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PANCE > GI > Flashcards

GI Flashcards

1
Q

What are the three borders of Hesselbach’s triangle?

A

Medial border: rectus abdominus - Superior border: inferior epigastric artery - Lateral border: inguinal ligament

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2
Q

What is the most common cause of painless rectal bleeding in pediatric population?

A

Polyps

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3
Q

What is intestinal pseudo-obstruction without evidence of mechanical cause called?

A

Ogilvie Syndrome

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4
Q

List the 6 “rule of 2” characteristics of Meckel’s diverticulum.

A

2% of population - 2 feet proximal to ileocecal valve - 2 inches long - 2 years old - 2:1 M:F ratio - 2 tissues: gastric & pancreatic

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5
Q

Slate colored skin may represent which underlying GI disorder?

A

Primary Biliary Cirrhosis

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6
Q

What agent is used to chelate copper in the treatment of Wilson’s disease?

A

Penicillamine

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7
Q

Treatment of chronic hepatitis due to hemochromatosis?

A

Phlebotomy and deferoxamine chelation

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8
Q

Treatment of chronic hepatitis due to Wilson’s disease?

A

Copper chelation

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9
Q

Treatment of chronic autoimmune hepatitis?

A

Corticosteroids

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10
Q

Treatment of chronic viral hepatitis B or C?

A

Pegylated interferon-alpha

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11
Q

What serum gastrin levels are found with Zollinger Ellison Syndrome?

A

> 150 pg/mL is suggestive - > 200 pg/mL is diagnostic

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12
Q

What level of eosinophilia is diagnostic of eosinophilic esophagitis on biopsy?

A

> 15 eosinophils/HPF

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13
Q

What type of diarrhea is seen in patients with cholera?

A

Secretory diarrhea

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14
Q

What type of diarrhea does lactose intolerance often cause?

A

Osmotic diarrhea

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15
Q

What type of infectious diarrhea is often linked to deli meats and can be deleterious in pregnant woman (lead to miscarriage)?

A

Listeria

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16
Q

Which vitamin deficiency can lead to problems clotting and excessive bleeding?

A

Vitamin K

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17
Q

Patient with Hepatitis C is at high risk for which malignancy?

A

Liver cancer

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18
Q

What disease is caused by vitamin C deficiency?

A

Scurvy

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19
Q

What disease is caused by niacin deficiency?

A

Pellagra

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20
Q

What vitamin deficiency can lead to cause rickets in children?

A

Vitamin D

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21
Q

Name the fat soluble vitamins.

A

Vitamins: ADEK

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22
Q

Congenital error of metabolism in which life-long avoidance of phenylalanine is required?

A

Phenylketonuria

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23
Q

What is the Dx? Nursing home patient with severe watery diarrhea after recent antibiotics.

A

C. difficile

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24
Q

Prophylactic antibiotic given to prevent traveler’s diarrhea?

A

Fluoroquinolone (e.g. ciprofloxacin) - (Pregnant woman or child give azithromycin)

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25
Q

Which disorder commonly has cobblestoning or skip lesions on imaging?

A

Chron’s

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26
Q

What test is used to diagnose lactase deficiency?

A

Lactose breath hydrogen test

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27
Q

Which vitamin deficiency is perifollicular petechiae suggestive of?

A

Vitamin C (Scurvy)

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28
Q

What diarrhea related infection may lead to meningitis in neonates and immunocompromised patients?

A

Listeria

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29
Q

What type of inguinal hernia is felt on the side of the finger during exam?

A

Direct

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30
Q

What type of inguinal hernia is felt on the tip of the finger during exam?

A

Indirect

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31
Q

Treatment for Giardia infection?

A

Metronidazole

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32
Q

Does Shigella cause bloody or non-bloody diarrhea?

A

Bloody diarrhea

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33
Q

Will umbilical hernias in children <12 months old usually resolve on their own?

A

Yes

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34
Q

Risk factors for ventral hernia?

A

Abdominal surgery - Age - Obesity - Wound infection - Surgical drains

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35
Q

What is the Dx and treatment? Stomach herniated up into thorax.

A

Paraesophageal hernia - Surgery recommended

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36
Q

Common symptoms associated with sliding hiatal hernia?

A

Reflux and heartburn

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37
Q

Patient with adenomatous colon polyp should have colonoscopy how often?

