Exam 1 Clinical DSAs Flashcards
(142 cards)
1
Q
Esophageal perf due to to a medical procedure (NG tube placement, ednoscopy)
A
Iatrogenic esophageal perf
2
Q
Esophageal perf due to retching, alcohol use, Boerhaave’s
A
Spontaneous esophageal perf
3
Q
Presents as chest pain, subcutaneous emphysema, Hamman’s sign (crunching sound when listening to heart)
A
GI life threatening chest pain:
Esophageal perf
4
Q
Angina, chest/epigastric pain, confirmed by ECG
A
Non-GI life threatening chest pain:
MI
5
Q
Sudden onset chest pain, SOB, hypoxia, hypercoaguable state, sinus tach on ECG
A
Non-GI life threatening chest pain:
PE
6
Q
Sudden onset chest/back pain, widened mediastinum on CXR, hypotension if popped
A
Non-GI life threatening chest pain:
Aortic dissection
7
Q
Chest pain, coffee ground emesis, hematemesis, melena, hematochezia
A
GI life threatening chest pain:
PUD
8
Q
Infectious esophagitis:
EGD shows large, shallow, superficial ulcers, biopsy with inclusion bodies
A
CMV infection
Tx: Gancyclovir, start ART in HIV pt
9
Q
Infectious esophagitis:
EGD shows multiple small deep ulcers, also has oral ulcers
A
HSV infection
Tx: acyclovir
10
Q
Infectious esophagitis:
EGS shows diffuse, linear yellow white plaques adherent to the mucosa
A
Candida infection
Tx: systemic therapy i.e. fluconazole
11
Q
Chest pain, hypertensive esophageal peristalsis (contractions too powerful) with greater amplitude and duration, normal relaxation but elevated baseline pressure
A
Nutcracker esophagus
12
Q
Chest pain (retrosternal), multiple spastic contractions in the esophagus, uncoordinated esophageal contraction, barium swallow shows corkscrew or rosary bead esophagus
A
Diffuse esophageal spasm
13
Q
Esophageal disorder secondary to GERD, weak LES, stomach acid damages esophagus, may progress to Barrett esophagus
A
Reflux esophagitis
14
Q
Chest pain (retrosternal), allergic or atopic condition, eosinophilia, esophageal rings on EGD
A
Eosinophilic esophagitis
Tx: swallow glucocorticoids
15
Q
Esophageal disorder caused by taking oral medication without water while supine (commonly in hospitalized pts)
A
Pill induced esophagitis
Prevention: take meds w/ water
16
Q
Complications of eosinophilic esophagitis
A
Food impaction, perforation, stricture
17
Q
Esophageal disorder caused by ingestion of alkali or acid solution
A
Caustic esophagitis
Accidental (children)
Deliberate (suicidal)
18
Q
Prevention of pill induced esophagitis
A
Take pills with water, dont give oral meds to pts with esophageal dysmotility/dysphagia/strictures
19
Q
Caustic esophagitis Tx
A
Stabilize, ICU, supportive care, EGD to assess extent of injury
20
Q
Caustic esophagitis DO NOT
A
NO nasogastric lavage to flush out (risk of re-exposure)
NO corticosteroids or abx
21
Q
Dysphagia localized to the neck
A
Oropharyngeal dysphagia
22
Q
Dysphagia localized to the chest
A
Esophageal dysphagia
23
Q
Oropharyngeal dysphagia, progressive, bad breath, barium swallow before EGD due to risk of perforation
A
Zenker diverticulum
Complication = perforation
24
Q
Oropharyngeal or esophageal dysphagia, intermittent symptoms, not progressive, Barium swallow shows thin diaphragm-like membranes, Plummer-Vinson syndrome association
A
Esophageal web (proximal)
[Shatzki ring (distal)]
