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UWORLD-STEP2 (BA) > IM- GI > Flashcards

IM- GI Flashcards

1
Q

The 3 risk factors for C-Diff colitis

A
  1. Recent abx
  2. Hospitalization
  3. PPI
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2
Q

The 3 clinical presentations for C-Diff colitis

A
  1. Profuse diarrhea
  2. Fulminant colitis or
  3. Toxic megacolon
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3
Q

How do you diagnosis C-diff?

A

Stool PCR

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4
Q

How do you treat C-diff?

A

Oral vancomycin or fidaxomicin

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5
Q

the presence of “succussion splash” heard on auscultation of the upper abdomen indicates?

A

Gastric outlet obstruction (GOO)

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6
Q

Dysphagia and halitosis

A

Zenker diverticulum

- also regurgitation and aspiration

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7
Q

How to diagnosis Zenker Diverticulum?

A

Barium esophagram

Esophageal manometry

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8
Q

How do you manage Zenker diverticulum?

A

With open/endoscopic Surgery
or
cricopharyngeal myotomy

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9
Q

The 3 risk factors for pancreatic cancer that are hereditary include

A
  • 1st degree relative with pancreatic cancer
  • Hereditary pancreatitis
  • Germline mutations (BRCA 1, BRCA 2, Peutz-Jeghers syndrome)
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10
Q

The 3 risk factors for pancreatic cancer that are enviromental include

A
  1. Cigarette smoking (most significant)
  2. Obesity, low physical activity
  3. Nonhereditary chronic pancreatitis
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11
Q

If U/S suggests intrahepatic cholestatsis, and you suspect PBC (primary biliary cholangitis), what is the next step

A

obtain serum anti-mitochondrial antibody titers, which are highly sensitive to PBC

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12
Q

What are the 3 main causes of steatorrhea and with others that are rare

A
  1. Pancreatic insufficiency
  2. Bile salt-related
  3. Impaired intestinal surface epithelium
  4. others that are rare
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13
Q

Causes of steatorrhea from pancreatic insufficiency (2)

A
  • Chronic pancreatitis (alcohol abuse, cystic fibrosis, or autoimmune/hereditary pancreatitis)
  • Pancreatic cancer
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14
Q

Causes of steatorrhea from bile salt-related problems (5)

A
  • Small-bowel Crohn disease
  • Bacterial overgrowth
  • Primary biliary cirrhosis
  • Primary sclerosis cholangitis
  • Surgical resection of ileum
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15
Q

Causes of steatorrhea from impaired intestinal surface epithelium (3)

A
  • Celiac disease
  • AIDS enteropathy
  • Giardiasis
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16
Q

Causes of steatorrhea from rare conditions (3)

A
  • Whipple disease
  • Zollinger-Ellison syndrome
  • Medication-induced
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17
Q

Hyperestrinism in cirrhosis leads to 5 conditions

A
  • Gynecomastia
  • Testicular atrophy
  • decreased body hair
  • spider angiomas
  • palmar erythema
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18
Q

What is Rome diagnostic criteria?

A

Used to diagnose irritable bowel syndrome (IBS)

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19
Q

What criteria are included in Rome to diagnose IBS

A

Recurrent abdominal pain/discomfort > or = 3 days/month for the past 3 months & > or = 2 of the following

  • Symptom improvement with bowel movement
  • Change in frequency of stool
  • Change in form of stool
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20
Q

The steps in managing bleeding esophageal varies

A
  1. Hemodynamic support (IVF bolus…)
  2. Pharmacologic treatment (octreotide)
  3. endoscopic therapy (band ligation, sclerotherapy)
  4. Prophylactic abx
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21
Q

Upper Endoscopy shows multiple stomach ulcer and thickened gastric folds, suspected Dx?

A

Gastrinoma (Zollinger-Ellison syndrome)

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22
Q

What is your next step after endoscopy for Gastrinoma suspicion?

A

Check serum gastric level after off PPI therapy for 1 week

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23
Q

If gastric level is >1000pg/ml what is your next step?

A

Check gastric pH off PPI therapy for 1 week

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24
Q

if pH is < or = 4 for suspected gastrinoma what is your next step?

A

Further testing to localize gastrinoma

if pH <4 it is not gastrinoma

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25
Q

Serum gastrin level off PPI therapy for 1 week shows 110-1000 pg/ml what is the next step?

