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ABIM-GI November 16th, 2022 > Endoscopy > Flashcards

Endoscopy Flashcards

1
Q

What is the incidence of DEATH from EGD?

A

1 in 10,000 patients (respiratory and cardiac - SEDATION)

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2
Q

Is RECENT MI a relative CONTRAINDICATION to EGD?

A

YES

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3
Q

What are some of the COMPLICATIONS that can be experienced from endoscopy using UNCLEAN SCOPES?

A

BACTEREMIA, PHLEBITIS, ASPIRATION PNA, ENDOCARDITIS

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4
Q

Esophageal DILATION and SCLEROTHERAPY carry a higher risk of what COMPLICATION?

A

BACTEREMIA

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5
Q

Which EGD perocedure carries the HIGHEST RISK for ASPIRATION PNA?

A

HIGH-VOLUME UGIB

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6
Q

Does ASPIRIN increase the risk of an UGIB during EGD?

A

NO

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7
Q

How can METHEMOGLOBINEMIA occur during EGD?

A

ORAL TOPICAL ANESTHESIA

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8
Q

What complication can occur in a patient with ASCITES undergoing esophageal variceal BANDING?

A

INFECTION of ASCITES

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9
Q

Colon PREPS using MAGNESIUM, SODIUM POHOSPHATE or MANNITOL can cause what issues?

A

TOXICITY in patients with** RENAL FAILURE** (especially in patients on ACE-I, ARBs and NSAIDs)

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10
Q

MANNITOL or LACTULOSE should NEVER be used for COLON preps, why?

A

Can cause EXPLOSIONS with ELECTROCAUTERY

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11
Q

What should be CONSIDERED in all patients undergoing endoscopic procedures who have PACEMAKERS and the potential use of ELECTROCAUTERY is there?

A

GROUNDING PAD AWAY from the HEART and pacemaker should be tuned OFF during procedure

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12
Q

How LONG after a **COLONIC POLYPECTOMY **can there be a procedure-related BLEED?

A

A FEW WEEKS

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13
Q

HIGHEST RISK of PERFORATION during a COLONOSCOPY occurs after what SURGERY?

A

HYSTERECTOMY (mostly in rectosigmid or junction of sigmoid and descending)

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14
Q

Colon PERFORATIONS due to AGGRESSIVE INUFFLATION occur where?

A

CECUM

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15
Q

What is the MISS rate on COLONOSCOPY for polyps >1 cm; < 5 mm?

A

> 1 cm - 6%
< 5 mm - 27%

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16
Q

Is the RISK of STROKE, MI or PE by stopping anti-thrombotic agents > than the risk of the BLEED that one is trying to manage endoscopcially?

A

Usually YES

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17
Q

What is an EMERGENCY option for the REMOVAL of the EFFECT of DABIGATRAN (PRADAXA) in a patient with an emergent profuse bleed?

A

HEMODIALYSIS (or IDARUCIZUMAB, a monoclonal antibody antidote)

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18
Q

What is the REVERSAL AGENT that can be used with APIXABAN (eliquis) and RIVEROXABAN (xarelto)?

A

ADNEXANET ALFA

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19
Q

What is the REVERSAL AGENT used when anticoagulation is on board with INR >2.5 and endoscopy is needed?

A

4-FACTOR PROTHROMBIN COMPLEX CONCENTRATE + Vit K or FFP

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20
Q

When is PROTAMINE used as the reversal agent for HEPARIN potentiated BLEED when endoscopy is needed?

A

LIFE-THREATENING BLEED

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21
Q

In a patient with a RECENTLY-PLACED VASCULAR STENT (< 1 year) or Acute Coronary Syndrome, on ANTICOAGULATION, what is done if ENDOSCOPY is needed?

A

CONSULTATION with the prescribing service

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22
Q

How should ANTICOAGULATION be RESUMED in a patient after endoscopy with HIGH RISK of REBLEED?

A

UNFRACTIONATED HEPARIN (short half-life)

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23
Q

What is done with a patient requiring endoscopy and who are on ANTIPLATELET AGENTS (clopidogrel)?

A

HOLD these until HEMOSTASIS is achieved

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24
Q

For patients with A-FIB associated with VALVULAR DISEASE, MECHANICAL heart valve, LVAD, history of CVA or CHF, CHADSVASC score >2, age >75, prior TIA or CVA, HTN or DM, what is the recommendation for those taking anticoagulation prior to elective ENDOSCOPY?

A

Use HEPARIN or LMWH BRIDGE (these are HIGH-RISK patients)

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25
Q

For patients with history of DVT, non-valvular A-FIB, BIOPROSTHETIC VALVES, what is recommended for those taking anticoagulation prior to elective ENDOSCOPY?

