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Step 2 > Step Up- GI > Flashcards

Step Up- GI Flashcards

1
Q

This is the most common site of distant spread of colorectal cancer

A

Liver through the portal circulation

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2
Q

Risk of CRC in a patient with familial adenomatous polyposis?

A

100% by 3rd or 4th decade

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3
Q

Polyps + osteomas and dental abnormalities

Possibly with benign soft tissue tumors

A

Gardner syndrome

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4
Q

This test is an important screen in a patient with gardner syndrome

A

colonoscopy– nearly 100% develop CRC by age 40

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5
Q

Turcot syndome

A

Polyps + medulloblastoma or gliblastoma multiforme

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6
Q

patient with pigemented spots around lips and multiple GI hamartomas

A

Peutz-Jeghers syndrome

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7
Q

Most common cause of large bowel obstruction in adults?

A

CRC

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8
Q

Abx that are most commonly associated with pseudomembranous colitis

A

Clindamycin

Ampicillin

Cephalosporins

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9
Q

Tx for C. diff colitis?

A

Mtronidazole or oral vancomycin

Metronidazole can not be used in children and pregnant patients

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10
Q

Deficiency of this in wilson disease

A

ceruloplasmin

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11
Q

Medical tx for wilson disease

A

d-penicillamine

Zinc- prevents uptake

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12
Q

Potential effects of hemochromatosis

A

Cirrhosis

Cardiomyopathy

Diabetes

Artritis (2nd and 3rd mcp, hips and knees)

Hypogonadism

Hypothyriodism

Hyperpigmentation of skin

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13
Q

Lab findings in hemochromatosis

A

Decreased TIBC

Increased Transferrin saturation

Increased Iron

Elevated Ferritin

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14
Q

This tumor can develop in females on OCP…

A

Hepatocellular adenoma

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15
Q

treatment for hepatocellular adenoma

A

Stop offending agent like OCP

If it does not regress, resect it

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16
Q

Most common benign liver tumor

A

Cavernous hemangioma

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17
Q

27 year old female with RUQ pain, started OCPs a few months ago. Fullness in the RUQ, what test?

A

RUQ ultrasound or CT

Likely hepatocellular adenoma

Stop OCP and watch in case of rupture

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18
Q

Two kinds of hepatocellular carcinoma…

Which is associated with Hepatitis infection

A

nonfibrolamellar– most common and associated with HepB and C

Fibrolamellar– not associated. more treatable

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19
Q

These chemicals are associated with HCC

A

Aflatoxin

PVC

Thorotrast

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20
Q

These are diseases that increase risk for HCC

A

Cirrhosis

AAT deficiency

Hemochromatosis and wilson disease

schostosomiasis

hepatic adenoma

cigarette smoking

glycogen storage diseases

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21
Q

This tumor marker is commonly elevated in HCC

A

AFP

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22
Q

How is the histology of NASH different from alcoholic fatty liver?

A

It ISNT!

Histologically they are the same. Differentiated based on Hx (obesity, dm, HLD but NO ALCOHOL)

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23
Q

Gilbert disease cause

A

decreased activity of UDP-glucuronyl transferase

increased unconjugated bili

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24
Q

Cause of hydatid liver cysts

A

Echinococcus granulosis and multilocularis

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25
Q

This portion of the liver is the most commonly affected by hydatid liver cysts

A

Right lobe

26
Q

Complication associated with hydatid cyst?

This medication is given with surgery

A

Rupture leading to anaphylaxis

Mebendazole given with surgery

27
Q

Causes and treatment of pyogenic liver abscess

A

Causes: E. coli, klebsiella, proteus, enterococcus, anaerobes

IV Abx and drainage

28
Q

Cause of amebic liver abscess

A

Entamoeba histolytica

Fecal-oral

Gay dudes…

29
Q

Tx of entomoeba histolytica

A

metronidazole

30
Q

Causes of budd chiari syndrome

A

hypercoagluable states

myeloproliferative disorders

pregnancy

chronic inflammatory disease

infection

cancer

trauma

31
Q

Dark urine is an indication of this subset of hyperbilirubinemia. Why?

