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UWORLD ABIM > GI > Flashcards

GI Flashcards

1
Q

mgmt rectovaginal fistual

A

IBD related:

  • asx: observe
  • mild: cipro/flagyl
  • mod to severe: Infliximab first! (any anti-tnf)…only if persistent dz then surgery

Non-IBD: surgery

20-30% crohns pt will develop anorectal fistula

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2
Q

Mgmt post corrosive ingestion

A
  • CXR and abdominal xray will identify perforation
  • if no perf on xrays, early EGD w/in first 24 hours to assess and grade esophageal involvement

acute mgmt does not have role for barium swallow (can ID strictures later)

No NG insertion b/c can induce perforation

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3
Q

common complications of Roux-en-y

A
  1. Stomal Stenosis (20%): n/v/abdominal pain/early satiety. Dx EGD. Tx endoscopic balloon dilation
  2. Cholelithiasis (40%): give prophy URSDA for up to 6 mo post op
  3. Dumping syndrome (50%): abdominal pain, n, hypotension, reflex tachycardia. Avoid by replacing simple carbs for complex carbs
  4. SIBO: abdominal distention, flatulence, diarrhea. macrocytic anemia. fat malabsorption (D, A, B1, b12).
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4
Q

SIBO

A

Cause: strictures/surgery (anatomical) or motility (DM, scleroderma)
Dx: jejunal aspirate or positive hydrogen breath test
Tx: abx (rifaximin, augmentin), avoid opiates, increase fat and reduce carbs in diet, promotility agents

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5
Q

Anemia in celiac disease

A

microcytic from iron deficiency

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6
Q

T/F: All patients with UGI found to have ulcer should be admitted

A

False, if clean base ulcer and stable its low risk and give regular diet and DC on once-daily PPI

high risk features = active bleeding, visible vessel, adherent clot

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7
Q

Tx of recurrent c dif

A

First recurrence: Vanc PO in a prolonged taper

Multiple recurrence: Vanc PO followed by rifaximin

can use fidaxomicin instead of vanc. recurrence due to spores, not resistance to meds

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8
Q

fatigue and pruritis with cholestatic labs in a middle age female

A

Primary biliary cholangitis

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9
Q

Tx for PBC

A

URSDA (delays progression)

Risk of osteoporosis/osteomalacia so give Ca and Vit D supp

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10
Q

Anti-HBs ( Hepatits B surface antibody)

A

If + Hepatitis B core antibody, IgG (anti-HBc): Resolved Previous Infection

If - anti-HBc: immunity from previous vaccination

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11
Q

HBsAg (surface antigen)

A

if + anti-HBc, IgM (core antibody IgM): acute HBV

if + anti-HBc, IgG: chronic inactive carrier state

Anti-HBs is negative in acute and chronic infection

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12
Q

how to tell acute/chronic HBV versus resolved

A

HBsAG: positive in acute and chronic infections

Anti-HBs: positive in resolved previous infection (and those with immunity from prior vaccine)

These are not positive together ever

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13
Q

Hep B serologies

A

HBcAb: Exposure
HBsAg: Infection
HBsAb (Anti-HBs): Immunity

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14
Q

T/F: Lipase levels remain elevated in chronic pancreatitis

A

False, usually normal. Presents with abdominal pain and pancreatic insufficiency (steatorrhea, malabsorption, diabetes)

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15
Q

Failure of initial standard triple therapy for H Pylori

A

Occurs in 20%

Step 1: Eradication testing (urea breath test, fecal Ag test or repeat EGD)

  • if positive: quadruple therapy or different triple therapy
  • note: PPIs reduce sensitivity of these tests (so if + on PPI, highly likely positive)
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16
Q

Treatment reg for H Pylori

A

Triple Therapy:
PPI + Clarithromycin + Amoxicillin
or
(alt)PPI + Clarithromycin + Metronidazole

Quadruple Therapy: PPI + Bismuth + Metronidazole + Tetracycline

all regimens 10-14 days

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17
Q

T/F: In absence of alarm features for GERD, EGD is not indicated prior to failure of 4-8 weeks of bid PPI therapy

A

TRUE. ALarm sxs i.e. wt loss, GI bleed, dysphagia, odynophagia.