A

Secretin stimulation test; if + it is Gastrinoma and do further testing to localize
if - it is not gastrinoma

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26
Q

What are the 3 risk factors for Acalculous cholecystitis?

A
  • Severe trauma or recent surgery
  • Prolonged fasting or TPN
  • Critical illness (sepsis, ICU)
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27
Q

Clinical presentation for Acalculous cholecystitis?

A
  • Fever, leukocytosis, Elevated LFT’s, RUQ pain,

- Jaundice and RUQ mass (less common)

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28
Q

What is the treatment for C-diff with initial episode?

A
  • Vanomycin PO
    or
  • Fidaxomicin
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29
Q

What is the tx for C-diff 1st recurrence?

A

Vancomycin PO in a prolonged pulse/taper course
or
Fidaxomicin if vancomycin was used in initial episode

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30
Q

What is the tx for C-diff multiple recurrence?

A
  • Vancomycin PO followed by rifaximin

- Fecal microbiota transplant

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31
Q

What is the tx for Fulminant C-diff like hypotension/shock, ileum, megacolon?

A
  • Metronidozole IV
    + high-dose vancomycin PO (or per-rectum if ileum is present)
  • Surgical evaluation
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32
Q

Acute liver failure is defined as severe acute liver injury without underlying liver disease and it’s 3 characteristics include

A
  • elevated aminotransferases (often >1000)
  • Hepatic encephalopathy
  • synthetic liver dysfunction (defined as prolonged PT with INR >1.5)
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33
Q

Treatment for Acute liver failure

A

Transplant

Only half of pt with out transplant will survive

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34
Q

Ascites fluid with bloody color cause (3)

A
  • Trauma
  • Malignancy
  • TB (Rare)
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35
Q

Ascites fluid with milky color cause (2)

A
  • Chylous (lymph and emulsified fats/FFA)

- Pancreatic

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36
Q

Ascites fluid with turbid color cause

A

Possible infection

Turbid- cloudy, opaque or thick with suspended matter

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37
Q

Ascites fluid with straw color cause

A

benign causes

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38
Q

Ascites fluid with neutrophils count >250 means

A

Peritonitis (secondary or spontaneous bacterial)

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39
Q

Ascites fluid with total protein <2.5 (low protein ascites), causes (2)

A
  • Cirrhosis

- Nephrotic syndrome

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40
Q

Ascites fluid with total protein > or = 2.5 (high protein ascites)

A
  • CHF
  • Constrictive pericarditis
  • pertoneal carcinomatosis
  • TB
  • Budd-Chiari syndrome
  • Fungal (coccidioidomycosis)
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41
Q

Serum-ascites albumin gradient (SAAG) > or = 1.1 indicates

A

Portal Hypertension (cardiac ascites, cirrhosis, Budd-Chiari syndrome)

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42
Q

Serum-ascites albumin gradient (SAAG) < 1.1 indicates

A

Absence of portal hypertension

TB, Peritonea carcinomatosis, pancreatic ascites, nephrotic syndrome

43
Q

Uncoordinated, simultaneous contractions of esophageal body

A

Diffuse esophageal spasm (DES)

44
Q

Intermittent chest pain, dysphasia for solids and liquids

A

Diffuse esophageal spasm (DES)

45
Q

How do you diagnose Diffuse esophageal spasm

A
  • Manometry

- Esophagram

46
Q

In Diffuse esophageal spasm, what do you see with Manometry

A
  • Intermittent peristalsis

- multiple simultaneous contractions

47
Q

In Diffuse esophageal spasm, what do you see with Esophagram

A

“Corkscrew” pattern

48
Q

Jaundice triggered by fasting or consuming of a fat-free diet, physical exertion, febrile illness, stress or menstruation

A

Gilbert Syndrome

49
Q

The 4 most common causes of cirrhosis in USA are

A
  • Viral hepatitis
  • Chronic alcohol abuse
  • Nonalcoholic fatty liver disease
  • Hemochromatosis
50
Q

What are the treatments for diffuse esophageal spasm?

A
  • CCB or Nitrates or Tricyclics
51
Q

What can happen after several retching and vomiting?

