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step II > amboss 7/4 > Flashcards

amboss 7/4 Flashcards

1
Q

what is the presentation of hepatitis A infections

A

fever, jaundice, high bili, Serum transaminase levels are highly elevated (400–1000 U). Unlike in alcoholic hepatitis, ALT levels are greater than AST levels (the AST/ALT ratio is usually < 1). If the AST/ALT ratio is > 1 in a patient with acute viral hepatitis, acute liver failure (fulminant hepatitis) should be suspected.

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2
Q

what is the presentation of hepatitis B

A

usually asymptomatic, can produce a chronic hepatitis years later

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3
Q

how is hep B transmitted

A

sexually, parentally (needlestick), perinatally

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4
Q

bacillus cerus food poisoning occurs in what foods

A

foods that are heated/coooked and then reheated
It grows in heated food that cools down too slowly or in food that is improperly refrigerated. Reheated rice is a common source of infection.
which leads to nausea and vomiting approximately 30 minutes to 6 hours after ingestion.

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5
Q

what is the presentation of amebiasis from entameoba histolytica

A

and causes both intestinal disease (bloody loose stools) and extraintestinal disease (amebic liver abscess). Patients with an amebic liver abscess typically present with fever and pain in the RUQ that is possibly exacerbated by inspiration.

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6
Q

how is entamoeba spread

A

This pathogen is spread fecal-orally in endemic regions (Mexico, Southeast Asia, India)

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7
Q

what are the ultrasound findings for entamoeba infection

A

a solitary hypoechoic lesion in the liver makes the diagnosis of amebiasis extremely likely.

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8
Q

what is the diagnostic test of choice for suspected GI bleed

A

Esophagogastroduodenoscopy (EGD)

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9
Q

what is the test of choice for boerhaave sydnrome

A

CT scan chest; contrast esophgram with gastrographin NOT barium. contrast only done if patient is stable `

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10
Q

what is the difference between boerhaave and mallory weis

A

borehaave is transmural rupture

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11
Q

how is the diagnosis made for mallory Weiss tear

A

endoscopy

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12
Q

treatment for boerhaave

A

surgical repair

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13
Q

what is the treatment for entamoeba histolytica

A

metronidazole

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14
Q

what is the treatment for anal fissure

A

sitz bath and nifedipine

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15
Q

is hep c RNA or DNA

A

RNA

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16
Q

glutamate dehydrogenase antigen screening is for what

A

C diff

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17
Q

what is the test for lactose intolerance

A

hydrogen breath test

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18
Q

what is the test for celiac disease

A

antitissue transglutaminase; IgG deaminated gliadin peptide test

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19
Q

how do you treat whipples disease

A

IV ceftriaxone; maintenance therapy with Bactrim should be followed for one year

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20
Q

what is the presentation of whipples

A

joint pain and malabsorption

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21
Q

what can happen when an amoebic cyst is drained

A

anaphylactic shock

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22
Q

what is first line therapy for hemorrhoids

A

docusate and lidocaine if painful

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23
Q

what is the therapy for internal hemorrhoids if first line medical therapy fails

A

rubber band ligation

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24
Q

what is the next step in management after achalasia is found on barium swallow

A

endoscopy because must rule out pseudoachalasia

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25
Q

what is the most common cause of gastroenteritis in adults

A

norovirus

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26
Q

presentation of norovirus

A

presents with gastroenteritis caused by norovirus, which usually manifests with nausea, acute-onset vomiting, watery, non-bloody diarrhea, and abdominal cramps following an incubation period of 12–48 hours. Because norovirus is transmitted fecal‑orally, the woman might have contracted the illness from eating contaminated food or water or contact with contaminated surfaces.

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27
Q

what antibody is associated with ulcerative colitis

A

pANCA

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28
Q

what is the treatment for GERD

A

Proton-pump inhibitors (PPIs) are the first-line treatment for moderate to severe GERD. Of all medications that are used in GERD, PPIs are associated with the greatest reduction in symptoms and relapse rates. Since this patient has had symptoms daily for the past month, PPIs are the treatment of choice in combination with dietary and lifestyle modifications, including avoiding late night meals, elevating the head of the bed while sleeping, and weight loss.

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29
Q

what does the stool look like in someone with giardiasis

A

it will have cysts in it

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30
Q

what is the treatment for giardiasis

A

metronidazole

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31
Q

are we vaccinated for hep A f

A

yes. between the ages of 12-23months

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32
Q

Is PEP necessary for children exposed to hep A

A

no….if they are up too date on vaccines and above the age of 2

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33
Q

what is the treatment for acute hep c

A

Sofosbuvir and ledipasvir, both direct-acting antivirals, are the first-line treatment for chronic hepatitis C infection of genotypes 1, 4, 5, and 6. Treatment of chronic hepatitis C infection depends on viral genotype, history of antiviral treatment, and the degree of liver fibrosis. The duration of treatment is typically 12 weeks.

