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MS3 Year > GI > Flashcards

GI Flashcards

1
Q

Diagnostic step for a Meckel’s diverticulum?

A

Technetium-99 scan

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2
Q

Anemia in a gastric bypass pt, what’s the dx?

A

B12 deficiency

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3
Q

Oral lesions, vesicles on an erythematous base and odynophagia in an AIDS patients, what’s the dx? How do you tx?

A

HSV esophagitis; (val)acyclovir

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4
Q

How do you diagnose PUD?

A

Endoscopy w/bx (EGD)

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5
Q

What are the risk factors for gallstones (cholesterol)? pigmented?

A

fat, female, forty, fertile, and Native American; hemolysis, African American

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6
Q

Foul smelling, difficult to flush diarrhea that slows down at night, dx?

A

osmotic diarrhea

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7
Q

First step in a GI bleed? The next four things?

A

2 large bore IV’s! 1) IVF bolus; 2) type and cross and transfuse as needed; 3) IV PPI; 4) call GI for EGD

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8
Q

What is the best tx for achalasia?

A

myotomy (can also do dilation though risk of perf, and botulinum toxin, though needs to be redone)

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9
Q

Alternative bowel habits with pencil thin stools, dx and what’s next?

A

colon cancer; start with colonoscopy

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10
Q

25 yo man with watery diarrhea, weight loss, and fistulas - dx?

A

Crohn’s disease

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11
Q

40 yo woman with jaundice and no alcohol or viruses, dx? How do you diagnose? Tx?

A

primary biliary cirrhosis; biopsy (imaging is normal); transplant

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12
Q

How do you localize a gastrinoma?

A

somatostatin receptor scintillography

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13
Q

You do a large volume paracentesis, what should you do immediately after?

A

IV albumin

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14
Q

RUQ pain, jaundice, fever, altered mental status and hypotension; dx? next step?

A

ascending cholangitis (reynold’s pentad); ERCP (first) and abx (at same time)

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15
Q

What do you get if you’re worried about a GI bleed in a healthy term neonate right after delivery?

A

Apt test (a medical test used to differentiate fetal or neonatal blood from maternal blood found in a newborn’s stool or vomitus - positive means fetal blood)

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16
Q

When do you give antibiotics to pancreatitis? Which one?

A

Meropenem if an FNA/bx grows an organism

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17
Q

There is a GI bleed not seen on endoscopy, and they require transfusions every 3 hours, next step?

A

brisk bleed - do an arteriogram

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18
Q

Colon cancer screening starts when?

A

50 in everyone, or 10 years before diagnosis in any first degree relative

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19
Q

Gallstones and dilated common bile duct on ultrasound, dx?

A

choledocholithiasis

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20
Q

Name 8 etiologies of cirrhosis

A

VW HAPPENs
1) viral hepatitis; 2) wilson’s disease; 3) hemochromatosis; 4) alpha-1 anti-trypsin; 5) Primary sclerosing cholangitis; 6) primary biliary cholangitis (b = bitches); 7) EtOH; 8) NASH/NAFL

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21
Q

Painless rectal bleeding in a patient greater than 50 yo, dx? Tx?

A

Diverticular hemorrhage

can embolize if severe

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22
Q

White blood cells and blood in diarrhea lasting 8 weeks, dx? Next step?

A

inflammatory diarrhea, get a colonoscopy

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23
Q

Early satiety, weight loss, in a Japanese man, dx?

A

gastric cancer

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24
Q

What do you add to the usual 5 things in GI bleed if they are cirrhotic?

A

Octreotide (for varices) and ceftriaxone (for SBP prophylaxis)

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25
Q

When do you do a colonoscopy for diverticulitis?

A

2-6 wks after resolution

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26
Q

Diabetes, nausea, vomiting, and abdominal pain chronically, dx?

A

gastroparesis

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27
Q

Continuous lesions, crypt abscesses, diagnosis?

A

ulcerative colitis

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28
Q

Diarrhea from a chinese food buffet line, dx?

A

Bacillus cereus

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29
Q

What is the bx of Barrett’s esophagus going to look like?

A

intestinal metaplasia

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30
Q

Prophylaxis for spontaneous bacterial peritonitis?

A

fluoroquinolone

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31
Q

What test do you do to investigate intussusception?

A

Air enema

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32
Q

Burning retrosternal chest pain better with sitting up and antacids, dx?

A

GERD

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33
Q

What is the tx of gallstone pancreatitis?

A

ERCP

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34
Q

What is the diagnostic step for primary biliary cirrhosis?

