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Clinical Medicine II > Exam 1: GI > Flashcards

Exam 1: GI Flashcards

1
Q

A hiatal hernia is diagnosed using

A

Barium Swallow

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2
Q

50-94% of patients with Gerd have a

A

Type 1 hiatal hernia

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3
Q

In order to diagnose GERD, you would do a

A

EGD (Esophagogstrododenoscopy)

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4
Q

A surgical option for the treatment of GERD that also repairs hiatal hernias at the same time is called

A

Nissen Fundoplication

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5
Q

Famotidine (H2 receptor antagonist) dose for GERD tx is

A

10 mg twice daily

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6
Q

Cimetidine (H2 receptor antagonist) dose for GERD tx is

A

200 mg twice daily

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7
Q

Treatment of Mild Gerd includes

A
  1. lifestyle changes
  2. H2 receptor antagonists “-tidine”
  3. Antacids
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8
Q

Treatment of severe Gerd includes

A
  1. Lifestyle changes
  2. Proton pump inhibitors (PPIs “-prazole”)
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9
Q

Omeprazole (PPI) dose for GERD tx is

A

10 mg daily

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10
Q

Lansoprazole (PPI) dose for GERD tx is

A

15 mg daily

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11
Q

Pantoprazole (PPI) dose for GERD tx is

A

20 mg daily

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12
Q

Most common esophageal disorder is

A

Achalasia

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13
Q

Diagnosis of achalasia includes

A

Barium swallow (displaying a “birds beak”)

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14
Q

treatment options for achalasia includes

A
  • Pneumatic balloon dilation (~50% effective)
  • Endoscopic botulinum toxin (wears off)
  • Esophageal myotomy (Heller myotomy)
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15
Q

A false diverticulum / outpouching of mucosa is known as

A

Zenker’s diverticulum

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16
Q

Zenker’s diverticulum is diagnosed with

A

Fluoroscopy with barium

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17
Q

Treatment of a Zenker’s diverticulum that is < 1 cm is

A

conservative management

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18
Q

Treatment of a Zenker’s diverticulum that is > 1 cm is

A

Excision of the diverticulum

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19
Q

Esophageal spasm is diagnosed via

A

manometry

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20
Q

Mallory Weiss syndrome is diagnosed via

A

EGD (Esophagogstrododenoscopy); usually resolves spontaneously

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21
Q

Esophageal varices are diagnosed via

A

EGD (Esophagogstrododenoscopy)

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22
Q

The best way to diagnose an esophageal perforation is

A

chest CT most sensitive

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23
Q

How treat esophageal perforation

A

NG tube placement + antibiotics with emergent surgical repair

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24
Q

Diagnosis / Treatment of foreign bodies include

A

Endoscopy (EGD) both dx and therapeutic

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25
Q

what type of hernia is when the GE junction rises above the diaphragm but the fundus remains below the GE junction?

A

Type I (sliding)

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26
Q

Gerd and Barret’s esophagus are both associated with which type of esophageal cancer?

A

Adenocarcinoma

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27
Q

MC causes of gastritis include

A

H-pylori infection and chronic NSAID use

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28
Q

To define the anatomical location of gastritis you would do a

A

Endoscopy

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29
Q

To determine the etiology of gastritis you would do a

A

biopsy

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30
Q

If H.pylori gastritis was suspected you could dx it with

A

Urea C13 or C14 breath testing OR H.pylori stool antigen

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31
Q

Treatment of gastritis includes

A

PPI, H2 blockers, and +/- sucralfate

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32
Q

Dx of Peptic ulcer disease includes

A

EGD and Biopsy (can also test for H-pylori)

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33
Q

Tx of uncomplicated PUD is

A

PPI (like omeprazole) x 2 weeks with antibiotics for H. pylori

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34
Q

Tx of complicated PUD is

A

PPI x 4 weeks with antibiotics for H. pylori

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35
Q

Antibiotic tx for H.pylori is

A

Clarithromycin (500 mg) and amoxicillin (1g) BID regimen x 14 days

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36
Q

Esomeprazole dose for tx of PUD is

A

20-40 mg

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37
Q

Lansoprazole dose for tx of PUD is

A

30 mg

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38
Q

Omeprazole dose for tx of PUD is

A

20-40 mg

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39
Q

what type of gastric ulcer dz has the lowest risk of cancer?

A

Type II

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40
Q

what type of gastric ulcer dz is the most common?

A

Type I

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41
Q

what type of gastric ulcer dz is secondary to chronic NSAID use?

