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USMLE Step 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

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USMLE® Step 1 flashcards
1
Q

esophageal disorders leading to narrowing will result in

A

dysphagia and weight loss

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2
Q

name the causes of dysphagia (7)

A
  1. achalasia
  2. cancer
  3. rings/webs
  4. Zenker’s diverticulum
  5. spastic d/o’s
  6. scleroderma
  7. eosinophilic esophagitis
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3
Q
  • YOUNG nonsmoker
  • dysphagia to solids AND liquids at the same time
  • REGURGITATION of food
  • ASPIRATION of previously eaten food
A

achalasia

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4
Q

best INITIAL test for achalasia

A

barium swallow

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5
Q

MOST ACCURATE test for achalasia

A

esophageal manometry

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6
Q

endoscopy in achalasia is done for what purpose?

A

to EXCLUDE cancer

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7
Q

best INITIAL treatment for achalasia

A

pneumatic dilation, or surgical myotomy

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8
Q

pneumatic dilation for achalasia is done when?

A

surgical myotomy is UNSUCCESSFUL

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9
Q

treatment for achalasia if pt refuses pneumatic dilation/surgical myotomy

A

botulinum toxin injection

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10
Q
  • dysphagia to solids THEN liquids
  • +/- heme-positive stool, or ANEMIA
  • often pts > 50 yoa
  • smoker/drink alcohol
A

esophageal cancer

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11
Q

best INITIAL test for esophageal cancer

A

endoscopy

barium swallow if endoscopy isn’t a choice

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12
Q

best INITIAL treatment for esophageal cancer

A

RESECTION

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13
Q

surgical resection of esophageal cancer should be followed by

A

5-fluorouracil (5-FU)

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14
Q

name the causes of rings/webs causing dysphagia (3)

A
  1. Plummer-Vinson syndrome
  2. Schatzki’s ring
  3. peptic stricture
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15
Q

best INITIAL test for rings/webs

A

barium swallow

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16
Q
  • PROXIMAL stricture
  • IDA
  • middle-aged females
A

Plummer-Vinson syndrome

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17
Q

best INITIAL treatment for Plummer-Vinson syndrome

A

iron

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18
Q
  • DISTAL ring

- INTERMITTENT symptoms of dysphagia

A

Schatzki’s ring

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19
Q

best INITIAL treatment for Schatzki’s ring

A

pneumatic dilation

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20
Q
  • dysphagia

- longstanding acid reflux

A

peptic stricture

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21
Q

treatment for peptic stricture

A

pneumatic dilation

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22
Q
  • horrible bad breath from rotting food in back of esophagus

- dilation of posterior pharyngeal constrictor muscles

A

Zenker’s diverticulum

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23
Q

best INITIAL test for Zenker’s diverticulum

A

barium swallow

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24
Q

best INITIAL treatment for Zenker’s diverticulum

A

surgical resection

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25
Q
  • dysphagia
  • h/o allergies
  • mean of 5 years before diagnosis is made
A

eosinophilic esophagitis

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26
Q

test for eosinophilic esophagitis

A

endoscopy w/ biopsy

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27
Q

treatment for eosinophilic esophagitis

A

PPT and budesonide

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28
Q
  • severe chest pain w/o risk factors for ischemic heart disease
  • pain after drinking cold beverage
  • normal EKG/stress test/coronary angiography
A

diffuse esophageal spasm

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29
Q

MOST ACCURATE test for diffuse esophageal spasm

A

manometry

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30
Q

barium swallow may show what during an episode of spasm in diffuse esophageal spasm

A

corkscrew pattern

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31
Q

treatment for diffuse esophageal spasm

A
  • CCB

- nitrate

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32
Q

difference between diffuse esophageal spasm and Prinzmetal’s variant angina

A

ST segment elevation

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33
Q
  • diffuse disease

- reflux symptoms

A

scleroderma

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34
Q
  • odynophagia
  • HIV-NEGATIVE

what is the next step in management?

A

endoscopy

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35
Q
  • odynophagia

- HIV-POSITIVE w/ CD4 count

A

fluconazole

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36
Q
  • odynophagia

- HIV-POSITIVE w/ CD4 count

A

endoscopy

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37
Q

> 90% of esophagitis in HIV-positive pts are caused by?

