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STEP 2 GI > STEP 2 GI > Flashcards

STEP 2 GI Flashcards

1
Q

Hepatitis (drug/viral) histology?

A

Hepatic cell necrosis with mononuclear infiltrate.

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2
Q

Drugs causing hepatitis histology?

A

INH, phenytoin

alpha-methyldopa, halothane

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3
Q

Drugs causing fatty liver histology?

A

valproate, tetracyclines, antiretrovirals

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4
Q

Drugs causing fulminant/toxic liver failure?

A

acetaminophen, amanitoxin, CCl4

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5
Q

Drugs causing hepatic granulomas?

A

allopurinol

phenylbutazone

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6
Q

Drugs causing elevated liver enzymes but no histologic changes?

A

OCPs

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7
Q

Drugs causing cholestatic liver histology?

A

chlorpromazine, nitrofurantoin, anabolic steroids, erythromycin

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8
Q

Definition of acute liver failure / FHF?

Prognosis/Tx?

A

Rapid ( 1.5)
with no pre-existing liver disease or cirrhosis
Prognosis: 40% survive w/o transplant (acute)

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9
Q

TX of hepatic encephalopathy?

A

lactulose, rifaximin

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10
Q

Features of Crohn’s?

A 
Skip lesions, perianal lesions, fistulas, fissures
Cobblestone mucosa
Noncaseating granulomas
Transmural lesions
Creeping fat mesentery
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11
Q

Features of UC?

A

rectal involvement
crypt abscesses
HLA-B27, PsorA/joints, PSC
bloody diarrhea

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12
Q

Migratory superficial thrombophlebitis?

A

Trousseau’s sign
Pancreatic, lung, etc ca
scan it

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13
Q

Abx for PBC?

A

anti-mitochondrial

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14
Q

Abx for autoimmune hepatitis?

A

anti-smooth muscle

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15
Q

Abx for PSC?

A

(p-ANCA?)

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16
Q

Diverticulitis mgmt: when outpt? when inpt with broad IV abx? When drainage? When surg?

A

If elderly, sick, or risk facs: hospitalize and IV abx
If fluid collection 3 cm: CT perc drainage
If fails: surgical I&D
If perfs or fistulizes: colonic resection

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17
Q

Peutz-Jeghers features?

A

Mucocutaenous pigmentation
GI polyposis
Maybe estrogen secreting tumor with precocious puberty

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18
Q

what is “succussion splash”?

A

stethoscope on LUQ, rock pt at hips, if splash sound indicates incomplete gastric emptying, sign of outflow obstruction

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19
Q

BRBPR ddx? Workup?

A 
Brisk UGIB - check gastric aspirate
diverticulosis - hx of constipation
hemorrhoids - rectal exam
angiodysplasia - hx of ESRD or AS (Heyde's sydndrome -> von Willebrand IIA)
Workup:
-colonoscopy / endoscopy
-if negative, tagged RBC scan
-surgery
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20
Q

enterobius (pinworm) dx/tx?

A

scotch tape test

albendazole or pyrantel pamoate for household

21
Q

strongyloides tx?

A

ivermectin

22
Q

onchocerca volvulus tx?

A

ivermectin

23
Q

trypanosoma cruzi tx?

A

benznidazole

24
Q

entamoeba histolytica dx, tx?

A

dx stool microscopy (trophozoites with ingested RBCs)
aspirate from liver abscess
serum antigen / antibodies
tx: metronidazole

