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MTB STEP 2 (R) > MTB 2 CK - Gastroenterology > Flashcards

MTB 2 CK - Gastroenterology Flashcards

1
Q

What’s the presentation of GERD ? 5 ( Yeah you keep getting this wrong motherfu*ka )

A
  • Substernal Chest Pain without cardiac disease
  • Chronic Cough
  • Belching
  • Metallic or Sour Taste
  • Wheezing Without Reactive airway disease
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2
Q

What is a uncommon cause of GERD ?

A
  • Hyper-Ca2
  • Calcium is a Secondary Messenger for Gastrin
  • Ca increased acid production
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3
Q

Which meds are risk factors GERD ? 5

A
  • Theophylline
  • Diazepam
  • Prochlorperazine
  • Promethazine
  • Estrogen Replacement
    All relax the LES
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4
Q

What’s the best initial test ? Most accurate test ? When is endoscopy indicated ? for GERD ?

A
  • Best initial Test / tx = PPI for 4-6 weeks
  • Most accurate Tx = 24 hour pH monitoring
  • Endoscopy indicated when Sx persists or Alarm Sx :
    Dysphagia
    Odynophagia
    GI bleeding or Anemia
    Weight Loss
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5
Q

What are the Alarm Sx for GERD ?

A 
- Needs immediate Endoscopic Eval 
Dysphagia 
Odynophagia 
GI Bleeding or Anemia 
Weight loss
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6
Q

When is 24 hour pH is indicated for GERD ?

A
  • Asthma begins in a adult with GERD
  • Hoarseness
  • Sleep Apnea is comorbid
  • Med Tx has failed
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7
Q

What’s the Tx for Gerd ?

A
  • Lifestyle Change
  • Medical Tx - PPI
  • Surgical Tx - Nissen Fundoplication when PPI fail
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8
Q

What are the FYI’s of GERD ?

A
  • H. Pylori Doesn’t cause GERD
  • Carafate is always the wrong answer
  • Antacids have only 20% short term relief
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9
Q

What are the findings of schatzki ring ?

A
  • Intermittent dysphagia

- Midesophagel narrowing on barium swallowing

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10
Q

What is contraindicated in a pt with Zenker Diverticulum ?

A
  • NG tube

- Risks perforation

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11
Q

45 y.o. presents to the ED severe crushing chest pain. Troponin is normal. Ekg is normal. Fat b*tch just hit the startbucks drive thru for a cold frap. Pain doesn’t get worse with exertion. Can’t swallow and is drooling . What’s the Dx ? what’s the best test ? most accurate test ? tx ?

A
  • Esophageal Spasm
  • Best test - Barium
  • Most Accurate test - Manometry shows abnormal only at time of spasm difficult to time
  • Tx - CCB
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12
Q

Odynophagia vs Dysphagia ?

A
  • Odynophagia = usually infectious needs a biopsy
  • Dysphagia =
    younger pt = motility problem
    older pt = cancer / stroke
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13
Q

How can you tell Candidal Esophagitis vs CMV or HSV ?

A
  • Candidal can have normal esophagus without ULCERS
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14
Q

Which medications have Pill Esophagitis Reactions ?

A

1) Alendronate
2) Doxy
3) NSAIDS
4) Potassium

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15
Q

72 y.o. Pt has severe substernal chest pain. Burning in nature. Intermittent for several weeks. Sometimes worse with food. PmHx of Osteoperosis. She is Diaphoretic , Distressed . No Crepitus around the clavicles . Had a Hematemesis before admission . What’s the Dx ? most accurate test ?

A
  • Pill Esophagitis

- Most accurate test = Endoscopy

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16
Q

Eosinophilic Esophagitis Seen with what sx ?

A
  • Young Pt with odynophagia
  • Asthmatics
  • Furrowed appearing esophagus
  • Concentric grooves
    Tx Steroids
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17
Q

HSV , CMV Esophagitis viral culture must be taken at the margin. Otherwise you may get a false negative .

