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FES & FLS > FES > Flashcards

FES Flashcards

1
Q

No light at distal end

A
  1. Light source plug - Plugged in & on.
  2. Not in stand by mode.
  3. Clean scope tip.
  4. Burnt out Bulb.
  5. Dirty distal lens.
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2
Q

Irrigation solution

A

Sterile water
Saline crystallizes in channel

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3
Q

Out of focus

A
  1. White balance
  2. Clean lens
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4
Q

No irrigation

A
  1. Bottle contains water
  2. Bottle connected to umbilical cord
  3. Connection too tight
  4. Bottle lid too tight
  5. Power on
  6. Occluded/stuck valve
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5
Q

No insufflation

A
  1. Umbilical cord seated in light source. Needs to be screwed in
  2. Power turned on
  3. Stuck/Occluded valve
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6
Q

Clogged valve/nozzle

A
  1. Clean valve
  2. Flush channel with cleaning solution, followed by clean water
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7
Q

Unable to pass instrument

A
  1. Correct size selected
  2. Instrument tip closed
  3. Decrease tip deflection
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8
Q

Routine “high level disinfection”

A

Gluteraldehyde
Disinfection doe not work with foreign materials

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9
Q

Sterile “Overnight” cycle

A

Ethylene Oxide Gas

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10
Q

Location of suction port

A

5 - 7 O’Clock

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11
Q

Cart

A
  1. Monitor
  2. Video processor
  3. Light source
  4. Water bottle
  5. Image printer/recorder
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12
Q

Umbilical cable

A

Air & water valve

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13
Q

Umbilical cable - Partial depress

A

Air

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14
Q

Umbilical cable - Complete depress

A

Cleans lens

Withdraws air to force water into camera

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15
Q

Light cord

A

Coherent stacks of optic fibers

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16
Q

Positioning: ERCP

A

Prone with head to right
Left lateral decubitus if difficulty intubating duodenum
Supine: Associated with higher difficulty in intubating the papilla

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17
Q

Positioning: Colonoscopy

A

Left lateral decubitus

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18
Q

Positioning: APR

A

Supine

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19
Q

Fiber optic endoscope

A

Fragile
Fibers break = Dark spots on screen
Bronch and choledocoscopes only

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20
Q

Video endoscopes

A

Contraindication: Stricture (Can test with dummy pill)
Pregnancy
MRI
Dysphagia (Can endoscopically be placed in stomach)

Prep: NPO x 8hrs
Simethicone, Reglan, PEG

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21
Q

Timing of endoscopy in ESRD

A

Day after HD

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22
Q

Risk during Colonoscopy

A

Minor: Hypoxia (5.6%), hypotension, bradycardia, arrhythmia

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23
Q

Preprocedural labs

A

None
Cardiac Hx: EKG
Respiratory Hx: CXR
Coags: Hypocoaguability
General anesthesia: Pregnancy screen

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24
Q

Iso-osmotic (Polyethlene glycol PEG)

A

Safe in CHF, ESRD, Elecrolyte abnormaities, Liver disease

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25
Q

Hyperosmolar (Magnesium Citrate)

A

Better tolerated
Induces CCK release

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26
Q

Sodium Phosphate

A

Adverse effect: Hyperphosphatemia, Hypokalemia
Contraindication: CKD, AKI, CHF, ACS, lleus, Ascites, Pediatrics

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27
Q

Indication for antibiotics

A

Endocarditis risk (Prosthetic valve, prior endocarditis, surgical shunt, Tetrology of fallot, congenital heart disease, MVP, HOCM, valvular disease)
Esophageal dilation
Variceal sclerotherapy
ERCP (w/ ductal obstruction)
Pancreatic lesions
Percutaneous gastrostomy tubes

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28
Q

Safe INR

A

<1.5

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29
Q

ASA/NSAIDs

A

No contraindication for endoscopy

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30
Q

Post Colonoscopy

A

Major: Perforation, Bleeding, Post scope syndrome, Bronchospasm (0.07%)

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31
Q

Mortality: Colonoscopy

A

0.007%-0.001%

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32
Q

Mortality: EGD

A

0.0001% (1:10,000)

