Gastrointestinal Review Flashcards
1
Q
What is the term for difficulty swallowing?
A
Dysphagia
2
Q
Birds beak esophagus on barium swallow should make you think of what diagnosis?
A
Achalasia
3
Q
What is the most common location for an anal fissure?
A
Posterior midline
4
Q
Crohn’s is found where in the GI tract?
A
It can be from esophagus to anus.
5
Q
What does HBsAG (hep B surface antigen) indicate?
A
Active Hep B infection
6
Q
How do you treat achalasia?
A
Loosen up the muscle - botox, dilation or surgery.
7
Q
A corkscrew appearance on barium study should make you think of what diagnosis?
A
Esophageal spasms
8
Q
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
A
Pancreatitis
9
Q
In order to contract hepatitis D what must you already have?
A
Hepatitis B
10
Q
Left lower quadrant pain and tenderness should make you think of what diagnosis?
A
Diverticulitis
11
Q
What is the treatment for most Mallory-Weiss tears?
A
Watchful waiting, these will typically resolve within 48 hours.
12
Q
Thumbprint sign on abdominal film should make you think of what diagnosis?
A
Intestinal ischemia
13
Q
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
A
Early they are hyperactive. Late they are absent.
14
Q
A patient has had GERD for years. Over the past year he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
A
Esophageal strictures
15
Q
What are two treatments you should consider for esophageal strictures?
A
Dilation of the esophagus and long term PPIs.
16
Q
What are two common predisposing factors for esophageal varices?
A
Portal HTN and cirrhosis often caused by alcoholism.
17
Q
What is a common symptom that goes along with chest pain for GERD patients?
A
Dry cough
18
Q
What medication is most commonly used for long term treatment of GERD?
A
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole.
19
Q
What is the imaging modality of choice for pancreatitis?
A
CT
20
Q
What is the best test to check for H. pylori?
A
Urea breath test
21
Q
Is peptic ulcer disease more common in the duodenum or the stomach?
A
Duodenum
22
Q
What is the most common location for a pancreatic tumor?
A
75% occur in the head of the pancreas.
23
Q
With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?
A
Exacerbated
24
Q
Fasting gastrin will be above what level with gastrinoma?
A
> 150 pg/ml
25
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
26
Most gallstones are made of what substance?
Cholesterol
27
What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?
Murphy's sign, Cholecystitis
28
What is the most specific test for acute cholecystitis?
HIDA
29
What is the gold standard for diagnosis and treatment of bile duct stones?
ERCP
30
What is Charcot's triad?
RUQ pain, fever, jaundice
31
What is Reynold's pentad and why does it matter?
Charcot's triad + hypotension + altered mental status. It indicates high risk of sepsis.
32
What disease is defined as an immunologic response to gluten?
Celiac
33
What is the main risk factor for esophagitis?
Immunocompromised patient
34
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
35
List two common offending agents for pill induced esophagitis?
NSAIDS, KCL, iron, antibiotics
36
A thirty year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
Scleroderma
37
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
Zenker's diverticulum
38
What is the most common cause of peptic ulcer disease?
H. pylori
39
What is most specific diagnostic test for peptic ulcer disease?
Endoscopy
40
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
41
A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Cholecystitis
42
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
43
What is the most common cause of acute bacterial cholangitis?
Choledocholithiasis
44
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
45
What two viral hepatitis infections are self limiting?
Hepatitis A and hepatitis E
46
Pica is often related to what type of anemia?
Iron deficiency anemia
47
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection.
48
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B.
49
What it is the recommended treatment for hepatitis C infection?
Pegylated interferon alpha-2
50
What medication used in hepatitis B infection helps prevent the need for liver transplant?
Lamivudine
51
There are vaccines for which two versions of hepatitis?
Hepatitis A and hepatitis B
52
Will a patient with achalasia have dysphagia to liquids, solids or both?
Both
53
If you have heartburn that does not improve with medication what is the most likely diagnosis?
Gastrinoma
54
What are the two main complications of cirrhosis?
Portal HTN & liver insufficiency
55
What is a good beta blocker to reduce portal HTN?
Propranolol
56
What tumor marker may be used for liver cancer?
alpha-Fetoprotein
57
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
58
Describe Cullen's sign.
Umbilical ecchymosis often related to pancreatitis.
59
What are the 5 points of Ranson's criteria on admission?
older than 55, WBC>16, glucose>200, LDH>350, AST>250
60
What is the first step in treating GERD?
Lifestyle modification
61
Steatorrhea should make you think of what diagnosis?
Pancreatitis
62
Describe Courvoisier's sign.
Nontender, palpable gall bladder which may indicate pancreatic neoplasm.
63
What tumor maker can be used to follow pancreatic cancer?
CA-19-9
64
A patient complains of periumbilical pain which has now moved over McBurney's point. What is the most likely diagnosis?
Appendicitis
65
Describe how to perform the psoas sign.
The patient is supine and attempts to raise right leg against resistance.
66
What is the term for painful swallowing?
Odynophagia
67
Describe how to perform the obturator sign.
The patient is supine and attempts to flex and internally rotate right hip.
68
What is the best imaging study for acute appendicitis?
CT
69
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody.
70
How much fiber should you normally get in a day?
About thirty grams
71
What treatment should be started for asymptomatic diverticulosis?
None
72
Is surgery curative for Crohn's or ulcerative colitis?
Ulcerative colitis
73
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
74
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
Crohn's disease
75
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products - sulfasalazine, mesalamine.
76
Currant jelly stool should make you think of what diagnosis?
Intussusception
77
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
78
What is the most common cause of lower GI bleed?
Diverticulosis
79
What is the most common location of colorectal cancer?
Cecum about 38%
80
Colorectal cancer patients are almost all older than what age?
90% of patients are older than 50.
81
An epigastric olive shaped mass should make you think of what diagnosis?
Pyloric stenosis
82
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
83
Under routine circumstances when should patients begin getting screening colonoscopies?
Age 50
84
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
85
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
86
Which is more likely to pass into the scrotum, a direct or indirect hernia?
Indirect
87
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
88
What is the first line of treatment for an anal fissure?
Fluid and fiber
89
What are two things that an anal fissure off midline might suggest?
Crohn's, syphilis, HIV, neoplasm
90
What medical treatment is given for a gastrinoma?
Proton pump inhibitors
91
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
92
How do you treat an H. pylori infection?
PPI + 2 Abx, commonly omeprazole + clarithromycin and amoxicillin or PPI +metronidazole + tetracycline.
93
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
94
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
95
What is the most common anorectal problem affecting patients over 50?
Hemorrhoids
96
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
97
Salivary amylase breaks down what macronutrient?
Carbohydrates
98
What is the medical term for feeling like there is a lump in your throat?
Globus
99
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
100
Describe Grey-Turner's sign.
Flank ecchymosis often related to pancreatitis.
101
What are the first three steps of managing pancreatitis?
NPO, pain control, fluids
102
A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis?
Gastric volvulus
103
What is the most common cause of a folate deficiency?
Alcoholism
104
Should diverticulitis always be admitted?
No mild cases can be treated as outpatients with rest and clear fluids.
105
Which NSAID has the highest rate of peptic ulceration?
Naproxen
106
What is the diagnostic test of choice for Zenker's diverticulum?
Barium swallow will show the diverticulum.
107
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
108
At what age and how often should fecal occult blood tests be performed as a screening tool?
Beginning at age 50 and they should be done every year.
109
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma.
110
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias makeup 50% of all adult hernias.
111
How is celiac disease most commonly diagnosed?
Endoscopic biopsy
112
Define pellagra?
Niacin (B3) deficiency
113
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Cytomegalovirus
114
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful.
115
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
116
Does adenocarcinoma arises from the proximal or distal esophagus?
Distal
