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USMLE Step 2 CK > Gastroenterology > Flashcards

Gastroenterology Flashcards

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USMLE® Step 1 flashcards
1
Q

INITIAL TEST- WEIGHT LOSS BLOOD IN STOOL ANEMIA, ODYNOPHAGIA, DYSPHAGIA

A

ENDOSCOPY

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2
Q

DIAGNOSIS- <50YRS, PROGRESSIVE DYSPHAGIA (SOLIDS TO LIQ), NO TOXOMANIA

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

ACHALASIA

BARIUM ESOPHAGRAM(BIRD BEAK), MANOMETRY(NO LES RELAX-BAD PLEXUS), CXR, ENDOSCOPY

MANOMETRY

PNEUMATIC DILATION(3%PERFORATION),BOTOX(EVERY3-6MO),SURGICAL SECTIONING/MYOTOMY

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3
Q

DIAGNOSIS->=50YRS, PROGRESSIVE DYSPHAGIA, ALCOHOL AND TABACCO USE, 5-10YRS WITH GERD

INITIAL TEST-
ACC. TEST-
INITIAL TEST-

A

ESOPHAGEAL CANCER

BARIUM THEN ENDOSCOPY+BIOPSY; CT/MRI(FOR SPREAD); PET(DETERMINES CONTENTS/ANATOMIC LOCALITY OF LESION: TO SEE IF RESECTABLE)

ENDOSCOPY+BIOPSY

RESECTION+CHEMOTHERAPY+RADIATION; STENT PLACEMENT(IF NOT SURGICALY POSSIBLE/PALLIATION)

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4
Q

DIAGNOSIS- SUDDEN ONSET OF CHEST PAIN, NORMAL EKG, PRECIPITATED BY DRINKING COLD LIQUIDS

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

DIFFUSE ESOPHAGEAL SPASM (DES) OR NUT CRACKER ESOPHAGUS

BARIUM (WHILE SPASM=CORKSCREW); MANOMETRY

MANOMETRY

CCB AND NITRATES (LIKE ANGINA)

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5
Q

DIAGNOSIS- PROGRESSIVE ODYNOPHAGIA, AID’S CD4+=43MM^3

INITIAL TEST-
INITIAL TEST-

A

INFECCTIOUS ESOPHAGITIS: ESOPHAGEAL CANDIDIASIS 90% OF TIME, 10% CMV AND HSV

INFECCTIOUS ESOPHAGITIS= ORAL FLUCONAZOLE; IF NOT BETTER-ENDOSCOPY

FLUCONAZOLE RESITANT CANDIDIASIS CONFIRMED BY ENDOSCOPY= AMPHOTERICIN

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6
Q

TIP- NYSTATIN IS ONLY FOR ORAL CANDIDIASIS

TIP- ESOPHAGITIS DRUG INDUCED: DOXYCYCLINE, ALENDRONAT, KCL

A

TRUE

TRUE

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7
Q

DIAGNOSIS- INTERMITTENT DYPHAGIA, ACID FELUX, HIATAL HERNIA

INITIAL TEST-
INITIAL TREAT-

A

SCHATZKI RING/STEAKHOUSE SYNDROME(SOLID FOOD DYSPHAGIA)

BARIUM STUDY THEN ENDOSCOPY (SHOWS
FIBROSIS/SCARRING)

PNEUMATIC DILATION

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8
Q

DIAGNOSIS- DYSPHAGIA, IRON DEFICIENCY ANEMIA, GLOSSITIS

INITIAL TEST-
INITIAL TREAT-

A

PLUMMER-VINSON SYNDROME

BARIUM STUDY THEN ENDOSCOPY; IRON PANNEL

IRON REPLACEMENT (MAY RESOLVE LESION/WEB)

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9
Q

DIAGNOSIS- DYSPHAGIA, HALITOSIS AND REGURGITATION OF FOOD PARTICLES; HX. ASPIRATION PNEUMONIA

INTIAL TEST-
INITIAL TREAT-

A

ZENKER DIVERTICULUM

BARIUM STUDY

SURGERY

TIP- NASOGASTRIC TUBE AND ENDOSCOPY ARE DANGEROUS IN ZENKER DIVERTICULUM

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10
Q

DIAGNOSIS- DYSPHAGIA, REFLUX, SYSTEMIC AUTO-ANTIBODIES

INITIAL TEST-
INITIAL TREAT-

A

SCLERODERMA

MANOMETRY= DECREASED LES PRESSURE

PPI’S

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11
Q

TIP- MANOMETRY FOR A.S.S.?

A

ACHALASIA, SPASM, SCLERODERMA

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12
Q

DIAGNOSIS- UPPER GI BLEED( HEMATEMESIS BRIGHT RED OR MELENA) AFTER VOMITING OR RETCHING

INTIAL TEST-
INITIAL TREAT-

A

MALLORY-WEISS TEAR

HX./ ENDOSCOPY

SELFLIMITED; PERSISTENT BLEEDING: INJECT EPINEPHRINE OR ELECTROCAUTERY

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13
Q

TIP- MALLORY-WEISS VS BOERHAAVE SYNDROME?

