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DIT STEP 2 > GI > Flashcards

GI Flashcards

1
Q

Food poisoning as a result of food sitting out too long

A

Staph aureus

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2
Q

Not effective cleanser in preventing transmission of C dif

A

Alcohol based sanitizer

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3
Q

Rice-water stools

A

Cholera or ETEC

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4
Q

Which anti-lipid rx binds C dif toxin

A

Cholestyramine

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5
Q

Diarrhea + recent ingestion of water from stream

A

Giardia, E. histolytica

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6
Q

Diarrhea from seafood

A

Vibrio cholera, parahaemolytica

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7
Q

Dehydrated child with greenish diarrhea in winter months

A

Rotavirus

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8
Q

Diarrhea – > pink eye

A

Adenovirus

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9
Q

Treatment of Hep B

A

IFN alpha (standard or pegylated) or antiviral such as lamivudine, adefovir, entecavir, or telbivudine

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10
Q

Treatment of Hep C

A

Pegylated IFN + ribavirin

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11
Q

What anatomical structures are highlighted in barium swallow

A

Esophagus, LES, stomach

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12
Q

What anatomical structures are highlighted in gastric emptying study

A

STomach, pyloric sphincter, duodenum

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13
Q

What anatomical structures are highlighted in small bowel follow through

A

Stomach to terminal ileum

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14
Q

What anatomical structures are visualized with barium enema

A

Colon, appendix

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15
Q

Difference between Mallory Weiss and Boerhaave syndrome

A

Mallory Weiss is less serious and is a mucosal laceration. Boerhaavee is esophageal rupture.

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16
Q

Bloody diarrhea from poultry

A

Salmonella or campylo

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17
Q

Next step after H&P in workup of patient complaining of dysphagia

A

Barium swallow

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18
Q

Meds that can be used in treatment of DES and achalasia

A

Nifedipine, CCBs, nitrates

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19
Q

Anti depressant used to treat DES

A

TCAs

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20
Q

Tx of entamoeba histolytica

A

Metronidazole

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21
Q

Tx of Giardia

A

Metronidazole

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22
Q

Treatment of salmonella or shigella

A

Try not to treat salmonella but if its really severe give them a FQ or TMP-SMX. Same for shigella.

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23
Q

Tx of campylobacter

A

Erythromycin

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24
Q

2 systemic causes of parotid disease

A

Sarcoidosis, neoplasm

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25
Q

Difficulty swallowing both liquids and solids

A

Neuromuscular pathology

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26
Q

Complications of myotomy in treatment of achalasia

A

GERD

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27
Q

Nitrates relieve pain of DES but exacerbate pain of?

A

GERD

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28
Q

Neck mass that increases in size while drinking liquids

A

Zenker’s diverticulum

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29
Q
A

Zenkers

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30
Q
A

Diffuse esophageal spasm

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31
Q

Which antacid causes constipation?

A

Aluminum

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32
Q

Which antacid causes diarrhea?

A

Magnesium

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33
Q

2 side effects of cimetidine

A

Impotence, gynecomastia

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34
Q

Thrombocytopenia in a patient with GERD

A

Stop their H2 antag!

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35
Q

PPIs may increase effects of which 3 meds?

A

Warfarin, phenytoin, benzos

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36
Q

Esoph CA in upper 2/3

A

Likely squamous cell

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37
Q

Esoph cancer in lower 1/3

A

Adenocarcinoma

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38
Q

What are 3 deficiencies seen post-gastrectomy?

A

B12, iron, calcium

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39
Q

Most common complication seen after gastric bypass

A

Incisional hernia

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40
Q

Serum marker seen in gastric CA

A

CEA

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41
Q

Treatment for gastric cancer

A

Distal 1/3: partial gastrectomy

Mid/upper: total gastrectomy

Both also get chemo and radiation.

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42
Q

EGD with bx in 65 y.o. male reveals gastric cancer. What is the next step in the management?

A

CT scan of abdomen/pelvis to stage

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43
Q

What is the next step in mgmt of a patient with recurrent duodenal ulcers seen on at least 2 EGDs?

A

Check serum gastrin to r/o zollinger ellison

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44
Q

Presenting features that help distinguish gastric from duodenal ulcers

A

Gastric: pain soon after eating and eating worsens pain.

Duodenal: pain 2-4 hours after eating and eating initially eases pain.

