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DIT Flashcards

1
Q

triad of Plummer Vinson syndrome

A
  • dysphagia
  • esophageal webs/glossitis
  • iron deficiency anemia
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2
Q

most commonly used study for dysphagia

A

upper endoscopy

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3
Q

What part of GI tract is evaluated by gastric emptying study

A

stomach, pyloric sphincter, duodenum

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4
Q

What part of GI tract is evaluated by small bowel follow through?

A

stomach to terminal ileum

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5
Q

What part of GI tract is evaluated by barium enema?

A

rectum to appendix

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6
Q

treatment options besides myotome for achalasia

A

pneumatic dilation, botulinum toxin, nitrates/nondihydro CCB

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7
Q

MOA h2 blockers

A

reversibly block H2 histamine receptors and inhibit acid secretion

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8
Q

which H2 blocker can cause gynecomastia and impotence in men?

A

cimetidine

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9
Q

MOA PPI

A

irreversibly inhibit H-K ATPase on parietal cells which will block acid secretion

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10
Q

Diagnostic test of choice for esophageal cancer

A

EGD w/ biopsy

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11
Q

Treatment sliding vs paraesophageal hernia

A

sliding - PPI (not too bad) (LES and stomach up thru diaphragm)
paraesopheal - surgical (can lead to incarceration and ischemia, even though LES is in normal spot)

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12
Q

Tests to dx H. pylori

A
  • urea breath test
  • serum abs (will be positive if any hx of h pylori…doesn’t mean you have active infection)
  • stool antigen (good cost effective initial test)
  • EGD with biopsy (gold standard, but most invasive)
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13
Q

causes of infectious esophagitis and how to differentiate on upper endoscopy

A

candida - yellow white plaques, HIV patient
HSV - small, deep ulcerations; multinucleated giant cells with intraNUCLEAR inclusions; positive Tzanck
CMV - large, superficial; intraCYTOPLASMIC inclusions,

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14
Q

treatment for GERD

A

LIFESTYLE: weight loss, elevate head of bed, small frequent meals, avoid alcohol/coffee/chocolate

pharm: PPIs (chronic/frequent) or H2 blockers, antacids (mild/infrequent)

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15
Q

curling vs. Cushing ulcers

A

curling - 2/2 burns (“burn from curling iron”), hypovolemia from burn -> ischemia of GI tissue
Cushing - 2/2 TBI, increased ICP; increased vagal output will lead to increase in gastric acid

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16
Q

best treatment for duodenal ulcer

A

remove offending agent if any (alcohol, NSAIDs)
since >90% of duodenal ulcers are from H pylori

TRIPLE THERAPY! (PPI, Amox, clarithromycin)

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17
Q

gastric cancer (most likely adenocarcinoma) that metastasizes to ovary

A

kruckenburg tumor

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18
Q

MCC type of gastric cancer

A

adenocarcinoma (esp high prevalence in Korea and Japan, due to nitrosamine diet)

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19
Q

What is the only malignancy that can be cured with antibiotics?

A

MALT lymphoma (complication of h pylori!)

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20
Q

Person diagnosed with gastric cancer presents with swelling/mass at base of neck…

A

Virchow node (supraclavicular lymph node)

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21
Q

What tests to check for if person has recurrent ulcers

A

check gastrin level to r/o Zollinger Ellison

THEN EVAL FOR MEN TYPE 1

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22
Q

Patient presents with diarrhea, epigastric pain with hx of recurrent ulcers, hypercalcemia

A

ZE syndrome due to MEN 1 (pituitary, parathyroid, pancreatic)

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23
Q

triple therapy

A

PPI
amox
clarithro

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24
Q

What can you prescribe for person with ulcers due to chronic NSAID use (i.e. from arthritis)

A

misoprostol (NSAIDs block PGE, so give PGE)