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33
Q

Procedural monitoring

A

Pulse Ox
Verbal stimulation
End tidal CO2
Vitals q 5 min
Telemetry

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34
Q

Risk factors for ERCP desaturation

A

Age >60
ASA >3
Procedural length

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35
Q

Monitoring: COPD

A

Use capnography to detect CO2 retention

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36
Q

Prior to each drug administration

A

Always check BP

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37
Q

Propofol

A

Preferred
Continuous End tidal and EKG

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38
Q

Midazolam

A

Shorter duration
Less venous irritation
Water soluble
Anterograde amnesia

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39
Q

Flumazenil

A

Risk of seizures with chronic benzodiazepine use

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40
Q

Remifentanyl

A

Better than propofol
Better HD stability
Better patient satisfaction
Shorter recovery time
Same respiratory depresssion

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41
Q

Half life of Narcan

A

60-90 minutes

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42
Q

Nitric oxide

A

Not tolerated well

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43
Q

Precedex

A

HD instability
Required analgesic
Longer recovery
Difficult administration

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44
Q

Contraindications: Small caliber endoscopy

A

Coagulopathy
Prior naso/oro/hypopharynx surgery

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45
Q

Complications: Small caliber endoscopy

A

Vagal stimulation
(Hypotension, hypoxia, epistaxis)

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46
Q

Anesthesia: Small caliber endoscopy

A

Lidocaine + Benzocaine + Oxymetazoline

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47
Q

Side effect of Lidocaine + Benzocaine + Oxymetazoline

A

Aspiration
Methemoglobinemia
Anaphylaxis

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48
Q

Complication rate: EGD

A

1.4%

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49
Q

Complication rate: Colonoscopy

A

0.42%
Most common: Missed polyps

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50
Q

Conscious sedation

A

Higher rate of mortality and morbidity

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51
Q

Bispectral index (BIS) monitoring

A

Score 0-100
0 = Coma
82 = Endoscopy
100 = Awake

Low accuracy in detecting deep sedation

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52
Q

Discharge criteria

A

Alert
Ambulating
Tolerating Clears

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53
Q

Surveillance: FAP

A

Q 1-2 years
Age: 10
Rule out duodenal neoplasm with EGD

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54
Q

Surveillance: Barretts (Low
Risk)

A

< 3 cm
Q 2 years (No dysplasia)

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55
Q

Surveillance: Barretts (Medium risk)

A

> 3 cm
Q1 year

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56
Q

Surveillance: Barretts (High risk)

A

Low grade dysplasia
Q 6 months

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57
Q

Surveillance: Varices w/ sclerotherapy

A

Q 6-8 weeks

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58
Q

Surveillance: Gastric or esophageal ulcer

A

Q6 weeks
Until ulcer healed w/ biopsy/brushing

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59
Q

Surveillance: Pernicious anemia

A

Single endoscopy
No follow up

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60
Q

Contraindications: EGD

A

HD unstable
Cannot tolerate sedation

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61
Q

Positioning: EGD

A

LLD
Head elevated
Turn to right for fundus bleeding

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62
Q

Technique: EGD scope introduction

A

Insert to posterior pharyngeal wall
Tip up to epiglottis
Deflect down to aretynoids
Marker: 15 cm

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63
Q

Technique: Passing duodenal superior angle

A

90 Right
Angle up
Dial right

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64
Q

Avoiding aspiration on EGD

A

Bite block reverses jaw thrust
Monitor
- Gastric distention
- Sedation level
- Head elevation
- Fluid removal from gastric fundus
- Decompression prior to scope withdrawal

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65
Q

Areas of perforation: EGD

A

Cricopharyngeus
Pharynx
Superior duodenum

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66
Q

Morbidity (Most common): EGD

A

Respiratory depression (drug induced) - 70%
Airway obstruction

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67
Q

Biopsy: EGD

A

Only biopsy mucosal lesions
Submucosal lesions = EUS/ FNA

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68
Q

Surveillance: Colonoscopy

A

Age: 45 - q10 years
First degree relative with colorectal cancer at 40 yrs or 10 yrs before youngest relative
< 60 years onset : q 5 years
> 60 years onset: q 10 years

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69
Q

Surveillance: HNPCC

A

Age: 20 - 25 years
Q 1-2 years colonoscopy
10 years prior to family member diagnosis