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45
Q

Ranson’s criteria for acute

A

Glucose > 200

AST > 250

LDH > 350

Age > 55

WBC >16

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46
Q

Ransons criteria 48 hrs

A

Ca < 8 (means triglycerides are binding the calcium, indicating saponification)

Hct drop > 10%

O2 < 60

BUN increase >5

Base deficiency > 4

Sequestration of fluid > 6 L

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47
Q

Tx of H pylori

A

PPI + clarithro + metronidazole or amoxicillin

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48
Q

Most sensitive and specific lab test for dx of chronic pancreatitis

A

Low fecal elastase

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49
Q

What Chem 7 lab abnormality is seen in pts with an upper GI bleed?

A

OIncreased BUN because bacteria in the gut break down hemoglobin.

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50
Q

Complications of pancreatic cancer

A

5 year survival < 2 %

Successful whipple procedure has 5 year survival 20-30%

Migratory thrombophlebitis (Trousseau syndrome)

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51
Q

2 drugs used in non-resectable insulinoma

A

Octreotide, diazoxide

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52
Q

Rash seen in glucagonoma

A

Migratory necrolytic erythema

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53
Q

Multiple insulinomas should make you consider?

A

MEN 1

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54
Q

Type A gastritis occurs where?

A

Fundus

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55
Q

Type B gastritis occurs where?

A

Antrum

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56
Q

Which type of gastritis is associated with auto-antibodies to parietal cells?

A

Type A

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57
Q

Lab differences between Type A and Type B gastritis

A

Type A has decreased gastrin and decreased gastric acid level.

Type B has increased gastric acid level.

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58
Q

Conditions associated with Type A gastritis

A

Pernicious anemia, Achlorhydria, Thyroiditis

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59
Q

Which type of gastritis is associated with increased risk for gastric cancer?

A

Type B

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60
Q

Complications of PUD

A

Posterior ulcers erode into gastroduodenal artery

Anterior ulcers perforate

Lymphoproliferative d/o (e.g., MALT lymphoma)

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61
Q

Younger patients are more likely to get what kind of ulcers?

A

Duodenal

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62
Q

ZE syndrome: gastrin producing tumor most frequently where?

A

Duodenum (70%) or pancreas.

63
Q

Patients with PUD who require NSAID should get what?

A

COX-2 inhibitors.

64
Q

2 lab abnormalities seen in ZE syndrome

A

Increased fasting gastrin

Positive secretin stimulation test (higher than expected levels of gastrin after secretin is administered)

65
Q

How do you get gastric SCC?

A

Invasion from esophagus

66
Q

2 “nodes” seen in gastric cancer

A

Sister mary joseph : periumbilical node

Virchows: left supraclavicular node

67
Q

Increased 2-glucuronidase in gastric secretions should make you think?

A

Gastric cancer

68
Q

Linitis plastica

A

Leather bottle stomach seen in gastric cancer

69
Q

A recent cuban immigrant with sx of malabsorption is found to have megaloblastic anemia. Dz? tx?

A

Tropical sprue. Folate replacement along with tetracycline or sulfa abx for 3-6 mos

70
Q

Classic time frame for which post op ileus resolves in the diff parts of the gut

A

Stomach: 48-72

Small intestine: 24 hrs

Colon: 3-5 days

71
Q

Most common cause of SBO

A

ABC. Adhesions, bulge (incarc hernia), cancer

72
Q

Classic characteristic of acute mesenteric ischemia

A

Pain out of proportion to exam

73
Q

4 tumors that can cause secretory diarrhea

A

Carcinoid, VIPoma, gastrinoma, medullary thyroid CA

74
Q

Most likely cause of malabsorption in pt with a + Sudan stain and a normal D - xylose test

A

Intestinal wall architecture must be fine if they can absorb carbs so this is pancreatic insufficiency

75
Q

Tx of Whipples

A

TMP-SMX or ceftriaxone x 12 mos

76
Q

What serum lab findings might help distinguish crohns from UC

A

Crohns: + ASCA

UC: + p-anca

77
Q

Tx for constipation dominant IBS

A

Zelnorm (legaserod). Due to increasd risk of MI, use is limited to those in crtiical need who have no preexisting heart conditions. Dose only for flares up to 8 weeks at a tiem. If no success after 1 month, discontinue.