A

Candida

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38
Q

treatment for pill esophagitis

A
  • sit up
  • drink a lot of water
  • remain upright for 30 minutes after
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39
Q
  • SUDDEN UGIB
  • violent retching/vomiting
  • there may be hematemesis or melena
A

Mallory-Weiss tear

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40
Q

test for Mallory-Weiss tear

A

endoscopy

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41
Q

treatment for Mallory-Weiss tear

A

most spontaneously resolve

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42
Q

treatment for Mallory-Weiss tear if bleeding does NOT resolve

A

endoscopic epinephrine injection

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43
Q
  • epigastric pain/substernal chest pain
  • sore throat
  • metallic or bitter taste
  • hoarseness
  • chronic cough
  • wheezing
  • nausea
A

GERD!!

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44
Q

diagnosis and treatment for GERD

A

PPI

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45
Q

if no response to PPI for GERD symptoms, next step in management

A

endoscopy

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46
Q

if GERD symptoms persist and EGD is normal, next step in management

A

24-hour pH monitoring

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47
Q

alarm symptoms in pt w/ GERD indicating endoscopy

A
  • weight loss
  • anemia
  • blood in stool
  • dysphagia
  • reflux for more than 5-10 years
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48
Q
  • PREcancerous lesion of lower esophagus

- 0.5%/year transform into cancer

A

Barrett esophagus

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49
Q

test for Barrett esophagus

A

endoscopy

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50
Q

endoscopic finding: Barrett esophagus (metaplasia)

next step in management

A

PPI and repeat EGD every 2-3 years

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51
Q

endoscopic finding: low-grade dysplasia

next step in management

A

PPI and repeat EGD in 3-6 months

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52
Q

endoscopic finding: high-grade dysplasia

next step in management

A
  • endoscopic mucosal resection
  • endoscopic ablation
  • distal esophagectomy
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53
Q

MCC of epigastric discomfort

A

non-ulcer dyspepsia (diagnosis of exclusion)

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54
Q

test for non-ulcer dyspepsia

A

endoscopy

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55
Q

treatment for non-ulcer dyspepsia

A
  • H2 blocker
  • liquid antacid
  • PPI
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56
Q

treatment for REFRACTORY non-ulcer dyspepsia

A

treat for Helicobacter pylori

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57
Q

MCC of peptic ulcer disease (duodenal/gastric)

A

H. pylori

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58
Q

after H. pylori, MCC of PUD

A
  • NSAIDs
  • head trauma
  • burns
  • intubation
  • Crohn’s disease
  • Zollinger-Ellison syndrome
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59
Q

what % of GU pts develop gastric cancer?

A

4%

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60
Q

gastritis can be associated w/

A

H. pylori

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61
Q

treatment for H. pylori

A
  • omeprazole
  • clarithromycin
  • amoxicillin
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62
Q

MOST ACCURATE test for gastritis

A

endoscopy w/ biopsy

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63
Q

treatment if initial H. pylori treatment fails

A

repeat triple therapy w/ 2 new abx

  • PPI
  • metronidazole
  • tetracycline
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64
Q

if H. pylori treatment fails twice

A

evaluate for ZES (gastrinoma)

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65
Q

stress ulcer prophylaxis should be given to the following:

A
  • head trauma
  • intubation and mechanical ventilation
  • burns
  • coagulopathy AND steroid use in combination
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66
Q
  • epigastric pain
  • H. pylori positive
  • NO ulcer or gastritis
A

non-ulcer dyspepsia

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67
Q

EVERYONE on an H2 blocker or PPI has an

A

ELEVATED GASTRIN LEVEL

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68
Q

diagnostic test ZES

A

gastrin level and gastric acid output

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69
Q

test the gastrin level and gastric acid output for ZES when the following is present:

A
  • large ulcer (> 1cm)
  • multiple ulcers
  • ulcer distal to ligament of Treitz
  • recurrent/persistent ulcer despite H. pylori treatment
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70
Q

if gastrin level and acid output are elevated in ZES, next step

A

localize the gastrinoma

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71
Q

MOST ACCURATE test for ZES

A

secretin suppression test

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72
Q

treatment of ZES for LOCAL disease

A

surgical resection

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73
Q

treatment of ZES for metastatic disease

A

lifelong PPI

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74
Q

clue about the presence of a parathyroid problem w/ ZES, and multiple endocrine neoplasia (MEN) syndrome

