High Yield Book Flashcards by Brian Lappas

Two conditions with temperature-pulse dissociation?

Leiptospirosis - doxycycline
Typhoid fever - fluoroqinolone

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Diarrhea + dysmotility + heart failure + nueropathy

Amyloidosis

Secondary = AA

Primary = AL light chains

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What size of fibrovascular polyp of esophagus can you snare if no vessels?

<2 cm

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Rare reaction to mesalamine?

Pericarditis

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Nodules throughout GI tract with path showing “needle shaped clefts”

Cholesterol emboli to GI tract

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What vessel abnormality can cause solid food dysphagia?

R subclavian artery

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Fever + diarrhea + VitB12 + AIDS

Cryptosporidium

Tx: anti-retrovirals and nitazoxanide

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Recurrent abdominal pain + lip swelling

What is deficiency?

What can you give to prevent attacks?

Hereditary angioedema

C1 esterase activity

Tx: infuse c1 esterase

ppx with Danozol

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Sudden outbreak of seborrheic keratosis in elderly patient?

GI malignancy

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Development of acanthosis nigricans without diabetes?

GI malignancy

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New diabetes + dermititis + diarrhea

Glucagonoma

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plucked chicken skin + GI bleeding

pseudoxanthoma elasticum

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Dysphagia with keratoderma of palms and soles of feet?

What’s the do not miss?

Tylosis

SCC of the esophagus

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Multiple GI harmartomas with hair loss and nail involvement?

Cronkhite-Canada syndrome

(not inherited)

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Thickend gastric folds with bx showing corkscrew foveolar hyperplasia

Menetrier’s

Tx: H pylori

Antiepidermal growth factor receptor antibody

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Two conditions associated with A1AT not to miss?

Cervical artery dissection

Neutraphilic panniculitis

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Gallbladder polyp any size with stones?

cholecystectomy

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Any concern for acute mesenteric ischemia or superior mesenteric artery embolism? Next step?

IR and amergent angiography

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Timing difference for post BMT and GVHD vs VOD?

VOD is 21 days

GVHD is 100 days

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GI tract tumor that appears green and stains +myeloperpxidase? What is major risk?

Granulocytic sarcoma (extrameddulary myeloblastoma) called a CHLOROMA

Risk of AML leukemia

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Young women with cramping and abdominalpain worse during period and improves with NSAIDs?

Endometriosis

Can see noduels that come and go in GI tract

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Tx for severe scute cryoglobulinemia?

Plasmapharesis

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Harmartomas throughout GI tract?

What is mutation?

3 cancer risks?

Cowdens

PTEN (Cowden wears number 10 with cow utters and large thyroid and cervix)

Thyroid, breast, endometrial

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Side effec of furosemide?

Pancreatitis

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AIDS and infection with Bartonella with enlarged liver?

Peliosis Liver cysts that communicate directly with sinusoidal system Tx Bartonella with erythromycin

Name most likely pathogen and how to treat: diarrhea after raw shellfish

Vibrio Supportive care

Name most likely pathogen and how to treat: chocolate milk

Listeria

Name most likely pathogen and how to treat: Fried rice

Name most likely pathogen and how to treat: bloody diarrhea and undercooked beef

E coli EHEC 0157:H7 HUS/TTP

Name most likely pathogen and how to treat: Diarrhea on cruise ship

Norovirus

Name most likely pathogen and how to treat: Diarrhea pet turtle

Salmonella

Name most likely pathogen and how to treat: diarrhea cirrhosis, sepsis and death

Name most likely pathogen and how to treat: MCC travelers diarrhea

E coli ETEC (enterotoxigenic)

Two small bowel infections with PAS+?

Whipple MAC (+AFB)

MCC secondary lymphangiectasia?

Heart failure Sarcoid Retroperitoneal fibrosis Sarcoidosis

Mechanism of linaclotide

guanylate cyclase receptor agonist

Mechanism of lubiprostone?

Chloride channel 2 receptor agonist

Post operative ileus medication?

