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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
Q

MOD for [HFE mutation 1° Hemochromatosis]

A

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

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26
Q

FerriTin > 1000 usually indicates ⬜

________________

What other lab values is found with this?

A

HEMOCHROMATOSIS

________________

[95% Transferrin Saturation]

Presents after 40 yo

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27
Q

Wilson’s Dz Etx

A
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28
Q

Wilson’s Dz Sx -4

A
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29
Q

Wilson’s Dz Tx

A
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30
Q

What is the most common cause of Cirrhosis and how is it diagnosed?

A

NASH! ; Liver Biopsy

NASH RF: Obesity, DM, Hyperlipidemia

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31
Q

Autoimmune hepatitis dx

________________

tx-2

A

Dx = Biopsy

________________

  1. prednisone
  2. azathioprine
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32
Q

Why is drinking alcohol in a pt with Hep C dangerous?

A

Hep C ⬆︎⬆︎⬆︎⬆︎ Liver damage from alcohol!!

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33
Q

How do you interpret positive Hep C serology?

A

Hep C Ab = exposure at some point

Hep C RNA titers = determines status (HIGH = chronically active vs negative = resolved)

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34
Q

Tx for Hepatic Encephalopathy -2
________________
What’s their MOA -2

A
  1. Lactulose (converts NH3 –> NH4+ in colon - and ⬆︎peristalsis –> DIARRHEA)
  2. Rifaximin abx (⬇︎NH3 producing colonic bacteria)
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35
Q

Vaccinations for pts with Chronic Hepatitis -4

A
  1. Hep A (acute viral hepatits can –> Fulminant Liver failure!)
  2. Hep B (acute viral hepatits can –> Fulminant Liver failure!)
  3. Flu
  4. Pneumococcal
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36
Q

Why is Octreotide given for active Esophageal Varices Rupture

A

it vasoconstricts splanchnics –> ⬇︎pressure from splanchnics to the esophagus

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37
Q

Spontaneous Bacterial Peritonitis Etx

________________

“Ascites Can Never Totally Suck”

A

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

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38
Q

Spontaneous Bacterial Peritonitis Sx-4

A
  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

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39
Q

What are the purposes of Peritoneal fluid analysis in pt with ascities? -2

A
  1. Determine Cause
  2. Determine presence of Infection

Causes = Cirrhosis > [Ovarian CA=TB=nephrOtic syndrome=R HF]

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40
Q

Other than Cirrhosis, what are other causes of ascites? -4

A
  1. Ovarian CA
  2. nephrOtic syndrome
  3. TB
  4. R HF

These will have a SAAG < 1.1

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41
Q

Spontaneous Bacterial Peritonitis Tx -2

A

Ciprofloxacin

vs

Norfloxacin

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42
Q

Indications for Liver Transplant -3

A
  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]
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43
Q

D-Lactic Acidosis is seen in pts with ⬜
________________
Etx?
________________
CP-2

A

Short bowel syndrome
________________
Unabsorbed Carbs are metabolized by intestinal bacterial –> D-lactic acid which is absorbed –>
________________
Confusion + Ataxia during carb loading

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44
Q

Wilson’s Disease Dx Labs - 2

A
  1. Low Ceruloplasmin ( < 20 mg/dL) -ceruloplasmin binds to ⬆︎ free flaoting copper
  2. ⬆︎Urinary Copper
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45
Q

What are the most common biomarkers for unhealthy EtOH usage? - 6

A
  1. AST: ALT ratio ≥ 2:1
  2. ⬆︎GGT
  3. ⬆︎Carbohydrate-deficient Transferrin
  4. ⬆︎FerriTin
  5. Macrocytosis
  6. Pancytopenia
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46
Q

If a pediatric pt with hypertrophic pyloric stenosis has electrolyte abnormalitites, do you immediately go to surgery or correct electrolytes/hydration first?

A

Electrolytes/Hydration FIRST!

Dx = US

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47
Q

Dx for Celiac disease - 2

________________

wt loss+ iron deficiency anemia + dermatitis herpetiformis = CELIAC!

