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Step 2 CK > GI > Flashcards

GI Flashcards

1
Q

Symptom that usually= esophagus path

A

dysphagia

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2
Q

Clues that distinguish achalasia from cancer

A
  • younger person

- difficulty with solids and liquids all at once

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3
Q

Path for achalasia

A

^^ LES tone

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4
Q

First test for most esophageal disorders

A

barium swallow (but not always most ACCURATE)

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5
Q

Two esophageal diseases diagnosed by biopsy

A

cancer

barretts esophagus

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6
Q

How to treat achalasia

A
  • dilation
  • surgery
  • botox
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7
Q

Palliative treatment for esophageal cancer

A

stent placement to allow swallowing

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8
Q

Most accurate test for dx for achalasia and DES

A

manometry

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9
Q

Treatment for esophageal candidiasis

A

fluconaolze –> endoscopy if this doesn’t work to look for CMV (large)/HSV(small) ulcers

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10
Q

Tretment for DES

A

CCB

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11
Q

Meds that cause esophagitis

A

doxycycline
alendronate
KCl

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12
Q

What is Plummer Vinson Syndrome?

A

proximal rings and IDA (treat with iron)

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13
Q

Where is a schatzi ring and how does it present?

A

distal –> steakhouse dysphagia

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14
Q

Diagnosis and Treatment of Zenkers Diverticulum

A

barium swallow, there is NONE

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15
Q

How does scleroderma effect the esophagus?

A
  • unable to close sphincter
  • reflux
  • decreased LES tone
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16
Q

Treatment of scleroderma effecting esophagus

A

PPIs

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17
Q

Presentation of Mallory Weiss Tear

A

nonpenetrating tear of only mucosa

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18
Q

Which ulcer type is BETTER with food?

A

dudodenal =weight gain

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19
Q

Best empiric treatment for epigastric pain?

A

PPIs better than H2i

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20
Q

Duration of GERD needed to cause metaplasia

A

5-10 years

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21
Q

How to manage low grade esophageal dysplasia

A

PPis and rescope q6-12 months

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22
Q

When to give stress ulcer px

A

vent
burn
head trauma
coagulopathy

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23
Q

Top 2 most common causes PUD

A 
#1 H pylori 
#2 NSAIDs
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24
Q

Effect of alcohol and tobacco on ulcers?

A

don’t cause but prevent healing

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25
Q

Appropriate followup testing after treatment for H pylori

A

30-60 days post treatment do breath test or stool antigen

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26
Q

What is triple therapy for H pylori?

A

2 abx + PPI (amox/clarithro)

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27
Q

Alternative abx if patient cannot tolerate amox or clarirtho

A

tetramycin or metronidazole

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28
Q

How to manage failure of treatment in GU/DU

A

GU- endoscopy to exclude cancer

DU- breath test or stool test –> switch abx

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29
Q

Which is assc with cancer- GU or DU?

A

GU

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30
Q

When to scope in NUD that doesn’t improve on PPI?

A

over 55 or alarm symptoms

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31
Q

How does zollinger Ellison cause diarrhea?

A

^^gastrin = ^^ acid = inactive lipase = diarrhea

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32
Q

Best test for zollinger Ellison

A

gastrin response to secretin injection

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33
Q

Clue to MEN in ZE

A

High Ca = parathyroid = pancreatic + parathyroid = MEN

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34
Q

How to best test for mets in ZE

A

somatostatin receptor scintigraphy/ endoscopic US

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35
Q

How to treat ZE

A

local only- remove

mets- don’t remove, PPIs life long

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36
Q

Dx and Tx of diabetic gastroparesis

A

usually clinical though nuclear emptying study is most accurate

erythromycin; metaclopromide

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37
Q

Cause of diabetic gastroparesis

A

autonomic neuropathy- cant sense stomach stretch

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38
Q

Most common cause of upper/ lower GI bleeding

A

upper: ulcer
lower: diverticulosis

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39
Q

Define orthostasis

A

10 pt rise in pulse; 20 pt drop in systolic

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40
Q

Ways to locate GI bleed

A

capsule, nuclear, angio

NOT CT/MRI

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41
Q

When to transfuse in GI bleed / most common blood product

A

HCT under 30 with PRBCs

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42
Q

When to give FFP/platelets

A

FFP if PT/INR ^^ and active bleed.

Platelets if plts low (under 50k) and active bleed

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43
Q

Aside from fluid/ blood what other treatment is given for GI bleeds

A
  • PPI if upper
  • octreotide if varices
  • endoscopy
  • abx to prevent SBP
  • BBer to prevent repeat spontaneous bleed
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44
Q

Treatment of recurrent c diff

A

another course of metronidazole

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45
Q

What are the requirements for B12 and iron absorption

A
  • bowel wall + pancreatic enzymes= B12

- bowel wall= iron

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46
Q

How to dx celiac

A
  • antigliadin
  • antiendomysial
  • endoscopy to r/o lymphoma
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47
Q

Clues to whipple assc malabsorption

A
  • fever

- neuro/ocular findings

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48
Q

Chronic pancreatitis dx

A

calcifications on AXR, ACT

secretin stim = no release of bicarb rich fluid

49
Q

How to distinguish celiacs from tropical sprue

A

cant do it clinically –> abs or endoscopy

50
Q

Treatment for whipples disease? Tropical sprue?

A

whipples- ceftriaxone –> Bactrim

tropical sprue- Bactrim –> tetracycline

51
Q

Purpose of dxylose testing

A

distinguishes bowel wall from pancreatic enzyme disorders

-Dxylose normal in pancreatic disease, abnl in bowel wall disorder ie celiac

52
Q

Dx and Tx of carcinoid

A

dx- 5HIAA

tx- octreotide

53
Q

How to distinguish lactose intolerance from other forms of malabsorption?

A

weight loss, should get none in lactose intolerance

54
Q

Cause of tropical sprue vs whipples disease

A

tropical- unknown bug
whipples- t whipplei

both diagnosed with endoscopy and biopsy

55
Q

Clues to IBS

A
  • worse at morning

- relieved by BM or change in stools

56
Q

Treatment of IBS

A

loperamide (diarrhea)
dicyclomine/ hyocyamine
SSRI/tricyclic
fiber, lubiprostone (^BM frequency)

57
Q

Systemic effects of both IBD forms

A
  • arthralgias
  • uveitis
  • skin changes
  • PSC (UC)
58
Q

Ab for UC? CD?

A

UC- ANCA

CD- ASCA

59
Q

Which IBD has skip lesions? transmural inflammation?

A

skip- CD

transmural- UC

60
Q

When to start colon cancer screening in IBD

A

8 years post colonic involvement q1-2 years

61
Q

Maintenance treatment for IBD? Exacerbation ?

A

Maintenance- mesalamine

Exacerbation- steroids (prednisone, budesonide)

62
Q

How to wean IBD pts off steroids if have recurrence everytime you stop?

A

azathioprine

6MP

63
Q

Important px med for all IBD patients

A

vitamin D, Ca

64
Q

Tx of perianal CD

A

metro

Cipro

65
Q

Last resortment for fistulae/ unresponsive disease before surgery?

A

anti-TNFa (infliximab)

66
Q

How to prevent diverticulosis from worsening?

A

fiber

67
Q

How to dx diverticulitis

A

CT, notttt a scope because high risk for perf

68
Q

Treatment of diverticulitis

A

NPO –> Cipro + metro –> surg if no response of perf/abscess/fistula etc

69
Q

How to handle patient with first degree relative that has colon cancer?

A

start screening 10 years earlier than family member had the cancer or at 40. Do q5 if family member was younger than 40.

70
Q

How to screen pt with HNPCC/ FAP

A

HNPCC- start at 25 then q1-2 years

FAP- start at 12 then q1 year

71
Q

How to screen for colon cancer in pt with polyp

A

repeat q3-5 years

72
Q

How to screen pt with personal hx of colon cancer

A

repeat 1 year post resection, 3 years post op, then q5

73
Q

Polyposis syndromes aside from HNPCC/FAP:

screening?