A

MUCOSAL VS FULL PENETRATION OF ESOPHAGUS

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14
Q

DIAGNOSIS- EPIGASTRIC PAIN + WORSE WITH FOOD
DIAGNOSIS- EPIGASTRIC PAIN + WEIGHT LOSS
DIAGNOSIS- EPIGASTRIC PAIN + TENDERNESS
TIP-TENDERNESS IS?
DIAGNOSIS- EPIGASTRIC PAIN + DIABETIC, BLOATING
DIAGNOSIS- EPIGASTRIC PAIN + BAD TAST, COUGH, HOARSE+ RADIATES TO CHEST
DIAGNOSIS- EPIGASTRIC PAIN + NOTHING

A 
GASTRIC ULCER
GASTRIC ULCER OR CANCER
PANCREATITIS OR BILIARY DISEASE
INCREASED PAIN TO PALPATION OR PRESSURE
GASTROPARESIS
GERD
NON-ULCER DYSPEPSIA
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15
Q

INITIAL TEST- EPIGASTRIC PAIN + SOMETHING
TIP- BARIUM STUDIES IS A GOOD TEST START ONLY IN THE?
INTIAL TREAT- EPIGASTRIC PAIN

A

ENDOSCOPY

ESOPHAGUS

PPI’S, H2 BLOCKERS: RANITIDINE, NIZATIDINE, CIMETIDINE, FAMOTIDINE (WORKS IN 70%), ANTIACIDS( WORKS 70%), MISOPROSTOL=OBSOLETE

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16
Q 
TIP- RELAXED LES (GERD) WORSE WITH?
INTIAL TEST- GERD
INITIAL TREAT- GERD MILD/INTERMITTENT
INITIAL TREAT- GERD EROSIVE
INITIAL TREAT- GERD NON RESPONSIVE (5%)
A

NICOTINE, ALCOHOL, CAFFEINE, CHOCOLATE, PEPPERMINT, LATE-NIGHT MEALS, OBESITY

HX. THEN IF DYSPHAGIA, ODYNOPHAGIA, WEIGHT LOSS, ANEMIA OR 5-10YRS EVOLUTION= ENDOSCOPY

LOSE WEIGHT IF OBESE, AVOID TRIGGERS, EAT 3 HOURS BEFORE BEDTIME, ELEVATE BED 6-8IN. + ANTIACID OR H2

LOSE WEIGHT IF OBESE, AVOID TRIGGERS, EAT 3 HOURS BEFORE BEDTIME, ELEVATE BED 6-8IN. + PPI’S

SURGICAL: NISSEN FUNDOPLICATION(WRAP STOMACH TO LES), ENDOCINCH: SUTURE AROUND LES, HEAT/RADIATION OF LES (SCARRING)

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17
Q

DIAGNOSIS- 5YRS WITH NON TREATED GERD

INITIAL TEST-
INITIAL TREAT- 1/3
INITIAL TREAT- 2/3
INITIAL TREAT- 3/3

A

BARRET ESOPHAGUS

ENDOSCOPY/ BIOPSY=COLUMNAR METAPLASIA

BARRET ALONE= PPI’S AND RESCOPE EVERY 2-3 YEARS

BARRETT + LOW GRADE DYSPLASIA= PPI’S AND RESCOPE EVERY 6-12 MONTHS

BARRETT+ HIGH GRADE DYSPLASIA=ABLATION WITH ENDOSCOPY: PHOTODYNAMIC THERAPY, RADIOFREQUENCY ABLATION, ENDOSCOPIC MUCOSAL RESECTION

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18
Q

DIAGNOSIS- EPIGASTRIC PAIN+BLEEDING OR PAINLESS BLEEDING IF NOT + HX. ALCOHOL, NSAID, H. PYLORI, PORTAL HYPERTENSION, TRAUMA/STRESS/INF; B12DEF./UREMIA

INITIAL TEST-
INITIAL TREAT-

A

GASTRITIS

ENDOSCOPY (BEST AND ACC.); SEROLOGY(H. PYLORI LACKS SPECIFICITY);UREA C13/14 BREATH (ONLY ACTIVE); STOOL ANTIGEN(ONLY ACTIVE)

PPI’S OR H2 BLOCK, SUCRALFATE (COMMENLY WRONG), ANTIACIDS (NOT AS EFFECTIVE)

TIP- VOLUME TO MANIFESTATION:COFFEE-GOUND EMESIS(5-10ML), HEME(GUAIAC) STOOL(5-10ML), MELENA (50-100ML)

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19
Q

TIP- PORPHYLASIS GASTRITIS?

