Gastroenterology Review Questions - CRASH! Medical Review Series
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- Опубликовано: 20 ноя 2015
- For the older version, with sound: • Gastroenterology Revie...
(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
q3..answer should be IBS as there there is young age, recent symptoms and discomfort..lactose intolerance symptoms will be from
birth...so its IBS with predominant diarrhoea ..not lactose int
In Question No. 2. In my opinion we should do EGD, since he denies the difficulty in swallowing and no blood in vomit . If we do Barrrium Test, it will figure out the disease with esophagus, but, for us , the Best management test is given as EGD. isn't?
Yes I think EGD is correct and is the appropriate therapy for this pt because regardless of what the barrium swallow will show, you will still end up doing EGD as you are concerned about cancer. EGD is also diagnostic and therapeutic so if you do find something that is concerning for cancer or any of the esophagitis you need to biopsy it and could treat it all at the same time.
Also the problem with barium swallow is regardless of the result, positive or negative, you still need biopsy so you have to do EGD.
Not sure if you guys gives a damn but if you are stoned like me atm then you can stream all of the latest movies and series on instaflixxer. Been streaming with my gf for the last couple of weeks xD
@Zaid Drew definitely, I have been using instaflixxer for since december myself :D
Great work as always. Ono of the best USMLE channel. Thank you so much Dr. Bolin
these video are great!!! Thank you so much.
Thank you so much for this!
For the older version, with sound: ruclips.net/video/5C7MYOD9sHo/видео.html
Fantastic effort. Thanks so much. In question#8, mild pallor is due to the inability of the proximal intestine to absorb iron, thus, iron deficiency anemia manifested as mild pallor.
Also they can get Chronic microbleeds as well
For question 1 you said you could try histamine 1 antagonists for patient's symptoms but I think you meant histamine 2 antagonists (H2 blockers) as they are what is commonly used in treatment of GERD. H1 blockers are the anthistamines and would be used in the treatment of allergic reactions.
Thank you Dr Polin for your great support..can you please creat more questions in this section! It's Very long section ,thank you in advance
جزاكم الله خيرا وافرا....many thanks
Thio-Purine-Methyl-Transferase (TPMT)
Dr. Pual you have really helped me appreciation medicine in a place with rare internet,well elucidated lectures have given us confidence.
watching from south sudan
Excellent lecture.
question 4 part b - younger or older - if alarm or red flag exists you choose the test accordingly -- seriously need to update this material !
In question 2, if a barium swallow was going to show anything wouldn't he have had some issues with his swallow?
:) Thanks a ton! :)
Thank you.
Thank you very helpful
1:02:09 for the steroid sparing drugs [6-MP / Azathioprine] you also want to make sure the patient is not on allopurinol. Xanthine-oxidase inhibitor mediated toxicity
Friday, November 4, 2022. Gastroenterology: In the Gastrointestinal (Digestive) Tract and Pathology Therein, the focus of this video is Didactic and for Competency Examination Purposes. USMLE Examination Practice Question Number One 1: Omeprazole, a Classic Proton Pump Inhibitors (PPI) is also Available OTC (Nexium/Prilosec). I reckoned this and chose another Possible Choice, namely EKG, as it can be performed at Low Cost and Rules out much other possible concomitant and/or aetiologic possibilities (Cardiopathy). Q 2: Herein, also. I thought the standard of Diagnostic Procedure was first Visualization basically (Esophagogastroduodenoscopy) and then after, if Positive for Abnormal Structure/Morphology, a justified Presumptive Diagnosis (Herein Malignancy) is made, and only thereafter, the more Time-Consuming and Expensive Procedure, the Barium Swallow, possibly the more Direct and Sensitive Diagnostic Imaging for Cancer; Q3: Surprise again. Irritable Bowel Syndrome, the Chronic Pain, is an Attractive Choice because of the Stigmata/Stereotypic Association (Female, Flatulence and Age) to Feminine Habitus and Predispositions. Lactose Intolerance! Anyway. Q4: Right on. Endoscopy (EGD for Epigastric Pain). Q5: First Line Recommended Initial Therapy/Treatment for H. pylori Infection (Eradication Regimen), Antibiotic Therapy, with Clarithromycin, a Macrolide Antibiotic (23s/50S Protein Synthesis Inhibition Mechanism), and the Aminopenicillin Amoxicillin, a Beta-lactam Antibiotic and Cell Wall Biosynthesis Inhibitor, with a PPI (Parietal Cell H+ / K+ ATP Pump Inhibition) and a possible Bismuth, an Antidiarrheal/Bismuth Agent, addendum) with a antimicrobial and Antisecretory Effect; or Second line: Metronidazole, a Nitroimidazole Derivative and Protein Synthesis