A

Every 3-5 years

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38
Q

Rectal mass rectal bleeding and tenesmus?

A

Rectal cancer (solitary tenesmus may occur with anal inflammation)

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39
Q

What type of hemorrhoids are usually painless?

A

Internal hemorrhoids

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40
Q

Tender indurated area at perianal area/gluteal cleft?

A

Pilonidal Cyst

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41
Q

What disorder is colon dilation air fluid levels and thumbprinting sign on imaging suggestive of?

A

Toxic megacolon (Thumbprinting may also occur with mesenteric ischemia)

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42
Q

Treatment for fecal impaction?

A

Digital rectal /manual disimpaction - Diet with fiber stool softeners/laxatives for prevention

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43
Q

What is the Dx? Acute abdominal pain. KUB shows dilated loops of bowel with air fluid levels.

A

Small bowel obstruction

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44
Q

Name the 3 most common symptoms of pellagra.

A

“Diarrhea - Dementia - Dermatitis (3 “D”s)

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45
Q

At what age should routine colonoscopy screening begin for men and women?

A

Age 50

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46
Q

Most common type of colon cancer?

A

Adenocarcinoma

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47
Q

What is the DX? 65-year-old male 3 months of recent weight loss poor appetite new constipation and anemia.

A

Think colon cancer

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48
Q

Celiac sprue intestinal biopsy findings?

A

Villous atrophy

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49
Q

Good test for malabsorption?

A

Fecal fat testing

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50
Q

Steatorrhea is often associated with which type of bowel disorders?

A

Malabsorption disorders

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51
Q

Intestinal angina?

A

Chronic mesenteric ischemia

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52
Q

What is the Dx? 60-year-old male smoker complains of recurrent dull abdominal cramps/pain within 1 hour of eating meals.

A

Chronic mesenteric ischemia

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53
Q

What is severe abdominal pain out of proportion to physical exam findings suggestive of?

A

Acute mesenteric ischemia

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54
Q

Acute thrombosis or embolism of the celiac or mesenteric arteries?

A

Acute mesenteric ischemia

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55
Q

Name the criteria used to diagnose Irritable bowel syndrome.

A

Rome criteria: Pain relieved with defecation - Change in frequency and form - Altered stool passage - Passage of mucus

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56
Q

Inflammatory bowel disease that may affect the entire GI tract from mouth to anus?

A

Chron’s

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57
Q

What are the extraintestinal manifestations that can be seen in ulcerative colitis patients?

A

Pyoderma gangrenosum - Arthritis - Ankylosing spondylitis - Erythema nodosum - Uveitis

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58
Q

Inflammatory bowel disease that only affects the large intestines?

A

Ulcerative colitis

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59
Q

Inflammatory bowel disease that often presents with bloody diarrhea?

A

Ulcerative colitis

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60
Q

What is the Dx? Newborn with double bubble sign on abdominal X-ray.

A

Duodenal atresia

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61
Q

List 3 antibiotic regimens which can be used for diverticulitis?

A

Quinolone with metronidazole - Amoxicillin-clavulanate - Trimethoprim-sulfamethoxazole

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62
Q

Treatment for acute diverticulitis?

A

Initial: NPO/IV fluids antibiotics - May require surgery if perforation or abscess

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63
Q

+anti-tissue transglutaminase +antigliadin and +anti endomysial antibodies are suggestive of what disorder?

A

Celiac sprue

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64
Q

What cardiac disorders are acute mesenteric ischemia associated with?

A

Atrial fibrillation - MI - CHF

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65
Q

What genetic abnormality is duodenal atresia associated with?

A

Hereditary Spherocytosis

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66
Q

What criteria are used to predict mortality in acute pancreatitis?

A

Ranson’s criteria

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67
Q

What chronic viral diseases increases the chance of liver cancer?

A

Hepatitis B and C (C increases chances more than B)

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68
Q

What tumor marker may be elevated in liver cancer?

A

Alpha-fetoprotein

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69
Q

Common causes of constipation?

A

Lack of fiber - Opiate use - hypothyroidism

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70
Q

Sign seen with appendicitis with pain over the right lower quadrant one-third of the distance from the ASIS to the umbilicus?

A

McBurney’s

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71
Q

Tumor marker elevated with pancreatic cancer?

A

CA 19-9

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72
Q

Most common type of pancreatic cancer?

