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Step 2 CK (primary set) > GIT > Flashcards

GIT Flashcards

1
Q

Cause of whipple disease

A

Tropherima whippeli

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2
Q

clue for whipple

A

PAS positive during biopsy

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3
Q

Extra intestinal manif of Whipple(2)

A

Polyarthropathy Migratoire

Heart problem–>CHF

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4
Q

What can you in late stage of whipple

A

Dementia

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5
Q

Clue for Celiac disease

A

Biopsy showing villous atrophy

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6
Q

Marker for cealiac disease(2)

A

IGA anti tissue transglutaminase

IGA anti endomysial antibodies

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7
Q

What can cause negativity of these markers in case of celiac disease(IGATT)

A

IGA deficiency

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8
Q

Other name of cealiac disease

A

celiac sprue

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9
Q

in GIT what can happen in celiac sprue

A

Malabsorption

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10
Q

Consequences of Malabsorption in celiac sprue(3)

A

Low
Vit D
Vit K
Iron

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11
Q

consequence of low vit D in celiac disease

A

hypocalcemia

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12
Q

consequence of hypocalcemia and low vit D in celiac disease(3)

A

Osteomalacia
bone pain
fracture

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13
Q

consequence of vit A deficiency in adult

A

Hyperkeratosis

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14
Q

Low vit K consequence

A

easy bruising

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15
Q

Clue for Achalasia

A

dysphagia for solids and liquids

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16
Q

Dx of Celiac and whiple

A

intestinal Biopsy

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17
Q

workup for achalasia(3)

A

baryum swallow
Manometry
endoscopy

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18
Q

finding in Bayum swallow for achalasia

A

bird beak appearance

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19
Q

Finding during manometry in Achalasia(3)

A

Elevating resting LES pressure
Incomplete LES relaxation
Absence of peristaltism in the esophageal body

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20
Q

why performing endoscopy in achalasia

A

to rule out a cancer in distal esophagus

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21
Q

quid of pseudo achalasia

A

cancer in distal esophagus causing achalasia

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22
Q

what to thing in achalasia and weight loss

A

cancer de l ‘oesophage

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23
Q

when thinking of cancer in achalasia(3)

A

Symptom > 6 months
patient more than 60 years
Weight loss

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24
Q

cause of constipation in multiple myeloma

A

Hypercalcemia

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25
Q

first thing to do in front of constipation

A

check calcium

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26
Q

Symptoms of hypercalcemia(4)

A

constipation
increased urination
neurologisc Symptom
renal dysfunction

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27
Q

most common complication of gastric ulcer

A

hemorrage

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28
Q

What to do if you suspect abdominal viscus perforation

A

chest x ray

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29
Q

chest x ray in abdominal viscus perforation

A

free air under the diaphragm

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30
Q

high yield question,characteristics of malignancy in polyps(3)

A

Macro:sessile
Micro:villous type
size:> 2,5 cm

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31
Q

Most common non neoplastic polyp in colon?

A

Hyperplastic

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32
Q

polyps in Peutz jeghrer syndrome

A

hamarthoma

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33
Q

quid of shifting phenomenon in acute appendicitis(2)

A

pain in ombilic

later pain oin RLQ

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34
Q

why shifting phenomenon occurs

A

visceral pain followed by somatic pain

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35
Q

exolanation of shifting phenomenon

A

Periombilical pain is visceral

but RLQ pain is somatic

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36
Q

what cause somatic pain in RLQ in appendicitis

A

irritation of parietal peritoneum

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37
Q

clue for acute pancreatitis

A

epigastric pain
worse when standing or lying supine
inproved with sitting up or leaning forward

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38
Q

etiology of acute pancreatitis(6)

A 
chronic alcoholism
Gallstones
Hyperlipidemia
drugs
infection
trauma
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39
Q

infection causing acute pancreatitis(3)

A

CMV
leginella
aspergillus

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40
Q

hyperlipidemia causing acute pancreatitis

A

type 1 ,4 et 5

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41
Q

drugs causing acute pancreatitis(3)

A

dianoxine
azathioprine
acid valproic

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42
Q

work up for acute pancreatitis(3)

A

Amylase and lipase
echo
CT

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43
Q

amylase and lipase in acute pancreatitis

A

3 a 4 fois la normale

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44
Q

local complication in acute pancreatitis(4)

A

pancreatic pseudocyst
pancreatic necrosis (necrotizing)
pancreatic abces
peripancreatic fluid

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45
Q

regional complication in acute pancreatitis(2)

A

ileus

Gi bleeding

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46
Q

A distance complication in acute pancreatitis(3)

A

ARDS
Left side pleural effusion
acute renal failure

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47
Q

clue for duodenal ulcer

A

pain relieved by eating

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48
Q

clue for gastric ulcer

A

pain worsened by eating

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49
Q

surveillance of patient with cirrhosis(2)

A

upper digestive endoscopy

sonograhy abdomen

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50
Q

when to perform sono abd in cirrhosis surveillance and why(2)

A

q 6 mois

to look for hepato cellular carcinoma

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51
Q

upper digestive endoscopy in cirrhosis why?

