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Step2CK > GI Uworld > Flashcards

GI Uworld Flashcards

1
Q

What intervention provides the long term relief for Duodenal Ulcer

A

antibiotics and pantoprazole

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2
Q

majority of duodenal ulcers caused by

A

H pylori or NSAIDs

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3
Q

which defect in abdominal wall is not covered by membrane or skin

A

gastroschisis

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4
Q

rapid periumbilical pain that is out of proportion to exam findings

A

acute mesenteric ischemia

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5
Q

risk factors for acute mesenteric ischemia

A

atherosclerosis
embolic source
hypercoagulable

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6
Q

lab values in acute mesenteric ischemia

A

leukocytosis
elevated amylase and phosphate levles
metabolic acidosis

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7
Q

Dx acute mesenteric ischemia

A

CT angiography

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8
Q

indications of worsening SBO

A

fever, hemodynamic instability (hypotension and tachy)
guarding
luekocytosis
low bicarb!! metabolic acidosis

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9
Q

no Ab anti tissue transaminases but Bx shows villous atrophy

A

celiacs still

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10
Q

confirm Dx pyloric stenosis

A

US

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11
Q

30 yo with vomting and abdominal pain for 24 hours. crampy diffuse getting worse. BM 3 days ago
emesis is green no blood
dec appetite
distended bowel with hyperactive sounds and diffusely tender
normal electrolytes and cBC

A

SBO from adhesions is most likely

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12
Q

best Dx image for pancreatic CA

A

CT

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13
Q

neonate with bilious vomting

A

malrotation, volvulus

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14
Q

NG tube placed in neonate with bilious vomtiing and there is no free air in stomach (aka no double bubble)

A

now do upper GI series

barium swallow

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15
Q

most common cause lower GI bleeding in adults

A

diverticulosis

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16
Q

painless bleeding from rectum in adult

A

diverticulosis

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17
Q

reye sundrome presentaion

A

vomiting, agitation, irrational behavior

progressing lethargy, stupor and restlessness

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18
Q

lab findings in reye syndrome

A 
hyperammonemia
normal or slighly elevated bili and alk phos
long PT
hypoglycemia
mod t osevere inc LFTs and LDH
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19
Q

microvesicular steatosis in kidneys and brain

A

reye syndrome

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20
Q

when to suspect spontaneous bacterial peritonitis

A

any patient with cirrhosis and ascites accompanied by fever or change in mental status

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21
Q

Abdomainl XR findings in necrotizing enterocolitis

A

air in bowel wall “train track or double line”
and portal veins
“pneumatosis intestinalis”

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22
Q

pneumatosis intestinalis

A

from NEC in newborn. risk with prematurity

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23
Q

what cause zenker diverticulum

A

sphincter dysfunction and esophageal dymotility

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24
Q

typical GERD findings in patient, next step

A

Upper GI endoscopy

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25
Q

biggest risk factor for pancreatitis

A

alcohol consumptions

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26
Q

Tx appendiceal abscess

A

IV hydration, Antibiotics, bowel rest and interval appendectomy

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27
Q

anemia in patient taking aspirin and NSAID

A

likely Fe deficient from chronic bleeding

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28
Q

what happens in anemia of chronic disease

A

suppresion RBC production by inflammatory cytokines

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29
Q

what type of damage in reye syndrome

A

microvesicular fatty infiltration

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30
Q

best Dx for acute gallstone pancreatitis

A

RUQ US if inconclusive the ERCP

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31
Q

chronic alcoholic with cirrhosis with vague symptoms like weakness and fatigue, next step

A

esophageal endoscopy

and US of liver every 6 months to look for hepatocellular carcinoma

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32
Q

when do you introduce pureed foods to infants

A

6 months

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33
Q

when to introduce cows milk to infants

A

1 year

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34
Q

why does rifaxamin help with encephalopath

A

decrease number of ammonia producing bacteria in colon

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35
Q

why is there steatorrhea in zollinger ellison

A

inactivation of pancreatic enzymes by increased stomach acid

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36
Q

crypt abscesses

A

UC

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37
Q

porphyria cutanea tarda

A

fragile skin, photosensitivity and vesicles and erosions on dorsum of hands
seen in Hep C

