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Step 2 CK > GI > Flashcards

GI Flashcards

1
Q

Indications for Endoscopy

A

Weight loss
Blood in stool
Anemia

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2
Q

Dx test for anatomical issue in esophagus

A

Barium then EGD if +

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3
Q

Dx test for physiological issue in esophagus

A

Barium then EGD if -

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4
Q

Dx test for mucosal issue in esophagus

A

EGD

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5
Q

Dx test for Acid issue in esophagus

A

24hr pH

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6
Q

Dx test for small bowel issue

A

Capsule endoscopy

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7
Q

Features of pts with achalasia

A 
Under 50
Both solids and liquids
No smoking or alcohol
Halitosis
Regurgitation
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8
Q

Most accurate test for Achalasia

A

Manometry

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9
Q

What is Dx with Bx in esophagus

A

Barrett

Cancer

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10
Q

Features of pts with esophageal cancer

A

Over 50
Solids then liquids
Alcohol and smoking
>5-10 yrs of GERD sx

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11
Q

Best initial test for esophageal CA

A

Barium

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12
Q

Rx esophageal CA

A

Resection along with chemo and radiation

Stent if cannot resect (sx rx)

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13
Q

2 forms of esophageal spasms

A

Diffuse esophageal spasm

Nutcracker esophagus

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14
Q

Precipitate esophageal spasm

A

Drinking cold liquid

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15
Q

Best initial test esophageal spasm

A

Esophogram

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16
Q

Most accurate test for esophageal spasm

A

Manometry (also used to distinguish types)

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17
Q

Rx esophageal spasm

A

CCB and nitrates

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18
Q

Dysphagia in HIV w/ CD4

A

Fluconazole

EGD if rx fails

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19
Q

Rare sequelae of Plummer-Vinson

A

Squamous cell carcinoma

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20
Q

Rx Schatzki ring

A

Pneumatic dilation

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21
Q

Main Sx in Schatzki ring

A

Intermittent dysphagia of solids

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22
Q

Rx in Plummer-Vinson

A

Fe replacement

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23
Q

Cause of Schatzki ring

A

Acid reflux

Associated with hiatial hernia

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24
Q

Best test for Zenker

A

Barium

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25
Q

Rx Zenker

A

Surgery

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26
Q

Pills causing esophagitis

A

Doxy
Alendronate
KCl

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27
Q

Pt presentation for schleroderma esophagitis

A

Reflux with hx of scleroderma or progressive systemic sclerosis

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28
Q

When is Manometry used

A

Achalasia
Scleroderma
Spasm

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29
Q

Management of scleroderma

A

PPIs

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30
Q

Problem with esophagus in scleroderma

A

LES doesn’t close

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31
Q

Sx difference between mallory-weiss and borhaave

A 
M-W = blood
Borhaave = no blood
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32
Q

What is Borhaave

A

Full penetration of esophagus

M-W is only mucosal tear

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33
Q

MCC epigastric pain

A

Non-ulcer dyspepsia

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34
Q

Hx Pain worse with food

A

Gastric ulcer

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35
Q

Hx Pain better with food

A

Duodenal ulcer

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36
Q

Hx Weight loss

A

Cancer, gastric ulcer

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37
Q

Hx Tenderness

A

Pancreatitis

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38
Q

Hx Bad taste, cough, hoarse

A

Gastroesophageal reflux

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39
Q

Hx Diabetes, bloating

A

Gastroparesis

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40
Q

No Hx

A

Non-ulcer dyspepsia

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41
Q

Only way to understand etiology of epigastric pain from ulcer

A

EGD

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42
Q

AE of H2 blockers

A

Tachyphylaxis

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43
Q

What is GERD

A

Inappropriate relaxation of LES

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44
Q

Complaints in GERD

A

Sore throate
Metallic taste
Hoarseness
Cough

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45
Q

EGD in GERD

A

Signs of obstruction
Weight loss
Anemia or heme + stool
>5-10 yrs of sx

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46
Q

Confirm etiology of GERD if Dx is not clear

A

24hr pH monitoring

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47
Q

Rx GERD

A

Weight loss (BEST)
Avoid EtOH, nicotine, caffeine, chocolate, peppermint
NO eating 3hrs before bed
Elevate head of bed 6-8 inches

