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Step 2 UWORLD > GI > Flashcards

GI Flashcards

1
Q

Complications of Primary Biliary Cholangitis (+Anti-mitochondrial, autoimmune destruction intrahepatic bile ducts, xanthomas, pruritis)

A
  • Cirrhosis
  • malabsorption (fat-soluble deficiencies)
  • HCC
  • metabolic bone dz: Osteoporosis/Osteomalacia
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2
Q

Blunting of villi + Malabsorption

A

Celiac (not Lactose def –>would have normal villi)

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3
Q

colonoscopy rules for Crohns/UC pts

A

Initiate 8 years post-dx and repeat with biopsy every 1-2 years

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4
Q

AST and ALT ratio in alcoholic hepatitis (not full-blown cirrhosis)

A

2:1 AST:ALT “ASSHOLE”

usually both <300

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5
Q

Chronic pancreatitis presents with chronic epigastric pain, diabetes, and malabsorption; it is classically relieved by:

A

Sitting forward!!! (just like pericarditis)

–>dx using CT, not lipase levels

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6
Q

AFP is used to screen for ________ in pts with cirrhosis/viral hepatitis

A

Hepatocellular carcinoma

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7
Q

Drug of choice for Primary Biliary Cholangitis

A

Ursodeoxycholic acid (UDCA)

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8
Q

Malabsorption + duodenal and jejunal ulcers

A

Zollinger-Ellison Syndrome

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9
Q

Gastrin-secreting tumor of pancreas or duodenum

A

Zollinger-Ellison Syndrome

Acid hypsecretion = duodenal/jejunal ulcers

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10
Q

What is the mechanism behind malabsorption in Zollinger Ellison Syndrome?

A

“Pancreatic enzyme INACTIVATION” (not deficiency)

–>gastrin-secreting tumor = acid hypersecretion = inactivation of enzymes

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11
Q

Bile acids are resorbed in the ______; impaired absorption is typically seen in:

A

Ileum

Crohns, secondary to ileal resection

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12
Q

Cancers associated with Lynch syndrome

A

Colorectal
Endometrial
Ovarian

The female CEO got Lynched

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13
Q

Hyperbilirubinemia + Predom elevated ALP: dx + next step

A

Cholestasis (intra vs extrahepatic on ddx)…get abdominal US/CT
–>Biliary dilatation = extrahepatic

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14
Q

Pt with ALT >150, epigastric pain radiating to back, and no hx of alcohol use…what’s suspected dx/next step?

A

Most likely Gallstone Pancreatitis…need US of RUQ!!! (Not CT of abdomen).

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15
Q

when do you start colonsocopy?

A

If no hx of CRC, 50

If affected 1st-degree relative, at 10 years before their age at dx or at 40, whichever comes first

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16
Q

Malabsorption + normal D-xylose absorption test

A

enzyme deficiencies (pancreatic insuff)

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17
Q

Malabsorption + impaired absorption fo D-xylose (decreased excretion)

A

small intestine mucosal disease (Celiac)

–>xylose is absorbed in small intestine without enzymes

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18
Q

How do you stage gastric adenocarcinoma after dx is made with biopsy?

A

CT abdomen/pelvis

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19
Q

major cause of morbidity in cirrhosis (i.e. this is what you want to be checking for in next step mgmt)

A

Esophageal Varices!!! Get an upper endoscopy every year

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20
Q

Primary prophylaxis for esophageal varices (i.e. pt with cirrhosis)

A
  1. non-selective beta blockers (propranolol, nadolol)
    - ->reduce portal pressure b/c unopposed alpha = vasoconstrction
  2. endoscopic variceal ligation
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21
Q

birds beak on barium swallow

A

Achalasia

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22
Q

Impaired peristalsis in distal esophagus and impaired relaxation of LES

A

Achalasia

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23
Q

Best way to dx achalasia?

A

Manometry

note: barium esophagram, which has bird beak finding, is not the most sensitive

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24
Q

Tx protocol for Esophageal varice hemorrhage (cirrhosis patients)

A
  1. Large Bore IV Fluids
  2. Prophylactic Antibiotics (ceftriaxone) + OCREOTIDE (inhibits vasodilating hormones, get splanchnic vasoconstriction)
  3. Urgent endoscopic therapy:
    A)Bleeding stopped: beta blocker + endoscopic band ligation in 1-2 weeks
    B)Bleeding: temp balloon tamponade, then Transjugular Intrahepatic Portosystemic Shunts (TIPS)
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25
Q

Dysphagia, regurgitation, and episodic chest pain that radiates to the back and is precipitated by emotional stress/hot or cold foods

A

Think esophageal spasm disorder –> get manometry

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26
Q

What causes Zenker diverticulum?