A

biopsy only (imaging is normal)

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35
Q

What is the tx of peptic ulcer disease causing bleeding?

A

PPI

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36
Q

Two most common causes of pancreatitis?

A

1) EtOH; 2) gallstones

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37
Q

Bloody diarrhea, renal failure in a child, dx?

A

TTP/HUS and shiga like toxin

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38
Q

Name 5 causes of esophagitis. How does pt present?

A

PIECE: 1) Pill induced; 2) Infectious; 3) Eosinophilic; 4) Caustic (strong base or strong acid ingestion); 5) gErd

odynophagia or dysphagia

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39
Q

Poultry, eggs, and diarrhea, dx?

A

Salmonella

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40
Q

Screening for hepatocellular carcinoma? (in pts with cirrhosis or hep B)

A

ultrasound and AFP q6 months

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41
Q

Tx for Barrett’s metaplasia?

A

high dose PPI

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42
Q

How do you tx diffuse esophageal spasm?

A

nitro spray or calcium channel blockers (smooth muscle relaxation)

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43
Q

Watery diarrhea that has no change in frequency with sleeping or NPO, dx?

A

secretory diarrhea (osmotic has no sleeping sxs because it is affected by diet)

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44
Q

You get an ultrasound and aren’t sure if it is cholecystitis - what do you do?

A

HIDA scan

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45
Q

Colicky RUQ abdominal pain - what’s the dx? and next step?

A

gallstones (cholelithiasis) - get a RUQ U/S

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46
Q

Watery diarrhea, weight loss, fistula formation, dx?

A

Crohn’s

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47
Q

You’re worried about a GI bleed in a premature neonate - what do you get?

A

XR

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48
Q

Caribbean farmer, negative antibodies, and blunting of intestinal villi, dx?

A

Tropical sprue (tx with antibiotics)

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49
Q

Familial adenomatous polyposis progression? Tx? Mutation?

A

polyps at 18, cancer at 28, dead at 38; prophylactic colectomy; APC gene

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50
Q

What medical tx can you offer pts with wilson’s disease? What is affected in Wilsons (3)?

A

penicillamine; 1) basal ganglia - chorea; 2) liver = cirrhosis; 3) eyes: Kayser-Fleischer rings

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51
Q

What’s special about rectal ulcerative colitis?

A

no risk of colon cancer, so doesn’t need the screening colonoscopy or colectomy

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52
Q

How do you dx gastroparesis?

A

gastric emptying study (gt 60% at 2 hrs or gt 10% left at 4 hrs, then test is positive)

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53
Q

How do you tx diabetic gastroparesis?

A

small meals, control sugars, add pro kinetic agents (metoclopramide chronically, erythromycin for flares; domperidone outside of US)

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54
Q

Cirrhosis and COPD, dx?

A

alpha-1 anti-trypsin deficiency

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55
Q

What three cancers are seen with HNPCC/Lynch? What’s the underlying problem?

A

Colorectal, endometrial, ovarian; DNA mismatch repair

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56
Q

When do you get a CT scan in pancreatitis?

A

When you think it’s pancreatitis but the lipase is normal (equivocal)

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57
Q

Transmural tear, mediastinitis, dx?

A

Boerhaave’s

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58
Q

Guy tries to kill himself by drinking battery acid, what do you do?

A

protect airway, EGD (to determine severity), maintain NPO (NEVER neutralize or induce emesis)

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59
Q

What is the tx for regular c. diff? severe c. diff?

A

oral metronidazole; oral vanc + IV metronidazole (attack it from both sides of GI tract - luminal and basolateral)

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60
Q

When do you go to EGD for GERD without alarm symptoms?

A

after 6 wks of PPI without relief

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61
Q

How do you tx severe refractory ulcerative colitis?

A

colectomy

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62
Q

Fatty liver on ultrasound but no alcohol or viral hepatitis, dx?

A

NASH/NAFL (nonalcoholic steatohepatitis/ fatty liver disease)

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63
Q

Paracentesis is done and there are 1000 white cells, 75% polys, what is it?

A

spontaneous bacterial peritonitis

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64
Q

You suspect Boerhaave’s, what’s the first step?

A

Gastrograffin (in other cases its usually barium, but gastrograffin is less irritating to the mediastinum if there is a perforation)

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65
Q

How do you diagnose a carcinoid tumor?

A

5-HIAA in the urine

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66
Q

The question is about jaundice, there is a lot of T bili but very little D bili - what’s the dx?

A

hemolysis or hematoma

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67
Q

Paroxysmal dysphagia to large caliber food, dx? Tx?

