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[2a] A ⼀ Step 2 OD USLME > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

When should ALT/AST be obtained in regards to Statin therapy?-2

A

BEFORE starting statins

and then PRN

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2
Q

Gilbert’s Syndrome Etx

A

Dysfunctional conjugation of [unconjugated bilirubin] to [Conjugated bilirubin] by UGT –> [⬆︎UnConjugated Bilirubin] worst w/[stress/virus/illness]

Crigler Najjar = WORST VERSION of this in which UGT is ABSENT!

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3
Q

Most Liver Dz has ALT > AST

What conditions involve [AST > ALT - 2:1 ratio]? -3

A

only a FEW…

  1. Fibrosis ADVANCED
  2. EtOH Hepatitis (Make a ToaSt to drinks)
  3. Wilson’s Dz
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4
Q

w/u for Hepatitis -6

You’ve already gotten back Aminotransferases

A

AVIRAL

  1. [ALT/AST REPEAT LABS FIRST!!]
  2. [Viruses (Hepatitis Viruses and HIV)]
  3. Iron studies = hemochromatosis
  4. [RUQ US = Cirrhosis and biliary tree dz]
  5. [Albumin + PT/INR] = is liver making proteins
  6. [Lipid panel + HbA1C] = r/o NASH/NAFLD
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5
Q

Which bacteria are typically involved with Diverticulitis?-2

A

E.coli & Bacteroides Fragilis

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6
Q

Abx tx regimens for Diverticulitis-4

A

4 options

  1. [PO: Amox/Clav]
  2. [PO: Flagyl + Cipro]
  3. [PO: Flagyl + Bactrim]
  4. [IV: Flagyl + CefTriaxone]
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7
Q

Presentation for Autoimmune Hepatitis -3

A

“Tired w/ a Tan and Doesn’t Eat = Girls Best Dream!”

  1. Fatigue (most common)
  2. Jaundice
  3. Anorexia
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8
Q

What Labs support Autoimmune Hepatitis-3

A
  • Anti-LKM (Liver/Kidney/Muscle)
  • ANA
  • Antismooth muscle

Note: The only way to diagnose AH is Biopsy!!

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9
Q

What is a GI Cocktail consist of-3

A

the LAMe GI Cocktail waitress

  1. Antacid
  2. Lidocaine
  3. Muscarinic R Blocker
  4. GERD indication
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10
Q

Low platelets may indicate _____(4)

A
  1. Cirrhosis
  2. [DIC on Sepsis]
  3. [SLE Antiphospholipid Syndrome]
  4. Hemetologic abnormality (HUS, TTP, ITP)

Platelet range = 150 - 450 K

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11
Q

Mngmnt for UnComplicated Pancreatitis - 3

A

IVF

Pain Mngmt

NPO

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12
Q

Most common causes of Upper GI Bleed -4

A

PEEM

PUD > Esophageal Varices > Esophageal Erosion > Mallary-Weis tear

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13
Q

Most common causes of Lower GI Bleed -5

A

Diverticulosis > [Colitis (Ischemic>IBD>Radiation)]> [Hemorrhoids/Anal Fissure] > Colon CA > [s/p polypectomy]

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14
Q

⬜ is the most common cause of Upper GI Bleed.

________________

Name the risk factors for developing this-9

A

PUD

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15
Q

The 3 types of Shock are Cardiogenic, Hypovolemic and Distributive

Which 3 sub-types make up Distributive Shock

________________

what’s unique about this type of shock?

A

Distributive = SAS

Sepsis / Anaphylaxis / Spinal

________________

Distributive will have WARM extremities (others are cold)

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16
Q

What are causes of Biliary-related elevated ALP -3

A
  1. Cholestasis
  2. Liver infection (TB/CMV/MAC)
  3. Liver damage (CHF/EtOH cirrhosis)
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17
Q

You see a Jaundiced pt. What must his Total bilirubin at least be?

