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PCM III Exam 1 > CIS 2: GI Case > Flashcards

CIS 2: GI Case Flashcards

1
Q

Tearing pain w/ the passage of bowel movements, a small amount of blood on the TP or on surface of stool is indicative of?

A

Anal fissures

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2
Q

Abdominal pain followed by profuse bleeding is indicative of?

A

Ischemic colitis

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3
Q

During PE of someone with GIB what is the first thing that needs to be assessed/established?

A

Hemodynamic instability

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4
Q

What sign/sx is associated w/ blood volume loss of at least 15%?

A

Orthostatic hypotension or increase in HR of 20 bpm

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5
Q

What sign/sx is associated w/ blood volume loss of at least 40%?

A

Supine hypotension

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6
Q

What is a clinical finding associated with mild to moderate hypovolemia?

A

Resting tachycardia

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7
Q

What is the BUN:Cr ratio in an upper GI bleed?

A

30:1

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8
Q

Abruptly stopping a beta-blocker can lead to?

A

Rebound sinus tachycardia

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9
Q

How fast can KCl be given through a peripheral IV without being irritating to the vein?

A

10 mEq per hour

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10
Q

Giving 1 unit of PRBC’s should increase HgB by how much?

A

1 g/dL

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11
Q

Which skin manifestation is a common finding in those w/ IBD?

A

Erythema Nodosum

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12
Q

What is the initial management of an acute lower GI bleed?

A
  • Supportive: IV access
  • Appropriate setting (outpatient/inpatient/ICU)
  • O2 + IVF + blood products
  • Assessment and management of coagulopathies
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13
Q

In patients with ongoing lower GI bleeding or high-risk clinical features what needs to be performed and how soon?

A
  • Colonoscopy
  • Within 24 hrs of presentation after adequate colon prep
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14
Q

Prepping a resuscitated pt with lower GI bleed for colonoscopy requires 4-6 L of polyethylene glycol, which can be given how if the patient is not able to get the formula down on their own?

A

Nasogastric tube

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15
Q

What should be done first if considering blood transfusion w/ packed RBC’s in a pt with lower GI bleed that has stable hemoglobin and no acute bleed?

A

Type and screen

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16
Q

Young pts w/o comorbid illness may not require transfusion until the hemoglobin is at what level?

A

<7 g/dL

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17
Q

Older patients and those who have severe comorbid illnesses such as CAD require hemoglobin to stay above what level?

A

≥9 g/dL

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18
Q

Which patients may require a blood transfusion despite apparently normal levels of hemoglobin?

A

Pts w/ active bleed AND hypovolemia

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19
Q

If considering a blood transfusion, but need iron studies, when must they be taken?

A

BEFORE tranfusion because will be inaccurate afterwards

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20
Q

Which diagnostic imaging technique used for lower GIB is noninvasive, sensitive to low rates of bleeding and can be repeated for intermittent bleeding?

A

Radionuclide imaging

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21
Q

Which widely available diagnostic imaging technique used for lower GIB is noninvasive, accurately localizes bleeding source, and provides anatomic detail?

A

CT angiography

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22
Q

What are 4 potential serious complications of a patient w/ UC?

A
  • Toxic Megacolon (emergency surgery –> colectomy)
  • Primary sclerosing cholangitis (M>F)
  • Ankylosing spondylitis
  • Pyoderma gangrenosum
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23
Q

What are 5 potential complications or risks for someone with Chron Disease?

A
  • Fistulas/strictures
  • Fissures
  • Pigmented gallstones
  • Malabsorption
  • Kidney stones
24
Q

UC and Chron disease are both associated with an increased risk for what bleeding disorder?

A

DVT

25
Q

Retroperitoneal hemorrhage may be apparent on PE as the Cullen or Grey Turner Sign, describe the location for each.

A
  • Cullen = peri-umbilical ecchymosis
  • Grey Turner sign = flank ecchymosis
26
Q

Colorectal cancer screening should begin at what age in a healthy person w/ life expectancy >10 year?

Should continue until what age?

A
  • Begin at age 45
  • Until age 75
27
Q

At what age are people no longer screen for colorectal cancer?

A

over 85

28
Q

What is the recommended screening for colorectal cancer in pt w/ first-degree relative w/ colorectal cancer diagnosed at age ≤60 yo or two first-degree relatives at any age?

