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#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 > GASTROINTESTINAL > Flashcards

GASTROINTESTINAL Flashcards

1
Q

Organisms that produce ENTEROTOXIN. Prominent symptoms include Vomiting and diarrhea (watery). Incubation period 8-72 hrs.

A
  • V. cholerae
  • Enterotoxigenic E.coli
  • K. pneumoniae
  • Aeromonas spp
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2
Q

There is an interval between the disappearance of HBsAg and the appearance of anti-HBsAb. This period is referred to as the ____.

A

WIndow period

During this interval, anti–hepatitis B core antigen (anti–HBc) is the only detectable serology

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3
Q

MOST common cause of LGIB

A

Hemorrhoids

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4
Q

GASTRIC OR DUODENAL ULCER?

Risk of Malignancy is common and should be biopsied

A

Gastric ulcer

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5
Q

In the ICU setting, a rising ___ may be a sign of an occult GI bleeding.

A

BUN

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6
Q

What are the two types of gallstones?

A

o Cholesterol stones (90%): contain >50% cholesterol monohydrate

o Pigment stones: composed primarily of Ca2+

  • Black type (common in those with chronic hemolytic states)
  • Brown type (due to chronic biliary infection)
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7
Q

Benign GUs are MOST often found

A

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

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8
Q

What is the most common non-infectious cause of acute diarrhea?

A

Side effect of medications

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9
Q

“Cork-screw” esophagus

A

Diffuse esophageal spasm

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10
Q

Now the single most common risk factor for Hepatitis C is ____

A

injection drug use

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11
Q

Best diagnostic work-up for pancreatitis

A

CT scan of the abdomen with IV contrast (done 3-5 days into hospitalization when patients are not responding to supportive care to look for local complications such as necrosis)

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12
Q

urgent endoscopy age cutoffs are:

A
  • >55 for dyspepsia with alarm
  • >40 for PUD with alarm
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13
Q

Common first line H. pylori treatment:

A

o Triple therapy: “OCA” - Omeprazole + Clarithromycin + Amoxicillin

o Quadruple therapy: “TOMB” - Tetracycline + Omeprazole + Metronidazole + Bismuth

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14
Q

n children and adolescents – MOST common colonic cause of significant GIB

A

IBD and juvenile polyps

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15
Q

Loperamide dose.

A

Loperamide 4mg/tab 1 tab as initial dose then 2mg after each loose stool is recommended. Maximum dose of Loperamide is 8mg/day.

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16
Q

Most severe histologic consequence of GERD

A

Barrett’s metaplasia with the associated risk of adenocarcinoma

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17
Q

How do you classify hemorrhoidal disease?

A

o External hemorrhoids: originate below dentate line, covered by squamous epithelium, and are painful when thrombosed

o Internal hemorrhoids (majority): originate above dentate line, covered with mucosa

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18
Q

aberrant blood vessels from dilatation of the terminal aspect of the blood vessel

A

Angioectasia

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19
Q

AST:ALT < 1

A

chronic viral hepatitis, NAFLD

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20
Q

What is the initial treatment of cirrhotic ascites?

A

Restriction of sodium intake (next line of management: Spironolactone + Furosemide)

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21
Q

presence of IDA, weight loss, symptoms of obstruction, abdominal pain, BM changes

A

Colonic mass

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22
Q

most frequent visceral site of metastasis of colon CA

A

Liver

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23
Q

the first serologic marker to appear after infection with Hepatitis B. This is repeated after 6 months for those who had an acute Hepatitis B infection to document chronicity

A

HBsAg

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24
Q

AST:ALT > 2

A

alcoholic liver disease

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25
Q

GOLD standard for confirmation of Barrett’s esophagus

A

Endoscopic biopsy

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26
Q

Child-Pugh classification of liver failure is still a reliable prognosticator for tolerance of hepatic surgery – only Child A should be considered for resection. Enumerate the components for scoring.

A
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27
Q

Useful INITIAL diagnostic test when mechanical obstruction is suspected

A

Endoscopy

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28
Q

Procedures of choice for visualization of biliary tree

A

ERCP, MRCP

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29
Q

Gold standard in diagnosing most liver diseases

A

Liver Biopsy

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30
Q

Differentiate Ulcerative colitis from Chron’s disease

A
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31
Q

distinguish portal HPN vs nonportal HPN

A

Serum-ascites-albumin-gradient (SAAG):

o SAAG ≥1.1 g/dL: presence of portal hypertension

o SAAG <1.1 g/dL: not related to portal hypertension

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32
Q

Charcot’s triad of cholangitis:

A

o Fever

o Pain

o Jaundice

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33
Q

What is the mainstay of treatment for hepatic encephalopathy?

A

Lactulose

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34
Q

drop in systolic pressure of > 20 mm Hg or a rise in pulse of > 10 beats per minute

A

Orthostasis

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35
Q

Two predominant causes of PUD

A

NSAID ingestion infection

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36
Q

Forrest classification of ulcers

A
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37
Q

Non-invasive H.pylori tests

A

Urea breath test

Serology

Stool Angtigen

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38
Q

liver or biliary tract disease, Dubin-Johnson, Rotor

A

Conjugated bilirubinemia

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39
Q

GASTRIC OR DUODENAL ULCER?

Precipitated by food

A

GASTRIC ULCER

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40
Q

Cervical CA screening

A

at age 21-65 PAP every 3 years

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41
Q

predominates during 1 st 6 months after acute infection. Present even at the window period

A

IgM Anti-HBc

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42
Q

MOST common esophageal symptom

A

Heartburn / pyrosis

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43
Q

Review the serology in viral Hepatitis B

A
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44
Q

an area of discoloration in the periumbilical area seen in pancreatitis

A

Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage

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45
Q

hallmark symptom of liver disease & most reliable marker of severity

A

Jaundice

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46
Q

Organisms that produce PREFORMED TOXINS. Prominent symptom include vomiting and watery diarrhea

A
  • Bacillus cereus
  • Staphylococcus aureus

Clostridium perfringens

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47
Q

Tests to document H. pylori eradication (think GI tract as the source!):

A

o Urea breath test (gastric) - test of choice

o Stool antigen (intestines)

o Rapid urease test (gastric)

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48
Q

Most common complication of peptic ulcer disease (PUD)

A

GI bleeding

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49
Q

Stigmata of Cirrhosis

A

o Palmar erythema o Spider angiomata o Gynecomastia o Testicular atrophy o Dupuytren’s contractures o Caput medusae

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50
Q

Organisms that produce CYTOTOXIN. Prominent symptom is crampy abdominal pain.

A
  • C. difficile
  • Hemorrhagic E.coli
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51
Q

Staging and Treatment of hemorrhoids

A
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52
Q

Mass located in this location:

§ develop obstruction and even perforation

§ X-ray often shows “apple-core or napkin-ring” deformity annular, constricting lesion

A

transverse and descending colon

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53
Q

MOST frequent finding in GU or DU

A

Epigastric tenderness

54
Q

Level of obstruction in the portal venous system in portal hypertension due to Budd-Chiari syndrome

A

Posthepatic

55
Q

most important treatment intervention in pancreatitis

A

Safe, aggressive intravenous fluid resuscitation

56
Q

first line ancillary procedure if blood tests suggest cholestasis

A

Ultrasound

57
Q

Classification of portal HTN

A
58
Q

Procedure of choice for detection of stones?

A

Gallbladder UTZ

59
Q

indicates presence of portal hypertension

A

SAAG ≥1.1 g/dL

60
Q

The Bedside Index for Severity in Acute Pancreatitis (BISAP) score has been developed to identify patients at high risk for mortality or severe disease early during the course of acute pancreatitis.

The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis.

Enumerate the parameters for the scoring.

A
61
Q

GASTRIC OR DUODENAL ULCER?

  • Occurs 90 min to 3 hrs after a meal
  • Relieved by antacids or food
A

DUODENAL ULCER

62
Q

Test of choice for documenting eradication of H.pylori

A

Urea breath test

63
Q

Mainstay of treatment of nonalcoholic fatty liver disease

A

Weight loss and exercise

64
Q

Endoscopic therapy of CHOICE for esophageal varices

A

Ligation

65
Q

recommended as the initial test in unexplained dyspepsia >55 years old or who have alarm factors because of the purported elevated risks of malignancy and ulcer

A

Upper endoscopy

66
Q

MOST common cause of UGIB

A

Peptic ulcer

67
Q

CENTRAL role in gastric epithelial defense/ repair

A

Prostaglandin

68
Q

drop in blood pressure or rise in pulse from a lying to a standing or seated position

A

Orthostatic hypotension

69
Q

If local anal processes, which rarely require hospitalization, are excluded, the most common causes of LGIB in adults are ____________

A

diverticula, vascular ectasias (especially in the proximal colon of patients >70 years), neoplasms (primarily adenocarcinoma), colitis (ischemic, infectious, idiopathic inflammatory bowel disease), and post- polypectomy bleeding.