A

HOLD meds and RESUME post procedure, NO BRIDGING (LOW-RISK)

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26
Q

In a patient with a DRUG-ELUTING stent, ot a patient on DVT anticoagulation, what is the recommendation for ELECTIVE ENDOSCOPY?

A

WAIT until anticoagulation period is completed (12 months for the stents)

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27
Q

Do ASPIRIN and NSAIDs need to be stopped for ENDOSCOPIC procedures?

A

NO

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28
Q

What is the RECOMMENDATION for the THIENOPYRIDINES (clopidogrel, prasugrel and ticagrelor) prior to ENDOSCOPIC procedures?

A

For HIGH-RISK (of bleeding)procedures, HOLD these for 5-7 DAYS and switch to ASA monotherapy. For LOW-RISK procedures, these may be continued. These may be RESTARTED once endoscopic hemostasis is achieved.

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29
Q

What should be done with a GP IIb/IIIa (eptifibatide, tirofiban) infusion when a patient requires an EMERGENT endoscopic procedure for ACUTE GIB?

A

DISCONTINUE the infusion (if needed, platelet transfusion or DDAVP may be considered)

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30
Q

When can WARFARIN be restarted after an ENDOSCOPIC procedure?

A

ON THE SAME DAY if no ongoing bleeding

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31
Q

For RAPIDLY-ACTING (Novel Oral Anti-Coagulants) such as DABIGRATAN, APIXABAN and RIVAROXABAN, WHEN can these agents be restarted after ENDOSCOPIC procedures?

A

Once ADEQUATE HEMOSTASIS is ensured (no furtheer signs of bleeding) so 12-24 HOURS after and if not use HEPARIN BRIDGE 2-6 HOURS after the procedure. These are ALL RENALLY cleared.

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32
Q

If ANTITHROMBOTIC therapy MUST be restarted after an EMERGENT/URGENT endoscopic procedure, what is the SAFEST WAY to go?

A

IV UNFRACTIONATED HEPARIN (fast half-life)

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33
Q

HOW do you BRIDGE a patient for an ELECTIVE ENDOSCOPIC procedure with LMWH?

A

HOLD the WARFARIN for 5 DAYS and CONCOMITANTLY start the LMWH and DISCONTINUE the LMWH 8 HOURS before the procedure.

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34
Q

In which patients can you NOT use LMWH for BRIDGING for ENDOSCOPIC procedures?

A

PREGNANT WOMEN with MECHANICAL HEART VALVES (thromboses)

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35
Q

Are PROPHYLACTIC antibiotics for ENDOCARDITIS recommended for patients undergoing ENDOSCOPIC procedures?

A

NO

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36
Q

For WHICH endoscopic procedure is the SUGGESTION of PROPHYLACTIC antibiotics against ENDOCARDITIS, REASONABLE?

A

ERCP when CHOLANGITIS (E. coli) is suspected and HIGH-RISK patient (prosthetic heart valve, heart transplant, history of previous infectious endocarditis, and congenital heart conditions pre/post repair)

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37
Q

In patients considered for ERCP in which there is the suspicion of INCOMPLETE DRAINAGE - OBSTRUCTION, PSC, HILAR STRICTURES, HEPATIC TRANSPLANT, what is RECOMMENDED?

A

ANTIBIOTICS to cover GM-negatives and Enterococci

38
Q

What is the RECOMMENDATION for PROPHYLAXIS for EUS-FNA of CYSTIC lesions?

A

ANTIBIOTICS

39
Q

What is the RECOMMENDATION for PROPHYLAXIS for PEG procedures?

A

CEFAZOLIN 30 minutes BEFORE procedure

40
Q

What is the RECOMMENDATION for PROPHYLAXIS for ALL patients with CIRRHOSIS and ACUTE GIB?

A

IV CEFTRIAXONE or ORAL NORFLOXACIN

41
Q

Is ANTIBIOTIC PROPHYLAXIS recommended for synthetic vascular and non-valvular grafts or ORTHOPEDIC JOINT procedures prior to ENDOSCOPIC procedures?

A

NO

42
Q

What is the RECOMMENDATION for ANTIBIOTIC PROPHYLAXIS prior to COLONOSCOPY procedures for patients on CONTINUOUS PERITONEAL DIALYSIS?

A

1 g AMPICILLIN + one dose of an AMONOGLYCOSIDE with or without METRONIDAZOLE with EMPTYING of the ABDOMEN

43
Q

What is the RECOMMENDED CECAL intubation RATE for ENDOSCOPISTS?

