Gastro Conrad Fischer Medquest Pharm

Question 1

42 yr female, HBsAg + > 6mo, HBcAg +

Dx?

Answer 1

Def of Chronic Hep B

Question 2

1st marker to inc with chronic Hep B? 2nd?

Answer 2

HbsAg

2nd - HbeAg

Question 3

HBeAg is analogous to what in HIV?

Answer 3

DNA viral load

Question 4

40 female persistent epigastric pain #1 cause?

Answer 4

non ulcer dyspepsia

Question 5

gastritis presents with

Answer 5

painless bleeding

Question 6

Pt has epigastric pain and on PPI and failed? next step?

Answer 6

Biopsy

Question 7

alarm sx of H. pylori gastritis

Answer 7

weight loss, anemia, dysphagia, guaiac pos stool

Question 8

What not do serology over biopsy ?

Answer 8

Serology can’t tell you if new/old infection - like FTA for syphillis

Question 9

Tx for H. pylori - Rx and MoA of them

Answer 9

PPI + 2 Antibiotics +/- Bismuth subsalicylate

Clarithromycin + Amoxicillin

can switch to
Tetracyclin + Metronidazole

Question 10

List PPI & MoA

Answer 10

Lansoprazole
Ome-
Panto-
Rabe-
Esome-

Irreversibly inhibit H+/K+ ATPase in stomach parietal cells

Question 11

PPI side effects

Answer 11

acute interstitial nephritis
dec serum Mg/Ca absorption —> bone demineralization and fracture

Ca absorbed better in acidic environment

Question 12

SE effect of PPI that is also caused by certain antibiotics? Which antibiotic in particular?

Answer 12

Inc risk of C. diff infection - Can be caused by any antibiotic, but Clindamycin in particular

Question 13

When do you add bismuth?

Answer 13

Add to metro + tetracyclin if 1st round of antibiotic doesn’t work. For the anti inflammatory effect

Question 14

Unique side effect of bismuth

Answer 14

black colored stool, that isn’t heme or guaiac +

Question 15

MoA and major side effect of tetracylcin

Answer 15

affects 30S of ribosomes
photosensitivity (and teratogenecity)

Question 16

Metronidazole - MoA and used for what organisms

Answer 16

(-) nucleic acid synthesis by forming toxic free radical metabolites

used for anerobic infections below diaphram, and protozoal infections

Question 17

SE of Metronidazole

Answer 17

Disulfiram rxn w/ alcohol, headache, metallic taste, rarely seizures

Question 18

List H2 blockers

Answer 18

Cimetidine, Ranitidine, Famotidine, Nizatidine

Question 19

Why do we target histamine in acid reflux?

Answer 19

Histamine stimulates the other 2 stimulations of p+ pumps

1) Ach (+) H/K ATPase
2) Gastrin –> CCK2-R

Ca2+ dependent pathway

Question 20

56 yr man w. acute variceal hemorrhage from alcoholic cirrhosis
rec IV fluids and rec blood transfusion + FFP

Why not vitamin K?

Rx most likely benefit pt now?

Answer 20

too slow

Octreotide - dec portal pressure bc receptor all through GI tract
& banding

Question 21

What if Rx fails?

Answer 21

TIPS - Transjugular Intrahepatic Portal Systemic Shunt

Question 22

Octreotide - other uses? MoA in these cases?

Answer 22

Glucagon/insulinoma
Carcinoid
ZE syndrome

Can dec portal pressure, splanchnic blood flow, (-) PRL, GH, (-) diarrhea in carcinoid

Question 23

How is propranolol useful in acute variceal bleed?

Answer 23

It isn’t, no effect on acute bleed.

Question 24

Only time to treat an endo overproduction w/ Rx before surgery?

Answer 24

PRL-oma - use dopamine agonist

Question 25

48 man with altered mental status 2ndary to hepatic insufficiency Most effective Tx for Pt 1?

Answer 25

Lactulose - (-) NH4 absorption in GI Rifamixin - (-) bacteria in bowel

Question 26

Why not use Neomycin for this pt?

Answer 26

can lead to renal issues

Question 27

SE of Lactulose use?

Answer 27

Bloating, diarrhea, flatulence --\> hyper Na and HypOkalemia - bc colon used K+ to make feces

Question 28

Lactulose MoA

Answer 28

non absorbed disaccharide, can't break down w/o lactase - acidifies bowels, bacteria eat it and release acid, which converts NH3 --\> NH4+ , which can't be absorbed, inc renal excretion bc charged particle

Question 29

Why does liver issues --\> renal issues?

Answer 29

Intravascular volume depleted, low albumin --\> HIGH RAAS, kidney v susceptible to toxic injury Hepatic disease = VC of kidney in Abnormal way - starves them off

Question 30

Lab changes in hepatorenal disease??

Answer 30

Dec Urine Na \< 20 meq/L Bun/Cr ratio INC - \> 20 same lab values as pre renal azotemia

Question 31

Sx of hepatorenal syndrome?

