FES written exam 2024 Actual Questions and Answers with complete solution Time frames for upper endoscopy - Familiar polyposis Ans- 1-2 years Patient positioning for ERCP Ans- prone position with the head turn toward the right shoulder patient positioning for upper endoscopy Ans- left side down, head slightly up.Maneuver to look at the GE junction Ans- J maneuver (tip up), rotate the shaft of the scope CCW and withdraw, pulling the scope into the proximal body and cardia, rotate the scope 360 around the GE jx, techniques to decrease post ERCP pancreatitis Ans- selective bile duct cannulation w/ guidewire, stenting pancreatic dut w/ stent or guidewire for difficult CBD cannulation, limiting contrast injection into the pancreatic duct Technique for billiary sphincterotomy Ans- apply pressure w/ cutting wire toward 11 o'clock direction, continue the sphincterotomy until the intramural portion is cut. Use blended current with cutting and coag at 15-20J. Alt: can use balloon dilation but a/w higher rate of post-ECRP pancreatitis Direction of pancreatic cannulation during ERCP Ans- 1 to 3 o'clock position When to stop warfarin before ERCP Ans- stop 5 days before and switch to heparin or lovenox if peri- procedural anticoagulation is required. This can be stopped a day prior to the procedure rate of post ERCP pancreatitis Ans- 3-5% Timing of colonoscopy for first degree relative w/ CRC or adenomas prior to age 60 Ans- colonoscopy at age 40 or 10 years before the youngest affected relative, whichever is earlier. Then repeat every 5 yrs 1 / 2
Indications for ECRP Ans- Tissue sampling - bile duct, pancreatic duct, ampulla bx chronic pancreatitis/divisum pancreatic malignancy billiary malignancy Benign strictures Ductal disruption/injury Jaundice cholangitis gallstone pancreatitis dilated CBD maneuvers to enter IC valve Ans- rotate the scope until the valve is at the bottom of the visual field, look down into the valve, gently insufflate air to open up the valve, OR retroflex the tip in the cecum and shorten the scope (hook the IV valve) cancer detection rate of brush biopsy Ans- 20-60% band ligation vs sclerotherapy for esophageal varices Ans- equal efficacy but baldn ligation has lower complication rate.cancer detection rate of needle aspiration Ans- 6-30% how long after sphincterotomy can the bleeding complication manifest? Ans- immediate up to 14 days relative contraindications for colonoscopy Ans- anal fissure, recent MI, PE, large bowel obstruction Time frames for upper endoscopy - esophageal varices s/p sclerotherapy and banding Ans- q6-8weeks Indications for screening colonoscopies Ans- over 50 y/o, repeat every 10 years
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