A

Anti-TED (IgA or IgG) ➜ DUODENAL BX FOR CONFIRMATION

_________________

(TissueTransGlutaminase/Endomysial/DeaminatedGliadin)

(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!

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48
Q

Why can’t US be used to diagnose Primary Biliary Cholangitis?

A

PBC involves Anti-mitochondrial abs attacking intrahepatic biliary duct ONLY.

US can only see EXTRAhepatic

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49
Q

Other than complications from cholestasis, what other complications are associated with Primary Biliary Cholangitis? - 3

A
  1. HLD with Xanthelasma
  2. Metabolic bone disease
  3. Autoimmune thyroid disease
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50
Q

Although CXR in Boerhaave syndrome can show ⬜3 ,

what is the confirmation dx?-2

A

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]

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51
Q

Complications of GERD - 3

A
  1. Barrett’s esophagus
  2. Erosive esophagitis
  3. Esophageal peptic strictures (circumferential narrowing)
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52
Q

Causes of Esophageal pepetic strictures (circumferential esophageal narrowing –> solid food dysphagia only) - 4

A
  1. GERD
  2. Radiation
  3. Systemic slcerosis
  4. Caustic ingestions
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53
Q

Characteristics for Carcinoid Syndrome - 10

A

Cardiac (Tricuspid Regurgitation)

Do not confuse with VIPoma which presents similarly but affects Pancreas while Carcinoid affects small intestine

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54
Q

[T or F] Screening Ammonia levels should be ordered on pts with cirrhosis with or without encephalopathy

A

FALSE - only order Ammonia if hepatic encephalopathy is suspected

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55
Q

Pt has cirrhosis with esophageal varices

What is the prophylactic mngmt for this pt? - 2

A

[General B Blockers (nadalol) OR Variceal ligation] –(if refractory)–> [TIPS-Transjugular intrahepatic portosystemic shunt]

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56
Q

A pt has been diagnosed with Gastric ADC

What’s the next immediate step?

A

TUMOR STAGING via CT to determine px/tx

Note: HPylori eradication is only helpful for gastric MALT

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57
Q

Tx for asymptomatic gallstones

A

NOTHING

Lap Chole is only indicated for sympatomatic gallstones!

58
Q

Tx for Complicated Gallstones

GS with concomitant cholecysitis, choleDocholithiasis, pancreatitis

A

Lap Chole sometime within 3 days

59
Q

Tx for ACTIVE variceal bleeding - 3

A
  1. Octreotide (splanchnic vasoconstriction & ⬇︎glucagon –>⬇︎portal blood flow)
  2. Endoscopic Sclerotherapy
  3. Intubation if airway compromised from vomiting
60
Q

In Cirrhosis, what all does ⬆︎Estrogen cause? - 5

A
  1. Gynecomastia
  2. ⬇︎Body Hair
  3. Palmar Erythema
  4. Spider Angiomas
  5. Testicular Atrophy
61
Q

Describe Biliary Cyst
________________
Tx?

A

[Congenital or Acquired] Biliary tree Dilatations that may be [intra or extrahepatic], [single or multiple]

________________

Tx = Surgery

62
Q

When do you typically see pancreatic pseuocyst

A

as a complication of acute or chronic pancreatitis

63
Q

Esophageal Spasm cp - 3
________________
dx?

A
  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
Q

what is the most common Cancer of the liver

A

Metastasis(can be solitary) from another primary (i.e. COLON or pancreatic - since these send their venous blood directly to liver)

2nd = Hepatocellular carcinoma

65
Q

Hepatic angiosarcoma etx

A

(Vinyl Chloride gas, arsenic, thorium) exposure –> RARE liver neoplasm in older men

66
Q

Focal nodular hyperplasia and Hepatic Adenoma are typically seen in _____. Which is typically asymptomatic?

A

young women ; FNH

67
Q

What is long term relief for pts with PUD - 3

A

CAP the PUD

TRIPLE TX!

  1. Clarithomycin
  2. Amoxicillin
  3. PPI

Smoking and EtOH cessation can help but don’t offer LONG TERM change

68
Q

Clinical manifestations of Cirrhosis - 13

A
69
Q

What is the purpose of the D-xylose test

A

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
Q

How are the results of the D-xylose test interpreted? ; How does Rifaximin play a role in this?