Answer 31

fluid overload ascites edema low urine Na (like in dehydration)

Question 32

When kidneys dehydrated, effect?

Answer 32

hold onto vol and Na, BUN Inc bc of Inc ADH leading to inc urea resorption @ collecting duct (urea transporter)

Question 33

Tx for Hepatorenal syndrome?

Answer 33

replace liver Midodrine - alpha (+)'r also used for orthostatic hypotension, shunt blood --\> kidney Octreotide Albumin infusion - intravascular vol dec bc of dec albumin

Question 34

Penacillamine used for?

Answer 34

chelator for Cu - Wilson's disease

Question 35

Other Rx used for Wilson's disease?

Answer 35

Trientine and Zn

Question 36

Sx of Wilson's disease

Answer 36

Liver - hepatitis, liver failure Brain - dysarthria, dystonia, tremor, Parkinsonism + hemolytic disease + renal disease

Question 37

#1 test of Wilson's disease?

Answer 37

Slit lamp test - K-F rings

Question 38

Most common wrong ans for best test for Wilson's

Answer 38

Ceruloplasmin levels

Question 39

Wilson's disease leads to what renal issue?

Answer 39

Nephrotic syndrome

Question 40

Penacillamine is also used for?

Answer 40

Hg and Zinc overload cysteinuria arsenic poisoning

Question 41

Cu builds up in thalamus leading to ?

Answer 41

choreoform movements paranoia psychosis not seen in hepatic encephalopathy

Question 42

54 man alcoholic - n/v, blood from esoph varices Rx ?

Answer 42

fluid, blood, platelet, FFP

Question 43

Pt has been given these several times before, 2x treated w/ esoph band ligation been transfused and has normal PT time next course of action?

Answer 43

TIPS

Question 44

How to prevent next episode of variceal bleed

Answer 44

nadalol propranolol

Question 45

Tx of acute esoph bleeding?

Answer 45

Octreotide endoscopic band ligation

Question 46

What is TIPS?

Answer 46

catheter placed into hepatic v and shunt created thru liver to portal vein, done in flouroscopy

Question 47

Pt v distressed by persistent Sx of epigastric and chest pain from GERD Which Rx relieve heartburn and GERD sx?

Answer 47

1) liquid antiacid + H2B (Cimetidine, Ranitidine) then 2) PPI

Question 48

If GERD is severe?

Answer 48

Surgical repair of columnar metaplasia = Fundoplication (suture around LES to tighten it up)

Question 49

Why do you need to scope surgical GERD pt every 2 years?

Answer 49

0.5 -1 %/yr --\> esoph cancer

Question 50

Why is Cisopride never the ans?

Answer 50

most likely to cause Torsades

Question 51

T or F GERD is caused by H. Pylori

Answer 51

FALSE. does not cause reflux, a loose LES does.

Question 52

What can cause a loose LES?

Answer 52

nicotine, chocolate, alcohol, caffeine

Question 53

When to treat H. pylori?

Answer 53

1/2 of gen pop is H.pylori pos, only treat if have Gastric PUD Malt lymphoma

Question 54

How to treat low grade dysplasia? high grade dysplasia? Barrett's esoph

Answer 54

Low grade - scope in 6 mo high grade - scrape/cut it out Barrett's - scope in 2 mos

Question 55

38 yr woman w/ dysphagia to solids and liquids

Answer 55

Achalasia

Question 56

How do diff dx achalasia from Zenker's , Scleroderma, and esoph cancer?

Answer 56

Zenker's - bad breath Scleroderma - puffy, taut skin, no wrinkles Esoph cancer - \> 30, smoker/drinker, solids, then liquids

Question 57

What is the next test in this pt?

Answer 57

Barium studies

Question 58

Achalasia also associated with what other dz?

Answer 58

Schatzki ring Plummer Vinson Nut cracker esophagus Diffuse esoph spasm

Question 59

Tx of Achalasia -

Answer 59

1) Pneumatic dilation - can cause perforation or Surgery (Heller myotomy) If refused - Botox - wears off after 6 mos

Question 60

27 healthy GI fellow develops severe bloody diarrhea and abdomen pain over the last day. 10 + BM/ day pulse 125 temp 103 F What type of re-hydration should he rec? why?

Answer 60

saline - will stay in vascular space NOT 5% dextrose in water - that's like free water - will move EC

Question 61

Should this pt rec antibiotics, if so, which one? mech?

Answer 61

Bc we don't know what organism is Flouroquinolonen - treat most common causes (-) DNA gyrase

Question 62

Most common micro causes of bloody diarrhea?

Answer 62

1. C. jejuni - can also give erythromycin 2. Salmonella

Question 63

To whom can you not give flouroquinolones? why?

Answer 63

To younger person - affects chondrocytes leads to tendon rupture

Question 64

What do you give a younger person if can't give flouroquinolones?

Answer 64

TMP SMX eythromycin