Diagnostics Flashcards Preview

GI > Diagnostics > Flashcards

Flashcards in Diagnostics Deck (102):
1

what virus commonly found in daycare is less common now that there is a vaccine?

rotavirus

2

your patient has been hospitalized for 5 days, will their sample work for stool cultures?

nope, rejected if hospitalized >3 days

3

blunt abdominal trauma imaging

focused assessment with sonography for trauma (FAST)
(at bedside)

4

you suspect a mid GI bleed. what imaging could you use to investigate?

enteroscopy

5

HBV DNA in serum is bound to _____. is it typically infectious?

IgG, rarely infectious

6

imaging modality of choice for pancreatitis?

CT (esp in urgent/emergent)

7

what can you use to visualize the whole dang small intestine?

push enteroscopy (but still difficult AF due to tortuosity of intestines, balloon-assisted endoscopy facilitates)

8

what lab test should all pts with HCV infection undergo prior to tx

quantitative NAT with HCV genotyping

9

which liver enzyme is more specific for hepatocellular injury

ALT (more than AST)

10

total bilirubin can be elevated due to what 3 things

1. overproduction of bilirubin (hemolysis)
2. impaired uptake, conjugation, or excretion of bilirubin
3. backward leakage from damaged hepatocytes or bile ducts (hepatitis, autoimmune, drugs, obstruction)

11

what does the presence of IgM anti-HAV indicate?

acute infection - hep a

12

what is first line colorectal cancer screening test?

colonoscopy

13

what might you see on imaging for diverticulitis?

stranding, wall thickening, wall enhancement

14

how is hep D diagnosed?

presence of anti-HDV or HDV RNA in serum

15

what abnormalities might you see on an abdominal xray?

air, fluid, radiopacities (FB or calcifications)

16

compared to HBeAg, anti-HBe tells you what?

indicates less viral replication and infectivity

17

describe the antibody/antigen situation in a patient who has a vaccination against Hep B

HBsAg neg, Anti-HBs pos, Anti-HBc IgG neg, HBeAg neg, Anti-HBe neg

18

imaging of choice for appendicitis?

CT (usually without contrast) imaging

but if chronic, consider contrast

19

you should only order bacterial culture & sensitivity stool studies if (3)

1. diarrhea >1 week or recurring
2. sxs of dysentery (fever, blood, tenesmus)
3. high-risk host or public health concern

20

what is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis, and cholecystitis?

GGT

21

can you perform a flex sig on a pt with diverticulitis?

heck no

22

your patient has iron deficiency anemia and you suspect GI bleed. what dx imaging should you use?

colonoscopy

23

hep C Ab indicates

present or resolved infection

24

what should you do after you place an NG tube?

get an xray! (prior to putting anything through it)

25

two modes of imaging for cholecystitis?

common finding?

ultrasound

Murphy's sign (US)

26

turtle shells on an xray indicate

trapped fluid in dilated loops of bowel -- air fluid levels

27

do you test for c diff in asymptomatic patients?

nope

28

what is urea breath test particularly helpful for?

diagnosis and documenting successful treatment of H. pylori

(same for stool antigen)

29

what is the gold standard for small bowel (tumors, bleeding) visualization?

video capsule endoscopy

30

hyper-unconjugated bilirubin is defined as

<15-20% of total bilirubin is direct

31

when do you use a diagnostic peritoneal lavage

trauma, hemorrhage, ruptured intestine

32

will PT be increased or decreased in a patient with liver disease

increased (once CFs drop to 30-40% normal levels)

33

first study used for jaundice

US

34

what technique combines contrasted radiography with endoscopy to look at bile and pancreatic ducts?

ERCP

35

MC cause of ascites

portal hypertension resulting from cirrhosis

decreased plasma protein synthesis by the liver results in decreased colloid osmotic pressure
results in primarily water leaking into the peritoneal space (transudate)

36

what is SAAG

serum albumin level : ascitic fluid albumin level; tells you if portal hypertension is present

37

what does ERCP look at?

pancreatic and biliary ducts

38

apple core sign associated with what?

colon tumor seen on barium enema

39

when would you want to see the small intestine with enteroscopy

when you suspect mid-GI bleeding

40

what parallels HBeAg but is more sensitive and precise marker of viral replication and infectivity?

HBV DNA

41

high SAAG >1.1 indicates

portal hypertension

42

which pancreatic enzyme is highly specific to the pancreas?

lipase

43

do you test for cured c diff?

nope

44

when is paracentesis indicated? (3)

1. eval of new ascites
2. suspected bacterial peritonitis
3. therapeutic large-volume paracentesis

45

what do you need to tell a patient about their diet before a fecal fat study?

high fat diet for 3 days before and through collection

46

what parasite should you think of in HIV positive and sporadic water-related outbreaks?

cryptosporidium

47

HBeAg is found only in HBsAg positive serum soon after its detection and tells you what

presence indicates viral replication and infectivity

48

you suspect your patient has swallowed a foreign body. what imaging might you first obtain?

chest and upright abdominal film

49

describe the antibody/antigen situation in a patient who has recovered from Hep B

HBsAg neg, Anti-HBs pos, anti-HBc IgG pos, HBeAg neg (anti-Hbe can be pos or neg)

50

can you use flexible sigmoidoscopy in patients with diverticulits?

nope

51

what appears with anti-HBc IgM but persists?

anti-HBc IgG

52

does albumin drop slowly or quickly with acute problems

slowly

prealbumin drops quickly when deprived of protein/calories

53

what imaging modality can be used as a screening in trauma?

