Alpa-MKSAP Flashcards
(108 cards)
1
Q
Name 3 medications that cause Pill Induced Esophagitis
A
Alendronate, quinidine, tetracycline, doxycycline, KCl, ferrous sulfate
2
Q
Eosinophilic Esophagitis
- Endoscopic finding
- How many eosinophils seen on high power field
- Treatment (Hint: first try…)
A
- Trachealization of esophagus, longitudinal furrows, luminal narrowing
- > 15 eosinophils
- Try 8 weeks of PPI for GERD Induced Esophagitis, then aerosolized topical glucocorticoid/prednisone
3
Q
Oropharyngeal Dysphagia:
Signs/Symptoms
Dx
A
Coughing
Choking
Nasal regurgitation
Dx: modified barium swallow/ videofluoroscopy
4
Q
Treatment for Candida albicans Esophagitis
A
PO fluconazole
5
Q
Treatment for CMV Esophagitis
A
Ganciclovir/Valganciclovir, ulcer Center Biopsy
6
Q
Treatment for HSV Esophagitis
A
Acyclovir, ulcer edge biopsy
7
Q
Surveillance for Barretts Esophagus
- No dysplasia
- Low grade dysplasia
- High grade dysplasia
A
- Repeat 3-5 years
- Repeat 6-12 months
- Repeat 3 months
8
Q
Name 3 Adverse Effects of PPI
A
- Increased infections (CAP & Cdiff) since acid balance changes
- Malabsorption
Magnesium, B12, Iron,
Calcium causing poor bone density - Chronic Atrophic Gastritis
- Sporadic fundic gastric polyps
9
Q
First line therapy for H pylori infection
Second line therapy for H Pylori infection
A
PPI + Clarithomycin + Amoxicillin
PPI + Clarithomycin + Metronidazole (PCN allergy)
PPI + Bismuth + Metronidazole + tetracycline
PPI + Levaquin + Amoxicillin
Note- always confirm eradication
10
Q
Mutation associated with Gastrointestinal Stromal Tumor (GIST)
A
KIT oncogene mutation
CD 117
11
Q
Name 5 medications that cause of Acute Pancreatitis
A
Furosemide, didanosine, mesalamine, HCTZ, Simvastatin, 6MP/AZA
12
Q
Name 3 infections that cause of Acute Pancreatitis
A
Mumps, Coxsackie B, CMV, Toxoplasmosis, HIV, Aspergillus, HSV, Varicella, Hepatitis B, cryptococcus
13
Q
How to diagnose microcalculi with pancreatitis
A
Increased aminotransferases & secretin enhanced MRCP
14
Q
Types And Differences of Autoimmune Pancreatitis
A
CT finding: pancreatic enlargement/ featureless border
Type 1 AIP: systemic, extrapancreatic involvement, increased IgG4
Type 2 AIP: duct centric chronic pancreatitis, normal IgG4, no extrapancreatic symptoms
15
Q
How to calculate Stool Osmotic Gap
A
290 - 2 (Stool Na+ Stool K+)
16
Q
Diagnosis And Etiology of Secretory Chronic Diarrhea
A
Large volume, doesn’t stop with fasting
Stool Osmotic Gap
17
Q
Ulcer found in the 2nd part of duodenum
A
Gastrinoma
18
Q
Diagnosis And Etiology of Osmotic Chronic Diarrhea
A
Stops with Fasting
Stool Osmotic Gap > 100
Carbohydrate Malabsorption (Lactose)
19
Q
Diagnosis And Etiology of Steatorrhea
A
> 14 grams of stool fat (on 100 gram fat diet)
Small Bowel Mucosal Disorders- Celiac Disease, Pancreatic insufficiency, small intestinal bacterial overgrowth, bile acid deficiency, lymphatic obstruction
20
Q
Lab tests for chronic Diarrhea
A
Fecal Fat Stool Osmotic gap Stool WBC Stool Calprotectin Stool lactoferrin
21
Q
HLA subtypes Celiac Disease
A
HLADQ2 & HLADQ8
22
Q
Signs/symptoms of Celiac Disease
A
Weight loss, stearrhoea, nutritional deficiency, iron deficiency anemia, Vitamin ADEK
Dermatitis Herpetiformis
23
Q
Disorders associated with celiac disease
A
Microscopic colitis
Lymphocytic gastritis
T cell Lymphoma
IBS-D
24
Q
Lab tests for Celiac Disease
A
IgA tissue transgluminase
Endomysial antibody
Deaminated Gliadin peptide
25
Biopsy results of Celiac Disease
Intraepithelial lymphocytes
Crypt elongation
Villous blunting/atrophy
26
Extra intestinal manifestations of IBS
```
Oral apthous ulcers
Arthalgias
Ankylosising spondylitis
Uveitis
Scleritis
Pyoderma gangrenosum
Erythema nodosum
```
27
What enzyme to check before starting IBD immunomodulators?
