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USMLE STEP 3 Questions > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

C-scope screen in pt with first deg fam member w colon ca

A

Cscope at 40 or 10 yrs before fam colon ca dx

Repeat q3-5 yrs

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2
Q

Follow up interval after polypectomy in colonoscopy

A

Small rectal hyperplastic polypS- 10 yr

Up to 2 2 cm sessile polyp or adenocarcinoma should have repeat in 2 months

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3
Q

FAP familial adenomatous polyposis should have how often cscope?

A

Yearly

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4
Q

If you choke on fishbone and still have symptoms ie vague discomfort, trouble swallowing… Next step is to

A

Get urgent endoscopy bc of risk of esophageal perf if remains for more than 24 hrs

Plain film may not be useful for small objects

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5
Q

What is higher risk for colon ca- smoking or alcohol??

A

Alcohol is. Smoking only if > 30 yrs

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6
Q

Lfts 900 with tb 5.2 and u/s shows no gallstones or duct dilatation and pt just has weakness and jaundice… Should u admit pt??

A

No. Manage outpt.

Hospitalize if high f, high coag markers, older

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7
Q

Tx for active hep b infection - positive hbe ag, hbs, anti-hbc is usually just supportive care

When it is severe ie coagulopathy what is tx?

A

Lamivudine if have hepc, immune suppressed, fulminent failure

Only give hep b ig and hep b vaccine as postexposure proph to healthcareworkers

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8
Q

Chances of hep b progression to chronic hep b?

A

Depends on age- adults is 5%
Children are 20-50%

To eval hep b progression trend lfts. If they remain elevated >6 months then chronic.

Also look at prothrombin level for prognostics

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9
Q

Elevated ast, alt with normal bili and alp is due to?

Nxt lab test to check?

A

Autoimmune hepatitis- can affect thyroid, pleurisy, pericarditis

Check anti smooth and ANA

Vs ggt is to look for cholestasis- liver vs bone as cause

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10
Q

> 55 yo who has DYSPepsia (abdominal pain, epigastric fullness) should get what type of workup?

A

Egd.

Ppi alone if have reflux symptoms

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11
Q

Abd pain, loose stools or ileus, HIGH wbc count should raise suspicion for ? Next step

A

C diff colitis

Even if c diff negative may need to do flex sig to look for pseudomembranous colitis

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12
Q

Is apache score or ransons criteria better for prognosis in pt with pancreatitis?

A

Apache bc dont have to wait 48 hrs to include in scoring

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13
Q

saag >1.1 means portal htn which includes conditions like

A

Chf, cirrhosis, alcoholis hepatitis

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14
Q

Primary biliary cirrhosis tests?

A

Antimitochondrial ab. Due to destruction of small and medium bule ducts. Leads to esld, hld, osteoporosis

Tx is ursodeoxycholic acid and liver tx

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15
Q

What is most likely complication during hospitalization for pt with variceal bleed? And how do u prevent it?

A

Infection ie SBP. Could also get uri, uti.

Prevent with cipro x 7-10 days

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16
Q

Sensation of food stuck in throat, decreased peristalsis in esophagus, and DECR LES tone

A

Scleroderma

not the same as achlasia where you have INCR LES tone!!

17
Q

Button battery in esophagus of kid -what should u do?

A

Endoscopic removal. If it is in stomach then can expect to pass. But while in esophagus there is risk for tissue damage and liquefaction necrosis bc esophagus more narrow

18
Q

Abd pain, bloating, flatulence, diarrhea for months and find b12 def anemia. What is next step to dx?

A

Small intestine bowel overgrowth- egd with jejunal aspiration showing >10 to the fifth organisms.

Tx is diet to high fat, low carb, abx like augmentin and rifaximin

Risks in scleroderma or poor motility

19
Q

Tx of toxic megacolon

A

Ng tube, icu, steroids!!!

No sulfasalazine in acutely ill pts

20
Q

Pernicious anemia- dx? What do u see on egd?

A

Dx w IF antibody or antiparietal

On egd see absent rugae in fundus and gastric body

21
Q

Meld score measures what? What is it used for?

A

Inr, bili, creatinine

Measures 90 d survival, liver transplant list priority, placement kf tips

22
Q

A cva pt who failed s&s multiple times (asp pna) and not eating much should get what for nutrition?
Liquid mod oral feeding
Peg placement

A

Peg bc oral feeding fails

23
Q

Cholecystectomy induced diarrhea due to what

A

Bile acid influx into colon

Cholestyramine binds bile salt

24
Q

Antihbc total positive. Rest of acute hep panel neg. What is next test?

A

Measure igM antihbC and lfts

25
Q

Mediastinitis and esophageal perf- best way to dx is?

A

Esophagram w water soluble. If neg and still suspect then use barium swallow.

Much better than ct scan which can miss a small tear!

26
Q

Suspected peritonitis due to perf peptic ulcer confermed on xray. Next step is

A

Ivf and abx!!!! And then surgery

NO barium in perf viscus !! It is contraindicated

27
Q

What is next step in dysphagia pt who had ear pain, trouble swallowing s&l, smoker; and ASPIRATING?

A

Aspirating points to upper oropharyngeal rather than esophageal so get a nasopharyngeal laryngoscope or esophagram!

Not even as useful as barium swallow (videofluroscopic)
Not even egd

28
Q

Upper esophageal mass in smoker is likely

A

Scc in alcoholic smoker

Vs adenocar is seen in pts w gerd, barrets and seen in LOwer esophagus

29
Q

Guy w recurrent pancreatitis on egd found to have isolated gastrice varices (not esophageal). Due to?

A

Splenic vein thrombosis since splenic vein lies behind pancreas

Vs budd chiari syn due to hepatic vein thrombosis w ruq pain, hepatomeg, jaundice and ascites

30
Q

Pt w constipation who changed diet to incr fiber but still constipated. Next step?

A

Psyllium laxative!!!!!

If that doesnt work then miralax and docusate

31
Q

Someone w hx pud s/p gastric surgery now w gi bleed and abd guarding should get what test next?

A

Egd! High risk of rebleed after surg

Not ctap!!!

32
Q

Hcv is dx by

A

Hcv rna pcr !!! Not just hcv ab which takes 12 wks to develop!!!

33
Q

What anomaly is present in pt w mallory weiss tear?

A

Hiatal hernia

34
Q

Pt w normal a1c 6 mo later develops a1c 8 and hx of pancreatitis. Tx?

A

Pancreatogenic dm- require insulin as beat management bc destruction of alpha and beta cells

35
Q

Screw in stomach. What to do

A

Egd to remove bc sharp

USMLE STEP 3 Questions (20 decks)

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