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Master the Boards Step 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Unlike dysphagia, odynophagia suggests an __ process, such as ___

A

infectious; HIV, HSV, Candida, or CMV

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2
Q

To diagnose dysphagia, do a ___ first

A

barium study; if it’s in the stomach, do an endoscopy first

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3
Q

Young nonsmoker with dysphagia to both solids and liquids =

A

achalasia

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4
Q

Most accurate test for achalasia is

A

esophageal manometry

-it will show super high pressure at the LES

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5
Q

How does botulinum toxin work?

A

It inhibits the release of acetylcholine at the neuromuscular junction, relaxing skeletal muscle

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6
Q

Dysphagia to solids, then liquids, plus anemia/blood in stool =

A

esophageal cancer

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7
Q

Dysphagia + weight loss = ___

Dysphagia + weight looss + anemia/bloody stool = ___

A

esophageal pathology

cancer

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8
Q

Treat esosinophilic esophagitis with

A

PPT’s and budesonide

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9
Q

___ syndrome is associated with iron deficiency anemia and is more common in middle aged women

A

Plummer-Vinson syndrome

A/w squamous cell esophageal cancer

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10
Q

To avoid perforation, DO NOT do endoscopy or place an NG tube in patients with

A

Zenker’s diverticulum

BAD BREATH, OLD DUDE

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11
Q

Treat esophageal spasm with

A

calcium channel blockers and nitrates

the same treatment as for Prinzmetal’s angina

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12
Q

Unlike esophageal spasm, Prinzmetal’s variant angina will show

A

ST segment elevation and an abnormality on stimulation of the coronary arteries

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13
Q

Giving empiric __ for esophageal candidiasis is both

A

therapeutic and diagnostic

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14
Q

Most cases of Mallory Weiss Tear resolve spontaneously, but if they don’t, give

A

epinephrine injection to stop the bleeding

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15
Q

If Barrett esophagus is found, treat with

A

PPI and repeat endoscopy every 2-3 years

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16
Q

If low-grade dysplasia of esophagus is found, treat with

A

PPI and repeat endo in 3-6 months

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17
Q

If high-grade dysplasia of esophagus is found, treat with

A

endoscopic mucosal resection, ablative removal, or distal esophagectomy

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18
Q

Gastritis can be atrophic, caused by ___, and associated with __

A

pernicious anemia

Vitamin B12 deficiency

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19
Q

If repeat treatment for H. pylori fails, evaluate for

A

Zollinger-Ellison syndrome (gastrinoma)

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20
Q

To test for ZE syndrome, check

A

gastrin level and gastric acid output

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21
Q

The most accurate test for ZES is

A

secretin suppression; normal patients will show a decreased level of gastrin and acid output upon secretin infusion. There will be no change in ZES patients

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22
Q

ZES + hypercalcemia is probably

A

MEN syndrome due to parathyroid involvement

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23
Q

When should colonoscopy be performed in Crohns and UC patients?

A

Every 1-2 years after 8 years of colonic involvement

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24
Q

Crohn’s disease will be ___ positive while UC will be ___ positive

A

ASCA

ANCA

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25
Best initial therapy for both crohns and ulcerative colitis is
mesalamine | NOT sulfasalazine due to rash, hemolytic anemia, and interstitial nephritis side effects
26
For perianal involvement of crohns, treat with
metronidazole and ciprofloxacin
27
The most common cause of food poisoning is
campylobacter
28
Do not give platelets or antibiotics in ___ as it will make the situation much worse!
E. coli 0157:H7 HUS
29
Shellfish + liver disease + skin lesions =
Vibrio vulnificus
30
If blood is not described in cases of infectious diarrhea, test for
fecal leukocytes
31
Best initial therapy for severe infectious diarrhea is
ciprofloxacin severe = blood, fever, abdominal pain, hypotension/tachycardia (shock)
32
Which pathogens will NEVER present with bloody diarrhea?
``` Rotavirus Norovirus Giardia Staph aureus Bacillus cereus Cryptosporidiosis Scombroid ```
33
What pathogen causes the fastest onset of diarrhea?
Scombroid-within ten minutes of eating infected seafood, the patient will have vomiting, diarrhea, wheezing, and flushing!
34
Treat scombroid with
antihistamines
35
If c. diff colitis is successfully treated with metronidazole then recurs later, treat with
metronidazole again, not vancomycin
36
Toxic megacolon must be treated with
surgery
37
What dairy product can be kept in diet in lactose intolerant patients?
YOGURT!
38
All forms of fat malabsorption are a/w
hypocalcemia oxalate overabsorption and kidney stones easy bruising and elevated PT/INR due to vitamin K not being absorbed Vitamin B12 malabsorption
39
The B12 deficiency found in fat malabsorption is due to
destruction of the terminal ileum or loss of pancreatic enzymes
40
Test for chronic fat malabsorption with
Sudan black stain of stool for presence of fat OR 72 hour fecal fat test (most sensitive)
41
Pancreatic enzymes are NOT necessary for ___ absorption
iron
42
Best initial tests for celiac are
antigliadin, antiendomysial, and antitissue transglutaminase antibodies
43
Bowel biopsy is always needed for celiac disease, even if dx is confirmed with antibody testing, to exclude
bowel wall lymphoma
44
Treat tropical sprue with
doxycycline or bactrim for 3-6 months
45
Treat whipple dz with
tetracycline or bactrim
46
Amylase and lipase will likely be normal in
chronic pancreatitis; best initial test then is abdominal x-ray/CT; most accurate is secretin stimulation testing
47
The wrong answer for diarrhea predominant IBS treatment is
probiotics, as there is unclear evidence
48
If one family member had colon cancer, start screening at age
40, or 10 years before the age of the family member who had cancer
49
Lynch syndrome =
3 family members, 2 generations, one under age 50 when diagnosed with colon cancer. Start screening every 1-2 yrs at age 25
50
Start screening sigmoidoscopies at age __ for familial adenomatous polyposis
12
51
A buncha osteomas might be
Gardner's syndrome. Screen at same time as you would for FAP (age 12)
52
Melanotic spots on the lips and hamartomatous polyps throughout the small bowel and colon =
Peutz-Jeghers syndrome; NO extra colon cancer screening needed
53
Juvenile polyposis is markedly different from
FAP; no extra colon cancer screening needed
54
If a dysplastic polyp is found on colonoscopoy, repeat the test in
3-5 years
55
The most accurate test for diverticulosis is
barium enema; treat with high fiber diet
56
Best antibiotics for diverticulitis are
quinolones or cephalosporins with metronidazole
57
The most important thing to do in suspected GI bleeding is
assess for hemodynamic instability
58
In addition to fluids, CBC, PT/INR, when there's large volume GI bleeding you should get
a GI consult and an EKG
59
It is more important to correct the __, __, or ___ in a GI bleed than to obtain an endoscopy
anemia, thrombocytopenia, or coagulopathy
60
What is the mechanism of octreotide in helping with variceal bleeding?
It is a somatostatin analog that decreases portal hypertension
61
The most common complication of a TIPS procedure is
hepatic encephalopathy
62
Valvular heart disease + older patient + acute abdominal pain =
acute mesenteric ischemia
63
Acute mesenteric ischemia will show metabolic __ due to elevated __
acidosis; lactic acid is high due to tissue damage
64
Manage dumping syndrome (super rare) with
frequent, small malls
65
Treat acute panreatitis with
ERCP
66
When CT shows >30% necrosis of the pancreasis, treat with
imipenem and CT-guided biopsy
67
All patients with acute hepatitis will show an elevated
conjugated (direct) bilirubin, leading to bilirubin in the urine (urobilinogen)
68
Viral hepatitis shows elevated __ | Drug-induced hepatitis shows increased __
ALT AST ViraL, aLt
69
Healed/recovered Hep B will show which antibodies?
core antibody and surface antibody positive. negative for surface antigen and e-antigen!
70
Vaccinated for Hep B =
positive only for Hep B surface antibody
71
Acute hep C is treated with
oral protease inhibitors
72
What predicts the response to therapy for Hep C?
Genotype
73
How do you tell if there's been a response to therapy for Hep C?
PCR-RNA viral load
74
There is very little correlation between Hep C and __
LFTs
75
In an unvaccinated person who gets exposed to Hep B, give
Hep B immune globulin and hep B vaccine
76
Prophylactic propanolol can be very helpful in
cirrhosis patients at risk of esophageal varices
77
If the serum to ascites gradient is >1.1, then ___ is present
portal hypertension
78
Treat SBP with
cefotaxime or ceftriaxone
79
Middle aged woman with itching =
Primary biliary cirrhosis also on exam, xanthelasmas
80
Most accurate test for PBC is
antimitochrondrial antibody; liver biopsy
81
Treat PBC and PSC both with
ursodeoxycholic acid
82
The difference between primary biliary cirrhosis and primary biliary CHOLANGITIS (aka primary sclerosing cholangitis) is
bilirubin is normal in biliary cirrhosis and elevated in biliary cholangitis (PSC)
83
ERCP showing beading of the biliary system =
primary sclerosing cholangitis
84
Best initial test for wilson's disease is
slit lamp eye exam looking for Kayser Fleischer rings, but on CCS order that AND low ceruloplasmin level
85
Most accurate test for Wilson's disease is
liver biopsy
86
Treat Wilson's dz w/
Penicillamine or trientine, possibly with zinc
87
The most common cause of death from hemochromatosis is
cirrhosis
88
Bronze diabetes =
hemochromatosis
89
What will iron studies look like in hemochromatosis?
Elevated serum iron and ferritin levels LOW TIBC SUPER HIGH iron saturation (>45)
90
Treat Hemochromatosis with
phlebotomy
91
What will serum protein electrophoresis show in Autoimmune Hepatitis?
Hypergammaglobulinemia Positive ANA and microsomal antibody will also be shown Liver bx is most accurate!
92
Treat autoimmune hepatitis with
prednisone
93
There is no therapy for __hepatitis
Nonalcoholic steatohepatitis (NASH)

Master the Boards Step 3 (19 decks)

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