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Gastroenterology Flashcards

1
Q

Young patient with dysphagia to both solids and liquids. Most likely diagnosis?

A

Achalasia, failure of lower esophageal sphincter to relax

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2
Q

Best initial test and most accurate test to diagnose achalasia?

A

Best initial test - Barium swallow

Most accurate test - Esophageal manometry

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3
Q

Treatment for achalasia?

A

Best treatment is surgical myotomy.
Pneumatic dilation if myotomy unsuccessful
Botox if patient refuses surgery

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4
Q

Esophageal cancer with no metastasis. Treatment?

A

Surgical resection followed by chemotherapy with 5-fluorouracil

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5
Q

Plummer-Vinson syndrome characterized by?

A

Proximal esophageal stricture with associated iron deficiency anemia. Associated with esophageal squamous cell cancer.

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6
Q

Best initial treatment for Plummer-Vinson syndrome?

A

Iron replacement

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7
Q

Schatzki’s ring (peptic stricture) characterized by?

A

Distal stricture due to acid reflux. Patient has intermittent dysphagia.

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8
Q

Treatment for Schatzki’s ring?

A

Pneumatic dilation

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9
Q

Patient with chest pain occurring after drinking cold beverage. CAD ruled out. Diagnosis?

A

Diffuse esophageal spasm

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10
Q

Most accurate diagnostic test for diffuse esophageal spasm? Treatment?

A

Manometry

Treat with Ca channel blockers, nitrates

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11
Q

Medications that can cause esophagitis?

A

Doxycycline, Bisphosphonate (Alendronate). Otherwise it is always due to infection.

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12
Q

Management of Mallory-Weiss tear?

A

Usually resolve spontaneously. Persistent bleeding can give epinephrine injection.

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13
Q

Symptoms of GERD?

A 
Sore throat
Metallic or bitter taste
Hoarseness
Chronic cough
Wheezing
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14
Q

GERD refractory to PPIs. Next step in treatment?

A

Surgical procedure to narrow distal esophagus (Nissen fundoplication, or endoscopically making LES tighter)

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15
Q

Endoscopy shows Barret’s esophagus. Next step in management?

A

PPI and repeat endoscopy in 2-3 years

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16
Q

Esophageal biopsy reveals low-grade dysplasia. Next step in management?

A

PPI and repeat endoscopy in 3-6 months

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17
Q

Esophageal biopsy reveals high-grade dysplasia. Next step in management?

A

Endoscopic mucosal resection, ablative removal, or distal esophagectomy

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18
Q

2 causes of gastritis?

A

H. pylori or pernicious anemia (will see B12 deficiency)

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19
Q

Treatment for H. pylori?

A

PPI, Clarithromycin, and Amoxicillin

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20
Q

Treatment for H. pylori resistant to first-line agents?

A

PPI, Metronidazole and Tetracycline

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21
Q

Gastritis resistant to antibiotics and PPI, next step?

A

Evaluate for Zollinger-Ellison syndrome (gastrinoma)

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22
Q

Indications for stress ulcer prophylaxis?

A

Head trauma
Intubation
Burns
Concomitant coagulopathy and steroid-usage

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23
Q

Characterestics of ulcers concerning for Zollinger-Ellison syndrome (gastrinoma)?

A

Multiple ulcers
>1cm in size
Distal location, near the ligament of Treitz
Recurrent or persistent despite H. pylori treatment

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24
Q

Diagnostic options to evaluate for Zollinger-Ellison syndrome?

A

Endoscopic ultrasound
Nuclear somatostatin scan - very sensitive
Secretin stimulation - Most accurate test

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25
Secretin IV infusion normally does what to gastrin levels and gastric acid output?
Decreases both gastrin levels and gastric acid output
26
Treatment for local versus metastatic Zollinger-Ellison syndrome?
Local - surgical resection | Metastatic - lifelong PPI
27
Zollinger-Ellison syndrome with hypercalcemia, next step in evaluation?
Evaluate parathyroid problems and suspect Multiple Endocrine Neoplasia (MEN) syndrome
28
Infectious diarrhea etiologic agent that is also associated with Guillain-Barre syndrome?
Campylobacter
29
Infectious diarrhea etiologic agent that is also associated with Hemolytic Uremic Syndrome?
E. coli 0157:H7
30
What do you not give to patients suffering from E. coli 0157:H7 infectious diarrhea?
Platelet transfusions or antibiotics
31
Infectious diarrhea from eating vegetable or pork contaminated with rodent urine/feces?
Yersinia
32
Treatment for amebic infectious diarrhea?
Metronidazole
33
Antibiotic options for infectious diarrhea?
Fluoroquinolones (cipro)
34
HIV patient with CD4<100 and infectious diarrhea. Organism identified via modified acid-fast stain. What organism?
Cryptosporidiosis
35
Patient with diarrhea 10 minutes after eating tuna/mackarel/mahi mahi. Also has wheezing and flushing. Diagnosis? Treatment?
Scombroid poisoining | Treat with diphenhydramine
36
Antibiotic most associated with C. diff?
Clindamycin
37
Treatment steps for C. diff?
1. Metronidazole 2. Oral Vancomycin 3. Fidaxomicin 4. Fecal transplant
38
Most common cause of chronic diarrhea?
Lactose intolerance
39
Chronic diarrhea along with flushing and episodes of hypotension. Most likely diagnosis?
Carcinoid Syndrome
40
Diagnostic evaluation and treatment for Carcinoid Syndrome?
Check urinary 5-HIAA level | Treat with somatostatin analogues (octreotide)
41
Differential diagnosis of fat malabsorption?
Celaic disease Tropical Sprue Chronic Pancreatitis Whipple's disease
42
Complications of long-standing untreated fat malabsorption?
Hypocalcemia (from Vitamin D deficiency) Oxalate kidney stones (Oxalate overabsorption) Increased INR (vitamin K malabsorption) Vitamin B12 malabsorption
43
Diagnostic testing for fat malabsorption?
Sudan black stool stain | 72 hour fecal fat
44
Chronic diarrhea with fat malabsorption and vesicular skin lesion. Diagnosis?
Celiac Disease (skin lesion is dermatitis herpetiformis)
45
Celiac disease. Best initial test and definitive diagnosis?
Best initial - antigliadin, antiendomysial, antitissue transglutaminase antibodies Definitive diagnosis - Small bowel biopsy
46
Small bowel biopsy must be done in patients with celiac disease to rule out?
Bowel wall lymphoma
47
What foods need to be removed from diet for patients with celiac disease?
Wheat, oats, rye, barley
48
Fat malabsorption. Small bowel biopsy shows microrganisms. Diagnosis and treatment?
Tropical Sprue | Treat with Tetracycline or Bactrim for 3-6 months
49
Fat malabsorption syndrome associated with arthralgias, neurologic abnormalities, ocular findings?
Whipple's disease
50
Whipple's disease. Best initial test and definitive diagnosis?
Initial - Stool PCR for Tropheryma whippelii | Definitive diagnosis - Small bowel biopsy
51
Treatment for Whipple's disease?
Tetracyclinie or Bactrim for 12 months
52
Most accurate test for chronic pancreatitis?
Secretin stimulation test
53
Step-wise treatment options for Irritable Bowel Syndrome?
1. Fiber 2. Antispamodic/anticholinergic drugs (dicyclomine, hyoscyamine) 3. TCAs (amitriptyline)
54
Colon cancer screening recommendation for a patient predisposed to Hereditary Nonpolyposis Colon Cancer Syndrome (Lynch syndrome)?
Every 1-2 years starting at age 25
55
Colon cancer screening recommendation for a patient predisposed to Familial Adenomatous Polyposis?
Start screening sigmoidoscopies at age 12. Colectomy once polyps are found
56
Multiple colonic polyps with osteomas (benign bone tumor). Diagnosis?
Gardner's syndrome
57
Hamartomatous polyps throughout small bowel and colon, melanotic spots on the lips. Diagnosis?
Peutz-Jeghers syndrome
58
Colon cancer screening recommendation in Juvenile Polyposis?
No extra screening recommendations. Juvenile polyposis has multiple extra hamartomas in bowel, but these do not have an increased risk of cancer
59
What tests do you avoid during acute diverticulitis due to risk of bowel perforation?
Colonoscopy and Barium enema
60
Standard antibiotic regimen for diverticulitis?
Cipro (gram-negatives) and Flagyl (anaerobes)
61
Approximately how much body fluid volume is lost by the time a patient is tachycardic >100 or hypotensive SBP<100?
30%
62
Most common complication of TIPS procedures?
Hepatic encephalopathy
63
Drug classes that can cause constipation?
Calcium channel blockers, Narcotics, Anticholinergics (TCAs)
64
Acute pancreatitis, CT shows >30% necrosis. Next step?
Start Imipenem | CT-guided biopsy
65
Medical treatment for diabetic gastroparesis?
Erythromycin or Metoclopramide
66
GI effects of erythromycin?
Increases motilin in the gut, a hormone that stimulates gastric motility
67
Medications that can cause acute pancreatitis?
Thiazides, Didanosine, Stavudine, Azathioprine
68
Causes of pancreatitis?
``` Alchol Gallstones Medications Infection Trauma Post-ERCP Hypertriglyceridemia ```
69
Ascitic fluid analysis shows what in SBP?
Cell count > 250 neutrophils
70
Treatment options for chronic hepatitis B?
``` Lamivudine Adefovir Entecavir Telbivudine Tenofovir Interferon ```
71
Treatment for chronic Hepatitis C?
Interferon with Ribavirin and Boceprevir or Telaprevir
72
Most common adverse effect of Ribavirin?
Anemia
73
SAAG >1.1 signifies?
Ascitic fluid from cirrhosis or CHF
74
Ascitic fluid analysis shows what in SBP?
Cell count > 250 neutrophils
75
Bronze diabetes?
Hemochromatosis
76
Middle aged woman presenting with itching. Xanthelasmas present on exam. Labs show elevated alk phos and normal bilirubin. Antimitochondrial antibody positive. Diagnosis? Treatment?
Primary Biliary Cirrhosis | Treat with ursodeoxycholic acid
77
Kayser Fleischer rings on slit lamp exam pathognomonic for?
Wilson's disease
78
Wilson's disease presentation?
Cirrhosis/liver disease, choreiform movement disorder, neuropsychiatric abnormalities, hemolysis
79
Treatment for Wilson's disease?
Penicillamine or trientine
80
Bronze diabetes?
Hemochromatosis
81
Best initial test for hemochromatosis? Definitive diagnosis?
Best initial - Elevated serum iron (>45%) and ferritin, low TIBC Definitive - Liver biopsy or may do MRI of pancreas in conjunction with HFe gene mutation testing
82
Best initial tests and definitive diagnosis for autoimmune hepatitis?
Best initial - ANA and antismooth muscle antibody. Serum protein electrophoresis shows hypergammaglobulinemia Most accurate - Liver biopsy

Medicine (10 decks)

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