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25
3 most common causes UGIB?
1. PEPTIC ULCER (gastric > duodenal) 2. esophagitis 3. varices
26
Which type of GI bleed is more likely to make you HDS unstable
UGI! always r/o with NG lavage or EGD if unclear
27
How to assess volume status quickly in unstable patient
BP, HR, UOP
28
How to dx UGIB?
NG tube and lavage, endoscopy (definitive)
29
How to dx LGIB?
- IF BRISK, R/O LGIB W/ NG LAVAGE - anoscopy/sigmoidoscopy for younger stable patients - colonoscopy if stable; arteriography/exlap if unsstable
30
MCC UGIB
1. diverticulosis (debatable) 2. angiodysplasia 3. IBD 4. hemorrhoids/fissures colon cancer, AVM
31
three MCC SBO
"A B C" adhesions (previous surgery) bulge (incarcerated hernia) cancer (most commonly colon mets)
32
how to manage sbo
- NPO - IV fluids - NG TUBE DECOMPRESSION - watch wait vs. surgery (lap and adhesion lysis)
33
chronic diarrhea, joint pain, ataxia/dementia
Whipple disease
34
how to dx Whipple
- endoscopy with biopsy (blunting of villi) - PAS positive (foamy macrophages in lamina propria) - fat droplets
35
rx Whipple
- 2months ceftriaxone | - 12 months TMP-SMX to prevent relapse
36
hematologic finding tropical sprue
megaloblastic anemia (usu. folic acid/b12 malabsorption)
37
chronic diarrhea, foul smelling, microcytic anemia, Haiti
tropical sprue
38
hematologic finding celiac
IDA
39
caucasian patient with bulky foul diarrhea, steatorrhea, weight loss, osteopenia
celiac
40
rx tropical sprue
- tetracycline | - folic acid +/- B12 supplementation
41
how to dx inflammatory diarrhea
- FOBT | - fecal leukocytes
42
positive Sudan stain
indicates steatorrhea
43
positive D-xylose test
carb malabsorption (no d-xylose found in blood even after drinking it)
44
how to dx lactase deficiency
``` lactose breath hydrogen test lactose absorption (failure blood glucose to rise after oral lactose challenge) ```
45
stool osmolar gap > 125
osmotic diarrhea | lactulose, celiac, Whipple, pancreatic insufficiency, milk of magnesia
46
stool osmolar gap < 50
secretory diarrhea | carcinoid, VIPoma, ETEC, cholera, gastrinoma
47
MCC viral gastro in adults and children
adults - norvirus | children - rotavirus
48
Complications of cdiff
pseudomembranous colitis | toxic megacolon
49
c diff commonly associated with which abx?
clindamycin
50
Triad of HUS
hemolytic anemia thrombocytopenia acute renal failure
51
treatment EHEC
NOT ANTIBIOTICS!!!! may worsen symptoms due to toxin release instead hydration and supportive therapy
52
rx Shigella
fluoroquinolones | TMP-SMX
53
Which diarrheal pathogen can imitate appendicitis
yersenia pestis
54
diarrhea, pharyngitis
yersenia pestis
55
bloody diarrhea, liver abscess
e histolytica
56
diarrhea, fever, myalgia, PERIORBITAL EDEMA, EOSINOPHILIA
trichinella spiralis rx with albendazole/mebendazole
57
diarrhea, cysts in muscle and brain
taenia sodium (tapeworm)
58
rx Tania solium
gut infection - praziquantel | neurocysticercosis - albendazole +/- steroids
59
if you have bloody diarrhea, fever, dehydration, immunocomprosed....what empiric abx to start
fluoroquinolone
60
diagnostic criteria for IBS
ROME 1. abd pain/discomfort >3 days, in last 3 months 2. 2/3 of following (relief with defecation, change in frequency, change in consistency)
61
rx IBS consipation
``` high fiber psyllium polyethelyne glycol lubiprostone linaclotide ```
62
rx diarrhea IBS
loperamide | eluxadoline
63
rx abdominal pain with either type of IBS
antispasmodics (dicyclomine, hyoscyamine)
64
best imaging study for IBD
barium study
65
perianal fissures and fistulas