Inhibitor, and Tetracycline (Tetracycline Antibiotics and a 30s Proteins Synthesis Inhibitor/bacteriostatic), PPI Triple Therapy (or Quadruple Therapy [Bismuth]) if Diarrhea and Pain Persist (Refractory/Alternate Therapy). Q6: In a Mallory-Weiss Tear (a Superficial Lesion), the EGD (Endoscopy) can be both Diagnostic and Therapeutic (Thermal Sclerotherapy/Multipolar Electrocautery (MPEC) Differentiation is essential as Transmural Laceration/Perforation (Boerhaaven Syndrome) is much more Severe (Clinically Possible). Q7: Acute Pancreatitis herein Clinically Diagnosis (Acute Pain Referral to Back or Pain Profile is Indicative of Pancreatic Inflammation). Q8 (24:22): Lipase (Lipase Blood Levels/Serum Lipase) is more Specific to Pancreatitis than Amylase, another relevant Pancreatic Enzyme (3x Normal Levels is an Indication of Pathology). Q8: A Positive Anti-Gliadin Assay (Serology) is Diagnostic of Celiac Disease (also Anti-Tissue Transglutaminase [anti-TG2] Immunoglobulin A [IgA]). Q9: Hepatitis A Virus (HAV) is the only Foodborne Possible Aetiology out of all Hepatitides, yielding Inflammation of the Liver and Stigmata Thereof (Jaundice [Scleral Icterus, Fatigue, Pallor [Anemia], Abdominal Pain and Low-Grade Fever); Q10: Primary Biliary Cirrhosis (PBC) is like Sjoegren's Disease an Autoimmune Disease Process ( SSx: Cirrhosis, Ascites [Portal Hypertension], common to Middle-Aged Females and known Autoantibodies Disorders, while Primary Sclerosing Cholangiitis (PSC) has an Association with Inflammatory Bowel Disease (IBD/Ulcerative Colitis); Q11: Anti-Mitochondrial Antibodies (AMA) Titers will be Positive in PBC and Negative in PSC (Differential Diagnosis is Settled definitively via Serology); Q12: Liver Biopsy (A common Procedure when Liver Transplant is an Option for Treatment [as it can be Curative] or Malignancy is a Possibility [Hepatocellular Carcinoma]); Q13: Esophagogastroduodenoscopy (EGD) Visualization of the Upper GI Tract in particular to Rule out Malignancy (Justification herein is Age and Dysphagia, an Alarm Symptom); Q14: Barium Esophagram is in Accordance to Symptoms and Pathology suspected and/or Relevant, a Zenker's Diverticulum (A Pharyngeal Pouch) or a Pseudodiverticulum, allowing Visualization of the Relevant Anatomy (Pharyngoesophageal Area); Q15: Achalasia is the Narrowing of the Esophagus showing the Distinctive "Bird's Beek" Morphology proving Clinicopathology Correlation; Q16: Nifedipine, A Calcium Channel Blocker (CCBs) is First Line Standard Medical Therapy for Achalasia with Botulinum Toxin Injection as a Second Line Therapy if Refractory to CCBs; Q17: Ischemic Colitis (Necrosis and Ischemia/Thrombosis of the Bowel) is herein characterized by the Abdominal Wall Hypertrophy and the Air visualization on Radiology (SSx of Acute Mesenteric Arterial Occlusion) while a Bowel Wall Perforation would have had Signs of Pneumoperitoneum (Subdiaphragmatic Free Gas); Q18: Crohn's Disease is Idiopathic Inflammation of the Gastrointestinal Tract usually sparing the Rectum; Q19: Pentasa (Generic Name Mesalamine [Aminosalicylates Drug Class]) is the Indicated Medication for Crohn's Disease (Symptomatic Treatment of the Inflammatory Process) while Corticosteroids are Indicated for Acute Flares (Aggravations of ongoing Pathology) as in PO Budesonide and IV Methylprednisolone (Inpatient Setting); and 6-Mercaptopurine, an antimetabolite, is a Cytotoxic Purine Analog Drug Class indicated upon verification of TPMT Levels (Normal to High Levels) and when PO Corticosteroids have been Prolonged in Therapy (Contraindication Beyond 6 Months of Therapy; Taper PO Steriods on or Around 4 Months); Furthermore Biologics (Infliximab/Adalimumab; Monoclonal Antibodies) can be used in combination for Refractory Disease upon a Negative PPD Test of Tuberculosis. These Therapeutic Agents are most effective and Least Affordable; Q20: Irritable Bowel Syndrome (IBS) is a Pain Syndrome with GI Manifestations (Diarrhea and Abdominal Pain). Pain is Relieved with Bowel Movement is Indicative of IBS (Stool Test, Colonoscopy and other Tests should be Negative; Diagnosis of Exclusion). The Rome Criteria sets the Conditions by which IBS is Applicable; Q21: In ongoing Hematemesis, Normal Saline Bolus (Full Rate) is indicated for Fluid Resuscitation. Variceal Hemorrhage has 1) Fluid Resuscitation, 2) IV Octreotide, 3) EGD Endoscopy (Both Diagnostic and Therapeutic), 4) TIPS Surgery (If Variceal Banding fails), 5) Blakemore Tube is Interim to EGD and TIPS or TIPS and Invasive Surgery; and 6) Although not for Hemorrhage, Beta Blockers are Concomitant to other Procedures and Therapies. Goodness! My first IBS case is just phenomenal. Just Kidding, she had been known for Hypochondriac Tendencies and actually ingested plenty of laxatives. Munchausen Syndrome was the diagnosis. MD Paul W. Bolin, es gut zu essen aber zu leben zu essen nicht wahr ist. Heil!