A

>90% in ALL cases and > 95%in SCREENING in a HEALTHY adult - photo documentation should be obtained

44
Q

What is the RECOMMENDED ADENOMA DETECTION RATE (ADR) in colonoscopy for MEN and WOMEN?

A

MEN >30% & WOMEN >20% (>25% together)

45
Q

What is the RECOMMENDED SURVEILLANCE COLONOSCOPY FREQUENCY for a patient with a FIRST DEGREE RELATIVE who developed COLON CANCER BEFORE 60 YO and for one that developed it AFTER 60 YO?

A

BEFORE 60 YO - every 5 years
AFTER 60 YO- every 10 years

46
Q

What is the RECOMMENDED NEXT SURVEILLANCE COLONOSCOPY for a patient found to have a colonic ADENOMATOUS POLYP >2 cm which was removed in PIECEMEAL FASHION?

A

NEXT in 3-6 MONTHS then in 1 YEAR

47
Q

In a patient who has undergone CURATIVE SURGICAL RESECTION of a CANCER in the COLON or RECTUM, when is the RECOMMENDED NEXT COLONOSCOPY?

A

1 YEAR (then in 3 years, then every 5 years) or 3-6 months if obstructive colorectal cancer

48
Q

What is the ANTIDOTE for DABIGATRAN?

A

IDARUCIZUMAB

49
Q

What is the ANTIDOTE for BOTH APIXABAN and RIVAROXABAN?

A

ANDEXANET ALFA

50
Q

When are ANTIBIOTICS RECOMMENDED PRIOR to ERCP

A

ONLY if INCOMPLETE DRAINAGE is ANTICIPATED in spite of the ERCP (hilar stricture, PSC)

51
Q

For WHICH TWO EGD procedures is BACTEREMIA an 8% RISK?

A

BALLOON DILATION (perforation) and VARICEAL THERAPY (peritonitis and aspiration)

52
Q

What kind of CONSTRAST is used when SUSPECTING an ENDOSCOPIC PERFORATION?

A

WATER-SOLUBLE CONTRAST ONLY

53
Q

What is the 30-DAY MORTALITY RISK for PEG placement?

A

15%

54
Q

Sodium Phosphate and Mag Citrate colon preps can cause what?

A

EXACERBATE or INDUCE IRREVERSIBLE RENAL FAILURE

55
Q

Why are MANNITOL and LACTULOSE NOT used as COLON PREPS?

A

Cause EXPLOSIONS with CAUTERY

56
Q

What is the KEY to a good outcome POST ENDOSCOPIC PERFORATION?

A

EARLY RECOGNITION

57
Q

Patient becomes BLUE and CYANOTIC appearing but ALERT TALKING just after given MIDAZOLAM, SpO2 LOW but PaO2 is NORMAL?

A

METHEMOGLOBINEMIA - treat with METHYLENE BLUE IV (altered Hb Iron)

58
Q

After CAUTERY POLYPECTOMY, pt develops abdominal pain, mild FEVER, mild LEUKOCYTOSIS, NO FREE AIR, what happened?

A

TRANSMURAL BURN (no surgery, observe only)

59
Q

For what INR does a patient require anticoagulation REVERSAL prior to EGD with HEMOSTASIS?

A

INR >2.5

60
Q

What should be done with ANTICOAGULANTS (warfarin, heparin, factor Xa inhibitors, direct thrombin inhibitors) when treating a patient ENDOSCOPICALLY for HEMOSTASIS?

A

HOLD them to FACILITATE HEMOSTASIS

61
Q

For a patient on WARFARIN with SEVERE, LIFE-THREATENING BLEEDING, what MUST be done PRIOR to ENDOSCOPY?

A

4-FACTOR CRYOPRECIPITATE + Vit K or FFP

62
Q

What should be done PRIOR to DISCONTINUING ANTI-PLATELET therapy for ENDOSCOPIC procedures?

A

CONSULT PRESCRIBING PHYSICIAN BEFORE HOLDING (drug-eluting stent < 1 YEAR; bare metal stent < 30 DAYS; ACS < 90 DAYS

63
Q

How LONG should WARFARIN be HELD for prior to ELECTIVE ENDOSCOPY?

A

5 DAYS

64
Q

How LONG should DABIGATRAN (Pradaxa) be HELD for prior to ELECTIVE ENDOSCOPY?

A

1-3 DAYS (longer for decreased GFR - 4-6 days) - SAME with other NOACs

65
Q

VALVULAR A-FIB, MECHANICAL VALVE, H/O CVA, CHF, ChADsVAsc >2, LVAD, post-ACS, what is recommended for ANTICOAGULATION MANAGEMENT prior to ENDOSCOPY?

