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INTERNAL MED IP/OP > GI > Flashcards

GI Flashcards

1
Q

What are the common causes of esophagitis?

A

CMV and HSV

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2
Q

A pt presents with odynophagia or dysphagia and retrosternal pain and they have HIV – what dx do you think of?

A

Esophagitis

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3
Q

How would we dx esophagitis?

A

endoscopy

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4
Q

A pt presents with a dysphagia and receives a barium swallow that shows a birds beak deformity – dx? Tx?

A

Achalasia, tx = CCB and nitrates (eventually dilation)

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5
Q

If a pt has dysphagia what should be done first to find a cause?

A

endoscopy helps to r/o malignancy

Barium swallow is an okay place to start

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6
Q

If a pt has regurgitation of undigested food along with dysphagia and halitosis – dx? Tx?

A

Zenker diverticulum (out-pouching in the pharynx)

Tx w/ surgery

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7
Q

If dysphagia progresses from solids to liquids – what do you think of?

A

esophageal carcinoma

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8
Q

If a pt has chest pain and dysphagia that will occur even when they don’t eat– dx? Tx?

A 
Diffuse esophageal spaspm AKA Nutcracker
 
Diagnose with manometry
 
Treat with CCB, nitrates, and botox
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9
Q

What disorder occurs in the proximal esophagus and is associated with iron deficiency anemia?

A

Plummer-vinson syndrome

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10
Q

Where does Schatski esophageal ring occur?

A

Distal esophagus

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11
Q

What is the most common type of esophageal cancer?

A

Adenocarcinoma – Associated with Barrett’s

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12
Q

What’s the most common risk factor for esophageal cancer?

A

Smoking and chronic alcohol

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13
Q

What is Budd-chiarii syndrome?

A

Thrombosis of the portal vein leading to esophageal varicies

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14
Q

What’s the most common cause for esophageal varicies?

A

cirrhosis leading to Portal HTN

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15
Q

A pt presents with hematemesis or coffee ground emesis what should you think of?

A

Esophageal varicie

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16
Q

How do we prevent an esophageal bleed?

A

If a pt has cirrhosis Tx with BB’s; Endoscopic band ligation (also for acute bleed)

Abx, shunts, liver transplant, STOP drinking

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17
Q

A pt was vomiting and then started to vomit blood – dx? Tx?

A

Mallory Weiss tear

Tx = generally resolves on it’s own; PPI can help

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18
Q

What’s the most common cause of acute hepatitis?

A

Viral – Hep A and E

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19
Q

What are the phases of sxs for viral hepatitis?

A

Prodoromal = malaise, myalgia, fatigue, N/V/D, abdominal pain

Icterus = jaundice, pruritis, liver tenderness

Convalescent = return to well being

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20
Q

How high would a bilirubin be in hepatitis?

A

Greater than 3.0

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21
Q

How high would AST/ALT be in hepatitis?

A

Greater than 5,000

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22
Q

If AST is greater than ALT what should you think?

A

Alcohol hepatitis

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23
Q

If ALT is greater than AST what should you think?

A

Viral hepatitis

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24
Q

Which two hepatitis are transferred fecal-orally?

A

Hep A and E

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25
Q

Which hepatitis can occur because of shellfish?

A

Hep A

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26
Q

Which Hepatitis can only occur with another form of hepatitis, and which one?

A

Hep D can only occur in the presence of Hep B

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27
Q

Which hepatitis is due to IV drug use, cirrhosis, or blood transfusion?

A

Hep C

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28
Q

If a pt has a positive HbsAg – Dx?

A

Active Hep B

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29
Q

If a pt has a positive Anti-HBs – Dx?

A

Resolved Hep B infection OR vaccinated

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30
Q

What does the presence of an IgG tell us about Hep B?

A

Chronic infection or Resolved infection (depending if it with the HBsAg or the Anti-HBs)

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31
Q

What’s the most common blood-borne infection in the US?

A

Hep C

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32
Q

If AST is greater than ALT by 2:1 what do you think of?

A

Cirrhosis

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33
Q

What type of anemia is seen in cirrhosis?

A

Megaloblastic

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34
Q

How do we treat someone with cirrhosis?

A

Abstinence from alcohol, vitamin supplementation, nutritional supplementation, immunizations, liver transplant

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35
Q

What are the tumor markers for liver cancer?

A

Alpha fetoprotein and GGTP

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36
Q

If a pt has edema form portal HTN what should we treat them with?

A

Spironolactone

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37
Q

How do we Dx and treat diverticulitis?

A

Cipro and flagyl

Diagnose with a CT

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38
Q

Skip lesions and fistulas are present in what disorder?

A

Crohn’s

39
Q

Mucosal irritation of the colon only is what?

A

Ulcerative colitis

40
Q

Is ulcerative colitis or chron’s disease where continuous damage would occur?

A

Ulcerative colitis

41
Q

For both crohn’s and ulcerative colitis – how would we treat an acute exacerbation?

A

Corticosteroids

42
Q

A pt with diverticulosis should have a diet high in what?

A

Fiber

43
Q

When does colonscopy screening start?

A

Age 50

44
Q

If a colonoscopy shows pedunculated, small, or tubular – what does that mean?

A

Good

45
Q

If a colonscopy shows sessile, no stalk, or villous – what does that mean?

A

Bad

46
Q

If a colonscopy has 1-2 benign polyps – when do we repeat?

A

5 years

47
Q

If a colonscopy show premalignant polyp – when do we repeat?

A

3 years

48
Q

If a colonscopy shows dysplasia or lots of polys – when do we repeat?