A

to rule out varices

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52
Q

prevention of esophageal varices

A

non selective B blocker

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53
Q

Tetrad of carcinoid syndrome

A

flushing
diarrhea
wheezing
valvular heart disease

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54
Q

cause of carcinoid syndrome

A

carcinoid tumor

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55
Q

localisation of carcinoid tumor(4)

A

small intestine
appendix
colon
bronchial tubes

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56
Q

physiopatho of symptoms in carcinoid tumor

A

tumor secreting serotonin

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57
Q

RX of carcinoid tumor

A

octreoctide

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58
Q

complication of flushing in Carcinoid syndrome (2)

A

Hypotension

tachycardia

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59
Q

quid of rome 3 criteria

A

dx IBS(inflammatory bowel syndrome)

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60
Q

rome 3 criteria what symptom in center

A

abdominal cramps

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61
Q

rome 3 criteria(5)

A 
abdominal cramps
3 days /month
2 month consecutifs and>/ 2 de ces symptomes
-symptoms improved with bowel mvts
-change infrequency of stool
-change in form in stool
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62
Q

in what situation to not consider IBS(4)

A

abdominal cramps plus rectal bleeding
“ “ plus weight loss
“ “ plus anemia
nocturnal abdominal awakening the patient

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63
Q

colonoscopy in IBS

A

normal colonic mucosae

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64
Q

condition for carcinoid tumor to produce serotonin

A

when tumor has metastasis in liver

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65
Q

work up for carcinoid syndrome

A

5 hydroxy indol acetic in urine and blood

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66
Q

quid of 5 HIAA

A

metabolites of serotonin

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67
Q

why liver metastasis produces this syndrome

A

5 hydroxytryptophan is degraded in the liver to inactivate 5HIAA

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68
Q

precursor of serotonin(5 hydrohy tryptamine)

A

tryptophan

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69
Q

role of tryptophan

A

synthesis of niacin

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70
Q

why you have low niacin i carcinoid tumor(2)

A

tryptophan is used to produce serotonin

niacin is low produced

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71
Q

Niacin deficiancy symptom(4D)

A

Diarrhea
Dementia
Dermatitis
Death

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72
Q

origin of folate

A

green leafy vegetables and liver meat

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73
Q

why cooked food lack folate(toast type diet)

A

folate is heat sensitive

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74
Q

Most common cause of meleana(2)

A

upper GI bleeding

lower GI bleeding proximal to the splenic flexure

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75
Q

Most common cause of upper GI bleeding

A

peptic ulcer disease

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76
Q

clue for zollinger ellison syndrome(2)

A

multiple gastric and duodenal ulcer

fat in stool

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77
Q

Why fat in stool in zollinger ellison syndrome

A

inactivation of pancreatic enzyme by hyper acid production by stomach

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78
Q

quid of succusion splash

A

you place a sthetoscope on upper abdomen and rock the patient back and forth
you will hear a splash

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79
Q

interpretation of succusion splash

A

gastric outlet obstruction

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80
Q

what to do in presence of a patient with generalized adenopathy,weihgt loss and diarrhea?

A

test for HIV

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81
Q

differentiate Mono from HIV

A

no weight loss in Mono

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82
Q

characteristic of rash in pellagra

A

present on sun exposed area

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83
Q

cause of Zn deficiency(2)

A

total parenteral nutrition

malabsorption

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84
Q

clue for ZN deficiency(3)

A

alopecia
pustulous or bullous lesion periorificial
wound healing impaired

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85
Q

lieu of Zn absorption

A

jejunum

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86
Q

cause of pancreatic cholera

A

VIPOMA

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87
Q

pancreatic mass plus watery diarrhea

A

Vipoma

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88
Q

what vipoma secretes

A

vasoactive intestinal peptide

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89
Q

link between Vipoma and an carcinoid syndrome

A

both can produce flushing

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90
Q

more common cause of cirrhosis(4)

A

Hep B et C
alcoholic liver disease
non alcoholic fatty liver disease
hemochromatosis

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91
Q

Less common cause of cirrhosis(7)

A 
autoimmune
PBC
PSC in IBD
Alpha 1 antitrypsine
cardiac cirrhosis
medications
wilson disease
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92
Q

medication causing cirrhosis(2)

A

metotrexate

INH

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93
Q

most common cause of cirrhosis in US(2)

A

Hep B and C

alcohol

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94
Q

Marker of PBC

A

antimitochondrial antibody

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95
Q

acute pancreatitis and suspiscion of gallstones

A

perform US

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96
Q

most common cause of acute pancreatitis (2)

