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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
Q

Secretin IV infusion normally does what to gastrin levels and gastric acid output?

A

Decreases both gastrin levels and gastric acid output

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26
Q

Treatment for local versus metastatic Zollinger-Ellison syndrome?

A

Local - surgical resection

Metastatic - lifelong PPI

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27
Q

Zollinger-Ellison syndrome with hypercalcemia, next step in evaluation?

A

Evaluate parathyroid problems and suspect Multiple Endocrine Neoplasia (MEN) syndrome

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28
Q

Infectious diarrhea etiologic agent that is also associated with Guillain-Barre syndrome?

A

Campylobacter

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29
Q

Infectious diarrhea etiologic agent that is also associated with Hemolytic Uremic Syndrome?

A

E. coli 0157:H7

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30
Q

What do you not give to patients suffering from E. coli 0157:H7 infectious diarrhea?

A

Platelet transfusions or antibiotics

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31
Q

Infectious diarrhea from eating vegetable or pork contaminated with rodent urine/feces?

A

Yersinia

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32
Q

Treatment for amebic infectious diarrhea?

A

Metronidazole

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33
Q

Antibiotic options for infectious diarrhea?

A

Fluoroquinolones (cipro)

34
Q

HIV patient with CD4<100 and infectious diarrhea. Organism identified via modified acid-fast stain. What organism?

A

Cryptosporidiosis

35
Q

Patient with diarrhea 10 minutes after eating tuna/mackarel/mahi mahi. Also has wheezing and flushing. Diagnosis? Treatment?

A

Scombroid poisoining

Treat with diphenhydramine

36
Q

Antibiotic most associated with C. diff?

A

Clindamycin

37
Q

Treatment steps for C. diff?

A
  1. Metronidazole
  2. Oral Vancomycin
  3. Fidaxomicin
  4. Fecal transplant
38
Q

Most common cause of chronic diarrhea?

A

Lactose intolerance

39
Q

Chronic diarrhea along with flushing and episodes of hypotension. Most likely diagnosis?

A

Carcinoid Syndrome

40
Q

Diagnostic evaluation and treatment for Carcinoid Syndrome?

A

Check urinary 5-HIAA level

Treat with somatostatin analogues (octreotide)

41
Q

Differential diagnosis of fat malabsorption?

A

Celaic disease
Tropical Sprue
Chronic Pancreatitis
Whipple’s disease

42
Q

Complications of long-standing untreated fat malabsorption?

A

Hypocalcemia (from Vitamin D deficiency)
Oxalate kidney stones (Oxalate overabsorption)
Increased INR (vitamin K malabsorption)
Vitamin B12 malabsorption

43
Q

Diagnostic testing for fat malabsorption?

A

Sudan black stool stain

72 hour fecal fat

44
Q

Chronic diarrhea with fat malabsorption and vesicular skin lesion. Diagnosis?

A

Celiac Disease (skin lesion is dermatitis herpetiformis)

45
Q

Celiac disease. Best initial test and definitive diagnosis?

A

Best initial - antigliadin, antiendomysial, antitissue transglutaminase antibodies
Definitive diagnosis - Small bowel biopsy

46
Q

Small bowel biopsy must be done in patients with celiac disease to rule out?

A

Bowel wall lymphoma

47
Q

What foods need to be removed from diet for patients with celiac disease?

A

Wheat, oats, rye, barley

48
Q

Fat malabsorption. Small bowel biopsy shows microrganisms. Diagnosis and treatment?

A

Tropical Sprue

Treat with Tetracycline or Bactrim for 3-6 months

49
Q

Fat malabsorption syndrome associated with arthralgias, neurologic abnormalities, ocular findings?

A

Whipple’s disease

50
Q

Whipple’s disease. Best initial test and definitive diagnosis?

A

Initial - Stool PCR for Tropheryma whippelii

Definitive diagnosis - Small bowel biopsy

51
Q

Treatment for Whipple’s disease?

A

Tetracyclinie or Bactrim for 12 months

52
Q

Most accurate test for chronic pancreatitis?

