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Step 2 CK > GI > Flashcards

GI Flashcards

1
Q

What diagnoses require manometry for most accurate test?

A

Achalasia

Diffuse esophageal spasm

Nutcracker esophagus

Scleroderma (immobile esophagus- presents like reflux)

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2
Q

When should you suspect esophageal cancer and what do you do?

A

PROGRESSIVE dysphasia (solids then liquids)

Can only officially dx w/ biopsy (may do initial barium swallow)

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3
Q

AIDS pt w/ odynophagia

A

Suspect esophageal candida and treat empirically with oral fluconazole

If no improvement then endoscopy w/ biopsy

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4
Q

How do you diagnose Zenker diverticulum?

A

Barium study

No endoscopy or NG tube - PERFORATION RISK

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5
Q

Barrett Esophagus Mgt

A

Endoscopy after 5-10 yrs GERD sx

If just metaplasia … PPI + re-scope 2-3 yrs

If low grade dysplasia … PPI + re-scope 6-12 mo

If high grade dysplasia … ablation, resection w/ scope

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6
Q

4 times to use stress ulcer ppx

A

1- mechanical ventilation

2- burns

3- head trauma

4- coagulopathy

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7
Q

H pylori Tx

A

PPI + clarithromycin + amoxicillin

If do not respond …add metro or tetracycline

If PCN allergy … clarithromycin + metro

Can add bismuth to aid in resolution

**test 30-60 days for eradication confirmation (stool antigen or breath test)

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8
Q

Gastrinoma

A

1-2 cm mass normally in distal duodenum

High gastrin levels (esp despite secretin injection)

Sx = persistent ulcers despite h pylori eradication, diarrhea

Look for high Ca++ (MEN)

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9
Q

1st steps in upper GI bleed?

A

ABCs - bolus of normal saline (BEFORE DIAGNOSIS)

1- normal saline

2- packed RBCs if HCT low

3- FFP if high PT/INR

4- Platelets if < 50,000 while bleeding

5- Octreotide if vatical

6- scopes, PPI, surgery ?

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10
Q

1 Cause Upper GI Bleed & Lower GI Bleed

A

Upper = PUD

Lower = diverticulosis

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11
Q

Tx of Varices

A

ABCs - fluid resuscitation

Octreotide

Propranolol for long-term mgt to prevent later episodes of bleeding

Abx for SBP ppx (ceftriaxone because E coli)

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12
Q

Tx of C diff

A

ORAL VANCO (not metro)

If no response –> fidaxomicin

If multiple recurrences –> fecal transplant

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13
Q

Sx Dx and Tx of Whipple’s Disease

A

Diarrhea

Arthralgia

Dementia

Sz

Fever

lymphadenopathy

ocular findings

Dx = must get biopsy with scope

Tx = ceftriaxone then bactrim

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14
Q

Carcinoid Syndrome

A

Flushing, wheezing, intermittent diarrhea, R side cardiac problems

5-IHAA in urine

Tx = octreotide

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15
Q

Tx of SIBO

A

Rifaximin

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16
Q

Colon Cx Screening (Normal and special populations)

A

Normal = 50 yo then q 10 yrs (if have polyp then q 3-5 yrs)

Family hx? Then 10 yrs before that relative diagnosed OR 40 yo

HNPCC - 25 yo q 1-2 yrs

FAP = every yr from age 12

Juvenile polyposis = start at age 12

Gardner = sigmoidoscopy at age 12 (teeth, osteomas, soft tissue tumors)

Peutz-Jegher = at age 8 q 3 yrs (melanotic spots on lips and skin)

17
Q

SAAG

A

SAAG < 1.1 - infection, nephrotic, cx

SAAG > 1.1 - portal HTN, hepatic vein thrombosis, constrictive pericarditis, CHF (high protein)

18
Q

Hep B Tx (which one for pregnancy?)

A

MONOTHERAPY

  • adefovir
  • entecavir
  • tenofovir (PREG)
  • Interferon alpha
  • lamivudine
  • telbivudine
19
Q

Hep C Tx

What predicts response to tx?

How do you measure response to tx?

A

Combo agents dep on genotype (Sofosbuvir, etc)

  • genotype predicts
  • Meas viral PCR for response
20
Q

What tells you the extent of liver damage in Hep C?

A

Liver biopsy

21
Q

Wilson Disease - how does it present? What is the most accurate diagnostic test? Tx?

A

Sx - psychosis, tremor, sz, ataxia, dysarthria, coombs neg hemolytic anemia, RTA or stones

Kayser-Fleischer rings (brown) - slit lamp

Most accurate = inc copper excretion in urine after administration of penicillamine

Tx = penicillamine, zinc, trientine

22
Q

4 Components of MELD Score

A

Age

Cr

INR

Bilirubin

23
Q

Focal Nodular Hyperplasia in Liver

A

Benign

Stellate star scarring in center (vessel)

No tx

24
Q

Hepatic Adenoma

A

Grows w/ estrogen (preg)

May rupture

Small malignant potential

25
Q

Hepatic Hemangioma

A

US, CT, MRI

Rarely cause RUQ pain

If < 5 cm - no tx

26
Q

How does diffuse esophageal spasm present?

A

Chest or epigastric pain NOT with exertion that improves w/ Ca channel blockers or nitrates (CONFUSED W/ ATYPICAL CP)

Can be precipitated by drinking cold liquids

Think of it as similar to Prinzmantel angina

Normal ECG, stress, esophagram, endoscopy

27
Q

Acute Hep B Serology

A

Order HB surface antigen (HBsAg)

Order HB core IgM (HBC IgM)

First thing to appear in serum is HB surface antigen –> HB surface antibody (there is a window period in between this transition when only core IgM is present)

28
Q

Microscopic Colitis

A

Watery, non-bloody diarrhea

Triggers - smoking, PPIs, SSRIs, NSAIDs, ranitidine

Biopsy - lymphocytic invasion in lamina propria

Tx - stop trigger, +/- budenoside and loperamide for symptomatic relief

Esp in women > 60 yo

Step 2 CK (28 decks)

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