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Uworld Shelf Questions DF > IM: GI > Flashcards

IM: GI Flashcards

1
Q

pt with cirrhosis and ascites accompanied by FEVER and LETHARGY which is concerning for what

dx how

A

SBP and hepatic encephalopathy

dx with paracentesis and neutro;hil count over 250

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2
Q

most common organisms with SBP and treatment and what would be for ppx

A

e coli and klebsiella most common then strep

3rd gen ceph to treat

fluoroquin for SBP ppx

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3
Q

SAAG of ____ or more is SBP

A

1.1

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4
Q

ascites fluid characteristics: total protein 2.5 or more

A

CHF, constritive pericarditis, budd chiari, fungal

under 2.5 is cirrhosis, nephrotic syndrome

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5
Q

SAAG of 1.1 or more indicates what

A

portal HTN

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6
Q

asictes can be due to what

A

portal HTN causes: cardiac ascites, cirrhosis

non portal HTN: malignancy, pancreattisis, nephrotic syndrome TB

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7
Q

SAAG calculated how

A

subtract the peritoneal fluid albumin from serum albumin

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8
Q

major risk factors for pancreatic cancer
hereditary

environmental

A

hereditary: fam history of cancer
hered pancreatitis
BRCA1,2 or peutz heghers

envir: smoking

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9
Q

elevated alkaline phosphatase out of proportion to the transaminases suggests what disease

A

intrahepatic cholestasis or biliary obstruction

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10
Q

how do you confirm PSC

A

endoscopic retrograde or magnetic resonance cholangiopancreatography

multifocal narrowing with intrahepatic and extrahepatic duct dilation

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11
Q

peptic ulcer disease refers to ulerations where

A

stomach or duodenum from h pylori or NSAIDs

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12
Q

melana occurs in what GI bleeds

A

proximal to ligament of treitz

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13
Q

niacin deficiency in devloping countries and in devloped

A

developing: pops taht subsist primarly on corn products
developed: pts with alcoholism or chronic ilness

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14
Q

abdominal pain, vomiting, diarrhea, with neuo sx that are episodic sx

A

AIP

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15
Q

etiology of colovesical fistula

A

diverticular disease (sigmoid most common)
crohns
malignancy

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16
Q

dx of colovesical fistula

A

abdominal CT with oral or rectal contrast (not IV)

colonscopy

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17
Q

treatment for giardia lamblia

A

metronidazole

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18
Q

diagnosing giardia

A

stool antigen assay or microsopy for oocysts and trophozoites

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19
Q

steps in variceal hemorrhage

A

1) 2 large bore IV caths
2) IV octreotide and abx
3) EGD therapy
- if stops bleed = done, do px with Block and band ligation 1-2 weeks later
- if bleed continues balloon tamponade
- if early rebleed then repeat endoscopy therapy

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20
Q

if variceal hemorrhage will not stop what is last effort

A

TIPS or shunt surgery

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21
Q

packed red blood cells can replenish what

A

hemoglobin, only need when under or at 7

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22
Q

platelet transfusions are generally reserved for what pts

A

with active bleed and platelet count under 50k

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23
Q

treatment for nonalcoholic fatty liver disease

A

diet and exercise

consider bariatric surgery if BMI is 35 or more

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24
Q

AST and ALT in NAFLD

A

mildly elevated, ratio near 1 or less

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25
Q

US finding in NAFLD

A

hyperchoic texture on US

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26
Q

antinuclear antibody titers are senstivie marker for what hepatitis

A

autoimmune

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27
Q

methylmalonic acid level is elevated in B12 or folate deficiency?

A

just B12

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28
Q

treatment for duodenal ulcer

A

PPI and antibiotic

amoxicillin plus clarithromycin

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29
Q

treatment for PBC

A

ursodeoxycholic acid

liver transplant for advanced disease

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30
Q

complications of PBC

A

malabsorption, fat soluble vitamin deficiencies
osteoporosis, osteomalacia
hepatocellular carcinoma

sever hyperlipidemia which may manifest with xanthelasmas

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31
Q

bile salt diarrhea occurs in what pts

A

with terminal ileal disease, bc impaired bile absorption in ileum leads to increase in coon = diarrhea

also can occur from insufficient bile salt absroption by TI immediately postop period after cholecystectomy, resolves in weeks to months

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32
Q

restrictive cardiomyopathy and liver cirrhosis may be seen in pts with what

A

hemochromatosis due to excess iron deposition

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33
Q

autoimmune destruction of intrahepatic bile ducts

how about intra and extrahepatic

A

intra = pbc

extra and intra = PSC

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34
Q

chronic liver disease and tsh and t3 and t4

A

liver usually makes Thyroxine binding globulin and transthyretin, albumin too

decreased in disease = lower T3 and T4 in circulation but free T3 and T4 unchanged so TSH normal

