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Gastroenterology > Alpa-MKSAP > Flashcards

Alpa-MKSAP Flashcards

1
Q

Name 3 medications that cause Pill Induced Esophagitis

A

Alendronate, quinidine, tetracycline, doxycycline, KCl, ferrous sulfate

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2
Q

Eosinophilic Esophagitis

  1. Endoscopic finding
  2. How many eosinophils seen on high power field
  3. Treatment (Hint: first try…)
A
  1. Trachealization of esophagus, longitudinal furrows, luminal narrowing
  2. > 15 eosinophils
  3. Try 8 weeks of PPI for GERD Induced Esophagitis, then aerosolized topical glucocorticoid/prednisone
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3
Q

Oropharyngeal Dysphagia:
Signs/Symptoms
Dx

A

Coughing
Choking
Nasal regurgitation

Dx: modified barium swallow/ videofluoroscopy

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4
Q

Treatment for Candida albicans Esophagitis

A

PO fluconazole

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5
Q

Treatment for CMV Esophagitis

A

Ganciclovir/Valganciclovir, ulcer Center Biopsy

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6
Q

Treatment for HSV Esophagitis

A

Acyclovir, ulcer edge biopsy

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7
Q

Surveillance for Barretts Esophagus

  1. No dysplasia
  2. Low grade dysplasia
  3. High grade dysplasia
A
  1. Repeat 3-5 years
  2. Repeat 6-12 months
  3. Repeat 3 months
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8
Q

Name 3 Adverse Effects of PPI

A
  1. Increased infections (CAP & Cdiff) since acid balance changes
  2. Malabsorption
    Magnesium, B12, Iron,
    Calcium causing poor bone density
  3. Chronic Atrophic Gastritis
  4. Sporadic fundic gastric polyps
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9
Q

First line therapy for H pylori infection

Second line therapy for H Pylori infection

A

PPI + Clarithomycin + Amoxicillin
PPI + Clarithomycin + Metronidazole (PCN allergy)
PPI + Bismuth + Metronidazole + tetracycline

PPI + Levaquin + Amoxicillin

Note- always confirm eradication

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10
Q

Mutation associated with Gastrointestinal Stromal Tumor (GIST)

A

KIT oncogene mutation

CD 117

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11
Q

Name 5 medications that cause of Acute Pancreatitis

A

Furosemide, didanosine, mesalamine, HCTZ, Simvastatin, 6MP/AZA

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12
Q

Name 3 infections that cause of Acute Pancreatitis

A

Mumps, Coxsackie B, CMV, Toxoplasmosis, HIV, Aspergillus, HSV, Varicella, Hepatitis B, cryptococcus

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13
Q

How to diagnose microcalculi with pancreatitis

A

Increased aminotransferases & secretin enhanced MRCP

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14
Q

Types And Differences of Autoimmune Pancreatitis

A

CT finding: pancreatic enlargement/ featureless border
Type 1 AIP: systemic, extrapancreatic involvement, increased IgG4
Type 2 AIP: duct centric chronic pancreatitis, normal IgG4, no extrapancreatic symptoms

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15
Q

How to calculate Stool Osmotic Gap

A

290 - 2 (Stool Na+ Stool K+)

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16
Q

Diagnosis And Etiology of Secretory Chronic Diarrhea

A

Large volume, doesn’t stop with fasting

Stool Osmotic Gap

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17
Q

Ulcer found in the 2nd part of duodenum

A

Gastrinoma

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18
Q

Diagnosis And Etiology of Osmotic Chronic Diarrhea

A

Stops with Fasting
Stool Osmotic Gap > 100
Carbohydrate Malabsorption (Lactose)

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19
Q

Diagnosis And Etiology of Steatorrhea

A

> 14 grams of stool fat (on 100 gram fat diet)
Small Bowel Mucosal Disorders- Celiac Disease, Pancreatic insufficiency, small intestinal bacterial overgrowth, bile acid deficiency, lymphatic obstruction

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20
Q

Lab tests for chronic Diarrhea

A 
Fecal Fat
Stool Osmotic gap
Stool WBC 
Stool Calprotectin 
Stool lactoferrin
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21
Q

