fourth-MKSAP Flashcards

1
Q

Patient comes in with maroon stools, hemoglobin 10,

No blood seen in the emergency department and patient is hemodynamically stable, what is the appropriate diagnostic test?

-Colonoscopy?
-CTA abdomen?
-Upper endoscopy?

A

Colonoscopy

If there was an active bleed or the patient was hemodynamically unstable–>
Start CTA,
THEN and will do upper endoscopy,If CTA did not show any source/Provide any answers

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2
Q

What is an ideal combination therapy for Crohn’s disease with___and___, in order to achieve glucocorticoid free remission and mucosal healing

A

Anti-TNF agent, immunomodulators

Infliximab, azathioprine respectively

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3
Q

When is tagged RBC nuclear scintigraphy of the right answer?

A

When everything else has been done i.e. CTA, colonoscopy, and are all negative

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4
Q

___Is a antitumor necrosis factor agent, and can be used for severe Crohn’s disease

A

Infliximab

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5
Q

___Is An immunomodulators, and can be used in Crohn’s, But therapy with this can fail

A

Azathioprine, Or 6-mercaptopurine

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6
Q

What are causes of fat malabsorption?

A

Infections i.e. Giardia, Whipple disease
Pancreatic dysfunction
Celiac disease
Tropical sprue
Small intestine bacterial overgrowth

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7
Q

Diagnostic test for SIBO-small intestinal bacterial overgrowth

A
  • Positive result on glucose breath test
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8
Q

What are the clinical signs of fat malabsorption

A
  • Abdominal discomfort, flatulence, bloating, diarrhea with floating stools
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9
Q
  • What are the causes of SIBO?
A

Various conditions like:
Impaired motility
Strictures i.e. Crohn’s disease
Blind loops i.e. small bowel diverticula

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10
Q
  • What is the pathogenesis of SIBO?
A

There is excessive intraluminal bacteria that he conjugate the bile salts–>this causes interference in the formation of micelles–>fat absorption impeded without micelles

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11
Q
  • Treatment of SIBO?
A

Empiric antibiotic therapy with monitoring

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12
Q

If tissue transglutaminase IgA is normal, his upper endoscopy with duodenal biopsy necessary?

A

No

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13
Q
  • Patient on warfarin For A-fib,found to have bleeding gastric ulcer that is now clipped, INR <2.5 question is about when to resume warfarin?
A

Resume warfarin in 7 days, No heparin needed unless mechanical prosthetic valve, also do not need heparin because INR is therapeutic at a pretty good goal

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14
Q
  • Patient with early satiety, found to have gallstones on ultrasound, should she go to cholecystectomy?
A

No, because this is considered asymptomatic gallstones, therefore clinical obs, if there is a polyp found in the gallbladder, then cholecystectomy would be a good idea because of high risk of gallbladder cancer

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15
Q
  • What is the pathophysiology behind the colicky pain and gallstones?
A

Patient ate a fatty meal–>stimulation of the gallbladder–>obstructive cystic duct from gallstone or sludge against which gallbladder is trying to contract–>RUQ/epigastric pain, pain radiates to scapula, may have N, V, diaphoresis, lasts 30 minutes to 6 hours

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16
Q
  • Name of the mutation for Lynch syndrome
A

Germline mutation and mismatch repair genes: MLH1, MSH 6, PMS2, MSH2, EPCAM-epithelial cell adhesion molecule gene

17
Q

Germline mutation and mismatch repair genes: MLH1, MSH 6, PMS2, MSH2, EPCAM-epithelial cell adhesion molecule gene

A

20-25-colonoscopy, repeat every 1 to 2 years, can start surveillance 2 to 5 years before earliest cancer diagnosis and family
30-35-EGD, repeat every 2 to 5 years

18
Q
  • What are all the cancers involved in Lynch syndrome?
A

Endometrial cancer-MC
Stomach and small bowel cancer
Colon cancer

19
Q
  • What is a confirmatory test for hepatopulmonary syndrome?
A

Echocardiogram

20
Q
  • Portal pulmonary hypertension, can occur from___disease, and the initial screening test is___
A

Cirrhosis and portal hypertension
Echocardiogram

21
Q
  • If a patient with cirrhosis is having worsening oxygen saturation when sitting upright, and dyspnea when sitting upright, suspect___syndrome
A

Hepatopulmonary syndrome

22
Q
  • If you see this___fungal infection in HIV patient’s mouth, treated with___
A

Candida esophagitis
Oral fluconazole

23
Q
  • Can you initiate Reglan in a patient to suspect to have gastroparesis?
A

No, must be initiated after diagnosis is confirmed with 4-hour gastric scintigraphy-in other words gastric emptying study

24
Q
  • What does elevated level of fecal calprotectin mean?
A

It means colonic inflammation, warrants further investigation with colonoscopy

25
Q
  • These medications___have been associated with development of microscopic colitis
A

NSAIDs
PPI
SSRIs
Nonmedication etiology is idiopathic

26
Q
  • What is the treatment of microscopic colitis?
A

Symptomatic treatment with loperamide
Discontinue the causative medications i.e. NSAIDs, SSRI, PPI
If none of those work, may need oral budesonide

27
Q
  • Histology of a specimen of bowel shows intraepithelial lymphocytosis, what is the diagnosis?
A

Microscopic colitis, other names it goes by: Lymphocytic colitis, collagenous colitis

28
Q
  • What are the symptoms of microcytic colitis?
A

Abrupt or gradual onset of watery diarrhea, relapsing-remitting course over months to years, sometimes can have weight loss and abdominal pain too

29
Q
  • What is the medication to help manage dermatitis herpetiformis? And there is 1 caution to take with this medication…
A

Dapsone, you must test for G6PD deficiency before starting this though!!!

30
Q
  • Treatment for achalasia?
A

Botulinum toxin injection
Balloon dilation
Endoscopic myotomy or laparoscopic myotomy