A

MECHANICAL VENTILATION, BURNS, HEAD TRAUMA, COAGULOPATHY

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20
Q

DIAGNOSIS- GASTRITIS EROSIVE/ WITH EPIGASTRIC PAIN

INITIAL TEST-
INITIAL TREAT-

A

PEPTIC ULCER DISEASE (PUD)

ENDOSCOPY; GI SERIES (CANNOT DETECT CANCER; OR INFECTION THOUGH)

PPI’S, CLARITHROMYCIN, AMOX;THEN PPI’S, METRONIDAZOLE AND TETRACYCLINE + BISMUTH; THEN BREATH TEST (IN GU: ENDOSCOPY LOOK FOR CANCER)

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21
Q

TIP- CAUSE OF PUD

TIP- ALCOHOL AND TOBACCO DO NOT CAUSE ULCERS BUT DELAY HEALING

TIP- DU-PUD VS GU-PUD

TIP- PUD TREAT FAILURE IS FROM?

A

H.PYLORI THEN NSAIDS; RARE: STRESS, TUMOR, GRANULOMAS: CROHN

TRUE

IMPROVED WITH EATING VS WORSE BY EATING; 0% CANCER VS 4% CANCER; H.PYLORI 80-90% VS 50-70%

NONADHERENCE TO MEDICATIONS, ALCOHOL, TOBACCO, NSAID’S

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22
Q

DIAGNOSIS-EPIGASTRIC PAIN NO ULCER?

INITIAL TREAT-

A

NON-ULCER DYSPEPSIA (NUD)

PPI’S

TIP- SCOP NUD IF?= 45 TO 55 YRS OLD, “ALARM” DYSPHAGIA, WEIGHT LOSS, ANEMIA

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23
Q

DIAGNOSIS- LARGE ULCER (OVER 1-2CM), RECURRENT AFTER H.PYLORI, DISTAL(DUODENUM), MULTIPLE, DIARRHEA(ACID INACT. LIPASE)

INITIAL TEST- GASTRINOMA 1/2
INITIAL TEST- GASTRINOMA 2/2
INITIAL TREAT- GASTRINOMA

P.ASS.

A

GASTRINOMA

ENDOSCOPY, HIGH GASTRIN LEVELS AND HIGH ACID LEVELS WITH PPI’S, H2 OR SECRETIN

IMAGE: CT/MRI OF ABDOMEN (FOR METS); THEN SOMATOSTATIN RECEPTOR SCINTIGRAPHY(OCTREOTIDE SCAN)+ENDOSCOPIC ULTRASOUND

LOCAL=SURGERY; METS=PPI’S TO BLOCK ACID PRODUCTION

INCREASED SOMATOSTATIN RECEPTORS AND MEN(MULTIPLE ENDOCRINE NEOPLASIA)

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24
Q

DIAGNOSIS- DM, ABDOMINAL DISCOMFORT, “BLOATING” CONSTIPATION, ANOREXIA, NAUSEA AND VOMITING, SATIETY

INITIAL TEST-
INTIAL TREAT-

A

DIABETIC GASTROPARESIS

NUCLEAR GASTRIC MOTILITY TEST

ERYTHROMYCIN AND METOCLOPROMIDE

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25
Q

TIP- DIABETIC GASTROPARESIS IS DUE TO?

A

NEUROPATHY=CANNOT SENSE STRETCH AND PRODUCE REFLEX MOTILITY

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26
Q

DIAGNOSIS- BRIGHT RED BLOOD ON STOOL, ORTHOSTASIS(10 RISE ON PULSE ON STANDING), TACHYCARD, DROP BP 1/2

TIP- % BLOOD LOSS: ORTHOSTASIS; PULSE >100 PER MIN; SYS BP

A

LOWER GI BLEED: DIVERTICULOSIS, ANGIODYSPLASIA (AVM), POLYPS/CANCER, IBD, HEMORROIDS, UPPER GI HIGH VOLUME/SPEED TRANS

BLOOD LOSS: 15-20%; 30%; 30%

UPPER GI BLEED: HIGH VOLUME FROM CANCER, GASTRITIS, ESOPHAGITIS, DUODENITIS, VARICES

VICEREAL BLEED: LIVER, SPLEEN

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27
Q 
INITIAL TEST- GI BLEED 1/3
TIP-10% OF RECTAL BLEED IS?
INITIAL TREAT- GI BLEED 1/4
INITIAL TEST- GI BLEED 2/3
INITIAL TEST- GI BLEED 3/3
A

SEVERITY TREATMENT-FLUIDS; THEN LAB: Hct, Plt, PT, PTT/INR BLEEDING TIME; NG TUBE; ENDOSCOPY AFTER

UPPER GI BLEED: RAPID TRANSIT

SEVERITY TREATMENT; VERY OFFTEN RESOLVES ALONE JUST STABILIZE PATIENT

NUCLEAR BLEEDING SCAN-UNCLEAR ENDOSCOPY; ANGIOGRAPHY-SPECIFIC VESSEL FOR SURGERY;

