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step 2 ck > GI > Flashcards

GI Flashcards

1
Q

biopsy for IBS would show…

A

normal colonic mucosa

it is a functional disorder (no organic cause)

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2
Q

when is liver transplant indicated in acetaminophen toxicity?

A

hepatic encephalopathy grade 3 or 4
PT>100sec
or
serum Cr >3.4

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3
Q

achalasia

A

inability for LES to relax= aperistalsis
BOTH liq and solids
birds beak

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4
Q

tx for esophageal spasm

A

ca ch blocker

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5
Q

pain with swallowing and cd4 <100?

A

esophageal candidiasis –> empiric oral fluconazole (NOT endoscopy unless no improvement)
(thrush does NOT need to be present)

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6
Q

plummer vinson syndrome

A

esophageal web with dysphagia
ass. with iron def anemia NOT due to blood loss
occasionaly can turn to squamous cell ca

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7
Q

zenker diverticulum

A

outpoucheing of posterior pharyngeal constrictor muscles
dysphagia, hallitosis, and regurgitation

dx w barium studies
surgery (NO ENDOSCOPY it would be dangerous)

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8
Q

in scleroderma or systemic sclerosis what happens to the LES?

A

unable to close properly (lower pressure)

tx with ppi

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9
Q

mallory weiss vs borhouves

which is NONpenetrating

A

mallory weiss

will resolve on its own

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10
Q

gastric vs duodenal ulcer

A

gastric is worse w food

duodenal is better w food

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11
Q

diabetic with epigastric pain and bloating?

A

gastroparesis (decreased abilityto sense stretch)

no need to do any diagnosis, give erythromycin or metoclopramide to increase motility

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12
Q

tx for the following
barretts (metaplasia)
low grade dysplasia in esophagus
high grade “ “

A

barrets –> PPI and rescope in 2 years
low grade –> PPI and rescope in 6 mo
high grade –> ablation/resection

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13
Q

how to eradicate h pylori in ulcer disease?

A

triple therapy
PPI + 2 abx (clarithromycin and amoxicillin
) –> retest with stool ag or breath test to ensure resolution

if penicillin allergy can use clarithromycin and metronidazole

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14
Q

ZES

A

zollinger ellison

gastrinoma – high gastrin despite high gastri aid level

gastrin remains high even after secretin injection

if hypercalcemia –> clue for MEN1! (PTH)

do ct/mri –> then do somatostatin receptor scintography and endoscopic ultrasound

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15
Q

specific med given with varcieal bleeding?

next steps?

A

ocreotide (somatostatin dereases portal pressure)

banding –> TIPS (transjugular intrahepatic portosystemic shunting) if banding fails

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16
Q

do you replae platelets at 50k count?

A

only if there is active bleeding otherwise not until ,«10-20k

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17
Q

biopsy for celiacs will show

A

flattened villi

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18
Q

most accurate test for chronic pancreatitis?

A

secretin stimulation test (normal pancreas will release lots of bicarb rich fluid after secretin injection)

19
Q 
treatment for 
1 chronic pancreatitis
2 celiac disease
3 whipple disease
4 tropical sprue
A

1 enzyme replacement
2 avoid gluten
3 ceftriaxone or tmp-smx
4 tmp smx or tetracycline

20
Q

intermittent diarrhea flushing weezing and right sided heart abnormalities
what is it?
best dx?
tx?

A

carcinoid syndrome
dx with 5HIAA urine test
tx with ocreotide

21
Q

does weight loss occur with lactose intolerance?

A

NO

22
Q

is IBS associated with weight loss?

A

NO

weightloss is seen with IBD (crohns/UC)

23
Q

what is loperamide for?

A

anti-diarrhea

24
Q

crohns vs Uc

A

crohns = skin lesions, transmural granulomas, fistulas, abscesses, perianal disease, tx with mesalamine, infliximab for fistulas

UC = curable by surgery, limited to mucosa, no fistulas, no obstruction, no perianal dz, ANCA+, tx with mesalamine, ass with sclerosing cholangitis

25
Q

tx for diverticulitis?

diverticulosis?

A

diverticulitis = ciprofloxacin and metronidazole or amox-clav

diverticulosis = fiber + bran/methylcellulose/psyllium

26
Q

routine colon cancer screening

A

age 50+ every 10 yrs colonoscopy

family hx: then start at 40 or 10 years before age of family member had dx

27
Q

FAP

A

thousands of polyps with abnormal APC test

start colon cancer screening at 12 yo with annual sigmoidoscopy

28
Q

peutz jaegers

A

multiple hamartomatous polyps with melanotic spots on lips and skin

increased freq of breast, gonadal, and pancreatic cancer

NO increased colon cancer screening

29
Q

gardner syndrome

A

color cancer + osteomas + desmoid tumors + soft tissue tumors

30
Q

turcot syndrome

A

colon cancer + CNS malignancy

31
Q

juvenile polyposis

A

colon cancer + multiple hamartomatous polyps

32
Q 
what is associated with worst pancreatitis prognosis?
high amylase
high lipase
pain intensity
low calcium
crp rising
A

low ca

ca binds to fat in bowel and leads to malabsorption due to low lipase

33
Q

spnotaneous bacteial peritonitis

A

infections without perforation

cell count with >250 neutrophils

tx cefotaxime or ceftriaxone

**all SBP patients need lifelong prophylaxis to prevent recurrence (tmp smx)

34
Q

tx for hepatic encephalopathy (ascites + neuro)

A

lactulose and rifamixin

35
Q

tx for hepatic varicies

A

propanolol and banding

36
Q

hypoxia when sitting upright?

A

hepatopulmonary syndrome

37
Q

woman in 40-50s, fatigue and itching, fat, normal bili with high alk phos, xanthelesma, osteoporosis

dx?
tx?

A

PBC

tx: ursodeoycholic acid

38
Q

PSC
associated with?
dx?
tx?

A

IBD
dx with mrcp or ercp = narrowing/beading of biliary system

tx ursodeoxycholic acid or cholestyramine

39
Q

hemachromatosis

A

overabsorption of iron in duodenum
men present earlier than women (menses offset increases)

skin darkening
tests show elevated iron and ferritin and low TIBC

tx deferoxamine/phlebotomy

40
Q

most accurate test for hemachromatosis?

A

liver biopsy

41
Q

treatment for
1 chronic hep B?
2 chronic hep C?

A

1 ONE med (pick one: tenofovir, lamivudine, entecavir, interferon, ,etc)

2 chronic hepc is NEVER tx with just 1 med.
genotype 1 = lepipasvir and sofosbuvir
genotypes 2 and 3 = sofosbuvir and ribavirin

42
Q

psychosis/delusion + kayser fleischer rings + renal + liver issues

A

wilsons disease

copper isnt being excreted

43
Q

wilsons dz

tx?

A

penicillamine or zinc

44
Q

anti-smooth muscle ab indicates?

tx?

A

autoimmune hepatitis

prednisone

step 2 ck (16 decks)

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