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GI Flashcards

1
Q

alarming symptoms to do endoscopy

A

weight loss
blood in stool
anemia

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2
Q

alarming symptoms to do endoscopy

A

weight loss
blood in stool
anemia

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3
Q

YOUNG patient with progressive dysphagia for solids and liquids

A

achalasia

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4
Q

most accurate test in achalasia

A

manometry

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5
Q

tx of achalasia

A

DILATION, no cure

  1. botox injections
  2. pneumatic balloon dilations
  3. heller myotomy
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6
Q

chance of perforation with pneumatic balloon dilation

A
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7
Q

dx of esophagus disorders

A

RADIOLOGIC tests okay to do first, but always lack the specificity of endoscopy

BIOPSY– only diagnostic of cancer and baretts

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8
Q

most important clue for esophageal cancer

A

PROGRESSIVE dysphagia

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9
Q

PROGRESSIVE DYSPHAGIA by age

A

YOUNG- achalasia+ NO smoking/alcohol

OLD- esophageal cancer+ YES smoking/alcohol

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10
Q

best initial test for esophageal cancer

A

BARIUM

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11
Q

DIAGNOSTIC test for esophageal cancer

A

BIOPSY ie. most accurate

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12
Q

generally for cancer the radiologic test is…

A

NEVER the most accurate

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13
Q

YOUNG patient with progressive dysphagia for solids and liquids

A

achalasia

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14
Q

most accurate test in achalasia

A

manometry

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15
Q

tx of achalasia

A

DILATION, no cure

  1. botox injections
  2. pneumatic balloon dilations
  3. heller myotomy
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16
Q

chance of perforation with pneumatic balloon dilation

A

less than 3%

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17
Q

dx of esophagus disorders

A

RADIOLOGIC tests okay to do first, but always lack the specificity of endoscopy

BIOPSY– only diagnostic of cancer and baretts

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18
Q

most important clue for esophageal cancer

A

PROGRESSIVE dysphagia

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19
Q

PROGRESSIVE DYSPHAGIA by age

A

YOUNG- achalasia+ NO smoking/alcohol

OLD- esophageal cancer+ YES smoking/alcohol

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20
Q

best initial test for esophageal cancer

A

BARIUM

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21
Q

DIAGNOSTIC test for esophageal cancer

A

BIOPSY ie. most accurate

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22
Q

generally for cancer the radiologic test is…

A

NEVER the most accurate

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23
Q

sudden onset chest pain

worsened by drinking COLD LIQUIDS

A

diffuse esophageal spasm

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24
Q

most accurate diagnosis of eso spasm

A

MANOMETRY

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25
Q

treatment of diffuse esophageal spasm

A

CCB’s

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26
Q

drugs a/w esophagitis

A
  1. alendronate
  2. doxycycline
  3. KCl
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27
Q

intermittent dysphagia

A

shatzki ring

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28
Q

barium for diffuse esophageal spasm

A

corkscrew esophagus

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29
Q

2 investigations contra-indicated in zenkers

A

NG tube
endoscopy

since can–> PERFORATION–> more dangerous

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30
Q

manometry= answer for

A
  1. spasm
  2. achalasia
  3. scleroderm
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31
Q

pain= symptom,

equivalent to….

A

tenderness=sign

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32
Q

MCC of epigastric pain

A

NON-ulcer dyspepsia= 50-90%

which is not admitted to the hospital, thus we don’t see on wards majority of the time

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33
Q

PC:

  • epigastric pain
  • no significant hx
  • patient less than 50 years old
A

NON-ulcer dyspepsia

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34
Q

PC:

  • diabetes
  • bloating
A

GASTROPARESIS

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35
Q

WRONG TX answer for epigastric pain

A

= MISOPROSTOL

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36
Q

which quadrant does IBS classically present in?

A

LUQ– since splenic flexure syndrome

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37
Q

diagnosis of GERD

A

can be clinical alone (not all symptoms have to be present)

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38
Q

isolated pyrosis on OGD—>

A

NORMAL

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39
Q

when does GERD–> Barrett’s: 5 YEARS

A

invasive treatment for GERD:

  1. nissen fundoplication
  2. endocinch: LES suture
  3. local heat/radiation
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40
Q

can gastritis be made from a clinical diagnosis alone?

A

NOOOOOOO– definitive diagnosis from endoscopy

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41
Q

capsule endscopy for upper GI bleed

A

WRONG answer!

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42
Q

do alcohol and smoking cause peptic ulcer disease

A

NOOOOOO, they do DELAY HEALING of ulcers

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43
Q

most accurate test for H.pylori diagnosis

A

ENDSCOPY

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44
Q

stress ulcer prophylaxis indicated in

A
  1. mechanical ventilation
  2. burns (curling)
  3. head trauma (cushings)
  4. coagulaopathy
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45
Q

random but HY risk factor for acute gastritis

A

URAEMIA

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46
Q

GI bleeding WITHOUT pain

A

gastritis

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47
Q

can PUD dx be made from clinical alone?

