Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UWorld > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Epigastric pain that radiates to R shoulder is most suggestive of …

A

Cholelithiasis … (pancreatitis won’t radiate to shoulder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Typical duration of abdominal pain in setting of cholelithiasis?

A

< 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Best initial test for diagnosing cholelithiasis?

A

Abdominal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best treatment for patients with typical biliary colic symptoms and confirmed gallstones on US?

A

Pain management + Elective laparoscopic cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

US finding that suggests pancreatitis due to gallstones?

A

Dilation of CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Patient presents with abdominal pain, jaundice, LFT abnormalities; CBD appears dilated on US – diagnosis?

A

Choledocholithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Best treatment for Choledocholithiasis?

A

ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Best treatment for Cholangitis?

A

ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2 most common sites of metastasis for choriocarcinoma?

A

Lungs, Vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

41 yo female presents 4 months post-partum with abnormal vaginal bleeding; Exam shows enlarged uterus, vascular vaginal lesion; Labs show (+) pregnancy test – diagnosis?

A

Choriocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Post-cholecystectomy diarrhea is a type of ___ diarrhea

A

Bile-salt induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What accounts for colonic stimulation in the setting of post-cholecystectomy diarrhea?

A

Bile acids are secreted from the liver directly into the intestinal lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In which 2 settings is bile-salt induced diarrhea present?

A

Ileal resection, Short bowel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Best treatment for bile-salt induced post-cholecystectomy diarrhea?

A

Cholestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of cholestyramine in treatment of bile-salt induced post-cholecystectomy diarrhea?

A

Resin that binds and sequesters bile-salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epidemiology of hepatic adenoma?

A

Young women on OCPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Appearance of hepatic adenoma on CT?

A

Well-demarcated lesion, Shows peripheral enhancement with IV contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Best treatment for hepatic adenomas <5 cm in size?

A

Discontinuation of OCPs … (usually results in tumor regression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Best treatment for hepatic adenomas that are symptomatic, or >5 cm in size?

A

Surgical resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 protect factors against colon CA?

A

High-fiber diet, NSAID use, Hormone replacement therapy, Regular exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 most common symptoms associated with Primary Biliary Cholangitis (PBC)?

A

Fatigue, Pruritis, Xanthelasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lab value associated with PBC?

A

Elevated alkaline phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Highly-specific antibody associated with PBC?

A

Anti-mitochondrial antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnostic test for PBC?

A

Liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Appearance of liver biopsy in setting of PBC?

A

Fibrosis + obliteration of intrahepatic bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which treatment may slow the progression of PBC?

A

Ursodeoxycholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Only curative treatment for PBC?

A

Liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Common complication of PBC?

A

Osteopenia/Osteoporosis … from Vitamin D deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Best treatment for prevention of Osteopenia/Osteoporosis in setting of PBC?

A

Ca2+, Vitamin D, Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Alternate name for Vitamin B2?

A

Riboflavin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clinical presentation of Riboflavin deficiency?

A

Angular cheilosis, stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Alternate name for Vitamin B1?

A

Thiamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical presentation of Thiamine deficiency?

A

Wet Beriberi, Wernicke-Korsakoff Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Alternate name for Vitamin B3?

A

Niacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Clinical presentation of Niacin deficiency (aka Pellagra)?

A

3 D’s … Diarrhea, Dermatitis, Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Metabolic + electrolyte disturbance associated with pyloric stenosis?

A

Hypokalemic, hypochloremic metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Renal lab results associated with pyloric stenosis?

A

Elevated creatinine + BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Why might BUN and creatinine be elevated in setting of pyloric stenosis?

A

Pre-Renal AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Diagnostic test for pyloric stenosis?

A

Abdominal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Initial step of treatment for pyloric stenosis?

A

Rehydration + correction of electrolyte abnormalities … Before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which 2 ABX are associated with increased risk of pyloric stenosis?

A

Azithromycin + Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Azithromycin + Erythromycin belong to class of …

A

Macrolides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Why might Azithromycin + Erythromycin be prescribed to an infant?

A

Post-exposure prophylaxis against pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Feeding behavior that might increase an infant’s risk for pyloric stenosis?

A

Bottle-feeding, rather than breast-feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Clinical presentation of anal abscess?

A

Severe, constant pain accompanied by fever; Erythematous, indurated mass with fluctuance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Typical location of anal abscesses?

A

Midway between anus + ischial tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Best management of anal abscesses?

A

Prompt I&D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which patients with anal abscesses should also be treated with ABX?

A

DM, immunosuppression, cellulitis, valvular heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Most common complication of anal abscesses?

A

Fistula formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Clinical presentation of anal abscess, complicated by fistula formation?

A

Abscess that undergoes I&D, but continues to drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Most common location of abdominal pain in setting of lactose intolerance?

A

Periumbilical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

2 foods that contain high lactose content?

A

Milk, ice cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

2 foods that contain low lactose content?

A

Cheese, yogurt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How can you distinguish lactose intolerance from gluten intolerance?

A

Gluten intolerance = patients undergo weight loss + growth failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Chronic watery diarrhea, bloating, flatulence in adults is suspicious for …

A

Lactose intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cause of Lactose intolerance?

A

Reduced activity of lactase enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Additional evaluation + management for patients with new-onset Lactose intolerance?

A

Ca2+ and Vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Classic triad of clinical presentation for intussusception?

A

Episodic abdominal pain, Red currant jelly stool, Sausage-shaped mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Imaging study of choice for intussusception?

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Classic US finding seen in cases of intussusception?

A

Target sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Best initial management for intussusception?

A

Air enema, Water-soluble enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What accounts for telescoping of bowel in setting of intussusception?

A

Lymphoid hyperplasia (Peyer’s patches), Pathologic lead point (Meckel diverticulum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Most common age of presentation for intussusception?

A

6 months – 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Complication of intussusception?

A

Intestinal perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Clinical presentation of Intestinal perforation in cases of intussusception?

A

Severe abdominal pain, rebound, guarding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Best initial management of suspected Intestinal perforation in intussusception?

A

Abdominal XR … looking for free air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

If free air is noted on abdominal XR, what is next step of management for suspected Intestinal perforation in intussusception?

A

Surgical repair (immediate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Best test to evaluate pancreatic cysts for malignancy?

A

Endoscopic US with aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Triad of symptoms seen in acute appendicitis?

A

Fever, R-sided abdominal pain, Leukocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What accounts for lack of peritoneal signs (+ McBurney’s TTP) in setting o appendicitis during pregnancy?

A

Upward displacement of appendix … decreased contact with peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Best initial evaluation of suspected appendicitis during pregnancy?

A

Compression US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Complication of untreated appendicitis?

A

Pylephlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Pylephlebitis refers to …

A

Infective portal vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Clinical presentation of Pylephlebitis?

A

Fever, RUQ pain, jaundice, hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Pylephlebitis commonly results from …

A

Untreated appendicitis or diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Why does Pylephlebitis result from infection of abdominal cavity?

A

Portal vein drains that majority of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Best treatment of Pylephlebitis?

A

Prolonged ABX therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Definition of acute diarrhea?

A

Lasting <14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Definition of dysentery?

A

Acute diarrhea with visible blood + mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

4 most common pathogens responsible for dysentery?

A

Salmonella, Shigella, EHEC, Campylobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Non-infectious causes of dysentery?

A

Inflammatory bowel disease, Ischemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

3 aspects of initial evaluation of dysentery?

A

Stool culture, immunoassay for Shiga toxin, Fecal leukocyte count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Low fecal leukocyte count in the setting of dysentery suggests …

A

Invasive amebiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

G6PD deficiency results in ___ hyperbilirubinemia

A

Unconjugated (indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Additional lab feature of G6PD deficiency?

A

Hemolytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Appearance of G6PD deficiency on blood smear?

A

Bite cells with Heinz bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Inheritance pattern of G6PD deficiency?

A

X-linked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Best treatment for cases of mild G6PD deficiency?

A

Supportive care (hydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Best treatment for cases of moderate/severe G6PD deficiency?

A

Phototherapy, exchange transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Biliary atresia results in ___ hyperbilirubinemia

A

Conjugated (direct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Etiology of biliary atresia?

A

Destruction of extrahepatic biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Breastmilk jaundice results in ___ hyperbilirubinemia

A

Unconjugated (indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

At what age does colon CA screening begin for general population?

A

50 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

3 options for colon CA screening in general population?

A

Colonoscopy q10y, Flexible sigmoidoscopy q5y, High sensitivity fecal occult blood testing q1y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Recommended age of screening for patient with colon CA in 1st-degree relative?

A

40 yo … OR 10 years prior to age of diagnosis (whichever comes first)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

3 features of adenomatous polyp associated with increased risk of colon CA?

A

Size > 1 cm, Villous morphology, High-grade dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Recommendation for patients with high-risk adenomatous polyp?

A

Repeat colonoscopy in 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Patient with high-risk adenomatous polyp completes colonoscopy 3 years after initial discovery of high-risk adenomatous polyp; No new polyps are found - what is recommended follow-up?

A

Repeat colonoscopy in 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

1st step of workup for patient with suspected gastroparesis?

A

Upper GI endoscopy, Barium swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Value of upper GI endoscopy or barium swallow in the initial evaluation of suspected gastroparesis?

A

Rule out mechanical obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Diagnostic test for suspected gastroparesis?

A

Nuclear gastric emptying study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Metabolic abnormality associated with gastroparesis?

A

Unstable diabetic control, frequent hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Clinical presentation of gastroparesis?

A

Delayed emptying, sweating, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What accounts for sweating in the setting of gastroparesis?

A

Autonomic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Best management of gastroparesis?

A

Dietary modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

2 medications that may be used in cases of gastroparesis, unresponsive to dietary changes?

A

Erythromycin, Metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Clinical presentation for oropharyngeal dysphagia?

A

Difficulty initiating swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Clinical presentation for esophageal dysphagia?

A

Delayed sensation of food sticking in chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Typical etiology of dysphagia that involves both solids and liquids?

A

Neuromuscular disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Typical etiology of dysphagia that involves solids?

A

Mechanical obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

2 best initial tests for patient with suspected Mechanical obstruction causing dysphagia?

A

Nasopharyngeal laryngoscopy, Barium swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Typical location of esophageal adenocarcinoma?

A

Mid-distal esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Typical location of esophageal squamous cell carcinoma?

A

Upper esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Strongest risk factor for development of esophageal adenocarcinoma?

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Strongest risk factor for development of esophageal squamous cell carcinoma?

A

Smoking, ETOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Pathology of Barrett’s esophagus?

A

Metaplastic columnar epithelium replacing normal stratified squamous epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Risk of Barrett’s esophagus?

A

Development into esophageal adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Gross appearance of Barrett’s esophagus?

A

Columnar epithelium that appears as red velvet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

EGD shows intestinal metaplasia (Barrett’s) without dysplasia – best management?

A

Repeat EGD in 3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

EGD shows intestinal metaplasia (Barrett’s) with low-grade dysplasia – best management?

A

Repeat EGD in 0.5-1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

EGD shows intestinal metaplasia (Barrett’s) with high-grade dysplasia – best management?

A

Endoscopic eradication therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Patient with HX of ulcerative colitis presents with diarrhea, abdominal pain; Vitals show fever, tachycardia, abdominal tympany to percussion – diagnosis?

