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Clin Med > GI > Flashcards

GI Flashcards

1
Q

duration of pain in cholecystitis?

A

> 5 hr

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2
Q

cholecystitis wall thickening on US

A

> 4-5mm

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3
Q

test of choice if US is unclear for suspected cholecystitis

A

HIDA

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4
Q

where is the obstruction in cholangitis?

A

CBD

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5
Q

bacteria MCC of cholangitis

A

E coli

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6
Q

charcot’s triad

A

RUQ pain, jaundice, f/c (in 50-75%)

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7
Q

reynold’s pentad

A

charcot’s triad + AMS + hypotensive

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8
Q

gold standard diagnostic for cholangitis

A

ERCP

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9
Q

abx for cholangitis

A

Zosyn

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10
Q

duration of pain in cholelithiasis

A

30 min - 5 hr

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11
Q

duration of pain in choledocholithiasis

A

> 6hr

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12
Q

UDCA (ursodeoxycholic acid) med x 6-9 months will dissolve stone under what 3 conditions?

A

<5mm, low calcification, high cholesterol

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13
Q

surgery req for gallstone of what size?

A

> 10mm

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14
Q

consider what dx if anal fissure NOT located in the mid-line posterior or anterior position

A

IBD

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15
Q

MCC of lower GI bleed

A

diverticulosis

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16
Q

what test should always be ordered after an episode of diverticulitis?

A

colonoscopy 6+ wks later

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17
Q

abx for mild diverticulitis

A

cipro + metronidazole

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18
Q

MCC of lower GI bleed in <50

A

Hemorrhoids

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19
Q

smoking is protective for what GI dx?

A

UC

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20
Q

IBD w/ transmural inflammation

A

CD

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21
Q

IBD w/ skip lesions

A

CD

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22
Q

IBD w/ granulomata

A

CD

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23
Q

1st line for maintaining remission in CD (2 meds)

A

Azathioprine(Imuran) and 6-mercaptopurine (6-MP) PO

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24
Q

1st line tx for inducing remission in UC

A

Mesalamine

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25
Q

type of pain in acute mesenteric ischemia

A

Sudden, severe, poorly localized abd pain out of proportion to exam

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26
Q

toxic megacolon has extreme colon dilation > __cm

A

6cm

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27
Q

meds that cause pill esophagitis

A

DANIKA: doxy, ASA, NSAIDs, Iron, KCL, alendronate

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28
Q

High BUN, normal creatinine is highly suggestive of _____ GI bleed.

A

upper

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29
Q

1st and 2nd MCCs of gastritis

A

1) H pylori
2) NSSAIDs and aspirin

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30
Q

triple therapy for H pylori

A

Amoxicillin + Clarithryomycin + PPI X 14 days

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31
Q

quad therapy for H pylori

A

Bismuth subsalicylate (Pepto-Bismol) + Metronidazole + Tetracycline + PPI X 14 days

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32
Q

MCC of upper GI bleed

A

PUD

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33
Q

duodenal or gastric ulcers more common?

A

duodenal

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34
Q

which type of PUD? sx better w/ food, but worse 2-5 hours post-prandial and at night (11PM to 2AM)

A

duodenal

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35
Q

gastric PUD sx happen when?

A

sx worsen with food (esp 1-2 hours after meals)

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36
Q

what is the Dx? ALT & AST>1,000

A

acute hepatitis

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37
Q

most common bloodborne infx in US

A

hepatitis C

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38
Q

alchoholic hepatitis AST/ALT ratio

A

> 1.5

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39
Q

if platelet count is <150 suspect ____

A

liver dz

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40
Q

infectious diarrhea: MCC worldwide

A

norovirus

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41
Q

Infectious Diarrhea: MCC (bacterial) in US

A

campylobacter

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42
Q

Infectious Diarrhea: MCC (viral) in US adults

A

norovius

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43
Q

Infectious Diarrhea: MCC (viral) in kids worldwide

A

rotavirus

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44
Q

Infectious Diarrhea: MCC in travelers

A

ETEC

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45
Q

Infectious Diarrhea: campylobacter tx if severe

A

cipro or azithromycin

46
Q

Infectious Diarrhea: 2 pathogens that can cause HUS from abx

A

EHEC, shigella (closely related to E coli)

47
Q

tx for C diff

A

PO vanc

48
Q

tx for giardia

A

metronidazole

49
Q

tx if severe vibrio

A

doxy

50
Q

what type of gastric polyps can become CA?