A

Direct

It is the only form that can be excreted in the urine

32
Q

Intrahepatic causes of + urine bilirubin (conjugated)

A

Hepatocelluar disease

Dubin-johnson, rotor syndrome

Drug induced

PBC

PSC

33
Q

Extrahepatic causes of + urine bilirubin

A

gallstones

pancreatic cancer (head)

cholangiocarcinoma

periampullary tumor

biliary atrisia

34
Q

Causes of unconjugated hyperbilirubinemia

A

Gilbert

Crigler-Najjar

Haundice of the newborn

diffuse liver disease like cirrhosis

35
Q

Mild elevations of AST and ALT (low hundreds) think about…

A

Chronic viral hepatitis or acute viral hepatitis

36
Q

Moderately elevated ALT and AST (high hundreds to thousands) think about…

A

acute viral hepatitis

37
Q

Severly elevated AST and ALT (>10,000) think about…

A

Extensive necrosis

  • Shock liver (ischemia)
  • Acetominophen tox
  • Severe viral hepaitis
38
Q

Mnemonic for causes of LFT elevation…

A

Autoimmuno hepatitis

Hep B

Hep C

Drugs or toxins

Ethanol

Fatty Liver

Growths

Hemodynamic compromise (CHF)

Iron and others (Wilson, and AAT deficiency)

39
Q

Alk Phos is elevated but GGT is not. What should be suspected?

A

Pregnancy or bone disease

40
Q

Most common cause for acute cholangitis

A

Choledocolithiasis

41
Q

RUQ, jaundice and fever

A

Charcots triad

The pentad include AMS and septic shock– rapidly fatal

42
Q

Cancer associated with primary sclerosin cholangitis

A

Cholangiocarcinoma

43
Q

Primary sclerosing cholangitis is associated with this GI disorder

A

ulcerative colitis

44
Q

Clinical features of primary sclerosing cholangitis

A

Puritis

fever

weight loss

obstructive jaundice

45
Q

ERCP findings in PSC

A

Beads on a string of biliary tree

46
Q

Biliary tree disease associated with +AMA

A

primary biliary cirrhosis– middle aged women

47
Q

Treatment for primary biliary cirrhosis`

A

Cholestyramine– tx of puritis

Calcium, bisphosphonates and Vit D– osteoporosis

Ursodeoxycholic acid– slows disease progression

48
Q

This is the most common cause of pancreatitis in children

A

Blunt abdominal trauma

49
Q

Which is more specific for pancreatitis? Lipase or amylase?

A

Lipase

50
Q

Cause of hypocalcemia in pancreatitis

A

Saponification

Calcium is chelated in the digesting fat

51
Q

Ranson criteria

A

GA LAW

Glucose >200

LDH >350

AST >250

WBC >16000

52
Q

Circumferential ring in the lower esophagus ALWAYS accompanied by a sliding hiatal hernia

A

Shatzki ring (distal esophageal web)

53
Q

Plummer-vinson syndrome

A

upper esophageal webs accompanied by iron deficiency anemia, koilonychia and atrophic oral mucosa

54
Q

What is the underlying cause of zenker and epiphrenic diverticula

A

motility disorder increasing esophageal pressure

55
Q

This divertuculum is located near the tracheal bifurcation

A

traction diverticula

56
Q

Most common cause of PUD

A

H. pylori

57
Q

H. pylori more commonly causes ulcers in the area…do they have high malignancy potential?

A

duodenal

NO the high potential for malignancy exists in the stomach

58
Q

Which blood type is associated with gastric ulcers? Duodenal ulcers?

A

Type A= gAstric ulcers

Type O= duOdenal ulcers

59
Q

Most sensitive test for H. pylori? Most convenient?

A

Most sensitive is biopsy with microscopy

Most convenient is urease breath test– also asseses effective therapy

60
Q

Pain better with food

A

Duodenal ulcer

61
Q

Pain worse with food

A

Gastric ulcer

62
Q

Diabetic with bloating and constipation

A

Gastroparesis from autonomic neuropathy

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