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First Aid Step 2 > GI > Flashcards

GI Flashcards

1
Q

Pt presents with sudden onset severe, diffuse abd pain. Exam: peritoneal signs, AXR reveals free air under diaphragm. Management?

A

Emergent laparatomy to repair perforated viscus

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2
Q

Most likely cause of acute lower GI bleed in pts > 40

A

Diverticulosis

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3
Q

Dx modality used when US equivocal for cholecystitis

A

HIDA

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4
Q

Risk factors cholithiasis

A 
Fat
Female
Fertile
Forty
Flatulent
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5
Q

Inspiratory arrest during palpation of RUQ

A

Murphys’ acute cholecystitis

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6
Q

Most common cause SBO in pts with no Hx abd surg

A

Hernia

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7
Q

Most common cause SBO in pts with Hx abd surg

A

Adhesions

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8
Q

Diarrhea bug: most common

Tx

A

Campylobacter

Erythromycin

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9
Q

Diarrhea bug: recent abx

A

C diff

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10
Q

Diarrhea bug: camping

A

Giardia

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11
Q

Diarrhea bug: Traveler’s

A

ETEC

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12
Q

Diarrhea bug: Church picnics/mayo -room temp food

-Mechanism of infection

A

S aureus

Preformed toxin

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13
Q

Diarrhea bug: Uncooked hamburgers

Tx

A

E coli O157: H7

Abx may worsen due to toxin release as bugs die so hydrate

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14
Q

Diarrhea bug: fried rice

A

Bacillus cereus

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15
Q

Diarrhea bug: poulty/eggs

A

Salmonella

Campy - 2nd most common

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16
Q

Diarrhea bug: raw seafood

A

Vibrio cholerae (COPIOUS WATERY DIARRHEA), HAV

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17
Q

Diarrhea bug: AIDS

A

Isospora
Crypotosporidium
MAC

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18
Q

Diarrhea bug: Pseudoappendicitis

A

Yersinia

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19
Q

25 yo Jewish man presents with pain and watery diarrhea after meals, Exam shows fistulas between bowel and skin and nodular lesions on tibias

A

Crohns

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20
Q

Inflammatory disease of colon with inc risk colon CA

A

UC

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21
Q

Extraintestinal manifestations of IBD

A 
Uveitis
Ankylosing spondylltis
Pyoderma gangrenosum
Erythema nodosum
Primary sclerosing cholangitis
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22
Q

Tx IBD

A

5ASA and steroids during exacerbation

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23
Q

Difference Mallory Weiss vs Boerhaave

A

Malloary: superficial in mucosa
Boerhaave: full thickness rupture

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24
Q

Charcot’s triad

A

RUQ pain
Jaundice
Fever/chills

–Signs of ascending cholangitis

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25
Q

Reynold’s pentad

A

Charcot’s triad +
Shock
Mental status change

–Signs of suppurative ascending cholangitis

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26
Q

Medical Tx hepatic encephalopathy

A

dec protein intake
Lactulose
Rifaximin

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27
Q

First step management acute GI bleed

A

ABC

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28
Q

4 yo with oliguria, petechiae, jaundice after illness with bloody diarrhea. Dx and cause

A

HUS 2/2 E coli O157: H7

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29
Q

Post HBV exposure Tx

A

HBV IVIG

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30
Q

Classic causes of drug induced hepatitis

A

TB meds - RIP
Acetaminophen
Tetracyclines

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31
Q

40 yo obese woman with elevated ALP and bilirubin, pruritis, dark urine, clay colored stools

A

Biliary tract obstruction

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32
Q

Hernia with highest risk of incarceration – indirect, direct, or femoral

A

Femoral

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33
Q

50 yo man with Hx alcohol abuse presents with boring epigastric pain that radiates to back and relived by sitting forward. Tx?

A

Confirm Dx acute pancreatitis with elevated amylase and lipase
NPO, IVF, O2, analgesics, time

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34
Q

Common viral causes of gastroenteritis

A 
Norwalk
Coxsackie A1
Echovirus
ADenovirus
Rotavirus in kids
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35
Q

Bloody diarrhea

A 
Campylobacter
C diff (can also be watery)
EHEC - 0157: H7
Salmonella
Shigella- really bad
Yersinia
Entamoeba histolytica
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36
Q

Honey, home canning bug
Flaccid paralysis
Tx?

