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1
Q

What is the next best step in management for a pt who presents with dysphagia without anemia/bleeding and dx is unknown?

A

Barium (swallow) Study

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2
Q

What is the next best step in management of a pt with dysphagia, wt loss, heme positive stool or anemia?

A

Endoscopy

Only do barium if endoscopy is not an option

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3
Q

What is the best initial treatment for esophageal cancer?

A

Surgical resection for non-metastatic disease

Chemo after surgery: 5-Fluorouracil

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4
Q

What is the most likely dx in a middle age woman presenting with dysphagia and iron deficiency anemia?

A

Plummer-Vinson Syndrome

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5
Q

What is a serious complication associated with Plummer Vinson Syndrome?

A

Squamous Cell Esophageal Cancer

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6
Q

What is the best initial treatment for Plummer-Vinson Syndrome?

A

Iron Replacement

also , on CCS, include stool softeners as iron can lead to constipation

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7
Q

What is the best initial treatment for Schatzki’s Ring and Peptic Stricture?

A

Pneumatic Dilation

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8
Q

What muscle group is affected in Zenker’s Diverticulum?

A

Posterior Pharyngeal Constrictor Muscles

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9
Q

How are Prinzmetal’s Angina and Esophageal spastic disorders distinguished?

A

Prinzmetal’s Angina will have ST elevation and abnormality with Coronary Stimulation.

No cardiac abnormalities found with Esophageal disorder

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10
Q

What is the treatment for Esophageal spastic disorders and Prinzmetal’s Angina?

A

Calcium Channel Blockers and Nitrates

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11
Q

What is the next best step in management for a HIV-neg pt with odynophagia?

A

Endoscopy

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12
Q

What is next best step in management for HIV-pos pt presenting with odynophagia and CD4 ct

A

Fluconazole

Note: perform endoscopy only if no response to fluconazole

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13
Q

What is the most common cause of esophagitis in HIVpos pt?

A

Candida Esophagitis

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14
Q

What is the treatment for pt with high grade esophageal dysplasia?

A

Surgical resection, ablation, or distal esophagectomy

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15
Q

What is the treatment for pt with Low-grade dysplasia?

A

PPI and repeat endoscopy in 3-6 mos

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16
Q

What is the treatment for pt with Barret’s esophagus?

A

PPI and repeat endoscopy q 2-3 yrs

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17
Q

What is next best step in management for pt >45 yo who presents with epigastric discomfort for several weeks with no other symptoms and heme-neg stool?

A

Upper Endoscopy

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18
Q

What are the indications for stress ulcer prophylaxis?

A

Head trauma
Intubation/ mechanical ventilation
Coagulopathy w/ steroid use
Burns

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19
Q

What is the indication for Helicobacter triple therapy?

A

Iff pt has positive Bx WITH gastritis or ulcer on endoscopy.

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20
Q

What is the most likely dx for pt presenting with Gastrinoma and Hypercalcemia?

A

MEN I Syndrome (MEN gene mutation)

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21
Q

What biological marker prophile is associated with Crohn’s Disease?

A 
Antineutrophil cytoplasmic Ab (ANCA)-Neg
Antisaccharomyces cervicsiae (ASCA)-Pos
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22
Q

What biological marker prophile is associated with Ulcerative Colitis?

A

ANCA: Pos
ASCA: Neg

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23
Q

What is the best initial therapy to treat UC and Crohn’s Disease?

A

Mesalamine

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24
Q

What are the side effects of sulfasalazine?

A

Rash
Hemolytic Anemia
Interstitial Nephritis

(thus not firstline therapy to treat IBD)