A

Type III

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42
Q

If a gastric ulcer fails to heal after adequate medical therapy then it is highly suggested of an

A

underlying malignancny

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43
Q

Indications for the surgical treatment of gastric ulcers is

A

bleeding, perforation, obstruction, intractability, and high suspicion of malignancy

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44
Q

All surgical procedures of gastric ulcers involves

A

excision of the ulcer (unlike duodenal ulcer)

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45
Q

Surgical options to repair gastrointestinal continuity after an ulcer includes one of three options

A
  • Billroth I
  • Billroth II
  • Roux-en-Y
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46
Q

Operative intervention such as Truncal vagotomy with pyloroplasty or antrectomy is treatment for

A

Complicated PUD (manifestations of complicated gastric AND duodenal ulcers)

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47
Q

MC cause of UGI bleeds is

A

Bleeding PUD

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48
Q

Bleeding PUD is confirmed with

A

EGD / endoscopy

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49
Q

Perforated PUD is diagnosed via

A

Upright CXR that may show free intraperitoneal air (pneumoperitoneum)

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50
Q

Inability to tolerate oral intake / projectile vomiting shortly after eating; weight loss
Also a possible complication of Bilroth I is suggestive of

A

Gastric outlet obstruction

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51
Q

Intractable PUD is sx of persistent dz after adequate non-operative therapy which should alert to possible rare causes of ulcer dz such as

A
  • Zollinger-Ellison syndrome
52
Q

Zollinger-Ellison syndrome is

A

A gastrin secreting tumor where 2/3s are malignant

53
Q

Zollinger-Ellison syndrome is dx via

A

EGD/Endoscopy plus an elevated serum gastrin

54
Q

First line tx for Zollinger-Ellison syndrome is

A

PPIs

55
Q

Crohn’s disease is dx via

A

Colonoscopy (plus EGD) OR plus MR/CT enterography

56
Q

Dx test of choice for ulcerative colitis is

A

colonoscopy

57
Q

Barium enema dx test for ulcerative colitis shows

A

Loss of haustrae and pseudopolyps

58
Q

Ulcerative colitis has a HIGHER RISK for ____________ than Crohn’s

A

colon cancer

59
Q

what is the most common benign liver lesion?

A

Cavernous Hemangioma

60
Q

what type of benign liver lesions are most typically found in middle aged women 20-50 yrs?

A

Hepatic adenoma

61
Q

A hepatic adenoma has a higher risk of hepatocellular cancer in

A
  • larger lesions >5cm
  • and in men
62
Q

What type of benign hepatic lesions have a classic central, stellate star on CT w/ contrast or a spoke wheel pattern on arteriography?

A

Focal Nodular Hyperplasia (FNH)

63
Q

Initial diagnostic imaging for hepatic cysts is

A

Ultrasound

64
Q

A hepatic abscess is treated with

A
  • aspiration / drain placement
  • Abx for bacterial abscess
  • *Flagyl for amebic abscess
65
Q

Tx of spontaneous bacterial peritonitis of the liver (infection of ascitic fluid) is

A

Cefotaxime or Ceftriaxone

66
Q

Triple therapy tx including Albumin/octreotide/midodrine are used to treat

A

Hepatorenal syndrome

67
Q

Hepatic Hydrothorax is usually on what side?

A

right side

68
Q

What condition is a pleural effusion with cirrhosis and NO evidence of underlying cardio/pulm disease?

A

Hepatic hydrothorax

69
Q

Portopulmonary HTN is dx via

A

Right heart catheterization

70
Q

Wilson’s disease is a disease of

A

Copper metabolism

71
Q

Kayser-Fleischer rings in the eyes are associated with what disease?

A

Wilson’s disease

72
Q

If Wilson’s disease is caught early, it can be treated with

A

D- penicillamine

73
Q

Hemochromatosis is a disease of

A

excessive iron deposition

74
Q

Hemochromatosis treatment includes

A

Serial phlebotomy

75
Q

What is the largest risk factor (90%) for Hepatocellular carcinoma?

A

Cirrhosis

76
Q

In patients with liver cirrhosis, all liver lesions are ___________ until proven otherwise

A

Hepatocellular carcinoma

77
Q

A type of cholangiocarcinoma (gallbladder cancer) that occurs at the right and left hepatic ducts is known as a

A

Klatskin tumor

78
Q

90% of pancreatic neoplasms are

A

ductal adenocarcinoma

79
Q

The biggest risk factor for pancreatic cancer is

A

Cigarette smoking!

80
Q

Alpha feta-protein can be monitored in what type of cancer

A

Hepatocellular Carcinoma

81
Q

CA-19-9 can be monitored in what type of cancer?

A

Pancreatic cancer

82
Q

what is Whipple’s triad consist of

A
  1. fasting hypoglycemia
  2. with associated sx
  3. And immediate relief of sx after the administration of IV glucose
83
Q

What is Whipple’s triad suggestive of?

