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USMLE Step 2 - Top 5% > Gastroenterology 💩 > Flashcards

Gastroenterology 💩 Flashcards

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USMLE® Step 1 flashcards
1
Q

Mx for acute fatty liver disease of pregnancy

A

delivery

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2
Q

Dx this:
Patient with bowel issues, having to strain for poo, and rectal fullness. Have white mucopurulent discharge from anus, but no perianal issues. Patient is 23 years old, and has a new male partner

A

Neisseria G proctitis

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3
Q

Dx and Tx for Neisseria G proctitis

A

NAAT of discharge and Doxy Foxy

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4
Q

gastric cancer general signs

A

mild/vague epigastric pain/fullness. worse when eating. weight loss. can be seen with dysphagia if proximal

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5
Q

When do we do the prophylactic proctocolectomy in FAP

A

late teens, early 20’s. Or if there is CRCA or high grade dysplasia

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6
Q

who goes directly to an endoscopy for esoph CA check

A

above 50 and alarm symptoms (weight loss, occult bleeding, early satiety)

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7
Q

what should a young/low risk patient with esophageal symptoms have done before an endoscopy

A

esophagram

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8
Q

failure to thrive definiton on growth charts

A

weight deceleration crossing two or more major percentiles (50, 25, 10 etc.)

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9
Q

Tx for biliary atresia

A

Kasai (hepatoportoenterostomy)

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10
Q

Gold standard to Dx biliary atresia

A

intraoperative cholangiography

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11
Q

Mx of wound dehiscence and evisceration

A

emergency Sx to prevent strangulation

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12
Q

when are abdominal binders used in the setting of wound dehiscence

A

prior to Sx (not long term), but are CI’d in high risk wounds

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13
Q

mx of superficial wound dehiscence. what can we give to prevent high risk wounds from dehiscence

A

wound packing and saline gauze. Negative pressure dressings can prevent dehiscence

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14
Q

if suspect perf of viscus, and the CXR is negative… order what?

A

CT (can detect smaller air releases). unless patient is unstable…. go straight to surgery anyway

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15
Q

first invx for infected necr. pancreatitis? if that is equivocal?

A

CT (see the necro and gas produced), or aspirate and culture if CT equivocal

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16
Q

Dx of colonovesical fistula

A

CT with rectal or oral contrast

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17
Q

New onset of constipation in >50 year old woman… with early satiety and distension. must do what?

A

Pelvic US to rule out ovarian CA. Obviously do colonoscopy to rule out CRCA too

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18
Q

GI Bleed and Hb less than X, or less than Y if unstable. Then transfuse

A

X = 7
Y = 9

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19
Q

Quick neonatal bilious emesis algorithm

A
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20
Q

Hirshsprungs disease Dx steps

A

Would do X-ray first (see obstruction). Then an upper GI contrast series. Then our suction biopsy

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21
Q

Good tests to do to rule out fictitious diahrrea

A

Stool osm, osm gap, stool electrolytes

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22
Q

Best nutrition for patient with moderate to severe burns

A

Best give enteral within 24 hours. Due to hyper metabolic syndrome. Helps keep intestinal intergrity and reduced risk of sepsis compared to parenteral

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23
Q

Biliary atresia invx to diagnose (two answers to this according to UW)

A

Liver biopsy. But intraoperative cholangiography is diagnostic

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24
Q

Ascites with paracentesis yielding multiple bloody aspirates…. Highly suggest what?

A

HCC

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25
Q

If a patient <45 comes with blood on toilet paper after poo. No other symptoms. How to Mx

A

Do anoscopy, to check for likely hemorrhoids/fissure, and to rule our unlikely polyp/cancer. Do colonoscopy if cannot find cause. Straight o colonoscopy if >45 or has alarm symptoms

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26
Q

XRay differences between SBO and ileus

A

Ileus: no air fluid levels and generally dilation of all bowel.
SBO: air fluid levels and area of decompression

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27
Q

Mx of post op ileus

A

Fluids and bowel rest/observe

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28
Q

Management of neonatal umbilical hernia

A

Observation only…. Elective Sx at 5 years old.

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29
Q

Tx for umbilical granuloma

A

Topical silver nitrate

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30
Q

Dx this:

Sudden abdomen pain in adolescent. Was doing sport. Abdomen distended. Signs of shock. Free fluid in abdomen. Mild anemia.

A

Splenic rupture

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31
Q

Main risk factors for sigmoid volvulus

A

Chronic constipation (causes sigmoid redundancy). And neurogenic bowel conditions

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32
Q

Treatment for giardia (consider 1st line, best for kids and preg)

A

1st: tinidazole or nitazoxanide
Kids: metro
Preg: paromomycin

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33
Q

What is pseudoachalasia

A

A Halas is like symptoms, abused instead by obstruction (like CA)

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34
Q

In achalasia suspicion case… once done barium swallow, what other two invx should be done and why?