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18
Q

Presentation and mgmt of the most common cause of esophagitis in AIDs patient

A

Candida

  • mild to mod odynophagia (pain mild compared to CMV, HSV)
  • oral thrush (not always present)
  • dysphagia

Tx with empiric trial of oral fluconazole (Nystatin doesn’t work in HIV patients) aka don’t need EGD if high clinical suspicion. unless red flag sxs

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19
Q

Peritoneal dialysis associated peritonitis

A

wbc>100 or neutrophil >50%. may not have fever or leukocytosis. Tx with intraperitoneal vanc and ceftriaxone/cefepime

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20
Q

Liver disease + neuropsychiatric dz in young patient

A

Wilson dz. All get slit lamp. Dx by increased serum/urine Copper and low ceruloplasmin. Tx with pencillamine or trientine to prevent permanent sequelae.

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21
Q

Most common cause of acute liver failure in US

A

Acetaminophen toxicity

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22
Q

T/F: Cholecystectomy should be performed after recovery from gallstone pancreatitis

A

True!! Reduce risk of recurrence. do it BEFORE discharge

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23
Q

Features suggestive of celiac disease but negative serology

A

Measure serum IgA levels, high prevalence of deficiency in celiac patients (only test if serology neg).

Patient with + serology or highly suggestive need endoscopy with biopsy (“small bowel enteroscopy”) to confirm dx PRIOR to starting gluten-free diet (reduces biopsy sensitivity). A cutaneous bx showing dermatitis herpetiformis is also diagnostic.

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24
Q

Differentiate eosinophilic esophgitis from pill-induced esophagitis

A

EE: Dysphagia (difficulty swallowing) and chest pain and heartburn. Usually in young man with history of atopy (asthma, allergies) i.e. Roshee

PIE: Odynophagia (painful)…and retrosternal CP
PIE is PAINFUL IF EATING

Neither need EGD routinely.

For EE: dietary modifications, swallowed fluticasone/budesonide (topical glucocorticoid). Eval includes 8 week trial of a PPI

for PIE: DC offending agent and supportive, will self-resolve

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25
Q

Barium esophagram is used for:

A

diagnosing anatomical abnormalities and neuromuscular disorders (achalasia)

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26
Q

EGD findings in EE

A

longitudinal furrows, multiple esophageal (concentric) rings, white specks and mucosal friability

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27
Q

first step in any patient with impaired gastric motility

A

EGD to exclude gastric outlet obstruction from mechanical/mucosal etiology. even if highly suspicious for gastroparesis

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28
Q

marked colonic dilation without mechanical obstruction (no TP) in a hospitalized/institutionalized man >60

A

Ogilvie syndrome: acute colonic pseudo-obstruction.

Treat conservatively, serial abdominal exam and xray to eval perforamtion. NG/rectal tube decompression. Consider Neostigmine for those who fail conservative management, though theres many CI

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29
Q

Chronic diarrhea in middle aged female with normal appearing mucosa

A

Likely microscopic colitis (r/o celiac). biopsy shows lymphocytic infiltration. Remove triggers (nsaids), try antidiarrheal agents (loperamide, bismuth) and can use oral budesonide . No increased risk for malignancy

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30
Q

Chest pain and respiratory distress after forceful vomiting

A

Booerhaave syndrome.

Clues:

  • rapid development of pleural effusion (usually left-sided)
  • subcutaenous emphysema (mediastinal air/retrocardiac air shadow)
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31
Q

UC patient with elevated alk phos

A

PSC

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32
Q

Antibodies positive in Autoimmune Hepatitis (young/middle aged females with range from asx LFT elevation to acute liver failure)

A

Anti-smooth muscle

Anti-liver/kidney microsomal antibody (LKM-1)

ANA

false positive HCV AB

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33
Q

Diagnosing hepatopulmonary syndrome

A

Need contrast echo (bubble study), will show intrapulmonary vascular dilations (IVPD). this causes R->L shunting and manifests in platypnea (dyspnea when sitting upright relieved supine) and orthodeoxia (opposite of orthopnia)

no good tx other than liver transplant

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34
Q

If you suspect spontaneous esophageal rupture (Booerhave):

A

Contrast esophogram is the study of choice. A CXR may show mediastinal or free peritoneal air, f/u with the contrast esophgram or CT.

