1. Gastrointestinal Blueprint Questions, Answers and Explanations

2. Question 1 1. Your patient is a 25 year old male that presents with RLQ pain, WBC 14.5, and voluntary guarding in the RLQ. His scrotal exam is unremarkable. He has no abdominal distension and his bowel sounds are normal. Which of the following is the best imaging modality to evaluate this patient. A. Abdominal Ultrasound B. CT scan of Abdomen and Pelvis C. 3 view Abdominal Series D. Intravenous Pyelogram

3. Answer 1 1. Choice B is the correct answer. CT scan of the abdomen and pelvis is the imaging study of choice. This study has the highest yield. Abdominal ultrasound can be attempted but often the appendix is not visualized especially if their is a lot of bowel gas. Intravenous Pyelogram is for kidney stones. A three view abdomen is useful when there is a suspicion of a bowel obstruction or perforation. Air fluid levels would be seen in the case of a bowel obstruction on the upright films and pneumoperitoneum would be seen in the case of perforation.

4. Question 2 2. All of the following are common causes of large bowel obstructions except? A. Volvulus B. Adhesions C. Cancer D. Diverticulitis

5. Answer 2 2. Choice B is the correct answer. Adhesions are not a common cause of large bowel obstruction. Adhesions are a common cause of a small bowel obstruction. Tumors are the most common cause of large bowel obstructions. Diverticulitis and Volvulus can cause large bowel obstructions.

6. Question 3 3. Which of the following is true regarding Meckel's Diverticulum? A. It is congenital remnant of the omphalomesenteric duct B. It affects 15 percent of the population C. It usually presents with abdominal pain D. The hematochezia is painful

7. Answer 3 3. Choice A is the correct answer. Meckel's Diverticulum has the rule of two's. It occurs in in 2% of the population. It is found about two feet from the ileocecal valve, and is about two inches long. Meckel's diverticulum is typically painless until it becomes inflamed.

8. Question 4 4. The most common cause of acute diarrhea is? A. Campylobacter B. Shigella C. E. Coli D. Viruses

9. Answer 4 4. Choice D is the correct answer. Acute diarrhea is defined as diarrhea lasting less than 14 days. Viruses are the most common cause. Campylobacter, Shigella, and E.Coli are all causes of acute diarrhea but occur with much less frequency than viral infections.

10. Question 5 5. Which of the following is not true regarding Crohn's Disease? A. Crohn's is a recurrent disorder B. Most common involves the terminal ileum C. Granulomatous Process D. Always begins at the rectum

11. Answer 5 5. Choice D is the correct answer. Crohn's disease is a disorder that is transmural and can affect any where from the mouth to the anus. It affects the terminal ileum mostly. Crohn's causes skip lesions, unlike ulcerative colitis that starts at the rectum and tracts proximally.

12. Question 6 6. All of the following are risk factors for esophageal cancer except? A. Poor oral hygiene B. Obesity C. Herpes Simplex Virus D. Barrett's Esophagus

13. Answer 6 6. Choice C is the correct answer. Herpes simplex virus is not a risk factor for esophageal cancer. Human papillomavirus is a risk factor for esophageal cancer. Poor oral hygiene, obesity, Barrett's Esophagus, caustic strictures, atrophic gastritis, achalasia, family history, and certain medications put you at risk for esophageal cancer.

14. Question 7 7. Your patient is a 45 year old female that presents with epigastric discomfort improved with eating. You have sent her for outpatient labs and she has a positive H. Pylori antibody. She has never had H. Pylori in the past. Which of the following is an acceptable antibiotic regimen for H. Pylori eradication? A. azithromycin and amoxicillin B. metronidazole and clindamycin C. clarithromycin and metronidazole D. ciprofloxacin and tetracycline

15. Answer 7 7. Choice C is the correct answer. Acceptable antibiotic regimens for H. Pylori eradication include: clarithromycin and metronidazole, metronidazole and tetracycline, or amoxicillin plus clarithromycin. Azithromycin, clindamycin, and ciprofloxacin are not helpful in H. Pylori eradication.

16. Question 8 8. Your patient is a 5 week old caucasian male that presents with vomiting, and weight loss. This has been going on for approximately 2 days. Physical exam reveals a "olive like" mass at the rectus abdominus muscle. Which of the following tests would be most helpful in confirming the diagnosis? A. KUB B. Ultrasound C. CT scan of Abdomen and Pelvis D. 24 hour pH probe

17. Answer 8 8. Choice B is the correct answer. This patient has pyloric stenosis. An "olive like" mass is consistent with pyloric stenosis. Pyloric stenosis typically presents at 3-6 weeks. Usually is the first born caucasian male. A 24 hour pH probe would be helpful for determining if reflux was present.

18. Question 9 9. Which serotype of Hepatitis requires Hepatitis B to replicate? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

19. Answer 9 9. Choice D is the correct answer. Hepatitis D requires the serotype Hepatitis B to be present in order to replicate.

20. Question 10 10. The most common cause of cirrhosis other than alcohol in the United States is? A. Hemochromatosis B. Hepatitis C C. Autoimmune hepatitis D. Fatty Liver Disease

21. Answer 10 10. Choice B is the correct answer. The most common causes of cirrhosis is the US are alcoholism and Hepatitis C. Other causes of cirrhosis include hepatitis B, hemochromatosis, autoimmune hepatitis, non alcoholic fatty liver disease, primary sclerosing cholangitis, medications, Wilson's Disease, alpha 1 antitrypsin deficiency, portal fibrosis, infections, right heart failure, and venous occlusive disease.