CAPSULE ENDOSCOPY-UPPER/LOWER ENDO NO SHOW; EKG/LACTATE LEVEL-ISCHEMIA

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28
Q 
TIP- NEVER CT/MRI IN?
INITIAL TREAT- GI BLEED 2/4
INITIAL TREAT- GI BLEED 3/4
INITIAL TREAT- GI BLEED 4/4
TIP- WHEN TO USE Plt's?
TIP- SCLEROTHERAPY IS?
A

GI BLEED

SEVERITY TREATMENT: FLUID 1-2L PER HR, PACKED RED BLOOD CELLS(Hct<10000-20000 SPONTANEOUS BLEED

NEVER THE ANSWER

29
Q

DIAGNOSIS- ANTIBIOTIC USE+ DIARRHEA

INITIAL TEST-
INITIAL TREAT-

A

AAD MOST COMMON CLOSTRIDIUM DIFFICILE

STOOL C.DIFF TOXIN TEST OR PCR, BLOOD/WBC IN STOOL

METRONIDAZOLE; THEN VANCOMYCIN OR FIDAXOMICIN (IF NEVER RESPOND TO METRO)

TIP- RETREAT WITH METRONIDAZOLE IF RECURRENT RESPONDENT C.DIFF

30
Q

DIAGNOSIS- GLUTEN STEATORRHEA, DEFICIENCY IN ADEK VIT.:HYPOCALCEMIA, OSTEOPOROSIS, BLEEDING, EASY BRUISING, ANEMIA, NEUROPATHY (B12)

INITIAL TEST-
INITIAL TREAT-

A

CELIAC DISEASE

SMALL BOWEL BIOPSY: FLAT VILLI=CELIAC DISEASE; ORGANISM=WHIPPLE AND TROPIC SPRUE;ANTI-TRANSGLUTAMINASE,ENDOMYSIAL,IGA GLIADIN; ABDOMINAL. XRAY

AVOID GLUTEN

31
Q

DIAGNOSIS- ARTHRALGIAS, OCULAR FINDINGS, NEUROLOGIC ABNORMALITIES (DEMENTIA, SEIZURES) FEVER, LYMPHADENOPATHY, STEATORRHEA

INITIAL TEST-

INITIAL TREAT-

A

WHIPPLE DISEASE

SMALL BOWEL BIOPSY: FLAT VILLI=CELIAC DISEASE; ORGANISM=WHIPPLE AND TROPIC SPRUE;ANTI-TRANSGLUTAMINASE,ENDOMYSIAL,IGA GLIADIN; ABDOMINAL. XRAY

CETRIAXONE, TRIMETHOPRIM/SULFAMETHOXAZOLE

32
Q

DIAGNOSIS- EPIGASTRIC PAIN, STEATORRHEA

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

CHRONIC PANCREATITIS

ABDOMINAL XRAY, CT SCAN, SECRETIN STIMULATION TESTING

SECRETIN STIMULATION TESTING: IV SECRETIN+ NG TUBE-NORMAL=LARGE VOL. BICARB FLUID

ENZYME REPLACEMENT

TIP- D-XYLOSE TEST IS OLD METHODE TO DEF. WALL VS PANCREATIC AFFECTION (NORMAL IN PANCREAS)

33
Q

TIP- 10% CELIAC DISEASE GET?

TIP- MALABSORPTION DIFERENTIALS?

A

DERMATITIS HERPETIFORMIS

CELIAC, WHIPPLE, TROPIC SPRUE, PANCREATITIS

34
Q

INITIAL TEST- MALABSORPTION

INITIAL TREAT- TROPICAL SPRUE

A

SMALL BOWEL BIOPSY: FLAT VILLI=CELIAC DISEASE; ORGANISM=WHIPPLE AND TROPIC SPRUE;ANTI-TRANSGLUTAMINASE,ENDOMYSIAL,IGA GLIADIN; ABDOMINAL. XRAY

TMP/SMX, TETRACYCLINE

35
Q

DIAGNOSIS- FLUSHING, WHEEZING, CARDIAC ABNORMALITIES (RIGHT SIDE)

INITIAL TEST-
INITIAL TREAT-

A

CARCINOID SYNDROME

URINE 5-HYDROXYINDOLEACETIC ACID (5-HIAA) TEST

OCTREOTIDE (SOMATOSTATIN)

36
Q

DIAGNOSIS- NAUSEA, VOMMITING AFTER MILK, DIARRHEA

INITIAL TEST-

INITIAL TREAT-

A

LACTOSE INTOLERANCE

REMOVE MILK, WAIT AND SEE

REMOVE LACTOSE PRODUCT OR ADD LACTASE PILLS

37
Q

DIAGNOSIS- PAIN+ DIARRHEA, CONSTIPATION: RELIEVED WITH BOWEL MOVEMENT, LESS AT NIGHT

INITIAL TEST-
INITIAL TREAT-

A

IBS

EXCLUDE ALL OTHER

FIBER IN DIET, ANTISPASMODIC AGENTS-HYOSCYAMINE, DICYCLOMINE; TCA’S OR SSRI’S, ANTIMOTILITY ANGENTS, LUBIPROSTONE; LUBIPROSTONE

