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Gastro Review > GI ID@ > Flashcards

GI ID@ Flashcards

1
Q

Main features of ciguatera

A

3-6 hrs - N/V, nonbloody diarrhea, cramping

3-72 hrs - paresthesias, blurred vision, nerve palsies cold dysesthesia, bradycardia, hypotn, hrt block

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2
Q

What causes ciguatera?

A

dinoflagellate toxin in fish skin - cannot be prevented with freezing or cooking

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3
Q

What sxs of scromboid?

A

Histamine poisioning sxs - 1 to few hrs after ingestion - warmth, flushing, rash, pruritis, palpitations, tachycardia, HA, blurred vision, resp distress

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4
Q

What causes scromboid?

A

Not freezing fish fast enough - tuna, mackarel, or swordfish

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5
Q

How to tx ciguatera?

A

Supp cares

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6
Q

How to tx scromboid?

A

Antihistamines if needed but usu better by 12 hours o own

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7
Q

What is tetrodotoxin?

A

Puffer fish neurotoxin - leads to rapid and fatal NM weakness

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8
Q

What is the tx of campylobacter?

A

flouroquinolone or azithromycin

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9
Q

How to tx Listeria?

A

ampicillin and if CNS sxs, ICed, or IE add gentamicin

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10
Q

Which bact cause of meningitis can lead to high LCs?

A

Listeria

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11
Q

What is D latum?

A

A tapeworm

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12
Q

How to tx all tapeworms?

A

Praziquantel

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13
Q

Sxs of D latum?

A

megaloblastic anemia (B12 def), eosinophilia, fatigue, diarrhea

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14
Q

MC org to cause travelers diarrhea?

A

ETEC

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15
Q

When to tx travelers diarrhea?

A

4+ stools/d, fever, blood, mucus in stool

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16
Q

How to tx travelers diarrhea?

A

Azithro for kids, preg F, Asian travel; flouroquins otherwise

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17
Q

Where is E histo prevalent?

A

India, Africa, Mexico, C/SA, Asia

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18
Q

Who tends to get E histo infxn when traveling?

A

MSM

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19
Q

What is E histo?

A

A parasite

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20
Q

Where does E histo mainly affect?

A

Cecum/Asc colon

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21
Q

HIV pts with E histo can get what complication?

A

Liver abscess

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22
Q

Strongyloides sxs?

A

Mild waxing and waning GI sxs, cutaneoues, pulm sxs, eos

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23
Q

Best way to dx strongyloides?

A

Duod aspirate or strong test (Enterotest)

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24
Q

How to tx strongyloides?

A

Ivermectin or albendazole

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25
Q

Who gets cryptospor?

A

HIV pts

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26
Q

Sxs of cryptospor

A

Mild diarrhea, severe enteritis, biliary tract dz, wasting

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27
Q

How to dx cryptospor?

A

microscopy - oocysts pink or red with acid fast stain

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28
Q

How to tx cryptospor in HIV pt?

A

HAART

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29
Q

Which infxn AW iron overload (HCTosis)?

A

Yersinia

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30
Q

Infxn and RLQ pain…

A

Yersinia or campylobacter

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31
Q

Yersinia/CB - which can also cause pharyngitis?

A

Yersinia

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32
Q

Yersinia tx

A

None

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33
Q

Yersinia tx in ICed

A

Flouroquin

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34
Q

What is cystoisospora belli?

A

Protozoal infxn

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35
Q

Who gets CIS belli?

A

AIDS

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36
Q

Sxs of CIS belli?

A

Watery diarrhea, wt loss, EOS

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37
Q

T/F: CIS causes esoinophilia?

A

True - only protozoa that does

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38
Q

Tx of CIS belli?

A

Bactrim

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39
Q

Viral GI infxns typically cause what sx predominantly?

A

Vomiting

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40
Q

What is the tx of cholera?

A

ORT & doxy, single dose 300 mg

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41
Q

What is the rea of the GIT affected by cholera?

A

Duod/jejunum

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42
Q

How does cholera produce diarrhea?

A

TPers in the SI altered so large fluid secreted in SI, colon cannot compensate for it

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43
Q

Which blood group more likely to get severe cholera infxn?

A

Blood group O

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44
Q

How to differentiate ciguatera from paralytic shellfish poisoning?

A

PSP - rapid onset of weakness and paralysis

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45
Q

Sxs of botulism

A

vomit, diarrhea, Cranial nerve dysfxn, descending paralysis in hours to days

46
Q

List of exclusions to stool donors

A

IBS, IBD, Abx exposure, metab syndrome, neuropsych dz, live in UK > 3 months, inc age

47
Q

T/F: Stool TP from related donor is safer than nonrelated?

A

False

48
Q

Which tests to obtain from stool donors?

A

Hep A, B, C, HIV, syphilis, C diff, bact panel, giardia, rotavirus

49
Q

SB biopsy of strongyloides?

A

Larvae within wall

50
Q

Ascaris vs stronglyloides

A

Both very similar but ascaris only in ppl who travel outside of US; also most ascaris pts asxatic

51
Q

Best tx of strongyloides?

A

Ivermectin

52
Q

Why can strongyloides have high burden and cause SIRS?

A

Can complete entire life cycle in humans

53
Q

T/F: Strongyloides hyperinfxn can be fatal in ICed pts

A

True

54
Q

Vibro vulnificus from what?

A

Oysters

55
Q

VVul more common in who?

A

Liver dz, alcoholism

56
Q

Typical VVul tip off

A

Bullous skin lesions

57
Q

How to tx campylobacter?

A

Usually nothing but if severe dz can use azithromycin or FQ

58
Q

What is a nonTB bact cause of lymphocytic meningitis?

