GI Flashcards
1
Q
Food poisoning as a result of food sitting out too long
A
Staph aureus
2
Q
Not effective cleanser in preventing transmission of C dif
A
Alcohol based sanitizer
3
Q
Rice-water stools
A
Cholera or ETEC
4
Q
Which anti-lipid rx binds C dif toxin
A
Cholestyramine
5
Q
Diarrhea + recent ingestion of water from stream
A
Giardia, E. histolytica
6
Q
Diarrhea from seafood
A
Vibrio cholera, parahaemolytica
7
Q
Dehydrated child with greenish diarrhea in winter months
A
Rotavirus
8
Q
Diarrhea – > pink eye
A
Adenovirus
9
Q
Treatment of Hep B
A
IFN alpha (standard or pegylated) or antiviral such as lamivudine, adefovir, entecavir, or telbivudine
10
Q
Treatment of Hep C
A
Pegylated IFN + ribavirin
11
Q
What anatomical structures are highlighted in barium swallow
A
Esophagus, LES, stomach
12
Q
What anatomical structures are highlighted in gastric emptying study
A
STomach, pyloric sphincter, duodenum
13
Q
What anatomical structures are highlighted in small bowel follow through
A
Stomach to terminal ileum
14
Q
What anatomical structures are visualized with barium enema
A
Colon, appendix
15
Q
Difference between Mallory Weiss and Boerhaave syndrome
A
Mallory Weiss is less serious and is a mucosal laceration. Boerhaavee is esophageal rupture.
16
Q
Bloody diarrhea from poultry
A
Salmonella or campylo
17
Q
Next step after H&P in workup of patient complaining of dysphagia
A
Barium swallow
18
Q
Meds that can be used in treatment of DES and achalasia
A
Nifedipine, CCBs, nitrates
19
Q
Anti depressant used to treat DES
A
TCAs
20
Q
Tx of entamoeba histolytica
A
Metronidazole
21
Q
Tx of Giardia
A
Metronidazole
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.
23
Q
Tx of campylobacter
A
Erythromycin
24
Q
2 systemic causes of parotid disease
A
Sarcoidosis, neoplasm
25
Difficulty swallowing both liquids and solids
Neuromuscular pathology
26
Complications of myotomy in treatment of achalasia
GERD
27
Nitrates relieve pain of DES but exacerbate pain of?
GERD
28
Neck mass that increases in size while drinking liquids
Zenker's diverticulum
29
Zenkers
30
Diffuse esophageal spasm
31
Which antacid causes constipation?
Aluminum
32
Which antacid causes diarrhea?
Magnesium
33
2 side effects of cimetidine
Impotence, gynecomastia
34
Thrombocytopenia in a patient with GERD
Stop their H2 antag!
35
PPIs may increase effects of which 3 meds?
Warfarin, phenytoin, benzos
36
Esoph CA in upper 2/3
Likely squamous cell
37
Esoph cancer in lower 1/3
Adenocarcinoma
38
What are 3 deficiencies seen post-gastrectomy?
B12, iron, calcium
39
Most common complication seen after gastric bypass
Incisional hernia
40
Serum marker seen in gastric CA
CEA
41
Treatment for gastric cancer
Distal 1/3: partial gastrectomy
Mid/upper: total gastrectomy
Both also get chemo and radiation.
42
EGD with bx in 65 y.o. male reveals gastric cancer. What is the next step in the management?
CT scan of abdomen/pelvis to stage
43
What is the next step in mgmt of a patient with recurrent duodenal ulcers seen on at least 2 EGDs?
Check serum gastrin to r/o zollinger ellison
44
Presenting features that help distinguish gastric from duodenal ulcers
Gastric: pain soon after eating and eating worsens pain.
Duodenal: pain 2-4 hours after eating and eating initially eases pain.
45
Ranson's criteria for acute
Glucose \> 200
AST \> 250
LDH \> 350
Age \> 55
WBC \>16
46
Ransons criteria 48 hrs
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
47
Tx of H pylori
PPI + clarithro + metronidazole or amoxicillin
48
Most sensitive and specific lab test for dx of chronic pancreatitis
Low fecal elastase
49
What Chem 7 lab abnormality is seen in pts with an upper GI bleed?
OIncreased BUN because bacteria in the gut break down hemoglobin.
50
Complications of pancreatic cancer
5 year survival \< 2 %
Successful whipple procedure has 5 year survival 20-30%
Migratory thrombophlebitis (Trousseau syndrome)
51
2 drugs used in non-resectable insulinoma
Octreotide, diazoxide
52
Rash seen in glucagonoma
Migratory necrolytic erythema
53
Multiple insulinomas should make you consider?
MEN 1
54
Type A gastritis occurs where?
Fundus
55
Type B gastritis occurs where?
Antrum
56
Which type of gastritis is associated with auto-antibodies to parietal cells?
