Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM III Final > GI CIS > Flashcards

GI CIS Flashcards

1
Q

Describe type of bleeding associated with hemorrhoids

A

Painless bleeding, usually associated with BM, coats the stool at end of defecation. Blood may drip into toilet or stain toilet paper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe type of bleeding associated with anal fissures

A

Small amount on toilet paper or surface of stool; usually dx on history of tearing pain with passage of BM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe type of bleeding associated with diverticula

A

Painless, profuse bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which is more likely to exhibit hematochezia — UC or crohns?

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe presentation of infectious colitis

A

Similar clinical presentation and endoscopic appearance of UC; excluded with stool and tissue cultures, stool studies, and on biopsies of the colon (EHEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What condition may present as abdominal pain followed by profuse hematochezia?

A

Ischemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T/F: polyps are typically symptomatic and result in intermittent large amounts of bleeding

A

False, they are typically asymptomatic and most often detected by colon cancer screening tests as occult bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe type of bleeding associated with proctitis

A

Insidiously with intermittent rectal bleeding, passage of mucus, and mild diarrhea associated with fewer than 4 small loose stools per day (like mild UC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe type of bleeding associated with rectal ulcers

A

Can present with bleeding, passage of mucus, straining during defecation, and sense of incomplete evacuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Important hx and PE points to ask/perform on GIB patient

A

Prior episodes of GI bleeding?
Chance of pregnancy in females
PMH of IBD, cancer, CV dz, diverticulosis, PUD
Medications — ask about NSAIDs, ACs, antiplatelet agents

PE: assess hemodynamic stability, general exam, CV, skin, abdominal, DRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is smoking related to IBD?

A

Stopping smoking is risk factor for UC

Starting smoking is risk factor for Crohns, continued smoking = poorer prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

BUN:Cr ratio seen in upper GIB

A

30:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AST:ALT ratio in alcoholic

A

2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anatomical division of an upper GIB vs lower GIB

A

Ligament of Treitz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recognize what abruptly stopping a beta blocker can lead to

A

Rebound sinus tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How fast can KCl be given through a peripheral IV?

A

10 mEq/hr (otherwise it is irritating the vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How many g/dL would you expect the Hgb to rise from 1 unit of PRBCs?

A

1g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Primary tx for acute IBD flare

A

Corticosteroids (IV or PO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Condition often seen with IBD characterized by red nodular areas on shins

A

Erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Initial management of acute lower GIB

A

Supportive: IV access, admit to appropriate setting, O2, IVF, blood products, assessment/management of coagulopathies

In cases of ongoing bleeding or high risk features: colonoscopy should be done w/i 24 hours of presentation after adequate colon prep (typically 4-6 L polyethylene glycol — may require NG tube)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Considerations for blood transfusion with PRBCs (type and screen vs. type and cross), what are Hgb requirements of special pt populations?

A

First type and screen in Hgb is stable and no acute bleed

Type and cross for young pts without comorbidities (may not require transfusion until Hgb <7), older pts who have severe comorbid conditions like CAD require Hgb of >9

Obtain iron studies if desired BEFORE transfusion, otherwise inaccurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F: pts with active bleeding and hypovolemia may require transfusion even if they have a normal Hgb

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diagnostic test for GIB that is noninvasive, sensitive to low rates of bleeding, and can be repeated for intermittent bleeding, BUT it has to be performed during active bleed, has poor localization, not therapeutic, and not widely available

A

Radionuclide imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnostic test for GIB that is noninvasive, accurately localizes bleeding source, provides anatomic detail, and is widely available; BUT it has to be performed during active bleeding, is not therapeutic, and may require IV contrast+radiation exposure

A

CT angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diagnostic test for GIB that accurately localizes bleeding source, therapy possible with super-selective embolization, and does not require bowel prep; BUT has to be performed during active bleeding and has potential for serious complications

A

Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pros and cons to colonoscopy

A

Pros: precise dx and localization regardless of active bleeding or type of lesion; endoscopic therapy is possible

Cons: need colon prep for optimal visualization, risk of sedation in acutely bleeding pt, definite bleeding source (stigmata) infrequently identified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complications/risks in pts with UC

A

Toxic megacolon (emergency — surgery for colectomy)

Primary sclerosing cholangitis (M>F)

Ankylosing spondylitis

Pyoderma gangrenosum

28
Q

Complications/risks in crohns

A

Fistulas/strictures

Fissures

Pigmented gallstone formation

Malabsorption

Kidney stones

29
Q

Complications seen with BOTH UC and crohns

A

Colon cancer, DVT

30
Q

Signs of retroperitoneal hemorrhage on PE

A

Cullen sign — periumbilical ecchymosis

Grey turner sign — flank ecchymosis

31
Q

American cancer society guidelines for colorectal cancer screening for ppl at average risk

A

Start regular screening at age 45, continue through age of 75

For people age 76-85, base decision on person’s preferences, life expectancy, overall health, and prior screening hx