A

Ductal adenocarcinoma

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73
Q

Ecchymoses around the umbilicus which represents retroperitoneal or intra-abdominal bleeding?

A

Cullen’s sign

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74
Q

What is the Dx? Epigastric pain radiating to back with elevated lipase.

A

Acute Pancreatitis

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75
Q

What does a porcelain gallbladder or a radiopaque gallbladder on imaging suggest?

A

Gallbladder cancer

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76
Q

What disease process does Charcot’s triad (fever, jaundice and RUQ pain) suggest?

A

Cholangitis

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77
Q

What are the routes of transmission for hepatitis C?

A

Infants: perinatal infection Adults: Blood to blood exposure - Sexual - IV drug abuse - tattoos

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78
Q

What are the routes of transmission for hepatitis B?

A

Infants: perinatal infection Adults: Blood to blood exposure - Sexual - IV drug abuse

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79
Q

What are the routes of transmission for hepatitis A?

A

Fecal-oral

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80
Q

Which types of hepatitis have available vaccines?

A

Hepatitis A and B

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81
Q

Non-alcoholic steatohepatitis (AKA non-alcoholic fatty liver disease) risk factors?

A

Diabetes obesity - Metabolic syndrome - Steroid use - CAD

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82
Q

What are +Anti-Mitochondrial antibodies associated with?

A

Primary Biliary Cirrhosis

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83
Q

What is the Dx? Fatigue Pruritus hepatomegaly associated with high alk phos cholesterol and bilirubin.

A

Primary Biliary Cirrhosis

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84
Q

Treatment for acetaminophen toxicity?

A

Acetylcysteine

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85
Q

Treatment for Wilson’s disease?

A

Copper chelation

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86
Q

Most common type of Hepatitis which is transferred via fecal-oral route?

A

Hepatitis A

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87
Q

What findings are expected in a patient who is immune to Hepatitis B due to vaccination?

A

HBsAg negative - Anti-HBc negative - Anti-HBs positive

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88
Q

What findings are expected in a patient who is immune to Hepatitis B due to natural infection?

A

HBsAg negative - Anti-HBc IgG positive - Anti-HBs positive

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89
Q

RUQ palpation maneuver reveals pain and cessation of inspiration. What is this called? What does it indicate?

A

Murphy’s sign = cholecystitis

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90
Q

Most common type of gastric cancer?

A

Gastric adenocarcinoma

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91
Q

Medications to treat gastroparesis?

A

Metoclopramide - IV erythromycin

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92
Q

Treatment for gastritis?

A

Proton pump inhibitor - Treat H. Pylori if present - Remove irritants

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93
Q

List two medications which may cause cholelithiasis?

A

Ceftriaxone and Clofibrate

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94
Q

What two hematological disorders may cause cholelithiasis?

A

Sickle cell disease and Hereditary spherocytosis

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95
Q

What GI cancer is acanthosis nigricans associated with?

A

Gastric adenocarcinoma

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96
Q

What side effect must patients be counseled on prior to metoclopramide treatment?

A

Tardive Dyskinesia

97
Q

What medications may result in a false-negative urea breath test in a patient with H. pylori?

A

Proton pump inhibitors - H2 blockers - Bismuth - Antibiotics

98
Q

What symptoms of GERD may present as a pulmonary disease process?

A

Hoarseness cough wheeze

99
Q

Syndrome with elevated gastrin levels?

A

Zollinger Ellison

100
Q

What type of GI ulcer has pain relief with food?

A

Duodenal ulcer

101
Q

In addition to peptic stricture what is another complication of chronic GERD?

A

Barrett’s esophagus

102
Q

What disorder can cause heartburn hoarseness and atypical chest pain?

A

GERD

103
Q

What is the Dx? Hematemesis from esophageal laceration after forceful retching.

A

Mallory-Weiss tear

104
Q

Motility disorder caused by degeneration of Auerbachs plexus?

A

Achalasia

105
Q

What medication may be used to treat stable esophageal varices?

A

Beta blockers

106
Q

Name 2 viruses seen in infectious esophagitis.

A

HSV (Herpes Simplex Virus) and CMV (Cytomegalovirus)

107
Q

In which conditions do you often see infectious esophagitis?

A

Immunocompromised: HIV - Cancer patients - Bone marrow transplant patients

108
Q

Medication used to treat candida esophagitis?

A

Fluconazole

109
Q

What conditions are associated with eosinophilic esophagitis?