Type A
57
Lab differences between Type A and Type B gastritis
Type A has decreased gastrin and decreased gastric acid level.
Type B has increased gastric acid level.
58
Conditions associated with Type A gastritis
Pernicious anemia, Achlorhydria, Thyroiditis
59
Which type of gastritis is associated with increased risk for gastric cancer?
Type B
60
Complications of PUD
Posterior ulcers erode into gastroduodenal artery
Anterior ulcers perforate
Lymphoproliferative d/o (e.g., MALT lymphoma)
61
Younger patients are more likely to get what kind of ulcers?
Duodenal
62
ZE syndrome: gastrin producing tumor most frequently where?
Duodenum (70%) or pancreas.
63
Patients with PUD who require NSAID should get what?
COX-2 inhibitors.
64
2 lab abnormalities seen in ZE syndrome
Increased fasting gastrin
Positive secretin stimulation test (higher than expected levels of gastrin after secretin is administered)
65
How do you get gastric SCC?
Invasion from esophagus
66
2 "nodes" seen in gastric cancer
Sister mary joseph : periumbilical node
Virchows: left supraclavicular node
67
Increased 2-glucuronidase in gastric secretions should make you think?
Gastric cancer
68
Linitis plastica
Leather bottle stomach seen in gastric cancer
69
A recent cuban immigrant with sx of malabsorption is found to have megaloblastic anemia. Dz? tx?
Tropical sprue. Folate replacement along with tetracycline or sulfa abx for 3-6 mos
70
Classic time frame for which post op ileus resolves in the diff parts of the gut
Stomach: 48-72
Small intestine: 24 hrs
Colon: 3-5 days
71
Most common cause of SBO
ABC. Adhesions, bulge (incarc hernia), cancer
72
Classic characteristic of acute mesenteric ischemia
Pain out of proportion to exam
73
4 tumors that can cause secretory diarrhea
Carcinoid, VIPoma, gastrinoma, medullary thyroid CA
74
Most likely cause of malabsorption in pt with a + Sudan stain and a normal D - xylose test
Intestinal wall architecture must be fine if they can absorb carbs so this is pancreatic insufficiency
75
Tx of Whipples
TMP-SMX or ceftriaxone x 12 mos
76
What serum lab findings might help distinguish crohns from UC
Crohns: + ASCA
UC: + p-anca
77
Tx for constipation dominant IBS
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
Less common causes of SBO
Volvulus, intussusception, Crohns, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis
79
Most common benign small bowel tumor
Leiomyoma
80
Most common malignant small bowel tumor
Adenocarcinoma
81
Most commonly involved part of colon in mesenteric ischemia
Left colon. Rectum is typically spared thanks to collateral circulation
82
Most common cause of large bowel obstruction
Neoplasm
83
Abdom x ray shows bowel distension proximal to obstruction
Large bowel obstruction
84
Where is ethanol absorbed
In the stomach
85
Tx of anal fissure (medical)
Topical nitroglycerin, botox injections, bethanechol etc to relax sphincter. Sphincterotomies have a 10-30% risk of incontinence .... ew
86
MCC of acute lower GI bleeding in pts age \>40
Diverticulosis
87
Most common tumor in appendix
Carcinoid
88
Most common location of carcinoid tumor
Small bowel
89
Drugs used in symptom relief for carcinoid syndrome
Cyproheptadine for diarrhea and/or anorexia
Albuterol and/or theophylline for asthma sx
Codeine and/or cholestyramine for diarrhea
90
If sx of carcinoid syndrome are refractory to octreotide, what med can you add?
IFN alpha.
91
NOT precancerous polyps
Hyperplastic polyps
92
Polyps most often cancerous ?
Tubular \> tubulovillous \> villous
93
Change in bowel habits is more indic of cancer where ?
Left side of colon. Come on.
94
Staging for colorectal CA with lymph node involvement
Stage III. This also means you need chemo
95
What are the recommendations for colorectal CA surveillance after colon resection
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
2 most common mets in colorectal CA
Liver, lung
97
Iron deficiency anemia, weakness = colorectal CA in which side ?
Right side.
98
Which polyposis syndrome gets prophylactic colectomy?
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
Mutations in APC gene seen in what 3 diseases?
FAP, turcot syndrome, and Gardner syndrome
100
Gardner syndrome
Similar to FAP but also have bone and soft tissue tumors
101
Turcot syndrome
Many malignant colonic adenomas with addition of malignant CNS tumors
102
Juvenile polyposis
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
Neoplasms of HNPCC tend to occur where in the colon?
Proximal colon
104
Pigmented gallstones most typically seen due to ?
Chronic hemolysis. High iron content, making it visible on xray
105
In an elderly patient with depuytrens contractures, what should you consider?
