GI comp Flashcards
1
Q
What are the three borders of Hesselbach’s triangle?
A
Medial border: rectus abdominus - Superior border: inferior epigastric artery - Lateral border: inguinal ligament
2
Q
What is the most common cause of painless rectal bleeding in pediatric population?
A
Polyps
3
Q
What is intestinal pseudo-obstruction without evidence of mechanical cause called?
A
Ogilvie Syndrome
4
Q
List the 6 “rule of 2” characteristics of Meckel’s diverticulum.
A
2% of population - 2 feet proximal to ileocecal valve - 2 inches long - 2 years old - 2:1 M:F ratio - 2 tissues: gastric & pancreatic
5
Q
Slate colored skin may represent which underlying GI disorder?
A
Primary Biliary Cirrhosis
6
Q
What agent is used to chelate copper in the treatment of Wilson’s disease?
A
Penicillamine
7
Q
Treatment of chronic hepatitis due to hemochromatosis?
A
Phlebotomy and deferoxamine chelation
8
Q
Treatment of chronic hepatitis due to Wilson’s disease?
A
Copper chelation
9
Q
Treatment of chronic autoimmune hepatitis?
A
Corticosteroids
10
Q
Treatment of chronic viral hepatitis B or C?
A
Pegylated interferon-alpha
11
Q
What serum gastrin levels are found with Zollinger Ellison Syndrome?
A
> 150 pg/mL is suggestive - > 200 pg/mL is diagnostic
12
Q
What level of eosinophilia is diagnostic of eosinophilic esophagitis on biopsy?
A
> 15 eosinophils/HPF
13
Q
What type of diarrhea is seen in patients with cholera?
A
Secretory diarrhea
14
Q
What type of diarrhea does lactose intolerance often cause?
A
Osmotic diarrhea
15
Q
Name the 3 most common symptoms of pellagra.
A
Diarrhea - Dementia - Dermatitis (3 D”s)
16
Q
What type of infectious diarrhea is often linked to deli meats and can be deleterious in pregnant women (lead to miscarriage)?
A
Listeria
17
Q
Which vitamin deficiency can lead to problems clotting and excessive bleeding?
A
Vitamin K
18
Q
Patient with Hepatitis C is at high risk for which malignancy?
A
Liver cancer
19
Q
What disease is caused by vitamin C deficiency?
A
Scurvy
20
Q
What disease is caused by niacin deficiency?
A
Pellagra
21
Q
What vitamin deficiency can lead to cause rickets in children?
A
Vitamin D
22
Q
Name the fat soluble vitamins.
A
Vitamins: ADEK
23
Q
Congenital error of metabolism in which life-long avoidance of phenylalanine is required?
A
Phenylketonuria
24
Q
What is the Dx? Nursing home patient with severe watery diarrhea after recent antibiotics.
A
C. difficile
25
Prophylactic antibiotic given to prevent traveler's diarrhea?
Fluoroquinolone (e.g. ciprofloxacin) - (Pregnant woman or child give azithromycin)
26
Which disorder commonly has cobblestoning or skip lesions on imaging?
Crohn's
27
What test is used to diagnose lactase deficiency?
Lactose breath hydrogen test
28
Which vitamin deficiency is perifollicular petechiae suggestive of?
Vitamin C (Scurvy)
29
What diarrhea related infection may lead to meningitis in neonates and immunocompromised patients?
Listeria
30
What type of inguinal hernia is felt on the side of the finger during exam?
Direct
31
What type of inguinal hernia is felt on the tip of the finger during exam?
Indirect
32
Treatment for Giardia infection?
Metronidazole
33
Does Shigella cause bloody or nonbloody diarrhea?
Bloody diarrhea
34
Will umbilical hernias in children <12 months old usually resolve on their own?
Yes
35
Risk factors for ventral hernia?
Abdominal surgery - Age - Obesity - Wound infection - Surgical drains
36
What is the Dx and treatment? Stomach herniated up into thorax.
Paraesophageal hernia - Surgery recommended
37
Common symptoms associated with sliding hiatal hernia?
Reflux and heartburn
38
Patient with adenomatous colon polyp should have colonoscopy how often?
Every 3-5 years
39
Rectal mass rectal bleeding and tenesmus?
Rectal cancer (solitary tenesmus may occur with anal inflammation)
40
What type of hemorrhoids are usually painless?
Internal hemorrhoids
41
Tender indurated area at perianal area/gluteal cleft?
Pilonidal cyst
42
What disorder is colon dilation air fluid levels and thumbprinting sign on imaging suggestive of?
Toxic megacolon (Thumbprinting may also occur with mesenteric ischemia)
43
Treatment for fecal impaction?
Digital rectal /manual disimpaction - Diet with fiber stool softeners/laxatives for prevention
44
What is the Dx? Acute abdominal pain. KUB shows dilated loops of bowel with air fluid levels.
Small bowel obstruction
45
At what age should routine colonoscopy screening begin for men and women?
Age 50
46
Most common type of colon cancer?
Adenocarcinoma
47
What is the DX? 65-year-old male 3 months of recent weight loss poor appetite new constipation and anemia.
Think colon cancer
48
Celiac sprue intestinal biopsy findings?
Villous atrophy
49
Good test for malabsorption?
Fecal fat testing
50
Steatorrhea is often associated with which type of bowel disorders?
Malabsorption disorders
51
Intestinal angina?
Chronic mesenteric ischemia
52
What is the Dx? 60-year-old male smoker complains of recurrent dull abdominal cramps/pain within 1 hour of eating meals.
Chronic mesenteric ischemia
53
What is severe abdominal pain out of proportion to physical exam findings suggestive of?
Acute mesenteric ischemia
54
Acute thrombosis or embolism of the celiac or mesenteric arteries?
Acute mesenteric ischemia
55
Name the criteria used to diagnose Irritable bowel syndrome.
Rome criteria: Pain relieved with defecation - Change in frequency and form - Altered stool passage - Passage of mucus
56
Irritable bowel disease that may affect the entire GI tract from mouth to anus?
Crohn's
57
What are the extraintestinal manifestations that can be seen in ulcerative colitis patients?
Pyoderma gangrenosum - Arthritis - Ankylosing spondylitis - Erythema nodosum - Uveitis
58
Inflammatory bowel disease that only affects the large intestines?
Ulcerative colitis
59
Inflammatory bowel disease that often presents with bloody diarrhea?
Ulcerative colitis
60
What is the Dx? Newborn with double bubble sign on abdominal X-ray.
Duodenal atresia
61
List 3 antibiotic regimens which can be used for diverticulitis?
Quinolone with metronidazole - Amoxicillin-clavulanate - Trimethoprim-sulfamethoxazole
62
Treatment for acute diverticulitis?
Initial: NPO/IV fluids antibiotics - May require surgery if perforation or abscess
63
.+anti-tissue transglutaminase +anti gliadin and +anti endomysial antibodies are suggestive of what disorder?
Celiac sprue
64
What cardiac disorders are acute mesenteric ischemia associated with?
Atrial fibrillation - MI - CHF
65
What genetic abnormality is duodenal atresia associated with?
Hereditary Spherocytosis
66
What criteria are used to predict mortality in acute pancreatitis?
Ranson's criteria
67
What chronic viral disease increases the chance of liver cancer?
Hepatitis B and C (C increases chances more than B)
68
What tumor marker may be elevated in liver cancer?
Alpha-fetoprotein
69
Common causes of constipation?
Lack of fiber - Opiate use - hypothyroidism
70
Sign seen with appendicitis with pain over the right lower quadrant one-third of the distance from the ASIS to the umbilicus?
McBurney's
71
Tumor marker elevated with pancreatic cancer?
CA 19-9
72
Most common type of pancreatic cancer?
Ductal adenocarcinoma
73
Ecchymosis around the umbilicus which represents retroperitoneal or intra-abdominal bleeding?
Cullen's sign
74
What is the Dx? Epigastric pain radiating to back with elevated lipase.
Acute pancreatitis
75
What does a porcelain gallbladder or a radiopaque gallbladder on imaging suggest?
Gallbladder cancer
76
What disease process does Charcot's triad (fever, jaundice and RUQ pain) suggest?
Cholangitis
77
What are the routes of transmission for hepatitis C?
Infants: perinatal infection Adults: Blood to blood exposure - Sexual - IV drug abuse - tattoos
78
What are the routes of transmission for hepatitis B?
Infants: perinatal infection Adults: Blood to blood exposure - Sexual - IV drug abuse
79
What are the routes of transmission for hepatitis A?
Fecal-oral
80
Which types of hepatitis have available vaccines?
Hepatitis A and B
81
Non-alcoholic steatohepatitis (AKA non-alcoholic fatty liver disease) risk factors?
Diabetes obesity - Metabolic syndrome - Steroid use - CAD
82
What are +Anti-Mitochondrial antibodies associated with?
Primary Biliary Cirrhosis
83
What is the Dx? Fatigue Pruritus hepatomegaly associated with high alk phos cholesterol and bilirubin.
Primary Biliary Cirrhosis
84
Treatment for acetaminophen toxicity?
Acetylcysteine
85
What findings are expected in a patient who is immune to Hepatitis B due to vaccination?
HBsAg negative - Anti-HBc negative - Anti-HBs positive
86
What findings are expected in a patient who is immune to Hepatitis B due to natural infection?
HBsAg negative - Anti-HBc positive - Anti-HBs positive
87
RUQ palpation maneuver reveals pain and cessation of inspiration. What is this called? What does it indicate?
Murphy's sign = cholecystitis
88
Most common type of gastric cancer?
Gastric adenocarcinoma
89
Medications to treat gastroparesis?
Metoclopramide - IV erythromycin
90
Treatment for gastritis?
Proton pump inhibitor - Treat H. Pylori if present - Remove irritants
91
List two medications which may cause cholelithiasis?
Ceftriaxone and Clofibrate
92
What two hematological disorders may cause cholelithiasis?
Sickle cell disease and Hereditary spherocytosis
93
What GI cancer is acanthosis nigricans associated with?
Gastric adenocarcinoma
94
What side effect must patients be counseled on prior to metoclopramide treatment?
Tardive Dyskinesia
95
What medications may result in a false-negative urea breath test in a patient with H. pylori?
Proton pump inhibitors - H2 blockers - Bismuth - Antibiotics
96
What symptoms of GERD may present as a pulmonary disease process?
Hoarseness cough wheeze
97
Syndrome with elevated gastrin levels?
Zollinger Ellison
98
What type of GI ulcer has pain relief with food?
Duodenal ulcer
99
In addition to peptic stricture what is another complication of chronic GERD?
Barrett's esophagus
100
What disorder can cause heartburn hoarseness and atypical chest pain?
GERD
101
What is the Dx? Hematemesis from esophageal laceration after forceful retching.
Mallory-Weiss tear
102
Motility disorder caused by degeneration of Auerbach's plexus?
Achalasia
103
What medication may be used to treat stable esophageal varices?
Beta blockers
104
Name 2 viruses seen in infectious esophagitis.
HSV (Herpes Simplex Virus) and CMV (Cytomegalovirus)
105
In which conditions do you often see infectious esophagitis?
Immunocompromised: HIV - Cancer patients - Bone marrow transplant patients
106
Medication used to treat candida esophagitis?
Fluconazole
107
What conditions are associated with eosinophilic esophagitis?
Allergic conditions - Asthma
108
What type of esophagitis is often caused by bisphosphonates?
Non-infectious
109
Vitamin C deficiency is associated with what problems?
Scurvy (Fatigue - Petechiae - Bleeding gums - Impaired wound healing)
110
Vitamin B6 deficiency is associated with what problems?
Anemia - Weakness - Insomnia
111
Niacin (Vitamin B3) deficiency is associated with what problems?
Pellagra -Diarrhea - Flushing - Psychosis
112
Vitamin B2 deficiency is associated with what problems?
Glossitis - Seborrheic dermatitis
113
Vitamin B1 deficiency is associated with what problems?
Beriberi (CHF - Peripheral neuropathy - Wernicke's - Cerebellar SX
114
What does Vitamin K deficiency result in?
Vitamin K deficiency leads to less factors and bleeding (increased PT/INR)
115
What factors is Vitamin K deficiency associated with?
Vitamin K is needed to make clotting factors 2,7,9 and 10
116
Vitamin E deficiency is associated with what problems?