A
  • just FYI
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18
Q

What is the tx for Barrett’s esophagus ?

A

Depends on the Endoscopic Findings

  • Non Dysplastic or Barrett Esophagus = PPI repeat endoscopy in 3 yrs
  • Low Grade Dysplasia: Give PPIs and repeat EGD in 3-6 ( 6-12 months ? ) months
  • High Grade Dysplasia or Carcinoma : Surgery
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19
Q

Mallory Weiss vs Boerhaave’s Syndrome ?

A

MW =

  • Chest Pain
  • Hematemesis no SUB-Q Air
  • no Neck Pain tear’s usually Distal LES

Boerhaave’s =

  • full thickness tear 2/2 to retching
  • SUB-Q Air
  • Neck Pain
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20
Q

How does Esophageal Perforation present ? 4

A
  • Severe Retrosternal Chest pain after vomiting
  • Odynophagia and Hematemesis
  • SUB-Q Air
  • Radiation of pain to left shoulder
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21
Q

What is the most accurate test for Esophageal Perf? tx ?

A
  • most accurate = gastrografin esophogram
    shows contrast outside the lumen of the esophagus
  • Surgery of Esophagus and Debridement of the Mediastinum
  • Esophageal Stents
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22
Q

What are the warning signs for PUD / Gastric Ulcer ?

A

Weight loss
Early Satiety
Anemia

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23
Q

What is the Dx testing for PUD/Gastric ulcer ?