A

Secretin stimulation test

53
Q

Step-wise treatment options for Irritable Bowel Syndrome?

A
  1. Fiber
  2. Antispamodic/anticholinergic drugs (dicyclomine, hyoscyamine)
  3. TCAs (amitriptyline)
54
Q

Colon cancer screening recommendation for a patient predisposed to Hereditary Nonpolyposis Colon Cancer Syndrome (Lynch syndrome)?

A

Every 1-2 years starting at age 25

55
Q

Colon cancer screening recommendation for a patient predisposed to Familial Adenomatous Polyposis?

A

Start screening sigmoidoscopies at age 12. Colectomy once polyps are found

56
Q

Multiple colonic polyps with osteomas (benign bone tumor). Diagnosis?

A

Gardner’s syndrome

57
Q

Hamartomatous polyps throughout small bowel and colon, melanotic spots on the lips. Diagnosis?

A

Peutz-Jeghers syndrome

58
Q

Colon cancer screening recommendation in Juvenile Polyposis?

A

No extra screening recommendations. Juvenile polyposis has multiple extra hamartomas in bowel, but these do not have an increased risk of cancer

59
Q

What tests do you avoid during acute diverticulitis due to risk of bowel perforation?

A

Colonoscopy and Barium enema

60
Q

Standard antibiotic regimen for diverticulitis?

A

Cipro (gram-negatives) and Flagyl (anaerobes)

61
Q

Approximately how much body fluid volume is lost by the time a patient is tachycardic >100 or hypotensive SBP<100?

62
Q

Most common complication of TIPS procedures?

A

Hepatic encephalopathy

63
Q

Drug classes that can cause constipation?

A

Calcium channel blockers, Narcotics, Anticholinergics (TCAs)

64
Q

Acute pancreatitis, CT shows >30% necrosis. Next step?

A

Start Imipenem

CT-guided biopsy

65
Q

Medical treatment for diabetic gastroparesis?

A

Erythromycin or Metoclopramide

66
Q

GI effects of erythromycin?

A

Increases motilin in the gut, a hormone that stimulates gastric motility

67
Q

Medications that can cause acute pancreatitis?

A

Thiazides, Didanosine, Stavudine, Azathioprine

68
Q

Causes of pancreatitis?

A 
Alchol
Gallstones
Medications
Infection
Trauma
Post-ERCP
Hypertriglyceridemia
69
Q

Ascitic fluid analysis shows what in SBP?

A

Cell count > 250 neutrophils

70
Q

Treatment options for chronic hepatitis B?

A 
Lamivudine
Adefovir
Entecavir
Telbivudine
Tenofovir
Interferon
71
Q

Treatment for chronic Hepatitis C?

A

Interferon with Ribavirin and Boceprevir or Telaprevir

72
Q

Most common adverse effect of Ribavirin?

73
Q

SAAG >1.1 signifies?

A

Ascitic fluid from cirrhosis or CHF

74
Q

Ascitic fluid analysis shows what in SBP?

A

Cell count > 250 neutrophils

75
Q

Bronze diabetes?

A

Hemochromatosis

76
Q

Middle aged woman presenting with itching. Xanthelasmas present on exam. Labs show elevated alk phos and normal bilirubin. Antimitochondrial antibody positive. Diagnosis? Treatment?

A

Primary Biliary Cirrhosis

Treat with ursodeoxycholic acid

77
Q

Kayser Fleischer rings on slit lamp exam pathognomonic for?

A

Wilson’s disease

78
Q

Wilson’s disease presentation?

A

Cirrhosis/liver disease, choreiform movement disorder, neuropsychiatric abnormalities, hemolysis

79
Q

Treatment for Wilson’s disease?

A

Penicillamine or trientine

80
Q

Bronze diabetes?

A

Hemochromatosis

81
Q

Best initial test for hemochromatosis? Definitive diagnosis?

A

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
Q

Best initial tests and definitive diagnosis for autoimmune hepatitis?

A

Best initial - ANA and antismooth muscle antibody. Serum protein electrophoresis shows hypergammaglobulinemia
Most accurate - Liver biopsy

Medicine (10 decks)

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