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MKSAP Flashcards

1
Q

PBC specific antibodies (name 3)

A
  1. Anti mitochondrial
  2. Anti-sp100
  3. Anti- gp210
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2
Q

Rx for PBC

A

Ursodeoxyxholic acid —> improved histology and survival

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3
Q

AI disease associated with PBC requiring annual checks

A

Thyroid stimulating antibodies

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4
Q

Rx of acute Hep A

A

Supportive care

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5
Q

Hep A route of transmission

A

Feco- oral

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6
Q

Hep A post exposure prophylaxis in:
1. Age <40 years
2. Age >40 years, immunocompromised, or CLD

A
  1. HAV vaccine within 2 weeks
  2. Vaccine + HAV immunoglobulin
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7
Q

Duration of fluid administration in acute pancreatitis

A

12-24 hours

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8
Q

Indications for ERCP in acute pancreatitis

A

Persistent transaminitis showing ongoing biliary obstruction

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9
Q

Most conning pancreatic NET associated with MEN

A

Gastrinoma —> insulinoma

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10
Q

What is the first step in evaluating constipation

A

Alarm features of colon cancer:
1. Age >50
2. Acute change in bowel habits
3. Weight loss
4. Family h/o colorectal CA
5. Unexplained anemia

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11
Q

What are the three types of constipation based on transit time

A
  1. Normal transit
  2. Slow transit
  3. Dysnergetic
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12
Q

First exam to be performed for constipation

A

DRE

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13
Q

Three conditions associated with PSC and how to screen them

A
  1. IBD —> colonoscopy at the time of diagnosis and every 1-2 years
  2. Cholangiocarcinoma —> CEA 19-9 and MRCP every 1-2 years
  3. GB carcinoma —> annual ultrasound
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14
Q

6 indications for Barrett esophagus screening

A
  1. GERD >5 years
  2. Age >50 years
  3. Male sex
  4. Obese
  5. Tobacco use
  6. Family h/o Barrett esophagus or esophageal CA
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15
Q

What is the duration of PPI trial for GERD

A

8 weeks

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16
Q

Partial response to PPI at 8 weeks. Next step?

A

Twice daily dosing

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17
Q

Alarm symptoms in GERD

A
  1. Weight loss
  2. Hematemesis/ malena
  3. Dysphagia
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18
Q

Blood tests that suggest hereditary hemochromatosis

A
  1. High serum ferretin
  2. High transferrin saturation >45%
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19
Q

Confirmatory test for verification hemochromatosis

A

Genetic testing for HFE gene mutation

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20
Q

Frequency of abdominal pain for IBS diagnosis

A

1 day/week x 3 months

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21
Q

Diagnostic test for microscopic colitis

A

Right and left colonoscopy with biopsy

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22
Q

Identifying source of GI bleed in HD unstable patient. Most sensitive test that detects minimal bleeding?

A

CTA even better than conventional angiography

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23
Q

When should colonoscopy be performed for evaluation of Lowe GI bleed?

A

If the patients is HD stable. Otherwise do CTA

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24
Q

First test of choice for evaluation of lower GIB

A

CTA

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25
Q

First test of choice for evaluation of upper GI bleed

A

EGD

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26
Q

4 causes of upper GIB in patients with corrhosis and what is the treatment approach for each

A
  1. Esophageal varices —> banding and ligation
  2. Gastric varices —> CTA first to identify anatomy; spleenectomy, TIPS, or retrograde ballon occlusion
  3. Portal HTN gastropathy —> portal HTN management
  4. Prominent vascular ectasias —> APC
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27
Q

Age of colonoscopy for FAP

A

10

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28
Q

What are the annual screenings that FAP patients undergo? Mnemonic

A

T - Thyroid Us every year for papillary thyroid CA
U
C - colonoscopy every year
E - EGD at age 25 with Bx of gastric fundic polyps
D - duodenoscopy

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29
Q

Does treatment of Hep C eliminate the risk of HCC

A

No and screening with abdominal US should be performed every 6 months

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30
Q

Specific IBD pattern associated with PSC

A

Rectal soaring, mid colitis, and backwash ilitis

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31
Q

Malignancy highly associated with PSC requiring yearly surveillance

A

Cholangiocarcinoma requiring yearly CA 19-9 and MRCP

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32
Q

Frequency of Pap smear in patients with IBD receiving immunosuppressive meds

A

Annually

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33
Q

Malignancies seen in patients with IBD M. Mnemonic

A

C - colorectal
C - cervical
s - skin

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34
Q

Diagnostic criteria for eosinophilia esophagitis

A
  1. Dysphagia - can be intermittent due to presence of rings, furrows, strictures
  2. Biopsy with >15 eosinophils/hpf without other apparent cause - no GERD, vial or fungal infection
  3. Exclusion of other causes including HES
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35
Q

Treatment of eosinophilia esophagitis

A

PPI + swallowed budesonide/fluticasone

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36
Q

What is narcotic bowel syndrome

A

Centrally mediated GI hyperalgesia of the guy characterized by worsening abdominal pain with incremental doses of opiates

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37
Q

What is Centrally mediated abdominal pain syndrome (CAPS). What are the typical presenting symptoms

A

Generalized constant/near constant/ frequently recurring abdominal pain which is not associated with food intake or bowel movements.