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48
Q

What does peppermint do in GERD

A

Dilate LES

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49
Q

Rx mild/intermittent sx in GERD

A

Liquid antacids

H2 blockers

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50
Q

Rx persistent sx/erosive esophagitis

A

PPIs for 4-6wks

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51
Q

Surgical optionsin GERD (when meds fail)

A

Nissen fundoplication
Endocinch
Heat/radiation to scar

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52
Q

Should be avoided after nissen fundoplication

A

Carbonated beverages

Rx Simethicone then NG

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53
Q

How long does columnar metaplasia take to develop with reflux

A

5yrs

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54
Q

Only way to be certain of Barrett

A

Bx

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55
Q

Rate of progression of Barrett to CA

A

0.5% of Barrett per year

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56
Q

Rx Barrett

A

PPIs and rescope every 2-3yrs

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57
Q

Rx low-grade dysplasia

A

PPIs and rescope every 6-12 months

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58
Q

Rx high grade dysplasia

A

Ablation - Photodynamic therapy, radiofrequency, mucosal resection

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59
Q

Main causes of gastritis

A 
Alcohol
NSAIDs
H. pylori
Portal HTN
Stress - Burns, trauma, sepsis, multiorgan failure
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60
Q

Cause of atrophic gastritis

A

B12 deficiency

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61
Q

MC presentation of gastritis

A

Painless GI bleeding

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62
Q

Volume of blood loss in coffee ground emesis

A

5-10mL

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63
Q

Volume of blood loss in heme+ stool

A

5-10mL

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64
Q

Volume of blood loss in melena

A

50-100mL

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65
Q

Most accurate test for gastritis

A

EGD

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66
Q

Problem with serology for H. pylori

A

Only works on 1st dx

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67
Q

Problem with urea breath test

A

Only good to test for eradication

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68
Q

Problem with sucralfate

A

Only works in acidic environment

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69
Q

Who can’t get sucralfate (AlOH)

A

Dialysis pts cannot excrete Al containing compounds

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70
Q

Who gets stress ulcer prophylaxis

A

Mechanic ventilation
Burns
Head trauma
Coagulopathy

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71
Q

Most accurate test for H. pylori

A

EGD with Bx

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72
Q

Less common causes of PUD

A 
Burns
Head trauma
Crohn
Gastric CA
ZES
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73
Q

Effect of alcohol/smoking of gastric ulcers

A

Delay healing

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74
Q

Most accurate test for PUD

A

Upper endoscoply

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75
Q

Only method for detecting gastric CA

A

EGD

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76
Q

H.pylori presence in PUD by location

A

Duodenal - 80-90%

Gastric - 50-70%

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77
Q

What can you add to ABX rx if ulcer is treatment resistant

A

Bismuth

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78
Q

MCC Rx failure for ulcers

A

Nonadherence
Alcohol
Tobacco
NSAIDs

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79
Q

What percentage of gastric ulcers are associated with CA

A

4

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80
Q

When to scope pts with dyspepsia

A 
>45-55
Alarm sx (dysphagia, wt loss, anemia)
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81
Q

Rx non-ulcer dyspepsia

A

Empirically with PPIs if

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82
Q

What is non-ulcer dyspepsia

A

Epigastric pain with normal EGD

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83
Q

Features of gastrinoma

A

Large (>1-2cm)
Recurrent (H.pylori eradicated)
Distal (in duodenum)
Multiple

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84
Q

Why are gastrinomas associated with diarrhea

A

Acid inactivates lipase

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85
Q

Most accurate diagnostic test for ZES

A

High gastrin levels with high gastric acidity
High gastrin levels despite high gastric acid output
Persistent high gastrin despite injecting secretin

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86
Q

Single most accurate test for gastrinoma

A

Response to secretin

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87
Q

Exclude metastatic disease in pancreas with dx of gastrinoma

A

Somatostatin receptor scintigraphy (nuclear octreotide scan) combined with endoscopic U/S if CT and MRI nl

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88
Q

Rx ZES

A

Surgery

Mets get lifelong PPI w/o resection

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89
Q

Meds to improve gut motility in diabetic gastroparesis

A

Erythromycin

Metoclopromide

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90
Q

Most accurate test for diabetic gastroparesis

A

Nuclear gastric emptying study

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91
Q

Why isn’t D5W used in fluid resucitation

A

Doesn’t stay in the vascular space

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92
Q

MCC UGI bleed

A

Ulcer

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93
Q

MCC LGI bleed

A

Diverticulosis followed by angiodysplasia

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94
Q

Orthostasis

A

> 10 rise in pulse lying to sitting or standing
OR
20pt drop in SBP when sitting up

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95
Q

Percent of blood loss in orthostasis

A

15-20%

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96
Q

Percent of blood loss when HR>100

A

30%

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97
Q

Percent of blood loss when SBP

A

30%

98
Q

Who gets variceal bleeds

A

Cirrhosis

99
Q

When to give pRBCs in GI bleed

A

HCT

100
Q

When do give FFP in GI bleed

A

INR

101
Q

When to give platelets in GI bleed

A

Platelet count

102
Q

Rx variceal bleed

A

Octreotide

103
Q

Role of PPI in UGI bleed

A

Reduces mortality

104
Q

Role of propranolol in GI bleed

A

Prevent subsequent episodes

105
Q

Main ABX implicated in c. diff diarrhea

A

Clindamycin

106
Q

Best initial test for C. diff

A

Stool toxin or PCR

107
Q

When to give oral vanco in C. diff

A

2 failed trials of metro

108
Q

Alternative to vanco in C. diff

A

Fidaxomicin

109
Q

MCC malabsorption in adults

A

Celiac

110
Q

Main malabsorption syndromes

A 
Celiac (autoimmune)
Whipple (infectious)
Chronic pancreatitis (acquired)
111
Q

Vit D def manifestation

A

Hypocalcemia

Osteoporosis

112
Q

Vit K def manifestation

A

Bleeding

Easy bruising

113
Q

Vit B12 def manifestation

A

Anemia
Hypersegmented neutrophils
Neuropathy

114
Q

Main presentation of malabsorption

A

Steatorrhea

Weight loss

115
Q

10% of celiac present with

A

Dermatitis herpetiformis

116
Q

Key word in Whipple

A

PAS+ Macrophages

117
Q

Rx Whipple

A

Ceftriaxone followed by TMP/SMX

118
Q

Distinction between chronic pancreatitis and celiac

A

Fe deficiency (celiac)

119
Q

Most specific test for celiac

A

Anti-tissue transglutaminase

120
Q

3 tests for celiac

A

Anti-tissue transglutaminase
Antiendomysial Ab
IgA antigliadin Ab (retest for IgG if -ve)

121
Q

Still gluten sensitive after 3mos of gluten free diet

A

Non-compliance

122
Q

Gluten sensitivity after 10yrs of gluten free diet

A

Lymphoma

123
Q

Why do Bowel Bx in Celiac

A

R/O Lymphoma

124
Q

Dx tests for Chronic pancreatitis

A

ABD XR - 50-60% sensitive for calcifications
ABD CT - 80-90% sensitive for calcifications
Secretin stimulation

125
Q

Most accurate test for chronic pancreatitis

A

Secretin stimulation - Place NG. NL pancreas releases tons of bicarb after IV secretin