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34
Q

what is the treatment for chronic hep c

A

pegalyated interferon and riboviron

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35
Q

what is hepatitis core antibody indicate

A

Chronic -either inactive or acitve

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36
Q

what is the hepatitis B envelope antigen suggest

A

this means active –think “Envelope Ective”

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37
Q

what does an inactive chronic hep b infection look like on seriology

A

with chronic hepatitis B has a normal ALT level and a hepatitis B DNA load of less than 2,000 IU/mL
they will have a positive core antibody; positive envelope antibody; and positive surface antigen.

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38
Q

what is suppurative sialadenitis

A

The condition is most commonly caused by S. aureus and typically presents with sudden swelling of the salivary glands (most often the parotid gland), tenderness, fevers, chills, and secretion of purulent material from the salivary duct, as seen here.

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39
Q

what is the treatment for suppurative sialadenitis

A

nafcillin and metronidazole

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40
Q

what is candida esophagitis treated with

A

oral fluconazole

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41
Q

what is the difference between thrush and esophagitis

A

white plaques that are scraped off easily, indicating oral thrush. Additionally, her dysphagia is consistent with esophagitis. Together, oral thrush and esophagitis in a patient with a positive HIV test is most likely caused by Candida albicans.

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42
Q

what is the treatment for active hep b infection

A

pegylated interferon is indicated if the ALT is great than 2X the upper limit of normal; tenofovir is used for patients with contraindications such as autoimmune disease

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43
Q

what do you give patients with fulminant liver failure

A

n-acetyl cysteine

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44
Q

what is the intervention of choice for pancreatic head cancer

A

Whipple

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45
Q

what is the treatment of choice for acute cholangitis

A

ERCP

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46
Q

why is cholecystectomy not the treatment of choice for acute cholangitis

A

because that wouldn’t remove the stone in the common bile duct

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47
Q

what is the course of management for hiatal hernia with severe features

A

lifestyle modification and medical management with PPIs, H2 receptor antagonists, then surgical intervention

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48
Q

what is hiatal hernia with severe features

A

severe features are refractory GERD, esophageal ulceration, bleeding, strictures

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49
Q

what is type I hiatal hernia

A

when the gastroesophageal junction is above the diaphragm

this is also called sliding

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50
Q

what is type 2 hiatal hernia

A

when the fundus of the stomach is above the diaphragmatic barrier

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51
Q

what is type 3 hiatal hernia

A

when there is a fundus and the gastroesophageal line is above the diaphragm

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52
Q

what is a type 4 hiatal hernia

A

when the stomach is completely above the diaphragm

also call upside-down stomach

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53
Q

what is a femoral hernia

A

Rare type of hernia, they are always below the inguinal ligament. they are associated with increased bulging on increased intrabdominal pressure

54
Q

what is an indirect hernia

A

most common type of hernia in both men and women. palpable groin protrusion above the inguinal ligament t these are located lateral to the epigastric arteries. these are treated with surgery immediately so that strangulation does not occur

55
Q

what is a direct hernia

A

Direct inguinal hernias manifest as a visible and/or palpable groin protrusion above the inguinal ligament and are associated with pain that worsens during physical activity. However, they usually occur in men > 40 years of age and are uncommon in women.

56
Q

what are the differences between direct and indirect hernias

A

indirect is the most common.
men age > 40 are more likely to get direct
direct hernias cause pain on exertion

57
Q

what is the first step in someone with small bowel obstruction

A

conservative trial is indicated. nasogastric tube placement for decompression, fluid resuscitation, and electrolyte correction as well as bowel rest

58
Q

what is the best prognostic indicator for pancreatitis

A

hematocrit. this is based on volume status. if significant third spacing is occurring then the hematocrit will become hemoconcentrated. Or the hematocrit can drop due to necrotizing pancreatitis

59
Q

what is cholecystitis

A

inflammation of the gallbladder, most often caused by a stone blocking the cystic duct

60
Q

what is cholangitis

A

biliary obstruction and stasis. if infection then acute

61
Q

pregnancies/mulparity increases the risk for gallstones by how much and why

A

The risk of gallstone disease is about 10 times greater among multiparous women than nulliparous women. Higher estrogen levels during pregnancy increase the secretion of cholesterol into bile, while higher progesterone levels decrease the production of hydrophilic bile acids, resulting in a decreased ability of bile to sequester cholesterol.