25
Iron deficiency anemia, esophageal webs, glossitis, angular cheilitis
Plummer-Vinson Syndrome
*webs increase SCC risk
26
Dry mouth and eyes, swollen salivary glands, + anti SSA/Ro or anti SSB/LA abs, esophageal motility probs
Sjogren's syndrome
27
Sjogrens syn complicatinos
Oral/esphageal candida, B cell non-Hodgkin lymphoma
28
Structural esophageal dysphagia, intermittent and not progressive, food bolus impaction, barium swallow shows ring at gastroesophageal junct
Schatzki ring
Complication: food bolus impaction
29
Structural esophageal dysphagia, secondary to GERD, but heartburn symptoms are improved
Esophageal stricture
30
Esophageal cancer in middle 1/3 of esophagus, progressive dysphagia, risk factors = smoking + acohol
Esophageal SCC
Tx: esophagectomy (surgery)
31
Esophageal cancer in distal 1/3 of esophagus, progressive dysphagia, risk factors = Barrett esophagus
Esophageal adenocarcinoma
Tx: endoscopic ablation
32
Esophageal dysphagia due to abnormal motility, loss of NO producing inhibitory neurons in myenteric plexus, birds beak on barium swallow
Achalasia
Dx by esophageal manometry
33
Achalasia due to spontaneous or unknown cause
primary achalasia
34
Achalasia due to Chagas dz
secondary achalasia
35
Esophageal dysphagia due to abnormal motility, caused by smooth muscle fibrosis, CREST syndrome, Scl-70 (diffise) and anti-centromere abs (limited)
Scleroderma
36
Esophageal stricture progression of symptoms
Dysphagia progressively worsens, heartburn progressively improves
37
Complication of longstanding GERD, intestinal metaplasia of lower esophagus that may progress to esophageal adenocarcinoma, typically asymptomatic
Barrett esophagus
38
Prevention of Barrett esophagus to adenocarcinoma
PPI > H2 blocker
endoscopic ablation
surveillance endoscopy
39
Imminent desire to vomit
nausea
40
forceful expulsion of gastric contents through the mouth
vomiting
41
gentle expulsion of gastric contents in the absence of nausea and diaphragmatic contraction
regurgitation
42
regurgitation, rechewing and reswallowing of food from the stomach
ruminatoin
43
N/V, constipation, intermittent abdominal pain; most commonly caused by adhesions; high pitched tinkling bowel sounds, dx w/ KUB XR
small bowel obstruction
44
Postprandial fullness, N/V, possibly due to CN X damage, retention observed on gastric emptying study
gastroparesis
May be caused/exacerbated by diabetes mellitus, controlling blood sugar may help prevent
45
Extraperitoneal N/V etiologies
Labrinthine Dz: CN VIII problem
Intracerebral: mass, SAH
Psychiatric
Medications (side effects)
46
Always do this lab in a female pt of childbearing age presenting with N/V
Urine pregnancy test or beta-hCG blood test
47
Alarm features of GERD
Constant/severe pain, dysphagia/odynophagia => needs further workup with endoscopy, imaging, surg consult
Others: weight loss, dehydration, vomiting, mass, hematemesis, IDA
48
Typical GERD symptoms
heartburn, relationship w/ meals, leaning back, etc.
49
Atypical GERD symptoms
Asthma, chronic cough, aspiration
50
GERD management
PPI > H2 blocker
Lifestyly modifications
51
Inflammatory changes to gastric mucosa due to an imbalance between defense and acidic environment; caused by alchohol, medications, etc.
