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Midterm - random Qs Flashcards

1
Q

What mechanical dysphasia is usually asymptomatic unless circumferential. And if they are circumferential they cause intermittent dysphasia to solids

A

Webs

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2
Q

What is Plummer-Vinson syndrome?

A

Proximal esophageal webs PLUS iron-def anemia

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3
Q

What is the diverticulum called that is located in hypopharyngeal region?

A

Zenker’s diverticulum

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4
Q

Triad of Zenker’s diverticulum sx

A

Dysphagia
Halitosis
Aspiration

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5
Q

GERD Pathophysiology

A

Inappropriate LES relaxation

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6
Q

Things that make you higher risk for GERD

A 
Abdominal obesity
Pregnancy
Gastric distinction (over-indulgence)
Delayed gastric emptying e.g. diabetes
Smoking
Hiatal hernia
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7
Q

GERD #1 and #2 Sx

A

Heartburn
Acid regurgitation

And these Sx are good enough for initial Dx and treatment. If there are alarm Sx as well, then need to do more.

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8
Q

Globus hystericus is what?

A

AKA globus sensation

Perfection of lump or fullness in throat (but there is nothing)

Often occurs in setting of anxiety or obsessive-compulsive disorders but can be due to GERD as well

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9
Q

DDX duodenal ulcers vs gastric ulcers (age, acid levels)

A

Gastric: OLDER >60 yo with normal-to-low acid levels. P worse with eating.

Duodenal: YOUNGER 30-55 yo with normal-to-high acid levels. P relieved by eating.

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10
Q

Common risk factors PUD (peptic ulcer disease)?

A

H.pylori and NSAIDS

Also: smoking tobacco, chronic alcohol use, COPD, CAD, CKD

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11
Q

Is Tylenol (acetaminophen) a risk factor for PUD?

A

No. It’s not an NSAID

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12
Q

Most common PUD complication

A

Bleeding. Hematemesis or melena

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13
Q

What is Zollinger-Ellison Syndrome?

A

PUD due to endocrine tumor that produces too much gastrin which causes gastric acid hypersecretion

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14
Q

chronic alcohol abuse labs?

A

2:1 AST:ALT (Scotch before Lunch)

Macrocytic anemia MCV >91 um^3

GGT > 35 U

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15
Q

Etiology of hepatocellular liver disease

A 
NAFLD
Alcoholic hepatitis
Viral hepatitis
AI disease
Dru-induced
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16
Q

Etiologies of obstructive liver disease

A

Gallstone disorders
Sclerosis get cholangitis
Pancreatitis
Pancreatic cancer

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17
Q

Liver specific signs of liver disease

A

Jaundice, dark ruin, light/clay-colored stool, pruritis

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18
Q

What are 3 ways to get jaundice?

A

Intrahepatic cholestasis
Post-hepatic cholestasis
Non-hepatic jaundice either Gilbert’s syndrome or hemolytic jaundice due to disorders of RBC breakdown

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19
Q

When do spider angiomata cause concern for liver disease?

A

When they are in the arms, face, upper torso.

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20
Q

Excoriations

A

Chronic scratching due to pruritis

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21
Q

More advanced liver disease signs:

A 
Mm wasting
Weight loss
Ascities
Edema
Caput Medusa
Bruising
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22
Q

Overt hepatic failure

A

Hepatic encephalopathy

Asterixis (hand tremor when wrist extended)

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23
Q

1 cause of acute liver failure

A

Drugs

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24
Q

1 drug that causes acute liver failure

A

Acetaminophen (APAP)

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25
Q

What is max safe total daily dose of Acetaminophen (APAP) for adults

Max safe SINGLE dose for adults?

A

Daily dose: 4000 mg

Single dose: 1000 mg

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26
Q

What 2 elevated labs suggest obstructive liver disease?

A

Alkaline phosphatase and GGT (gamma-glutamyl transferase)

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27
Q

Risk factors for nonalcoholic fatty liver disease

A

Overweight/obese BMI >25

Insulin resistance/diabetes A1C >5.7

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28
Q

What is NASH

A

Non-Alcoholic SteatoHeptatits

2nd stage of NAFLD

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29
Q

How do you Dx NAFLD?

A

1 - increase liver fat >5%
2 - absence of unhealthy alcohol consumption
3 - exclude other possible causes of liver fat accumulation

30
Q

NAFLD-related cirrhosis is 3-4X [more/less] common than cirrhosis caused by hep C

A

MORE

31
Q

Dyspepsia vs gastritis

A

Dyspepsia describes upper GI sx

Gastritis is inflammatory pathology of gastric mucosa

32
Q

What patient pop is likely to get gastroparesis?

A

Poorly controlled diabetes melitus due to autonomic neuropathy

Could also be caused by meds.

