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Step 1 2019 First Aid Flashcards > Gastro Conrad Fischer Medquest Pharm > Flashcards

Gastro Conrad Fischer Medquest Pharm Flashcards

1
Q

42 yr female, HBsAg + > 6mo, HBcAg +

Dx?

A

Def of Chronic Hep B

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2
Q

1st marker to inc with chronic Hep B? 2nd?

A

HbsAg

2nd - HbeAg

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3
Q

HBeAg is analogous to what in HIV?

A

DNA viral load

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4
Q

40 female persistent epigastric pain #1 cause?

A

non ulcer dyspepsia

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5
Q

gastritis presents with

A

painless bleeding

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6
Q

Pt has epigastric pain and on PPI and failed? next step?

A

Biopsy

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7
Q

alarm sx of H. pylori gastritis

A

weight loss, anemia, dysphagia, guaiac pos stool

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8
Q

What not do serology over biopsy ?

A

Serology can’t tell you if new/old infection - like FTA for syphillis

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9
Q

Tx for H. pylori - Rx and MoA of them

A

PPI + 2 Antibiotics +/- Bismuth subsalicylate

Clarithromycin + Amoxicillin

can switch to
Tetracyclin + Metronidazole

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10
Q

List PPI & MoA

A

Lansoprazole
Ome-
Panto-
Rabe-
Esome-

Irreversibly inhibit H+/K+ ATPase in stomach parietal cells

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11
Q

PPI side effects

A

acute interstitial nephritis
dec serum Mg/Ca absorption —> bone demineralization and fracture

Ca absorbed better in acidic environment

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12
Q

SE effect of PPI that is also caused by certain antibiotics? Which antibiotic in particular?

A

Inc risk of C. diff infection - Can be caused by any antibiotic, but Clindamycin in particular

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13
Q

When do you add bismuth?

A

Add to metro + tetracyclin if 1st round of antibiotic doesn’t work. For the anti inflammatory effect

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14
Q

Unique side effect of bismuth

A

black colored stool, that isn’t heme or guaiac +

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15
Q

MoA and major side effect of tetracylcin

A

affects 30S of ribosomes
photosensitivity (and teratogenecity)

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16
Q

Metronidazole - MoA and used for what organisms

A

(-) nucleic acid synthesis by forming toxic free radical metabolites

used for anerobic infections below diaphram, and protozoal infections

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17
Q

SE of Metronidazole

A

Disulfiram rxn w/ alcohol, headache, metallic taste, rarely seizures

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18
Q

List H2 blockers

A

Cimetidine, Ranitidine, Famotidine, Nizatidine

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19
Q

Why do we target histamine in acid reflux?

A

Histamine stimulates the other 2 stimulations of p+ pumps

1) Ach (+) H/K ATPase
2) Gastrin –> CCK2-R

Ca2+ dependent pathway

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20
Q

56 yr man w. acute variceal hemorrhage from alcoholic cirrhosis
rec IV fluids and rec blood transfusion + FFP

Why not vitamin K?

Rx most likely benefit pt now?

A

too slow

Octreotide - dec portal pressure bc receptor all through GI tract
& banding

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21
Q

What if Rx fails?

A

TIPS - Transjugular Intrahepatic Portal Systemic Shunt

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22
Q

Octreotide - other uses? MoA in these cases?

A

Glucagon/insulinoma
Carcinoid
ZE syndrome

Can dec portal pressure, splanchnic blood flow, (-) PRL, GH, (-) diarrhea in carcinoid

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23
Q

How is propranolol useful in acute variceal bleed?

A

It isn’t, no effect on acute bleed.

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24
Q

Only time to treat an endo overproduction w/ Rx before surgery?

A

PRL-oma - use dopamine agonist

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25
Q

48 man with altered mental status 2ndary to hepatic insufficiency

Most effective Tx for Pt 1?

A

Lactulose - (-) NH4 absorption in GI
Rifamixin - (-) bacteria in bowel

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26
Q

Why not use Neomycin for this pt?

A

can lead to renal issues

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27
Q

SE of Lactulose use?

A

Bloating, diarrhea, flatulence

–> hyper Na and HypOkalemia - bc colon used K+ to make feces

28
Q

Lactulose MoA

A

non absorbed disaccharide, can’t break down w/o lactase - acidifies bowels, bacteria eat it and release acid, which converts NH3 –> NH4+ , which can’t be absorbed, inc renal excretion bc charged particle

29
Q

Why does liver issues –> renal issues?

A

Intravascular volume depleted, low albumin –> HIGH RAAS, kidney v susceptible to toxic injury

Hepatic disease = VC of kidney in Abnormal way - starves them off

30
Q

Lab changes in hepatorenal disease??

A

Dec Urine Na < 20 meq/L
Bun/Cr ratio INC - > 20
same lab values as pre renal azotemia

31
Q

Sx of hepatorenal syndrome?