A

Listeria

59
Q

Comm acquired C diff in which type of pts?

A

Younger, female, fewer other illnesses, less abx exposure, less severe clinical course

60
Q

Which pt has higher risk of CAP while on PPI tx?

A

Older age, shorter duration of tx

61
Q

Sushi/freshwater fish inc risk of which infxn?

A

D latum

62
Q

How to tx D latum?

A

Praziquantel

63
Q

What is MC viral gastroenteritis in kids and adults?

A

Kids - rotavirus

Adults - norovirus

64
Q

Which infxns work by secreting enterotoxins?

A

ETEC and vibrio cholera

65
Q

Which infxn adheres to mucosa and effaces it causing diarrhea?

A

EHEC and EPEC

66
Q

Which infxn penetrates gut mucosa and spreads causing ulcers and damage?

A

Shigella, C jejuni, EIEC

67
Q

T/F: Uncomplicated yersinia infxn does not need tx?

A

True

68
Q

Classic hookworm findings?

A

IDA, peripheral eos, pruritis rash before sxs, hypoalbuminemia

69
Q

Name types of hookworms

A

Necator americanus, ancylostoma duodenale

70
Q

How to tx hookworm?

A

3 days of albendazole

71
Q

How to tx vibrio cholera infxn?

A

Single dose of doxy

72
Q

What are classic words for vibrio cholera?

A

Rice water stools

73
Q

Classic findings of shiga toxin producing E coli

A

abdominal pain, diarrhea, NO fever, rare leuks in stool

74
Q

How to dx shiga toxin producing E coli (O157:H7)

A

Stool EIA for shigatoxin

75
Q

How to distinguish paralytic shellfish poisioning from ciguatera?

A

Shellfish poisoning has rapid onset of neuro sxs and no bradycardia

76
Q

What does scromboid poisoning PW?

A

IgE related sxs - flushing, face/neck rash, warmth, erythematous rash, palpitations, tachycardia

77
Q

What is Chinese liver fluke?

A

Clonorchis sinensis

78
Q

How to treat clonorchis sinensis?

A

Praziquantel

79
Q

What percent of C diff infxn is comm acquired?

A

30-40%

80
Q

T/F: Test of cure should be performed in C diff pts regardless of if they have continued sxs.

A

False, do not retest if no sxs

81
Q

What percent of pts with neg C diff testing will have positive result if retested within 2 weeks?

A

<5%

82
Q

Strongyloides most typically affects which part of the gut?

A

Small intestine

83
Q

Where is strongyloides most prominent in the US?

A

Southeast

84
Q

List the MC protozoal infxns

A 
Giardia intestinalis
Entamoeba histolytica
Cyclospora cayetanenensis 
Cryptosporidium 
Microsporidium
Schistosomiasis
85
Q

List the MC worm (helminth) infxns

A 
Ascaris lumbricoides (roundworm)
Trichiuris trichiuria (whipworm)
Ancylostoma duodenale (hookworm)
Necator americanicus (hookworms)
Strongyloides (threadworm)
D latum (tapeworm)
86
Q

WHat is used for tx of C jejuni when indicated?

A

Azithro or levofloxacin

87
Q

T/F: C jejuni is AW post infxous IBS

A

True

88
Q

T/F: 30% of pts with GBS need ventilator support.

A

True

89
Q

How long after C jejuni infxn does GBS set in?

A

1-2 weeks

90
Q

What is the MC source of yersinia infxn?

A

Pig intestine (chitterlings)

91
Q

Common findings in Salmonella typhi infxn?

A

Skin rash, temp-pulse disassociation (fever with bradycardia), RLQ pain

92
Q

Where is Salmonella common?

A

India

93
Q

If see CMV on colon bx, what should be done?

A

Immunostaining for CMV to check burden to see if innocent bystander or if true infxn

94
Q

Foamy macs on SI bx seen in what?

A

Whipples dz

95
Q

How to tx Whipples dz?

A

Ceftri followed by 1 yr of bactrim

96
Q

How to distinguish MAC from WHipples dz?

A

Both have foamy macs in SI on PAS stain

MAC in pts with HIV and Acid fast + in MAC, neg in WHipples

97
Q

What is the mechanisms of scromboid?

A

High histamine leads to sxs

98
Q

Fish in scromboid

A

Tuna, mahi mahi, mackrel

99
Q

How to tx tropical sprue?

A

Tetracycline + folate for 6-13 months

100
Q

Where one gets tropical sprue?

A

DR, PR, Cuba, Haiti, India, Middle East

101
Q

What is mechanism of tropical sprue?

A

Thought to be infxous but not 100% sure

102
Q

Which infxn can cause partial villous blunting?

A

Giardia

103
Q

How long after exposure to giardia do sxs start?

A

1 week

104
Q

How to tx giardia?

A

Metronidazole, nitazoxanide, quinacrine, tinidazole

105
Q

With tx, what % of giardia pts relapse?

A

20%

106
Q

Associations:

  1. Heart block/brady
  2. Temp-pulse disassociation
  3. Megaloblastic anemia + eos
  4. IDA + Hypoalb + rash
A
  1. Ciguatera
  2. Salmonella typhi
  3. D latum (tapeworm)
  4. Hookworm
107
Q

3 days of albendazole treats what?

A

Hookworm or Whipworm

108
Q

Bactrim used to tx what?

A

CIS belli

109
Q

FQ or azithro used to tx what?

A

Campylobacter (when needed), Travelers diarrhea

110
Q

FQ only used to tx what?

A

Yersinia in ICed pt

Gastro Review (15 decks)

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