Cirrhosis
106
Distinguishing feature between right sided heart failure and budd chiari
JVD seen in right sided heart failure
107
What should you worry about if paracentesis detects a very high albumin and LDH equal to 60% serum LDH?
Neoplastic process
108
Lab level to check when you suspect hemochromatosis
Ferritin
109
Complications of hemochromatosis
CHF, DM, hepatoma, hypopituitarism, cirrhosis
110
Tx of Wilsons disease
Penicillamine or trientene. Vitamin B6 supplementation. Long-acting zinc. Dietary copper restriction like shellfish
111
Inheritance of alpha 1 antitrypsin
Autosomal co-dominant. If heterozygote, you may not get it but then if you smoke, you're more likely to develop.
112
Distinguishing PBC from PSC
Gender, presence/absence of anti mitochondrial antibodies and ERCP
113
Most common presenting sx of PBC
Fatigue and pruritis. Pruritis often starts during pregnancy but is not relieved post-partum.
114
Skin changes seen in PBC
Hyperpigmentation due to melanin deposition, xerosis, dermatographism, xanthelasma and/or xanthoma
115
Labs in PBC
Elevated alk phos and GGT
Elevated serum direct and indirect bili (but not in early disease) and elevated cholesterol
116
Serum anti-mitochondrial antibodies
PBC
117
First line for PBC
UDCA. If not sufficient, may add colchicine +/- methotrexate
118
Treatment for pruritis in PBC
Cholestyramine
119
Labs in PSC
Possible positive p-ANCA. Also elevated GGT and alk phos as well as increased direct + indirect bili. Increased cholesterol. Normal AST and ALT.
120
What drug increases production of UDP glucuronyl transferase
Phenobarbital
121
Unconjugated hyperbilirubinemia is caused by what 2 main things
Excess bilirubin production or impaired conjugation.
122
Impaired bili conjugation causes ??
Physiologic jaundice of newborn
Deficiency of glucuronyl transferase (Gilbert, Crigler Najjars)
Hepatocellular disease, like cirrhosis
123
3 causes of excess bili production
Hemolytic anemia
Disorders of erythropoiesis
Internal hemorrhage resorption
124
2 main causes of conjugated hyperbilirubinemia
Decreased hepatic bilirubin excretion
Extrahepatic biliary obstruction
125
Decreased hepatic bilirubin excretion causes
Hepatocellular disease
Drug impairment
Impaired transport (Rotor, Dubin-Johnson)
126
Which Crigler Najjar is more serious
Type I
127
Treatment of Crigler Najjar type I
Phototherapy, plasmapheresis, calcium phosphate with orlistat, liver tx
128
If you see a male with a hepatic adenoma ?
Suspect anabolic steroid use. Also could be due to glycogen storage disease types I and III
129
Paraneoplastic disorders seen with hepatocellular CA
Refractory water diarrhea, hypercalcemia, skin lesions, excessive RBC production, hypoglycemia
130
Labwork in pyloric stenosis
Hypochloremic, metabolic alkalosis.
131
Newborn with bilious vomiting, diarrhea, hematochezia, metabolic acidosis
Necrotizing enterocolitis! TPN, decompression
132
Risk factors for intussusception
CF, meckels diverticulum, adenovirus (inflames peyer patches), HSP
133
MCC of bowel obstruction in first 2 years of life
Intussusception
134
Which abx is contraindicated in neonates with hyperbilirubinemia and why?
Ceftriaxone because it displaces bilirubin from albumin, so likelihood of kernicterus goes way up
135
Physiologic jaundice
Starts day 2-3, peaks at \<10 mg/dL on day 3-5
136
Exaggerated physiologic jaundice/breastf eeding jaundice
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
Breast milk jaundice
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
Characteristics that might help identify newborn jaundice as pathological
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
Large bowel obstructions are most commonly caused by ..
Neoplasms!!! Diverticular disease and volvulus. Remaining causes include intussusception and impaction.
140
Sigmoid volvulus
141
Sigmoid volvulus
142
Cecal volvulus
143
Cecal volvulus
144
Cecal volvulus
145
Appendicitis
146
Appendicitis
147
Heart dz associated with carcinoid syndrome
Right sided valvular disease /murmurs. Sometiems requires heArt surgery.
148
What is the next step in mgmt of a patient that is found to have a calcified gallbaldder
Biopsy
149
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?
3 years.
150
Abx treatment of diverticulitis
TMP-SMX/FQ + metronidazole. Augmentin
151
You find 2 tubular adenomas \<1 cm in a pt on colonoscopy. Repeat colonoscopy when?
5 years.
152
You find a single tubular adenoma \>1 cm on colonoscopy. When is the next scheduled?
3 years.
153
You find a villous adenoma on a pt. When is the next colonoscopy?
3 years.
154
You find a single 3 cm sessile polyp on colonoscopy. When do you repeat?
3-6 months.
