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GI Boards > Acing the Boards > Flashcards

Acing the Boards Flashcards

1
Q

What is esophagitis dissicans superficialis? What conditions is this seen in?

A

Sloughing esophageal mucosa in tubes (look at pics)

Seen in pemphigus vulgaris, bisphosphonate therapy, and celiac disease

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2
Q

Symptoms of leptospirosis

A

Conjunctival injection, pulse-temp dissociation, elevated AST/ALT < Bili, caused by swimming in rodent urine infested water

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3
Q

Triad of symptoms of gastric volvulus and treatment?

A

Severe nausea and retching without vomiting, inability to pass NG tube, epigastric pain.

Tx is surgical emergency

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4
Q

GI symptoms of amyloid

A

Diarrhea, gastroparesis, small intestinal bacterial overgrowth.

Can present with neuropathy, hepatosplenomegaly, etc.

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5
Q

Most likely cause of jaundice in pregnant women?

A

Viral hepatitis

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6
Q

Cause of globus sensation and oral projection when coughing? Worst complication of this?

A

Fibrovascular polyp of the esophagus. Can cause asphyxiation. Usually need EUS prior to removal.
Can be removed if <2cm and no penetrating vessels.

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7
Q

Common side effect of mesalamine

A

Pericarditis or pleuritis. Discontinue medication

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8
Q

What condition is marked by high ESR, eosinophilia, anemia, nodules in colon with needle shaped clefts?

A

Cholesterol emboli to the colon

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9
Q

What condition shows oblique filling defect of the esophagus on esophagram?

A

Dysphagia Lusoria— aberrant takeoff of right subclavian artery that passes from left to right behind esophagus

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10
Q

CD4 count that predisposes to Cryptosporidiosis

A

<180

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11
Q

Cause of hereditary angioedema?

A

C1 esterase deficiency. It’s autosomal dominant. Can be triggered by ace inhibitors.

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12
Q

Melkersson-Rosenthal Syndrome

A

Fissured tongue, facial paralysis, noncaseating granulomas of the tongue. Facial Crohn’s

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13
Q

How to treat C1 esterase deficiency

A

Long term:Danazol
Short term: infusion of c1 esterase

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14
Q

What causes Acanthosis nigricans?

A

Gastric malignancy, HCC, and lung cancer.

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15
Q

Signs of Zinc deficiency? Which patients are zinc deficient?

A

Think about beer drinkers, Crohn’s or patients on TPN. Erythematous, scaling vesiculopustular plaque on legs and face. And diarrhea.

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16
Q

Glucagonoma Symptoms

A

Think DDW: Dermatitis, diabetes, weight loss.

Patients get necrolytic migratory erythema (scaling rash over 1-2 weeks).

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17
Q

What condition is marked by plucked-chicken skin, angioid streaks in eyes, GI bleeding?

A

Pseudoxanthoma Elasticum (deposition of elastic tissue). Caused by ABC6 mutation

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18
Q

What is the event that is the predominant cause of GERD?

A

TLESR

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19
Q

How to treat refractory GERD by reducing TLESR? How does it work?

A

Baclofen reduces TLESRs by being a GABA agonist

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20
Q

Hyperkeratosis of the hands and feet association with GI disease

A

Tylosis (AD inheritance), these patients have increased risk of SCC esophagus

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21
Q

Sign of Hirschsprung’s disease on anorectal manometry

A

No rectoanal inhibitory reflex (RAIR) (no anal relaxation with insufflation of rectum)

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22
Q
A
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23
Q

What is Cronkhite-Canada Syndrome? Inheritance pattern?

A

Protein losing enteropathy, gastric enteric and colonic hamartomas. Also causes alopecia and dystrophic fingernails. Not inherited.

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24
Q

Symptoms of Menetrier disease?

A

Thickened gastric folds, corkscrew foveolar hyperplasia on histology, lots of mucus, diarrhea

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25
Q

Differential for large gastric folds

A

Menetrier disease, gastric lymphoma, ZE syndrome

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26
Q

How to diagnose ZE on secretin stim test

A

Increase in gastric >200. Usually gastrin is >1000.

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27
Q

When to do cholecystectomy for gallbladder polyp?