A

fluid overload
ascites
edema
low urine Na (like in dehydration)

32
Q

When kidneys dehydrated, effect?

A

hold onto vol and Na, BUN Inc bc of Inc ADH leading to inc urea resorption @ collecting duct (urea transporter)

33
Q

Tx for Hepatorenal syndrome?

A

replace liver

Midodrine - alpha (+)’r also used for orthostatic hypotension, shunt blood –> kidney
Octreotide

Albumin infusion - intravascular vol dec bc of dec albumin

34
Q

Penacillamine used for?

A

chelator for Cu - Wilson’s disease

35
Q

Other Rx used for Wilson’s disease?

A

Trientine and Zn

36
Q

Sx of Wilson’s disease

A

Liver - hepatitis, liver failure

Brain - dysarthria, dystonia, tremor, Parkinsonism
+ hemolytic disease
+ renal disease

37
Q

1 test of Wilson’s disease?

A

Slit lamp test - K-F rings

38
Q

Most common wrong ans for best test for Wilson’s

A

Ceruloplasmin levels

39
Q

Wilson’s disease leads to what renal issue?

A

Nephrotic syndrome

40
Q

Penacillamine is also used for?

A

Hg and Zinc overload
cysteinuria
arsenic poisoning

41
Q

Cu builds up in thalamus leading to ?

A

choreoform movements
paranoia
psychosis

not seen in hepatic encephalopathy

42
Q

54 man alcoholic - n/v, blood from esoph varices

Rx ?

A

fluid, blood, platelet, FFP

43
Q

Pt has been given these several times before,

2x treated w/ esoph band ligation

been transfused and has normal PT time

next course of action?

A

TIPS

44
Q

How to prevent next episode of variceal bleed

A

nadalol
propranolol

45
Q

Tx of acute esoph bleeding?

A

Octreotide
endoscopic band ligation

46
Q

What is TIPS?

A

catheter placed into hepatic v and shunt created thru liver to portal vein,

done in flouroscopy

47
Q

Pt v distressed by persistent Sx of epigastric and chest pain from GERD

Which Rx relieve heartburn and GERD sx?

A

1) liquid antiacid + H2B (Cimetidine, Ranitidine)

then
2) PPI

48
Q

If GERD is severe?

A

Surgical repair of columnar metaplasia = Fundoplication (suture around LES to tighten it up)

49
Q

Why do you need to scope surgical GERD pt every 2 years?

A

0.5 -1 %/yr –> esoph cancer

50
Q

Why is Cisopride never the ans?

A

most likely to cause Torsades

51
Q

T or F GERD is caused by H. Pylori

A

FALSE. does not cause reflux, a loose LES does.

52
Q

What can cause a loose LES?

A

nicotine, chocolate, alcohol, caffeine

53
Q

When to treat H. pylori?

A

1/2 of gen pop is H.pylori pos, only treat if have

Gastric PUD

Malt lymphoma

54
Q

How to treat low grade dysplasia?
high grade dysplasia?
Barrett’s esoph

A

Low grade - scope in 6 mo

high grade - scrape/cut it out
Barrett’s - scope in 2 mos

55
Q

38 yr woman w/ dysphagia to solids and liquids

A

Achalasia

56
Q

How do diff dx achalasia from Zenker’s , Scleroderma, and esoph cancer?

A

Zenker’s - bad breath
Scleroderma - puffy, taut skin, no wrinkles
Esoph cancer - > 30, smoker/drinker, solids, then liquids

57
Q

What is the next test in this pt?

A

Barium studies

58
Q

Achalasia also associated with what other dz?

A

Schatzki ring
Plummer Vinson
Nut cracker esophagus
Diffuse esoph spasm

59
Q

Tx of Achalasia -

A

1) Pneumatic dilation - can cause perforation or Surgery (Heller myotomy)

If refused - Botox - wears off after 6 mos

60
Q

27 healthy GI fellow develops severe bloody diarrhea and abdomen pain over the last day.

10 + BM/ day

pulse 125

temp 103 F

What type of re-hydration should he rec? why?

A

saline - will stay in vascular space

NOT 5% dextrose in water - that’s like free water - will move EC

61
Q

Should this pt rec antibiotics,

if so, which one?

mech?

A

Bc we don’t know what organism is

Flouroquinolonen - treat most common causes

(-) DNA gyrase

62
Q

Most common micro causes of bloody diarrhea?

A
  1. C. jejuni - can also give erythromycin
  2. Salmonella
63
Q

To whom can you not give flouroquinolones?

why?

A

To younger person - affects chondrocytes
leads to tendon rupture

64
Q

What do you give a younger person if can’t give flouroquinolones?

A

TMP SMX

eythromycin

65
Q
A

Step 1 2019 First Aid Flashcards (63 decks)

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