A

alcohol

gallstones

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97
Q

first thing to do in patient with acute pancreatitis

A

U/S to rule out cholelithiasis and choledocholithiasis

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98
Q

first image in pancreatitis

A

sono abdomen

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99
Q

risk # 1 for pancreatitis cancer

A

chronic pancreatitis

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100
Q

the second major risk factor for pancreatic ca(2)

A

hereditary

and environmental

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101
Q

whta’s the major hereditary risk for pancreatic cancer(3)

A

hereditary pancreatitis
germline mutation
first relative with pancreas cancer

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102
Q

germline mutation for hereditary pancreatic cancer(3)

A

BRCA-1
BRCA-2
Peutz jegher

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103
Q

Environmental risk for pancreatic cancer(4)

A

cigarette
obesity
low exercice
non hereditary pancreatitis

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104
Q

epigastric pain and ictere best test to do

A

U/S to rule out biliairy obstruction

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105
Q

epigastric pain and weight loss best test to do

A

CT abdomen

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106
Q

anal fissure treatment

A

stool softener

local anesthetic

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107
Q

why use local anesthetic in anal fissure

A

to remove the spasm

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108
Q

Patient seen in ED with hypotension and hematemesis(3)

or any patient received in ED

A

Airway
Breath
Circulation

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109
Q

Patient after several episodes of vomiting develops hematemesis

A

Malorry weiss syndrome

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110
Q

cause of mallory weiss

A

increased intragastric pressure causes tear in gastric mucosa and distal esophagus

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111
Q

what arteries are involved in Mallory weiss

A

submucosal arteries in proximal stomach and distal esophagus

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112
Q

pourcentage of bleeding caused by mallory weiss

A

10%

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113
Q

risk for barret

A

adenocarcinoma of esophagus

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114
Q

type of esophagus cancer in alcohol and smoker

A

SCC

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115
Q

Cause of increased bilirubin mainly conjugated with high ALP(5)

A 
PSC
PBC
Choledocholithiasis
pregnancy
cholangiocarcinoma
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116
Q

work up for increased bilirubin conjugue with high ALP(3)

A

CT
U/S
Antimitochindrial antibody

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117
Q

Approach of hyperbilirubinemia(2)

A

Conjugue

non conjugue

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118
Q

approach of bilirubin conjugue(3)

A

know if it’s AST ALT ALP normal
Predominance of ALP
Predominance of AST/ALT

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119
Q

cause high bilirubin non conjugue

A

gilbert
hemolysis
reduced uptake

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120
Q

cause high bilirubin conjugue with normal everything else(2)

A

Rotor

dubin jhonson

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121
Q

Cause increased bilirubin conjugue and high AST ALT predominantely(2)

A

hepatitis

hemochromatosis

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122
Q

cause of Hepatitis(6)

A 
viral
ischemic
autoimmune
toxin
drug
alcohol
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123
Q

chest pain and dysphagia in young girl

A

spasm diffus de l’oesophage

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124
Q

work up for spasm diffus de l’oesophage

A

eosphagram

manometry

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125
Q

esophagram for spasm diffus de l’oesophage

A

corkskrew apperance

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126
Q

manometry for spasm diffus de l’oesophage

A

contraction and relaxation of LES

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127
Q

RUQ pain after cholecystectomy

A

post cholecystectomy syndrome

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128
Q

cause of post cholecystectomy syndrome(2)

A

biliairy

extra biliairy

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129
Q

biliary cause of post cholecystectomy syndrome(2)

A

cystic duct stone

common bile duct retained

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130
Q

extra biliary cause of post cholecystectomy syndrome(2)

A

pancreatitis

PUD

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131
Q

Dx of post cholecystectomy syndrome

A

ERCP

MRCP(Magnetic resonnance cholangiopancreatography)

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132
Q

what the two main things to look pseudomembranous colitis

A

WBC

Creatine level

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133
Q

CAT si WBC< 1500 0and creat< 1,5 fois baseline

A

Metronidazole

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134
Q

CAT si WBC> 15000 and creat> 1,5 fois baseline

A

oral vancomycin

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135
Q

CAT si WBC> 15000 and creat> 1,5 fois baseline plus ileus

A

oral vancomycin plus IV metro

or rectal vancomycin switch)

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136
Q

CAT si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2

A

surgery

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137
Q

surgery for pseudomembranous colitis

A

si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2

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138
Q

type de surgery in pseudomembranous colitis

A

subtotal colectomy

diverting loop ileostomy with colonic lavage

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139
Q

antibiotic most commonly involved in pseudomembranous colitis(4)

A

clindamycin
quinolone
penicilin
cephalosporin

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140
Q

confirmatory dx fror pseudomembranous colitis

A

Cdif toxin by PCR

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141
Q

indication of fidaxomycin in pseudomembranous colitis(2)

A

reccurent colitis

sevfer colitis not able to tolerate oral vancomycin

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142
Q

microcytic anemia first cause

A

GI blood loss

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143
Q

work up GI in microcytic anemia(2)