Check TPMT before AZA/6MP
28
What condition is associated with Ulcerative Colitis?
| Hint: Biliary structure
Primary Sclerosing Cholangitis
29
What serology associated with Ulcerative Colitis?
pANCA
30
Biopsy finding on Ulcerative Colitis
Continuous, superficial inflammation, ulceration, edema
31
Biopsy finding on Crohn's Disease
Transmural, apthous ulcers, deep ulcers, cobblestoning, granuloma, skip lesions
32
What serology associated with Crohn's Disease?
ASCA + NOD2CARD15
33
Adverse Effect associated with Nalalizumab
PML
| Check for JC virus
34
2 types of microscopic colitis
1. Lymphocytic
| 2. Collagenous
35
Stepwise treatment of microscopic colitis
1. Loperamide, diphenoxylate
2. Bismuth
3. Budenoside, 5-ASA, cholestyramine, anti TNF
36
What condition is associated with IBS-D?
Celiac Disease
37
Name 3 Modifiable Risk Factors for Colorectal Neoplasia
```
High dietary fat
Red meat
Low Fiber
Smoking
Obesity
DM type 2
Alcohol
```
38
Name 3 Non-Modifiable Risk Factors for Colorectal Neoplasia
Male, Older Age, Black, IBD, PSC, Hx of adenoma, acromegaly
39
Amsterdam Criteria II for Hereditary Nonpolyposis Colon Cancer (MMR deficiency)
3 or more relatives with cancer in HNPCC
2 generations
1 relative is 1st degree
1 before age of 50
40
Name 3 types of cancer that is associated with Familial Adenomatous Polyposis
(APC gene mutation)
Colorectal, duodenal, ampullary, gastric, hepatoblastoma, thyroid cancer
41
Diagnosis Criteria for Serrated Polyposis Syndrome
1. More than 5 Serrated polyps proximal to sigmoid
2. Having a serrated polyp and relative with SPS
3. More than 20 serrated polyps
Need yearly colonoscopy!
42
Indications for 3 year Post Polypectomy Surveillance
3-10 adenoma, > 10mm, villous, high grade dysplasia, traditional serrated adenoma
43
Serology for Active Hepatitis B
+ surface antigen
+ e antigen
+ core IgM
Will resolve in 6 months, follow LFTs
44
Serology for Naturally Immune Hepatitis B
+ surface antibody
| + core IgG
45
Serology for vaccinated Hepatitis B
+ surface antibody
46
Serology for Immune-tolerant Chronic Hepatitis B
> 1 million DNA
+ surface antigen
+ core IgG
+ e antigen
47
Serology for Immune-active Chronic Hepatitis B
> 10,000 DNA
+ surface antigen
+ core IgG
+ e antigen
Increased ALT
48
Serology for Immune-Control Chronic Hepatitis B
49
Serology for Reactivation Chronic Hepatitis B
> 10,000 DNA
+ surface antigen
+ core IgG
+ e antibody
50
First Line Treatment for Hepatitis B
Entecavir & Tenofovir
51
When to treat Hepatitis B?
| What is the goal?
