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EOR - Internal Med > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

sx of hepatitis a

A

fatigue/malaise
n/v
anoreia
fever
RUQ pain

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2
Q

transnission of hep A

A

fecal-oral

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3
Q

dx for hep A

A

IgM anti HAV

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4
Q

hep A vaccination recs

A

routine beginning at 1 yo

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5
Q

transmission of hep B

A

sexual
sanguineous

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6
Q

vaccine recs for hep b

A

routine for all starting at birth

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7
Q

transmission for hep C

A

IVDU
sexual
sanguineous

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8
Q

mc route of transmisson for hep C

A

IVDU

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9
Q

screening and dx tesst for hep C

A

screening: anti HCV abs
dx: HCV RNA quantitation

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10
Q

2 complications of hep C

A

cirrhosis
HCC

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11
Q

hep D only occurs in the presence of

A

hep B infxn

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12
Q

what makes you suspect hep D

A

severe/worsening hep B infxn

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13
Q

dx for hep B

A

HDV abs

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14
Q

what pt pop makes you think hep E

A

pregnant, 3rd world countries

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15
Q

complication of hep E

A

high infant mortality

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16
Q

what is toxic hepatitis

A

APAP toxicity

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17
Q

3 rf for NAFLD

A

obesity
HLD
insulin resistance

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18
Q

LFT pattern for NAFLD

A

ALT > AST
elevated ALP

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19
Q

all pt’s w. suspected NAFLD should get what imaging

A

US

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20
Q

US findings of NAFLD

A

steatohepatitis ->
increased echogenicity
coarsened echotexture of liver

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21
Q

gs dx for NAFLD

A

liver bx showing macrovesicular fatty infiltrates

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22
Q

tx for NAFLD

A

lifestyle
liver transplant

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23
Q

what are the 4 serologic tests associated w. Hep B

A

anti HBc IgM
anti HBc IgG
HBsAg
Anti HBs

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24
Q

(+) Anti-HBc IgM
(+) HbsAg

A

acute HBV infxn

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25
Q

(+) HbsAg

A

early acute HBV infxn

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26
Q

(+) Anti-HBc IgG
(+) Anti-HBs

A

resolved acute HBV infxn

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27
Q

(+) Anti HBs

A

HBV vaccine/immunity

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28
Q

(+) Anti-HBc IgG
(+) HBsAg

A

chronic HBV infxn

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29
Q

two Hep C serology tests

A

HCV RNA
Anti-HCV

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30
Q

(+) HCV RNA

A

acute HCV infxn

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31
Q

(+) anti-HCV

A

resolved HCV infxn

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32
Q

(+) HCV RNA
(+) anti-HCV

A

chronic HCV infxn

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33
Q

2 hep A serology tests

A

IgM HAV Ab
IGg HAV Ab

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34
Q

(+) IgM HAV Ab

A

acute HAV infxn

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35
Q

(+) IgG HAV Ab

A

past HAV infxn

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36
Q

what is this showing

A

flank ecchymosis -> pancreatitis

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37
Q

describe pain w. pancreatitis

A

abdominal pain radiating to the back

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38
Q

mnemonic for causes of pancreatitis

A

get smashed
gallstones
etoh
trauma
steroids
mumps
autoimmune
scorpion
hypercalcemia
ercp
drugs

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39
Q

gs dx for pancreatitis

A

CT

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40
Q

most sensitive test for chronic pancreatitis

A

ERCP

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41
Q

what is this showing

A

periumbilical ecchymosis -> cullen sign

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42
Q

ranson’s criteria for poor prognosis w. pancreatitis

A

at admit:
ldh > 350
age > 55
bg > 200
wbc > 16,000
ast > 250

at 48 hr:
calcium < 8
hct drop > 10%
Po2 < 60
bun rise > 1.8
base deficit > 4
sequestration of fluid > 6L

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43
Q

2 complications of pancreatitis

A

pseudocyst
necrosis

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44
Q

chronic pancreatitis triad

A

pancreatic calcification
steatorrhea
DM

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45
Q

tx for pancreatitis

A

IVF
analgesics
bowel rest

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46
Q

anorectal fistulas are a complication of

A

anorectal abscesses

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47
Q

tx for anorectal fistula

A

surgery

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48
Q

tearing rectal pain and bleeding with or shortly after defacation, bright red blood on tp

