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GI Flashcards

1
Q

Dysphagia to B solid and liquid is a motility prob. Differentials?

A

Progressive w/ cough- achalasia
Progressive w/Heartburn- scleroderma

Intermittent w/ chest pain- DES

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2
Q

Dxtix for DES

A

Barium swallow showing corkscrew appearance

Tx: trial of PPI; CCB

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3
Q

First bite dyaphagia

A

Lower esophageal ring/ schatzki’s ring

Tx: pneumatic dilatation

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4
Q

Findings in achalasia

A

Birds beak appearance
Manometry showing dec peristalsis and inc LES tone

Tx: surgical myotomy

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5
Q

Egd reveals concentric rings

A

Eosinophilic esophagitis

Tx: trial of PPI; budesonide

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6
Q

Regurgitation of food eaten several days before

A

Zenker’s diverticulum

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7
Q

HIV with odynophagia, what to do?

A

Trial of fluconazole/ itraconazole

If persistent, EGD to r/o HSV or CMV

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8
Q

Dysphagia to solids is an obstruction problem. Differentials?

A

Progressive and Age > 50- r/o CA
Progressive w/ heartburn: peptic stricture

Intermittent: eosinophilic esophagitis

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9
Q

Indications for EGD

A 
Anemia
Melena
Weight loss
Dysphagia or odynophagia
Poor response to PPI for 4-8 weeks
GERD sx > 5 yrs
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10
Q

T/F tx of barrett’s esophagus w/ PPI or fundoplication reverses the epithelial changes

A

F

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11
Q

EGD for Barretts

A

If no dysplasia, rpt in 3 yrs
If w/ low grade dysplasia, rpt in 6 mos. if still dysplasia, rpt in 1 yr; if already metaplasia, repeat in 3yrs
If high grade dysplasia, endoscopic radiation ablation and repeat egd in 1 yr

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12
Q

Dxtic for esophageal rupture

A

Gastrograffin study

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13
Q

Difference bet type A and B chronic gastritis

A 
Type A: (AAA)
more common in fundus
Atrophic gastritis
Anemia - Pernicious 
adenoCA-- 3x risk (no need for surveillance)
Inc gastrin

Type B:
H pylori associated
More common in antrum

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14
Q

T/F diet, personality, occupation play a role in PUD

A

F

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15
Q

Tx of maltoma?

A

H pylori tx

After tx repeat biopsy before annpuncing cure bec t (8,11) has poor response to tx

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16
Q

Best test for h pylori diagnosis when px is on PPI

A

Ab testing

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17
Q

Tx regimen for PUD

A

PAC: PPI + amox + clarithro
MOC: Metro + Omep + clarithro

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18
Q

Tx failure w/ PUD regimen

A

Tetracycline + bismuth + metro + PPI

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19
Q

Zollinger ellison syndrome

A

Gastrinomas; associated w: men 1

Presents w/ diarrhea/ steatorrhea

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20
Q

Dxtic for ZES

A

Fasting gastrin level
If not dxtic, IV secretin w/c inc gastrin to > 1000
CT or somatostatin scintigraphy to localize

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21
Q

Tx for ZES

A

PPI, resection

Life expectancy normal if surgery curative; otherwise it’s 2 yrs

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22
Q

What to do w/ clean based ulcer on egd

A

If

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23
Q

If bleeding ulcer, visible vessel, bleedinb varices on egd what to do?

A

Monitor for 72hrs

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24
Q

What meds to give for esophageal varices

A

Nonselective BB- propranolol, nadolol, carvedilol

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25
Q

T/F banding is better than sclerotherapy

A

T

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26
Q

ReBleeding after banding/sclerotherapy?

A

MELD 24 - transplant

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27
Q

Gastric varices w/o esophageal varices on EGD

A

Do CT – consider splenic vein thrombosis

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28
Q

Dumping syndrome etiology/tx?

A

Sx: palpitations, tachycardia, sweating, hypotension

Early (15min): rapid emptying
Delayed (90 min postprandial): hypoglycemia

Tx: small frequent feeds
Low carbo diet

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29
Q

Afferent loop syndrome?

A

Postgastrectomy there is postprandial bloating/pain relieved with bilious vomiting

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30
Q

Blind loop syndrome

A

Postgastrectomy – bacterial overgrowth (low B12, normal folate) — steatorrhea

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31
Q

Extrinsic compression of cbd

A

Mirrizzi’s syndrome

Tx: cholecystectomy

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32
Q

Gb sludge & pancreatitis?