Acute Liver Failure, abnormal ALT with DNA
52
Hepatitis B: when to screen for Hepatocellular Carcinoma
```
Cirrhosis
Asian male > 40
Asian female >50
African >20
Family Hx
High ALT with DNA >10,000
```
53
What is the goal of treatment for Hepatitis C?
Sustained Virologic Response
| Undetectable RNA 6 months after treatment
54
How to calculate Maddrey's Discriminant Function
| What value do you treat Acute Alcoholic Hepatitis
4.6 ((PT- control PT) + total bilirubin)
| >32
55
Name 3 Contraindications for giving Prednisolone for Acute Alcoholic Hepatitis
Infection, variceal bleed, AKI
56
Serology associated with Autoimmune Hepatitis
Serum IgG
ANA
Antismooth muscle
57
How to treat Autoimmune Hepatitis
Glucocorticoid
| Azathioprine
58
Non acetaminophen related Acute Liver Failure with grade I-II hepatic encephalopathy will benefit from what therapy?
NAC
59
Serology with Wilson Disease
decreased Alk Phos, decreased ceruloplasmin, urine copper > 250 over 24 hours
60
Primary Biliary Cirrhosis: immune mediated destruction of small intralobular bile ducts
Dx & Tx
Dx: + Antimitochondrial antibody test
Tx: Ursodiol will slow disease progression
61
Cancer associated with Primary Sclerosing Cholangitis
| How to screen for it?
Cholangiocarcinoma
| CA 19-9 and imaging every 1 year
62
When do you start colorectal screening in IBD patient?
8-10 years after diagnosis, then ever 1-2 years
| If Crohn's disease or UC affecting more than rectum
63
When to start screening in Hereditary Nonpolyposis Colon Cancer?
Colonoscopy every 1-2 years starting at age 20
| EGD every 2-3 years starting at age 30
64
How to diagnose Hepatitis E? What regions is it found in?
HEV IgM
| India/Asia, Central America
65
2 Big causes of Portal Hypertension
1. Cirrhosis
| 2. Portal Vein Thrombosis in Budd Chiari Syndrome
66
How often to screen for esophageal varicies in a cirrhotic patient?
Every 3 years
67
Name 5 precipitants for Hepatic Encephalopathy
Alcohol, Benzodiazepines, Opioids, Hypoxia, Electrolyte Abnormality, Infection, GI Bleed, TIPS
68
Diagnose Hepatopulmonary Syndrome
Platypnea/Orthodeoxia- decreased O2/SOB while upright
Arterial Oxygen tension 15
Intrapulmonary shunting on Echo (agitated saline)
Tx: O2 and transplant
69
Diagnose Portopulmonary Hypertension
Essentially pulmonary hypertension with chronic liver disease
Check TTE, RV systolic pressure > 50
Tx: Prostacyclin analogue, endothelian antagonists, phosphodiesterase inhibitor
70
How much albumin to give if large volume paracentesis?
8 grams of 25% albumin for each liter removed
71
Indications to give Albumin in SBP
Creatinine > 1, BUN > 30, Bilirubin > 4
72
Hepatorenal syndrome
If creatinine > 1.5, lack of response to albumin challenge (1 gram/kg/day for 2 days), and no other explanation of AKI
73
Specific Type of Food to avoid if you are cirrhotic
Oysters/Shellfish for Vibrio Vulnificus
74
What does Focal Nodular Hyperplasia look like on imaging?
Arterial phase enhancement with central star
| Unless symptomatic, who cares
75
What hormone makes Hepatocellular Adenoma bigger?
ESTROGEN!
76
If this proto-oncogene is present in Hepatocellular Adenoma, there is more concern for malignancy potential?