A

Esophageal dysmotility (motor dysfunction), UES dysf(x)

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27
Q

Where does colon cancer mets most commonly go?

A

Liver

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28
Q

Who is the classic type of patient for autoimmune hepatitis?

A

young - middle aged women with dramatic increase in transaminases and bili

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29
Q

transaminases in alcoholic hepatitis

A

AST>ALT 2:1 ratio, but transaminases won’t be sky high…AST usually around 300

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30
Q

Requirements for dx Acute Liver Failure

A
  1. Severely elevated transaminases (usually >1000)
  2. Signs of Hepatic Encephalopathy (confusion, asterixis)
  3. Synthetic Liver dysfunction ( INR>1.5)
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31
Q

most common causes of acute liver failure

A

drug toxicity (Acetaminophen) and acute viral hepatitis (HAV, HBV), also ischemia

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32
Q

what clinical symptoms differentiate Acute liver failure from just acute hepatitis

A

Hepatic encephalopathy (confusion, asterixis)

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33
Q

What is courvosier’s sign?

A

Obstructive jaundice + palpable, nontender gallbladder

= Pancreatic Cancer (adenocarcinoma)

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34
Q

What does abdominal imaging show in a patient with pancreatic adenocarcinoma?

A

Intra and Extra hepatic biliary duct dilation (bile backs up)

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35
Q

How do you distinguish between Intrahepatic vs Extrahepatic cholestasis (impaired biliary flow)?

A

RUQ US!!
Intra: no biliary tract dilation
Extra: Bile duct dilated (gallstones)

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36
Q

Who does PBC (Primary biliary cholangitis/cirrhosis) present in?

A

Middle aged women, presents with fatigue, pruritis, hepatomegaly and elevated ALP

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37
Q

elevated anti-mitochondrial antibodies

A

PBC

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38
Q

elevated anti-smooth muscle antibodies

A

Autoimmune hepatitis–>tx with oral glucocorticoids

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39
Q

Isoniazid toxicity

A

INH Injures Neurons and Hepatocytes.

Causes liver injury that looks similar to viral hepatitis

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40
Q

Drugs/toxins that cause direct (i.e. not idiosyncratic) hepatic injury

A

These are dose-dependant.

Carbon tetrachloride, Acetaminophen, Tetracycline, Amanito phalloides mushroom

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41
Q

Idiosyncratic drug/toxin hepatic injury

A

There are not dose-dependant.

Isoniazid, chlorpromazine, halothane, antiretrovirals,

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42
Q

2 types of dysphagia

A

Oropharyngeal (Difficulty initiating swalling…cough, choking, nasal regurg, aspiration pneumonia)
–>Needs videofluoroscopic modified barium swallow

vs Esophageal (achalasia etc)
-->needs normal barium swallow + manometry
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43
Q

Causes of oropharyngeal dysphagia (vs esophageal)

A

Stroke
Dementia
Oropharyngeal malignancy
NMJ Disorders (i.e. Myasthenia Gravis)

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44
Q

Dysphagia to solids and liquids at onset vs progressive solid to liquid

A

both at onset: motility disorder

progression: mechanical obstruction

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45
Q

Liver dz + Neuropsychiatric dz in patient <35

A

Wilson’s dz. Tx with penicillamine or trientine

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46
Q

Duodenal and jejunal ulcers, abdominal pain, diarrhea

A

Think Zollinger-Ellison (Gastrinoma)

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47
Q

+ Secretin stimulation test

A

Zollinger-Ellison. Normally secretin inhibits gastrin, this condition = gastrinoma = gastrin remains high after secretin

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48
Q

Most common cause of adult-onset malabsorption diarrhea

A 
Lactose Intolerance 
(brush border enzyme def)
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49
Q

LLQ pain, Fever, Leukocytosis

A

Divertucilitis –> Need abdominal CT w/contrast

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50
Q

Whipple’s triad

A

PAS+ the CAN of Whipped Cream
Cardiac
Arthralgias
Neurologic

+ Malabsorption (=dz)

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51
Q

Pt has endoscopy leading to esophageal rupture. Next step?