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38
Q

HCV patients also have what condition usually

A

essential mixed cryoglobulinemia

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39
Q

waxing and waning transaminase levels

A

Hep C

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40
Q

CF findings

A

recurrent infections
growth failure
steatorrhea, malabsorption ADEK
because malabsorption K can have higher susceptibility to bleeding and bruising

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41
Q

tests for CF

A

sweat Cl testing
fecal elastase
genotyping

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42
Q

CF patients at risk for

A

pancreatitis, DM and infertility

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43
Q

what meds are assoc with acute pancreatitis

A 
valproic acid
diuretics: furosemid and thiazides
drugs for IBD: ASA and sulfasalazine
immuno: azathioprine
HIV: didanosine and pentamidine
antibiotics: metro and tetracycline
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44
Q

test for lactulose intolerance

A

+ H breath test

low stool pH and increased stool osmotic gap

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45
Q

nonalcoholic fatty liver disease

A

middle aged obese with metabolic syndrome
bland steatosis to ecrosis to cirrhosis
macrovesicular fat deposition and peripheral displacement nuclei

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46
Q

What is nonalcoholic fatty liver disease related to

A

insulin R and increased peripheral lipolysis TG synthesis and hepatic uptake

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47
Q

triple bubble sign

A

jejunal atresia

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48
Q

what increases risk for GI atresia in utero

A

mom using vasoconstrictive meds or tobacco or cocaine

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49
Q

severe pancreatitis causes hypotension how

A

increased vascular permeability

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50
Q

most common liver mass

A

metastatsis

solid or multiple

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51
Q

anti HBs +

anti HBc +

A

resolved hep B infection

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52
Q

when do you have antiHBe +

A

recovery phase of HBV

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53
Q

what Ab if you are immune to Hep B from natural infection

A

IgG anti HBc and Anti HBs

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54
Q

Tx for duodenal hematoma in child

A

NG suction and parenteral nutrition

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55
Q

Tx for acute cholescytisis

A

cholecystectomy within 72 hours

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56
Q

radiology of acalculous cholecystiis

A

gallbladder thickening and distension

pericholecystic fluid

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57
Q

Tx for acalculous cholecystitis

A

percutaneous cholecytostomy under radiologic guidance

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58
Q

Patients with acalculous cholecystitis

A

critically ill

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59
Q

Tx for diverticulitis with abscess formation

A

CT guided percutaneous drainage

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60
Q

labs in intrahepatic cholestasis of preganncy

A

intense pruritis
elevated bile acids
elevated LFTs
Dx of exclusion

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61
Q

associated disorder in hirschspurng

A

downs

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62
Q

ileal obstruction of meconium

A

CF

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63
Q

brick red urate crystals in diapers

A

sign of mild dehydration

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64
Q

Tx for breastfeeding failur jaundice in newborn

A

increase frequency of feedings and duration

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65
Q

3 week old with jaundice and pale stool
breast feeding well
increased direct bili
coombs negative

A

biliary atresia

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66
Q

how to Dx biliary atresia

A

intraoperative cholangiogram

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67
Q

first step in Dx biliary atresia

A

abnormal US to look for abnormal or absent gallbladder

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68
Q

kasai procedure

A

used in biliary atresia
hepatoportoenterostomy
allows time for growth and reduces the mortality assoc with hepatic transplant in same age group

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69
Q

when does physiologic jaundice resolve

A

in first week

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70
Q

when does breast milk jaundice occur

A

second week

increased unconjugated bili up to 10-30

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71
Q

CXR findings in acute pancreatitis

A 
can have any:
pleural effusion
atelectasis
elevated hemidiaphragm
pulmonary infiltrates
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72
Q

hepatolenticular degeneration

A

wilsons disease

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73
Q

what cardiac drug increases serum digoxin levels

A

CCBs like amiodarone, verapamil, quinidine

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74
Q

signs Sx dig toxicity

A 
anorexia
n/v
abdominal pain
fatigue
confusion
weakness
color vision abnormalities
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75
Q

where is a mallory weiss tear

A

mucosal tear at the GEJ

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76
Q

Hepatorenal syndrome

A

dangerous complication ESRD
decreased GFR in absence of schock, proteinuria or other causes renal dysfunction
type 1 is rapid
type 2 survive 3-6 months