Pleural fluid analysis would show very high amylase.

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35
Q

Interpret SAAG

A

SAAG>1.1 = portal hypertension from cirrhosis or HF
Look at ascitic fluid protein
<2.5 = cirrhosis
>2.5 = HF, budd-chiari

SAAG <1.1 “are you KIDding me?”
Ascitic protein
<2.5 = nephrotic syndrome
>2.5 = malignancy, TB

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36
Q

Acetaminophen overdose

A

acute liver failure with LFTs in thousandssss

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37
Q

middle aged female with fatigue, pruritis, elevated alk phos

A

Primary biliary cholangitis

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38
Q

T/F: IDA is typically seen in celiac dz

A

true

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39
Q

Pseudoachalasia

A

older patient with achalasia sxs. Screen for malignancy (obstructive) with EUS or CT

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40
Q

Tx for achalasia

A
  • Pneumatic dilation or surgical myotomy

- if they’re old and would not be a good candidate for procedure, botox injection

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41
Q

intermittent dysphagia to solids/liquids (especially cold liquids)

A

DES. Barium swallow with corkscrew appearance

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42
Q

Tx for DES

A

CCB

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43
Q

Young patient with intermittent solid food dysphagia

A

Schatzki ring (intermittently catches on it)

vs peptic stricture in older patient

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44
Q

esophageal cancer

A

Upper 2/3: Squamous cell (smoking, drinking)

Lower 1/3: adenocarcinoma (reflux, barretts)

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45
Q

IDA + dysphagia in elderly women

A

plummer vinson syndrome (web in upper esophagus)

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46
Q

EoE EGD

A

stacked circular rings,trachEEEEEEalization, friability.

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47
Q

Food impaction and dysphagia in young adult with hx of asthma/eczema/allergic rhinitis

A

Eosinophilic esophagitis

Dx with EGD w/biopsy

Tx with PPI or swallowed fluticasone/budesonide

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48
Q

common meds for pill induced esophagitis

A

doxycycline, nsaids, KCl, iron, alendronate

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49
Q

Initial approach to dyspepsia

A

<60: H pylori test and treat. If + H pylori, tx. Persistent sxs then 8 weeks PPI. + sx still low-dose TCA.

> 60: EGD

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50
Q

Meds to stop before H pylori testing

A

Stop PPI for 2 weeks

Stop Abx for 4 weeks

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51
Q

H pylori tx

A 
Triple Therapy: OCLAM
Omeprazole + CLarithromycin + 
Amoxicillin. 
**If pencillin allergy --> 
Metronidazole instead of amox

If they hav e received macrolide (i..e had Zpak a few months ago), then quadruple therapy OBMT:
Omprezole + Bismuth + Metronidazole + Tetracycline

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52
Q

T/F: Low cancer risk in duodenal ulcer

A

True, don’t need post-surveillance really

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53
Q

Zollinger-Ellison syndrome

A

diarrhea, erosive esophagitis, DISTAL ulcers, high gastrin level. Secretin stim test will have same or higher gastrin. can do octreotide scan to localize the gastrinoma. surgical resection, high dose PPI

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54
Q

Presentation and dx of oropharyngeal dysphagia

A

Choking/coughing in a patient with neuro or muscular disorder i.e. stroke patient. Includes Zenker diverticulum fyi.

Dx: Modified barium swallow/videofluoroscopy

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55
Q

T/F: Celiac patients are at risk for intestinal lymphoma

A

true, dietary compliance helps reduce risk

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56
Q

SIBO

A

Dx: carb breath testing (lactulose, glucose) or jejunal aspirate/culture

Tx: - abx (rifaximin, augmentin)
-high fat, low carb diet

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57
Q

T/F: Young patient with dyspepsia, no red flag sxs and normal labs should be treated with PPI trial

