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USMLE STEP 2 CK RETAKE > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

Cholelithiasis Hx, Dx, Tx

A 
Hx: Fat, Female, Forty 
Colicky Abdominal pain, RUQ 
Radiates to the shoulder 
Worse with fatty foods 
Dx-RUQ US shows gallstones 
Tx: Elective cholecytectomy 
Ursodeoxycholic acid
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2
Q

Cholecystitis Hx

A

Obstruction of the cystic duct
Hx- Constant Pain
Positive murphys sign
Mild Fever

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3
Q

Cholecystitis Dx Workup and findings

A

Dx- RUQ US
Pericholecystic fluid with thickened gallbladder wall
HIDA Scan shows perfusion

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4
Q

Cholecystitis Tx

A

NPO
IV Fluids
IV ABx
Cholecystectomy (Urgent)

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5
Q

Choledocholithiasis Hx

A

Gallstones in CBD
Possible hepatitis and pancreatitis
Hx: Painful jaundice, positive murphy sign
fever leukocytosis

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6
Q

Choledocholithiasis Dx Workup and findings

A

RUQ US- obstruction with dilated ducts
MRCP
Elevated AST, ALT, AMylase, Lipase

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7
Q

Choledocholithiasis Tx

A

ERCP (urgent)
Cholecystectomy Electively
NPO, IV Fluids, Abx

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8
Q

Cholangitis Charcot’s Triad

A

RUQ pain
Jaundice
Fever

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9
Q

Cholangitis Reynolds Pentad

A 
Hypotension 
AMS 
RUQ Pain 
Jaundice
Fever
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10
Q

Cholangitis Description

A

Gall stone in the CBD plus an infection

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11
Q

Cholangitis Dx, Tx

A

Dx- RUQ US shows dilated ducts
Tx: ERCP Emergently
IV fluids, NPO, Abx
Cholecystectomy Urgently

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12
Q

What antibiotics should you use in gall bladder disorders

A

Ciprofloxacin +MTZ

Ampicillin, gentamicin + MTZ

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13
Q

Esophagitis Etiology (PIECE)

A 
Pill induced 
Infectious 
Eosinophilic 
Caustic 
gErd
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14
Q

Esophagitis Pt Hx, Dx

A

Odynophagia or dysphagia
Dx: Endoscopy with biopsy
PPI

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15
Q

Pill induced Esophagitis Hx, Dx, Tx

A

NSAID, Tetracycline, Bisphosphonates, HAART
Dx- Endoscopy with biopsy
Tx: Remove offending agent
Time+ PPI

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16
Q

Eosinophilic Esophagitis Hx, Dx, Tx

A

Hx- Allergic reaction, asthma, atopy, allergies
Dx: EGD with biopsy - >15 eo hpf
Tx-PPI
if PPI fails -> Oral aerosolized steroids

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17
Q

Caustic (ingestion) Esophagitis Hx, Dx, Tx

A

Hx- Hoarseness, stridor, Intubate
Dx: EGD
Tx: Low severity, liquid diet
High severity- NPO for 72 hours EGD

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18
Q

What should you not do in a circumstance of caustic ingestion

A

Never neutralize the pH

Never Induce Emesis

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19
Q

Achalasia Etiology

A

Absent Myenteric plexus

LES cannot relax

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20
Q

Achalasia Hx, Dx, Tx

A 
Mid-sternal Globus sensation
Dx- Barium Swallow, Birds beak 
Manometry 
EGD with Bx to rule out cancer 
Tx: Myotomy 
Botlinum if terrible surgical candidate
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21
Q

Scleroderma CREST

A 
Calcinosis 
Raynauds 
Esophageal dysmotility 
Sclerosis 
Telangiectasias
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22
Q

Scleroderma Esophageal dysmotility Dx, TX

A

Dx: Barium
Manometry
EGD With Bx
Tx: PPI

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23
Q

Diffuse Esophageal spasm Hx

A

Pt: MI Sx better with CCB

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24
Q

Diffuse Esophageal spasm Dx

A

Dx: Rule out MI
Barium (Corkscrew Esophagus/Beads on a string)
Manometry
EGD with Bx

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25
Q

Diffuse Esophageal Spams Tx

A

CCB

Nitrates as needed

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26
Q

GERD presentation

A 
Typical- Burning chest pain 
Worse by layng down 
worse with spicy foods 
Better with Antacids, Sitting up 
Atypical- Hoarseness, Coughing, Stridor 
nocturnal Asthma
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27
Q

GERD Dx workup

A

PPI and lifestyle modifications for six weeks
if that fails EGD with Bx
if with ALARM symptoms perform EGD first

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28
Q

GERD Metaplasia Tx

A

High dose PPI

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29
Q

GERD Dysplasia Tx

A

Local Ablation

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30
Q

GERD Adenocarcinoma

A

Resection

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31
Q

H. Pylori When do you use Serology testing

A

When patient has not been treated for H. Pylori and is not on a PPI

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32
Q

H. Pylori when to use urea breath test

A

To make the initial diagnosis of H. Pylori

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33
Q

H. Pylori Stool antigen

A

used to confirming eradication

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34
Q

Best test for H. Pylori Diagnosis

A

EGD with Bx

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35
Q

H. Pylori treatment

A

Clarithromycin, amoxicillin, PPI

can use MTZ if penicillin allergy

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36
Q

Zollinger- Ellison Syndrome Etiology and Hx

A

Gastrinoma

Big virulent, refractory ulcers and diarrhea

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37
Q

Zollinger-Ellison Syndrome Gastrin testing and Dx workup, Tx

A 
Gastrin levels 
Normal <250
Confirmed >1600 
between 250-1600 perform Secretin stimulation test 
use SRS to find gastrinoma 
Tx- Resection
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38
Q

Gastroparesis Pt Hx

A

Patient with diabetes, chronic nausea/vomiting, abdominal pain with eating, peripheral neuropathy

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39
Q

Gastroparesis Dx, Tx

A

Dx: EGD, Emptying Study
Tx: Avoid Opiates, anticholinergics
Maintain good glucose control, low fiber small volume meals

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40
Q

Gastroparesis emptying study

A

must be off opiates with good glucose control
>60% left after 2 hours
>10% left after 4 hours

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41
Q

Enterotoxic causes of acute diarrhea (watery)

A 
Watery diarrhea 
C. Diff 
ETEC 
Vibrio 
S. Aureus 
B. Cereus 
Giardia
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42
Q

Invasive causes of acute diarrhea

A

Bloody diarrhea with fever, leukocytosis, fecal WBCs
Salmonella (chicken)
HUS -shigella, EHEC 0157:H7 (uncooked meat)
C. Jejuni
A. Histolytica (HIV/AIDs)

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43
Q

Most common cause of acute diarrhea

A

Viral gastroenteritis

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44
Q

Signs and symptoms of acute diarrhea not caused by virus

A 
Bloody diarrhea 
Duration >3 day
Hospitalized
High fever >104 
Severe abdominal pain 
Immunocompromised
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45
Q

C. Diff Dx, Tx

A

Dx- PCR (NAAT)
Tx: Oral vancomycin, for severe cases
Fidaxomycin for refractory cases/recurrent cases
add metronidazole if others are not available or resistant to monotherapy with VANC
all else fails stool transplant

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46
Q

Acute diarrhea work up if not viral

A

Stool WBC, RBC

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47
Q

Stool WBC/ RBC negative

A

Enterotoxic causes

perform ova parasite

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48
Q

Stool WBC/RBC positive

A

Invasive organism

Perform stool Cx and colonoscopy

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49
Q

Acute Diarrhea
Stool Cx postive
Colonoscopy negative

A

treat with antibiotics

50
Q

Chronic diarrhea causes to rule out

A 
laxative abuse
medication 
C. Diff 
Lactose intolerance 
Celiac Sprue
51
Q

Chronic Diarrhea Work-up

A

Fecal WBC/RBC
Fecal Osm
Fecal Fat
NPO

52
Q

Chronic diarrhea inflammatory work up

A

Colonoscopy with biopsy

53
Q

Secretory Chronic diarrhea workup

A

Hormones

EGD with Bx

54
Q

VIPoma work up

A

Chronic diarrhea
VIP level
Resection

55
Q

Carcinoid GI

A

Excess Serotonin
Diarrhea and flushing
5HIAA in the urine, CT scan
Resection

56
Q

Malabsorption presents

A

Depending on the area of malabsorption there will be extra intestinal manifestations

57
Q

Duodenal malabsorption

A

Folate-Macrocytic Anemia
Iron- Microcytic Anemia
Calcium- Osteporosis

58
Q

Terminal ileum Malabsorption

A

Bile salts Fat soluble vitamins

B12

59
Q

Fat soluble vitamins deficiency manifestations

A

A-Night blindness
D-Osteoporosis
E-Nystagmus
K-Bleeding

60
Q

Celiac Sprue Pt, Hx

A

Gluten allergy, IgA Mediated

Hx: Diarrhea, Bloating, Weight loss, Dermatitis Herpatiformis

61
Q

Celiac Sprue Dx, Tx

A

Serology- TTG, Endomysial Ab
EGD with Bx - Blunting of the villi
Tx: Avoid gluten

62
Q

Whipples Disease Hx, Dx, Tx

A

Malabsorption-diarrhea with brain, joint, and LN manifestations
Dx: EGD with Bx
Tx: TMP-SMX
Doxycycline

63
Q

Diverticulosis Hx

A

Chronic constipation
>50 year old
Low fiber and veggies diet
high red meat diet

64
Q

Diverticulosis Dx, Tx

A

Dx: colonoscopy
Tx: increase fiber, fruits and vegetables in the diet

65
Q

Sx of uncomplicated diverticulosis

A

Postprandial LLQ pain
relieved by bowel movement
Tx: Increase fiber

66
Q

Diverticulitis Pt Hx

A 
Left sided appendicitis 
constant LLQ pain 
Fever 
Leukocytosis 
Tender
67
Q

Diverticulitis Dx

A

X-ray to rule out perf

CT IV contrast abdomen

68
Q

Diverticulitis Tx Mild

A

Liquid diet, Oral ABx

69
Q

Diverticulitis Tx Severe

A

NPO, IV ABx

70
Q

Diverticulitis Tx Abscess

A

NPO, IV ABx, Drain

71
Q

Diverticulitis Tx Perforations

A

Ex lap, IV ABx

72
Q

Refractory Diverticulitis Tx

A

Hemicolectomy

73
Q

ABx to use with diverticulitis

A

gentamycin-ampicillin, MTZ

Ciprofloxacin, MTZ

74
Q

Diverticular hemorrhage Hx, Dx, Tx

A

Painless hematochezia
Dx: Colonoscopy
Arteriogram
Tx: Embolize

75
Q

Colon Cancer screening time for Low risk, Who is low risk

A

1 or 2 polyps, <1 cm, tubular, low grade

every 5-10 years

76
Q

Colon cancer screening time for High Risk, Who is high risk?

A

> 3 polyps, >1 cm, Villous, high grade

every 1-3 years

77
Q

Colon cancer screening, very high risk

A

> 10 polyps

every 2-6 months

78
Q

Familial adematous polyposis

A

APC gene
Thousands of polyps young patient
Tx: Prophylactic colectomy
start screening 10 or 12

79
Q

Lynch Syndrome, HNPCC -screening, diagnosis

A

Screen 20-25 years old

3 Cancers, 2 generations, 1 premature

80
Q

Cancers in Lynch Syndrome

A

Colorectal
Endometrial
Ovarian

81
Q

Wilsons Disease hx, Dx, Tx

A 
Chorea, cirrhosis, kaiser fleischer rings 
Dx: Slit lamp 
Ceruloplasmin 
Bx 
Tx: Penacillamine 
Transplant
82
Q

Hemochromatosis Hx, Tx, Dx

A 
Bronze DM (hyperpigmentation) 
DIA CHF 
Cirrhosis 
Dx: Ferritin >1000 
Transferrin >50% 
Bx 
Tx: Phlebotomy
83
Q

Alpha 1 Antitrypsin Deficiency

A

Young patient with COPD
Dx: Bx PAS + Macrophages
Tx: Transplant

84
Q

Primary Sclerosing Cholangitis Hx, Dx, Tx

A 
Associated with UC 
Male, pruritus, painless jaundice, 30-50 years old 
Dx: MRCP= beads on a string 
Bx: Onion skin fibrosis 
Tx: transplant
85
Q

Primary Biliary Cirrhosis Hx, Dx, Tx

A

Women, Pruritus, Jaundice painless
Bx
Transplant

86
Q

Esophageal Varices Dx,

A

EGD

87
Q

Esophageal varices Tx Active Bleeding

A

Banding

88
Q

Esophageal varices Tx

A

Beta blockers

89
Q

Esophageal varices Tx reccurent bleeding

A

TIPs

90
Q

Ascites fluid SAAG > 1.1 causes

A

RHF, Cirrhosis

91
Q

Ascites Fluid SAAG < 1.1

A

TB, CA

92
Q

Ascites Dx, Tx

A 
Dx: Paracentesis 
Tx: Furosemide
Spironolactone 
Fluid restriction 
Therapeutic paracentesis
93
Q

Spontaneous Bacterial Peritonitis Hx, Dx, Tx

A

Hx: Asx, Fever and abdominal pain
Dx: Paracentesis leukocytes >250
Tx: IV ceftriaxone

94
Q

GI Bleed work up

A
  1. Stabilize
  2. EGD
  3. for lower GI bleed depends on rate of bleeding
95
Q

GI bleed stabilization process

A 
2 large bore IVs 
IV fluids 
IV PPI 
TypenX
Call GI
96
Q

No active bleed lower GI

A

Colonoscopy

97
Q

Brisk bleeding lower GI

A

Arteriogram

98
Q

Ongoing bleeding Lower GI

A

Tagged RBC Scan

99
Q

what do you do if you still cant find the GI bleed

A

Pill cam endoscopy

100
Q

Causes of upper GI bleed

A 
Varices 
PUD 
Mallor-Weiss Tear 
Boorheaves 
Dielofoy
101
Q

Causes of Lower GI Bleed

A

Hemorrhoids
Ischemic Colitis
Diverticular Hemorrhage
Mesenteric Ischemia

102
Q

Hemorrhoids internal/external

A

Internal Painless bleeding

external pain without blood

103
Q

Mesenteric Ischemia Hx, Dx, Tx

A 
Gut attack 
patient is a vasculopath, A-fib
Pain out of proportion to PE 
Pain with eating, weight loss 
Dx: Angiogram 
Tx: Resection/revascularization
104
Q

Ischemic Colitis Hx, Dx, Tx

A

Watershed areas
Hx: Hypotensive, Painful BRBPR
Dx: Colonoscopy
Tx: Supportive

105
Q

Pancreatitis Hx

A

Epigastric pain radiating to the back
Positional pain
N/V/A

106
Q

Pancreatitis Dx

A

Lipase 3x ULN

if lipase is negative CT scan

107
Q

Pancreatitis Tx

A 
NPO 
IV fluids 
Analgesia 
refeed on request 
ERCP for gallstones 
Meropenum for ABx
108
Q

Pancreatitis early complications

A 
1-3 days 
ARDS
Saponification 
pleural effusion 
ascites
109
Q

Pancreatitis mid complications

A

1-3 weeks

Infection

110
Q

Pancreatitis Late complications

A

3-7 weeks
Abscess - drain
Pseudocyst

111
Q

Pseudocyst Tx <6cm, <6wks old

A

Watch and wait

112
Q

Pseudocyst Tx >6 cm, >6wks old

A

Drain with Bx

113
Q

Ulcerative Colitis

Description

A

Continuous lesions, affects the rectum stays in the colon
Superficial, Crypt abscesses
Bloody diarrhea
increased risk for CRC

114
Q

Crohns Disease

Description

A

Skip lesions can affect any part of the GI tract
Transmural inflammation, Non caseating Granulomas
Watery Diarrhea with weight loss

115
Q

Crohns Extra intestinal manifestations

A

Fistula formation

B12, fat malabsorption, iron deficiency

116
Q

Tx Mild IBD

A

5 ASA compounds - UC

Mesalamine

117
Q

Tx Moderate IBD

A

Immune modulators

6 MP, Azathioprine

118
Q

Tx Severe IBD

A

TNF inhibitors
Steroids, ABx
For UC - Surgical resection

119
Q

Antiobiotics to use in IBD

A

Ciprofloxacin, MTZ

120
Q

Conjugated Jaundice Urine

A

Dark Urine

121
Q

Unconjugated Jaundice Urine

A

Kernicterus, Urine is normal

122
Q

Causes of Painless Jaundice

A

Cancer
Stricture
PSC
PBC

USMLE STEP 2 CK RETAKE (15 decks)

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