What to do

A

Ercp w/ biliary sampling — cholecystectomy

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33
Q

Why do yearly US for ulcerative colitis?

A

To look for GB polyps

If + and > 1cm, cholecystectomy bec of high risk of CA

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34
Q

Marker for autoimmune pancreatitis?

A

IgG4

Tx: steroids

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35
Q

Finding in pancreatic divisum

A

Dilated dorsal duct

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36
Q

In pancreatitis, marker for biliary etiology?

A

ALT 2x elevated; alkphos rises later

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37
Q

Soap bubble sign in pancreatitis

A

Abscess; abx and drainage

For persistent fever > 72 hrs, open drainage

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38
Q

Persistently elevated amylase in pancreatitis?

A

Consider pseudocyst

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39
Q

Worrisome features of pancreatic cysts

A 
Solid component
Enhancing thickened wall
Nodule
RBCs or inflammatory cells
Size 3cms or more
Dilated pancreatic duct > 1cm
\+ cea
\+ pathology
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40
Q

What to do if pancreatic cyst has worrisome features

A

Confirm with EUS

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41
Q

3cm panc cyst w/ no worrisome features on eus

A

MRI or EUS every 3-6mos

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42
Q

2cm panc cyst w/ no worrisome features on eus

A

MRI or EUS every 2-3 yrs

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43
Q

Dx for steatorrhea

A

Stool fat > 40g

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44
Q

Tx for chronic pancreatitis

A

Pancrealipase x 6 wks; if no response, pregabalin

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45
Q

Path in IBD

A

UC: shallow ulcers w/ crypt abscess
CD: deep ulcers w/ granuloma

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46
Q

Xray in IBD

A

UC + CD: toxic megacolon

CD: string sign

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47
Q

Extraintestinal manifestations are common in which IBD?

A

UC

They mirror UC activity except for Ankylosing spondylitis and PSC

48
Q

When to do colonoscopy for IBD

A

8 yrs after diagnosis then every 1-3 yrs after

49
Q

Labs for IBD

A

UC: p anca
CD: Asca

50
Q

Tx for IBD

A

Mesalamine +/- metronidazole

51
Q

What to do for flares of IBD

52
Q

Steroid sparing drugs for IBD?

A

6 mercaptopurine and azathioprine

53
Q

In IBD unresponsive to 6 MP or azathioprine

A

Infliximab (anti-TNF)

54
Q

Px with IBD presents with diarrhea and leukocytosis

A

R/o c diff

55
Q

Ca oxalate stones common in which IBD

56
Q

Which diarrhea stops with eating

57
Q

How to differentiate secretory fr osmotic diarrhea

A

Stool osmotic gap
Na + K x 2
Secretory: 50

58
Q

Most common cause of invasive diarrhea

A

Campylobacter (undercooked poultry)

59
Q

Tx of ETEC

A

Loperamide; azithro x 5 days

60
Q

How to culture O157:H7 e coli

A

McConkey + sorbitol agar

61
Q

Diarrhea after eating soft cheese

62
Q

Frothy stool after camping

A

Giardia
Dx: stool ELISA
Tx: metronidazole

63
Q

Most common viral cause of age in adults

64
Q

Ate fish, had perioral paresthesias

A

Ciguatera toxin

65
Q

Ate fish had flushing

66
Q

Ate fish, had ascending paralysis

A

Tetradotoxin

67
Q

Flask shaped ulcers

A

Amoebic colitis

68
Q

Tx for cryptosporidium

A

Nitazoxanide

69
Q

Rule out what dse in pxs with irritable bowel syndrome

A

Celiac with TTG ab

70
Q

Osmotic diarrhea turns red with NaOH

A

Laxative abuse

71
Q

Flow of drugs in c diff

A

Flagyl – flagyl again – vanco po – vanco pulsed tx – vanco po + iv flagyl – fidaxomicin

72
Q

What nutrients absorbed in duodenum

A

Ca, mg, fe, fa

73
Q

What nutrients absorbed in ileum

A

B12, fat soluble vit (adek)

74
Q

Mucosal causes of malabsorption will be positive for what test?