How often should they be screened?

A

Every 5 years beginning at age 40 or 10 years before the age of youngest affected relative (whichever is first)

29
Q

In pt w/ family history of FAP, they should be referred for genetic testing and a sigmoidoscopy should be performed starting at what age?

A

Age 10-12 yo

30
Q

In pt w/ family hx of HNPCC (aka Lynch) syndrome they should be referred for genetic testing and colonscopy should be performed how often and beginning at what age?

A

Every 1-2 yrs beginning at age 20-25 yo; or 10 years younger than youngest age of colorectal cancer dx in family

31
Q

What are the 2 stool based screening tests for colorectal cancer that can be done annually?

A
  • gFOBT
  • FIT
32
Q

Which stool based screening test for colorectal cancer has improved accuracy compared with FOBT and can be done with a single specimen?

A

FIT

33
Q

How often can you use FIT-DNA screen for colorectal cancer?

A

Every 1-3 years

34
Q

What is a pro and con of using FIT-DNA vs. FIT for screening of colorectal cancer?

A
  • Specificity is lower than FIT = more false positives, more diagnostic colonoscopies, and more associated AE’s per screening test
  • Improved sensitivity compared w/ FIT per single screening test
35
Q

What is the gold standard direct visualization screening test for colorectal cancer?

How often is it performed?

A

Colonoscopy every 10 years

36
Q

What are 2 direct visualization screening tests for colorectal cancer that can be done every 5 years?

A
  • CT colonography
  • Flexible sigmoidoscopy
37
Q

Which form of IBD shows non-caseating granulomas on histology?

A

Chron’s

38
Q

What are 4 prophylactic treatments for DVT’s?

A
  • Sequentiall compression stockings/devices (SCDs)
  • TED hose (compression hose)
  • Anticoagulation
  • Early ambulation
39
Q

Before beginning tx w/ azathiopurine what needs to be checked?

A

TPMT enzyme activity

40
Q

Before starting an immunomodulatory or biologic medication to treat IBD what things need to be checked?

A
  • PPD skin test for Quantiferon gold (+/- CXR) for TB
  • Viral hepatitis serology
41
Q

What are 4 risk factors for AAA?

A
  • Age >65
  • Hx of smoking
  • Male gender
  • First-degree relative w/ hx of AAA repair
42
Q

In pts >50 yo a normal aorta is no more than how many cm wide?

A

3cm wide (average, 2.5 cm)

43
Q

What 2 screening methods for AAA decrease mortality in male smokers 65 yo or older?

A

Palpation followed by US

44
Q

Rupture of an AAA is 15x more likely in an AAA of what size?

A

>4cm

45
Q

A periumbilical or upper abdominal mass w/ expansile pulsations that is 3cm or more wide suggests?

A

AAA

46
Q

What does it mean for an IV to be locked (i.e., saline lock or heparin lock)?

A

Not hooked up to any infusion, is flushed w/ saline or heparin and then locked

47
Q

What are the cc/hr of IVF of NS for maintenance?

A

125 cc/hr

48
Q

IVF at NS 1 liter bolus is used when what is needed?

A

Wide open, need rapid-rehydration

49
Q

What are 2 unacceptable treatments to someone who is a Jehovah’s witness?

A

1) Transfusion of allogenic whole blood, RBC’s, white cells, platelets, or plasma
2) Preoperative autologous blood donation (PAD or predeposit)

50
Q

Collateral ganglia inhibition of which 2 ganglia are relevant for UC?

A

1) Superior mesenteric ganglia
2) Inferior mesenteric ganglia

51
Q

Posterior Chapman’s point for colon?

A

TP of L2 to TP of L4, extending laterally to iliac crest

52
Q

Posterior Chapman’s point for Rectum?

A

Sacrum, at lower end of SI articulation bilaterally

53
Q

What is the expected span when palpating the liver and should be felt where?

A

6-12 cm at the mid-clavicular line on right

54
Q

What is the expected span of the spleen when palpating and where should it be felt?

A

From ribs 6-10 at the mid-axillary line

55
Q

Rebound tenderness is testing for what?

A

Peritoneal inflammation

PCM III Exam 1 (12 decks)

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