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Internal Med > OME - GI > Flashcards

OME - GI Flashcards

1
Q

How to treat HepC genotype 1b?

SEs?

A

Peg-I + Ribavirin

Psychosis, depression, flu-like sx

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2
Q

What are the 4 MC causes of infectious esophagitis?

A

Candida
Herpes
CMV
HIV

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4
Q

Colonoscopy shows low risk, f/u in 5-10 years, what is found:

polyps?

Size?

Type?

Grade?

A

1-2 polyps

< 1 cm

Tubular

Low-grade

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7
Q

What Abx do you treat ascending cholangitis with?

A

Cipro + Metronidazole
OR
Ampicillin-Gentamycin + Metronidazole

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8
Q

GI erosion = ?

Ulcer?

A

Break < 5mm

> 5mm

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9
Q

How to screen for HCC in HepB?

Treat how?

A

AFP and US

Peg IFN-alpha-2a and antiviral (Lamivudine, entecavir)

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10
Q

MCRP shows beads on a string is what?

Treatment?

What pathology?

A

PSC

cholestyramine, do NOT stent
Ultimately need TRANSPLANT

Extrahepatic ducts

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12
Q

Diagnose PSC how?

See what?

What else can you use, what will you see?

A

MRCP

Beads on a string

ERCP will show onion-skin fibrosis

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13
Q

What are the etiologies of Cirrhosis?

A

VW HAPPENS

Viral - HepB + C
Wilsons
Hemochromatosis 
A1-anti-trypsin
PSC
PBC
Ethanol
NASH/NAFLD
Something rare
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14
Q

Pt w/colicky RUQ pain that radiates to the shoulder has what?

A

Cholelithiasis

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16
Q

What is the major black box SE of metoclopramide?

A

Tardive dyskinesia

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18
Q

Mild UC treat how?

What makes it mild?

A

5-ASA or Mesalamine/Sulfasalazine

Normal vitals, labs, and weight

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19
Q

Pt that has virulent ulcers refractory to PPI has what?

How do you work it up?

A

Gastrinoma

1 - endoscopy
2 - serum gastrin
3 - secretin stim test
4 - SRS/CT to find

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20
Q

What is the best test to Dx pancreatitis?

What else can you use?

A

Lipase > 3x Upper limit of normal

CT scan

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21
Q

What is an anatomical variant in the cardia of the stomach that becomes easily eroded by gastritis or ulcers?

A

Dieulafoy’s lesion —> superficial artery

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23
Q

Pt that has malabsorption w/brain, lymph, and joint problems has what?

Treatment?

A

Whipple disease

Bactrim or Doxy

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25
Q

Pt w/low severity from caustic esophagitis treat how?

High?

A

Liquid —> solid w/in 48 hours

NPO x 72 hours

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26
Q

Before you can give Abx for pancreatitis that is infected, what must you do first?

A

Get a biopsy

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27
Q

What is Courvosier’s sign?

Means what?

A

NonTender palpable enlarged GB

Pancreatic cancer

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28
Q

How do you test for Wilson’s?

Tx:

A

24 hour urine copper
Slit lamp
Serum Ceruloplasmin

Penicillamine

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29
Q

Liver biopsy shows PAS+ hepatocytes, what is the Dx?

A

Alpha-1-anti-trypsin deficiency

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30
Q

HCC is screened when?

Obtain what tests?

Confirmatory test is what?

A

Q6m

RUQ US, AFP

Triple phase CT scan

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31
Q

When should you get a colonoscopy after a bout of diverticulitis?

A

2-6 weeks after resolution as to not miss any cancer

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36
Q

What is the histological PATH of scleroderma?

Presents how?

Treat how?

A

Collagen in esophagus, LES cannot contract

Relentless GERD

PPI but no cure

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37
Q

How to Dx SBP?

Treat how?

Prophylax for what?

Secondary SBP pts need what?

A

> 250 neutrophils in fluid

Ceftriaxone

Total protein < 1 need prophylax w/FQ

Metronidazole, Ex-LAP for perf

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38
Q

Pt w/chronic N/V, early satiety and negative EGD has what?

Common in what pts?
Have what additional sx?

A

Gastroparesis

Diabetics
Peripheral neuropathy

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39
Q

What is the most sensitive test for invasive bacteria?

A

Lactoferrin

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40
Q

Liver biopsy shows balloon degeneration and Mallory bodies, what is the Dx?

A

Alcoholic cirrhosis

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42
Q

Pt w/SIRS criteria after pancreatitis generally occurs when?

