the diaphragm
- If there is a lesion on the lesser curve of the stomach or periampullary region of the duodenum that is difficult to see, or cannot be approached directly, repeat endoscopy using a (blank) might be of value.: side-viewing endoscope
- (blank) is a false diverticulum occurring in the posterior hypopharynx that is sometimes associated with foreign body sensation, throat irritation, dysphagia or halitosi: Zenker's diverticulum (ZD)
- If the majority of the stomach is intrathoracic and you are having difficulty intubating the pylorus. What maneuver can you do to get access to it?: retroflexion
- Which classification do you use for the following
17 / 35 pathologies? Erosive esophagitis? Esophageal varices Barretts Neoplasms Bleeding ulcers: erosive esophagitis- LA Esophageal varices- Size classification Barretts- Prague C neoplasm- Paris Bleeding ulcer- Forest
- In normal anatomy the Z line is usually located where? Hiatal hernia?: distal esophagus The Z line, the GE junction are proximal to pinch of diaphragm
- What do you use to classify hiatal hernias?: hill grading
- In the presence of columnar metaplasia of the seophagus. the Z line is proximal to the (blank): Esophagogastric Junction
- Hill grades?: 1 good ridge, tight around scope
19 / 35 They are basically a reverse jaw thrust because they push the jaw and tongue posteriorly.
- What areas of the esophagus are prone to iatrogenic perforation?: Pharynx, cricopharyngeus, duodenum
- What to do if you suspect esophageal perforation?: water soluble upper GI or CT
- Which of the following is an indication for surveillance with upper en- doscopy? A. Intestinal metaplasia of the stomach without metaplasia B. Pernicious anemia with prior normal upper endoscopy c. History of gastrectomy for benign disease d. baretts esophagus: D. Barretts
- A patient was found to have Barretts esophagus on upper endoscopy. Pathology reports metaplasia with no dysplasia. The recommendation for re- peat endoscopy is?: 3 years.
- Which hill grade classification best describes a patient found to have a hiatus that is wide open all the time and a sphincter this is displaced axially?: Hill grade IV
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- The American cancer society lowered their colorectal cancer screening rec- ommendation starting at age ***: 45
- People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of ***: 75
- Increased risk patients for colonoscopy screening are? What age should they start getting colonoscopies?: 1st degree releatives with CRC, Adenomas or serrated lesions before 60. or 2 first degree relatives with CRC at any age. 40 y/o or 10 years before 1st diagnosis
- Patients with no polyps seen at index colonoscopy require their next colonoscopy in (blank): 10 years.
- Patients with small (< 10mm) hyperplastic polyps in the rectum or sigmoid require their next colonoscopy in (blank): 10 years.
- Patients with one or two small (< 10mm) adenomatous polyps completely excised require their next colonoscopy in 5 years: 5- 10 years.
- Patients with three or more adenomatous polyps or patients
