GI Flashcards
1
Q
alarming symptoms to do endoscopy
A
weight loss
blood in stool
anemia
2
Q
alarming symptoms to do endoscopy
A
weight loss
blood in stool
anemia
3
Q
YOUNG patient with progressive dysphagia for solids and liquids
A
achalasia
4
Q
most accurate test in achalasia
A
manometry
5
Q
tx of achalasia
A
DILATION, no cure
- botox injections
- pneumatic balloon dilations
- heller myotomy
6
Q
chance of perforation with pneumatic balloon dilation
A
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
8
Q
most important clue for esophageal cancer
A
PROGRESSIVE dysphagia
9
Q
PROGRESSIVE DYSPHAGIA by age
A
YOUNG- achalasia+ NO smoking/alcohol
OLD- esophageal cancer+ YES smoking/alcohol
10
Q
best initial test for esophageal cancer
A
BARIUM
11
Q
DIAGNOSTIC test for esophageal cancer
A
BIOPSY ie. most accurate
12
Q
generally for cancer the radiologic test is…
A
NEVER the most accurate
13
Q
YOUNG patient with progressive dysphagia for solids and liquids
A
achalasia
14
Q
most accurate test in achalasia
A
manometry
15
Q
tx of achalasia
A
DILATION, no cure
- botox injections
- pneumatic balloon dilations
- heller myotomy
16
Q
chance of perforation with pneumatic balloon dilation
A
less than 3%
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
18
Q
most important clue for esophageal cancer
A
PROGRESSIVE dysphagia
19
Q
PROGRESSIVE DYSPHAGIA by age
A
YOUNG- achalasia+ NO smoking/alcohol
OLD- esophageal cancer+ YES smoking/alcohol
20
Q
best initial test for esophageal cancer
A
BARIUM
21
Q
DIAGNOSTIC test for esophageal cancer
A
BIOPSY ie. most accurate
22
Q
generally for cancer the radiologic test is…
A
NEVER the most accurate
23
Q
sudden onset chest pain
worsened by drinking COLD LIQUIDS
A
diffuse esophageal spasm
24
Q
most accurate diagnosis of eso spasm
A
MANOMETRY
25
treatment of diffuse esophageal spasm
CCB's
26
drugs a/w esophagitis
1. alendronate
2. doxycycline
3. KCl
27
intermittent dysphagia
shatzki ring
28
barium for diffuse esophageal spasm
corkscrew esophagus
29
2 investigations contra-indicated in zenkers
NG tube
endoscopy
since can--> PERFORATION--> more dangerous
30
manometry= answer for
1. spasm
2. achalasia
3. scleroderm
31
pain= symptom,
| equivalent to....
tenderness=sign
32
MCC of epigastric pain
NON-ulcer dyspepsia= 50-90%
| which is not admitted to the hospital, thus we don't see on wards majority of the time
33
PC:
- epigastric pain
- no significant hx
- patient less than 50 years old
NON-ulcer dyspepsia
34
PC:
- diabetes
- bloating
GASTROPARESIS
35
WRONG TX answer for epigastric pain
= MISOPROSTOL
36
which quadrant does IBS classically present in?
LUQ-- since splenic flexure syndrome
37
diagnosis of GERD
can be clinical alone (not all symptoms have to be present)
38
isolated pyrosis on OGD--->
NORMAL
39
when does GERD--> Barrett's: 5 YEARS
invasive treatment for GERD:
1. nissen fundoplication
2. endocinch: LES suture
3. local heat/radiation
40
can gastritis be made from a clinical diagnosis alone?
NOOOOOOO-- definitive diagnosis from endoscopy
41
capsule endscopy for upper GI bleed
WRONG answer!
42
do alcohol and smoking cause peptic ulcer disease
NOOOOOO, they do DELAY HEALING of ulcers
43
most accurate test for H.pylori diagnosis
ENDSCOPY
44
stress ulcer prophylaxis indicated in
1. mechanical ventilation
2. burns (curling)
3. head trauma (cushings)
4. coagulaopathy
45
random but HY risk factor for acute gastritis
URAEMIA
46
GI bleeding WITHOUT pain
gastritis
47
can PUD dx be made from clinical alone?