A

>2

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18
Q

[Dubin Johnson syndrome] and [Rotor Syndrome] etx

A

Inability to secrete Conjugated bile into Bile Duct

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19
Q

General Approach to Elevated ALP

A
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20
Q

[Primary Biliary Cirrhosis] etx

A
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21
Q

1st and 2nd symptom stages of [Primary Biliary Cirrhosis]

A
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22
Q

[Primary Biliary Cirrhosis] Dx

_________________

tx-2

A

Dx = [AntiMitochondrial Ab]

________________

Tx = [Ursodeoxycholic Acid] ➜ [Liver Transplant]

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23
Q

[Primary Sclerosing Cholangitis] etx

A
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24
Q

[Primary Sclerosing Cholangitis] dx

A

ERCP beading pattern

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25
MOD for [HFE mutation 1° Hemochromatosis]
HFE mutation --\> Liver & Enterocytes **falsely** detecting low iron --\> [1 and 2] --\> [Liver Cirrhosis & HCC] AND **BRONZED SKIN** 1. Liver DEC Hepcidin release ---\> [INC Ferroportin on Enterocytes basolaterally]--\>INC iron absorption 2. Enterocytes [INC Apical DMT1] --\> ALSO INC iron absorption *Presents after 40 yo*
26
FerriTin \> 1000 usually indicates ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What other lab values is found with this?
**HEMOCHROMATOSIS** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [95% Transferrin Saturation] *Presents after 40 yo*
27
Wilson's Dz Etx
28
Wilson's Dz Sx -4
29
Wilson's Dz Tx
30
What is the most common cause of Cirrhosis and how is it diagnosed?
NASH! ; Liver Biopsy ## Footnote *NASH RF: Obesity, DM, Hyperlipidemia*
31
Autoimmune hepatitis dx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx-2
Dx = Biopsy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. prednisone 2. azathioprine
32
Why is drinking alcohol in a pt with Hep C dangerous?
Hep C ⬆︎⬆︎⬆︎⬆︎ Liver damage from alcohol!!
33
How do you interpret positive Hep C serology?
Hep C Ab = exposure at some point Hep C **RNA titers = determines status** *(HIGH = chronically active vs negative = resolved)*
34
Tx for Hepatic Encephalopathy -2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What's their MOA -2
1. Lactulose (converts NH3 --\> NH**4+** in colon - and ⬆︎peristalsis --\> DIARRHEA) 2. Rifaximin abx (⬇︎NH3 producing colonic bacteria)
35
Vaccinations for pts with Chronic Hepatitis -4
1. Hep A *(acute viral hepatits can --\> Fulminant Liver failure!)* 2. Hep B *(acute viral hepatits can --\> Fulminant Liver failure!)* 3. Flu 4. Pneumococcal
36
Why is Octreotide given for **active** Esophageal Varices Rupture
it vasoconstricts splanchnics --\> ⬇︎pressure from splanchnics to the esophagus
37
Spontaneous Bacterial Peritonitis Etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ "*Ascites* **C**an **N**ever **T**otally **S**uck"
**Cirrhotic** **Immunosuppression** --\> Infection of ascitic fluid ---\> Hepatic Encephalpathy or [Type 1 Hepatorenal syndrome]! ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *These pts may NOT have peritoneal signs because it's blunted by ascitic fluid!* Fluid cx will show organisms with neutrophils\>250
38
Spontaneous Bacterial Peritonitis Sx-4
1. *Diffuse* Abd pain 2. paralytic iLeus 3. hepatic encephalopathy (evidenced by [Reitan trail connect the number test]) 4. fever *These pts may NOT have peritoneal signs because it's blunted by ascitic fluid!* Fluid cx will show organisms with neutrophils ≥250
39
What are the purposes of Peritoneal fluid analysis in pt with ascities? -2