A

endoscopy

colonoscopy

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144
Q

in the work up of microcytic anemia what to do if endoscopy and colonoscopy are negative

A

capsule endoscopy to look small intestine

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145
Q

MEN 1

A

3 tumors
gastrinoma
2 adenomas(pituitaire and parathyroid)

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146
Q

MEN 2a

A

2 tumors
parathyroid hyperplasia
Pheo
Medullary thyroid cancer

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147
Q

clue for diarhhea cused cryptosporidium parvum(3)

A

HIV
low CD4
modified acid stain (oocyst)

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148
Q

acid fact stain plus oocyst

A

isospora belly

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149
Q

epidemio of isospora

A

no isospora is US

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150
Q

4 reasons to ask endoscopy in GERD(4)

A

> 50 ans
Symptoms> 5 ans
signes de danger
facteur de risque de ca

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151
Q

singnesd e danger dans GERD(5)

A 
Persisting vomiting
digestive hemorrage
anemia
perte de poids
odynophagia and dysphagia
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152
Q

how’s platelet in in chron

A

reactive thrombocytosis

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153
Q

Hallmark of chron(2)

A

involvement mouth to anus

fistula

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154
Q

Clue for chron(4)

A

chronic diarrhea
with abd pain and
weight loss in
young patient

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155
Q

Back pain and anemia in patient on warfarin

A

spontaneous retroperitoneal hematoma

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156
Q

epigastric pain cause(4)

A

MI
PUD
cholecystitis
Aortic dissection

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157
Q

epigastric pain with irradiation in both arms

A

infero post MI

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158
Q

Management of asymptomatic diverticulosis

A

high fiber intake

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159
Q

how constipation causes diverticuli

A

Increase presure in colon creates weak spots

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160
Q

quid of diverticuli

A

saclike protrusion of colonic wall

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161
Q

dysphagia for both solids and liquids

A

motility problem

162
Q

Dysphagia for solids first then for liquids(2)

A

ca oesophage

stricture

163
Q

best test for in case of dysphagia

A

baryum esophagram

164
Q

if baryum esophagram is not conclusive next step in case of dysphagia

A

upper GI endoscopy

165
Q

Ascites with fever and neurologic symptom(confusion and lethargy)

A

spontaneous bacterial infection(peritonitis)

166
Q

criteria of SBP

A

> 250 WBC in fluid ascites

167
Q

Important test for SBP DX

A

Paracenthesis

168
Q

bugs causing SBP(2)

A

klebsiella

E coli

169
Q

Rx of SBP

A

3 e generation cephalosporin

170
Q

massive GI bleeding by cirrhosis RX first

A

ABC de l’urgence

octreoctide

171
Q

Massive hemorrage with depressed consciousness

A

Intubation is indicated

172
Q

indication of platelet transfusion in GI bleeding caused by cirrhosis

A

platelet<50 000

173
Q

how to stop hemorrage in cirrhosis(2)

A

band ligation

or sclerotherapy

174
Q

patient returning from mexico develops foul smelling diarrhea

A

giardiasis

175
Q

zone in the US with giardiasis

A

rocky mountains

176
Q

rx of giardiasis

A

Metronidazole

177
Q

how giardiasis causes digestive problem

A

by adhering to mucosal surface by adhesive disks causing malabsorption

178
Q

3 types of polyps(3)

A

hyperplastic
adenoma
hamartoma

179
Q

pill esophagitis (3)

A

koh
quinidine
iron

180
Q

antibio causing esophagitis

A

cycline

181
Q

nsaids causing esophagitis

A

all NSAIDS

182
Q

biphosphonate and pill esophagitis

A

alendronate

183
Q

colonic angyodysplasia

A

painless GI bleeding

plus aortic stenosis

184
Q

Quid of Heyde’s syndrome

A

painless GI bleeding

plus aortic stenosis

185
Q

why GI bleeding in Heyde’s syndrome

A

Because of AV malformation

186
Q

management of non bleeding cirrhosis

A

non selective B blocker

187
Q

non selective b blocker used in non bleeding cirrhosis

A

propranolol

nadolol

188
Q

mangement of non bleeding cirrhosis if B blocker is contreindicated

A

primary preventive band ligation

189
Q

how BB prevents bleeding in cirrhosis

A

decreased portal flow

190
Q

GI bleeding with anemia

A

packed red blood cell

191
Q

condition of packed red blood cell in anemia

A

Hb< 7

Hb< 9 symptomatic or active acute coronary syndrome

192
Q

quid of speed ball

A

cocaine and heroin use

193
Q

risk of speed ball use

A

rhabdomyolysis

194
Q

vaccin a donner in IV drud user

A

Hep B vaccine

195
Q

cause of hypotension in severe pancreatitis(Necrotizing pancreatitis)