A

Urgent dx with water-soluble contrast esophagram, then barium study if needed

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52
Q

T/F: Peptic ulcer dz refers only to gastric ulcers

A

False, refers to both gastric and duodenal ulcers that are most commonly caused by H pylori or NSAIDs

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53
Q

Who is most likely to develop hepatic adenoma?

A

Middle aged women on OCPs

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54
Q

Infection of ascites fluid, low-grade fever, abdominal pain, gas in the small/large bowel

A

Spontaneous Bacterial Peritonitis

  • ->Paracentesis = dx study of choice
  • ->Ceftriaxone to treat, fluoroquinolones for proph
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55
Q

Who is the steroetypical patient for factitious diarrhea (laxative abuse)?

A

Female, employed in health care field, may have hx of multiple hospitalizations. Nocturnal BM and crampy abdominal pain are associated.
–>Characteristic colonsocopy finding: melanosis coli = dark brown discoloration/”alligator skin’ or pigment in MQs

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56
Q

Mgmt of gallstones

A

Asx: No tx
Typical biliary colic sx: Elective laparoscopic cholecystectomy. Give URDA in poor surg cand
Complicated (cholecystitis/choledocholithiasis): Cholecystectomy w/in 72 hours

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57
Q

Young men + IBD + p-ANCA

A

Primary Sclerosing Cholangitis. ParthS Colon wearing Mara and chopping onions

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58
Q

What’s clinically associated with Primary Sclerosing Cholangitis?

A

IBD (Ulcerative colitis); Fatigue and Pruritis; hepatosplenomegaly/jaundice
–>Can lead to cholangitis (dec fat soluble vit, osteoporosis) , cholestasis, biliary cirrhosis, cholangiocarcinoma

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59
Q

Patient comes in presenting with GERD. When would you not just give trial of PPI?

A

+ Alarm sxs: dysphagia, odynophagia, wt loss, anemia, GI blood, recurrent vomiting
or
Men >50 w/sxs >5 years and cancer risk factors (tobacco use)

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60
Q

Features of Zinc deficiency

A

Alopecia
Pustular skin rash
Impaired taste
Impaired wound healing

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61
Q

Patients on TPN are at risk for deficiency of:

A

Trace minerals…

  1. Zinc (Alopecia/poor taste/pustular skin rash)
  2. Selenium (cardiomyopathy, thyroid/immune dysf(x))
  3. Copper (Neuro deficits, brittle hair, sideroblastic anemia, skin depigmentation)
  4. Chromium (impaired Glucose control in DM)
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62
Q

features that distinguish biliary colic (due to gallstone) vs cholecystitis

A

colic: resolves within 4-6 hours
cholecystitis: +abdominal pain, fever, leukocytosis

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63
Q

porcelain gallbladder

A

Calcified gallbadder due to chronic cholecystitis, usually do cholecystectomy due to high rates of gallbladder carcinoma

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64
Q

why does TPN predispose to gallstone?

A

gallbladder stasis

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65
Q

T/F: Toxic megacolon can be the initial presenting sx of IBD

A

TRUE PEASANT. Bloody diarrhea, abdominal distention, fever/tachy/hypotension. –>do abdominal Xray if suspect

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66
Q

T/F: Most common cause of bright red GI bleeding in adults is hemorrhoids

A

False…diverticulosis. Esp if seeing things like dizzyness/hypotension/gross bleeding. most cases self-resolve

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67
Q

Patients with ____ GI bleeding have elevated BUN/Cr ratio

A

Upper (i.e. PUD…coffee ground emesis).

Due to increased urea production (Hgb breakdown in intestine) + absorption (hypovolemia)

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68
Q

How do you evaluate ascites?

A

Serum-to-ascites albumin gradient (Serum - Fluid)
>1.1 = Portal HTN (cardiac/cirrhosis..increase Hydro P)
<1.1 = Non-portal (Malignancy (increased cap permeability), pancreatitis, TB, nephrotic)

69
Q

What is acute liver failure?

A

Triad of elevated aminotransferases (can be really high), hepatic encephalopathy (asterixis, confusion, somnolence), synthetic liver dysf(x) (INR >1.5).