A

Toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

DOC for management for toxic megacolon?

A

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

MOA of Glucocorticoids in management for toxic megacolon?

A

Decrease severity of underlying inflammatory bowel disease (IBD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Which patients with toxic megacolon should NOT receive Glucocorticoids?

A

Patients with toxic megacolon secondary to C. diff infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Which medications should be held in the setting of toxic megacolon?

A

Meds that decrease peristalsis … opioids, anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Non-pharmacologic management for toxic megacolon?

A

NG tube placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

22 yo male presents with R shoulder pain, dry cough; Reports open laparotomy 2 weeks ago for appendectomy; Exam shows fever, abdominal TTP; Labs show leukocytosis - diagnosis?

A

Subphrenic abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

2 hallmark aspects of clinical presentation for Subphrenic abscess?

A

Cough, R shoulder pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Diagnostic test for Subphrenic abscess?

A

Abdominal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

65 yo male presents with severe upper abdominal pain; Reports HX of GERD; PE shows extreme TTP of abdomen, but exam is limited by patient discomfort – diagnosis?

A

Peritonitis … caused by ruptured peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Best management of ruptured peptic ulcer?

A

Emergency surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Additional treatments for ruptured peptic ulcer, before patient goes to OR?

A

IV fluids, IV ABX, IV PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

IV ABX in setting of ruptured peptic ulcer should cover …

A

Gram (-) bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Most common cause of small bowel obstruction in patients with HX of abdominal surgery?

A

Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

65 yo female presents with epigastric pain, worse after eating, radiating to back; States that she has no desire to eat, lost 20 lbs; HX of T2DM, HTN, smoking, HLD, CABG; CT abdomen demonstrates diffuse aortic atherosclerosis – diagnosis?

A

Acute mesenteric ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What accounts for severe abdominal pain after eating in setting of Acute mesenteric ischemia?

A

Increased O2 demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

3 diagnostic tests for Acute mesenteric ischemia?

A

CT angiogram, MR angiogram, US duplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Gold-standard test for diagnosis of Acute mesenteric ischemia?

A

Angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

33 yo female presents with elevated alkaline phosphatase levels – which additional lab value suggests liver abnormality vs. bone abnormality?

A

Elevated g glutamyl transpeptidase (GGT = liver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Initial management of symptomatic hepatic sarcoidosis?

A

Systemic glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

CXR finding seen in sarcoidosis?

A

Bilateral hilar adenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

48 yo male presents with AMS; Reports HX of ETOH cirrhosis; PE shows asterixis; Labs show elevated ammonia – diagnosis?

A

Hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Circumstance that may increase patient’s likelihood of developing hepatic encephalopathy?

A

Volume loss (hypovolemia) … due to use of furosemide for treatment of volume overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

In addition to hypovolemia, what are 2 other changes that can precipitate hepatic encephalopathy in a cirrhotic patient?

A

Hypokalemia, Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

1st step in treatment of hepatic encephalopathy that was likely precipitated by hypovolemia?

A

Electrolyte + fluid repletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

3 drugs in Analgesic class that may cause pancreatitis?

A

Acetaminophen, NSAIDs, Mesalamine, Sulfasalazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

4 drugs in ABX class that may cause pancreatitis?

A

TMP-SMX, Metronidazole, Tetracyclines, Isoniazid

149
Q

2 drugs in Antiepileptic class that may cause pancreatitis?

A

Valproate, Carbamazepine

150
Q

3 drugs in Anti-HTN class that may cause pancreatitis?

A

HCTZ, Chlorthalidone, Furosemide

151
Q

2 drugs in Anti-viral class that may cause pancreatitis?

A

Lamivudine, Didanosine

152
Q

1 drug in Anti-inflammatory class that may cause pancreatitis?

A

Azathioprine

153
Q

What is the best test for confirming diagnosis of acute pancreatitis in patient with high clinical suspicion?

A

Lab analysis … better than CT abdomen with contrast!

154
Q

Limitation of CT abdomen in diagnosis of acute pancreatitis?

A

CT has low SN during first 72 hours of presentation

155
Q

Diagnostic lab result for acute pancreatitis?

A

Serum lipase + amylase > 3x ULL

156
Q

When should CT abdomen be used in diagnosis of pancreatitis?

A

CT abdomen should be reserved for cases of diagnostic uncertainty (non-confirmatory lipase/amylase values)

157
Q

2 most common causes of acute pancreatitis?

A

Gallstones, ETOH

158
Q

If patient with acute pancreatitis has no evidence of gallstones or ETOH use – what should next step of workup be?

A

Lipid panel to evaluate triglyceride level

159
Q

Level of triglycerides typically associated with acute pancreatitis?

A

TG > 1,000

160
Q

Clinical presentation of infected pancreatic necrosis?

A

Patient with acute pancreatitis is treated with supportive care … persistent abdominal pain condition deteriorates (fever, leukocytosis, hypotension)

161
Q

Best management of infected pancreatic necrosis?

A

IV ABX

162
Q

Most common pathogen responsible for infected pancreatic necrosis?

A

Gram (-) bacteria

163
Q

ABX of choice for infected pancreatic necrosis?

A

Meropenem; Fluoroquinolone + metronidazole

164
Q

Diagnostic test for infected pancreatic necrosis?

A

CT abdomen

165
Q

CT scan result that suggests infected pancreatic necrosis?

A

Gas within pancreatic necrosis

166
Q

Clinical presentation of Spontaneous Bacterial Peritonitis (SBP)?

A

Fever, Abdominal pain, AMS

167
Q

Diagnostic test for Spontaneous Bacterial Peritonitis (SBP)?

A

Ascitic fluid showing > 250 PMNs

168
Q

Best management of Spontaneous Bacterial Peritonitis (SBP)?

A

Empiric ABX

169
Q

Empiric ABX of choice for Spontaneous Bacterial Peritonitis (SBP)?

A

3rd generation cephalosporins

170
Q

ABX of choice for SBP prophylaxis?

A

Fluoroquinolones

171
Q

Additional aspect of management for patient with Spontaneous Bacterial Peritonitis (SBP) … in addition to IV ABX?

A

IV albumin

172
Q

What is the most commonly used calculation to predict mortality in patient with liver disease?

A

MELD score

173
Q

4 aspects of MELD score used to predict mortality in patient with liver disease?

A

Bilirubin, INR, creatinine, Na+

174
Q

45 yo male presents to ED 8 weeks after pancreatitis; Reports persistent abdominal pain; Labs show slightly elevated serum lipase - diagnosis?

A

Pancreatic pseudocyst

175
Q

Best management for asymptomatic Pancreatic pseudocyst?

A

Supportive

176
Q

Best management for symptomatic Pancreatic pseudocyst?

A

Surgical + endoscopic drainage

177
Q

Which structure separates the upper and lower GI tract?

A

Ligament of Trietz

178
Q

Bright red blood per rectum is nearly always due to ..

A

Lower GI bleed

179
Q

Hematemesis and melanoma are most commonly caused by ..

A

Upper GI bleed

180
Q

BUN:creatinine ratio of ___ is suggestive of upper GI bleed

A

> 20

181
Q

NG lavage with aspiration of bile and absence of blood increases likelihood of …

A

Lower GI bleed

182
Q

Best initial step of work up for suspected lower GI bleed?

A

Colonoscopy

183
Q

If no bleeding source is found during colonoscopy for suspected lower GI bleed what is next best step of work up?

A

EGD

184
Q

Best first step of work up for suspected upper GI bleed?

A

EGD

185
Q

Definition of chronic diarrhea?

A

Lasting 4+ weeks

186
Q

First step of workup for chronic diarrhea?

A

Comprehensive HX

187
Q

Next step of workup for chronic diarrhea?

A

Stool analysis (pH, microscopy, WBCs, parasites, fat content)

188
Q

In additional to chronic diarrhea, what is another aspect of clinical presentation commonly seen in Celiac disease?

A

Microcytic anemia

189
Q

Celiac disease causes a type of ___ diarrhea

A

Osmotic

190
Q

Histology associated with Celiac disease?

A

Villous atrophy, infiltration of lymphocytes

191
Q

What kind of anemia is associated with Small Intestinal Bacterial Growth (SIBO)?

A

B12 deficiency … macrocytic anemia

192
Q

In addition to dietary modification, what are other steps of treatment for Celiac disease?

A

ADEK, iron, Ca2+, Folate supplementation … DEXA scan for Vitamin D deficiency

193
Q

Which vaccine should be administered to patients with Celiac disease?

A

Pneumococcal vaccine … due to hyposplenism

194
Q

Alternate name for Boerhaave Syndrome?

A

Esophageal perforation

195
Q

Diagnostic test for Boerhaave Syndrome?

A

Esophagraphy, CT scan with water-soluble contrast

196
Q

Hallmark PE finding for Boerhaave Syndrome?

A

Crepitus

197
Q

Example of water-soluble contrast used in CT scan used to diagnose Boerhaave Syndrome?

A

Diatrizoate

198
Q

Best management of Boerhaave Syndrome?

A

Emergency surgical consult

199
Q

Clinical presentation of Mallory Weiss tear?

A

Hematemesis

200
Q

Diagnostic test for Mallory Weiss tear?

A

EGD

201
Q

Best management of Mallory Weiss tear?

A

Most heal spontaneously; Acid suppression

202
Q

CXR findings associated with Boerhaave Syndrome?

A

L-sided pleural effusion, Pneumomediastinum

203
Q

Complication of Boerhaave Syndrome?

A

Acute mediastinitis

204
Q

Clinical presentation of Boerhaave Syndrome complicated by Acute mediastinitis?

A

Fever, retrosternal CP

205
Q

Most common cause of recurrent symptoms in patient with Celiac disease?

A

Continued gluten intake

206
Q

3 risk factors for development of rectal prolapse?

A

Constipation, BPH, Pelvic surgery

207
Q

Clinical presentation of rectal prolapse?

A

Rectal bleeding, Protruding rectal mass

208
Q

Appearance of protruding rectal mass in rectal prolapse?

A

Concentric rings of rectal mucosa

209
Q

Best management of partial thickness rectal prolapse?

A

Medical management

210
Q

Best management of full thickness rectal prolapse?

A

Urgent surgical intervention

211
Q

Complication of untreated full thickness rectal prolapse?

A

Strangulation, gangrene of rectal mucosa

212
Q

31 yo male presents with RUQ pain; Labs show elevated bilirubin, very elevated ALT/AST levels – diagnosis?

A

Acute hepatitis

213
Q

When can anti-HCV Ig be detected?

A

2-6 months after Hep C exposure

214
Q

When can HCV RNA be detected?

A

Days after Hep C exposure

215
Q

Which patients are candidates for delayed cholecystectomy in gallstone pancreatitis?

A

Severe gallstone pancreatitis with organ failure (hypotension not responsive to fluid resuscitation)

216
Q

Mainstay of treatment for Hepatitis C infection?

A

Direct-acting anti-virals

217
Q

Additional management of Hepatitis C infection?

A

Prevent Hep A + Hep B infection (can precipitate liver failure) … vaccinate against Hep A + Hep B

218
Q

Most common complication of diverticulitis?

A

Colonic abscess

219
Q

Clinical presentation of diverticulitis complicated by Colonic abscess?

A

Diverticulitis that does not improve after 2-3 days of ABX treatment

220
Q

First step of workup for a patient with suspected colonic abscess as complication of diverticulitis?

A

Repeat CT

221
Q

2 aspects of diagnosis of C. diff infection, requiring ABX treatment?

A

(+) stool antigen testing; watery diarrhea (3+ stools in 24 hours)

222
Q

2 risk factors for development of C. diff infection?

A

ABX use; PPI use (gastric acid suppression)

223
Q

Classic manometry findings in patient with diffuse esophageal spasm?

A

Multiple simultaneous contractions

224
Q

3 DOCs for patients with diffuse esophageal spasm?

A

CCBs, nitrates, TCAs

225
Q

Most common etiology of fecal impaction?

A

Constipation, reduction in anal sphincter tone

226
Q

Best management of fecal impaction?

A

Manual disimpaction, followed by an enema

227
Q

31 yo male presents for epigastric fullness, occasional nausea; Workup is otherwise negative - diagnosis?

A

Dyspepsia

228
Q

What is best management of dyspepsia without alarm symptoms in patients < 60 yo?

A

H. pylori testing

229
Q

What is best management of dyspepsia in patients > 60 yo, or with alarm symptoms?

A

EGD

230
Q

63 yo male presents with SOB, fatigue; PE shows mucosal pallor; Stool testing for occult blood is (+); Labs show Hgb 8.6, MCV 70; Colonoscopy reveals several small, flat cherry red lesions in R colon - diagnosis?

A

Angiodysplasia

231
Q

Angiodysplasia is most strongly associated with which 3 other condition?

A

ESRD, Von Willebrand Disease, Aortic stenosis

232
Q

53 yo male presents for recurrent biliary colic, nausea; PE reveals mild TTP with guarding, diminished bowel sounds; Labs show WBC 16; T100.4; Abd XR shows generalized distention of small and large intestines, intraperitoneal free air - diagnosis?

A

Bowel injury

233
Q

What is next best step in management for suspected bowel injury?

A

Abdominal CT with oral contrast

234
Q

Acute management of hypertriglyceridema-associated pancreatitis includes …

A

Insulin, or plasmapheresis for rapid lowering of serum TG levels

235
Q

Long term management of hypertriglyceridema-associated pancreatitis, to prevent recurrence?

A

Fenofibrate, gemfibrozil

236
Q

40 yo male presents with (+) Anti-HBc levels in routine labs; What is next step in management?

A

Measure IgM anti-HBc, liver enzyme levels

237
Q

What defines the “window period” in Hepatitis B infection?

A

Fall in HBsAg, before rise in anti-HBc

238
Q

What is typically the only diagnostic marker found in acute HBV infection during “window period”?

A

IgM anti-HBc

239
Q

2 yo female presents with bloody stool; Afebrile, VSS; Technicium-99 scan shows increased uptake in RLQ - diagnosis?

A

Meckel’s diverticulum

240
Q

Pathogenesis of Meckel’s diverticulum?

A

Persistent vitelline duct

241
Q

Alternate name for vitelline duct?

A

Omphalomesenteric duct

242
Q

Typically location of Meckel’s diverticulum?

A

Within 2 feet of ileocecal valve

243
Q

Clinical presentation of Meckel’s diverticulum?

A

Painless GI bleed

244
Q

Etiology of Meckel’s diverticulum?

A

Ectopic gastric tissue

245
Q

Best management of symptomatic Meckel’s diverticulum?

A

Surgical resection

246
Q

Clinical presentation of intussusception?

A

Significant abdominal pain

247
Q

Treatment consideration for clozapine?

A

Routine labwork to monitor ANC

248
Q

What is the preferred initial therapy for insomnia?

A

CBT

249
Q

DOC for decreasing cravings in patients with ETOH?

A

Naltrexone

250
Q

Indication for buproprion in substance abuse?

A

Used to treat depression, smoking cessation … (not effective in ETOH use disorder)

251
Q

Route of transmission for C. Diff?

A

Fecal-oral

252
Q

Etiology of C. Diff infection?

A

Ingested spores germinate the colon to become fully-functional bacilli

253
Q

When does spitting up typically resolve in children?

A

12-18 months

254
Q

67 yo female presents with upper abdominal pain; Reports episgastric fullness, nausea that occurs after eating; No GERD, colonoscopy 3 years ago was NML - what is next best step of workup?

A

EGD

255
Q

67 yo female presents with upper abdominal pain; Reports episgastric fullness, nausea that occurs after eating; No GERD, colonoscopy 3 years ago was NML - diagnosis?

A

Dyspepsia

256
Q

What is best management of new-onset dyspepsia in adults > 60?

A

EGD

257
Q

RBC transfusion threshold for patients with stable GI bleed?

A

HGB < 7

258
Q

Which patients should qualify for transfusion threshold < 8?

A

Patients with CAD

259
Q

First line treatment for viral gastroenteritis?

A

Fluid repletion

260
Q

43 yo male presents with diarrhea, cramping abdominal pain, NV, dizziness, sweating, SOB; Partial gastrectomy performed 1 month ago - diagnosis?

A

Dumping syndrome

261
Q

What is best intervention for Dumping syndrome?

A

High-protein, Low-CHO diet

262
Q

Best treatment regimen for H. pylori infection?

A

PPI, amoxicillin, clarithromycin

263
Q

Clinical presentation of radiation proctitis?

A

Bloody diarrhea, mucus drainage, tenesmus

264
Q

62 yo male presents with periumbilical pain, sudden-onset; 2 weeks ago, was diagnosed with STEMI, requiring PCI; Labs show leukocytosis, AGMA - diagnosis?

A

Acute mesenteric ischemia

265
Q

Best test to establish diagnosis of Acute mesenteric ischemia?

A

Abdominal CTA

266
Q

55 yo male presents for blood-tinged vomit, beginning after he consumed a large amount of ETOH last night; Hgb 9.8, PL 90, K 3.2, AST 112, ALT 49; EGD shows erythematous ulcerations, varices in the gastric fundus - what is most likely cause of these varices?

A

Splenic vein thrombosis

267
Q

Most patients with Splenic vein thrombosis have history of …

A

Pancreatic CA, pancreatitis

268
Q

What is the hallmark of clinical presentation for Splenic vein thrombosis?

A

Isolated gastric varices

269
Q

62 yo female presents with R groin heaviness and discomfort; Pain is worse with cough and standing; PE shows R femoral hernia - what is best management?

A

Refer for surgical repair

270
Q

62 yo male presents for burning pain in epigastric region, occurring 30-40 min after meals; No V, melena, hematemesis; Smoking HX for 20 yrs; Upper EGD is used to evaluate ___ in this patient

A

Cellular metaplastic changes

271
Q

2+ risk factors that warrant EGD in patients for evaluation of Barrett’s esophagus?

A

Age > 50, Male, Smoking (former or current), Caucasian, Hiatal hernia, OB, 1st degree relative with Barrett’s

272
Q

36 yo female presents for hip pain, radiating into lower back; HX of BL OA, morbid OB, OSA; BMI is 41 - what is next best step of management?

A

Referral for bariatric surgery

273
Q

3 indications for bariatric surgery?

A

BMI > 40; BMI > 35 with T2DM/HTN/OSA; BMI > 30 with resistant T2DM

274
Q

When should all patients undergo screening colonoscopy?

A

40 yo

275
Q

If patient has a NML initial screening colonoscopy or 1st-degree relative with colorectal cancer diagnosed at age >60, how often should patient undergo screening colonoscopy?

A

Every 10 years

276
Q

If patient has an ABNML initial screening colonoscopy or 1st-degree relative with colorectal cancer diagnosed at age <60, how often should patient undergo screening colonoscopy?

A

Every 5 years

277
Q

34 yo male presents to ICU 3 days after MVC with head trauma and blunt chest trauma; Patient is noted to have heme (+) liquid stool - what intervention could have prevented patient’s current condition?

A

PPI administration

278
Q

62 yo male presents for follow-up after recent hospitalization; Treated for bacterial prostatitis with ciprofloxacin; Now has 4-5 watery bowel movements per day, stool testing is (+) for C. Diff – how should this patient’s ABX regimen be changed?

A

Switch ciprofloxacin to TMP-SMX

279
Q

4 ABX with low risk for C. Diff?

A

TMP-SMX, Macrolides, Tetracycline, Aminoglycosides

280
Q

3 ABX with high risk for C. Diff?

A

Fluoroquinolones, Cephalosporins, Clindamycin

281
Q

In addition to oral vancomycin, what is another appropriate treatment for patients with C. Diff?

A

Oral fidaxomicin

282
Q

Etiology of recurrent C. Diff infection?

A

Re-infection by same strain of C. Diff, likely due to persistent spores

283
Q

Clinical presentation of acute cholangitis?

A

Charcot triad – fever, jaundice, RUQ pain

284
Q

Additional clinical presentation for acute cholangitis?

A

Fever, jaundice, RUQ pain + hypotension, AMS (Raynaud pentad)

285
Q

2 lab results seen in setting of acute cholangitis?

A

Elevated direct bilirubin, Elevated alkaline phosphatase

286
Q

Appearance of acute cholangitis on abdominal imaging?

A

Biliary dilation

287
Q

Best management of acute cholangitis?

A

ERCP

288
Q

Best diagnostic test for acute mesenteric ischemia?

A

CT angiogram

289
Q

Etiology of acute colonic ischemia?

A

Transient reduction in blood flow to colon due to hypovolemic state

290
Q

Which portions of the bowel are most affected by acute colonic ischemia?

A

Watershed areas (splenic flexure, rectosigmoid junction)

291
Q

Clinical presentation for acute colonic ischemia?

A

Bloody diarrhea

292
Q

Appearance of acute colonic ischemia seen in abdominal XR?

A

Colonic distension, pneumatosis

293
Q

What are the 2 best lab tests for evaluation of autoimmune hepatitis?

A

ANA, Anti-smooth muscle Ig

294
Q

Change to AST and ALT in autoimmune hepatitis?

A

Normal AST and ALT

295
Q

25 yo female with FHX of celiac disease presents for bone pain over both shins; Reports weight loss; Personal HX of vitiligo; Labs show absent Vitamin D, decreased Ca2+, increased alkaline phosphatase, decreased phosphorus, microcytic anemia – diagnosis?

A

Celiac disease

296
Q

What is the best initial test of choice for a male > 50 yo with iron deficiency anemia and (+) fecal occult blood test?

A

Colonoscopy

297
Q

Next step of workup for male > 50 yo with iron deficiency anemia, (+) fecal occult blood test, and NML colonoscopy?

A

EGD

298
Q

60 yo male presents for wellness visit; Had a normal screening colonoscopy 10 years ago; Really didn’t like the colonoscopy prep, so recently has a sigmoidoscopy, which showed 2 villous adenomatous polyps – what is next best step of treatment?

A

Colonoscopy ASAP

299
Q

Best management for any patient who has a suspicious finding on flexible sigmoidoscopy?

A

Urgent colonoscopy

300
Q

How often should flexible sigmoidoscopy be repeated for patients with normal findings?

A

Every 5 years

301
Q

45 yo male with extensive Celiac history presents with mid-abdominal pain; PE shows black stools, abdominal distension; Labs show (+) occult blood – diagnosis?

A

Enteropathy-associated T-cell lymphoma (EATL)

302
Q

Which portion of the bowel is typically affected by Enteropathy-associated T-cell lymphoma (EATL)?

A

Proximal jejunum

303
Q

3 complications of Enteropathy-associated T-cell lymphoma (EATL)?

A

Bowel perforation, SBO, GI bleeding

304
Q

Major risk factor for Enteropathy-associated T-cell lymphoma (EATL)?

A

Untreated celiac disease

305
Q

Clinical presentation of Enteropathy-associated T-cell lymphoma (EATL)?

A

B symptoms, Abdominal pain, GI bleeding

306
Q

39 yo male presents with burning epigastric pain, worse after meals during past 3 months; Patient has tried ranitidine for past 2 weeks, minimal relief – what is next best step?

A

H. pylori stool or breath test

307
Q

Best initial treatment of GERD?

A

Lifestyle modification, 8 weeks of PPI therapy

308
Q

3 common aspects of clinical presentation for GERD?

A

Hoarseness, throat irritation, chest pain

309
Q

Symptoms of GERD are typically exacerbated by …

A

ETOH

310
Q

54 yo male with HX of ETOH abuse presents with cough, SOB; Lung exam shows decreased breath sounds on R, dullness to percussion; Abdomen is distended with (+) fluid wave; Labs suggest transudative pleural effusion – diagnosis?

A

Hepatic hydrothorax

311
Q

Etiology of Hepatic hydrothorax?

A

Effusion of peritoneal ascites through the diaphragm

312
Q

On which side do Hepatic hydrothorax typically occur?

A

R … R hemidiaphragm is thinner, with more porous defects

313
Q

What is best management for a Hepatic hydrothorax (transudative pleural effusion)?

A

Furosemide, spironolactone, dietary Na restriction

314
Q

3 yo male presents for constipation; Family has adjusted diet to include more fiber/water; PE shows had stool retention, with small anal fissure present; What is best long-term therapy to benefit patient?

A

Oral osmotic laxative therapy

315
Q

3 complications of pediatric constipation?

A

Anal fissure, UTI, hemorrhoids

316
Q

Example of Oral osmotic laxative therapy used for pediatric constipation?

A

Lactulose

317
Q

52 yo female presents with SOB, massive ascites, 25-lb weight loss; HX of COPD, CAD, Hepatitis C; Extensive smoking and ETOH HX, family HX of breast CA; Labs show AST 78, ALT 55, Total protein 5.6, serum albumin 2.8; Ascitic fluid shows WBC 150, albumin 2.2, Amylase 48, Glucose 32 – what is etiology of this patient’s ascites?

A

Ovarian cancer

318
Q

SAAG level that suggests portal HTN?

A

SAAG > 1.1

319
Q

3 diagnosis with SAAG > 1.1?

A

Portal HTN, CHF, Alcoholic hepatitis

320
Q

SAAG level that suggests nonportal HTN?

A

SAAG < 1.1

321
Q

5 conditions associated with SAAG < 1.1?

A

Pancreatitis, peritoneal carcinoma, peritoneal TB, nephrotic syndrome, serositis

322
Q

54 yo female presents with RUQ pain; PE shows fever, tachycardia, RUQ tenderness with guarding; Labs shows leukocytosis; US shows several small gallstones without CBD dilation or gallbladder wall edema; Murphy’s sign is negative – diagnosis?

A

Acute cholecystitis

323
Q

3 aspects of Clinical presentation for Acute cholecystitis?

A

Fever, RUQ pain, Leukocystosis

324
Q

54 yo female presents with RUQ pain; PE shows fever, tachycardia, RUQ tenderness with guarding; Labs shows leukocytosis; US shows several small gallstones without CBD dilation or gallbladder wall edema; Murphy’s sign is negative – Best management?

A

HIDA scan … performed when RUQ US is inconclusive, but still high clinical suspicion for acute cholecystitis

325
Q

46 yo male with HX of ETOH use presents with AMS; During workup, he experiences large-volume hematemesis with BRB; Vitals are now BP 100/50 and HR 110 – what is next best step of management?

A

Endotracheal intubation

326
Q

46 yo male with HX of ETOH use presents with AMS; During workup, he experiences large-volume hematemesis with BRB; Vitals are now BP 100/50 and HR 110; After intubation, patient undergoes upper GI endoscopy – what additional treatment is also indicated now?

A

IV octreotide

327
Q

MOA of IV octreotide in treatment of acute variceal bleeding?

A

Decreases elevated pressure through varices by decreasing splanchnic flow

328
Q

46 yo male with HX of ETOH use presents with AMS; During workup, he experiences large-volume hematemesis with BRB; Vitals are now BP 100/50 and HR 110; After intubation, patient undergoes upper GI endoscopy – at time of discharge, which medication should patient receive to decrease future risk of recurrent variceal bleeding?

A

Non-selective b blocker

329
Q

Most common etiology of Porcelain gallbladder?

A

Chronic cholelithiasis

330
Q

Best management of Porcelain gallbladder?

A

Prophylactic cholecystectomy

331
Q

Etiology of physiologic gynecomastia in obese men?

A

Imbalance of testosterone vs. estrogen … Decreased testosterone production, and increased conversion of testosterone to estrogen by aromatase in adipose tissue

332
Q

62 yo male presents with nausea, vomiting, crampy lower abdominal pain + distention; Last BM was 4 days ago; PSHX of appendectomy, surgical repair of perforated ulcer; PE shows abdominal distension, increased bowel sounds, tympany; Initial labs show many electrolyte abnormalities; Imaging in ED shows multiple air-fluid levels in small intestine, consistent with SBO; Some air is seen in the colon – diagnosis?

A

Partial SBO … (due to some air in colon)

333
Q

Best management of Partial SBO?

A

Observation and supportive care

334
Q

What is initial aspect of workup for patients with delayed gastric emptying?

A

Exclude mechanical obstruction … via EGD, or CT/MRI

335
Q

After mechanical obstruction has been excluded in a patient with delayed gastric emptying – what is next step of workup?

A

Confirm impaired motility with gastric emptying study

336
Q

Study used to confirm the diagnosis of gastroparesis?

A

Scintigraphic gastric emptying study

337
Q

In a patient with confirmed gastroparesis (due to DM) – what is best initial therapy?

A

Advise small frequent meals … in addition to glycemic control

338
Q

Recommended meal content in patients with gastroparesis (due to DM)?

A

Low fat, only soluble fiber

339
Q

Firstline DOC for gastroparesis (due to DM)?

A

Metoclopramide

340
Q

2 additional drug options for gastroparesis (due to DM)?

A

Domperidone, erythromycin

341
Q

51 yo male presents with abdominal cramping, nausea, bloody diarrhea; Diarrhea described as large-volume red/maroon liquid; Reports sprained ankle 2 weeks ago, treating with ibuprofen; HX of diverticulosis; Vitals show HR 112, BP 90/60; Exam shows diaphoresis; Rectal exam (+) for maroon stool; HBG 12 – diagnosis?

A

Hematochezia

342
Q

Patients with hematochezia and HD instability should be assumed to have …

A

Upper GI source of bleeding

343
Q

Best management of suspected upper GI bleed?

A

Volume resuscitation, then EGD

344
Q

What is most appropriate recommendation for pregnancy after bariatric surgery?

A

Pregnancy should be delayed for at least 1 year after bariatric surgery … to stabilize nutritional status

345
Q

Indication for bariatric surgery?

A

BMI 35 + 1 comorbidity (DM, HTN, OSA) … OR … BMI 40

346
Q

What are 2 obstetric benefits of bariatric surgery in females of child-bearing age?

A

Decreased risk of preeclampsia, gestational DM

347
Q

55 yo male presents after 1 episode of hematemesis; HX of cirrhosis, ascites; EGD shows esophageal varices – what is most likely complication that this patient will develop in hospital?

A

SBP

348
Q

Best prophylactic ABX for prevention of SBP in patients with recent variceal bleeding?

A

Ceftriaxone x7 days

349
Q

Which ABX should be started in patients with SBP who cannot complete 7-day trial of ceftriaxone?

A

Transition to TMP-SMX or fluoroquinolone

350
Q

53 yo male presents for intermittent abdominal pain, steatorrhea; Long history of alcohol abuse - which of the following tests is most likely to provide a diagnosis?

A

MRCP

351
Q

Diagnostic alternative to MRCP in the diagnosis of chronic pancreatitis?

A

Abdominal CT

352
Q

What is the hallmark finding on MRCP and abdominal CT for chronic pancreatitis?

A

Pancreatic calcifications

353
Q

Best management of chronic pancreatitis?

A

Lifestyle, dietary modification

354
Q

What is the best approach to pain management in the setting of chronic pancreatitis?

A

Reassess in 1-2 months for pain improvement

355
Q

42 yo female with chronic ETOH use presents with severe mid abdominal pain; Labs show MCV 102, Na 133, K 3.1, Cl 94, BUN 24, Lipase 652, TC 220; Which lab value is strongest indication of poor prognosis?

A

BUN > 20

356
Q

5 lab findings that indicate poor prognosis in setting of acute pancreatitis?

A

BUN, hematocrit, CRP, advanced age, obesity

357
Q

33 yo male presents for solid-food dysphagia; Reports previous episode that resolved after ‘following a diet’; Reports periodic CP behind sternum; Currently smokes 1PPD - diagnosis?

A

Esophageal stricture

358
Q

Esophageal stricture is a complication of …

A

GERD

359
Q

Etiology of Esophageal stricture as a complication of GERD?

A

Results from the healing process of ulcerative esophagitis

360
Q

What causes rectal bleeding in the setting of diverticulosis?

A

Eroded small colonic artery

361
Q

Etiology of diverticulosis?

A

Outpouching of colon wall at points of weakness where vasa recta penetrate the circular muscle of colon

362
Q

What is the appropriate duration of PPI trial for treatment of GERD?

A

8 weeks + lifestyle modifications

363
Q

Recommendation for patient whose brother was recently diagnosed with colon cancer at age 52?

A

Begin colon cancer screenings at 10 years prior to diagnosis, or at age 40 (whichever comes first)

364
Q

50-hour old male presents with bilious emesis; has not yet passed meconium, birth by C-section; PE shows distended abdomen, no stool is palpable in rectal vault; abdominal x-ray shows multiple dilated loops of large bowel, no air in rectum; contrast enema shows normal caliber rectosigmoid colon, dilated descending colon – diagnosis?

A

Hirschsprung disease

365
Q

What is the gold standard diagnostic test for Hirschsprung disease?

A

Rectal suction biopsy

366
Q

Appearance of meconium ileus on contrast enema?

A

Microcolon

367
Q

Appearance of Hirschsprung disease on contrast enema?

A

Dilated descending colon, narrow sigmoid colon

368
Q

30-year-old male presents with nausea, vomiting, diarrhea, abdominal cramping, fever; symptoms began 12 hours ago after consuming smoothie that contained 3 raw eggs; stool culture positive for Salmonella - what is best management?

A

Supportive care

369
Q

32-year-old Hispanic man presents after an episode of choking on fishbone; patient drank 4 glasses of water, still reports difficulty swallowing saliva, can still feel fishbone lodged in posterior throat – next step of work-up?

A

Perform urgent endoscopy to remove fishbone

UWorld (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions