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Step2 CK > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Next step in patient with recurrent duodenal ulcers despite medical treatment?

A

Test for Zollinger-Ellison syndrome , gastrin levels

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2
Q

Most effective treatment of duodenal ulcers not due to ZE syndrome?

A

Triple therapy treatment for H. pylori

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3
Q

What presenting factors help differentiate between gastric and duodenal ulcer?

A

Gastric ulcer: pain is worsened with eating

Duodenal ulcer: pain occurs 2-4 hours after eating and is alleviate with food

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4
Q

What Chem7 abnormality is seen in upper GI bleed?

A

Increased BUN

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5
Q

What is Ranson’s criteria for prognosis in acute pancreatitis (24 and 48 hours)

A

24 hours: Glu>200,AST>250,LDH>350,Age>55 years,WBC>16,000
48hours: Ca5, base deficit >4, sequestration of fluid >6L

If calcium is decreasing it means it is binding to triglycerides in saponification

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6
Q

Serum markers of pancreatic cancer

A

CEA and CA19-9

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7
Q

Common causes of acute pancreatitis

A

ETOH, gallstones, trauma, hypertriglyceridemia, hypercalcemia, medications (antiretroviral)

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8
Q

What is the triple therapy for H.pylori?

A

PPI, clarithromycin, methotrexate/amoxicillin

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9
Q

Treatment for gastric carcinoma

A

If upper stomach then subtotal gastrectomy
If mid and lower stomach then total gastrectomy

Both followed by chemo and radiation

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10
Q

Treatment of pancreatic cancer isolated to pancreatic head?

A

Whipple’s procedure

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11
Q

Most specific and sensitive test for chronic pancreatitis

A

Decreased fecal elastase

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12
Q

Treatment for chronic pancreatitis

A

Stop ETOH!!
Replace enzymes
Pain control

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13
Q

Organism that causes food poisoning associated with mayonnaise or creamy foods stays out too long

A

Staph aureus

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14
Q

“Rice water stools”

A

Vibrio cholera and ETEC

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15
Q

Diarrhea transmitted via pet feces

A

Yersenia entercolitica

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16
Q

Diarrheal organism associated with reheated rice

A

Bacillus cereus

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17
Q

MCC of traveler’s diarrhea

A

ETEC

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18
Q

Diarrheal organism associated with drinking from a stream

A

Giardia lamblia

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19
Q

Diarrheal organism associated with recent antibiotic treatment

A

C. Difficile; pseudomembranous colitis

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20
Q

Mild diarrheal infection that can turn into a Life threatening CNS infection

A

Taenia solium can cause neurocysticircosis

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21
Q

Diarrheal organism associated with undercooked hamburger meat

A

EHEC

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22
Q

Diarrheal organism associated with seafood

A

Vibrio cholera, vulnificus and parahemolyticus

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23
Q

Diarrheal organism associated with poultry

A

Salmonella and campylobacter

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24
Q

Diarrheal illness associated with pink eye

A

Adenovirus

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25
Q

Bloody Diarrheal organism associated with liver abscess

A

Entamoeba histolytica

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26
Q

Diarrheal organism associated with HIV

A

Cryptosporidium and isospora

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27
Q

Diarrheal illness associated with dehydration in children, especially during winter months

A

Rotavirus

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28
Q

Next step in 65 year old patient found to have gastric carcinoma on EGD Biopsy?

A

CT scan of abdomen and pelvis to see the extend of spread(staging)

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29
Q

Common side effects of the following antacids: aluminum hydroxide, mg hydroxide and ca carbonate

A

Aluminum- constipation
magnesium- diarrhea
Calcium- increased risk of peptic ulcers

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30
Q

Common side effects of H2 blockers and PPIs?

A

H2 blockers (cimetidine, rinatadine) neutropenia/thrombocytopenia, gynecomastia and impotence

PPI (omeprazole) well tolerated but can increase the dosages of medications like benzos, warfarin and carbamazepine

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31
Q

Treatment for gastroenteritis caused by: enteoameba

A

Metronidazole

32
Q

Treatment for gastroenteritis caused by: giardia

A

Metronidazole

33
Q

Treatment for gastroenteritis caused by: shigella

A

Fluoroquinilones or TMP SMX

34
Q

Treatment for gastroenteritis caused by: campylobacter

A

Erythromycin

35
Q

Treatment for gastroenteritis caused by:salmonella

A

Fluoroquinilone or TMP SMX

36
Q

Next step in management in patient that comes to ER complaining of abdominal pain and xray shows free air in the abdomen?

A

This xray confirms perforation, so immediately to OR for laparotomy with repair

37
Q

Dx and Tx for recent Cuban immigrant with signs of malabsorption and megaloblastic anemia?

A

Tropical sprue, tx with folic acid and possibly tetracycline antibiotics for 3-6 months

38
Q

Time frame for resolution of post-operative ileus at the stomach, small bowel and large bowel?

A

Stomach: 48-72 hours
Small bowel: within 24 hours
Large bowel: 3-5 days

39
Q

Dx and Tx: pt comes to the ER with vomiting, abdominal pain and distention; xray shows two distinct areas of the sigmoid that are distended?

A

This is the classic double bubble sign of sigmoid volvulus; colonoscopy for detorsion of colon

40
Q

Clinical signs that are seen in appendicitis patients

A

Psoas sign: pain with hip extension
Rovsings sign: pain in RLQ upon palpate on of LLQ
Obturator sign: pain with passive internal rotation of the flexed hip

41
Q

Treatment of Crohn’s disease

A

Acute flare: steroids
Chronic tx: mesalamine (5-ASA), sulfasalazine (colonic involvement), 6-mercaptopurine , azathioprine, and for severe cases anti-TNFa medications

42
Q

Most common causes of small bowel obstruction

A

ABC

Adhesions, bulge (incarcerated hernia) and cancer (metastatic CRC)

43
Q

Classic question stem for acute mesenteric ischemia

A

Abdominal pain out of proportion to physical findings

44
Q

Findings that are classically associated with IBS; and findings that are worrisome and should question Dx of IBS

A

Findings associated with IBS: abdominal discomfort 12wk/year, relief with defecation, increased frequency of BM, change in BM appearance, straining, urgency, feeling of incomplete voiding, mucus with BM

WORRISOME: any signs of malabsorption like weight loss or anorexia, worsening pain, pain that awakens patient from sleep

45
Q

What is the most likely malabsorptive syndrome in a patient with +Sudan stain of stool but normal D-xylose testing?

A

Fat in stool suggests pancreatic insufficiency; normal D-xylose shows normal villus architecture in bowel capable of absorbing carbohydrates

46
Q

Treatment for Whipple’s disease

A

12 months of antibiotic treatment with TMP-SMX OR CEFTRIAXONE

47
Q

Antibodies seen in celiac sprue

A

+ anti-endomysial and anti-gliadin antibodies

48
Q

What kinds of tumors can cause a secretory diarrhea?

A

Gastrinoma, VIPoma, carcinoid, medullary thyroid tumor

49
Q

What serum findings can help differentiate Crohn’s and ulcerative colitis

A

Crohn’s +ASCA

Ulcerative colitis +P-ANCA

50
Q

Treatment for acute mesenteric ischemia

A

NPO, bowel rest with IVF aNd NGT with suction for decompression
Broad spectrum antibiotics, papauvarin to decrease arterial spasm
Diagnose with angiography
Embololectomy or surgical resection (necrosis) if needed

51
Q

Most common causes of acute pancreatitis

A

Alcohol, gallstones

Hypercalcemia, hypertriglyceridemia, trauma and medications

52
Q

Next step in management in a pt>50 years old with minimal bright red blood per rectum on toilet paper but not on BM?

A

Anoscopy, look for hemorrhoids or fissures that may explain bleeding

53
Q

MCC of pain, swelling or the mid-coccygeal area of the skin and subcutaneous tissue?

A

Pilonidal cyst

54
Q

MCC of recurrent LLQ pain that is relieved by defecation

A

Diverticulosis

55
Q

Patients at increased risk for acalculous cholecytitis

A

TPN, critically ill patients, burn patients

56
Q

What is charcot’s triad and what is it used for? What is Reynolds pentad?

A

Triad: fever, RUQ pain and jaundice
It is used to diagnose ascending cholangitis
Pentad: add hypotension and altered mental status

57
Q

What is the next step in management of a Patient found to have a calcified gallbladder (aka porcelain gallbladder)?