A

When >1cm or if patient presents with biliary pain

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28
Q

Time course of hepatic sinusoid outflow obstruction vs GVHD

A

Sinusoid: 21 days
GVHD: >100days

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29
Q

What are chloromas (granulocytic sarcoma)? How to distinguish on pathology? What are they a precursor to?

A

Green looking lesions throughout the GI tract that are myeloperoxidase positive. They are a precursor to AML.

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30
Q

Cowden’s Syndrome and genetic mutation/inheritance pattern

A

Bumps on face and hands (trichilemmomas), cobblestoned tongue, colon hamartomas. Mutation in PTEN tumor suppressor. Autosomal dominant. Increased risk of breast, thyroid, endometrial cancers

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31
Q

Common lasix side effect?

A

Pancreatitis (also 6MP, azathioprine, HCTZ)

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32
Q

What causes fever, ALP+GGT elevations, AST/ALT elevations, and heterogeneous and enlarged liver in HIV patients? What predisposes to this condition? How to treat?

A

Peliosis hepatis: blood filled cystic spaces communicating with sinusoids on liver biopsy in the setting of a bartonella henselae infection (and basillary angiomatosis). Tx with erythromycin 2g daily

33
Q

Diarrhea caused by
Milk
Undercooked beef (bloody)
Rice
Shellfish from gulf coast?
Travelling?

A

Milk - listeria
Ecoli O157H7 (TTP-HUS)
B.cereus
Vibrio vulnificus or parahemolyticus
ETEC

34
Q

What diarrhea causing bacteria is deadly to cirrhotics

A

Vibrio Vulnificus

35
Q

How to treat HP

A

Quad therapy: PPI, bismuth, tetracycline, metronidazole for 10-14d

Triple therapy: PPI clarithro amoxicillin for 10-14 days (if not Pen allergic)
PPI clarithro metronidazole (10-14 days if pen allergic)

36
Q

What condition has arthritis, diarrhea, cardiac arrhythmias? Histology? How to treat?

A

Whipple Disease, PAS + macrophages (but AFB negative, as opposed to MAC), Tx with ceftriaxone and then a year of Bactrim DS

37
Q

Cause of intestinal lymphagiectasia? What are the symptoms?

A

Heart failure. Causes protein and fat malabsorption, diarrhea

38
Q

What antibiotic can cause pill esophagitis

A

Doxycycline

39
Q

What medication can cause hepatic fibrosis?

A

Methotrexate

40
Q

Most constipating TCA? Least constipating TCA? Middle option?

A

Amitripyline is most constipating
Nortriptyline is middle
Desipramine is least constipating.

41
Q

What is alvimopan

A

A peripherally acting opioid antagonist used to treat post-op ileus

42
Q

PAS positive macrophages and AFB+?

A

MAC

43
Q

What causes flask shaped ulcers? How to treat?

A

Entamoeba histolytica, treat with metronidazole. Can see motile trophozoites with ingested RBC

44
Q

Terminal Ileitis in AIDS patient?

A

Think tuberculosis or cryptosporidiosis

45
Q

Diarrhea in AIDS patient after visit to developing country with eosinophilia? Charcot-Leyden crystals in stool? How to treat

A

Cystoisospora Belli, treat with Bactrim

46
Q

Which condition presents with abdominal pain and focal oval area of fat with inflammatory stranding and a linear central attenuating line through the fat? How to treat?

A

Epiploic appendagitis - tx with NSAIDs, NOT surgery

47
Q

How to treat abdominal wall pain?

A

Inject lidocaine, can follow up with long acting steroid

48
Q

How does FMF present? How to treat?

A

Severe abdominal pain in times of stress, fever, cellulitis type rash, elevated ESR. Tx with colchicine.

49
Q

Gastric layers on EUS

A

Mucosa (bright)
Muscularis mucosa (dark)
Submucosa (bright)
Muscularis propria (dark)
Serosa (bright)

50
Q

CD117 (c-kit) positive 4th layer lesion. What does it arise from?

A

Muscularis propria lesion that is CD117 positive is a GIST. May respond to imatinib. Arises from interstitial cell of cajal

51
Q

4th layer gastric lesion with actin positivity

A

Leiomyoma

52
Q

Spherical anechoic sub -epithelial gastric mass?

