GI Flashcards
With achalasia will the patient have dysphagia to liquids, solids or both?
Both
With a gastric ulcer are the patient’s exacerbated or relieved with food?
Exacerbated
Which NSAID has the highest rate of peptic ulceration?
Naproxen
Which is more likely to pass into the scrotum, a direct or indirect hernia?
Indirect
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful.
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
Early they are hyperactive. Late they are absent
What two viral hepatitis infections are self limiting?
A and E
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
What tumor marker may be used for liver cancer?
alpha-Fetoprotein
What tumor maker can be used to follow pancreatic cancer?
CA-19-9
What treatment should be started for asymptomatic diverticulosis?
None
What medication used in Hep B infection helps prevent the need for liver transplant?
Lamivudine
What medication is most commonly used for long term treatment of GERD?
PPIs - omeprazole, lansoprazole, pantoprazole
What medical treatment is given for a gastrinoma?
PPIs
What it is the recommended treatment for Hep C infection?
Pegylated interferon alpa-2a
What is the treatment for most Mallory-Weiss tears?
Self limiting, typically within 48 hours
What is the term for painful swallowing?
Odynophagia
What is the term for difficulty swallowing?
Dysphagia
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
What is the most specific test for acute cholecystitis?
HIDA
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
What is the most common location of colorectal cancer?
Cecum 38%
What is the most common location for an anal fissure?
Posterior midline
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
What is the most common cause of peptic ulcer disease?
H. pylori
What is the most common cause of lower GI bleed?
Diverticulosis
What is the most common cause of folate deficiency?
Alcoholism
What is the most common cause of acute bacterial cholangitis?
Choledocholitaisis
What is the most common anorectal problem affecting patients over 50?
Hemorrhoids
What is the medical term for feeling like there is a lump in your throat?
Globus
What is the main risk factor for esophagitis?
Immunocompromised patient
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
What is the imaging modality of choice for pancreatitis?
CT
What is the gold standard for diagnosis and treatment of bile duct stones?
ERCP
What is the first step in treating GERD?
Lifestyle modification
What is the diagnostic test of choice for Zenker’s diverticulum?
Barium swallow will show the diverticulum
What is the best test to check for H. pylori?
Urea breath test
What is the best imaging study for acute appendicitis?
CT
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
What is Reynold’s pentad and why does it matter?
Charcot’s triad + hypotension + altered mental status. It indicates high risk of sepsis
What is most specific diagnostic test for peptic ulcer disease?
Endoscopy
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is a good beta blocker to reduce portal HTN?
Propranolol
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
What does HBsAG (Hep B surface antigen) indicate?
Active Hep B infection
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
What does Anti-HBs (Hep B surface antibody) indicate?
Recovery from infection or immunization to Hep B
What does an Anti-HBc (hepB core antibody) indicate?
Previous or ongoing infection Hep B infection
What disease is defined as an immunologic response to gluten?
Celiac
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products - sulfasalazine, mesalamine
What causes Mallory-Weiss tears?
Forced vomiting or retching (Often involving alcohol)
What are two treatments you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs
What are two things that an anal fissure off midline might suggest?
Crohn’s, syphilis, HIV, neoplasm
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
What are the two main complications of cirrhosis?
Portal HTN & liver insufficiency
What are the first three steps of managing pancreatitis?
NPO, pain control, fluids
What are the 5 points of Ranson’s criteria on admission?
older than 55, WBC>16, glucose>200, LDH>350, AST>250
Under routine circumstances when should patients begin getting screening colonoscopies?
Age 50
Thumbprint sign on abdominal film should make you think of what diagnosis?
Intestinal ischemia
There are vaccines for which two versions of hepatitis?
Hep A and Hep B
Steatorrhea should make you think of what diagnosis?
Pancreatitis
Should diverticulitis always be admitted?
No mild cases can be treated as outpatients with rest and clear fluids.
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
Salivary amylase breaks down what macronutrient?
Carbohydrates
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
Pica is often related to what type of anemia?
Iron deficiency anemia
Patient complains of RUQ pain 20 minutes after a meal. What diagnosis should you be thinking of?
Cholecystitis
Patient complains of regurgitating undigested food several hours after a meal. What diagnosis should you be thinking of?
Zenker’s diverticulum
Patient complains of periumbilical pain which has now moved over McBurney’s point. What diagnosis should you be thinking of?
Appendicitis
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
One half of all adult hernias are direct or indirect?
Indirect inguinal hernias makeup 50% of all adult hernias
Name the sign. Patient is supine and attempts to raise right leg against resistance.
Psoas sign
Name the sign. Patient is supine and attempts to flex and internally rotate right hip
Obturator sign
Most gallstones are made of what substance?
Cholesterol
LLQ pain and tenderness should make you think of what diagnosis?
Diverticulitis
List two common offending agents for pill induced esophagitis?
NSAIDS, KCL, iron, Abx
Is surgery curative for Crohn’s or ulcerative colitis?
Ulcerative colitis
Is peptic ulcer disease more common in the duodenum or the stomach?
Duodenum
Inhibited inspiration with pressure over the RUQ is called what? What diagnosis does it suggest?
Murphy’s sign, Cholecystitis
In order to contract Hep D what must you already have?
Hep B
If you have heartburn that does not improve with medication what diagnosis should you be thinking about?
Gastrinoma
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma
How much fiber should you get in a day?
30 grams
How is celiac most commonly diagnosed?
Endoscopic biopsy
How do you treat an H. pylori infection?
PPI + 2 Abx, commonly omeprazole + clarithromycin and amoxicillin or PPI +metronidazole + tetracycline
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
First line of treatment for an anal fissure?
Fluid and fiber
Fasting gastrin will be above what level with gastrinoma?
> 150 pg/ml
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
Describe Grey-Turner’s sign.
Flank ecchymosis often related to pancreatitis
Describe Cullen’s sign
Umbilical ecchymosis often related to pancreatitis
Describe Courvoisier’s sign
Nontender, palpable gall bladder may indicate pancreatic neoplasm
Define pellagra?
Niacin (B3) deficiency
Currant jelly stool should make you think of what diagnosis?
Intussusception
Crohn’s is found where in the GI tract?
It can be from esophagus to anus
Colorectal cancer patients are almost all older than what age?
90% of patients are older than 50
Birds beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
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.
An epigastric olive shaped mass should make you think of what diagnosis?
Pyloric stenosis
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What diagnosis should you be thinking of?
CMV
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What diagnosis should you be thinking of?
Herpes simplex virus
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
A patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What diagnosis should you be thinking of?
Gastric volvulus
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
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?
Esophageal strictures
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
Crohn’s disease
30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What diagnosis should you be thinking of?
Scleroderma