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25
What is the treatment for controlling sx of Fistulizing Crohn's Disease?
Infliximab
26
What test must be done prior to starting Infliximab?
PPD (if positive give INH)
27
What is the best treatment for management of acute sx with UC and Crohn's Disease?
Budesonide (steroids) | has very little systemic side effects
28
What is best treatment to manage pt with UC/Crohn's who has severe and recurrent sx when steroids are stopped?
Azathioprine and 6-mercaptopurine
29
What is the best treatment for pt with perianal involvement with Crohn's Disease?
Metronidazole and Ciprofloxacin
30
What is best initial test in a pt suspected of antibiotic -associated (c.diff) diarrhea?
stool Toxin assay
31
What are the causes of fat malabsorption?
Chronic Pancreatitis Celiac Diesase (Non-tropical Sprue) Tropical Sprue Whipple Disease
32
What are associated complications of fat malabsorption?
``` Hypocalcemia (vit d def and soponification) --> osteoporosis Oxaloacetate stones (increased absorption) Easy bruising (factor-type bleedingd/t Vit K def) Vit B12 def (terminal ileum damage or pancreatic damage) ```
33
What is the best initial test for malabsorption?
Stool Sudan black stain (for fat presence)
34
Waht is the most sensitive test for malabsorption? | can use to r/o
72-hr Fecal fat test
35
What micro/macro nutrient malabsorption can be associated with Celiac disease?
Fat malabsorption Iron (terminal ileum destruction)--> microcytic anemia Folate (vili damage-blunted microvili)
36
What is the best initial test in pt suspected of Celiac Disease?
Anti-gliadin Ab Anti-endomysial Ab Anti-tissue transglutaminase Ab
37
What is the most accurate test for dx'ing Celiac Disease?
Small Bowel Bx (always do this test to dx and r/o lymphoma of small bowel)
38
What is the standard treatment for tropical Sprue?
Doxycycline or TMP/SMX for 3-6 months
39
What is the treatment for pt presenting with foul smelling stools that float, B12 deficiency, neurological findings, ocular sx, joint pain, and diarrhea?
Tetracycline or TMP/SMX for 12 months | Whipple Disease treatment
40
What is the order of treatment for IBS?
Initial: Fiber FIber no help: Add Dicyclomine/Hyoscyamine (anichol/antispasmodic) Antichol/antispas no help: Add TCA (Amitriptyline)
41
What medications can cause acute pancreatitis?
Thiazides (Diuretic) Didanosine(NRTI) Stavudine(NRTI) Azathiprine (Crohn's to wean off steroids)
42
What is the best initial test to dx acute pancreatitis?
Serum Amylase/Lipase
43
What is the most accurate test to dx acute pancreatitis?
Abdominal CT
44
What are some other useful tests in managing acute pancreatitis?
MRCP (if CT unclear) Urine Trypsinogen Peptide (to measure severity) ERCP (if dilates hepatic ducts w/o pancreatic head mass) Note: ERCP is diagnostic and therapeutic so use when it seems possible that it can also treat something!
45
If CT scan of pt with acute pancreatitis shows >30% necrosis, what is next step in management?
Start Antibiotics Imipenem (gram negative/anaerobic coverage) CT-guided biopsy (if infected/necrotic pancreas on bx--> debridement)
46
What are the general presenting features of acute Hepatitis?
Jaundice Fatigue Weight Loss Dark Urine (elevated direct bilirubin)
47
What symptoms are associated with Serum-sickness phenomenon and Hepatitis B and C?
Joint Pain Fever Urticaria
48
Which type of hepatitis is most severe in pregnancy?
Hepatitis E
49
For which type of acute Hepatitis infection is there treatment?
Acute Hepatitis C only
50
What is the treatment for acute/chronic Hepatitis C?
Interferon/Ribavirin and Oral Protease Inhibitor (Ledipasvir, Simeprevir, Sofosbuvir) Note: Ledipasvir with Interferon is best combo for Genotype 1 Hepatitis C.
51
Which pt is the best candidate for chronic Hep B treatment?
``` Pt with: HbsAg elevated Hep B PCR for DNA DNA polymerase HbeAg ```
52
What are the single agent treatment options for chronic Hep B?
``` Lamivudine Adefovir Entecavir Telbivudine Tenofovir Interferon ```
53
What are the side effects of Interferon?
``` Fatigue Flu-like sx Arthralgias Myalgias Depression Thrombocytopenia ```
54
What is the most common side effect of ribavirin?
Anemia
55
What is the best initial test for dx'ing Acute Hep C?
Hep C Antibody (cannot tell viral activity)
56
What is the most accurate test for Acute Hep C?
Hep C PCR (RNA) This tells best, the viral activity, and response to treatment.
57
What is the best test to determine Hep C severity?
Liver Bx