A

anal fissure

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49
Q

tx for anal fissure

A

sitz bath
increased fiber/water
stool softeners/laxatives

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50
Q

2 hallmark sx of anorectal ca

A

rectal bleeding
feeling of incomplete bowel emptying (tenesmus)

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51
Q

mc type of anorectal ca

A

adenocarcinoma

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52
Q

tx for anorectal ca

A

surgical excision
xrt
chemo

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53
Q

2 hallmark sx of colon ca

A

painless rectal bleeding
change in bowel habits

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54
Q

mc type of colon ca

A

adenocarcinoma

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55
Q

what is this showing

A

apple core lesion -> colon adenocarcinoma

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56
Q

colon ca screening recs for average risk pt’s

A

start at 45
end at 75

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57
Q

3 stool tests for colon ca screening and how often they should be done

A

gFOBT - yearly
FIT - yearly
FIT-DNA - 1-3 years

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58
Q

how often should a flexible sigmoidoscopy be performed for colon ca screening

A

q 5 years

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59
Q

imaging for colon ca screening

A

CT colonography q 5 years

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60
Q

tumor marker for colon ca

A

CEA

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61
Q

characteristics of malignant polyp

A

> 1 cm
sessile
villous

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62
Q

characteristics of benign polyp

A

pedunculated
< 1 cm
tubular

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63
Q

tx for colon ca

A

surgery
chemo

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64
Q

mc cause of esophageal ca worldwide vs US

A

worldwide: squamous cell
US: adenocarcinoma

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65
Q

esophageal adenocarcinoma is mc a complication of

A

barrett’s

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66
Q

location of esophageal adenocarcinoma vs squamous cell

A

adenocarcinoma: distal 1/3
squamous: proximal 2/3

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67
Q

screening recs for esophageal adenocarcinoma for pt’s w. barrett’s

A

endoscopy q 3-5 years

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68
Q

2 rf for sqamous cell esophageal ca

A

smoking
etoh

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69
Q

sx of esophageal squamous cell carcinoma

A

progressive dysphagia
wt loss
hoarseness

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70
Q

tx for esophageal ca

A

surgery

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71
Q

2 mc sx of gastric ca

A

abd pain
unexplained wt loss

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72
Q

mc type of gastric ca

A

adenocarcinoma

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73
Q

2 hallmark PE findings for gastric ca

A

virchow’s node (supraclavicular)
sister mary joseph’s node (umbilical)

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74
Q

dx for gastric ca

A

upper endoscopy w. bx

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75
Q

what is linitis plastica on bx

A

diffuse thickening of stomach wall d/t ca infiltrtion

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76
Q

tx for gastric ca

A

gastrectomy
xrt
chemo

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77
Q

what does dermatitis herpetiformis make you think of

A

celiac

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78
Q

6 conditions associated w. celiac

A

T1DM
AI hepatitis
thyroid dz
down’s syndrome
turner’s syndrome
williams syndrome

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79
Q

what type of ca is associated w. celiac dz

A

small bowel lymphoma

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80
Q

dx for celiac

A

IgA anti-endomysial (EMA)
anti tissue transglutaminase (anti-TTG)
small bowel bx - gs

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81
Q

celiac dz is associated w. what 2 genetic markers

A

HLA-DQ8
HLA-DQ2

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82
Q

infxn of the biliary tract 2/2 obstruction, which leads to biliary stasis and bacterial overgrowth

A

cholangitis

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83
Q

mcc of cholangitis

A

choledocholithiasis

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84
Q

all causes of cholangitis

A

choledocholithiasis
pancreatic ca
biliary neoplasm
post op strictures
ERCP/PTC
choledochal cysts

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85
Q

4 organisms associated w. cholangitis

A

e.coli
enterococcus
klebsiella
enterobacter

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86
Q

charcot’s triad for cholangitis

A

fever
jaundice
RUQ pain

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87
Q

reynold’s pentad for cholangitis

A

charcot’s triad
+
AMS
hypotn

88
Q

imaging for cholangitis: initial vs gs

A

initial: US
gs: ERCP

89
Q

tx for cholangitis

A

emergent ERCP w. stent
cipro + metro
IVF
analgesics
post acute cholecystectomy

90
Q

inflammation and fibrosis of intrahepatic and extra hepatic bile ducts

A

primary sclerosing cholangitis

91
Q

3 hallmark sx of primary sclerosing cholangitis

A

jaundice
pruritis
hepatosplenomegaly

92
Q

what 4 conditions are associated w. primary sclerosing cholangitis

A

UC
cholangiocarcinoma
pancreatic ca
colorectal ca

93
Q

only definitive tx for primary sclerosing cholangitis

A

liver transplant

94
Q

inflammation of the GB mc associated w. gallstones

A

cholecystitis

95
Q

5 f’s of cholecystitis

A

female
forty
fat
fertile
fair

96
Q

fever, leukocytosis, jaundice

A

cholecystitis

97
Q

imaging for cholecystitis: initial vs gs

A

initial: US
gs: HIDA

98
Q

US findings of cholecystitis

A

gallbladder wall > 3 mm
pericholecystic fluid
gallstones

99
Q

LFT pattern of cholecystitis

A

elevated ALP and GGP
elevated conjugated bilirubin

100
Q

porcelain gallbladder is a complication of

A

chronic cholecystitis

101
Q

gs imaging for choledocholithiasis

A

ERCP

102
Q

tx for cholecystitis

A

cholecystectomy in 24-48 hr

103
Q

referred right scapular pain from cholelithiasis

A

boas sign

104
Q

2 mcc of cirrhosis

A
  1. etoh
  2. chronic hep B/C
105
Q

tumor marker for HCC

A

AFP

106
Q

what is budd chiari syndrome

A

hepatic vein thrombosis - complication of cirrhosis

107
Q

budd chiari triad

A

abd pain
ascites
hepatomegaly

108
Q

complications of cirrhosis

A

portal htn
ascites
esophageal varices
hepatorenal syndrome
hepatic encephalopathy
hepatocellular carcinoma

109
Q

4 sx of portal htn

A

ascites
peripheral edema
splenomgaly
varicosity of veins

110
Q

mcc complication of cirrhosis

A

ascites

111
Q

work up for ascites

A

abd US
paracentesis
serum albumin gradient

112
Q

management of ascites

A

Na restriction
diuretics
paracentesis

113
Q

3 indications for paracentesis w. ascites

A

tense ascites
SOB
early satiety

114
Q

4 sx of ruptured esophageal varices

A

retching/dyspepsia
hypovolemia
hypotn
tachycardia

115
Q

pathophys of hepatorenal syndrome w. cirrhosis

A

progressive ESLD -> vasoconstriction -> decreased renal perfusion -> oliguria, azotemia, hypotn

116
Q

what is asterixis

A

flapping tremor w. flexed hands - think hepatic encephalopathy

117
Q

prolonged _ indicates severe cirrhosis

A

PT/PTT

118
Q

nail findings of cirrhosis

A

terry’s nails -> white nail beds

119
Q

7 skin changes associated w. cirrhosis

A

spider angiomata
palmar erythema
jaundice
scleral icterus
ecchymoses
caput medusae
hyperpigmentation

120
Q

HCC screening recs

A

abd US q 6-12 mos

121
Q

which IBD is associated w. aphtous ulcers and polyarthralgia

A

crohn’s

122
Q

mc location for crohn’s

A

terminal ileum

123
Q

cobblestoning, skip lesions, and linear fissures

A

crohn’s

124
Q

which IBD is transmural and which is limited to the mucosa/submucosa

A

crohn’s: transmural
UC: mucosa/submucosa

125
Q

what is this showing

A

string sign on barium study -> strictures -> crohn’s

126
Q

4 common complications of crohn’s

A

obstruction
abscess
fistula
sinus tracts

127
Q

best dx test for crohn’s

A

colonoscopy

128
Q

what abs may distinguish crohn’s from UC

A

crohn’s: (+) anti-saccharomyces cerevisiae abs (ASCA)

129
Q

management of crohn’s

A

elemental diet
vitamin supplementation
smoking cessation
pharm:
1. aminosalicylates - first line
2. steroids
3. immune modifying drugs
4. anti TNF’s

130
Q

name 2 aminosalicylates used in crohn’s

A

mesalamine - preferred/best for maintenance
sulfasalazine - 2nd line

131
Q

s.e of sulfasalazine

A

hepatitis
pancreatitis
allergic rxn
fever

132
Q

utility of steroids in crohn’s

A

acute flares

133
Q

t/f: surgery is recommended for crohn’s

A

f!
due to high risk of recurrence

134
Q

painless BRBPR

A

diverticulitis

135
Q

mc location for diverticulitis

A

sigmoid colon

136
Q

dx for diverticulitis

A

CT w. oral/rectal/IV contrast
colonoscopy 1-3 mos after flare up

137
Q

2 CT findings of diverticulitis

A

fat stranding
bowel wall thickening

138
Q

indications for surgical resection w. diverticulitis

A

recurrent flareups
perforation
fistula
abscess

139
Q

gradual/progressive dysphagia to solids, PMH GERD

A

esophageal stricture

140
Q

3 types of esophageal stricture

A

web
plummer-vinson
schatzki ring

141
Q

thin membranes in the mid-upper esophagus - congenital vs acquired

A

esophageal webs

142
Q

esophageal webs
dysphagia
IDA

A

plummer vinson

143
Q

diaphragm-like mucosal rink that forms at the esophagogastric junction

A

schatzki ring

144
Q

dx for esophageal strictures

A

upper endoscopy

145
Q

management of esophageal strictures

A

endoscopic dilation
r.o cancer

146
Q

management of esophageal varices

A

-endoscopic banding vs sclerotherapy vs balloon tamponade
-IV octreotide
-bb for secondary prophylaxis
-TIPS for refractory

147
Q

screening recs for esophageal varices

A

cirrhosis + portal htn - screen q 2-3 years
monitor small varices q 1-2 years

148
Q

2 types of esophagitis

A

non-infectious
infectious

149
Q

5 causes of non-infectious esophagitis

A

reflux
medication-induced
eosinophilic
xrt
corrosive

150
Q

2 meds associated w. errosive esophagitis

A

NSAIDs
bisphosphonates

151
Q

pt w. asthma sx and GERD not responsive to antacids

A

eosinophilic esophagitis

152
Q

dx for eosinophilic esophagitis

A

bx

153
Q

what is this showing

A

ribbed esophagus w. multiple corrugated rings -> eosinophilic esophagitis

154
Q

4 xrt drugs that cause esophagitis

A

doxorubicin
bleomycin
cyclophosphamide
cisplatin

155
Q

common cause of corrosive esophagitis

A

ingestion of alkali or acid from attempted suicide

156
Q

2 hallmark sx’s of infectious esophagitis

A

odynophagia
chest pain

157
Q

what pt pop makes you think of infectious esophagitis

A

immunocompromised

158
Q

3 mc pathogens associated w. infectious esophagitis

A

candida albicans
HSV
cytomegalovirus

159
Q

what is this showing

A

linear yellow-white plaques -> candida esophagitis

160
Q

tx for fungal esophagitis

A

fluconazole

161
Q

4 viral causes of esophagitis

A

HSV
CMV
EBV
myobacterium

162
Q

what is this showing

A

shallow punched out lesions on EGD -> HSV esophagitis

163
Q

what is this showing

A

large, solitary ulcers/erosions on EGD -> CMV esophagitis

164
Q

tx for CMV esophagitis

A

ganciclovir

165
Q

dx for infectious esophagitis

A

endoscopy w. bx/culture
double contrast esophagram

166
Q

tx for infectious esophagitis based on cause

A

candida: fluconazole
HSV: acyclovir
CMV: ganciclovir
corrosive: steroid
eosinophilic: topical steroids, SABA

167
Q

3 causes of gatritis to know

A
  1. h.pylori - mc
  2. NSAIDs/etoh
  3. autoimmune/hypersensitivity
168
Q

location of gastritis w. h pylori infxn

A

antrum
body

169
Q

2 dx tests for h pylori

A

urea breath test
fecal antigen

170
Q

why do NSAIDs cause gastritis

A

diminish local prostaglandin production in stomach/duodenum

171
Q

what does autoimmune gastritis make you think of

A

pernicious anemia

172
Q

what test is positive in pernicious anemia

A

schilling

173
Q

location of autoimmune/hypersensitivity gastritis

A

body of the fundus

174
Q

management of gastritis

A

stop offending agent
PPI x 4-8 weeks
abx if h pylori
UGI endo
US

175
Q

triple therapy for h pylori

A

clarithromycin
amoxicillin
PPI

176
Q

quadruple therapy for h pylori

A

tetracycline
omeprazole
metro
bismuth

177
Q

gs dx test for GERD

A

24 hr pH monitoring

178
Q

7 indications for endoscopy w. GERD

A

dysphagia
recurrent vomiting
wt loss
hematemesis
anemia
melena
age > 50

179
Q

management of GERD (4)

A

H2 blockers
PPI
lifestyle
nissen fundoplication

180
Q

varicose veins of the anus/rectum

A

hemorrhoids

181
Q

6 rf for hemorrhoids

A

constipation/straining
pregnancy
portal HTN
obesity
prolonged sitting or standing
anal intercourse

182
Q

hallmark sx of hemorrhoids

A

painless BRBPR

183
Q

indications for anoscopy w. hemorrhoids

A

BRBPR
suspected thrombosis

184
Q

2 types of hemorrhoids

A

internal
external

185
Q

indication for excision of hemorrhoid

A

external thrombosed

186
Q

3 indications for rubber band ligation of hemorrhoid

A

protrudes w. defacation
enlargement
intermittent bleeding

187
Q

indication for closed hemorrhoidectomy

A

permanently prolapsed

188
Q

2 mcc of hepatic ca

A
  1. cirrhosis
  2. chronic hep C
189
Q

protrusion of stomach thru the esophageal hiatus

A

hiatal hernia

190
Q

2 types of hiatal hernia

A

type 1 - sliding - mc
type 2 - rolling

191
Q

GE junction and stomach slie into the mediastinum

A

type 1/sliding hiatal hernia

192
Q

fundus of the stomach protrudes thru diaphragm w. GE junction

A

type 2/rolling hiatal hernia

193
Q

which type of hiatal hernia requires surgical intervention

A

type 2/rolling

194
Q

5 sx of hiatal hernia

A

epigastric pain
substernal regurgitation
dysphagia
chest palpitations
SOB

195
Q

gs dx for hiatal hernia

A

US

196
Q

definition of IBS according to rome IV criteria

A

recurrent abd pain on average at least one day per week in the last 3 mos associated w. 2 or more:
-related to defecation
-associated w. change in stool frequency
-associated w. change in stool form/appearance

197
Q

management of IBS

A

loperamide vs colace/psyllium
tegaserod maleate
rifamixin (diarrhea)
exercise

198
Q

where do mallory weiss tears occur

A

GEJ

199
Q

common presentation of mallory weiss tear

A

etoh intake -> forceful vomiting -> hematemesis

200
Q

upper endoscopy findings of mallory weiss tear

A

superficial longitudinal mucosal erosions

201
Q

management of mallory weiss tear

A

supportive
cauterize vs epi

202
Q

3 causes of PUD

A

h pylori
NSAIDs
zollinger ellison

203
Q

which type of ulcer is improved w. food

A

duodenal

204
Q

gs dx for PUD

A

endoscopy

205
Q

gs dx for h pylori

A

endoscopy w bx

206
Q

what h pylori test should be used to confirm eradication after tx

A

stool antigen

207
Q

which h pylori test can confirm infxn but should not be used to cofirm eradication

A

serologic abs

208
Q

management of PUD

A

ppi - most effective
h2 blockers
abx if h pylori
surgery for refractory

209
Q

3 hallmark sx of UC

A

hematochezia
pus filled diarrhea
tenesmus

210
Q

mc location for UC

A

rectum

211
Q

imaging findings of UC

A

loss of haustral markings
lumen narrowing

212
Q

what dx test should be used for UC if you are concerned for colon perf

A

flex sigmoidoscopy

213
Q

what is this showing

A

lead pipe apperance -> UC

214
Q

which IBD is associated w. toxic megacolon

A

UC

215
Q

definitive tx for UC

A

colectomy

216
Q

pharm management of UC

A

prednisone
mesalamine

217
Q

abs assocaited w. UC

A

antineutrophil cytoplasmic abs (pANCA)

EOR - Internal Med (13 decks)

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