126
Q

Rx chronic pancreatitis

A

Enzyme replacement

127
Q

Rx celiac

A

Gluten free diet

128
Q

Rx tropical sprue

A

TMP/SMX

Tetracycline

129
Q

Main sx in carcinoid

A

Intermittent diarrhea
Flushing
Wheezing
R sided cardiac abnormalities

130
Q

Best initial dx test for carcinoid

A

5-HIAA

131
Q

Rx for carcinoid

A

Octreotide

132
Q

Weight loss in lactose intolerance

A

No

133
Q

Dx lactose intolerance

A

Remove all milk products from diet and wait 1 day for sx resolution

134
Q

What is IBS

A

Pain syndrome with diarrhea, constipation or both

135
Q

Weight loss in IBS

A

No

136
Q

Alleviating factors in IBS pain

A

BMs
Night
Change in bowel habit (like diarrhea)

137
Q

Rx IBS

A 
Fiber
Antispasmodic agents (Hyoscyamine, Dicyclomine)
TCAs
Antimotility agents (loperamide)
Lubiprostone (Ca channel activator)
138
Q

Extraintestinal similarities in UC and Crohn’s

A

Arthralgias
Uveitis, Iritis
Erythema nodosum, Pyoderma gangrenosum
Sclerosing cholangitis (more in UC)

139
Q

Which form of IBD leads to colon CA

A

Both

140
Q

What is the risk of colon CA from IBD related to

A

Duration of colon involvement

141
Q

Colon CA screening in IBD

A

8yrs after initial Dx, then every 1-2yrs

142
Q

Crohn’s specific features

A 
Skip lesions
Transmural granulomas
Fistulas and abscesses
Masses and obstruction
Perianal disease
143
Q

UC specific features

A

Curable by surgery

Entirely mucosal

144
Q

Most accurate test for IBD

A

Colonoscopy

145
Q

Which IBD has anemia

A

Both

146
Q

Serology in IBD

A

UC - ANCA

Crohn - ASCA

147
Q

When is serology +ve in IBD

A
148
Q

Rx IBD exacerbations

A

Steroids - Prednisone, Budesonide

149
Q

Chronic maintenance of IBD remission

A

Asacol - UC
Pentasa - Crohn’s
Rowasa - Rectal UC

All 5-ASA derivatives (mesalamine)

150
Q

Wean IBD pts off steroids with

A

Azathioprine

6-MP

151
Q

Rx Crohn’s perianal disease

A

Cipro

Metro

152
Q

Rx fistulae Crohn’s

A

Infliximab - TNF inhibitor

153
Q

Cure for UC

A

Colectomy

154
Q

When to do surgery for Crohn’s

A

Obstruction

155
Q

Features of diverticulosis

A 
Meat-filled diet
65-70yrs
LLQ pain
Constipation
Bleeding
Maybe Infection
156
Q

When is diverticulitis the most likely Dx

A

LLQ pain
Fever
Leukocytosis
Palpable mass sometimes

157
Q

Best initial test for diverticulitis

A

ABD CT

158
Q

Most accurate test for diverticulosis

A

Colonoscopy

Barium isn’t as accurate

159
Q

Decrease rate of complications from diverticulosis

A

Bran
Psyllium
Methylcellulose
Increased dietary fiber

160
Q

Rx diverticulitis

A 
Cipro and metro
Amoxicillin/clavulanate
Pipercillin/tazobactam
Ticarcillin/calvulanate
Ertapenem
161
Q

Organisms in diverticulitis

A

E. coli and anaerobes

162
Q

When to do surgery in diverticulitis

A

Meds fail
Recurrences
Perf, fistula, abscess, stricture, obstruction
Younger

163
Q

Feed pts with acute diverticulitis

A

NO

164
Q

Routine colon CA screening

A

At 50 and every 10 years

165
Q

Single family member with Hx colon CA screening

A

10yrs earlier than age of family member dx or 40 (whichever comes first)

166
Q

3 family members, 2 gen, 1 before 50 colon CA screening

A

HNPCC

Start at 25 and then every 1-2 yrs

167
Q

FAP colon CA screening

A

Sigmoidoscopy at age 12 and then every year

Colectomy with presence of polyp

168
Q

Colon CA screening with hx of polyp

A

Every 3-5yrs

169
Q

Screening for colon CA w/ hx of colon CA

A

Colonoscopy at 1yr after resection then at 3yrs then every 5yrs

170
Q

Features of Peutz-Jeghers

A

Melanotic spots on lips and skin

Increased freq or breast, gonadal and pancreatic CA

171
Q

Gardner syndrome

A

Colon CA associated w/ osteomas, desmoid tumors, other soft tissue tumors

172
Q

Turcot syndrome

A

Colon CA with CNS malignancy

173
Q

Juvenile polyposis

A

Colon CA with multiple hamartomatous polyps

174
Q

MCC acute pancreatitis

A

Alcohol

Cholelithiasis

175
Q

Cause of gallstones

A

Increased estrogen

Leads to SM relaxation –> bile stasis –> stones

176
Q

Best dx test for gallstones

A

U/S

177
Q

Less common cause of pancreatitis

A 
Trauma
Hypertriglyceridemia
Hypercalcemia
Infection
Drugs (toxicity and allergy)
Obstruction, ERCP, CF
Scorpion sting
178
Q

MC presentation of acute pancreatitis

A

Acute epigastric pain + tenderness

N/V

179
Q

Best Dx test for choledocolithiasis

A

MRCP

180
Q

Rx choledocolithiasis

A

ERCP

181
Q

Sx cholangitis

A 
RUQ pain
Fever
Jaundice
Changing MS
Hypotension
182
Q

Next step in suspected cholangitis

A

ABX for enteric G+ and G-

183
Q

After ABX in cholangitis

A

ERCP (If stone confirmed)

184
Q

Best initial test in pancreatitis

A

Amylase and Lipase

185
Q

Most specific test in pancreatitis

A

CT

186
Q

How much is extensive necrosis

A

> 30%

187
Q

Labs in pancreatitis

A

Leukocytosis, drop in HCT over time with rehydration
Elevated LDH, AST
Hypoxia, Hypocalcemia
Elevated urinary trypsinogen activation peptide

188
Q

Rx acute pancreatitis

A

NPO
IV hydration
Analgesia
PPIs

189
Q

Rx of acute pancreatitis with extensive necrosis

A

ABX (imipenem, meropenem)
Needle Bx
Surgical resection

190
Q

Role of ERCP in acute pancreatitis

A

Remove stones, dilate stricture

Place stent

191
Q

Sx common to all chronic liver disease

A 
Ascites
Coagulopathy
Asterixis, encephalopathy
Hypoalbuminemia and edema
Spider angiomata and palmar erythema
Portal HTN and varices
Thrombocytopenia
Renal insufficiency
Hepatopulmonary syndrome
192
Q

When to perform paracentesis in ascites

A

New-onset
ABD pain and tenderness
Fever

193
Q

SAAG score >1.1

A

Portal HTN
CHF
Hepatic vein thrombosis
Constrictive pericarditis

194
Q

SAAG score

A

Infections (except SBP)
Cancer
Nephrotic syndrome

195
Q

SBP

A

Infection w/o perforation of the bowel

196
Q

MC organism in SBP

A

E. coli

Can also be cause by pneumococcus

197
Q

Best initial test for SBP

A

Cell count with >250 neutrophils

198
Q

Most accurate test for SBP

A

Fluid culture

199
Q

Rx SBP

A

Ceftriaxone or Cefotaxime

200
Q

Prophylaxis for recurrent SBP

A

Norfloxacin or TMP/SMX

201
Q

Rx ascites and edema in cirrhosis

A

Spironolactone and other diuretics

Serial paracentesis

202
Q

Rx coagulopathy and thrombocytopenia in cirrhosis

A

FFP

Platelets (only in active bleeding)

