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Medicine Boards - Erica > GI > Flashcards

GI Flashcards

1
Q

Ferritin level suggestive of hemochromatosis

A

> 1000 in the absence of inflammation or other liver disease (alcoholic liver disease can elevate ferritin)

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2
Q

Interpreting stool osmotic gap

A

Given in calculator: 290 – 2 × [stool sodium + stool potassium]
>100: osmotic diarrhea

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3
Q

SAAG interpretation

A

Given in calculator: serum albumin - ascitic fluid

>1.1: cardiac vs cirrhosis

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4
Q

ascitic fluid total protein to figure out cause of ascites

A

> 2.5: CHF, carcinomatosis, TB, fungal

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5
Q

SAAG >1.1 and ascitic fluid total protein

A

cirrhosis

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6
Q

SAAG >1.1 and ascitic fluid total protein >2.5

A

cardiac ascites, Budd Chiari

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7
Q

SAAG

A

nephrotic syndrome, myxedema

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8
Q

SAAG 2.5

A

infections, malignancy, pancreatic ascites

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9
Q

Causes of pill-induced esophagitis

A

alendronate, quinidine, tetracycline, doxycycline, potassium chloride, ferrous sulfate, and mexiletine

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10
Q

SBP cell count threshold

A

> 250 PMNs

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11
Q

When to give albumin in SBP

A

Cr >1 mg/dL
Tbili >4 mg/dL
BUN >30 mg/dL
-> 1.5 g/kg of intravenous albumin (25%) on the day of diagnosis and 1 g/kg of albumin on day 3

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12
Q

When to perform upper endoscopy: “alarm features”

A

onset after age 50 years; anemia; dysphagia; odynophagia; vomiting; weight loss; family history of upper gastrointestinal malignancy; personal history of peptic ulcer disease, gastric surgery, or gastrointestinal malignancy; and abdominal mass or lymphadenopathy on examination.
Otherwise try PPI, can empirically test for H pylori if high risk (eg developing country)

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13
Q

Hepatorenal syndrome (HRS) Dx:

A

(1) an increase in the serum creatinine level to greater than 1.5 g/dL (132.6 µmol/L) over days to weeks
(2) lack of response to an albumin challenge of 1 g/kg/d for 2 days
(3) the absence of shock, nephrotoxic drugs, active urine sediment, proteinuria greater than 500 mg/d, and ultrasound evidence of parenchymal kidney disease or obstruction

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14
Q

Treatment of hepatorenal syndrome

A

in the ICU: albumin and norepi

outside the ICU: Midodrine, octreotide, and albumin

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15
Q

When to give prophylactic PPI in setting of NSAID use

A 
age 65 years or older
concomitant use of aspirin (of any dose)
anticoagulants
other NSAIDs
glucocorticoids
high-dose NSAID use
chronic comorbid illness
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16
Q

IBS definition

A

abdominal pain or discomfort that occurs in association with altered bowel habits over a period of at least 3 months -> ie generally don’t need testing EXCEPT if diarrhea predominant should test for celiac

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17
Q

When to do cholecystectomy for gallbladder polyp

A

> 1cm in size

Any size with primary sclerosing cholangitis or gallstones

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18
Q

Treatment of Crohn’s

A

thiopurine (azathioprine or 6-mercaptopurine) +/- anti-TNF (infliximab, adalimumab, and certolizumab)

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19
Q

IBD colonoscopy schedule

A

surveillance colonoscopy every 1 to 2 years beginning after 8 to 10 years of disease
or every 1 year beginning at the time of primary sclerosing cholangitis diagnosis
or if only ulcerative colitis of the rectum, regular screening schedule

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20
Q

Colonoscopy schedule with high risk family Hx

A

high risk = a first-degree relative with colon cancer or advanced adenoma diagnosed at age

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21
Q

Colonoscopy schedule w Lynch syndrome

A

colonoscopy every 1 to 2 years beginning at age 20 to 25 years, or 2 to 5 years earlier than the youngest age at diagnosis of colorectal cancer if the affected relative was less than 25 years old.

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22
Q

Colonoscopy schedule serrated polyps

A

large (≥10 mm) or dysplastic sessile serrated polyps or traditional serrated adenomas should undergo colonoscopy in 3 years.
smaller ( every 5yrs
Serrated polyposis syndrome = multiple or large serrated polyps -> every 1yr

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23
Q

Pyoderma gangrenosusm

A

painful pustules that rapidly ulcerate and expand, with edematous, rolled, or undermined borders that may have a violaceous hue; PG may be an extraintestinal manifestation of Crohn disease

24
Q

Type 1 autoimmune pancreatitis

A

Older men (average 40s)
1. focal pancreatic enlargement with a featureless rim and a nondilated pancreatic duct
2. increased serum IgG4 level
3. extrapancreatic organ involvement (sclerosing cholangitis or IgG4-associated cholangitis)
Tx: prednisone

25
Q

Surveillance schedule for Barrett’s

A

No dysplasia -> every 3-5yrs
Low grade dysplasia -> every 6-12mo
High-grade dysplasia requires either more aggressive surveillance or treatment to remove BE (such as with endoscopic ablation or esophagectomy).