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70
Q

Proctoscope

A

Cannot assess posterior wall of rectum

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71
Q

Contraindications: Colonoscopy

A

Absolute: Peritonitis
Relative: Anal fissure, recent MI, PE, SBO

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72
Q

Scope size that reaches cecum

A

160 cm

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73
Q

Scope size for flex sigmoidoscopy

A

70 cm

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74
Q

Technique: Rectosigmoid junction

A

Tip deflection
Counterclockwise torque
Clockwise torque

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75
Q

Technique: Colonic loops

A

Withdraw/ jiggle scope
Apply external pressure on sigmoid to hold loop in place and prevent formation

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76
Q

Location of torque removal

A

Descending colon/sigmoid (circular muscle) junction

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77
Q

Techniques: Splenic flexure

A

Slit or fold
Down + Left
Place patient on back or to the right to open slit
Shorten scope once traversed (<50 cm)

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78
Q

Transverse colon

A

Triangular
Evacuate air to lessen difficulty of traversing hepatic flexure
Apply abdominal pressure/ place patient on back

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79
Q

Hepatic flexure

A

Straight up
Blue hue of liver

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80
Q

Technique: Ascending colon

A

Clockwise torque
Tip down + right
Loop reduction
Suction
Place patient to right/ back
70 cm

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81
Q

Anatomy: Ascending colon

A

Green mucus
Large diameter

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82
Q

Cecum

A

Crow’s feet (confluence of tenias and ICV) —> Appendiceal orifice

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83
Q

Technique: Terminal Ileum

A

ICV at bottom of screen
Tip down to valve
Insufflate to open valve
80/90 cm
Can retroflex into cecum = high risk of perforation

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84
Q

Scope withdrawal time

A

6 minutes

Adenoma detection rate: Men 30%, WOmen 20%

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85
Q

Poor prep

A

Can abandon colonoscopy
Stool balls in large diverticulum will be present despite repeat preps

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86
Q

Mucosa stuck in port

A

Remove cap on instrument

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87
Q

Rigid endoscopy

A

Most accurate way of localizing rectal lesions and measurement

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88
Q

Localizing lesion for removal

A

Tattooing with carbon microparticles

Circumferential (4 times) 1mL into submucosa
Distal to lesion

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89
Q

Vagal response to colonoscopy

A

Cessation of scope movement
IVF

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90
Q

Lipoma

A

No need for resection
Yellow bulge into lumen with mucosal covering

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91
Q

Colitis?

A

Biopsy

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92
Q

Angiodysplasia

A

Most common in right colon
If no bleeding no therapy needed

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93
Q

Perforation: Colonoscopy

A

Scope torquing
High air pressure
Blow out of diverticulum
Location: Rectosigmoid

94
Q

Trend in mucosal ischemia

A

White -> Green -> Black

95
Q

Scope with side view

A

Duodenoscope
Allows for visualization of duodenal strictures
Must loop along greater curvature of stomach to enter pylorus
Blind advancement into esophagus (Maintain center to avoid injury)

96
Q

External source of illumination

A

Xenon arc
Halogen filled tungsten filament lamp
LED

97
Q

Combination of button and scope channel

A

Blue: Air (Hover)/Water (Press)
Red: Suction & Biopsy

98
Q

If no irrigation channel

A

Use suction/biopsy

99
Q

How many wheels does a scope have

A

Two wheels

100
Q

Brush biopsy detection rate

A

30-60%

Higher than FNA

101
Q

Indications for biopsy in ERCP

A

Ductal pathology: Ampulla/ductal biopsy
Chronic pancreatitis
Pancreas divisum
Malignany
Strictures
Ductal Injury
Jaundice
Cholangiitis
Gallstone pancreatitis
Ductal dilation

102
Q

FNA detection rate

A

6-30%

103
Q

Technique: Sphincterotomy

A

11 O’clock on ampulla
Blend setting
15-20 J

104
Q

Higher risk of post procedural pancreatitis

A

3-5%
Endoscopic balloon dilation

105
Q

Stone removal: Balloon

A

Good: Multiple stone removal
Bad: Small stones in large duct, sharp stones

Adverse effect: Post procedural pancreatitis

106
Q

Stone removal: Basket

A

Good: Large stone
Intrahepatic stones
Small stones in large ducts.