A

Schatzki’s ring (ring at GE junction); lysis during EGD (“steakhouse dysphagia”)

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68
Q

How do you localize a gastrinoma?

A

Somatostatin receptor scintillography (SRS)

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69
Q

How do you diagnose acute pancreatitis?

A

Lipase (greater than 3x ULN)

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70
Q

What is the tx for refractory c. diff?

A

fidaxomicin (can also try fecal transplant)

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71
Q

See a picture of someone’s eye and the vignette is about cirrhosis, dx and next step?

A

Wilson’s disease; get a urinary copper

72
Q

Sausage shaped mass and currant jelly diarrhea - dx?

A

intussusception

73
Q

Corkscrew esophagus on barium swallow, dx? How does that pt present?

A

diffuse esophageal spasm; heart attack symptoms that get better with nitro (must r/o ACS first)

74
Q

AIDS and Diarrhea, dx?

A

cryptosporidium (or emoeba hystolica)

75
Q

How do you treat a crohn’s flare?

A

steroids + Abx

76
Q

What is the hep C tx?

A

Direct acting agonists

77
Q

How do you tx spontaneous bacterial peritonitis?

A

ceftriaxone (cover strep and GNR)

78
Q

What vaccinations should a pt with cirrhosis receive?

A

hep A and hep B!

79
Q

Post-prandial LLQ abdominal pain relieved with bowel mvmt in old person? Young person?

A

think diverticular spasm (contractions of diverticula); think IBS

80
Q

What do you do about an anal fissure in a child?

A

Treat constipation if present, check for IBD if older child

81
Q

“Apple-core” lesion on a barium enema - dx?

A

Colon cancer (barium enema is not a screening test for colon cancer - when you find colon cancer it’s already late stage)

82
Q

Multiple shallow gastric ulcers - you’re thinking?

A

NSAIDs (pt with chronic arthritis)

83
Q

LLQ abdominal pain, fever, leukocytosis, greater than 50 yo, dx?

A

diverticulitis

84
Q

Nocturnal asthma w/o daytime asthma, dx?

85
Q

Diverticulitis and CT scan shows an abscess, what do you do next?

A

IV abx and drain

86
Q

What is the first step in the management of GERD?

87
Q

Diabetes, diastolic CHF, hyperpigmentation, and cirrhosis, dx and next step?

A

Hemochromatosis, get a ferritin level

88
Q

Picture of pigmented dots on their lip and vignette is about colon cancer, what’s the dx?

A

Peutz-Jeghers

89
Q

After a diagnosis of achalasia from barium and manometry, what is the next best step?

A

EGD with biopsy to rule out cancer (pseudoachalasia) - looking for absence of myenteric plexus

90
Q

Bloody diarrhea and weight loss in a young man, dx?

A

Ulcerative colitis

91
Q

What are the ultrasound findings for a cholecystitis (3)?

A

1) pericholecystic fluid; 2) thickening of the gallbladder wall; 3) gallstones

92
Q

What gets absorbed in the duodenum? terminal ileum?

A

FIC = folate, iron, calcium; bile salts and B12

93
Q

What would make you work up acute diarrhea and not assume it’s viral (Name 4 of 7)?

A

1) high fever (gt/= 104); 2) blood/pus; 3) electrolyte abnormalities; 4) abx use; 5) duration gt 3 days; 6) immunosuppressed; 7) severe abdominal pain

94
Q

What is the most common cause of diarrhea if no risk factors?

A

viral gastroenteritis

95
Q

Bx of achalasia will show what?

A

Absence of myenteric (Auerbach) plexus

96
Q

Beads on a string on MRCP, dx?

A

Primary sclerosing cholangitis

97
Q

Gnawing epigastric pain that radiates to the back, changes with food, what’s the dx?

A

Peptic ulcer disease

98
Q

Prophylaxis for a stress ulcer for a pt in the ICU on the ventilator?

99
Q

Diarrhea after antibiotic use, dx?

100
Q

Umbilical ecchymosis and pancreatitis, what’s the sign?

A

Cullen’s

101
Q

Bloody diarrhea after uncooked hamburgers, dx?

A

e coli O157:H7

102
Q

RUQ pain, jaundice, and fever is what diagnosis? How do you tx?

A

Charcot’s triad = cholangitis; ERCP emergently and IV Abx (cipro + metronidazole)

103
Q

Best test for celiac sprue?

A

EGD with bx showing blunting of intestinal villi

104
Q

What is the case of cyclic vomiting syndrome?

105
Q

Pt needs NSAIDs, but has ulcers, what are your options?