Usually ACETAMINOPHEN toxicity, potentiated by chronic alcohol use

70
Q

Jaundice, fever, RUQ pain

A

Cholestasis!!!!!

Charcot’s triad

71
Q

most common causes of acute cholestasis

A

Biliary stasis –> biliary obstruction from gallstones, malignancy, or stenosis
—>Imaging = Common bile duct dilation

72
Q

For hep B markers, what is the window period?

A

the lag in between HbsAg disappearing and anti-HBs appearing….anti-HBc is always elevated, even during this window phase

73
Q

Anti-seizure medication (i.e. valproic acid) can cause n/v, fever, weight loss due to:

A

Acute Pancreatitis

74
Q

Causes of conjugated bilirubinema + Normal AST, ALT, ALP

A

Rotor, Dubin-Johnson (defective hepatic secretion of bili)

75
Q

causes of conjugated bilirubinemia + elevated ALP

A

pancreatic cancer, PBC, PSC, cholangiocarcinoma, choledocholithiasis, cholestasis of pregnancy

76
Q

causes of conjugated bilirubinemia + elevated AST, ALT

A

viral/autoimmune/alcoholic/ischemic/toxin hepatitis, hemochromatosis

77
Q

+ urine bilirubin assay mean what?

A

buildup of Conjugated Bilirubin (UCB is not water soluble, CB is)

78
Q

+ urobilinogen in urine

A

buildup of Unconjugated bilirubin

79
Q

Clinical manifestations of hyperesterinism in cirrhosis

A

Spider angiomatas, palmar erythema, gynecomastia, loss of pubic hair, testicular atrophy

80
Q

Clinical manifestations of portal htn in cirrhosis

A

esophageal varices, splenomegaly, ascites, caput medusa (enlarged abdominal veins), anorectal varices

81
Q

clinical manifestations of hepatic synthetic dysf(x) in cirrhosis

A

Edema, echhymosis

82
Q

ERCP is an excellent dx tool for ______ cancer

A

Pancreatic….make sure to get a CT before doing the procedure

83
Q

When do you do a TIPS procedure?

A

Transjugular Intrahepatic Portosystemic Shunt is used for ASCITES that doesn’t respond to diuretics , or if there is active/2 variceal bleeding

84
Q

Which tests characterize Lactose Intolerance?

A

+ breath Hydrogen test
+ stool for reducing substances
low stool pH
increased stool osmotic gap

85
Q

which population is most affected by lactose intolerance?

A

Asian

86
Q

decreased libido and trouble maintaining erection, gynecomastia, decreased T3 T4

A

chronic liver dz

87
Q

Risk factors for C dif infection

A

Age > 65, antibiotics use, PPI use (acid suppression),

88
Q

T/F: Diverticulosis is associated with diarrhea

A

False, with constipation

89
Q

T/F: CEA levels are useful for screening for colon cancer

A

False. They are only useful for establishing a baseline and following treatment efficacy/recurrence

90
Q

most common place CRC spreads

A

Liver

91
Q

T/F: Villous adenomas have higher malignant potential than tubular adenomas

A

True

92
Q

When do you expect patients with Familial Adenomatous Polyposis to get CRC?

A

the risk is 100% by third or fourth decade of life

–>this is why you get a prophylactic colectomy

93
Q

What is needed in a patient with FAP?

A

Prophylactic colectomy –>100% get CRC by 40’s

94
Q

FAP + osteomas/soft tissue tumors/extra teeth

A

Gardner Syndrome. Also 100% CRC by 40’s

95
Q

FAP + cerebellar tumors

A

Turcot Syndrome (“Turban)

96
Q

Hamartomas through GI tract, hyperpigmented mouth/lips/hands/genitalia; increased risk of many carcinomas (stomach, breast, GI)

A

Peutz-Jeghers

97
Q

most common cause of large bowel obstruction in adults

A

CRC

98
Q

R-side vs L-sided tumors in CRC (clinical)

A

R side:Triad of anemia, weakness, RLQ mass. MELENA
(large diameter here so change in bowel habits or obstruction uncommon)

L side: obstruction, change in bowel habits, HEMATOCHEZIA

99
Q

signs of rectal cancer

A

Hematochezia, tenesmus, rectal mass/feeling of incomplete evacuatino of stool

100
Q

which type of polyp is more likely to be malignant, sessile or pedunculated

A

Sessile (flat)

101
Q

what causes diverticulosis and where is it most commonly found?

