panies and investigate websites to
learn what products are marketed
and/or are in clinical development.
Learn about the accomplishments,
policies, philosophies, and culture
of different companies so you can
differentiate them and determine
which may be the right fit.
In summary, biopharmaceutical
companies provide career opportu-
nities for gastroenterologists that
advance patient care and are pro-
fessionally satisfying. The variety of
job roles and large number of com-
panies, which differ in size, scope,
and culture, allow for mutually pro-
ductive matches among physician
scientists. If you want to contribute
your medical skills to the part of
the health care sector that drives
creation of drug products to address
unmet medical needs, consider a
career in the biopharmaceutical in-
ANSWERS // From page 3
Q1: ANSWER: D
This patient has no medical comorbidities, and based on
epidemiological studies will most likely have a peptic ulcer.
He had a bloody NG aspirate, which may limit endoscopic
visualization. After stabilization, the first priority is to ensure that timely endoscopy can be performed in an effective manner. The patient has no comorbidities to suggest a
variceal bleed, therefore intravenous octreotide (Choice C)
and prophylactic antibiotics (Choice E) would be inappropriate. The patient does not demonstrate altered mental
status, hemodynamic or respiratory instability, and therefore endotracheal intubation (Choice B) is not necessary.
Iced-saline gastric lavage is without demonstrated benefit,
and it may be harmful by inducing ischemic mucosal injury
to previously noninvolved areas of gastric mucosa (Choice
A). Intravenous erythromycin prior to endoscopy has been
reported to clear the stomach and improve endoscopic
examination. Furthermore, erythromycin was found to
be cost effective with an increase in quality-adjusted life-years.
1. Carbonell, N., Poulwels. L., Boelley, P. Y., et al. Erythromycin infusion prior
to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled trial. Am. J. Gastroenterol. 2006;101:1211-5.
2. Winstead, N.S., Wilcox, C.M.. Erythromycin prior to endoscopy for acute
upper gastrointestinal hemorrhage: a cost-effectiveness analysis. Aliment.
Pharmacol. Ther. 2007;15:1371-7.
Q2: ANSWER: D
Multiple colorectal adenomas may be attributable to the
autosomal dominant polyposis syndrome, familial adenomatous polyposis (FAP), due to germline mutations in the
APC gene, or secondary to mutations in the base excision
repair gene MUTYH. MUTYH-associated polyposis (MAP) is
an autosomal recessive trait characterized by the presence
of adenomatous polyposis and an increased risk of colorectal cancer. Germline mutations in MLH1, MSH2, MSH6,
PMS2 genes would be indicative of Lynch syndrome. Lynch
syndrome is characterized by early onset of CRC and a
predisposition to cancers of the endometrium, ovary, stomach, small bowel, urinary tract, and brain. Individuals with
Lynch syndrome do not develop a large number of polyps
as seen in MAP and FAP. Immunohistochemical analysis
and microsatellite instability testing of the sigmoid adenocarcinoma would be indicated if the diagnosis of Lynch
syndrome were being considered. BMPR1A, SMAD4 mutations are associated with juvenile polyposis syndrome
(JPS) that is characterized by the development of multiple
juvenile polyps and not adenomas. STK11 gene mutations
are associated with Peutz Jeghers syndrome (PJS). Individuals with PJS do not present with multiple adenomas but
instead have hamartomatous polyps.
1. American Gastroenterological Association medical position statement: hereditary colorectal cancer and genetic testing. Gastroenterology