GI Flashcards
0
Q
Most effective study for evaluating suspected oropharyngeal dysphagia
A
Videofluoroscopy (aka modified barium swallow)
1
Q
Diagnosis: solid-food dysphagia that occurs episodically for months to years
A
Esophageal web or distal esophageal ring (Schatzki ring)
2
Q
Preferred screening test when achalasia is suspected clinically
A
Barium swallow
3
Q
Confirmatory test for achalasia
A
Esophageal manometry
4
Q
First-line therapies for achalasia (2)
A
Laparoscopic myotomy of the LES or endoscopic pneumatic dilatation
5
Q
First-line therapy for the extraesophageal manifestations of GERD
A
PPIs
6
Q
Use of this class of drugs is associated with infectious esophagitis in otherwise healthy patients
A
Inhaled corticosteroids
7
Q
Characteristic symptom of infectious esophagitis
A
Odynophagia
8
Q
Most common cause of infectious esophagitis
A
Candida albicans
followed by CMV and HSV
9
Q
Esophageal condition that presents with extreme dysphagia and food impaction
A
Eosinophilic esophagitis
10
Q
Treatment for esophageal candidiasis
A
Fluconazole or itraconazole
11
Q
Treatment for HSV esophagitis
A
Oral acyclovir or famciclovir
give IV if patient cannot swallow
12
Q
Treatment for HSV esophagitis unresponsive to acyclovir or famciclovir
A
IV foscarnet
13
Q
Treatment for CMV esophagitis
A
Ganciclovir or foscarnet
14
Q
Age at which patients with nonulcer dyspepsia require investigation with upper endoscopy
A
> 55 years
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
16
Q
Best way to diagnose PUD
A
Upper endoscopy
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
18
Q
Initial treatment of gastric outlet obstruction in PUD
A
Nasogastric suction and IV PPI
19
Q
Diagnosis: abdominal pain, bloating, difficulty belching after fundoplication surgery
A
Gas-bloat syndrome
Tx: diet modification
20
Q
Diagnosis: loose stools and malabsorption after gastric bypass
A
Blind loop syndrome
Tx: antibiotics and nutritional supplements
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
22
Q
Initial study in patients with acute symptoms of gastroparesis
A
Upper endoscopy
23
Q
Imaging test for chronic symptoms of gastroparesis or acute symptoms with negative upper endoscopy
A
Nuclear medicine solid-phase gastric emptying study
24
Treatment for acute gastroparesis
IV erythromycin
25
Treatment for chronic gastroparesis
Metoclopramide
26
Serious complication of metoclopramide therapy
Tardive dyskinesia
27
Diagnostic tests for celiac disease (2)
IgA anti-tissue transglutaminase or IgA anti-endomysial antibody assay
28
Diagnostic tests for celiac disease in patients with IgA deficiency (3)
IgG anti-tissue transglutaminase, IgG antiendomysial antibodies, IgG antigliadin antibodies
29
Definitive diagnosis for celiac disease requires either of these 2
Small bowel biopsy or presence of dermatitis herpetiformis
30
Common endocrine conditions in patients with celiac disease (2)
Type 1 diabetes mellitus and autoimmune thyroid disease
31
Malignancy with increased incidence in celiac disease
Small bowel lymphoma
32
Pruritic papulovesicular rash on the extensor surfaces seen in patients with celiac disease
Dermatitis herpetiformis
33
Treatment of celiac disease or dermatitis
Gluten-free diet
34
Most common reason for failure of a gluten-free diet in celiac disease
Nonadherence
35
Tests to assss effectiveness of diet therapy in patients with celiac disease
IgA antigliadin or IgA anti-tissue transglutaminase antibody
36
Diagnosis: chronic diarrhea/malabsorption with history of IBS and iron deficiency anemia
Celiac disease
37
Diagnosis: chronic diarrhea/malabsorption with chronic pancreatitis, hyperglycemia, hx of panc resection, cystic fibrosis
Pancreatic insufficiency
| Tx: pancreatic enzyme replacement
38
Diagnosis: chronic diarrhea/malabsorption with previous surgery, small bowel diverticulosis, dysmotility
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Bacterial overgrowth
(Tx: empiric trial of antibiotics or do hydrogen breath test)
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39
Diagnosis: chronic diarrhea/malabsorption after resection of >200 cm distal small bowel
Short-bowel syndrome
| Tx: replace nutrient and electrolyte deficiencies
40
Diagnosis: resection of <100 cm distal ileum, now with nonfatty diarrhea
Short-bowel syndrome with bile acid enteropathy
| Tx: empiric trial of cholestyramine
41
Diagnosis: chronic diarrhea/malabsorption with arthralgia, fever, neurologic, ocular, or cardiac disease
Whipple disease
| Dx: small bowel biopsy and PCR; tx: antibiotics for 12 months
42
Diagnosis: chronic diarrhea/malabsorption with hx of travel to India or Puerto Rico, weight loss, malaise, folate or vit B12 def, steatorrhea
Tropical sprue
| Dx: small bowel biopsy; tx: sulfonamide or tetracycline and folic acid
43
Diagnosis: prolonged traveler's diarrhea, diarrhea after a camping trip, or outbreak in a day-care center
Giardiasis
| Dx: identify parasites or antigen in stool; tx: metronidazole
44
Drug contraindicated in cases of ileal resection >100 cm because it will worsen bile salt deficiency and steatorrhea
Cholestyramine
45
Most common complication of acute pancreatitis
Pancreatic pseudocysts
46
Preferred route of nutrition for moderate to severe pancreatitis
Enteral jejunal feedings
47
Most sensitive imaging study for chronic pancreatitis
Abdominal CT
48
Young adults with chronic pancreatitis require genetic testing for this condition
Cystic fibrosis
49
Diagnosis: hypergammaglobulinemia (IgG4), diffuse pancreatic enlargement and/or a mass lesion, irregular main pancreatic duct
Autoimmune pancreatitis
50
Cornerstone of treatment for autoimmune pancreatitis
Corticosteroids
51
Most common cause of upper abdominal pain among patients aged >50 years
Biliary pain
52
Treatment for biliary colic that can decrease the risk of progression to acute cholecystitis
NSAIDs
53
Contraindications to the use of interferon alfa in chronic hepatitis B (4)
Decompensated cirrhosis, active autoimmune disorders, severe cytopenias, major depression
54
Endocrine disorder seen in 10% of patients taking interferon alfa
Hypothyroidism
55
Most prevalent bloodborne infection in the US
Hepatitis C
56
Standard treatment for chronic hepatitis C genotypes 2, 3, and 4
Pegylated interferon alfa plus ribavirin
57
Treatment for hepatitis C genotype 1
Protease inhibitor (boceprevir or telaprevir) in combination with interferon alfa plus ribavirin
58
HFE gene testing for hemochromatosis is indicated when the fasting serum transferrin saturation is at this level
>45%
59
Destructive arthropathy of the 2nd and 3rd MCP joints characterized by distinctive hook-like osteophytes are seen in this disorder
Hemochromatosis
60
Indications for liver biopsy in hemochromatosis (2)
(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
HFE genotypes diagnostic of hemochromatosis
Homozygous C282Y or compound heterozygous C282Y/H63D
62
Treatment of choice for hemochromatosis
Phlebotomy
63
Target serum ferritin in the treatment of hemochromatosis
<50 ng/mL
64
Type of anti-LKM antibodies in autoimmune hepatitis
Anti-LKM1
| also seen in hepatitis C
65
Diagnostic triad of primary biliary cirrhosis
(1) Cholestatic liver profile, (2) positive antimitochondrial antibody, (3) compatible histologic findings on liver biopsy
66
Primary therapeutic agent for primary biliary cirrhosis
Ursodeoxycholic acid
67
Most common type of IBD associated with primary sclerosing cholangitis
Ulcerative colitis
68
Initial diagnostic study for primary sclerosing cholangitis
Abdominal ultrasonography
69
Malignancies that should be screened annually in patients with primary sclerosing cholangitis (2)
Hepatocellular carcinoma and colon cancer
| No recommendations regarding cholangiocarcinoma or gallbladder cancer but incidence is also increased in PSC
70
Organisms associated with AIDS cholangiopathy (2)
CMV and Cryptosporidium infection
71
Treatment for pruritus in primary sclerosing cholangitis
Cholestyramine
72
Criteria used to define severe alcoholic hepatitis (4)
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
Medications associated with the development of NASH (4)
Tamoxifen, estrogen, amiodarone, corticosteroids
74
Most common cause of acute liver failure
Acetaminophen overdose
75
Cause of outbreaks of acute liver failure associated with foods such as raspberries and scallions
Acute HAV infection
76
Presence of these findings is suggestive of acute fatty liver of pregnancy rather than HELLP syndrome (2)
Hypoglycemia and encephalopathy
77
Treatment for acute liver failure in Wilson disease
D-penicillamine or trientine
78
Treatment for elevated intracranial pressure in acute liver failure
Mannitol
| Do not use corticosteroids
79
Diagnostic test for hepatopulmonary syndrome
Contrast-enhanced transthoracic echocardiography with agitated saline administration
80
Urine sodium concentration in hepatorenal syndrome
<10 meq/L (10 mmol/L)
81
First choice treatment for primary prophylaxis of variceal bleeding
Propranolol or nadolol
| Second choice: endoscopic band ligation
82
First choice treatment for acute variceal bleeding
Octreotide with endoscopic band ligation and prophylactic antibiotics
(Second choice: TIPS or shunt surgery)
83
In cirrhosis, treatment for ascites not responding to low-sodium diet
Spironolactone with or without furosemide
84
Volume of paracentesis that requires albumin administration
>5 L
85
Treatment for spontaneous bacterial peritonitis
Cefotaxime and albumin
86
Primary complication of TIPS
Portosystemic encephalopathy
87
Most common cause of jaundice during the first and second trimester of pregnancy
Viral hepatitis
88
Treatment of choice for intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid
89
Symptom duration in the definition of irritable bowel syndrome
3 months
90
Patients with IBS and diarrhea should be evaluated for this disorder
Celiac disease
91
First-line treatments for pain in IBS
Antispasmodic agents (dicyclomine, hyoscyamine)
92
This drug should not be used to treat IBS because of the risk of ischemic colitis
Alosetron
93
Least common inflammatory bowel disease
Microscopic colitis
94
Prominent symptom in ulcerative colitis (compared with Crohn disease)
Diarrhea
95
Prominent symptom in Crohn disease (compared with ulcerative colitis)
Abdominal pain
96
IBD that is alleviated by smoking
Ulcerative colitis
| Smoking is a risk factor for Crohn disease
97
Barium enema is contraindicated in moderate to severe ulcerative colitis because this procedure may precipitate this complication
Toxic megacolon
98
Condition that must be considered in a patient with Crohn disease and cystitis
Enterovesical fistula
99
Frequency of bowel movements in mild ulcerative colitis
<4 per day
| With occasional blood in stool, normal VS, Hgb, ESR
100
Treatment for mild ulcerative colitis
5-ASA agents (mesalamine or sulfasalazine)
101
Treatment for moderate UC
Induction with prednisone, maintenance with 5-ASA or 6-MP or azathioprine
102
Frequency of bowel movements in severe UC
>6 per day
| With bleeding, fever, PR >90/min, ESR >30 mm/h, anemia
103
Treatment for severe UC
IV corticosteroids ff. by cyclosporine or infliximab if no response; surgery if refractory
104
Treatment for mild to moderate CD involving the small or large bowel
5-ASA
105
Treatment for mild to moderate CD involving the ileum or right colon
Budesonide
106
Treatment for fistula in Crohn disease
Infliximab or adalimumab
107
Drug with best documented efficacy in microscopic colitis
Budesonide
108
Drugs which may contribute to symptoms of microscopic colitis
NSAIDs
109
Disease duration of IBD at which surveillance colonoscopy is needed
8 years
| Done every 1-2 years
110
Rate of recurrence of acute diverticulitis
30%
111
Risk of subsequent attacks after a second episode of acute diverticulitis
50%
| Surgical resection of affected colon is indicated
112
Most common cause of acute mesenteric ischemia
Emboli
113
Inotropic drug which can cause ischemic colitis
Digitalis
114
Intra-arterial thrombolysis may be done for acute mesenteric ischemia without peritoneal signs if initiated within this time after onset
12 hours
115
Etiologic agent: foodborne diarrhea 6 hours after ingestion
Staphylococcus aureus or Bacillus cereus
116
Etiologic agent: foodborne diarrhea 8-14 hours after ingestion
Clostridium perfringens
117
Etiologic agent: foodborne diarrhea >14 h after ingestion
Virus, ETEC, EHEC
118
Bacterial cause of colitis that can mimic appendicitis or Crohn disease
Yersinia enterocolitica
119
Loperamide and diphenoxylate are contraindicated in EHEC colitis due to this possible complication
HUS
120
Loperamide and diphenoxylate are contraindicated in C. difficile infection due to this possible complication
Toxic megacolon
121
Most common illness to affect visitors to developing countries
Traveler's diarrhea
122
Most common causative agent of traveler's diarrhea
ETEC
123
Causative agent of shipboard epidemics of viral gastroenteritis
Caliciviruses (e.g., Norwalk virus)
124
Most common cause of acute care hospital-acquired diarrhea
Clostridium difficile
125
Treatment for pregnant patients with C. difficile antibiotic-associated diarrhea
Oral vancomycin
126
Use of antimotility agents in CDAD is associated with this complication and is therefore contraindicated
Toxic megacolon
127
Drug of choice for amebic colitis and amebic liver abscess
Metronidazole
128
Chronic diarrhea is defined as lasting longer than this duration
4 weeks
129
Fecal osmotic gap in secretory diarrhea
<50 mosm/kg
130
Formula for fecal osmotic gap
290 - 2 x (Stool Na + Stool K)
131
Fecal osmotic gap in osmotic diarrhea
>125 mosm/kg
132
Stool osmolarity in factitious diarrhea due to chronic laxative abuse
<250 mosm/kg
133
Most common cause of osmotic diarrhea
Lactase deficiency
134
Diagnosis: chronic diarrhea, coexistent pulmonary diseases, and/or recurrent Giardia infection
Common variable immunodeficiency
135
Test of choice following negative repeat upper endoscopy/colonoscopy in patients with obscure bleeding
Wireless capsule endoscopy