Qa
Thank you! Would appreciate your help! What is the differance between question 2 and question 4 first step management? Why is the answer in Question 4 isn't barrium X-ray as it is explained in question 2? Thanks to Dr Bolin and to other friend who can help me figure this out! :)
olgamati9
when he is older go for EGD.. when young go initially for barium meal.. i am not sure abt this!!!
Thank you sir :)
RLQ pain applies to apendisitis as well. Even though that is not the case in this clinical vignette.
question 2 - egd 1st .. not barium swallow unless you have indication of narrowing of esophagus at distal end or difficulty in swallowing etc -- youre gonna waste time with a barium swallow -- go to EGD . bc even if there is stricture at the distal end - you can dilate with a scope or take biopsy in esophagus as necessary - with a red flag you DO NOT waste time with unnecessary tests like a barium swallow if its not specifically indicated.
Theres no audio
Sorry Dr Bolin I did not know best initial medical Tx of achlasia is also Nifedipine , ccb I always thought is pneumatic dilation initially or surgical myotomy or Botulinium toxin injection, will check on that......Thank you
Also questions 13 and 14 - why wouldn't the first step be a barium esophagram? Thank you!
he says different in the previous vedioes!!!
Why for question 2 we do a barium swallow but not for question 12?
he said if the pt have weight loss we should do barium swallow .....
alaa abu kosh weight loss is one of the warning signs like age
Question 2 is wrong, when you have alarm symptoms, you should go straight to EGD regardless of age.
Great Video, Thanks Dr. Bolin. Would you please explain why Q13 did not choose barium/esophgram? Why do EGD before endoscopy? Base on your Q2 explanation, it would make more practical to peform Barium before EGD!
Saideh
confusing!!!
Purely because of dysphagia in a patient older than 45. So age is the deciding factor here, if he were 35 for example, he will get a barium swallow
EGD is endoscopy, but maybe its a typo. I do think that the answer to 13 should be manometry because it is more specific to achalasia which the patient seems to have. Although the patient regurgitated undigested food, it doesn't look like he has zenkers diverticulum, because the fullness is below the coastal margin and the food is not rotten/fermented and foul smelling. Unless there are zenkers diverticulum that can extend or occur at such a low level. I think the issue may just be a poorly worded question.
Why treat signs symptoms without investigation of cause? Is "management " better than getting to the root of the issues and railing the cure is in the cause? Thank you for your opinions.
treat symptoms firstly then find the cause as early as possible!!
Please fix the sound on the GI videos, if possible!!
Fola Babalola yeah
Audio not working!
Does anyone know which browser the sound is working in?
ruclips.net/video/5C7MYOD9sHo/видео.html
There’s no sound?!?
Wrong check for sinus cavity parasites, there excrements are an irritant and patients can have severe to a symptomatic responses. This is a point that causes several misdiagnosis and medications that treat the symptoms but not the underlying health problem.
Nice
Omeprazole is also available OTC so the first question is confusing.
But it's not an antacid
Packed red blood cells play no role in resuscitation? Seriously?!
Do humans bleed salt water?
17.) The answer is Ulcerative Colitis.
Saad Siddiqui
why??
I am thinking it's crohn's vs UC because crohns causes low grade fever and UC does not. Both can cause bloody diarrhea.
Iam anable to hear u in this lecture
ruclips.net/video/5C7MYOD9sHo/видео.html
apologies: computer error in last comment: should read 'healing' not railing.
dysphagia is quite common - it is NOT an alarm symptom by itself - do you honestly think every pt with dysphagia goes for EGD?
dude.. question 4 -- you dont jump on cancer -- 52 yr old is not considered old in terms of boards - 65 and above is .. secondly - pt has osteoarthritis - you are to assume she is overusing NSAIDs possibly causing a peptic ulcer causing the epigastric pain -- you still do an EGD for it but you dont JUMP to cancer .. yes thats a possibility but its not the 1st go to diagnosis -- theres no other red flags for indicating cancer like hematemesis, weight loss, etc
wrong for question 12 -- if a patient is regurgitating undigested food and has pain on swallowing at epigastric or mid epigastric region -- first thing you do is barium swallow to check for out pouching or zenckers diverticulum or achalasia / birds beak presentation - if yes - then you proceed to EGD .. there were NO alarm symptoms - not being able to eat is NOT an alarm symptom -- come on !
Thank you Dr. Paul Bolin. Aren't the questions a bit too easy?
Patients who are bleeding need blood not saline as in question 20. Has been shown that giving patients who are loosing blood crystalloids is associated with poor outcomes. only indication for IV fluids is the lack of access to blood products..which shouldn't be an issue in a hospital setting
well in hospital setting the patient would have to be group and crossed initially so in the interim fluid bolus wud be best step. thats my logic. so id set up for transfusion but give fluids in interim
Hepatidides