third-MKSAP Flashcards
In a patient with hepatitis, what indicates an ACTIVE infection?
Positive hep C RNA
Is a___chance that the hep C virus will spontaneously resolve Within this ___time
20 to 50% chance
First 6 months(Keep monitoring hep C RNA during this time)
When should you start treatment for hep C?
After 6 months when you have monitored during this time and it has not went away
Because there is a chance that hep C may spontaneously resolve within the first 6 months
If patient has iron deficiency anemia, EGD/colonoscopy negative, what is the next diagnostic step?
Capsule endoscopy for small bowel bleed eval
To evaluate for bowel bleed, CTA or tagged red cell scintigraphy or good options if there is___bleed
Active
There is a gallstone 5 mm in size in a patient with gallstones, management should be cholecystectomy versus repeat ultrasound/monitoring in 6 months or 12mo?
Cholecystectomy
Because even though gallstone <1 cm, is associated alongside gallstones which increases the chances of malignancy
Lifestyle modifications recommended for GERD
-If obese, lose weight
-Quit smoking
-Avoid late evening meals and eat 3 hours before bedtime
-Elevate head of bed
-Eliminate triggers if recognized i.e. alcohol, Tomato
-Avoid large meals
In this patient you see Charcot’s triad and CBD obstruction with stone on ultrasound, what the next step?
Urgent ERCP, sphincterotomy and stone extraction
Obviously alongside antibiotics targeting and Enterobacter
Gallbladder polyp size___is a risk factor for malignancy, and treatment is___
> 1 cm
Cholecystectomy
Gallbladder polyps associated with___disease are likely to be malignant alongside___size
Associated with PSC-primary sclerosing cholangitis, or gallstones
Any size
Discontinuing___helps with chronic pancreatitis pain
This is a substance
Tobacco
Patient on aspirin for primary prevention now
Has a gastrointestinal bleed, at time of discharge aspirin should be___resumed/discontinued
Discontinued indefinitely
Patient on aspirin for secondary Prevention now
Has a gastrointestinal bleed, at time of discharge aspirin should be___resumed/discontinued
Resumed as soon as bleeding has been controlled
What is considered aspirin use for primary prevention?
Aged 40-60 who have ASCVD risk of 10% or greater
What is considered aspirin use for Secondary prevention?
You have stroke or MI
Antibody/serological test for celiac disease must occur while patient is___
Actually on a gluten diet
Being on a gluten-free diet can reduce sensitivity of the tissue transglutaminase IgA antibody test, Therefore place him back on a gluten diet and then test again 1 to 3 months in
Normal CBD size
1.5-6-ish millimeter
In a patient with gallstone pancreatitis where gallstone has passed, this cholecystectomy have to be done in hospital or upon follow-up?
Must be done before discharge
___Pancreatic cystadenoma has malignant potential
Mucin producing cysts, including intraductal papillary mucinous neoplasm and mucinous cystic neoplasms
___Pancreatic cystadenoma does not have malignant potential
Non mucin producing cysts
Likely serous cystadenoma-They look like lobulated bunch of grapes on imaging
For Peutz-Jeghers syndrome, the presence of 2 out of 3 is a diagnostic criteria
-Peutz-Jeghers type hematoma polyps, in GI tract
-Multiple melanotic macules on mouth, buccal mucosa, nose, genitalia, eyes, fingers
-Family history of PJS
What are some symptoms of eosinophilic esophagitis?
Dysphagia
Food bolus obstruction
What is diagnosis criteria of the Eosinophilic esophagitis
-Esophageal biopsy with >15 Eosinophil counts
-No other causes of eosinophilia Of the esophagus
-Dysphagia
What is the treatment of eosinophilic esophagitis?
-PPI
-Swallowed topical glucocorticoids like fluticasone, budesonide
-Biologics
-Endoscopic dilation
Water other causes of eosinophilia of the esophagus?
GERD
Hypereosinophilic syndrome
Infections
Autoimmune or connective tissue disorder
Crohn’s disease with esophageal involvement
Drug hypersensitivity reaction
What conditions are associated with eosinophilic esophagitis?
Atopy like asthma, rhinitis, dermatitis, Food allergies or seasonal allergies
What is the surveillance for hepatitis C virus?
What are you looking for?
Every 6 months of U/S, alpha-fetoprotein
Hepatocellular carcinoma
Pancreatic pseudocyst do not require drainage unless___and___
Pseudocyst becomes infected
Patient is symptomatic
Definition of pancreatic pseudocyst
Peripancreatic fluid collections that persist beyond 4 weeks
And has no epithelial layer to the wall
Name all 4 types of fluid collections that can be seen in acute pancreatitis
-Pancreatic pseudocyst
-Acute peripancreatic fluid collections
-Acute necrotic collections
-Walled off necrosis(Necrotic area liquefies, and becomes encapsulated within a well-defined wall surrounding the necrotic area)
Acute necrotic collections develop in___timeline of acute pancreatitis
Within first 4 weeks, Of acute pancreatitis
Patient has Pancreatic pseudocyst with abdominal pain, what is the treatment?
Endoscopic drainage with FNA
We are treating it only because it asymptomatic-Otherwise no intervention necessary
Patient has walled off necrosis around pancreas, with the next step for treatment?
Cystogastrostomy and necrosectomy
Definitely not endoscopic fine-needle aspiration!!!