People over 85 should no longer get screened

32
Q

Recommended colorectal cancer screening for first-degree relative with colorectal cancer or adenomas dx at age <60 or two first-degree relatives dx at any age

A

Begin colonoscopy at age 40 or 10 years before age of youngest affected relative, repeat q5y

33
Q

Recommended colorectal cancer screening for first-degree relative with colorectal cancer or adenomas dx at age >60y or two second degree relatives with colorectal cancer

A

Same options as average risk, but begin at age 40

34
Q

Recommended screening for pts with FAP

A

Refer for genetic testing or annual screening by sigmoidoscopy beginning at age 10-12

35
Q

Recommended screening for pts with HNPCC

A

Refer for genetic testing, or colonoscopy every 1-2 years beginning at age 20-25 years, or 10 years younger than youngest age of colorectal ca dx in family

36
Q

Frequency of gFOBT screening for colorectal cancer

A

Every year

37
Q

FIT is a colorectal cancer screening used annually just like gFOBT, which one is more accurate?

A

FIT

38
Q

What stool-based colorectal cancer screening method can be done every one or three years?

A

FIT-DNA

[specificity is lower than for FIT, resulting in more false-positive results, more diagnostic colonoscopies, and more associated adverse events; improved sensitivity compared with FIT per single screening test]

39
Q

Direct visualization tests for colon cancer and the frequency with which they must be done

A

Colonoscopy = GOLD STANDARD — every 10 years if normal

CT colonography = q5y

Flexible sigmoidoscopy = q5y

Flexible sigmoidoscopy with FIT = flex sig q10, with FIT every year

40
Q

UC or Crohns?

Mucosal lesions

A

UC

[crohns is transmural]

41
Q

UC or Crohns?:

Anywhere along GI tract with most common site being TI

A

Crohns

[UC most common in rectum]

42
Q

UC or Crohns?:

ASCA positive

A

Crohns

[UC is pANCA positive]

43
Q

Which type of IBD has skip lesions, non-caseating granulomas, and creeping fat?

A

Crohns

44
Q

Which type of IBD commonly has bloody diarrhea and crypt abscesses?

A

UC

45
Q

Methods for DVT prophylaxis in IBD pts

A

SCDs
TED hose (compression stockings)
Anticoagulation
Early ambulation

46
Q

Before starting an immunomodulatory or biologic medication, what should be checked?

A

TPMT enzyme activity (before azathiopurine)

PPD skin test or Quantiferon gold (+/- CXR) — checks for TB

Viral hepatitis serology

47
Q

Abdominal aortic exam

A

Press firmly deep into upper abdomen, slightly to left of midline, and identify aortic pulsations

In pts 50+, assess width by pressing deeply in upper abdomen with one hand on each side (nml is not more than 3 cm wide)

Ease of feeling aortic pulastions varies greatly with the thickness of the abdominal wall and with the anteroposterior diameter of the abdomen

48
Q

IV order for SL

A

Saline lock — not hooked up to any infusion, flushed with saline and then locked

49
Q

IV order for HL

A

Heparin lock, not hooked up to any infusion, flushed with heparin and then locked

50
Q

IV order for KVO

A

Keep vein open, hooked up to infusion at slow rate (~30 cc/hr)

51
Q

Maintenance rate for IVF

A

IVF at NS 125 cc/hr

52
Q

IVF orders for rapid re-hydration

A

IVF at NS 1 liter bolus

53
Q

What patients might refuse blood products?

A

Jehovah’s witness

54
Q

Chapmans reflex lateral, proximal 1/5th of right high, anteriorly on tensor fascia lata

A

Cecum

55
Q

Chapmans point on right lateral middle 3/5ths of thigh, anterior distribution of IT band

A

Ascending colon

56
Q

Chapmans point proximal to knee, anterolateral aspect of thigh bilaterally

A

Transverse colon

57
Q

Chapmans point lateral, proximal 1/5th of left thigh, anteriorly on tensor fascia lata

A

Sigmoid colon

58
Q

Anterior chapmans point left lateral middle 3/5ths of thigh, anterior distribution of IT band

A

Descending colon

59
Q

Chapmans point medial aspect of proximal thigh over lesser trochanters bilaterally

A

Rectum

60
Q

Posterior chapmans point transverse process L2 to transverse process L4, extending laterally to iliac crest

A

Colon

61
Q

Posterior chapmans point - sacrum at lower end of SI articulation bilaterally

A

Rectum

62
Q

Collateral ganglia inhibition at superior and inferior mesenterics = relevant regions for ______ _____ (condition)

A

Ulcerative colitis

63
Q

Normal bowel sound frequency

A

5-34 clicks/min

Abnormal is high pitched, decreased, or absent

64
Q

Where should you hear dullness on percussion of abdomen?

A

Liver and spleen

65
Q

Expected liver span

A

6-12 cm at midclavicular line on R

66
Q

Expected spleen span

A

From ribs 6-10 at midaxillary line on L

67
Q

What is courvoisiers sign

A

Enlarged, nontender gallbladder secondary to pancreatic dz or cancer

PCM III Final (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions