Gastroenterology Flashcards
1
Q
Core principle in treating relapsed H. pylori infection
A
Use different antibiotics
MKSAP 20
This approach helps prevent antibiotic resistance.
2
Q
What are the gastric emptying tests?
A
Scintigraphy, wireless capsule, gastric emptying breath test
MKSAP 20
These tests assess how quickly food leaves the stomach.
3
Q
Which infectious agents cause watery diarrhea?
A
C. difficile, viruses, E. coli, cholera, cryptosporidia, G. duodenalis
MKSAP 20
These pathogens are common culprits in gastrointestinal infections.
4
Q
What is the treatment for constipation after ineffective lifestyle and dietary interventions?
A
Bulking agents, stimulant and osmotic laxatives, secretagogues, biofeedback
MKSAP 20
These options can help stimulate bowel movements.
5
Q
What is the treatment for dumping syndrome?
A
Frequent small meals
MKSAP 20
This dietary modification helps manage symptoms.
6
Q
What are the indications for ERCP in chronic pancreatitis?
A
None
MKSAP 20
ERCP is not routinely indicated in chronic pancreatitis cases.
7
Q
What are the SIBO diagnostic criteria?
A
Symptoms plus positive breath test or improvement with empiric treatment
MKSAP 20
These criteria help confirm the diagnosis of small intestinal bacterial overgrowth.
8
Q
What bone test should be considered at the time of celiac disease diagnosis?
A
DXA
MKSAP 20
Dual-energy X-ray absorptiometry (DXA) assesses bone density.
9
Q
What diagnosis is suggested by painless jaundice and a ‘sausage-shaped’ pancreas?
A
Autoimmune pancreatitis
MKSAP 20
This condition can mimic pancreatic cancer but has distinct features.
10
Q
What is the treatment of mild colonic ischemia?
A
Supportive care
MKSAP 20
Management includes hydration and monitoring.
11
Q
What are the indications for drainage of pancreatic pseudocysts?
A
Significant symptoms, infection
MKSAP 20
These factors necessitate intervention to relieve symptoms or prevent complications.
12
Q
Which ARB is associated with celiac-like enteropathy?
A
Olmesartan
MKSAP 20
This medication has been linked to gastrointestinal side effects resembling celiac disease.
13
Q
What diseases are associated with autoimmune gastritis?
A
Pernicious anemia, iron deficiency, SIBO, gastric neoplasms
MKSAP 20
These conditions can arise due to chronic inflammation of the gastric mucosa.
14
Q
What are the most common causes of upper gastrointestinal bleeding (UGIB)?
A
PUD, varices, Mallory-Weiss tears
MKSAP 20
These causes are prevalent in clinical practice.
15
Q
At what age should CRC screening begin if CRC is diagnosed in two first-degree relatives?
A
Age 40 years or 10 years before youngest relative’s diagnosis, whichever is earliest
MKSAP 20
This guideline helps catch colorectal cancer early in high-risk individuals.
16
Q
What is the supporting test for GERD extraesophageal manifestations?
A
Ambulatory pH monitoring off acid-suppressive therapy
MKSAP 20
This test helps identify acid reflux contributing to non-esophageal symptoms.
17
Q
What is the most common cause of small-bowel bleeding?
A
Angiodysplasia
MKSAP 20
This vascular abnormality often leads to gastrointestinal hemorrhage.
18
Q
What are the indications for H. pylori testing?
A
Active PUD, PUD history without documented H. pylori cure, MALT lymphoma, endoscopic resection of early gastric cancer
MKSAP 20
Testing is crucial in these clinical scenarios to guide treatment.
19
Q
Which bowel segment is most commonly affected in Crohn disease?
A
Ileocecal area
MKSAP 20
This region is frequently involved in inflammatory bowel disease.
20
Q
What is the treatment for all patients with Barrett esophagus?
A
PPI and lifestyle changes (smoking cessation, weight loss)
MKSAP 20
These interventions help manage the condition and reduce cancer risk.
21
Q
What is the initial test for fecal incontinence?
A
Rectal examination
MKSAP 20
This assessment is critical in evaluating anal function.
22
Q
What is the timing of colonoscopy after removal of 3-4 adenomas <10 mm?
A
3-5 years
MKSAP 20
Follow-up colonoscopies are essential for monitoring polyp recurrence.
23
Q
What diagnosis is suggested by dysphagia to solids alone?
A
Mechanical obstruction
MKSAP 20
This symptom typically indicates a physical blockage in the esophagus.
24
Q
What is the gold standard celiac disease diagnostic test?
A
Duodenal biopsy
MKSAP 20
This procedure confirms the diagnosis by assessing intestinal damage.
25
What are the IBS dietary restrictions?
Avoidance of trigger foods, gluten, dairy, and FODMAPs
| MKSAP 20
## Footnote
These dietary changes can alleviate symptoms for many patients.
26
Infectious agents causing dysentery or bloody diarrhea
Campylobacter, hemorrhagic E. coli, E. histolytica, Shigella, Salmonella
| MKSAP 20
## Footnote
These agents are important to consider in differential diagnoses of gastrointestinal infections.
27
Acute anal fissure treatment
Sitz bath and bulk laxatives
| MKSAP 20
## Footnote
Sitz baths help relieve pain and promote healing, while bulk laxatives prevent straining.
28
Most common causes of chronic diarrhea
IBS-D, functional causes, medications
| MKSAP 20
## Footnote
Understanding these causes is crucial for effective management of chronic diarrhea.
29
Transfusion threshold for UGIB in stable patient without CVD
7 g/dL
| MKSAP 20
## Footnote
This threshold helps guide transfusion decisions in acute gastrointestinal bleeding.
30
Role of routine antibiotics in acute pancreatitis
None
| MKSAP 20
## Footnote
Antibiotics are not recommended unless there is an infection.
31
Indications for repeat endoscopy for gastric ulcer
Persistent symptoms, ulcer of unknown cause, no biopsy at initial endoscopy
| MKSAP 20
## Footnote
Repeat endoscopy is vital for management and surveillance.
32
Role of systemic glucocorticoids in IBD
Induction of remission, not maintenance therapy
| MKSAP 20
## Footnote
They are effective in managing flare-ups but not for long-term control.
33
Recommended surveillance in serrated polyposis syndrome
Colonoscopy every 1-3 years, removal of polyps >5 mm
| MKSAP 20
## Footnote
This protocol helps reduce the risk of colorectal cancer.
34
Preferred diagnostic tests in LGIB with instability or rapid ongoing bleeding
CTA; immediate upper endoscopy if no source on CT
| MKSAP 20
## Footnote
These tests aid in quick diagnosis and management of lower gastrointestinal bleeding.
35
Diagnosis suggested by postprandial vasomotor symptoms, abdominal cramping, diarrhea
Dumping syndrome
| MKSAP 20
## Footnote
This condition is often seen after gastric surgery.
36
Crohn disease colonoscopy finding
Mucosal inflammation with skip areas
| MKSAP 20
## Footnote
Skip lesions are characteristic of Crohn's disease, distinguishing it from ulcerative colitis.
37
Angiographic findings suggesting chronic mesenteric ischemia
>70% stenosis of two of three mesenteric arteries
| MKSAP 20
## Footnote
This finding indicates significant vascular compromise.
38
Colonoscopy timing after acute diverticulitis
6-8 weeks after symptom resolution
| MKSAP 20
## Footnote
This timing allows for healing and better visualization.
39
Measures to prevent acute diverticulitis recurrence
High-fiber diet; lifestyle changes; avoidance of NSAIDs, glucocorticoids, opioid analgesics
| MKSAP 20
## Footnote
These interventions are essential for prevention.
40
Age to initiate screening for gastric cancer in Lynch syndrome
30-40 years
| MKSAP 20
## Footnote
Early screening is critical due to the increased risk in this population.