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77
Q

Tx for hepatorenal syndrome

A

renal transplant

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78
Q

painless GI bleeding

A

angiodysplasia most common in right colon

so if vignette says colonoscopy years ago could not visualize ascending colon

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79
Q

angiodysplasia of colon is more common in what patients

A

aortic stenosis, vWdisease, renal disease

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80
Q

Tx angiodysplasia colon

A

cautery

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81
Q

keratomalacia

A

cloudy cornea

82
Q

bilious emesis in neonate

work up

A

Abdominal XR to rule out pneumoperitoneum

then water soluble contrast enema

83
Q

microcolon

A

meconium ileus

84
Q

abnormal D xylose

A

low levels= celiac

would be normal in pancreatitis because is absorbed in proximal small intestine without enzymes or brush border

85
Q

clinical feature achalasia

A

chronic dysphagia, progressive solids to liquids

86
Q

Dx acalculous cholecystitis

A

Abdominal US

87
Q

neutrophilic cryptitis

A

both crohns and UC

88
Q

recurrent PUD with multiple duodenal ulcers and jejunal ulcers
thickened gastric folds

A

suspect zollinger ellison

gastrinoma

89
Q

risk with hiatal hernia

A

adenocarcinoma of esophagus because cause gERD which inc risk for CA

90
Q

Dx chronic pancreatitis

A

CT to look for pancreatic calcifications

91
Q

management variceal hemorrhage

A

volume resuscitation
IV octreotide
antibiotics

92
Q

what non antibiotics increase risk c diff

A

long term PPI use or histamine 2 R antagonist use

93
Q

first step to dx acute pancreatitis

A

serum amylase and lipase

94
Q

liver is black
hyper direct bili
pigment in hepatocytes

A

dubin johnson

95
Q

how to confirm dubin johnson

A

coproporphyrin urine levels will be high

96
Q

absent bowel sounds and dilated small and large bowel

A

paralytic ileus

97
Q

man had gastroduodenoscopy showing antral ulcer and 4/7 biopsies are consistent with adenocarcionma
next step?

A

CT scan

98
Q

what is panendoscopy

A

esophagoscopy
bronchoscopy
laryngoscopy

99
Q

Blunt abdominal trauma and has low BP ad no peritoneal signs or anything

A

splenic laceration

100
Q

Tx toxic megacolon

A

IV fluids
antibiotics
IV corticosteroids for IBD induced
bowel rest

101
Q

newborn with feeding intolerance, abdominal distension and bloody stools

A

NEC

102
Q

why are newborn with congenital heart disease more prone to NEC

A

lack of perfusion of mesentary

103
Q

patient with acute pancreatitis likely to stones, resolves

now what?

A

cholescystectomy to prevent further acute pancreatitis episodes

104
Q

difficulty initiating swallowing

next step

A

videofluoroscopuc modified barium swallow

105
Q

recurrent right lower lobe pneumonia in elderly patient…

A

likely aspiration

106
Q

child has hemi hyperplasia of body

A

beckwith wiedemann

107
Q

what is the mutation in beckwith wiedemann

A

deregulation of imprinted gene on chrom 11p15

108
Q

macrosomia macroglossia, hemihyperplasia

likely to have what abdominal defect

A

omphalocele

beckwith wiedemann

109
Q

complications beckwith wiedemann

A

wilms tumor

hepatoblastoma

110
Q

congenital disorder of tryptophan absorption

A

hartnup

they get pellagra

111
Q

Acute intermittent porphyria

A

abdominal pain, vomiting, diarrhea

neuro Sx of agitation, paresthesias, confusion

112
Q

SLE like malar rash

diarrhea

A

pellagra

113
Q

week after Blunt abdominal trauma comes back with shaking chills poor appetite and deep abdominal pain

A

pancreatic laceration

114
Q

if there is air in urine of a patient

A

evaluate for colovesical fistula

115
Q

how to Dx colovesical fistula

A

abdominal CT with oral or recta contrast
do not use IV
colonoscopy to tule out malignancy