**Alvimopan** peripheral mu antagonist

Mechanism of Baclofen?

GABA agonist

HIV CD4\<200 and diarhea with: tenesmus, bloody diarrhea and paresthesias in saddle area

HSV proctitis

HIV CD4\<50 and diarhea with: colonic biopsy with acid+ foamy macrophages

MAC look for bulky lymphadenopathy Tx ethanbutol/rifabutin with azithromycin

HIV CD4\<200 and diarhea with: flask shaped colonic ulcers and motile trophozoites

Entamoeba histolytica colitis Tx: Flagyl followed by paramomycin

GI infections causing terminal ilieitis?

TB Salmonella Yersina MAC

HIV CD4\<200 and diarhea with: colonic ulcers with owl eyes inclusion bodies

CMV

HIV CD4\<200 and diarhea with: eosinophilia and voluminous diarrhea

Isospoa bellie enteritis (Charcot Leyden crystals in stool) Intracytoplasmic vacules (unlike crypto) Tx: Bactrim

HIV CD4\<200 and diarhea with: fever, diarrhea, terminal ileitis and cholecystitsi

Cryptosporidiosis Tx: immunosuppressive therapy and maybe nitazoaxanide (no intracelluar vacules like isoospora belli)

Left sided abdominal pain with focal area of fat on CT with a line through it? How treated?

Epiploic appendagitis Tx: NSAIDs (not surgery)

Intense abdominal pain after excercise with fever and elevated ESR? Treatment?

FMF (defect encodes protein called pyrin) Tx: colchicine

Gastric mass: hypoechoic 4th layer with c-kit+ CD117 When to remove? When to treat with what type of chemo?

GIST arrises from interstitial cells of Cajal (10-30% malignancy) Remove when \>3cm

Gastric mass: hypoechoic 4th layer, actin+, negative c-kit

Leiomyoma

Gastric mass: Extramural, anechoic spherical structure at site of subepithelial bulge

Duplication cyst

Gastric mass: hyperechoic well circumscribed arrising from 3rd layer

Lipoma

What layer is lipoma arise from ?

3rd layer

Gastric mass: Elevated gastrin, hypoechoic and 2nd/3rd layers

Carcinoma Type I: elevated gastrin with atrophic gastritis Type II: elevated gastrin with ZES Type II: normal gastrin (high malignancy - surgically resect)

Gastric mass: hypoechoic 4th layer, actin+, **vimentin+**, c-kit negative

**Glomus** tumors Arise from smooth muscle of blood vessel Negative malignancy potential

Gastric mass: hypoechoic 4th layer, S-100+

Swannoma

Gastric mass: hypoechoic mass arising from 3rd layer with central umbilication

Pancreatic rest

Dysphagia and a shawl like rash and rings around eyes with weakness in proximal muscle groups and nodules on knuckles Which muscles are involved? Treatment?

Dermatomyositis Weakness of the striated muscle in the proximal esophagus Tx: steroids

Systemic sclerosis affects what muscles?

Fibrosis of smooth muscles

CEA level of pancreatic cyst that is worrisome?

\>192

Brain imaging with occipital calcifications?

Celiac disease | (also related to seizures)

Thickend gallbladder wall appears to invaginate on itself? Management?

Adenomyomatosis Benign - NTD

What stool test to distuinguish pancreatic enzyme deficiency from fat malabsorption?

Sudan stain checking for triglycerides

Young patient from Middle East with paraproteinemia (elevated alpha chain) and small bowel bx with dense lymphoplasmacytic infiltrate?

Immunoproliferative small intesinal disease (IPSID) Associated with Campylobacter jejuni Tx: Ampicillin and Flagyl, chemo and radiation

Two cutaneous and visceral carvernous hamangioma syndromes? Which one has bone-overgrowth, soft tissue hyperplasia and varicose veins?

Blue rubber bleb nevus syndrome Klippel-Trenaunay-Weber has the bone-overgrowth

TI resection of greator or less than 100cm is what mechanism and how treated?