NOOOOO need endoscopy and biopsy
48
what can help in resolution of PUD
bismuth with triple therapy
49
H.PYLORI TESTS OF CURE (and treatment failure)
1. UREA BREATH TEST
2. STOOL ANTIGEN
3. SEROLOGY
4. Endoscopy and bx
50
repeat bx and endoscopy for which type of ulcer
GU since chance of getting cancerous
51
failed therapy to PUD
1. non-adherence
2. NSAID's
3. alcohol
4. smoking
52
when to scope if PC= DYSPEPSIA
1. age>55
2. alarming symptoms:
- dysphagia
- weight loss
- anemia
53
treatment for Non-Ulcer Dyspepsia
1. PPI's
| 2. IF symptoms persists + H.pylori present= treat H.pylori
54
PC gastrinoma:
recurrent LARGE intractable MULTIPLE ulcers on endoscopy
DIARHEA, gnawing, burning abdominal pain with some GI bleeding
55
after endoscopy with gastrinoma....
high gastrin levels off antisecretory therapy with high gastric acidity
56
most accurate test gastrinoma
SECRETIN functional test
57
excluding metastatic disease with gastronome (after CT/MRI normal)
somatostatin receptor nuclear scintigraphy
AND
endoscopic US
58
any need for special tests for diabetic gastroparesis
NO, clinical PC (note: most accurate test: nuclear gastric emptying study, rarely needed)
59
tx for diabetic gastroparesis
INCREASE MOTILITY:
- erythromycin
- metoclopromide
60
most nb initial mgmt of GI bleeding
BLOOD PRESSURE
| --> Bolus normal saline
61
role of NG tube
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
MAJORITY of GI bleeding stops with.....
ADEQUATE FLUID RESUSCITATION
| = most important step in mgmt GI bleeding
63
mgmt GI bleeding
1. fluid resusc
| 2. packed RBCs if Hct
64
when are platelets transfuse ACTIVE bleeding GI
65
tx variceal bleeding
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
recurrent episode of C.diff after treated well with metronidazole first time
TRY AGAIN with metronidazole orally
67
FAILED treatment of C.diff with metronidazole
oral vancomycin or
| fidaxomicin
68
diagnostic tests of chronic pancreatitis
1. abdo XR- Ca
2. abdo CT- Ca
3. secretin stimulation test (if normal will release large amounts of bicarb rich fluid)
69
is it okay to eat rice and drink wine in celiac?
YES
70
tx whipples
ceftriaxone
| TMP/SMX
71
tx tropical sprue
TMP/SMX
| tetracycline
72
any weight loss in lactose intolerance and IBS
NOOOOOOOO
73
any calorie deficiency in lactose intolerance
NOOOOOOO
74
tx of lactose intolerance
oral lactase replacement
75
2 antispasmodics for IBS
hyosycamine
| dicyclomine
76
weird new antibody for crohns
anti-saccharomyces cervesiae
77
fistulae tx in crohns disease
infliximab
78
specific steroid in IBD
budesonide
79
conservative tx of diverticulosis
brain
psyllium
methylcelluose
increase distally fiber
80
best initial test in diverticulitis
abdominal CT
81
contraindicated in diverticulitis
colonoscopy and barium
82
tx of diverticulitis
cipro and metro
83
routine colon cancer screening
every 10 years starting at 50yo
84
single fam member colon cancer screening
10yrs BEFORE onset or 40yo (whichever is younger),
| repeat every 5 years if family member
85
3 family members, 2 generations, 1 premature-- HNPCC colon cancer screening
start at 25yo, with colonoscopy every 1-2yrs
86
FAP colon cancer screening
sigmoidoscopy age 12, every year
87
need for frequent screening colonoscopy for peutz, turbot, gardner, juvenile polyposis?
NOOOOOOOO NEED
88
prognostic factor for pancreatitis
LOW calcium (because used up in saponification)
89
best initial tests for pancreatitis
amylase and lipase
90
most specific test for pancreatitis
abdo CT with IV and oral contrast
91
extensive necrosis of the pancreas in pancreatitis?
>30%
92
abdo CT ALWAYS given with....
IV and ORAL contrast-- to better define and outline abdominal structures
93
infected necrotic pancreatitis tx:
necrectomy-- surgically debride pancreas to prevent ARDS and death
94
if suspect >30% necrosis on CT or MRI for pancreatitis...
ADD antibiotics: imipenem or meropenem
| DECREASE mortality
95
SAAG liver disease
serum ascites albumin gradient
96
SAAG
infection (Except SBP)
cancer
nephrotic syndrome
97
SAAG>1.1g/dL
portal HTN
CHF
hepatic vein thrombosis
constrictive pericarditis
98
any perforation in SBP?
NOOOOOO
99
best initial test in SBP?
cell count> 250neutrophils
100
variceal bleeding + ascites,
| prophylaxis for........
SBP prophylaxis
101
tx SBP
ceftriaxone or cefotaxime
102
after SBP, fu tx
LIFE LONG ABX PROPHYLAXIS
103
tx for hepatorenal syndrome
octreotide
| midodrine
104
ORTHODEOXIA
hypoxia when standing upright= hepatopulmonary syndrome
105
only cause of cirrhosis when DO NOT need bx
PSC: since MRCP--> string of bead appearance
106
infections in HFE
YLV
yersinia
listeria
vibrio vulnificus
since all feed off of iron
107
confirming dx of HFE
try and spare doing a biopsy---
| abdominal MRI + HFE gene (C282Y)
108
phlebotomy in HFE
if done when have liver fibrosis--> can resolve liver fibrosis BEFORE CIRRHOSIS develops
109
active chronic hepatitis and
| persistent chronic hepatitis
NO LONGER RELEVANT
110
biopsy with viral hepatitis
can better understand urgency of treatment if fibrosis is present or worsening
111
tx hep B
```
MONOTHERAPY
lamivudine
telbivudine
adefovir
tenofovir
entecavir
interfron
```
112
tx hep C
COMBO THERAPY
| only for ACUTE HEP C
113
tx hep C genotype 1:
ledipasvir + sofosbuvir
114
tx hep C genotypes 2 and 3:
ribavirin + sofosbuvir
115
SE's of interferon
arthralgias
thrombocytopenia
leukopenia
depression
116
SE's of ribavarin
anaemia
117
SE's adefovir
RENAL dysfunction
118
SE's of lamivudine
NONE
119
new thing for wilsons
coombs NEGATIVE haemolytic anaemia
120
moa of zinc in wilsons disease
INTERFERES with copper intestinal ABSORPTION
121
decreased caeruloplasmin
NOT the most accurate test in wilsons disease;
| because in all liver disorders will have decreased liver proteins
122
dysphagia and HIV CD levels
CD less than 100
123
tx of dysphagia and HIV empirically
fluconazole
124
if no response to fluconazole in HIV
upper endoscopy with bx
125
tx of barretts alone
PPI's
| rescope every 2-3 years
126
low grade eso dysplasia
PPI's
| rescue every 6-12months
127
high grade dysplasia eso
ablation with endoscopy: photodynamic, radio frequency, endoscopic mucosal
128
5-10ml of GI blood loss
coffee ground, and guac positive
129
50-100ml of GI blood loss
melena
130
if patient has allergy to penicillin and needs H.pylori tx
- PPI
- clarithromycin
- metronidazole
131
when to do surgery in diverticulitis
unreponsive to medical tx
recurrent infection
complications: perforation, fistula, abscess, stricture, obstruction
132
most accurate test for chronic pancreatitis
secretin stimulation test (normal test= bicarb in fluid)
133
does treating UC improve PSC?
NOOOOOO, the patient will evidently end up with OLT