38
Q

DIAGNOSIS- DIARRHEA, BLOOD IN STOOL, WIGHT LOSS, AND FEVER

P.ASS.-ARTHRALGIAS, UVEITIS, IRITIS, SKIN: ERYTHEMA NODOSUM, PYODERMA GANGRENOSUM, SCLEROSING CHOLANGITIS(UC)

A

IBD

IBD

39
Q

DIAGNOSIS- SKIP LESIONS, TRANSMURAL GRANULOMAS, FISTULAS AND ABSCESSES, MASSES AND OBSTRUCTION, PERIANAL DISEASE

INITIAL TEST- IBD
INTIAL TREAT- IBD 1/3
TIP- IBD STEROIDS?
INITIAL TREAT- IBD 2/3
INITIAL TREAT- IBD 3/3
A

CROHNS

ENDOSCOPY (ACC. TEST) WHEN REACHED, BARIUM STUDIES(CD), SEROLOGIC: ANCA(UC), ANTISACCHAROMYCES CEREVESIAE ANTIBODY(ASCA) (CD)&ANEMIA

ACUTE: STEROIDS CHRONIC: 5-ASA DERIV.-ASACOL(MESALAMINE)IN UC AND PENTASA(MESALAMINE) CD ROWASA(MESA.) RECTUM UC

AZATHIOPRINE AND 6-MERCAPTOPURINE-TO TAKE OFF STEROIDS+CALCIUM&VITD, PERIANAL CD: CIPROFLOXACIN/METRONIDAZOLE

FISTULAE: ANTI-TNF (INFLIXIMAB), SURGERY: CD-PALIATIVE FOR OBSTRUCTION; UC-CURED BUT WITH COLECTOMY

40
Q

DIAGNOSIS- CURABLE BY SURGERY, ENTIRELY MUCOSAL, NO FISTULAS, NO ABSCESSES, NO OBSTRUCTION, NO PERIANAL DISEASE

INITIAL TEST- IBD
INTIAL TREAT- IBD 1/3
INITIAL TREAT- IBD 2/3
INITIAL TREAT- IBD 3/3

A

ULCERATIVE COLITIS

ENDOSCOPY (ACC. TEST) WHEN REACHED, BARIUM STUDIES(CD), SEROLOGIC: ANCA(UC), ANTISACCHAROMYCES CEREVESIAE ANTIBODY(ASCA) (CD)&ANEMIA

ACUTE: STEROIDS CHRONIC: 5-ASA DERIV.-ASACOL(MESALAMINE)IN UC AND PENTASA(MESALAMINE) CD ROWASA(MESA.) RECTUM UC

AZATHIOPRINE AND 6-MERCAPTOPURINE-TO TAKE OFF STEROIDS+CALCIUM&VITD, PERIANAL CD: CIPROFLOXACIN/METRONIDAZOLE

FISTULAE: ANTI-TNF (INFLIXIMAB), SURGERY: CD-PALIATIVE FOR OBSTRUCTION; UC-CURED BUT WITH COLECTOMY

41
Q

TIP- WHEN SHOULD SCREENING OCCUR IN IBD?

A

AFTER 8 TO 10 YRS OF COLONIC INVOLVEMENT, WITH COLONOSCOPY EVERY 1 TO 2 YRS

42
Q

TIP- IBD STEROIDS?

A

PREDNISONE OR BUDESONIDE

43
Q

DIAGNOSIS- LEFT LOWER QUADRANT ABDOMINAL PAIN, CONSTIPATION, BLEEDING

INTIAL TEST-
INTIAL TREAT-

A

DIVERTICULOSIS

COLONOSCOPY, BARIUM STUDIES

BRAN, PSYLLIUM, METHYLCELLULOSE, INCREASE FIBER

44
Q

DIAGNOSIS- OLDER PT. LEFT LOWER QUAD PAIN AND TENDERNESS, FEVER, LEUKOCYTOSIS, PALPABLE MASS, BLEEDING

INITIAL TEST- DIVERTICULITIS
INITIAL TREAT- DIVERTICULTIS 1/3
INITIAL TREAT- DIVERTICULTIS 2/3
INITIAL TREAT- DIVERTICULTIS 3/3

A

DIVERTICULITIS

CT SCAN; NEVER-COLONOSCOPY/BARIUM ENEMA- WEAK WALL

COVER: E.COLI AND ANAEROBES- CIPROFLOXACIN
COMBINED WITH METRONIDAZOLE OR AMOXICILLIN/CLAV,

TICARCILLIN/CLAVULANATE OR PIPER/TAZ,ERTAPENEM; DO NOT FEED; SURGERY: NO RESPONSE, FREQUENT RECURRENCES, PERFORATION,

FISTULA FORMATION, ABSCESS, STRICTURES OR OBSTRUCTION ESPECIALY YOUNG PT.