A

hypERcalcemia

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75
Q

both CD and UC can present w/

A
  • fever
  • abdominal pain
  • diarrhea
  • bloody stools
  • weight loss
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76
Q

extraintestinal manifestations of IBD

A
  • joint pain
  • iritis/uveitis
  • pyoderma gangrenosum/erythema nodosum
  • sclerosing cholangitis
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77
Q

features more common to CD

A
  • masses
  • skip lesion
  • upper GI tract
  • perianal disease
  • transmural granulomas
  • fistulae
  • hypocalcemia from fat malabsorption
  • obstruction
  • calcium oxalate kidney stones
  • cholesterol gallstones
  • vitamin B12 malabsorption from terminal ileum involvement
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78
Q

diagnosis for CD and UC

A

barium swallow or endoscopy

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79
Q

when diagnosis of CD or UC, what can be helpful

A

blood tests

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80
Q

ASCA and ANCA in CD

A

ASCA POSITIVE

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81
Q

ASCA and ANCA in UC

A

ANCA POSITIVE

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82
Q

best INITIAL treatment for both CD and UC

A

mesalamine

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83
Q

adverse effects of sulfasalazine

A
  • rash
  • hemolytic anemia
  • interstitial nephritis
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84
Q

treatment for acute exacerbation of CD and UC

A

budesonide

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85
Q

treatment for severe CD and UC w/ recurrent symptoms when steroids are STOPPED

A

azathioprine, or 6-mercaptopurine

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86
Q

most useful treatment for CD associated w/ FISTULA formation

A

infliximab

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87
Q

treatment for perianal involvement in CD

A

metronidazole and ciprofloxacin

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88
Q

curative treatment for UC

A

surgical resection of colon

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89
Q

most important feature of infectious diarrhea

A

presence of blood indicating invasive bacterial pathogen

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90
Q

infectious diarrhea +/- blood may be d/t which pathogens?

A
  • Campylobacter
  • Salmonella
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • E. coli (including E. coli O157:H7)
  • Shigella
  • Yersinia
  • amoeba
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91
Q
  • diarrhea

- MCC of food poisoning

A

Campylobacter

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92
Q

Campylobacter can be associated w/

A
  • Guillain-Barre syndrome

- reactive arthritis

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93
Q
  • diarrhea

- transmitted by chickens and eggs

A

Salmonella

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94
Q
  • diarrhea

- associated w/ seafood

A

Vibrio parahaemolyticus

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95
Q
  • diarrhea
  • most commonly associated w/ HUS (effects of verotoxin)
  • h/o undercooked beef
A

E. coli O157:H7

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96
Q

which treatments should be AVOIDED in HUS

A

platelet transfusion and antibiotics

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97
Q
  • diarrhea
  • associated w/ shellfish
  • septicemia is MUCH more likely in pt w/ liver disease - - necrotizing wound infections can occur in skin lesions
A

Vibrio vulnificus

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98
Q
  • diarrhea
  • secretes Shiga toxin
  • also, associated w/ reactive arthritis
  • 2nd MCC of HUS
A

Shigella

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99
Q
  • diarrhea
  • rodents are natural reservoir
  • transmission is through food contaminated w/ infected urine/feces
A

Yersinia

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100
Q

diarrhea, which may be associated w/ liver abscesses

A

amoeba

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101
Q

best INITIAL test for infectious diarrhea

A

fecal leukocytes

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102
Q

MOST ACCURATE test for infectious diarrhea

A

stool culture

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103
Q

treatment for infectious diarrhea: mild disease

A

none; will resolve on its own

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104
Q

best INITIAL treatment for infectious diarrhea: severe disease

A

fluoroquinolones

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105
Q

severe infectious diarrhea is defined as having the following

A
  • blood
  • fever
  • abdominal pain
  • hypotension and tachycardia
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106
Q

infectious diarrhea (which NEVER presents w/ blood) may be d/t which pathogens?

A
  • viruses
  • Giardia
  • Staphylococcus aureus
  • Bacillus cereus
  • Cryptosporidium
  • Scombroid
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107
Q
  • diarrhea
  • camping/hiking
  • men who have sex w/ men
  • bloating, flatus, signs of steatorrhea
A

Giardia

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108
Q

more accurate test for Giardia

A

stool ELISA Ag

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109
Q

treatment for Giardia

A

metronidazole or tinidazole

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110
Q
  • diarrhea

- associated with mayonnaise and vomiting

A

Staphylococcus aureus

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111
Q
  • diarrhea

- associated w/ refried Chinese rice and vomiting

A

Bacillus cereus

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112
Q
  • diarrhea

- HIV-positive pt w/ CD4 cells

A

Cryptosporidium

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113
Q

test for Cryptosporidium

A

modified acid-fast stain

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114
Q

treatment for Cryptosporidium

A

HAART and nitazoxanide

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115
Q
  • diarrhea
  • histamine fish poisoning
  • FASTEST onset diarrhea, w/i 10 MINUTES
  • vomiting, wheezing, flushing
A

