GI/nutrition 11% Flashcards
A 52 y/o male presents with abdominal pain, and cramping, he has been constipated for the last month and has been feeling more tired then usual. He has a history of colorectal polyps and has notice dark stool. He has loss 20 lbs in the last month. Abdominal mass noted on palpation. He has also notice a change in bowel habits.
A. What is the most likely diagnosis? B. what diagnostic studies? C. what is the treatment? D. What is the most likely cell type? E. what is the screening recommendation?
A. colorectal CA B. Colonoscopy w/ biopsy C. surgery, chemo rare, no radiation D. Adenocarcinoma E. screening -Asymptomatic w/ no family HX: starting at 50 and q10 years after -family hx: start at 40 y/o
A 45 year old CEO presents to your clinic with complaints of severe heartburn and upper abdominal pain that have been present for the past few weeks. Pain is slightly improved with OTC Prilosec and Tums, and better with meals, but between meals pain is severe. Which diagnosis is most likely?
A. What is this patients diagnosis?
B. What is the diagnostic studies of choice?
C. How would you treat this patient?
D. What are important lifestyle changes this patient can make to improve?
E. What is the pathophysiology?
DDX?
A. Peptic ulcer disease
B. UGI Endoscopy to detect small or healing ulcers.
C. Treatment
1. Stop smoking, EtOH and NSIADS (if he is taking any)
2. PPI + clarithromycin + amoxicillin
D. Stop smoking and EtOH
E. Ulceration of upper digestive system cause by NSAIDS, H. Pylori, stress, or alcohol
DDX: Gastritis Neoplasm Cholangitis cholelithesis Irritable bowel
A patient presents with epigastric pain, nausea, vomiting, anorexia, early satiety or weight loss. Pain does not radiate, he has not notice any other symptoms. Physical exam findings show mild epigastric pain on palpation. No fever.
A. What is the most likely diagnosis?
B. What studies can you do to confirm your diagnosis?
C. what is the treatment?
D. What is the pathophys?
A. Gastritis
B. Endoscopy w/ biopsy and urea breath test
C. Treat the cause, remove aggravating factor.
D. Inflammation of the stomach
-Autoimmune disorder: type A involving body if stomach
-H. pylori: type B, involving the antrum and body of stomach
DDX? PUD irritable bowel chalangitis cholelithesis bowel obstruction
A pt presents with a mild fever and vomiting. He has also been having non bloody, watery diarrhea for the last 5 days. He has been drinking lots of water to keep hydrated. Denies weight loss. On abdominal exam, pt complain of mild, diffuse tenderness. No blood in stool, coffee grounds stool or bright red blood.
A. what is the most likely diagnosis?
B. what is the treatment?
DDX?
A.Gastroenteritis
B. supportive, hydration most are self limiting
DDX: C. Diff colitis Giardia cryptosporidium food poisoning
A. what is diarrhea?
B. clinical presentation?
C. diagnostic studies?
D. treatment?
A. increased in frequency or volume of stool ( > 3 liquid/semisolid stool per day for at least 2 consecutive days)
B. presentation
-large volume, without inflammation: pancreatic insufficiency, ingestion of preform toxin
-bloody, with fever: invasive organism or IBD
C. culture for bacterial or other causative agents
D. Hydration, most are self limiting
A. what is constipation?
B. what is the treatment?
A. decrease in stool volume and increase firmness accompanied by straining
B. increase fiber and fluid intake and exercise
A pt presents with a “boring” epigastric pain that radiates to the back. He says that when he leans forward, the pain is better. He has also been throwing up and nauseated. He has a history of drinking 8 beers a night for the last year. On exam pt has decreased bowel sound and epigastric tenderness on palpation. Labs shows increased serum lipase (3x upper limit), increase ALT/AST.