HLA subtypes Celiac Disease

A

HLADQ2 & HLADQ8

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22
Q

Signs/symptoms of Celiac Disease

A

Weight loss, stearrhoea, nutritional deficiency, iron deficiency anemia, Vitamin ADEK
Dermatitis Herpetiformis

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23
Q

Disorders associated with celiac disease

A

Microscopic colitis
Lymphocytic gastritis
T cell Lymphoma
IBS-D

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24
Q

Lab tests for Celiac Disease

A

IgA tissue transgluminase
Endomysial antibody
Deaminated Gliadin peptide

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25
Q

Biopsy results of Celiac Disease

A

Intraepithelial lymphocytes
Crypt elongation
Villous blunting/atrophy

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26
Q

Extra intestinal manifestations of IBS

A 
Oral apthous ulcers
Arthalgias
Ankylosising spondylitis 
Uveitis 
Scleritis 
Pyoderma gangrenosum 
Erythema nodosum
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27
Q

What enzyme to check before starting IBD immunomodulators?

A

Check TPMT before AZA/6MP

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28
Q

What condition is associated with Ulcerative Colitis?

Hint: Biliary structure

A

Primary Sclerosing Cholangitis

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29
Q

What serology associated with Ulcerative Colitis?

A

pANCA

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30
Q

Biopsy finding on Ulcerative Colitis

A

Continuous, superficial inflammation, ulceration, edema

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31
Q

Biopsy finding on Crohn’s Disease

A

Transmural, apthous ulcers, deep ulcers, cobblestoning, granuloma, skip lesions

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32
Q

What serology associated with Crohn’s Disease?

A

ASCA + NOD2CARD15

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33
Q

Adverse Effect associated with Nalalizumab

A

PML

Check for JC virus

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34
Q

2 types of microscopic colitis

A
  1. Lymphocytic

2. Collagenous

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35
Q

Stepwise treatment of microscopic colitis

A
  1. Loperamide, diphenoxylate
  2. Bismuth
  3. Budenoside, 5-ASA, cholestyramine, anti TNF
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36
Q

What condition is associated with IBS-D?

A

Celiac Disease

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37
Q

Name 3 Modifiable Risk Factors for Colorectal Neoplasia

A 
High dietary fat
Red meat 
Low Fiber
Smoking
Obesity 
DM type 2
Alcohol
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38
Q

Name 3 Non-Modifiable Risk Factors for Colorectal Neoplasia

A

Male, Older Age, Black, IBD, PSC, Hx of adenoma, acromegaly

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39
Q

Amsterdam Criteria II for Hereditary Nonpolyposis Colon Cancer (MMR deficiency)

A

3 or more relatives with cancer in HNPCC
2 generations
1 relative is 1st degree
1 before age of 50

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40
Q

Name 3 types of cancer that is associated with Familial Adenomatous Polyposis
(APC gene mutation)

A

Colorectal, duodenal, ampullary, gastric, hepatoblastoma, thyroid cancer

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41
Q

Diagnosis Criteria for Serrated Polyposis Syndrome

A
  1. More than 5 Serrated polyps proximal to sigmoid
  2. Having a serrated polyp and relative with SPS
  3. More than 20 serrated polyps

Need yearly colonoscopy!

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42
Q

Indications for 3 year Post Polypectomy Surveillance

A

3-10 adenoma, > 10mm, villous, high grade dysplasia, traditional serrated adenoma

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43
Q

Serology for Active Hepatitis B

A

+ surface antigen
+ e antigen
+ core IgM

Will resolve in 6 months, follow LFTs

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44
Q

Serology for Naturally Immune Hepatitis B

A

+ surface antibody

+ core IgG

45
Q

Serology for vaccinated Hepatitis B

A

+ surface antibody

46
Q

Serology for Immune-tolerant Chronic Hepatitis B

A

> 1 million DNA
+ surface antigen
+ core IgG
+ e antigen

47
Q

Serology for Immune-active Chronic Hepatitis B

A

> 10,000 DNA
+ surface antigen
+ core IgG
+ e antigen

Increased ALT

48
Q

Serology for Immune-Control Chronic Hepatitis B

A
49
Q

Serology for Reactivation Chronic Hepatitis B

A

> 10,000 DNA
+ surface antigen
+ core IgG
+ e antibody

50
Q

First Line Treatment for Hepatitis B

A

Entecavir & Tenofovir

51
Q

When to treat Hepatitis B?