chrons
66
cobblestoning on barium study
chrons
67
crypt abscesses on barium study
UC
68
associated with PSC
UC
69
arthralgia, erythema nodosum
chrons
70
"string sign"
chrons
71
pyoderma gangrenous, uveitis
UC
72
name some DMARDs for IBD treatment
mesalamine | sulfsalaizne
73
name some anti TNF agents for IBD
infliximab, adalilmuab (useful for extra intestinal rheum complications
74
"lead pipe" on barium study
UC
75
which IBD is amenable to surgical treatment
UC | ulcerative "col"it is - limited to "col"on, can just resect colon
76
warning signs that you aren't dealing with just IBS
- weight loss - bloody stool - anemia/electrolyte imbalance - worsening abdominal pain - pain so bad that it wakes you up from sleep
77
how to rx volvulus if no signs of perforation, and if there is?
flexible sigmoidoscopy if no perf | laparotomy +/- sigmoid resection if there is perf
78
blood supply to small intestine and large intestine
small intestine - SMA | large - SMA and IMA
79
areas most likely to get intestinal ischemia
watershed areas 1. splenic flexure 2. transverse colon
80
how to confirm diagnosis of intestinal ischemia
CT angiogram
81
RLQ pain on passive hip extension
psoas sign
82
RLQ pain with LLQ palpation
Rovsing's sign (suggetsts appendicitis)
83
symptoms of carcinoid syndrome
``` "Be FDR" bronchospasm flushing diarrhea right sided valvular disease ```
84
pathophys of cardiac symptoms in carcinoid syndrome
serotonin induced fibrosis of valvular endocardium causes RESTRICTIVE CARDIOMYOPATHY
85
how to be asymptomatic from carcinoid tumor
if tumor originates in gut (serotonin broken down in liver first) in order to cause symptoms, tumor must originate in LUNGS
86
how to dx carcinoid tumor
24 hour urinary 5-HIAA don't mix this up with urine VMA In PHEO
87
rx carcinoid syndrome
octreotide/depot lanreotide (decreases gut motility) b2 agonists for bronchospasm loperamide for diarrhea
88
rx anal fissures
stool softeners topical nitroglycerin botulinum toxin (helps with painful spasm) partial sphincterotomy (last resort; high risk incontinence)
89
what to do if you have young patient with BRBPR minimal on tissue
anoscopy
90
complications of PBC
osteopenia | metabolic bone disease
91
which has higher cancer risk: hyper plastic polyp or tubular adenoma?
tubular adenoma hyperplastic polyp is NOT PRE CANCEROUS highest risk is villous adenoma
92
FAP gene
APC (tumor suppressor gene)
93
pigmented lesion on lips, oral mucosa | GI tract hamartoma
Peutz Jehgers (benign hamartomas)
94
38 year old man has father who had colon cancer age 62. when to start screening?
40! not 50, or 52...40 in anyone with family history or 10 years before diagnosis in relative
95
colon cancer syndrome without polyp formation
hereditary non-polyposis colon cancer (HNPCC) Lynch syndrome
96
3 components of post treatment surveillance colon cancer
- CEA q3-6 months for at least 3 years - CT abd/chest/pelvis q1 year at least three years - colonoscopy annually then q3-5 years depending on finding
97
tumor marker pancreatic cancer
CA-19 9
98
how to dx insulinoma and differentiate from exogenous insulin
ELEVATED C-PEPTIDE | hypoglycemia, elevated fasting insulin
99
rx insulinoma
diazoxiede or octreotide to suppress insulin secretion
100
painful pruritic migratory rash on FACE and PERINEUM | refractory diabetes
glucagonoma
101
rx glucagonoma
octreotide | surgical resection if possible
102
lab abnormalities in VIPoma
decreased stool osmolar gap | elevated vasoactive intestinal peptide

CK_GI (3 decks)

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