A

False, H pylori test and treat first. If negative then PPI trial

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58
Q

screening in IBD patient with PSC

A

annual colonoscopy, inc risk colorectal ca

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59
Q

liver nodule mgmt

A

<1cm: US f/u 3 mo
>1cm: Liver MRI (or multiphase CT)

percutaneous biopsy not usually recommended

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60
Q

colon ca screening in IBD patients

A

8-10 years after dx, then q 1-3 years

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61
Q

colon ca screening in patient with first degree relative +

A

age 40 or 10 years prior to age of dx, whichever is earlier

62
Q

EGD in Z-E syndrome

A

thickened gastric folds, multiple stomach ulcers, ulcers distal to the duodenum (i.e. jejunum). Check gastrin level, then pH. associated with MEN-1 syndrome…usually responds to PPI

63
Q

Mgmt celiac dz

A

Gluten-free diet
Obtain DEXA @ dx, increased risk osteopenia/osteoporosis
Pneumococcal vaccination (at risk for hyposplenism)
Vit def: iron, calcium, vit d, folic acid

no need for colonoscopy

64
Q

Medication for dermatitis herpetiformis

A

dapsone + gluten free diet

65
Q

T/F: always think about c diff when IBD patient has a flare up

A

true

66
Q

UC patient with elevated alk phos or elevated LFTs

A

PSC

67
Q

screening in PSC

A

colonoscopy @ dx and EVERY SINGLE YEAR BRO

68
Q

SIBO is associated with

A

Dysmotility: DM or Systemic Sclerosis

Terminal ileum resection

Pernicious anemia

will see high folate and low b12

Dx: lactulose/glucose/ hydrogen breath test
Tx: antibiotics (Rifaximin, augmentin)

69
Q

Amount of terminal ileum resection for malabsorption

A

<100cm TI resected: bile acid diarrhea. tx with cholestyramine.
>100cm: fatty acid diarrhea. don’‘t use cholestyramine (liver cant keep up when this much is lost and so youre already bile acid deficient).

70
Q

When you see a patient for f/u of diverticulitis…

A

check to see if they are up to date on colonoscopy. if not they should get one in about 8 weeks (when no more inflam)

71
Q

tx of diverticulitis

A

Mild: PO abx and CLD @ home for 7-10 days, usually cipro flagyl

If can’t do oral intake, admit for IV ceftriaxone and fluids

72
Q

T/F: Patient with suspected diverticulitis should get colonoscopy now

A

False, risk of perforation from air insufflation. They do need to get a f/u colonoscopy once resolved if not up to date

73
Q

isolated right-sided ischemic colitis

A

suggestive of SMA thrombus, will need CTa

74
Q

sigmoid volvulus, which patient

A

elderly in institution or neuropsych dz/dementia

75
Q

classic triad for chronic pancreatitis

A

Pancreatic calcification
Diabetes
Steatorrhea

76
Q

double duct sign

A

Both pancreatic duct and common bile duct dilated: consider pancreatic head mass

77
Q

T/F: Patient with symptomatic cholelithiasis should have elective cholecystectomy

A

TRUE

78
Q

gallstone associated with hemolysis

A

pigmented stone

79
Q

acalculous cholecystitis

A

sick ICU patient, needs chole tube

80
Q

Which patients with HBV need US q6 months?

A

those for HCC screening:

  • cirrhosis
  • asian men>40 and asian women>50
  • black patients>20
81
Q

tx for autoimmune hepatitis

A

glucocorticoids + azothioprine

82
Q

treatment for hepatorenal

A

Albumin (volume mgmt)
Octreotide (inc SVR, MAP)
Midodrine (inc SVR)

83
Q

tx for wilson’s

A

penicillamine (chelates the copper) with pyridoxine supplementation

84
Q

Dermatitis, Diarrhea, Dementia

A

Pellagra = Niacin (vit b3) deficiency

85
Q

Thiamine def

A

Wet beri beri: HF
Dry: neuropathy
Wernicke and Korsakoff

86
Q

T/F: Hydroxyurea is helpful to decrease frequency of pain crisis and acute chest syndrome but not useful in acute sick cell mgmt

