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STEP 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

How does achalasia present?

A

Young, nonsmoker, dysphagia to both solids and liquids, regurgitation, aspiration

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2
Q

What is the best initial test for achalasia?

A

Barium swallow

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3
Q

What is the most accurate test for achalasia?

A

esophageal manometry (shows absence of peristalsis)

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4
Q

What is the best initial therapy for achalasia?

A

Pneumatic dilation or surgical myotomy

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5
Q

What is the alternative treatment for achalasia?

A

Botox, when patient refuses other treatments

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6
Q

How does esophageal cancer present?

A

Dysphagia for solids first then liquids, may have heme-positive stool or anemia Smokers and drinkers

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7
Q

What is the best initial test for esophageal cancer?

A

endoscopy

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8
Q

What is the best initial procedure for esophageal cancer?

A

surgical resection

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9
Q

What other adjuncts are needed after surgical resection of esophageal cancer?

A

5-fluorouracil

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10
Q

What is Plummer-Vinson syndrome? And what is the treatment?

A

Proximal esophageal stricture found with iron deficiency anemia; Replacement of iron is the treatment

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11
Q

What is Schatzki’s ring and what is the treatment?

A

distal ring stricture with intermittent symptoms of dysphagia; best initial therapy is pneumatic dilation

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12
Q

What is a peptic stricture and what is the treatment?

A

stricture resulting from acid reflux; treated with pneumatic dilation

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13
Q

How does Zenker diverticulum present?

A

dysphagia with really stinky breath because rotting food in the back of esophagus because of dilation of the posterior pharyngeal constrictor muscles

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14
Q

What is the best initial test for Zenker diverticulum?

A

barium study

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15
Q

What is the best initial therapy for Zenker’s diverticulum?

A

surgical resection

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16
Q

How does esophageal spasm(nutcracker esophagus) present?

A

severe chest pain usually after drinking cold beverage

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17
Q

What is the most accurate test for esophageal spasm?

A

manometry

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18
Q

What is the treatment for esophageal spasm?

A

CCB

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19
Q

What is the first test for esophagitis on a HIV negative patient?

A

Endoscopy

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20
Q

What do you do when an HIV patient with esophagitis that has CD4 cell count <100?

A

Give fluconazole Candida esophagitis causes >90% esophagitis in HIV patients

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21
Q

What is Mallory Weiss tear?

A

tear in esophagus caused by retching/vomiting, causes sudden upper GI bleed

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22
Q

What is the diagnostic test for Mallory Weiss tear?

A

Endoscopy

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23
Q

What is the treatment for Mallory Weiss tear?

A

most cases resolve spontaneously, epinephrine is used if bleeding persists

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24
Q

What is the diagnostic test for GERD?

A

PPI, both diagnostic and therapeutic

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25
Q

If PPI does not control GERD, what is the next step in management?

A

Surgical/endoscopic procedure to narrow distal esophagus

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26
Q

What is Barrett esophagus?

A

precancerous lesion from chronic reflux

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27
Q

What is the diagnostic test for Barrett esophagus?

A

Endoscopy and biopsy

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28
Q

How is Barrett esophagus treated?

A

PPI and repeat endoscopy every 2-3 years

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29
Q

How do you diagnose non-ulcer dyspepsia?

A

After endoscopy has excluded gastric cancer, ulcer disease, gastritis

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30
Q

What is peptic ulcer disease?

A

Can be either duodenal ulcer or gastric ulcer with the most common cause being H. pylori

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31
Q

What infection is gastritis associated with?

A

H. pylori infection

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32
Q

What is the most accurate test for gastritis?

A

endoscopy with biopsy

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33
Q

What is the treatment for gastritis?

A

Clarithromycin, Amoxicillin, PPI - only if H. pylori is associated with the disease

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34
Q

If patient has epigastric pain, H. pylori positive, and no ulcers, what is the treatment?

A

PPI alone, no abx needed because there is no ulcer disease

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35
Q

How is Zollinger-Elllison syndrome diagnosed?

A

Elevated gastrin level and elevated gastric acid output

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36
Q

What is the most accurate test for Zollinger Ellison syndrome?

A

Endoscopic Ultrasound Nuclear somatostatin scan Secretin supression (MOST ACCURATE)

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37
Q

What is the treatment of Zollinger-Ellison syndrome?

A

surgical resection

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38
Q

What are the diagnostic tests for UC and Crohns?

A

endoscopy

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39
Q

What are the blood blood tests that are positive for Crohns disease?

A

ASCA- Positive ANCA- Negative

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40
Q

What are the blood blood tests that are positive for Ulcerative colitis?

A

ASCA- Negative ANCA- Positive

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41
Q

What is the best initial treatment for both UC and Crohns?

A

Mesalamine

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42
Q

What are the other treatments for UC/Crohns?

A
  • Steroids: Budesonide - Azathioprine and 6-mercaptopurine(patients with severe disease used when steroids are no longer in use) - Infliximab- used to control fistula formation in CD patients (must screen for tuberculosis because infliximab can release dormant granulomas) - Metronidazole & Ciprofloxacin- used when there is perianal involvement Surgery- curative in UC by removing colon
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43
Q

What is the most common cause of food poisoning?

