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IM MTB > GI > Flashcards

GI Flashcards

1
Q

Diagnosis of achalasia

A

Manometry is the most accurate test and will show failure of the LES to relax
Barium esophagram will show a birds beak
Upper endoscopy is useful to rule out malignancy

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2
Q

Achalasia treatment

A

Pneumatic dilation, myomectomy or surgical sectioning is more effective but more dangerous
Botox injections – last 3 to 6 months

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3
Q

For cancer, what is never the most accurate test?

A

Radiologic tests, For example, esophageal cancer needs an endoscopy and biopsy

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4
Q

Best test for diffuse esophageal spasm and nutcracker esophagus

A

Manometry, which will show a different pattern of abnormal contraction and each of them
Corkscrew appearance when spasm is occurring
Treated with CCBs and nitrates, similar to Prinzmetal angina, PPIs can help

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5
Q

Dysphagia and HIV patient with CD4 less than 100, what to do next?

A

Empirically start flucanazole, assuming esophageal candidiasis
If no improvement, upper endoscopy with biopsy and if large ulcerations it’s CMV treat with ganciclovir, if small – HSV, acyclovir

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6
Q

How to detect rings and webs

A

Barium studies of the esophagus

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7
Q

Zenker is diagnosed with? Treatment?

A

Barium studies, surgery

Not NG tube or endoscopy, dangerous for these people they may perforate

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8
Q

How to scleroderma present, management?

A

Reflux, inability to close the LES, manage with PPI’s

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9
Q

Manometry for

A

Achalasia, spasm, Scleroderma

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10
Q

Stress ulcer prophylaxis indicated in

A

Mechanical ventilation, burns, head trauma, coagulopathy

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11
Q

Cancer and gastric versus duodenal ulcers

A

4% of gastric, virtually no duodenal

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12
Q

Therapy for H. Pylori

A

PPI + clarithromycin + amoxicillin
If refractory: metronidazole + tetracycline
If gastric ulcer, repeat ulcer to exclude malignancy
Test of cure: stool antigen or breath test

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13
Q

Non ulcer dyspepsia management

A

If under 45, empiric with PPI
If over 55, endoscopy
Also if dysphagia weight loss, anemia

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14
Q

Gastrinoma is often associated with?

A

Diarrhea since the acid inactivated lipase

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15
Q

If gastrinoma + hypercalcemia?

A

MEN 1: hyperparathyroidism

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16
Q

Once gastrinoma confirmed, next best step is to?

A

Exclude mets: CT/MRI of abdomen, if normal then somatostatin receptor scintigraphy + endoscopic US

17
Q

GIB treatment

A

IVF
transfuse PRBCs when HCT below 30 in elderly/CAD pts
If drops below 20-25 in others
FFP
platelets if below 50k + bleeding
Varices: Octreotide decreases portal pressure, banding, TIPS, propranolol/nadolol, abx to prevent SBP

18
Q

Treatment for Whipple

Tropical sprue?

A

Ceftriaxone followed by Bactrim

Tropical sprue: bactrim, tetracycline

19
Q

Distinction between chronicle pancreatitis and celiac

A

Celiac will have iron deficiency as it requires an intact bowel wall to be absorbed, but does not need pancreatic enzymes
In contrast vitamin B12 needs both

20
Q

Diagnosis of chronic pancreatitis

A

Abdominal XR, CT

Most accurate: secretin stim test: healthy will release large volume HCO3- rich fluid

21
Q

IBS treatment

A

Hyocyamine, Diclocyamine

TCAs, loperamide, lubiprostone, linaclotide

22
Q

Treatment of IBD

A 
5-ASA agent: mesalamine
Azathioprine, 6-MP to wean of steroids
Calcium, vitamin D
Perianal Crohns: cipro and metro
Anti-TNF: infliximab if severe
Surgery especially for UC
23
Q

Diverticulitis treatment

A 
Cipro + Flagyl
Augmentin
Zosyn
Timentin
Carbapenem
NPO
Surgery if no response, recurrent infections, perforation, abscess, fistula, obstruction
24
Q

HNPCC screening

FAP?

A

Begin at 25, scope every 1-2 yrs

FAP: sigmoidoscopy at 12 every year

25
Q

paracentesis should be performed if?

A

new-onset ascites, abdominal pain/tenderness, fever

26
Q

SAAG over 1.1

A

think “dilute” ascites fluid- pushed out: portal HTN, CHF, hepatic vein thrombosis, constrictive pericarditis

27
Q

SAAG less than 1.1

A

think leakage (“exudate” like): infections (except SBP), cancer, nephrotic syndrome?

28
Q

MC etiologies of SBP

treatment

A

E. coli, S. pneumo, NOT anaerobes
treat with cefotaxime or ceftriaxone
frequently recur, prophylax with norfloxacin or bacterium if low albumin in ascites
all variceal bleeding with ascites needs SBP ppx

29
Q

treatment of hepatorenal syndrome

A

somatostatin (octreotide), midodrine

30
Q

when to think hepatopulmonary syndrome

A

orthodexia

hypoxia with sitting upright

31
Q

normal bilirubin with elevated alk phos, xanthomas, osteoporosis, think? how to diagnose? tx?

A

PBC
most accurate test is liver biopsy, most accurate blood test: AMA Ab
bilirubin and IgM levels elevate LATER
treat with urso

32
Q

IBD, pruiritis, ^alk phose, GGTP, bilirubin, think?

most accurate test?

A

PSC
MRCP*/ERCP(generally don’t need intervention) is best test, shows narrowing/beading/strictures in biliary system
biopsy not needed (only cause of cirrhosis that does not need biopsy)
treat with urso or cholestyramine, does NOT improve with IBD resolution (colectomy)

33
Q

mild ^AST, Alk phos, fatigue, joint pain, ED, amenorrhea, skin darkening, DM, cardiomyopathy, think? what infections are more common? dx?

A

hemochromatosis
pituitary involvement- amenorrhea/ED
infections with Vibrio vulnificus, Yersina, Listeria (feed on iron)
dx liver biopsy after ^iron/ferritin, but abdominal MRI and HFE (C282y) genetic testing may spare need for liver biopsy
EKG may show condition defects, echo CM

34
Q

hemochromatosis treatment

A

phlebotomy
if are refractory or are anemic and have hemochromatosis from over transfusion (thalassemia), iron chelation therapy: deferoxamine (IV/IM), deferasirox, deferiprone (oral)

35
Q

treatment for hepatitis B

A

any 1 of the following: (combo tx is not more effective)

adefovir, lamivudine, telbivudine, entecavir, tenofovir, interferon

36
Q

treatment of hepatitis C

A

acute: interferon, ribavirin, and either telaprevier or boceprevir
chronic: combo of ledipasvir and sofosbuvir (genotype 1)
sofosbuvr and ribavirin (genotypes 2, 3)
+ interferon, ribavirin, boceprevir when treatment fails
combo therapy is best, follow with PCR viral load

37
Q

cirrhosis, hepatic insufficiency, psychosis, tremor, ataxia, seizures, coombs negative hemolytic anemia, RTA or nephrolithiasis, think?

A

Wilsons
best initial test: slit lamp for Kayser-Fleischer rings
LOW ceruloplasmin
liver biopsy shows ^copper
most accurate test: abnormally increased copper excretion AFTER penicillamine (chelates)
other tx: Zn: interferes with absorption, trientine: chelates

38
Q

autoimmune hepatitis markers

A

+ANA, +anti-liver-kidney microsomal Abs, ^IgG, +anti-smooth muscle Abs
treat with prednisone +/- azathioprine

IM MTB (7 decks)

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