What is the goal?

A

Acute Liver Failure, abnormal ALT with DNA

52
Q

Hepatitis B: when to screen for Hepatocellular Carcinoma

A 
Cirrhosis
Asian male > 40
Asian female >50
African >20
Family Hx
High ALT with DNA >10,000
53
Q

What is the goal of treatment for Hepatitis C?

A

Sustained Virologic Response

Undetectable RNA 6 months after treatment

54
Q

How to calculate Maddrey’s Discriminant Function

What value do you treat Acute Alcoholic Hepatitis

A

4.6 ((PT- control PT) + total bilirubin)

>32

55
Q

Name 3 Contraindications for giving Prednisolone for Acute Alcoholic Hepatitis

A

Infection, variceal bleed, AKI

56
Q

Serology associated with Autoimmune Hepatitis

A

Serum IgG
ANA
Antismooth muscle

57
Q

How to treat Autoimmune Hepatitis

A

Glucocorticoid

Azathioprine

58
Q

Non acetaminophen related Acute Liver Failure with grade I-II hepatic encephalopathy will benefit from what therapy?

A

NAC

59
Q

Serology with Wilson Disease

A

decreased Alk Phos, decreased ceruloplasmin, urine copper > 250 over 24 hours

60
Q

Primary Biliary Cirrhosis: immune mediated destruction of small intralobular bile ducts
Dx & Tx

A

Dx: + Antimitochondrial antibody test
Tx: Ursodiol will slow disease progression

61
Q

Cancer associated with Primary Sclerosing Cholangitis

How to screen for it?

A

Cholangiocarcinoma

CA 19-9 and imaging every 1 year

62
Q

When do you start colorectal screening in IBD patient?

A

8-10 years after diagnosis, then ever 1-2 years

If Crohn’s disease or UC affecting more than rectum

63
Q

When to start screening in Hereditary Nonpolyposis Colon Cancer?

A

Colonoscopy every 1-2 years starting at age 20

EGD every 2-3 years starting at age 30

64
Q

How to diagnose Hepatitis E? What regions is it found in?

A

HEV IgM

India/Asia, Central America

65
Q

2 Big causes of Portal Hypertension

A
  1. Cirrhosis

2. Portal Vein Thrombosis in Budd Chiari Syndrome

66
Q

How often to screen for esophageal varicies in a cirrhotic patient?

A

Every 3 years

67
Q

Name 5 precipitants for Hepatic Encephalopathy

A

Alcohol, Benzodiazepines, Opioids, Hypoxia, Electrolyte Abnormality, Infection, GI Bleed, TIPS

68
Q

Diagnose Hepatopulmonary Syndrome

A

Platypnea/Orthodeoxia- decreased O2/SOB while upright
Arterial Oxygen tension 15
Intrapulmonary shunting on Echo (agitated saline)
Tx: O2 and transplant

69
Q

Diagnose Portopulmonary Hypertension

A

Essentially pulmonary hypertension with chronic liver disease
Check TTE, RV systolic pressure > 50
Tx: Prostacyclin analogue, endothelian antagonists, phosphodiesterase inhibitor

70
Q

How much albumin to give if large volume paracentesis?

A

8 grams of 25% albumin for each liter removed

71
Q

Indications to give Albumin in SBP

A

Creatinine > 1, BUN > 30, Bilirubin > 4

72
Q

Hepatorenal syndrome

A

If creatinine > 1.5, lack of response to albumin challenge (1 gram/kg/day for 2 days), and no other explanation of AKI

73
Q

Specific Type of Food to avoid if you are cirrhotic

A

Oysters/Shellfish for Vibrio Vulnificus

74
Q

What does Focal Nodular Hyperplasia look like on imaging?

A

Arterial phase enhancement with central star

Unless symptomatic, who cares

75
Q

What hormone makes Hepatocellular Adenoma bigger?

A

ESTROGEN!

76
Q

If this proto-oncogene is present in Hepatocellular Adenoma, there is more concern for malignancy potential?

A

Beta-catenin nuclear reactivity
(May need surgical resection or radiofrequency ablation
if tumor > 5 cm or positive for beta-catenin

77
Q

What does Hepatic Hemangioma look like on imaging?