45
Q

DIAGNOSIS- PT >50YRS OR PT FM OR 40YRS WITH 1 FAMILY MEMBER WITH COLON CANCER OR 10 YRS BEFORE FAMILY EVENT, HEREDITARY

DIAGNOSIS- THREE FAMILY MEMBERS 2 GEN, 1 PREMATURE

A 
COLON CANCER SCREEN
COLON CANCER SCREEN
COLON CANCER SCREEN
COLON CANCER SCREEN
COLON CANCER SCREEN
46
Q

DIAGNOSIS- MELANOTIC SPOTS ON LIPS AND SKIN; INCREASED FREQUENCY OF BREAST CANCER, INCREASED GONADAL AND PANCREATIC CANCER + COLON CANCER

A

PEUTZ JEGHERS SYNDROME

47
Q

DIAGNOSIS- OSTEOMAS, DESMOID TUMOR, OTHER SOFT TISSUE TUMOR+ COLON CANCER

A

GARDNER SYNDROME

48
Q

DIAGNOSIS- CNS MALIGNANCY + COLON CANCER

A

TURCOT SYNDROME

49
Q

DIAGNOSIS- MULTIPLE HAMARTOMATOUS POLYPS + COLON CANCER

A

JUVENILE POLYPOSIS

50
Q

TIP- COLON CANCER SYNDROMES SCREENING FREQUENCY IS?

A

THE SAME AS COLON CANCER

51
Q

DIAGNOSIS- ACUTE EPIGASTRIC PAIN + TENDERNESS + NAUSEA/VOMITING; IN SEVERE CASE: HYPOTENSION, FEVER

P.ASS.- ALCOHOLISM/ CHOLELITHIASIS; OR TRAUMA, HYPERTRIGLYCERIDEMIA; HYPERCALCEMIA; INFECTION; DRUG TOX;DRUG ALLERGY; DUCTAL OBSTRUCTION, ERCP, CYSTIC FIBROSIS; SCORPION STING

INITIAL TEST- ACUTE PANCREATITIS 1/2
INITIAL TEST- ACUTE PANCREATITIS 2/2
TIP- ULTRASOUND IS GOOD?
INITITAL TREAT- ACUTE PANCREATITIS
INITITAL TREAT- ACUTE PANCREATITIS
A

ACUTE PANCREATITIS

ACUTE PANCREATITIS

AMYLASE AND LIPASE; CT SCAN-CONTRAST (MOST SPECIFIC); NEEDLE BIOPSY IF 30% NECROSIS “EXTENSIVE”; LAB: CBC-LEUKOCYTOSIS, DROP IN Htc OVER TIME WITH REHYDRATION, INC. LDH,AST
,

HYPOXIA, HYPOCALEMIA, ELEVATED URINARY TRYPSINOGEN ACT. PEP; IMAGE: CT OR MRI SCAN(PSEUDOCYST), MRCP (FOR STONES, STRICURE, TUMOR)-ERCP (FOR THERAPY), PLAIN XRAY=SENTINEL LOOP OF BOWEL(LUQ),

NO NOT FOR PANCREATITIS

NPO, IV HYDRATION (HIGH VOLUME), ANALGESIA, PPI’S DECREASE PANCREATIC STIMULATION TO ACID ENTERING DOUDENMUM

EXTENSIVE NECROSIS: ADD ANTIBIOTICS-IMIPENEM OR MEROPENEM, DRAIN PSEUDOCYSTS AND SURGICAL DEBRIDEMENT( PREVENT ARDS); OBSTRUCTIVE PANCREAS: ERCP + STENTS

52
Q

TIP- PENTAMIDINE, DIDANOSINE, AZATHIOPRINE, ESTROGENS SIDE EFFECT

TIP- A STONE, A STRICTURE, TUMOR, AND OBSTRUCTION

TIP- PAIN STRAIGHT THROUGH BACK “LIKE SPEAR” VS GOES AROUND SIDE TO BACK

TIP- SEVERITY IS DETERMINED BY?

A

ACUTE PANCREATITIS

ACUTE PANCREATITIS

ACUTE PANCREATITIS VS CHOLECYSTITIS

CALCIUM LEVELS

53
Q

DIAGNOSIS- ASCITES, COAGULOPATHY(ALL FACTORS BUT VIII), ASTERIXIS, ENCEPHALOPATHY, SPIDER ANGIOMATA AND PALMAR ERYTHEMA, PORTAL HYPERTENSION-VARICES, THROMBOCYTOPENIA-SPLENIC SEQUESTRATION, RENAL INSUFFICIENCY (HEPATORENAL SYNDROME), HEPATOPULMONARY SYNDROME

A

CHRONIC LIVER DISEASE/CIRRHOSIS

54
Q

TIP- HEPATOPULMONARY SYNDROME IS?
TIP- PARACENTESIS SHOULD BE PERFORMED IF?
TIP- SAAG 1.1g/Dl ?

A

ORTHODEOXIA- HYPOXIA UPON SITTING UPRIGHT

NEW ONSET ASCITES, ABDOMINAL PAIN AND TENDERNESS, FEVER (SHOWS SERUM ASCITES ALBUMIN GRADIENT)

INFECTIONS(EXCEPT SBP), CANCER, NEPHROTIC SX.; OR PORTAL HYPERTENSION(CAUSED BY LOW ALBUMIN), CHF, HEPATIC VEIN THROMBOSIS, CONSTRICTIVE PERICARDITIS

55
Q

INITIAL TEST- CHRONIC LIVER DISEASE/CIRRHOSIS

A

LFT; BIOPSY

56
Q

DIAGNOSIS- ASCITES, FEVER, NO PERFORATION OF BOWEL

INITIAL TEST-
INITIAL TREAT-

A

SPONTANEOUS BACTERIAL PERITONITIS (E.COLI OR PNEUMOCOCCUS) = SBP

CELL COUNT > 250 NEUTROPHILS, GRAM STAIN: IS NEGATIVE; FLUID CULTURE (ACC. TEST)

CEFOTAXIME OR CEFTRIAXONE; IF RECURS AND LOW ALBUMIN: PROPHYLAX WITH NORFLOXACIN OR TMP/SMX

57
Q

DIAGNOSIS- ALCOHOLIC; LIVER DISEASE WITH
EXCLUSION OF ALL OTHER CAUSES

INITIAL TEST- ?
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 1/8
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 2/8
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 3
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 4
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 5
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 6
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 7
INITIAL TREAT- CHRONIC LIVER DISEASE/CIRRHOSIS 8

A

ALCOHOLIC LIVER DISEASE

LAB: AST»>ALT, GGTP IF BINGE DRINKING; PE: LIVER DISEASE; BIOPSY

ASCITIES AND EDEMA: SPIRONOLACTONE AND OTHER DIURETICS, SERIAL PARACENTESES FOR LARGE VOLUME ASCITES

COAGULOPATHY AND THROMBOCYTOPENIA: RRP AND PLATELETS ONLY IF BLEEDING OCCURS

ENCEPHALOPATHY: LACTULOSE, RIFAXIMIN

HYPALBUMINEMIA: NO SPECIFIC THERAPY

SPIDER ANGIOMATA AND PALMAR ERYTHEMA: NO SPECIFIC THERAPY

VARICES: PROPRANOLOL AND BANDING VIA ENDOSCOPY

HEPATORENAL SYNDROM: SOMATOSTATIN (OCTREOTIDE), MIDODRINE

HEPATOPULMONARY SYNDROME: NO SPECIFIC THERAPY

58
Q

DIAGNOSIS- WOMAN 40-50’S, FATIGUE AND ITCHING, NORMAL BILIRUBIN AND ELEVATED ALKALINE PHOSPHATASE; LIVER DISEASE

P.ASS.-
INITIAL TEST-
INTIAL TREAT-

A

PRIMARY BILIARY CIRRHOSIS (PBC)

XANTHELASMA/XANTHOMA, OSTEOPOROSIS

LIVER BIOPSY (ACC. TEST); LAB: ANTIMITOCHONDRIAL ANTIBODY, IGM AND BILIRUBIN HIGH WHEN DISEASE ADVANCED; NOTE: TX FOR 8 LIVER SYMPTOMS

URSODEOXYCHOLIC ACID

59
Q

DIAGNOSIS- IBD-UC+ PRURITIS, ELEVATED ALKALINE PHOSPHATSE AND GGTP, BILIRUBIN LOOKS LIKE PBC

ACC. TEST-
INITIAL TEST-
INITIAL TREAT-

A

PRIMARY SCLEROSING CHOLANGITIS

ERCP- BEADING, NARROWING OR STRICTURES IN BILIARY SYSTEM

ERCP; BIOPSY

CHOLESTYRAMINE OR URSODEOXYCHOLIC ACID; NOTE: TX FOR 8 LIVER SYMPTOMS

60
Q

TIP- IS DISEASE CURED WITH IBD-UC COLECTOMY?

A

NO- PSC PROGRESSES

61
Q

DIAGNOSIS- LIVER DISEASE+ EMPHYSEMA (COPD); YOUNG PT (<40) NONSMOKER; FAMILY HX.

