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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
Q

Best initial therapy for both crohns and ulcerative colitis is

A

mesalamine

NOT sulfasalazine due to rash, hemolytic anemia, and interstitial nephritis side effects

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26
Q

For perianal involvement of crohns, treat with

A

metronidazole and ciprofloxacin

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27
Q

The most common cause of food poisoning is

A

campylobacter

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28
Q

Do not give platelets or antibiotics in ___ as it will make the situation much worse!

A

E. coli 0157:H7 HUS

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29
Q

Shellfish + liver disease + skin lesions =

A

Vibrio vulnificus

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30
Q

If blood is not described in cases of infectious diarrhea, test for

A

fecal leukocytes

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31
Q

Best initial therapy for severe infectious diarrhea is

A

ciprofloxacin

severe = blood, fever, abdominal pain, hypotension/tachycardia (shock)

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32
Q

Which pathogens will NEVER present with bloody diarrhea?

A 
Rotavirus
Norovirus
Giardia
Staph aureus
Bacillus cereus
Cryptosporidiosis
Scombroid
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33
Q

What pathogen causes the fastest onset of diarrhea?

A

Scombroid-within ten minutes of eating infected seafood, the patient will have vomiting, diarrhea, wheezing, and flushing!

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34
Q

Treat scombroid with

A

antihistamines

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35
Q

If c. diff colitis is successfully treated with metronidazole then recurs later, treat with

A

metronidazole again, not vancomycin

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36
Q

Toxic megacolon must be treated with

A

surgery

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37
Q

What dairy product can be kept in diet in lactose intolerant patients?

A

YOGURT!

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38
Q

All forms of fat malabsorption are a/w

A

hypocalcemia
oxalate overabsorption and kidney stones
easy bruising and elevated PT/INR due to vitamin K not being absorbed
Vitamin B12 malabsorption

39
Q

The B12 deficiency found in fat malabsorption is due to

A

destruction of the terminal ileum or loss of pancreatic enzymes

40
Q

Test for chronic fat malabsorption with

A

Sudan black stain of stool for presence of fat OR 72 hour fecal fat test (most sensitive)

41
Q

Pancreatic enzymes are NOT necessary for ___ absorption

A

iron

42
Q

Best initial tests for celiac are

A

antigliadin, antiendomysial, and antitissue transglutaminase antibodies

43
Q

Bowel biopsy is always needed for celiac disease, even if dx is confirmed with antibody testing, to exclude

A

bowel wall lymphoma

44
Q

Treat tropical sprue with

A

doxycycline or bactrim for 3-6 months

45
Q

Treat whipple dz with

A

tetracycline or bactrim

46
Q

Amylase and lipase will likely be normal in

A

chronic pancreatitis; best initial test then is abdominal x-ray/CT; most accurate is secretin stimulation testing

47
Q

The wrong answer for diarrhea predominant IBS treatment is

A

probiotics, as there is unclear evidence

48
Q

If one family member had colon cancer, start screening at age

A

40, or 10 years before the age of the family member who had cancer

49
Q

Lynch syndrome =

A

3 family members, 2 generations, one under age 50 when diagnosed with colon cancer. Start screening every 1-2 yrs at age 25

50
Q

Start screening sigmoidoscopies at age __ for familial adenomatous polyposis

A

12

51
Q

A buncha osteomas might be

A

Gardner’s syndrome. Screen at same time as you would for FAP (age 12)

52
Q

Melanotic spots on the lips and hamartomatous polyps throughout the small bowel and colon =

A

Peutz-Jeghers syndrome; NO extra colon cancer screening needed

53
Q

Juvenile polyposis is markedly different from

A

FAP; no extra colon cancer screening needed

54
Q

If a dysplastic polyp is found on colonoscopoy, repeat the test in

A

3-5 years

55
Q

The most accurate test for diverticulosis is

A

barium enema; treat with high fiber diet

56
Q

Best antibiotics for diverticulitis are

A

quinolones or cephalosporins with metronidazole

57
Q

The most important thing to do in suspected GI bleeding is

A

assess for hemodynamic instability

58
Q

In addition to fluids, CBC, PT/INR, when there’s large volume GI bleeding you should get

A

a GI consult and an EKG

59
Q

It is more important to correct the __, __, or ___ in a GI bleed than to obtain an endoscopy

A

anemia, thrombocytopenia, or coagulopathy

60
Q

What is the mechanism of octreotide in helping with variceal bleeding?

A

It is a somatostatin analog that decreases portal hypertension

61
Q

The most common complication of a TIPS procedure is

A

hepatic encephalopathy

62
Q

Valvular heart disease + older patient + acute abdominal pain =

A

acute mesenteric ischemia

63
Q

Acute mesenteric ischemia will show metabolic __ due to elevated __

A

acidosis; lactic acid is high due to tissue damage

64
Q

Manage dumping syndrome (super rare) with

A

frequent, small malls

65
Q

Treat acute panreatitis with

A

ERCP

66
Q

When CT shows >30% necrosis of the pancreasis, treat with

A

imipenem and CT-guided biopsy

67
Q

All patients with acute hepatitis will show an elevated

A

conjugated (direct) bilirubin, leading to bilirubin in the urine (urobilinogen)

68
Q

Viral hepatitis shows elevated __

Drug-induced hepatitis shows increased __

A

ALT
AST

ViraL, aLt

69
Q

Healed/recovered Hep B will show which antibodies?

A

core antibody and surface antibody positive.

negative for surface antigen and e-antigen!

70
Q

Vaccinated for Hep B =

A

positive only for Hep B surface antibody

71
Q

Acute hep C is treated with

A

oral protease inhibitors

72
Q

What predicts the response to therapy for Hep C?

A

Genotype

73
Q

How do you tell if there’s been a response to therapy for Hep C?

A

PCR-RNA viral load

74
Q

There is very little correlation between Hep C and __

A

LFTs

75
Q

In an unvaccinated person who gets exposed to Hep B, give

A

Hep B immune globulin and hep B vaccine

76
Q

Prophylactic propanolol can be very helpful in

A

cirrhosis patients at risk of esophageal varices

77
Q

If the serum to ascites gradient is >1.1, then ___ is present

A

portal hypertension

78
Q

Treat SBP with

A

cefotaxime or ceftriaxone

79
Q

Middle aged woman with itching =

A

Primary biliary cirrhosis

also on exam, xanthelasmas

80
Q

Most accurate test for PBC is

A

antimitochrondrial antibody; liver biopsy

81
Q

Treat PBC and PSC both with

A

ursodeoxycholic acid

82
Q

The difference between primary biliary cirrhosis and primary biliary CHOLANGITIS (aka primary sclerosing cholangitis) is

A

bilirubin is normal in biliary cirrhosis and elevated in biliary cholangitis (PSC)

83
Q

ERCP showing beading of the biliary system =

A

primary sclerosing cholangitis

84
Q

Best initial test for wilson’s disease is

A

slit lamp eye exam looking for Kayser Fleischer rings, but on CCS order that AND low ceruloplasmin level

85
Q

Most accurate test for Wilson’s disease is

A

liver biopsy

86
Q

Treat Wilson’s dz w/

A

Penicillamine or trientine, possibly with zinc

87
Q

The most common cause of death from hemochromatosis is

A

cirrhosis

88
Q

Bronze diabetes =

A

hemochromatosis

89
Q

What will iron studies look like in hemochromatosis?

A

Elevated serum iron and ferritin levels
LOW TIBC
SUPER HIGH iron saturation (>45)

90
Q

Treat Hemochromatosis with

A

phlebotomy

91
Q

What will serum protein electrophoresis show in Autoimmune Hepatitis?

A

Hypergammaglobulinemia
Positive ANA and microsomal antibody will also be shown
Liver bx is most accurate!

92
Q

Treat autoimmune hepatitis with

A

prednisone

93
Q

There is no therapy for __hepatitis

A

Nonalcoholic steatohepatitis (NASH)

Master the Boards Step 3 (19 decks)

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