107
Q

Large stone

A

Stent (plastic) and repeat ERCP

108
Q

Biliary stent

A

Patency: 3-6 months
Replace if clogged (Higher pancreatitis rate 3-6 months)
Placed across ampulla

109
Q

Pancreatic stent

A

Patency: 3 weeks
Risk of damage to pancreatic duct

110
Q

Self expanding metal stents

A

Longest patency rates (Especially if covered)
Palliation/Malignant obstruction

111
Q

Nasobiliary tube

A

Good: Does not need repeat endoscopy for removal

112
Q

Contraindication: ERCP

A

Absolute: None
Relative: Coagulopathy
HD instability
Pregnancy
Severe gastritis
Duodenal strictures

113
Q

Antiplatelets

A

Hold 10 days prior
Hold 5-7 days post procedure

114
Q

Warfarin

A

Hold 5 days before procedure
Transition to Lovenox
Hold Lovenox 1 day prior to procedure

115
Q

Technique: Intubating duodenum with Duodenoscope (side viewing scope)

A

Turn tip to right

116
Q

Location of major papilla in D2

A

1-2 O’clock

117
Q

Pancreatic duct cannulation in ampulla

A

1-3 O’clock

118
Q

CBD cannulation in ampulla

A

11-12 O’clock

119
Q

Post ERCP Risk reduction

A

Indocin 100 mg
Selective cannulation with guidewire prior to contrast
Stent pancreatic duct if CBD cannulation was difficult
Limit contrast in pancreatic duct

120
Q

Risk factors for post ERCP cholangitis

A

Manipulation
Contrast in the biliary tree that was not fully decompressed

121
Q

Duodenal stricture preventing ERCP

A

Dilate with forward viewing scope —> repeat ERCP

122
Q

Perforation of Biliary tree

A

0.5%
Transpapillary & Transbadominal drainage
Avoid surgery in the acute period

123
Q

Duration of post procedure bleeding

A

2 Weeks
Most common: Immediately or when eschar sloughs (7-8 days)
Snare cautery
Repeat thermal therapy is not advised

124
Q

Risk factor for rebleeds

A

Active bleed
Visible vessel
Red/Dark/White maturing clot
Ulcer >2 cm
Age >60
Comorbidities
Shock
Coagulopathy
Anemia

125
Q

Bleeding risk factors mandating endoscopic intervention

A

Active bleed
Visible vessel

126
Q

Risk factor for perforation when achieving hemostasis

A

Repeated use of Thermal energy
Can occur up to 2 weeks post procedure.
Delayed recognition leads to heightened morbidity & mortality

127
Q

Improve visualization during bleeding by

A

Lavage
Irrigation
Clot removal via position change

128
Q

Warm fluid

A

Prevents hypothermia and cogulopathy

129
Q

Larger caliber evacuation tubes

A

Edwald - Used for lavage

130
Q

Gastric motility agents to allow for blood passage

A

UGI Bleed: Erythromycin, Reglan
LGIB: Polyethylene glycol

131
Q

Nonthermal Technique for hemostasis

A

Submucosal injection
Band ligation
Endoscopic clips
Endoloop
Balloon tamponade

132
Q

Band ligation complication (Esophageal varices, internal hemorrhoids)

A

Esophageal ulceration
Stricture formation
Less complications than sclerotherapy, same level of success
Poor visualization during banding

133
Q

Submucosal injection

A

Epinephrine (1:10,000) +/- Sclerosant solution

134
Q

Endoscopic clip

A

When thermal energy use is dangerous or has been unsuccessful.
Lower rate of success
Difficult in post pyloric bulb or requiring retroflexion (fundus, cardia)
Location: Thin walled areas

135
Q

Balloon Tamponade

A

Endoscopic sphincterotomy
Risk of overinflation and tearing

136
Q

Coaptive Hemostasis

A

Probe - Tamponade + Thermal energy
Occluding vessel via pressure from multipolar probe and applying energy
Decreases heat sink effect
Better visualization
Size limit: 2 mm

137
Q

Bipolar & Heater probe

A

Most common
Allow use of irrigation
Sizes: 2.3 mm & 3.2 mm – Larger sizes require therapeutic channel
Deeper areas

