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FunMed GI Exam > GI exam > Flashcards

GI exam Flashcards

1
Q

Upper GI bleed is classified as a bleed above which landmark?

A

Ligament of treitz - caused by esophageal varices, Mallory-Weiss tears, cancer, PUD

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2
Q

Which category of illness is characterized by “Coffee ground” hematemesis?

A

upper GI bleed

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3
Q

Hematochezia is associated with upper or lower GI bleeds?

A

lower - caused by IBD, anorectal disease, infectious colitis

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4
Q

A patient has undergone gastric bypass surgery and now there is bacterial communication between small intestine and colon. What is going on and what is the treatment of choice?

A

Bacterial overgrowth syndrome; treat with Antibiotics (Metronidazole)

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5
Q

What is the confirmation of diagnosis for Celiac sprue?

A

Endoscopy and BIOPSY! you need the pathology to confirm. If negative for villi destruction, the patient just has Gluten sensitivity

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6
Q

True or False: Tropical sprue is similar to Celiac sprue in that the villi of the small intestine are damaged, confirmed on biopsy. Therefore, eliminating gluten treats tropical sprue as well.

A

FALSE! gluten free diets do not improve symptoms, and tropical sprue is treated with Antibiotics: Tetracycline for 6 months

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7
Q

What must you rule out to consider tropical sprue?

A

Ova and Parasite testing must be negative 3 times before considering tropical sprue.

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8
Q

Treatment for short bowel syndrome?

A

Gattex (Teduglutide) - CAUTION! risk of cancer due to increasing intestinal/cellular growth.

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9
Q

What is the hallmark symptom of acute appendicitis?

A

Anorexia!!

They will also have pain starting in periumbilical region, and migrating to RLQ

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10
Q

Patient presents with anorexia, n/v, pain that started in umbilicus region and has now migrated to the RLQ. On exam, Pain at McBurney’s point. What is your plan of action?

A

Send right to OR for laparoscopic appendectomy.
If history, symptoms, exam confirm Appendicitis, you can take quicker action. IF SYMPTOMS ARE ATYPICAL (no pain at mcburney’s point), get a CT first to confirm

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11
Q

If patient has appendicitis, but you notive rigors, high fever, and positive heel jar, what do you have to be concerned of?

A

rupture (causing peritonitis)

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12
Q

The loss of peristalsis in intestines WITHOUT obstruction is?

A

Acute paralytic ileus

causes: post-surgery, peritoneal irritation, medications

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13
Q

When auscultating the abdomen on a patient with acute paralytic ileus, you should hear which type of bowel sounds?

A

Diminished

If you were to hear tinkling noises, that would indicate obstruction

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14
Q

Treatment for acute paralytic ileus?

A

Bowel rest, IV fluid/electrolytes

NO OPIOIDS or anticholinergics (slow the bowels more)

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15
Q

Patient has feculent emesis and crampy abdominal pain that comes in waves. What do you think is going on?

A

Small bowel obstruction

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16
Q

How do you confirm small bowel obstruction?

A

Xray upright (will show air-fluid levels)

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17
Q

True or false: Diagnostic for small bowel obstruction is the same for large bowel obstruction

A

FALSE: do Colonoscopy to assess for large bowel obstruction

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18
Q

This twist in the bowel causes obstruction, ischemia, and is a surgical emergency

A

Volvulus

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19
Q

How do you approach treatment for a patient with an upper GI bleed?

A

Get them hemodynamically stable FIRST! and then handle the source of bleeding (endoscopic clips, epi injection, mechanical compression, etc).

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20
Q

This disease is characterized by transmural inflammation of the GI tract, from mouth to perianal area

A

Crohn’s disease

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21
Q

Smoking and jewish descent are risk factors to which disease?

A

Crohn’s disease

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22
Q

In a patient with crohn’s disease, you may see extraintestinal manifestations, such as arthritis, cholelithiasis, and which other skin defect?

A

pyoderma gangrenosa

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23
Q

Colonoscopy and biopsy is diagnostic for crohn’s disease. What does the endoscopy look like?

A

Skip lesions = segmental involvement, meaning areas of inflammation adjacent to areas of normal mucosa.

Will also see aphthoid ulcers, stellate ulcers, and strictures

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24
Q

What is they histology of the GI tract for someone with crohn’s disease?