203
Q

Rx Encephalopathy in cirrhosis

A

Lactulose and rifaximin

204
Q

Rx varices in cirrhosis

A

Propranolol and banding via endoscopy

205
Q

Rx hepatorenal syndrome in cirrhosis

A

Somatostatin

Midodrine

206
Q

Sign of hepatopulmonary syndrome

A

Orthodexia - Hypoxia upon sitting upright

207
Q

Most accurate test to dx cirrhosis

A

Liver Bx (except sclerosing cholangitis)

208
Q

Features of PBC

A

Woman 40s-50s
Fatigue, itching
Normal bili with elevated ALP

209
Q

Unique features of PBC

A

Xanthelasma/Xanthoma

Osteoporosis

210
Q

Only cure for PBC

A

Liver transplant

211
Q

Most accurate test to dx PBC

A

Liver Bx

212
Q

Most accurate blood test for PBC

A

AMA

213
Q

Rx PBC

A

Ursodeoxycholic acid

214
Q

80% PSC associated with

A

IBD

215
Q

Most accurate test for PSC

A

ERCP

216
Q

Rx PSC

A

Cholestyramine

Ursodeoxycholic acid

217
Q

What to look for in A1AT def

A

Liver disease

Emphysema (COPD)

218
Q

Problem in hemochromatosis

A

C282y mutation

Overabsorption of Fe in duodenum

219
Q

Why do men present earlier than women in hemochromatosis

A

Menstruation delays onset of fibrosis and cirrhosis

220
Q

Presentation of hemochromatosis

A 
50s, Increased AST, ALP with:
Fatigue and joint pain (pseudogout)
Erectile dysfunction, Amenorrhea
Skin darkening
DM
Cardiomyopathy
221
Q

Best initial test for hemachromatosis

A

Increased serum Fe and ferritin

Decreased TIBC

222
Q

Most accurate test for hemochromatosis

A

Liver Bx for increased Fe

223
Q

Spare pt from liver bx in hemochromatosis

A

MRI with abnormal genetic test

224
Q

Fe chelation in hemochromatosis

A

Pts who cannot be managed with phlebotomy

Anemia and have hemochromatosis from overtransfusion

225
Q

Fe chelation agents

A

Deferoxamine
Deferasirox
Deferiprone

226
Q

Chronic Hep B

A

Surface Ag+ for >6mos

227
Q

Hep B agents

A 
Adefovir
Lamivudine
Telbivudine
Entecavir
Tenofovir
IFN
228
Q

AE IFN

A

Arthralgias
Thrombocytopenia
Depression
Leukopenia

229
Q

AE Ribavirin

A

Anemia

230
Q

AE Adefovir

A

Renal dysfunction

231
Q

Defect in Wilson

A

Decreased ceruloplasmin –> Cu not excreted –> builds up

232
Q

Features of Wilson

A

Cirrhosis, hepatic insufficiency
Neuro sx (psychosis, tremor, dysarthria, ataxia, seizures)
Coombs neg hemolytic anemia
RTA or nephrolithiasis

233
Q

Best initial test for Wilson

A

Slit-lamp

234
Q

Most accurate test for Wilson

A

Increased urine Cu after penicillamine

235
Q

Therapies for Wilson

A

Penicillamine (chelates and removes)
Zinc - Stops intestinal absorption
Trientine - chelates

236
Q

What to look for in autoimmune Hep

A

Young woman
Signs of liver inflammation
+ve ANA

237
Q

Specific tests for autoimmune Hep

A

Liver-kidney microsomal Abs
High gamma globulin
Anti-SM Abs

238
Q

Most accurate test for autoimmune Hep

A

Liver Bx

239
Q

Rx autoimmune Hep

A

Prednisone

Azathioprine

240
Q

MCC mildly abnormal LFTs

A

NASH

241
Q

Most accurate test for NASH

A

Liver Bx

242
Q

Associations with NASH

A

Obesity
DM
Hyperlipidemia
Steroid use

Step 2 CK (21 decks)

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