138
Q

Monopolar cautery

A

Higher risk of full thickness injury
Deeper areas

139
Q

Variables in probe success

A

Probe size
Force of application
Power setting
Duration of energy delivery

140
Q

Argon plasma coagulation (APC)

A

Advantage: Does not dislodge clot
Superficial (Palliative, Cleaning up)
Broad areas [Gatric antral vascular extasis (GAVE)]
Thin areas [Cecum]
Disadvantage: High perforation risk
No tamponade effect
Cannot reach deeper

141
Q

Cold biopsy

A

Spiked forcep - Allows for multiple specimens in a single pass without tissue loss

142
Q

Colonic gas

A

Replace colonic gas with air to decrease amount of flammable gas

143
Q

Resective Technique

A
  1. Snare polypectomy
  2. Transection
144
Q

Snare polypectomy

A

Pedunculated polyp
Pull polyp away from bowel, broad contact

145
Q

Transection

A

Short monopolar bursts -> Tighten snare

146
Q

Polyp retrieval

A

Small: Suction into trap
Large: Suction into tip w/ scope withdrawal
Retrieval net
Lost polyp: Stool straining

147
Q

Sessile Polyp

A
  1. Elevate submucosa w/ saline/hyaluronic acid
  2. Place snare around lesion
  3. Suction polyp into port to raise it

*Need two-channel therapeutic endoscopes

148
Q

Failure of sessile lesion to rise with saline injection

A

Involvement of submucosa
Endoscopic resection not advisable

149
Q

Safe excision needed for (raised base with saline)

A
  1. Larger sessile polyps
  2. Angulated portions of intestinal tract
  3. Thin walled areas of colon (cecum)
150
Q

Piecemeal Excision

A
  1. Polyp stalk >2-2.5 cm
  2. Polyp base >1-1.5 cm
151
Q

Safe areas to perform multiple snare excisions

A

Thicker or extraperitoneal areas
(Rectum)

152
Q

Periampullary duodenal adenoma excision

A

Consider biliary & pancreatic duct stenting

153
Q

Post polypectomy syndrome

A

Focal pain and tenderness without free air or exravasation on imaging
Treatment: Bowel rest & antibiotics

154
Q

Sampling technique

A
  1. Cold biopsy
  2. Spiked biopsy forcep
  3. Hot biopsy
  4. Brush cytology
  5. Repetitive biopsy (Required therapeutic endoscopy with 3.7 mm port)
155
Q

Submucosal Pathology

A

Requires endoscopic ultrasound (EUS) and dual channel therapeutic endoscopy to delineate bowel wall depth

156
Q

Enhanced visualization

A

Chromoscopic, spectroscopic, and magnification techniques

157
Q

Lugol solution (1-2%)

A

Stains glycogen containing normal esophageal squamous mucosal cells

158
Q

Methylene Blue (0.5-1%)

A

Stains intestinal absorptive epithelium
Identifies areas of intestinal metaplasia and focal carcinoma

159
Q

Spectroscopy

A

Distinguishes dysplastic and malignant cells from benign epithelium
Narrow bandwidth imaging defines differences in tissue vascularity

160
Q

Magnifying Endoscope/ Chromoscopes

A

Delineates mucosal crypt architecture
Risk of more advanced colonic neoplasia (delayed diagnosis)

161
Q

Nd:YAG

A

Deep areas of hemostasis

162
Q

Alcohol injection

A

Inexpensive ablative therapy
Unpredictable depth of infiltration

163
Q

Photodymanic therapy

A

Protoporphyrin derivative (porfimer sodium) compound injected IV and concentrates within neoplastic tissue
Wavelength laser light deployed causing photochemical reaction to porfimer sodium leading to production of singlet oxygen and targeted cell death
Advantage: Barrett’s ablation (Dysplastic)
Palliative therapy (esophageal carcinoma)

164
Q

Percutaneous Endoscopic Gastrostomy (PEG)

A

Indications:
1. Functioning GI tract but cannot take enteral feeds
2. Gastric decompression
3. Gastropexy for volvulus reduction

Contraindication:
1. Massive ascites
2. Diffuse gastric cancer
3. Distal obstruction
Relative: Threat to pulling out tube

165
Q

Percutaneous Endoscopic Jejunostomy (PEJ)