Scombroid

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116
Q

treatment for Scombroid

A

diphenhydramine

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117
Q
  • antibiotic-associated diarrhea

- develops several days to weeks after abx use

A

Clostridium difficile

118
Q

best INITIAL test Clostridium difficile diarrhea

A

stool toxin assay

119
Q

initial treatment for mild/moderate CDI

A

PO metronidazole or PO vancomycin

120
Q

treatment for severe CDI

A

PO vancomycin +/- IV metronidazole

121
Q

definition of severe CDI

A
  • WBCs > 15,000

- serum albumin

122
Q

treatment for complicated CDI

A
  • PO vancomycin and IV metronidazole

- surgery consult

123
Q

definition of complicated CDI

A
  • toxic megacolon
  • peritonitis
  • respiratory distress
  • hemodynamic instability
124
Q

alternate treatment for severe and recurrent CDI

A

fidaxomicin

125
Q

chronic diarrhea (> 4 weeks) causes

A
  • lactose intolerance
  • carcinoid syndrome
  • IBD
126
Q

MCC of chronic diarrhea and flatulence

A

lactose intolerance

127
Q

chronic diarrhea associated w/ flushing and episodes of hypotension

A

carcinoid syndrome

128
Q

test for carcinoid syndrome

A

urinary 5-HIAA level

129
Q

treatment for carcinoid syndrome

A

octreotide (somatostatin analog)

130
Q

chronic diarrhea w/ blood in stools, fever, and weight loss

A

IBD

131
Q
  • chronic diarrhea ALWAYS associated w/ weight loss
A

malabsorption

132
Q

name the causes of malabsorption (4)

A
  1. celiac disease (gluten sensitive enteropathy)
  2. tropical sprue
  3. chronic pancreatitis
  4. Whipple’s disease
133
Q

ALL forms of fat malabsorption are associated w/

A
  • hypocalcemia (vitamin D deficiency)
  • oxalate kidney stones
  • easy bruising and elevated PT/INR (vitamin K malabsorption)
  • vitamin B12 malabsorption
134
Q

best INITIAL test for malabsorption

A

Sudan black stain for stool

135
Q

MOST SENSITIVE test for malabsorption

A

72-hour fecal fat

136
Q
  • iron malabsorption and microcytic anemia
  • folate malabsorption
  • dermatitis herpetiformis
A

celiac disease

137
Q

best INITIAL tests for celiac disease

A
  • anti-gliadin Ab
  • anti-endomysial Ab
  • anti-tissue transglutaminase Ab
138
Q

MOST ACCURATE test for celiac disease

A

small bowel biopsy

139
Q

D-xylose test result in celiac disease, Whipple’s disease, and tropical sprue

A

ABNORMAL (villous lining is destroyed)

140
Q

what test should be done even if diagnosis of celiac disease has been confirmed?

A

small bowel biopsy to EXCLUDE bowel wall lymphoma

141
Q

treatment for celiac disease

A

gluten free diet

142
Q

MOST ACCURATE test for tropical sprue

A

small bowel biopsy showing microorganisms

143
Q

treatment for tropical sprue

A

doxycycline, or TMP/SMX for 3-6 MONTHS

144
Q
  • malabsorption
  • arthralgia (MCC presenting symptom)
  • neurological abnormalities
  • ocular findings
A

Whipple’s disease

145
Q

MOST ACCURATE test for Whipple’s disease

A

small bowel biopsy showing PAS POSITIVE organisms

146
Q

treatment for Whipple’s disease

A

tetracycline, or TMP/SMX for 12 MONTHS

147
Q
  • malabsorption
  • h/o alcoholism
  • h/o multiple episodes of pancreatitis
  • amylase/lipase will most likely be normal
A

chronic pancreatitis

148
Q

best INITIAL tests for chronic pancreatitis

A
  • abdominal XR (pancreatic calcifications)

- CT scan of abdomen

149
Q

MOST ACCURATE test for chronic pancreatitis

A

secretin stimulation testing

150
Q

D-xylose test in chronic pancreatitis will be

A

NORMAL

151
Q

treatment for chronic pancreatitis

A

pancreatic enzymes

152
Q
  • abdominal pain relieved by BM
  • abdominal pain that’s less at night
  • abdominal pain w/ diarrhea alternating w/ constipation
A

irritable bowel syndrome (IBS)

153
Q

all diagnostic tests for IBS will be?

A

normal

154
Q

best INITIAL treatment for IBS

A

fiber

155
Q

if fiber does not relieve pain in IBS, next treatment

A
  • dicyclomine

- hyoscyamine

156
Q

if fiber, and dicyclomine don’t work for IBS, last resort treatment

A

TCA

157
Q

colonoscopy screening: general population

A
  • begin at 50 yoa

- repeat every 10 years

158
Q

colonoscopy screening: 1 family member w/ colon cancer

A
  • begin at 40 yoa, OR 10 years before age of family member who had cancer
159
Q

colonoscopy screening: 3 family members, 2 generations, or 1 premature (

A
  • begin at 25 yoa

- repeat every 1-2 years

160
Q

colonoscopy screening: FAP

A
  • begin sigmoidoscopies at 12 yoa

- COLECTOMY once polyps are found

161
Q
  • colon polyps

- osteomas (benign bone tumors)

A

Gardner’s syndrome

162
Q
  • hamartomatous polyps throughout small bowel and colon

- melanotic spots on lips

A

Peutz-Jeghers syndrome

163
Q
  • multiple extra hamartomas in bowel

- no significant increase in cancer risk

A

juvenile polyposis

164
Q

colonoscopy screening: DYSplastic polyp found

A

repeat colonoscopy every 3-5 years after polyp was found

165
Q
  • LLQ abdominal pain

- LGIB

A

diverticulosis

166
Q

MOST ACCURATE test for diverticulosis

A

barium enema

167
Q
  • complication of diverticulosis
  • LLQ abdominal pain
  • TENDERNESS
  • FEVER
  • ELEVATED WBC COUNT
A

diverticulitis

168
Q

best test for diverticulitis

A

CT scan of abd/pelvis

169
Q

is CI in diverticulitis d/t increased risk of perforation

A

colonoscopy

170
Q

treatment for diverticulosis

A

high-fiber diet

171
Q

treatment for diverticulitis

A

antibiotics against GNR and anaerobes

metronidazole and ciprofloxacin

172
Q

GI bleed: red blood

A

LGIB

173
Q

GI bleed: black stool

A

UGIB (when proximal to ligament of Treitz (duodenum/jejunum))

174
Q

MOST important step in managing an acute GI bleed

A

determine if pt is hemodynamically unstable

175
Q

GI bleed management:

when do I transfuse PRBCs?

A
  • Hct
176
Q

GI bleed management:

when do I transfuse FFP?

A

elevated PT/INR and vitamin K is too slow

177
Q

GI bleed management:

when do I transfuse platelets?

A
  • if pt is bleeding/undergo surgery w/ platelets
178
Q

MCC of death in GI bleeding

A

myocardial ischemia

179
Q

what should be ordered on an older pt w/ GI bleeding?

A

EKG to r/o ischemia

180
Q

most important treatment for acute GI bleeding

A

fluid resuscitation

181
Q

most important measure of severity of GI bleeding

A

pulse and BP

182
Q

what if pulse is still elevated, or BP is still low in pt w/ GI bleeding and is becoming hypotensive?

A

oxygenate (intubate if needed) and c/w IVF

183
Q

more important in GI bleed than endoscopy

A

correcting anemia, thrombocytopenia, or coagulopathy

184
Q

with adequate fluid resuscitation, even w/o endoscopy 80% of GI bleeds

A

stop bleeding

185
Q

should be added to initial fluid resuscitation if GI bleed is d/t ulcer disease

A

PPI

186
Q

unnecessary stress ulcer ppx w/ PPIs increases risk of

A

pneumonia and Clostridium difficile colitis

187
Q
  • alcoholic and/or cirrhosis w/ hematemesis
  • splenomegaly
  • thrombocytopenia
  • spider angiomata
  • gynecomastia
A

variceal bleeding

188
Q

should be added to initial fluid resuscitation if GI bleed is d/t variceal bleeding

A

octreotide (somatostatin analog)

decreases portal hypertension

189
Q

treatment for variceal bleeding aside from fluid resuscitation and octreotide

A

EGD to do banding

190
Q

if variceal bleeding PERSISTS, next step in management

A

transjugular intrahepatic portosystemic shunt (TIPS)

shunt between PORTAL vein and HEPATIC vein

191
Q

MC complication of transjugular intrahepatic portosystemic shunt (TIPS) procedure

A

hepatic encephalopathy

192
Q

prevents future episodes of variceal bleeding

A

propranolol

193
Q

temporary measure to stop variceal bleeding to allow time for a shunt to be placed

A

Blakemore gastric tamponade balloon

194
Q

UPPER GIB can have the following causes: (6)

A
  1. PUD
  2. esophagitis
  3. gastritis
  4. duodenitis
  5. varices
  6. cancer
195
Q

LOWER GIB can have the following causes: (6)

A
  1. angiodysplasia
  2. diverticular disease
  3. polyps
  4. ischemic colitis
  5. inflammatory bowel disease
  6. cancer
196
Q
  • test performed to detect site of bleeding IF endoscopy cannot
  • gives you location, but not exact cause
A

tagged red cell scan

technetium bleeding scan

197
Q
  • tells you precise vessel that is bleeding

- may be done PREOPERATIVELY in massive GI bleeding to let you know which part of the colon to resect

A

angiography

198
Q

can detect location of GIB from SMALL BOWEL, IF upper and lower endoscopies cannot

A

capsule endoscopy

199
Q
  • embolus from heart resulting in infarction of bowel
  • SUDDEN onset of extremely severe abdominal pain
  • +/- bleeding
  • PE is relatively benign
  • older pt w/ h/o valvular heart disease
A

acute mesenteric ischemia

200
Q

look for what on blood tests of acute mesenteric ischemia

A
  • metabolic acidosis (elevated lactic acid d/t ischemia)

- elevated amylase level

201
Q

MOST ACCURATE test for acute mesenteric ischemia

A

angiography

202
Q

treatment for acute mesenteric ischemia

A

surgical resection of bowel

surgical emergency

203
Q

treatment in mesenteric ischemia NOT caused by emboli

A

treat underlying flow state

204
Q

management of constipation

A

correct underlying cause

205
Q

possible causes of constipation: (7)

A
  1. dehydration (decreased skin turgor in elderly pt w/ BUN:Cr ratio > 20:1)
  2. CCB
  3. opioids
  4. hypothyroidism
  5. DM (loss of sensation in bowels)
  6. ferrous sulfate iron replacement
  7. anticholinergics (including TCAs)
206
Q

differentiating between UGIB and black stool d/t ferrous sulfate iron replacement

A

blood is cathartic causing RAPID BM

207
Q

treatment of constipation

A

hydration and increased fiber

208
Q
  • prior gastric surgery
  • SHAKING, SWEATING, WEAKNESS
  • +/- hypotension
A

dumping syndrome

209
Q

mechanism of hypotension in dumping syndrome (2 possible mechanisms)

A
  1. rapid release of gastric contents in duodenum –> osmotic draw into bowel
  2. rapid rise in blood glucose –> reactive hypoglycemia
210
Q

management of dumping syndrome

A

frequent small meals

211
Q
  • longstanding diabetes
  • bloating
  • constipation
  • diarrhea
A

gastroparesis

212
Q

mechanism of gastroparesis

A
  • main stimulant to gastric motility is DISTENSION

- DM damages sensory nerves

213
Q

treatment for gastroparesis

A
  • erythromycin

- metoclopramide

214
Q

mechanism of erythromycin in gastroparesis

A

increases motilin in gut (hormone that stimulates gastric motility)

215
Q
  • severe midepigastric abdominal pain and tenderness
  • MCC are alcohol and gallstones
  • vomiting w/o blood
  • anorexia
A

acute pancreatitis

216
Q

other causes of acute pancreatitis

A
  • hypertriglyceridemia
  • trauma
  • infection
  • ERCP
  • medications (thiazides, didanosine, stavudine, azathioprine)
217
Q

severe acute pancreatitis signs and lab findings

A
  • hypotension
  • metabolic acidosis
  • leukocytosis
  • hemoconcentration
  • hyperglycemia
  • hypocalcemia
  • hypoxia
218
Q

best INITIAL test for acute pancreatitis

A

amylase and lipase

219
Q

MOST ACCURATE test for acute pancreatitis

A

CT scan of abdomen

220
Q

detects causes of biliary and pancreatic duct obstruction not found on CT scan

A

MRCP

221
Q
  • consider if there is dilation of CBD WITHOUT pancreatic head mass
  • detects presence of stones/strictures
  • can REMOVE stones and DILATE strictures
A

ERCP

222
Q

urinary test used to determine severity of pancreatitis

A

trypsinogen activation peptide

223
Q

treatment for acute pancreatitis

A
  • no feeding (bowel rest)
  • hydration
  • pain medications
224
Q

most precise method of determining pancreatitis severity

A

CT scan

225
Q

Ranson’s criteria and CT scan are methods to determine which patients require

A

pancreatic debridement

226
Q

when the CT scan shows > 30% NECROSIS of pancreas, the pt should:

A
  • receive abx such as imipenem, and

- undergo CT-guided biopsy

227
Q

if biopsy shows INFECTED, NECROTIC pancreatitis, pt should undergo

A

surgical debridement

228
Q

hepatitis B is associated w/ what in 30% of cases

A

polyarteritis nodosa (PAN)

229
Q

hepatitis C is associated w/

A

cryoglobulinemia

230
Q
  • jaundice
  • fatigue
  • weight loss
  • dark urine (bilirubin)
A

acute hepatitis

231
Q
  • jaundice
  • fatigue
  • weight loss
  • dark urine (bilirubin)
  • present w/ serum sickness-phenomena (joint pain, urticaria, and fever)
A

hepatitis B and C

232
Q

hepatitis E is most severe in

A

pregnant females (can be fatal)

233
Q

ALL patients w/ acute hepatitis will have an ELEVATED?

A

conjugated (direct) bilirubin

234
Q

viraL hepatitis gives an ELEVATED

A

aLt

235
Q

hepatitis from drugS gives and ELEVATED

A

aSt

236
Q

MOST ACCURATE tests for hepatitis A, C, D, and E

A

serology

237
Q

MOST ACCURATE tests for hepatitis B

A
  • surface Ag
  • core Ab
  • e-Ag
  • surface Ab
238
Q

FIRST test to become abnormal in ACUTE hepatitis B infection

A

SURFACE Ag

239
Q

ALT elevation, e-Ag, and symptoms all occur AFTER

A

SURFACE Ag

240
Q

CHRONIC hepatitis B gives same serologic pattern as acute hepatitis B, but has

A

PERSISTENCE OF SURFACE AG > 6 MONTHS

241
Q

ONLY acute hepatitis that CAN be treated

A

hepatitis C

242
Q

best INITIAL test for acute hepatitis C

A

hepatitis C Ab

243
Q

MOST ACCURATE tests for acute hepatitis C

A
  • hepatitis C PCR

- liver biopsy

244
Q

MOST ACCURATE way of determining response to treatment for acute hepatitis C, which is based on GENOTYPE

A

hepatitis C PCR

245
Q

MOST ACCURATE way to determine extent of liver damage in acute hepatitis C

A

liver biopsy

246
Q

treatment for acute hepatitis C

A

interferon, ribavirin, and PI (ledipasvir, simeprevir, or sofosbuvir)

247
Q

treatment for chronic hepatitis B

A

single agent!

  • lamivudine
  • adefovir
  • entecavir
  • telbivudine
  • tenofovir
  • interferon
248
Q

MC adverse effect of ribavirin

A

anemia

249
Q

treatment of chronic hepatitis C genotype 1

A

ledipasvir and sofosbuvir

250
Q

treatment of chronic hepatitis C all other genotypes

A
  • simeprevir

- boceprevir

251
Q

MC reason to need liver transplantation in USA

A

chronic hepatitis C

252
Q

strongest indications for hepatitis A and B vaccination in ADULTS

A
  • chronic liver disease
  • household contacts w/ hepatitis A or B
  • men who have sex w/ men
  • chronic blood product recipients
  • IVDA
253
Q

specific indication for hepatitis A vaccination

A

travelers

254
Q

specific indications for hepatitis B vaccination

A
  • health care workers
  • dialysis pts
  • DM pts
255
Q
  • edema from low oncotic pressure
  • gynecomastia
  • palmar erythema
  • splenomegaly
  • thrombocytopenia from splenic sequestration
  • encephalopathy
  • ascites
  • esophageal varices
A

cirrhosis

256
Q

treatment for edema from low oncotic pressure in cirrhosis pts

A

spironolactone and diuretics

257
Q

treatment for encephalopathy in cirrhosis pts

A

lactulose

258
Q

treatment for ascites in cirrhosis pts

A

spironolactone

259
Q

treatment for esophageal varices in cirrhosis pts

A
  • propranolol to prevent bleeding

- banding to stop acute bleeding

260
Q

what should be done in the following?

  • new ascites
  • pt w/ ascites develops pain, fever, or tenderness
A

paracentesis

261
Q

if serum-to-ascites albumin GRADIENT (SAAG) is > 1.1

A
  • portal hypertension from cirrhosis

- CHF

262
Q

neutrophils > 250 on paracentesis

A

spontaneous bacterial peritonitis (SBP)

263
Q

treatment for spontaneous bacterial peritonitis (SBP)

A

cefotaxime

264
Q

causes of chronic liver disease (cirrhosis): (7)

A
  1. alcoholic cirrhosis
  2. primary biliary cholangitis
  3. primary sclerosing cholangitis
  4. Wilson’s disease
  5. hemochromatosis
  6. autoimmune hepatitis
  7. nonalcoholic steatohepatitis (NASH)
265
Q
  • diagnosis of exclusion

- longstanding h/o alcohol abuse

A

alcoholic cirrhosis

266
Q
  • middle-aged FEMALE c/o itching
  • +/- xanthelasma (cholesterol deposit)
  • may have h/o AI d/o’s
A

primary biliary cholangitis

267
Q

best INITIAL test for primary biliary cholangitis

A

elevated alkaline phosphatase w/ a NORMAL bilirubin level

268
Q

MOST ACCURATE tests for primary biliary cholangitis

A
  • anti-mitochondrial Ab (AMA)

- liver biopsy

269
Q

treatment for primary biliary cholangitis

A

ursodeoxycholic acid

270
Q
  • associated w/ 80% of IBD cases
  • also presents w/ itching
  • elevated alkaline phosphatase
  • ELEVATED BILIRUBIN level
A

primary sclerosing cholangitis

271
Q

MOST ACCURATE tests for primary sclerosing cholangitis

A
  • ERCP (shows “beading” of biliary system)
  • anti-smooth muscle Ab (ASMA)
  • ANCA positive
272
Q

treatment for primary sclerosing cholangitis

A

ursodeoxycholic acid

273
Q
  • liver disease
  • choreiform movement d/o
  • neuropsychiatric abnormalities
  • hemolysis
A

Wilson’s disease

274
Q

best INITIAL test for Wilson’s disease

A

slit lamp looking for Kayser Fleischer rings

on CCS check for low ceruloplasmin level as well

275
Q

MOST ACCURATE test for Wilson’s disease

A

liver biopsy

276
Q

treatment for Wilson’s disease

A

penicillamine, or trientine

277
Q

most often caused by a genetic d/o causing overabsorption of iron

A

hemochromatosis

278
Q

aside from liver disease, other manifestations of hemochromatosis:

A
  • restrictive cardiomyopathy
  • skin darkening
  • join pain
  • damage to pancreas (leads to DM)
  • pituitary accumulation w/ panhypopituitarism
  • infertility
  • hepatoma
279
Q

best INITIAL test for hemochromatosis

A
  • ELEVATED SERUM IRON
  • ELEVATED FERRITIN
  • LOW TIBC
  • EXTREMELY ELEVATED IRON SATURATION (> 45%)
280
Q

MOST ACCURATE test for hemochromatosis

A

liver biopsy

281
Q

what, in combination, are sufficient for diagnosis of hemochromatosis?

A

MRI of liver, AND HFe gene mutation

282
Q

treatment for hemochromatosis

A

phlebotomy

283
Q
  • young female w/ other AI diseases

- liver disease

A

autoimmune hepatitis

284
Q

best INITIAL tests for autoimmune hepatitis

A
  • ANA
  • anti-smooth muscle Ab (ASMA)
  • SPEP
285
Q

MOST ACCURATE test for autoimmune hepatitis

A

liver biopsy

286
Q

treatment for autoimmune hepatitis

A
  • prednisone

- azathioprine for steroid-sparing medication

287
Q
  • strongly associated w/ obesity, DM, hyperlipidemia

- hepatomegaly

A

nonalcoholic steatohepatitis (NASH)

288
Q

best INITIAL test for nonalcoholic steatohepatitis (NASH)

A

ALT > AST

289
Q

MOST ACCURATE test for nonalcoholic steatohepatitis (NASH)

A

liver biopsy showing fatty infiltration

looks just like alcoholic liver disease

290
Q

treatment for nonalcoholic steatohepatitis (NASH)

A

control underlying causes (weight loss, DM control, DLD management)

USMLE Step 3 (20 decks)

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