A

adenomatous

51
Q

type of colon polyp ASW greatest CA risk

A

adenomatous, specifically villous

52
Q

SCC in esophagus found in what part?

A

upper

53
Q

urine test for suspected carcinoid syndrome?

A

24hr urine with 5-HIAA excretion (metabolized serotonin end product)

54
Q

for low risk, colonoscopy Q 10 yrs starting at age ___

A

45

55
Q

what is Dx? peripheral smear: normocytic hemolytic anemia during crisis: “bite” cells + Heinz bodies hallmark

A

G6PD defic

56
Q

deficiency of what vitamin can cause Wernicke’s encephalopathy?

A

B1

57
Q

top 3 causes of pancreatitis

A

gallstones, alcohol, hypertriglyceridemia

58
Q

pancreatitis pain worse when ___ (3)

A

lying supine, drinking, and eating (esp fatty foods)

59
Q

pancreatitis pain relieved by ___ (2)

A

Relieved by sitting forward or fetal position.

60
Q

1st line tx for pancreatitis

A

aggressive IVF resuscitation (20ml/kg bolus, then 5-10ml/kg/hr for first 24 hrs).

61
Q

alvarado score is for ___

A

appendicitis (can r/o)

62
Q

abx for non-perforated appendicitis

A

Cefazolin or ceftriazone + metronidazole OR Zosyn

63
Q

dermatitis herpetiformis is pathognomonic for ___

A

Celiac

64
Q

Initial test of choice for Celiac

A

Anti-tissue transglutaminase antibodies IgA (must be eating gluten)

65
Q

Most common abd emergency for kids <2

A

intussusception

66
Q

LB or SB obstructions more common?

A

SB

67
Q

Adynamic Ileus: bowel sounds would be ______

A

absent / decreased

68
Q

bowel obstruction (early): bowel sounds would be ____

A

high pitched / tinkling

69
Q

PE to consider for liver dz

A

Abd: liver palpation, percussion for size of liver, percussion/tap if can’t palpate liver, listen for friction rubs (for liver inflammation), fluid wave, shifting dullness. asterixis
PV: edema
lungs: pleural effusions
eyes: sclera
skin: telangiectasias, spider angiomas, fingernails

70
Q

tx for hepatic encephalopathy

A

lactulose

71
Q

preferred med to induce remission in CD

A

budesonide

72
Q

2 parts of LFTs for hepatocellular damage

A

AST, ALT

73
Q

is AST or ALT more specific for liver injury

A

ALT

74
Q

3 parts of LFTs for cholestasis

A

T bili, alk phos, GGT

75
Q

think what dx if pt has PUD sx + diarrhea?

A

ZES

76
Q

anti-mitochonrial antibody (AMA) is ASW which GI dx?

A

primary biliary cholangitis

77
Q

truest liver function test

A

PT

78
Q

xanthomas/xanthelasmas are seen in which dz of cholestatic injury?

A

PBC

79
Q

thrombosis of hepatic veins, nutmeg liver. tx is anticoags. dx?

A

budd-chiari syndrome

80
Q

Dubin-Johnson syndrome: liver appears _____ on bx

A

black

81
Q
A
82
Q

general rule of colon CA: R side tends to ______, L side tends to ______

A

R bleeds
L obstructs

83
Q

Antidote for cardio toxicity in tca overdose

A

Na bicarb

84
Q

Antidote for amphetamine toxicity

A

Ammonium chloride

85
Q

Antidote for ethylene glycol /antifreeze

A

IV ethanol

86
Q

Is gastric lavage ok in base ingestion?

A

No

87
Q

Is activated charcoal ok in salicylate toxicity

A

Yes

88
Q

Is gastric lavage ok with iron toxicity

A

Yes

89
Q

Med for iron toxicity

A

Deferoxamone

90
Q

PE finding most specific for SBO

A

abd distention

91
Q

A 30-year-old man with a 10-year history of alcohol overuse presents with a symmetrical erythematous facial rash in areas that are exposed to the sun. He reports being a little confused and forgetful lately. A urine test shows a deficiency in N-methylnicotinamide. What additional symptom might be seen due to this deficiency?

