Answer 30

30.  Choice D is the correct answer.  The peak incidence of cecal volvulus is usually between the ages of 25-35.  Sigmoid volvulus is more common with the elderly.  Neurological disease does not have any predisposition to development of volvulus.

Question 30

30.  Which of the following is true regarding cecal volvulus?

A.  Most often seen in the elderly
B.  History of chronic constipation
C.  History of significant neurologic disease
D.  Most commonly seen in 25-35 year olds

Answer 29

29.  Choice C is the correct answer.   Pellagra is a deficiency of Vitamin B3 (Niacin).  Pellagra tends to be a complication of bariatric surgery and alcoholics.  It presents with a hyperpigmented rashes, nausea, vomiting, diarrhea, insomnia, anxiety, disorientation, delusions, dementia, and encephalopathy.

Question 29

29.  Pellagra is a deficiency of which of the following Vitamins?

A.  Vitamin B6
B.  Vitamin K
C.  Vitamin B3 (Niacin)
D.  Biotin

Answer 28

28.  Choice A is the correct answer.  Magnesium citrate is contraindicated in the presence of bowel obstructions.  This would make the obstruction worse and create more pressure which is the purpose of NG decompression.  Patients with bowl obstructions should be NPO.  Morphine and Phenergan are indicated in bowel obstructions.

Question 28

28.  Your patient is a 64 year old male that presents with abdominal distention, vomiting and hypoactive bowel sounds.  His 3 view abdomen reveals dilated loops of small bowel and multiple air fluid levels.  All of the following are appropriate management except?

A.  Magnesium Citrate
B.  NG decompression
C.  Morphine
D.  Phenergan

Answer 27

27.  Choice B is the correct answer.  Zenker's diverticulum are esophageal diverticulum in the cervical portion of the esophagus and involve the upper esophageal sphincter.  Achlasia, Scleroderma and Chagas disease are diseases that effect the intrinsic nervous system and the body of the esophagus.

Question 27

27.  Which of the following is a potential etiology of esophageal motility disorder involving the upper esophageal sphincter (UES)?

A.  Achlasia
B.  Zenker's Diverticulum
C.  Scleroderma
D.  Chagas Disease

Answer 26

26.  Choice D is the correct answer.  It is usual for healthy 21 year olds to develop varices.  With bleeding varices there tends to be no preceding non bilious emesis.  AV malformation would just likely start bleeding also.  Mallory Weiss tears typically have several episodes of non bilious emesis that precede the bright red emesis.  Endoscopy there is longitudinal mucosal lacerations in the distal esophagus and proximal stomach caused by retching.  

Question 26

26.  Your patient is a 21 year old male that presents with bright red emesis that started after several episodes of non bilious emesis.  He is otherwise healthy and afebrile.  The bleeding appeared to stop spontaneously.  Which of the following is the most likely to be the etiology of this bleeding?

A.  Esophageal Varices
B.  Gastric Varices
C.  AV Malformation
D.  Mallory Weiss Tear