A

Esophagus suptur (Boerhaave syndrome)

52
Q

Treatment for nonalcoholic fatty liver disease

A
  • Diet and exercises

- Consider bariatric surgery if BMI > or = 35

53
Q

Temp >100F, Abd pain/tenderness, AMS, hypotension, hypothermia, paralytic ileum with sever infection is a clinical presentation for

A

Spontaneous bacterial peritonitis

54
Q

Pt infected with H-Pylori can be predisposed to peptic ulcer disease- can present with those symptoms (3)

A
  • Dyspepsia
  • Postparandial fullness
  • Nausea
55
Q

The most common causes of liver metastases are (3)

A
  • GI tract
  • Lung
  • Breast
56
Q

Zollinger-Ellison syndrome 80% is Sporadic and 20% ?

A

MEN1

57
Q

Markedly elevated serum gastrin (>1000pg/ml) in the presence of normal gastric acid (pH<4)

A

Zollinger-Ellison syndrome

58
Q

Work up for Zollinger-Ellison syndrome

A
  • Endoscopy

- CT/MRI & somatostatin receptor scintigraphy for tumor localization

59
Q

Patients with Zollinger-Ellison syndrome have impaired fat absorption because of

A

Pancreatic enzyme inactivation

60
Q

AST 3,720, ALT 3,250 with patient who was hypotensive what is the cause of abnormal liver function panel

A

Ischemic hepatic injury

61
Q

In what area of the esophagus does Mallory-Weiss tears occur?

A

Distal esophagus at the GE junction (Gastroesophageal)

- With multiple episodes of nausea and vomiting

62
Q

The most common cause of exudative pleural effusions that are infectious (4)

A
  • Parapneumoniac
  • TB
  • Fungal
  • Empyema
63
Q

The most common cause of exudative pleural effusions that are non-infectious 2

A

Malignancy & PE

64
Q

Three processes that cause transudate effusions

A
  • Decreased intrapleural
  • decreased plasma oncotic pressure
  • Elevated hydrostatic pressure
65
Q

Three processes that cause exudative effusions

A
  • increased capillary permeability
  • increased pleural membrane permeability
  • Disruptions of lymphatic outflow
66
Q

A complicated parapneumonic effusions will have pH?Glucose? WBC?
Tx should include _____ & ______

A
  • pH <7.1
  • Glucose <60
  • WBC >50,000
  • Tx with antibiotics and drainage
67
Q

The tx for uncomplicated parapneumonic includes

A

Antibiotics (no need to drain)

68
Q

Pt hospitalized for CAP (community acquired PNA) what kind of abx regimen (2)?

A
  • Fluroquinolone (Moxifloxacine) or

- A beta-lactam plus macrolide (Ceftriaxone + azithromycin)

69
Q

The common manifestation of systemic sclerosis? and its presentation

A

Pulmonary artery hypertension

- Dyspnea that leads to R ventricular enlargement and R sided heart failure

70
Q

The common mechanism of pulmonary hypertension in Systemic sclerosis is ____________ leading to increased pulmonary vascular resistance

A

hyperplasia of the intimal smooth muscle layer of the pulmonary arteries

71
Q

The 3 main problems that are ARDS patient lung has are

A
  • Impaired gas exchange
  • decreased lung compliance
  • Pulmonary Arterial pressure
72
Q

What is the impaired gas exchange in ARDS pt due to?

A

Ventilation-Perfusion mismatch

73
Q

What is the decreased lung compliance in ARDS pt due to (2)?

A
  • loss of surfactant &

- Increased elastic recoil of edematous lungs

74
Q

What is the pulmonary arterial pressure in ARDS pt due to (3)?

A
  • Hypoxic vasoconstriction
  • Destruction of lung parenchyma
  • compression of vascular structure from PEEP in mechanically vented pt
75
Q

ACE inhibitors cause chronic nonproductive cough in 5-20% of pt due to? 4

A
  • Increased Kinins
  • Increased Substance P
  • Increased Prostaglandins (causes bronchial irritation)
  • Increased thromboxane (causes bronchoconstriction)
76
Q

Clinical associations for Adenocarcinoma lung (2)

A
  • Clubbing
  • Hypertrophic osteoarthropathy (digital clubbing along with painful joint enlargement, periostosis of long bones, and synovial effusions)
77
Q

Clinical associations for SSC of lung (1)

A

Hypercalcemia

78
Q

Clinical association for SCC of lung (small cell carcinoma) (3)

A
  • Cushing syndrome
  • SIADH
  • Lamber-Eaton syndrome
79
Q

Clinical association for Large cell carcinoma of lung (2)

