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Uworld Step 2 > Block 49,50: GI > Flashcards

Block 49,50: GI Flashcards

1
Q

how can you clinical determine lactose intolerance

A
  1. positive hydrogen breath test
  2. positive stool test for reducing substances
  3. low stool pH
  4. increased stool osmotic gap
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2
Q

typical clinical features of Carcinoid syndrome

A
  • episodic flushing
  • secretory diarrhea
  • wheezing
  • murmur of tricuspid regurgitation
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3
Q

diagnostic tool for Carcinoid syndrome

A

elevated 24-hour urinary 5-hydroxyindoleacetic acid

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4
Q

“pounding” sensation in neck and lower extremity edema is what type of clinical symptoms

A

flushing

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5
Q

First step in management of oropharyngeal dysphagia

A

videofluoroscopic modified barium swallow

  • evaluate swallowing mechanics
  • degree of dysfunction
  • severity of aspiration
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6
Q

what is oropharyngeal dyspagia

A

difficulty initiating swallowing

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7
Q

Spontaneous rupture of esophagus

A

Boerhaave syndrome

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8
Q

X-ray of Boerhaave syndrome

A
  • unilateral pleural effusion with or without penumothorax
  • subcutaneous or medatstinal emphysema
  • widened medastinum
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9
Q

pleural fluid analysis for boerhaave syndrome

A
  • low pH

- high amylase

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10
Q

chronic GERD and new dysphagia and symmetric lower esophageal narrowing suggests

A

esophageal peptic stricture

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11
Q

What can cause pellagra

A

niacin deficiency

- prolonged isoniazid therapy can interfere with niacin metabolism

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12
Q

clinical features of pellagra

A
  • dermatitis
  • diarrhea
  • dementia
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13
Q

Niacin can be synthesized endogenously from what

A

tryptophan

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14
Q

Associated skin findings for UC

A
  • erythema nodosum

- pyoderma gangrenosum

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15
Q

diagnosis and treatment for Zenker’s diverticulum

A

Contrast esophagram

surgery

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16
Q

Most common malignancy of liver

A

metastasis from another primary source

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17
Q

who usually gets hepatic adenoma

A
  • benign liver tumors in young women

- associated with OCP use

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18
Q

Diagnosis for esophageal cancer

A

esophageal endoscopy with biopsy

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19
Q

where does esophageal adenocarcinoma occur? Risks for getting it

A

area of barrett esophagus

- smoking and GERD

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20
Q

where does esophageal squamous cell carcinoma occur? risks for it?

A
  • anywhere

- alcohol

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21
Q

2 common causes of ascities

A
  1. cirrhosis due to alcoholic liver

2. chronic viral hepatitis

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22
Q

who develops hepatic hydrothorax and what is it

A
  • cirrhosis and portal hypertension who have abdominal ascites and peripheral edema
  • pleural effusion
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23
Q

how are hepatic hydrothorax created

A

small defects in the diaphragm

- more common on right side due to less muscular hemidiaphragm

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24
Q

clinical feature of hepatopulmonary syndrome

A
  • platypnea: increased dyspnea while upright

- orthodeoxia: oxygen desaturation while upright

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25
Q

2 causes of acute pancreatitis

A

gallstones

chronic alcohol abuse

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26
Q

first step in diagnosis for gallstone-indueced pancreatitis

A

abdominal ultrasound

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27
Q

patient with acute pancreatitis with no alcohol history and no gallstones presents but had a recent heart cath. had what to cause the acute pancretitis

A

cholesterol emboli

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28
Q

management of uncontrollable cause of acute pancreatitis

A

supportive care

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29
Q

drugs that are most common causes of pill esophagitis

A

tetracyclines
potassium chloride
bisphosphonates
NSAIDS

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30
Q

clinical feature of pill esophagitis

A

sudden-onset odynophagia and retrosternal pain

- difficult swallowing

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31
Q

what should be suspected with history of chronic pancreatitis who develop abdominal pain and weight loss

A

pancreatic cancer

32
Q

pancreatic cancer patients with jaundice should have what initial work up

A

Abdominal ultrasound

33
Q

pancreatic cancer patients without jaundice should have what initial work up

A

abdominal CT

34
Q

what should be suspected in a patient with cirrhosis and ascites accompanied by either fever or a change in mental status

A

bacterial peritonitis

35
Q

diagnostic test for bacterial peritonitis

A

paracentesis

36
Q

Common causes of cirrhosis in the united states

A
  • viral hepatitis
  • chronic alcohol abuse
  • nonalcoholic fatty liver disease
  • hemochromatosis
37
Q

treatment for actively bleeding esophageal varices

A
  • hemodynamic support
  • octreotide
  • endoscopic therapy
  • prophylactic antibiotics
38
Q

when do you use temporary balloon tamponade in varices

A

uncontrollable bleeding

39
Q

lab values for alcoholic hepatitis

A

increase: gamma-glutamyltransferase and ferritin

AST and ALT always less than 500

40
Q

patient with chronic abdominal pain, diarrhea, weight loss and evidence of inflammation likely has

A

crohn disease

41
Q

where can crohn disease occur

A

mouth to anus

- ulcers in mouth can be present (aphthous ulcers)

42
Q

treatment for hepatic encephalopathy

A

nonabsorbable disaccharides ( lactulose, lactitol)

43
Q

astreixis

A

flapping tremor with outstretched hands

44
Q

what is chlordiazepoxide

A

long-acting benzodiazepine

- treat alcohol withdrawal

45
Q

for gastric adenocarcinoma, what determines treatment options and prognosis?

A

CT scan of abdomen and pelvis

46
Q

standard of care for familial adenomatous polyposis

A
  • frequent colonoscopic screening starting in childhood

- elective proctocolectomy

47
Q

patient with a family history of colonic polyps and osteomas and alteration in tumor suppressor gene adenomatous polyposis coli has what

A

familial adenomatous polyposis

48
Q

explain aspirin and NSAID role in colon cancer

A

reduced risk for colon cancer but not if you have FAP

49
Q

patient has recurrent peptic ulcer disease with multiple ulcer and jejunal ulceration and gastric folds. what should you suspect

A

Zollinger-Ellison syndrome

50
Q

what is the next step in managment for suspected gastrinoma

A

fasting serum gastrin level greater than 1000 pg/mL

  • if negative then secretin stimulation test
  • if negative then calcium infusion study
51
Q

serum chomogranin A is a marker for

A

neuroendocrine tumors

52
Q

what does esophagram for diffuse esophageal spasm show

A

“crockscrew” pattern

53
Q

first line treatment for diffuse esophageal spasm

A

calcium channel blockers

54
Q

patients with resolved hepatitis B infection are positive for

A

anti-HBs
anti-HBc

negative: HBsAg

55
Q

patients who are immunized with hep B are positive for

A

anti-HBs

negative: HBsAg
anti-HBc

56
Q

what mode of management is chronic pancreatitis diagnosed

A

pancreatic calcifications on CT scan or plain film

57
Q

chronic epigastric abdominal pain that can radiate to the back and is partially relieved by sitting upright or leaning forward

A

chronic pancreatitis

58
Q

what is the diagnosis to confirm primary biliary cholangitis

A

anti-mitochondrial antibody titer

59
Q

cholestasis

A

impaired biliary flow

60
Q

autoimmine hepatits is associated with what elevated titers

A

antinuclear antibodies

anti-smooth muscle antibodies

61
Q

when should patients with UC be screened for colonoscopy

A
  • colonoscopy 8 years after initial diagnosis of UC

- repeat 1-2 years thereafter

62
Q

acalculous cholecystitis

A

an acute inflammation of the gallbladder in the absence of gallstones

63
Q

acute cholangitis is usually due to what

A

common bile duct obstruction by a gallstone or malignancy

64
Q

who usually get nonalcoholic fatty liver disease

A

obesity and diabetes

65
Q

AST/ALT ratio for nonalcoholic fatty liver disease

A

less than 1

66
Q

2 major risk factors for c. diff

A
  1. antibiotic use

2. gastric acid suppression

67
Q

most common cause of iron deficiency anemia

A

GI blood loss

68
Q

what heart changes can occur from anemia

A
  • tachycardia from hypoxemia

- systolic murmur due to hyperdynamic circulation

69
Q

Mallory-Weiss tear

A

incomplete mucosal tear at the Gastroesophageal junction, usually due to protracted vomiting

70
Q

Boerhaave syndrome

A

spontaneous rupture of esophagus

71
Q

Charcot triad? diagnosis

A

fever
jaundice
right upper quadrant abdominal pain

Acute cholangitis

72
Q

ultrasound of acute cholangitis

A

common bile duct dilation

73
Q

short, annular stricture alternating with normal bile duct

A

primary sclerosing cholangitis

74
Q

Gilbert syndrome

A

reduced bilirubin glucuronidation

- intermittent jaundice due to mild, unconjugated hyperbiliruibinemia

75
Q

when is D-penicillamine used

A

wilson disease

76
Q

Ursodeoxycholic acid treats

A

primary biliary cholangitis

gallstone disease

77
Q

Lynch syndrome causes what? and has a high risk for waht

A

colorectal cancer

- endometrial carcinoma

Uworld Step 2 (30 decks)

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