A
  1. Gastroparesis
  2. Atony
  3. Functional GOO
  4. Reflux/aspiration
166
Q

Pull Technique (PEG)

A

Attach pull PEG at oral end of guidewire
Pull retrograde through mouth
Secure PEG with bumper

167
Q

Replacing PEG & PEJ

A

When no longer functional

168
Q

PEG leaks

A

Loosen PEG, prevent movement

169
Q

GC fistula

A

If early, operative closure

170
Q

PEG dislodged w/ peritonitis

A

OR
Closure of track
Place tube elsewhere

171
Q

Push Technique (PEG)

A

Advance PEG over stiff nonlooped wire
Secure external bumper

172
Q

Russel Approach (PEG)

A

Patients with laryngeal/esophageal carcinoma
Avoids seeding cancer
Stomach held up by T fasteners
Needle -> Dialator -> Balloon tipped catheter

173
Q

PEJ Placement

A

Pediatric colonoscope
Small G tube
Fluouroscopy

174
Q

Dilations

A

Do not dilate beyond 3 sequential bougie sizes

175
Q

Dyphagia relieved at what bougie size

A

40F

176
Q

Where can objects not be retrieved endoscopically

A

Treitz to Treves (IC valve)

177
Q

Stones in common hepatic duct proximal to cystic duct

A

Choledocotomy

178
Q

Stone removal on IOC

A
  1. Saline flush
  2. Glucagon to flush through Oddi
  3. Basket or forcep
179
Q

Foreign body amenable for removal

A
  1. In esophagus
  2. Irregular and in stomach
  3. Rectum or sigmoid
180
Q

https://img.medscapestatic.com/pi/meds/ckb/43/35343tn.jpg

A

Barrett’s Esophagus

181
Q

https://www.researchgate.net/publication/319412550/figure/fig1/AS:533599172923392@1504231364579/Endoscopy-revealed-an-esophageal-perforation-in-the-left-side-of-the-upper-thoracic.png

A

Perforation

182
Q

https://img.medscapestatic.com/pi/meds/ckb/88/35688tn.jpg

A

Gastric ulcer

183
Q

https://www.gastrotraining.com/wp-content/uploads/2010/07/image00110.jpg

A

Zenker Diverticulum

184
Q

https://journal.medizzy.com/wp-content/uploads/2022/06/imageXml-2.png

A

Hiatal Hernia

185
Q

https://www.endoscopy-campus.com/wp-content/uploads/2016/07/Grad_II_Bild1.jpghttps://www.endoscopy-campus.com/wp-content/uploads/2016/07/Grad_II_Bild1.jpg

A

Esophageal varices

186
Q

https://f6publishing.blob.core.windows.net/cdc8fdfa-78d9-4514-b143-bf5b514b534d/WJGE-2-252-g003.jpghttps://f6publishing.blob.core.windows.net/cdc8fdfa-78d9-4514-b143-bf5b514b534d/WJGE-2-252-g003.jpg

A

Esophagitis

187
Q

http://3.bp.blogspot.com/-lMaa7zKBbIk/Teqb96ej_gI/AAAAAAAACkY/8JdM77nHCvs/w1200-h630-p-k-no-nu/schatzki_ring.jpg

A

Schatzki Ring

188
Q

https://upload.wikimedia.org/wikipedia/commons/4/49/Endoscopic_view_of_fundic_gland_polyps.jpg

A

Fundic gastric polyp

189
Q

https://img.medscapestatic.com/pi/meds/ckb/65/291065tn.jpg

A

Gastric adenocarcinoma

190
Q

https://www.researchgate.net/publication/283184318/figure/fig4/AS:614032855797775@1523408249679/Colonoscopic-images-of-hypertrophic-Peyers-patches-in-the-terminal-ileum_Q640.jpg

A

Peyer’s patches in terminal ileum

191
Q

https://upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Argon_plasma_coagulation.jpg/300px-Argon_plasma_coagulation.jpg

A

Angiodysplasia

192
Q

https://study.com/cimages/multimages/16/cc463b5c-0d7e-4127-8929-116b6776fc4d_intestinal_ulcer.jpeghttps://study.com/cimages/multimages/16/cc463b5c-0d7e-4127-8929-116b6776fc4d_intestinal_ulcer.jpeg