Neuropathy - Ataxia - Hemolytic anemia
117
What test is both diagnostic and therapeutic for a patient with intussusception?
Barium enema
118
A sausage shaped mass and currant jelly stool are consistent with what diagnosis?
Intussusception
119
A newborn with bilious vomiting and a non-distended abdomen is found to have a double bubble sign on KUB. What is your diagnosis?
Duodenal atresia
120
What exam finding would be possibly seen on radiologic work up for child with pyloric stenosis?
US for identification shows a Double-track - Follow up barium studies show String sign and Shoulder sign
121
Use of what antibiotic is associated with increased risk of pyloric stenosis?
Clarithromycin (Note: erythromycin is also associated)
122
A baby presents with vomiting and abdominal exam reveals an olive like mass in the RUQ. What do you suspect?
Pyloric stenosis
123
A baby with untreated PKU will develop what long-term complications?
Mental retardation
124
A newborn brought from a developing nation at day 12, has a mouse like smell to the urine. What do you suspect?
Phenylketonuria (PKU)
125
What organism commonly causes diarrhea after drinking in a mountain stream?
Giardia
126
What virus commonly causes breakouts of diarrhea on cruise ships?
Norovirus
127
What virus commonly causes breakouts of diarrhea in day care centers?
Rotavirus
128
What diarrhea is associated with poorly done home canned foods?
C. Perfringens
129
What diarrhea is associated with a patient post antibiotics?
C. Difficile
130
What diarrhea associated with picnics and egg salad?
Staph Aureus
131
What diarrhea associated with undercooked poultry or pork?
Salmonella
132
What diarrhea associated with shellfish?
Vibrio cholerae
133
What is the most common cause of traveler's diarrhea?
E. coli
134
Which type of inguinal hernia is congenital and generally happens before age one?
Indirect
135
A 14 year old male presents with a protruding mass that touches the side of the index finger with coughing. What is your diagnosis?
Direct inguinal hernia
136
A small umbilical hernia is tender to the touch, not reducible and purple in color. What is the recommend treatment plan?
Emergent surgery for strangulated hernia
137
Obesity and previous abdominal surgery has lead to a very large ventral herniation. What is the recommended treatment?
Observation or elective surgery as they rarely strangulate
138
What type of hernia can worsen GERD symptoms?
Hiatal hernia
139
What is the recommended follow-up time for colonoscopy in a patient who had polyps removed?
Repeat colonoscopy in 3 to 5 years
140
What is the recommended treatment for a perianal cyst?
Surgical drainage
141
Are polyps located in the distal colon and rectum usually benign or cancerous?
Benign
142
Anal cysts can be benign or cancerous. Which of the following is cancerous? (Teratoma, epidermoid, dermoid)
Teratoma
143
A 64 year old male presents with bloody stools. Digital rectal exam reveals a step off at Bulmer's shelf. What is your diagnosis?
Rectal cancer
144
A 45 year old female presents with painful defecation, pruritus of the anus and occasional blood. What is your diagnosis?
Internal hemorrhoids
145
What is the recommended treatment of a pilonidal cyst?
Surgical drainage
146
A 25 year old male has a large red tender abscess located in the gluteal cleft near the coccyx. What is your diagnosis?
Pilonidal cyst
147
Both mesenteric ischemia and toxic megacolon may have a thumb printing sign on imaging. What differentiates the two on physical exam?
Mesenteric ischemia has a soft abdomen - Toxic megacolon as rigid abdomen
148
What is the recommended treatment for an elderly patient with fecal impaction?
Digital rectal disimpaction followed by dietary changes that increase fluids and dietary fiber
149
X-ray showing dilated large intestine and a large amount of stool in the sigmoid colon in an elderly patient is most likely represents what disorder?
Fecal impaction
150
What is the most common location for a large bowel obstruction?
Sigmoid colon
151
What would be the expected findings on KUB in a patient with a mechanical obstruction?
Dilated loops of bowel with air fluid levels and little or no gas in the colon
152
What is the most common cause of mechanical obstruction in a patient with history of abdominal surgery?
Adhesions
153
A patient undergoes a barium study of the colon and an "Apple core" lesion is found. What do you suspect?
