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Rizk Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Most common cause of upper GI bleed?

A

Duodenal ulcer

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2
Q

___ refers to single large tortuous arteriole in submucosa; Causes bleeding due to erosion of submucosa

A

Dieulafoy

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3
Q

First step of treatment for patient who develops severe upper GI bleeding?

A

ABCs … secure the airway

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4
Q

Most common cause of lower GI bleed?

A

Diverticulosis

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5
Q

Does Diverticulosis result in painless or painful bleeding?

A

Painless

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6
Q

Additional cause of painless lower GI bleed?

A

Angiodysplasia

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7
Q

Which step of workup should be avoided in patients with suspected diverticulitis?

A

Colonoscopy

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8
Q

Best step of workup for patient with suspected diverticulitis?

A

CT abdomen

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9
Q

9 yo male presents with recurrent painless rectal bleeding; Denies fever, skin rash; No FHX of colon CA; Colonoscopy is NML – diagnosis?

A

Meckel’s diverticulum

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10
Q

First step of workup for patient with suspected lower GI bleed?

A

Insert NG tube to rule out upper GI bleed

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11
Q

Best test for suspected lower GI bleed that does not respond to conservative therapy?

A

Colonoscopy

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12
Q

Best initial test in patient with dysphagia?

A

Barium swallow

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13
Q

Next step in workup for patient with dysphagia?

A

EGD

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14
Q

Best diagnostic tool for esophageal rupture?

A

Extravasation of oral (water-soluble) contrast

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15
Q

Prognosis for Schatzki’s lower esophageal ring?

A

Benign … requires dilatation

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16
Q

Best diagnostic test for Zenker’s diverticulum?

A

Barium swallow … avoid EGD due to risk for esophageal perforation

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17
Q

Patient presents with HX of lye ingestion 15 years age – best recommendation?

A

EGD

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18
Q

Patient presents with HX of lye ingestion 15 years age – complication?

A

Squamous cell carcinoma

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19
Q

72 yo male presents with 4 months of dysphagia; Upper GI shows bird-beak stricture in distal esophagus – next best step of management?

A

EGD … rule-out adenocarcinoma causing pseudo-achalasia

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20
Q

Etiology of achalasia?

A

Loss of Auerbach’s plexus … failed relaxation of distal esophagus

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21
Q

Achalasia in South American male who also presents with arrhythmia + CHF – diagnosis?

A

Chagas Disease

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22
Q

Change to LES tone in scleroderma?

A

Loss of tone

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23
Q

Management to avoid for patient with scleroderma who complains of dysphagia?

A

Endoscopy … increased risk of esophageal perforation

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24
Q

Best treatment for diffuse esophageal spasm?

A

CCB, NTG

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25
Q

Condition associated with oropharyngeal dysmotility?

A

Dermatomyositis

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26
Q

Most effective study for evaluating suspected oropharyngeal dysmotility?

A

Video fluoroscopy

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27
Q

All of the following medications can cause pill esophagitis, except for one – K+ supplements, tetracyclines, NSAIDs, CCBs, ascorbic acid?

A

CCBs

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28
Q

Which medication might cause odynophagia in young female?

A

Doxycycline … taking for acne

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29
Q

Best treatment for Odynophagia in immunocompromised patients, due to Candida?

A

Ketoconazole

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30
Q

Best treatment for Odynophagia in immunocompromised patients, due to HSV?

A

Acyclovir

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31
Q

Best treatment for Odynophagia in immunocompromised patients, due to CMV?

A

Ganciclovir

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32
Q

Which 2 aspects of GERD are associated with risk of GERD symptoms?

A

Duration, frequency

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33
Q

Which symptom will NOT be caused by Barrett’s esophagus?

A

Dysphagia … Barrett’s esophagus is purely HISTOLOGIC, not structural narrowing of esophagus

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34
Q

Appearance of Barrett’s esophagus on EGD?

A

Intestinal metaplasia

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35
Q

All of the following are risk factors for SCC of esophagus, except for one – HPV, GERD, Achalasia, ETOH, Smoking?

A

GERD

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36
Q

Most colon cancers arise from …

A

Adenomas

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37
Q

There is no malignant potential associated with which type of polyp?

A

Hyperplastic

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38
Q

Diagnostic test for FAP?

A

Proctoscopy

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39
Q

In addition to increased risk for colon CA, patients with FAP are at increased risk of …

A

Duodenal CA … perform EGD

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40
Q

Which type of familial adenomatous condition is associated with bony prominences?

A

Gardner’s Syndrome

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41
Q

In addition to colon colon adenomas, what is another manifestation of Turcot Syndrome?

A

CNS tumors

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42
Q

Peutz-Jeghers Syndrome is associated with ___ polyps

A

Hamartomatous

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43
Q

Are the Hamartomatous polyps in Peutz-Jeghers Syndrome responsible for patient’s increased risk of colon CA?

A

No … In Peutz-Jeghers Syndrome, several adenomas are scattered among the hamartomas

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44
Q

Amsterdam Criteria for Lynch Syndrome?

A

Colon CA … 3 first degree relatives, 2 successive generations, 1 family member diagnosed < 50 yo

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45
Q

Best treatment for Stage 3 colon CA?

A

CTX

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46
Q

Best CTX for colon CA?

A

5-FU + Leucovorin

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47
Q

Most common type of anal CA?

A

Squamous cell carcinoma

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48
Q

Most common cause of anal CA?

A

HPV infection

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49
Q

Best treatment for anal CA?

A

Concurrent XRT + CTX therapy

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50
Q

Clinical presentation for anal fissure?

A

Bright red blood in stool, painful defecation

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51
Q

Best treatment for anal fissure?

A

Topical anesthetic, treat constipation

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52
Q

Best treatment for acute mesenteric ischemia?

A

Emergency surgery

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53
Q

Clinical presentation for ischemic colitis?

A

Significant rectal bleeding

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54
Q

Best treatment for ischemic colitis?

A

ABX, IV fluids

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55
Q

Most common locations of ischemic colitis?

A

Watershed areas

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56
Q

Best diagnostic test for intestinal angina?

A

Angiogram

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57
Q

Most common site of intestinal angina?

A

Splenic flexure

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58
Q

Secretory diarrhea is mediated by …

A

Toxins

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59
Q

At what point should secretory diarrhea be treated with ABX?

A

If patient becomes febrile

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60
Q

DOC for travelers diarrhea, with fever?

A

Single dose of ciprofloxacin

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61
Q

Alternate name for inflammatory diarrhea?

A

Invasive

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62
Q

Most common pathogen responsible for bloody diarrhea?

A

Campylobacter

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63
Q

Symptoms in Campylobacter infection mimic …

A

Appendicitis

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64
Q

Treatment that is contraindicated in HUS?

A

ABX treatment (makes symptoms worse)

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65
Q

Pathogen that causes inflammatory diarrhea with febrile seizures?

A

Shigella

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66
Q

DOC for Shigella inflammatory diarrhea?

A

TMP-SMX

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67
Q

Best treatment for entamoeba histolytica-related amebic liver abscess?

A

Metronidazole … (not surgical drainage)

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68
Q

RUQ pain with acute diarrhea in immigrant – diagnosis?

A

Entamoeba histolytica

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69
Q

Peritoneal signs with acute diarrhea – diagnosis?

A

Campylobacter

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70
Q

Sickle cell patient with acute diarrhea – diagnosis?

A

Salmonella

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71
Q

Characteristic of Cryptosporidium + Isospora belli in HIV (+) patients with watery diarrhea?

A

Acid-fast

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72
Q

Rash associated with celiac disease?

A

Dermatitis herpetiformis

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73
Q

Best treatment for Dermatitis herpetiformis?

A

Dapsone

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74
Q

Most common location of carcinoid tumors?

A

Terminal ileum, appendix

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75
Q

DOC for carcinoid syndrome?

A

Octreotide

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76
Q

Which vitamin deficiency is most common to develop in setting of carcinoid syndrome?

A

Niacin

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77
Q

Why is niacin deficiency associated with carcinoid syndrome?

A

Tryptophan&raquo_space; Serotonin … need Tryptophan for production of niacin

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78
Q

Best test for screening H. pylori infection, as well as confirming eradication?

A

Urea breath test

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79
Q

Most common cause of upper GI bleeding?

A

Peptic ulcer disease

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80
Q

2 most common causes of Peptic ulcer disease?

A

H. pylori infection; NSAID use

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81
Q

Most common cause of failed H. pylori eradication?

A

Course of treatment did not last full 2 weeks

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82
Q

Next step of workup for non-healing gastric ulcers?

A

EGD + 6 biopsy samples to rule out gastric CA

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83
Q

Risk for colon CA – greater in Crohn’s Disease (CD) or Ulcerative Colitis (UC)?

A

UC

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84
Q

Characteristic of colon CA in UC?

A

Multiple sites

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85
Q

Smoking – makes inflammation worse in UC or CD?

