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USMLE STEP 2 > UW - Med/GI > Flashcards

UW - Med/GI Flashcards

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USMLE® Step 1 flashcards
1
Q

What are cannonball metastases in the liver most likely to indicate?

A

Primary tumor of the GI tract, lung, or breast (follow other sx to dx)

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2
Q

Where does prostate cancer usually metastasize to?

A

Pelvic lymph nodes

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3
Q

How would a patient w/ colon cancer metastasized to the liver present? How can you diagnosis?

A

Ab pain, microcytic anemia, + fecal occult blood, hepatomegaly w/ hard liver edge

CT w/ IV contrast

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4
Q

What is the recommended treatment for non-bleeding esophageal varices and why?

A

Nonselective beta blockers (propranalol, nadalol) –> leads to unopposed alpha mediated vasoconstriction and decreased portal venous flow

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5
Q

How do you treat an active esophagela variceal bleed and why? General long term Tx for bleeding esophageal varices?

A

Octreotide - splanchnic vasoconstriction, reduced portal flow (via glucagon inhibition)

Endoscopic sclerotherapy for long term cure

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6
Q

What are the hallmark signs of carcinoid syndrome?

A

Episodic flushing (85%), Secretory diarrhea w/ ab cramps, cutaneous telangiectasias, bronchospasm, & tricuspid regurgitation

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7
Q

What symptoms are consistent w/ chronic Hep C infection? Major non-hepatic associations?

A

Nonspecific sx (nausea, anorex, myalgia, wt loss, fatigue), Transaminitis, cirrhosis (20%), risk of HCCa

Heme: mixed cryoglobulinemia (50%)
Renal: membranoproliferative glomerulonephrits
Skin: Porphyria cutanea tarda (fragile skin, photosensitivity, vesicles/erosions on hand) lichen planus
Endocrine: Increased risk of diabetes

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8
Q

What is polyarteritis nodosa most often associated w/?

A

Hepatitis B

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9
Q

What contributes to the chronology of pain in acute appendicitis?

A
  1. Viscera are inflamed - dull poorly localized peri-umb pain
  2. Somatic pain - Inflam of parietal peritoneum and skeletal muscles localize to RLQ, more severe
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10
Q

How may GERD exacerbate asthma symptoms?

A

airflow obstruction via increased vagal tone, heightened bronchial reactivity, and microaspiration of gastric contents in upper airway (30-90% of asthma pts)

Supine position after large meal, laryngitis, change in voice quality

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11
Q

What is the clinical presentation of someone with esophageal rupture? How can you diagnose?

A

Chest/Ab pain, systemic findings (fever), SubQ emphysema in neck, Hamman sign (crunching sound on chest auscultation)

Dx w/ Chest imaging: wide/pneumo mediastinum, Pneumothorax, pleural effusion (late), esoph wall thick (CT), Leak at perf site on water soluble contrast esophagogram

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12
Q

A patient presents w/ acute pancreatitis and crops of yellow/red papules on arms and shoulders. What should be done next?

A

Measure fasting lipid profile for hypertryglyceridemia (causing pancreatitis and xanthomas)

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13
Q

What are the most prominent causes of acute pancreatitis? Rare?

A

Alcohol use and gallstones

Others: Hypertrigs, recent ERCP, trauma, infection, medication

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14
Q

What lab findings can be used to distinguish hepatic cell injury vs. biliary duct obstruction?

A 
Cells = Transaminases
Duct = Alk Phos and BR
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15
Q

What signs indicate spontaneous bacterial peritonitis in setting of chronic cirrhosis? What should be done for these patients?

A

Fever/subtle changes in mental status, and sometimes ab pain, transaminitis (mild)

Do Diagnostic paracentesis (+ fluid culture and PMNs 250)

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16
Q

What is the most common cause of bile ductopenia (markedly decreased bile ducts on biopsy) in adults? Other causes?

A

1 = Primary biliary cirrhosis

Others: Failing liver transplant, Hodgkin’s dz, GVH Dz, Sarcoid, CMV, HIV, and medication tox

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17
Q

What are the liver biopsy findings for the following conditions: Acet Tox? Alcoholic hepatitis? TPN?

A
  1. Acet: Centrilobular/diffuse necrosis
  2. EtOH: Hepatocyte swelling/necrosis, mallory bodies, PMN infiltration
  3. TPN: Cholestasis which can progress to fibrosis
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18
Q

What are the liver biopsy findings in: Primary biliary cirrhosis? Primary sclerosing cholangitis? Chronic Hep B?

A
  1. PBC: Markedly decreased bile ducts (ductopenia)
  2. PSC: Periductal portal tract fibrosis, segmental stenosis of extrahep/intrahep bile ducts
  3. HBV: HC injury, sinusoidal cell reactive changes, inflammation/fibrosis of portal tracts
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19
Q

What is serum chromogranin A a marker for?

A
  • Well differentiated neuroendocrine tumors

- Also elevated in Carcinoid tumors, Hyperthyroid, chronic atrophic gastritis, and chronic PPI tx

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20
Q

What is the most common cause of ascites and what is indicated for all patients w/ new onset ascites?

A
  • Cirrhosis in 80% of cases (Usually EtOH liver dz or hep C cause)
  • Paracentesis to determine etiology
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21
Q

What conditions can progress to acute liver failure (ALF) and how can you identify?

A

Viral hepatitis, Drugs (acet), Alcoholic/autoimmune, WIlsons, Budd chiari, Ischemia/malignant infiltration

Worsening PT/INR and bilirubin, increased transaminases >10x normal

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22
Q

What is the first step upon finding gastric adenoCA on endoscopy?

A

CT abdomen/pelvis, PET/CT and other diagnostic imaging since most Gastric adenos are found in advanced stages (90%)

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23
Q

What drug works like Somatostatin and what is its use?

A

Octreotide (long acting analogue of Som) - Reduces splanchnic blood flow, inhibiting gastric acid secretion, and exerting gastric cytoprotective effects

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24
Q

What is serum-to-asciteds-albumin gradient (SAAG) used for?

A

Diagnoses etiology of ascites -> SAAG calculated by subtracting ascites fluid albumin from serum albumin. SAAG > 1 g/dL indicates portal HTN, SAAG

25
Q

What is the purpose the D-xylose test?

A

Dxylose is a simple sugar monosaccharide, therefore it is reabsorbed right away in proximal small intestine (if decreased absorptive capacity, serum D-xylose levels will be low)

This test measures the absorptive capacity of the small intestine, therefore it is helpful in diagnosing celiac disease (note: bacterial overgrowth can cause false positive results b/c of sugar fermentation)

26
Q

What drug is useful for nausea as a result of gastroparesis?

A

Motilin receptor agonist (Erythromycin)

27
Q

What dermatological finding is associated w/ primary biliary cirrhosis?

A

Xanthelasma (soft yellow plaques on medial aspect of eyelid bilaterally) and pruritis

28
Q

What are the features of niacin deficiency?

A

Pellagra: 3 D’s, dermatitis, diarrhea, dementia

Also, general weakness, irritable, vomit, ab pain, loss of appetite

29
Q

What are the most common causes of acute pancreatitis?

A 
#1 - gallstones (biliary pancreatitis) and alcohol consumption
-Hypertriglyceredemia, recent ERCP
30
Q

What test should be done on patient’s w/ acute pancreatitis and no prior history of alcohol use?

A

RUQ ultrasound to look for gallstones (better than CT, in which often gallstones won’t appear)

31
Q

What are the causes of small intestinal bacterial overgrowth? How can you diagnose?

A
  1. Anatomical abnormalities (strictures, surgeries)
  2. Motility disorders (diabetes, scleroderma)
  3. Chronic dz (ESRD, AIDS, cirrhosis, old age)

Dx: Endoscopy -> jejunal aspirate showing >10^5 organisms & glucose breath Hydrogen testing

32
Q

How can you diagnose irritable bowel syndrome (IBS)?

A

Rome criteria : Chronic abdominal pain (>= 3days/month for at least 3 months) and >= 2 of the following; improved w/ bowel movement, change in frequency of stool, change in form of stool

33
Q

What clinical signs are consistent w/ fulminant helpatic failure and which patients are prone to it? What is the treatment?

A

-Hepatic encephalopathy w/in 8 weeks of acute liver failure
-Heavy users of Acetaminophen, Alcohol, or Meth
Tx: Liver transplant ASAP (FHF has >80% mortality rate)

34
Q

What would you find on esophageal manometry in diffuse esophageal spasm?

A

Multiple contractions on lower and middle esophagus tracings –> causes severe non-cardiac chest pain

35
Q

What should be done in all elderly patients w/ microcytic anemia and generalized fatigue? (no matter what the other labs show)

A

Colonoscopy and endoscopy (MUST rule out carcinoma, or upper GI bleed; guaiac may be negative on one test and later +)

36
Q

What vitamin can patients become deficient in when they have Carcinoid syndrome and why?

A

Niacin; b/c tryptophan in cells is used up to make serotonin, resulting in less tryp available to make niacin/NAD

37
Q

What is angiodysplasia and what symptoms do patients usually present with?