A

C botulinum

Tx: Botulism antitoxin

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37
Q

Gray pseudomembranes on colonic mucosa

Tx

A

C diff

Tx: metronidazole or oral vanc

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38
Q

Overcrowding, food or water

Tx

A

Shigella

Cipro or TMP-SMX if severe

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39
Q

Oysters, watery diarrhea within 24 hrs of eating

A

Vibrio parahemolyticus

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40
Q

Pork of fresh produce

RLQ pain

A

Yersinia enterocolitica

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41
Q

Cysts and trophozoites in stool

Tx

A

Giardia (camping) Entamoeba (poor sanitation

Metronidazole, Paramomycin (Enamoeba only)

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42
Q

Acid fast stain of stool shows parasites

Tx

A

Cryptosporidium

Nitazoxanide

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43
Q

Undercooked pork, myalgias, periorbital edema, eosinophilia

Tx

A

Taenia spiralis

Albendazole, mebendazole if bad

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44
Q

Undercooked pork, CNS Sx

Tx

A

Taenia solium
Praziquantel
Albendazole + steroids if CNS Sx

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45
Q

Hepatitis- fecal oral, usu shellfish; self limited disease, vaccine available for travel
Type of RNA/DNA

A

Hep A

Picornavirus - ssRNA

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46
Q

Water, fecal oral route; high maternal mortality in pregnant

Type of RNA/DNA

A

Hep E

Calcivirus - ssRNA

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47
Q

Spread via blood, sexual contact
Complication is chronic hepatitis
Type of virus
Tx

A

Hep C
Flavivirus- ssRNA
IFN alpha or ribavirin

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48
Q

Spread via blood, sexual contact
Risk of hepatocellular carcinoma, fulminant hepatitis, chronic hepatitis/cirrhosis
Type of virus
Tx

A

Hep B
IFN alpha or antivirals like lamivudine, adefovir, entecavir
Vaccine available
Hepadnavirus: ds DNA

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49
Q

Requires coexistent Hep B infection
Risk of severe hepatitis/cirrhosis
Type of virus

A

Hep D
Delta agent - incomplete ssRNA
Tx with Hep B vaccine

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50
Q

HBsAg - surface: neg
HBeAg: neg
Anti-HBs (Ab): pos
Anti-HBc (Ab to core): neg

A

Vaccinated

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51
Q

HBsAg - surface: neg
HBeAg : neg
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): Positive IgM

A

Acute infection window 12-20 wks after exposure

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52
Q

HBsAg - surface: Positive
HBeAg : neg
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): positive IgG

A

Chronic infection with leesser viral replication - good prognosis

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53
Q

HBsAg - surface: positive
HBeAg : positive
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): Positive IgM

A

Acute infection 4-12 wks postexposure

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54
Q

HBsAg - surface: positive
HBeAg : positive
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): pos IgG

A

Chronic infection with active viral replication

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55
Q

HBsAg - surface: neg
HBeAg : neg
Anti-HBs (Ab): Positive
Anti-HBc (Ab to core): Positive IgG

A

Previous infection - recovered

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56
Q

Mg vs Al

A

Mg: diarrhea
Al: constipation

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57
Q

H2 antagonists
Examples
mechanisms

A

“tidine”
Reversibly block H2 to inhibit gastric acid secretion
Cimetidine may cause gynecomastia and impotence

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58
Q

PPI
Examples
MEchanism

A

“prazole”

Irreversibly block parietal cell H/K ATPase to block gastric acid secretion

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59
Q

Most common cause diarrhea adult vs kids

A

Adult: lactose intolerance
Kids: rotavirus

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60
Q

Type A vs Type B chronic gastritis

A

A: fundus, autoAB parietal cells causing pernicious anemia, dec gastrin and gastric acid
B: antrum, H pylori, inc gasric acid

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61
Q

PUD: gastric vs duodenal

A

Food causes Gain of pain in Gastric; Decreases pain with duodenal

62
Q

Curling vs Cushing ulcer

A

Curling- burn pt

Cushing- TBI

63
Q

Why must stop PPI before gastrin testing?

A

Inhibits gastrin release

64
Q

Zollinger Ellison - where, assoc

A

Pancreas or duodenum

MEN I

65
Q

Virchow node

A

left supraclavicular LN gastric cancer

66
Q

Sister May Joseph node

A

periumbilical gastric cancer

67
Q

Krukenberg tumor

A

Mets to ovary

68
Q

Weight loss, bloating, diarrhea, steatorrhea, glossitis, dermatitis,, edema

A

Malabsorption

69
Q

Celiac vs tropic

A

Celiac responds to removal of gluten

70
Q

Cause of Whipple diase

A

Tropheryma whippelii

71
Q

How to determine osmotic gap

A

290-2 (Na+K)
>125- osmotic diarrhea
<50 secretory

72
Q

Continuous disease, bloody diarrhea, lead pie on barium enema, + pANCA

A

UC

73
Q

Entire GI tract with skip lesions, entire bowel wall, perianal fissure and fistulas

A

Crohns

74
Q

Flushing, diarrhea, bronchoconstriction, TV or PV disease

A

Carcinoid

75
Q

Where carcinoid tumors

A

Bronchopulm tree
Ileum
Rectum
Appendix

76
Q

Dx carcinoid

A

Lab: inc 5HIAA in urine
Rad: Indium - 111 scintography to find tumors

77
Q

Mets colon CA

A

lung an dliver

78
Q

Hundreds of polyps in colon, near certain development of malignant neoplasm, prophy with subtotal colectomy

A

FAP- familial adenomatous polyposis

79
Q

Multiple genetic mutations, cancer from normal appearing mucosa, neoplasms tend to form in proximal colon

A

HNPCC

80
Q

Similar to FAP + bone and soft tissue tumors

A

Gardner

81
Q

Polyps are hamartomas with low risk of malignancy, mucocutaneous pigmentation of mouth, hands, genitals

A

Peutz-Jeghers

82
Q

Many colonic adneomas with malignant potenential, comorbid CNS tumors

A

Turcot

83
Q

Polyps of colon, small bowel and stomach that are frequently source of GI bleding; increased risk of malignancy later in life

A

Juvenile polyposis

84
Q

Ranson criteria on admission - mortality from acute pancreatitis

A 
GA LAW
Glc>200
AST>250
LDH>350
Age>55
WBC>1600
85
Q

CEA and CA 19-9

A

Pancreatic cancer

86
Q

Whipple procedure- what removed

A 
HEad of pancreas
Distal stomach
COmmon bile duct
GB
Proximal jejunum
Duodenum
87
Q

Complication pancreatic cancer

A

Trousseau - migratory thrombophlebitis

88
Q

Whipple triad

A

Sx hypoglycemia while fasting
Hypoglyemia
Improvement with card load

DO WORKUP FOR INSULINOMA

89
Q

Labs insulinoma

A

Increased fasting insulin and increased C peptide

90
Q

Endocrine pancreatic cancer usually malignant

A

Glucagonoma

91
Q

Watery diarrhea- endocrine tumor

A

VIPoma

92
Q

Migrator necrolytic erythema

A

Glucogonoma

93
Q

Charcot triad

Next step?

A

RUQ pain
Jaundice
Fever

Suspect cholangitis and do US or HIDA

94
Q

Calcified GB may mean

A

Chronic cholecystitis

10-30% of time is cancer

95
Q

Primary sclerosing cholangitis vs primary biliary cirrhosis

A

PSC: male, non antimito Ab, possible + pANCA, ERCP shows pearls on a string (stricturing and irregularity of ducts)

PBS: female, + antimito Ab and ANA; ERCP nothing exciting

96
Q

Prehepatic vs posthepatic vs intrahepatic effect on bili

A

Pre: inc indirect
Post: inc direct
Intra: both or either

97
Q

Gilbert vs Crigler Najjar I

A

Gilbert: jaundice with exercise, stress, fasting; ind bili 5, CNS 2/2 kernicterus

Crig Naj II like gilbert- Tx phenobarb to increase glucoronosyltransferase

98
Q

Paracentesis of ascites vs bacterial peritonitis

A

Ascities: protein 250, protein >1m glc normal serum LDH

99
Q

Paracentesis shows high albumin and LDH equal to 60% serum LDH…suspect

A

Neoplasm

100
Q

Tx Wilson disease

A

Trientine or penicillamine

101
Q

Alpha 1 antitrypsin findings

A

Liver cirrhosis and pablobular emphysema with obstructive PFT pattern

102
Q

Liver + OCP

A

benign neiplasm

103
Q

Biopsy of liver CI??

A

Hypervascular organ - risk hemorrhage

104
Q

Liver mets come from

A

Breast
Colon
Lung

More common than primary

105
Q

Paraneoplastic syndromes with hepatoma

A 
Hypoglc
Excesive RBC
Refractory watery diarrhea
HyperCa
Variable skin lesions
106
Q

Hepatitis that leads to hepatoma

Weird ither things that lead to hepatoma

A

HBV or HCV
Aflatoxin from Aspergillus
Schistosomiasis

107
Q

String sign barium swallow, olive sized mass on palpation, projectile emesis.
Labs?

A

Pyloric stenosis

Dec Cl and K, metabolic alkalosis

108
Q

Billous vomiting, hematochezia, air in bowel wall

Labs

A

Necrotizing enterocolitis

Metabolic acidosis with dec Na

109
Q

Biopsy show no ganglia in bowel

A

Hirschsprung

110
Q

Currant jelly stool, sausage like abdominal mass

A

Intussusception

111
Q

Rule of 2 Meckel

A 
2% population 
M 2x more than F
2 ft ileocecal valve
Sx <2 yrs
2 types ectopic - pancreatic or gastric
112
Q

Kernicterus is when bili deposits where

A

Basal ganglia

Hippocampus

113
Q

Findings that would indicate nonphysiological cause for neonatal jaundice

A

Jaundice within first 24 hrs of life
Total bili > 15
Dir bili >2

114
Q

FTT- what percentile

A

<3

115
Q

Esophageal webs, Fe def anemia, glossitis

A

Plummer Vinson

116
Q

Positive Tzanck

A

HSV

117
Q

Oral ulcers, biopsy shows intranuclear and intracytoplasmic inclusions, retinitis, colitis

A

CMV

118
Q

Pts with GERD should avoid

A 
Caffeine
Mints
EtOH
Onions
Garlic
Chocholate
Nicotine
119
Q

Signet ring cells on biopsy

A

Gastric cancer - diffuse type

120
Q

MALT

A

Lymphoma 2/2 H pylori

Can Tx with abx

121
Q

Flask shaped ulcers, water in developing country

Tx

A

Entamoeba histolytica

Metronidazole

122
Q

Watery diarrhea causes

A 
Vibrio
Rotavirus
ETEC
Cryptosporidium
Giardia
123
Q

Gallstone ileus 0how

A

Gallstone erodes through intestinal wall into lumen and lodges at ileocecal valve

124
Q

Pt with hx carcinoid tumor presents with symmetric dry hyperpigmented skin lesions, persistent diarrhea, irritable??

A

Pellagra- niacin (B6) def 2/2 carcinoid

Tryptophan is precursor to both 5HT and Niacin - tumor takes tryptophan

125
Q

4 D pellagra

A

Dermatitis
Dementia
Diarrhea
Death

126
Q

Ogilvie syndrome

A

Pseudo-obstruction of large bowel

127
Q

S bovis…check for

A

colon cancer

128
Q

Risk colon cancer

A 
Increased age
FAP, HNPCC
FH
UC>>Crohns
Polyps: villous>tubular, sessile>>pedunculated
High fat and low fiber
129
Q

HbSAg - what does it mean

A

Continued presence indicates carrier state

130
Q

HBsAb - what does it mean

A

Indicated immunity to HBV

131
Q

HBcAb - what does it mean

A

IgM + during window period

IgG indicator of prior or current infection

132
Q

HBeAg = what does it mean

A

Indicator of transmissibility - BEware

133
Q

Bacterial cause diarrhea: GBS, HUS, TTP

A

Campylobacter

134
Q

Triad Reye syndrome

A

Encephalopathy
Fatty liver degen
Transaminase elevation

2/2 ASA in kids = mito damage

135
Q

No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA

A

Idiopathic AI hepatitis

136
Q

Coagulopathy caused by cirrhosis - Tx

A

FFP

VIt K will not work

137
Q

Hemochromatosis affects what organs

A 
Liver
Heart
Skin
Pancreas
Joints
138
Q

Bacterial cause diarrhea: GBS, HUS, TTP

A

Campylobacter

139
Q

Serum ascites albumin graduent - how to determine

A

= serum albumin - ascites albumin

140
Q

SAAG >1.1 vs <1.1

A

> 1.1: RELATED TO PORTAL HTN

  • Presinusoidal: splenic or portal v thrombosis, schstosomiasis
  • Sinusoidal: Cirrhosis
  • Postsinusoidal: RHF, constrictive pericarditis, Budd Chiari

<1.1: NOT RELATED TO PORTAL HTN

  • Nephrotic
  • TB
  • Peritoneal carcinomatosis (ovarian cancer)
141
Q

Acute prerenal failur ein setting of advanced cirrhosis

UNa <10

A

Hepatorenal syndrome

142
Q

Coagulopathy caused by cirrhosis - Tx

A

FFP

VIt K will not work

143
Q

NASH association

A

IR

Metabolic syndrome`

144
Q

Triad Reye syndrome

A

Encephalopathy
Fatty liver degen
Transaminase elevation

2/2 ASA in kids = mito damage

145
Q

No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA

A

Idiopathic AI hepatitis

146
Q

Bronze diabetes

A

Hemochromatosis

147
Q

Liver disease + CNS or psych manifestation

Kayser-Flsecher rings

A

Think Wilson disease

Copper in lentiform nucleus AKA hepatolenticular degeneration

148
Q

Liver disease results in prolonged PTT or PT

A

PT

149
Q

Ranson 48 hrs later

A

Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit (negative base excess) > 4 mEq/L
Sequestration of fluids > 6 L

150
Q

Tx PUD w/ H pylori

A

Omeprazole
Amoxicillin (metro if allergic)
Clarithromycin

151
Q

Toxic megacolon criteria

A 
3 of these
Fever>38C
HR>120 bpm
Neutrophilic leukocytosis>10500
Anemia
At least one of the following: 
V depletion
Altered sensorium
Electrolyte changes
Hypotension

First Aid Step 2 (22 decks)

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