A

Manometry (confirms diagnosis), and endoscopy to rule out pseudoachalasia

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35
Q

Go through dyspepsia work up

A

> =60 or alarm symptoms, patient should have EGD. If below 60 and no alarm symptoms, patient can do H pylori test. If h pylori negative, we can do trial of PPIs.

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36
Q

Name causes of elevated SAAG ascites and lower SAAG ascites

A

High: HF, Budd chiari, cirrhosis. Low: Tb, malig, nephrotic syndrome

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37
Q

Indications to do liver transplantation in paracetamol overdose

A

If severe ALF, which looks like it’s not improving. Generally signs of hepatica enceph (grade III, IV). High Cr > 3.4, PT > 100,

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38
Q

Mx of ischmeic colitis

A

Conservative (Iv fluids, Abx, bowel rest. Resection if perf or necr

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39
Q

Patient with cholecystectomy signs and crepitus in RUQ/ air in GB wall on US

A

Emphysetmous cholecystectomy

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40
Q

Can we liver transplant in Colon mets to liver

A

No…. It’s a CI

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41
Q

Can we ruse radioTx in cancer proximal to the rectum

A

No, due to increase risk of enteritis

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42
Q

Should exclusively breastfeed until…?

A

6 mo

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43
Q

If you exclusively breastfeed, you are at risk of …..? Deficiency

A

Vit D

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44
Q

All infants are at risk of what deficiency, especially if drink too much cows milk

A

Iron

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45
Q

Hemochromatosis sus patient… with ferritin above 1000…. How to mx

A

Phlebotomy. Don’t wait for HFE mutation check.

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46
Q

Drugs causing pancreatitis

A

Furosemide, thiazide, sulfadiazine (sulfas)

Azathioprine, didanosine, metronidazole, tetracycline

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47
Q

Refeeding syndrome Tx

A

Aggressive repletion of electrolytes.

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48
Q

Optimal form of nutrition for critically ill patients?

A

Enteral, via tube. Not parenteral, due to increase infx risk and gut mucosal atrophy

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49
Q

What is intrahepatic cholestasis of pregnancy, and why is it risk to baby

A

Due to high estrogen, there is more bile stasis. Risky in older women. Bile salts cross the placenta and are toxic to baby….. so Tx with URSO, anti H, deliver at 37

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50
Q

Women with other AI, has lost prandial pain and fullness. Maybe some anemia signs

A

AI gastritis … not always abvious b12 def

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51
Q

Dx this

Girl with recurrent committing episodes. Has then in clusters…. 100% ok between episodes. Mum has migraines. Serious diseases excluded

A

Cyclical vomiting syndrome

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52
Q
A

Hard to tell!!

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53
Q

Why is is impossible for infants to get c diff infx

A

Neonates are often colonized with C difficile but do not develop symptomatic disease due
to absent intestinal receptors to the bacterial toxins.

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54
Q

If GB perforates, does it cause free air under diaphragm

A

No. GB doesn’t really have much gas in it

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55
Q

Mx overview on necrotising enterocolitis

A

To start
Discontinuation of enteral feeds
• Nasogastric decompression
interventions • Blood cultures & empiric antibiotics
Intravenous fluid repletion

Monitoring
• Serial complete blood count & electrolytes
• Serial abdominal examinations & imaging

Indications for surgery
• Bowel perforation (pneumoperitoneum)
• Clinical deterioration despite medical management (suggestive of bowel necrosis)

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56
Q

Name some Alarm features, that would make you want to do a further work up in IBD

A

Older age of onset (≥50)
Gastrointestinal bleeding
Nocturnal diarrhea
Worsening pain
• Unintended weight loss
• Iron deficiency anemia
• Elevated C-reactive protein
• Positive fecal lactoferrin or calprotectin
• Family history of early colon cancer or IBD

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57
Q

Drugs causing pancreatitis. Generally is this pancreatitis severe or mild

A
  1. Diuretics (furosemide, thiazides)
  2. Drugs for inflammatory bowel disease (sulfasalazine, 5-ASA)
  3. Immunosuppressive agents (azathioprine)
  4. HIV-related medications (didanosine, pentamidine)
  5. Antibiotics (metronidazole, tetracycline)

And CS

Mild

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58
Q

Diverticulosis on right or left… which causes more bleeding

A

Diverticulosis is most common in the sigmoid colon, but diverticular bleeding is more common in the right colon.

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59
Q

Massive lower GI bleed… in old patient. What is he most likely cause

A

Diverticula bleed

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60
Q

Burn injury nutrition

A

Enteral ASAP. unless hemodynamic ally unstable, since low BF to GI tract is a CI

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61
Q

Signs an symptoms of rectal prolapse

A
  • Abdominal discomfort
    • Straining or incomplete bowel evacuation, fecal incontinence
    • Digital maneuvers possibly required for defecation
  • Erythematous mass extending through anus with concentric rings (full-thickness
    prolapse) or radial invaginations (non-full-thickness prolapse)
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62
Q

Why are ACE inhibitor s CId in cirrhosis patients

A

Patients with cirrhosis have low mean arterial pressure due to splanchnic vasodilation and are
dependent on the renin-angiotensin-aldosterone system to help normalize blood pressure and renal
perfusion.