A
  • Upper Endoscopy with Biopsy to rule out cancer

- Duodenal ulcer don’t get cancer

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24
Q

How do you dx H. Pylori ? -

A
  • If Endoscopy and Biopsy are done no test needed for
    H. Pylori
  • If not then :
    1. Serology : Very Sensitive but can’t tell old vs new infections
  1. Breath Test and Stool Antigen: Useful to see if tx worked. Sensitivity of both is affected with PPI and antibiotics.
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25
What's the best test for CURED H. Pylori infection ?
- Urea Breath Test or - STool sample
26
After PUD is resolved . Pt must be RE-Scoped . why ?
- the only way to exclude cancer 100% | - even if biopsy is normal
27
What's the greatest risk factor for developing Duodenal Ulcer Disease ?
- H. pylori
28
What is a important agent that doesn't not cause GERD ?
- H. pylori
29
When is a 24 hour pH monitoring indicated in pts with GERD sx ? 4
- Asthma begins with GERD Sx - Hoarseness persists - Sleep Apnea is comorbid - Medical Tx has Failed
30
What's the best initial test for GERD ?
- PPI administration
31
What are the best tx for Achalasia ?
- Pneumatic Dilation OR - Surgical Myotomy
32
What's the clinical sx for Schatzki ring ? tx
- Intermittent dysphagia - Mid Esophageal narrowing on barium swallow - Pneumatic Dilation ( same tx in Achalasia ) 4% risk of Perforation
33
What are Schatzki ring almost always 97% associated with ?
- Hiatal Hernia
34
What are the esophageal spasms ?
- Sx - starts when drinking cold water - Diffuse Esophageal Spasm = 20% more contractions on manometry - Hypertensive Peristalsis ( Nutcracker) = normal contraction in smooth muscle via manometry - Tx : CCB or Imipramine - Barium swallow shows Rosebead or Corkscrew shape for Nutcracker
35
Odynophagia in a old vs young pt etiology ?
- Old = Stroke or Cancer | - young = infectious
36
What's the MCC of Infective Esophagitis in a AIDs/HIV pt w/
- Candidiasis 90% of the time - Start with Oral Fluconazole - Then IV Amphotericin - Nystatin Oral = Treats only ORAL Candidiasis not Esophageal Candidiasis - Candida doesn't need to be present to have pt infected vs CMV or HSV causing infective esophagitis
37
What are the causes of dysphagia ?
- Achalasia - Esophageal Cancer - Peptic Rings from acid exposure - Zeneker - Esophageal Spasm
38
What are the caused of Esophagitis ?
- CMV , HSV , Candidiasis - Pill Esophagitis - Eosinophilic Esophagitis
39
What's the Tx for Plummer Vinson Syndrome ?
Treat Iron Deficiency first = sometimes resolves sx
40
What esophageal dx needs manometry ?
- Achalasia - Spasm - Scleroderma
41
What is the only way to truly understand the etiology of epigastric pain from ulcer diseases ?
- Endoscopy w/ possible biopsy
42
When is Endoscopy Indicated for GERD ? -
- Signs of Obstruction like dysphagia or odynophagia - Weight loss - Anemia or Heme Positive Stools - > 5 years of Sx to exclude Barrett's
43
What are the Sx of Esophageal Perforation ? what's the Dx Test ?
- Retrosternal Chest Pain - Odynophagia - SUB-Q air especially with Heart Beat = Hamman's Sign - Radiation of pain to left shoulder Dx - gastrografin esophogram = shows contrast outside the lumen
44
what's the common presentation of Gastritis ? DX ?
- Bleeding without Pain - but Severe Erosive gastritis can have pain - you can't usually answer the Dx question from H/P alone Dx = needs a endoscopy to diagnose
45
Which Dx need endoscopy ?
- Barrett's - Cancer - PUD - Peptic Ulcer ( duodenal and gastric ulcer disease) - Gastritis ( No Ulcer ) - Non-Ulcer Dyspepsia - H.Pylori - not needed but most accurate way to diagnose
46
Stress ulcer prophylaxis is indicated in which pts?
- Mechanical ventilation - Burns - Head Trauma - Coagulopathy
47
PPI is the first line tx in ?
- GERD - Scleroderma - PUD
48
Whats the causes of Gastritis vs PUD ?
Gastritis - ETOH - NSAIDS - H. Pylori - Portal HTN - Stress - burns , trauma , sepsis , uremia PUD - Gastric Ulcer and Duodenal Ulcer - MC = H. pylori - NSADIS = 2nd MC
49
What common irritants do not cause ulcers ?
- Alcohol - Tobacco they delay healing of ulcers
50
What is the most accurate test for H. Pylori?