A

D xylose test

75
Q

Dxtic for celiac sprue

76
Q

Diarrhea + iron def + rash

A

Think celiac sprue

77
Q

Rash of celiac sprue

A

Dermatitis herpetiformis

78
Q

Tx of Dermatitis herpetiformis

79
Q

Brother of px w/ celiac dse wants to be tested

A

HLA DQ 2 or 8

80
Q

Tropical sprue diff of carribean and asian types

A

Caribbean: normal folic, low b12
Asian: low folic, normal b12

Vs bacterial overgrowth; high folic, low b12

81
Q

Pathology of tropical sprue

A

Flattened villi with lymphocytes or plasma cells

Fr klebsiella or e coli

82
Q

Tx of tropical sprue

A

Tetracycline + folic

83
Q

Tx for whipples dse

A

Bactrim or tetracycline x 1 yr

84
Q

Dxtic for bacterial overgrowth

A

Hydrogen breath test, xylose 14c breath test

85
Q

Tx for bacterial overgrowth

A

Cipro, flagyl

86
Q

Short bowel syndrome:

Postoperative diarrhea tx

87
Q

Short bowel syndrome:

Persistent diarrhea tx

A

Cholestyramine

Defect: dec bile acid absorption

88
Q

Short bowel syndrome:

Greasy stools tx

A

Med chain triglycerides

Defect: dec bile acids

89
Q

Microscopic colitis tx

A

Budesonide po

90
Q

Recurrent LLQ pain w/o fever or WBCs in px known to have diverticulosis

A

Symptomatic diverticular dse

Tx: mesalamine, rifaximine

91
Q

Med known to cause diverticulitis w/ perforation

A

Tocilizumab

92
Q

Tx for acute vs chronic mesenteric ischemia

A

Acute: thrombolysis, surgery
Chronic: angioplasty, revasc

93
Q

Tx for ischemic colitis

A

Hydration and abx

94
Q

AVMs in all organs

A

Osler-weber-rendau

Tx: cautery, laser coagulation, sclerotherapy

95
Q

Chronic constipation unresponsive to laxatives

A

Polyethylene glycol

96
Q

CA px w/ constipation unresponsive to golytely

A

IV methylnatrexone

97
Q

Acute pseudocolonic obstruction

A

Ogilvie’s syndrome

Dxtic: CT w/ water soluble enema

Tx: rectal tube, neostigmine

98
Q

Whirl sign on xray, what to do

A

Sigmoid volvulus

Flexible sigmoidoscopy

99
Q

Needlestick injury, what to do?

A

Hep b titers 10: reassurance

100
Q

Who to treat for hep b

A

ALT x 2 normal

Compensated cirrhosis

101
Q

Tx for hep b

A 
Tenofovir
Entecavir
Adefovir
Lamivudine
Alpha interferon
Telbivudine
102
Q

Pregnant woman with hep b, how to prevent transmission

A

Treat mother with telbivudine, give immunoglobulin and vaccine to baby

103
Q

Who to check for hep c ab

A

Born bet 1945-1965

104
Q

Needlestick fr hep c + px what to do

A

Hcv RNA now then 12 wks after

105
Q

Tx for hep c

A

Sofusbuvir + ribavirin + ifn

106
Q

Tx for hep c if depressed

A

Sofusbuvur + simeprivir x

12 wks

107
Q

Serology of hep d superinfection

A

Hbs IgG + HDV

108
Q

Primary biliary cirrhosis findings

A

*hypercholesterolemia with high HDL
Dec vit adek
AMA ab +
Liver biopsy- granulomas/ lymphocytic destruction of bile ducts

109
Q

Tx for PBC

A

Liver transplant

Ursodeoxycholic acid slows down progression

110
Q

Autoimmune hepatitis most specific finding

A

Antismooth muscle ab

Biopsy: piecemeal necrosis
Tx: pred +/- azathioprine

111
Q

Tx for alcoholic hepatitis

A

Steroids

Discriminant factor > 32

112
Q

Contraindication to steroids in alcoholic hepatitis

A

GI bleed

SBP

113
Q

What to use if steroids cannot be used in alcoholic hepatitis

A

Pentoxyfylline

114
Q

How to diagnose nASH

115
Q

Contraindications for liver transplant

A

Active alcohol or illegal drug use
Extrahepatic CA
Unresolved sepsis

116
Q

Relative contraindications to luver transplant

A

HIV

Hep B e ag +

117
Q

Tx for wilsons

A

Penicillamine + pyridoxine; trientine

CARDIO (4 decks)

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