A

add misoprostol (if cardiac risk) or switch to celecoxib (if no cardiac risk)

106
Q

What antibiotics for ascending cholangitis (2 options)?

A

1) cipro + metronidazole
or
2) amp + gent + metronidazole

107
Q

Document eradication of H pylori with?

A

Stool antigen

108
Q

How do you manage a pancreatic pseudocyst?

A

if less than 6 cm and 6 wks, wait; if greater than 6 cm and 6 weeks, drain

109
Q

Painful RUQ, tenderness, jaundice, dx?

A

Gallstones (specifically choledocolithiasis - stones in the common bile duct)

110
Q

How do you tx candida esophagitis?

A

oral fluconazole (systemic disease! nystatin swish and spit not enough)

111
Q

Diarrhea after a picnic?

A

Staph aureus

112
Q

Multiple, refractory ulcers, H. pylori negative, what’s the dx?

A

Zollinger-Ellison (gastrinoma)

113
Q

Inspiratory arrest on palpation of the gallbladder shows what?

A

Murphy’s sign - positive for cholecystitis

114
Q

There was a GI bleed two weeks ago, both the EGD and colonoscopy were negative, next step?

A

Pill-cam endoscopy

115
Q

If there is no hemolysis, isolated hyperbilirubinemia (unconjugated) may indicate __, which is usually asymptomatic

A

Gilbert syndrome

116
Q

Bx of esophagus reveals 30 eosinophils per high power field, what is the next step?

A

PPI!!! (tx eosinophilic esophagitis as GERD first; if that fails can use oral aerosolized steroids)

117
Q

Painful bloody bowel mvmt in a child, relieved by knee-chest position, dx?

A

intussusception

118
Q

Malabsorption, palpable rash on buttocks and legs, dx?

A

dermatitis herpetiformis - celiacs

119
Q

Clay colored stools, painless jaundice, dx?

A

Cancer or stricture (can get an MRCP = MR cholangiopancreatography)

120
Q

What is seen on bx in pt with alpha-1 anti-trypsin deficiency?

A

PAS+ macrophages

121
Q

There was a GI bleed last week and it stopped, EGD was negative, next step?

A

Colonoscopy

122
Q

Pt with PUD, and gastrin level 700, what do you do next?

A

Secretin stim test (give secretin and an increase in serum gastrin over 200 is diagnostic of ZE gastrinoma); if gastrin were gt 1600 to begin with, you would know it’s a gastrinoma

123
Q

Tx for esophageal dysplasia?

A

ablative therapy

124
Q

Tx for hemochromatosis (before cirrhosis)

A

Phlebotomy or deferoxamine/deferasirox

125
Q

What are colon cancer screening options?

A 
Colonoscopy q10y OR
Flex sigmoidoscopy q5y + FOBT q3y OR
FOBT q1y (FOBT = fecal occult blood testing)
126
Q

What’s the route of transmission for Hep A? Hep B? Hep C?

A

Fecal Oral; vertical (asia), sex (US), drug/needles; blood (IV drugs or blood transfusion)

127
Q

Superficial mucosal tear, self limiting GI bleed, dx?

A

Mallory-Weiss

128
Q

You suspect celiac sprue, what’s the first test?

A

Look for antibodies (anti-TTG or endomysial)

129
Q

Halitosis, old man, regurgitates undigested food, dx? Confirmatory dx test?

A

Zenker’s diverticulum - do a barium swallow

130
Q

What three things should you look for in pt with necrotizing enterocolitis?

A

intraventricular hemorrhage (ultrasound with doppler), retinopathy of prematurity (optho exam); bronchopulmonary dysplasia

131
Q

Flushing, wheezing, diarrhea, and right sided cardiac fibrosis, dx?

A

Carcinoid tumor

132
Q

While waiting for a transplant in pts with primary sclerosing cholangitis, what medical tx can you offer?

A

ursodeoxycholic acid (not for PBC though)

133
Q

40 yo woman with pruritus, dark urine, and an elevated direct bilirubin, without pain, diagnosis?

A

primary biliary cirrhosis

134
Q

Dark urine and pale stools signal a diagnosis of ___.

A

conjugated hyperbilirubinemia

135
Q

How do you tx severe refractory Crohn’s?

136
Q

Flapping tremor, altered mental status, cirrhosis, dx and next step?

A

Hepatic encephalopathy (asterixis) - give lactulose

137
Q

When do you go straight to EGD for GERD without treating?

A

alarm symptoms: n/v, WL, anemia

138
Q

Supraclavicular lymph node, dx?

A

Virchow’s node, gastric cancer

139
Q

How do you diagnose hepatocellular carcinoma?