INITIAL TEST-
INITIAL TREAT-

A

ALPHA 1-ANTITRYPSIN DEFICIENCY CIRRHOSIS

A1-ANTITRYPSIN

REPLACE TRYPSIN

62
Q

DIAGNOSIS- PT 50’S, MILD INCREASES IN AST AND ALKALINE PHOSPHATASE: FATIGUE; JOINT PAIN(PSEUDOGOUT); ED; AMENORRHEA IN WOMEN(PIT IVOLVED); SKIN DARKEN; DIABETES; CARDIOMYOPATHY

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

HEMOCHROMATOSIS CIRRHOSIS OR JUST FIBROSIS (NOTE REVERSABLE)

IRON STUDIES: INC. IRON AND FERRITIN; DECR. TIBC/ TRANSFERRIN SAT. IMAGE: MRI (SHOWS IRON DEPOSITS ON LIVER); GENETIC TEST

LIVER BIOPSY

PHLEBOTOMY; IF NOT POSSIBLE OR ANEMIC OVERTRANSFUSED CAUSE=CHELATION:DEFEROXAMINE(IM), DEFERASIROX,DEFERIPRONE(ORAL)

63
Q

TIP- C282Y?

TIP- VIBRIO VULNIFICUS, YERSINA AND LISTERIA INFECTIONS OCCUR BECAUSE?

TIP- ALSO IN SIDEROBLASTIC ANEMIA?

A

GENE MUTATION= OVERABSORPTION OF IRON IN THE DUODENUM

THEY FEED ON IRON

PRUSSIAN BLUE STAIN OF RBC’S

64
Q

DIAGNOSIS- CHRONIC HEPATITIS B OR C + LIVER DISEASE

INITIAL TEST- B
INITIAL TEST- C
INITIAL TREAT- CHRONIC B
INITIAL TREAT- CHRONIC C

A

HEPATITIS CIRRHOSIS

HEPATITIS B CIRRHOSIS= HEP B DNA LEVEL BY PCR (VIRAL REPLICATION ACTIVITY); BIOPSY(DEGREE OF IFLAMMATION AND FIBROSIS= URGENCY TO TREAT)

HEPATITIS C CIRRHOSIS(80% CHRONIC) =HEP C PCR RNA VIRAL LOAD (VIRAL ACTIVITY)

CHRONIC HEP B CIRRHOSIS=ONE OF: ADEFOVIR, LAMIVUDINE, TELBIVUDINE, ENTECAVIR,TENOFOVIR, INTERFERON

CHRONIC HEP C CIRRHOSIS=COMBO: INF, RIBAVIRIN + ONE OF: TELAPREVIR OR BOCEPREVIR (SAME FOR ACUTE)

65
Q

TIP- LIVER CANCER AND CIRRHOISIS AND POLYARTERITIS NODOSA ARE CAUSED BY?

A

BOTH HEP B AND C

66
Q

TIP- ARTHRALGIAS, THROMBOCYTOPENIA, DEPRESSION, LEUKOPENIA
TIP- ANEMIA
TIP-TENAL DYSFUNTION
TIP-NONE

A

INF
RIBAVIRIN
ADEFOVIR
LAMIVUDINE

67
Q

DIAGNOSIS- LIVER DISEASE+ NEUROLOGICAL SYMPTOMS: PSYCHOSIS, TREMOR,DYSARTHRIA, ATAXIA OR SEIZURES, COOMBS NEGATIVE HEMOLYTIC ANEMIA, RTA OR NEPHROLITHIASIS

TIP- PSYCHOSIS AND DELUSIONS OCCUR BECAUSE?
INITIAL TEST-
INITIAL TREAT-

A

WILSON DISEASE CIRRHOSIS

THE COPPER ACCUMULATES NOT TO CONFUSE: ENCEPHALOPATHIC FEATURES OF DELIRIUM

SLIT-LAMP=KAYSER-FLEISCHER RINGS; CERULOPASMIN-LOW(NOT ALWAYS OR ALL PROTEINS LOW); LIVER BIOPSY(INC. COPPER)

CHELATE: PENICILLAMINE OR TRIENTINE; ZINC(INTERFERES WITH INTESTINAL COPPER ABSORPTION)

68
Q

DIAGNOSIS- YOUNG WOMAN; LIVER INFLAMMATION; POSITIVE ANA

INITIAL TEST- AUTOIMMUNE HEPATITIS
INITIAL TREAT- AUTOIMMUNE HEPATITIS

A

AUTOIMMUNE HEPATITIS

LIVER-KIDNEY MICROSOMAL ANTIBODIES, HIGH: GAMMA GLOBULIN(IgG), AND ANTI-SMOOTH MUSCLE ANTIBODIES; LIVER BIOPSY

PREDNISONE AND OR AZATHIOPRINE

69
Q

DIAGNOSIS- NONALCOHOLIC, STEATORRHEA + RUQ DISCOMFORT

INITIAL TEST-
INITIAL TREAT-

A

NONALCOHOLIC STEATOHEPATITIS (NASH) OR NONALCOHOLIC FATTY LIVER DISEASE

LFT= MILDLY ABNORMAL; TEST FOR: OBESITY, DIABETES, HYPERLIPIDEMIA CORTICOSTEROID USE; LIVER BIOPSY (ACC. TEST)-EXCLUDE SERIOUS LIVER DISEASE

CORRECT UNDERLYING CAUSE

USMLE Step 2 CK (9 decks)

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