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GI Flashcards

1
Q

Celiac classic

A 
Diarrhea 
Weight loss
Anemia (iron deficiency) 
Bloating 
\+/- steatorrhea 
Dermatitis herpitiformis
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2
Q

Most severely inflamed area in celiac? The result?

A

Proximal bowel

Results > iron , Ca, folate deficiency

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3
Q

Primary sclerosing cholangitis classic?

A 
RUQ pain 
Jaundice 
Pruritus 
High ALP
High bilirubin 
\+ve p-ANCA
Hx UC
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4
Q

Most common hepatic disease in UC?

A

Primary sclerosing cholangitis

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5
Q

Dx sclerosing cholangitis?

A

MRCP

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6
Q

ERCP vs MRCP?

A

ERCP has higher rate of complications.

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7
Q

Safest OTC laxative?

A

Senna

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8
Q

SE of phenolphthalein + Castro oil?

A

Malabsorption
Dehydration
Lipoid pneumonia
Cathartic colon

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9
Q

SE of bisacodyl?

A

Suppository = rectal burning

Oral = low K, camps, vomiting

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10
Q

SE of milk of magnesia

A

High Mg
Dehydration
Watery stool
Fecal incontinence

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11
Q

What’s psyllium

A

Fiber

Bulk-forming laxative.

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12
Q

How do you assess cure of H. Pylori?

A

Urea breath test

Endoscopic biopsy

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13
Q

What can’t be used to assess cure of H. Pylori? Why?

A

Antibodies level

Remain +ve 6-12 months after Rx

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14
Q

Gastric outlet obstruction classic?

A 
Nonbilious vomitus
Food particles 
W/in 1 hr of meal 
Epigastric fullness 
Dilated stomach (tympanitic mass)
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15
Q

Complication of prolonged vomiting?

A

HypoCl
HypoK
Metabolic alkalosis

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16
Q

Radiation proctitis classic

A 
Hx of radiation. 
Painful defecation 
Diarrhea 
\+/- rectal bleed 
=> scope: friable mucosa + telangiectasia.
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17
Q

Indications of TPN?

A

Poor functioning GI tract (obstruction, fistula, short bowel)
Can’t tolerate other means

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18
Q

Extra intestinal Sx of IBD?

A
  1. MSK
    Arthralgia
    Ankylosing spondylitis
  2. Derm:
    Erythema nodusom, pyoderma ganagrenosum, aphthus ulcers.
3. Hepatic 
Primary sclerosing cholangitis 
Autoimmune hepatitis 
Fatty liver 
Fall stones
  1. Ocular:
    Uveitis, iritis, episcleritis
    Corneal ulcer
    Retinal vascular
  2. Renal
    Ca oxylate stones
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19
Q

What explains the risk of fistulae in Crohn’s

A

Transmural inflammation

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20
Q

Rx of choice in fistulizing crohn’s?

A

Anti-TNF (1st line)

AZA, 6-MP (2nd line)

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21
Q

Indication of oral steroids in IBD?

A

Suppress acute flares

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22
Q

Rx of acute diverticulitis

A

Bed rest
IVF
NPO
IV Abx

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23
Q

Dx acute diverticulitis

A

CT

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24
Q

Rx of gastroparesis

A

Small frequent meals
Glycemic control
1st > Pro-kinetics (domperidone, metoclopramide)

2nd > erythromycin

3rd > cisapride

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25
Q

What’s Gilbert’s disease

A

Indirect hyperbilirubinemia caused by glucuronyl transferase impairment.

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26
Q

What investigation is contraindicated during acute flares of UC? Why?

A

Barium enema

Risk of perforation

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27
Q

Non alcoholic fatty liver associations

A

T2DM

Obesity

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28
Q

Complications of nonalcoholic fatty liver

A

Cryptogenic cirrhosis esp in obese

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29
Q

Labs in alcoholic fatty liver

A

AST/ALT ratio > 2

Most sensitive + specific

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30
Q

Late sign of achalasia?

