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Internal Medicine - MCCQE 1 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the role of UDP glucouronosyltransferase?

A

UDP-G converts UC bilirubin into C bilirubin; Then c bilirubin is excreted by the transporter protein into the bile system

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2
Q

How does liver toxicity occurs in acetaminophen overdose?

A

Acetaminophen results in production of toxic metabolite called NAPQI. NAPQI is normally detoxified through the process of glucuronidation in the liver by glutathione. But this process is overwhelmed during acetaminophen toxicity. N acetylcysteine increases the level of Glutathione and acts as an antidote if given early.

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3
Q

How to diagnose Wilson disease?

A

ceruloplasmin level (low); Urinary excretion (High); Kayser-Fleischer rings on slit-lamp examination

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4
Q

What is diagnostic imaging of choice in primary sclerosing cholangitis?

A

Magnetic resonance cholangiopancreatography (MRCP)

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5
Q

What two syndromes of unconjugated hyperbilirubinemia?

A

Crigler-Najjar syndrome and Gilbert syndrome; In C-N syndrome UDP-G enzyme is absent whereas in Gilbert syndrome it has decreased activity due to mutation.

“Gilbert is UNder CN tower”

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6
Q

What are two syndromes of conjugated hyperbilirubinemia with normal AST, ALT and ALP?

A

Rotor syndrome and Dubin-Johnson syndrome; In D-J syndrome on liver biopsy shows dark colored hepatocytes due to defect in excretion of the conjugated bilirubin from the liver cells.

“DJ rides Rotten Cycle”

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7
Q

What causes hepatic encephalopathy?

A

Ammonia (NH3) causes neurotoxicity in the setting of liver dysfunction.

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8
Q

How does diuretics worsen hepatic encephalopathy?

A

low intravascular volume with metabolic alkalosis and hypokalemia.

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9
Q

Why patients with cirrhosis should avoid ACE inhibitors and angiotensin receptor blockers?

A

Patients with cirrhosis has low mean arterial pressure due to splanchnic vasodilation. They rely on RAAS system to normalize blood pressure and renal perfusion. ACE inhibitors and ARBs blunt this critical response and promote organ hypoperfusion.

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10
Q

What is the medical management of ascites in cirrhotic patients?

A

initial management includes furosemide with spironolactone, sodium restriction and alcohol abstinence

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11
Q

how to initially evaluate ascites?

A

Abdominal ultrasound and diagnostic paracentesis (SAAG, cell count and differential, total protein)

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12
Q

What is the prophylactic management for esophageal variceal hemorrhage?

A

Endoscopic variceal ligation or non selective beta blockers (propanolol or nadolol)

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13
Q

What are the two anastomoses in Roux-en-Y gastric bypass?

A

Gastrojejunal and Jejunojejunal anastomoses

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14
Q

How does Roux-en-Y gastric bypass surgery induces weight loss?

A

by restricting food intake and promoting malabsorption

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15
Q

What is D-xylose test?

A

D-xylose is a monosaccharide that is absorbed by the normal proximal intestinal mucosa. However, any disease affecting the proximal small intestinal mucosa such as celiac disease results in less absorption of d-xylose and low d-xylose levels detected in urine.

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16
Q

What is the most common cause of lower GI bleeding in adults?

A

Diverticulosis; Diagnose with Colonoscopy; Colonoscopy is contraindicated in diverticulitis (fever, abd pain)

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17
Q

What are two bacteria that are strongly associated with colon cancer and require colonoscopy?

A

Clostridium septicum and streptococcus bovis (Gallolyticus)

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18
Q

What is the diagnostic test for giardiasis?

A

Stool antigen assay or PCR testing

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19
Q

How to diagnose Lactose intolerance if unclear?

A

Hydrogen breath test

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20
Q

How to diagnose C difficile colitis?

A

Stool PCR for c difficile genes or Stool enzyme immunoassay for c difficile toxin and glutamate dehydrogenase antigen

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21
Q

What type of meds need to be avoided with any kind of porphyria?

A

Any drugs that induce hepatic P450 cytochrome (eg barbiturates like sodium thiopental)

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22
Q

What is maximum daily dosage of acetaminophen allowed?

A

4000mg

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23
Q

What are the clinical finding associated with portal hypertension?

A

caput medusae, hemorrhoids, splenomegaly, esophageal varices

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24
Q

What is the best test of choice for suspected case of diverticulitis?

A

CT scan of abdomen

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25
Q

Barett’s esophagus increases the risk of what?

A

Esophageal Adenocarcinoma

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26
Q

What junction is involved in the diagnosis of barett’s esophagus?

A

squamo-columnar junction

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27
Q

What is the treatment of choice for fistulizing CD?

A

Anti-TNFs like infliximab

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28
Q

What is the acute treatment of acute intermittent porphyria?

A

IV hematin (Heme B), Glucose and pethidine (demerol). For patients with seizures, phenytoin should also be involved.

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29
Q

Which class of antibiotics has the greatest penetration for pancreas?

A

Carbapenems (eg, imipenem, merpenem)

30
Q

What is the best test to establish the diagnosis of acute intermittent porphyria?

A

urinary porphobilinogen and total porphyrins

31
Q

What is achalasia? What is the most accurate diagnostic method?

A

Dysphagia of the both solids and liquids due to absence of peristalsis and impaired relaxation of LES in response to swallowing. The accurate diagnostic method is esophageal manometry.

32
Q

What should be done next in people with isolated elevation of alkaline phosphatase (ALP)?

A

Measure 5’-nucleotidase; if elevated, cholestasis is the most likely cause.

33
Q

In liver disease, what is suggestive of chronic hepatitis?

A

low serum albumin level

34
Q

What is diagnostic modality of choice for acute upper GI bleeding?

