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Internal Medicine > Git > Flashcards

Git Flashcards

1
Q

defect in achlasia

A

loss of inhibitory neurons in LES that are responsible for blocking the impulses that cause contraction

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2
Q

pattern of dysphagia in achlasia

A

progressive to both solids and liquids simultaneously

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3
Q

pattern of dysphagia in esophagial ca

A

to solids that progresses to liquids

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4
Q

when is there dysphagia to both liquids and solids

A

in motility disorder

in growing obstruction:first solids than liquids

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5
Q

which is the gold std/most accurate test for achlasia

A

manometry

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6
Q

barrium esophagraphy shows____in achlasia

A

bird beak

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7
Q

best initial therapy for achlasia

A

pneumatic dilation

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8
Q

Tt of achlasia

A
  1. pneumatic dilation
  2. botulinum injection
  3. myotomy
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9
Q

disadvantage of botulinum toxin

A

repeated injections needed

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10
Q

complication of myotomy in achlasia

A

reflux

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11
Q

eosophageal SCC and adenoca found in which regions of esophagus

A

SCC-proximal 2/3

ADENO- distal1/3

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12
Q

best initial diagnosis of esophageal ca via

A

endoscopy as Dx is biopsy based

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13
Q

best initial diagnosis of esophageal ca via

A

endoscopy as Dx is biopsy based

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14
Q

chemotherapeutic drug used for git malignancy

A

5FU

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15
Q

defect in esophagus of scleroderma

A

decreases motility
open tube which neither contracts nor relax

atrophy and fibrosis of smooth muscle

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16
Q

most accurate test for dysphagia in scleroderma

A

motility studies

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17
Q

diff bw nutcracker esophagus and DES

A

they are same except the difference in manometric pattern

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18
Q

dysphagia pattern in DES

A

intermittent chest pain and dysphagia

at any time(not always with swallowing as in esophagitis)

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19
Q

dysphagia pattern in DES

A

intermittent chest pain and dysphagia

at any time(not always with swallowing as in esophagitis)

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20
Q

barium studies in esophagial spasm shows

A

corkscrew pattern

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21
Q

most accurate test for DES/nutcracker esophagus

A

manometry

also in achlasia

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22
Q

Tt of nutcracker/DES

A

CCB/nitrates

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23
Q

DES can be confused with

A

prinzmetal angina

sublingual nitroglycerin relieves chest pain in both

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24
Q

diagnosis of rings/webs made by

A

barium

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25
Q

Tt of rings/webs

A

PVS-Fe

both pneumatic dilation

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26
Q

cause of the pain of esophagitis

A

since it occurs only on swallowing so causes by rubbing of food against an inflamed esophagus

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27
Q

main risk factors for candida esophagitis

A

HIV AIDS(<200/mm3 :CD4)

diabetes mellitus

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28
Q

common pills causing esophagitis

A 
fe
vitC
K
dronates
tetracyclines
quinine
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29
Q

if the patient is HIV + , we assume esophagitis due to

A

candida

give fluconazole(diagnostic as well as therapeutic)

if no imp then endoscopy with biopsy to R/o other causes.

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30
Q

characteristic features of zenkers diverticulum

A

express undigested food(eg on pillow)

halitosis

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31
Q

Dx of zenkers via

A

barium

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32
Q

mallory weis

A

nontransmural tears in lower esophagus and proximal stomach ass with retching/vomiting

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33
Q

most common presentation of mallory weis synd

A

upper git bleed(malena)

no dysphagia/odynophagia

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34
Q

criterion for endoscopy foe epigastric pain

A

all patients above 45yrs whether alarm symtoms present or not.

below 45 yrs : only if alarm symptoms present and if symptoms not resolving

alarm sym:wt loss, dysphagia, bleeding

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35
Q

LES is not an anatomic sphincter

A

yes

not found in cadaver

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36
Q

epigastric pain in GERD can be differentiated from others by

A 
sore throat
metallic taste
hoarseness
cough
wheezing
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37
Q

most accurate test for gerd

A

24 hr PH monitering

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38
Q

is endoscopy useful in Dx of gerd

A

no

normal endoscopy does not exclude reflux

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39
Q

all PPIS/ H2 blockers are equal in efficacy

A

yes

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40
Q

tt of H.pylori

A

PPI+amoxicillin+ clarithromycin

if not tted then

PPI + metronidazole + tetracycline

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41
Q

features of ulcers of ZES

A

Recurrent

large

multiple

distal portion of duodenum

resistant to routine therapy

ass with diarrhoea and steatorrhoea

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42
Q

the most accurate test for metastatic ZES

A

endoscopic U/S

then somatostatin receptor scintigraphy

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43
Q

Dx of gastroparesis

A

gastric emptying study with rdiolabelled

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44
Q

ASCA anti saccharomyces cerevisae Ab positive in

A

crohns ds(neg in UC)

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45
Q

fistulising CD tt

A

infliximab( inhibits TNF)

