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BOARDS > GI > Flashcards

GI Flashcards

1
Q

diagnostic spot for pain in appendicitis

A

mcburney’s point

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2
Q

pain w/ straightening leg in appendicitis

A

psoas sign

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3
Q

xray findings in appendicitis

A

sentinel loop and absence of air in the RLQ OR nothing

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4
Q

functional dyspepsia diagnosis

A

recurrent pain in upper abdomen or periumbilical pain that does not change with stooling and no organic cause (must be present at least once per week for at least 2 months to make diagnosis)

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5
Q

functional dyspepsia treatment

A

smaller more frequent meals, H2 blocker or PPI, and avoid things that exacerbate symptoms (NSAIDs, spicy food, soda, caffeine) - sometimes antidepressant

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6
Q

IBS diagnosis

A

abdominal pain that improves with stooling or change in stool frequency/consistency
(symptoms once per week for at least 2 months)

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7
Q

IBS treatment

A

decrease sorbitol, fructose and gassy foods, TCA’s

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8
Q

childhood functional abdominal pain definition

A

episodic or continuous pain w/ loss of daily activities and headache, limb pain or sleep disruption (symptoms must be at least once a week for at least 2 months)

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9
Q

acute, incapacitating periumbilical abdominal pain that lasts >1 hour with pallor, anorexia, nausea, vomiting, headache or photophobia with weeks of no symptoms between

A

abdominal migraine

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10
Q

abdominal migraine treatment

A

remove triggers (caffeine, nitrate foods) and decreasing stress

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11
Q

watery diarrhea comes from

A

small intestine

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12
Q

suspicions with watery diarrhea

A

cholera or C. diff

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13
Q

diarrhea with blood, mucous and WBCs

A

inflammatory diarrhea

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14
Q

oral rehydration solution for moderate to severe dehydration with diarrhea

A

2% glucose with 90 men NaCl

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15
Q

what test do you use to find WBCs in diarrhea

A

methylene blue

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16
Q

diarrhea with neutrophils

A

infectious

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17
Q

leading cause of diarrhea in infants worldwide

A

rotavirus (2nd is adenovirus)

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18
Q

viral diarrhea diagnostic

A

PCR antigen testing of stool

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19
Q

watery, non-bloody diarrhea with fever and vomiting in children under 2 w/ poor sanitation

A

enteropathogenic E. coli (EPEC)

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20
Q

severe watery non bloody diarrhea and cramping while travelin

A

enterotoxigenic E. coli (ETEC)

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21
Q

watery diarrhea that becomes bloody after a few days with severe pain/cramping but no fever

A

shiva toxin producing E. coli (STEC) - O157:H7

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22
Q

antibiotics in STEC

A

can cause increased release of shiga toxin and increased risk of HUS

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23
Q

blood and mucous tinged diarrhea with tenesmus but no fever

A

enteroinvasive e. coli (EIEC)

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24
Q

most common cause of parasitic diarrhea worldwide

A

giardia intestinalis

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25
Q

acute watery non bloody foul smelling diarrhea with abdominal pain and flatulence

A

giardia intestinalis

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26
Q

giardiasis diagnosis

A

enzyme immunoassay (EIA) and direct fluorescence antibody (DFA) assays in stool

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27
Q

treatment for giardiasis

A

self- limited but if needs treatment - tinidazole, metronidazole or nitazoxanide

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28
Q

clinitest

A

tests for reducing substances (all dietary sugars except sucrose) - presence = sugar malabsorption

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29
Q

hydrogen breath test

A

positive = sugar malabsorption (gut ferments sugar causing hydrogen production which is absorbed in the blood and excerpted in lungs)

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30
Q

length of test for fecal fat measurement

A

must be 3 days

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31
Q

vasoactive intestinal peptides

A

produced w/ neuroblastoma, cause diarrhea

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32
Q

most common cause of chronic diarrhea in children up to age 3

A

toddler’s diarrhea (excessive fruit juice intake)

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33
Q

formed stool in the AM with looser stools later, normal growth and development

A

toddler’s diarrhea

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34
Q

bilious vomiting during the first day of life

A

duodenal atresia

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35
Q

double bubble sign on xray

A

duodenal atresia

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36
Q

cecum fails to descend and is stuck to the posterior R abdominal wall

A

malrotation (compresses duodenum)