Colon Cancer
154
What is the most common type of colon cancer?
Adenocarcinoma
155
A 17 year old presents with abdominal pain, bloating, flatulence, and diarrhea after ingesting dairy. What is the test used to make the diagnosis?
Lactase breath hydrogen test
156
What lab antibodies would likely be positive in a patient with Celiac sprue?
+anti-tissue transglutaminase, +antigliadin and +anti endomysial antibodies
157
Celiac sprue is an abnormal immune response to what food product?
Gluten
158
What are the fat-soluble vitamins?
A - D - E - K
159
What is the test of choice for malabsorption?
Fecal fat
160
A patient presents with acute mesenteric ischemia. What medication may be given via the angiography to improve blood flow while the patient waits for surgery?
Papaverine for vasodilation via angiogram until in patient gets to OR
161
What finding on abdominal X-ray is suggestive of acute mesenteric ischemia?
Thumb-printing of small bowel or right colon due to submucosal bleeding (Thumb printing may also be seen with toxic megacolon)
162
What is the gold standard for diagnosis of mesenteric ischemia?
Angiography
163
A diabetic presents with abdominal pain that begins one hour after eating and resolves a few hours later. What is your suspected diagnosis?
Chronic mesenteric ischemia
164
A 55 year old male presents with acute abdominal pain. He is in atrial fibrillation and has a relatively benign exam. What is your diagnosis?
Mesenteric ischemia
165
What antibodies will be found positive in Crohn's disease?
#NAME?
166
What antibodies will be found positive with ulcerative colitis?
#NAME?
167
Patient presents with alternating diarrhea and then constipation. A complete workup and physical exam are normal. What do you suspect?
Irritable bowel syndrome
168
What are the three major complications of ulcerative colitis?
Toxic megacolon - Primary Sclerosing Cholangitis - Colorectal cancer
169
Crohn's disease affects what part of the GI tract?
Mouth to anus
170
Which type of diverticular problem generally is painless bleeding?
Diverticulosis
171
Which type of laxative is first in the line of treatment after lifestyle changes and adequate fiber?
Osmotic Laxatives
172
A patient having less than two bowel movements per week is defined as having what?
Constipation
173
What is the test of choice to diagnose appendicitis in an adult?
CT
174
What is the test of choice to diagnose appendicitis in a child?
Ultrasound
175
What is Iliopsoas sign?
RLQ pain with R hip extension
176
What is Obturator sign?
RLQ pain upon flexion and internal rotation of RLE
177
What is Rovsing's sign?
RLQ pain upon palpation of LLQ
178
What is McBurney's sign?
Pain upon palpation of the RLQ
179
What tumor marker is elevated in pancreatic cancer?
CA-19-9
180
Patients with chronic pancreatitis commonly need pharmacological supplementation for what two problems?
Insulin for diabetes and pancreatic enzymes for digestion
181
A 45 year old male alcoholic with epigastric abdominal pain and radiation to mid back develops ARDS. What is the most likely diagnosis?
Acute pancreatitis and sepsis
182
A family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, and cardiomyopathy are suggestive of what disorder?
Hereditary Hemochromatosis
183
A 65 year old male with central obesity and ultrasound finding of a fatty liver can eventually develop what condition?
NAFLD (Non Alcoholic Fatty Liver Disease) may lead to cirrhosis
184
Primary biliary cirrhosis often has high elevation of alkaline phosphatase and bilirubin levels. What is the gold standard for diagnosis?
Gold standard - antimitochondrial antibodies found with liver biopsy
185
Diffuse, multifocal strictures and focal dilation of bile ducts with a "beaded look" are found on a patient with ulcerative colitis. What is your suspected diagnosis?
Primary Sclerosing cholangitis
186
What is the medical management of ascites due to cirrhosis?
Single morning oral doses of spironolactone and furosemide
187
Primary biliary cirrhosis is commonly associated with what GI disease process?
Ulcerative colitis
188
What test provides definitive diagnosis of liver cancer?
Liver biopsy
189
What tumor marker is elevated in liver cancer?
Alpha-fetoprotein
190
A patient presents with AMS and hepatomegaly. Physical exam reveals ring-like deposits in the eyes. What is the suspected diagnosis?