A. what is the most likely diagnosis?
B. What is the treatment?
C. Most common cause?
A. Pancreatitis
B. NPO, IVF, pain management, close monitor inpatient
C. Alcohol consumption
A. what are the 2 types of inflammatory bowel disease?
B. How does Crohn’s present?
C. What are the diagnostic study?
D. treatment?
A. Crohn's disease and ulcerative colitis B. presentation -usually distribute from the mouth to anus with skip areas -abdominal pain and diarrhea in pt -most common in terminal ileum C. colonoscopy D. treatment -acute: oral prednisone -maintenance:meslamine -stop smoking
A pt presents with intermittent periumbilical pain that localize to the RLQ (McBurney point) and becomes constant. Pain is worst with movement. He is also nauseated. Physical exam showed rebound tenderness, + McBurneys, posts and obturator sign. His temp is 101.
A. what is the most likely diagnosis?
B. what diagnostic studies?
C. what is the treatment?
D. What is the pathophys?
A. Appendicitis B. studies -Lukocytosis (10-20k) -Abdominal CT to confirm diagnosis C. Appendectomy D. patho -obstruction of the appendix > inflammation and infection (most common fecalith)
A pt present with abdominal pain, distention, and vomiting partially digested food. Physical exam reveals bowel sounds that are high pitched and comes in rushes. X-ray shows air fluid levels.
A. what is the diagnosis?
B. what studies?
C. cause?
D. treatment?
A. bowel obstruction B. X-ray showing air fluid levels C. cause -small bowel: adhesion and/or hernias -large bowel: neoplasm D. treatment -NPO, nasogastric suctioning, IV fluids and monitoring
viral hepatitis
- diagnosis
- clinical therapeutics
- history and physical
- diagnostic studies
- health maintenance
- clinical intervention
- scientific concepts
Jaundice
- diagnosis
- clinical therapeutics
- history and physical
- diagnostic studies
- health maintenance
- clinical intervention
- scientific concepts
A. what is the cholecystitis?
B. what is the clinical presentation?
C. Studies?
D. treatment
Case
44 y/o obese female, presents with acute, sharp epigastric pain 2 hours after large meals. she vomited once.
A. obstruction of the bile duct, usually by stones, leading to chronic inflammation.
B. colicky epigastric pain that localizes to RUQ and becomes steady and increase in intensity. Usually occurring after high fat meals. Shoulder pain can also occur in some pt. N/V and low grade fever. Leukocytosis.
C. studies
-increase bili in urine (after 24 hrs)
-ultrasound shows a thickens gallbladder wall
-positive Murphy’s sign
D. labroscopic cholecystectomy
A 45 year old female presents to your office with intermittent, right upper quadrant pain. The patient states that it has been occurring on and off for the past two years and usually begins after eating a meal and subsides after several hours. On physical exam, the patient is overweight and demonstrates no abdominal pain to palpation.
A. What is the diagnosis?
B. studies?
C. treatment?
A. cholelithiasis
B. Abdominal US
C. laparoscopic cholecystectomy
A. What are the early presentation of cirrhosis?
B. what are the late stages of cirrhosis?
C. what diagnostic studies?
A. Weakness, fatigue, weight loss, abdominal pain/distention
B. ascites, pleural effusion, edema, esophageal varices
C. studies
-Anemia common, Elevated AST and alkaline phosphate, decrease albumin and INR
-US, CT, MRI to confirm size and number of nodules
D. treatment
-stop EtOH
-Na restriction, bed rest, spironolactone
-liver transplant
giardias and other parasitic infection
- diagnosis
- clinical therapeutics
- history and physical
- diagnostic studies
- health maintenance
- clinical intervention
- scientific concepts
A. what is hiatal hernia?
B. presentation?
C. studies?
D. treatment?
A. portion of the stomach prolapses through the diaphragmatic esophageal hiatus
B. reflux (GERD) symptoms, most are asymptomatic
C. barium UGI series
D. treatment
-acid reduction
-surgical reduction
A patient presents with heartburn, especially after meals and when she wakes up in the morning. She has tried to use OTC antacid and that helped her symptom. ROS as stated in HPI, physical exam normal.
A. what is the most likely diagnosis?
B. When should you consider endoscopy?
C. what is the treatment?
D. what is the patho of this disease?
A. GERD B. 45+ pt with new onset of sx C. Treatment -lifestyle mod -PPI D. reflux of gastric acid caused by a weakening of the lower esophageal sphincter
A patient presents with recurrent pain and discomfort in the abdomen at least 3 days per month over the past 3 months. The symptoms only improves when he defecates. Associated symptoms includes: alternating diarrhea and constipation. Physical exam normal. ROS normal. Patient has a history of depression.
A. This diagnosis is also the most common cause of chronic abdominal pain in the US. What is it?
B. what diagnostic studies?
C. what is the treatment?
DDX?
A. irritable bowel syndrome
B. studies to rule out other cause of ABD pain
C. reassurance, high fiber diet, adding bulking agent (psyllium hydrophilic mucilloid
DDX: Ischemic bowel disease bowel obstruction cholelithesis neoplasm
A patient presents to your clinic with odynophagia and dysphagia. He is on chemo therapy for CA.
A. what is the most likely diagnosis?
B. what are the common cause?
C. What diagnostic studies?
D. what is the treatment?
A. infectious esophagitis B. Canida, CMV, HSV C. studies -Endoscopy showing large, deep ulcers (CMV or HSV), multiple shallow ulcers (HSV) or white plaques (canida) -cytology/culture to determine cause D. treatment -canida: flucocanazole or ketoconazole -HSV: acyclovir -CMV: IV geniclovir
A. what is colonic polyps? B. what is the presentation of polyps? C. what are the diagnostic studies? D. what is the treatment? E. risk of CA for 1. hyperplastic 2. tubular 3. vilious
A. Polyps in the colon, genetic polyps ~ increased risk of CA
B. Generally asymptomatic but, can have constipation, flatulence and rectal bleeding.
C. barium enemia, sigmoidoscopy, colonoscopy w/ histology
D. depends on size/type
-larger: remove and frequent follow up
-single polyp: follow up ever 10 years
-increased number: followup every 5 years
E. risk of CA
1. low
2. medium
3. high
A. What is ulcerative colitis?
B. How does it present?
C. What studies?
D. what is the treatment?
A. Inflammatory bowel disease that usually only involves the large bowel
B. presentation
-usually start distally and spread proximal, no skip areas
-tenesmus and blood, pus-filled diarrhea
-Mucous discharge from the rectum
-usually insidious onset
C. sigmoidoscopy or colonoscopy
D. treatment
-topical or oral aminosalicylates and corticosteroids
-surgery
A pt presents with weakness, dizziness, syncope associated with hematemesis (coffee ground vomitus), melena (black stools with a rotten odor) and epigastric pain. He has a history of using NSAIDS for low back pain, history of ulcers.
A. what is the likely cause? B. what are the common cause? C. what is important to check for on physical exam? D. studies E. treatment
A. upper GI bleed
B. PUD, varices, mallory wiest, NSAIDS, malignancy
C. Make sure patient is hemodynamically stable, check orthostatic vitals (HR increase >10-15, SBP dec > 20 and DBP dec > 10) and AMS
D. EGD (upper endoscopy aka esophagstroduodensocpy)
E. tx
-Bore IV
-IVF or transfusion if active bleeding
-varices: PPI + octreotide
-PUD/gastritis/esophagitis: high does IV PPI
A. What is the most common presentation of lower GI bleed?
B. what are the common causes?
C. studies?
D. treatment?
A. presentation -right side colon: maroon colored stool -left colon: bright red B. causes -diverticular disease: painless bleeding -ischemic colitis -neoplasm -hemorrhoids/fissure C. colonoscopy D. treatment -colonoscopy to locate and fix the bleeding
What is AIMS-65?
A. AIMS 65, > 2 ICU
- Albumin 1.5
- Mental status change
- SPB
A. What is charcot triad?
B. What is reynolds triad?
A. Jaundice, fever, abd pain
B. AMS and hypotension + charcots
What is the most common type of hernia?
indirect inguinal
