Acing the Boards Flashcards
What is esophagitis dissicans superficialis? What conditions is this seen in?
Sloughing esophageal mucosa in tubes (look at pics)
Seen in pemphigus vulgaris, bisphosphonate therapy, and celiac disease
Symptoms of leptospirosis
Conjunctival injection, pulse-temp dissociation, elevated AST/ALT < Bili, caused by swimming in rodent urine infested water
Triad of symptoms of gastric volvulus and treatment?
Severe nausea and retching without vomiting, inability to pass NG tube, epigastric pain.
Tx is surgical emergency
GI symptoms of amyloid
Diarrhea, gastroparesis, small intestinal bacterial overgrowth.
Can present with neuropathy, hepatosplenomegaly, etc.
Most likely cause of jaundice in pregnant women?
Viral hepatitis
Cause of globus sensation and oral projection when coughing? Worst complication of this?
Fibrovascular polyp of the esophagus. Can cause asphyxiation. Usually need EUS prior to removal.
Can be removed if <2cm and no penetrating vessels.
Common side effect of mesalamine
Pericarditis or pleuritis. Discontinue medication
What condition is marked by high ESR, eosinophilia, anemia, nodules in colon with needle shaped clefts?
Cholesterol emboli to the colon
What condition shows oblique filling defect of the esophagus on esophagram?
Dysphagia Lusoria— aberrant takeoff of right subclavian artery that passes from left to right behind esophagus
CD4 count that predisposes to Cryptosporidiosis
<180
Cause of hereditary angioedema?
C1 esterase deficiency. It’s autosomal dominant. Can be triggered by ace inhibitors.
Melkersson-Rosenthal Syndrome
Fissured tongue, facial paralysis, noncaseating granulomas of the tongue. Facial Crohn’s
How to treat C1 esterase deficiency
Long term:Danazol
Short term: infusion of c1 esterase
What causes Acanthosis nigricans?
Gastric malignancy, HCC, and lung cancer.
Signs of Zinc deficiency? Which patients are zinc deficient?
Think about beer drinkers, Crohn’s or patients on TPN. Erythematous, scaling vesiculopustular plaque on legs and face. And diarrhea.
Glucagonoma Symptoms
Think DDW: Dermatitis, diabetes, weight loss.
Patients get necrolytic migratory erythema (scaling rash over 1-2 weeks).
What condition is marked by plucked-chicken skin, angioid streaks in eyes, GI bleeding?
Pseudoxanthoma Elasticum (deposition of elastic tissue). Caused by ABC6 mutation
What is the event that is the predominant cause of GERD?
TLESR
How to treat refractory GERD by reducing TLESR? How does it work?
Baclofen reduces TLESRs by being a GABA agonist
Hyperkeratosis of the hands and feet association with GI disease
Tylosis (AD inheritance), these patients have increased risk of SCC esophagus
Sign of Hirschsprung’s disease on anorectal manometry
No rectoanal inhibitory reflex (RAIR) (no anal relaxation with insufflation of rectum)
What is Cronkhite-Canada Syndrome? Inheritance pattern?
Protein losing enteropathy, gastric enteric and colonic hamartomas. Also causes alopecia and dystrophic fingernails. Not inherited.
Symptoms of Menetrier disease?
Thickened gastric folds, corkscrew foveolar hyperplasia on histology, lots of mucus, diarrhea
Differential for large gastric folds
Menetrier disease, gastric lymphoma, ZE syndrome
How to diagnose ZE on secretin stim test
Increase in gastric >200. Usually gastrin is >1000.
When to do cholecystectomy for gallbladder polyp?
When >1cm or if patient presents with biliary pain
Time course of hepatic sinusoid outflow obstruction vs GVHD
Sinusoid: 21 days
GVHD: >100days
What are chloromas (granulocytic sarcoma)? How to distinguish on pathology? What are they a precursor to?
Green looking lesions throughout the GI tract that are myeloperoxidase positive. They are a precursor to AML.
Cowden’s Syndrome and genetic mutation/inheritance pattern
Bumps on face and hands (trichilemmomas), cobblestoned tongue, colon hamartomas. Mutation in PTEN tumor suppressor. Autosomal dominant. Increased risk of breast, thyroid, endometrial cancers
Common lasix side effect?
Pancreatitis (also 6MP, azathioprine, HCTZ)
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?
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
Diarrhea caused by
Milk
Undercooked beef (bloody)
Rice
Shellfish from gulf coast?
Travelling?
Milk - listeria
Ecoli O157H7 (TTP-HUS)
B.cereus
Vibrio vulnificus or parahemolyticus
ETEC
What diarrhea causing bacteria is deadly to cirrhotics
Vibrio Vulnificus
How to treat HP
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)
What condition has arthritis, diarrhea, cardiac arrhythmias? Histology? How to treat?