A

no…

no increased screening for peutz jegher, turcot etc

74
Q

Peutz Jegher = hamartomous colonic polyp +

A

^ risk breast/ gonadal/ pancreatic cancer

melanotic spots

75
Q

Gardner syndrome = colon cancer+

A

osteomas/ soft tissue tumors/ desmoid tumors

76
Q

Turcot syndrome= colon cancer+

A

CNS malignancy

77
Q

Juvenile Polyposis =

A

hamartomatous polyps

78
Q

Common causes of acute pancreatitis

A
  • obstruction (stones, tumors, strictures, etc)
  • alcohol
  • trauma
79
Q

Marker of severe pancreatic disease

A

low Ca; more than 30% necrosis

80
Q

Role of MRCP/ ERCP in pancreatitis

A

MRCP- etiology

ERCP- treatment

81
Q

Treatment of acute pancreatitis

A

NPO
IVF
pain control
PPI

82
Q

Treatment of pancretitis with more than 30% necrosis

A

bx
imipenem/meropenem
surgical debridement with + bx

83
Q

Clue to hepatopulmonary syndrome

A

platypnea

breathing worse when upright

84
Q

Clue to hepatorenal syndrome

A

SUDDEN kidney failure, usually after some bleed or diuretic use

85
Q

Causes of SAAG LESS than 1.1

A

cancer
infxn other than SBP
nephrotic syndrome

86
Q

Portal hypertension/ CHF ascites SAAG

A

more than 1.1 (more protein in the serum than the ascetic fluid)

87
Q

What is SBP px and who gets it?

A

-prior SBP
-variceal bleeding with ascites
Bactrim or norfloxacin

88
Q

Treatment of SBP + clue

A

more than 250 neutros

ceftriaxone or cefotaxime

89
Q

Most common bug in SBP

A

e coli but have risk anaerobes

90
Q

Treatment of hepatorenal syndrome

A

ocetrotide or midodrine

91
Q

Treatment of varices

A

propanolol

92
Q

Treatment of hepatic encephalopathy

A

rifamixin and lactulose

93
Q

Treatment of hepatic ascites

A

spironolactone

94
Q

Lab clue to sudden binge drinking

A

high GGTP

95
Q 
PBC:
sex
age 
antibody 
clue
A

female
40-50
AMA
xanthelasma

96
Q

Treatment of PBC

A

ursodeoxycholic acid

97
Q

Only cause of cirrhosis for which bx is not the most accurate dx

A

PSC

98
Q

PSC lab/clue

A

itching
GGTP high
MRCP beading/strictures

99
Q

Treatment for PSC

A

same as PBC

ursodeoxycholic acid/ cholestyramine

100
Q

Treatment of a1at def

A

replace the enzyme

101
Q

Cause of hemochromatosis

A

mutation causing ^^ iron absorption in duodenum

102
Q

Labs assc with hemochromatosis

A

^^AST/ALT; ^^iron and ferritin; low TIBC

103
Q

Skin changes in hemochromatosis

A

bronzing + DM = bronze DM

104
Q

Infxn assc with hemochromatosis

A

vibrio
listeria
Yersinia
(feed on iron)

105
Q

Most accurate test for hemochromatosis

Most reasonable

A

liver bx = accurate

genetic test + MRI = reasonable can spare pt the bx

106
Q

Meds for hemochromatosis

A

all start with defer….
deferoxamine= injected, others oral

also need phlebotomy

107
Q

Both Hep A and B can be assc with what vasculitis?

A

Polyarteritis nodosa

108
Q

Treatment of acute Hep C ? hep b?

A

inferferon, ribavirin, and EITHER telepravir or boceprevir for hep c

acute hep b not treated

109
Q

Treatment of chronic hep C ?

A

2 drugs… sofosbuvir + ledispavir (type 1) or ribavirin (type 2-3)

110
Q

Number of antivirals used to treat hep B

A

one end of –vudine or –ovir (or interferon)

111
Q

Effects of interferon

A

thrombocytopenia, leukopenia

112
Q

Effects of ribavirin

A

anemia

113
Q

Wilsons- labs

A

low cerulpplasmin

high Cu

114
Q

In addition to rings/ neuro sx… what are systemic signs of wilsons disease

A

RTA, nephrolithiasis, hemolytic anemia (coombs negative)

115
Q

Best initial test for Wilson disease

A

slit lamp exam of eyes

116
Q

Most accurate dx for wilsons

A

increased cu excretion in urine after giving penicillamine

**DECREASED CERULOPLASMIN ISNT MOST ACCURATE

117
Q

Treatments for wilsons

A

peniclliamine
Zinc= impaired Cu absorption
Trientene= chelator

118
Q

Autoimmine hepatitis ab

A

anti smooth muscle ab (ASMA)

NOT to be confused with AMA (PBC)

119
Q

Treatment of autoimmune hepatitis

A

predisone and/or azathioprine

Step 2 CK (8 decks)

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