A

Peripheral nodular enhancement filling in toward center of lesion in later phases
No estrogen dependence or malignancy potential
Only if > 10 cm or symptomatic, who cares

78
Q

What organism causes hepatic amebic cysts? How do you treat it?

A

Entamoeba histolytica
Tx: Metronidazole
Will see right hemidiaphragm elevation

79
Q

How to treat Chronic Portal Vein Thrombosis?

A

You don’t! Hah

80
Q

What is Budd Chiari Syndrome?

A

Obstruction of Hepatic Venous Outflow by Thrombus

81
Q

Most common cause of upper GIB?

A

PUD

82
Q

What the hell is Dieulafoy Lesion?

A

Large tortuous submucosal arteriole in gastric cardia

83
Q

What’s a low risk ulcer?

How do you treat it?

A

Clean Base, flat pigmented spot

Give PO PPI

84
Q

What’s an intermediate risk ulcer?

A

Adherent Clot

85
Q

What’s a high risk ulcer?

How do you treat it?

A

Arterial spurting or visible blood vessel

IV PPI for 72 hours!

86
Q

Most common cause of lower GIB?

A

Diverticulosis

87
Q

Most common cause of obscure GIB?

A

Angiodysplasia

88
Q

What is the bleeding rate detected Technetium Labeled Nuclear Scan?

A

0.1-0.4 mL/min

89
Q

What is the bleeding rate detected Angiography?

A

> 0.5 mL/min

90
Q

3 Different Types of Endoscopy (that go further)

A
  1. Push Enteroscopy- you can advance beyond ligament of treitz into jejunum
  2. Spiral Enteroscopy
  3. Balloon Assisted Enteroscopy
91
Q

When do you screen for colon cancer in patient with crohns or Ulcerative colitis?

A

8 years after diagnosis and then Q1-2 years afterwards

92
Q

When do you screen patients with familial adenomatous polyposis syndrome for colon cancer?

A

Annually starting at age 12 with sigmoidoscopy and then at age 16 switch to colonoscopy.

If find polyp - consider colectomy

93
Q

How often do you screen Adenomas > 1 cm?

A

Screen every 3 years

94
Q

How often do you screen patients with >4 total Adenomas ?

A

Screen every 3 years

95
Q

How often do you screen patients with villous Adenomas?

A

Screen every 3 years

96
Q

Name three MEDICATIONS that can theoretically decrease the risk of colon cancer

A

Aspirin > 20 years
Celecoxib (NSAID)
Sulindac (NSAID)
Estrogens

97
Q

Malignancy potential of hyper plastic polyps?

A

None.

98
Q

Which gene is mutated in familial adenomatous polyposis? Which chromosome is it on?

A

APC gene

(Adenomatous polyposis coli gene) on chromosome 5q

99
Q

Lady with Lynch syndrome found to have adenomatous polyps - what is next screening test?

A

Transvaginal ultrasound to rule out ovarian cancer

100
Q

Colon cancer Screening for patients with hyperplastic polyps.

A

Colonoscopy every 10 years

OR

FIT testing annually PLUS
Sigmoidoscopy every 5 years

101
Q

Work up of unexplained iron deficiency anemia in a man or postmenopausal woman

A

EGD if 50

102
Q

How often do you screen patients with Adenomas

A

Screen every 5-10 years

103
Q

When to screen patients with tubular Adenomas >1 cm or multiple tubular Adenomas

A

Screen every 3 years

104
Q

Obstructive colon cancer s/p removal with pre op colonoscopy void of other lesions - how often you repeat colonoscopy and CEA

A

Colonoscopy every 1 year then 3 years then 5 years if all return normal.

CEA every 3-6 months X 2 years then every 1 year X 5 years

105
Q

Consider d/c colonoscopies at what age?

A

Age 75

But if patient still very active and healthy co side stopping instead at age 85

106
Q

When to screen patient with HNPCC

A

Screen 10 years earlier than youngest HNPCC relative or at age 25 whichever is earlier with colonoscopy q2 years till 40 then annually after

107
Q

Treatment of anal canal mucosa cancer

A

External beam RT
5FU
Mitomycin

108
Q

Treatment of anal margin cancer

A

Local excision

Gastroenterology (1 decks)

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