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46
Q

main SE of infliximab

A

reactivation of Tb(do PPD)

arthralgia

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47
Q

mainstay of tt in IBD

A

mesalamine

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48
Q

acute exacerbation in IBD tted by

A

steroids

best BUDESONIDE(less systemic toxicity)

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49
Q

perianal IBD tted by

A

ciprofloxacin and metronidazole

50
Q

why antibiotics are CI in EHEC diarrhoea

A

HUS happen when org dies

platelet transfusion also CI even if low

51
Q

MCC of infectious diarrhoea

A

campylobactor

salmonella

52
Q

presence of leukocytes in stool indicates

A

intestinal invasion

blood may not be present..appears 24-36 hrs after…(exception : E.histolytica)

53
Q

best emperic therapy for infectious diarrhoea

A

ciprofloxacin (other FQs) +/- metronidazole

54
Q

___ antibiotic is highly ass with C.diff

A

clindamycin

55
Q

c.diff is largely a nosocomial ds

A

yes

56
Q

c.diff is largely a nosocomial ds

A

yes

57
Q

cause of c.diff diarrhoea.

A

toxins A and B

enterotoxic and cytotoxic effects

58
Q

tt of c.diff diarrhoea

A

metronidazole

59
Q

when is oral vancomycin given in c.diff

A

failed therapy with metro

resist to metro

allergic to metro

pregnant

<10 yr child

critically ill

60
Q

if c.diff recurrs which antibiotic to be given

A

metronidazole

not vanco

61
Q

fodaxomicin

A

can be used in c.diff

62
Q

Dx of c.diff

A

LAMP(loop mediated isothermal amplification)

detects toxin A and B genes

earlier ELSIA was used: detects toxin

63
Q

main symptom in IBS

A

pain

other:

only diarrhoea

only constipation

or both

no nocturnal symptom-as in UC/CD

pain relieved by change in bowel habbit

no constitutional symptom

64
Q

tegaserod amd alosetron

A

constipation predominant IBS

diarrhoea induced IBS

both work by manipulating serotinin level

65
Q

how does TCA work in IBS

A

relax bowel

treats depression

analgesic effect with neuropathic pain

66
Q

carcinoid treated with

A

octreotide(somatostatin analog )

67
Q

CF of carcinoid

A

diarrhoea

flushing

tachycardia

hypotension

right heart- tricuspid insufficiency, pul stenosis

rash- due to niacin deficiency

68
Q

why is endoscopy or nasogastric tube CI in zenkers

A

for the risk of perforation

69
Q

name malabsorption syndromes

A

most common : celiac ds and chronic pancratitis

others:
tropical sprue
whipple ds

70
Q

what is common in all the malabsorption syn

A

steatorrhoea
wt loss
deficiency of fat sol vitamins

71
Q

what is unique to celiac ds

A

its association with dermatitis herpetiformis ..seen in apprx 10% of people.

72
Q

what are the distinguishing features of whipple ds to other Malabs syn

A

arthralgia 80%

dementia 10%

ophthaloplegia

73
Q

most accurate test for

  1. celiac
  2. ch pancreatitis
  3. tropical sprue
  4. whipple
A
  1. secretin/low trypsin
  2. biopsy- loss of villi
  3. biopsy -org
  4. biopsy - specific Trophyrema whippelii
74
Q

secretin test in ch. pancreatitis

A

if u place nasogastric tube into duodonem and inject secretin in blood , the pancreas ll not release bicarbonate and enz in gut.

75
Q

trypsin and not amylase/lipase are used as a measure of ch pancreatitis.

A

yes

low trypsin( in acute: high)

amylase/lipase may be normal

76
Q

why is biopsy done in celiac ds if it can be found out by serology

A

to rule out small bowel lymphoma

77
Q

diff ch pancreatitis from other causes

A

repeated episodes of pancreatitis( from alcohol/ gallstones)

calcification

78
Q 
diff ch pamcreatitis and mucosal defect on the basis of the following.
D-xylose in urine
Fe
B9
B12
A,D,E,K
A 
ch pancreatitis:
\+
\+
\+
-
-
mucosal defect
-
-
-
-
-
79
Q

antibodies seen in celiac ds

A

IgA—— endomysial Ab

IgA/G- tissue transglutaminase

IgA/G- deamidated gliadin peptide

80
Q

most senistive and specific Ab in celiac ds

A

IgA anti-tissue transglutaminase

81
Q

diagonsing celiac ds in IgA deficiency with Abs

A

IgA endomysial and transglutaminase are falsely normal

82
Q

Rx of celiac ds

A

gluten free diet

dermatitis herpetiformis-dapsone

83
Q

Rx of ch. pancreatitis

A

oral replacement of enz

84
Q

Rx of tropical sprue

A

TMP-SMX or doxycycline

85
Q

Rx of whipple ds

A

TMP-SMX or doxycycline or ceftriaxone (×1yr)

86
Q

when is the colour of the stool is blackish

A

ferrous sulphate tablets

bleeding

bismuth subsalicylate

87
Q

blood causes diarrhoea and iron tablets cause constipation

A

yes

88
Q

best Dx of diverticulosis via

A

colonoscopy

89
Q

best diagnosis of diverticulitis via

A

CT scanning

Barium and endocopy are contraindicated because of risk of perforation.

90
Q

common presentation of diverticulosis

A

left lower quaderant pain

91
Q

how to distinguish diverticulitis from diverticulosis

A

fever

more intense pain

increase in WBC

tenderness

92
Q

cause of diverticulosis

A

MCC- low fibre diet

93
Q

Rx of diverticulitis

A

ciprofloxacin + metronidazole

others
ampi/sul
pip/tazo
genta+cefotetan/cefoxitin

94
Q

most likely cause of black coloured stool with diarrhoea

A

bleeding

blood acts as cathartic

95
Q

left sided colon ca mostly presents with

A

obstruction and dec stool calibre

not seen with right sided(heme+ brown stool with ch anemia)

96
Q

endocarditis by streptococcus bovis and clostridium septicum ass with

A

colon ca

97
Q

what would you do if an xray finds osteomas as an incidental finding

A

colonoscopy

98
Q

what would you do in a strepto.bovis endocarditis

A

colonoscopy(colon ca)

99
Q

garderner syndrome

A 
ass with colon ca with multiple soft tissue tumors:
osteomas
lipomas
cysts
fibrosarcoma

OSTEOMA PARTICILARLY IN MANDIBLE

100
Q

peutz jeghers syn

A

ass with hamartomatous polyps and hyperpigmentation in skin, lips and buccal mucosa

101
Q

turcot syn

A

ass with colon ca and CNS malingnancies

102
Q

cowden syndrome

A

ass with colon ca

103
Q

most accurate diagnostic test for colon ca

A

colonoscopy

sigmoidoscopy detects onl 60% of ca as it cant see entire colon

104
Q

colon ca screening

A

everyone >50 yrs of age

  1. most accurate- COLONOSCOPY(every 10 yr)
  2. sigmoidoscopy (every 1-2 yr)
  3. fecal occult blood anually
105
Q

why is colonoscopy better than sigmoidoscopy

A

sigmoidoscopy ll only reach the lesion upto 60 cm missing the rest 40% of ca.

106
Q

lynch syndrome is ass strongly with ca of

A

colon
endometrium
ovarian

107
Q

FAP

A

100%penetrance

initially adenoma (25yrs) which ll progress to ca (by 50 yrs)

108
Q

a person presented with git bleeding with a history of abdominal aortic aneurysm repair in the past 6 mths to a yr

A

aortoenteric fistula

109
Q

Rx of long term management of potal hypertension

A

propanolol

110
Q

separation of upper and lower git bleeding done anatomically through

A

ligament of Treitz , which anatomically separates the duodenum from jejunum

111
Q

treatment of acute bleeding due to varices

A
  1. general measures for git bleeding
  2. octreotide
  3. band(sclerotherapy not used as more side effects)
  4. TIPS( SE: hepatic encephalopathy)
112
Q

how to manage case of git bleeding

A

Rx first and then search for eitology

1.bolus of NS/RL

  1. CBC
    (a) .HCT - tranfuse packed RBC if <30 %

(b) . platelets - transfuse if <50,000
3. PT- if less: fresh frozen plasma
4. NG tube
5. endoscopy:both to find site and cause of bleeding

113
Q

melena occurs when ____ amount of blood has been lost

A

atleast 100mL from upper git

114
Q

lower and upper git bleeding presents as

A

lower–red blood in stools

upper–black stool/ malena, hemetemesis

115
Q

define orthostasis

A

> 10 point rise in pulse when the patient goes from supine to the standing / sitting position.

OR >20 point drop in SP on change in position.

there should atleast be a min in the measurement of pulse / BP to allow time for normal ANS diacharge to acc position change

116
Q

if pulse >100/min OR SP <100… .indicates how much blood loss

A

> 30 %

117
Q

most accurate test to determine the cause of both upper and lower git bleeding

A

endoscopy

118
Q

role of nuclear bleeding scan in GI bleeding

A

used when endoscopy is not able to reveal the cause even when there is active bleeding.

detects low vol bleeds 0.1-0.2mL / min

RBC of patient are tagged with Tc and reinjected….tagged cells are then detected.

119
Q

how angiography can be used for evaluation og GI bleeding

A

rarely used because it needs a higher vol of blood loss >0.5mL/ min

120
Q

when both upper and lower endoscope are unrevealing in GI bleeding ..the most likely site of bleeding is

A

small bowel

121
Q

capsule endoscopy

A

new modality to visualize small bowel which is not visualised by upper (till lig treitz)/lower (just past ileocaecal valve)endoscope.

swallows capsule with electronic camera..tramsmits thousands of images

Internal Medicine (9 decks)

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