58
What are the criteria for Hep A and B vaccination?
``` Chronic liver disease Household contacts w/ Hep A or Hep B Chronic recipient of Blood products Men who have sex with men IV drug users ```
59
What are the indications for Hep B vaccination alone?
Health Care workers Dialysis pts Diabetes
60
What are the common features of a pt with Cirrhosis?
``` Edema (low serum albumin) Gynecomastia Palmar erythema Splenomegaly Thrombocytopenia (splenic sequestration) Ascites (tx with Spironolactone) Encaphalopathy (tx with lactulose) Esophageal Varices (banding if they bleed, Propranolol to prevent bleeding) ```
61
What test should be included in the management of pt recently diagnosed with liver cirrhosis?
Endoscopy (to detect esophageal varices)
62
When should a paracentesis be done for pt with ascites?
If it is New Ascites and/or Pain, Fever, Tenderness present
63
What test should be included in work up of ascites?
Albumin (serum and ascites)--> use to calculate SAAG SAAG>1.1: Portal Hypertension or CHF SAAG check cell count (> 250 neutrophils)
64
What is the treatmetn for Spontaneous Bacterial Peritonitis (SBP)?
Cefotaxime
65
What is the best initial test for a middle-aged woman with a h/o autoimmune disease presenting with itching w/w/o Xanthelesmas?
``` Alk Phos (elevated) Bilirubin (normal) ``` To dx Primary Biliary Cirrhosis
66
What is the treament for pt with PBC and PSC?
Ursodeoxycholic Acid
67
What is the most accurate test to dx PBC?
Antimitochondrial Ab (AMA) and Liver Bx | can hv elevated IgM level also
68
What is the most likely dx in a pt with h/o IBD, presenting with itching and found to have elevated alk phos and bilirubin?
Primary Sclerosing Cholangitis (PSC)
69
What are the most accurate tests to dx PSC?
ERCP (beaded biliary system) ANCA positive Anti-smooth muscle Ab (ASMA)
70
What is the most likely diagnosis of a pt presenting with liver disease/cirrhosis, choreiform movement, neuropsychiatric abnormalities w/w/o hemolysis?
Wilson's Disease (copper metabolism disorder- low ceruloplasmin)
71
What is the best initial test to dx Wilson's Disease?
Slit Lamp ocular exam: Kayser Fleischer rings Note (for CCS order slit lamp and ceruloplasmin level even though cerloplasmin is less sensitive and less specific)
72
What is most accurate test for dx'ing WIlson's disease?
Liver Bx
73
What is the treatment of choice for Wilson's disease?
Penicillamine or Trientine
74
What is the most likely diagnosis for a pt who has the following test results: High Serum Fe, High Ferritin, Low TIBC?
Hemochromatosis
75
What is the most common underlying cause of Hemochromatosis?
HFe gene mutation
76
What organs are typically affected in Hemochromatosis?
``` Liver (Cirrhosis and Hepatoma) Pancreas (Bronze Diabetes) Heart (Restricted Cardiomyopathy) Gonads (Infertility) Skin (Hyperpigmentation) Joint (pseudogout/Calcium Pyrophosphate deposition) Pituitary (panhypopituitarism) ```
77
What is the beat initial test in dx'ing Hemochromatosis?
Iron studies
78
What is the most accurate test for dx'ing Hemochromatosis?
Liver Bx or | MRI w/genetic testing
79
What is the most common cause of death in Hemochromatosis?
Cirrhosis
80
What is the treatment for Hemochromatosis?
Phlebotomy
81
What are the best initial tests to dx Autoimmune Hepatitis?
ANA and SPEP (hypergammaglobulinemia)
82
What is the most accurate test in pt with Autoimmune Hepatitis?
Liver Bx
83
What autoantibodies are associated with Autoimmune hepatitis?
ANA | ASMA
84
What is the best treatment for managing Autoimmune Hepatitis?
Prednisone (can use azathioprine to wean off steroids)
85
What conditions are most strongly associated with Non-alcoholic Steatohepatitis (NASH)?
Obesity Diabetes Hyperlipidemia
86
What physical finding is commonly present in pt with NASH?
Hepatomegaly
87
What is the best initial test to dx NASH?
Liver enzymes (ALT> AST)
88
What is the most accurate test to dx NASH?
Liver Bx: fatty infiltrate (like alcoholic liver)
89
What hepatic serology is associated with Acute Hepatitis B infection?
HbsAg HbeAg HbcAb
90
What serology is associated with the Window period in Hepatitis B infection (recovering)?
HbcAb
91
What stage of Hep B infection is associated with a positive HbcAb and HbsAb
Resolved infection, Past Hep B infection
92
What serology indicated chronic Hep B infection?
HbsAg present >6 months HbeAg HbcAb
93
What tests indicate active viral replication in HepB?
HbeAg, HepB DNA pol, HepB DNA PCR

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