25
cyclic vomiting syndrome associated with?
family hx of migraines, can consider sumatriptan
26
gastric dumping syndrome?
after gastric surgery (vagotomy, partial gastrectomy) nausea, weakness, diaphoresis 30min after meal simple carbohydrates provoke dietary modification -> octreotide -> surgery
27
sudden vision loss with floaters, on exam "red glow with loss of fundus details" assoc / tx?
``` vitreous hemorrhage (seen with proliferative diabetic retinopathy) tx: conservative ```
28
SBP threshold for abx therapy?
250 neutrophils/uL
29
tx for esophageal varices?
``` prophylaxis: -propranolol or nadolol -nitrates -banding -TIPS acute: resuscitation endoscopy -> sclerotherapy / sengstaken tube octreotide ```
30
iron toxicity vs acetaminophen toxicity?
both: nausea, vomiting, abdominal pain, hepatotoxicity | iron only: GI hemorrhage
31
celiac dz antibodies?
anti-endomysial
32
liver cyst with eggshell calcifications?
hyatid cyst
33
causes of acute pancreatitis?
``` I GET SMASHED: Idiopathic Gallstones EtOH / MetOH Trauma Steroids Mumps / Malignancy Autoimmune (unusual) Scorpion sting/spider bite Hyperlipidemia/hypercalcemia ERCP or other surgery Drugs: -azathioprine -mercaptopurine -valproate -furosemide -estrogen -methyldopa -H2 blockers / cimetidine -organophosphates -abx ```
34
Tropical sprue endemic areas? | Tx?
``` nb it looks like celiac with a travel hx Haiti Cuba PR DR (not Jamaica) s/sx due to folate malabsorption tx: tetracycline and folate ```
35
how to test for *chronic* pancreatitis?
CT abdomen - lipase/amylase may be nl
36
prolonged PPI use: 3 risks
C diff increased colonization of upper GI tract -> incr pneumonia risk impaired calcium absorption -> osteoporosis
37
surveillance for cirrhotics?
ultrasound and serum AFP every 6 mos to screen for HCC surveillance EGD for varices -if variceal bleed, EGD yearly and beta blocker
38
phases of chronic hep b infection?
``` immune tolerance: 10-30 yrs -positive HbeAg and HbsAg, high replication -nl ALT immune clearance -HbeAg positive -> zero -HbsAg positive (if infection cleared, becomes negative) -inflammation, +ALT inactive carrier state: -HbsAg+ -dx: 3nl ALTs and 2-3 negative HBV DNA over 1 yr -variable inflammation HbeAg negative chronic hepatits: -+ALT, +HBV DNA ```
39
homocystinuria - enzyme defect? lab abnormalities? classic features? tx?
cystathionine synthase elevated homocysteine and methionine levels fair hair and eyes, developmental delay, CVA, marfanoid body habitus B12, folate, B6, antiplatelet/anticoagulation therapy
40
pill esophagitis drugs?
tetracyclines KCl, Fe bisphosphonates NSAIDs
41
renal insufficiency + nitroprusside = ?
cyanide toxicity
42
dyspepsia workup?
dyspepsia = discomfort/fullness after meal Alarm symptoms: weight loss, anemia, bleeding, vomiting, early satiety If alarm symptoms: EGD If typical GERD: acid reduce If NSAIDs: stop them or add acid reduce otherwise, if age 55, EGD
43
tx for hypothermia:
if mild-moderate (i.e. no coma, ventricular arrhythmias, pulmonary edema) - room temp IVF, passive rewarming if severe: - active external (heated blankets) and internal warmed IVF and humidified O2
44
folate antagonists?
``` phenytoin phenobarbital primidone trimethoprim methotrexate ```
45
complications of carcinoid syndrome?
``` (after mets to liver) flushing diarrhea bronchospasm valvular lesions (R>L) niacin deficiency: -due to overproduction of serotonin -serotonin precursor is tryptophan -tryptophan is also a precursor for niacin synthesis ```
46
tx of serotonin syndrome?
benzos and cyproheptadine
47
clotting problem in alcoholic / other malnourished person?
think vitamin K deficiency
48
what is melanosis coli? what is the significance of this finding?
dark brown staining of colon with lymph nodes shining through as pale patches sign of laxative abuse (anthraquinones = bisacodyl) often nocturnal diarrhea

STEP 2 GI (1 decks)

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