fourth-MKSAP Flashcards
***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?
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
What is an ideal combination therapy for Crohn’s disease with___and___, in order to achieve glucocorticoid free remission and mucosal healing
Anti-TNF agent, immunomodulators
Infliximab, azathioprine respectively
When is tagged RBC nuclear scintigraphy of the right answer?
When everything else has been done i.e. CTA, colonoscopy, and are all negative
___Is a antitumor necrosis factor agent, and can be used for severe Crohn’s disease
Infliximab
___Is An immunomodulators, and can be used in Crohn’s, But therapy with this can fail
Azathioprine, Or 6-mercaptopurine
What are causes of fat malabsorption?
Infections i.e. Giardia, Whipple disease
Pancreatic dysfunction
Celiac disease
Tropical sprue
Small intestine bacterial overgrowth
Diagnostic test for SIBO-small intestinal bacterial overgrowth
- Positive result on glucose breath test
What are the clinical signs of fat malabsorption
- Abdominal discomfort, flatulence, bloating, diarrhea with floating stools
- What are the causes of SIBO?
Various conditions like:
Impaired motility
Strictures i.e. Crohn’s disease
Blind loops i.e. small bowel diverticula
- What is the pathogenesis of SIBO?
There is excessive intraluminal bacteria that he conjugate the bile salts–>this causes interference in the formation of micelles–>fat absorption impeded without micelles
- Treatment of SIBO?
Empiric antibiotic therapy with monitoring
If tissue transglutaminase IgA is neg, is upper endoscopy with duodenal biopsy necessary?
No
- 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?
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
- Patient with early satiety, found to have gallstones on ultrasound, should she go to cholecystectomy?
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
- What is the pathophysiology behind the colicky pain and gallstones?
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
- Name of the mutation for Lynch syndrome
Germline mutation and mismatch repair genes: MLH1, MSH 6, PMS2, MSH2, EPCAM-epithelial cell adhesion molecule gene
lynch syndrome when to start scope surveillance
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
- What are all the cancers involved in Lynch syndrome?
Endometrial cancer-MC
Stomach and small bowel cancer
Colon cancer
- What is a confirmatory test for hepatopulmonary syndrome?
Echocardiogram
- Portal pulmonary hypertension, can occur from___disease, and the initial screening test is___
Cirrhosis and portal hypertension
Echocardiogram
- If a patient with cirrhosis is having worsening oxygen saturation when sitting upright, and dyspnea when sitting upright, suspect___syndrome
Hepatopulmonary syndrome
- If you see this___fungal infection in HIV patient’s mouth, treated with___
Candida esophagitis
Oral fluconazole
- Can you initiate Reglan in a patient to suspect to have gastroparesis?
No, must be initiated after diagnosis is confirmed with 4-hour gastric scintigraphy-in other words gastric emptying study
- What does elevated level of fecal calprotectin mean?
It means colonic inflammation, warrants further investigation with colonoscopy
- These medications___have been associated with development of microscopic colitis
NSAIDs
PPI
SSRIs
Nonmedication etiology is idiopathic
- What is the treatment of microscopic colitis?
Symptomatic treatment with loperamide
Discontinue the causative medications i.e. NSAIDs, SSRI, PPI
If none of those work, may need oral budesonide
- Histology of a specimen of bowel shows intraepithelial lymphocytosis, what is the diagnosis?
Microscopic colitis, other names it goes by: Lymphocytic colitis, collagenous colitis
- What are the symptoms of microcytic colitis?
Abrupt or gradual onset of watery diarrhea, relapsing-remitting course over months to years, sometimes can have weight loss and abdominal pain too
- What is the medication to help manage dermatitis herpetiformis? And there is 1 caution to take with this medication…
Dapsone, you must test for G6PD deficiency before starting this though!!!
- Treatment for achalasia?
Botulinum toxin injection
Balloon dilation
Endoscopic myotomy or laparoscopic myotomy