\<100cm = cholestyramine \>100- fat malabsorption, medium chain FAs

Stool gap for chronic diarrhea and what does pH tell you?

Gap \>50 is osmotic pH \<5 is sugar malabsorption pH \>5 is probably laxative

Chronic pancreatitis resulting in gastric outlet obstruction?

Groove pancreatitis causing fibrosis and duodenal obstruction

Heriditary colorectal cancer syndrome buzzword: Mandibular osteoma

FAP APC on chrome 5 **Mandibular and skull osteomas, desmoid tumors, lipomas, epidermoid cysts, sebaceous cysts** **Brain medulloblastomas and gliomas**

Heriditary colorectal cancer syndrome buzzword: Ureteral cancer

HNPCC -Lynch syndrome Mismatch repair MLH1, MSH2 **Ureteal cancer, ovarian, stomach, small intestine, biliary tree** 3 close relatives, 2 generations, 1 before age 50

Heriditary colorectal cancer syndrome buzzword: Facial angiofibromas (adenoma sebaceum)

Tuberous sclerosis Diffuse hamartoma with colonic ganglioneuromas and schwann cells

Heriditary colorectal cancer syndrome buzzword: Medulloblastoma

FAP

Heriditary colorectal cancer syndrome buzzword: Trichilemmoma

Cowdens Syndrome

Heriditary colorectal cancer syndrome buzzword: Sertoli cell testicular tumors

Peutz-Jeghers syndrome Chrome 9 serine threonine kinase Diffuse harmartomous polyps **Extracancers include sertoli testicular tumors, ovarian sex cord tumors, pancreatic tumors**

UDCA in PBC does not improve what two things?

Osteoporosis and fatigue

Which BB is preferred in pregnancy?

Propranolol

What syndrome increases risk of esopahgeal SCC with keritonosis of hands and feet?

Tylosis keritonosis of hands and feet and FAMMM

Syndromes associated with increased risk of pancreatic cancer that warrents surveilance?

Puetz Jegger (STK11/LKB1) Heriditary Pancreatitis FAMMM (CDKN2A) Lynch (HPSS)

Patient with peripheral fat necrosis and lipase hypersecretion syndrome?

Acinar cell pancreatis cancer

MCC neonatal hepatitis?

A1AT abn folded protein accumulating in ER"

Treatment of primary lymphangiectasia?

Low fat diet with medium chain triglycerides

Complications of intestinal transplant?

PTLD CMV Rejection

Diarrhea, dermatitis and dementia?

Pellagra B3 Niacin dificiency Check urinary N methyl -nicotinamide

Diarrhea with anemia and neutrapenia

Copper

Why is enteral feeding good for pancreatitis?

Decreases risk of bacterial translocation

Hypercholesterol dementia dermatitis

Magnesium

Follicular hyperkeratosis and night blindness

Vit A deficiency

Glucose intolerance + peripheral neuropahty + encephalopathy

Chromium

Hep E infection form wild boar/game: Tx?

Immunocompetent: observe Solid organ transplant: Riboviron 3 months

Sofosbuvir What genotype? Can't give to? Special considerations?

All GFR \<30

Sofosbuvir + Ledipavir What genotype? Can't give to? Special considerations?

No 2,3 (harvoNI !) GFR \<30

Sofosbuvir + Velpatasir What genotype? Can't give to? Special considerations?

All GFR \<30

Sofosbuvir + Voxilaprevir What genotype? Can't give to? Special considerations?

All GFR \<30 Great for previously treated and failed SVR

Elbasvir + Grazoprevir What genotype? Can't give to? Special considerations?

No 3 (Check your elbow when shotting 3s) Decompensated cirrhotics PPI OKAY

Glecoprovir + pibrentasivir What genotype? Can't give to? Special considerations?

All genotypes Can give to ESRD and cirrhotics Avoid statins

European child with bone fractures and hepatomegaly

Gouchers (lipid layden bx) Glucocerebrosidase deficiency HCC and blood malignancy risk Tx: eliglustat