41
Secondary drug prophylaxis for variceal bleeding
Nonselective β-blockers (propranolol, nadolol, preferably carvedilol)
| MKSAP 20
## Footnote
These medications help reduce the risk of bleeding from varices.
42
Diagnosis suggested by moderate cramping pain followed by bloody diarrhea
Colonic ischemia
| MKSAP 20
## Footnote
This presentation warrants immediate evaluation due to potential complications.
43
Preferred diagnostic test in stable LGIB without rapid bleeding
Colonoscopy
| MKSAP 20
## Footnote
It allows for direct visualization and potential intervention.
44
Colorectal cancer screening frequency in IBD
8 years after diagnosis, every 1-2 years
| MKSAP 20
## Footnote
Increased surveillance is necessary due to heightened cancer risk.
45
IBS-C first-line treatment
Polyethylene glycol
| MKSAP 20
## Footnote
This osmotic laxative is effective for constipation-predominant IBS.
46
Age to begin CRC screening if CRC diagnosed in first-degree relative age <60 years
Age 40 years or 10 years before relative's diagnosis, whichever is earliest
| MKSAP 20
## Footnote
Early screening is crucial for those with family history.
47
Preferred agent for preventing NSAID-related upper GI complications
PPIs
| MKSAP 20
## Footnote
Proton pump inhibitors are effective in reducing the risk of ulcers.
48
Diagnoses to exclude in suspected IBS-D
Giardiasis, celiac disease, IBD
| MKSAP 20
## Footnote
These conditions can mimic IBS-D and require different management.
49
Treatment of chronic pancreatitis steatorrhea
Pancreatic enzymes
| MKSAP 20
## Footnote
Enzyme replacement therapy is essential for nutrient absorption.
50
Colonic ischemia imaging
Abdominal CT
| MKSAP 20
## Footnote
This imaging modality is helpful in diagnosing colonic ischemia.
51
First test to evaluate dyspepsia in patients age <60 years
Noninvasive H. pylori testing
| MKSAP 20
52
Diagnosis to exclude in achalasia
Tumor at GE junction (pseudoachalasia)
| MKSAP 20
53
Most common cause of acute pancreatitis
Biliary disease, including gallstones, biliary sludge, and biliary crystals
| MKSAP 20
54
Treatment duration of PPI in uncomplicated GERD
8 weeks; then lowest dose possible with annual attempt to discontinue
| MKSAP 20
55
Diagnosis suggested by continuous colonic inflammation beginning at anorectal verge, extending proximally
Ulcerative colitis
| MKSAP 20
56
Diagnostic criteria for Candida esophagitis
Symptoms plus oral candidiasis
| MKSAP 20
57
Adjunctive drug treatment for patients with cirrhosis and upper GI bleeding
Antibiotics
| MKSAP 20
58
H. pylori eradication tests
Urea breath test, fecal antigen test, or gastric biopsy
| MKSAP 20
59
Factors suggesting an upper GI source of hematochezia
Melena, liver disease, hemodynamic instability
| MKSAP 20
60
Symptoms and signs of pancreatic cancer
Abdominal pain, back pain, weight loss, jaundice, new-onset diabetes mellitus
| MKSAP 20
61
Preferred test for histologic confirmation of pancreatic cancer
Endoscopic ultrasonography–guided FNA biopsy
| MKSAP 20
62
Initial diagnostic imaging test in acute pancreatitis
Abdominal ultrasonography
| MKSAP 20
63
Preferred celiac disease screening test
Anti–tissue transglutaminase IgA antibody
| MKSAP 20
64
Indications for upper endoscopy for dyspepsia
Age ≥60 years
| MKSAP 20
65
Treatment for gastric adenoma and large gastric hyperplastic polyp
Resection
| MKSAP 20
66
Endoscopy timing for rapid UGIB
Within 12 hours of presentation
| MKSAP 20
67
Most common causes of PUD
NSAIDs and H. pylori
| MKSAP 20
68
Gastroparesis drug treatment