A

Duplication cyst (embryonic remnant of stomach development)

53
Q

What gastric layer do lipomas arise from?

A

Third layer (submucosa, which is bright)

54
Q

Where do carcinoids arise from? How to treat?

A

2nd or 3rd layer, ECL cells. Often multiple. Grow with gastrin. Treat types 1 and 2 (from atrophic gastritis or ZE) with endoscopic resection, treat type 3 (sporadic) with surgery

55
Q

What gastric lesion arises from 4th layer, c-kit negative, but actin and vimentin positive?

A

Glomus tumor (smooth muscle cells of blood vessels)

56
Q

4th layer gastric lesion that is positive for S-100

A

Schwannoma

57
Q

Pre-pyloric gastric mass with central umbilication arising from 3rd layer?

A

Pancreatic rest – benign no need for resection

58
Q

Difference between jackhammer esophagus and DES?

A

Jackhammer has preserved peristalsis, just very forceful. DES is uncoordinated, so causes inability to swallow

59
Q

Dysphagia years after polio?

A

Post-polio syndrome

60
Q

What is the CEA threshold for resection of branch duct IPMN?

A

192, resect if higher

61
Q

When to resect BD-IPMN?

A

If >3cm, if abdominal pain, if CEA>192, if thickened, or solid nodule resect

62
Q

Rare brain findings of celiac disease

A

Epilepsy and bilateral occipital calcifications

63
Q

Zinc deficiency signs

A

Rash and hair loss (beer drinkers, cirrhosis, TPN)

64
Q

Air under the diaphragm with right angled septations in COPD patient?

A

Chilaiditi syndrome. It’s the colon, if patient is asymptomatic do nothing. If obstructed, NG decompression

65
Q

Diarrheal disease in young men from Middle East with cobblestoned upper GI mucosa, lymphoplasmocytic infiltrate in small intestine, and alpha chain paraproteinemia? What organism is this associated with?

A

This is immunoproliferative small intestinal disease (IPSID). Can be associated with campylobacter jejuni (tx with amp and flagyl. Similar to MALT lymphoma but presents in younger men

66
Q

What condition causes bloody rectal effluent in a patient with an ileostomy?

A

Diversion colitis

67
Q

How to treat diversion colitis?

A

Short chain fatty acid enemas

68
Q

What is a hepatic lesion with a central scar that remains hypotenuse on imaging? How to treat?

A

Focal nodular hyperplasia, no treatment necessary

69
Q

How to treat hepatic adenoma?

A

Remove surgically especially if >5cm given chance for malignancy

70
Q

What condition has numerous hypodense nodules in the liver that show regenerative nodules around the portal triads?

A

Nodular regenerative hyperplasia (NRH). Usually caused by drugs, stop offending agent. Can be associated with azathioprine

71
Q

Liver lesion that is bright on T1 and does not disrupt architecture?

A

Probably fatty focal infiltration (pseudo mass)

72
Q

Cutaneous hemagiomas, small bowel obstructions, GI bleeding?

A

Blue rubber bleb nevus syndrome

73
Q

Groove Pancreatitis

A

Inflammation of the “groove” between head of panc and duodenum. Causes severe inflammatory stricturing of duodenum and nonmalignant gastric outlet obstruction. Treat conservatively, but patients may need surgery

74
Q

What is MALS? What are the symptoms?

A

Median arcuate ligament syndrome compresses celiac trunk. Causes abdominal bruit, pain with eating, weight loss

75
Q

MALS VS SMA syndrome

A

Mals compresses celiac artery and causes pain, SMA syndrome is marked by weight loss and obstruction of SMA and pain

76
Q

Recurrent infections and giardiasis?

A

CVID -chronic variable immunodeficiency, impaired B cell function and low IgG

77
Q

Hemosiderosis path vs hemochromatosis

A

Hemosiderosis seen with chronic viral dz, alcohol, and NAFLD. Iron in Kuppfer cells and not hepatocytes. Hemochromatosis the iron is in hepatocytes

78
Q

Where to biopsy for CMV vs HSV?

A

CMV in the “C”enter
HSV at the “h”edge

GI Boards (11 decks)

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