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Family Medicine > GI > Flashcards

GI Flashcards

1
Q

Sx: GERD + dysphagia

A

Possible developed peptic stricture

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2
Q

Dx GERD

A

Gold std = 24 hr pH monitoring

Endoscopy bx not necessary for uncomplicated cases

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3
Q

Dx aspiration of gastric contents result in PNA

A

Lipid laden macrophages on bronch

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4
Q

Bloody diarrhea bacteria causes

A 
SECS
Salmonela
Ecoli
Campylobacter
Shigella
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5
Q

Diarrhea acid/base disturbance

A

metabolic acidosis + hypo K

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6
Q

Fecal leukocytes in stool - what do you think of?

A 
Campylobacter
Salmonella
Shigella
E coli
C diff

NOT
Staph
Clostridia
Viral

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7
Q

Loperamide

A

antidiarrheal agent

DO NOT give for diarrhea w/ fever of blood in stool

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8
Q

Dx IBS

A

Dx of exclusion

Need sx for 3 mon

change in freq or consistency of stool (diarrhea or constipation)

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9
Q

management of hyperbilirubinemia in the newborn infant at 35 or more weeks gestation

A

frequent clinical assessment of jaundice

treatment based on the total serum bilirubin level, the infants age in hours, and risk factors.

Phototherapy should not be started based solely on the total serum bilirubin level.

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10
Q

double bubble sign in newborn..what is it?

A

Cecal volvulus

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11
Q

Infantile colic

A

usually begins during the second week of life and typically occurs in the evening.

characterized by screaming episodes and a distended or tight abdomen.

Unknown etiology

no abnormalities on physical examination and ancillary studies,

symptoms usually resolve spontaneously around 12 weeks of age.

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12
Q

Necrotizing enterocolitis

A

child will appear ill, with symptoms including irritability, poor feeding, a distended abdomen, and bloody stools.

Abdominal plain films will show pneumatosis intestinalis, caused by gas in the intestinal wall, which is diagnostic of the condition.

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13
Q

Hypertrophic pyloric stenosis

A

is a narrowing of the pyloric canal caused by hypertrophy of the musculature.

Usually 3rd-5th wks of life

Projectile NON BILIOUS vomiting after feeding, weight loss, and dehydration are common.

US to confirm dx

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14
Q

Intussusception

A

Usually in 3 months - 5 years

Mostly in males.

Triad:
intermittent colicky abdominal pain,
vomiting,
bloody, mucous stools

Rectal examination may reveal either occult blood or frankly bloody, foul-smelling stool, classically described as currant jelly.

Dx and Tx: air enema using fluoroscopic guidance

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15
Q

Meckels diverticulum

A

is the most common congenital abnormality of the small intestine.

It is prone to bleeding because it may contain heterotopic gastric mucosa.

Abdominal pain, distention, and vomiting may develop if obstruction has occurred, and the presentation may mimic appendicitis.

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16
Q

Eradication of Helicobacter pylori significantly reduces the risk of

A

ulcer recurrence and rebleeding in patients with duodenal ulcer,

reduces the risk of peptic ulcer development in patients on chronic NSAID therapy.

No effect on GERD

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17
Q

Celiac sprue

A

an autoimmune disorder characterized by inflammation of the small bowel wall, blunting of the villi, and resultant malabsorption

dermatitis herpetiformis

Others:
Fe deficiency anemia
osteopenia
elevated transaminases

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18
Q

What is dx for peritonitis?

Next step once diagnosed?

A

neutrophil count >250/mL

antibiotic therapy should be started immediately without waiting for culture results

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19
Q

GI pathogens resistant to chlorine water

A

Cryptosporidium
Giardia
Entamoeba histolytica
Hep A

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20
Q

Hep B needle stick. What do youdo?

A

If…
Vaccinated = test for hep B antibodies
- if ab levels not ok, give HBIG + hep B booster

Unvaccinated = HBIG ASAP + Hep B vaccine series

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21
Q

leading cause of bacterial diarrhea in the U.S.