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38
Q

Typical presenting feature of acute mesenteric ischemia

A

Acute onset peri umbilical pain with sudden urge to defecate

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39
Q

Medication associated with microscopic colitis

A

NSAID

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40
Q

Medications associated with microscopic colitis

A

NSAID
SSRI
PPI

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41
Q

Score used to determine NAFLD severity and associated management

A

Fibrosis score calculator or FIB-4

  1. Low risk —> weight loss and lifestyle
  2. Indeterminate —> elastography for liver stiffness score
  3. High risk —> hepatology and fibrous can
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42
Q

Which antibodies even thought clinically irrelevant are elevated in NAFLD

A
  1. Anti-smooth muscle
  2. ANA
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43
Q

Is NAFLD same as NASH?

A

No

44
Q

Which two meds should be administered for SBP? One that we always give and the other which is always forgotten

A

Their gen cephalosporin and albumin

45
Q

First step in evaluation of chronic diarrhea

A

Stool osmotic gap

46
Q

Formula for stool osmotic gap

A

290- 2 x (stool Na + stool K)

47
Q

Stool osmolarity gap suggesting osmotic diarrhea

A

> 100

48
Q

Diet for osmotic diarrhea

A

FODMAP

49
Q

How to differentiate hepatic adenoma from hyperplasia

A

MRI with sodium contrast —> excreted in bile and therefore not seen with hepatic adenoma

50
Q

Electrolyte derangements and vitamin Vedic I envy associated with PPI use

A
  1. Electrolytes - hypo Mg, Ca, K
  2. Vitamin B12
51
Q

Which other bowel conditions are associated with celiac disease

A

IBS, microscopic colitis, SIBO, HIV

52
Q

3 indications for Hep B treatment

A
  1. Acute liver failure
  2. Immune active phase
  3. Reactivation
53
Q

Antivirals for Hep B

A

Entecavir and Tenofovir

54
Q

Drug of choice to induce and maintain remission in UC

A

Mesalamime or 5-ASA

55
Q

Preferred route for 5-ASA delivery in IBD

A

Topical through suppository or enema as almost all of the drugs is absorbed in jejunum and only 20% is deliver to colon when administered orally

56
Q

Which is better - confined oral and topical ASA or either of them alone?

A

Combined

57
Q

I’m addition to PPI, this medication has been shown to improve chest pain symptoms in SS associated reflux disease

A

Low dose antidepressant- amitriptyline or trazodone

58
Q

Differentials for granulomatous lesions in the liver

A
  1. NHL
  2. Drug toxicity
  3. TB
  4. Fungal
  5. Brucellosis
  6. Q fever
59
Q

The only sarcoidosis that is not treated

A

Hepatic sarcoidosis

60
Q

NSAID is required but patient had GI bleed before NSAID

A

COX-2 selective NSAID + PPI

61
Q

How do you differentiate cardiac from cirrhotic ascites since both have SAAG >1.1

A

Bg total protein level of ascitic fluid
1. Cirrhotic: <2.5
2. Cardiac: >2.5

62
Q

Most common drugs associated with DILI with chole static pattern

A

Amoxicillin- clavulinic acid
Valproic acid
Phenytoin

63
Q

Should you treat HCV in a patient with depcmpensated cirrhosis

A

No it worsens decompensation

64
Q

What are the indications of liver transplant referral?

A
  1. MELD Na>15
  2. Decompensated cirrhosis
65
Q

Three constitutions associated with porphyria cutanea yards

A
  1. Hep C (most common)
  2. Alcoholic liver disease
  3. Hemochromatosis
66
Q

Rx of porphyria cutanea tarda

A
  1. Avoid Sun
  2. HCQ
  3. Phlebotomy for iron overload
67
Q

Rx of severe IC not responding to 5-ASA

A

Infliximab/Golimumab + Azathioprine

68
Q

Recombinant factor Xa

A

Andexanet

69
Q

6 differentials for steatorrhea

A
  1. Pancreatitis
  2. SIBO
  3. Giardiasis
  4. Whipples
  5. Celiac
  6. Tropical spruce
70
Q

Diagnostic test for SIBO (usually performed)

A

Hydrogen breath test

71
Q

Gold standard for SIBO diagnosis

A

Small bowel aspirate culture

72
Q

2 scores used to determine mortality in upper GI bleed

A
  1. Glasgow-Blatchford
  2. Rockall scores
73
Q

How to der mine need for hospital observation bs discharge in patients with bleeding ulcers

A

Type of ulcer and risk of rebleeding:
1. Low risk: no endoscopic intervention performed —> clean base ulcers with pigmented spots and Mallory tears —> discharge
2. High risk: endoscopic intervention performed —> bleeding ulcer, ulcer with visible non bleeding vessel, and ulcer with stuck clots —> observe for 72 hours