A

acute and chronic GRANULOMAS

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25
Q

Not all Crohn’s patients have ileal involvement (so colonoscopy wouldn’t show anything abnormal). How do we assess these patients?

A

Upper GI series with barium or capsule endoscopy

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26
Q

Assessing patient for GI symptoms, and upper GI barium shows nodular thickening, string sign, and cobblestoning. What is their diagnosis?

A

Crohn’s disease

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27
Q

What is the initial treatment for mild Crohns? (it will coat the GI tract)

A

5-Aminosalicylate (5-ASA)

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28
Q

If patient initiated on 5-ASA for crohns is unresponsive, which step do you take next?

A

Add a corticosteroid

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29
Q

Treatment for Crohns: mild disease, low risk?

A

Budesonide 8-12 weeks (if ilieocecal)Prenisone 4-8 weeks (if diffuse or L colon)

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30
Q

What is the treatment for refractory crohn’s?

A

Continue the steroids and ADD an immunomodulator (azathioprine or methotrexate)

If young patient with severe disease, consider biologic + immunomodulator

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31
Q

What will you see on upper GI barium swallow for someone with crohns?

A

nodular thickening
string sign
cobblestoning

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32
Q

What is the difference in location of infection regarding crohn’s VS ulcerative colitis?

A

ulcerative colitis is ONLY the colon (not the small bowel like crohns)

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33
Q

What is the treatement for mild-moderate UC that is L-sided/pancolitis?

A

oral and topical 5-ASA.

If they need more help, add a steroid

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34
Q

What effect does smoking have on patients with Ulcerative colitis

A

smoking actually relieves the symptoms (unlike crohns, it makes it worse)

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35
Q

What does endoscopy for UC look like?

A

diffuse, circumferential, continuous inflammation
micropurulent exudates
bleeding

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36
Q

Do you perform a barium study to diagnose Ulcerative colitis?

A

NO - use endoscopy

if barium study was performed you would see a “lead pipe” colon

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37
Q

How is the depth of inflammation different in patients with UC (as opposed to crohn’s)?

A

in UC, the inflammation is confined to the mucosal layer

in crohns, it is transmural

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38
Q

what is the hallmark symptom for a UC patient?

A

BLOODY DIARRHEA - due to its rectal/colon location!

vs. crohn’s, there isn’t any blood because it’s coming from the ileum

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39
Q

Treatment for severe UC

A

oral steroid + high dose oral 5-ASA + topical 5-ASA +/- Antibiotics

(if they dont’ respond to this - hospitalize)

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40
Q

when do you consider a colectomy in the treatment of fulminant UC?

A

if there is no response to treatment within 4-7 days.

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41
Q

A patient presents with chronic watery diarrhea, but colonoscopy results were unremarkable. What is the next step?

A

Suspect Microscopic colitis - need biopsy, which will reveal collagenous histopath
(treat empirically)

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42
Q

Treatment for microscopic colitis?

A

Antidiarrheal, then bismuth, then budesonide, then immunomodulators/biologics (step up therapy)

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43
Q

you find outpouchings incidentally on a patient, (diverticulosis). They are asymptomatic. What is the treatment?

A

high fiber diet and/or fiber supplements

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44
Q

If an outpouching in the colon gets infected and perforates, this disease is called?

A

Diverticulitis

uncomplicated vs complicated

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45
Q

How does the treatment vary between complicated and uncomplicated diverticulitis?

A

uncomplicated: outpatient, Rx antibiotics (Cipro or metronidazole), bowel rest

Complicated: inpatient - IV antibiotics

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46
Q

Which disease is the Hinchey classification used for?

A

Diverticulitis - assesses level of perforation and guides surgical intervention

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47
Q

How is IBS different from IBD (crohn’s and UC)?

A

IBS is NOT inflammatory, it is a FUNCTIONAL disorder.

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48
Q

How long does a patient have abdominal pain and altered bowel habits before considering an IBS diagnosis?

A

> 3 months

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49
Q

Visceral hypersensitivity is one of the associated symptoms in which disorder?

A

IBS - peripheral and central pain processing are heightened

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50
Q

IBS can be categorized into different subtypes. What are they?