78
Q

Less common causes of SBO

A

Volvulus, intussusception, Crohns, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis

79
Q

Most common benign small bowel tumor

A

Leiomyoma

80
Q

Most common malignant small bowel tumor

A

Adenocarcinoma

81
Q

Most commonly involved part of colon in mesenteric ischemia

A

Left colon. Rectum is typically spared thanks to collateral circulation

82
Q

Most common cause of large bowel obstruction

A

Neoplasm

83
Q

Abdom x ray shows bowel distension proximal to obstruction

A

Large bowel obstruction

84
Q

Where is ethanol absorbed

A

In the stomach

85
Q

Tx of anal fissure (medical)

A

Topical nitroglycerin, botox injections, bethanechol etc to relax sphincter. Sphincterotomies have a 10-30% risk of incontinence …. ew

86
Q

MCC of acute lower GI bleeding in pts age >40

A

Diverticulosis

87
Q

Most common tumor in appendix

A

Carcinoid

88
Q

Most common location of carcinoid tumor

A

Small bowel

89
Q

Drugs used in symptom relief for carcinoid syndrome

A

Cyproheptadine for diarrhea and/or anorexia

Albuterol and/or theophylline for asthma sx

Codeine and/or cholestyramine for diarrhea

90
Q

If sx of carcinoid syndrome are refractory to octreotide, what med can you add?

A

IFN alpha.

91
Q

NOT precancerous polyps

A

Hyperplastic polyps

92
Q

Polyps most often cancerous ?

A

Tubular > tubulovillous > villous

93
Q

Change in bowel habits is more indic of cancer where ?

A

Left side of colon. Come on.

94
Q

Staging for colorectal CA with lymph node involvement

A

Stage III. This also means you need chemo

95
Q

What are the recommendations for colorectal CA surveillance after colon resection

A

CEA every 3 mos for 3 years

CT of chest/abdomen/pelvis every year

CEA

Colonoscopy at 1 yr, 3 yr, then every 5 yr

96
Q

2 most common mets in colorectal CA

A

Liver, lung

97
Q

Iron deficiency anemia, weakness = colorectal CA in which side ?

A

Right side.

98
Q

Which polyposis syndrome gets prophylactic colectomy?

A

FAP. These kids get flex sig or colonoscopy every year starting at age 10, when multiple adenomas are identified then colectomy is indicated. Also get upper GI endoscopy at time of colectomy/early 30s then q3-5 yrs if no lesions identified.

99
Q

Mutations in APC gene seen in what 3 diseases?

A

FAP, turcot syndrome, and Gardner syndrome

100
Q

Gardner syndrome

A

Similar to FAP but also have bone and soft tissue tumors

101
Q

Turcot syndrome

A

Many malignant colonic adenomas with addition of malignant CNS tumors

102
Q

Juvenile polyposis

A

Multiple polyps that are a frequent source of GI bleeding found in stomach, colon and small bowel. Slightly increased risk of malignancy later in life

103
Q

Neoplasms of HNPCC tend to occur where in the colon?

A

Proximal colon

104
Q

Pigmented gallstones most typically seen due to ?

A

Chronic hemolysis. High iron content, making it visible on xray

105
Q

In an elderly patient with depuytrens contractures, what should you consider?

A

Cirrhosis

106
Q

Distinguishing feature between right sided heart failure and budd chiari

A

JVD seen in right sided heart failure

107
Q

What should you worry about if paracentesis detects a very high albumin and LDH equal to 60% serum LDH?

A

Neoplastic process

108
Q

Lab level to check when you suspect hemochromatosis

A

Ferritin

109
Q

Complications of hemochromatosis

A

CHF, DM, hepatoma, hypopituitarism, cirrhosis

110
Q

Tx of Wilsons disease

A

Penicillamine or trientene. Vitamin B6 supplementation. Long-acting zinc. Dietary copper restriction like shellfish

111
Q

Inheritance of alpha 1 antitrypsin

A

Autosomal co-dominant. If heterozygote, you may not get it but then if you smoke, you’re more likely to develop.

112
Q

Distinguishing PBC from PSC

A

Gender, presence/absence of anti mitochondrial antibodies and ERCP

113
Q

Most common presenting sx of PBC

A

Fatigue and pruritis. Pruritis often starts during pregnancy but is not relieved post-partum.

114
Q

Skin changes seen in PBC

A

Hyperpigmentation due to melanin deposition, xerosis, dermatographism, xanthelasma and/or xanthoma

115
Q

Labs in PBC

A

Elevated alk phos and GGT

Elevated serum direct and indirect bili (but not in early disease) and elevated cholesterol

116
Q

Serum anti-mitochondrial antibodies

A

PBC

117
Q

First line for PBC

A

UDCA. If not sufficient, may add colchicine +/- methotrexate

118
Q

Treatment for pruritis in PBC

A

Cholestyramine

119
Q

Labs in PSC

A

Possible positive p-ANCA. Also elevated GGT and alk phos as well as increased direct + indirect bili. Increased cholesterol. Normal AST and ALT.