A

increased capillary permeability

196
Q

quid of severe pancreatitis

A

pancreatitis plus at least one organ failure

197
Q

cullen sign

A

periumbilical bluish discoloration

198
Q

Meaning of cullen sign

A

hemoperitoneum(pancreatitis)

199
Q

grey turner sign

A

reddish discoloration in flank

200
Q

Meaning of grey turner sign

A

retroperitoneum(pancreatitis)

201
Q

risk factor for severe pancreatitis

A 
age > 75 ans
obesity
alcohol
CRP>150
Increase BUN
ARDS
202
Q

rx of acute pancreatitis(3)

A

fluid
pain control
bowel rest

203
Q

aspirin and GI bleeding

A

acute erosive gastritis

204
Q

mechanism of action of aspirin

A

block cyclooxygenase pathway—> no prostaglandin

205
Q

role of prostaglandine

A

effect protecteur sur la muqueuse gastrique

206
Q

rx of acsites(4)

A 
sodium and water restriction
spironolcatone 
loop diuretic(1 l/day of diuresis)
frequent abdominal paracenthesis(2-4 l if renal perfusion is OK)
207
Q

water restriction in cirrhosis

A

< 2 L day

208
Q

warning with diuretic in cirrhosis(spirono and furosemide)

A

agressive diuresis

can cause hepato renal syndrome

209
Q

iron deficiency anemia in patient taking NSAIDS

A

GI bleeding

210
Q

ca associated with hemochromatosis

A

hepatocellular carcinoma

211
Q

what are the 3 mutations associated with Hemochromatosis(3)

A

HFE
L2824
H63D

212
Q

cause of bacterial overgrowth(3)

A

motility problem
strictures in GI
other causes

213
Q

motility problem causing overgrowth bacterial(2)

A

sclerodermia

diabetes

214
Q

other causes of bacterial overgrowth(4)

A

end stage renal disease
cirrhosis
AIDS
advanced age

215
Q

gold standard to Dx bacterial overgrowth

A

endoscopy with aspiration in jejunum

216
Q

finding in endoscopy in jejunum aspiration in bacterial overgrowth

A

bacteria>10exposant 5 bact /ml

217
Q

bacteria causing bacterial overgrowth(4)

A

E coli
lactobacillus
bacteroides
streptococci

218
Q

manif of bacterial overgrowth

A

chronic diarrhea

219
Q

Rx of bacterial overgrowth(2)

A

augmentin

or rifamixin pdt 7 a 10 jours

220
Q

cause of mesenteric ischemia(abdominal angina)(2)

A

atherosclerosis

occlusion of visceral arteries

221
Q

clue for mesenteric ishemia

A

severe abdominal pain after eating

222
Q

Dx of abdominal angina(2)

A

Doppler abdomen
or
angiography

223
Q

pain with foof d Dx(2)

A

PUD

abdominal angina

224
Q

auscultation clue for abdominal angina

A

50 % des cas

abdominal bruit

225
Q

similitude between Chron and TB

A

both have granuloma

226
Q

characteristic of chron

A 
transmural lesion
skip lesions
creeping fat appearrance
fistula/fissure
perianal disease
mouth to anus
227
Q

why fistula in chron

A

transmural lesion

228
Q

disease with granuloma(4)

A

TB
Chron
sarcoidosis
yersinia infection

229
Q

initial bleeding management caused by varices(3)

A

fluid
octreoctide IV
sclerotherapy or band ligation

230
Q

quid of octreoctide

A

somatostatin analog

231
Q

next step in managing bleeding varices if success in initial step(2)

A

Bblocker

repeat endoscopic band ligation in 2 a 3 weeks

232
Q

failure of initial management of varices

A

ballon tamponnade
or
TIPS or shunt surgery

233
Q

TIPS

A

transjugular intrahepatic portosystemic shunt

234
Q

if rebleeding after initial management next step(2)

A

try endoscopic rx
or
TIPS/Shunt surgery

235
Q

tube used in ballon tamponade(3)

A

sengstaken blackmore
Minessota
linton nachlas

236
Q

type of problem in zencker

A

motor dysfunction and incoordination

237
Q

rx of zencker

A

crycopharyngeal myotomy

238
Q

localisation of zencker

A

above upper esophageal sphincter

239
Q

quid of zencker

A

posterior herniation through the fibers of cricopharyngeal muscles

240
Q

what cause the herniation in zencker

A

incoordination between the contraction of pharynx and contraction of upper esophageal sphincter

241
Q

complication of zencker(4)

A

trachea compression
aspiration pneumonia
erosion and bleeding
regurgitation

242
Q

indication of H pylory

A

< 55

no alarm symptom

243
Q

indication of endoscopy in dyspepsia(2)

A

> 55 ans with new dyspepsia

any age with alarm symptom

244
Q

quid of dyspepsia(3)