A

IBS-C: constipation
IBS-D: diarrhea
IBS-M: constipation and diarrhea
IBS-U: uncategorized

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51
Q

patient presents with 4 months small volume diarrhea, abdominal pain, and visceral hypersensitivity. However, their exam is normal. Labs all WNL. What are you diagnosing her with?

A

Irritable bowel syndrome

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52
Q

True or false: we treat IBS with topical and oral 5-ASA

A

FALSE: treatment includes exclusion of gas-producing foods, low FODMAPs, exclusion of lactose/gluten trials. Treat the abdominal pain with an antispasmodic (hyoscayamine)
IBS-C: add a laxative
IBS-D: add an antidiarrheal

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53
Q

Most common type of neoplastic polyps?

A

Adenomatous

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54
Q

True or false: adenomatous polyps can be pedunculated (stalked) or sessile (flat)

A

TRUE

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55
Q

The symptoms of colon cancer can vary depending on the location of the malignant polyp/tumor. Explain the differences in signs/symptoms based on location

A

Right bowel: no symptoms, no blood in stool. May have unexplained anemia

L bowel(rectosigmoid): hematochezia (fresh blood in stool), tenesmus (rectal pain when defecating), cramping abdominal pain

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56
Q

FAP and Lynch syndrome are risk factors to?

A

colon cancer

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57
Q

In a person being assessed for colon cancer, which organs should you check for metastasis?

A

Breasts in female - common that breast cancer is from colon cancer mets
Also check for hepatomegaly/ascites as metastasis is common to the liver as well

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58
Q

Radiography shows “Apple core” lesion. What diagnosis are you thinking?

A

Colon cancer

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59
Q

Although you may see “apple core” lesions on imaging when you assess for colon cancer, what is the gold standard diagnostic?

A

Colonoscopy and BIOPSY!!

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60
Q

treatment goal for colon cancer?

A

resect the tumor.

Sometimes colectomy is required to remove cancerous portion.

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61
Q

Pharmacological treatment for colon cancer?

A

5-FU

Add folinic acid (leucovorin) to improve the function of 5-FU

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62
Q

Is radiation effective in colon cancer?

A

No- due to peristalsis

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63
Q

True or false: removing polyps prevents cancer, and early detection increases surgical cure rate.

A

True

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64
Q

FOBT (stool tests) are great because they aren’t invasive, and they can detect blood in the stool. However, what is their downfall?

A

They cannot detect polyps - still need routine colonoscopy

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65
Q

20% of children with rectal prolapse also have what disease?

A

cystic fibrosis - newborns undergo chloride sweat testing

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66
Q

pharmacological treatment for colon cancer?

A

5FU (sometimes with folinic acid; acts as synergist to 5FU)

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67
Q

Redundant sigmoid colon, pelvic nerve damage, and weak pelvic floor muscles can lead to what?

A

rectal prolapse

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68
Q

fecal incontinence is defined as involuntary passage of fecal material for what period of time?

A

> 1 month (person’s must be over age 4)

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69
Q

1/2 of patients with fecal incontinence also have ____?

A

urinary incontinence

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70
Q

distinguishing between internal and external hemorrhoids is based on which structures?

A

the dentate line

71
Q

Internal hemorrhoids require ______ for diagnosis while external hemorrhoids require ___________

A

anoscopic evaluation; direct visualization

72
Q

Treatment for a 3 year old child with an asymptomatic umbilical hernia?

A

nothing! – will close by age 4-5

73
Q

What do you call an acute or chronic, recurrent abscess with hair follicles along the sacrococcygeal region?

A

Pilonidal disease

74
Q

In celiac sprue, what is the actual irritant that causes the damage to the villi?

A

gliadin

75
Q

tTG is a good antibody test for celiac sprue, but what is the DIAGNOSTIC test?

A

endoscopy + biopsy (patient has to be ingesting gluten during test)

76
Q

Treatment for bacterial overgrowth syndrome?

A

metronidazole

77
Q

what is the diagnostic test for diverticulitis?

A

CT scan - shows pericolic fat infiltration, thickened colon wall, fat stranding

78
Q

treatment for uncomplicated diverticulitis?

A

outpatient: antibiotics (Cipro/metronidazole) and bowel rest

79
Q

treatment for complicated diverticulitis?

A

inpatient: IV antibiotics (piperacillin), analgesics, bowel rest

80
Q

What is the Hinchey classification used for?