116
Q

common cause post op ileus

A

opiate use

117
Q

8 year old with extrahepatic cystic mass and normal gallbladder

A

biliary cyst

118
Q

signs of biliary cyst

A

abdominal pain and obstructive jaundice

119
Q

Tx biliary cyst in child

A

surgical resection to preven obstruction and malignant transformation

120
Q

someone on total parenteral nutrition and has gallstones, why

A

gallbladder stasis

121
Q

non caseating granulomas. which IBD

A

crohns

122
Q

most common causes of cirrhosis

A

chronic Hep B or C
alcoholic
nonalcoholic
hemochromatosis

123
Q

anticoagulated patient with weakness and dizziness and evidence anemia
back pain

A

internal hemorrhage

retroperitoneal

124
Q

which polyp in colon is most premalignant

A

villous adenoma

125
Q

colon cancer more in sessile polyps or stalked(pedunculated)

A

sessile

126
Q

26 year old with 4 weeks intermitten abdominal pain and cramps with rectal urgency and bloody diarrhea, nausea and de appetite
getting more severe
no PMH
fever and lower BP high HR
distension with diffuse tenderness and mucus mixed blood in vault. anemic with lots of leukoctyes and inc ESR

A

After IV fluids do abdominal XR to Dx toxic megacolon

127
Q

vit B12 stores last how long

A

3-4 years

128
Q

rotors syndrome is a defect in what

A

defect in hepatic excretion of bilirubin

will have + urine dip for bilirubin with negative urobilinogen

129
Q

panlobular mononuclear infiltration of liver

A

hepatic cell necrosis

130
Q

biggest intervention to decrease risk pancreatic cancer

A

smoking cessation

131
Q

Tx for PBC

A

ursodeoxycholic acid

delays progression

132
Q

Ca all around gallbladder

A

porcelain

increased risk of adenocarcinoma

133
Q

hepatic encephalopathy occurs why

A

livers inability to break down ammonia into urea

134
Q

hepatic hydrothorax results in

A

transudative pleural effusions

135
Q

patient with cirrhosis and large pleural effusion that wont go away with diuretics

A

transjugular intrahepatic portosystemic shunt

136
Q

elevated direct bilirubin

elevated alk phos

A

cholestasis
intra or extrahepatic
extra will have dilated ducts
intra does not

137
Q

most common mets colon CA

A

liver

138
Q

hard hepatomegaly and mildly elevated liver enzymes

A

do CT to look for malignancy

139
Q

what helps prevent variceal bleeding

A

beta blockers propanolol nadolol

140
Q

if patient with varices in esophagus has CI to beta blocker therapy

A

do endoscopic ligating

141
Q

courvoisier sign

A

nontender! distended gallbladder at right costal margin

seen in pancreatic cancer from back up

142
Q

surgery for gastroschisis

A

single stage closure

143
Q

surgery for omphalocele

A

staged closure with silastic silo

144
Q

biopsy of colon with laxative abuse

A

dark brown discoloratino of colon with lymph follicles shining through as pale patches “melanosis coli”
pigment in macrophages of lamina propria

145
Q

most important indicator of acute hepatic failure

A

PT will increase

146
Q

lab values that indicate acute liver failure

A

increased PT and INR
bilirbuin inc
transaminases can decrease

147
Q

signs of B2 riboflavin def

A

angular cheilosis, stomatitis, glossitis
normocytic anemia
seborrheic dermatitis

148
Q

signs of scurvy

A

punctate hemorrhage
gingivitis
corkscrew hair

149
Q

Lynch syndrome

A

HNPCC

150
Q

Lynch syndrome II is assoc with

A

endometrial CA

151
Q

rehydration for children

A

oral if mild

mod-severe use normal saline

152
Q

area commonly involved in ischemic colitis

A

splenic flxsure

153
Q

presentation of achalasia but also with weight loss and rapid onset

A

think of malignancy causing psuedoachalasia

do an endoscopy

154
Q

Tx for acute cholangitis

A

ERCP with spincterotomy

155
Q

acute errosive gastritis

A

severe hemorrhagic erosive lesions after exposure to injurious agents

156
Q

close contacts of someone with Hep A

A

give Ig

157
Q

Dx carcinoid syndrome

A

urinary excretion 5HIAA
CT.MRI abdomen and pelvis
octreoscan
echo

158
Q

features carcinoid

A 
episodic flushing
secretory diarrhea
cutaneous telangiectasias
bronchospasm
tricuspid regurg
159
Q

risk factors for milk protein induced colitis

A

FMH allergies, eczema, asthma

160
Q

what causes the ascites in portal HTN

A

increased hydrostatic P

161
Q

SAAG to indicate portal HTN

A

> 1.1

162
Q

SAAG to indicate other causes

A
163
Q

elevated AST and ALT with a ration

A

NAFLD

164
Q

when to begin screening colonoscopies in patients with IBD

A

begin 8 years post Dx

colonoscopy with Bx every 1-2 years

165
Q

bowel sounds in acute ischemia

A

decreased

166
Q

bowel sounds in SBO

A

increased

167
Q

suspect pancreatic CA, how does jaundice affect workup

A

if they are jaundiced first do US

no jaundice then do CT

168
Q

what to give patient on warfarin if need immediate surgery

A

FFP

169
Q

MEN I

A

primary PTH
enteropancreatic tumors
Pituitary

170
Q

MEN2A

A

Medullary thyroid
Pheo
PTH hyerplasia

171
Q

MEN2B

A

Medullary thyroid
Pheo
mucosal and intestinal neuromas
marfanoid

172
Q

Tx for anal fissures after stool softeners and sitz baths

A

topical lidocaine and nifedipine

173
Q

post gastrectomy complications

A

dumping syndrome

loss of normal action pyloric sphincter and rapid empyting of gastric contents

174
Q

signs of dumping syndrome

A

abdominal pain, diarrhea, nausea
hypotension.tachy
dizziness, confusion, fatigue diaphoresis

175
Q

presentation emphysematous cholecystitis

A

fever, RUQ pain, n/v

crepitus adjacent to gallbladder

176
Q

Dx emphysematous cholecystitis

A

air fluid in gallbladder, gas in gallbladder wall
cultures with clostridium or E coli
indirect hyperbili with mildly elevated LFTs

177
Q

tx emphysematous cholecystitis

A

EM cholecystectom

broad spec antibiotics

178
Q

zinc deficiency

A

alopecia
abnormal taste
bullous pustulous lesions

179
Q

testing to H pylori

A

breath or stool

180
Q

if H pylori testing is negative, next step

A

PPI trial for 4-6 weeks

181
Q

what pills induce esophagitis

A

tetracyclines
Aspirin and NSAIDs
bisphosphonates
KCl

182
Q

choanal atresia

A

newborn with cyanosis aggravated by feeding and relieved by crying

183
Q

CHARGE syndrome

A

coloboma, heart defects, atresia choanae, retardation of growth, GU anomalies, ear abnormalities/deafness

184
Q

Dx choanal atresia

A

failure to pass oropharynx catheter

confirmed by CT

185
Q

Tx MALT lymphoma

A

since caused by H pylori do the PPI clarithromycin and amoxicillin regimen

186
Q

ischemic hepatopathy

A

rapid and massive increase in transaminases

187
Q

pleural effusion fluid has low pH and very high amylase

alcoholic

A

assume booerhave syndrome and esophageal perforation

will have pneumomediastinum

188
Q

cholesterol emboli

A

livedo reticularis
acute kidney injury
pancreatitis and mesenteric ischemia
supportive care for pancreatitis

189
Q

immunizationf for people with HCV

A

Hep B and A

190
Q

GGT and ferritin levels in alcoholic hepatitis

A

both are increased

191
Q

dermatitis herpetiformis

A

erythematous vesicular rash over extensor surfaces elbows and knees

192
Q

management pyloric stenosis

A

first IV hydratio and K replacement then surgery

193
Q

Dx acute diverticulitis

A

abdominal CT with contrast

194
Q

Dx hyperTG as cause of pancreatitis

A

fasting lipid profile

lipase will be like extremely high high

195
Q

how to Dx psoas abscess

A

CT of abdomen and pelvis

196
Q

abnormal lab value in patients with only upper GI bleed

A

inc BUN/Cr ration from increased urea in intestinal breakdown of Hb and increased reabsorption for hypovolemia

197
Q

19 year old Dx with FAP

A

need elective procto-colectomy

198
Q

cyclical vomiting syndrome is highest in children with Hx of what

A

migraine HA

199
Q

Tx for cyclical vomiting syndrome

A

hydration and antiemetics

200
Q

coffee bean sign

A

sigmoid volvulus

201
Q

what cause spider angiomas and palmar erythema in cirrhosis

A

hyperestrinism from impaired hepatic metabolism of circulating estrogens
P450 cytochrome system

Step2CK (26 decks)

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