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Internal Medicine Boards > GI > Flashcards

GI Flashcards

1
Q

Dysphagia for solid and liquids

Bird’s beak

Travel to South America

Dx?

A

Chagas’ disease

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2
Q

Testing for Achalasia:

2.

3.

Treatment?

A

Barium swallow

Esophageal manometry

EGD

Tx - surgical myotomy or endo dilation, (Botox second line), (CCB or nitrates 3rd line)

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3
Q

Causes of pill-induced esophagitis

A

NSAIDs

Tetracyclines

Potassium chloride

Iron

Alendronate

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4
Q

Pancreatitis

Sjogren, PSC, IBD

Increased IgG4

A

Autoimmune pancreatitis Type I

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5
Q

Chronic pancreatitis

No systemic disease

Normal IgG4

A

AIP Type II

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6
Q

Secretory diarrhea

Flushing

Dx?

Tx?

A

Carcinoid

Urinary 5-HIAA excretion

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7
Q

Chronic diarrhea with

Arthralgia, fever, cardiac disease, neurological or ocular disease

Dx, treatment

A

Whipple disease (tropherema whippeli)

12 months ABx

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8
Q

Chronic diarrhea plus

Travel to India/Puerto Rico, malabsorption, WL, b12 deficiency

Dx, Tx

A

Tropical sprue (small bowel biopsy)

Sulfonamide or tertracycline PLUSfolate

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9
Q

Ascitic fluid

SAAG cutoff/meaning

Total Protein cutoff/meaning

A

Phtn, cirrhosis, heart failure > 1.1
TB or infection < 1.1

Heart failure prot > 2.5
Phtn cirrhosis <2.5

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10
Q

Anti smooth muscle Ab

A

PSC

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11
Q

Dx PSC, then do what?

A

Colonoscopy

80% have UC

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12
Q

Cirrhosis with AKI mgmt

Definition of HRS

A

Fluid challenge with albumin

  1. AKI > 1.5 from baseline over days to weeks
  2. Not responsive to colloid challenge
  3. Absence of shock, proteinuria, US evidence of kidney disease, nephrotoxic agents, etc
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13
Q

Acute liver failure
Less than 40 yo
HL anemia
Low alk phos

A

Wilson disease

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14
Q

Polyps and gallstone indications for chole

A

Polyp > 1 cm

Any polyp with gallstones

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15
Q

Crohns treatment in pregnancy

A

Certolizumab

Anti-TNFs are safe and effective during pregnancy

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16
Q

Colonoscopy screening in

Patients with UC AND Crohns involving 1/3 of colon

Lynch syndrome

Large >1cm, or dysplastic serrated sessile polyps

A

Every 1-2 years after 8-10 years of disease

Every 1-2 years after age 20-25, or 2-3 years before youngest first degree relative diagnosed

Repeat in 3 years

17
Q

Ulcerative painful pustular rash in IBD

A

Pyoderma gangrenosum

18
Q

Ab in PBC

Ab in autoimmune hep

A

Anti mitochondrial

Anti smooth muscle Ab

19
Q

Treatment of PBC

Suspected disease but negative Ab, next step?

A

Ursodiol

Biopsy

20
Q

GIB who don’t need hospitalization

A

Need all 4

Age < 60
No HD instability
No gross rectal bleeding
ID of obvious anorectal source on exam

21
Q

Hepatocellular adenoma criteria for resection

A

Size > 5 cm
Beta-catenin/glutamine synthetics activity positive
Males
Hemorrhage

22
Q

Amsterdam II criteria for HNPCC RFs

Screening for HNPCC

A

3+ relatives with colorectal, endometrial, ovarian, urothelial, gastric, brain, small bowel, hepatobiliary, or skin cancers

2 successive generations of affected relatives

One affected 1st degree relative and 2 others

AND

One cancer dx before age 50

Screen: every 1-2 years at 25 or 2-5 years prior to youngest dx

23
Q

GIB obscure

Workup

A

EGD and colo

Repeat EGD or colo depending on symptoms

Capsule
+ then push

24
Q

MELD cutoff for liver transplant

A

15

25
Q

Milan criteria for HCC

A

3 tumors < 3 cm

One tumor < 5 cm

Indication for liver transplant because they do well

26
Q

Cirrhotic with UGIB

Mgmt?

A

Octreotide and Abx (cipro or norfloxacin, or rocephin)

Then EGD

27
Q

When to resume ASA after GO bleed in CV patient

A

3-5 days

28
Q

First line tx H pylori

Second line (2)

A

Clarithromycin, amox, ppi

  1. Bismuth subsalicylate, metronidazole, tetracycline, ppi x 10-14 d
  2. Levofloxacin, amox, ppi x 10 d
29
Q

H/o colon cancer

Screening after surgery

A

1, 3 yr then every 5

30
Q

Adenoma features needing colo in 3 years (4)

A

Adenoma > 10 mm
3-10 adenomas
Adenoma with villous component
Adenoma with high grade dysplasia

31
Q

NET size requiring partial gastrectomy

A

2 cm

32
Q

Treatment for UC if low TPMT level

A

TNF inhibitors

High chance of bone marrow tox if 6-MP or azathioprine

33
Q

Who needs HCC surveillance for chronic Hep B? (6)

A 
African patient > 20 yo
Cirrhotics
Asian men > 40 yo
Asian women > 50 yo
Fam hx of HCC
Persistently elevated ALT or HBV DNA > 10,000
34
Q

How to diagnose insulinoma

A

72 hr fast

If +, CT pancreas

If negative, EUS

Internal Medicine Boards (11 decks)

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