A

Campylobacter

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22
Q

Tx thrombosed external hemorrhoid

A

If within 48 hrs onset
- elliptical excision of hemorrhoid

If no pain or > 48 hrs onset

  • Sitz baths
  • laxatives
  • stool softners
  • local analgesia
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23
Q

Travelers Diarrhea ppx

Tx?

A

Both cipro

Azithromycin for tx

Rifamixin for tx if no blood

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24
Q

Acute gastroenteritis suspected next step is what?

A

Order stool for fecal leukocytes

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25
Q

Recent reports of epidemics of gastroenteritis on cruise ships are consistent with

A

Norwalk virus infections due to waterborne or foodborne spread

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26
Q

A 24-year-old white female presents to the office with a 6-month history of abdominal pain. A physical examination, including pelvic and rectal examinations, is normal. Which one of the following would indicate a need for further evaluation?

A. Relief of symptoms with defecation
B. Changes in stool consistency from loose and watery to constipation
C. Passage of mucus with bowel movements
D. Abdominal bloating
E. Worsening of symptoms at night

A

Irritable bowel syndrome (IBS) is a benign, chronic symptom complex of altered bowel habits and abdominal pain. It is the most common functional disorder of the gastrointestinal tract. The presence of nocturnal symptoms is a red flag which should alert the physician to an alternate diagnosis and may require further evaluation. The other symptoms listed are Rome I and II criteria for diagnosing irritable bowel syndrome.

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27
Q

Key risk factors for hepatitis C infection are

A

long-term hemodialysis, intravenous drug use, blood transfusion or organ transplantation prior to 1992, and receipt of clotting factors before 1987

Not as much sexually transmitted, rare from mom to baby

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28
Q

Serum neuron-specific enolase (NSE) testing, as well as spot urine testing for homovanillic acid (HVA) and vanillylmandelic acid (VMA), should be obtained if

A

neuroblastoma or pheochromocytoma is suspected

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29
Q

Prelim eval for IBD

A

A CBC, serum chemistry panel, and erythrocyte sedimentation rate

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30
Q

Omeprazole is associated with an increased risk of

A

community-acquired pneumonia

Clostridium difficile colitis.

acutely decrease the absorption of vitamin B 12 ,

decreases calcium absorption, leading to an increased risk of hip fracture.

31
Q

The rotavirus vaccine is an oral vaccine recommended for infants in a 3-dose schedule at

A

ages 2, 4, and 6 months.

The first dose should be given between 6 and 12 weeks of age, with additional doses given at 4 to 10-week intervals.

The vaccine cannot be initiated after 12 weeks of age and should not be administered after 32 weeks of age.

32
Q

The diagnosis of giardiasis is suggested by

A 
foul-smelling, soft, or loose stools; 
foul-smelling flatus; 
belching; 
marked abdominal distention; 
the virtual absence of mucus or blood in the stool.
33
Q 
Bilious vomiting
Currant jelly stools
Sausage shaped mass in abdomen
Young person
Intermittent pain
A

Intussusception

34
Q

Tx intusussception

A

Barium enema is dx and tx

Water soluble contrast better if think perf as it doesn’t irritate peritoneum

35
Q

1 cause of obstruction in baby

A

Pyloric stenosis

36
Q

Dx volvulus

A

Surgery if hemodynamically unstable

Upper GI series imaging if hemodynamically stable

37
Q

Labs for obese pt

A

TSH
Lipids
Fasting glucose
LFTS for fatty liver

38
Q

BMI is not an accurate measure of overweight/obesity in patients with

A

heart failure, pregnant women, body builders, and certain ethnic groups

39
Q

Meds for obesity that are ok long term

A

sibutramine

orlistat

40
Q

potential candidates for surgical treatment of obesity.

Types of surgery?

A

Patients with a BMI > 40,

or > 35 with comorbid conditions (severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy, and severe diabetes mellitus)

2 most common surgeries: Roux-en-Y gastric bypass and “lap banding.”

Roux-en-Y gastric bypass involves the construction of a small (10-30 mL) gastric pouch that empties into a segment of jejunum. This is mostly a restrictive procedure, but there is some degree of associated malabsorption.

In lap banding, an adjustable silicone gastric band is laparoscopically placed around the upper stomach just distal to the gastroesophageal junction. The band has a balloon connected to a subcutaneously implanted port, which can be inflated or deflated to reduce the circumference of the band.

41
Q

current practice is to introduce solid foods into the diet at what age

A

4-6 mos

extrusion reflex (pushing foreign material out of the mouth with the tongue) makes feeding of solids difficult and often forced. This reflex disappears around the age of 4 months, making feeding easier

42
Q

Refeeding syndrome

A

can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally).

These shifts result from hormonal and metabolic changes and may cause serious clinical complications.

The hallmark biochemical feature of refeeding syndrome is hypophosphatemia.

43
Q

Macroglossia is associated with…

A 
Down syndrome
Tumor
Amyloidosis
Acromegaly
Cretinism
44
Q

Deep abdominal infections are often treated with

A

a cephalosporin, such as cefoxitin,

or a combination of fluoroquinolone plus metronidazole to cover anaerobic infections.

45
Q

FDA approved for IBS in women with constipation

A

Lubiprostone

MoA: selectively activates intestinal chloride channels and increases fluid secretion

has a side effect of nausea in significant percentage of patients

46
Q

What can you use for ab pain in IBS?

A

mild-to-moderate abdominal pain: Dicyclomine, an antispasmodic anticholinergic medication

more persistent and severe pain: low-dose TCAs, like amitriptyline

47
Q

UA with bilirubin. What does this suggest?

A

Conjugated bilirubin is excreted in the urine, whereas unconjugated bilirubin is not.

48
Q

Gilbert syndrome

A

is a congenital reduction of conjuga- tion of bilirubin in the liver.

49
Q

Causes of elevated unconj hyperbilirubinemia

A

Gilbert

Hemolysis

50
Q

Causes conjugated hyperbilirubinemia

A

Hep a, b, c
Etoh abuse
Post hepatic obstruction (eg pancreatic ca, gallstones)

51
Q

Hep C Disease activity can be monitored by

A

serial measurements of HCV RNA

transaminases levels.

52
Q

Hep C tx

A

Chronic hepatitis C can be treated with antiviral therapy, using ribavirin and/or interferon

53
Q

Transaminase levels from alcohol abuse typically show

A

the aspartate aminotransferase (AST) being elevated out of proportion to the alanine aminotransferase (ALT)

viral hepatitis usually causes greater elevations of the ALT

54
Q

Serology of chronic hep c

A

Both HCV RNA and Anti-HCV antibodies are present in chronic Hep C

55
Q

Early diagnostic endoscopy should be considered for patients with

A

new- onset dyspepsia who are older than age 55 years

who have symptoms that may be associated with upper GI malignancy

Weight loss
Progressive dysphagia
Recurrent vomiting
Gastrointestinal bleeding
Family history of cancer

56
Q

PUD distribution in GI

A

Duodenal ulcers are more prevalent overall,

gastric ulcers are more common in NSAID users

57
Q

Tests for h pylori

A

Stool antigen testing

  • now the preferred non-invasive office test
  • superior positive predictive value and ability to be used posttreatment to test for eradication.
  • However, for this test to be accurate, patients must not have been treated with PPIs for at least 2 weeks prior to testing.

Serologic testing for anti–H pylori antibodies
- It is highly sensitive for the presence of a history of infection but cannot distinguish an active infection from a treated infection.

Active infection can be confirmed by urea breath testing. This test is performed by having the patient ingest a carbon-labeled urea compound, which is then metabolized by urease from the H pylori organism. The labeled CO2 released by this process is measured in exhaled breath. This test is highly sensitive and specific, but is limited by availability and expense.

The gold standard for diagnosis is endoscopy with biopsy testing for H pylori

58
Q

the most common cause of abnormal liver tests in the developed world

A

Non-alcoholic fatty liver disease (NAFLD)

59
Q

What has been shown to relieve symptoms of IBS?

A

Daily use of peppermint oil

60
Q

test for an active H pylori infection

A

stool antigen

Urea breath test

61
Q

Tx ascites

A

Grade 2 ascites (visible clinically by abdominal distention, not just with ultrasonography), the initial treatment of choice is diuretics along with salt restriction.