Beta-catenin nuclear reactivity
(May need surgical resection or radiofrequency ablation
if tumor > 5 cm or positive for beta-catenin
77
What does Hepatic Hemangioma look like on imaging?
Peripheral nodular enhancement filling in toward center of lesion in later phases
No estrogen dependence or malignancy potential
Only if > 10 cm or symptomatic, who cares
78
What organism causes hepatic amebic cysts? How do you treat it?
Entamoeba histolytica
Tx: Metronidazole
Will see right hemidiaphragm elevation
79
How to treat Chronic Portal Vein Thrombosis?
You don't! Hah
80
What is Budd Chiari Syndrome?
Obstruction of Hepatic Venous Outflow by Thrombus
81
Most common cause of upper GIB?
PUD
82
What the hell is Dieulafoy Lesion?
Large tortuous submucosal arteriole in gastric cardia
83
What's a low risk ulcer?
| How do you treat it?
Clean Base, flat pigmented spot
| Give PO PPI
84
What's an intermediate risk ulcer?
Adherent Clot
85
What's a high risk ulcer?
| How do you treat it?
Arterial spurting or visible blood vessel
| IV PPI for 72 hours!
86
Most common cause of lower GIB?
Diverticulosis
87
Most common cause of obscure GIB?
Angiodysplasia
88
What is the bleeding rate detected Technetium Labeled Nuclear Scan?
0.1-0.4 mL/min
89
What is the bleeding rate detected Angiography?
> 0.5 mL/min
90
3 Different Types of Endoscopy (that go further)
1. Push Enteroscopy- you can advance beyond ligament of treitz into jejunum
2. Spiral Enteroscopy
3. Balloon Assisted Enteroscopy
91
When do you screen for colon cancer in patient with crohns or Ulcerative colitis?
8 years after diagnosis and then Q1-2 years afterwards
92
When do you screen patients with familial adenomatous polyposis syndrome for colon cancer?
Annually starting at age 12 with sigmoidoscopy and then at age 16 switch to colonoscopy.
If find polyp - consider colectomy
93
How often do you screen Adenomas > 1 cm?
Screen every 3 years
94
How often do you screen patients with >4 total Adenomas ?
Screen every 3 years
95
How often do you screen patients with villous Adenomas?
Screen every 3 years
96
Name three MEDICATIONS that can theoretically decrease the risk of colon cancer
Aspirin > 20 years
Celecoxib (NSAID)
Sulindac (NSAID)
Estrogens
97
Malignancy potential of hyper plastic polyps?
None.
98
Which gene is mutated in familial adenomatous polyposis? Which chromosome is it on?
APC gene
| (Adenomatous polyposis coli gene) on chromosome 5q
99
Lady with Lynch syndrome found to have adenomatous polyps - what is next screening test?
Transvaginal ultrasound to rule out ovarian cancer
100
Colon cancer Screening for patients with hyperplastic polyps.
Colonoscopy every 10 years
OR
FIT testing annually PLUS
Sigmoidoscopy every 5 years
101
Work up of unexplained iron deficiency anemia in a man or postmenopausal woman
EGD if 50
102
How often do you screen patients with Adenomas
Screen every 5-10 years
103
When to screen patients with tubular Adenomas >1 cm or multiple tubular Adenomas
Screen every 3 years
104
Obstructive colon cancer s/p removal with pre op colonoscopy void of other lesions - how often you repeat colonoscopy and CEA
Colonoscopy every 1 year then 3 years then 5 years if all return normal.
CEA every 3-6 months X 2 years then every 1 year X 5 years
105
Consider d/c colonoscopies at what age?
Age 75
But if patient still very active and healthy co side stopping instead at age 85
106
When to screen patient with HNPCC
Screen 10 years earlier than youngest HNPCC relative or at age 25 whichever is earlier with colonoscopy q2 years till 40 then annually after
107
Treatment of anal canal mucosa cancer
External beam RT
5FU
Mitomycin
108
Treatment of anal margin cancer
Local excision