A

Allergic conditions - Asthma

110
Q

What type of esophagitis is often caused by bisphosphonates?

A

Non-infectious

111
Q

Vitamin C deficiency is associated with what problems?

A

Scurvy (Fatigue - Petechiae - Bleeding gums - Impaired wound healing)

112
Q

Vitamin B6 deficiency is associated with what problems?

A

Anemia - Weakness - Insomnia

113
Q

Niacin (Vitamin B3) deficiency is associated with what problems?

A

Pellagra -Diarrhea - Flushing - Psychosis

114
Q

Vitamin B2 deficiency is associated with what problems?

A

Glossitis - Seborrheic dermatitis

115
Q

Vitamin B1 deficiency is associated with what problems?

A

Beriberi (CHF - Peripheral neuropathy - Wernicke’s - Cerebellar SX

116
Q

What does Vitamin K deficiency result in?

A

Vitamin K deficiency leads to less factors and bleeding (increased PT/INR)

117
Q

What factors is Vitamin K deficiency associated with?

A

Vitamin K is needed to make clotting factors 2,7,9 and 10

118
Q

Vitamin E deficiency is associated with what problems?

A

Neuropathy - Ataxia - Hemolytic anemia

119
Q

What test is both diagnostic and therapeutic for a patient with intussusception?

A

Barium enema

120
Q

A sausage shaped mass and currant jelly stool are consistent with what diagnosis?

A

Intussusception

121
Q

A newborn with bilious vomiting and a non-distended abdomen is found to have a double bubble sign on KUB. What is your diagnosis?

A

Duodenal atresia

122
Q

What exam finding would be possibly seen on radiology work up for child with pyloric stenosis?

A

US for identification shows a Double-track - Follow up barium studies show String sign and Shoulder sign

123
Q

Use of what antibiotic is associated with increased risk of pyloric stenosis?

A

Clarithromycin (Note: erythromycin is also associated)

124
Q

A baby presents with vomiting and abdominal exam reveals an olive like mass in the RUQ. What do you suspect?

A

Pyloric stenosis

125
Q

A baby with untreated PKU will develop what long-term complication?

A

Mental retardation

126
Q

A newborn brought from a developing nation at day 12, has a mouse like smell to the urine. What do you suspect?

A

Phenylketonuria (PKU)

127
Q

What organism commonly causes diarrhea after drinking in a mountain stream?

A

Giardia

128
Q

What virus commonly causes breakouts of diarrhea on cruise ships?

A

Norovirus

129
Q

What virus commonly causes breakouts of diarrhea in day care centers?

A

Rotavirus

130
Q

What diarrhea is associated with poorly done home canned foods?

A

C. Perfringens

131
Q

What diarrhea is associated with a patient post antibiotics?

A

C. Difficile

132
Q

What diarrhea associated with beef, pork, poultry and egg salad? (maybe picnic?)

A

Staph Aureus

133
Q

What diarrhea associated with undercooked poultry or pork?

A

Salmonella

134
Q

What diarrhea associated with shellfish?

A

Vibrio cholerae

135
Q

What is the most common cause of traveler’s diarrhea?

A

E. coli

136
Q

Which type of inguinal hernia is congenital and generally happens before age one?

A

Indirect

137
Q

A 14 year old male presents with a protruding mass that touches the side of the index finger with coughing. What is your diagnosis?

A

Direct inguinal hernia

138
Q

A small umbilical hernia is tender to the touch, not reducible and purple in color. What is the recommend treatment plan?

A

Emergent surgery for strangulated hernia

139
Q

Obesity and previous abdominal surgery has lead to a very large ventral herniation. What is the recommended treatment?

A

Observation or elective surgery as they rarely strangulate

140
Q

What type of hernia can worsen GERD symptoms?

A

Hiatal hernia

141
Q

What is the recommended follow-up time for colonoscopy in a patient who had polyps removed?

A

Repeat colonoscopy in 3 to 5 years

142
Q

What is the recommended treatment for a perianal cyst?

A

Surgical drainage

143
Q

Are polyps located in the distal colon and rectum usually benign or cancerous?

A

Benign

144
Q

Anal cysts can be benign or cancerous. Which of the following is cancerous? (Teratoma, epidermoid, dermoid)

A

Teratoma

145
Q

A 64 year old male presents with bloody stools. Digital rectal exam reveals a step off at Bulmer’s shelf. What is your diagnosis?

