1. 1. A 45 year old man is referred by his primary care physician because of new onset of dysphagia of 4 wks duration. The pt has a history of heartburn self medicated. An UGIT study showed a distal esophageal mass lesion. Which of the following statements are incorrect?
a. The lesion is most likely due to metastatic cancer
b. Pt probably has had Barrets
c. Bx would show adenoca
d. Sq cell cancer is unlikely in this location
2. 2. Endoscopy was performed on the previous pt and the findings confirm your suspicion. You now want to begin to stage the mass. Which of the following would be the first procedure of choice?
a. Positron emission tomography (PET)
b. CT of chest and upper abd
c. EUS with FNA if lymph nodes are present
d. Video assisted thoracoscopy with bx
3. 3. A 75 year old lady presented to ER with SOB, melena and a hg of 6.9. her PMH is remarkable for AF, OA and a question of PUD. Medications include: warfarin, digoxin, and indomethacin. Gastroscopy confirms the presence of gastric ulcer with stigmata of recent bleeding. Which of the following placed this pt at increased risk for GI bleeding from use of NSAIDs?
b. Past h/o DU
c. Anticoagulant therapy
d. History of Cardiovascular dz
e. All of the above
4. 4. From speaking with the physician of the previous pt, it is apparent that she suffers from severe pain if she does not take NSAIDs. He asks you if she can continue taking NSAIDs. Your recommendations would be:
a. Switch from indomethacin to a cox-2 inhibitor
b. Evaluate for HP and eradicate if found
c. Add a daily PPI as prophylaxis
d. Reasses the risk-benefit ratio of warfarin therapy for a pt who has had GI bleeding
e. All of the above
5. 5. A 45 yr old male presents with melena and has a coffee ground NG aspirate, hg of 11.9 with evidence of orthostais and tachycarida. Which of the following would warrant endoscopic Rx?
a. a nonbleeding vissible vessel in a 1cm gastric ulcer
b. A flat red spot in a 2cm DU
c. An oozing DU
d. Oozing from a mosiac mucosa in the stomach
e. 1 & 3
f. 2 & 4
6. 6. Which of the following is not a predictor of increased mortality in UGI bleeding?
a. Pt who is an 82 year old
b. Bleeding in a pt who has pneumonia and sepsis
c. Pt with red hematemesis at ER
d. Pt with a nonbleeding visible vessel in a large gastric ulcer
7. 7. A 24 year old women presented e 3m h/o diarrhea and wt loss e no fhx, travel hx, alcohol abuse and no associated symptoms, labs showed mild IDA. A fecal study shows 28 g of fat/24hrs. Abn D-xylose test but normal SBFT. Endomysial ab is increased. The next step is
a. Pancreatic function tests
b. Quantitative SB culture
c. SB biopsy
d. Treat with a gluten free diet
e. Serum test for tissue transglutaminase