A

Dilated esophagus
Air fluid level
Retained food
On CXR

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31
Q

Dx of achalasia?

A

Nanometry

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32
Q

What must be r/o in achalasia?

A

Tumor of gastroesophegeal junction

R/o via endoscopy

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33
Q

Risk of developing adenocarcinoma from Barrett’s?

A

<1%

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34
Q

Dx gastroparesis

A

Gastric emptying scintigraphy

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35
Q

Labs in acute HepB infection

A

HBsAg

HBcAg IgM

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36
Q

Rx of acute HepB?

A

Not specific
Stop alcohol
Stop liver offending agents

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37
Q

Most common cause of minimal per recall bleed in < 50 yrs

A 
Anorectal pathology 
Hemorrhoids
Fistula 
Polyps 
Proctitis 
Ulcers 
Cancer
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38
Q

Approach to PR bleed?

A

< 50 yrs
1. Anoscopy if no cause identified > colonoscopy

> 50
Straight colposcopy
Higher risk of Ca

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39
Q

Organism in spontaneous bacterial peritonitis

A

E. coli > klebsiella > Strept

Single organism

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40
Q

WBC in ascetic fluid of spontaneous bacterial peritonitis

A

WBC > 500

Neutrophil > 250

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41
Q

Acute mesenteric ischemia classic?

A

Elderly
Abdominal pain (out of proportion)
+/- AFib

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42
Q

Warning signs in IBS?

A 
Rectal bleeding 
Anemia 
Weight loss
Fever 
FHx CRC
Onset > 50 yrs
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43
Q

Rx of diarrhea in IBS?

A

Loperamide

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44
Q

Market of chronic liver disease? Why?

A

Low albumin

It’s 1/2life 26 days

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45
Q

Most commonly involved area in crohns?

A

Terminal ileum

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46
Q

Drug causes dysphagia?

A

Ant dopaminergic

Atypical antipsychotics (resperidone)

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47
Q

Ranson’s Criteria?

A 
< 48 hr:
Age > 55
WBC > 16
LDH > 350
AST > 250
Glucose > 10

> 48 hr:
Hct >10% drop
BUN > 1.79
Ca < 2 
O2 < 60
Base deficit > 4
Fluid needs > 6L
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48
Q

Dx of alcoholic liver disease?

A

AST:ALT > 2

AST 2x higher than ALT

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49
Q

Pancreatic enzyme in alcoholic pancreatitis?

A

Amylase is less likely to be elevated.

High lipase:amylase ratio (more specific in alcoholic)

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50
Q

Dx gallstones?

A

US

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51
Q

PEG tube risk?

A

Increases risk of pressure ulcer.

Aspiration risk is not reduced.

Increase discomfort

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52
Q

P450 Inhibitors

A 
Ciprofloxacin
Fluconazole
Clarithromycin
Grapefruit 
CCB
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53
Q

P450 inducers

A

Phenytoin
St. John’s
Rifampin

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54
Q

Strep bovis association

A

Colon Ca

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55
Q

Sign of secretory diarrhea

A

Not relieved by fasting

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56
Q

Would you Rx asymptomatic call stone?

57
Q

Most common cause of acute pancreatitis

A

Gall stones.

Alcohol

58
Q

Dx acute pancreatitis?

A

Pain radiated to back
Better leaning forward
High amylase / lipase

59
Q

Rx acute pancreatitis

A

IVF
Pain control
NPO + nutritional support.

60
Q

When to give Abx in acute pancreatitis

A

Imipenem

Complicated with infected pancreatic necrosis

61
Q

Specific test for acute pancreatitis

A

Lipase 3x normal level.

62
Q

What effect amylase levels in acute pancreatitis & how?

A

TG

High TG = low amylase

63
Q

Are amylase level associated with severity of acute pancreatitis

64
Q

What dose lactic acidosis + abdominal pain indicate

A

Intestinal ischemia

65
Q

Rx intestinal ischemia

A

IVF

Surgical resection

66
Q

Pale stool + dark urine indicates

A

Obstructive jaundice

67
Q

IMP lab in obstructive jaundice

68
Q

Constipation prophylaxis in opioids Rx?