Acute gastritis
52
Inflammatory changes to gastric mucosa caused by H. Pylori or autoimmunity
Chronic gastritis
53
Autoantibodies against parietal cells and/or intrinsic factor
Type A chronic gastritis
54
gastritis caused by H. Pylori in the antrum of the stomach
Type B chronic gastritis
55
H. Pylori detection
Upper endoscopy with gastric biopsy for H. Pylori (done first)
Fecal antigen test, urea breath test used to confirm eradication
56
Gram - curved rod that produces urease, Cag-A toxin
H. Pylori
57
Treatment for gastric MALToma
kill H. Pylori
58
Painful ulcers in the stomach caused by H. Pylori or NSAIDs
PUD
59
Burning epigastric pain that worsens after eating food, adenocarcinoma risk
Gastric ulcer
60
Gnawing epigastric pain that improves after eating, low adenocarcinoma risk
Duodenal ulcer
61
Alarm features of PUD
Perforation and bleeding
62
EDG w/ biopsy in PUD pt
Detect adenocarcinoma/metaplasia and/or H. Pylori
63
PUD Treatment
PPI, H2 blocker
Eradicate H. Pylori
Exclude malignancy (GU only)
64
Pneumomediastinum (free air under diaphragm) due to perforation of hollow GI organ
Perforated viscus
65
treatment for perforated viscus
Emergency surgery
NPO, IV abx, preop labs, surg consult
66
Dyspepsia w/ unintentional weight loss, possible Virchow node, Leser-Trelat sign, Sister Mary Joseph nodule
gastric adenocarcinoma
67
Can an upper GI bleed present with hematochezia?
Yess, if massive
>1000 mL of blood loss
68
UGIB co-morbidities
Aortic stenosis, renal dz, smoking, portal HTN, ETOH abuse, H. Pylori
69
Signs of hypovolemia
resting tachycardia, hypotension, acute abdomen
70
How should Hb rise w/ transfusion
Hb should increase 1g/dL for each unit of blood
71
Peptic ulcer caused by excessive burns, hypovolemia leads to gastric mucosal ischemia and necrosis
Curling ulcer
*stress ulcer
72
Peptic ulcer caused by intracranial mass (or head injury) stimulating CN X, leading to excessive acid production
Cushing ulcer
*stress ulcer
73
Prevention of stress ulcer caused by severe medical or surgical illness
PPI, enteral nutrition
74
Size >5mm
Red wale markings
Severity of liver disease
Active alcohol abuse
Risks for (re)bleeding of esophageal varicies
75
Esophageal varicies bleeding prevention
B blocker, band ligation
76
Esophageal varicies bleeding treatment
```
IV fluids
Correct coagulopathy (FFP, platelets, Vit K)
Emergent EGD with variceal banding
```
77
Aberrent large submucosal artery rupture in the stomach
Dieulafoy lesion
78
Watermelon stomach, multiple superficial telangectasias in the gastric antrum
Gastric antral vascular ectasias (GAVE)
79
Coffee ground emesis, acloholics (portal HTN gastropathy), severe stress, no significant inflammation on histo
Hemorrhagic erosive gastritis
80
Gastrinoma, associated with MEN 1, serum fasting gastrin >1000pg/mL, secretin stimulation test
Zollinger-Ellison
81
Superficial mucosal tear of the esophagus caused by vomiting/retching
Mallory Weiss Tear
82
Transmural tear of the esophagus caused by vomiting/retching, air in mediastinum
Boerhaave Syndrome
83
DDx for lower GI bleed pts under 50
infectious colitis, IBD, anal fissures/hemorrhoids, Meckel
84
DDx for lower GI bleed pts over 50
Malignancy, diverticulosis, AV malformations (i.e. angiodysplasia), ischemic colitis
85
RLQ pain, mimics appendicitis, worsened with tobacco use, fistulas, bile salt malabsorption => gallstones or kidney stones, risk for colon cancer
Crohn Disease
86
LLQ pain, bloody diarrhea, tenesmus, smoking protective (recently stopped smoking pt?)
Ulcerative colitis
87
Prevention of colorectal cancer in Crohn/UC
cancer screening
88
Prevention of kidney stones/flank pain in Crohn's
calcium supplement
Ca binds oxalate that makes the stones
89
Complication of ulcerative colitis (RUQ pain) that can progress to cholangiocarcinoma
Primary sclerosing cholangitis => cholangiocarcinoma
90
Surgical intervention in IBD
Crohn's: surgery only if necessary, can make worse
UC: surgery is curative if pharm intervention fails
91
RUQ pain in Crohn's dz due to bile salt malabsorption (chronic secretory diarrhea)
Gallstones
most commonly affects terminal ileum, where bile is reabsorbed; less bile allows stones to precipitate in gallbladder
92
Extraintestinal manifestations of UC
erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis
93
Ischemic colitis diagnostic risk
sigmoidoscopy
bowel is friable and at risk of perf when ischemic
94
Increased venous pressure at anal venous plexus, causes bright red blood in stool
Hemorrhoids
treat with laxatives or band ligation if necessary
95
Severe tearing pain during defecation followed by throbbing discomfort, may be mild hematochezia with blood on the toilet paper
Anal fissure (ulceration of the anus)
treat goal is to promote effortless, painless bowel movements (with fiber supps, topical anesthetics, nitroglycerin ointment, botulinum toxin A)
96
Anal cancer (anal mass) caused by
HPV
vaccination prevents!
tx with radiation/chemo
97
Itchy and uncomfortable butthole due to poor hygiene, infections, parasites (pinworm)
perianal pruritis
treat underlying cause
98
Gi bleeding that is not apparent to the patient
Occult GI bleed
sugestive of colon cancer, perhaps celiac dz
99
Colorectal cancer screening test that tests for occult bleeding
Fecal occult blood test (FOBT)
100
Colorectal cancer screening test that tests for hemoglobin in the stool
fecal immunochemical test
*more sensitive than FOBT
101
Colorectal cancer screening test that tests for stool hemoglobin and methylated gene markers from excreted tumor cells
fecal DNA test
102
When to start colorectal cancer screening
45 years old
103
___ sided colon cancers present with rectal bleeding, altered bowel habits, abdominal or back pain
Left
104
___ sided colon cancers present with anemia, occult blood in stool, weight loss, and are typically diagnosed late
Right
105
Typically in older patients, presents as occult GIB, painless GI bleeding, IDA (fatigue), normal initial endoscopic eval
Arteriovenous malformations (AVM) / Angioectasia
can be diagnosed with capsule endoscopy
106
Unintentional weight loss (5-10% in 6 mo) workup
Cancer (DRE, pelvic exam)
Poor dentition (oral exam)
Malabsorption, IBD (occult blood stool)
107
AAA prevention
screening in males 65-75 who have smoked, family history
108
AAA treatment
Monitor, high risk if greater than 5cm in diameter
Surgery
109
Progression of pain with appendicitis
vague periumbilical or epigastric pain that later localizes to RLQ, often initiated by fecalith
110
Spontaneous massive dilation of the right colon or cecum without mechanical obstruction, typically in ICU patient
Acute colonic pseudo-obstruction (Ogilvie Syndrome)
cecal diameter greater than 10-12cm at greater risk of perf
111
Management of Ogilvie Syndrome
assess cecal size with abdominal radiographs
Rectal tube (gas expulsion)
Discontinue drugs that decrease intestinal motility
Colonoscopic decompression, surgery
112
Diverticulitis treatment
Inpatient: IV fluids, NPO, Abx
Outpatient: Abx, liquid diet
113
Contraindicated diagnostic in acute diverticulitis
endoscopy or barium enema
*perforation risk in early disease stages
114
Inadequate blood flow through mesenteric vessels, leading to ischemia and necrosis of bowel wall, arterial or venous obstruction, pain out of proportion to exam
Acute mesenteric ischemia
Dx with CT angiography
115
