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CK_GI > DIT > Flashcards

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
Q

3 most common causes UGIB?

A
  1. PEPTIC ULCER (gastric > duodenal)
  2. esophagitis
  3. varices
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26
Q

Which type of GI bleed is more likely to make you HDS unstable

A

UGI! always r/o with NG lavage or EGD if unclear

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27
Q

How to assess volume status quickly in unstable patient

A

BP, HR, UOP

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28
Q

How to dx UGIB?

A

NG tube and lavage, endoscopy (definitive)

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29
Q

How to dx LGIB?

A
  • IF BRISK, R/O LGIB W/ NG LAVAGE
  • anoscopy/sigmoidoscopy for younger stable patients
  • colonoscopy if stable; arteriography/exlap if unsstable
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30
Q

MCC UGIB

A
  1. diverticulosis (debatable)
  2. angiodysplasia
  3. IBD
  4. hemorrhoids/fissures
    colon cancer, AVM
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31
Q

three MCC SBO

A

“A B C”

adhesions (previous surgery)
bulge (incarcerated hernia)
cancer (most commonly colon mets)

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32
Q

how to manage sbo

A
  • NPO
  • IV fluids
  • NG TUBE DECOMPRESSION
  • watch wait vs. surgery (lap and adhesion lysis)
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33
Q

chronic diarrhea, joint pain, ataxia/dementia

A

Whipple disease

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34
Q

how to dx Whipple

A
  • endoscopy with biopsy (blunting of villi)
  • PAS positive (foamy macrophages in lamina propria)
  • fat droplets
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35
Q

rx Whipple

A
  • 2months ceftriaxone

- 12 months TMP-SMX to prevent relapse

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36
Q

hematologic finding tropical sprue

A

megaloblastic anemia (usu. folic acid/b12 malabsorption)

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37
Q

chronic diarrhea, foul smelling, microcytic anemia, Haiti

A

tropical sprue

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38
Q

hematologic finding celiac

A

IDA

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39
Q

caucasian patient with bulky foul diarrhea, steatorrhea, weight loss, osteopenia

A

celiac

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40
Q

rx tropical sprue

A
  • tetracycline

- folic acid +/- B12 supplementation

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41
Q

how to dx inflammatory diarrhea

A
  • FOBT

- fecal leukocytes

42
Q

positive Sudan stain

A

indicates steatorrhea

43
Q

positive D-xylose test

A

carb malabsorption (no d-xylose found in blood even after drinking it)

44
Q

how to dx lactase deficiency

A 
lactose breath hydrogen test
lactose absorption (failure blood glucose to rise after oral lactose challenge)
45
Q

stool osmolar gap > 125

A

osmotic diarrhea

lactulose, celiac, Whipple, pancreatic insufficiency, milk of magnesia

46
Q

stool osmolar gap < 50

A

secretory diarrhea

carcinoid, VIPoma, ETEC, cholera, gastrinoma

47
Q

MCC viral gastro in adults and children

A

adults - norvirus

children - rotavirus

48
Q

Complications of cdiff

A

pseudomembranous colitis

toxic megacolon

49
Q

c diff commonly associated with which abx?

A

clindamycin

50
Q

Triad of HUS

A

hemolytic anemia
thrombocytopenia
acute renal failure

51
Q

treatment EHEC

A

NOT ANTIBIOTICS!!!! may worsen symptoms due to toxin release

instead hydration and supportive therapy

52
Q

rx Shigella

A

fluoroquinolones

TMP-SMX

53
Q

Which diarrheal pathogen can imitate appendicitis

A

yersenia pestis

54
Q

diarrhea, pharyngitis

A

yersenia pestis

55
Q

bloody diarrhea, liver abscess

A

e histolytica

56
Q

diarrhea, fever, myalgia, PERIORBITAL EDEMA, EOSINOPHILIA

A

trichinella spiralis

rx with albendazole/mebendazole

57
Q

diarrhea, cysts in muscle and brain

A

taenia sodium (tapeworm)

58
Q

rx Tania solium

A

gut infection - praziquantel

neurocysticercosis - albendazole +/- steroids

59
Q

if you have bloody diarrhea, fever, dehydration, immunocomprosed….what empiric abx to start

A

fluoroquinolone

60
Q

diagnostic criteria for IBS

A

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
Q

rx IBS consipation

A 
high fiber
psyllium
polyethelyne glycol
lubiprostone
linaclotide
62
Q

rx diarrhea IBS

A

loperamide

eluxadoline

63
Q

rx abdominal pain with either type of IBS

A

antispasmodics (dicyclomine, hyoscyamine)

64
Q

best imaging study for IBD

A

barium study

65
Q

perianal fissures and fistulas

A

chrons

66
Q

cobblestoning on barium study

A

chrons

67
Q

crypt abscesses on barium study

A

UC

68
Q

associated with PSC

A

UC

69
Q

arthralgia, erythema nodosum

A

chrons

70
Q

“string sign”

A

chrons

71
Q

pyoderma gangrenous, uveitis

A

UC

72
Q

name some DMARDs for IBD treatment

A

mesalamine

sulfsalaizne

73
Q

name some anti TNF agents for IBD

A

infliximab, adalilmuab (useful for extra intestinal rheum complications

74
Q

“lead pipe” on barium study

A

UC

75
Q

which IBD is amenable to surgical treatment

A

UC

ulcerative “col”it is - limited to “col”on, can just resect colon

76
Q

warning signs that you aren’t dealing with just IBS

A
  • weight loss
  • bloody stool
  • anemia/electrolyte imbalance
  • worsening abdominal pain
  • pain so bad that it wakes you up from sleep
77
Q

how to rx volvulus if no signs of perforation, and if there is?

A

flexible sigmoidoscopy if no perf

laparotomy +/- sigmoid resection if there is perf

78
Q

blood supply to small intestine and large intestine

A

small intestine - SMA

large - SMA and IMA

79
Q

areas most likely to get intestinal ischemia

A

watershed areas

  1. splenic flexure
  2. transverse colon
80
Q

how to confirm diagnosis of intestinal ischemia

A

CT angiogram

81
Q

RLQ pain on passive hip extension

A

psoas sign

82
Q

RLQ pain with LLQ palpation

A

Rovsing’s sign (suggetsts appendicitis)

83
Q

symptoms of carcinoid syndrome

A 
"Be FDR"
bronchospasm
flushing
diarrhea
right sided valvular disease
84
Q

pathophys of cardiac symptoms in carcinoid syndrome

A

serotonin induced fibrosis of valvular endocardium causes RESTRICTIVE CARDIOMYOPATHY

85
Q

how to be asymptomatic from carcinoid tumor

A

if tumor originates in gut (serotonin broken down in liver first)

in order to cause symptoms, tumor must originate in LUNGS

86
Q

how to dx carcinoid tumor

A

24 hour urinary 5-HIAA

don’t mix this up with urine VMA In PHEO

87
Q

rx carcinoid syndrome

A

octreotide/depot lanreotide (decreases gut motility)
b2 agonists for bronchospasm
loperamide for diarrhea

88
Q

rx anal fissures

A

stool softeners
topical nitroglycerin
botulinum toxin (helps with painful spasm)
partial sphincterotomy (last resort; high risk incontinence)

89
Q

what to do if you have young patient with BRBPR minimal on tissue

A

anoscopy

90
Q

complications of PBC

A

osteopenia

metabolic bone disease

91
Q

which has higher cancer risk: hyper plastic polyp or tubular adenoma?

A

tubular adenoma

hyperplastic polyp is NOT PRE CANCEROUS

highest risk is villous adenoma

92
Q

FAP gene

A

APC (tumor suppressor gene)

93
Q

pigmented lesion on lips, oral mucosa

GI tract hamartoma

A

Peutz Jehgers (benign hamartomas)

94
Q

38 year old man has father who had colon cancer age 62. when to start screening?

A

40!

not 50, or 52…40 in anyone with family history or 10 years before diagnosis in relative

95
Q

colon cancer syndrome without polyp formation

A

hereditary non-polyposis colon cancer (HNPCC) Lynch syndrome

96
Q

3 components of post treatment surveillance colon cancer

A
  • 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
Q

tumor marker pancreatic cancer

A

CA-19 9

98
Q

how to dx insulinoma and differentiate from exogenous insulin

A

ELEVATED C-PEPTIDE

hypoglycemia, elevated fasting insulin

99
Q

rx insulinoma

A

diazoxiede or octreotide to suppress insulin secretion

100
Q

painful pruritic migratory rash on FACE and PERINEUM

refractory diabetes

A

glucagonoma

101
Q

rx glucagonoma

A

octreotide

surgical resection if possible

102
Q

lab abnormalities in VIPoma

A

decreased stool osmolar gap

elevated vasoactive intestinal peptide

CK_GI (3 decks)

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