69
Q

Sx of biliary colic

A

Episodic epigastric / RUQ non colicky pain
Radiates to Rt shoulder
At night

70
Q

How to confirm a high ALP is related to liver disease?

A

Measure 5’-nucleotides

71
Q

What must be r/o in persistently high liver enzymes

A

Viral Hepatitis

72
Q

Rx of hiccups

A
  1. Physical maneuvers
    Irrupting breath cycle (breath holding)
    Valsalva
    Cotton swab stimulation
    Vagal maneuver (press eyes + ice bag on forehead)
    Counteract irritation of diaphragm (knee to chest / lean forward)
  2. Drugs:
    - Chlorpromazine > drowsiness + tardive dyskinesia
  • Metclopromide > tardive dyskinesia
  • baclofen not very effective
73
Q

Best initial test for RUQ pain?

74
Q

Causative organism of epiglottis

A

H. Influenzae B

75
Q

Epiglottitis classic

A 
Muffled voice 
Strider (high pitch)
Swallow difficulty 
Drooling 
Tripod /. Lean forward 
Tender LN
76
Q

Rx of epiglottitis

A

Supportive

Maintain airway = call ER!

77
Q

Rx of chronic cough + no clear cause

A

Trial of PPI even if not symptomatic

78
Q

T/F: tolerance to constipation of opioids develops over time.

79
Q

1st Rx in constipation in elderly?

A
  • Bowel retraining
  • Diet fibers
  • exercise
80
Q

2n Rx in constipation

A 
Laxatives 
Stool softener (not helpful in ill elderly)
81
Q

Rx of PUD

A

PPI 4 weeks

Of not healed = prolong Rx + look for underlying Dz

82
Q

Melanosis coli classic

A
  • blue-brown-black discoloration of colon mucosa.
  • intense color inside anal sphincter, lighter in sigmoid.
  • from fecal stasis + use of laxatives
83
Q

Drug induces esophagitis

A

Tetracycline esp. doxycycline.

Others: NSAIDs, KCL, iron, Bisphosphonate, quindine

84
Q

Wilsons disease inheritance

84
Q

Pathophysiology of wilsons.

A

Excessive copper deposition in liver, CNS

85
Q

Wilsons Rx

A

D-penicillamine

86
Q

Monitor Rx of Wilsons

A

Urinary copper excretion

Normal < 40

87
Q

Dx Wilsons

A

Urinary copper

Serum cerulopasmin

88
Q

Classic Wilsons

A

Neuro: ataxia, can’t speak, spasticity.

Eye: kayser-Fischer ring

Abnormal LFT

89
Q

Toxic dose of acetaminophen

A

7.5 g

150 mg/kg

90
Q

Stages of acetaminophen toxicity

A
  • 1st (24 HR):
    Asymptomatic
    Anorexia, N/V
    Diaphoresis
- 2nd (72 HR):
RUQ pain
NV 
High HR, low BP. 
Labs = high BUN, creatinine, LFT + oliguria
- 3rd:
Jaundice 
Coagulopathy 
Encephalopathy 
Low glucose.
  • 4th (21 days)
91
Q

Liver transplant indication in acetaminophen toxicity

A

Creatinine > 300
INR 6.5
PH < 7.3

92
Q

Hints for MEN 1

A

Persistent PUD
High Ca
Diarrhea
FHx

93
Q

Dx ZOllinger-Ellison

A

Gastrin level

94
Q

Investigations in dysphagia

A

Barium swallow

95
Q

Sensitive enzyme for acute pancreatitis?

96
Q

What enzyme maybe normal / doesn’t correlate to severity of acute pancreatitis

97
Q

MCC of PUD?

