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PANRE > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the best diagnostic test for PUD

A

Endoscopy

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2
Q

What does the Urea breath test identify?

A

H pylori

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3
Q

A 65 yo male has had GERD for years. Over the past 1 year he has noticed an increased difficulty in swallowing his food. What is the most likely diagnosis?

A

Esophageal strictures.

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4
Q 
Which of the following is a presdisposing factor for esophageal varies? 
GERD
African American
Portal hypertension
Crohn's disease
A

Portal hypertension

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5
Q

A string sign on a barium swallow should make you think of what diagnosis?

A

Pyloric stenosis

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6
Q

A bird’s beak sign on barium swallow should make you think of what diagnosis?

A

Achalasia

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7
Q

A corkscrew sign on barium swallow should make you think of what diagnosis?

A

Esophageal spasms

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8
Q

How do you initially treat H pylori infection?

A

2 antibiotics and 1 ppi
Omeprazole + clarithromycin and amoxil
omeprazole + TCN and Metronidazole

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9
Q

List 3 items in Charot’s triad

A

Jaundice, RUQ pain and fever

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10
Q

Which 2 Hepatitis viruses have vaccines?

A

Hep A and B

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11
Q

A hepatitis panel reveals that a patient has Anti-HepB antigen. What does this indicate?

A

The patient is currently infected with Hepatitis B

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12
Q

What is Murphy’s sign?

A

Inhibited inspiration with pressure over the RUQ secondary to pain - found in Cholecystitis.

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13
Q

What is Cullen’s sign?

A

Periumbilical ecchymosis associated with pancreatitis.\

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14
Q

What is the poses sign and when would you expect to find it?

A

Pain with passive right hip extension or active right hip flexion. Associated with acute appendicitis.

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15
Q

On physical examination, you elicit tenderness over McBurney’s point. What diagnosis is immediately in your differential?

A

Appendicitis

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16
Q

What are the first 3 steps in managing pancreatitis?

A

NPO, IV fluids and pain medication.

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17
Q

List all 5 of Ranson’s criteria

A 
age >55, WBC >16,000; Glucose >200; LDH >350
Aspartate aminotrasferase  (AST)>250
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18
Q

What does Ranson’s criteria indicate?

A

It is a clinical prediction rule for predicting the severity/prognosis of acute pancreatitis.

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19
Q

45 yo male presents with low grade fever and and pain. He has had non-bloody diarrhea x2weeks.
He states that this has happened severe times before and usually clears out after about a week. You decide to send the patient for a colonoscopy. On the report it mentions a cobblestoning appearance. What is the most likely diagnosis?

A

Crohn’s disease.

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20
Q

How is a definitive diagnosis of celiac disease made?

A

Endoscopic biopsy.

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21
Q

What are 2 tests to diagnosis lactose intolerance?

A

Hydrogen in breathe after dose of dairy rich drink (increase hydrogen present)
or given dairy to fasting patient and measure glucose level in 2 hours - glucose will remain low as It can’t convert to sugar as it lacks the enzyme.

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22
Q

What are the side effects of a PKU(phenylketonuria)

defiance?

A

found in infants - they lack the ability to digest phenylalanine - and its accumulation leads to severe brain damage and mental retardation.

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23
Q

How would you treat a baby with a +PKU screen?

A

diet very low in phenylalanine must be strictly followed.for minimal retardation.

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24
Q

what are the risk factors for gastric cancer?

A

chronic H pylori infection, eating foods high in nitrates (smoked or pickled), smoking and ETOH

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25
Q

Treatment of gastric cancer?

A

often not diagnosed until advanced stage due to symptoms consistent with GERD. Treat with surgical excision/radiation and chemo

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26
Q

What are gall stones made of?

A

Cholelithiasis (gall stones) are created from cholesterol and other fatty by-products in the gall bladder. They can block the ducts from the gall bladder to the pancreas and liver.

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27
Q

What physical exam finding is pathoneumonic for pyloric stenosis?

A

olive shaped mass in the abdomen. Projectile vomiting is the key subjective complaint in an infant.