A
  • AVMs of GI tract
  • often in patients >60yo
  • Anemia, painless GI bleed, ESRD, and murmur of Aortic Stenosis (turbulent flow through valve causes disruption of von Willebrand multimers
38
Q

How do you manage acute pancreatitis?

A

NPO, IV fluids, analgesics (non-absorbable Abx only given when local infection occurs - in 30% of acute necrotizing pancreatitis)

39
Q

What are hepatic adenomas commonly associated with?

A
  • OCP use

- elevated Alk Phos and GGT

40
Q

How do you differentiate Mallory Weiss from esophageal perforation?

A

Mallory Weiss is incomplete mucosal tear at GE jct, resulting in hematemesis

-Esophageal perforation leads to pneumomediastinum (Boerhaave Syndrome!!)

41
Q

What is the best diagnostic test for lactose intolerance?

A

Lactose Hydrogen breath test - patient’s ingest lactose and H2 is measured (elevated = bacterial carbohydrate metabolism)

42
Q

What is the proper management of someone who has ingested large quantities of a chemical compound?

A
  • Stabilize vital signs and start IV fluids
  • Serial CXR and AXR to assess for damage (e.g. perforation)
  • Upper GI endoscopy w/in 12-24 hrs to assess damage
43
Q

How do you treat MALT lymphoma in a patient who does not have involvement of surrounding nodes?

A
  1. H. Pylori may have role so first you give Omeprazole, clarithromycin and amoxacillin
  2. If this fails give ChemoTx (CHOP - cyclophos, adriamycin, vincristine, prednisone + or - bleomycin)
44
Q

How often should routine colonoscopy surveillance be done in patients with ulcerative colitis? Would they require prophylactic colectomy w/ ileal pouch?

A
  • Pts w/ UC at higher risk for colon cancer
  • After disease has been present for 8 years, do colonoscopy and repeat every 1-2 years
  • Resect colon if evidence of dysplasia
45
Q

What is used to treat primary biliary cirrhosis?

A
  • Ursodeoxycholic acid slows disease progression and improves symptoms
  • Methotrexate and colchicine show moderate benefit
  • Refractory, severe cases require Liver transplant
46
Q

What is Trousseau’s syndrome most often associated with and how does it present?

A

Associated w/ malignancy; most often pancreas then lung, prostate, stomach, colon

-Causes a hypercoaguable state leading to migratory superficial thrombophlebitis

47
Q

How can gastrinomas cause steatorrhea?

A

Increased acid production which inactivate’s proteins and enzymes in pancreatic juices

48
Q

What is a possible cause of dysphagia in a patient w/ history of GERD?

A

Esophageal stricture

49
Q

How can Zollinger-Ellinson syndrome lead to malabsorption/steatorrhea?

A

Excess stomach acid produced from gastrin secreting tumor inactivates pancreatic enzymes

50
Q

What is ursodeoxycholic acid used for?

A

Patients w/ symptomatic gallstones who are poor surgical candidates –> dissolves gallstones

51
Q

What classic clinical features are associated w/ splenic abscess? What are risk factors for this?

A

-Fever, leukocytosis, LUQ ab pain, left sided pleuritic chest pain (if left pleural effusion)
Risks: Infection (endocarditis) w/ hematogenous spread, sickle cell disease, HIV/immunosuppression, IV drug use, trauma

52
Q

What are the key features of disseminated gonococcal infection (gonococcemia)?

A

-Polyarthralgias, tenosynovitis, and painless vesiculopustular rash,

53
Q

What is hepatic hydrothorax? How do you treat?

A

Transudative pleural effusion as a complication of cirrhosis
Tx1: therapeutic thoracocentesis and salt restricted diet + diuretics
Tx2: Transjugular intrahepatic portosystemic shunt (if Tx1 fails)

54
Q

What is emphysematous cholecystitis?

A

Form of acute cholecystitis 2/2 infection of gallbladder wall w/ gas forming bacteria

55
Q

What dangerous complication can be the first presentation for IBD? How can you confirm? What do you want to avoid?

A

Toxic megacolon –> do Abd X Rays

-Colonoscopy risks perforation, do not do until stabilized

56
Q

How do you diagnose toxic megacolon?

A

Radiographic evidence of colonic distension + at least 3 of (fever >38C, HR >120, PMN leukocytosis >10.5k, Anemia) + at least one of (volume depletion, AMS, HoTN, electrolyte disturbance)

57
Q

What does the presentation of hypogonadism, arthtropathy, diabetes and hepatomegaly suggest?

A

Hemochromatosis

58
Q

What study is most useful for evaluating suspected diverticulosis, especially if bleeding occurs?

A

labeled erythrocyte scyntography and CT abd

USMLE STEP 2 (21 decks)

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