A

Rectal cancer

146
Q

A 45 year old female presents with painful defecation, pruritus of the anus and occasional blood. What is your diagnosis?

A

External hemorrhoids

147
Q

What is the recommended treatment of a pilonidal cyst?

A

Surgical drainage

148
Q

A 25 year old male has a large red tender abscess located in the gluteal cleft near the coccyx. What is your diagnosis?

A

Pilonidal cyst

149
Q

Both mesenteric ischemia and toxic megacolon may have a thumb printing sign on imaging. What differentiates the two on physical exam?

A

Mesenteric ischemia has a soft abdomen - Toxic megacolon as rigid abdomen

150
Q

What is the recommended treatment for an elderly patient with fecal impaction?

A

Digital rectal disimpaction followed by dietary changes that increase fluids and dietary fiber

151
Q

X-ray showing dilated large intestine and a large amount of stool in the sigmoid colon in an elderly patient is most likely represents what disorder?

A

Fecal impaction

152
Q

What is the most common location for a large bowel obstruction?

A

Sigmoid colon

153
Q

What would be the expected findings on KUB in a patient with a mechanical obstruction?

A

Dilated loops of bowel with air fluid levels and little or no gas in the colon

154
Q

What is the most common cause of mechanical obstruction in a patient with history of abdominal surgery?

A

Adhesions

155
Q

A patient undergoes a barium study of the colon and an ?Apple core? lesion is found. What do you suspect?

A

Colon Cancer

156
Q

What is the most common type of colon cancer?

A

Adenocarcinoma

157
Q

A 17 year old presents with abdominal pain, bloating, flatulence, and diarrhea after ingesting dairy. What is the test used to make the diagnosis?

A

Lactase breath hydrogen test

158
Q

What lab antibodies would likely be positive in a patient with Celiac sprue?

A

+anti-tissue transglutaminase, +antigliadin and +anti endomysial antibodies

159
Q

Celiac sprue is an abnormal immune response to what food product?

A

Gluten

160
Q

What are the fat-soluble vitamins?

A

A - D - E - K

161
Q

What is the test of choice for malabsorption?

A

Fecal fat

162
Q

A patient presents with acute mesenteric ischemia. What medication may be given via the angiography to improve blood flow while the patient waits for surgery?

A

Papaverine for vasodilation via angiogram until in patient gets to OR

163
Q

What finding on abdominal X-ray is suggestive of acute mesenteric ischemia?

A

Thumb-printing of small bowel or right colon due to submucosal bleeding (Thumb printing may also be seen with toxic megacolon)

164
Q

What is the gold standard for diagnosis of mesenteric ischemia?

A

Angiography

165
Q

A diabetic presents with abdominal pain that begins one hour after eating and resolves a few hours later. What is your suspected diagnosis?

A

Chronic mesenteric ischemia

166
Q

A 55 year old male presents with acute abdominal pain. He is in atrial fibrillation and has a relatively benign exam. What is your diagnosis?

A

Mesenteric ischemia

167
Q

What antibodies will be found positive in Crohn’s disease?

A

+ anti-saccarmyces cerevisae antibodies (ASCA)

168
Q

What antibodies will be found positive with ulcerative colitis?

A

+ anti-neutrophil cytoplasmic antibodies (pANCA)

169
Q

Patient presents with alternating diarrhea and then constipation. A complete workup and physical exam are normal. What do you suspect?

A

Irritable bowel syndrome

170
Q

What are the three major complications of ulcerative colitis?

A

Toxic megacolon - Primary Sclerosing Cholangitis - Colorectal cancer

171
Q

Crohn’s disease affects what part of the GI tract?

A

Mouth to anus

172
Q

Which type of diverticular problem generally is painless bleeding?

A

Diverticulosis

173
Q

Which type of laxative is first in the line of treatment of constipation after lifestyle changes and adequate fiber?

A

Osmotic Laxatives

174
Q

A patient having less than two bowel movements per week is defined as having what?

A

Constipation

175
Q

What is the test of choice to diagnose appendicitis in an adult?

A

CT

176
Q

What is the test of choice to diagnose appendicitis in a child?

A

Ultrasound

177
Q

What is Iliopsoas sign?

A

RLQ pain with R hip extension

178
Q

What is Obturator sign?