Dx how?

Treat how?

A

1-3 weeks, but mostly day 7

CT and Bx

Meropenem

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43
Q

SAAG < 1.1 means what?

Caused by what?

A

Non-portal HTN related, lots of STUFF in fluid

Cancer, TB

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47
Q

What is the simplest test that can be done for GI bleed?

What is almost always done?

A

NG tube

EGD

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49
Q

C diff diagnosed how?

Treated with what for repeated recurrences?

A

NAAT

Fidaxomicin

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50
Q

What causes ischemic colitis?

Presents how?

Dx how?

A

HoTN in watershed area

Painful, self-limiting bleed

Colonoscopy

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51
Q

What chemical is able to cross the BB barrier and cause hepatic encephalopathy?

A

Ammonia (NH3)

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54
Q

What are the causes of Esophagitis?

A 
PIECE
Pill induced
Infectious
Eosinophilic
Caustic
GERD
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55
Q

Young woman presents w/pruritis and jaundice, what do they have?

Dx how?

Tx?

A

PBC

Biopsy ONLY

Ursodeoxycholic acid

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56
Q

Pt w/elevated AST/ALT and conjugated bilirubin w/pruritus and jaundice has what?

A

Choledocholithiasis

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57
Q

Pt that you clinically suspect has pancreatitis but does not have an elevated lipase, what should you do?

A

order CT scan

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58
Q

What are the typical symptoms of GERD?

A

Retrosternal burning chest pain
Better w/sitting up and antacids
Worse w/spicy foods and recumbency

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60
Q

Pt w/esophageal spasm presents how?

Barium swallow shows what?

Treat how?

A

MI —> crushing retrosternal chest pain

Corkscrew esophagus / beads on a string

CCB, Nitros

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61
Q

What are the characteristics of unconjugated bilirubin?

A

Lipid-soluble
Crosses BBB
Not excreted in the urine
+ Kernicterus

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63
Q

Pt w/early satiety or abdominal fullness 3-7 weeks after acute pancreatitis has what?

Treat how?

A

Pseudocyst

Spontaneous resolve if < 6cm and < 6 weeks old
If NOT
Then surgical drainage

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65
Q

Pt w/suspected choledocholithiasis but US does NOT show dilated ducts, what to do next?

A

MRCP

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69
Q

SE of TIPS procedure?

Why?

A

Encephalopathy

Bypasses the liver

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74
Q

Pouts-Jeghers presents how?

A

No Malignant polyps, Hyperpigmented buccal mucosa, hamartomas (s.i. Tumors)

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76
Q

Pt that has acute pancreatitis but does not drink, what should you do next?

A

RUQ US to look for gallstones

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77
Q

SAAG > 1.1 means what?

Caused by what?

A

Portal HTN related, not much STUFF in the fluid

MC: Cirrhosis and Right-sided CHF
Budd Chiari
Portal/Splenic thrombosis
Schistosomiasis

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78
Q

Steakhouse dysphagia is what disease?

Barium shows what?

Tx?

A

Schatzki ring

Narrow lumen

Lyse the ring

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80
Q

What organisms to worry about in SBP?

A

Strep

G(-) Rods

81
Q

Jaundice d/t hemolysis or hematoma is what kind of bilirubin?

Dysfunction where?

A

Unconjugated

Prehepatic

83
Q

Liver biopsy shows onion skin fibrosis, what is the Dx?

A

PSC

84
Q

Pt w/acute chest pain, tachypnea, and left-sided pleural effusion after EGD has what?

Diagnose how?

A

Esophageal rupture

Water-soluble contrast (gastrografin) Esophagram

85
Q

LLQ ABD pain 1st step in w/u?

Next?

A

KUB

CT ABD

87
Q

What is Plummer Vinson syndrome?

Dx how?

A

Woman w/dysphagia, Fe def anemia, Webs, Esophageal Cancer

EGD w/Bx (Screen)

88
Q

US that is inconclusive for cholecystitis what should you do next?

A

HIDA scan

89
Q

What is the Gold standard to diagnose H pylori?

A

EGD w/biopsy, then rapid urease test or histology

91
Q

What is the SAAG score?

Determine it how?

A

Serum ascites albumin gradient

Paracentesis

92
Q

Hemochromatosis can cause what else?

D/t what?

A

Sexual dysfunction

Iron deposition in the pituitary

93
Q

Pt w/chronic diarrhea (> 4 weeks), how do you work up?

A

Osmotic gap
Blood/mucous
bowel habit pattern

94
Q

What is the age distribution of CD?

A

BiMODAL:

20-30 and 50-75

95
Q

Pt in the ICU that is getting WORSE, think of what?

A 
ARDS
Nutritional def (low alb, Vit K)
Polyneuropathy
AMS
Stress ulcer (prophylax w/PPI)
96
Q

In dysphagia is mechanical (obstructive) or motility (functional) progressive with liquids and solids?

A

Mechanical

97
Q

Pt w/cholecystitis what are you looking for?

A

US shows pericholecystic fluid
Gallstones
Gallbladder thickening

98
Q

Pt that is presenting with signs and symptoms of gastroparesis, what do you want to get 1st?

A

EGD to r/o obstruction

99
Q

How to treat gastroparesis?

A

PO metoclopramide for chronic

IV erythromycin for acute flare

100
Q

Person with cirrhosis will have what lab abnormalities?

A

Increased INR
Low Albumin
Thrombocytopenia (TPO made in liver)

103
Q

Pt w/cirrhosis that has ascites, Treat how?

A

Na < 2 g
H2O < 2 L/day
Diuresis w/Lasix and spironolactone
Tap 4-6 L if needed

104
Q

What vitamins are absorbed in the duodenum?

What else?

A

FIC
Folate, iron, calcium

Carbohydrates

109
Q

What are some red flags in diarrhea?

A 
Fever > 104
Severe dehydration
Blood, pus
Recent travel
> 3 days
ABD pain
Abx 
Hospitalization
112
Q

Pt that is not a surgical candidate w/cholelithiasis is treated how?

A

Ursodeoxycholic acid

113
Q

What causes biliary cholestasis?

What labs will be evaluated?

A

Sepsis
Meds
Cirrhosis

ALP, direct bili

116
Q

Stomach ulcers w/necrotic base and heaped margins has what origin?

A

Malignancy

117
Q

Colonoscopy shows high risk, f/u in 5-10 years, what is found:

polyps?

Size?

Type?

Grade?

A

3 or more polyps

1cm or bigger

Villous

High-grade

118
Q

1st step in w/u of malabsorption?

2nd?

3rd?

A

Fecal fat: > 6g of fat in stool in 24 hours = malabsorption

D-xylose scan: no absorption = intestinal border deficiency

EGD w/Bx

119
Q

What test do you get to Dx: hemochromatosis?

Treatment?

A

Ferritin in 1000s or Transferrin > 50%

Deferoxamine + serial phlebotomy

120
Q

Anti-Smooth muscle Ab means what?

A

Autoimmune hepatitis

123
Q

Gilbert’s and Crigler-Najjar are d/t build up of what?

Dysfunction where?

A

Unconjugated bilirubin

Intrahepatic

128
Q 
What is the MC cause of pancreatitis?
#2?

What else?

A

Gallstones
EtOH

Toxins (HIV meds), trauma (ERCP), TGs

129
Q

What causes mesenteric ischemia?

Presents how?

A

Atherosclerosis or AFib

Postprandial ABD pain, weight loss, POOP

130
Q

How do you treat varices acutely?

Chronic?

A

Banding

Nadolol

131
Q

What are the motility disorders?

Dx how?
2nd?
3rd?

A

Achalasia, scleroderma, spasm

Barium swallow
Manometry
EGD w/Bx

132
Q

Predominant symptoms of hoarseness, cough, and nocturnal asthma indicate what?

A

Atypical GERD

133
Q

When do early complications occur in acute pancreatitis?

What are they?

Best Dx lab for prognosis?

Treatment?

A

1-3 days post

ARDS, HypoCa, Pleural effusion, ascites

BUN, also use CXR or iCa

Intubation, give Calcium

135
Q

Pt that has extracolonic involvement of colon cancer, what is the treatment?

A

FOLFOX
5-Fu, Leucovorin, Oxaliplatin

Also can add Bevacizumab

138
Q

How do you medically manage Metaplasia (Barrett’s)?

If there is dysplasia?

A

High dose PPI
Annual EGD
If stable, then q3 years

Photoablation

140
Q

Pt w/painless jaundice, elevated ALP, elevated Direct bilirubin and dilated ducts has what?

Treat how?

Normally d/t what?

A

Stricture

Stent

ERCP or cholecystectomy

145
Q

How to diagnose gastroparesis?

+ test is what?

A

Emptying study

> 60% food in 2 hours
10% in 4 hours

146
Q

Pt w/hematemesis, fever, leukocytosis, and esophageal crepitus (Hamman’s Crunch) has what?

Require what?

A

Boerhaave syndrome

Emergent surgery

147
Q

What are the obstructive dysphagia diseases?

Dx how?
Next?

A

Rings, stricture, cancer

Barium swallow
EGD w/Bx

148
Q

What are the characteristics of conjugated bilirubin?

A

Water-soluble
Does NOT cross BBB
Will have DARK urine
No kernicterus

152
Q

What is the best noninvasive test to confirm diagnosis?

Confirm eradication?

A

Urea breath test

Stool Ag test

153
Q

HepA can be treated w/post exposure prophylaxis how?

A

IgG vaccine w/in 2 weeks of exposure

155
Q

Pt that has burns, has increased ICP, is in the ICU, or intubated needs what prophylaxis?

A

PPI

157
Q

MC causes of peptic ulcer?

Less common?

A

H. Pylori and NSAIDs

Curling - burns
Cushing - Steroids, ventilator causes Inc ICP
Gastrinoma - ZE

159
Q

What pills cause esophagitis?

A

NSAIDs
Tetracyclines, Bactrim
Bisphosphonates
HAART

160
Q

If C diff is negative and you are working up diarrhea, what do you want to order next?

Lastly?

A

Fecal leukocytes (wbc) and FOB (rbc)

Ova+parasites
Stool Cx, bx

161
Q

How do you diagnose Boerhaave syndrome?

Follow up how?

A

Gastrografin swallow

EGD

162
Q

Secretory diarrhea will have what findings?

A

Normal osmotic gap
+ Nocturnal symptoms
No change w/NPO
Normal fecal fat

164
Q

Thin walled GB seen in what setting?

What special sign?

Means what?

A

Pancreatic cancer

Courvesier’s sign

NonTender but palpable

165
Q

What causes Stricture?

Pt presents how?

Path from EGD shows what?

Treat how?

A

Long standing GERD

Weight loss

Symmetric stricture

PPI, resection

167
Q

What is Charcot’s triad?

Reynold’s Pentad?

A

RUQ pain, jaundice, fever

HoTN, AMS

168
Q

Pt that has GI and Jaw tumors has what?

A

Gardner syndrome

170
Q

HepC gets transmitted how?

What complications?

A

Blood and IV drug users

Cirrhosis, HCC

171
Q

Pt w/asthma, atony, and allergic reaction has what? EGD shows what.

Treat how?

If it fails?

A

EoE, Eosinophils > 15 hpf

Trial PPI

Aersolized steroids

172
Q

What is the triple therapy for H pylori?

A

PPI
Clarithromycin
Amoxicillin

174
Q

Pt w/constant RUQ pain has what?

Means what?

What other sx?

A

Cholecystitis

Stone in cystic duct

Mild fever and leukocytosis

177
Q

+ murphy sign in what path?

A

Cholecystitis
OR
Choledocholithiasis

181
Q

How to calculate osmotic gap?

Secretory indicated by what value?

Osmotic?

A

290 - 2*(Na + K)

< 50

> 100

182
Q

What are alarm symptoms for GERD?

A

N/V
Anemia
Weight loss
Dysphagia

186
Q

Pt w/esophageal varices, when do you get Propanolol?

Treat how in refractory disease?

A

Once bleeding stopped

TIPS

189
Q

Multiple shallow ulcers in stomach = what etiology?

Single large ulcer?

A

NSAID

H pylori

193
Q

Osmotic diarrhea will have what findings?

A

Inc osmotic gap
+ change w/NPO
Inc fecal fat

195
Q

Pt that has C diff w/renal failure, sepsis/shock may have what?

A

Toxic megacolon —> UC

196
Q

How to calculate stool osmoles?

What is normal?

A

2 * (Na + K)

280

199
Q

UC flare treated with what?

A

Prednisone + cipro/metro

202
Q

Treat HepC genotype 2 or 3 how?

A

Direct acting antiviral (end in -Vir)

Ie Borceprevir

215
Q

Pt w/GI bleed, how do you stabilize?

A

2 large bore IVs
IVF
Type + Cross

CBC
PT/PTT
EKG —> r/o mesenteric ischemia

216
Q

Pt that has a Brisk GI Bleed image how?

Slow bleed?

NO bleeding?

A

Angiogram

Tagged rbc

Colonoscopy

222
Q

Moderate UC treated with what?

Severe?

A

Azathioprine, 6-MP

Infliximab, cyclosporine

225
Q

Salmon-colored velvety mucosa in pt w/long hx of GERD has what?

A

Barrett’s

Internal Med (7 decks)

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