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Internal Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

[Diagnosis]

cervical CA, post brachytherapy, with tenesmus

A

radiation proctitis

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2
Q

___ term which refers to complete constipation with no passage of either feces or gas

A

Obstipation

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3
Q

___ difficulty emptying the bowels, usually associated with hardened feces

A

Constipation

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4
Q

[Diagnosis]

> / 3 months of bothersome postprandial fullness, early satiety, epigastric pain, or burning with symptom onset at least 6 months in the absence of organic cause

A

functional dyspepsia

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5
Q

what are the most common causes of indigestion

A
  1. GERD

2. Functional dyspepsia

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6
Q

[Diagnosis]

very severe abdomina pain but abdominal PE is relatively benign

A

Acute Mesentery Ischemia

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7
Q

[Diagnose]

25F, chest pain by burning sensation associated with unpleasant taste, sore throat, cough

A

Dx: GERD

Next step: start PPI

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8
Q

[Diagnose]

25F, chest pain by burning sensation associated with unpleasant taste, sore throat, cough with associated dysphagia

A

Dx: GERD
Next step: start PPE
Test: Upper endoscopy

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9
Q

Factors that exacerbate GERD

A
  1. Obesity
  2. Pregnancy
  3. Gastric hypersecretory states
  4. Delayed gastric emptyiing
  5. Disruption of esophageal peristalsis
  6. Gluttony
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10
Q

What is the most severe histologic consequence of GERD

A

Barrett’s metaplasia associated risk of adenoCA

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11
Q

The bitter taste receptors are controlled by what nerve?

A

Bitter = back of tongue = CN IX

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12
Q

[GERD]

in patients with drug-refractory symptoms, what will you suggest as workup?

A

Esophageal pH

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13
Q

[GERD]

When surgery is considered for GERD, what workup will you request?

A

esophageal manometry

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14
Q

What are the alarming manifestations of GERD that requires endoscopy?

A
  1. Dysphagia
  2. Weight loss
  3. Anemia
  4. Bleeding
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15
Q

Upper endoscopy is recommended as the initial test in unexplained dyspepsia of patients age?

A

> 55 years old

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16
Q

What is the surgical technique for chronic GERD?

A

Nissen Fundoplocation

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17
Q

[GERD]

What us the gold standard treatment for high grade dysplasia

A

Esophagectomy

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18
Q

What is the urgent endoscopy age cutoff for dyspepsia with alarm?

A

> 55 years old

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19
Q

What is the urgent endoscopy age cutoff for PUD with alarm?

A

> 40 years old

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20
Q

What is the most sensitive test of GERD

A

24hr ambulatory pH monitoring

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21
Q

What is the gold standard for confirming barrett’s esophagus?

A

Endoscopic biopsy

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22
Q

What is the useful initial diagnostic test when mechanical obstruction is suspected in GERD?

A

Endoscopy

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23
Q

What is the most common esophageal symptom of GED?

A

Heartburn/Pyrosis

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24
Q

What is the most common symptom of infectious esophagitis?

A

Odynophagia

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25
Q

[Diagnosis]

30M recurrent upper abdominal pain, burning, awakening him at night.

pain is more noted when meals are delayed, relieved after food intake, no weight loss

A

Dx: PUD, prob duodenal ulcer

Next Step: H. pylori testing

Next step if anemia is present: upper endoscopy

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26
Q

[GU vs DU]

Gastric acid output is normal or decreased

burning or gnawing abdominal pain

precipitated by food

A

GU

Biopsy GU lesions.

Usually, distal to the junction between antrum and acid secretory mucosa

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27
Q

[GU vs DU]

gastric output is increased
bicarb output is decreased

burning or gnawing abdominal pain that awakens the patient at night

relieved by antacids or food

A

DU

Rare risk of malignancy

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28
Q

What are the risk factors of H. pylori?

A
  1. Poor SES
  2. Crowded or unsanitary conditions
  3. Low educational attainment
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29
Q

What are the indications for testing for H. pylori?

A
  1. Active PUD
  2. History of PUD without prior treatment
  3. MALT
  4. Uninvestigated dyspepsia
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30
Q

How will you confirm the eradication of H. pylori?

A

Do a urea breath test 4 weeks after therapy

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31
Q

What test will you need to assess the susceptibility of H. pylori to clarithromycin?

A

PCR assay

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32
Q

What is the gold standard in diagnosing H. pylori?

A

Histologic evaluation of endoscopic biopsy

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33
Q

Cite examples of cytoprotective agents used in PUD

A
  1. Sucralfate
  2. Rebamipide
  3. Prostaglanding analogues (misoprostol)
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34
Q

What are the drugs involved in triple therapy for H. pylori eradication?

A
  1. Omeprazole
  2. Clarithromycin
  3. Amoxicillin
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35
Q

What are the drugs involved in quadruple therapy for H. pylori eradication?

A
  1. Tetracycline
  2. Omeprazole
  3. Metronidazole
  4. Bismuth
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36
Q

What are the 3 pathways that govern acid secretion?

A
  1. Acetylcholine via the parasympathetic NS
  2. Histamine release produced locally by enterochromaffin cells
  3. Gastrin released by the G cells
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37
Q

What eicosanoid plays a central role in gastric epithelial defense?

A

prostaglandin

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38
Q

Most common location of duodenal ulcers

A

first portion of duodenum

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39
Q

benign GU are usually founf

A

Distal to the junction between the antrum and the acid secretory mucosa

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40
Q

What are the two predominant causes of PUD?

A
  1. NSAID ingestion

2. H. pylori

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41
Q

Most discriminating symptom of DU?

A

pain that awakens the patient from sleep between midnight and 3am

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42
Q

What is the most frequent finding in both GU and DU?

A

epigastric tenderness

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43
Q

[Diagnose]

58/M boring epigastric pain, progressively worsening, radiating to the back

(+) malaise, nausea, vomiting.

HPN, dyslipidemia, heavy alcoholic beverage drinker. Soft distended abdomen, direct tenderness, no rebound tenderness

A

Dx: Acute pancreatitis
Next step: serum lipase
Best diagnostic workup: CT Scan with IV contrast

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44
Q

Patient with acute pancreatitis. Noted discoloration in the periumbilical area. What do you call this sign?

A

Cullen Sign

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45
Q

Patient with acute pancreatitis. Noted discoloration in the flank area. What do you call this sign?

A

Grey Turner Sign

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46
Q

What is the most common cause of acute pancreatitis?

A

Gallstone

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47
Q

What is the second most common cause of acute pancreatitis?

A

alcohol

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48
Q

What value of tricglyceride can cause acute pancreatitis?

A

> 1000 mg/dL

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49
Q

What is the most important clinical finding in regard to severity of the acute pancreatitis?

A

persistent organ failure (>48hr)

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50
Q

___ classification which defines the phases of acute pancreatitis, defines severity, clarifies imaging definition

A

Revised atlanta classification

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51
Q

What is the preferred pain medication for acute pancreatitis?

A

meperidine

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52
Q

What is the most common cause of death in patients with acute pancreatitis?

A

Hypovolemic shock

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53
Q

What are the components of charcot’s triad of cholangitis?

A
  1. Fever
  2. Pain
  3. Jaundice
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54
Q

When do we start feeding patients with acute pancreatitis?

A

Early enteral feeding using nasojejunal tube within 48hrs confers lower morbidity and mortality

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55
Q

What are the components of BISAP Score?

A 
BUN >25
Impaired mental status
SIRS >/2 of 4
Age >60
Pleural effusion
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56
Q

What are the markers of severity during hospitalization for Acute Pancreatitis

A
  1. Persistent organ failure

2. Pancreatic necrosis

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57
Q

What are the markers of severity at admission for Acute Pancreatitis?

A
  1. SIRS
  2. APACHE II
  3. Hct >44
  4. BUN >22, crea 2
  5. BISAP Score
  6. Organ failure
  7. SBP <90
  8. HR >130
  9. PaO2 <60
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58
Q

[diagnose]

45/Female RUQ pain after a large fatty meal

A

Dx: Cholelithiasis

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59
Q

What are the two types of gallstones

A
  1. Cholesterol

2. Pigment stones

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60
Q

Brown pigment stone is due to?

A

Chronic biliary infection

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61
Q

Black type pigment stone is due to?

A

chronic hemolytic state

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62
Q

what is the most important mechanism in formation of stone forming bile?

A

increased biliary secretion of cholesterol

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63
Q

Procedure of choice for detection of gallstone

A

Gallbladder UTZ

64
Q

Type of stones amendable for dissolution

A

radiolucent stone

65
Q

Cut off size of gallstone amenable for dissolution

A

<10mm

66
Q

What is the recommended dose of UDCA for dissolution

A

10-15 mg/kg/day

for 2 years to dissolve stones

67
Q

What are the triad for cholecystitis?

A
  1. RUQ tenderness
  2. Fever
  3. Leukocytosis
68
Q

What is the ultrasound criteria suggesting GB stone?

A

Acoustic shadowing of opacities within the GB lumen that changes with the patients position

69
Q

[diagnose]

45F burning epigastric pain 2 hours after meal

A

DU

70
Q

[diagnose]

40M with epigastric pain after a meal (+) Nausea (+) weight loss

A

GU

71
Q

[diagnose]

35M RUQ pain after a fatty meal

A

Acute cholecystitis

72
Q

[diagnose]

30/M obese, severe, dull epigastric pain radiating to the back

A

acute pancreatitis

73
Q

[diagnose]

30F fever, abdominal pain, jaundice

A

ascending cholangitis

74
Q

[diagnose]

21/F burning sensation behind sternum, bad metallic taste in the morning with cough

A

GERD

75
Q

[Guess the toxin producer]

1-8 hours, vomiting, watery diarrhea

A

preformed toxin since mabilis,

B. cereus
S. aureus

76
Q

[Guess the toxin producer]

8-24 hours, vomiting, watery diarrhea

A

preformed toxin

C. perfringes

77
Q

[Guess the toxin producer]

8-72 hours, vomiting, watery diarrhea

A

enterotoxin na to since 3 days-ish na
Remember: VEKA

V. cholerae
ETEC
K. pneumoniae
Aeromonas spp

78
Q

[Guess the toxin producer]

1-8 days, abdominal pain, fever, watery mushy diarrhea

A

Days na, so adherent

Crytosporidiosis
Helminths
EAEC
Giardia
EPEC
79
Q

[Guess the toxin producer]

12 to 72 hours, abdominal pain, fever, watery first then bloody diarrhea

A

cytotoxin na to

EHEC

80
Q

[Guess the toxin producer]

1-3 days, abdominal pain, fever, watery and occasional bloody

A

C. difficile

81
Q

[Guess the Invasive organism]

1-3 days, abdominal pain, fever, watery diarrhea

A

Viral

Rotavirus
Norovirus

82
Q

[Guess the Invasive organism]

12 hours to 11 days, abdominal pain, fever, watery or bloody diarrhea

A

Remember: SCARY

Salmonella
Campylobacter
Aeromonas
paRahaemolyticus 
Yersinia
83
Q

[Guess the Invasive organism]

12 hours to 8 days, abdominal pain, fever, bloody diarrhea

A

Remember: SEE

Shigella
ETEC
Entamoeba histolytica

84
Q

What are the indications for evaluation of diarrhea?

A
  1. Profuse diarrhea with dehydration
  2. Grossly bloody stools
  3. Fever >/ 38.5
  4. > 48 hours without improvement
  5. Recent antibiotic use
  6. New community outbreaks
  7. Severe abdominal pain in px >50 years old
  8. Elderly >/ 70 or ICC
85
Q

Most common cause of persistent diarrhea

A

Giardia

86
Q

___ type of diarrhea

abrupt-onset, persists at least 1 months lasting 1-3 years, associated with subtle inflammation of the distal small intestine or proximal colon

A

Brainerd diarrhea

87
Q

Can lead to hemolytic uremic syndrome

A
  1. EHEC 0157:H7

2. Shigella

88
Q

Loperamide is avoided in what type of diarrhea

A

Febrile dysentery

89
Q

Loperamide can be used in this case of diarrhea

Initial dose: 4mg/tab 1 tab as initial dose the 2mg after each stool

A

moderate/severe nonfebrile, non-bloody

90
Q

Which patients suffering with diarrhea will you give antibiotic?

A
  1. Immunocompromised
  2. Elderly
  3. Mechanical heart valves or recent vascular grafts
91
Q

Melena indicates that blood is present in GIT for at least ___ hours

A

At least 14 hours.

and as long as 3-5 days

92
Q

Orthostasis is when_____

A
  1. SBP drops >20mmHg OR

2. rise in pulse of >10bpm

93
Q

[Diagnose]

65M alcoholic, massive hematemesis

110/70 11 bpm
jaundice, ascites, edema

A

Dx: BEV
Next step: urgent endoscopy within 12hours

If (+) BEV seen: Endoscopic ligation and IV vasocactive medications

94
Q

What is the most common cause of UGIB?

A

peptic ulcer

95
Q

[Diagnosis]

vomiting, retching, coughing, before hematemesis who binges alcohol

A

Mallory-Weiss

96
Q

What is the cut-off depth to say that it is an ulcer

A

mucosa depth > 5mm

97
Q

[How will you manage this UGIB findings]

ulcer, Active bleeding, or visible bleeding

A
  1. IV PPI + endoscopic therapy
  2. ICU 1 day
  3. Ward 2 days
98
Q

[How will you manage this UGIB findings]

ulcer, adherent clot

A
  1. IV PPI with or without endoscopic therapy

2. Ward 3 days

99
Q

[How will you manage this UGIB findings]

ulcer that is flat, pigmented

A
  1. NO IV PPI or endoscopic therapy

2. Ward for 2 to 3 days

100
Q

[How will you manage this UGIB findings]

ulcer, clean base

A

Discharge

101
Q

[How will you manage this UGIB findings]

BEV

A
  1. Ligation
  2. IV vasoactive drug (octreotide)
  3. ICU 1-2 days
  4. Ward for 2 to 3 days
102
Q

[How will you manage this UGIB findings]

mallory-weiss tear, actively bleeding

A
  1. Endoscopic therapy

2. Ward 1-2 days

103
Q

[diagnose]

68/M no comorbids
passage of fresh blood per rectum

80/50 120bom,
abdomen is soft, nontender, normoactive bowel sounds, no stigmata of cirrhosis

DRE: fresh blood per examining finger, no mass no tenderness

A

After IVF and transfusion

next step: upper GI endoscopy to rule out UGIB before evaluating Lower GIT

104
Q

[diagnose]

68/M no comorbids
passage of fresh blood per rectum

80/50 120bom,
abdomen is soft, nontender, normoactive bowel sounds, no stigmata of cirrhosis

DRE: fresh blood per examining finger, no mass no tenderness

EGD is normal

A

Dx: diverticular disease

105
Q

Most common cause of LGIB

A

Diverticular disease

106
Q

[diagnose]

blood streaked stools, protruding rectal mass with occasional pain

A

hemorrhoidal disease

107
Q

[diagnose]

IDA, weight loss, tenesmos, abdomnal pain, BM changes

A

colonic mass

108
Q

pseudodiverticula is an outpouching composed of what layers

A

mucosa and submucosa only

109
Q

A right sided mass commonly present with?

A

anemia

110
Q

A mass is located on the left/right when it presents an obstructive sign prior to bleeding

A

left sided

111
Q

[Management of LGIB]

No hemodynamic instability, age <40, minimal bleeding

A

Flexible sigmoidoscopy

112
Q

[Management of LGIB]

No hemodynamic instability, age <40, more copious bleeding

A

Colonoscopy

113
Q

[Management of LGIB]

No hemodynamic instability, age >40, minimal bleeding

A

Colonoscopy

114
Q

Most common cause of UGIB?

A

peptic ulcer

115
Q

Most common cause of LGIB

A

hemorrhoids

116
Q

Endoscopic therapy of choice for BEV

A

ligation

117
Q

most common cause of obscure GIB in adults <50 years old

A

small bowel tumors

118
Q

most common cause of obscure GIB in adults >50 years old

A

vascular ectasia, NSAID-induced

119
Q

most common cause of significant LGIB in children

A

meckel’s diverticulum

120
Q

In children and adolescents, most common colonic cause of significant GIB

A

IBD, juvenile polyps

121
Q

[Test of choice]

UGIB

A

upper endoscopy

122
Q

[Test of choice]

LGIB, bleeding not massive

A

colonoscopy

123
Q

[Test of choice]

LGIB, bleeding massive

A

upper endoscopy

124
Q

[Test of choice]

massive obscure bleed

A

angiography

125
Q

what are the three hemorrhoidal complexes that traverse the anal canal

A

Left lateral
Right anterior
Right posterior

126
Q

[Diagnosis]

painless, bright red blood seen in toilet or upon wiping

A

Hemorrhoidal bleeding,

if with anemia, rule out colonic neoplasm

127
Q

[management of bleeding hemorrhoids]

Young, without history of colon CA

A
  1. Treat hemorrhoids firs

2. Colonoscopy if bleeding persists

128
Q

[management of bleeding hemorrhoids]

old, with bleeding

A
  1. Colonoscopy or flexible sigmoidoscopy
129
Q

[Management of hemorrhoids]

enlargement with bleeding

A

This is stage I

  1. Cortisone suppository, short course
  2. Sclerotherapy
  3. infrared coagulation
130
Q

[Management of hemorrhoids]

protrusion with spontaneous reduction

A

This is stage II

  1. Cortisone suppository, short course
  2. Sclerotherapy
  3. infrared coagulation
131
Q

[Management of hemorrhoids]

protrusion requiring minimal reduction

A

This is stage III

  1. Cortisone suppository, short course
  2. Rubberband ligation
  3. Operative hemorrhoidectomy
132
Q

[Management of hemorrhoids]

irreducible protrusion

A

This is stage IV

  1. Cortisone suppository
  2. Operative hemorrhoidectomy
133
Q

[location of colon CA]

IDA, large, large without obstructive symptoms, commonly ulcerates

A

cecum or ascending colon (right)

134
Q

[location of colon CA]

apple-core or napking ring deformity

obstruction + perforation

A

transverse and descending colon

135
Q

[location of colon CA]

hematochezia, tenesmus, narrowing of stool caliber

A

rectosigmoid

136
Q

How does NSAIDs and aspiring prevent the risk of colon CA?

A

suppress prostaglandin synthesis

137
Q

Colon CA frequently metastasize to

A

liver

138
Q

What is the best predictor of long-term prognosis?

A

pathologic stage at diagnosis

139
Q

What is the backbone of treatment of colon CA

A

5FU systemic therapy

140
Q

[When will you screen]

patient with one first degree relative with colon CA

A

10 years younger

141
Q

[When will you screen]

generally, you screen all patients for colon CA

A

at age 50

142
Q

[When will you screen]

patient with one first degree relative with colon CA and if with consideration of FAP at age 25

A

10 years younger

143
Q

[When will you screen]

colonoscopy is done every?

A

10 years

144
Q

[When will you screen]

sigmoidoscopy is done every?

A

5 years

145
Q

[When will you screen]

FOBT is done every?

A

every year

146
Q

[When will you screen]

for cervical CA

A

at age 21 to 65

PAP every 3 years
HPV co testing every 5 years

147
Q

[When will you screen]

for breast CA

A

at age 50 to 74

every 2 years

148
Q

[When will you screen]

for lung CA, do a plain chest CT

A

At age 55 to 80 if with at least 30 pack years of smoking, and have been smoking for the last 15 years

149
Q

[UC vs CD]

smoking prevents the disease

A

UC

Smoking is causative in CD

150
Q

[UC vs CD]

OCP increases the risk of?

A

CD

151
Q

[UC vs CD]

appendectomy is protective

A

UC

152
Q

[UC vs CD]

Gross blood in stool, mucus present, continuous disease, stricture

A

UC

ulcers, pseudopolyp, continuous, begins in rectum

153
Q

[UC vs CD]

systemic symptoms, pain, abdominal mass, fistylas, intestinal obstruction, colonic obstruction, recurrence

rectal sparing, cobblestoning

A

CD

Skip lesion, transmural, linear fissures

154
Q

[UC vs CD]

inflammation of the colon without skip lesion

A

UC

155
Q

[UC vs CD]

inflammation of the colon with skip lesions, chronic, more toxic patient with fistula

A

CD

Internal Medicine (10 decks)

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