A

assessing the need for surgery in patients with diverticulitis:
I & II: antibiotics and drainage; resect area in 6 weeks
III & IV: directly to surgery to remove deceased colon segment

81
Q

what is the disorder defined as an inflammatory condition of the colon due to perforation of the diverticula sac?

A

diverticulitis

82
Q

Where should an anal fissure be located to be assured that it is simply an anal fissure and nothing more?

A

Anterior and posterior

83
Q

What if you see a skin tag below an anal fissure?

A

this is a chronic issue

84
Q

what is the disorder defined by occlusion of anal glands at the dentate line?

A

anorectal abscess

85
Q

When is Goodsall’s rule used?

A

in anorectal abscesses, it’s used for fistula mapping

86
Q

treatment for anal fissure?

A

sitz bath
nitro paste
if severe, may consider lateral sphincterotomy (to resolve hypertonic sphincter)

87
Q

When is a hemorrhoidectomy considered in a patient with internal hemorrhoids?

A

those with stages 3 and 4; bleeding and prolapse that needs digital reduction or CANT be reduced

88
Q

If patient has an external hemorrhoid that is thrombosed, what is the time frame that clot evacuation needs to happen?

A

< 72 hours!

89
Q

treatment for pilonidal disease?

A

incision and drainage, hair removal

90
Q

what are the fat soluble vitamins?

A

Vit A, D, E, K

91
Q

deficiency in this causes follicular hyperkeratosis and night blindness

A

Vitamin A

92
Q

too much vitamin A causes what disorder? and what is it characterized by?

A

hypervitaminosis A; can lead to pseudotumor cerebri (increased intracranial pressure)

93
Q

deficiency in this causes distorted bones, rickets, osteomalacia

A

Vitamin D

94
Q

what serum protein do you check to assess Vitamin E levels?

A

serum alphtocopherol

95
Q

deficiency in this causes hemolytic anemia, absent reflex, and neuro disturbances

A

Vitamin E

96
Q

This vitamin is essential for pro-coagulants and anticoagulants, and a deficiency leads to excessive hemorrhage

A

Vitamin K

97
Q

this is SO important in pregnant women

A

Folate

98
Q

deficiency in folate can lead to what defect ?

A

fetus neural tube defects

99
Q

deficiency in this leads to pellagra (also diarrhea, dementia, glossitis, stomatitis)

A

Niacin B3

100
Q

deficiency in thiamine (B1) can lead to this syndrome, characterized by SOB, rapid HR, and edematous lower extremities

A

wet beriberi

101
Q

Decreased muscle function, numbness in hands, mental confusion, difficulty speaking are all signs of what complication of thiamine deficiency?

A

dry beriberi

102
Q

Describe the 2 stages of Wernicke-Korsakoff syndrome

A
  1. Wernecke encephalopathy: confusion, LOC, nystagmus

2. korsakoff syndrome (psychosis): IRREVERSIBLE memory damage and hallucinations

103
Q

what is the most common cause of lower GI bleeds?

A

Diverticulosis

104
Q

treatment for uncomplicated diverticulitis?

A

outpatient: antibiotics (Cipro/Metronidazole)

105
Q

diagnostic test for diverticulitis?

A

CT scan

106
Q

what is hamman’s sign?

A

mediastinal air on lung auscultation - heard in boerhaaves syndrome

107
Q

treatment for pill esophagitis?

A

sulcralfate - coats the ulcers so they can heal

108
Q

forceful vomiting causes spontaneous rupture at GE junction

A

boerhaaves

109
Q

nontransmural tear at GE junction, and most common cause of hematemesis

A

Mallory-Weiss tear

110
Q

treatment Mallory-weiss

A

nothing - heals on own. Uncontrolled bleeding can be treated with local epinephrine

111
Q

diagnostic test of choice for diagnosing esophageal cancer

A

scope and biopsy

112
Q

ongoing GERD can cause healthy esophageal epithelium to be replaced by metaplastic columnar and goblet cells. This disorder is known as…

A

Barretts Esophagus

113
Q

degeneration of ganglia in esophageal myenteric plexus, causes absent peristalsis and poor LES relaxation

A

Achalasia

114
Q

What condition might you see a “sigmoid” deformity on barium swallow?

A

achalasia

115
Q

You are assessing a patient for achalasia, however the results on Barium swallow were unclear. What is your next best test of choice?