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35
Q

AI can cause fatigue weakness anorexia and weight loss and hypogonadism in what

A

women

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36
Q

other causes of acute pancreatitis besides alcohol and gallstones

A

hyperTGemia (3rd most common)

meds like azathioprine, valp acid, thiazide diuretics

CMV
ERCP

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37
Q

lab finding in biliary pancreatitis and how to evaluate

A

ALT over 150

ERCP

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38
Q

chronic pancreatitis etiology

A

alcohol use
CF (children mainly)
ductal obstruction (malignancy and stones)
autoimmune

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39
Q

causes of chronic pancreatitis

cx features

image

tx

A

alcohol
CF in children
obstruction
autoimmune

cx: malabsorption, diarrhea, weight loss, DM, pain intervals in epigastric region that is releived with leaning FORWARD or sitting up
(think endocrine and exocrine issues)

image: calcification, dilated pancreas and ducts
tx: pain managment, stop smoke and drink, panc enzymes

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40
Q

can kristie get IDA

A

yes, she has celiacs

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41
Q

how do you diagnose chronic pancreatitis

A

CT scan abdomen showing calcifications

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42
Q

amylase and lipase in Chronic panc

A

not that elevated

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43
Q

acute erosive gastropathy can be caused from what

A

aspirin, cocaine and alcohol

vomiting on first episode

mallory weis would not present on first vomit

44
Q

hollow organ contraction and outlet obstruction describes what

A

biliary colic secondary to gallstones

45
Q

where does pain from pancreatitis radiate

A

back

46
Q

chronic GERD with new dysphagia and symmetric lower esophageal narrowing suggests what

asymmetric is more likely what

A

esophageal stricture

asym = adenocarinoma, takes around 20 yrs of barrets esophagus

47
Q

symmetric circumferential narrowing on barium swallow

A

stricture

48
Q

if have barrets esophagus and think it is a stricture still must do what

A

get a biopsy to rule out adenocarcinoma

do with endocsopy

49
Q

dysphagia to both solids and liquids and regurgitaitno of undigested food or saliva

dilation of proximal esophagus and narrow GE junction

A

achalasia

50
Q

treatment for hepatic encephalopathy

A

lactulose and rifaximin

51
Q

population that gets lactose intolerance the most

age and race

A

20-40

blacks, latin americans, asians, eubanks people

52
Q

where is lactose processed into glucose and galactase

A

brush border of duodenum

53
Q

treatment for toxic megacolon

A

IVF, broad spectrum antibiotics and bowel rest

IV corticosteroids for IBD induced toxic megacolon

54
Q

autoimmune hepatitis is characterized by what

A

elevated liver transaminases and postive ANA titer

55
Q

drug of choice for PBC

A

ursodeozycholic acid

56
Q

pharmacologic agents that can cause acute hepatitis

A

isoniazid, chlorpromazine, halothane, and antiretroviral therapy

57
Q

pt presents with septic shock and developed AST and ALT elevations one day later

A

ischemic hepatic injury or shock liver

58
Q

rapid massive increase in transaminases with modest accompanying elevations in total bilirubin and alk phosphatase

A

ischemic hepatic injury or shock liver

59
Q

nontender but palpable gallbladder at the right costal margin in a jaundiced pt is classic for what

A

courvoisier’s sign in pancreatic cancer

60
Q

diagnosing pancreatic cancer

A

US (often non diagnostic)
CT scan next

ERCP after first 2

61
Q

diagnosing boerhaave syndrome

A

CXR or CT scan shows wide mediastinum, pneumomediaastinum

CT scan shows esophageal wall thickening

water soluble contrast esophagogram shows leak at perforation site

62
Q

treatment for boerhaave

A

NPO, IV abx, PPI, nutrition

surgical drain and debridement of infected necrotic areas

63
Q

a perforated duodednal ulcer would cause what

A

epigastric pain with free air visualized under the diaphragm on KUB

64
Q

risk factors for acquiring C diff colitis

A

recent ABX
hospitalization
PPJ

65
Q

what is a consequence of you BMs with pelivc splanchnic nerve damage

A

constipation

66
Q

D-xylose test tests what

A

proximal small intestinal absorption

67
Q

if d xylose test shows decreased urine output of d xylose then what does this mean

A

it means that less was absorbed so most was lost in feces = malabsoprtion of SI

proximal small intest mucosal disease like celiacs

68
Q

d xylose test in pts with malabsorption due to enzyme deficiency like chronic pancreatitis

A

normal

69
Q

d xylose test in pt with crohns

A

normal bc terminal ileum absorption disrupted in crohns and d xylose absorbed proximal SI

70
Q

what mineral deficiency

brittle hair, skin depigmentation, neuro dysfunction, sideroblastic anemia, osteoperosis