A

Upper endoscopy

35
Q

What medication slows the progression of PBC?

A

Ursodiol

36
Q

What is the most appropriate management in patient with GI bleeding?

A

assess the patient for ABC and then look for the source of bleeding with either CT angiography or colonoscopy.

37
Q

What is the diagnostic modality of choice in suspected case of primary sclerosing cholangitis?

A

MRCP

38
Q

What are the complications of refeeding syndrome?

A

during refeeding in a malnourished person, there is an increase in insulin release which results in increased production of glycogen. Phosphate, magnesium and potassium are used up during the process. That change in electrolyte levels result in fluid shift which can result in increased workload and cardiac failure.

39
Q

What is ranson’s criteria?

A 
it is prognostic indicator of mortality in pancreatitis not due to gallstone. 
GALAW at admission:
Glucose >11mmol/L
Age >55
LDH >350
AST >250
WBCs >16x10^9
 C-HOBBS at 1st 48 hr after admission:
Calcium <2.0
Hct drop >10%
PaO2 <60
Base deficit >4 mmol/L
BUN rise >1.8 mmol/L
Est. fluid sequestration >6 L
40
Q

What is the best test to monitor the therapy in patient with Wilson’s disease?

A

Urinary copper excretion

41
Q

What is pathognomonic for Crohn’s disease?

A

Non caseating granuloma

42
Q

What is the recommended first line therapy for mild to moderate Crohn’s disease?

A

Budesonide

43
Q

Poor wound healing and hypogonadism due to low testosterone suggests deficiency of what nutrient?

A

Zinc

44
Q

What are the recommended endoscopic surveillance for patients with Barrett’s esophagus?

A

1) 3-5 years with No dysplasia; 2) 6-12 months with low grade dysplasia; 3) every 3 months for high grade dysplasia

45
Q

What is the appropriate management for acute ascending cholangitis?

A

IV fluids, Empiric antibiotics (gram positive, gram negative & anaerobes), endoscopic decompression after 72 hrs done with ERCP

46
Q

Antisaccharomyces cerevisiae (ASCA) Positive and ANCA negative?

A

Crohn’s disease

47
Q

ASCA negative and ANCA positive

A

Ulcerative colitis

48
Q

List of pathogens associated with infectious diarrhea?

A

Campylobacter, shigellae, E. coli, vibrio para, vibrio vulnificus, salmonella, yersinia, Amebic

49
Q

What is best initial and most accurate diagnostic test for infectious diarrhea?

A

Fecal leukocytes (best initial) and stool culture (most accurate)

50
Q

What is best diagnostic test for giardiasis?

A

Stool ELISA antigen

51
Q

Vomiting, diarrhea, wheezing, and flushing within 10 minutes of eating tuna, mackerel or mahi-mahi?

A

Scombroid (histamine fish poisoning); treatment with anti histamine like diphenhydramine

52
Q

Why is it always necessary to do bowel biopsy for celiac disease?

A

it is necessary to do biopsy in order to exclude bowel wall lymphoma.

53
Q

How to diagnose tropical sprue? And treatment?

A

Small bowel biopsy showing micro organism. Treatment is with tmp/smx or doxycycline

54
Q

What is lynch syndrome?

A

It is a hereditary nonpolyposis colon syndrome. It involves 3 family members, two generations, one premature (<50)

55
Q

When to start colonoscopy in lynch syndrome?

A

Every 1-2 years starting at age 25.

56
Q

When to start screening in patients with familial adenomatous polyposis?

A

At age 12. Perform colectomy once polyps are found.

57
Q

What is gardener’s syndrome?

A

Presents with benign bone tumours known as osteomas and other soft tissue tumours. Screening similar to FAP.

58
Q

What is Peutz Jeghers syndrome?

A

Presents with melanotic spots on the lips. Hamartomatous polyps throughout the small bowel and colon. Screening similar to FAP.

59
Q

What is contraindicated in diverticulitis?

A

Colonoscopy and barium enema

60
Q

What is the treatment for chronic hepatitis b?

A

“TALITE”

Tenofovir, adefovir, lamivudine, interferon, telbivudine, entecavir

61
Q

Bone de mineralization and RTA?

A

Tenofovir

62
Q

What is treatment of spontaneous bacterial peritonitis?

A

Cefotaxime or ceftriaxone

63
Q

What is the most sensitive imaging modality for detection of primary or metastatic lesions in ZES?

A

Somatostatin receptor scintigraphy

64
Q

What is the imaging of choice for suspected diverticulitis?

A

Abdominal CT scan

65
Q

What is the best management for pain-predominant IBS?

A

antispasmodic meds such as pinaverium, dicyclomine, hyoscyamine

66
Q

how to manage necrotizing pancreatitis?

A

CT abdomen to look for gas; If positive then prompt IV antibiotics are given. If CT results are equivocal then perform aspiration and culture of necrotic pancreatic material. Debridement is done once patient is stable and necrotic material has been encapsulate i.e walled off.

67
Q

How to diagnose for malignant biliary obstruction?

A

RUQ ultrasound or Abdominal CT; Tumor markers (CEA, CA-19, AFP);
Cholangiocarcinoma (CEA and CA-19 increase; AFP normal); Liver cancer (CEA, CA-19, AFP are increased)

68
Q

Management for blunt abdominal trauma (BAT)?

A

Management depends on hemodynamic status. Do FAST first; if pt is unstable then emergent surgery; if pt is stable then CT abd/pelvis for source of bleeding

69
Q

Signs of unstable AAA?

A

Flank/groin/abdominal pain; pulsatile mass; flank ecchymosis; limb ischema

70
Q

How to confirm the diagnosis of unstable AAA?

A

Abdominal CT scan

Internal Medicine - MCCQE 1 (13 decks)

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