U/S (FAST)

54

is an elevated amylase or lipase alone wo clinical signs pancreatitis

no way

55

what 3 types of lesions can be seen on a liver?

1. cystic
2. hypervascular
3. tumor (primary v metastatic)

56

what should you think of in travelers to Latin America and HIV positive?

cyclospora

57

how many negative
EIA toxin tests do you need to rule c diff out?

3 specimens on 3 different days

58

how is rotavirus detected?

ELISA or latex agglutination

59

most common c diff testing

EIA testing for toxins A and B (uses antibodies)

60

what dx imaging are you going to use to evaluate jaundice?

ERCP

61

routine stool culture screens for what 3 MC bacterial pathogens implicated in diarrhea?

salmonella, shigella, campylobacter

62

what is most often used for staging colon ca?

usually CT

MRI does have increasing sensitivity

63

hep G is associated with extensive exposure to what?

blood products

64

which liver enzyme is present in high amounts in heart and skeletal muscle?

AST

65

gold standard for imaging AAA

CT angiogram

66

what imaging can you use to differentiate between acute and chronic cholecystitis?

HIDA

...but you're not really getting this if the patient is acute

67

what point can an EGD not visualize beyond?

ligament of Treitz

68

what types of viral hepatitis are only acute? (never turn chronic)

A and E (acute starts with A, ends with E)

69

does HBcAg appear in serum

No

70

why type of endoscopy would be used for refractory GERD, esophageal varices, or upper GI bleed?

EGD (aka upper endoscopy)

71

what colitis is associated with antibiotics?

c diff

72

Anti-HBs is what

appears after clearance of HBsAg and after successful vaccination;
signals recovery fro HBV infection, noninfectivity, and immunity

73

what are two contraindications for ERCP?

acute pancreatitis, esophageal diverticula

(non acute pancreatitis okay)

74

HBsAg tells you what

first evidence of infection, persists throughout clinical illness; establishes infection and implies infectivity

75

what imaging tool for biliary tree eval can be both diagnostic and interventional?

ERCP (endoscopic retrograde cholangiopancreatography)

76

acute pancreatitis requires what features (two of three)

1. abdominal pain typical of acute pancreatitis
2. blood amylase and/or lipase >3x ULN
3. typical finding of pancreatic inflammation on contrast CT or MRI

77

what can be used to stage rectal, esophageal, and gastric cancer and identify pancreatic tumors?

endoscopic US

78

what is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis, and cholecystitis

GGT

79

invasive test of choice for helicobacter pylori

biospy urease

80

serology test for h pylori is helpful in what scenario?

to exclude h. pylori (does not distinguish between active and prior infection)

81

describe 2 major criteria for acceptable specimens for bacterial stool cultures

1. fresh (unpreserved) stool to lab in < 2 hrs
2. preserved specimen in <96 hours

82

diagnostic criteria for hep C

presence of anti-HCV by ELISA; may need confirmation with HCV RNA and anti HCV RIBA

83

imaging of choice for diverticulitis? why?

CT w IV contrast
concern for perforation

84

a disease that affects bilirubin metabolism after conjugation can be detected as

increased bilirubin in urine
(cholestasis, stones, obstructions)

85

indications for C diff testing

clinically significant diarrhea (>3 loose stools in 24 hrs) plus:
1. abx use in past 3 months
2. hospitalization, nursing home
3. advanced age

86

hepatitis D requires ?

coinfection with Hep B (specifically, presence of HBsAg)

87

Anti-HBc IgM appears soon after ____ and before _____

soon after HBsAg, before anti-HBs

88

how is norovirus detected?

RT- PCR
(only performed for epidemologic reasons)

89

what does presence of IgG anti-HAV indicate?

previous exposure to HAV, non-infectivity, & immunity

90

a general haziness or cloudy appearance of the abd indicates what?
what could be the etiology?

abnormal water shadows

etiologies: ascites, intra-abdominal bleeding, abscess, formation, etc

91

when will anti-HCV show up after exposure in acute hep C?

10 wk to 6 mo after exposure

92

are flexible sigs more or less effective than colonoscopies?

less

93

the MC cause of nosocomial diarrhea is

c diff

94

HCV RNA indicates

infection with HCV

95

when is a video capsule endoscopy used?

small bowel: tumors, obscure bleeding, polyposis syndromes, malabsorption syndromes, uncertain dx of Crohns

96

CDC recommends hep C screening for what populations?

1 time for adults born 1945-1965; also risk factors IVDU, tranfusion/organ transplant, recognized exposure

97

hyper-conjugated bilirubin is defined as

increased total bilirubin with >50% conjugated

98

if you suspect cryptosporidium, cyclospora, or giardia, what do you need to do?

communicate with lab; not tested on routine stool O and P

99

what is the primary modality for directly visualizing the GI tract?

endoscopy

100

can you do an EGD if the pt has esophageal diverticula or suspected perforation?

nope

101

string of pearls on xray indicates

small bowel obstruction

102

imaging for bowel obstruction

xray