1. Determine **Cause** 2. Determine presence of **Infection** ## Footnote *Causes = Cirrhosis \> [Ovarian CA=TB=nephrOtic syndrome=R HF]*
40
Other than Cirrhosis, what are other causes of ascites? -4
1. Ovarian CA 2. nephrOtic syndrome 3. TB 4. R HF These will have a SAAG \< 1.1
41
Spontaneous Bacterial Peritonitis Tx -2
Ciprofloxacin vs Norfloxacin
42
Indications for Liver Transplant -3
1. Type 1 Hepatorenal syndrome 2. Liver Failure (tx refractory/decompensating/fulminant) 3. [Cirrhosis 2/2 HCV with MELD \> 10 or from Portal HTN complication]
43
D-Lactic Acidosis is seen in pts with ⬜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Etx? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CP-2
Short bowel syndrome \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Unabsorbed Carbs are metabolized by intestinal bacterial --\> D-lactic acid which is absorbed --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Confusion + Ataxia during carb loading**
44
Wilson's Disease Dx Labs - 2
1. Low Ceruloplasmin ( \< 20 mg/dL) -*ceruloplasmin binds to ⬆︎ free flaoting copper* 2. ⬆︎Urinary Copper
45
What are the most common biomarkers for unhealthy EtOH usage? - 6
1. AST: ALT ratio ≥ 2:1 2. ⬆︎GGT 3. ⬆︎Carbohydrate-deficient Transferrin 4. ⬆︎FerriTin 5. Macrocytosis 6. Pancytopenia
46
If a pediatric pt with hypertrophic pyloric stenosis has electrolyte abnormalitites, do you immediately go to surgery or correct electrolytes/hydration first?
Electrolytes/Hydration FIRST! ## Footnote *Dx = US*
47
Dx for Celiac disease - 2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *wt loss+ iron deficiency anemia + dermatitis herpetiformis = CELIAC!*
Anti-**TED** (IgA or IgG) ➜ DUODENAL BX FOR CONFIRMATION \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (**T**issueTransGlutaminase/**E**ndomysial/**D**eaminatedGliadin) (IgA test may result in false negative if concurrent IgA deficiency is present!) *look for wt loss, iron deficiency anemia and dermatitis herpetiformis (elbows, knees, butt, back) in these pts!*
48
Why can't US be used to diagnose Primary Biliary Cholangitis?
PBC involves Anti-mitochondrial abs attacking **intra**hepatic biliary duct ONLY. US can only see EXTRAhepatic
49
Other than complications from cholestasis, what other complications are associated with Primary Biliary Cholangitis? - 3
1. HLD with Xanthelasma 2. Metabolic bone disease 3. Autoimmune thyroid disease
50
Although CXR in Boerhaave syndrome can show ⬜3 , what is the confirmation dx?-2
Boerhaave = violent vomiting --\> esophageal rupture 1. uL pleural effusion +/- PTX 2. pleural fluid high in amylase ( \> 2500) 3. widened mediastinum with emphysema Confirmation dx = CT or [contrast esophagography with Gastrografin]
51
Complications of GERD - 3
1. Barrett's esophagus 2. Erosive esophagitis 3. Esophageal peptic strictures (circumferential narrowing)
52
Causes of Esophageal pepetic strictures (circumferential esophageal narrowing --\> solid food dysphagia only) - 4
1. GERD 2. Radiation 3. Systemic slcerosis 4. Caustic ingestions
53
Characteristics for Carcinoid Syndrome - 10
**C**ardiac (Tricuspid Regurgitation) ## Footnote *Do not confuse with VIPoma which presents similarly but affects Pancreas while Carcinoid affects small intestine*
54
[T or F] Screening Ammonia levels should be ordered on pts with cirrhosis with or without encephalopathy
FALSE - only order Ammonia if hepatic encephalopathy is suspected
55
*Pt has cirrhosis with esophageal varices* What is the prophylactic mngmt for this pt? - 2
[**General B Blockers (nadalol) OR Variceal ligation**] --(if refractory)--\> [TIPS-Transjugular intrahepatic portosystemic shunt]
56
A pt has been diagnosed with Gastric ADC What's the next immediate step?
**TUMOR STAGING** via CT to determine px/tx ## Footnote *Note: HPylori eradication is only helpful for gastric MALT*
57
Tx for asymptomatic gallstones
**NOTHING** ## Footnote *Lap Chole is only indicated for sympatomatic gallstones!*
58
Tx for Complicated Gallstones ## Footnote *GS with concomitant cholecysitis, choleDocholithiasis, pancreatitis*
Lap Chole **sometime within 3 days**
59
Tx for ACTIVE variceal bleeding - 3
1. Octreotide (splanchnic vasoconstriction & ⬇︎glucagon --\>⬇︎portal blood flow) 2. Endoscopic Sclerotherapy 3. Intubation if airway compromised from vomiting
60
In Cirrhosis, what all does ⬆︎Estrogen cause? - 5
1. Gynecomastia 2. ⬇︎Body Hair 3. Palmar Erythema 4. Spider Angiomas 5. Testicular Atrophy
61
Describe Biliary Cyst \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx?
[Congenital or Acquired] Biliary tree Dilatations that may be [intra or extrahepatic], [single or multiple] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = Surgery
62
When do you typically see pancreatic pseuocyst
as a complication of acute or chronic pancreatitis
63
Esophageal Spasm cp - 3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx?
1. retrosternal chest pain **precipiated by emotional stress** and relieved with NTG 2. dysphagia **precipiated by emotional stress** and relieved with NTG 3. regurgitation **precipiated by emotional stress** and relieved with NTG \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx = Manometry showing multiple simultaneous contractions of the mid and lower esophagus
64
what is the most common Cancer of the liver
**Metastasis**(can be solitary) from another primary (i.e. COLON or pancreatic - since these send their venous blood directly to liver) ## Footnote 2nd = Hepatocellular carcinoma
65
Hepatic angiosarcoma etx
(Vinyl Chloride gas, arsenic, thorium) exposure --\> **RARE** liver neoplasm in older men
66
Focal nodular hyperplasia and Hepatic Adenoma are typically seen in \_\_\_\_\_. Which is typically asymptomatic?
young women ; FNH
67
What is long term relief for pts with PUD - 3
**CAP** the PUD **TRIPLE TX!** 1. **C**larithomycin 2. **A**moxicillin 3. **P**PI *Smoking and EtOH cessation can help but don't offer LONG TERM change*
68
Clinical manifestations of Cirrhosis - 13
69
What is the purpose of the D-xylose test
**In patients with steatorrhea**/**fatty stool**... It differentiates between 1. **Celiac disease** (D-xylose will be LOW in the urine because it can't be reasbsorbed in the small intestine because of villous atrophy) 2. **Pancreatic insufficiency** (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)
70
How are the results of the D-xylose test interpreted? ; How does Rifaximin play a role in this?
**In patients with steatorrhea**/**fatty stool**... It differentiates between 1. **Celiac disease** (D-xylose will be LOW in the urine because it can't be reasbsorbed in the small intestine because of villous atrophy) 2. **Pancreatic insufficiency** (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose) \*\*Small Intestine Bacterial Overgrowth can digest D-xylose before it has the chance to be reabsorbed --\> Falsely low D-xylose. Rifaxmin abx prevents this\*\*
71
Where do Mallory Weiss tears occur
longitudinal tears in the mucosa **near the Gastroesophageal junction**
72
Painless Jaundice DDx - 3
1. Pancreatic CA - obstructive 2. Biliary CA - obstructive 3. CholeDocholithiasis
73
When do you see GI bleeding from Gastritis - 2
1. ICU 2. Burns
74
Key signs of Laxative Abuse -3
1. **Nocturnal** watery diarrhea 2. Melanosis coli on cscope-image (dark brown discoloration of colon) 3. Metabolic ALKALOSIS (loss of K+ from laxative --\> ⬇︎Cl absorption --\>⬇︎Cl/HCO3 exchange --\> ⬆︎HCO3 in serum)
75
Describe colonic findings for Pseudomembranous colitis - 3
1. FRIABLE 2. Edematous 3. Erythematous
76
Toxic Megacolon cp - 3
1. Bloody Diarrhea 2. Systemic Toxicity (fever, tachycardia, hypotension) 3. Abd distension +/- peritonitis
77
Toxic Megacolon mngmt- 5
1. Abx 2. NPO 3. NG suction 4. +/- CTS if IBD associated 5. *SURGERY ONLY IF MEDICAL MNGMT FAILS*
78
Complications of Diverticulitis - 3
1. Colovesical fistula --\> pneumaturia, fecaluria, UTI sx 2. rupture 3. Abscess
79
Hepatic Adenoma is a benign \_\_\_type of tumor in young women, associated with ___ and \_\_\_ What are its complications?-2
epithelial ; OCP/Pregancy ; Rupture/MalignancyTransformation ## Footnote *this CAN cause biliary obstruction*
80
What is Mesenteric Angioplasty indicated for?
Chronic Mesenteric ischemia (evidenced by postprandial intestinal pain+ wt loss)
81
Chronic Mesenteric Ischemia cp - 3
1. unexplained chronic postprandial abd pain (**intestinal angina**) 2. Wt loss 3. Food Aversion ## Footnote *usually from atherosclerotic celiac or SMA*
82
Esophageal manometry showing hypercontractility inidcates what disease?
Eosinophilic esophagitis
83
Dx for Zenker's Diverticulum
Barium Contrast Esophagram ## Footnote *Dysphagia, Foul Breath, Regurgitation, Aspiration*
84
Postcholecystectomy syndrome etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx-2
s/p cholecystectomy, Biliary or Extra-Biliary causes --\> persistent abd pain or dyspepsia in pts \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx = Abd US --\> ERCP/MRCP
85
How do you confirm diagnosis for Esophageal Rupture?
Contrast Esophagram water soluble
86
Pt presents with narrowed "colon" How do you differentiate between Cystic Fibrosis and Hirschsprung disease
*almost all newborns with meconium iLeus have CF*
87
What are the main causes of Ascities - 5
**​****Cirrhosis from EtOH** \> [Ovarian CA=TB=nephrOtic syndrome=R HF]
88
What type of diarrhea is associated with decreased stool osmotic gap \< 50
Secretory ## Footnote *these are larger volume diarrhea that occurs during fasting or sleep*
89
What type of diarrhea is associated with diarrhea during fasting
Secretory ## Footnote *these are larger volume diarrhea that occurs during faSting or Sleep*
90
What type of diarrhea is associated with INCREASED stool osmotic gap \> 125
Osmotic ## Footnote *ex: Lactose intolerance*
91
Between Osmotic and Secretory Diarrhea, which type of diarrhea occurs during sleep?
Secretory ## Footnote *these are larger volume diarrhea that occurs during fasting or sleep*
92
What is the diagnosis in this infant?
Jejunal atresia ## Footnote *image shows TRIPLE bubble sign with gasless colon*
93
What is the major risk factor for the development of this condition?
maternal COCAINE use ## Footnote \*\*Jejunal atresia\*\* *image shows TRIPLE bubble sign with gasless colon*
94
Why are NSAIDs a common cause of iron deficiency anemia
chronic blood loss from GI tract ulcers
95
pancreatic calcifications on CT indicate what disease? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ how is the lipase affected by this?
Chronic Pancreatitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **MINIMAL CHANGE TO LIPASE** because of pancreatic burn out
96
Where is the intestinal enzyme lactase located? ; cp for lactose intolerance?
Duodenal brush border ; Chronic crampy postprandial pain and waterry diarrhea
97
Pt comes in with Hematochezia How do you work them up? (after doing a rectal)
98
What is a good empiric abx regimen for abdomianl infections? - 3
1. Amp 2. Gent 3. Flagyl
99
major signs of bowel obstruction - 3