- Biopsy
51
What's the best initial test ? Most accurate test for Zollinger Ellison ?
- Endoscopy has to confirm ulcer first then .... Best initial Test - Secretin challenge - pt shows high gastrin = positive - High Gastrin with high gastric acidity despite PPI use Most Accurate test - Somatostatin Receptor Scintigraphy with endoscopic Ultrasound exclude metastatic disease
52
Gastrinoma is usually seen with what sx ?
- Diarrhea because acidity inhibits lipase
53
What's the most common cause of UPPER vs Lower GI bleed ?
- Upper GI = Ulcer Disease | - Lower GI = Diverticular Disease
54
When a confirmed case of Gastrinoma is seen what's the next step ?
- Have to exclude metastatic disease - CT / MRI usually are done but have poor sensitivity * **- Use Somatostatin Scintigraphy ( Nuclear Octreotide Scan) with Endoscopic Ultrasound - Do this if MRI and CT are normal
55
What is the cause of diabetic gastroparesis ?
- autonomic damage | - unable to sense stretch of in the GI tract
56
What's the most accurate test for diabetic gastroparesis ?
- Nuclear Gastric Emptying Study | -
57
What sx are seen diabetic gastroparesis ?
- DMII for a long time
58
Normal Saline or Ringer lactate > 5% dextrose in water why ?
- D5W doesn't stay in the vascular space to raise blood pa as well as Normal Saline
59
Which is the only type of GI bleed can a Physical exam determine ?
- Variceal Bleeding
60
What's the MGMT goal of an GI Bleed ?
- Fluid Resus First | - 80% die of inadequate fluid replacement
61
56 y.o. Cirrhotic Pt has black stool . No hematemesis . NG tube shows bright red blood. What's the Dx ?
- Variceal rupture
62
What is the sign for NG tube is fully sensitive ?
- Bile in the Aspirate
63
What's the indication for capsule endoscopy ?
- Small intestine bleeding that can't be reached by endoscopy
64
What's the TX for GI bleeding ? 6
1) Fluid Resus | 2) Packed RBC if HCT =
65
What's the Tx for Esophageal Varice and Gastric Varice ? 5
1) octreotide 2) Banding 3) TIPS = associated with portosystemic encephalopathy . Connects the hepatic vein and Portal Vein 4) Propranolol - prevent future bleeding 5) Antibiotics - prevent SBP with Ascites
66
Sclerotherapy for Variceal Bleeding is NEVER RIGHT if BANDING is possible
just fyi
67
What's the tx for C. Diff ?
- Metronidazole | - Only Switch to PO Vancomycin if the Metronidazole didn't work or it's a severe case
68
What's the main diff in Sx for chronic pancreatitis vs gluten sensitive enteropathy celiac disease ?
- Celiac = has Iron DEFICIENCY - needs a intact bowel to absorb Fe - doesn't Need Pancreatic Juices
69
What's the best initial test? What's most accurate diagnostic test why else do we do it ? for Celiac ?
Best initial test = anti- gliadin , anti transglutaminase , anti endomysial Most Accurate = Small Bowel Biopsy to prove villous architecture abnormal and to EXCLUDE LYMPHOMA
70
What's the most accurate test? what's the best initial test ? for Chronic Pancreatitis ?
- Most accurate = NG tube Secretin Challenge - Normal response is bicarb release - Best initial = XR or CT for Calcifications on Pancreas
71
What's the best initial test ? what's the tx ? for Carcinoid ?
- best initial = Urinary 5 hydroxyindoleacetic acid | - tx = octreotide
72
What's the tx for IBS ?
Anti-Spasmodic Agents and Rest And Exercise - Dicyclomine - Hyoscyamine
73
What's the antibody seen in crohns vs ulcerative colitis ?
- Chrons - Anti-saccharomyces cerevisiae pos, ANCA negative | - Ulcerative colitis - Anti-saccharomyces cerevisiae NEG, ANCA POS
74
what are the extraintestinal manifestations of crohns vs UC ?
- Chronic = Kidney Stones, Erythema Nodosum , Episcleritis , Aphthous Ulcers - UC = Pyoderma Gangrenosum , Sclerosing Cholangitis
75
What' the tx in Crohns vs UC ? acute ? chronic ?
- Crohn's - Anti-TNF-Alpha - Infliximab - Surgery is not Curative - Surgery only done for obstruction - UC - Cyclosporine , Infliximab , Hemi to Total Hemicolectomy - Surgery is curative ``` Acute = Steroids Chronic = 5ASA-mesalamine ```
76
WHat's the purpose of Azathioprine and 6 mercaptopurine in IBD pts ?
- Used to wean pts of Steroids - Budesonide Specific for IBD | - Give Calcium and Vitamin D