62
Q

what does the serum-ascites-albumin gradient tell us

A

a SAAG > 1.1 indicates that the source is portal hypertension; < 1.1 hypoabuminemia, malignancy, infections or pancreatitis

63
Q

what is the best way to diagnose choledochothiais

A

trans abdominal ultrasound

64
Q

what is the treatment for an acute complicated inguinal hernia

A

this is an incarcerated hernia and must have open repair

65
Q

what is the treatment of choice for uncomplicated hernias

A

laparoscopic repair

66
Q

what is the management for Barretts esophagus

A

endoscopic mucosal resection and ablation therapy

67
Q

is there a risk for malignancy in barretts

A

yes. the risk increases by 0.7%/per year for adenoma carcinoma

68
Q

what is the management for borehaave syndrome

A

1) if healthy person with a small contained tear and no signs of sepsis then conservative management –ampicillin and sulbactam therapy.
2) if they do not meet the criteria for conservative management or fail then surgical intervention

69
Q

what is a sharply defined liver mass with a central scar

A

focal nodular hyperplasia.

70
Q

what is the treatment of choice for focal nodular hyperplasia

A

follow up imaging at 3-6 months is recommended to confirm the stability of the lesions, after which there is no further intervention

71
Q

do you discontinue OCPs in someone with focal nodular hyperplasia

A

No. although the tumors tend to be more vascular on OCPs, they are generally very stable and do not require intervention

72
Q

what are the treatment options for chronic pancreatitis

A

enzyme replacement therapy is recommended and can help control pain from stopping pancreatic stimulation.
if chronic pain persists then surgical intervention can help –whipple procedure has an 85% effectiveness for pain management

73
Q

what causes spontaneous bacterial peritonitis

A

bacterial translocation

74
Q

how is SBP defined

A

polymorphonuclear leukocyte concentration > 250

75
Q

which bacteria cause SBP

A

E coli or klebsiella

76
Q

what is the management of a hepatic adenoma

A

removing the OCPs and then reimage in 6 months-12 months for 2 years

77
Q

when is surgical intervention indicated for hepatic adenoma

A

when they are greater than 5 cm in size

78
Q

what is first line treatment for schatzki ring

A

mechanical dilation

79
Q

what is the most likely cause of GI bleeding in an infant

A

meckels

80
Q

what is the presentation of dumping syndomre

A

large amounts of carbohydrate rich foods causes fluid shifts and sympathetic activation due to the osmotic shift from the glucose. the person will experience flushing, palpitations diarrhea, need to lie down after eating

81
Q

when do you drain a pancreatic pseudocyst

A

when they are greater than 6cm or symptomatic

82
Q

which liver conditions have indirect hyperbilirubinemia

A

Gilberts and Criggler-Najjar

83
Q

what are the conditions that lead to direct hyperbillirubinemia

A

Rotors and Dublin-johnson

84
Q

what are the liver conditions that are asymptomatic and usually cause jaundice and scleral icterus sporadically; what are the differences between them

A

Gilbert’s and Rotors
Gilbert’s is indirect
Rotors is Direct.

Both are generally asymptomatic.
Gilbert’s usually causes bilirubinemia in after stress or fasting

85
Q

do you give someone with esophageal varices antibiotics

A

yes. 7 days of ceftriaxoine is standard treatment

86
Q

what is abdominal compartment syndrome

A

caused by tissue fluid build up due to prolonged surgery in which a lot of IVF or transfusions are undertaken. this causes compression of the vena cava and reduced blood return to the heart and JVD when the intraabdominal pressure extends into the thoracic cavity

87
Q

Abdominal distention and a marked dilation of the colon and cecum on imaging indicate

A

acute megacolon.

88
Q

when is appendicitis managed with conservative treatment

A

In patients with appendicitis who present after ≥ 5 days of symptoms, inflammation has usually led to a contained perforation (i.e., abscess) and immediate surgery is no longer indicated.

89
Q

what is the course of action for a hypotensive trauma patient with an inconclusive FAST

A

diagnostic peritoneal lavage

90
Q

what is the best indication for TIPS procedure

A

recurrent variceal hemorrhages

91
Q

what is the presentation of a resolving hep B infection

A

no antigen but IgM core

still have transamnitis

92
Q

what is the treatment for acute hep b infection

A

supportive therapy

93
Q

what is the treatment for hep b chronic that is activated

A

interferon alpha or tenofovir

94
Q

what is the treatment for acute hep c

A

pegylated Alpha interferon

95
Q

what is the treatment of choice for anal cancer

A

The combination of chemotherapy and radiation is the treatment of choice for patients with anal squamous cell cancer; it has been shown to be superior to surgery, with a 5-year survival rate of ∼ 80%.

96
Q

what can prevent pyloric stenosis

A

breast feeding only has a lower incidence of pyloric stenosis than infants that also bottle fed.

97
Q

what is there treatment of choice for enterocutaneous fistulas

A

TPN and ostomy pouch

they typically close on their own within 5-6 weeks

98
Q

what is the treatment for olgilvie syndrome

A

neostigmine

99
Q

what is the first step in treating postoperative ileus

A

reducing opioid use

100
Q

can you advance diet with postoperative ileus

A

no. this would further compress the obstructed bowel

101
Q

what is the treatment for congenital umbilical hernias

A

observation. most resolve spontaneous;ly

102
Q

what is the treatment of choice for sigmoid volvulus

A

endoscopic detorsion

103
Q

what is the treatment for duodenal hematomas

A

nasogastric decompression and TPN for bowel rest

104
Q

what is necessary in people with ascites when planning surgery

A

paracentesis. this will be therapeutic for the patient and reduce complications as ascites increase abdominal pressure and causes a higher likelihood of would dehiscence

105
Q

what are patients with pernicious anemia at risk for

A

gastric carcinoma. 90% have chronic atrophic gastritis

106
Q

what is the main mode of transmission for Yersinia enterolitica

A

undercooked pork

107
Q

what is the presentation of primary biliary cholangitis

A

a middle-aged woman, features of cholestatic jaundice (conjugated hyperbilirubinemia, ↑ ALP, unexplained itching), fatigue, hepatomegaly, and hepatocellular damage (↑ ALT, AST), along with symptoms of sicca syndrome (e.g., dry eyes, dry mouth) are highly suggestive of primary biliary cholangitis (PBC).

108
Q

what is the presentation of MEN1

A

90% will have hypercalcemia, Zollinger-Ellison syndrome

109
Q

what is the most significant environmental risk for pancreatic cancer

A

smoking

110
Q

what are the mamometry findings for diffuse esophageal spasms

A

multipeak contractions

111
Q

what is the definition of severe UC

A

, which is defined as ≥ 6 episodes of bloody diarrhea per day, severe abdominal cramps, systemic signs of toxicity (fever, tachycardia), and anemia or ESR ≥ 30 mm/hour.

112
Q

what is the treatment of choice for severe UC

A

sulfasalazine suppositories and oral prednisone

113
Q

what is the cause of Zener diverticulum

A

a pulsion-pseudodiverticulum and is caused by an inadequate relaxation of the upper esophageal sphincter (UES) leading to increased intraluminal pressure that results in outpouching of the pharyngeal wall. The condition usually forms in the hypopharynx within Killian triangle, an area of weakness in the posterior pharyngeal wall.

114
Q

the test of choice for evaluating oropharyngeal dysphagia.

A

A videofluoroscopic modified barium swallow

115
Q

what is hepatorenal syndrome

A

as the liver is dying, it secretes vasoactive compounds that reduce kidney perfusion. This causes increased RAAS, which then increases perfusion pressures but leads to further accumulation of ascites.

116
Q

what is black liver

A

Dubin Johnson

117
Q

what is the treatment for dubin-Johnson

A

None. usually no clinical findings

118
Q

what is hypersensitivity to gliadin

A

celiac disease

119
Q

what is a positive D-xylose test indicate

A

low levels indicate insufficient absorption. this could be due to damaged mucosa or bacterial overgrowth. testing after antibiotic treatment will resolve the difference

120
Q

peutz-jeghers syndrome is associated with what

A

ovarian, breast, pancreatic cancer

40% chance of colorectal cancer

121
Q

what is Gardner syndrome

A

The constellation of extracolonic manifestations of familial adenomatous polyposis (FAP), which includes hypertrophy of the retinal pigment epithelium, adrenal adenomas, osteomas, desmoid tumors, and cutaneous lesions.

122
Q

what happens when you drink and take metronidazole

A

DONT DRINK ON THE METRO. disulfiram reaction

123
Q

what follow up is required after treating H pyolri

A

urea breath test 4 weeks

124
Q

what is the most common cause of acute pancreatitis is

A

biliary pancreatitis from a stone

125
Q

what is a GI SE of amiodarone

A

transaminitis —it should be discontinued

126
Q

how do we scan for heptocellular carcinoma in patients with cirrhosis

A

ultrasound every 6 months

127
Q

what are the drugs of choice for primary prophylaxis against variceal bleeding

A

nadolol and propanolol

128
Q

what is the treatment for gastroparesis

A

metoclopramide

129
Q

where does squamous cell carcinoma of the esophagus usually occur and what causes it

A

upper 2/3 of the esophagus and its associated with smoking and drinking

130
Q

where is adenoma carcinoma of the esophagus usually located and what is it associated with

A

lower or distal esophagus and GERD

step II (22 decks)

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