A

CD

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86
Q

Smoking – makes inflammation better in UC or CD?

A

UC

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87
Q

Location of CD?

A

Any portion of GI – mouth to anus

88
Q

2 complications of CD?

A

Strictures, Fistula

89
Q

Appearance of mucosa in CD?

A

Cobblestoning … elevation of normal mucosa

90
Q

3 characteristics of GI inflammation in CD?

A

Transmural, Skip lesions, Non-caseating granuloma

91
Q

CD represents a Type ___ HSN reaction

A

4

92
Q

Extraintestinal manifestation of CD?

A

Pyoderma gangrenosum

93
Q

Treatment of pyoderma gangreneosum?

A

Steroids

94
Q

Ecthyma gangrenosum is associated with …

A

Pseudomonas infection

95
Q

Location of UC?

A

Rectum, Distal

96
Q

Histologic hallmark of UC?

A

Crypt abscesses (PMN inflammation)

97
Q

Appearance of GI in UC (not ulcers)?

A

Loss of haustra … “lead pipe”

98
Q

GI complication of UC?

A

Toxic megalcolon

99
Q

Extraintestinal manifestation of UC?

A

Primary Sclerosing Cholangitis

100
Q

When should you start colonoscopy CA screening for UC?

A

10 years after diagnosis, Every 2-3 years

101
Q

DOC for UC with diarrhea, but no bleeding?

A

5-ASA (Sulfalazine)

102
Q

DOC for UC with diarrhea AND bleeding?

A

Prednisone

103
Q

Are Prednisone and 5-ASA (Sulfalazine) safe during pregnancy?

A

YES

104
Q

DOC for mild CD?

A

5-ASA (Sulfalazine)

105
Q

2 DOCs for severe CD?

A

Infliximab, Natalizumab

106
Q

MOA of Infliximab?

A

TNFα inhibitor

107
Q

MOA of Natalizumab?

A

Ig against cell adhesion molecule α4-integrin

108
Q

UC patient with RUQ, increased LFTs?

A

Primary Sclerosing Cholangitis

109
Q

Bloody diarrhea in young patient?

A

UC

110
Q

Fecal soiling – CD or UC?

A

CD – most likely fistula

111
Q

Hydronephrosis without stones – UC or CD?

A

CD … from obstruction

112
Q

Pneumaturia – CD or UC?

A

CD – most likely fistula with bladder

113
Q

3 common extraintestinal manifestations of CD?

A

Calcium oxalate kidney stones, B12 deficiency, Hypocalcemia (Vitamin D deficiency)

114
Q

Appearance of UC on abdominal XR?

A

Loss of haustra

115
Q

Complication of UC?

A

Toxic megacolon

116
Q

HLA gene associated with Primary Sclerosing Cholangitis?

A

HLA-B8

117
Q

When should patients with UC begin colonoscopy screening?

A

8 years after diagnosis; Repeat every 1-2 years

118
Q

Next step of workup for UC patient who presents with low-grade dysplasia on biopsy?

A

Total colectomy

119
Q

Patient presents with dermatitis, dysgeusia – ID the trace element deficiency?

A

Zinc

120
Q

Patient presents with glucose intolerance, confusion, and neuropathy – ID the trace element deficiency?

A

Chromium

121
Q

Patient presents with cardiomyopathy – ID the trace element deficiency?

A

Selenium

122
Q

Electrolyte change associated with acute pancreatitis?

A

Hypercalcemia

123
Q

Most common cause of acute pancreatitis in children?

A

Abdominal trauma

124
Q

Anticonvulsant associated with acute pancreatitis?

A

Valproic acid

125
Q

___ refers to periumbilical discoloration seen in setting of acute pancreatitis

A

Cullen’s Sign

126
Q

___ refers to flank bruising seen in setting of acute pancreatitis

A

Turner’s Sign

127
Q

First step in management of acute pancreatitis?

A

Make patient NPO

128
Q

3 indications for ABX treatment in acute pancreatitis?

A

Infected pseudocyst, Necrotizing pancreatitis, Cholangitis

129
Q

Clinical presentation of chronic pancreatitis?

A

DM + Steatorrhea … without nephropathy + retinopathy

130
Q

Lab value that is helpful in diagnosis of chronic pancreatitis?

A

Low serum trypsinogen

131
Q

Best test for diagnosis of steatorrhea in chronic pancreatitis?

A

Quantification of fecal fat

132
Q

Appearance of chronic pancreatitis on XR?

A

Calcifications

133
Q

Appearance of chronic pancreatitis on ERCP?

A

Chain of lakes

134
Q

Most common type of pancreatic CA?

A

Adenocarcinoma

135
Q

Condition associated with Gastrinoma?

A

Zollinger-Ellison, MEN1 Syndrome

136
Q

Are most insulinomas benign or malignant?

A

Benign

137
Q

Metabolic disturbance associated with VIPoma?

A

Non-AG metabolic acidosis

138
Q

Triad of clinical symptoms seen in setting of VIPoma?

A

Watery diarrhea, hypokalemia, hypotension

139
Q

1st test to order for suspected cholecystitis?

A

US

140
Q

What is the most sensitive test for suspected cholecystitis?

A

HIDA scan

141
Q

HIDA scan finding that suggests cholecystitis?

A

Non-visualization of gallbladder, with visualization of CBD

142
Q

Best treatment of CBD stones?

A

ERCP

143
Q

Epidemiology of acalculus cholecystitis?

A

Ill, hospitalized patients

144
Q

Diagnostic finding for acalculus cholecystitis on US/CT?

A

Thickened gallbladder wall

145
Q

Best treatment for acalculus cholecystitis?

A

Cholecystectomy

146
Q

Patient presents with abdominal XR showing gallbladder with calcified outline (porcelain gallbladder) – best treatment (open vs. laparoscopic cholecystectomy)?

A

Open cholecystectomy … most likely malignancy

147
Q

34 yo female presents with 1-week HX of fatigue, jaundice, fever; HX of autoimmune hypothyroidism; Labs show elevated AST, elevated ALT, mildly-elevated total bilirubin; Hepatitis panel is NML – diagnosis?

A

Autoimmune hepatitis

148
Q

What is the serology test that will most likely help diagnose autoimmune hepatitis?

A

ANA, Anti-Smooth muscle Ig

149
Q

Route of transmission for Hepatitis A?

A

Fecal-oral

150
Q

Best treatment for Hepatitis A?

A

Supportive care

151
Q

Of patients with Hepatitis B, ___% will develop chronic disease

A

5%

152
Q

2 extrahepatic manifestations of Hepatitis B?

A

Membranous nephropathy, Polyarteritis nodosa

153
Q

Best treatment for infant born to mother who is (+) for HBsAg?

A

HB Ig + Vaccine immediately

154
Q

Best treatment for patient exposed to Hepatitis B via blood?

A

HB Ig + Vaccine

155
Q

Best treatment for patient exposed to Hepatitis B via sexual contact?

A

HB Ig

156
Q

Best treatment for patient exposed to Hepatitis B via household contact?

A

HB Ig

157
Q

2 indications for Hepatitis B treatment?

A

Elevated ALT, Moderate fibrosis on liver biopsy

158
Q

DOC regimen for Hepatitis B?

A

IFNa + Tenofovir/Entecavir

159
Q

2 contraindications to IFNa treatment of Hepatitis B?

A

Depression, Decompensated liver cirrhosis

160
Q

Which drug should be included in HAART therapy for patient with HIV + Hepatitis B?

A

Tenofovir

161
Q

Of patients with Hepatitis C, ___% will develop chronic disease

A

75-85%

162
Q

How should patients with asymptomatic Hepatitis C be screened for hepatocellular carcinoma?

A

US

163
Q

3 extrahepatic manifestations of Hepatitis C?

A

Mixed cryoglobulinemia, Membranoproliferative glomerulonephritis, Porphyria cutanea tarda

164
Q

3 components of treatment for Hepatitis C?

A

IFNa, Ribavirin, NS3/4A protease inhibitors

165
Q

NS3/4A protease inhibitors contain suffix “___”

A

-previr

166
Q

NS3/4A protease inhibitors are active against which genotype of Hepatitis C?

A

HCV genotype 1

167
Q

2 contraindications to IFNa treatment of Hepatitis C?

A

Depression, Cytopenia

168
Q

1 contraindication to Ribavirin?

A

Pregnancy (teratogenic)

169
Q

Route of transmission for Hepatitis E?

A

Fecal-oral

170
Q

Complication of Hepatitis E?

A

Fulminant liver failure in pregnant females

171
Q

Serologic test that can be used to diagnose Primary Biliary Cholangitis?

A

Anti-Mitochondrial Ig

172
Q

3 treatments for Primary Biliary Cholangitis?

A

Vitamin ADEK, Ursodeoxycholate, Colchicine

173
Q

MOA of Ursodeoxycholate in treatment of Primary Biliary Cholangitis?

A

Synthetic bild acid

174
Q

Definitive treatment for Primary Biliary Cholangitis?

A

Liver transplantation

175
Q

Condition associated with Primary Sclerosing Cholangitis?

A

Ulcerative colitis

176
Q

Appearance of Primary Sclerosing Cholangitis on ERCP?

A

Beading appearance

177
Q

Malignancy associated with Primary Sclerosing Cholangitis?

A

Cholangiocarcinoma

178
Q

Temporary treatment of Primary Sclerosing Cholangitis?

A

Dilation of liver strictures

179
Q

Definitive treatment of Primary Sclerosing Cholangitis?

A

Liver transplantation

180
Q

Which intervention does NOT change course of disease in Primary Sclerosing Cholangitis?

A

Colectomy

181
Q

Triad of clinical symptoms seen in setting of Hereditary Hemochromatosis?

A

Skin bronzing, Arthritis, DM

182
Q

Appearance of wrist XR in setting of Hereditary Hemochromatosis?

A

Hook-shaped osteophytes, Calcifications of triangular fibrocartilage

183
Q

Cardiac change associated with Hereditary Hemochromatosis?

A

Restrictive cardiomyopathy

184
Q

Which type of CA is associated with Hereditary Hemochromatosis?

A

Hepatocellular carcinoma

185
Q

Ferritin level that Is diagnostic in Hereditary Hemochromatosis?

A

Ferritin > 300

186
Q

Transferrin saturation that is diagnostic in Hereditary Hemochromatosis?

A

Transferrin > 50%

187
Q

Which gene is mutated in Hereditary Hemochromatosis?

A

HFE

188
Q

Treatment for Hereditary Hemochromatosis?

A

Phlebotomy

189
Q

Treatment for Hereditary Hemochromatosis in patient what develops anemia after phlebotomy?

A

Deferoxamine

190
Q

Definitive treatment for Hereditary Hemochromatosis?

A

Liver transplant

191
Q

Inheritance pattern of Wilson Disease?

A

AR

192
Q

3 sites of copper deposition seen in Wilson Disease?

A

Liver, Brain, Eyes

193
Q

2 most common clinical signs of Wilson Disease in adolescents?

A

Psychosis, Elevated LFTs

194
Q

2 DOCs for treatment of Wilson Disease?

A

D-penicillamine, Zinc

195
Q

Best treatment for patient with small varices, never bled?

A

Propranolol

196
Q

Best treatment for patient with small varices, never bled; Propranolol is contraindicated?

A

Band ligation

197
Q

Best treatment for patient with large varices, never bled?

A

Propranolol, or band ligation

198
Q

Best treatment for patient with actively-bleeding varices?

A

Band ligation + IV octreotide

199
Q

Best treatment for patient with recurrent varices, not actively-bleeding?

A

TIPS procedure

200
Q

TIPS procedure stands for …

A

Transjugular Intrahepatic Portal Shunting

201
Q

AE of TIPS procedure?

A

Increased hepatic encephalopathy

202
Q

Benefit of TIPS procedure?

A

Reduces variceal bleeding + ascites

203
Q

Downside of TIPS procedure?

A

No effect on mortality

204
Q

Recommended screening for liver cirrhosis with no varices?

A

EGD every 2-3 years

205
Q

Paracentesis shows bloody ascites – diagnosis?

A

Cancer

206
Q

Paracentesis shows cloudy ascites – diagnosis?

A

Infection

207
Q

Paracentesis shows milky ascites – diagnosis?

A

Lymphatic obstruction

208
Q

Recommended sodium restriction for ascites?

A

< 2000 mg/day

209
Q

Recommended albumin supplementation for paracentesis?

A

8g albumin per L of aspirated fluid

210
Q

Diagnostic test that suggests Spontaneous Bacterial Peritonitis?

A

Ascites that shows PMNs > 250/mL

211
Q

Clinical presentation of Spontaneous Bacterial Peritonitis?

A

Fever, chills, abdominal pain

212
Q

3 most common organisms responsible for Spontaneous Bacterial Peritonitis?

A

E. coli, Klebsiella, Strep pneumoniae

213
Q

Best treatment for Spontaneous Bacterial Peritonitis?

A

Cefotaxime + Albumin (survival benefits)

214
Q

3 events that might precipitate hepatic encephalopathy?

A

GI bleeding, Hypokalemia, Alkalosis

215
Q

Lactulose is a type of …

A

Disaccharide

Rizk Review (19 decks)

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