GI Flashcards
1
Q
duration of pain in cholecystitis?
A
> 5 hr
2
Q
cholecystitis wall thickening on US
A
> 4-5mm
3
Q
test of choice if US is unclear for suspected cholecystitis
A
HIDA
4
Q
where is the obstruction in cholangitis?
A
CBD
5
Q
bacteria MCC of cholangitis
A
E coli
6
Q
charcot’s triad
A
RUQ pain, jaundice, f/c (in 50-75%)
7
Q
reynold’s pentad
A
charcot’s triad + AMS + hypotensive
8
Q
gold standard diagnostic for cholangitis
A
ERCP
9
Q
abx for cholangitis
A
Zosyn
10
Q
duration of pain in cholelithiasis
A
30 min - 5 hr
11
Q
duration of pain in choledocholithiasis
A
> 6hr
12
Q
UDCA (ursodeoxycholic acid) med x 6-9 months will dissolve stone under what 3 conditions?
A
<5mm, low calcification, high cholesterol
13
Q
surgery req for gallstone of what size?
A
> 10mm
14
Q
consider what dx if anal fissure NOT located in the mid-line posterior or anterior position
A
IBD
15
Q
MCC of lower GI bleed
A
diverticulosis
16
Q
what test should always be ordered after an episode of diverticulitis?
A
colonoscopy 6+ wks later
17
Q
abx for mild diverticulitis
A
cipro + metronidazole
18
Q
MCC of lower GI bleed in <50
A
Hemorrhoids
19
Q
smoking is protective for what GI dx?
A
UC
20
Q
IBD w/ transmural inflammation
A
CD
21
Q
IBD w/ skip lesions
A
CD
22
Q
IBD w/ granulomata
A
CD
23
Q
1st line for maintaining remission in CD (2 meds)
A
Azathioprine(Imuran) and 6-mercaptopurine (6-MP) PO
24
Q
1st line tx for inducing remission in UC
A
Mesalamine
25
type of pain in acute mesenteric ischemia
Sudden, severe, poorly localized abd pain out of proportion to exam
26
toxic megacolon has extreme colon dilation > __cm
6cm
27
meds that cause pill esophagitis
DANIKA: doxy, ASA, NSAIDs, Iron, KCL, alendronate
28
High BUN, normal creatinine is highly suggestive of _____ GI bleed.
upper
29
1st and 2nd MCCs of gastritis
1) H pylori
2) NSSAIDs and aspirin
30
triple therapy for H pylori
Amoxicillin + Clarithryomycin + PPI X 14 days
31
quad therapy for H pylori
Bismuth subsalicylate (Pepto-Bismol) + Metronidazole + Tetracycline + PPI X 14 days
32
MCC of upper GI bleed
PUD
33
duodenal or gastric ulcers more common?
duodenal
34
which type of PUD? sx better w/ food, but worse 2-5 hours post-prandial and at night (11PM to 2AM)
duodenal
35
gastric PUD sx happen when?
sx worsen with food (esp 1-2 hours after meals)
36
what is the Dx? ALT & AST>1,000
acute hepatitis
37
most common bloodborne infx in US
hepatitis C
38
alchoholic hepatitis AST/ALT ratio
>1.5
39
if platelet count is <150 suspect ____
liver dz
40
infectious diarrhea: MCC worldwide
norovirus
41
Infectious Diarrhea: MCC (bacterial) in US
campylobacter
42
Infectious Diarrhea: MCC (viral) in US adults
norovius
43
Infectious Diarrhea: MCC (viral) in kids worldwide
rotavirus
44
Infectious Diarrhea: MCC in travelers
ETEC
45
Infectious Diarrhea: campylobacter tx if severe
cipro or azithromycin
46
Infectious Diarrhea: 2 pathogens that can cause HUS from abx
EHEC, shigella (closely related to E coli)
47
tx for C diff
PO vanc
48
tx for giardia
metronidazole
49
tx if severe vibrio
doxy
50
what type of gastric polyps can become CA?
adenomatous
51
type of colon polyp ASW greatest CA risk
adenomatous, specifically villous
52
SCC in esophagus found in what part?
upper
53
urine test for suspected carcinoid syndrome?
24hr urine with 5-HIAA excretion (metabolized serotonin end product)
54
for low risk, colonoscopy Q 10 yrs starting at age ___
45
55
what is Dx? peripheral smear: normocytic hemolytic anemia during crisis: “bite” cells + Heinz bodies hallmark
G6PD defic
56
deficiency of what vitamin can cause Wernicke's encephalopathy?
B1
57
top 3 causes of pancreatitis
gallstones, alcohol, hypertriglyceridemia
58
pancreatitis pain worse when ___ (3)
lying supine, drinking, and eating (esp fatty foods)
59
pancreatitis pain relieved by ___ (2)
Relieved by sitting forward or fetal position.
60
1st line tx for pancreatitis
aggressive IVF resuscitation (20ml/kg bolus, then 5-10ml/kg/hr for first 24 hrs).
61
alvarado score is for ___
appendicitis (can r/o)
62
abx for non-perforated appendicitis
Cefazolin or ceftriazone + metronidazole OR Zosyn
63
dermatitis herpetiformis is pathognomonic for ___
Celiac
64
Initial test of choice for Celiac
Anti-tissue transglutaminase antibodies IgA (must be eating gluten)
65
Most common abd emergency for kids <2
intussusception
66
LB or SB obstructions more common?
SB
67
Adynamic Ileus: bowel sounds would be ______
absent / decreased
68
bowel obstruction (early): bowel sounds would be ____
high pitched / tinkling
69
PE to consider for liver dz
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
tx for hepatic encephalopathy
lactulose
71
preferred med to induce remission in CD
budesonide
72
2 parts of LFTs for hepatocellular damage
AST, ALT
73
is AST or ALT more specific for liver injury
ALT
74
3 parts of LFTs for cholestasis
T bili, alk phos, GGT
75
think what dx if pt has PUD sx + diarrhea?
ZES
76
anti-mitochonrial antibody (AMA) is ASW which GI dx?
primary biliary cholangitis
77
truest liver function test
PT
78
xanthomas/xanthelasmas are seen in which dz of cholestatic injury?
PBC
79
thrombosis of hepatic veins, nutmeg liver. tx is anticoags. dx?
budd-chiari syndrome
80
Dubin-Johnson syndrome: liver appears _____ on bx
black
81
82
general rule of colon CA: R side tends to ______, L side tends to ______
R bleeds
L obstructs
83
Antidote for cardio toxicity in tca overdose
Na bicarb
84
Antidote for amphetamine toxicity
Ammonium chloride
85
Antidote for ethylene glycol /antifreeze
IV ethanol
86
Is gastric lavage ok in base ingestion?
No
87
Is activated charcoal ok in salicylate toxicity
Yes
88
Is gastric lavage ok with iron toxicity
Yes
89
Med for iron toxicity
Deferoxamone
90
PE finding most specific for SBO
abd distention
91
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
diarrhea
92
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
diet modification (try no FODMAPs first)
93
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
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
the drug of choice for the treatment of ventricular dysrhythmias and/or hypotension, secondary to tricarboxylic acid antidepressant (TCA) poisoning
Na bicarb
95
2 MC sx of ZES
Abdominal pain, diarrhea
96
Best initial test (most sensitive) for suspected ZES
Fasting gastrin
97
Test to ID tumor locations in ZES
Somatostatin receptor scintigraphy
98
Most sensitive test for esophageal webs and rings
Barium swallow
99
What finding on imaging is pathognomonic for chronic pancreatitis?
Calcified pancreas
100
Which has granulomas: UC or CD?
Crohns
101
Age to start sigmoidoscopy in FAP
10-12
102
Age to start colonoscopies in lynch syndrome
20-25
103
When to start colonoscopies in IBD
8-10years after dx
104
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)
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
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)
Omeprazole (Prilosec)
106
Which of the following complications of Crohn's disease most frequently requires surgery?
Hemorrhage
Intra-abdominal abscess
Malabsorption
Perforation
Intra-abdominal abscess
107
Which of the following symptoms most commonly indicates diarrhea of an inflammatory etiology?
Bloody stools
Large volume stools
watery stools
fatty stools
bloody
108
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
Primary biliary cirrhosis
109
triad of chronic pancreatitis
steatorrhea, DM, pancreatic calcifications
110
ranson criteria for acute pancreatitis
Glucose >200
Age >55
WBC >16,000
AST >250
LDH >350
111
tx for SBP
ceftriaxone or other 3rd gen