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37
Q

ladd bands

A

constrict the large and small bowel in volvulus

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38
Q

corkscrew appearance of duodenum with decreased intestinal air and gastric/duodenal dilation on xray

A

volvulus

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39
Q

test to assess malrotation or hiatal hernia

A

upper GI series

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40
Q

test to measure extent of reflux over 24 hours

A

pH probe aka esophageal impedance

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41
Q

test for gastroparesis

A

gastric emptying study

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42
Q

test to measure peristalsis and esophageal sphincter pressure

A

esophageal motility evaluation

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43
Q

zofran MOA

A

serotonin receptor antagonist

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44
Q

pyloric stenosis is more common in

A

white males

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45
Q

progressive non bilious vomiting in 2 to 5 month old

A

pyloric stenosis

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46
Q

pyloric stenosis labs

A

hypochloremic hypokalemic metabolic alkalosis and sometimes elevated indirect bilirubin

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47
Q

US findings for pyloric stenosis

A

length > 14 mm OR muscle thickness > 4 mm

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48
Q

pyloric stenosis treatment

A

correct electrolytes and IV rehydration, then pylotomyotomy

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49
Q

intense periods of vomiting lasting up to 48 hours with periods of feeling well between

A

cyclical vomiting

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50
Q

cyclical vomiting treatment during and episode

A

IV hydration

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51
Q

cyclical vomiting long term treatment

A

cyproheptadine, propranolol or TCA’s

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52
Q

forceful vomiting, weight loss, dysphagia and FTT

A

achalasia

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53
Q

cyst on the floor of the mouth

A

ranula

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54
Q

midline mass in the floor of the mouth

A

ectopic thyroid

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55
Q

ectodermal hypoplasia presentation

A

underdeveloped or no teeth

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56
Q

ectodermal hypoplasia diagnosis

A

skin biopsy showing no sweat pores

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57
Q

Ballermann streiff syndrome

A

underdeveloped small teeth

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58
Q

most common TE fistula

A

blind upper esophageal pouch

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59
Q

chronic autoimmune condition that presents at GERD that doesn’t respond to PPIs

A

eosinophilic esophagitis

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60
Q

eosinophilic esophagitis diagnosis

A

endoscopy with biopsy showing eosinophil predominant inflammation in the esophageal wall

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61
Q

medication to block gastric acid secretion

A

H2 blocker

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62
Q

medication to cast gastric mucosa

A

sulcralfate

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63
Q

medication to enhance bicarb production to decrease gastric acid production

A

prostaglandin analogues

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64
Q

medication that inhibits gastric acid pump

A

PPI

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65
Q

vomiting after eating with epigastric pain that wakes them from sleep and guaiac positive stool

A

peptic ulcer disease

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66
Q

peptic ulcer disease diagnostic study

A

endoscopy - histology (ulcers) and culture for H. pylori

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67
Q

NSAID induced gastric ulcer treatment

A

H2 blocker

68
Q

h. pylori treatment

A

1 to 2 weeks of PPI and 2 antibiotics (clarithromycin and amoxicillin OR clarithromycin and metronidazole)

69
Q

abdominal distention, anorexia, diarrhea, FTT, proximal muscle wasting, non resolving iron deficiency anemia

A

celiac disease

70
Q

celiac disease screening

A

elevated IgA antibodies to tissue transglutaminase OR IgA antibodies to endomysium

71
Q

celiac disease diagnosis

A

biopsy

72
Q

infant with small bowel resection and microcytic anemia

A

B12 deficiency (pernicious anemia)

73
Q

where is B12 absorbed

A

terminal ileum

74
Q

medication for IBS

A

amitriptyline

75
Q

chronic diarrhea, steatorrhea and hyponatremia

A

CF

76
Q

rectal prolapse think

A

CF, pertussis or chronic constipation

77
Q

syndrome with extra teeth, pre-malignant polyps in the large and small intestine and osteomas

A

gardner syndrome

78
Q

syndrome with mucosal pigmentation of the lips and gums and hundreds of colonic polyps

A

peutz-jeghers syndrome

79
Q

increased risk for UC in

A

ashkenazi (European) jews

80
Q

treatment of choice for infection with UC

A

metronidazole

81
Q

first line medical treatment for UC

A

5-ASA

82
Q

2nd line treatment for UC

A

steroids, 6-mercaptopurine or azathioprine or MTX, cyclosporine or tacrolimus

83
Q

IBD is associated with

A

HLA B27 antigen and ankylosing spondylitis

84
Q

risk of cancer in UC

A

20% per decade after the first 10 years of life

85
Q

extracolonic manifestations of UC

A

arthritis, mucocutaneous lesions and liver disease

86
Q

crowns disease descriptions

A

skip lesions on xray, cobblestone and transmural lesions on endoscopy, noncaseating granulomas

87
Q

extra intestinal manifestations of crohns

A

pyoderma gangrenosum of foot, erythema nodosum, arthritis, uveitis, renal stones

88
Q

IBD with continuous lesions

A

UC

89
Q

intussusception treatment

A

air enema

90
Q

must rule out what if child older than 6 presents with intussusception

A

lymphosarcoma

91
Q

congenital ganglionic megacolon aka

A

Hirschsprung’s disease

92
Q

Hirschsprung’s defect

A

absence of parasympathetic innervation of internal anal sphincter causing constant contraction

93
Q

classic presentation of hirschsprungs

A

no meconium in the first 48 hours

94
Q

hirschsprungs disease association

A

down syndrome

95
Q

infants strain to pass small liquid stools with tight band narrowing on the anus, self limited, remits by age 1

A

anal stenosis

96
Q

first test to distinguish upper vs lower GI bleed

A

nasogastric lavage

97
Q

hematemesis

A

bleeding proximal to the ligament of treitz

98
Q

test to determine if blood is babies or moms

A

apt test (negative = mom)

99
Q

tears in the mucosal lining where the esophagus meets the stomach

A

mallory-weiss tears

100
Q

causes of false positive guaiac

A

recent meat ingestion, horseradish, ferrous sulfate

101
Q

causes of false negative guaiac

A

vitamin C, outdated cards or improper storage

102
Q

hematochezia

A

bright red or maroon stools from distal bleed or massive proximal bleed (infectious, intussusception, rectal fissure, ingestion, meckel’s)

103
Q

painless rectal bleeding in child <2

A

meckel’s diverticulum

104
Q

meckel’s diverticulum diagnosis

A

technetium 99 pertechnetate scintigraphic study (ectopic gastric mucosa lights up)

105
Q

rule of 2’s

A

meckel’s diverticulum (age 2, 2 tissues (gastric and intestinal), 2 feet from ileocecal valve, 2 inches long, 2% of population)

106
Q

painless rectal bleeding in school age child

A

juvenile polyposis

107
Q

cholestatic jaundice diagnostic test

A

hepatobiliary scintigraphy

108
Q

increase direct bilirubin, pale stools and hepatomegaly

A

cholestatic jaundice (obstructive)

109
Q

medication to stimulate bile secretion and decrease serum bilirubin

A

phenobarbital

110
Q

treatment for biliary atresia if <2 months

A

kasai procedure (joins liver to the intestine)

111
Q

first test when biliary atresia is suspected

A

US, then HIDA scan, then biopsy

112
Q

most common cause of cholestatic jaundice in newborn

A

TPN

113
Q

labs to differentiate cholestatic jaundice from hepatocellulr

A

high alk phos in cholestatic

high SGPT/SGPOT in hepatocellular

114
Q

neontal jaundice, fever, acholic stools, RUQ pain and palpable mass

A

choledochal cyst

115
Q

gilbert syndrome defect

A

glucuronyl transferase deficiency

116
Q

intermittent elevated unconjugated bilirubin with illness or activity

A

gilbert syndrome (glucuronyl transferase deficiency)

117
Q

recent flu like illness or varicella and now comatose with elevated LFTs and serum ammonia

A

reye’s syndrome

118
Q

hepatolenticular degeneration aka

A

wilson’s disease

119
Q

Wilson’s disease diagnosis

A

low serum copper, elevated hepatic copper and decreased ceruloplasmin

120
Q

Wilson’s disease treatment

A

D-penicillamine to chelate copper and low copper diet

121
Q

side effect of Wilson’s disease treatment

A

D-penicillamine can cause aplastic anemia

122
Q

alpha 1 antitrypsin deficiency presentation

A

persistent jaundice in newborn

123
Q

organs that alpha 1 anti trypsin deficiency effects

A

liver (neonatal hepatitis with cholestasis), lung (COPD), skin (necrotizing panniculitis and psoriasis)

124
Q

portal HTN definition

A

portal venous pressure >5 to portal to hepatic vein pressure gradient >10

125
Q

most sensitive indicator of portal HTN and varices

A

splenomegaly

126
Q

pancreatitis can be associated with

A

pulmonary edema and pleural effusions

127
Q

most specific test to diagnose pancreatitis

A

abdominal US

128
Q

test to follow recurrent pancreatitis

A

ERCP

129
Q

common cause of recurrent pancreatitis in children

A

familial dyslipidemia

130
Q

pain radiating to R scapula

A

cholecystitis

131
Q

things that increase risk for gallstones

A

CF, ileal resection, TPN, CTX

132
Q

flu like symptoms and elevated LFTs

A

hepatitis A

133
Q

hepatitis A tranmission

A

fecal-oral (poor hygiene and sanitation)

134
Q

hepatitis A positive isolation

A

if works in daycare or food service - no work for one week from onset of symptoms

135
Q

how long can IgM be positive with hepatitis A

A

6 months

136
Q

hepatitis A treatment

A

supportive

137
Q

hepatitis B transmission

A

bodily fluids

138
Q

serologic test for acute hepatitis B

A

surface antigen, e antigen, HBV DNA

139
Q

HBeAg

A

indicated high viral load, infectivity, replication

140
Q

when do HBV-DNA and surface antigen disappear

A

6 months after appearance

141
Q

serologic testing during recovery from hep B

A

anti-HBc and anti-HBe

142
Q

surface antigen present for >6 months with hep B means

A

chronic infection

143
Q

serologic findings with hep B vaccination

A

positive HBsAb

144
Q

HBcAb

A

tells you they had a previous infection, now resolved

145
Q

complications of chronic HBV infection

A

fulminant hepatic failure and hepatocellulr carcinoma

146
Q

most common blood borne infection in the US

A

hepatitis C

147
Q

hep c transmission

A

bodily fluids

148
Q

hep C is associated with

A

cirrhosis and hepatocellulr carcinoma

149
Q

hepatitis D requirements

A

hep B surface antigen must be present (outer coat of D)

150
Q

hepatitis E transmission

A

fecal-oral

151
Q

pigmented penile lesions and hamartomatous intestinal polyps

A

Bannayan-Riley-Ruvalcaba syndrome (BRRS)

152
Q

syndrome with hyperkeratotic papillomas of the lips and tongue

A

cowden syndrome

153
Q

most reliable noninvasive test for lactase deficiency

A

breath hydrogen test

154
Q

most common anatomical esophageal abnormality

A

esophageal atresia with distal TE fistula

155
Q

when to preform endoscopy after caustic ingestion

A

12-24 hours after

156
Q

management of coins in the esophagus

A

endoscopic removal if still in the esophagus after 24 hours

157
Q

most common identifiable cause of chronic gastritis in children

A

h. pylori

158
Q

currant jelly stool

A

intussusception

159
Q

syndrome with hemihypertrophy and hamartomatous polyps

A

proteus syndrome

160
Q

best diagnostic test for Hirschsprung’s

A

suction rectal biopsy

161
Q

hepatits A prophylaxis

A

vaccine is >/=12 months, immunoglobulin if <12 months

162
Q

which hepatitis is DNA

A

B

163
Q

most common infectious cause of chronic liver disease in the US

A

hepatitis C

164
Q

diagnosis with conjugated hyperbilirubinemia and severe, unremitting pruritic, normal GGT

A

progressive familial intrahepatic cholestasis type 1 (PFIC1)

165
Q

diagnosis with anti smooth muscle antibodies present

A

autoimmune hepatitis type 1

166
Q

most common malignant liver tumor in children

A

hepatoblastoma

BOARDS (24 decks)

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