A

BRIDGING

66
Q

Pt has a POOR BOWEL PREP, when do you repeat colonoscopy?

A

WITHIN 1 YEAR

67
Q

Pt has a FAIR BOWEL PREP, when do you repeat colonoscopy?

A

5 YEARS

68
Q

Can a DIAGNOSIS of EOE be ENDOSCOPIC?

A

NO (histology only) - 15 eosinophils/hpf

69
Q

How is EOE treated?

A

Budesonide/Fluticasone and 2 MONTHS of PPI followed by repeat EGD with biopsies

70
Q

What is the RISK of BLEEDING of a NON-BLEEDING VISIBLE VESSEL (in an ulcer, etc.) WITHOUT medical INTERVENTION?

A

50%

71
Q

HIV patient with CANDIDA esophagus with an exophytic growth?

A

SQUAMOUS PAPILLOMA

72
Q

This is associated with an ABNORMAL PANCREATICO-BILIARY JUNCTION, abdominal PAIN and abnormal ERCP with long COMMON CHANNEL?

A

TYPE-I choledochocele (high-risk for CHOLANGIOCARCINOMA) - SURGERY

73
Q

ODYNOPHAGIA, ESOPHAGEAL LESIONS, MULTINUCLEATED GIANT CELLS (histology), WHERE DO YOU BIOPSY?

A

BORDER BIOPSY - HSV (NOT CENTER - CMV)

74
Q

ODYNOPHAGIA, ESOPHAGEAL LESIONS, OWL EYES (histology), WHERE DO YOU BIOPSY?

A

CENTER of ULCER (CMV) - not border as in HSV

75
Q

Incidental finding in ESOPHAGUS with ASYMPTOMATIC enlarged WHITISH plaques noted also in COWDEN’s SYNDROME, biopsies show ENLARGED SQUAMOUS CELLS with ABUNDANT CYTOPLASM, what is the TREATMENT?

A

GLYCOGENIC ACANTHOSIS - no treatment needed

76
Q

When the PANCREATIC DUCT is of what SIZE is SURGICAL EXCISION of an IPMN RECOMMENDED?

A

> 10 mm

77
Q

A patient with UC and PSC has an INCREASED RISK of what CANCERS?

A

COLON CANCER and CHOLANGIOCARCINOMA

78
Q

SPINDLE CELLS, CD117 POSITIVE?

A

GIST

79
Q

EUS: SUBMUCOSAL HYPERECHOIC GASTRIC LESION?

A

LIPOMA

80
Q

EUS: SUBMUCOSAL HYPOECHOIC GASTRIC LESION arising from MUSCULARIS PROPRIA, SPINDLE CELLS and CD177?

A

GIST

81
Q

SERRATED POLYPOSIS SYNDROME, what is recommended SURVEILLANCE?

A

EVERY 1 YEAR

82
Q

SESSILE SERRATED POLYPS < 1 cm WITHOUT DYSPLASIA, what is the recommended SURVEILLANCE?

A

EVERY 5 YEARS

83
Q

For SESSILE SERRATED POLYPS > 1 cm OR ANY SIZE with DYSPLASIA or TRADITIONAL SERRATED ADENOMA, what is the recommended SURVEILLANCE?

A

EVERY 3 YEARS

84
Q

What can cause HEMOSUCCUS PANCREATICUS (hemorrhage from the pancreatic duct)?

A

Contrast-enhanced CT or Angiography - PANCREATITIS with SPLENIC ARTERY PSEUDOANEURYSM

85
Q

**Is PSEUDOMALANOSIS DUODENI caused by laxative use as in melanosis coli? How is it treated?

A

NO, it is caused by macrophage uptake of blood, NO TREATMENT NEEDED

86
Q

How do you treat ENTEROBIASIS (pinworms in colon)?

A

MEBENDAZOLE or ALBENDAZOLE

87
Q

A patient with ISOLATED GASRTIC VARICES (fundus) are liekly due to SPLENIC VEIN THROMBOSIS caused by what condition?

A

PANCREATITIS - Do ABD CT (not TIPS)

88
Q

Like esophageal varices, these VARICES are also caused by PORTAL HTN, they can cause MASSIVE BLEEDING and are TREATED how?

A

RECTAL VARICES (beta-blockers + TIPS)

89
Q

Raised **WHITE VERRUCOUS LESIONS **in RECTUM on RETROLFEXION?

A

CONDYLOMA ACCUMINATA - HPV

90
Q

Small MUCOSAL BUMPS in DISTAL ILEUM?

A

LYMPHOID HYPERPLASIA - BENIGN

ABIM-GI November 16th, 2022 (8 decks)

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