A

NOOOOO need endoscopy and biopsy

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48
Q

what can help in resolution of PUD

A

bismuth with triple therapy

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49
Q

H.PYLORI TESTS OF CURE (and treatment failure)

A
  1. UREA BREATH TEST
  2. STOOL ANTIGEN
  3. SEROLOGY
  4. Endoscopy and bx
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50
Q

repeat bx and endoscopy for which type of ulcer

A

GU since chance of getting cancerous

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51
Q

failed therapy to PUD

A
  1. non-adherence
  2. NSAID’s
  3. alcohol
  4. smoking
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52
Q

when to scope if PC= DYSPEPSIA

A
  1. age>55
  2. alarming symptoms:
    - dysphagia
    - weight loss
    - anemia
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53
Q

treatment for Non-Ulcer Dyspepsia

A
  1. PPI’s

2. IF symptoms persists + H.pylori present= treat H.pylori

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54
Q

PC gastrinoma:

A

recurrent LARGE intractable MULTIPLE ulcers on endoscopy

DIARHEA, gnawing, burning abdominal pain with some GI bleeding

55
Q

after endoscopy with gastrinoma….

A

high gastrin levels off antisecretory therapy with high gastric acidity

56
Q

most accurate test gastrinoma

A

SECRETIN functional test

57
Q

excluding metastatic disease with gastronome (after CT/MRI normal)

A

somatostatin receptor nuclear scintigraphy
AND
endoscopic US

58
Q

any need for special tests for diabetic gastroparesis

A

NO, clinical PC (note: most accurate test: nuclear gastric emptying study, rarely needed)

59
Q

tx for diabetic gastroparesis

A

INCREASE MOTILITY:

  • erythromycin
  • metoclopromide
60
Q

most nb initial mgmt of GI bleeding

A

BLOOD PRESSURE

–> Bolus normal saline

61
Q

role of NG tube

A

LIMITED,
guide where to start with endoscopy
- pr bleed— can identify upper GI bleed– upper endoscopy for banding before colonoscopy
- malenia with cirri without hematemesis– NG tube with red blood–> use octreotide for varies and arrange urgent endoscopy for possible banding of varices

62
Q

MAJORITY of GI bleeding stops with…..

A

ADEQUATE FLUID RESUSCITATION

= most important step in mgmt GI bleeding

63
Q

mgmt GI bleeding

A
  1. fluid resusc

2. packed RBCs if Hct

64
Q

when are platelets transfuse ACTIVE bleeding GI

A
65
Q

tx variceal bleeding

A
  1. fluid
  2. blood
  3. FFP
  4. platelets
  5. octreotide
  6. banding
  7. TIPS
  8. propanolol= PREVENTS subsequent episodes of bleeding
  9. antibiotics to prevent ascites
66
Q

recurrent episode of C.diff after treated well with metronidazole first time

A

TRY AGAIN with metronidazole orally

67
Q

FAILED treatment of C.diff with metronidazole

A

oral vancomycin or

fidaxomicin

68
Q

diagnostic tests of chronic pancreatitis

A
  1. abdo XR- Ca
  2. abdo CT- Ca
  3. secretin stimulation test (if normal will release large amounts of bicarb rich fluid)
69
Q

is it okay to eat rice and drink wine in celiac?

A

YES

70
Q

tx whipples

A

ceftriaxone

TMP/SMX

71
Q

tx tropical sprue

A

TMP/SMX

tetracycline

72
Q

any weight loss in lactose intolerance and IBS

A

NOOOOOOOO

73
Q

any calorie deficiency in lactose intolerance

A

NOOOOOOO

74
Q

tx of lactose intolerance

A

oral lactase replacement

75
Q

2 antispasmodics for IBS

A

hyosycamine

dicyclomine

76
Q

weird new antibody for crohns

A

anti-saccharomyces cervesiae

77
Q

fistulae tx in crohns disease

A

infliximab

78
Q

specific steroid in IBD

A

budesonide

79
Q

conservative tx of diverticulosis

A

brain
psyllium
methylcelluose
increase distally fiber

80
Q

best initial test in diverticulitis

A

abdominal CT

81
Q

contraindicated in diverticulitis

A

colonoscopy and barium

82
Q

tx of diverticulitis

A

cipro and metro

83
Q

routine colon cancer screening

A

every 10 years starting at 50yo

84
Q

single fam member colon cancer screening

A

10yrs BEFORE onset or 40yo (whichever is younger),

repeat every 5 years if family member

85
Q

3 family members, 2 generations, 1 premature– HNPCC colon cancer screening

A

start at 25yo, with colonoscopy every 1-2yrs

86
Q

FAP colon cancer screening

A

sigmoidoscopy age 12, every year

87
Q

need for frequent screening colonoscopy for peutz, turbot, gardner, juvenile polyposis?