A

epigastric pain
bloating
early satiety

245
Q

patient with dyspepsia,no alarm symptom an less 55 ans with negative H pylori

A

PPI for 4 a 8 semaines

246
Q

cause of dyspepsia(5)

A 
GERD
AINS
PUD
Malignancy
functionnal dyspepsia
247
Q

workup for zollinger ellisson syndrome

A

gastrin level >1000 pg /ml

248
Q

workup for zollinger ellisson syndrome gastrin test inconclusive next step

A

secretin stimulation test

249
Q

biopsy finding in UC

A

neutrophylic cryptitis

250
Q

patient after coronary bypass develops abdominal pain and bloody diarrhea

A

Ischemis colitis

251
Q

why lactate is high in ischemic colitis

A

because of ischemia

252
Q

what area is most commonly involved in ischemic colitis and why

A

-splenic flexure
rectosigmoid junction
vascularisation by ended artery

253
Q

vascularisation of splenic flexure

A

narrow terminal branches of superior mesenteric artery

254
Q

vascularisation of rectosigmoid junction

A

narrow terminal branches of inferior mesenteric artery

255
Q

cause of ischemic colitis during coronary bypass (any surgery)

A

hypotension

256
Q

watershed area involved in ischemic colitis

A

-splenic flexure

rectosigmoid junction

257
Q

lactose intolerance workup(4)

A

H+ breath test
Low stool PH
high osmotic gap
osmotic substances in stools

258
Q

quid of high osmotic gap

A

> 50

259
Q

clue in lactose intolerance

A

no steatorrhea

260
Q

quid of bright red blood cell per rectum(2)

A

scant hematochezia

minimal scant bleeding

261
Q

Cause of red blood cell per rectum(4)

A

hemorroides
fissures
proctitis
rectal ulcer or Ca

262
Q

Best test in red blood cell per rectum(2)

A

anoscopy

proctoscopy

263
Q

quid of SAAG(2)

A

serum ascites albumin gradient

Albumin serum- albumin ascites

264
Q

Value of SAAG in ascites caused by SBP

A

> 1,1

265
Q

Importance of SAAG

A

> /1,1 ascites is caused portal hypertension

266
Q

spontaneous bacterial infection of ascites(3)

A

Hypotension
hypothermia
ileus

267
Q

Dx of SBP

A

SAAG > 1,1

Albumin ascites< 1

268
Q

when to avoid quinolones in SBP

A

patient already receives it for SBP prophylaxis

269
Q

first step in the workup of acute pancreatitis

A

amylase

lipase

270
Q

what are the main criteria to Dx acute pancreatitis

A

epigastric pain radiating in the back
amylase and lipase >3 f la normale
CT or U/S

271
Q

U/S of acute pancreatitis

A

hypoechoic image

272
Q

the most useful blood test in acute pancreatitis

A

Lipase

273
Q

why lipase is most useful blood test in acute pancreatitis

A

rises in 4-8 h

stay up 8-14 jours

274
Q

what about amylase

A

rises in 6-12h

apres 5 jours disparait

275
Q

patient with acute pancreatitis with amylase and lipase increases 3 f la normale

A

ni image is needed for the Dx of acute pancreatitis

276
Q

when to do CT in acute pancreatitis

A

Dx is unclear

failure of treatment

277
Q

chronic pancreatitis workup(2)

A

plain film

CT of abdomen

278
Q

image in Plain film or CT of abdomen for chronic pancreatitis

A

calcification

279
Q

cause of chronic pancreatitis(3)

A

alcohol
autoimmune
cystic fibrosis

280
Q

symptom of chronic pancreatitis(4)

A

Diabetes
weight loss
malabsorption
epigastric pain

281
Q

Rx of chronic pancreatitis(4)

A

Pain management
stop smoking
enzyme replacement
frequent small meals

282
Q

clue for inflammatory diarrhea(5)

A 
anemie
High ESR
Acute phase reactant
thrombocytosis
blood in stool or leucocyte
283
Q

what to think in chronic inflammatory diarhhea

A

IBD

284
Q

characteristics of fat malabsorption(3)

A

foul smelling diarrhea
difficult to flush
floating diarrhea

285
Q

3 main problem causing steatorrhee(3)

A

pancreatic insufficiency
bile salt related
impaired intestinal surface epithelium

286
Q

2 causes of pancreatic insufficiency

A

chronic pancreatitis

ca pancreatic

287
Q

What can impair epithelium intestinal surface(3)

A

AIDS
celiac disease
giardiasis

288
Q

problem with bile salt

A

foie

ileon

289
Q

Hepatic problem related to malabsorption(2)

A

PBC

PSC

290
Q

iIeal problem related to malabsorption(3)

A

cron
bacterial overgrowth
surgical resectionof ileon

291
Q

other causes related to malabsorption(3)

A

whipple
ZES
Medication induced

292
Q

Dx test for steatorrhea

A

sudan stain

293
Q

clue for diverticulitis(3)

A

LLQ pain
fever
elderly

294
Q

Diverticulitis rebelle aux antibiotiques DX(3)

A

complication
abcess
fistula
perforation

295
Q

best test yto evaluate complication in diverticulitis

A

CT scan of abdomen

296
Q

patient with barret and Heartburn 3 weeks later without Rx no more heart burn Dx?

A

benign peptic strictures

297
Q

What to do in peptic benign strictures and why(2)

A

biopsy

to ruleout adenocarcinoma

298
Q

quid of barret

A

intestinal metaplasuia of lower esophagus

299
Q

cause of peptic strictures(4)

A

GERD
Scleroderma
radiation
caustic ingestion

300
Q

clue for abdominal herpes pain

A

immunocompromised patient

develops abdominal pain elicits by light touch of abdomen

301
Q

what will appear in 1 week in this patient with abdominal herpes

A

skin lesion

302
Q

what appear first in herpes

A

the local pain

303
Q

Pain and rash in herpes(2)

A

pain can precede rash
or
both can appear simultaneously

304
Q

in manometry record how appears a contraction of esophagus

A

positive deflection

305
Q

in manometry record how appears a relaxation of esophagus

A

negative deflection

306
Q

next if ca gastric is detected

A

CT extent evaluation

307
Q

UC with high ALP

A

PSC

308
Q

what test to do in UC

A

sigmoidoscopy

309
Q

sigmoidoscopy finding in UC(2)

A

Mild erythema

mucosal inflammation

310
Q

complication of UC(2)

A

colorectal cancer

toxic megacolon

311
Q

extraintestinal manif of UC(4)

A

PCS
uveitis
eryhtema nodosum
spondyloarthropathy

312
Q

patietnn with multiple thrombophlebitis

A

check a cancer

313
Q

why cancer can cause thrombophlebitis

A

Hypercoagulability

314
Q

clue for factitious diarrhea

A

laxative abuse

315
Q

confirmatory Dx of factitious diarrhea

A

biopsy

316
Q

biopsy of factitious diarrhea

A

dark brown discoloration with lymph follicles shining through as a pale pathes(melanosis coli)

317
Q

laxative causing melanosis coli

A

antraquinone containing laxative

318
Q

antraquinone containing laxative

A

bisacodyl

319
Q

Dx of zencker

A

contrast esophagram

320
Q

Complication of PSC(5)

A 
cholelthiasis
cholestasis
cholangiocarcinoma
colon ca
biliary stricture intra et extra hepatique
321
Q

epigastric pain and weight loss

A

ca pancreas

322
Q

Dx test for ca pancreas

A

CT abdomen

323
Q

why patient on total parenteral nutrition develops gallstones

A

gallbladder stasis

324
Q

why gallbladder stasis in total parenteral nutrition

A

because no food in duodenum to cause activate release of cholecystokinine

325
Q

role of cholecystokinine

A

contraction of gallbladder

326
Q

why ileal resection causes gallstones(3)

A

because of decreased enterohepatic cycle
hepatic bile is oversaturated with cholesterol
gallstone formation

327
Q

why megaloblastic anemia in tropical sprue

A

B12-folic acid deficiency

328
Q

dx of tropical sprue

A

blunting villi

chronic infiltrationof inflammatory cells(Lymphs,plasma cells,eosinophils)

329
Q

important feature of tropical sprue

A

malabsorption

330
Q

why in GI bleeding causes high BUN

A

bacteria in gut degraded hb en Urea

331
Q

cause of BUN elevation with normal creat(3)

A

GI bleeding
prerenal azotemia
systemic steroids

332
Q

major side effect of digoxin toxicity

A

anorexia

333
Q

drug that can increase the level of digoxin

A

verapamil

furosemide

334
Q

why verapamil causes increase level of digoxin

A

by decrease the renal clearance of digoxin

335
Q

why furosemide causes increase level of digoxin

A

by causing hypokaliemia

336
Q

cardiac problem in digoxin toxicity(2)

A

bidirectionnal ventricular tachycardia

accelarated junctionnal rythm

337
Q

most common side effect of digoxin toxicity(3)

A

GI problem
anorexia
nausea
vomiting

338
Q

medication for seizure causing pancreatitis

A

acid valproic

339
Q

anti hta causing pancreatitis(2)

A

furosemide

thiazides

340
Q

drugs used in IBD causing pancreatitis

A

sulfasalazine

5-ASA

341
Q

immunosuppresor causing pancreatitis(2)

A

azathioprine

L asparaginase

342
Q

patient with HIV with pancreatitis(2)

A

didanosine

pentamidine

343
Q

Antibio involved in pancreatitis

A

metronidazloe

4 cycline

344
Q

cause of renal failure in hepato renal syndrome

A

renal hypoperfusion

345
Q

rx of hepatorenal syndrome

A

octreoctide
or
Midodrine

346
Q

prerenal failure

A

urine Na+ less than 10meq/L

347
Q

clue for intestinal occlusion(2)

A

vomiting

not passed gas

348
Q

Dx of intestinal occlusion(2)

A

plain film of abdomen

multiple air fluid

349
Q

rx for intestinal occlusion

A

surgery

350
Q

cause of toxic megacolon(5)

A 
UC
ischemic colitis
volvulus
diverticulus
obstructive cancer
351
Q

LLQ pain(2)

A

diverticulitis

complicated Ca

352
Q

localisation of celiac sprue

A

proximal intestine

353
Q

test for diagnosing celiac sprue

A

D xylose test

354
Q

D xylose test(3)

A

ingestion of D xylose
intact intestinal mucosa
urinary excretion 4,5-7,5g

355
Q

absent peristaltic waves and low LES tone

A

scleroderma

356
Q

UC plus fever Dx

A

rule out toxic megacolon

357
Q

chronic bloody diarrhea

A

UC

358
Q

Major criteria of Megacolon(4)

A

fever
HR>120
Neutrophilic leucocytes>10500
anemia

359
Q

Minor criteria(4)

A

hypotension
electrolytes disturbances
altered sensorium
volume depletion

360
Q

Dx of megacolon(2)

A

3 criteres major

plus one minor criteria

361
Q

dx diffuse spasm of esophagus

A

manometry

362
Q

clue for diffuse spasm of esophagus

A

retrosternal spasm

exacerbated by sttress and cold food

363
Q

drug used in diffuse spasm

A

nitroglycerin

364
Q

EKG in diffuse spasm of esophagus

A

normal

365
Q

quid of angiodysplasia(2)

A

dialted

ectatic thin walled vessels lined by endothelium

366
Q

disease with angyodysplasia(2)

A

end stage renal disease

aortic stenosis

367
Q

cardiac problem in whipple disease(2)

A

CHF

valvular regurgitation

368
Q

why many people with celiac disease has IDA antibody negative

A

because they have selective IGA deficiency

369
Q

role of endoscopy in achalasia

A

to rule out ca du bas oesophage

370
Q

quid of bird beak appearance

A

dilated esophagus with distal narrowing

371
Q

level of calcemia to have constipation

A

> 12

372
Q

severe epigastric pain spreadind all over the abdomen

A

chemical peritonitis due to perforated ulcer

373
Q

quid of polyps

A

adenoma

374
Q

condition of adenomas to become cancer(3)

A

villous
sessile
> 2,5 cm

375
Q

CT of acute pancreatitis

A

focal or diffuse pancreatic enlargement with heterogenous enhancement

376
Q

epigastric pain with high amylase and lipase and ALT>150 units/l

A

biliairy pancreatitis

377
Q

3 types of IBS

A

constipation predominant
diarhhea predominat
Mixed

378
Q

cause of pellagra

A

deficiency of NIACIN

379
Q

patient with cirrhosis and smooth muscle antibody microsomal type 1 positive cause?

A

autoimmune

380
Q

disease associated with autoimmune cirrhosis

A

thyroiditis

381
Q

hows pancreatic hormone in chronic pancreatitis

A

Normal

382
Q

post cholecystectomy syndrome work up(3)

A

abdomen U/S
ERCP
MRCP

383
Q

Dx of C difficile

A

stool studies

384
Q

microcytic anemia in elderly

A

FOBT

colonoscopy

385
Q

meaning of negative FOBT in microcytic anemia(2)

A

cant’t exclude GI blood loss with one FOBT negatif

perform colonoscopy

386
Q

what to do in any patient with acute abdominal pain

A

rule out MI with EKG

387
Q

chron granuloma

A

non caseating

388
Q

DX of ZES

A

fasting gastrin level

389
Q

cobble stone appearance

A

chron

390
Q

neutrophilic abcess

A

crhon

UC

391
Q

confirmatory DX of SBP(2)

A

Neutro >250micro/l

positive peritoneal fluid culture

392
Q

post ERCP patient develops epigastric pain

A

iatrogenic acute pancreatitis

393
Q

most common cause of malabsorption

A

alcoholic chronic pancreatitis

394
Q

complication of UC requiring surveillance

A

colon carcinoma

395
Q

Quid of PSC

A

stricture of medium sized and large intrahepatic and extra hepatic bile ducts

396
Q

most common consistent reversible risk factor of pancreatic cancer

A

smoking

397
Q

charateristic finding in imaging in pancreas ca (tete pancreas)

A

intra and extra hepatic biliairy tract dilation

398
Q

what will increase during GI bleeding

A

BUN/Creat ratio

399
Q

patient with UC develops fever weight loss and colonic dilation abdominal xray

A

toxic megacolon

400
Q

management of toxic megacolon(3)

A

IV steroids
Fluid management
nasogastric decompression

401
Q

Dx test for diverticulitis

A

ct scan of abdomen

Step 2 CK (primary set) (22 decks)

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