GI Flashcards
1
Q
Cause of whipple disease
A
Tropherima whippeli
2
Q
clue for whipple
A
PAS positive during biopsy
3
Q
Extra intestinal manif of Whipple(2)
A
Polyarthropathy Migratoire
Heart problem–>CHF
4
Q
What can you in late stage of whipple
A
Dementia
5
Q
Clue for Celiac disease
A
Biopsy showing villous atrophy
6
Q
Marker for cealiac disease(2)
A
IGA anti tissue transglutaminase
IGA anti endomysial antibodies
7
Q
What can cause negativity of these markers in case of celiac disease(IGATT)
A
IGA deficiency
8
Q
Other name of cealiac disease
A
celiac sprue
9
Q
in GIT what can happen in celiac sprue
A
Malabsorption
10
Q
Consequences of Malabsorption in celiac sprue(3)
A
Low
Vit D
Vit K
Iron
11
Q
consequence of low vit D in celiac disease
A
hypocalcemia
12
Q
consequence of hypocalcemia and low vit D in celiac disease(3)
A
Osteomalacia
bone pain
fracture
13
Q
consequence of vit A deficiency in adult
A
Hyperkeratosis
14
Q
Low vit K consequence
A
easy bruising
15
Q
Clue for Achalasia
A
dysphagia for solids and liquids
16
Q
Dx of Celiac and whiple
A
intestinal Biopsy
17
Q
workup for achalasia(3)
A
baryum swallow
Manometry
endoscopy
18
Q
finding in Bayum swallow for achalasia
A
bird beak appearance
19
Q
Finding during manometry in Achalasia(3)
A
Elevating resting LES pressure
Incomplete LES relaxation
Absence of peristaltism in the esophageal body
20
Q
why performing endoscopy in achalasia
A
to rule out a cancer in distal esophagus
21
Q
quid of pseudo achalasia
A
cancer in distal esophagus causing achalasia
22
Q
what to thing in achalasia and weight loss
A
cancer de l ‘oesophage
23
Q
when thinking of cancer in achalasia(3)
A
Symptom > 6 months
patient more than 60 years
Weight loss
24
Q
cause of constipation in multiple myeloma
A
Hypercalcemia
25
first thing to do in front of constipation
check calcium
26
Symptoms of hypercalcemia(4)
constipation
increased urination
neurologisc Symptom
renal dysfunction
27
most common complication of gastric ulcer
hemorrage
28
What to do if you suspect abdominal viscus perforation
chest x ray
29
chest x ray in abdominal viscus perforation
free air under the diaphragm
30
high yield question,characteristics of malignancy in polyps(3)
Macro:sessile
Micro:villous type
size:> 2,5 cm
31
Most common non neoplastic polyp in colon?
Hyperplastic
32
polyps in Peutz jeghrer syndrome
hamarthoma
33
quid of shifting phenomenon in acute appendicitis(2)
pain in ombilic
| later pain oin RLQ
34
why shifting phenomenon occurs
visceral pain followed by somatic pain
35
exolanation of shifting phenomenon
Periombilical pain is visceral
| but RLQ pain is somatic
36
what cause somatic pain in RLQ in appendicitis
irritation of parietal peritoneum
37
clue for acute pancreatitis
epigastric pain
worse when standing or lying supine
inproved with sitting up or leaning forward
38
etiology of acute pancreatitis(6)
```
chronic alcoholism
Gallstones
Hyperlipidemia
drugs
infection
trauma
```
39
infection causing acute pancreatitis(3)
CMV
leginella
aspergillus
40
hyperlipidemia causing acute pancreatitis
type 1 ,4 et 5
41
drugs causing acute pancreatitis(3)
dianoxine
azathioprine
acid valproic
42
work up for acute pancreatitis(3)
Amylase and lipase
echo
CT
43
amylase and lipase in acute pancreatitis
3 a 4 fois la normale
44
local complication in acute pancreatitis(4)
pancreatic pseudocyst
pancreatic necrosis (necrotizing)
pancreatic abces
peripancreatic fluid
45
regional complication in acute pancreatitis(2)
ileus
| Gi bleeding
46
A distance complication in acute pancreatitis(3)
ARDS
Left side pleural effusion
acute renal failure
47
clue for duodenal ulcer
pain relieved by eating
48
clue for gastric ulcer
pain worsened by eating
49
surveillance of patient with cirrhosis(2)
upper digestive endoscopy
| sonograhy abdomen
50
when to perform sono abd in cirrhosis surveillance and why(2)
q 6 mois
| to look for hepato cellular carcinoma
51
upper digestive endoscopy in cirrhosis why?
to rule out varices
52
prevention of esophageal varices
non selective B blocker
53
Tetrad of carcinoid syndrome
flushing
diarrhea
wheezing
valvular heart disease
54
cause of carcinoid syndrome
carcinoid tumor
55
localisation of carcinoid tumor(4)
small intestine
appendix
colon
bronchial tubes
56
physiopatho of symptoms in carcinoid tumor
tumor secreting serotonin
57
RX of carcinoid tumor
octreoctide
58
complication of flushing in Carcinoid syndrome (2)
Hypotension
| tachycardia
59
quid of rome 3 criteria
dx IBS(inflammatory bowel syndrome)
60
rome 3 criteria what symptom in center
abdominal cramps
61
rome 3 criteria(5)
```
abdominal cramps
3 days /month
2 month consecutifs and>/ 2 de ces symptomes
-symptoms improved with bowel mvts
-change infrequency of stool
-change in form in stool
```
62
in what situation to not consider IBS(4)
abdominal cramps plus rectal bleeding
" " plus weight loss
" " plus anemia
nocturnal abdominal awakening the patient
63
colonoscopy in IBS
normal colonic mucosae
64
condition for carcinoid tumor to produce serotonin
when tumor has metastasis in liver
65
work up for carcinoid syndrome
5 hydroxy indol acetic in urine and blood
66
quid of 5 HIAA
metabolites of serotonin
67
why liver metastasis produces this syndrome
5 hydroxytryptophan is degraded in the liver to inactivate 5HIAA
68
precursor of serotonin(5 hydrohy tryptamine)
tryptophan
69
role of tryptophan
synthesis of niacin
70
why you have low niacin i carcinoid tumor(2)
tryptophan is used to produce serotonin
| niacin is low produced
71
Niacin deficiancy symptom(4D)
Diarrhea
Dementia
Dermatitis
Death
72
origin of folate
green leafy vegetables and liver meat
73
why cooked food lack folate(toast type diet)
folate is heat sensitive
74
Most common cause of meleana(2)
upper GI bleeding
| lower GI bleeding proximal to the splenic flexure
75
Most common cause of upper GI bleeding
peptic ulcer disease
76
clue for zollinger ellison syndrome(2)
multiple gastric and duodenal ulcer
| fat in stool
77
Why fat in stool in zollinger ellison syndrome
inactivation of pancreatic enzyme by hyper acid production by stomach
78
quid of succusion splash
you place a sthetoscope on upper abdomen and rock the patient back and forth
you will hear a splash
79
interpretation of succusion splash
gastric outlet obstruction
80
what to do in presence of a patient with generalized adenopathy,weihgt loss and diarrhea?
test for HIV
81
differentiate Mono from HIV
no weight loss in Mono
82
characteristic of rash in pellagra
present on sun exposed area
83
cause of Zn deficiency(2)
total parenteral nutrition
| malabsorption
84
clue for ZN deficiency(3)
alopecia
pustulous or bullous lesion periorificial
wound healing impaired
85
lieu of Zn absorption
jejunum
86
cause of pancreatic cholera
VIPOMA
87
pancreatic mass plus watery diarrhea
Vipoma
88
what vipoma secretes
vasoactive intestinal peptide
89
link between Vipoma and an carcinoid syndrome
both can produce flushing
90
more common cause of cirrhosis(4)
Hep B et C
alcoholic liver disease
non alcoholic fatty liver disease
hemochromatosis
91
Less common cause of cirrhosis(7)
```
autoimmune
PBC
PSC in IBD
Alpha 1 antitrypsine
cardiac cirrhosis
medications
wilson disease
```
92
medication causing cirrhosis(2)
metotrexate
| INH
93
most common cause of cirrhosis in US(2)
Hep B and C
| alcohol
94
Marker of PBC
antimitochondrial antibody
95
acute pancreatitis and suspiscion of gallstones
perform US
96
most common cause of acute pancreatitis (2)
alcohol
| gallstones
97
first thing to do in patient with acute pancreatitis
U/S to rule out cholelithiasis and choledocholithiasis
98
first image in pancreatitis
sono abdomen
99
risk # 1 for pancreatitis cancer
chronic pancreatitis
100
the second major risk factor for pancreatic ca(2)
hereditary
| and environmental
101
whta's the major hereditary risk for pancreatic cancer(3)
hereditary pancreatitis
germline mutation
first relative with pancreas cancer
102
germline mutation for hereditary pancreatic cancer(3)
BRCA-1
BRCA-2
Peutz jegher
103
Environmental risk for pancreatic cancer(4)
cigarette
obesity
low exercice
non hereditary pancreatitis
104
epigastric pain and ictere best test to do
U/S to rule out biliairy obstruction
105
epigastric pain and weight loss best test to do
CT abdomen
106
anal fissure treatment
stool softener
| local anesthetic
107
why use local anesthetic in anal fissure
to remove the spasm
108
Patient seen in ED with hypotension and hematemesis(3)
| or any patient received in ED
Airway
Breath
Circulation
109
Patient after several episodes of vomiting develops hematemesis
Malorry weiss syndrome
110
cause of mallory weiss
increased intragastric pressure causes tear in gastric mucosa and distal esophagus
111
what arteries are involved in Mallory weiss
submucosal arteries in proximal stomach and distal esophagus
112
pourcentage of bleeding caused by mallory weiss
10%
113
risk for barret
adenocarcinoma of esophagus
114
type of esophagus cancer in alcohol and smoker
SCC
115
Cause of increased bilirubin mainly conjugated with high ALP(5)
```
PSC
PBC
Choledocholithiasis
pregnancy
cholangiocarcinoma
```
116
work up for increased bilirubin conjugue with high ALP(3)
CT
U/S
Antimitochindrial antibody
117
Approach of hyperbilirubinemia(2)
Conjugue
| non conjugue
118
approach of bilirubin conjugue(3)
know if it's AST ALT ALP normal
Predominance of ALP
Predominance of AST/ALT
119
cause high bilirubin non conjugue
gilbert
hemolysis
reduced uptake
120
cause high bilirubin conjugue with normal everything else(2)
Rotor
| dubin jhonson
121
Cause increased bilirubin conjugue and high AST ALT predominantely(2)
hepatitis
| hemochromatosis
122
cause of Hepatitis(6)
```
viral
ischemic
autoimmune
toxin
drug
alcohol
```
123
chest pain and dysphagia in young girl
spasm diffus de l'oesophage
124
work up for spasm diffus de l'oesophage
eosphagram
| manometry
125
esophagram for spasm diffus de l'oesophage
corkskrew apperance
126
manometry for spasm diffus de l'oesophage
contraction and relaxation of LES
127
RUQ pain after cholecystectomy
post cholecystectomy syndrome
128
cause of post cholecystectomy syndrome(2)
biliairy
| extra biliairy
129
biliary cause of post cholecystectomy syndrome(2)
cystic duct stone
| common bile duct retained
130
extra biliary cause of post cholecystectomy syndrome(2)
pancreatitis
| PUD
131
Dx of post cholecystectomy syndrome
ERCP
| MRCP(Magnetic resonnance cholangiopancreatography)
132
what the two main things to look pseudomembranous colitis
WBC
| Creatine level
133
CAT si WBC< 1500 0and creat< 1,5 fois baseline
Metronidazole
134
CAT si WBC> 15000 and creat> 1,5 fois baseline
oral vancomycin
135
CAT si WBC> 15000 and creat> 1,5 fois baseline plus ileus
oral vancomycin plus IV metro
| or rectal vancomycin switch)
136
CAT si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2
surgery
137
surgery for pseudomembranous colitis
si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2
138
type de surgery in pseudomembranous colitis
subtotal colectomy
| diverting loop ileostomy with colonic lavage
139
antibiotic most commonly involved in pseudomembranous colitis(4)
clindamycin
quinolone
penicilin
cephalosporin
140
confirmatory dx fror pseudomembranous colitis
Cdif toxin by PCR
141
indication of fidaxomycin in pseudomembranous colitis(2)
reccurent colitis
| sevfer colitis not able to tolerate oral vancomycin
142
microcytic anemia first cause
GI blood loss
143
work up GI in microcytic anemia(2)
endoscopy
| colonoscopy
144
in the work up of microcytic anemia what to do if endoscopy and colonoscopy are negative
capsule endoscopy to look small intestine
145
MEN 1
3 tumors
gastrinoma
2 adenomas(pituitaire and parathyroid)
146
MEN 2a
2 tumors
parathyroid hyperplasia
Pheo
Medullary thyroid cancer
147
clue for diarhhea cused cryptosporidium parvum(3)
HIV
low CD4
modified acid stain (oocyst)
148
acid fact stain plus oocyst
isospora belly
149
epidemio of isospora
no isospora is US
150
4 reasons to ask endoscopy in GERD(4)
> 50 ans
Symptoms> 5 ans
signes de danger
facteur de risque de ca
151
singnesd e danger dans GERD(5)
```
Persisting vomiting
digestive hemorrage
anemia
perte de poids
odynophagia and dysphagia
```
152
how's platelet in in chron
reactive thrombocytosis
153
Hallmark of chron(2)
involvement mouth to anus
| fistula
154
Clue for chron(4)
chronic diarrhea
with abd pain and
weight loss in
young patient
155
Back pain and anemia in patient on warfarin
spontaneous retroperitoneal hematoma
156
epigastric pain cause(4)
MI
PUD
cholecystitis
Aortic dissection
157
epigastric pain with irradiation in both arms
infero post MI
158
Management of asymptomatic diverticulosis
high fiber intake
159
how constipation causes diverticuli
Increase presure in colon creates weak spots
160
quid of diverticuli
saclike protrusion of colonic wall
161
dysphagia for both solids and liquids
motility problem
162
Dysphagia for solids first then for liquids(2)
ca oesophage
| stricture
163
best test for in case of dysphagia
baryum esophagram
164
if baryum esophagram is not conclusive next step in case of dysphagia
upper GI endoscopy
165
Ascites with fever and neurologic symptom(confusion and lethargy)
spontaneous bacterial infection(peritonitis)
166
criteria of SBP
> 250 WBC in fluid ascites
167
Important test for SBP DX
Paracenthesis
168
bugs causing SBP(2)
klebsiella
| E coli
169
Rx of SBP
3 e generation cephalosporin
170
massive GI bleeding by cirrhosis RX first
ABC de l'urgence
| octreoctide
171
Massive hemorrage with depressed consciousness
Intubation is indicated
172
indication of platelet transfusion in GI bleeding caused by cirrhosis
platelet<50 000
173
how to stop hemorrage in cirrhosis(2)
band ligation
| or sclerotherapy
174
patient returning from mexico develops foul smelling diarrhea
giardiasis
175
zone in the US with giardiasis
rocky mountains
176
rx of giardiasis
Metronidazole
177
how giardiasis causes digestive problem
by adhering to mucosal surface by adhesive disks causing malabsorption
178
3 types of polyps(3)
hyperplastic
adenoma
hamartoma
179
pill esophagitis (3)
koh
quinidine
iron
180
antibio causing esophagitis
cycline
181
nsaids causing esophagitis
all NSAIDS
182
biphosphonate and pill esophagitis
alendronate
183
colonic angyodysplasia
painless GI bleeding
| plus aortic stenosis
184
Quid of Heyde's syndrome
painless GI bleeding
| plus aortic stenosis
185
why GI bleeding in Heyde's syndrome
Because of AV malformation
186
management of non bleeding cirrhosis
non selective B blocker
187
non selective b blocker used in non bleeding cirrhosis
propranolol
| nadolol
188
mangement of non bleeding cirrhosis if B blocker is contreindicated
primary preventive band ligation
189
how BB prevents bleeding in cirrhosis
decreased portal flow
190
GI bleeding with anemia
packed red blood cell
191
condition of packed red blood cell in anemia
Hb< 7
| Hb< 9 symptomatic or active acute coronary syndrome
192
quid of speed ball
cocaine and heroin use
193
risk of speed ball use
rhabdomyolysis
194
vaccin a donner in IV drud user
Hep B vaccine
195
cause of hypotension in severe pancreatitis(Necrotizing pancreatitis)
increased capillary permeability
196
quid of severe pancreatitis
pancreatitis plus at least one organ failure
197
cullen sign
periumbilical bluish discoloration
198
Meaning of cullen sign
hemoperitoneum(pancreatitis)
199
grey turner sign
reddish discoloration in flank
200
Meaning of grey turner sign
retroperitoneum(pancreatitis)
201
risk factor for severe pancreatitis
```
age > 75 ans
obesity
alcohol
CRP>150
Increase BUN
ARDS
```
202
rx of acute pancreatitis(3)
fluid
pain control
bowel rest
203
aspirin and GI bleeding
acute erosive gastritis
204
mechanism of action of aspirin
block cyclooxygenase pathway---> no prostaglandin
205
role of prostaglandine
effect protecteur sur la muqueuse gastrique
206
rx of acsites(4)
```
sodium and water restriction
spironolcatone
loop diuretic(1 l/day of diuresis)
frequent abdominal paracenthesis(2-4 l if renal perfusion is OK)
```
207
water restriction in cirrhosis
< 2 L day
208
warning with diuretic in cirrhosis(spirono and furosemide)
agressive diuresis
| can cause hepato renal syndrome
209
iron deficiency anemia in patient taking NSAIDS
GI bleeding
210
ca associated with hemochromatosis
hepatocellular carcinoma
211
what are the 3 mutations associated with Hemochromatosis(3)
HFE
L2824
H63D
212
cause of bacterial overgrowth(3)
motility problem
strictures in GI
other causes
213
motility problem causing overgrowth bacterial(2)
sclerodermia
| diabetes
214
other causes of bacterial overgrowth(4)
end stage renal disease
cirrhosis
AIDS
advanced age
215
gold standard to Dx bacterial overgrowth
endoscopy with aspiration in jejunum
216
finding in endoscopy in jejunum aspiration in bacterial overgrowth
bacteria>10exposant 5 bact /ml
217
bacteria causing bacterial overgrowth(4)
E coli
lactobacillus
bacteroides
streptococci
218
manif of bacterial overgrowth
chronic diarrhea
219
Rx of bacterial overgrowth(2)
augmentin
| or rifamixin pdt 7 a 10 jours
220
cause of mesenteric ischemia(abdominal angina)(2)
atherosclerosis
| occlusion of visceral arteries
221
clue for mesenteric ishemia
severe abdominal pain after eating
222
Dx of abdominal angina(2)
Doppler abdomen
or
angiography
223
pain with foof d Dx(2)
PUD
| abdominal angina
224
auscultation clue for abdominal angina
50 % des cas
| abdominal bruit
225
similitude between Chron and TB
both have granuloma
226
characteristic of chron
```
transmural lesion
skip lesions
creeping fat appearrance
fistula/fissure
perianal disease
mouth to anus
```
227
why fistula in chron
transmural lesion
228
disease with granuloma(4)
TB
Chron
sarcoidosis
yersinia infection
229
initial bleeding management caused by varices(3)
fluid
octreoctide IV
sclerotherapy or band ligation
230
quid of octreoctide
somatostatin analog
231
next step in managing bleeding varices if success in initial step(2)
Bblocker
| repeat endoscopic band ligation in 2 a 3 weeks
232
failure of initial management of varices
ballon tamponnade
or
TIPS or shunt surgery
233
TIPS
transjugular intrahepatic portosystemic shunt
234
if rebleeding after initial management next step(2)
try endoscopic rx
or
TIPS/Shunt surgery
235
tube used in ballon tamponade(3)
sengstaken blackmore
Minessota
linton nachlas
236
type of problem in zencker
motor dysfunction and incoordination
237
rx of zencker
crycopharyngeal myotomy
238
localisation of zencker
above upper esophageal sphincter
239
quid of zencker
posterior herniation through the fibers of cricopharyngeal muscles
240
what cause the herniation in zencker
incoordination between the contraction of pharynx and contraction of upper esophageal sphincter
241
complication of zencker(4)
trachea compression
aspiration pneumonia
erosion and bleeding
regurgitation
242
indication of H pylory
< 55
| no alarm symptom
243
indication of endoscopy in dyspepsia(2)
>55 ans with new dyspepsia
| any age with alarm symptom
244
quid of dyspepsia(3)
epigastric pain
bloating
early satiety
245
patient with dyspepsia,no alarm symptom an less 55 ans with negative H pylori
PPI for 4 a 8 semaines
246
cause of dyspepsia(5)
```
GERD
AINS
PUD
Malignancy
functionnal dyspepsia
```
247
workup for zollinger ellisson syndrome
gastrin level >1000 pg /ml
248
workup for zollinger ellisson syndrome gastrin test inconclusive next step
secretin stimulation test
249
biopsy finding in UC
neutrophylic cryptitis
250
patient after coronary bypass develops abdominal pain and bloody diarrhea
Ischemis colitis
251
why lactate is high in ischemic colitis
because of ischemia
252
what area is most commonly involved in ischemic colitis and why
-splenic flexure
rectosigmoid junction
vascularisation by ended artery
253
vascularisation of splenic flexure
narrow terminal branches of superior mesenteric artery
254
vascularisation of rectosigmoid junction
narrow terminal branches of inferior mesenteric artery
255
cause of ischemic colitis during coronary bypass (any surgery)
hypotension
256
watershed area involved in ischemic colitis
-splenic flexure
| rectosigmoid junction
257
lactose intolerance workup(4)
H+ breath test
Low stool PH
high osmotic gap
osmotic substances in stools
258
quid of high osmotic gap
> 50
259
clue in lactose intolerance
no steatorrhea
260
quid of bright red blood cell per rectum(2)
scant hematochezia
| minimal scant bleeding
261
Cause of red blood cell per rectum(4)
hemorroides
fissures
proctitis
rectal ulcer or Ca
262
Best test in red blood cell per rectum(2)
anoscopy
| proctoscopy
263
quid of SAAG(2)
serum ascites albumin gradient
| Albumin serum- albumin ascites
264
Value of SAAG in ascites caused by SBP
>1,1
265
Importance of SAAG
>/1,1 ascites is caused portal hypertension
266
spontaneous bacterial infection of ascites(3)
Hypotension
hypothermia
ileus
267
Dx of SBP
SAAG > 1,1
| Albumin ascites< 1
268
when to avoid quinolones in SBP
patient already receives it for SBP prophylaxis
269
first step in the workup of acute pancreatitis
amylase
| lipase
270
what are the main criteria to Dx acute pancreatitis
epigastric pain radiating in the back
amylase and lipase >3 f la normale
CT or U/S
271
U/S of acute pancreatitis
hypoechoic image
272
the most useful blood test in acute pancreatitis
Lipase
273
why lipase is most useful blood test in acute pancreatitis
rises in 4-8 h
| stay up 8-14 jours
274
what about amylase
rises in 6-12h
| apres 5 jours disparait
275
patient with acute pancreatitis with amylase and lipase increases 3 f la normale
ni image is needed for the Dx of acute pancreatitis
276
when to do CT in acute pancreatitis
Dx is unclear
| failure of treatment
277
chronic pancreatitis workup(2)
plain film
| CT of abdomen
278
image in Plain film or CT of abdomen for chronic pancreatitis
calcification
279
cause of chronic pancreatitis(3)
alcohol
autoimmune
cystic fibrosis
280
symptom of chronic pancreatitis(4)
Diabetes
weight loss
malabsorption
epigastric pain
281
Rx of chronic pancreatitis(4)
Pain management
stop smoking
enzyme replacement
frequent small meals
282
clue for inflammatory diarrhea(5)
```
anemie
High ESR
Acute phase reactant
thrombocytosis
blood in stool or leucocyte
```
283
what to think in chronic inflammatory diarhhea
IBD
284
characteristics of fat malabsorption(3)
foul smelling diarrhea
difficult to flush
floating diarrhea
285
3 main problem causing steatorrhee(3)
pancreatic insufficiency
bile salt related
impaired intestinal surface epithelium
286
2 causes of pancreatic insufficiency
chronic pancreatitis
| ca pancreatic
287
What can impair epithelium intestinal surface(3)
AIDS
celiac disease
giardiasis
288
problem with bile salt
foie
| ileon
289
Hepatic problem related to malabsorption(2)
PBC
| PSC
290
iIeal problem related to malabsorption(3)
cron
bacterial overgrowth
surgical resectionof ileon
291
other causes related to malabsorption(3)
whipple
ZES
Medication induced
292
Dx test for steatorrhea
sudan stain
293
clue for diverticulitis(3)
LLQ pain
fever
elderly
294
Diverticulitis rebelle aux antibiotiques DX(3)
complication
abcess
fistula
perforation
295
best test yto evaluate complication in diverticulitis
CT scan of abdomen
296
patient with barret and Heartburn 3 weeks later without Rx no more heart burn Dx?
benign peptic strictures
297
What to do in peptic benign strictures and why(2)
biopsy
| to ruleout adenocarcinoma
298
quid of barret
intestinal metaplasuia of lower esophagus
299
cause of peptic strictures(4)
GERD
Scleroderma
radiation
caustic ingestion
300
clue for abdominal herpes pain
immunocompromised patient
| develops abdominal pain elicits by light touch of abdomen
301
what will appear in 1 week in this patient with abdominal herpes
skin lesion
302
what appear first in herpes
the local pain
303
Pain and rash in herpes(2)
pain can precede rash
or
both can appear simultaneously
304
in manometry record how appears a contraction of esophagus
positive deflection
305
in manometry record how appears a relaxation of esophagus
negative deflection
306
next if ca gastric is detected
CT extent evaluation
307
UC with high ALP
PSC
308
what test to do in UC
sigmoidoscopy
309
sigmoidoscopy finding in UC(2)
Mild erythema
| mucosal inflammation
310
complication of UC(2)
colorectal cancer
| toxic megacolon
311
extraintestinal manif of UC(4)
PCS
uveitis
eryhtema nodosum
spondyloarthropathy
312
patietnn with multiple thrombophlebitis
check a cancer
313
why cancer can cause thrombophlebitis
Hypercoagulability
314
clue for factitious diarrhea
laxative abuse
315
confirmatory Dx of factitious diarrhea
biopsy
316
biopsy of factitious diarrhea
dark brown discoloration with lymph follicles shining through as a pale pathes(melanosis coli)
317
laxative causing melanosis coli
antraquinone containing laxative
318
antraquinone containing laxative
bisacodyl
319
Dx of zencker
contrast esophagram
320
Complication of PSC(5)
```
cholelthiasis
cholestasis
cholangiocarcinoma
colon ca
biliary stricture intra et extra hepatique
```
321
epigastric pain and weight loss
ca pancreas
322
Dx test for ca pancreas
CT abdomen
323
why patient on total parenteral nutrition develops gallstones
gallbladder stasis
324
why gallbladder stasis in total parenteral nutrition
because no food in duodenum to cause activate release of cholecystokinine
325
role of cholecystokinine
contraction of gallbladder
326
why ileal resection causes gallstones(3)
because of decreased enterohepatic cycle
hepatic bile is oversaturated with cholesterol
gallstone formation
327
why megaloblastic anemia in tropical sprue
B12-folic acid deficiency
328
dx of tropical sprue
blunting villi
| chronic infiltrationof inflammatory cells(Lymphs,plasma cells,eosinophils)
329
important feature of tropical sprue
malabsorption
330
why in GI bleeding causes high BUN
bacteria in gut degraded hb en Urea
331
cause of BUN elevation with normal creat(3)
GI bleeding
prerenal azotemia
systemic steroids
332
major side effect of digoxin toxicity
anorexia
333
drug that can increase the level of digoxin
verapamil
| furosemide
334
why verapamil causes increase level of digoxin
by decrease the renal clearance of digoxin
335
why furosemide causes increase level of digoxin
by causing hypokaliemia
336
cardiac problem in digoxin toxicity(2)
bidirectionnal ventricular tachycardia
| accelarated junctionnal rythm
337
most common side effect of digoxin toxicity(3)
GI problem
anorexia
nausea
vomiting
338
medication for seizure causing pancreatitis
acid valproic
339
anti hta causing pancreatitis(2)
furosemide
| thiazides
340
drugs used in IBD causing pancreatitis
sulfasalazine
| 5-ASA
341
immunosuppresor causing pancreatitis(2)
azathioprine
| L asparaginase
342
patient with HIV with pancreatitis(2)
didanosine
| pentamidine
343
Antibio involved in pancreatitis
metronidazloe
| 4 cycline
344
cause of renal failure in hepato renal syndrome
renal hypoperfusion
345
rx of hepatorenal syndrome
octreoctide
or
Midodrine
346
prerenal failure
urine Na+ less than 10meq/L
347
clue for intestinal occlusion(2)
vomiting
| not passed gas
348
Dx of intestinal occlusion(2)
plain film of abdomen
| multiple air fluid
349
rx for intestinal occlusion
surgery
350
cause of toxic megacolon(5)
```
UC
ischemic colitis
volvulus
diverticulus
obstructive cancer
```
351
LLQ pain(2)
diverticulitis
| complicated Ca
352
localisation of celiac sprue
proximal intestine
353
test for diagnosing celiac sprue
D xylose test
354
D xylose test(3)
ingestion of D xylose
intact intestinal mucosa
urinary excretion 4,5-7,5g
355
absent peristaltic waves and low LES tone
scleroderma
356
UC plus fever Dx
rule out toxic megacolon
357
chronic bloody diarrhea
UC
358
Major criteria of Megacolon(4)
fever
HR>120
Neutrophilic leucocytes>10500
anemia
359
Minor criteria(4)
hypotension
electrolytes disturbances
altered sensorium
volume depletion
360
Dx of megacolon(2)
3 criteres major
| plus one minor criteria
361
dx diffuse spasm of esophagus
manometry
362
clue for diffuse spasm of esophagus
retrosternal spasm
| exacerbated by sttress and cold food
363
drug used in diffuse spasm
nitroglycerin
364
EKG in diffuse spasm of esophagus
normal
365
quid of angiodysplasia(2)
dialted
| ectatic thin walled vessels lined by endothelium
366
disease with angyodysplasia(2)
end stage renal disease
| aortic stenosis
367
cardiac problem in whipple disease(2)
CHF
| valvular regurgitation
368
why many people with celiac disease has IDA antibody negative
because they have selective IGA deficiency
369
role of endoscopy in achalasia
to rule out ca du bas oesophage
370
quid of bird beak appearance
dilated esophagus with distal narrowing
371
level of calcemia to have constipation
> 12
372
severe epigastric pain spreadind all over the abdomen
chemical peritonitis due to perforated ulcer
373
quid of polyps
adenoma
374
condition of adenomas to become cancer(3)
villous
sessile
> 2,5 cm
375
CT of acute pancreatitis
focal or diffuse pancreatic enlargement with heterogenous enhancement
376
epigastric pain with high amylase and lipase and ALT>150 units/l
biliairy pancreatitis
377
3 types of IBS
constipation predominant
diarhhea predominat
Mixed
378
cause of pellagra
deficiency of NIACIN
379
patient with cirrhosis and smooth muscle antibody microsomal type 1 positive cause?
autoimmune
380
disease associated with autoimmune cirrhosis
thyroiditis
381
hows pancreatic hormone in chronic pancreatitis
Normal
382
post cholecystectomy syndrome work up(3)
abdomen U/S
ERCP
MRCP
383
Dx of C difficile
stool studies
384
microcytic anemia in elderly
FOBT
| colonoscopy
385
meaning of negative FOBT in microcytic anemia(2)
cant't exclude GI blood loss with one FOBT negatif
| perform colonoscopy
386
what to do in any patient with acute abdominal pain
rule out MI with EKG
387
chron granuloma
non caseating
388
DX of ZES
fasting gastrin level
389
cobble stone appearance
chron
390
neutrophilic abcess
crhon
| UC
391
confirmatory DX of SBP(2)
Neutro >250micro/l
| positive peritoneal fluid culture
392
post ERCP patient develops epigastric pain
iatrogenic acute pancreatitis
393
most common cause of malabsorption
alcoholic chronic pancreatitis
394
complication of UC requiring surveillance
colon carcinoma
395
Quid of PSC
stricture of medium sized and large intrahepatic and extra hepatic bile ducts
396
most common consistent reversible risk factor of pancreatic cancer
smoking
397
charateristic finding in imaging in pancreas ca (tete pancreas)
intra and extra hepatic biliairy tract dilation
398
what will increase during GI bleeding
BUN/Creat ratio
399
patient with UC develops fever weight loss and colonic dilation abdominal xray
toxic megacolon
400
management of toxic megacolon(3)
IV steroids
Fluid management
nasogastric decompression
401
Dx test for diverticulitis
ct scan of abdomen