33
Q

The sx of gastroparesis are the sx of dyspepsia. So how do you diagnose gastroparesis?

A

EGD to r/o other causes

Confirm with radionuclide gastric emptying study

34
Q

Risk factors for gallstones

A

Obesity
Sudden weight loss
Oral contraceptive use and estrogen
Pregnancy

35
Q

What is biliary colic and how many pts get it?

A

1/3 get these sx:

  • abrupt onset
  • steady ache/fullness
  • severe pain: may radiate to right scap/shoulder
  • precipitated by eating fatty food
  • subsides w/in few hours

NO FEVER

36
Q

Timeline for acute cholecystitis

A

Biliary colic >5 hours and progressively getting worse

37
Q

Timeline for cholelithiasis

A

Biliary colic <2 hours

38
Q

What is ERCP?

A

Endoscopic retrograde cholangio-pancreatography

Combines fluoroscopic imaging and endoscopy. It can remove obstructing stones in the CBD

39
Q

Complications of choledocholithiasis if you don’t get stones out in time:

A

Cholangitis

Acute gallstone pancreatitis

40
Q

What is cholangitis?

A

Inflammation of bile duct (acute or chronic)

41
Q

Acute cholangitis

A

Ascending cholangitis

Charcot’s triad

42
Q

What is Charcot’s triad and what disease is it associated with?

A

Biliary pain
Jaundice
Spiking fever = leukocytosis

Acute cholangitis

43
Q

If dx of acute cholangitis is missed, what can happen?

A

Infection can continue and cause systemic toxicity aka Reynold’s Pentad:

1-3: Charcot’s Triad

  1. Hypotension
  2. Altered mental status (shock)
44
Q

Define cholelithiasis

A

Stones in gallbladder

45
Q

Define cholecysitis

A

Inflammation of gallbladder

46
Q

Define choledocholithiasis

A

Stones in CBD

47
Q

Define cholangitis

A

Inflammation of bile ducts ascending into liver

48
Q

Define cholecystectomy

A

Surgical removal of gallbladder

49
Q

Define calculous

A

Related to presence of gallstones

50
Q

Define acalculous

A

Absence of gallstones

51
Q

Define ERCP

A

Endoscopic retrograde cholangiopancreatography

52
Q

Define MRCP

A

Magnetic resonance cholangiopancreatography

53
Q

How are hepatitis viruses transmitted?

A 
A: Fecal-oral, contaminated food
B: blood, sex
C: blood-IV drug use
D: dependent on B
E:
54
Q

Which hepatitis virus does NOT carry the risk of becoming chronic infection

A

A

55
Q

Likelihood of chronic infection with HBV is grated in which age group?

A

Younger

Only 2-10% of people who contract HBV older than 35 yo develop chronic disease

56
Q

Complications of HBV

A

Progression to cirrhosis

Increased risk of hepatocellular carcinoma

57
Q

Which kind of viral hepatitis has NO immunizations?

A

HCV

58
Q

Patients for which kind of chronic hep need regular screening for hepatocellular carcinoma?

A

B and C

Every 6-12 months

59
Q

1 cause of acute pancreatitis

A 
#1 Gallstones
#2 Alcohol abuse
60
Q

Dx acute pancreatitis?

A

Refer to ED for blood work and imaging

Labs: lipase, amylase
Imaging: Abdominal CT scan

61
Q

What are the lab findings that confirm pancreatitis?

A

3x normal serum lipase and amylase

62
Q

Cullen’s sign

A

Bruising around belly button area

63
Q

Grey Turner’s sign

A

Bruising around flank area

64
Q

Classic presentation of acute pancreatitis?

A

Sudden, severe P epigastric region of abdomen that radiates to back

Steady P, “boring” quality

65
Q

Most common abdomen finding for pancreatitis?

A

Upper abdominal tenderness

Often WITHOUT guarding, rigidity or rebound tenderness because pancreas is retroperitoneal (cushioned)

66
Q

Is acute pancreatitis reversible or irreversible?

A

Reversible

Chronic is irreversible

67
Q

1 cause of chronic pancreatitis?

A

Alcohol abuse

Strong association with smoking

68
Q

Steatorrhea is seen in what disease?

A

Chronic pancreatitis

69
Q

Are amylase and lipase levels elevated with chronic pancreatitis?

A

Usually NOT strikingly elevated

70
Q

Tx chronic pancreatitis

A

1 - pancreatic enzymes
2 - control pain with Tylenol and NSAIDs
3 - avoid exacerbating factors: alcohol, tobacco, eat smaller meals
4 - monitor/treat blood sugar levels if elevated

71
Q

Cachexia

A

Wasting syndrome

GI (11 decks)

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