1. NV 2. peritoneal signs 3. hyperactive bowel sounds (unless perforation)
100
Diagnostic criteria for Toxic Megacolon
Confirmatory Abd X rays + ≥3 of the following: - Fever \>38C - HR \>120 - WBC \>10,500 - Anemia
101
Tx for Toxic Megacolon - 4
1. NG Decompression 2. IV CTS 3. Abx 4. IVF
102
What are the imaging findings for Ascending Cholangitis
Common Bile Duct dilation ## Footnote *Fever, RUQ pain, Jaundice = Charcot Triad*
103
Tx for Esophageal Spasm
CCB
104
Zenkers Diverticulum etx
**ESOPHAGEAL DYSMOTILITY** --\> Diverticulum above upper esophageal sphincter with posterior herniation **between fibers of cricopharyngeal muscle**
105
Achalasia cp?-2 ; Dx?
1. Chronic dysphagia to BOTH solids and liquids 2. Regurgitation Dx = Manometry
106
Wilson disease cp - 2
1. Liver dysfunction 2. NeuroPsychiatric sx (parkinsonism, dysarthria, depression) 3. Kayser Fleisher rings ## Footnote *etx: hepatic copper accumulation --\> leakage into serum --\> copper deposition in tissues*
107
Which lab value can be used to diagnose Wilson disease? ; Tx?-2
⬇︎Ceruloplasmin ; Tx: 1. D-penicillamine chelator 2. Zinc (interfes with Copper absorption) * etx: hepatic copper accumulation --\> leakage into serum --\> copper deposition in tissues*
108
Whipples disease dx?
PAS-positive material in lamina propria of small intestine bx * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* * Come to my Whipple **PAD**!*
109
Whipples disease cp -3
*Come to my Whipple **PAD**!* 1. **P**igmentation 2. **A**RTHRALGIAS 3. **D**IARRHEA a/w abd pain and wt loss +/- fever
110
What would a liver biopsy of a child with Reye syndrome show?
microvesicular steatosis ## Footnote *Reye --\> fulminant liver failure --\> Hyperammoniemia --\> neurotoxicity. Tx = supporitve*
111
Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer Px?
Colorectal ## Footnote Annual sigmoidoscopies (cscope if adenomas are found or if age 50) screening **starting 10 yo** ---\> elective proctocolectomy in early 20s (or if severe sx/CA develops)
112
Genetic testing revealing Lynch Syndrome puts pts at risk fro what CA? - 4
**COS****E** 1. **C**olorectal proximal colon 2. **O**varian 3. **S**kin 4. **E**ndometrial
113
What are other system complications of Primary Biliary Cirrhosis - 2
1. Metabolic bone disease (osteoporosis, osteomalacia) 2. Hepatocellular carcinoma ## Footnote *only INTRAhepatic*
114
Down syndrome is strongly associated with what GI conditions- 2
1. Duodenal atresia (double bubble xray) 2. Hirschsprung
115
cp for Cyclic Vomiting Syndrome - 2
**IN THE CONTEXT OF PERSONAL OR FAMILY _MIGRAINE_ HX** recurrent and predictable vomiting that spontaneously resolves with no sx in between episodes tx = antiemetics and antimigraine
116
Which conditions are associated with transaminases \> 1000 - 5
**D**ark **CASA** 1. **D**rug/toxin injury (APAP) (serum transminases are \> 3000!) 2. **C**ommon Bile Duct stone 3. **A**cute viral hepatitis 4. **S**hock Liver 5. **A**utoimmune Hepatitis
117
Which condition is associated with transaminases \> 3000
APAP --\> Acute Liver Failure ## Footnote *These pts should undergo early **consideration for Liver transplantation**, especially if not improving over time!*
118
Name the most common site of colon cancer metastasis
Liver
119
What's the first step in evaluating a pt with asymptomatic transaminitis?
Thorough HISTORY (EtOH, drug, travel, blood transfusion, sexual practices)
120
Dx for Diverticulitis
Contrast CT Abd Pelvis (PO and IV)
121
Endoscopic findings for Zollinger Ellison Gastrinoma - 2
1. Thickened Gastric Folds 2. Multiple Small Intestine Peptic Ulcers
122
Zollinger Ellison Gastrinoma - Dx?-2
Fasting Serum Gastrin \> 1000 --\> low gastric pH for confirmation