120
Q

What drug increases production of UDP glucuronyl transferase

A

Phenobarbital

121
Q

Unconjugated hyperbilirubinemia is caused by what 2 main things

A

Excess bilirubin production or impaired conjugation.

122
Q

Impaired bili conjugation causes ??

A

Physiologic jaundice of newborn

Deficiency of glucuronyl transferase (Gilbert, Crigler Najjars)

Hepatocellular disease, like cirrhosis

123
Q

3 causes of excess bili production

A

Hemolytic anemia

Disorders of erythropoiesis

Internal hemorrhage resorption

124
Q

2 main causes of conjugated hyperbilirubinemia

A

Decreased hepatic bilirubin excretion

Extrahepatic biliary obstruction

125
Q

Decreased hepatic bilirubin excretion causes

A

Hepatocellular disease

Drug impairment

Impaired transport (Rotor, Dubin-Johnson)

126
Q

Which Crigler Najjar is more serious

A

Type I

127
Q

Treatment of Crigler Najjar type I

A

Phototherapy, plasmapheresis, calcium phosphate with orlistat, liver tx

128
Q

If you see a male with a hepatic adenoma ?

A

Suspect anabolic steroid use. Also could be due to glycogen storage disease types I and III

129
Q

Paraneoplastic disorders seen with hepatocellular CA

A

Refractory water diarrhea, hypercalcemia, skin lesions, excessive RBC production, hypoglycemia

130
Q

Labwork in pyloric stenosis

A

Hypochloremic, metabolic alkalosis.

131
Q

Newborn with bilious vomiting, diarrhea, hematochezia, metabolic acidosis

A

Necrotizing enterocolitis! TPN, decompression

132
Q

Risk factors for intussusception

A

CF, meckels diverticulum, adenovirus (inflames peyer patches), HSP

133
Q

MCC of bowel obstruction in first 2 years of life

A

Intussusception

134
Q

Which abx is contraindicated in neonates with hyperbilirubinemia and why?

A

Ceftriaxone because it displaces bilirubin from albumin, so likelihood of kernicterus goes way up

135
Q

Physiologic jaundice

A

Starts day 2-3, peaks at <10 mg/dL on day 3-5

136
Q

Exaggerated physiologic jaundice/breastf eeding jaundice

A

Occurs in first week of life, peaks at 12-15 mg/dL, due to dehydration so make sure that the baby has more than 10 feeds/day

137
Q

Breast milk jaundice

A

Starts days 4-14 (usually after first week) due to substances in breast milk. May continue for weeks to months while breastfeeding. Improvement with teh substitution of formula for 48-72 hours is diagnostic.

138
Q

Characteristics that might help identify newborn jaundice as pathological

A

Any jaundice in 1st 24 hours

Rise in total bili by more than 0.5 mg/dL/hr

Rise in total bili more tjan 5 mg/dL/day

Direct hyperbili greater than 20% of total bili or >1.5 mg/dL

Total bili >13 mg/dL in term neonates

Jaundice appearing after 2-3 weeks of age

139
Q

Large bowel obstructions are most commonly caused by ..

A

Neoplasms!!! Diverticular disease and volvulus. Remaining causes include intussusception and impaction.

140
Q
A

Sigmoid volvulus

141
Q
A

Sigmoid volvulus

142
Q
A

Cecal volvulus

143
Q
A

Cecal volvulus

144
Q
A

Cecal volvulus

145
Q
A

Appendicitis

146
Q
A

Appendicitis

147
Q

Heart dz associated with carcinoid syndrome

A

Right sided valvular disease /murmurs. Sometiems requires heArt surgery.

148
Q

What is the next step in mgmt of a patient that is found to have a calcified gallbaldder

A

Biopsy

149
Q

60 y.o. male undergoes colonoscopy and is found to have 3 small tubular adenomas that are completely removed. When should he undergo his next colonoscopy?

A

3 years.

150
Q

Abx treatment of diverticulitis

A

TMP-SMX/FQ + metronidazole. Augmentin

151
Q

You find 2 tubular adenomas <1 cm in a pt on colonoscopy. Repeat colonoscopy when?

A

5 years.

152
Q

You find a single tubular adenoma >1 cm on colonoscopy. When is the next scheduled?

A

3 years.

153
Q

You find a villous adenoma on a pt. When is the next colonoscopy?

A

3 years.

154
Q

You find a single 3 cm sessile polyp on colonoscopy. When do you repeat?

A

3-6 months.

DIT STEP 2 (17 decks)

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