A

Increased intraluminal pressure (inner layer of colon bulges through wall)…this is why low fiber diets/constipation is a big cause

Sigmoid colon

102
Q

test of choice to dx diverticulosis

A 
barium enema
(abdominal xrays usually normal)
103
Q

Tx for diverticulosis

A

High-fiber foods (bran) to bulk the stool

Psyllium (if pt can’t tolerate bran)

104
Q

LLQ pain, fever, leukocytosis

A

Diverticulitis

105
Q

Dx of diverticulitis

A

CT abdomen and pelvis with oral and IV contrast

–> Barium enema (dx choice for diverticulosis) and colonoscopy are contraindicated due to risk of perforation!!!!

106
Q

Tx of uncomplicated diverticulitis (LLQ pain, fever, leukocytosis)

A

IV antibiotics, bowel rest (NPO), IV fluids

107
Q

When are you going to use IV Octreotide in an acute setting?

A

Stop Variceal bleeding in cirrhosis patient

causes splanchnic vasoconstriction and reduces portal pressure

108
Q

Tx of variceal hemorrhage in cirrhotic patient

A
  • IV antibiotics
  • IV octreotide initiated and continued for 3-5 days
  • Emergent Upper GI endoscopy (once pt stabilized), tx with either Variceal ligation or sclerotherapy
  • Nonselective beta blockers to prevent re-bleeding
109
Q

What test can help determine where ascites is due to portal HTN or another process

A

Paracentesis: measure Serum Ascites Albumin Gradient

SAAG>1.1g/dL = Portal HTN likely

110
Q

Clinical features of hepatic encephalopathy

A

Asterixis, decreased mental f(x), confusion, stupor, rigidity, hyperreflexia, Musty odor of breath (fetor hepaticus)

111
Q

Iron studies in Hemochromatosis

A

Increased Fe, Ferritin, Transferrin saturation

Decreased TIBC

112
Q

Cirrhosis, Diabetes, Skin hyperpigmentation

A

Triad for Hemochromatosis

113
Q

Complications of hemochromatosis

A

CIrrhosis, DM, Cardiomyopathy, HCC, Arthirits, hypogonadism

114
Q

Tx of hemochromatosis

A

phlebotomy

115
Q

T/F: AFP elevation is a useful screening tool for HCC

A

True (vs CEA is not for CRC)`

116
Q

When is a HIDA scan indicated?

A

If you are trying to dx acute cholecystitis (obstruction of the cystic duct leading to inflam of the gallbladder wall) and US isn’t definitive

117
Q

gold standard for choledocholithiasis (gallstones in the common bile duct)

A

ERCP (should do US first tho)

–>diagnostic and therapeutic

118
Q

what is the biggest cause of cholangitis (infection of the biliary tract)?

A

choledocholithiasis

gallstone in the common bile duct. leads to obstruction

119
Q

Tx of cholangitis

A

GIVE ANTIBIOTICS AND IV FLUIDS

–> will need ERCP urgently also

120
Q

autoimmune destruction of intrahepatic bile ducts (= bile stasis and cirrhosis)

A

PBC

121
Q

Tx for PBC

A

Ursodeoxycholic acid (delays progression)

cholestryramine sx for pruritis, calcium/bisphosphonates/vit D for osteoporosis

Liver transplant

122
Q

What manifestations of PBC correlate with its high association with hyperlipidemia?

A

Xanthelasmas (eye) and xanthomatas (skin)

123
Q

PSC is associated with which dz?

A

Ulcerative colitis

124
Q

Complications of PBC (autoimmune destruction of intrahepatic biliary tract…fatigue, pruritis, jaundice, RUQ pain etc)?

A

Malabsorption (fat soluble vit def)
osteoporosis/osteomalacia
HCC
(note: does NOT lead to ascending cholangitis, which is ass with extrahepatic biliary obstruction)

125
Q

Complications of PSC (fatigue and pruritis in UC dude)

A

cholangitis/cholelithiasis
cholangiocarcinoma (biggest risk factor for it)
cholestasis (malabsorption, osteoporosis)
colon cancer

126
Q

why does a patient with cholestasis develop osteoporosis?

