fifth-MKSAP Flashcards
- Causes of achalasia?
Viral or parasitic i.e. Chagas’s disease
Autoimmune
Neurodegenerative disorders
- What is the first-line diagnostic test for achalasia? And what will you see?
Barium esophagram or EGD
You will see dilation of esophagus with narrowing at GE junction
- Hepatic adenomas are malignant/benign___, and can be differentiated from focal nodular hyperplasia by imaging___
Benign
Abdominal MRI
- Hepatic adenomas are found typically in this demographic___, using this medication___
Women
Oral contraceptives
- Malignant transformation of hepatic adenoma includes size of___or greater, and adenoma with___activation
> 5 cm
Beta-catenin
- Treatment of non-suspicious hepatic adenoma includes___and follow-up in___time interval with___imaging
Discontinuation of any hormone medication
6-month follow-up
MRI
- Focal nodular hyperplasia are typically malignant/benign___
benign
- Simple hepatic cyst are typically malignant/benign___
Benign
- Hepatic hemangioma are typically malignant/benign___
Benign
- Is PPI commonly used as part of treatment for Mallory-Weiss tear?
Not really
- This electrolyte issue can occur from unnecessary and prolonged use of PPI
Hypomagnesemia, with subsequent hypokalemia and hypocalcemia
- This vitamin deficiency can be a result of PPI overuse
Vitamin B12 deficiency
- First-line treatment for dumping syndrome
Smaller more frequent meals
- What is the pathophysiology behind dumping syndrome
Rapid gastric emptying–>a lot of release of gastrointestinal hormones with vasoactive properties-which explains the vasomotor symptoms like diaphoresis, tachycardia, flushing, syncope
- What causes dumping syndrome?
Gastric surgery i.e. Roux-en-Y bypass, sleeve gastrectomy, esophagectomy, vagotomy
- What are the symptoms of dumping syndrome?
1 hour after eating: Abdominal pain, bloating, fullness, nausea/vomiting, diarrhea
Classic vasomotor symptoms to: Tachycardia, flushing, diaphoresis, syncope, pallor
(Happening because vasoactive hormones are released when food is suddenly pushed into the small intestines)
- How do you treat colon cancer in a patient with familial adenomatous polyposis?
Colectomy-subtotal, and follow-up with sigmoidoscopy annually
- Familial adenomatous polyposis has___mutation in the gene
APC gene
- The patient with hepatitis C recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment? Cirrhosis is not diagnosed yet
Surgical resection if there is no decompensated cirrhosis or portal hypertension
The patient with PMH of Cirrhosis is diagnosed also and is well compensated, hepatitis C
recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment?
Surgical resection, because there is no decompensated cirrhosis
- The patient with PMH of Cirrhosis is not the best compensated, there may be portal hypertension as well, hepatitis C
comes to your clinic because recently had a liver mass biopsied which shows hepatocellular cancer, what is the treatment?
Liver transplant because patient does not have well compensated cirrhosis, and there is portal hypertension
- If patient has hepatocellular cancer,___is when you do surgical resection versus___is when you do liver transplant************
Surgical resection if: Well compensated cirrhosis, no portal hypertension, normal liver function markers
Liver transplant if: Portal hypertension present, decompensated cirrhosis, abnormal liver function markers
- What is the way to diagnosed PSC-primary sclerosing cholangitis?
Liver biopsy!
- What diseases PSC associated with?
Ulcerative colitis
- If he had to use an imaging test for PSC, which would be? And if this was not showing PSC, does not rule out PSC?
MRCP, not not not ultrasound
If MRCP negative-and there is still cholestatic liver enzyme levels, do liver biopsy, MRCP alone does not rule it out in this case
- What is the colonoscopy screening needed for Crohn’s/UC?
Screen with colonoscopy 8 to 10 years after disease is diagnosed
AFTER negative screening, the SURVEILLANCE every 1 to 5 years depending on risk factors: Burden of colonic inflammation, family history of colon cancer, PSC
- Having PSC with__IBD puts you at a risk for___
Ulcerative colitis
Colon cancer
- If patient has GERD, with these risk factors___, they be screened for Barrett’s esophagus: You must have at least 3 of the following:
-Male
-White race
-Obesity
-Tobacco use
-Family history of Barrett’s
-Esophageal adenocarcinoma in a first-degree relative
-Over the 50 years of age
- A duration of___years or more, and__or more risk factors, is an indication for screening of Barrett’s esophagus with EGD
5 or more years of GERD symptoms
3 or more risk factors i.e. race, age, family history of Barrett’s etc.
- What is the histology of Barrett’s esophagus?
Intestinal metaplasia
Low-grade dysplasia
Intramucosal carcinoma
Acid mucin containing goblet cells on slide
what will you see on EGD for Barrett’s esophagus?
Salmon colored mucosa