A
  • Gynecomastia

- Galactorrhea

80
Q

The 3 most common causes of secondary digital clubbing are

A
  • Lung malignancies
  • Cystic fibrosis
  • R to L cardiac shunts
81
Q

Pt with obesity hypoventilation syndrome and obstructive sleep apnea can develop (5)

A
  • Chronic hypoxia
  • Hypercapnia (with compensatory metabolic alkalosis)
  • Secondary erythrocytosis
  • Pulmonary hypertension
  • Cor pulmonale
82
Q

The kidneys way for metabolic alkalosis compensation for hypercapnia is by (2)

A
  • Increased bicarbonate retention and

- Decreased reabsorption of Chloride

83
Q

Waking up at night
feeling tired
chocking sensation

A

Obstructive sleep apnea

84
Q

Acute episodes presents with cough, breathlessness, fever, and malaise,

Chronic exposure causes weight loss, clubbing, and honeycombing of the lung

A

antigen exposure - Hypersensitivity pneumonitis

85
Q

Exudate is inflammation with plural fluid pH of

A

7.3-7.45

86
Q

If pH <7.3 in pleural fluid it is mostly due to (2)

A
  • Bacteria (empyema)

- or decreased hydrogen ion efflux from the pleural space (pleuritis, tumor, pleural fibrosis)

87
Q

Dry cough, malaise for 2 months and bilateral hilar adenopathy

A

Sarcoidosis

88
Q

Chronic multisystem disorder due to noncaseating granulomatous inflammation

A

Sarcoidosis

89
Q

Erthyema nodosum
Hilar adenopathy
Migratory polyarthralgia
fever

A

Lofgren syndrome (Type of acute sarcoidosis)

90
Q

Facial nerve palsy
central diabetes insipidus
hypercalcemia

A

Central nervous system/endocrine manifestation of sarcodosis

91
Q

What will happened with pulmonary flow-volume loop in patient with fixed upper-airway obstruction (eg. laryngeal edema)

A

decreases the airflow rate during inspiration and expiration

92
Q

Scooped-out pattern during exhalation in pulmonary flow-volume loop indicates

A

asthma- due to decreased airflow during the effort-independent phase of exhalation

93
Q
  • Cough with daily mucopurulent sputum production
  • Rhinosinusities, dyspnea, hemoptysis
  • Crackles, wheezing
A

Bronchiectasis

94
Q

What are the testing used to evaluate bronchiectasis (5)

A
  • High resolution (HRCT) scan of the chest (initial diagnosis)
  • Immunoglobulin quantification
  • CF testing
  • Sputum culture (bacteria, fungi and mycobacteria)
  • Pulmonary function testing
95
Q

Upper lung lobe infiltrate is characteristic of bronchiectasis due to CF and the common bacteria is

A

Pseudomonas aeruginosa

96
Q

Childhood history of recurrent infection (meningitis, PNA) that predisposes to bronchiectasis

A

Complement deficiency causes susceptibility to encapsulated bacteria

97
Q

Hx of opportunistic infections (eg Candida, PCP) that predisposes to bronchiectasis

A

Cell-mediated immunity (DiGeorge syndrome, HIV)

98
Q

Splenic dysfunction causing bronchiectasis

A

susceptibility to encapsulated bacteria, Sickle-Cell anemia

99
Q

How is solitary pulmonary nodules defined? (4)

A
  • Rounded opacity
  • < or = 3cm in diameter (greater is mass)
  • Surrounded by pulmonary parenchyma
  • No associated lymph node enlargement
100
Q

7 factors that increases malignancy of a solitary pulmonary nodules

A
  • Large size
  • Advanced age
  • Female sex
  • Active or previous smoking
  • Family or personal hx of lung cancer
  • Upper lobe location
  • Spiculated radiographic appearance
101
Q

What is the size of a solitary pulmonary nodule that require additional management or surveillance?

A

> 0.8cm

102
Q

The 5 causes of middle mediastinal masses on chest x-ray include

A
  • Tracheal tumors
  • Pericardial cysts
  • Lymphoma
  • Lymph node enlargement
  • aortic aneurysms of the arch
103
Q

anterior mediastinum mass on chest x-ray is more likely to be

A

Thymoma

104
Q

the 6 causes of Posterior mediastinum mass on chest x-ray are

A
  • Meningocele (neurogenic tumors)
  • enteric cysts
  • Lymphomas
  • Diaphragmatic hernias
  • esophageal tumors
  • Aortic aneurysms

UWORLD-STEP2 (BA) (19 decks)

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