A

Block of bile (intra or extra hepatic) –> malabsorption of fat-soluble vitamins –> no vit D bruh

127
Q

Platelet counts > ______ are adequate for hemostasis during surgery

A

50,000 (so can be thrombocytopenic and its fine), so don’t need to transfuse platelets until below this

128
Q

The most rapid means of normalizing the PT time before surgery? i.e. a patient on warfarin with INR 2.1

A

FFP. restoration of vit-k dep clotting factors

129
Q

FFP vs cryoprecipitate

A

FFP: increases coag factors; immediate warfarin reversal (pre-op), DIC, cirrhosis

Cryoprecipitate: fibrinogen, factor VIII, vWF, fibronectin, factor XIII, use for deficiencies of facotr VIII (Hemo A and vWD)

130
Q

What are most cases of intussusception associated with?

A

Usually in a kid <2, following a viral infection…the “hypertrophy of Peyers patches” serves as nidus.

  • if cystic fibrosis, lead point = inspissated stool
  • Meckels is common congenital nidus
  • Henoch schonlein increases risk via small bowel hematoma (palpable purpura and joint pain)
131
Q

Conjugated bilirubinemia + normal LFTs/ALP

A

Dubin Johnson or Rotor

132
Q

Conjugated bilirubinemia + elevated LFTs

A

Viral/autoimmun (anti-smooth muscle)/toxin/alcoholic/ischemic hepatitis or Hemochromatosis

133
Q

conjugated bilirubinemia + elevated alk phos

A
  • cholestasis of pregnancy
  • malignancy (pancreas)
  • cholangiocarcinoma
  • PBC, PSC,
  • choledocholithiasis
134
Q

Pyridoxine deficiency (b6)

A 
depression
irritability
depression
dermatitis
stomatitis (mouth inflam)
elevated Homocytstine (risk of VTE/atherosclerosis)
135
Q

Riboflavin deficiency (b2)

A 
cheiliosis
glossitis
subhorreic dermatitis (genital usually)
pharyngitis
edema/erythema of mouth
136
Q

niacin deficiency (b3)

A

GI complaints with glossitis and watery diarrhea
dermatitis (in sun-exposed areas)
mental status changes/poor conc/dementia

137
Q

whats the acid-base status of mesenteric ischemia? other lab abnormalities?

A

LACTIC ACIDOSIS = metabolic acidosis

will see leukocytosis, elevated Hgb, elevated Amylase

138
Q

some markers of chronic inflammatory disease

A
  • leukocytosis
  • reactive thrombocytosis
  • elevated ESR
  • anemia
139
Q

Patient suspected of celiac disease has bx confirming (villous atrophy). Why might anti-transglutaminase/other labs be neagtive?

A

celiac can be associated with selective IgA deficiency, and the markers for celiac are IgA markers

140
Q

what kind of pleural effusion does boeerhave cause?

A

Exudative, high amylase, low pH. may contain food particles

141
Q

patient with NSAID and alcohol use has abdominal pain and peritonitis. how do you confirm the dx of this dz?

A

Confirm perforation in this peptic ulcer dz patient with upright xray of chest/abdomen showing free intraperitoneal air under the diaphragm

142
Q

what are 3 causes of AMS in an alcoholic (other than intoxication)?

A

Wernicke: look for ataxia and nystagmus

Hepatic encephalopathy: look for asterixis

Spontaneous bacterial peritonitis: esp cirrhosis patients. fever and subtle AMS changes, may have abd pain, paralytic ileus, dx w/paracentesis showing neutrophil >250. Give cephalosporins to tx, fluoroquinolones to ppx

143
Q

hypersegmented neutrophils

A

megaloblastic anemia

144
Q

incomplete obliteration of the vitelline (omphalomesenteric) duct

A

Meckels

145
Q

painless hematochezia in a toddler

A

Meckels

146
Q

dx test for meckels

A

tech99

147
Q

Fever, jaundice, RUQ pain with US showing bile duct dilation without gas in the gallbladder or biliary tree

A

Acute cholangitis

148
Q

Fever, RUQ pain, leukocytosis with US showing distended gallbladder with air in the gallbladder wall and lumen, no air in the biliary tree

A

Emphysematous cholecytitis

  • ->caused by c perfringens (gas forming)…will see air-fluid levels in GB
  • ->emergent cholecystectomy + ABx (amp-sulfbactam)
149
Q

New born has tracheal and esophageal defects. What else should be worked up?

A 
VACTERL (mesoderm)
Vertebral
Anal atresia
Cardiac defects
Tracheo-Esophago fistula
Renal defects
Limb deformities
150
Q

Respiratory distress and cyanosis with feeds that improves with baby crying

A

choanal atresia

151
Q

t/f: most common cause of hematochezia = hemorrhoids

A

false, diverticulosis!!

152
Q

major causes of c dif

A

antibiotics
age>65 and hospitalization
PPI

153
Q

T/F: omphalocele, gastroschisis and umbilical hernia at birth all should be surgically corrected

A

False. The first two yes. Umbilical hernia you wait to see if it resolves by age 5

154
Q

how can you tell diff btwn umbilical hernia and omphalocele

A

hernia: covered by SKIN
omphalocele: covered by PERITONEUM jignesh kamani

155
Q

T/F: Suspect SBPeritonitis in a cirrhosis/ascites patient with low grade fever/abdominal pain/AMS and fails the connect-the-dot test

A

True

156
Q

next step for patient with bright red blood per rectum

A

<40 and no red flags: ANOSCOPY
40-49: sigmoid/colonoscopy
>50 or any red flags: colonoscopy

Red flags = change in bowel habits, abdominal pain, wt loss, IDA, FHx CRC

157
Q

hospitalized patient/icu/sick dude gets ruq pain and fever. first thought?

A

acalculous cholecystitis

158
Q

What is the triad and tx of plummer vinson syndrome?

A

-Dysphagia
-Iron deficiency anemia
-Esophageal web
IT WILL BE A FEMALE SO DONT THINK PLUMBER SO MAN
“Female Plumbers DIE from esophageal SCC (increased risk)”
Tx: can NOT tx the webs…so you give Iron, and do regular cancer screening with EGD and bx

159
Q

For esophageal disorders (motility vs mechanical), what are the dx tests used?

A

For both: 1st test = Barium Swallow. Best test = EGD w/Bx

For motility disorders, you additionally use Manometry

160
Q

Why might I confuse esophageal stricture vs esophageal cancer?

A

Both presentations are the same. Pt with bad GERD, weight loss, some level of progressive dysphagia.

Barium Swallow: Stricture = symmetric lumen narrow; Cancer = asymmetric (mass on one side)
EGD w/Bx will obviously finalize dx
Tx: stricture = PPI and dilation; Cancer = surg/chem/rads

161
Q

old man regurg of undigested food

A

Zenkers

162
Q

Esophageal motility disorder due to lack of inhibitory neurons

A

Absent myenteric plexus results in a tight LES. There is NO mucosal abnormality
–>Achalasia

163
Q

Tx for achalasia

A

Best: Myotomy. f/u for GERD

Other: dilation (but risk of perf so myotomy pref), botulinum (for pts poor surg cand)

164
Q

what is schatzkis ring and how is it different from plummer vinson?

A

Schatzki: DISTAL ring causing intermittent dysphagia sxs. “Steakhouse dysphagia”…episodic. Only large caliber foods get stuck. Tx: Dilate (pnuematic dilation)

PV: also have IDA. The stricture/web is usually proximal (but can be anywhere)

165
Q

Diffuse esophageal spasm will initially present like a:

A

MI! Crushing retrosternal chest pain relieved with nitrates, but EKG and trops will be normal. Barium = “Corkscrew esophagus”. Tx = CCB or Nitroglycerin prn

166
Q

whats the diff btwn achalasia and scleroderma esophageal dysmotility?

A

Achalasia: fully contracted LES (loss of inhibitory neurons from myenteric plexus)

CREST: collagen replaecd smooth mm of LES, so LES CANNOT contract. manometry shows no contraction anywhere, patient has relentless GERD. Tx with PPIs

167
Q

how do you treat the esophgeal dysmotility and relentless GERD of scleroderma?

A

can only do symptomatic tx with PPI

168
Q

how often do UC patients need colonscopy?

A

8 years after dx and annually after that

169
Q

triple bubble + gasless colon + maternal cocaine use

A

Intestineal (JEJUNAL) atresia

Step 2 UWORLD (17 decks)

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