A

true. need blood or exchange transfusions for acute chest syndrome

87
Q

most common side effect external beam radiation for prostate cancer

A

sexual dysfunction

88
Q

stroke mgmt in sickle cell patient

A

Acute ischemic stroke: exchange transfusion

Recurrent stroke prophylaxis: simle transfusion

note: monitor for iron overload in patients getting chronic transfusions, they need periodic chelation therapy to prevent cirrhosis

89
Q

Tx for Essential thrombocythemia

A

low risk for clot: aspirin
higher risk: hydroxyurea

20% will develop acquired vWB dz: cytoreduction

90
Q

Philadelphia chromosome

A

t9:22, associated with CML

Philadelphia CreaMcheese Lite @ 9:22am

91
Q

JAK2 mutation

A

JACK mutated 2 JAK because he didn’t wear PPE

Polycythemia Vera
Primary Myelofibrosis (MF)
Essential Thrombocythemia

92
Q

associations with polycythemia vera

A
  • low epo, high rbc and hgb (its EPO independent due to JAK2 mutation)
  • pruritis in hot shower
  • check for PV In patient with PVT or budd-chiari (hepatic vein thrombus)
93
Q

low hgb
high wbc
high plt
abdominal pain/splenomegaly

A

usually CML

94
Q

direct coombs (antiglobulin) test

A

to evaluate for autoimmune hemolytic anemia (differentiate from hereditary spherocytosis which would be neg)

95
Q

tx for acute intermittent porphyria

(abdominal pain, autonomic dysfunction i.e. ileus, DARK/REDDISH urine, peripheral neuropathy (painful flaccid paralysis), neuropsych

A

glucose loading and IV hemin

96
Q

vitamin K related clotted factors

A

2, 7, 9, 10

Will see mainly PT prolongation with mild PTT in severe vit k def

97
Q

severe anemia in sickle cell

A
  1. Splenic sequestration (low hgb, inc reticulocytosis, rapidly enlarging spleen)
    Tx: splenectomy
  2. Aplastic crisis
    (markedly low reticulocytosis, usually from infection)
    Tx: supportive (including transfusions, oxygenation, hydration)
  3. Hyperhemolytic crisis
    (sudden worsening of anemia, but increased reticulocytosis. usually after acute sickling events)
98
Q

extra testing if suspecting ITP other than CBC and peripheral smear

A

r/o HIV, HCV (if risk factors)
if >60, bone marrow aspiration recommended to r/u MDS

if plt <30k, high dose oral steroids (1 mg/kg) even if asx

99
Q

Leukocytosis
Lack of symptoms
Lymphadenopathy
Hepatosplenomegaly

A

CLL (most common leukemia)

Dx: peripheral blood smear and flow cytometry of the peripheral blood

don’t really need imaging or LN/bone marrow bx

100
Q

T/F: Primary polycythemia is EPO independent

A

True, usually PV from JAK 2 mutation (so serum EPO would be low).

Secondary polycythemia from hypoxia = increased EPO

101
Q

testing order for suspected achalasia

A
  1. barium swallow (preferred screening test), will show bird beak narrowing
  2. Esophgeal manometry (incomplete LES relaxation, absence of peristalsis)
  3. EGD: r/o adenocarcinoma (pseudoachalasia) at GE j(x)
102
Q

tx for achalasia

A

Pneumatic dilation (endoscopic) and laparoscopic surgical myotomy

103
Q

when could you use ambulatory esophageal pH monitoring or imedeance pH testing

A

GERD sxs refractory to empiric PPI therapy. can get sx and reflux correlation

104
Q

tx for infectious esophagitis

A

Candida: Fluconazole or Itraconazole
CMV: Ganciclovir or foscarnet
HSV: Acyclovir, famciclovir or valacyclovir

*EE: swallowed fluticasone or budesonide

105
Q

T/F: F/u testing to document H pylori eradication should be performed at least 4 weeks after completion of therapy in any patient with positive H pylori

A

TRUE. don’t use serology i.e. elisa for IgG b/c this stays positive for a bit

106
Q

Tx for gastroparesis

A
  • small low fat meals 4-5x/day
  • acute gastroparesis: IV erythromycin
  • chronic: Metoclopramide

**Dystonia and parkinsonian-like tardive dyskinesia can happen from metoclopramide, must be stopped

107
Q

T/F: SIBO occurs most commonly with Roux en y

A

true

108
Q

crampy abdominal pain and loose stools 15 minutes after eating, then lightheadedness/tachycardia within 90 minutes. patient had a roux en y

A

Dumping syndrome (tx with small freq feedings and low carb meals)

109
Q

loose stools and malabsorption following gastric bypass surgery

A

Blind loop syndrome (SIBO)

tx with abx and nutritional supp

110
Q

When do you get CT in pancreatitis patient?

A

NOt always. only if it is severe, lasts longer than 48 hours or complications are suspected

111
Q

When do you do ERCP in gallstone pancreatitis?

A

if suspected ascending cholangitis. otherwise MRCP for dx (can see the stone size, it might pass on its own)

112
Q

autoimmune pancreatitis

A

-huge edematous pancreas (sausage-shaped)
-painless obstructive jaundice usually
Type 1: Increased IgG4. older men. dz like Sjogren, PSC, interstitial nephritis
Type 2: normal IgG, its IBD and chronic pancreatitis related
Tx steroids

113
Q

Yersinia enterocolitica colitis can mimic:

A

appendicitis and Crohns

114
Q

Giardia lamblia and Entamoeba histolytica is diarrhea caused by parasites and requires:

A

metronidazole

115
Q

chronic diarrhea workup

A
  • colonoscopy. view terminal ileum for crohns and take random biopsies of colonic mucosa to assess for microscopic colitis
  • if nondx, 48-72 hour stool collection with analysis of fat content. >14g/day = steatorrhea (eval celiac, SIBO, pancreatic insuff)
116
Q

how do you determine osmotic vs secretory diarrhea

A

Stool osmotic gap.

290 - (2x (Na +K))

>100 = osmotic (concentrated). usually lactase def. Its associated with EATING, improves with fasting and not nocturnal 
<50 = secretory (dilute). Large volume, NOCTURNAL BM, unchanged by fasting. things like VIPoma, gastrinoma (Z-E syndrome), carcinoid
117
Q

Diarrhea in female 45-60, unrelated to food (nocturnal sxs), normal colonoscopy

A

Likely microscopic colitis. Stop nsaids/PPI and bx

118
Q

nocturnal diarrhea and hx of SSc or DM (aka dysmotility)

A

SIBO. can do hydrogen breath test or empiric abx.

can also be seen in terminal ileum resection. may see combo of elevated folate and def of b12

119
Q

recurrent Giardia infections

A

CVID or selective IgA deficiency. check immunoglobulins. may have coexisting pulmonary disease

120
Q

diarrhea in AIDS

A

cryptosporidium

121
Q

Infection with _____ should be considered in patients with diarrhea after exposure to young children or contaminated water (lakes/streams)

A

Giardia lamblia

122
Q

tropical sprue

A

travel to india or puerto rico
malabsorption, folate or b12 def, steatorrhea

Dx small bowel biopsy
Tx: Doxy and folic acid for 6 months

123
Q

prolonged travelers diarrhea after camping/day care

A

Giardiasis. TX with metronidazole.

124
Q

Vasculitis + HBV and neg HCV

A

PAN

125
Q

Treatment of Hep B

A

Main drugs (pick one):

  • Entecavir
  • Tenofivir
  • PEG Interferon is an option with limitations (ok if pregnant, CI if cirrhosis, major depression, autoimmune disorders, severe cytopenias)
  • If HIV also: Emtricabine-Tenofivir
  • Don’t treat in immune tolerant phase (AKA normal LFTs despite high DNA level)
126
Q

How do you differentiate phases of Hep B?

