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Gastrointestinal APEA Questions with Complete Verified Solutions 2024/2025
Typology: Exams
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Positive Murphy's sign pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflamed gallbladder Murphy's sign pain with palpation of the RUQ during inspiration, indicative of cholecystitis McBurney's point Pain in RLQ with appendicitis McBurney's sign rebound tenderness associated with appendicitis Gold standard diagnostic tool for gallbladder disease Ultrasound The harder the gallbladder works, the _________ it gets. Thicker Muscle becomes bigger causing thickening What could cause dilated loops of bowel? Obstruction What diagnostic test determines level of obstruction? CT Name the initial diagnostic test for suspected divirtuculitis CT abd Which antibiotics treat diverticulitis? Flagyl and cipro What protects the lining of the stomach from the acid within it? Prostaglandins True negative Specificity True positive Sensitivity
What class of medications work the quickest to relieve GERD? antacids How long to antacids last? 30 minutes What class of medications decrease acid production? H2 antagonists How long do H2 antagonists work? 6 - 12 hours How long does it take for H2 antagonists to work? 60 - 120 minutes Name some examples of H2 antagonists Cimetidine (Tagamet) Ranitidine (Zantac) * pulled off market Famotidine (Pepcid) Nizatidine (Axid) What class of medications reduce gastric secretion? PPIs How long to prescribe PPIs 4 - 8 weeks If symptoms return after PPI trial? EGD Name some examples of PPIs Omeprazole (Prilosec) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Esomeprazole (Nexium) Pantoprazole (Protonix) Do Bulk laxatives cause dependence? Name a few. NO psyllium (metamucil) methylcellulose (citrucel) Fibercon What might bloody noctural diarrhea indicate? Inflammatory bowel disease Name 2 inflammatory bowel diseases chrons and ulcerative colitis
How to diagnose ulcerative colitis colonoscopy Symptoms of IBD (inflammatory bowel disease) bloody diarrhea, fatigue, fever, abdominal pain adenomatous polyps
bile duct obstruction gilberts disease What could an elevated PT/INR indicate (in the setting of abnormal LFTs) Cirrhosis, cancer of the liver Where is bilirubin stored? In the RBC What happens to the bilirubin when the RBC dies? It spills out of the RBC What happens with the spilled bilirubin from the dead RBC? The liver grabs it to recycle it. It the liver is sick, it cant catch all of the bilirubin, thus the bilirubin levels build up. The alkaline phosphatase (ALP) will be elevated in patients that present with issues such as- prostate cancer (poss mets to bone) causing bone breakdown= elevation in ALP and old adults that have potential/likely bone breakdown and slowed regeneratioin In viral hepatitis will the AST or ALT usually be higher? ALT Which forms of hepatitis causes chronic hepatitis? B,C,D IgM vs IgG IgM: antibody in INITIAL immune response; IgG: antibody in REPEATED exposure to the same antigen First immunoglobulin during acute infection- IgM Immunoglobulin produced when immune (after infection is gone) IgG What does it mean if + anti-HAV IgG Immune What does it mean if + anti-HAV IgM Infected (acute)
- anti HAV IgM and - IgG no infection, no immunity. consider vax HBsAg What does it mean? hepatitis B surface antigen Infected! Current or past
anti-HBs Hepatitis B surface antibody indicates immunity to HBV, either natural or vaccinated anti-HBc Totally hepatitis B core antibody. Indicates current or previous infection. IgM anti-HBc acute hep B BUT ... ** can persist 3-6 month or more and reappear with flare-ups of chronic hep B Zollinger-Ellison syndrome Gastrin-secreting tumor associated with ulcers of the stomach or duodenum Symptoms in infant including olive shaped mass located in the RUQ abdomen, projectile vomiting after eating, weight loss, irritability, dehydration. Pyloric stenosis How is pyloric stenosis diagnosed? abdominal ultrasound Rovsing's sign palpation of the left lower quadrant causes right lower quadrant pain that may indicate appendicitis celiac disease an inherited autoimmune disorder characterized by a severe reaction to foods containing gluten Antigliadin antibodies Celiac disease Which NSAID do less damage to the GI tract? WHy? Celecoxib (Celebrex) Because the only block COX 2 (they are selective nsaid) McBurney's point Pain in RLQ with appendicitis Which GI disruption causes diarrhea and is common among backpackers, campers? Giardiasis What is the incubation period of giardias? 7 - 14 days How long do the symptoms of giardiasis last? 2 - 4 weeks Treatment of Giardiasis
4 - 6 hours to prevent bowel loss how soon will a hepatitis b surface antigen be positive 3 - 4 weeks after exposure when do hepatitis c antibodies appear? 2 - 6 months following exposure if exposed to hep c less than 6 months ago, order- HCA RNA patients with cholelithiasis are sometimes ________. However if acute cholecystitis, they are _______. asymptomatic symptomatic most of the time, what are the causes of pancreatitis ETOH gallstones _________ can precipitate pancreatitis hypertriglyceridemia ___ % of patients with acute hep b are subclinical in symptoms. The risk of cirrhosis is ___. 70% rare what would usually be the symptoms of biliary colic pain in upper abd in response to eating fatty foods what is the least likely cause of painless blood on toilet paper in older adult anal fissure- because they are painful what is the gold standard for diagnosing appendicitis ct scan of abd a woman of childbearing age comes in with fever and right lower quad pain. what is the initial work up cbc, pregnancy test. if pregnancy ruled out, proceed with appendicitis work up list some medications that could cause constipation in older adults calcium channel blockers anticholenergics (flomax, oxybutinin) NSAIDS PPIS Calcium supplements
clinical presentation of acute hepatitis a variable symptoms, typically self limited classic symptoms of appendicitis rlq abd pain anorexia nausea vomiting symptoms of ulcerative colitis Abdominal pain/cramping (LLQ) Anorexia Weight loss Fever Diarrhea Abdominal distention Abdominal tenderness & firmness High pitched bowel sounds Rectal bleeding is there a hep c immunization? no when does diarrhea become a conern? signs of hypovolemia 6 unformed stools per 24 hours duration of illness > 48 hours recent abx use or hospitalization diarrhea in >70 year old patient most common symptoms of GERD heartburn, regurgitation, dysphagia a patient that presents to the clinic with 36 hours of diarrhea and moderate dehydration, what is the treatment electrolyte replenishment solution in patients with alcoholic hepatitis, the ast:alt ratio is typically 2: when the ALT isvery elevated, what must be considered infectious hepatitis what is the top cause of duodenal ulcer h.pylori what else causes duodenal ulcers
smoking, NSAID overuse When does IBS begin? before the age of 50 IBS symptoms abdominal pain, diarrhea, constipation signs of inflammatory bowel disease or bowel carcinoma weight loss blood in stool rectal bleeding nocturnal diarrhea