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Gastroenterology Board Correlates > gastroenterology_20150615044556 > Flashcards

gastroenterology_20150615044556 Flashcards

1
Q

KEY enzyme that controls the rate-limiting step in prostaglandin synthesis

A

Cyclooxygenase (COX)

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2
Q

TWO principal gastric secretory products capable of inducing mucosal injury

A

Hydrochloric acid and pepsinogen

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3
Q

Duodenal ulcers occur MOST often in

A

FIRST portion of the duodenum (>95%)

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4
Q

Account for the MAJORITY of DUs

A

H. pylori and NSAID-induced injury

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5
Q

Benign Gus are MOST often found

A

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

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6
Q

MAJORITY of GUs can be attributed to either

A

H. pylori or NSAID-induced mucosal damage

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7
Q

Two factors that PREDISPOSE to higher colonization of H. pylori

A

Poor socioeconomic status and less education

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8
Q

Play a critical role in maintaining mucosal integrity and repair

A

Prostaglandins

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9
Q

MOST discriminating symptom in duodenal ulcer

A

Pain that awakes the patient from sleep (between midnight and 3 AM)

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10
Q

MOST frequent finding in patients with GU or DU

A

Epigastric tenderness

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11
Q

Most common complication observed in PUD

A

Gastrointestinal bleeding

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12
Q

SECOND-MOST common ulcer-related complication

A

Perforation

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13
Q

LEAST-common ulcer-related complication

A

Gastric outlet obstruction

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14
Q

MOST potent acid inhibitory agents available

A

Proton pump (H+ K+-ATPase) inhibitors

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15
Q

MOST common toxicity with sucralfate

A

Constipation

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16
Q

MOST common toxicity with prostaglandin analogues

A

Diarrhea

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17
Q

MOST feared complication with amoxicillin, clindamycin

A

Pseudomembranous colitis (Tx: oral vancomycin, IV metronidazole)

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18
Q

MOST common cause for treatment failure in COMPLIANT patients

A

Antibiotic-resistant strains

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19
Q

Test of CHOICE for documenting eradication of H. pylori

A

Urea breath test (UBT)

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20
Q

Operations MOST commonly performed for duodenal ulcers

A
  • Vagotomy and drainage- Highly-selective vagotomy- Vagotomy with antrectomy
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21
Q

Treatment of CHOICE for an antral ulcer

A

Antrectomy (including the ulcer) with a Billroth I anastomosis

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22
Q

MOST frequent presenting complaint in recurrent ulceration

A

Epigastric abdominal pain

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23
Q

CORNESTONE of therapy for patients with dumping syndrome

A

Dietary modification

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24
Q

MOST commonly observed after truncal vagotomy

A

Post-vagotomy diarrhea

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25
Q

MAJORITY of gastrinomas occur within

A

Pancreas

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26
Q

MOST common nonpancreatic lesion (gastrinoma)

A

Duodenal tumors

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27
Q

MOST common cause of UGIB (50% of cases)

A

Peptic ulcers

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28
Q

FULL-THICKNESS tear of esophagus

A

Boerhaave Syndrome

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29
Q

PARTIAL-THICKNESS tear of esophagus

A

Mallory-Weiss tear

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30
Q

CLASSIC history of Mallory-Weiss tear

A

Vomiting, retching, coughing preceeding hematemesis

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31
Q

MOST important in the setting of hemorrhagic and erosive gastropathy (gastritis)

A

NSAIDs, alcohol, stress

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32
Q

Responsible for MAJORITY of cases of obscure GIB

A

Small intestinal sources of bleeding

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33
Q

MOST common cause of significant lower GIB in children

A

Meckel’s diverticulum

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34
Q

MOST common cause of LGIB

A

Hemorrhoids

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35
Q

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

A

IBD and juvenile polyps

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36
Q

BEST way to initially assess a patient with GIB

A

Heart rate and BP

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37
Q

Test of choice in UGIB

A

Upper endoscopy

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38
Q

Procedure of CHOICE in LGIB unless bleeding is too massive

A

Colonoscopy

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39
Q

Initial test for massive obscure bleeding

A

Angiography

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40
Q

CLASSIC symptoms of Gastroesophageal Reflux Disease (GERD)

A

Water brash and substernal heartburn

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41
Q

MOST sensitive test for diagnosis of GERD

A

24-hr ambulatory pH monitoring

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42
Q

MAJOR risk factor for adenocarcinoma

A

Barrett’s esophagus (metaplasia → squamous to columnar)

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43
Q

GOLD standard for confirmation of Barrett’s esophagus

A

Endoscopic biopsy

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44
Q

MOST common cause of esophageal chest pain

A

Gastroesophageal reflux

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45
Q

BEST test for the evaluation of proximal gastrointestinal tract

A

Endoscopy/Esophagogastroduodenoscopy (EGD)

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46
Q

Typical presentation of esophageal cancer

A

Progressive solid food dysphagia and weight loss

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47
Q

One of the MOST common causes of steakhouse syndrome

A

Schatzki ring

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48
Q

Cancer involving the middle 1/3 of the esophagus, associated with smoking

A

Esophageal squamous cell CA

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49
Q

Cancer involving the lower 1/3 of the esophagus, associated with GERD, Barrett’s esophagus

A

Esophageal AdenoCA

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50
Q

Characteristic symptom of infectious esophagitis

A

Odynophagia

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51
Q

Rule of 2’s in Meckel’s diverticulum

A

2% of the population2 y/o2 types of tissues involved2:1 M:F ratio2 in long2 ft from ileocecal valve

52
Q

Charcot’s Cholangitic triad

A

Mnemonic: FPJ - Fever, abdominal Pain, Jaundice

53
Q

Charcot’s Neurologic Triad of Multiple Sclerosis

A

Mnemonic: SIN - Scanning speech, Intentional tremor, Nystagmus

54
Q

Reynold’s Pentad

A

In addition to Charcot’s Cholangitic triad, also includes shock and confusion

55
Q

Rome Criteria for Irritable Bowel Syndrome

A

Recurrent abdominal pain or discomfort at least 3 days per month in the last three months associated with 2 or more of the following: improvement with defecation, onset associated with a change in frequency of stool, onset associated with a change in form (appearance) of stool

56
Q

Triad of Hepatopulmonary Syndrome

A

Liver disease, Hypoxemia, Pulmonary Arteriovenous Shunting

57
Q

Triad of Choledochal cyst

A

abdominal pain, jaundice, abdominal mass

58
Q

Classic Triad of Hemobilia

A

Biliary pain, Obstructive jaundice, Melena or occult blood in stools

59
Q

Diagnosis of acute pancreatitis REQUIRES TWO of the following

A

Typical abdominal pain3-fold or greater elevation in serum amylase and/or lipase levelConfirmatory findings on cross-sectional abdominal imaging

60
Q

A TRIAD of findings should alert one to the possibility of HEMORRHAGE from a pseudocyst

A

Increase in the size of the massA localized bruit over the massSudden decrease in hemoglobin level and hematocrit without obvious external blood loss

61
Q

Reduction in GFR with an elevation of serum creatinine level, but it is fairly stable

A

Type 2 HRS

62
Q

Alteration in mental status and cognitive function occuring in the presence of liver failure

A

Hepatic (Portosystemic) Encephalopathy

63
Q

Sudden forward voluntary movement of the wrist after it is bent back on an extended arm

A

Asterixis or liver flap

64
Q

Clinically innocuous entity in which a partial or complete septum (or fold) separates the fundus from the body

A

Phrygian cap

65
Q

Deep inspiration or cough during subcostal palpation of the RUQ usually produces increased pain and inspiratory arrest

A

Murphy’s sign

66
Q

Triad of Acute Cholecystitis

A

Sudden onset of RUQ tendernessFeverLeukocytosis

67
Q

Gallstone becomes impacted in the cystic duct or neck of the gallbladder causing COMPRESSION of the CBD, resulting in CBD obstruction and jaundice

A

Mirizzi’s syndrome

68
Q

Gas within the gallbladder lumen in plain abdominal films, dissecting within the gallbladder wall to form a gaseous ring, or in the pericholecystic tissues

A

Emphysematous Cholecystitis

69
Q

MAJOR intrahepatic radicles

A

Caroli’s disease

70
Q

Passage of gallstones into the CBD

A

Choledocholithiasis

71
Q

Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculus disease

A

Courvoisier’s law

72
Q

Blue discoloration around the umbilicus (result of hemoperitoneum)

A

Cullen’s sign

73
Q

Blue-red-purple or green brown discoloration of the flanks (reflects tissue catabolism of Hb)

A

Turner’s sign

74
Q

Defined by the presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive destruction of both exocrine and eventually endocrine tissue

A

Chronic pancreatitis

75
Q

Refers to an assessment of the severity or activity of liver disease, whether acute or chronic; active or inactive; mild, moderate, or severe

A

Grading

76
Q

Reflects the level of progression of the disease, based on the degree of hepatic fibrosis

A

Staging

77
Q

Indicates cirrhosis with a Child-Pugh score of >7 (Class B)

A

Decompensation

78
Q

Used to assess prognosis in cirrhosis and provide standard criteria for listing liver transplantation (Class B)

A

Child-Pugh score

79
Q

Used in assessing candidates for liver transplantation calculated using three noninvasive variables: INR, Serum bilirubin, Serum creatinine

A

MELD score

80
Q

More specific indicator of liver injury

A

ALT

81
Q

Hepatic inflammation and necrosis that continue for at least 6 months

A

Chronic Hepatitis

82
Q

Caused by Hep B, B+D, C

A

Chronic viral hepatitis

83
Q

Characterized by presence in the serum of HbeAg and HBV DNA levels

A

Replicative Phase (Hep B)

84
Q

CLASSIC syndrome occurring in young women

A

Type I Autoimmune Hepatitis

85
Q

Associated iwth Anti-LKM

A

Type II Autoimmune Hepatitis

86
Q

Type II Autoimmune Hepatitis, Hepatitis C

A

Anti-LKM1

87
Q

Drug-induced hepatitis

A

Anti-LKM2

88
Q

Chronic hepatitis D

A

Anti-LKM3

89
Q

Hemolytic anemia with spur cells and acanthocytes in patients with severe alcoholic hepatitis

A

Zieve’s syndrome

90
Q

Elevation of hepatic venous pressure gradient to > 5 mmHg

A

Portal hypertension

91
Q

Progressive impairment in renal function and a significant reduction in creatinine clearance within 1-2 weeks

A

Type 1 HRS

92
Q

Laboratory features that argue AGAINST irritable bowel syndrome

A

evidence of anemiaelevated sedimentation ratepresence of leukocytes or blood in stoolstool volume > 200-300ml/d

93
Q

Saclike herniation of the ENTIRE bowel wall

A

true diverticulum

94
Q

Involves only a protrusion of the mucosa through the muscularis propria of the colon

A

Pseudodiverticulum

95
Q

Air-fluid level in the LLQ on plain abdominal film

A

Giant diverticulum of the sigmoid colon

96
Q

Staging for perforated diverticular disease

A

Hinchey classification system

97
Q

Circumferential, full-thickness protrusion of the rectal wall through the anal orifice

A

Rectal prolapse (proccidentia)

98
Q

Majority of patient complains include anal mass, bleeding per rectum, and poor perianal hygiene

A

EXTERNAL prolapse

99
Q

Present with symptoms of BOTH constipation and incontinence

A

INTERNAL prolapse

100
Q

Involuntary passage of fecal material >10 ml for at least 1 month

A

Fecal incontinence

101
Q

Incontinence to flatus and occasional seepage of liquid stool

A

Minor incontinence

102
Q

Frequent inability to control solid waste

A

Major incontinence

103
Q

Goodsall’s Rule

A

Posterior external fistula will enter the anal canal in the posterior midlineAnterior fistula will enter the nearest cryptA fistula exiting > 3cm from the anal verge may have a complicated upward extension and may NOT obey Goodsall’s Rule

104
Q

Chronic anal fissures

A

present for > 6 weeks

105
Q

Characterized by cramping midabdominal pain, which tends to be more severe the higher the obstruction

A

Mechanical Intestinal Obstruction

106
Q

Features of liver injury, inflammation and necrosis predominate

A

Hepatocellular disease

107
Q

Features of bile flow inhibition predominate

A

Cholestatic (obstructive) disease

108
Q

Alcohol seeking behavior, despite its adverse effects

A

Dependence

109
Q

Visualizes only the rectum and a variable portion of the left colon, typically to 60 cm from the anal verge

A

Flexible sigmoidoscopy

110
Q

Dysphagia for solid and liquid food

A

Suggests a motility disorder such as achalasia

111
Q

Bird’s beak appearance; aganglionic cells in the esophagus

A

Achalasia

112
Q

Dysphagia for solid food

A

Suggestive of stricture, ring, or tumor

113
Q

Impaired LES relaxation and absent peristalsis

A

Esophageal manometry: Diagnostic criteria for achalasia

114
Q

Olive-shaped mass, non-bilous vomiting

A

Pyloric stenosis

115
Q

Aganglionic cells in the colon

A

Hirschprung disease

116
Q

Perception of a lump or fullness in the throat that is felt irrespective of swallowing

A

Globus Hystericus

117
Q

Diffuse esophageal spasm has been characterized radiographically by

A

Tertiary contractions or a “corkshrew esophagus”, “rosary bead esophagus’

118
Q

GU that fails to heal after 12 weeks of therapyDU that does not heal after 8 weeks of therapy

A

Refractory peptic ulcer disease

119
Q

Ulcer recurrence rates are higher, although the overall complication rates are the lowest of the three procedures

A

Highly-selective vagotomy

120
Q

Provides the lowest rates of ulcer recurrence, but has the highest complication rate

A

Vagotomy with Antrectomy

121
Q

Hypothetical gastinoma triangle (location of ~80% of gastrinomas)

A

Confluence of:cystic and CBD superiorlyjunction of the 2nd and 3rd portions of the duodenum inferiorlyJunction of the neck and body of the pancreas medially

122
Q

Characterized by large, tortuous gastric mucosal folds

A

Menetrier’s disease

123
Q

Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon

A

Ulcerative colitis (UC)

124
Q

Can affect any part of the GIT from the mouth to the anus

A

Crohn’s disease (CD)

125
Q

Characteristic of CD, both endoscopically and by barium radiography

A

Cobblestone appearance

126
Q

60-70% of UC patients; >5-15% of CD patients

A

pANCA positivity

127
Q

60-70% of CD patients; >10-15% of UC patients

A

ASCA positivity

Gastroenterology Board Correlates (1 decks)

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