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28
Q

What treatment do you recommend to the mom of a child diagnosed with pyloric stenosis?

A

Surgical correction is very successful.

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29
Q

What happens when a child has pyloric stenosis?

A

the pylorus (opening between eh stomach and duodenum) becomes enlarged - preventing the transport of food from the stomach to the small intestine. - genetic and develops after birth, not in utero

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30
Q

What is cholecystitis?

A

Inflamation of the gall bladder when bile accumulates, leading to inflammation, swelling and infection - usually caused by choleliathisis.

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31
Q

What are the risk factors for pancreatitis?

A

Excessive ETOH - binge or chronic
cholelithiasis and bile duct blockage
cystic fibrosis
elevated triglycerides

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32
Q

Treatment for pancreatitis?

A

NPO, IV fluids, pain medications - rarely surgical resection

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33
Q

This is a viral infection, transmitted by fecal oral route in contaminated water and food(shellfish).IT causes and pain, nausea and vomiting and jaundice but resolves in 2 months. WHO AM I?

A

Hepatits A

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34
Q

I am a blood borne viral infection caused by contact with tainted blood and body fluids. I cause nausea, vomiting, abdominal pain and jaundice. In severe cases I can cause chronic liver failure. WHO AM I?

A

Hepatits B

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35
Q

I can only exist with a Hepatits B infection?

A

Hepatits D

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36
Q

I am a blood born viral infection, the most serous of the Hepatitis - and the leading cause of liver transplants. I
can be treated with Peglated interferon and ribavirin - but usually don’t go away.

A

Hepatits C

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37
Q

This is the telescoping of the small bowel that causes the blood flow to be blocked and prevents movement of feces through the bowel. Always in kids - rarely in adults.

A

Intussusecption

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38
Q

What are the hallmarks of intussusecptin?

A

Currant jelly stool (frank blood is present), palpable mass on exam. N/V/Fever

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39
Q

Treatment of intussusception is barium /air enema. true or false?

A

True it forces the bowel to straighten and slides the telescoped portion back into place.. Usually does NOT reoccur.

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40
Q

Crohn’s disease can effect anywhere in the GI tract - true or false?

A

True - it is mouth to anus.

It is transmural - breaking through the mucosal lining.

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41
Q

The cure for Crohn’s is medication to resolve symptoms.

A

FALSE - there is no cure. you cane treat with meds, resection, antibiotics but not cure.

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42
Q

What is ulcerative colitis - and where is it found?

A

Inflammatory disease of the large intestine and rectum.

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43
Q

How do you treat Diverticulitis?

A

NPO, NG tube, antibiotics. Long term - dietary changes ( no foods with seeds and no popcorn) Usually resolves without surgery but resection of a small portion of the colon may be necessary.

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44
Q

What is toxic megacolon and how is it treated?

A

Disteneded colon from inflammatory bowel disease - extreme bowel distention, Patients may develop shock.

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45
Q

Treatment of Toxic megacolon is bowel rest x 24 hours then surgical resection if not affective. True or false?

A

True = it can result in shock and death if not treated.

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46
Q

What is the treatment of anorectal abscess?

A

sitz baths, I&d, possbile surgical excision. then antibiotics, dietary changes, etc.

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47
Q

Where does a pilonidal cyst form?

A

in the superior end of the cleft between the buttocks. Present equally in med and women.

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48
Q

How do you treat a pilonidal cyst?

A

warm sitz baths, antibiotics and potential surgical I&D

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49
Q

What is the surgical treatment of a hiatal hernia called?

A

Nissan Fundiplication

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50
Q

A patient is found to have a niacin defiency - PELLGRA- what do you need to watch out for?

A

B3 deficiency - Dementia, diarrhea, dermatitis

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51
Q

Bird beak esophagus on barium swallow should make you think of what diagnosis?

A

Achalasia

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52
Q

Where is the most common location for an anal fissure/

A

posterior midline

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53
Q

Crohn’s can be found where in the GI tract?

A

Esophagus to anus

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54
Q

What does HBsAG (Hep B surface antigen) indicate?

A

Active Hep B infection

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55
Q

How do you treat achalasia?

A

Loosen up the muscle - botox, dilation or surgery

56
Q

A corkscrew appearance on barium study should make you think of what diagnosis?

A

Esophageal spasms

57
Q

Epigastric pain that radiates to the back should make you think of what diagnosis?

A

Pancreatitis

58
Q

In order to have Hep D what must you already have?

A

Hep B

59
Q

Left Lower quadrant pain and tenderness should make you think of what diagnosis?

A

Diverticulitis

60
Q

What is the treatment for most Mallory Weiss tears?

A

Watchful waiting - these will typically resolve within 48 hours.

61
Q

A thumbprint sign on a n abdominal film should make you think of what diagnosis?

A

intestinal ischemia.

62
Q

What will the bowel sounds be early on in a SBO? what will they be later on?

A

early on they are hyperactive, later they will be absent.

63
Q

A patient has had GERD for years. Over the past year he has noticed an increase injury difficulty swallowing his food. This should make you think of what diagnosis??

A

Esophageal strictures

64
Q

What are 2 treatments you should consider for esophageal strictures?

A

Dilation of the esophagus and long term PPIs

65
Q

What are 2 common predisposing factors for esophageal varies?

A

Portal HTN and cirrhosis are often caused by Alcoholism.

66
Q

What is a common symptom that goes along with chest pain for GERD patients?

A

Dry cough

67
Q

What medication is most commonly used for long term treatment of GERD

A

PPIs - omeprazole, lasopazole, pantoprazole.

68
Q

What is the imaging modality of choice for pancreatitis?

A

CT

69
Q

what is the test test to check for H pylori?

A

Urea breath test

70
Q

Is peptic ulcer disease more commons in the duodenum or in the stomach?

A

Duodenum

71
Q

What is the most common location for a pancreatic tumor?

A

75% occur in the head of the pancreas

72
Q

With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?

A

Exacerbated

73
Q

Fasting gastrin will be above what level with a gastronome?

A

pyloric stenosis>150pg/ml

74
Q

Projectile vomiting should make you think of what diagnosis?

A

Pyloric stenosis

75
Q

Most gall stones are made of what substance?

A

cholesterol

76
Q

What is the name of the sign when a patient shows inhibited institution with pressure over the RUQ? what diagnosis does it suggest?

A

Murphy’s sign; cholesystitis

77
Q

What is the most specific test for acute choleysistis?

A

Hida

78
Q

What is the gold standard for diagnosis and treatment of bile duct stone?

A

ERCP

79
Q

What is Charot’s triad?

A

RUQ pain, fever and jaundice

80
Q

What is Reynold’s pentad and what does it matter?

A

Charot’s triad + hypotension+alterred mental status. It indicates and high risk of sepsis

81
Q

What disease is defined as immunologic response to gluten?

A

Celiac

82
Q

What is the main risk factor for esophagitis?

A

Immunocompromised patient.

83
Q

An endoscopy for presumed esophagitis shows multiple shallow ulcers. what is the most likely diagnosis ?

A

HSV

84
Q

list 2 common offending agents for pill induced esophagitis?

A

NSAIDS, Kcl, Iron, Antibiotics

85
Q

A 30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?

A

Scleroderma

86
Q

A patient complains of regurgitating undigested food for several hours after a meal. What is the most likely diagnosis?

A

Zenker’s Doverticulum

87
Q

What is the most common cause of PUD (peptic ulcer disease)?

A

H pylori

88
Q

What is the most specific diagnostic test for PUD?

A

endoscopy

89
Q

What is the only curative therapy for gastric adneocarcinoma?

A

surgical resection

90
Q

A patient present complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?

A

Choecystitis

91
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

92
Q

What is the most common cause of acute bacterial cholangitis?

A

Choleducocholithiasis

93
Q

Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?

A

Primary sclerosis cholangitis

94
Q

What 2 viral hepatitis infections are self limiting?

A

Hep A and Hep E

95
Q

Pica is ogre. related to what type of anemia?

A

Iron deficiency anemia

96
Q

What does and Anti-HBc (hep B core antibody) indicate?

A

Previous or ongoing hepatitis B infection

97
Q

What does AntiHBs (hep B surface antibody) indicate?

A

Recovery from infection or immunization to Hep B

98
Q

What is the recommended treatment for Hep C infection?

A

PEgylated interferon alpha 2

99
Q

What medication used in Hep B infection helps to prevent the need for liver transplant?

A

Lamivudine

100
Q

There are vaccines for which 2 versions of hepatitis?

A

Hep A and Hep B

101
Q

What is the most common locaation of colorectal cancer?

A

Cecum - 38%

102
Q

Colorectal cancer patients are almost all older than what age?

A

90% are older than 50yo.

103
Q

An elevated serum amylase and lipase should make you think of what diagnosis?

A

Pancreatitis

104
Q

Under routine circumstances when should patients begin getting screening colonoscopies?

A

50 yo

105
Q

What is the #1 cause of small bowel obstruction?

A

Post op adhesions

106
Q

Which is more likely to pass into the scrotum - a direct or indirect hernia?

A

indirect

107
Q

A string sign on barium swallow should make you think of what diagnosis?

A

pyloric stenosis

108
Q

What is the first line treatment for anal fissure?

A

fluid and fiber

109
Q

What are 2 things that an anal fissure off midline might suggest?

A

Crohns’, syphillis, HIV and neoplasm

110
Q

What medial treatment is given for a gastrinoma?

A

PPIs

111
Q

What is the term for an abscess in the sacrococcygeal cleft?

A

Pilonidal cyst (disease)

112
Q

How do you treat H pylori infection?

A

PPI + 2 antibiotics (omeprazole + clarithromycin+amoxil or Omperazole + metronidazole + tcn

113
Q

Painless bright red blood per rectum should make you think of what diagnosi?

A

Hemmorhoids

114
Q

A patient on Sulfazalazine for an inflammatory bowel disease should be supplemented with what vitamin?

A

Folate // folic acid

115
Q

What is the most common anorectal problem affecting patients over 50yo?

A

hemorrhoids

116
Q

A gastrinoma is also known as what syndrome?

A

Zollinger - Ellison syndrome.

117
Q

Salivary amylase breaks down what macronutrient?

A

Carbohydrates.

118
Q

What is the medical term for feeling like there is a lump in your throat?

A

globus

119
Q

What is the most common vessel blocked with intestinal ischemia?

A

Superior mesenteric artery

120
Q

Describe Grey-Turner sign.

A

Plant ecchymosis often related to pancreatitis

121
Q

What are the first 3 steps in managing pancreatitis?

A

NPO, pain control, ivf

122
Q

A patient presents with unproductive retching, acute localized epigastric distention and inability to pass an NG tube - what is the most likley diagnosis?

A

gastric volvulus

123
Q

What is the most common cause of a folate defiency?

A

Alcoholism

124
Q

Should diverticulitis always be admitted?

A

No - mild cases can be treated as OP with rest and clear fluids.

125
Q

Which NSAID has the highest rate of peptic ulceration?

A

Naproxen

126
Q

What is the leading cause of iron deficiency anemia?

A

Chronic GI bleed

127
Q

What is the test of choice to diagnosis Zenker’s diverticulm?

A

Barium swallow will show the diverticuli

128
Q

At what age and how often shoudl fecal occult blood tests be perfomred as a screening tool?

A

beginning at 50, done yearly

129
Q

Are 1/2 of all adult hernias direct or indirect?

A

Indirect make up 50% of all adult hernias

130
Q

Who is celiac disease most commonly diagnosised?

A

Endoscopic biopsy

131
Q

Define pellagra

A

Niacin ( B3) deficiency

132
Q

An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?

A

CMV (Cytomegalovirus)

133
Q

Whichare more painful - hemorrhoids above or below the dentate line?

A

Below the dentate line - internal hemorrhoids are ususaly not painful.

134
Q

An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis

A

intestinal ischemia

135
Q

Does adenosarcoma arise form the proximal or distal esophagus?

A

distal esophagus

PANRE (12 decks)

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