98
Q

Weight loss work up

A

CBC, CMP, occult blood, TSH

99
Q

Drugs cause weight loss

A 
SSRI
NSAIDs 
Bupropion 
Digoxin 
Metformin
100
Q

Drugs cause weight gain

A

Amitriptyline
Mirtazapine
Megestrol (serious SE)

101
Q

Antibodies in celiac

A

IgA anti-endomysial Ab.

102
Q

Rx of 2nd degree hemorrhoids

A

Band ligation.

103
Q

Drugs not helpful in COPD exacerbation

A

Inhaled steroids
Acetylcystine
Mucolytics

104
Q

Gallstone Ileus classic

A

Abdominal pain
N/V
AXR: air fluid level + pneumobilia

105
Q

Gallstone ileus pathophysiology

A

Bowel obstruction from gallstone passed through cholecystodudenal fistula

106
Q

Rigler’s triad

A

In gallstone ileus
Pneumobilia
Bowel obstruction
Gallstones in Rt iliac fossa.

107
Q

Diverticulitis classic

A

LLQ pain

Normal AXR

108
Q

Oral testosterone SE

A

Hepatotoxicity including neoplasms

109
Q

Acute diverticulitis Rx

A 
Outpatient 
Clear liquid diet 
Abx:
Cipro or TMP/SMZ + metro
Other options:
Moxifloxacin
Amoxi/Clavu
110
Q

Maximum daily dose of acetaminophen?

111
Q

Rx crohn’s

A
  1. Sulfasalazine or mesalazine

If not enough add Abx: metro > cipro

112
Q

Dx anal fistula

A

Scope +/- MRI

113
Q

Rx of gastroparesis in Parkinson’s? Why?

A

Domperidone

Doesn’t cross BBB

114
Q

Metclopromide in Parkinson’s

A

Contra indicated!

It’s dopamine antagonist crosses BBB

115
Q

Rx of ascites

A

Bed rest
Na restriction
Diuretics
Paracentesis

116
Q

AST:ALT in alcoholic vs non alcoholic fatty liver

A

Alcoholic: >2
Non: <1

117
Q

Rx of shigella diarrhea

A
  1. Fluids +/- fluoroquinolones
118
Q

Primary biliary cirrhosis

A 
Steatorrhea
Xanthelasma
Xanthoma
Pruritus 
High ALP
High Bilirubin 
Anti mitochondrial ab
119
Q

What’s megestrol

A

Pro gestational agent

For appetite stimulation

120
Q

SE of megestrol

A

ACTH suppression + adrenal suppression

PE

Thrombophlebitis

121
Q

Instruction w/ megestrol

A

Steroids before surgery

122
Q

Osmotic laxative

A

Polyethylene glycol

123
Q

Stimulant laxatives

A

Senna

Mineral oil

124
Q

Bulk forming laxative

A

Polycarbophil

125
Q

Rx of hemodynamically unstable UGI bleed

A

IVF

Vasopressin (terlipressin)

126
Q

SE of terlipressin

A

High PVR
Low CO
Low coronary blood flow

127
Q

Prevent terlipressin SE

A

Combine w/ glycerl trinitrate

128
Q

Meds contraindicated in UC? Why?

A

Narcotic anti diarrheal

Risk of toxic mega colon

129
Q

Zenker diverticulum classic

A

Halitosis
Late regurgitation of indigestion food
Choking on food

130
Q

Thrombosis hemorrhoids classic

A

Acute sever perianal pain w/ walking or sitting

131
Q

Rx thrombosed external hemorrhoids

A

Excision if < 72 HR

Conservative > 72 HR

132
Q

Rx of C. Diff

A

Metronidazole

If recurs metronidazole (not sever) or oral vanco ( sever / no response)

133
Q

Drug contraindicated in diabetic gastroparesis

A

Exenatide (GLP-1)

Pramlintide (amylin analogue)

134
Q

Risk group for barrett

135
Q

Normal ALP

136
Q

Normal ALT

137
Q

Normal AST

138
Q

Normal total bilirubin

A

< 20 umol/L
Or
< 1.2 mg/dL

CanQB (16 decks)

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