A  Diarrhea
B  Flushing
C  Gingivitis
D  Paresthesias
A

diarrhea

92
Q

A previously healthy 21-year-old woman presents to your office with abdominal pain and diarrhea for the past year. She describes the abdominal pain as located in the lower abdomen and relieved by defecation. Her diarrhea symptoms include a small volume of loose stool, typically after meals. She has tried over the counter antidiarrheal medication without relief. Which of the following is the most appropriate next step in management?

AColonoscopy
BDietary modification
CFood allergy testing
DTesting for ova and parasites
A

diet modification (try no FODMAPs first)

93
Q

Which of the following statements is true concerning patients with cholestatic jaundice?

AThey have decreased hepatic concentration of bile salts
BThey have decreased serum concentration of bile salts
CThey have decreased total bile salt pool size
DThey have increased bile salts in enterohepatic recirculation
A

They have decreased total bile salt pool size.

As bile salts are retained in the parenchyma of the liver during cholestasis, down-regulation occurs and less bile salts are produced, resulting in a decrease in the total bile salt pool size as well as a decrease in the enterohepatic recirculation of the bile salts.

94
Q

the drug of choice for the treatment of ventricular dysrhythmias and/or hypotension, secondary to tricarboxylic acid antidepressant (TCA) poisoning

A

Na bicarb

95
Q

2 MC sx of ZES

A

Abdominal pain, diarrhea

96
Q

Best initial test (most sensitive) for suspected ZES

A

Fasting gastrin

97
Q

Test to ID tumor locations in ZES

A

Somatostatin receptor scintigraphy

98
Q

Most sensitive test for esophageal webs and rings

A

Barium swallow

99
Q

What finding on imaging is pathognomonic for chronic pancreatitis?

A

Calcified pancreas

100
Q

Which has granulomas: UC or CD?

A

Crohns

101
Q

Age to start sigmoidoscopy in FAP

A

10-12

102
Q

Age to start colonoscopies in lynch syndrome

A

20-25

103
Q

When to start colonoscopies in IBD

A

8-10years after dx

104
Q

Which of the following laboratory tests, if positive, would be most indicative of Crohn’s disease?
A Antineutrophil cytoplasmic antibodies (ANCA)
B Antiendomysial antibodies (AEA)
C Antinuclear antibodies (ANA)
D Anti-Saccharomyces cerevisiae antibodies (ASCA)

A

ASCA
About 60-70% of patients with Crohn’s disease are positive for these antibodies which are directed at the cell walls of S. cerevisiae while only 10-15% of ulcerative colitis is found to be positive.

105
Q

Which of the following medications decreases the exchange of hydrogen for potassium by inhibiting hydrogen,potassium-ATPase?

Ranitidine (Zantac)

Misoprostol (Cytotec)

Sucralfate (Carafate)

Omeprazole (Prilosec)

A

Omeprazole (Prilosec)

106
Q

Which of the following complications of Crohn’s disease most frequently requires surgery?

Hemorrhage

Intra-abdominal abscess

Malabsorption

Perforation

A

Intra-abdominal abscess

107
Q

Which of the following symptoms most commonly indicates diarrhea of an inflammatory etiology?

Bloody stools

Large volume stools

watery stools

fatty stools

A

bloody

108
Q

A 50-year-old female presents to the office with elevated alkaline phosphatase levels. She denies abdominal pain. The history is negative for medications of any kind, and she denies alcohol use. Surgical history is negative. Which of the following is the most likely diagnosis?

Primary biliary cirrhosis

Pancreatitis

Cholecystitis

Fatty liver

Primary sclerosing cholangitis

A

Primary biliary cirrhosis

109
Q

triad of chronic pancreatitis

A

steatorrhea, DM, pancreatic calcifications

110
Q

ranson criteria for acute pancreatitis

A

Glucose >200
Age >55
WBC >16,000
AST >250
LDH >350

111
Q

tx for SBP

A

ceftriaxone or other 3rd gen

Clin Med (14 decks)

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