A

1 year

49
Q

What medications can makes GERD worse?

A

NSAIDS, Abx, iron, bisphosphonates

50
Q

When do you puruse an endoscopy for GERD?

A

If age is greater than 50, weight loss, melena, difficult/pain with swallowing, heavy alcohol/tobacco use, and non-responsive to treatments

51
Q

How do we treat GERD first?

A

Lifestyle modifications - stop smoking, eat several hours before bed, avoid large meals, irritating foods (tomatoes, chocolate, fried foods, caffeine), raise HOB

52
Q

What are the mainstay medications for GERD?

A

H2 blockers

PPI’s

53
Q

What are the ALARM symptoms for GERD?

A

Dysphagia, odynophagia, weight loss, and anemia

54
Q

A pt presents with a burning/gnawing pain that radiates to the back – Dx?

A

Peptic Ulcer Disease

Confirm with H. pylori testing – c-urea and fecal antigen testing

55
Q

How do we treat PUD?

A

PPI, clarithromycin, amoxicillin, and metronidazole

56
Q

If a stone is in the cystic duct – dx?

A

Cholecystitis

57
Q

if the stone is in the common bile duct – dx?

A

Choledocolithiasis

58
Q

What are the sxs of acute cholecystitis?

A

RUQ/epigastric pain, referred scapula pain, n/v, fever/chills.

59
Q

How do we confirm dx of acute cholecystitis?

A

U/S, CBC, LFTs, HIDA

60
Q

If we see fever, jaundice, RUQ pain – think?

A

Cholangitis (AKA charcot’s triad)

61
Q

IF we see fever, jaundice, RUQ pain, AMS, and shock – think?

A

Septic cholangitis (AKA renold’s pentad)

62
Q

How do we dx and tx choledocolithiasis?

A

dx = MRI

Tx = ERCP

63
Q

Epigastric pain that radiates to the back indicates what?

A

Pancreatitis

64
Q

What are the most common causes of acute pancreatitis?

A

Gallstones and alcohol

65
Q

What are 2 signs associated with pancreatitis?

A

Cullen’s (periumbilical)

Turner’s (flank ecchymosis)

66
Q

Is amilase or lipase more sensitive?

A

Lipase

67
Q

What’s the best imaging for pancreatitis?

A

CT or MRI

68
Q

What are the criteria for admission of acute pancreatitis?

A

Age older than 55, WBC greater than 16,000, glucose greater than 200, LDH greater than 2x normal, AST greater than 6x normal (high the score = more severe the disease)

69
Q

How do we treat acute pancreatitis?

A

NPO and supportive care (IV fluids)

70
Q

How do we treat chronic pancreatitis?

A

No alcohol, pancreatic enzyme replacement + PPI + low fat diet, insulin

71
Q

CA 19-9 is associated with what?

A

Pancreas

72
Q

If an elderly pt has maroon colored stools, melena, and fatigue – what dx?

A

Angiodysphagia (fragile blood vessels of colon)

73
Q

If a pt has dyspepsia, weight loss, anemia, and the presence of GI bleeding – what should you think of?

A

Gastric cancer

74
Q

If a pt has painless bright red blood with defecation – dx?

A

Internal hemorrhoid

75
Q

If a pt has painful bright red blood with defecation – dx?

A

External hemorrhoids

76
Q

Which type of hemorrhoids are graded?

A

Internal

77
Q

How do we treat first or second degree hemorrhoids?

A

Fiber, water, stool softner, cortisone

78
Q

How do we treat third or fourth degree hemorrhoids?

A

Surgical

79
Q

If you see an apple core on an abdominal film – dx?

A

Colon cancer

80
Q

How do you treat an anal fissure?

A

Bulk agents, stool softner, sitz baths, hydrocortisone

81
Q

A man is unable to sit due to pain, on palpation there is fluctuant mass – dx? Tx?

A

Anal fistula

Fistulotomy (left open by secondary intention to heal)
*must preserve sphincter muscles!

82
Q

How do we test for celiac disease?

A

Anti-tissue transglutaminase

83
Q

What form of hepatitis can be transferred from mom to baby?

A

Hep B

84
Q

Pain is out of proportion to exam – you think of ischemic bowel – what should you ask about the patient’s history?

A

Afib!!

85
Q

A pt presents with asterixis and AMS. He jaundiced on exam – dx? Tx?

A

Hepatic encephalopathy

Tx with lactulose (to scidify the stools by trapping ammonia)

86
Q

A pt has bloody diarrhea, fever, and cramps. There are WBC’s in his stool – dx? Tx?

A

Salmonella infection

Tx = Usually none, but if immunocompromised give Cipro

87
Q

If pt has diarrhea and ate shellfish -dx?

A

Vibrio

88
Q

How do we diagnose for giardia? Tx?

A

ELISA Tx with Metronidazole

89
Q

How do we treat c diff?

A

Metronidazole

90
Q

When should we further evaluate diarrhea?

A 
Fever greater than 101.3, bloody diarrhea, abdominal pain
 
More than 6 loose stools in 24 hours
 
Frail pts/immunocompromised
91
Q

How do we rehydrate pts?

A

½ tsp salt, 1 tsp baking soda, 8oz OJ diluted with 1L

92
Q

What causes appendicitis?

A

Fecolith (bacterial overgrowth via e. coli)

93
Q

What do parietal cells do?

A

Secrete intrinsic factor – necessary for vitamin B12 digestion

94
Q

What do chief cells do?

A

Secrete proenzymes pepsinogen and gastric lipse

INTERNAL MED IP/OP (9 decks)

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