A

An Insulinoma (tumor in the pancreas)

84
Q

In a patient with PUD and diarrhea that has NOT responded to tx you may suspect

A

Zollinger-Ellison syndrome

85
Q

Watery diarrhea and hypokalemia (esp. in kids < 10 yrs) is likely a

A

VIPoma (aka pancreatic cholera)

86
Q

VIPoma is dx via

A
  • fasting plasma VIP levels
  • measure diarrhea volume
87
Q

Tx of VIPoma is

A
  • Octreotide IM
  • Surgical resection or
  • Chemo (refractory cases)
88
Q

Most common type of stomach cancer that originates at the glandular tissue is

A

Gastric adenocarcinoma

89
Q

What is the #1 risk factor of stomach cancer?

A

H.pylori infection!!!

90
Q

an early symptom of stomach cancer is

A

dyspepsia

91
Q

first line dx of stomach cancer is

A

EGD with biopsy (then other stuff)

92
Q

Most common benign tumor of the small bowel is

A

Leiomyomas / Benign GIST

93
Q

2nd most common benign tumor of the small bowel that causes bleeding and obstruction is

A

hemangiomas

94
Q

what benign tumor of the small bowel has the potential to become adenocarcinoma?

A

Adenomas (should be resected if found)

95
Q

50% of all small intestinal malignancies is

A

adenocarcinoma

96
Q

Most common location of intestinal adenocarcinoma is in the

A

duodenum

97
Q

Small bowel adenocarcinoma is treated with

A

wide resection of involved bowel

98
Q

Small bowel adenocarcinoma tx if +lymph nodes

A

wide resection plus adjunctive chemotherapy

99
Q

Carcinoid tumor is dx with

A

Urinary 5-HIAA

100
Q

episodic cutaneous flushing, bronchospasm, wheezing, and cramping/diarrhea are all signs of

A

Carcinoid syndrome

101
Q

Carcinoid tumor is more likely to metastasize based on

A

The size of the tumor:
2% if <1cm
50% if 1-2cm
90% if >2 cm

102
Q

leiomyosarcoma (aka malignant GIST) metastasize to the

A

lung and liver

103
Q

colon cancer is most commonly caused by

A

Adenocarcinoma

104
Q

High risk factors for colon cancer include

A

-Familial adenomatous polyposis
- UC or Crohn’s over 10 yrs

105
Q

Screening a high pts for colon cancer is

A

fist colonoscopy before the age of 45 (usually 40) or if symptomatic; colonoscopy every 3-5 yrs

106
Q

typical screening for colon cancer

A
  • Colonoscopy at age 45-75
  • Polys = remove and repeat ever 5yrs
  • no polys = everyday 10 yrs
107
Q

If a pt elects to do a flexible sigmoidoscopy how often is one done?

A
  • every 5 yrs
  • or every 10 with fecal occult blood test
108
Q

what staging system is used to stage colon cancer?

A

Duke’s classification

109
Q

Duke’s classification

A

A = confined to the mucosa (>90% survival)
B1 = invades the muscularis propria (75%)
B2 = extends through the muscularis (60%)
C = same level as duke’s B but with positive notes (20-50%)
D = metastatic (<5%)

110
Q

what is a significant risk factor of anal cancer?

A

HPV

111
Q

sx of anal cancer include

A

rectal bleeding, discomfort, a mass, and pruritus (can be confused with hemorrhoids)

112
Q

most anal cancers in the US are

A

squamous cell carcinomas

113
Q

anal tumors are dx with

A

Colonoscopy with biopsy

114
Q

what does follow up of anal cancer involve?

A
  • Every three months (for first 2 yrs): Hx/PE, and CEA
  • Every 4-6 months for (2-5 yrs): Hx/PE, CEA
  • Colonoscopy every 1 yr after dx. If abnormal repeat the next year otherwise repeat in 2-3 yrs
115
Q

Biliary Dyskinesia is dx with

A

HIDA scan

116
Q

Tx of choledocholithiasis is

A

ERCP with removal and sphincterotomy

117
Q

In a hemodynamically stable patient with splenic trauma, the treatment of choice is…

A

Non-operative management

118
Q

In a unstable patient with splenic trauma, the treatment is

A

Laparotomy

119
Q

Best initial test if suspecting acute pancreatitis

A

amylase and lipase

120
Q

In cases of acute pancreatitis which of the following is associated with the worst prognosis?
A. Elevated amylase
B. Elevated lipase
C. Intensity of the pain
D. Low calcium
E. Rising C-reactive protein

A

D. Low calcium

121
Q

Dx test of choice to tx acute appendicitis is

A

CT with contrast

122
Q

Carcinoid lesions of the appendix less than 2cm and NOT at the base of appendix is treated with

A

Appendectomy

123
Q

Carcinoid lesions of the appendix GREATER than 2cm OR those at the base are treated with

A

Right hemicolectomy

124
Q

A postitive IgA anti-tissue transglutaminase antibody (tTG-IgA) indicates what disease?

A

Celiac Disease

125
Q

Initial diagnostic test of choice to dx chronic mesenteric ischemia is

A

CT with contrast

126
Q

Gold standard dx and tx of chronic mesenteric ischemia is

A

angiography

Clinical Medicine II (4 decks)

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