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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
Q

cyclic vomiting syndrome associated with?

A

family hx of migraines, can consider sumatriptan

26
Q

gastric dumping syndrome?

A

after gastric surgery (vagotomy, partial gastrectomy)
nausea, weakness, diaphoresis 30min after meal
simple carbohydrates provoke
dietary modification -> octreotide -> surgery

27
Q

sudden vision loss with floaters, on exam
“red glow with loss of fundus details”
assoc / tx?

A 
vitreous hemorrhage (seen with proliferative diabetic retinopathy)
tx: conservative
28
Q

SBP threshold for abx therapy?

A

250 neutrophils/uL

29
Q

tx for esophageal varices?

A 
prophylaxis:
-propranolol or nadolol
-nitrates
-banding
-TIPS
acute:
resuscitation
endoscopy -> sclerotherapy / sengstaken tube
octreotide
30
Q

iron toxicity vs acetaminophen toxicity?

A

both: nausea, vomiting, abdominal pain, hepatotoxicity

iron only: GI hemorrhage

31
Q

celiac dz antibodies?

A

anti-endomysial

32
Q

liver cyst with eggshell calcifications?

A

hyatid cyst

33
Q

causes of acute pancreatitis?

A 
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
Q

Tropical sprue endemic areas?

Tx?

A 
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
Q

how to test for chronic pancreatitis?

A

CT abdomen - lipase/amylase may be nl

36
Q

prolonged PPI use: 3 risks

A

C diff
increased colonization of upper GI tract -> incr pneumonia risk
impaired calcium absorption -> osteoporosis

37
Q

surveillance for cirrhotics?

A

ultrasound and serum AFP every 6 mos to screen for HCC
surveillance EGD for varices
-if variceal bleed, EGD yearly and beta blocker

38
Q

phases of chronic hep b infection?

A 
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
Q

homocystinuria - enzyme defect?
lab abnormalities?
classic features?
tx?

A

cystathionine synthase
elevated homocysteine and methionine levels
fair hair and eyes, developmental delay, CVA, marfanoid body habitus
B12, folate, B6, antiplatelet/anticoagulation therapy

40
Q

pill esophagitis drugs?

A

tetracyclines
KCl, Fe
bisphosphonates
NSAIDs

41
Q

renal insufficiency + nitroprusside = ?

A

cyanide toxicity

42
Q

dyspepsia workup?

A

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
Q

tx for hypothermia:

A

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
Q

folate antagonists?

A 
phenytoin
phenobarbital
primidone
trimethoprim
methotrexate
45
Q

complications of carcinoid syndrome?

A 
(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
Q

tx of serotonin syndrome?

A

benzos and cyproheptadine

47
Q

clotting problem in alcoholic / other malnourished person?

A

think vitamin K deficiency

48
Q

what is melanosis coli? what is the significance of this finding?

A

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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