Metoclopramide
| MKSAP 20
69
Indications for surgical treatment of GERD
Failure of PPIs, desire to stop PPI, intolerable PPI adverse effects
| MKSAP 20
70
Indications for surgery in Crohn disease
Medically refractory fistula, fibrotic stricture with obstructive symptoms, refractory symptoms, cancer
| MKSAP 20
71
Confirmatory tests for SIBO
Small-bowel aspirate culture, carbohydrate substrate–based breath testing
| MKSAP 20
72
Key lifestyle modifications in chronic pancreatitis
Smoking cessation, alcohol abstinence
| MKSAP 20
73
Endoscopic findings in eosinophilic esophagitis
Rings and furrows, luminal narrowing
| MKSAP 20
74
Preferred diagnostic test for acute mesenteric ischemia
CTA
| MKSAP 20
75
Adjunctive therapies for short bowel syndrome
Loperamide, PPI
| MKSAP 20
76
Treatment for moderate to severe Crohn disease in patients with high-risk disease or severe disease activity
Anti-TNF agents
| MKSAP 20
## Footnote
Anti-TNF agents are biologic therapies that target tumor necrosis factor, a key player in inflammation.
77
Empiric therapy for functional dyspepsia
PPI
| MKSAP 20
## Footnote
Proton pump inhibitors are used to reduce stomach acid and help alleviate symptoms.
78
Colitis with symptoms similar to IBS and celiac disease
Microscopic colitis
| MKSAP 20
## Footnote
Microscopic colitis is characterized by inflammation visible only under a microscope.
79
Laboratory test that may help distinguish IBD from IBS
Elevated fecal calprotectin
| MKSAP 20
## Footnote
Fecal calprotectin is a marker of intestinal inflammation.
80
Timing of next colonoscopy after removal of adenoma ≥10 mm
3 years
| MKSAP 20
## Footnote
Follow-up colonoscopy is recommended to monitor for recurrence.
81
Effect of tobacco use on IBD risk
Increased Crohn disease risk, decreased ulcerative colitis risk
| MKSAP 20
## Footnote
Tobacco smoking has a complex relationship with different types of IBD.
82
Diagnosis suggested by dysphagia to liquids
Motility disorder
| MKSAP 20
## Footnote
Dysphagia can indicate problems with esophageal motility.
83
Test required before thiopurine use
TPMT genotype or phenotype assay
| MKSAP 20
## Footnote
Thiopurines can cause myelosuppression, so TPMT testing is crucial.
84
Celiac disease treatment
Lifelong avoidance of wheat, rye, and barley
| MKSAP 20
## Footnote
This is essential to manage symptoms and prevent intestinal damage.
85
Age and interval for CRC screening in classic FAP
Age 10-15 years, repeated annually
| MKSAP 20
## Footnote
Classic familial adenomatous polyposis (FAP) necessitates early and regular screening.
86
IBS-D antibiotic treatment
Rifaximin
| MKSAP 20
## Footnote
Rifaximin is an antibiotic effective in treating IBS-D symptoms.
87
Serologic test for celiac disease in IgA deficiency
Anti–deamidated gliadin peptide IgG antibodies or tissue transglutaminase IgG antibodies
| MKSAP 20
## Footnote
These tests are alternatives when IgA is deficient.
88
Preneoplastic gastropathy due to chronic inflammation associated with H. pylori
Gastric intestinal metaplasia
| MKSAP 20
## Footnote
This condition is linked to an increased risk of gastric cancer.
89
Primary diagnostic tool for colonic causes of chronic diarrhea
Colonoscopy
| MKSAP 20
## Footnote
Colonoscopy allows direct visualization and biopsy of the colon.
90
Management of diarrhea and colitis caused by immune checkpoint inhibitors
Medication discontinuation; glucocorticoids or biologic therapy
| MKSAP 20
## Footnote
These are critical for managing immune-mediated adverse effects.
91
Settings for gastrointestinal neuroendocrine tumors
Zollinger-Ellison syndrome and atrophic gastritis
| MKSAP 20
## Footnote
These conditions are associated with increased risk for neuroendocrine tumors.
92
Factors associated with increased risk for rebleeding and death in UGI bleeding
Tachycardia, hypotension, age >60 years, major comorbid conditions
| MKSAP 20
## Footnote
These factors can significantly impact patient outcomes.
93
Anal cancer infectious risk factor
HPV
| MKSAP 20
## Footnote
Human papillomavirus is a well-known risk factor for anal cancer.
94
Treatment for Barrett esophagus with dysplasia
Endoscopic mucosal resection, followed by radiofrequency ablation or cryotherapy
| MKSAP 20
## Footnote
This approach is aimed at preventing progression to esophageal cancer.
95
IBD diagnostic test
Colonoscopy with biopsy
| MKSAP 20
## Footnote
This is the gold standard for diagnosing inflammatory bowel disease.
96
Diagnosis suggested by fistula, perianal disease, strictures, abscess
Crohn disease
| MKSAP 20
## Footnote
These symptoms are highly indicative of Crohn's disease.
97
Postprandial abdominal pain, fear of eating, weight loss
Chronic mesenteric ischemia
| MKSAP 20
## Footnote
This condition results from inadequate blood flow to the intestines.
98
Treatments for eosinophilic esophagitis
Elimination diets, PPI, topical glucocorticoids
| MKSAP 20
## Footnote
These treatments help manage eosinophilic esophagitis symptoms.
99
Ocular manifestations of IBD
Episcleritis, uveitis
| MKSAP 20
## Footnote
These are common extraintestinal manifestations of inflammatory bowel disease.
100
Acute pancreatitis lab tests predicting poor outcome
Elevated hematocrit and BUN
| MKSAP 20
## Footnote
These lab values are associated with increased severity in pancreatitis cases.
101
Cholecystectomy timing after biliary pancreatitis
Before hospital discharge
| MKSAP 20
102
Common cause of refractory celiac disease
Continued gluten exposure
| MKSAP 20
103
Rash pathognomonic for celiac disease
Dermatitis herpetiformis
| MKSAP 20
104
Nutritional approach in severe acute pancreatitis
Early enteral feeding
| MKSAP 20
105
Earliest age to initiate colonoscopy in Lynch syndrome
Age 20-25 years or 2-5 years before youngest relative's diagnosis
| MKSAP 20
106
Test for oropharyngeal dysphagia
Video fluoroscopic swallow study (modified barium swallow)
| MKSAP 20
107
Treatment for refractory chronic anal fissure
Sphincterotomy or botulinum injection
| MKSAP 20
108
Diagnosis suggested by large-volume watery diarrhea despite fasting
Secretory diarrhea
| MKSAP 20
109
Most common cause of secondary constipation
Medications
| MKSAP 20
110
Diagnostic test for hemodynamically significant or rapid small-bowel bleeding
CTA
| MKSAP 20
111
High-risk findings for PUD rebleeding
* Active bleeding
* Nonbleeding visible vessels
* Adherent clots
| MKSAP 20
112
Duration of high-dose intravenous PPI therapy in bleeding PUD with high-risk endoscopic appearance
3 days
| MKSAP 20
113
Diagnosis suggested by severe abdominal pain out of proportion to physical exam findings
Acute mesenteric ischemia
| MKSAP 20
114
Treatment of moderate to severe colonic ischemia in high-risk patients
* Hospitalization for supportive care
* Volume restoration
* Close observation
* Antimicrobials
| MKSAP 20
115
Gold standard diagnostic test for achalasia
Esophageal manometry
| MKSAP 20
116
Gastroparesis initial diagnostic test
Upper endoscopy
| MKSAP 20
117
Most common dermatologic manifestations of IBD
* Erythema nodosum
* Pyoderma gangrenosum
| MKSAP 20
118
When to resume aspirin for secondary prevention of CVD in GI bleeding
As soon as possible after hemostasis
| MKSAP 20
119
First step in managing uncomplicated GERD
Empiric PPI
| MKSAP 20
120
Best initial radiographic study for constipation
Abdominal flat-plate radiography
| MKSAP 20
121
Indications for colonoscopy for perianal symptoms
* Age >45 years
* Altered bowel habits
* Anemia
* IBD
* Weight loss
* Family history of CRC
| MKSAP 20
122
Drugs causing microscopic colitis
* NSAIDs
* SSRIs
* PPIs
| MKSAP 20
123
FAP genetic testing
APC gene testing
| MKSAP 20
124
Gastric cancer screening indications
* FAP
* Lynch syndrome
* Peutz-Jeghers syndrome
* Juvenile polyposis
| MKSAP 20
125
Treatment for acute mesenteric ischemia
* Surgery
* Endovascular intervention
| MKSAP 20
126
Preferred induction treatment for ulcerative colitis unresponsive to 5-ASA
Infliximab
| MKSAP 20
## Footnote
Infliximab is a monoclonal antibody used in patients who do not respond to traditional therapies.
127
Test for small-bowel bleeding after negative upper and lower endoscopy in stable patient
Capsule endoscopy
| MKSAP 20
## Footnote
Capsule endoscopy allows visualization of the small intestine, which is not easily accessible by traditional endoscopy.
128
Treatment for uncomplicated diverticulitis
Close observation without antibiotics
| MKSAP 20
## Footnote
This approach is often sufficient for mild cases that do not present with complications.
129
PUD prevention in at-risk patients who must take NSAIDs
COX-2 inhibitor plus PPI
| MKSAP 20
## Footnote
This combination helps to reduce the risk of peptic ulcer disease in patients requiring NSAID therapy.
130
Primary variceal bleeding treatment
Octreotide, somatostatin, or terlipressin; endoscopic therapy
| MKSAP 20
## Footnote
These treatments help control bleeding from varices in patients with portal hypertension.
131
Histologic characteristic of type 1 autoimmune pancreatitis
Elevated IgG4-positive cell count
| MKSAP 20
## Footnote
This finding is key in diagnosing type 1 autoimmune pancreatitis.
132
Indication for early CT in suspected acute pancreatitis
Diagnostic uncertainty
| MKSAP 20
## Footnote
Early imaging may be necessary to confirm the diagnosis or assess complications.
133
Induction treatment of mild to moderate ulcerative colitis
Oral and topical 5-ASAs
| MKSAP 20
## Footnote
5-ASA compounds are the first line in managing mild to moderate cases.
134
# MKSAP 20
Common symptoms of gastroparesis
Nausea, vomiting, upper abdominal pain, early satiety
| MKSAP 20
## Footnote
These symptoms reflect delayed gastric emptying.
135
Medications causing false-negative noninvasive H. pylori tests
PPIs, antibiotics
| MKSAP 20
## Footnote
These medications can suppress H. pylori detection in testing.
136
Conditions causing false-negative noninvasive H. pylori tests
Atrophic gastritis, intestinal metaplasia, MALT lymphoma
| MKSAP 20
## Footnote
These conditions can affect the accuracy of H. pylori testing.
137
When to restart aspirin for secondary CV prevention in bleeding peptic ulcer
Immediately after hemostasis is endoscopically confirmed
| MKSAP 20
## Footnote
This timing helps to balance the risk of further bleeding with cardiovascular protection.
138
Autoimmune pancreatitis treatment
Glucocorticoids
| MKSAP 20
## Footnote
Steroids are effective in managing inflammation in autoimmune pancreatitis.
139
Diagnosis suggested by dysphagia, late regurgitation of undigested food
Pharyngoesophageal (Zenker) diverticulum
| MKSAP 20
## Footnote
This condition is characterized by a pouch that forms in the esophagus, leading to swallowing difficulties.
