GI

Question 1

Plummer-Vinson syndrome

Answer 1

Próx esoph structures associated with ida and squamous cell esoph ca

Tx iron

Question 2

EGD vs barium vs manómetry

Answer 2

EGD for cancer concern

Manometry for achalasia, spastic dos

Barium for strictures, zenker

Question 3

How to dx nonulcer dyspepsia

Answer 3

Dx of exclusion after endoscopy to rule out ulcers, gastric cancer, and gastritis

Question 4

H pylori management

Answer 4

Only treat if associated with gastritis or ulcers, not gerd

Dx via endoscopy with bx or serology

Tx with ppi, clarithro, amox

Breath test and stool ag as test of cure

If not cured, do metronidazole and tetracycline

If that fails, test for ZE (gastrinoma)

Question 5

Crohn vs UC

Answer 5

Crohn - masses, skip lesions, upper gi involvement, perianal dz, transmural, fístulas

Surgery (remove colon) curative in Uc, not cd (only do if obst etc)

Question 6

Testing and dx of infectious diarrhea

Answer 6

Fecal leuks, stool cx most accurate
If mild, hydration
If severe, cipro

Invasive bugs can —> blood
Viruses, giardia, staph, b cereus, crypto, scombroid aren’t invasive and don’t cause blood in stool

Question 7

Celiac dx

Answer 7

Antigliadin, antiendomysial, antittg ig
Small bowel bx most accurate

Question 8

Tx tropical spruce and whipple dz

Answer 8

Tetracycline and bactrim for months

Whipple sx include neuro, arthralgias, ocular

Question 9

Pancreatic enzymes (replaced via pill in chronic pancreatitis)

Answer 9

Amylase, lipase, trypsin

Usually released in response to secretin but not with chronic pancreatitis

Question 10

IBS tx

Answer 10

Fiber

Then antispasmodic/antichol like dicyclomine or hyoscyamine to relax bowel

Then tca

Question 11

When to screen for colon cancer

Answer 11

• colonoscopy starting at 50 and every ten years or sigmoid every five; if find dysplastic polyp do next colo in 3-5yrs
• one family member with colon ca, start at 40 or 10 yrs before age of ca
• 3 family, two gen, or very young age<50 - start at 25 and do colo every 1-2 yrs for lynch
• fap or Gardner (fap plus bone and other tumors) - start sigmoid at 12 and do colectomy once find polyp
• peutz-Jeghers - sigmoid starting at 8yo, hamartomatous polyps throughout bowel

Question 12

Octreotide mech for esoph varices

Answer 12

Sst analog decreases portal htn

Question 13

Classification of laxatives

Answer 13

• stool softeners (eg colace)
• lubricant (eg mineral oil)
• osmotics (miralax, lactulose, mg)
• stimulants (senna, bisacodyl (Fulco lax), Castor oil)

Question 14

Hepatitis b serologies

Answer 14

Surface or e ag- active infection (acute or chronic)
Surface ig - vaccinated (no core) or recovered
Core ig only - recovering
Core and surface ig only - recovered

Question 15

Hep c testing

Answer 15

Ig (can’t distinguish active vs treated)
Then if pos, pcr-rna to tell if active and determine response to tx

Question 16

Acute vs chronic hep b tx

Answer 16

Acute - no tx
Chronic - lamivudine, adefovir, entecavir, telbivudine, tenofovir (AE = bone and rta)

Question 17

How to use SAAG

Answer 17

If >1.1 (so much more albumin in serum than ascites), ascites caused by portal htn

Else caused by increased vasc perm

Question 18

Pbc vs psc

Answer 18

• pbc middle aged women, autoimm, high alk phos with normal bili, antimitoch ig, ursodeox +/- obeticholic acid
• psc ibd, young male, elevated bili and alk phos, anti smooth mm ig and anca

Question 19

Wilson disease tests and tx

Answer 19

Tests - slit lamp for kayser fleischer and low ceruloplasmin
Tx - penicillamine or trientine +/- zinc

Question 20

Hemochromatosis tx

Answer 20

Phlebotomy

Not chelators, which are only used for over transfusion

Question 21

Bun:cr, urine osm, urine na for different causes of Aki

Answer 21

Prerenal: bun:cr high (>15), urine osm over 500, urine na low (<20)

Intrarenal: bun:cr low (less than 10), urine na high bc can’t reabs (>40) so urine osm moderate but <350 (except in contrast nephropathy when urine na is low bc decreased kidney perfusion so less filtered?)

Postrenal/bilateral obst: bun:cr high (>15)

Question 22

Infectious, bloody, inflamm diarrhea caused by

Answer 22

Shigella, stec (no fever), campylobacter, salmonella

Question 23

H pylori tx

Answer 23

Quadruple therapy: tetracycline bismuth, ppi, metronidazole

Then do eradication testing four weeks after finishing tx with urea breath test, stool antigen, or endoscopic testing (if they have another reason to need endoscopy)

Question 24

Saag

Answer 24

Serum albumin - ascites albumin
If >=1.1, portal hypertension (from CHF, cirrhosis, alc hep) else other cause of ascites (eg peritoneal carcinomatosis, tb, nephrotic, pancreatitis)

Question 25

Acute pancreatitis causes

Answer 25

Think etoh and gallstones, then TGs

Question 26

Things to order in diarrhea workup

Answer 26

Tsh
Stool tests
CBC
Inflammatory markers
Anti endomysial ig for celiac
Endoscopy with biopsy
Malnourishment - B12, folic acid, vitamin a, d, e, copper, iron, zinc, pt/inr (vit k)