A

campylobacter

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44
Q

What is the best initial test for infectious diarrhea?

A

fecal leukocytes(tells you that an invasive pathogen is present)

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45
Q

What is the most accurate for infectious diarrhea?

A

stool culture

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46
Q

What is the treatment with severe infectious diarrhea?

A

fluoroquinolones are best initial therapy

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47
Q

What antibiotic is most commonly associated with C diff?

A

clindamycin -but can be caused by any antibiotic

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48
Q

What is the best initial test for C diff?

A

Stool toxin assay

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49
Q

What is the best initial therapy for C diff?

A

Metronidazole switch to oral Vanc if there is no response to metronidazole(don’t use IV vanc)

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50
Q

How does carcinoid syndrome present?

A

Flushing and episodes of hypotension

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51
Q

What is the diagnostic test for carcinoid syndrome?

A

urinary 5-HIAA level

52
Q

How do you treat carcinoid syndrome?

A

octreotide

53
Q

What are the causes of fat malabsorption?

A

Celiac disease, tropical sprue, chronic pancreatitis, Whipple disease

54
Q

What are all forms of of malabsorption are associated with?

A

hypocalcemia (Vitamin D deficiency) oxalate kidney stones easy bruising and elevated INR Vitamin B12 malabsorption

55
Q

What is the best initial test for malabsorption?

A

Sudan black stain of stool for presence of fat

56
Q

What is the most sensitive test for malabsorption?

A

72-hour fecal fat

57
Q

What is the best initial test for celiac disease?

A

Anti-gliadin, antiendomysial, and antitissue transglutaminase antibodies

58
Q

What is the most accurate test for celiac disease?

A

Small bowel biopsy - must biopsy in order to rule out bowel lymphoma

59
Q

What is the treatment for celiac disease?

A

elimination of wheat, oats, barley from diet

60
Q

What is the treatment for tropical sprue?

A

doxycyline or TMP/SMX for 3-6 months

61
Q

How does Whipple’s disease present?

A

malabsorption plus arthralgia, neuologic abnormalities, ocular findings

62
Q

What is the most accurate test for Whipple’s disease?

A

small bowel biopsy showing PAS positivity

63
Q

What is the treatment for Whipple’s disease?

A

Tetracycline or TMP/SMX

64
Q

What is the best initial test for chronic pancreatitis?

A

abdominal xray

65
Q

What is the most accurate test for chronic pancreatitis?

A

secretin stimulation test

66
Q

What is the treatment for chronic pancreatitis?

A

replace pancreatic enzymes by mouth

67
Q

What are the symptoms of IBS?

A

pain relieved by BM, pain that is less at night, pain with diarrhea alternating with constipation

68
Q

What are the diagnostic tests that need to be ordered with IBS?

A

stool guaiac, stool WBC, culture, ova, and parasites

69
Q

What is the best initial therapy for IBS?

A

fiber

70
Q

If fiber fails as the first line for IBS, what should be tried next?

A

antispasmodic/anticholinergic agent

71
Q

What is the screening for colon cancer in the general population?

A

Begin at age 50 Colonoscopy every 10 years(best screening method) Fecal occult blood test yearly barium enema

72
Q

What is the screening for colon cancer for people who have one family member with colon cancer?

A

Colonoscopy starting at age 40 or 10 years before the age of the family member who had cancer

73
Q

What is the screening protocol for colon cancer for people who have three family members, two generations, one premature(<50)?

A

Colonoscopy every 1-2 years starting at age 25

74
Q

What is the screening for colon cancer for patient with familial adenomatous polyposis?

A

sigmoidoscopies at age 12

75
Q

What is the presentation of diverticulosis?

A

low fiber, high fat, LLQ pain, lower GI bleeding

76
Q

What is the most accurate test for diverticulosis?

A

barium enema

77
Q

What is the treatment for diverticulosis?

A

high fiber diet

78
Q

What is the presentation of diverticulitis?

A

LLQ pain, tenderness, fever, elevated WBCs

79
Q

What is the best diagnostic test for diverticulitis?

A

abdominal and pelvic CT

80
Q

What is the treatment for diverticulitis?

A

antibiotics cover gram negative(quinolone or cephalosporin), with anerobes use metronidazole. Cipro+Metronidazole

81
Q

What is the most important thing to do in acute GI bleeding?

A

determine if there is hemodynamic instability do orthostatics (>20 mmHg drop in systolic or rise in pulse >10 bmp)

82
Q

When to transfuse a patient packed RBCs?

A

Hct < 30 in older person Hct <20-25 in young person

83
Q

When do you transfuse FFP?

A

When PT/INR is elevated and vitamin K is too slow

84
Q

When do you transfuse platelets?

A

If patient is bleeding or about to undergo surgery and if platelets are <50,000

85
Q

What is the most common cause of death in GI bleeding?

A

MI, this is why you need to get an EKG in older patients with severe GI bleed

86
Q

What is the most important treatment that supersedes all other interventions when it comes to GI bleeds?