Wilsons disease (copper deposition)
191
Which of the hepatitis viruses is a DNA virus?
Hepatitis B (the rest are all RNA viruses)
192
A patient has positive Anti-HBc IGG, negative Anti-HBc IGM and positive HBsAg. What is the status of their hepatitis B?
Chronic hepatitis B
193
A patient has negative Anti-HBc IGG, positive Anti-HBc IGM and positive HBsAg. What is the status of their hepatitis B?
Acute active Hepatitis B (contagious)
194
Which viral Hepatitis causes a high infant mortality rate in a pregnant woman?
Hepatitis E
195
Which hepatitis can be obtained via blood transfusion and is likely to lead to cirrhosis and liver cancer?
Hepatitis C
196
Which hepatitis is only associated with hepatitis B?
Hepatitis D
197
A 24 year old returns from an Asian vacation tour and develops fatigue, fever, jaundice and hepatomegaly 3 days later. What is the likely cause?
Hepatitis A
198
A patient with painless jaundice weight loss and a palpable RUQ mass has what suspected diagnosis?
Gallbladder or Pancreatic cancer
199
What is the next test of choice in a patient with RUQ pain and an inconclusive US for cholecystitis?
Nuclear scan (HIDA or PIPIDA)
200
A patient presents to your office with weight loss and a palpable mass in the right upper quadrant. What X-ray finding supports gallbladder cancer?
Porcelain gallbladder
201
A patient with cholangitis develops confusion and hypertension. What do you suspect?
Acute obstructive suppurative cholangitis
202
A patient presents with fever, jaundice, and right upper quadrant pain. What do you suspect?
Cholangitis
203
During exam, palpation of the right upper quadrant during inspiration causes the patient to stop breathing in due to pain? What is the initial test of choice?
RUQ Ultrasound
204
What antibiotic is a major cause of biliary sludge?
Ceftriaxone
205
A patient presents with left supraclavicular lymphadenopathy and an umbilical lymph node. What do you suspect?
Gastric cancer or abdominal cancer (Left supraclavicular lymphadenopathy aka Virchow's node)
206
A diabetic regularly checking his post prandial glucose readings finds that despite a good meal his readings are low. What do you suspect?
Gastroparesis
207
What MEN I tumor causes excess gastric acid production?
Zollinger Ellison
208
A patient describes abdominal discomfort that is worse with meals and gets better an hour or so later after eating? What do you suspect?
Gastric ulcer
209
A patient describes abdominal discomfort that improves with meals and gets worse an hour or so later. What do you suspect?
Duodenal ulcer
210
A patient complains he regurgitates small amounts of food back into his mouth. He also has noted very foul-smelling breath. What do you suspect?
Zenker's diverticulum
211
What lifestyle change, in addition to smoking cessation, not eating before bedtime, and proper food choices, has the largest effect on GERD symptoms?
Weight loss
212
What is the gold standard for diagnosis of GERD?
pH monitoring with a intra-esophageal electrode
213
What surgical procedure is indicated for refractory GERD?
Nissen Fundoplication
214
Patient presents with bleeding esophageal varices. What medication is often given IV to stop the bleeding?
Octreotide and vasopressin
215
What disease process is commonly associated with esophageal varices?
Cirrhosis of the liver
216
What medication is indicated for the prevention of esophageal varices?
Beta Blockers - Nadolol or propranolol
217
A patient develops severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. What is the definitive treatment?
Emergent Surgery (Boerhaave's)
218
What is expected to be seen on endoscopy in a patient with a Mallory Weiss tear?
Long mucosal tears through venous or arterial plexus
219
A 24 year old male complains of bloody vomitus after a night of heavy drinking. What is the suspected cause of the bleeding?
Mallory Weiss tear
220
What is the treatment for the esophageal webs in Plummer Vinson disease?
Endoscopy and dilation plus Iron supplementation
221
A 60 year smoker presents with difficulty swallowing solids. What do you suspect?
Throat cancer
222
A female presents with dysphagia to solid foods and is found to be anemic. What is your expected finding on endoscopy?
Esophageal webs from Plummer Vinson (associated with iron deficiency anemia)
223
What is the main cause of strictures?
Healing scar due to ulcerative esophagitis
