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ABR > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Intermittent dysphagia to solids and liquids

Chest pain

A

Diffuse esophageal spasm

Barium swallow will show corkscrew esophagus

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2
Q

Management for lower esophageal (Schatzki’s) ring

A

Pneumatic dilatation

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3
Q

Management for achalasia

A

Surgical myotomy

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4
Q

Intervention to R/o psuedoachalasia

A

EGD

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5
Q

Food impaction
Stacked concentric rings
Biopsy reveals +eosinophils

A

Eosinophilic esophagitis

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6
Q 
HIV+
EGD with
1) large ulcer 
2) multiple small ulcers
3) multiple white plaque like lesions
A

1) CMV
2) Herpes
3) candida

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7
Q

Diagnosing esophageal rupture

A

Gastrograffin swallow study

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8
Q

Hypochlorhydria

EGD with striking involvement of gastric folds or rugae

A

Menetrier disease

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9
Q

Treatment for H. Pylori

A

14 days of

PPI, Amoxicillin, Clarithomycin

OR

Metronidazole, Omeprazole, Clarithromycin

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10
Q

Recurrent h. Pylori despite triple therapy

A

Tetracycline
Metronidazole
Bismuth salicylate
PPI

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11
Q

Diagnosing Zollinger-Ellison syndrome

A

Elevated fasting gastric

If not diagnostic, then IV secretin
» increase gastric > 1000

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12
Q

Gastric varies alone

Gastric and esophageal varies

A

Splenic v thrombosis

Cirrhosis

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13
Q

Management for postprandial dumping 15 min after with palpitations, Sweating, low BP

A

High fiber, complex carbs, protein rich foods

Rapid emptying

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14
Q

Management for postprandial dumping/hypotension > 90 min later with palpitations, tachycardia, confusions

A

Frequent small meals, liquid and puréed diet
Complex sugars, low fiber, increased protein

(Hypoglycemia)

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15
Q

Post-gastrectomy with fat and B12 malabsorption

A

Blind loop syndrome with bacterial overgrowth

Deconjugation of bile salts&raquo_space; steatorrhea

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16
Q

Next step in management after stabilizing patient with ascending cholangitis with Abx and IVF

A

ERCP

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17
Q

Management for cholodocolithiasis with dilated CBD

A

ERCP followed by cholecystectomy before discharge

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18
Q

Pancreas with Sausage shaped mass
Elevated IgG4

Management

A

Dx: Autoimmune pancreatitis

Tx: steroids

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19
Q

Recurrent pancreatitis
Ventral duct contents flowing normally to major papilla
Dorsal duct dilated and content flowing through minor papilla sluggishly

A

Pancreas divisum

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20
Q

Most important prognostic factor in acute pancreatitis

A

Increase BUN (>19 = poor prognosis)

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21
Q

Pancreatitis
Muscle spasms
Weakness

A

Hypocalcemia

Due to saponification

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22
Q 
Complications of pancreatitis at
2 days
< 2 weeks
1-4 weeks
4-6 weeks
Anytime
A 
2 days: fluid collections
< 2 wks: pancreatic necrosis 
1-4 wks: pseudocyst
4-6 wks: abscess
Anytime: splenic vein thrombosis
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23
Q

