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ACP Board Basics 3 > GI > Flashcards

GI Flashcards

0
Q

Most effective study for evaluating suspected oropharyngeal dysphagia

A

Videofluoroscopy (aka modified barium swallow)

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1
Q

Diagnosis: solid-food dysphagia that occurs episodically for months to years

A

Esophageal web or distal esophageal ring (Schatzki ring)

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2
Q

Preferred screening test when achalasia is suspected clinically

A

Barium swallow

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3
Q

Confirmatory test for achalasia

A

Esophageal manometry

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4
Q

First-line therapies for achalasia (2)

A

Laparoscopic myotomy of the LES or endoscopic pneumatic dilatation

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5
Q

First-line therapy for the extraesophageal manifestations of GERD

A

PPIs

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6
Q

Use of this class of drugs is associated with infectious esophagitis in otherwise healthy patients

A

Inhaled corticosteroids

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7
Q

Characteristic symptom of infectious esophagitis

A

Odynophagia

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8
Q

Most common cause of infectious esophagitis

A

Candida albicans

followed by CMV and HSV

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9
Q

Esophageal condition that presents with extreme dysphagia and food impaction

A

Eosinophilic esophagitis

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10
Q

Treatment for esophageal candidiasis

A

Fluconazole or itraconazole

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11
Q

Treatment for HSV esophagitis

A

Oral acyclovir or famciclovir

give IV if patient cannot swallow

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12
Q

Treatment for HSV esophagitis unresponsive to acyclovir or famciclovir

A

IV foscarnet

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13
Q

Treatment for CMV esophagitis

A

Ganciclovir or foscarnet

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14
Q

Age at which patients with nonulcer dyspepsia require investigation with upper endoscopy

A

> 55 years

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15
Q

Recommended management for patients 55 years old or less with nonulcer dyspepsia and negative H. pylori testing.

A

Empiric PPI for 4-6 weeks

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16
Q

Best way to diagnose PUD

A

Upper endoscopy

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17
Q

Aside from a PPI, this drug may be given to patients at high risk for developing NSAID-induced PUD but needs NSAID treatment

A

Misoprostol

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18
Q

Initial treatment of gastric outlet obstruction in PUD

A

Nasogastric suction and IV PPI

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19
Q

Diagnosis: abdominal pain, bloating, difficulty belching after fundoplication surgery

A

Gas-bloat syndrome

Tx: diet modification

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20
Q

Diagnosis: loose stools and malabsorption after gastric bypass

A

Blind loop syndrome

Tx: antibiotics and nutritional supplements

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21
Q

Diagnosis: abdominal cramps, nausea, loose stools 15 minutes after eating followed within 90 minutes by lightheadedness, diaphoresis, tachycardia; post-gastric resection or bypass surgery

A

Dumping syndrome

Tx: small frequent feedings, low-carb meals

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22
Q

Initial study in patients with acute symptoms of gastroparesis

A

Upper endoscopy

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23
Q

Imaging test for chronic symptoms of gastroparesis or acute symptoms with negative upper endoscopy

A

Nuclear medicine solid-phase gastric emptying study

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24
Q

Treatment for acute gastroparesis

A

IV erythromycin

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25
Q

Treatment for chronic gastroparesis

A

Metoclopramide

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26
Q

Serious complication of metoclopramide therapy

A

Tardive dyskinesia

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27
Q

Diagnostic tests for celiac disease (2)

A

IgA anti-tissue transglutaminase or IgA anti-endomysial antibody assay

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28
Q

Diagnostic tests for celiac disease in patients with IgA deficiency (3)

A

IgG anti-tissue transglutaminase, IgG antiendomysial antibodies, IgG antigliadin antibodies

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29
Q

Definitive diagnosis for celiac disease requires either of these 2

A

Small bowel biopsy or presence of dermatitis herpetiformis

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30
Q

Common endocrine conditions in patients with celiac disease (2)

A

Type 1 diabetes mellitus and autoimmune thyroid disease

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31
Q

Malignancy with increased incidence in celiac disease

A

Small bowel lymphoma

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32
Q

Pruritic papulovesicular rash on the extensor surfaces seen in patients with celiac disease

A

Dermatitis herpetiformis

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33
Q

Treatment of celiac disease or dermatitis

A

Gluten-free diet

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34
Q

Most common reason for failure of a gluten-free diet in celiac disease

A

Nonadherence

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35
Q

Tests to assss effectiveness of diet therapy in patients with celiac disease

A

IgA antigliadin or IgA anti-tissue transglutaminase antibody

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36
Q

Diagnosis: chronic diarrhea/malabsorption with history of IBS and iron deficiency anemia

A

Celiac disease

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37
Q

Diagnosis: chronic diarrhea/malabsorption with chronic pancreatitis, hyperglycemia, hx of panc resection, cystic fibrosis

A

Pancreatic insufficiency

Tx: pancreatic enzyme replacement

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38
Q

Diagnosis: chronic diarrhea/malabsorption with previous surgery, small bowel diverticulosis, dysmotility

A 
Bacterial overgrowth
(Tx: empiric trial of antibiotics or do hydrogen breath test)
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39
Q

Diagnosis: chronic diarrhea/malabsorption after resection of >200 cm distal small bowel

A

Short-bowel syndrome

Tx: replace nutrient and electrolyte deficiencies

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40
Q

Diagnosis: resection of <100 cm distal ileum, now with nonfatty diarrhea

A

Short-bowel syndrome with bile acid enteropathy

Tx: empiric trial of cholestyramine

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41
Q

Diagnosis: chronic diarrhea/malabsorption with arthralgia, fever, neurologic, ocular, or cardiac disease

A

Whipple disease

Dx: small bowel biopsy and PCR; tx: antibiotics for 12 months

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42
Q

Diagnosis: chronic diarrhea/malabsorption with hx of travel to India or Puerto Rico, weight loss, malaise, folate or vit B12 def, steatorrhea

A

Tropical sprue

Dx: small bowel biopsy; tx: sulfonamide or tetracycline and folic acid

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43
Q

Diagnosis: prolonged traveler’s diarrhea, diarrhea after a camping trip, or outbreak in a day-care center

A

Giardiasis

Dx: identify parasites or antigen in stool; tx: metronidazole

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44
Q

Drug contraindicated in cases of ileal resection >100 cm because it will worsen bile salt deficiency and steatorrhea

A

Cholestyramine

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45
Q

Most common complication of acute pancreatitis

A

Pancreatic pseudocysts

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46
Q

Preferred route of nutrition for moderate to severe pancreatitis

A

Enteral jejunal feedings

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47
Q

Most sensitive imaging study for chronic pancreatitis

A

Abdominal CT

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48
Q

Young adults with chronic pancreatitis require genetic testing for this condition

A

Cystic fibrosis

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49
Q

Diagnosis: hypergammaglobulinemia (IgG4), diffuse pancreatic enlargement and/or a mass lesion, irregular main pancreatic duct

A

Autoimmune pancreatitis

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50
Q

Cornerstone of treatment for autoimmune pancreatitis

A

Corticosteroids

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51
Q

Most common cause of upper abdominal pain among patients aged >50 years

A

Biliary pain

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52
Q

Treatment for biliary colic that can decrease the risk of progression to acute cholecystitis

A

NSAIDs

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53
Q

Contraindications to the use of interferon alfa in chronic hepatitis B (4)

A

Decompensated cirrhosis, active autoimmune disorders, severe cytopenias, major depression

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54
Q

Endocrine disorder seen in 10% of patients taking interferon alfa

A

Hypothyroidism

55
Q

Most prevalent bloodborne infection in the US

A

Hepatitis C

56
Q

Standard treatment for chronic hepatitis C genotypes 2, 3, and 4

A

Pegylated interferon alfa plus ribavirin

57
Q

Treatment for hepatitis C genotype 1

A

Protease inhibitor (boceprevir or telaprevir) in combination with interferon alfa plus ribavirin

58
Q

HFE gene testing for hemochromatosis is indicated when the fasting serum transferrin saturation is at this level

A

> 45%

59
Q

Destructive arthropathy of the 2nd and 3rd MCP joints characterized by distinctive hook-like osteophytes are seen in this disorder

A

Hemochromatosis

60
Q

Indications for liver biopsy in hemochromatosis (2)

A

(1) Confirmed hemochromatosis and abnormal liver enzymes to determine severity of liver disease, (2) negative HFE genotype but elevated serum transferrin saturation and serum ferritin level >1000 ng/mL to establish diagnosis

61
Q

HFE genotypes diagnostic of hemochromatosis

A

Homozygous C282Y or compound heterozygous C282Y/H63D

62
Q

Treatment of choice for hemochromatosis

A

Phlebotomy

63
Q

Target serum ferritin in the treatment of hemochromatosis

A

<50 ng/mL

64
Q

Type of anti-LKM antibodies in autoimmune hepatitis

A

Anti-LKM1

also seen in hepatitis C

65
Q

Diagnostic triad of primary biliary cirrhosis

A

(1) Cholestatic liver profile, (2) positive antimitochondrial antibody, (3) compatible histologic findings on liver biopsy

66
Q

Primary therapeutic agent for primary biliary cirrhosis

A

Ursodeoxycholic acid

67
Q

Most common type of IBD associated with primary sclerosing cholangitis

A

Ulcerative colitis

68
Q

Initial diagnostic study for primary sclerosing cholangitis

A

Abdominal ultrasonography

69
Q

Malignancies that should be screened annually in patients with primary sclerosing cholangitis (2)

A

Hepatocellular carcinoma and colon cancer

No recommendations regarding cholangiocarcinoma or gallbladder cancer but incidence is also increased in PSC

70
Q

Organisms associated with AIDS cholangiopathy (2)

A

CMV and Cryptosporidium infection

71
Q

Treatment for pruritus in primary sclerosing cholangitis

A

Cholestyramine

72
Q

Criteria used to define severe alcoholic hepatitis (4)

A

Any one of the ff: (1) Maddrey Discriminant Function 32 or >, (2) MELD score 18 or >, (3) Glasgow Alcoholic Hepatitis Score 9 or >, (4) encephalopathy or ascites

73
Q

Medications associated with the development of NASH (4)

A

Tamoxifen, estrogen, amiodarone, corticosteroids

74
Q

Most common cause of acute liver failure

A

Acetaminophen overdose

75
Q

Cause of outbreaks of acute liver failure associated with foods such as raspberries and scallions

A

Acute HAV infection

76
Q

Presence of these findings is suggestive of acute fatty liver of pregnancy rather than HELLP syndrome (2)

A

Hypoglycemia and encephalopathy

77
Q

Treatment for acute liver failure in Wilson disease

A

D-penicillamine or trientine

78
Q

Treatment for elevated intracranial pressure in acute liver failure

A

Mannitol

Do not use corticosteroids

79
Q

Diagnostic test for hepatopulmonary syndrome

A

Contrast-enhanced transthoracic echocardiography with agitated saline administration

80
Q

Urine sodium concentration in hepatorenal syndrome

A

<10 meq/L (10 mmol/L)

81
Q

First choice treatment for primary prophylaxis of variceal bleeding

A

Propranolol or nadolol

Second choice: endoscopic band ligation

82
Q

First choice treatment for acute variceal bleeding

A

Octreotide with endoscopic band ligation and prophylactic antibiotics
(Second choice: TIPS or shunt surgery)

83
Q

In cirrhosis, treatment for ascites not responding to low-sodium diet

A

Spironolactone with or without furosemide

84
Q

Volume of paracentesis that requires albumin administration

A

> 5 L

85
Q

Treatment for spontaneous bacterial peritonitis

A

Cefotaxime and albumin

86
Q

Primary complication of TIPS

A

Portosystemic encephalopathy

87
Q

Most common cause of jaundice during the first and second trimester of pregnancy

A

Viral hepatitis

88
Q

Treatment of choice for intrahepatic cholestasis of pregnancy

A

Ursodeoxycholic acid

89
Q

Symptom duration in the definition of irritable bowel syndrome

A

3 months

90
Q

Patients with IBS and diarrhea should be evaluated for this disorder

A

Celiac disease

91
Q

First-line treatments for pain in IBS

A

Antispasmodic agents (dicyclomine, hyoscyamine)

92
Q

This drug should not be used to treat IBS because of the risk of ischemic colitis

A

Alosetron

93
Q

Least common inflammatory bowel disease

A

Microscopic colitis

94
Q

Prominent symptom in ulcerative colitis (compared with Crohn disease)

A

Diarrhea

95
Q

Prominent symptom in Crohn disease (compared with ulcerative colitis)

A

Abdominal pain

96
Q

IBD that is alleviated by smoking

A

Ulcerative colitis

Smoking is a risk factor for Crohn disease

97
Q

Barium enema is contraindicated in moderate to severe ulcerative colitis because this procedure may precipitate this complication

A

Toxic megacolon

98
Q

Condition that must be considered in a patient with Crohn disease and cystitis

A

Enterovesical fistula

99
Q

Frequency of bowel movements in mild ulcerative colitis

A

<4 per day

With occasional blood in stool, normal VS, Hgb, ESR

100
Q

Treatment for mild ulcerative colitis

A

5-ASA agents (mesalamine or sulfasalazine)

101
Q

Treatment for moderate UC

A

Induction with prednisone, maintenance with 5-ASA or 6-MP or azathioprine

102
Q

Frequency of bowel movements in severe UC

A

> 6 per day

With bleeding, fever, PR >90/min, ESR >30 mm/h, anemia

103
Q

Treatment for severe UC

A

IV corticosteroids ff. by cyclosporine or infliximab if no response; surgery if refractory

104
Q

Treatment for mild to moderate CD involving the small or large bowel

A

5-ASA

105
Q

Treatment for mild to moderate CD involving the ileum or right colon

A

Budesonide

106
Q

Treatment for fistula in Crohn disease

A

Infliximab or adalimumab

107
Q

Drug with best documented efficacy in microscopic colitis

A

Budesonide

108
Q

Drugs which may contribute to symptoms of microscopic colitis

A

NSAIDs

109
Q

Disease duration of IBD at which surveillance colonoscopy is needed

A

8 years

Done every 1-2 years

110
Q

Rate of recurrence of acute diverticulitis

A

30%

111
Q

Risk of subsequent attacks after a second episode of acute diverticulitis

A

50%

Surgical resection of affected colon is indicated

112
Q

Most common cause of acute mesenteric ischemia

A

Emboli

113
Q

Inotropic drug which can cause ischemic colitis

A

Digitalis

114
Q

Intra-arterial thrombolysis may be done for acute mesenteric ischemia without peritoneal signs if initiated within this time after onset

A

12 hours

115
Q

Etiologic agent: foodborne diarrhea 6 hours after ingestion

A

Staphylococcus aureus or Bacillus cereus

116
Q

Etiologic agent: foodborne diarrhea 8-14 hours after ingestion

A

Clostridium perfringens

117
Q

Etiologic agent: foodborne diarrhea >14 h after ingestion

A

Virus, ETEC, EHEC

118
Q

Bacterial cause of colitis that can mimic appendicitis or Crohn disease

A

Yersinia enterocolitica

119
Q

Loperamide and diphenoxylate are contraindicated in EHEC colitis due to this possible complication

A

HUS

120
Q

Loperamide and diphenoxylate are contraindicated in C. difficile infection due to this possible complication

A

Toxic megacolon

121
Q

Most common illness to affect visitors to developing countries

A

Traveler’s diarrhea

122
Q

Most common causative agent of traveler’s diarrhea

A

ETEC

123
Q

Causative agent of shipboard epidemics of viral gastroenteritis

A

Caliciviruses (e.g., Norwalk virus)

124
Q

Most common cause of acute care hospital-acquired diarrhea

A

Clostridium difficile

125
Q

Treatment for pregnant patients with C. difficile antibiotic-associated diarrhea

A

Oral vancomycin

126
Q

Use of antimotility agents in CDAD is associated with this complication and is therefore contraindicated

A

Toxic megacolon

127
Q

Drug of choice for amebic colitis and amebic liver abscess

A

Metronidazole

128
Q

Chronic diarrhea is defined as lasting longer than this duration

A

4 weeks

129
Q

Fecal osmotic gap in secretory diarrhea

A

<50 mosm/kg

130
Q

Formula for fecal osmotic gap

A

290 - 2 x (Stool Na + Stool K)

131
Q

Fecal osmotic gap in osmotic diarrhea

A

> 125 mosm/kg

132
Q

Stool osmolarity in factitious diarrhea due to chronic laxative abuse

A

<250 mosm/kg

133
Q

Most common cause of osmotic diarrhea

A

Lactase deficiency

134
Q

Diagnosis: chronic diarrhea, coexistent pulmonary diseases, and/or recurrent Giardia infection

A

Common variable immunodeficiency

135
Q

Test of choice following negative repeat upper endoscopy/colonoscopy in patients with obscure bleeding

A

Wireless capsule endoscopy

ACP Board Basics 3 (10 decks)

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