A

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
Q

Where do Mallory Weiss tears occur

A

longitudinal tears in the mucosa near the Gastroesophageal junction

72
Q

Painless Jaundice DDx - 3

A
  1. Pancreatic CA - obstructive
  2. Biliary CA - obstructive
  3. CholeDocholithiasis
73
Q

When do you see GI bleeding from Gastritis - 2

A
  1. ICU
  2. Burns
74
Q

Key signs of Laxative Abuse -3

A
  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
Q

Describe colonic findings for Pseudomembranous colitis - 3

A
  1. FRIABLE
  2. Edematous
  3. Erythematous
76
Q

Toxic Megacolon cp - 3

A
  1. Bloody Diarrhea
  2. Systemic Toxicity (fever, tachycardia, hypotension)
  3. Abd distension +/- peritonitis
77
Q

Toxic Megacolon mngmt- 5

A
  1. Abx
  2. NPO
  3. NG suction
  4. +/- CTS if IBD associated
  5. SURGERY ONLY IF MEDICAL MNGMT FAILS
78
Q

Complications of Diverticulitis - 3

A
  1. Colovesical fistula –> pneumaturia, fecaluria, UTI sx
  2. rupture
  3. Abscess
79
Q

Hepatic Adenoma is a benign ___type of tumor in young women, associated with ___ and ___

What are its complications?-2

A

epithelial ; OCP/Pregancy ; Rupture/MalignancyTransformation

this CAN cause biliary obstruction

80
Q

What is Mesenteric Angioplasty indicated for?

A

Chronic Mesenteric ischemia (evidenced by postprandial intestinal pain+ wt loss)

81
Q

Chronic Mesenteric Ischemia cp - 3

A
  1. unexplained chronic postprandial abd pain (intestinal angina)
  2. Wt loss
  3. Food Aversion

usually from atherosclerotic celiac or SMA

82
Q

Esophageal manometry showing hypercontractility inidcates what disease?

A

Eosinophilic esophagitis

83
Q

Dx for Zenker’s Diverticulum

A

Barium Contrast Esophagram

Dysphagia, Foul Breath, Regurgitation, Aspiration

84
Q

Postcholecystectomy syndrome etx

________________

Dx-2

A

s/p cholecystectomy, Biliary or Extra-Biliary causes –> persistent abd pain or dyspepsia in pts

________________

Dx = Abd US –> ERCP/MRCP

85
Q

How do you confirm diagnosis for Esophageal Rupture?

A

Contrast Esophagram water soluble

86
Q

Pt presents with narrowed “colon”

How do you differentiate between Cystic Fibrosis and Hirschsprung disease

A

almost all newborns with meconium iLeus have CF

87
Q

What are the main causes of Ascities - 5

A

​Cirrhosis from EtOH > [Ovarian CA=TB=nephrOtic syndrome=R HF]

88
Q

What type of diarrhea is associated with decreased stool osmotic gap < 50

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

89
Q

What type of diarrhea is associated with diarrhea during fasting

A

Secretory

these are larger volume diarrhea that occurs during faSting or Sleep

90
Q

What type of diarrhea is associated with INCREASED stool osmotic gap > 125

A

Osmotic

ex: Lactose intolerance

91
Q

Between Osmotic and Secretory Diarrhea, which type of diarrhea occurs during sleep?

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

92
Q

What is the diagnosis in this infant?

A

Jejunal atresia

image shows TRIPLE bubble sign with gasless colon

93
Q

What is the major risk factor for the development of this condition?

A

maternal COCAINE use

**Jejunal atresia**

image shows TRIPLE bubble sign with gasless colon

94
Q

Why are NSAIDs a common cause of iron deficiency anemia

A

chronic blood loss from GI tract ulcers

95
Q

pancreatic calcifications on CT indicate what disease?

________________

how is the lipase affected by this?

A

Chronic Pancreatitis

________________

MINIMAL CHANGE TO LIPASE because of pancreatic burn out

96
Q

Where is the intestinal enzyme lactase located? ; cp for lactose intolerance?