A

copper

71
Q

what trace mineral deficiency: thyroid dysfunction, cardiomyopathy, immune dysfunction

A

selenium

72
Q

what trace mineral deficiency:

alopecia, pustular skin rash (mouth and extremities)
hypogonads
impaired wound healing
impaired taste
immune dysfunction
A

zinc

73
Q

zinc deficiency can be due to what disease

A

crohns and celiac or bowel resection

74
Q

patients dependent on what are at risk for trace mineral deficiency

A

TPN

75
Q

most common causes of cirrhosis in US is what

A

viral hep
chronic alcoholism
NAFLD
hemochromatosis

76
Q

cancers in the head of the pancreas present how

detect cancer how

A

jaundice (CBD obstruction) elevated alk phase and billy and steatorrhea

US to detect cancer and exclude other potential cuases of billy obstruction

77
Q

cancers in the body and tail of pancreas present how

detect how

A

no obstructive jaundice and usually painless

Abdominal CT scan

78
Q

ERCP in cancer use

A

reserved for pts with cholestasis who may require intervention like stenting

79
Q

what pathogen plays fole in MALToma

A

h pylori from chronic inflammation

B and T cells go to gastric lamina

80
Q

dx and treatment of MALToma

A

test for h pylori

h pylori eradication (quad therpay)
usually achieve complete remission

81
Q

colon cancer screening

flex sigmoid Q what

flex sig + FOBT q what

colonscopy Q what

A

FS= 5

FS and FOBT = 3

colonoscopy = 10

82
Q

diagnosing zenkers diverticulum

treating

A

contrast esophagram

surgery

83
Q

elderly man with dysphagia, regurgitation, fould smeling breath, aspiration and occasionally a palpable mass

A

zenkers diverticulum

84
Q

when should a proctocolectomy be done in a pt with FAP

when can it be delayed?

A

when pt initially presents with CRC or adenomas with high grade dysplasia

or pts with hemorrhage from neoplasia or significant increase in polyp number during screening interval

if not classic findings then surgery can be delayed until 20s

85
Q

standard of care for FAP

A

sigmoidoscopies for kids starting at 10-12 followed by annual colonscopies once colorectal adenoma detected

86
Q

PBC has intrahepatic or extrahepatic cholestasis on US?

A

intra

87
Q

xanthelasma with what autoimmune disease

A

PBC

88
Q

what other disease often occurs with PBC

A

autoimmune thyroid disease

89
Q

autoimmune hepatitis antibodies

and treatment

A

antinuclear antibodies

anti-SM antibodies

anti SMA and anti NA

AH SMAsh, NA

treat with glucocorticoids

90
Q

diagnosing esophageal perforation

A

CXR or CT scan: wide mediastinum, pneumomediastinum, pneumothorax, plueral effusion (late)

water soluble contrast esophagogram

91
Q

managing esophageal perforation

A

abx and supportaive care

surgiery if leakeage with systemic inflamm response

92
Q

salivary amylase in the pleural fluid

A

esophageal perforation

93
Q

elderly pt with IDA and negative FOBT what next

A

still do colonscopy and endoscopy

94
Q

what heart thing is associated with GI angiodysplasia

A

severe aortic stenosis causing occult GI bleed

95
Q

spontaneous pain, odynophagia for cold and hot food is what

regurgitation, and or chest pain precipitated by emothional stress too

what relieves

A

diffuse esophageal spasm

nitroglycerin and CC

96
Q

what is the diagnostic step for esophageal spasm

and what would it show

A

esophageal manometry

shows repetitive non peristaltic high amp contractions

97
Q

what to order in pt with IDA suspected

how to confirm

A

blood counts, iron study, fecal occult blood test

upper and lower GI endoscopy to confirm

98
Q

pleural fluid analysis: exudative, low pH and very high amylase

A

esophageal perforation (borhavee)

99
Q

treatment for boerhaave syndrome

A

surgery for thoracic perforations

conservative measure (ABX) for cervical perforations

100
Q

AR mutation of ATP7B

A

wilsons disease

101
Q

treatment for wilsons diseaes

A

chelators like D-penicillamine, trientine
zinc

liver transplant cures

102
Q

ceruloplasmin in wilsons

A

low

103
Q

postcholecystetcomy syndrome

A

biliary cause (retained CBD or cystic duct stone, billy dyskinesia)

extra-biliary (pancreatitis, PUD, CAD)

same pain prior to surgery still there

104
Q

tumors in FAP

A

CRC
desmoids and osteomas
brain tumors

Dez Brain FAPs

105
Q

VhL syndrome tumors

A

hemangioblastomas
clear cell renal carcinoma
pheochromocytoma

HPC

Uworld Shelf Questions DF (8 decks)

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