Inadequate blood flow through mesenteric vessels, atherosclerotic dz that progresses over time, abdominal angina, food fear
Chronic mesenteric ischemia
Dx with CT angiography
116
Acute small bowel obstruction treatment
Dx w/ KUB or abdominal series x-ray
NG tube suction
117
Bacteria contaminate peritoneum after intraabdominal viscus, mixed flora (mostly gram - and anaerobes), patients lie motionless in fetal position
Secondary peritonitis
*primary is due to cirrhosis
118
Secondary peritonitis treatment
Find perf with abdominal CT, immediate surgical intervention, Abx (fluoroquinolone, ceftriaxone, metronidazole)
119
Complication of ulcerative colitis or infectious enterocolitis (C.Diff), pt presents with septic shock
Toxic megacolon
120
Contraindicated diagnostic in toxic megacolon
endoscopy or barium enema due to perf risk
121
Twisted intestine and mesentery leading to large bowel obstruction and infarction, coffee bean or birds beak on imaging
Volvulus
sigmoid volvulus in pregnancy or older patients w/ constipation
122
Causes of non-inflammatory diarrhea
Some bacteria/viruses, drug side effect, food sweeteners
123
Antibiotic associated diarrhea
NOT C. DIFF ASSOCIATED
abx side effect (medication induced)
124
Antibiotic associated colitis
C. Diff takes over colon after clindamycin/ampicillin/3rd gen cephalosporin/fluoroquinolones
125
Acute diarrhea workup
Blood work (WBC, electrolytes, dehydration)
Stool studies (culture, C. Diff toxin, lactoferrin and calprotectin = inflammation)
126
Chronic diarrhea most common causes
Meds, IBS, lactose intolerance
127
Osmotic vs secretory diarrhea
Osmotic = high stool osmotic gap, solutes in lumen draw out water, improves with fasting
Secretory = normal osmotic gap, high volume watery diarrhea that does not improve with fasting
128
Osmotic diarrhea ddx
Meds, IBS, lactase deficiency, chronic infection, malabsorption, pseudodiarrhea/impaction
129
Meds notorious for causing chronic diarrhea
Metformin, cholinesterase inhibitor, SSRI, NSAID, Allopurinol
130
Altered bowel habits, abdominal pain, absence of detectable organic pathology, clinical diagnosis based on ROME criteria
Irritable bowel syndrome
131
Management for IBS
Low FODMAP diet
FODMAP are carbs associated with causing GI symptoms
132
Inability to pass stool, bloating, abdominal pain, rectal bleeding, LBP, feeling of incomplete pooping
Constipation
Complication: fecal impaction, stercoral ulcers
133
Complication of chronic laxative use, melanosis coli (benign hyperpigmentation of colon), paradoxical "diarrhea" (overflow incontenence)
Fecal impaction
134
Involuntary discharge of poop, normally caused by neuromuscular disorders
fecal incontinence
135
C. Diff diagnosis
History: recieved abx, fould smelling watery diarrhea 5-15 times per day
Labs: stool for C. Diff toxins (PCR), leukocytosis
136
C. Diff complications
toxic megacolon/hemodynamic instability can lead to colon perf and death
137
C. Diff treatment
Monitor for complications
Oral vanc, IV metronidazole
138
Immunologic response to gluten that causes diffuse damage to proximal small intestine mucosa with malabsorption
Celiac disease
139
Complication of Crohn disease, damage to terminal ileum leads to mild steatorrhea, impairment of absorption of fat soluble vitamins, watery secretory diarrhea
Bile salt malabsorption
140
Rare multi-system disease, gram + bacillus infectoin, weight loss, malabsorption (hypoalbuminemia => edema), chronic diarrhea
Whipple Disease
Tropheryma whipplei,
Endoscopy with biopsy shows PAS + macrophages w/ bacillus
141
Weight loss, diarrhea, bloating, dermatitis herpeteformis, endoscopy shows loss of villi and atrophy of duodenal folds
Celiac Dz
Normal biopsy excludes diagnosis
142
Celiac dz treatment/management
Remove all gluten from diet
*most common cause of tx failure is incomplete removal of gluten