A

NOOOOOOOO NEED

88
Q

prognostic factor for pancreatitis

A

LOW calcium (because used up in saponification)

89
Q

best initial tests for pancreatitis

A

amylase and lipase

90
Q

most specific test for pancreatitis

A

abdo CT with IV and oral contrast

91
Q

extensive necrosis of the pancreas in pancreatitis?

A

> 30%

92
Q

abdo CT ALWAYS given with….

A

IV and ORAL contrast– to better define and outline abdominal structures

93
Q

infected necrotic pancreatitis tx:

A

necrectomy– surgically debride pancreas to prevent ARDS and death

94
Q

if suspect >30% necrosis on CT or MRI for pancreatitis…

A

ADD antibiotics: imipenem or meropenem

DECREASE mortality

95
Q

SAAG liver disease

A

serum ascites albumin gradient

96
Q

SAAG

A

infection (Except SBP)
cancer
nephrotic syndrome

97
Q

SAAG>1.1g/dL

A

portal HTN
CHF
hepatic vein thrombosis
constrictive pericarditis

98
Q

any perforation in SBP?

A

NOOOOOO

99
Q

best initial test in SBP?

A

cell count> 250neutrophils

100
Q

variceal bleeding + ascites,

prophylaxis for……..

A

SBP prophylaxis

101
Q

tx SBP

A

ceftriaxone or cefotaxime

102
Q

after SBP, fu tx

A

LIFE LONG ABX PROPHYLAXIS

103
Q

tx for hepatorenal syndrome

A

octreotide

midodrine

104
Q

ORTHODEOXIA

A

hypoxia when standing upright= hepatopulmonary syndrome

105
Q

only cause of cirrhosis when DO NOT need bx

A

PSC: since MRCP–> string of bead appearance

106
Q

infections in HFE

A

YLV
yersinia
listeria
vibrio vulnificus

since all feed off of iron

107
Q

confirming dx of HFE

A

try and spare doing a biopsy—

abdominal MRI + HFE gene (C282Y)

108
Q

phlebotomy in HFE

A

if done when have liver fibrosis–> can resolve liver fibrosis BEFORE CIRRHOSIS develops

109
Q

active chronic hepatitis and

persistent chronic hepatitis

A

NO LONGER RELEVANT

110
Q

biopsy with viral hepatitis

A

can better understand urgency of treatment if fibrosis is present or worsening

111
Q

tx hep B

A 
MONOTHERAPY
lamivudine
telbivudine
adefovir
tenofovir
entecavir
interfron
112
Q

tx hep C

A

COMBO THERAPY

only for ACUTE HEP C

113
Q

tx hep C genotype 1:

A

ledipasvir + sofosbuvir

114
Q

tx hep C genotypes 2 and 3:

A

ribavirin + sofosbuvir

115
Q

SE’s of interferon

A

arthralgias
thrombocytopenia
leukopenia
depression

116
Q

SE’s of ribavarin

A

anaemia

117
Q

SE’s adefovir

A

RENAL dysfunction

118
Q

SE’s of lamivudine

A

NONE

119
Q

new thing for wilsons

A

coombs NEGATIVE haemolytic anaemia

120
Q

moa of zinc in wilsons disease

A

INTERFERES with copper intestinal ABSORPTION

121
Q

decreased caeruloplasmin

A

NOT the most accurate test in wilsons disease;

because in all liver disorders will have decreased liver proteins

122
Q

dysphagia and HIV CD levels

A

CD less than 100

123
Q

tx of dysphagia and HIV empirically

A

fluconazole

124
Q

if no response to fluconazole in HIV

A

upper endoscopy with bx

125
Q

tx of barretts alone

A

PPI’s

rescope every 2-3 years

126
Q

low grade eso dysplasia

A

PPI’s

rescue every 6-12months

127
Q

high grade dysplasia eso

A

ablation with endoscopy: photodynamic, radio frequency, endoscopic mucosal

128
Q

5-10ml of GI blood loss

A

coffee ground, and guac positive

129
Q

50-100ml of GI blood loss

A

melena

130
Q

if patient has allergy to penicillin and needs H.pylori tx

A
  • PPI
  • clarithromycin
  • metronidazole
131
Q

when to do surgery in diverticulitis

A

unreponsive to medical tx
recurrent infection
complications: perforation, fistula, abscess, stricture, obstruction

132
Q

most accurate test for chronic pancreatitis

A

secretin stimulation test (normal test= bicarb in fluid)

133
Q

does treating UC improve PSC?

A

NOOOOOO, the patient will evidently end up with OLT

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