Whipple Disease, PAS + macrophages (but AFB negative, as opposed to MAC), Tx with ceftriaxone and then a year of Bactrim DS
Cause of intestinal lymphagiectasia? What are the symptoms?
Heart failure. Causes protein and fat malabsorption, diarrhea
What antibiotic can cause pill esophagitis
Doxycycline
What medication can cause hepatic fibrosis?
Methotrexate
Most constipating TCA? Least constipating TCA? Middle option?
Amitripyline is most constipating
Nortriptyline is middle
Desipramine is least constipating.
What is alvimopan
A peripherally acting opioid antagonist used to treat post-op ileus
PAS positive macrophages and AFB+?
MAC
What causes flask shaped ulcers? How to treat?
Entamoeba histolytica, treat with metronidazole. Can see motile trophozoites with ingested RBC
Terminal Ileitis in AIDS patient?
Think tuberculosis or cryptosporidiosis
Diarrhea in AIDS patient after visit to developing country with eosinophilia? Charcot-Leyden crystals in stool? How to treat
Cystoisospora Belli, treat with Bactrim
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?
Epiploic appendagitis - tx with NSAIDs, NOT surgery
How to treat abdominal wall pain?
Inject lidocaine, can follow up with long acting steroid
How does FMF present? How to treat?
Severe abdominal pain in times of stress, fever, cellulitis type rash, elevated ESR. Tx with colchicine.
Gastric layers on EUS
Mucosa (bright)
Muscularis mucosa (dark)
Submucosa (bright)
Muscularis propria (dark)
Serosa (bright)
CD117 (c-kit) positive 4th layer lesion. What does it arise from?
Muscularis propria lesion that is CD117 positive is a GIST. May respond to imatinib. Arises from interstitial cell of cajal
4th layer gastric lesion with actin positivity
Leiomyoma
Spherical anechoic sub -epithelial gastric mass?
Duplication cyst (embryonic remnant of stomach development)
What gastric layer do lipomas arise from?
Third layer (submucosa, which is bright)
Where do carcinoids arise from? How to treat?
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
What gastric lesion arises from 4th layer, c-kit negative, but actin and vimentin positive?
Glomus tumor (smooth muscle cells of blood vessels)
4th layer gastric lesion that is positive for S-100
Schwannoma
Pre-pyloric gastric mass with central umbilication arising from 3rd layer?
Pancreatic rest – benign no need for resection
Difference between jackhammer esophagus and DES?
Jackhammer has preserved peristalsis, just very forceful. DES is uncoordinated, so causes inability to swallow
Dysphagia years after polio?
Post-polio syndrome
What is the CEA threshold for resection of branch duct IPMN?
192, resect if higher
When to resect BD-IPMN?
If >3cm, if abdominal pain, if CEA>192, if thickened, or solid nodule resect
Rare brain findings of celiac disease
Epilepsy and bilateral occipital calcifications
Zinc deficiency signs
Rash and hair loss (beer drinkers, cirrhosis, TPN)
Air under the diaphragm with right angled septations in COPD patient?
Chilaiditi syndrome. It’s the colon, if patient is asymptomatic do nothing. If obstructed, NG decompression
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?
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
What condition causes bloody rectal effluent in a patient with an ileostomy?
Diversion colitis
How to treat diversion colitis?
Short chain fatty acid enemas
What is a hepatic lesion with a central scar that remains hypotenuse on imaging? How to treat?
Focal nodular hyperplasia, no treatment necessary
How to treat hepatic adenoma?
Remove surgically especially if >5cm given chance for malignancy
What condition has numerous hypodense nodules in the liver that show regenerative nodules around the portal triads?
Nodular regenerative hyperplasia (NRH). Usually caused by drugs, stop offending agent. Can be associated with azathioprine
Liver lesion that is bright on T1 and does not disrupt architecture?
Probably fatty focal infiltration (pseudo mass)
Cutaneous hemagiomas, small bowel obstructions, GI bleeding?
Blue rubber bleb nevus syndrome
Groove Pancreatitis
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
What is MALS? What are the symptoms?
Median arcuate ligament syndrome compresses celiac trunk. Causes abdominal bruit, pain with eating, weight loss
MALS VS SMA syndrome
Mals compresses celiac artery and causes pain, SMA syndrome is marked by weight loss and obstruction of SMA and pain
Recurrent infections and giardiasis?
CVID -chronic variable immunodeficiency, impaired B cell function and low IgG
Hemosiderosis path vs hemochromatosis
Hemosiderosis seen with chronic viral dz, alcohol, and NAFLD. Iron in Kuppfer cells and not hepatocytes. Hemochromatosis the iron is in hepatocytes
Where to biopsy for CMV vs HSV?
CMV in the “C”enter
HSV at the “h”edge