123
You suspect a pt has Zollinger Ellison Gastrinoma but their Fasting Serum Gastrin was \< 1000 next steps?
Secretin test to stimulate gastrin release by abnormal gastrinoma cells ## Footnote *normal gastric G cells are actually inhibited by secretin so if Secretin fails to stimulate gastrin increase, hypergastrienmia is caused by something else*
124
Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer Which Adenomatous Polpys require the MOST colonoscopic surveillance? - 4
Colorectal 1. large polpys ≥1cm 2. high grade dysplasia 3. villous features (long glands on histo) 4. [≥3 concurrent adenoma polyps]
125
New Iron Deficiency Anemia in the elderly should always be considered to be from _____ until proven otherwise
GI blood loss ## Footnote *a single negative FOBT should NOT desuade from cscope/escope*
126
All pts with suspected Achalasia should undergo _____ before any treatment - Why?
Endoscopy ; r/o Cancer as the cause which = pseudoachalasia
127
What are the risk factors for Clostridium Difficile - 3
1. Abx 2. Gastric acid suppression (PPIs) 3. \>65yo
128
cp for [Riboflavin B2] deficiency - 3
1. Angular Cheilitis (fissures at corner of lips) 2. Glossitis (hyperemic tongue) 3. Seborrheic Dermatitis
129
Diagnostic criteria for Acute Liver Failure - 2
1. hepatic encephalopathy is present 2. INR≥1.5 ## Footnote *Most commonly from **D**rug/Toxin and **A**cute Viral hepatitis*
130
Which product is recommended to transfuse in acute GI bleeds
Packed RBCs
131
When is it indicated to tranfuse Platelets?
1. \<50K platelets **with active bleeding** 2. \<10K platelets total
132
cp for Zinc deficiency - 3
1. alopecia 2. impaired taste 3. dermatitis pustular with perioral involvement
133
How can Severe Pancreatitis cause Distributive Shock?
Pancreatitis releases pancreatic enzymes into vasculature which ⬆︎vascular permeability around the pancreas and allows fluid to enter the retroperitoneum --\> Even greater widespread vasoDilation
134
What's the most reversible risk factor for pancreatic cancer?
smoking
135
What are the laboratory findings for Lactose intolerance? - 5 ## Footnote *Lactose intolerance is most commonly seen in Asians*
1. ⬆︎stool osmotic gap (osmotic diarrhea) 2. +reducing substances in stool 3. **+hydrogen breath test (indicates intestinal bacterial carbohydrate catabolism)** 4. acidic stool pH 5. NO steatorrhea ## Footnote *Lactose Intolerance is most commonly seen in Asians*
136
cp for iron intoxication - 4
1. abd pain **with radiopaque tablets on radiographs** 2. hematemesis 3. AMS 4. metabolic acidosis ## Footnote *tx = deferoxamine or whole bowel irrigation*
137
Do you give activated charcoal (gastric decontamination) to an APAP OD pt who has no laboratory abnormalities on presentation?
YES! ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ That and APAP levels - they may be asymptomatic for the first 24 hours after ingestion
138
Describe the guideline options for colon cancer screening - 4
1. FOBT annually - 50 yo 2. Sigmoidoscopy every 5 years if combined with FOBT every 3 years - 50 yo 3. Colonoscopy every 10 years - 50 yo 4. **If 1st degree relative with Colon CA -Begin screening at 40 yo or 10 years before age of relative's dx**
139
Both Intrahepatic Cholestasis of Pregnancy and Acute Fatty Liver are complications of Pregnancy How do you discern the two?
Intrahepatic Cholestasis of Pregnacy = Pruritus cp vs Acute Fatty Liver = Liver Failure cp
140
*LATE* signs of Hepatic Encephalopathy -3
Asterixis Coma focal neuro ∆
141
*Early* signs of Hepatic Encephalopathy -2
**REVERSED SLEEP CYCLE** Personality Changes

[2a] A ⼀ Step 2 OD USLME (21 decks)

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