A

Duodenal brush border ;

Chronic crampy postprandial pain and waterry diarrhea

97
Q

Pt comes in with Hematochezia

How do you work them up? (after doing a rectal)

A
98
Q

What is a good empiric abx regimen for abdomianl infections? - 3

A
  1. Amp
  2. Gent
  3. Flagyl
99
Q

major signs of bowel obstruction - 3

A
  1. NV
  2. peritoneal signs
  3. hyperactive bowel sounds (unless perforation)
100
Q

Diagnostic criteria for Toxic Megacolon

A

Confirmatory Abd X rays

+ ≥3 of the following:

  • Fever >38C
  • HR >120
  • WBC >10,500
  • Anemia
101
Q

Tx for Toxic Megacolon - 4

A
  1. NG Decompression
  2. IV CTS
  3. Abx
  4. IVF
102
Q

What are the imaging findings for Ascending Cholangitis

A

Common Bile Duct dilation

Fever, RUQ pain, Jaundice = Charcot Triad

103
Q

Tx for Esophageal Spasm

A

CCB

104
Q

Zenkers Diverticulum etx

A

ESOPHAGEAL DYSMOTILITY –> Diverticulum above upper esophageal sphincter with posterior herniation between fibers of cricopharyngeal muscle

105
Q

Achalasia cp?-2 ; Dx?

A
  1. Chronic dysphagia to BOTH solids and liquids
  2. Regurgitation

Dx = Manometry

106
Q

Wilson disease cp - 2

A
  1. Liver dysfunction
  2. NeuroPsychiatric sx (parkinsonism, dysarthria, depression)
  3. Kayser Fleisher rings

etx: hepatic copper accumulation –> leakage into serum –> copper deposition in tissues

107
Q

Which lab value can be used to diagnose Wilson disease? ; Tx?-2

A

⬇︎Ceruloplasmin ;

Tx:

  1. D-penicillamine chelator
  2. Zinc (interfes with Copper absorption)
    * etx: hepatic copper accumulation –> leakage into serum –> copper deposition in tissues*
108
Q

Whipples disease dx?

A

PAS-positive material in lamina propria of small intestine bx

  • _______________*
  • Come to my Whipple PAD!*
109
Q

Whipples disease cp -3

A

Come to my Whipple PAD!

  1. Pigmentation
  2. ARTHRALGIAS
  3. DIARRHEA a/w abd pain and wt loss +/- fever
110
Q

What would a liver biopsy of a child with Reye syndrome show?

A

microvesicular steatosis

Reye –> fulminant liver failure –> Hyperammoniemia –> neurotoxicity. Tx = supporitve

111
Q

Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer

Px?

A

Colorectal

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
Q

Genetic testing revealing Lynch Syndrome puts pts at risk fro what CA? - 4

A

COSE

  1. Colorectal proximal colon
  2. Ovarian
  3. Skin
  4. Endometrial
113
Q

What are other system complications of Primary Biliary Cirrhosis - 2

A
  1. Metabolic bone disease (osteoporosis, osteomalacia)
  2. Hepatocellular carcinoma

only INTRAhepatic

114
Q

Down syndrome is strongly associated with what GI conditions- 2

A
  1. Duodenal atresia (double bubble xray)
  2. Hirschsprung
115
Q

cp for Cyclic Vomiting Syndrome - 2

A

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
Q

Which conditions are associated with transaminases > 1000 - 5

A

Dark CASA

  1. Drug/toxin injury (APAP) (serum transminases are > 3000!)
  2. Common Bile Duct stone
  3. Acute viral hepatitis
  4. Shock Liver
  5. Autoimmune Hepatitis
117
Q

Which condition is associated with transaminases > 3000

A

APAP –> Acute Liver Failure

These pts should undergo early consideration for Liver transplantation, especially if not improving over time!

118
Q

Name the most common site of colon cancer metastasis

A

Liver

119
Q

What’s the first step in evaluating a pt with asymptomatic transaminitis?

A

Thorough HISTORY (EtOH, drug, travel, blood transfusion, sexual practices)

120
Q

Dx for Diverticulitis

A

Contrast CT Abd Pelvis (PO and IV)

121
Q

Endoscopic findings for Zollinger Ellison Gastrinoma - 2

A
  1. Thickened Gastric Folds
  2. Multiple Small Intestine Peptic Ulcers
122
Q

Zollinger Ellison Gastrinoma - Dx?-2

A

Fasting Serum Gastrin > 1000 –> low gastric pH for confirmation

123
Q

You suspect a pt has Zollinger Ellison Gastrinoma but their Fasting Serum Gastrin was < 1000

next steps?

A

Secretin test to stimulate gastrin release by abnormal gastrinoma cells

normal gastric G cells are actually inhibited by secretin so if Secretin fails to stimulate gastrin increase, hypergastrienmia is caused by something else

124
Q

Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer

Which Adenomatous Polpys require the MOST colonoscopic surveillance? - 4

A

Colorectal

  1. large polpys ≥1cm
  2. high grade dysplasia
  3. villous features (long glands on histo)
  4. [≥3 concurrent adenoma polyps]
125
Q

New Iron Deficiency Anemia in the elderly should always be considered to be from _____ until proven otherwise

A

GI blood loss

a single negative FOBT should NOT desuade from cscope/escope

126
Q

All pts with suspected Achalasia should undergo _____ before any treatment - Why?

A

Endoscopy ; r/o Cancer as the cause which = pseudoachalasia

127
Q

What are the risk factors for Clostridium Difficile - 3

A
  1. Abx
  2. Gastric acid suppression (PPIs)
  3. >65yo
128
Q

cp for [Riboflavin B2] deficiency - 3

A
  1. Angular Cheilitis (fissures at corner of lips)
  2. Glossitis (hyperemic tongue)
  3. Seborrheic Dermatitis
129
Q

Diagnostic criteria for Acute Liver Failure - 2

A
  1. hepatic encephalopathy is present
  2. INR≥1.5

Most commonly from Drug/Toxin and Acute Viral hepatitis

130
Q

Which product is recommended to transfuse in acute GI bleeds

A

Packed RBCs

131
Q

When is it indicated to tranfuse Platelets?

A
  1. <50K platelets with active bleeding
  2. <10K platelets total
132
Q

cp for Zinc deficiency - 3

A
  1. alopecia
  2. impaired taste
  3. dermatitis pustular with perioral involvement
133
Q

How can Severe Pancreatitis cause Distributive Shock?

A

Pancreatitis releases pancreatic enzymes into vasculature which ⬆︎vascular permeability around the pancreas and allows fluid to enter the retroperitoneum –> Even greater widespread vasoDilation

134
Q

What’s the most reversible risk factor for pancreatic cancer?

A

smoking

135
Q

What are the laboratory findings for Lactose intolerance? - 5

Lactose intolerance is most commonly seen in Asians

A
  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

Lactose Intolerance is most commonly seen in Asians

136
Q

cp for iron intoxication - 4

A
  1. abd pain with radiopaque tablets on radiographs
  2. hematemesis
  3. AMS
  4. metabolic acidosis

tx = deferoxamine or whole bowel irrigation

137
Q

Do you give activated charcoal (gastric decontamination) to an APAP OD pt who has no laboratory abnormalities on presentation?

A

YES!

________________

That and APAP levels - they may be asymptomatic for the first 24 hours after ingestion

138
Q

Describe the guideline options for colon cancer screening - 4

A
  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
Q

Both Intrahepatic Cholestasis of Pregnancy and Acute Fatty Liver are complications of Pregnancy

How do you discern the two?

A

Intrahepatic Cholestasis of Pregnacy = Pruritus cp

vs

Acute Fatty Liver = Liver Failure cp

140
Q

LATE signs of Hepatic Encephalopathy -3

A

Asterixis

Coma

focal neuro ∆

141
Q

Early signs of Hepatic Encephalopathy -2

A

REVERSED SLEEP CYCLE

Personality Changes

[2a] A ⼀ Step 2 OD USLME (21 decks)

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