A

Manometry

116
Q

Gold standard diagnostic for DES

A

manometry

barium swallow is not diagnostic, but you would see “corkscrew esophagus” - not diagnostic because this can also be seen in some achalasia subtypes

117
Q

treatment for DES

A

Anxiolytics

118
Q

What 3 pathogens are commonly the cause of infectious esophagitis?

A

Candida albicans
Herpes simplex/zoster
CMV

119
Q

What is the hallmark symptom of infectious esophagitis?

A

Odynophagia

120
Q

What findings might you see on endoscopy of a suspected EoE patient?

A

edema
esophageal rings
longitudinal furrows
punctate exudate (pinholes)

121
Q

treatment of EoE

A

PPIs –> swallowed steroids if unrefractory to PPI.

122
Q

What treatment must you be very cautious of regarding EoE?

A

Dilation - high risk of perforation due to stiff-walled esophagus

123
Q

In patient newly diagnosed with GERD, you prescribe them with ____. However, what is the most important “treatment”?

A

PPIs; lifestyle modifications - lose weight, avoid acid-producing foods

124
Q

Surgical intervention options for GERD?

A

Toupe (fundoplication) - must have normal LES function

Nissen - partial fundoplication; for those with abnormal LES function

125
Q

Another name for gastrinoma?

A

ZES

126
Q

What is the most common cause of ulcers and the most likely to lead to gastric cancer?

A

H.pylori!

127
Q

Patient presents with acute gastritis. You are concerned for which organism, and need to request which lab/test/imaging to confirm?

A

H.pylori; fecal antigen and urea breath test are diagnostic (and best non-invasive option)

128
Q

You want to rule out h.pylori infection in a patient with urea breath test, but they cannot d/c their PPI (which is required for the breath test). What is your next best option?

A

Endoscope with biopsy for organism

129
Q

treatment for gastritis?

A

PPI + clarithromycin + amoxicillin

PPI + 2 Abx

130
Q

what is transmitted by the “kissing bug”

A

Chagas disease

131
Q

patient has gnawing, dull epigastric pain around 90 minutes post-meal, and it also wakes them up from sleep. What are you suspicious of?

A

PUD - Duodenal ulcers

132
Q

gnawing, dull epigastric pain that is precipitated by eating. What type of PUD do you suspect?

A

Gastric ulcers

133
Q

what is the major cause of GASTRIC ULCERS?

A

NSAID use

134
Q

what is the major contributor to Duodenal ulcers?

A

h.pylori

135
Q

treatment for PUD?

A

PPI + sucralfate

136
Q

what is the most common type of gastric cancer?

A

adenocarcinoma

lymphomas make up the other 2% of gastric cancer

137
Q

when assessing a patient for melena, indigestion, postprandial fullness, weight loss, you receive imaging back. You notice a “leather bottle” appearance, aka linitis plastic. What is this a sign of?

A

Diffuse gastric cancer. Water bottle appearance is due to a loss of distensibility of the gastric wall

138
Q

most common type of gastric cancer is the intestinal subtype. What causes this?

A

h.pylori.

Other risk factors: GERD, obesity, family hx

139
Q

your patient has a palpable enlarged stomach with a succession splash on exam. You then palpate Virchow and Irish lymph nodes. What do you suspect is going on?

A

Gastric Cancer

140
Q

CEA and CA19-9 are often elevated in which disease?

A

gastric cancer

141
Q

Treatment differs between a distal and proximal gastric carcinoma. What are the different treatment options?

A

Distal carcinoma: subtotal gastrectomy

Proximal carcinoma: total gastrectomy

142
Q

where is the most frequent extranodal site for lymphoma metastasis?

A

stomach - gastric lymphoma

143
Q

this pancreatic neuroendocrine tumor secretes gastrin, causing an increase in gastric acid secretion and growth of gastric mucosa

A

Zollinger-Ellison Syndrome (aka gastrinoma)

144
Q

Patient presents with DU, chronic diarrhea, but biopsy was negative for h.pylori. What is next on your differential?

A

ZES

145
Q

having the MEN1 gene is a risk factor for which disorder?

A

ZES

146
Q

What is the diagnostic test of choice for ZES?