A

triple phase CT scan (not a bx!)

140
Q

Diarrhea, travel to mexico or caribbean, dx?

141
Q

Never been tx before, dyspepsia, serology H pylori positive, how do you tx?

A

Treat with triple therapy (clarithromycin + amoxicillin + PPI) (MTZ if penicillin allergy)

142
Q

Patient presents with jaundice - what are the three categories of differentials?

A

1) hemolysis; 2) hepatocellular; 3) obstructive jaundice

143
Q

Dysphagia, webs, and iron deficiency anemia, dx?

A

Plummer Vinson syndrome (progresses to esophageal cancer)

144
Q

Bird’s beak on barium swallow, diagnosis?

145
Q

How do you tx pancreatitis?

A

NPO, IVF, pain control

146
Q

What is the best test for diagnosing cirrhosis?

A

Transjugular biopsy

147
Q

Serology associated with primary sclerosing cholangitis?

148
Q

What are the imaging keywords you’re looking for to diagnose necrotizing enterocolitis?

A

pneumatosis intestinalis (air in the wall of the bowel)

149
Q

Colon cancer and jaw bone cancers, dx?

A

Gardner’s

150
Q

How do you confirm the diagnosis of H. pylori (best test)?

A

EGD w/biopsy

151
Q

Old lady on oral antibiotics in a nursing home complains of odonophagia (painful swallowing), what’s the dx?

A

pill-induced esophagitis

152
Q

You see a picture of an electron microscopy on a malabsorption question. What’s the most likely dx?

A

Whipple’s disease (PAS positive organisms)

153
Q

When do you start colon cancer screening for ulcerative colitis?

A

8 years after diagnosis (q1y)

154
Q

HepBsAb means what? HepBcAb means what? HepBsAg means what? HepBeAg means what?

A

Immune; immune through exposure; infected; infectious

155
Q

Salmon colored lesion on endoscopy of the esophagus, dx?

A

Barrett’s

156
Q

Colon cancer and brain tumors, dx?

157
Q

Tx for esophageal adenocarcinoma?

158
Q

How do you tx MALToma?

A

treat H pylori = triple therapy

159
Q

Increased direct bilirubin, black liver, dx?

A

Rotors (Dubin Johnson is similar but no black liver)

160
Q

3 cancers, 2 generations, 1 premature, what’s the dx?

A

HNPCC (Lynch)

161
Q

What is the tx for intussusception?

162
Q

If you wanted to confirm lactase deficiency what would you do?

A

Breath test

163
Q

Skipped lesions and transmural inflammation, noncaseating granulomas, dx?

164
Q

Flank ecchymosis and pancreatitis, sign?

A

Turner sign (Grey-Turner sign - turn on your side/flank)

165
Q

What’s the first step in diagnosing hemochromatosis? What’s the definitive?

A

ferritin gt 1000; liver biopsy shows increased Fe

166
Q

Iron deficiency in a man, diagnosis and next step?

A

colon cancer; start with colonoscopy

167
Q

Name 4 of 7 complications of acute pancreatitis

A

Early (1-3 days): 1) ARDS; 2) hypocalcemia; 3) pleural effusion; 4) ascites
Mid (1-3wks): 5) infxn
Late (3-7wks): 6) abscess; 7) pseudocyst

168
Q

If you suspect lactase deficiency what should you do?

A

eliminate dairy (not breath test)

169
Q

Refractory diverticulitis (more than one episode), what do you do?

A

resection (hemicolectomy)

170
Q

40 yo man with ulcerative colitis and jaundice, what is the most likely dx and how do you diagnose?

A

primary sclerosing cholangitis, get an MRCP (beads on a string appearance) - ERCP with bx would show onion skin fibrosis

171
Q

What antibiotics do you use for diverticulitis?

A

GNR and anaerobe coverage:
cipro + MTZ
amp/gent + MTZ

172
Q

Epigastric pain radiating to the back, better with leaning forward, dx?

A

pancreatitis

173
Q

Diarrhea and camping, dx?

A

campylobacter

174
Q

Iron deficiency in a post menopausal woman, dx and next step?

A

colon cancer, start with colonoscopy

175
Q

Scleroderma causing esophageal dysmotility (collagen replaces muscle so LES cannot contract) - what is tx?

A

PPIs to tx symptoms since no cure (pt will present with relentless GERD)
Also do serology - CREST (anti-centromere) vs SS (anti-Scl-70)

176
Q

Hep B post-exposure prophylaxis? Hep C post-exposure prophylaxis?

A

Hep B IVIg; Interferon

MS3 Year (18 decks)

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