Worrisome features on CT scan for pancreatic cyst

A

Solid
Size > 3 cm
Dilated duct > 10 cm
Thickening of cyst

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24
Q

Pancreatic cyst with 2 worrisome

Features on CT scan

A

EUS-FNA

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25
Q

Pancreatic cyst with EUS-FNA confirming 2 worrisome features, but FNA negative

A

Resect

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26
Q

Pancreatic cyst with EUS-FNA negative for worrisome feature

A

MRI in 1 year then q 2 years

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27
Q

2 cm pancreatic cyst lesion on CT

F/u MRI in 1 year shows size change

A

EUS-FNA

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28
Q

Pancreatic cyst with EUS-FMA showing inflammatory cells and RBCs

A

Resect

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29
Q

Pancreatic cyst resected for malignant lesions

A

Repeat MRI q 2 years

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30
Q

Large pancreatic cyst resected but no evidence of malignancy

A

No need for f/u after resection

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31
Q

Best screening tool for IBD

A

Fecal calprotectin

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32
Q

Extraintestinal manifestations that mirror IBD

A

Erythema nodosum
Peripheral arthritis
Pyoderma gangrenosum

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33
Q

Extraintestinal manifestations that DO NOT mirror IBD

A

Sacroiliitis

Primary sclerosing cholangitis

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34
Q

Best treatment for stricture in IBD

A

Surgery

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35
Q

Diarrhea
RLQ mass
Ulcer on tongue

A

Crohn’s disease

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36
Q

Bloody diarrhea

Colonoscopy with erythematous appearance with friable mucosa in distal colon

A

Ulcerative colitis

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37
Q

Diarrheal illnesses that wake patient up at night

A

IBD
Bacterial overgrowth syndrome
Dumping syndromes

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38
Q

Maintenance medication for IBD

A

5-ASA (mesalamine)

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39
Q

Management for immune checkpoint inhibitors induced side effects (I.e. abdominal pain, diarrhea, rash)

A

Hold ICI and start steroids

40
Q

Ulcerative colitis
Jaundice, hepatomegaly
Beading and focal dilatation of biliary tree

A

Primary sclerosing cholangitis

41
Q

Rectal bleed
Tenesmus
Anal fissure
Leg ulcer

A

Ulcerative colitis

42
Q

Diarrhea of > 1L per day

Stool osmotic gap < 50

A

Secretory

43
Q

Diarrhea is < 1L per day

Stool osmotic gap > 50

A

Osmotic

44
Q

Prophylaxis for travelers diarrhea

A

Azithromycin

45
Q

Diarrhea
Seafood
Gram negative, comma-shaped organisms

A

Vibrio parahrmolyticus

46
Q

Diarrhea

T cell < 100

A

Cryptosporidium

47
Q

Diarrhea

T cell < 50

A

CMV

MAC

48
Q

N/V/D
Fish
Perioral parasthesias
Reversal of hot/cold sensation

A

Ciguatera toxin

Large reef fish

49
Q

Fish

Flushing, urticaria, Paresthesias

A

Scombroid poisoning

Histamine build up

50
Q

Fish
Paresthesias, weakness
Ascending paralysis, SOB

A

Tetrodotoxin

Puffer fish

51
Q

Diarrhea
Acute dysentery
Flask-shaped ulcers

A

Amoebic colitis

52
Q

Diarrhea

Turns red with NaOH

A

Laxative abuse

53
Q

Malabsorption

Very high fecal fat

A

Pancreatitis

54
Q

Malabsorption
High fecal fat
Low bile acid

A

Biliary disease

55
Q

Malabsorption
High fecal fat
Low bile acid
Abnormal breath test

A

Bacterial overgrowth

56
Q

Malabsorption
High fecal fat
Abnormal D-xylose

A

Mucosal

Lymphatic

57
Q

Diarrhea
Itching
Anemia

A

Celiac sprue

58
Q

Diagnosing celiac sprue

A

Transglutaminase IgG A Ab

If positive, small bowel biopsy
If negative, HLA DQ2 or 8&raquo_space; gluten challenge 6-8 weeks&raquo_space; repeat serology and biopsy

59
Q

Management for dermatitis herpetiformis

A

Dapson

60
Q

Diarrheal disease most associated with celiac sprue

A

Microscopic colitis

61
Q

Steatorrhea
Macrocytic anemia
Abnormal d-xylose
Flattened villi with lymphocytic and plasma cell infiltrate in the lamina propria

Management

A

Dx: Tropical sprue
Caribbean&raquo_space; B12 def
Asia&raquo_space; folate def

Tx: tetracycline + folic acid

62
Q

Arthritis
Dementia, visual disturbances
Foamy macrophages
PAS +

Management

A

Dx: Whipple’s disease

Tx: ceftriaxone + Bactrim or tetracycline

63
Q

Management for bile acid malabsorption

A

Medium chain triglycerides

64
Q

Management for bacterial overgrowth

A

Rifaximin

65
Q

Postprandial abdominal pain
Fear of eating
Weight loss
Decreased blood flow and atherosclerosis

A

Chronic mesenteric ischemia

66
Q

Sudden onset severe abdominal pain
N/V. Leukocytosis, lieus
Embolism in celiac or SMA

A

Acute mesenteric ischemia

67
Q 
Hematochezia 
Diarrhea
Abdominal pain
Low flow states
Thumbprinting colon
A

Ischemic colitis

68
Q

Post-radiation

Colonoscopy with Friability of mucosa

A

Radiation proctolitis

69
Q

Best management for opioid induced constipation

A

Senna

70
Q

Hepatitis DNA virus

A

Hepatitis B

71
Q

HBsAg +
Anti-HBs -
IgM

A

Acute hepatitis B

72
Q

HBsAg +
Anti-HBs -
IgG
Elevated ALT

A

Chronic Hepatitis B

73
Q

HBsAg +
Anti-HBs -
IgG
Normal ALT

A

Carrier Hepatitis B

74
Q

HBsAg -
Anti-HBs +
IgG

A

Past Hep B infection

75
Q

HBsAg -
Anti-HBs +
No Anti-HBc

A

Post Hep B vaccination

76
Q

HBsAg -
Anti-HBs -
IgG

A

Chronic Hep B
Past Hep B
False +

77
Q

Management for Post Hep B exposure and anti-HBs > 10 U/L or < 10 U/L

A

> 10: reassurance

< 10: HBIG + booster Hep B vaccine

78
Q

Indications for Hep B treatment

A

HBV DNA > 20,000 IU/mL + ALT >2x
HBV DNA > 10 IU/mL + cirrhosis
Any HBV DNA + immunosuppressed

If decompensated cirrhosis, transplant
If HBV DNA > 20,000 IU/mL + ALT 1-2x, biopsy

79
Q

Treatment for HepB

A

Tenofovir or
Entecavir or
Alpha-interferon

80
Q

Treatment for HepB + HIV

A

Tenofovir

81
Q

Adverse effect of interferon

A

Thyroid disease

82
Q

Prevention of neonatal Hep B in Hep B mother

A

Treat mother with Tenofovir and give newborn Hep B vaccine and HBIG

83
Q

Hep C Ab +
HCV RNA -
IGRA +

A

No Hep C

84
Q

HBc IgM + Hep D

A

Acute coinfection

Doesn’t make hepatitis worse

85
Q

HBc IgG + Hep D

A

Acute superinfection

Can cause fulminant hepatitis

86
Q

Elevated ALP
AMA +
Granulomas/Lymphocytic destruction of bile ducts

A

Primary Biliary cholangitis

87
Q

Smooth muscle Ab +

Piecemeal necrosis characteristic on biopsy

A

Autoimmune hepatitis

88
Q

Elevated ALP
Normal ALT
Inflammation with concentric fibrosis around bile ducts

A

Primary sclerosis cholangitis

89
Q

Screen for HCC

A

Liver US

90
Q

R/o HCC

A

Triple phase CT

91
Q

Management for MELD < 14

MELD > 15

A

< 14: TIPS

> 15: Transplant

92
Q

SAAG > 1.1

Total ascites protein > 2.5
< 2.5

A

Portal hypertension

> 2.5: RHF or Hep v thrombosis
< 2.5: Cirrhosis or portal v thrombosis

93
Q

SAAG < 1.1

Total ascites protein > 2.5
< 2.5

A

> 2.5: Pancreatitis, TB, peritoneal carinomatosis

< 2.5: Nephrotic syndrome

94
Q

Low serum ceruloplasmin
High urine copper level
Copper deposition in liver

A

Wilson disease

95
Q

Pregnant
Elevated transaminases
Coagulopathy
Increased Dbili and Ammonia

A

Acute fatty liver of pregnancy

ABR (12 decks)

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