A

RLQ pain upon flexion and internal rotation of RLE

179
Q

What is Rovsing’s sign?

A

RLQ pain upon palpation of LLQ

180
Q

What is McBurney’s sign?

A

Pain upon palpation of the RLQ

181
Q

What tumor marker is elevated in pancreatic cancer?

A

CA-19-9

182
Q

Patients with chronic pancreatitis commonly need pharmacological supplementation for what two problems?

A

Insulin for diabetes and pancreatic enzymes for digestion

183
Q

A 45 year old male alcoholic with epigastric abdominal pain and radiation to mid back develops ARDS. What is the most likely diagnosis?

A

Acute pancreatitis and sepsis

184
Q

A family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, and cardiomyopathy are suggestive of what disorder?

A

Hereditary Hemochromatosis

185
Q

A 65 year old male with central obesity and ultrasound finding of a fatty liver can eventually develop what condition?

A

NAFLD (Non Alcoholic Fatty Liver Disease) may lead to cirrhosis

186
Q

Primary biliary cirrhosis often has high elevation of alkaline phosphatase and bilirubin levels. What is the gold standard for diagnosis?

A

Gold standard - antimitochondrial antibodies found with liver biopsy

187
Q

Diffuse, multifocal strictures and focal dilation of bile ducts with a “beaded look” are found on a patient with ulcerative colitis. What is your suspected diagnosis?

A

Primary Sclerosing cholangitis

188
Q

What is the medical management of ascites due to cirrhosis?

A

Single morning oral doses of spironolactone and furosemide

189
Q

Primary sclerosing cholangitis is commonly associated with what GI disease process?

A

Ulcerative colitis

190
Q

What test provides definitive diagnosis of liver cancer?

A

Liver biopsy

191
Q

What tumor marker is elevated in liver cancer?

A

Alpha-fetoprotein

192
Q

A patient presents with AMS and hepatomegaly. Physical exam reveals ring-like deposits in the eyes. What is the suspected diagnosis?

A

Wilsons disease (copper deposition)

193
Q

Which of the hepatitis viruses is a DNA virus?

A

Hepatitis B (the rest are all RNA viruses)

194
Q

A patient has positive Anti-HBc IGG, negative Anti-HBc IGM and positive HBsAg. What is the status of their hepatitis B?

A

Chronic hepatitis B

195
Q

A patient has negative Anti-HBc IGG, positive Anti-HBc IGM and positive HBsAg. What is the status of their hepatitis B?

A

Acute active Hepatitis B (contagious)

196
Q

Which viral Hepatitis causes a high infant mortality rate in a pregnant woman?

A

Hepatitis E

197
Q

Which hepatitis can be obtained via blood transfusion and is likely to lead to cirrhosis and liver cancer?

A

Hepatitis C

198
Q

Which hepatitis is only associated with hepatitis B?

A

Hepatitis D

199
Q

“A 24 year old returns from an Asian vacation tour and develops fatigue, fever, jaundice and hepatomegaly 3 days later. What is the likely cause?

A

Hepatitis A

200
Q

A patient with painless jaundice weight loss and a palpable RUQ mass has what suspected diagnosis?

A

Gallbladder or Pancreatic cancer

201
Q

A patient presents to the ED with jaundice, high fever and RUQ pain after an ERCP. What is the likely causative organism?

A

E. Coli (cholangitis)

202
Q

What is the next test of choice in a patient with RUQ pain and an inconclusive US for cholecystitis?

A

Nuclear scan (HIDA or PIPIDA)

203
Q

A patient presents to your office with weight loss and a palpable mass in the right upper quadrant. What X-ray finding supports gallbladder cancer?

A

Porcelain gallbladder

204
Q

A patient with cholangitis develops confusion and hypertension. What do you suspect?

A

Acute obstructive suppurative cholangitis

205
Q

A patient presents with fever, jaundice, and right upper quadrant pain. What do you suspect?

A

Cholangitis

206
Q

During exam, palpation of the right upper quadrant during inspiration causes the patient to stop breathing in due to pain? What is the initial test of choice?

A

RUQ Ultrasound

207
Q

What antibiotic is a major cause of biliary sludge?

A

Ceftriaxone

208
Q

A patient presents with left supraclavicular lymphadenopathy and an umbilical lymph node. What do you suspect?