74
Q

Duration of octreotide for varices l bleeding

A

3-5 days

75
Q

Duration of antibiotics for cirrhosis and GI bleed

A

7 days regardless of other clinical factors

76
Q

Post endoscopic management of antiplatelets for UGI bleed

A
  1. Aspirin:
    Primary prevention of CVD—> discontinue
    Secondary prevention —> continue
    Start the day hemostasis documented on EGD
  2. PYP 12 inhibitors:
    Start within 5 days of hemostasis
77
Q

Post endoscopic AC management after UGI bleed

A
  1. High risk (mechanical valve, valvular A.fib, recent VTE) —> within 48 hours
  2. Others: within 7 days of hemostasis
78
Q

What are the two types of pancreatic cysts and which one has malignant potential requiring follow up

A
  1. Mucinous —> have malignant potential
  2. Serous —> no malignant potential —> no follow up required
79
Q

What is PJS

A

Hamartomatous Polyposis Syndrome involving the small intestines taht commonly presents as rectal bleed, bowel obstruction, and intrusive Orion

80
Q

Which malignancies are associated with PJS

A
  1. All GI - gastric, small bowel, colorectal
  2. Gonadal - GYN and testicular
  3. Breast
  4. Pancreatic
81
Q

What are the two types of gastric polyps and what is the French of repeat EGD

A
  1. Fundic polyps with no dysplasia -> most common; benign; no follow up EGD. Should be biopsied.
  2. Antral or dysplastic —> repeat EGD in 6-12 months depending on degree of dysplasia. Should be fully resected.
82
Q

Should outline surveillance EGD be performed for gastric ulcers to document healing? What are the only indications for repeat EGD

A
  1. No
  2. Indications:
    a. Suspicion for malignancy
    b. No responses after 8 weeks of PPI
83
Q

Is routine surveillance EGD indicated for gastric CA screening? What are the indications?

A

No. The indications are based on risk factors: history of gastric intestinal metaplasia, ethnicity (first or second gen from high incidence area), and first degree relative with gastric CA

84
Q

Rx if functional dyspepsia

A

TCA

85
Q

Timeline for development of travelers diarrhea

A

2 weeks

86
Q

Rx of travelers diarrhea

A

Oral hydration + antibiotic (for moderate and severe disease) azuthromycin or FQs + loperamide

87
Q

Rx of persistent H pylori (drugs and duration)

A

Drugs: 4 drug regimen of BOTM (bismuth, omeprazole, tetracycline, and metronidazole)
Duration: 14 days rather than the initial 10 days

88
Q

Initial treatment of H pylori

A

3 drug regimen with CAO (clarithromycin, omeprazole, and amoxicillin) x 10 days

89
Q

Rx of HSV esophagitis

A

Acyclovir

90
Q

Rx of CMV esophagitis

A

Ganciclovir

91
Q

Rx if candidal esophagitis

A

Fluconazole

92
Q

Rx of dermatitis herpetiformis

A

Dapsone —> check G6PD before

93
Q

Common meds causing pill induced esophagitis

A

KCL, Iron, NSAID, doxycycline, and bisphosphonates

94
Q

Is EGD indicated in pill induced esophagitis? If so when?

A

Not routinely. Only for persistent symptoms.

95
Q

What is the typical presentation of pill induced esophagitis

A

Dysphagia several hours to days after ingestion of offending pill

96
Q

What is the EGD finding in eosinophilia esophagitis

A

Rings, furrows, and strictures

97
Q

Dysphagia and odonophagia in candidal be viral esophagitis

A

Candida: more dysphagia
Viral: odynoohagia

98
Q

Peripheral eosinophils in eosinophilia esophagitis

A

Absent

99
Q

Achlasia is a —— motility disorder

A

Hypertonic

100
Q

Features distinguishing achlasia from psuedoachlasia

A

Age > 55 with duration <1 year and associated weight loss

101
Q

Medical therapy for achlasia not fit for surgery

A

CCB and nitrates

102
Q

Rome 4 criteria for functional dyspepsia

A

One of four:
1. PP fullness
2. Easily satiety
3. Epigastric pain
4. Epigastric burning

In the absence of a structural, organic, or metabolic cause.

Duration: symptom onset 6 months before diagnosis with at-least 3 months of symptoms

103
Q

Routine EGD for dyspepsia after age __

A

60

104
Q

ACG recs for evaluation of dyspepsia

A
  1. Age >60 : EGD
  2. Age <60 with multiple alarm features, high risk descent, family history of malignancy: EGD
  3. Age < 60 with few or no alarm features: H. Pylori testing and PPI trail
105
Q

4 indications for H. Pylori testing

A
  1. Active PUD
  2. History of PUD without documented cure for H. Pylori
  3. MALToma
  4. Gastric carcinoma
106
Q

Three types of gastric polyps and their malignant potential

A
  1. Fundic glad polyps associated with PPI use —> no malignancy
  2. Hyperplasticity : have malignant potential; >0.5 cm to be resected
  3. Adenomas: should be respected and surveyors e EGD 1 yr post resection and then every 3-5 years
107
Q

Lubiprostone, plecanatide, or linaclotide is recommended for patients with refractory irritable bowel syndrome-constipation subtype.

A

GI (1 decks)

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