77
Specific Differences between Crohn's VS UC ?
Chrons - - Perianal Disease/Abscess ( comes from Anal crypts, don't mix up with crypt abscess of UC that can happen elsewhere) - Mass and Obstructions - Fistulas - Anti-Sacchromyces Cerevisiae Pos but ANCA neg UC - Cure by surgery - None of the above - ANCA pos but ASCA neg
78
What's the most accurate test for IBD ?
- Endoscopy | -
79
What's the purpose of Azathioprine and 6 mercaptopurine in IBD treatment ?
- Used to wean pt off of steroids | - Everyone needs Calcium and Vitamin D = prevents kidney stones
80
What's the tx for fistulae in in Crohn's ?
- Infliximab | - Unresponsive ? = Surgery
81
What's the most accurate test for Diverticulosis ?
- Colonoscopy
82
What can help to dec complications of diverticulosis ? 4
- Bran - Psyllium - Methylcellulose - Inc Dietary Fiber
83
Diverticulitis sx ?
- LLQ tenderness ( with palpation ) - Fever - Leukocytosis - Palpable mass sometimes
84
What's the best initial test for Diverticulitis ?
- CT scan | - Don't Colonoscopy or Barium Swallow = Will Perforate
85
What are the Causes of Lower GI bleeding ? 6
- AVM / Angiodysplasia = Most Common - Diverticular Bleed = Right Sided Most Common - IBD - Hemorrhoids - Ischemic Colitis - Cancer
86
Where's the most common Diverticular bleed vs Diverticulitis ?
- DiverticulaR bleed = Right Sided Most Common | - Diverticulitis = Left Sided
87
What's the Tx for Diverticulitis ?
- Cipro = Covers GM- AND - Metronidazole = Covers Anaerobes or Beta Lactam / Lactamase combo
88
When do you operate on a pt with Diverticular Disease ? 3
- No response to med - Recurrence is frequent - Perforation , Abscess , Stricture or Obstruction - Young Pt more often than a old pt
89
Whats the MGMT of GI bleed ?
- Endoscopy - therapeutic and Dx | - Technetium Bleeding scan
90
What's the dx of Spontaneous Bacterial Peritonitis ?
- Infection without perforation - Best initial test : > 250 Neutrophils - Most Accurate test : Fluid Culture with no Gram Stain Findings
91
What's the Tx ? What's the special MGMT for Spontaneous Bacterial Peritonitis ?
- Tx = Cefotaxime and Ceftriaxone - HIGH RATE OF RECURRENCE *** Must prophylaxis with TMP-SMX or Norfloxacin
92
When are antibiotics needed on Pancreatitis Case ?
- 30% of Necrosis seen - Use Impenem or Mereopenem - only way to confirm is biopsy
93
What's the Triad for Primary Biliary Cirrhosis ?
- Woman in 40-50's - Fatigue and Itching - Normal Bilirubin with increased ALK Phos
94
P. Sclerosing Cholangitis vs P. Biliary Cirrhosis ?
- PSC - Women in 40's 50's Fatigue and Itching Normal Bilirubin with Inc ALK Phos ``` -PBC Pruritus High ALK Phos High GGTP High Bilirubin ```
95
PSC vs PBC Dx test most accurate ?
- PBC = Biopsy and Anti-Mito-Ab vs - PSC = MRCP or ERCP
96
P. Sclerosing Cholangitis is the only cause of Cirrhosis where you DON'T BIOPSY ***
Just FYI
97
When is Iron Chelation Therapy indicated for Hemochromatosis ?
- Can't be managed with phlebotomy | - Are Anemic and Hemochromatosis from overtransfusion like thalassemia
98
What's the tx for Chronic HEP B vs Chronic HEP C
- Hep B - can be monotherapy drug any vir , dine , or interferon - Hep C - can never be monotherapy Genotype 1 - ledipasvir and sofosbuvir both orally Genotype 2,3 - Sofosbuvir and ribavirin orally
99
What's the best initial test for Wilson's Disease ?
- Slit Lamp for Kayser Fleischer Rings | - Not ceruloplasmin - not the most accurate test b/c all proteins are down with liver dysfunction and cirrhosis
100
What are the most likely Sx seen with Wilson's Disease ? 3
- Neurological Sx- Psychosis , tremor , dysarthria , ataxia or seizures - Coombs Neg Hemolytic Anemia - Renal Tubular Acidosis or Nephrolithiasis - Wilson's aka Hepatolenticular Degeneration : gives Psychosis and Delusions not DELIRIUM that you would get with LIVER FAILURE
101
What's the most accurate test for Hepatolenticular Degeneration ?
- Wilson's | - Abnormally increased Copper Excretion in the urine after Penicillamine
102
What's the Tx for WIlson's besides drugs ?
- Penicillamine - Zinc - Stops Copper Absorption in the intestine -

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