A

Sterocoral ulcer

193
Q

https://media.sciencephoto.com/c0/16/67/21/c0166721-800px-wm.jpg

A

Crohn’s Colitis

194
Q

https://www.gastrointestinalatlas.com/imagenes/UlcerativePseudoPolipois4.jpg

A

Ulcerative colitis

195
Q

https://static-02.hindawi.com/articles/grp/volume-2013/192794/figures/192794.fig.001d.jpg

A

Radiation enteritis

196
Q

https://www.bmj.com/content/bmj/355/bmj.i6600/F3.large.jpg

A

Ischemic colitis

197
Q

https://healthjade.com/wp-content/uploads/2018/03/Pseudomembranous-colitis.jpg

A

C diff

198
Q

https://www.researchgate.net/publication/346919088/figure/fig5/AS:1022616718540809@1620822233607/Endoscopic-signs-of-colonic-lipoma-including-A-pillow-sign-and-B-naked-fat-sign-with.jpg

A

Lipoma

199
Q

https://www.frontiersin.org/files/MyHome%20Article%20Library/973883/973883_Thumb_400.jpg

A

Melanosis coli

200
Q

Forrest Classification

A

Bleeding ulcers

201
Q

Hill Grade

A

Hiatal hernia
I: Ring of tissue around scope
II: Widening of angle of his
III: Lumen does not close around scope
IV: Hiatal hernia present at all times, sphincter axial

202
Q

Los Angeles

A

Reflux esophagitis
A-D

203
Q

Prague

A

Barrettes’ Esophagus

204
Q

Right combination of button and channel

A

Suction + Biopsy

205
Q

No channel for irrigation

A

Suction + Biopsy channel

206
Q

Point to discuss in informed consent

A

Complications

207
Q

Preparation: Sigmoidoscopy

A

Enema

208
Q

High bleeding risk procedure

A

Esophageal dilation

209
Q

Request anesthesiologist specialist

A

Increased risk of complications due to comorbidities

210
Q

Boston bowel prep classification

A

Bowel prep classification

211
Q

Enteroscopy

A

Double balloon - Gold standard

212
Q

Scope: Proximal jejunum

A

Pediatric scope

213
Q

Complication: Billroth II

A

Pancreatitis
Perforation
Retrograde access via distal duodenum

214
Q

ERCP: Billroth II

A

Retrograde access from distal duodenum

215
Q

Indication: Sphincterotomy

A

Leaks
Obstruction
Stent placement

216
Q

Post sphincterotomy bleeding

A

Thermal & Endoclips

217
Q

ERCP Anatomy

A

CBD = Parallel to duodenum
Pancreatic duct = Perpendicular to duodenum
Minor papilla: Proximal to major papilla. Harder to intubate

218
Q

Cytology

A

When tissue removal is not needed

Esophageal candidiasis

219
Q

EUS Probe type

A

Curvilinear

220
Q

Biopsy on EUS can be taken up to the

A

3rd level of mucosa
1st: Superficial mucosa
2nd: Deep mucosa
3rd: Submucosa

221
Q

EUS/FNA Post procedure pancreatitis

A

<2%

222
Q

Lymph node anatomy

A

Benign: Triangular

Malignant: Hypoechoic
Size > 1cm
Irregular borders

223
Q

Magnification on standard high resolution endoscope

A

30x

224
Q

Magnification of zoom endoscope

A

150x

225
Q

High definition scope detects dysplasia

A

3 fold

226
Q

NICE classification

A

Hyperplastic: Lighter/Same as background
Adenoma: Browner than background
Invasive cancer: Dark brown, patchy white

227
Q

NBI zoom detects dyplasia in Barrett’s: sensitivity & specificity

A

95%

228
Q

DISCARD Trial

A

If NBI used, pathology is not needed for polyps <10 mm

229
Q

Technique: Distal duodenum

A

Torque clockwise

230
Q

Technique: Incisura

A

Torque ounterlockwise
Withdraw - See body & Cardia
Rotate endoscope 360 at GE junction

231
Q

Technique: Rectum

A

Flex tip
Bypass canals
20 cm

232
Q

Rockball Score

A

Likelihood of death with GIB

FES & FLS (3 decks)

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