GI Clinical Procedures & Protocols 2 — Questions and Answers
Question 1: Before performing a colonoscopy, the recommended bowel preparation solution for a patient with chronic kidney disease (CKD) is:
- Sodium phosphate (Fleet Phospho-soda)
- Polyethylene glycol (PEG) solution (Correct answer)
- Magnesium citrate
- Sodium picosulfate with magnesium citrate
Correct answer: Polyethylene glycol (PEG) solution
PEG-based solutions are preferred in CKD patients because they do not cause significant electrolyte shifts, unlike sodium phosphate which can cause hyperphosphatemia and acute kidney injury.
Question 2: During an upper endoscopy (EGD), a patient develops sudden bradycardia and hypotension. The FIRST intervention should be:
- Administer atropine IV
- Withdraw the endoscope and provide supplemental oxygen (Correct answer)
- Increase propofol infusion
- Administer epinephrine 1:10,000 IV
Correct answer: Withdraw the endoscope and provide supplemental oxygen
Withdrawing the scope relieves vagal stimulation while supplemental oxygen addresses hypoxia, which are the most common causes of vasovagal responses during EGD.
Question 3: The Forrest classification is used during endoscopy to:
- Grade the severity of esophageal varices
- Stratify rebleeding risk of peptic ulcers (Correct answer)
- Classify the depth of colorectal polyps
- Score the severity of Crohn's disease
Correct answer: Stratify rebleeding risk of peptic ulcers
The Forrest classification (Ia through III) categorizes stigmata of recent hemorrhage in peptic ulcers to guide decisions about endoscopic hemostasis.
Question 4: A patient undergoes ERCP and develops abdominal pain with lipase 3× the upper limit of normal within 24 hours. This complication is classified as:
- Mild post-ERCP pancreatitis (Correct answer)
- Moderate post-ERCP pancreatitis
- Severe post-ERCP pancreatitis
- ERCP-related cholangitis
Correct answer: Mild post-ERCP pancreatitis
Mild post-ERCP pancreatitis is defined by new-onset pain with amylase or lipase ≥3× ULN at 24 hours requiring hospitalization for 2–3 days without organ failure.
Question 5: Endoscopic submucosal dissection (ESD) differs from endoscopic mucosal resection (EMR) primarily in that ESD:
- Requires fluoroscopic guidance
- Allows en bloc resection of larger lesions (Correct answer)
- Is performed under general anesthesia only
- Uses argon plasma coagulation as the primary cutting tool
Correct answer: Allows en bloc resection of larger lesions
ESD uses specialized knives to dissect the submucosal layer, enabling en bloc resection of lesions >2 cm that would require piecemeal removal with EMR.
Question 6: When placing a percutaneous endoscopic gastrostomy (PEG) tube, the 'safe tract' is confirmed by:
- Fluoroscopic visualization of the stomach
- Transillumination of the abdominal wall and finger indentation seen endoscopically (Correct answer)
- Ultrasound guidance of the needle
- Aspiration of gastric contents through the needle
Correct answer: Transillumination of the abdominal wall and finger indentation seen endoscopically
Transillumination ensures the stomach is in direct contact with the abdominal wall, while endoscopic visualization of finger indentation confirms the puncture site avoids interposing bowel.
Question 7: After successful endoscopic band ligation of esophageal varices, the recommended time to the first surveillance endoscopy is:
- 1–2 weeks
- 1–3 months (Correct answer)
- 6 months
- 12 months
Correct answer: 1–3 months
Repeat endoscopy at 1–3 months after initial band ligation confirms variceal eradication and guides scheduling of subsequent surveillance sessions.
GI Clinical Procedures & Protocols 2
Before performing a colonoscopy, the recommended bowel preparation solution for a patient with chronic kidney disease (CKD) is: