GI

Question 1

Big picture, what is the patho of GERD?

Answer 1

LES is weak, acid refluxes and burns the esophageal mucosa causing esophagitis

Question 2

2 things that make GERD worse and better?

Answer 2

Burning chest pain that is made worse by laying down and Spicy foods
Made better by sitting up and antacids

Question 3

What is a presenting sign that will be important for the exam that he mentioned for GERD?

Answer 3

Nocturnal asthma

Question 4

Best way to diagnose/treat GERD initially?

Answer 4

PPI and lifestyle modifications for 6 weeks

Question 5

Best way to confirm diagnosing GERD?

Answer 5

Endoscopy and 24 hour pH monitoring

Question 6

Talk through the decision/treatment ladder for GERD?

Answer 6

Pt presents with GERD and give PPI and lifestyle mods for 6 weeks. If it improves, great, keep on low dose PPI. If not, endoscopy with biopsy which will show GERD, metaplasia, dyplasia, adenocarcinoma and resection.

Question 7

How to treat metaplasia and dysplasia?

Answer 7

High dose PPI for meta

Local ablation for dysplasia

Question 8

age group most commonly affected by Ulcerative Colitis?

Answer 8

20-30 and females more common

Question 9

3 associations with UC?

Answer 9

PSC, p ANCA and increased risk for colon cancer

Question 10

When to do colonoscopy for people diagnosed with UC?

Answer 10

At year 8 and every year thereafter

Question 11

Compare diarrhea in Crohns vs UC?

Answer 11

UC: bloody
Crohns: watery with weight loss and deficiencies

Question 12

How to treat IBD?
Mild?
Moderate?
Severe for both?
Flare ups?

Answer 12

5 ASA compounds (better for UC)
Immune modulators (both UC and Crohns)( 6 mercapto)
TNF inhibitors (infliximab) for Crohns and surgery for UC
Steroids and antibiotics

Question 13

How do we define acute and chronic diarhrea?

Answer 13

Acute is less than 2 weeks

Chronic is over 4 weeks

Question 14

What are the three most common types of chronic diarrhea?

Answer 14

Secretory, osmotic and inflammatory

Question 15

Two main identifiers of secretory chronic diarrhea?

Answer 15

Don’t have to change diet and there are night symptoms of diarrhea. This is watery diarrhea

Question 16

4 things to remember about osmotic diarrhea?

Answer 16

Osmotic gap is higher
Don’t eat the thing that is causing it
No symptoms at night
May be fat in poop if you have a malabsorption problem

Question 17

What do we find in inflammatory diarrhea?

Answer 17

RBCs, WBCs, mucus

Question 18

How do we calculate stool osmolar gap and what numbers mean secretory and osmotic?

Answer 18

Measured osmolars - calculated osmolars
290 - 2 (sodium and potassium)
Less than 50 is secretory over 100 osmotic

Question 19

When a pt presents with chronic diarrhea, what are 5 usual suspects to rule out first?

Answer 19

Laxative abuse, meds, lactose intolerance, c diff, celiac sprue

Question 20

Once the usuals are checked off, what tests do we need to do?

Answer 20

Fecal blood test, stool osmolar, and fecal fat.

Question 21

What test to do if you are thinking secretory?

Answer 21

Hormones to check vipoma, endoscopy and biopsy, and c diff

Question 22

What test to do if you are thinking inflammatory?

Answer 22

Colonoscopy

Question 23

Secretory diarrhea + pancreatic mass equals what and how do you diagnose and treat?

Answer 23

VIPOMA

Get a vip level and resection

Question 24

Flushing diarrhea and liver mass equals what and how do we diagnose and treat?

Answer 24

Carcinoid tumor that has spread to liver.
5HiAA urine
Resection

Question 25

Two most common causes of urethritis?
Big time clinical identifier?
Treatment?

Answer 25

Chlamydia and gonorrhea
Discharge/tenderness
Ceftriaxone plus azithromycin (doxy if cant be used)

Question 26

What are the 4 P’s of complicated pyelonephritis?

Answer 26

Penis, plastic, procedure, Pyelonephritis

Question 27

As we move up the urinary tract, what are the 4 main infections we are dealing with and how many days do we treat each one?

Answer 27

Urethritis
Cystitis (complicated 7 days, uncomplicated 3 days)
Pyelonephritis is 10 days
Perinephri abscess 14 days

Question 28

What are the two most common tests for UTI and what two tests to do if things are getting out of hand?

Answer 28

UA and Urine culture

CT and US

Question 29

3 things on UA for infection?

Answer 29

Leukocyte esterase
Nitrites
More than 10 WBCs per HPF

Question 30

Most common pt that presents with UTI?

Answer 30

18-25 female sexually active

Question 31

How do you treat asymptomatic bacteriuria in pregnant lady?

Answer 31

Amoxicillin first line

If penicillin allergy, give nitrofurantoin

Question 32

4 pathogens causing UTI?

Answer 32

E. coli, staph sapro, klebsiella, and proteus

Question 33

How to diagnose cystitis?

Top 3 drugs for it?

Answer 33

UA
TMP-SMX
Nitro
Fosfomycin

Question 34

Big difference between pyelonephritis and cystitis in patient presentation?
UA identifier for pyelonephritis?

Answer 34

Still have burning, frequency, urgency but not have systemic symptoms like fever, chills and CVA tenderness

White blood cell casts

Question 35

How to treat admission pyelonephritis and how to treat ambulatory pyelonephritis?

Answer 35

Ceftriaxone

Cipro

Question 36

How to treat just chlamydia?

Answer 36

Azithromycin

Question 37

What is the context where we see perinephric abscess?
How do you diagnose?
How do you treat?

Answer 37

Pyelonephritis with abx not getting better?
CT
incision and drainage, 14 days of abx