A

Gastric cancer or abdominal cancer (Left supraclavicular lymphadenopathy aka Virchow’s node)

209
Q

A diabetic regularly checking his post prandial glucose readings finds that despite a good meal his readings are low. What do you suspect?

A

Gastroparesis

210
Q

What MEN I tumor causes excess gastric acid production?

A

Zollinger Ellison

211
Q

A patient describes abdominal discomfort that is worse with meals and gets better an hour or so later after eating? What do you suspect?

A

Gastric ulcer

212
Q

A patient describes abdominal discomfort that improves with meals and gets worse an hour or so later. What do you suspect?

A

Duodenal ulcer

213
Q

A patient complains he regurgitates small amounts of food back into his mouth. He also has noted very foul-smelling breath. What do you suspect?

A

Zenker’s diverticulum

214
Q

What lifestyle change, in addition to smoking cessation, not eating before bedtime, and proper food choices, has the largest effect on GERD symptoms?

A

Weight loss

215
Q

What is the gold standard for diagnosis of GERD?

A

pH monitoring with a intra-esophageal electrode

216
Q

What surgical procedure is indicated for refractory GERD?

A

Nissen Fundoplication

217
Q

Patient presents with bleeding esophageal varices. What medication is often given IV to stop the bleeding?

A

Octreotide and vasopressin

218
Q

What disease process is commonly associated with esophageal varices?

A

Cirrhosis of the liver

219
Q

What medication is indicated for the prevention of esophageal varices?

A

Beta Blockers - Nadolol or propranolol

220
Q

A patient develops severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. What is the definitive treatment?

A

Emergent Surgery (Boerhaave’s)

221
Q

What is expected to be seen on endoscopy in a patient with a Mallory Weiss tear?

A

Long mucosal tears through venous or arterial plexus

222
Q

A 24 year old male complains of bloody vomitus after a night of heavy drinking. What is the suspected cause of the bleeding?

A

Mallory Weiss tear

223
Q

What is the treatment for the esophageal webs in Plummer Vinson disease?

A

Endoscopy and dilation plus Iron supplementation

224
Q

A 60 year smoker presents with difficulty swallowing solids. What do you suspect?

A

Throat cancer

225
Q

A female presents with dysphagia to solid foods and is found to be anemic. What is your expected finding on endoscopy?

A

Esophageal webs from Plummer Vinson (associated with iron deficiency anemia)

226
Q

What is the main cause of strictures?

A

Healing scar due to ulcerative esophagitis

227
Q

A Schatzki ring causes what type of dysphagia? (solids, liquids or both)

A

Solids

228
Q

A stroke commonly causes what type of dysphagia? (solids, liquids or both)

A

Both

229
Q

What is your diagnosis for a patient with systemic, tight, shiny skin and complaints of dysphagia of both solids and liquids?

A

Scleroderma

230
Q

What result is expected on barium swallow in a patient with Esophageal spasm?

A

Corkscrew appearance

231
Q

A bird beak result is obtained on a barium swallow. What type of dysphagia does the patient likely have? (solids, liquids or both)

A

Dysphagia to both liquids and solids occurs with achalasia

232
Q

What medication is used to treat oral candidiasis?

A

Oral fluconazole

233
Q

A cancer patient receiving chemotherapy has a sore throat. Examination shows white mucosal plaque like lesions. What do you suspect?

A

Candidiasis

234
Q

A patient presents with a severely painful throat status post bone marrow transplant. Examination reveals multiple vesicles. What do you suspect?

A

HSV (Herpes Simplex Virus) - HSV is common in solid organ and bone marrow recipients

235
Q

What is the most likely organism causing wide based deep vesicular oral lesions in an AIDS patient?

A

CMV (Cytomegalovirus)

236
Q

A bone marrow recipient has shallow 1 -2 mm volcano like lesions on the lips and buccal mucosa. What is the likely cause?

A

HSV (Herpes Simplex Virus)

237
Q

A patient presents with GERD like symptoms refractory to antacids and a history of asthma. What biopsy findings would be expected?

A

Eosinophils from allergic esophagitis

238
Q

What agent is commonly used for osteoporosis prevention and can also lead to non infectious esophagitis?

A

Alendronate or other bisphosphonates (risedronate - ibandronate)

239
Q

What is the recommended treatment for a family exposed to a member of their household with active hepatitis A?

A

Immunoglobulin

PANCE (9 decks)

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