A

Immune tolerant: normal ALT despite +HBeAg and high HBV DNA. *No tx indicated

Inactive carrier stage: +HBeAg and HBV DNA <20,000. *No tx indicated

Chronic Phases:
Immune active: HBeAg +, elevated ALT and HBV DNA >10,000
or
Immune escape: HBeAg -, elevated ALT and HBV DNA>10,000
(Escape is without the E)

Reactivation phase: HBeAg negative, ALT up, HBV up

127
Q

Chronic SBP prophylaxis

A

Use fluoroquinolone (cipro) in:

  • any hx of SBP
  • high risk: ascitic protein < 1.5 + any of Na <130, bili >3, Cr >1.2, BUN>25
  • while hospitalized if ascitic protein <1
  • for 7 days if active bleeding (variceal)
128
Q

tx of cirrhotic ascites not responding to low sodium diet

A

Spironolactone +/- lasix

129
Q

T/F: Stop ACE-i, ARB and NSAIDs in patient with ascites (cirrhotic)

A

true

130
Q

how often do cirrhotics get US

A

every 6 months to screen for HCC

131
Q

how is vertical transmission of HBV prevention?

A

Pregnant woman with HBV DNA >200,000 @ 24-28 weeks gestation: Tx with tenofovir, telbivudine or lamivudine

All babies born to chronic HBV mothers: active HBV vaccine + passive (HBV Immune globulin) immunization

132
Q

gastroparesis testing

A

acute sxs: EGD to r/o obstruction

chronic or neg EGD: nuc med gastric emptying scan

*Glucose <275 needed if DM (impairs gastric emptying)

133
Q

Chronic pancreatitis dx

A

most common cause is EtOH

young patient: consider sweat cl test for CF

old patient: eval for cancer and autoimmune pancreatitis

134
Q

T/F: Stop nsaids and PPIs in microscopic colitis patient

A

true

135
Q

T/F: Get DEXA and watch for bone health/osteoporosis/osteodystrophy in cirrhotics and celiacs

A

true

136
Q

Back pain in IBD patient

A

think of Ankylosing Spondylitis or Sacroiliitis

137
Q

T/F: Angiography or CTa plays role for acute mesenteric ischemia but NOT for suspected ischemic colitis

A

true

138
Q

AMI vs Ischemic colitis

A

AMI: Usually from afib/ambolus. Acute severe pain. Need angiography. Likely need an intervention or surgery/embolectomy.

Ischemic colitis: usually mild to moderate, painless hematochezia will bring patients in. Low flow states or vasoconstricting meds. Don’t need angiography, dx with colonoscopy. Tx with bowel rest and observation, usually no intervention.

139
Q

T/F: All patients with Hep B need US q 6months to screen for HCC

A

No, but high risk people do:

  • black >20 years old
  • asian men >40, women >50
  • cirrhotics
  • have family hx
  • ALT elevated, HBV DNA >10,000

*For HCV, just cirrhotics get US q 6 mo

140
Q

T/F: Test for HBV before initiating tx for HCV

A

true, hep b can often be reactivating during HCV antiviral therapy

141
Q

Tx of HCV

A

Sofosbuvir and ledipasvir (or other vir drugs).

142
Q

T/F: Prednisolone can be useful in patients with alcoholic hepatitis

A

true

stop if bili doesn’t improve by day 10

Dont use if GI bleed, infection, kidney dz or pancreatitis

143
Q

best screening test for hemochromatosis

A

fasting serum transferrin saturation

ferritin can be elevated in advanced liver disease but can have normal iron sat

144
Q

surveillance in hemochromatosis patient

A

US q6 mo for HCC screen

First degree relatives should undergo screening for disease

145
Q

HELLP vs Acute Fatty Liver of Pregnancy

A

HELLP: More MAHA

AFLP: More encephalopathy and coagulation abnormalities

both have features of preeclampsia, hemolysis, low platelets, normal bili possible and both require prompt delivery

146
Q

RUQ pain
Pelvic adnexal tenderness
Leukocytosis
Cervical smear shows gonococci

A

Fitz-hugh-curtis syndrome (gonococcal or. chlamydial perihepatitis)

147
Q

biliary colic/cholecystitis + air in biliary tree. may have small bowel obstruction

A

cholecystenteric fistula (gallstone ileus)

148
Q

RUQ pain, diarrhea and obstructive jaundice in AIDS

A

Cryptosporidium induced AIDS cholangiopathy

149
Q

painless hematochezia in a young patient and normal EGD/colonoscopy

A

meckels diverticulum

150
Q

LGI bleed + mucocutaneous telangiectasias

A

Hereditary hemorrhagic telangietasia

UWORLD ABIM (10 decks)

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