26
Q

Primary biliary cirrhosis

A

Middle aged woman
Sx: fatigue, dry eyes, dry mouth, pruritus, hyperlipidemia
Dx: cholestatic livery enzymes (alk phos >1.5x ULN) plus positive anti-mitochondrial Abs
Tx: ursodiol

27
Q

Lower GI bleed candidates for outpt mgmt

A

age less than 60 years
no hemodynamic instability
no evidence of gross rectal bleeding
identification of an obvious anorectal source of bleeding on rectal examination or sigmoidoscopy

28
Q

When to resect hepatic adenomas

A

5 cm
males
evidence of hemorrhage on imaging
exhibit β-catenin nuclear reactivity (positive activation or glutamine synthetase) due to higher risk malignant transformation

29
Q

NSAID associated bleeding gastric ulcer and must be on NSAIDs?

A

Celecoxib (COX2 selective NSAID) plus BID PPI

30
Q

HNPCC Dx

A

(1) three or more relatives with an HNPCC–associated cancer (including colorectal, endometrial, ovarian, urothelial, gastric, brain, small bowel, hepatobiliary, or skin)
(2) two successive generations of relatives affected
(3) one affected relative a first-degree relative to two other affected relatives
(4) one cancer diagnosed before age 50 years

31
Q

Microscopic colitis: collagenous vs lymphocytic

A

Collagenous: thickening of the subepithelial collagen band (usually >10 µm)
Lymphocytic: intraepithelial lymphocytosis (>20 intraepithelial lymphocytes per 100 epithelial cells). Ask about NSAIDs, ASA, PPIs

32
Q

MELD threshold for liver transplant referral

A

> = 15

33
Q

TIPS contraindicated

A

MELD >15-18

Tbili >4

34
Q

Endoscopically cured polyps

A

Invasive adenocarcinoma arising in a pedunculated polyp confined to the submucosa and possesses no adverse histologic features such as poor differentiation, lymphatic or vascular invasion, or involved margins
-> no need for surgery or imaging, just repeat colonoscopy in 3mo

35
Q

Screening interval for large (>2cm) polyps

A

if adenoma or cancer (and favorable features) -> every 3-6mo (to make sure fully removed)

36
Q

Low risk gastric ulcers

A

clean-based or have a nonprotuberant pigmented spot

Tx for bleeding low risk gastric ulcers: oral PPI, resume diet w/in 24hrs, early hospital discharge (eg can be at 24hrs)

37
Q

Milan criteria

A

in pts w cirrhosis
up to three hepatocellular carcinoma tumors ≤3 cm or one tumor ≤5 cm
Tx: liver transplant

38
Q

HCC Dx in cirrhosis pts

A

can be based on imaging alone:

lesions larger than 1 cm that enhance in the arterial phase and have washout of contrast in the venous phase

39
Q

UC and no improvement in oral steroids

A

Anti-TNF (infliximab, adalimumab, and golimumab) or IV steroids

40
Q

Aspirin for CAD in the setting of GI bleed 2/2 PUD

A

aspirin should be resumed within 3 to 5 days; aspirin reduces mortality tenfold over 30 days while increasing rebleeding rates only twofold

41
Q

Second line therapy for failed initial H pylori treatment:

10-day course of clarithromycin, amoxicillin, and omeprazole

A

since it is 2/2 clarithromycin resistance:

(1) a 10- to 14-day course of bismuth subsalicylate, metronidazole, tetracycline, and a proton pump inhibitor (PPI) -> need this combo 2/2 metronidazole resistance
(2) a 10-day course of levofloxacin, amoxicillin, and a PPI.

42
Q

Screening colonoscopy and CTs post curative colon Ca surgery

A

follow-up colonoscopy at 1 year and 3 years after curative surgical resection; if results of these colonoscopies are normal, the surveillance interval can be extended to 5 years.
Annual CT abdomen pelvis x5yrs

43
Q

3yr colonoscopy screening interval

A

(1) an adenoma 10 mm or larger
(2) three to ten adenomas
(3) an adenoma with a villous component (such as a tubulovillous or villous adenoma)
(4) an adenoma with high-grade dysplasia

44
Q

Treatment of Type I gastric neuroendocrine tumor

A

Type I: associated with autoimmune atrophic gastritis and hypergastrinemia
Curative treatment of type I gastric neuroendocrine tumors is achieved with endoscopic removal of these lesions when they are small (2cm

45
Q

Threshold for HBV treatment

A

HBV RNA >10,000

46
Q

When to screen for HCC in chronic HBV (including inactive carrier state)

A

= ultrasound screening q6mo if initial ultrasound normal

(1) patients with cirrhosis
(2) Asian men older than 40 years
(3) Asian women older than 50 years
(4) African people >20yo
(5) patients with a family history of HCC
(6) patients with persistent hepatocellular inflammation (defined as elevated alanine aminotransferase [ALT] level and HBV DNA level greater than 10,000 IU/mL)

47
Q

Risk factors for progression to chronic pancreatitis

A

male sex, alcohol use, and tobacco use

48
Q

Screening interval for 1-2

A

5-10yrs

49
Q

Screening interval for 3-10 adenomas, >10mm adenoma, villous histology, or high grade dysplasia

A

3yrs

50
Q

Screening interval for >10 adenomas on a single exam

A
51
Q

Screening interval for

A

10yrs

52
Q

Screening interval for

A

5yrs

53
Q

Screening interval for >=10mm sessile serrated polyp or sessile serrated polyp with dysplasia or traditional serrated adenoma

A

3yrs

54
Q

Screening interval for serrated polyposis syndrome

A

1yr

55
Q

Clues to Wilson’s dz

A 
Low alk phos (copper interferes with synthesis)
Moderate elevation of liver enzymes despite other evidence of more severe disease
Hemolytic anemia (sudden release of copper can cause hemolysis)

Medicine Boards - Erica (11 decks)

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