A

secretin test! gastrin levels increase with the administration of secretin

147
Q

gallstones and alcohol can cause prematurely activated pancreatic enzymes to autodigest themselves. this is called?

A

acute pancreatitis

148
Q

you might see Cullen’s sign and grey-turner on physical exam as a characteristic of what disease?

A

Acute pancreatitis
Cullen’s: blue discoloration around umbilicus
Grey-turner: blue/green/brown flanks

149
Q

In acute pancreatitis, which serum protein is the most significant for diagnosis?

A

Amylase and Lipase will both be elevated; LIPASE is more specific

150
Q

diagnostic gold standard for diagnosing acute pancreatitis?

A

Abdominal US first.

If unsuccessful, can move to CT

151
Q

How does the Atlanta classification for acute pancreatitis help decipher between interstitial and necrotizing subtypes and severity?

A

Interstitial: pancreatic blood supply is maintained - CT shows functioning vessels because the contrast is being picked up

Necrotizing: Contrast is not being picked up by the pancreatic vessels = necrosis

152
Q

True or false: 90% acute pancreatitis resolves on own.

A

True. NPO; let the pancreas rest

153
Q

treatment ZES

A

acid control (PPI) and surgical resection of pancreatic tumor

154
Q

irreversible damage and stellate cell activation, causing inflammatory process in pancreas

A

chronic pancreatitis?

155
Q

_____ is the most common cause of chronic pancreatitis in adults, while in kids it’s _______

A

alcohol, cystic fibrosis

156
Q

patient presents with abdominal pain, exacerbated by eating. Pain radiates to the back, but physical exam finding unremarkable. Patient is laying on L side, drawing knees into chest. suspiciousof what?

A

chronic pancreatitis

157
Q

serum lipase and serum amylase normal to slightly elevated, signifies what?

A

CHRONIC pancreatitis; really elevated lipase would indicate acute.

158
Q

diagnostic test for chronic pancreatitis?

A

ERCP – visualizes pancreatic duct system.

CT is helpful as well for looking at other hallmark changes

159
Q

most common causes of pancreatic cancer

A

smoking & diabetes

most common location is head of the pancreas

160
Q

Pruritis, new onset diabetes, weight loss raise suspicion for?

A

Pancreatic cancer

161
Q

Diagnostic test for pancreatic cancer

A

CT - allows vision of surrounding viscera, vessels, lymph involvement.

Also do ERCP to visualize ductal system

162
Q

Treatment pancreatic cancer?

A

CHEMO & Gemcitabine

only 10% tumors are resectable.

163
Q

This GI disorder is neat because its diagnostic test is actually the treatment as well. Commonly caused after gastric bypass surgery

A

Bacterial overgrowth syndrome - give metronidazole

164
Q

With acute paralytic ileus, should you be worried about obstruction?

A

No

165
Q

what would you see on CT scan of diverticulitis?

A

pericolic fat infiltration
thickened colon wall
fat stranding
(if perforated/complicated, will show stricture, free air, abscess, fistula)

166
Q

True or false: After confirming the presence of diverticulitis via CT scan, you need to perform a colonoscopy to exclude cancer RIGHT AWAY

A

FALSE! do not perform a colonoscopy while actively inflamed, administer the Abx and wait 6 weeks

167
Q

Patient present with a Hinchey stage III diverticulitis. What is your plan of action?

A

directly to surgery - remove the diseased section of colon.

168
Q

Which Hinchey stages of diverticulitis only require drainage of the abscess and antibiotics?

A

Stages 1 and 2

169
Q

This disorder is a FUNCTIONAL disorder of the GI tract, NOT INFLAMMATORY

A

IBS

170
Q

A patient presenting with bowel changes associated with stress and visceral hypersensitivity raises concern for…

A

IBS

171
Q

Which criteria helps in diagnosis IBS?

A

Rome IV
abdominal pain > 1 day per week for >3 months
pain with defecation
change in stool form and frequency

172
Q

treatment IBS?

A

diet changes, laxative or antidiarrheal (depending on the subtype), and antispasmodic medication for abdominal pain

173
Q

deficiency in this vitamin causes hemorrhage. Check prothrombin time

A

Vitamin K

174
Q

in someone with suspected fecal incontinence, what do you check for on physical exam?

A

during rectal exam, check for sphincter tone. May also need manometry to assess muscle function

FunMed GI Exam (1 decks)

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