A

Volume resuscitation

87
Q

What is the presentation of variceal bleeding?

A

Alcoholic with hemetemesis and/or cirrhosis; splenomegaly, low platelets, spider angiomata

88
Q

What is the treatment for variceal bleeding?

A

octreotide as an initial order Upper GI (variceal banding) If bleeding persists, TIPS (transjugular intrahepatic portosystemic shunt) to lower portal pressure

89
Q

If endoscopy does not reveal the source of GI bleeding, what is the next best test?

A

technetium bleeding scan(tagged red cell scan)- gives location, but not cause

90
Q

What test is indicated if the upper and lower endoscopy does not reveal the location of the bleed?

A

capsule endoscopy, can detect location of GI bleed from the small bowel

91
Q

How does acute mesenteric ischemia present?

A

sudden severe abdominal pain, older patient with valvular heart disease

92
Q

What is the initial lab findings for acute mesenteric ischemia?

A

metabolic acidosis and elevated amylase

93
Q

What is the most accurate test for acute mesenteric ischemia?

A

angiography

94
Q

What is the treatment for acute mesenteric ischemia?

A

surgical resection of bowel, surgical emergency

95
Q

What are some causes of constipation?

A

dehydration, calcium channel blockers, narcotic use, hypothyroid, diabetes, ferrous sulfate, anticholinergic meds

96
Q

What is the treatment for diabetic gastroparesis?

A

Erythromycin or metoclopromide

97
Q

What is the best initial test for diagnosis of acute pancreatitis?

A

amylase, lipase

98
Q

What is the most accurate test for acute pancreatitis?

A

abdominal CT

99
Q

What is the treatment of acute pancreatitis?

A

NPO(bowel rest), hydration, pain meds

100
Q

What is the treatment for necrotic pancreatitis?

A

If CT shows >30% of necrosis, patient should receive antibiotics(imipenem), CT guided biopsy; If biopsy shows necrotic pancreas, patient should have debridement

101
Q

How does hepatitis present?

A

jaundice, fatigue, weight loss, dark urine caused by bilirubin

102
Q

Antigen and Antibody chart for Hepatitis B……

A
103
Q

What is the best initial test for Hepatitis C?

A

Hep C antibody

104
Q

What is the most accurate test for acute Hepatitis C?

A

Hep C PCR

Liver biopsy is the most accurate way of determining the seriousness of the disease

105
Q

What is the treatment chronic hepatitis B?

A

antiviral therapy

Lamivudine, adefovir, entecavir, tellbivudine, tenofivir, interferon

106
Q

What is the treatment for Chronic hepatitis C?

A

Interferon with Ribavarin and boceprevir

107
Q

When is vaccination for hepatitis A and B?

A

during childhood

108
Q

What are the indications for vaccination of hepatitis A and B?

A

Chronic liver disease, household contact with Hep A,B; men who have sex with men; chronic recipients of blood products, IV drug abusers

109
Q

What is the treatment for a healthcare worker that has never been vaccinated that is stuck by a needle of a chronic Hep B patient?

A

Give hepatitis Ig and Hepatitis B vaccine

110
Q

What are the features of cirrhosis?

A

edema(treat with spirinolactone), gynecomastia, palmar erythema, splenomegaly, thrombocytopenia, encephalopathy, esophageal varices(treat with propranalol)

111
Q

When do you preform paracentesis on patient with ascites?

A

Any new ascites, patient with pain, fever, or tenderness

112
Q

How is spontaneous bacterial peritonitis diagnosed?

A

cell count >250 neutrophils

113
Q

How is ascites treated?

A

cefotaxime

114
Q

What is the SAAG(serum-to-ascites albumin gradient) in patients with portal hypertension?

A

>1.1, if it is lees than 1.1, portal hypertension is not present

115
Q

What is the best initial test for primary biliary cirrhosis?

A

elevated Alk Phos with normal bilirubin

116
Q

What is the most accurate test for primary biliary cirrhosis?

A

AMA antibody

117
Q

What is the treatment for PBC?

A

ursodeoxycholic acid

118
Q

How does primary sclerosing cholangitis present?

A

elevated bilirubin with elevated Alk phos

119
Q

What is the most accurate test PSC?

A

ERCP showing beading of biliary system, Anti-smooth antibody, ANCA positive

120
Q

What is the treatment for PSC?

A

Ursodeoxycholic acid

121
Q

What are the characteristics of WIlsons disease?

A

patient with cirrhosis and choreiform movements and neuropsychiatric abnormalities

122
Q

What is the best initial test for Wilson’s disease?

A

slit lamp looking for Kayser Fleischer rings

123
Q

What is the most accurate test Wilson’s disease?

A

liver biopsy

124
Q

What is the treatment for Wilson’s disease?

A

penicillamine, trientine

125
Q

What is the best initial diagnostic test for hemochromatosis?

A

elevated serum iron and ferritin levels and low iron binding capacity

126
Q

What is the most accurate test for hemochromatosis?

A

liver biposy

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