  • spironolactone better than loops
  • NOT thiazides

Grade 3 ascites. (gross ascites with marked abdominal distention),

  • large volume paracentesis
  • then salt restriction + diuretics.
62
Q

Why do you avoid NSAIDs in cirrhotics?

A

they can increase the risk of bleeding in cirrhotic patients, as they further impair platelet function.

NSAIDs decrease blood flow to the kidneys and can increase the risk of renal failure in patients with cirrhosis.

63
Q

Herpangina

A

is a febrile disease caused by coxsackieviruses and echoviruses.

Vesicles and subsequent ulcers develop in the posterior pharyngeal area

64
Q 
Which one of the following is found most consistently in patients diagnosed with irritable bowel syndrome?   (check one)
 A. Passage of blood per rectum 
 B. Passage of mucus per rectum 
 C. Abdominal pain 
 D. Constipation 
 E. Diarrhea
A

A large review of multiple studies identified abdominal pain as the most consistent feature found in irritable bowel syndrome (IBS), and its absence makes the diagnosis less likely. Of the symptoms listed, passage of blood is least likely with IBS, and passage of mucus, constipation, and diarrhea are less consistent than abdominal pain

65
Q

ppx for traveler’s diarrhea

A

Not recommended - only if immunocompromised or diarrhea would be too much of a hardship for trip

Rifaximin

66
Q

Increased ALP and 5’ nucleotidase

A

Alkaline phosphatase is elevated in conditions affecting the bones, liver, small intestine, and placenta. The addition of elevated 5’-nucleotidase suggests the liver as the focus of the problem. Measuring 5’-nucleotidase to determine whether the alkaline phosphatase elevation is due to a hepatic problem is well substantiated, practical, and cost effective

67
Q

An accepted regimen for outpatient treatment of diverticulitis is

A

amoxicillin/clavulanate

68
Q

What is associated with decreased absorption of calcium carbonate

A

Long-term histamine H2 -blocker or proton pump inhibitor use

Patients taking these medications who require calcium supplementation should use calcium citrate to improve absorption.

69
Q

A 5-month-old infant has had several episodes of wheezing, not clearly related to colds. The pregnancy and delivery were normal; the infant received phototherapy for 1 day for hyperbilirubinemia. He had an episode of otitis media 1 month ago. There is no chronic runny nose or strong family history of asthma. He spits up small amounts of formula several times a day, but otherwise appears well. His growth curve is normal. An examination is unremarkable except for mild wheezing.
Which one of the following is the most likely diagnosis?
(check one)
A. Benign reactive airway disease of infancy
B. Gastroesophageal reflux
C. Unresolved respiratory syncytial virus infection
D. Early asthma
E. Cystic fibrosis

A

Gastroesophageal reflux is a common cause of wheezing in infants. At 5 months of age, most infants no longer spit up several times a day, and this is a major clue that this child’s wheezing may be from the reflux. In addition, there is no family history of asthma and the wheezing is not related to infections.Cystic fibrosis is more likely to present with recurrent infections and failure to thrive than with intermittent wheezing.

70
Q

Intrahepatic cholestasis of pregnancy

A

classically presents as severe pruritus in the third trimester.

Characteristic findings include the absence of primary skin lesions and elevation of serum levels of total bile acids.

71
Q

When give infants cow’s milk

A

DO NOT give if < 12 mo old

Can give solid foods after 4-6mo age

Whole cow’s milk does not supply infants with enough vitamin E, iron, and essential fatty acids, and overburdens their system with too much protein, sodium, and potassium.

72
Q

1 cause of death after bariatric surgery

A

1 = Pulmonary emboli

Others

  • anastomotic leaks
  • resp failure
73
Q

pANCA positive in which IBD?

A

Ulcerative colitis

74
Q 
Malabsorptive diarrhea
Wt loss
Migratory non-deforming arthritis
LAD
low grade fever

what is this?

A

Whipple dz

GM+ bacillus Tropheryma whippelii

Family Medicine (11 decks)

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