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63
Q

How long does it take usually for achalasia to present fully

A

patients with achalasia have symptoms for approximately 5 years before receiving a diagnosis,

Crazy right

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64
Q

Everyone with likely achalasia… needs what invx? And why?

A

Endoscopic evaluation can differentiate between achalasia and pseudoachalasia. In achalasia, this
evaluation usually shows normal-appearing esophageal mucosa and a dilated esophagus with possible residual material; in addition, it is generally possible to easily pass the endoscope through the lower esophageal sphincter. All patients need this

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65
Q

Diagnostic requirements of Acute liver failure

A
  • Severe acute liver injury (ALT & AST often >1,000 U/L)
    • Signs of hepatic encephalopathy (eg, confusion, asterixis)
  • Synthetic liver dysfunction (INR≥1.5)
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66
Q

Abdomen structure Tx

A

Sx resect

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67
Q

Red flags for underlying issue in intuss

A

Recurrent
Atypical location
Atypical age
Persistent bleed

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68
Q

Most common cause of intuss, not peyers patches hypertrophy

A

Mekels diverticulum

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69
Q

Mx overview for sigmoid volvulus

A

Flexible sigmoidoscopy (therapeutic), then elective colectomy to prevent recurrent.
Emergency surgery if perf or peritonitis.

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70
Q

Blunt abdominal trauma:

Why do non peritonitis/stable patients do CTAP after positive FAST

A

A positive FAST strongly suggests intraabdominal injury. In stable patients, there is time to pursue more definitive imaging (eg, CT scan) to visualize the site and extent of injury. In contrast, HDUS
patients with a positive FAST require immediate laparotomy.

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71
Q

Some not so known symptoms of Zenker

A

Undirected food regurgitate. This food is often regurgitated later and appears undigested because it has not been exposed to gastric enzymes. Aspiration of the regurgitated food may lead to recurrent aspiration pneumonia.

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72
Q

What are the causes of traction diverticula of the mid esophageal diverticula

A

Chronic inflammation in the mediastinum (eg, due to tuberculosis or fungal infections) can lead
to the formation of midesophageal diverticula due to the pull (traction) of adjacent scar

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73
Q

Pancreatic cancer and Jaundice, first invx

A

US, then do CT. CT straight away if no jaundice

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74
Q

How can baclofen help in alcoholics

A

Baclofen has been shown to decrease alcohol cravings in patients with alcoholic liver disease and can help with cessation.

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75
Q

Choledochocele triad, and why does it cause high bilirubin

A

Abdomen pain, palpable mass, jaundice. The main duct (unified CBD and pancreatic duct) is abnormally long and prone to plugging

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76
Q

Dx and Tx of food induced allergic proctocolitis

A

Clinical diagnosis confirmed by symptom resolution after protein elimination
• Breastfed infants: restrict dairy (‡ soy) from maternal diet
• Formula-fed infants: switch to hydrolyzed formula

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77
Q

Risk factors for C diff

A

Recent antibiotic use or
hospitalization
• Advanced age (>65)
• Gastric acid suppression (eg,
PPl, H2 blocker)
• Underlying inflammatory bowel
disease
• Chemotherapy

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78
Q

How and how often do we screen in cirrhosis patients

A

Abdominal US very 6mo to check for HCC

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79
Q

Risks of UC on preg? Are usually Tx safe?

A

preterm delivery and small for gestational age. Usual Txs are safe. UC will worsen in preg, so make sure it’s Managed well

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80
Q

Three ways battery can cause esoph erosion

A

Button batteries create an external current that can lead to tissue corrosion. In addition, leaking alkaline battery solution causes liquefaction necrosis of surrounding mucosa. As with any lodged object, pressure necrosis can also occur because of local inflammation and ischemia.

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81
Q

When are Balloon tamponade with the Sengstaken-Blakemore, Minnesota, or Linton-Nachlas tubes used in upper GI bleed

A

Balloon tamponade with the Sengstaken-Blakemore, Minnesota, or Linton-Nachlas tubes can
be used for the temporary control of bleeding when early endoscopy is unavailable or other modalities are unavailable and medical management is unsuccessful. Used until proper intervention can be done, but never first line

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82
Q

When to use contrast angiography for upper GI bleed

A

Contrast angiography should be considered in the small number of patients with UGIB who are
not able to be stabilized sufficiently to undergo upper endoscopy or in whom upper endoscopy is
unsuccessful in controlling hemorrhage.

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83
Q

How does focal nodular hyperplasia present on US

A

imaging will show evidence of increased arterial flow and sometimes a central scar.

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84
Q

Difference between physiological and pathological GERD in infants. How to Mx each

A

• Physiologic
Asymptomatic
“Happy spitter”
Reassurance
Positioning therapy

Pathologic (GERD)
o Failure to thrive
o Significant irritability
o Sandifer syndrome
Thickened feeds
Antacid therapy
If severe, esophageal
pH probe monitoring
& upper endoscopy

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85
Q

What is sandifier syndrome

A

Infants with GERD, and intermittent opisthontonic posturing

86
Q

Goats milk for infants, issue?

A

Goat milk is deficient in folate and would result in a macrocytic anemia.

87
Q

Stress ulcer Tx? And when to do prophylaxis for ICU patients

A

Prophylactic acid suppressive agents (eg, proton pump inhibitors
[PPls], H2 blockers) are a mainstay in the prevention of stress ulcerations. However, they are typically
reserved for high-risk patients (eg, bleeding diathesis, prolonged mechanical ventilation, recent Gl bleed) due to the potential harms associated with these agents, including pneumonia and Clostridiodes (formerly Clostridium) difficile infection. Patients who develop ulcerations should receive PPl and close monitoring; endoscopy may be required in those with clinically significant bleeding.

88
Q

How to screen patients with first degree relative with CRCA. Consider if relative was above or below 60 years old

A

relative’s CRC was diagnosed at an early age (ie, <60), the patient’s screening colonoscopy should
be repeated every 5 years. If the relative’s CRC was diagnosed at a later age (ie, ≥60) and the patient has a normal initial colonoscopy, the patient has only a nominally increased risk for CRC and may undergo repeat screening as for an average-risk patient.

89
Q

Other than colonoscopy, which other test has good sensitivity to screen for CRACA

A

FIT-DNA

90
Q

Meconium ileus vs hirschorungs on X-ray

A

Meconium ileus has micro colon and hirschprungs has megacolon

91
Q

What screening to cirrhosis patients need

A

all patients with cirrhosis should undergo screening endoscopy to exclude varices, determine risk of variceal hemorrhage, and indicate strategies for prevention of hemorrhage. And need US of liver

92
Q

When is large volume paracentesis done for ascites

A

Large- volume therapeutic paracentesis is indicated in case of respiratory compromise or significant abdominal discomfort

93
Q

When is TIPS indicated in varies/ascites

A

A transjugular intrahepatic portosystemic shunt is often used as salvage therapy in patients
with refractory ascites or esophageal varices who have failed endoscopic or medical management.

94
Q

Hepatic hydrothroax usually on which side

A

Right

95
Q

Why is AST so much higher than ALT in alcoholic cirrhosis

A

A ratio of AST to ALT >2 (thought to be due to hepatic deficiency of pyridoxal 5’-phosphate, an ALT enzyme cofactor)

96
Q

Three main causes of super high ALT and AST

A

If marked elevations (>25 times the upper limit) of AST and ALT are present, toxin-
induced (eg, acetaminophen), ischemic, or viral hepatitis should be suspected.

97
Q

Triggers for microscopic colitis

A

Smoking, medications (eg, NSAIDs, PPIs, SSRIs, ranitidine)

98
Q

Mx of splenic rupture (consider if stable of unstable)

A
  • Catheter-based angioembolization (stable patients)
    • Emergency splenectomy (unstable patients)
99
Q

Malrotation of small intestine can cause which two complications

A

Volvulus (intermittent or complete), Ladd band obstruction

100
Q

Omphalocele and malroation linked?

A

Yes, they occur at the same stage, so they can be seen at high incidence together

101
Q

Risk factors for incisional hernia after surgery

A

Obesity
Tobacco smoking
Poor wound healing (eg, immunosuppression, malnutrition)
Vertical or midline incision
Surgical site infection

102
Q

Time frame for acute organ rejection

A

Less than 3 mo

103
Q

How long after abdominal trauma does it take for duodenal hematoma to present

A

As the hematoma progressively expands over the subsequent 24-48 hours, partial or
complete obstruction of the duodenal lumen can develop.

104
Q

Overview of RFs for c diff
Recent antibiotic use or
hospitalization
Risk factors
• Advanced age (>65)
Gastric acid suppression (eg,
PPI, H2 blocker)
• Underlying inflammatory bowel
disease
Chemotherapy

A
105
Q

Why is barium enema contraindicated if perforation sus

A

Because it can leak into the abdomen and is toxic

106
Q

What invx to order if sus perf, but X-ray equivocal

A

Order CT abd

107
Q

How can diverticulitis cause urine leuk esterase positive

A

Bladder symptoms (eg, urgency, frequency, dysuria) or sterile pyuria (eg, positive leukocyte
esterase, negative nitrite/bacteria) due to bladder irritation from adjacent sigmoid colon inflammation

108
Q

Summary of ascites total protein and SAAG can tell us

A

Total Protein low in nephrotic and cirrhosis, due to low protein generally. SAAG > 1.1 tells us it’s portal HTN related.

109
Q

How to confirm a potential spontaneous bacterial peritonitis

A

The diagnosis is confirmed by an absolute polymorphonuclear cell count ≥250/mm?.

110
Q

What colour is the ascitic fluid in bowel perforation

A

Patients typically have brown (bilious) ascites,

111
Q

BUN:Cr >20 can mean what in GI.

A

blood urea nitrogen to creatinine ratio > 20) is consistent with upper gastrointestinal bleeding

112
Q

Hb levels for transfusing GI bleed

A

stable patients without significant comorbid conditions should receive PRBC transfusion for
hemoglobin <7 g/dL. A higher threshold of hemoglobin <9 g/dL can be considered for patients with acute coronary syndrome. If there is big bleed, then can raise threshold a bit, since it can falsely raise the Hb

113
Q

When to transfuse PLT

A

Less than 10, or less than 50 if bleeding

114
Q

How does hitschsprungs present in children, if mild

A

Children/adolescents: Chronic constipation, failure to thrive

115
Q

Further evaluation for IBS with diarrhea or constipation

A

IBS with diarrhea
o Stool cultures
• Celiac disease screening
o 24-hr stool collection
o Colonoscopy or flexible sigmoidoscopy & biopsy

IBS with constipation
• Radiography
• Flexible sigmoidoscopy & colonoscopy

116
Q

Why some patients have recurrent cecal volvulus

A

patients with cecal volvulus tend to be younger and often report prior self-resolving episodes because many have a congenital mobile cecum (ie, mesentery failed to fuse with the parietal peritoneum).

117
Q

X-rays power to Dx sigmoid vs cecal volvulus

A

However, plain radiographs are diagnostic less often in cecal than in sigmoid volvulus, so abdominopelvic CT scan is typically performed.

118
Q

Main difference in Mx for cecal volvulus and sigmoid volvulus

A

Treatment is emergency laparotomy and resection of the volvulized colonic segment (eg, right colectomy). Endoscopic detorsion is not advised (success rate: <5%-20%). Whereas success rates are better for sigmoid endoscopic detorsion

119
Q

Dx this

fever, right upper quadrant pain (which may be severe), leukocytosis,
and elevated liver function studies. The diagnosis is confirmed with abdominal imaging; CT scan
classically demonstrates a well-defined, hypoattenuating, rounded lesion,

A

Liver abscess

120
Q

How can diverticulitis cause liver abcess

A

This patient likely developed the abscess as a result of his recent diverticulitis,
which allowed for the spread of bacteria from the inflamed intestines through the portal circulation.

121
Q

Little pathophys of PAN in terms of arterial damage

A

PAN causes segmental, transmural inflammation in the arterial wall
and damages the internal and external elastic laminae, which results in arterial lumen narrowing and
microaneurysms.

122
Q

If someone has ascites and in the Q they mention albumin in blood and paracentesiss. Do what?

A

Calc SAAG

123
Q

Discuss mild ulcerative colitis. How it presents, how it’s Treated

A

Clinical features
<4 watery bowel movements per day
• Hematochezia is rare or intermittent

Laboratory findings
• No anemia
• Normal ESR & CRP

Treatment
• 5-Aminosalicylic acid agents (eg, mesalamine,
sulfasalazine) for induction and maintenance

124
Q

Can pancreatic cancer cause gastric outlet obs

A

Yes, it can invade pylorus and stomach

125
Q

Signs of Chronium deficiency

A

Glucose intolerance in DM , and high cholesterol

126
Q

Signs of Cu deficiency

A

Brittle hair
Copper
• Skin depigmentation
• Neurologic dysfunction (eg,
ataxia, peripheral
neuropathy)
• Anemia
• Osteoporosis

127
Q

Selenium deficiency signs

A
  • Thyroid dysfunction
    • Cardiomyopathy
    • Immune dysfunction
128
Q

Mg deficiency signs

A

Alopecia
• Pustular skin rash (perioral
region & extremities)
Crusting skin
Hypogonadism

129
Q

Most common signs of pancreatic cancer

A

Weight loss and fatigue. Then abdomen and back pain. 80% of patients have this.

130
Q

How is dumping syndrome caused. And what is the diagnosis and Mx

A

From bariatric or Nissan Sx. (Pyloric sphincter ducked or vagus snipped)

Clinical diagnosis

Mx
• Small, frequent meals
• Replacement of simple sugars with complex carbohydrates
• Incorporation of high-fiber & protein-rich foods

131
Q

Describe the role of the C. difficile PCR toxin test for Dx

A

Many patients (20%) are carriers of Clostridioides difficile, and false-positive results can occur
with highly sensitive PR tests, which do not differentiate toxin-producing from non-toxin-producing
organisms; testing should be used only in the appropriate clinical context

132
Q

Gamma gap above what is considered big

A

4

133
Q

Are the Transaminases substantially increased in alcoholic hep?

A

No, 200-300. Not >400

134
Q

Crepitus in abdominal wall adjacent to gallbladder and cholecystectomy signs…. Maybe the Dx is?

A

Emphysematous cholecysitis

135
Q

Mx of emphysematous cholecystitis

A
  • Emergency cholecystectomy
    • Broad-spectrum antibiotics with Clostridium coverage (eg, piperacillin-
    tazobactam)
136
Q

Two fun facts for emphysamtous cholecystitis. About bilirubin levels and imaging issues

A

Bilirubin is high due to C. Perfringes causing hemolysis. US becomes less relaible since gas is in the GB

137
Q

First step in patient with mildly high AST/ALT

A

patient’s history, to provide insight as to whether the transaminase elevation
could be caused by alcohol, medications (eg, NSAIDs, antibiotics, HMG-CoA reductase inhibitors,
antiepileptic drugs, antituberculous drugs, herbal preparations), or viral agents.

138
Q

Patient with chronically mildly elevated LFTS, (AST/ALT). What tests should be considered

A

Testing for viral hepatitis B and C, hemochromatosis, and fatty liver should then be undertaken to further evaluate chronically elevated transaminases.

139
Q

How is formula fed infants at increased risk of hypertrophic pyloric sphincter

A

, compared with breastfed infants, formula-fed infants have slower gastric emptying and typically consume more volume in less time. This increased gastric burden may stimulate pyloric muscle growth.

140
Q

How does roux en Y cause stenosis, how would it present, how do we Dx andand Mx

A

(anastomotic) stenosis, caused by progressive narrowing of the GJ anastomosis that leads to obstruction of gastric pouch outflow. This complication usually occurs within the first year. Patients typically have progressive symptoms including nausea, postprandial vomiting, gastroesophageal reflux, and dysphagia, to the point of not tolerating liquids.
Diagnosis requires visualization of the G anastomosis via esophagogastroduodenoscopy (EGD), during
which balloon dilation can be performed to open the narrowing. Patients sometimes require surgical
revision if balloon dilation fails.

141
Q

Red flags for Pediatric constipation

A

Lower extremity neurologic symptoms (eg, weakness) and sacral anomalies (eg, hair tuft) concerning for spinal dysraphism, as well as a history of poor growth. In this case, poor weight gain in the setting of constipation warrants consideration of celiac disease, cystic fibrosis, or hypothyroidism. Poor linear growth, in particular, is concerning for hypothyroidism, which can also present with lethargy, cold intolerance, and dry skin.

142
Q

Mx overview for intuss

A

Retrograde pneumatic (ie, air enema) or hydrostatic (ie, contrast enema) pressure reduces the telescoped bowel in most cases. Laparotomy is indicated if enema reduction is ineffective, if a pathological lead point is identified, or if the patient has signs of perforation (eg, free air
on x-ray, rigid abdomen)

143
Q

Dyspepsia/ulcer pain vs gall stones

A

Ulcer is described as burning (as opposed to dull like gall stones)

144
Q

Vital signs in necr enterocolitis

A

Unstable

145
Q

A false-positive D-xylose test (ie, low urinary D-xylose level despite normal mucosal absorption) can be
seen in the following:

A

• Delayed gastric emptying
• Impaired glomerular filtration
Small intestinal bacterial overgrowth (SIBO), leading to bacterial fermentation of the D-xylose
before it can be absorbed. SIBO is treated with rifaximin; so give that and do the test again

146
Q

We see blood in stool of acute mesnteric ischemia. But is this occult or frank

A

Fecal occult blood testing may
be positive due to friability of ischemic intestinal mucosa, but frank hematochezia is rare until later in the disease course.

147
Q

Symptoms of perirectal fistula

A
  • Perirectal pain, discharge
    • Inflammatory papule/pustule
    • Palpable fistula tract
148
Q

Some random labs findings of acute fatty liver of preg, and the Mx

A

Profound hypoglycemia
• 1Aminotransferases (2-3x normal)
Bilirubin
Thrombocytopenia
Disseminated intravascular coagulopathy

deliver

149
Q

Neuro symptoms in b12 def

A

poor concentration and irritability to depression and dementia.

150
Q

Riboflavin def signs

A

cheilosis, glossitis, and seborrheic dermatitis.

151
Q

Pyridoxine deficiency signs

A

irritability and depression, glossitis,
peripheral neuropathy, and seborrheic dermatitis.

152
Q

General idea to Tx colon cancer with hepatic mets

A

When metastatic spread is confined to the liver, surgical resection of both the hepatic
mass and the primary tumor can be curative,

153
Q

Gastroschisis mx

A

The exposed bowel is covered with sterile saline dressings and plastic wrap immediately after delivery to minimize insensible heat and fluid losses (due to intestinal fluid sequestration). A nasogastric tube is placed to decompress the stomach, antibiotics are administered, and the defect is repaired surgically.

154
Q

Infant dyschezia pathophysiology

A

• Failure to coordinate increased intraabdominal pressure with relaxation of the pelvic floor muscles
- Inadequate abdominal muscle tone to produce an effective Valsalva maneuver

155
Q

Presentation of infant dychezia

A

Crying, turning red in the face, and straining for
greater than 10 minutes, followed by passage of a soft, nonbloody stool. Infants are otherwise well-
appearing with no abnormalities on physical examination.

156
Q

Main cause of death in acute liver failure

A

Cerebral edema is a potential complication of ALF that may lead to coma and brain stem herniation, and is the most common cause of death.

157
Q

E. And P. Effect on gallbladder

A

, estrogen causes an increase in cholesterol secretion and progesterone causes a reduction in
bile acid secretion, causing increased cholesterol saturation of bile. Progesterone also slows gallbladder emptying and thus facilitates the formation of cholesterol gallstones during pregnancy.

158
Q

How to tell clinically if a loop of bowel is in a hernia

A

When a bowel loop is present within the hernia, it is often tympanitic to percussion.

159
Q

Subphrenic abscesses comes from what?

A

Subphrenic abscess (rare) can cause fever and abdominal pain and are complications from perforation peritonitis

160
Q

Neuropsych complications of celiacs

A

Despression, anxiety, neuropathy (peripheral)

161
Q

Why does alkalosis worsen hepatic enceph

A

Metabolic alkalosis (elevated bicarbonate), which can also exacerbate HE as it promotes conversion
of ammonium (NH.*), which cannot enter the CNS, to NH3, which can enter the CNS

162
Q

In theory protein restriction should help hepatic enceph, but it can worsen malnutriton in liver patients. When can we do protein restriction.

A

Protein restriction is generally limited to patients who have required transjugular intrahepatic
portosystemic shunting (TIPS).

163
Q

Can old patients have anemia normally, without pathology

A

Yes, baseline anemia for which no etiology is apparent, the so-called “idiopathic anemia of ageing.”

164
Q

Dx and Mx for SIBO

A

Diagnostic tests include carbohydrate breath tests (eg, lactulose, glucose) that measure the production of
hydrogen and/or methane by intestinal flora. Endoscopy with jejunal aspirate and culture showing
increased bacterial burden (>103 colony-forming units/mL) is the gold standard but invasive. Management
involves empiric antibiotics (g, rifaximin).

165
Q

Presentation of post stomal stenosis

A

typically occurs in the first 1-2 months after gastric bypass surgery, and although it can
cause bloating, it typically presents with dysphagia and vomiting of undigested food rather than with
diarrhea.

166
Q

Minimal bright red bloood per rectum cause

A

most often is due to benign disorders such as hemorrhoids or anal fissures. However, more serious disorders (eg, proctitis, ulcers, colorectal polyps, cancer) are possible.

167
Q

Minimal bright red per rectum Mx. Consider if red flag or not

A

Anoscopy, or colonoscopy if red flags

168
Q

Patient on warfarin. What do to before Op?

A

Stamp warfarin, give PCC (FFP second line), IV vit K

169
Q

Giving PCC is good for how long? And how rapid does it work to correct PCC

A

Works in mins, but lasts hours only

170
Q

Main drawback to FFP over PCC

A

Need more units and increase risk of overload . And needs cross match

171
Q

Heaptorenal syndrome and spont bacterial perontitis (or ascites) recquire which fluids

A

albumin is indicated in the treatment of hepatorenal syndrome or spontaneous bacterial peritonitis.

172
Q

Causes of oropharyngeal dysphagia

A

Underlying etiologies for oropharyngeal dysphagia can include stroke, advanced dementia, oropharyngeal malignancy, or neuromuscular disorders (eg, myasthenia gravis).

173
Q

What medications can increase the risk of megacolon in UC

A

Risk with use of antimotility agents (eg, loperamide) or opioids

174
Q

Contrast symptom timings in proximal and more distil SBO.

A

Complete proximal obstructions are characterized by early vomiting, abdominal discomfort, and abnormal contrast filling on x-ray. Mid or distal obstructions typically present as colicky abdominal pain, delayed vomiting, prominent abdominal distension, constipation-obstipation, hyperactive bowel sounds, and dilated loops of bowel on abdominal x-ray.

175
Q

Maroon coloured stool on right or left colon usually

A

Right

176
Q

In blunt trauma to abd, what can cause a delayed perf

A

• Bowel contusion (eg, thickened [edematous] proximal small bowel on initial CT scan) progressing to
full-thickness injury
• Injured mesenteric vasculature (eg, mesenteric hematoma on initial CT scan) progressing to
ischemia and necrosis

so don’t be too hasty to discharge

177
Q

Secondary lactase deficiency? Last forever?

A

Usually after gastroent, but also after crohns etc. when mucosa heals, it goes away, so no need to H breath test

178
Q

What is FODMAP diet, and where is it used

A

loperamide and the
low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) diet
represent initial steps in the management of irritable bowel syndrome (IBS).

179
Q

Do we see high CRP in celiacs.

A

Rarely

180
Q

Go through PANCREAS mnemonic for pancreatitis severity

A
181
Q

Tx of chemo diarrhoea

A

Management includes oral hydration and antidiarrheal therapy with loperamide or diphenoxylate-
atropine.

182
Q

How to diagnose chemo diarrhea and when to do more tests

A

Clinical Dx, so just Tx with loperamide and if resistant do further stool tests like ac diff

183
Q

What is the ALT, FBC like in Gilbert

A

Normal

184
Q

3 scenarios we do Sx in c diff

A

Signs of peritonitis: Diffuse abdominal tenderness, rebound tenderness (ie, tenderness with release
of palpation pressure)
• Colonic dilation: Megacolon (ie, colonic diameter >6 cm) on abdominal x-ray, with associated loss of
smooth muscular tone (eg, decreased diarrhea)
• Increased serum lactate: Possible marker of colonic ischemia

185
Q

Name some red flags for Pediatric function constipation

A

Delayed passage of meconium
• Fever or vomiting
“Ribbon” stools
• Poor growth
Severe abdominal distension
• Abnormal examination findings (eg, displaced anus, tuft at gluteal cleft)

186
Q

Tx for Pediatric functional constipation

A

1 Dietary fiber & water intake
• Limit cow’s milk (<24 oz/day)
• Laxatives (eg, polyethylene glycol)
• Age-appropriate toileting guidance
• ‡ Enemas/suppositories if severe and chronic

187
Q

Correct amount of milk consume for kids

A

milk is appropriate (16-24 oz daily); my age

188
Q

Risk factors for atraumatic splenic rupture

A

Hematologic malignancy (eg,
leukemia, lymphoma)
• Infection (eg, CMV, EBV, malaria)
• Inflammatory disease (eg, SLE,
pancreatitis)
• Splenic congestion (eg, cirrhosis,
pregnancy)
• Medications (eg, anticoagulation, G-
CSF)

189
Q

What is kehr sign

A

Left shoulder tip referred pain from splenic rupture

190
Q

Blood pressure aims in abdomen trauma and likely hemorrhage

A

With balanced resuscitation, blood products are administered only as needed to maintain a blood pressure (eg,
mean arterial pressure ~65 mm Hg) sufficient for tissue perfusion, until definitive hemorrhage control (eg, surgical
intervention) can be achieved.

191
Q

Urea breath test less spec or sens than stool Ag

A

Less sensitive (bad for me!)

192
Q

Sus viscus perforation but X-ray negative

A

Do CT

193
Q

Mild gastroparesis first line

A

Hydration and small meals

194
Q

Two diabetic drugs to avoid in gastroparesis

A

GLP ag and pramlinitide

195
Q

Bezoar severe… mx?

A

Do endoscopic removal or even Sx

196
Q

Splenic rupture if stable and unstable

A

Stable: angioemb

Unstable: splenectomy

197
Q

VIPoma Ca, glucose, Cl and K levels

A

High calcium and glucose

Low K and Cl

198
Q

How to differentiate stress ulcer from ischaemic colitis.

A

Ischaemic colitis we usually have a greater quantity of blood. And is usually more painful

199
Q

My three causes of super high ALT/AFT

A

 Ischaemic hepatitis, paracetamol, acute hepatitis virus

200
Q

Ophalocele is linked to which obstruction disorder

A

Maltaotion (occur at the same time)

201
Q

Is IBD flare a risk for c diff

A

Yrs

202
Q

Diagnose constipation clinically in a child, what do you do

A

As long as no red flags, just increase fluids and give a laxative. Don’t need to do x-ray

203
Q

Normal amount of milk for an infant

A

24 oz

204
Q

All new Ascites need what to be checked

A

PMN number. If above 250 equals SBP. Don’t always need cytology, amylase, triglyceride. Only do this if suspect

205
Q

Polyarteritis nodosa can cause what GI symptom

A

Mesenteric ischaemia

206
Q
A
207
Q

How can pancreatic cancer cause gastric signs

A

If a Pancreatic cancer Invades the stomach, then it can cause gastric outlet obstruction

208
Q

boerhaave causes FEVER 🥵

A
209
Q

Gamma gap is calculated how. What is the upper limit

A

Total protein minus albumin. Any more than four, this is pathological. Seen an autoimmune hepatitis

210
Q

Treatment of meconium ileus

A

Hyperosmolar enema. Potentially surgical evacuation

USMLE Step 2 - Top 5% (34 decks)

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