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0. pdf review ? > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are alarm symptoms in GERD?

A
  1. Dysphagia

  2. Odynophagia

  3. Weight loss

  4. Anemia

    Anyone with alarm symptoms needs endoscopy!
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2
Q

What are the three most common medications responsible for esophagitis?

A
  1. Tetracyclines

  2. NSAIDs

  3. Alendronate
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3
Q

36 year old patient with HIV is presenting with odynophagia. What is the next best step?

A

The next best step is a trial dose of fluconazole. By far, the most common etiology will be esophageal candidiasis.

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4
Q

A patient presenting with regurgitation of undigested food and foul smelling breath is most likely suffering from what condition?

A

Zenker diverticulum - this is an outpouching of the pharynx.

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5
Q

Barrium swallow in achalasia will show what finding?

A

Barrium swallow will show a birds beak.

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6
Q

What is the treatment for plummer vincent syndrome?

A

Treatment of choice is oral iron therapy.

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7
Q

What is the medication of choice to control esophageal variceal bleeding?

A

Octreotide. After bleeding has been controlled, the next step is to have TIPS or a surgical shunt placed.

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8
Q

Non bleeding varices are treated with what medication for prophylaxis?

A

These patients are treated with a beta blocker and is continued indefinitely.

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9
Q

What is the most common medication responsible for gastritis?

A

NSAIDs

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10
Q

Why does a gastric ulcer require follow up endoscopy to document resolution?

A

These are at increased risk for gastric cancer, therefore, documented resolution is re- quired to rule out malignancy.

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11
Q

What is the test of choice to diagnose H-pylori?

A

Urea breath test is the test of choice. An acceptable alternative is stool antigen testing. Both can be used to test for cure.

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12
Q

Endoscopy is indicated for first time dyspepsia in patients over what age?

A

Anyone over 50 years of age with first time dyspepsia requires endoscopy.

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13
Q

Gastric cancers are usually what type?

A

Most will be adenocarcinoma

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14
Q

What are three risk factors for gastric cancer?

A
  1. H-pylori infection

  2. Smoking

  3. Alcohol
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15
Q

A 2 month old patient presents with projectile vomiting after feeding. What is the next best test?

A

The next best step is abdominal ultrasound to look for pyloric stenosis.

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16
Q

What physical exam finding will point towards the diagnosis of cholecystitis?

A

Murphys Sign - Palpatation of the RUQ while the patient inhales will cause patient to stop breathing secondary to pain.

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17
Q

What is charcots triad?

A
  1. Fever

  2. Jaundice

  3. RUQ Pain
    This is the classic triad seen in cholangitis.
18
Q

What are risk factors for cholelithiasis?

A
  1. Obesity

  2. Rapid weight loss

  3. Pregnancy
19
Q

What is the most accurate and predictive test of liver function?

A

PT and INR is the most accurate marker for liver function.

20
Q

Who should be universally screened for hepatitis C?

A

The CDC recommends that all patients born 1945-1965 be screened for hepatitis C once, even if asymptomatic.

21
Q

What is the next best test to order if a patient has a positive hepatitis C antibody?

A

Remember, antibodies stay positive for life. Therefore, this might simply be past infec- tion. The next step is hepatitis C RNA to look for active infection.

22
Q

What are the two most common causes of cirrhosis?

A
  1. Hepatitis C


2. Alcohol

23
Q

What AST:ALT ratio is indicative of alcoholic liver disease?

A

A ratio of 2:1 is indicative of alcoholic liver disease.

24
Q

A patient is presenting with epigastric pain that radiates to the back. Nausea and vomiting are also noted. Bilateral flank discoloration is noted - what is this sign?

A

This is the classic presentation for pancreatitis. This is called Grey-Turner sign which in- dicates hemorrhage.

25
Q

When are antibiotics indicated for pancreatitis?

A
  1. Necrosis evident on CT

  2. Failure to improve in one week

  3. Sepsis
26
Q

What is the most specific clinical indicator of appendicitis?

A

Tenderness at Mcburney’s point.

27
Q

What imaging modality is first line in children with suspected appendicitis?

A

First line will be ultrasound. If positive, the patient goes to the OR. If unequivocal or negative but high suspicion remains, the next step is CT scan.

28
Q

A positive tissue transglutimase antibody and endomysial antibody are seen in what disease?

A

This is used to diagnose celiac disease.

29
Q

What antibiotics are used in diverticulitis?

A
  1. Augmentin
    OR

  2. Ciprofloxacin and metronidazole
30
Q

What is the diagnostic test of choice for diverticulitis?

A

Patients should have CT scan done. Six weeks after resolution patients should have a colonoscopy done. Never perform colonoscopy with active diverticulitis as there is in- creased risk of perforation

31
Q

pANCA will be positive in what disease?

A

Ulcerative colitis will be pANCA positive. Crohns will be ASCA positive.

32
Q

What is the first line treatment for IBD?

A

5-ASA

33
Q

A 6 month old male presents abdominal pain and currant jelly stool. You palpate an epigastric mass. What is the first line treatment for this patient?

A

Diagnostic enema is also considered to be therapeutic. If this does not reduce, then surgery is indicated.

34
Q

What is the screening guideline for colon cancer?

A

Screening starts at age 50 and stopped at 75.

  1. Colonoscopy every 10 years

  2. Sigmoidoscopy every 5 years

  3. Fecal occult testing yearly
35
Q

What imaging test should be ordered for a suspected small bowel obstruction?

A

The first test should be an abdominal X-ray. Very few indications exist for abdominal x- ray; know this one.

36
Q

What is borchadts triad?

A
  1. Abdominal/Chest pain

  2. Vomiting

  3. Inability to pass nasograstic tube

    This is indicative of small bowel obstruction
37
Q

Toxic megacolon is defined as dilation over what number?

A

> 6cm of dilation noted on abdominal x-ray = toxic megacolon.

38
Q

What type of hernia will present with a scrotal mass or bulge?

A

Indirect Hernia

39
Q

By what age should most congenital umbilical hernias resolve by?

A

Most resolve by three years of age. If it hasn’t, then surgery is indicated.

40
Q

What antibiotic is most commonly associated with C-Diff?

A

Clindamycin, but be aware that any antibiotic can lead to c-diff infection.

41
Q

How would you classify inflammatory diarrhea?

A

Diarrhea that contains white blood cells or blood.

42
Q

What is the most commonly isolated bacteria in infectious diarrhea?

A

Campylobacter infection.

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