A

Do a Biopsy because this is suspicious for gallbladder cancer

58
Q

How does interventional treatment in diverticulosis and diverticulitis differ?

A

In diverticulosis you would diagnose with barium enema and colonoscopy, this would be dangerous in diverticulitis because there is inflammation so in this case you would do a ct scan.

59
Q

How does interventional treatment for cholecytitis and ascending cholangitis differ?

A

In both IVF and antibiotics would be given
In cholecystitis a cholecystectomy would be done; unless the patient is unstable and the. An ERCP would be done first
In ascending cholangitis drainage would be performed via ERCP first and theN a cholecystectomy would be done once inflammation has reduced

60
Q

What stage Dx: patient with CRC that has positive lymph nodes? And why is this important?

A

This is stage III disease and requires chemo after resection of the colon

61
Q

A 60 year old male undergoes colonoscopy and is found to have 3 small tubular adenomatous polyps that are then removed, when should he have a follow up colonoscopy?

A

Every 3 years; if he had 1-2 polyps he would get a colonoscopy every 5 years

62
Q

Pt is a 40 year old male that says father had CRC at the age of 55 when should he have his first colonoscopy?

A

Begin screening these patients (family hx

63
Q

What antibiotics should be used for diverticulosis outpatient?

A

Oral antibiotics: coverage for gram - and anaerobes
flouroquinilones and metro
Amoxicillin and clauvalanic acid
TMP-SMX and metronidazole

64
Q

How are anal fissures managed?

A

Stool softeners, topical NG/CCB or Botox if refractory to reduce spasms. Sx for repair

65
Q

What are the MCC of upper GI bleeding

A

Esophageal varies, Mallory Weiss tears, gastritis, esophagitis, peptic ulcer disease

66
Q

What is the most common cause of lower GI Bleeding?

A

Hemorrhoids, fissures, IBD, diverticulosis, meckles diverticulum, AVM, mesenteric ischemia, colon cancer

67
Q

What is the best way to asses volume status in acute GI bleed?

A

In these cases HCT and hemoglobin will tell us nothing because the patient is not hemodiluted by treatment yet, he just has low volume.

This is better monitored with blood pressure, urine output and heart rate

68
Q

What causes Whipple’s disease and how is it diagnosed?

A

Caused by a bacteria.

Diagnosed by showing PAS positive foamy macrophages and villus atrophy on biopsy

69
Q

What are some differences seen between chronic pancreatitis and celiac sprue?

A

Celiac sprue will also have iron def anemia and serum antibodies

70
Q

Treatment for celiac sprue

A

Remove gluten from diet and give steroids if refractory

71
Q

Treatment for tropical sprue

A

Tetracycline or TMP-SMX for 3-6 months

Folic acid replacement

72
Q

Symptoms of carcinoid syndrome, diagnosis and treatment

A

Intermittent diarrhea, flushing, wheezing and cardiac abnormalities (right)
Diagnose with 5-HIAA in urine
Treat: octreotide or local resection; treat niacin deficiency

73
Q 
Condition associated with the following deficiencies:
Vit DEAK
Folate def anemia
Iron def anemia
B12 def
Niacin def
A

Vit DEAK can be lost in all malabsorptive conditions where fat is lost
Folate def anemia associated with tropical sprue
Iron def anemia associated with celiac disease
B12 def in any disease where bowel wall or panc enzymes affected
Niacin def in carcinoid syndrome

74
Q

When should colonoscopic screening occur in patients with Crohns or ulcerative colitis?

A

Start 8-10 years after disease states

Scope every 1-2 years

75
Q

How is the diagnosis of Crohns different from ulcerative colitis?

A

Because crohns can happen anywhere In the GI you need both small bowel barium follow through and colonoscopy; will show string sign or skip lesions. If still unclear check for ASCA IN CROHNS

Ulcerative colitis is restricted to colon so only need colonoscopy; will show lead piping with colonic shortening. If still unclear check for ANCA

76
Q

Treatment of Crohns and Ulcerative colitis:

A

Acute: steroids, taper off, if recur then azathioprine or 6-MP to wean
Chronic: 5-ASA derivatives (asacol and pentasa=mesalamine)
If severe or unresponsive therapy: TNF alpha agents

If bowel obstruction in Crohns then surgery; colectomy is rarely done but is curative for UC

Step2 CK (12 decks)

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