70
Q

Phase of hepatitis characterized with Anorexia, nausea, vomiting, malaise, arthralgia, headache, pharyngitis, cough, coryza precede onset of jaundice by 1-2 weeks

A

Prodromal phase

71
Q

Responsible for MAJORITY of cases of obscure GIB

A

Small intestinal sources of bleeding

72
Q

________ is the leading cause of acute pancreatitis; followed by alcohol.

A

gallstone

73
Q

Alkaline phosphatase > AST, ALT

A

cholestatic conditions

74
Q

CLASSIC symptoms of GERD

A

Water brash and substernal heartburn

75
Q

Alarming manifestations (requiring endoscopy)

A

o Dysphagia

o Weight loss

o Anemia

o Bleeding

76
Q
A
77
Q

Presence of scleral icterus indicates total bilirubin level of at least ___

A

2.5-3mg/dL

78
Q

Elevation of AST/ALT >1000 U/L

A

o Viral hepatitis

o Ischemic liver injury

o Toxin- or drug-induced liver injury

79
Q

Lung CA screening

A

at age 55-80 if with at least 30 pack years of smoking history, and have been smoking for the last 15 years, do a plain chest CT scan at least once

80
Q

Most common organism in spontaneous bacterial peritonitis (SBP)

A

Escherichia coli

81
Q

MOST common cause of significant lower GIB in children

A

Meckel’s diverticulum

82
Q

MOST common cause of esophageal chest pain

A

Gastroesophageal reflux

83
Q

MAINSTAY of treatment of PUD

A

Eradication of H. pylori and therapy / prevention of NSAID induced disease

84
Q

treatment for chronic hepatitis B infection and is part of an antiretroviral prophylaxis if the patient was HIV positive.

A

Oral Lamivudine

85
Q

MOST potent acid inhibitory agents available

A

Proton Pump inhibitors

86
Q

most discriminating symptom of duodenal ulcer

A

Pain that awakens the patient from sleep

87
Q

MOST sensitive test for diagnosis of GERD

A

24-h ambulatory pH monitoring

88
Q

most common physical sign (50-90%) of hepatocellular CA.

A

Hepatomegaly

89
Q

manifesting as ecchymosis or discoloration of the flanks. seen in pancreatitis

A

Grey Turner’s sign refers to an uncommon subcutaneous manifestation of intra-abdominal pathology manifesting as ecchymosis or discoloration of the flanks.

90
Q

mass in this location become large without any obstructive symptoms or bowel habit changes. But they commonly ulcerate leading to chronic blood loss (IDA)

A

cecum and ascending colon

91
Q

Invasive H.pylori tests

A

Rapid urease test

histology

culture

PCR assay

92
Q

Smoking and appendectomy are protective to what type of IBD?

A

Ulcerative Colitis

93
Q

Characteristic symptom of infectious esophagitis

A

Odynophagia

94
Q

for diagnosis of Hepatitis C (no way of determining acute vs chronic Hep C infection via serology)

A

Anti-HCV

95
Q

Breast CA screening

A

at age 50-74 mammography every 2 years

96
Q

Duodenal ulcers occur MOST often in what specific location

A

FIRST portion of the duodenum (>95%)

97
Q

Differentiate types of diarrhea according to duration :

A

o Acute: < 2 weeks

o Persistent: 2-4 weeks

o Chronic: > 4 weeks

98
Q

most common and most characteristic symptoms of liver disease, typically occurs after activity or exercise, rarely after adequate rest (afternoon rather than morning fatigue)

A

Fatigue

99
Q

What are the three hemorrhoidal complexes that traverse the anal canal?

A

Left lateral, right anterior, and right posterior

100
Q

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

A

Cyclooxygenase (COX)

101
Q

What is the next step if esophageal varices are documented?

A

Endoscopic ligation and IV vasoactive medications (e.g., octreotide)

102
Q

Hemorrhoid stage where sclerotherapy is the treatment of choice

A

Stage I with enlargement and bleeding

103
Q

marker for hepatitis A during the acute illness, may persist up to several months

A

IgM Anti-HAV

104
Q

Significant alcohol intake

A

Alcohol intake of 30g or more (3 Pilsen cans) everyday

105
Q

the most common cause of death in pancreatitis

A

Hypovolemic shock

106
Q

BT is recommended when Hgb ____

A

Hgb < 7g/dL

107
Q

classic history of vomiting, retching, or coughing preceding hematemesis, especially in alcoholic patient. Commonly in gastric side of GEJ.

A

Mallory-Weiss tear

108
Q

“Ulcer definition” is ____ depth

A

>5mm

109
Q

Prostate CA screening

A

start at age 50

110
Q

Organisms that produce ENTEROADHERENT TOXIN. Prominent symptom is crampy abdominal pain. Incubation period 1-8 days.

A
  • Enteropathogenic E. coli
  • Enteroadherent E.coli
  • Giardia
  • Cryptosporidiosis
  • Helminths
111
Q

gold standard treatment for high-grade dysplasia

A

Esophagectomy

112
Q

What important serologic test would you request to check for acute viral hepatitis A and B?

A

Anti-HAV IgM

HBsAg and Anti-HBc IgM

113
Q

GASTRIC OR DUODENAL ULCER?

Pathophy: Gastric acid output normal or decreased

A

Gastric Ulcer

114
Q

What is the characteristic bleeding of diverticular bleeding?

A

Abrupt in onset, painless, sometimes massive, and often from the right colon (chronic/occult bleeding is not characteristic)

115
Q

MOST common cause of obscure GIB in adults

A
  • Vascular ectasia, tumors, NSAID induced
  • For <40-50 years: small bowel tumors
  • For >50-60 years: vascular ectasia, NSAID-induced
116
Q

Screening for colon CA schedule:

A

• At age 50 (10 years younger if with one first degree relative with Colon

CA and if with consideration of familial polyposis start at age 25)

o colonoscopy every 10 years

o Sigmoidoscopy every 5 years

o FOBT annually

117
Q

hemolysis, Crigler-Najjar, Gilbert

A

Unconjugated bilirubinemia

118
Q

Standard indications for testing for H. pylori

A
  • Active PUD
  • History of PUD without prior treatment
  • MALT
  • Uninvestigated dyspepsia (if population prevalence >20%)
119
Q

Triad for cholecystitis

A

RUQ tenderness, fever, leukocytosis

120
Q

What are the markers for chronic hepatitis?

A

Persistence of HBsAg or HBeAg

121
Q

represents high level of viral replication and high infectivity

A

Hepatitis B precore antigen (HBeAg)

122
Q

Defined as ≥3 months of bothersome postprandial fullness, early satiety, or epigastric pain or burning with symptom onset at least 6 months before diagnosis in the absence of organic cause

A

Functional dyspepsia

123
Q

protruding rectal mass with occasional pain and blood streaked stools

A

Hemorrhoidal bleeding

124
Q

Melena: indicates blood present in GIT for at least ______

A

14 hours and as long as 3-5 days

125
Q

Most important mechanism in formation of stone-forming bile?

A

Increased biliary secretion of cholesterol

126
Q

Test of Choice:

  • UGIB: _______
  • LGIB (unless with massive bleed): _____
  • Massive obscure bleed: _____
A
  • UGIB: upper endoscopy
  • LGIB (unless with massive bleed): colonoscopy
  • Massive obscure bleed: angiography
127
Q

Complications of PUD

A

Most common: gastrointestinal bleeding

Second most common: perforation

Least common: gastric outlet obstruction

128
Q

Portal HPN: defined as elevation of hepatic venous pressure gradient >____

A

>5 mmHg

129
Q

GASTRIC OR DUODENAL ULCER?

Gastric acid output is ­increased and HCO3 secretion is decreased

A

Duodenal Ulcer

130
Q

infectious, ischemic, drug-induced (NSAID); frequently accompanied by diarrhea

A

Colitis

#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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