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Casey: Panre > Gastrointestinal > Flashcards

Flashcards in Gastrointestinal Deck (114):
1

Term for difficulty swallowing

Dysphagia

2

Bird beak esophagus on barium swallow should make you think of what dx

Achalasia

3

What is the most common location for an anal fissure?

Posterior midline

4

Crohn's disease is found where in the GI tract?

It can be from the esophagus to the anus

5

What does HBsAg (hep B surface antigen) indicate?

Active hep B infection

6

How do you treat achalasia?

Loosen up the muscle--Botox, dilation or surgery

7

A corkscrew appearance on barium study should make you think of what dx?

Esophageal spasms

8

Epigastric abdominal pain which radiates to the back should make you think of what dx?

Pancreatitis

9

IOT contract hepatitis D what must you already have?

Hep B

10

Left lower quadrant pain and tenderness should make you think of what dx?

Diverticulitis

11

What is the treatment for most Mallory-Weiss tears?

Watchful waiting, these will typically resolve within 48 hours

12

A thumbprint sign on an abdominal film should make you think of what dx?

Intestinal ischemia

13

What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?

Early they are hyperactive. Late they are absent.

14

A pt has had GERD for yrs. over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what dx?

Esophageal strictures

15

What are two tx you should consider for esophageal strictures?

Dilation of the esophagus and long term PPIs

16

What are 2 common predisposing factors for esophageal varices?

Portal HTN and cirrhosis often caused by alcoholism

17

What is a common symptom that goes along with chest pain for GERD pts?

Dry cough

18

What medication is most commonly used for long term treatment of GERD?

Proton pump inhibitors
Omeprazole
Lansoprazole
Pantoprazole

19

What is the imaging modality of choice for pancreatitis?

CT

20

What is the best test to check for H. Pylori?

Urea breath test

21

Is peptic ulcer disease more common in the duodenum or the stomach?

Duodenum

22

What is the most common location for a pancreatic tumor?

75% occur in the head of the pancreas

23

With a gastric ulcer are the patient's symptoms exacerbated or relieved with food?

Exacerbated

24

Projectile vomiting should make you think of what dx?

Pyloric stenosis

25

Most gallstones are made of what substance?

Cholesterol

26

What is the name of the sign when a pt shows inhibited inspiration with pressure over the RUQ? What dx does it suggest?

Murphy's sign
Cholecystitis

27

What is the most specific test for acute cholecystitis?

HIDA

28

What is the gold standard for dx of and tx of bile duct stones?

ERCP

29

What is Charcot's triad?

RUQ pain
Fever
Jaundice

30

What is Reynold's Pentad and why does it matter?

Charcot's triad plus
Hypotension
Altered mental status
It indicates sepsis and is endoscopic emergency

31

What diseas is defined as an immunologic response to gluten?

Celiac

32

What is the main risk factor for esophagitis?

Immunocompromised pt

33

An endoscopy for presumed ulcers shows multiple shallow ulcers. What is the most likely dx?

Herpes simplex virus

34

List 2 common offending agents for pill induced esophagitis?

NSAIDS, KCl, iron, antibiotics

35

A 30 yr old AA woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely dx?

Scleroderma

36

What is the most common cause of peptic ulcer disease?

H. Pylori

37

What is the most specific diagnostic test for peptic ulcer disease?

Endoscopy

38

What is the only curative tx for gastric adenocarcinoma?

Surgical resection

39

A pt c/o right upper quadrant pain :20 after meals. What is the most likely dx?

Cholecystitis

40

What does ERCP stand for?

Endoscopic retrograde cholangiopancreatography

41

What is the most cause of acute bacterial cholangitis?

Choledocolithiasis

42

Onion ring fibrosis from a bile duct bx should make you think of what dx?

Primary sclerosing cholangitis

43

What two viral hepatitis infections are self limiting?

Hepatitis A & E

44

Pica is often related to what type of anemia?

Iron deficiency

45

What does an Anti-HBc (hep B core antibody) indicate?

Previous or ongoing hepatitis B infection

46

What does Anti-HBs (hep B surface antibody) indicate?

Recovery from infection or immunization to hepatitis B

47

What is the recommended tx for hepatitis C infection?

Pegylated interferon alpha-2

48

What medication used in hepatitis B infection helps prevent the need for liver transplant?

Lamivudine

49

There are vaccines for which 2 versions of hepatitis?

Hepatitis A and B

50

Will a pt c achalasia have dysphagia to liquids, solids or both?

Both

51

If you have heartburn that does not improve with medication, what is the most likely dx?

Gastrinoma

52

What are the 2 main complications of cirrhosis?

Portal HTN and liver insufficiency

53

What is a good beta blocker to reduce portal HTN?

Propranolol

54

What tumor marker may be used for liver cancer?

Alpha-Fetoprotein

55

What are the two most common causes of pancreatitis?

Cholelithiasis and ETOH

56

Describe Cullen's sign

Umbilical ecchymosis often related to pancreatitis

57

What are the 5 points of Ranson's criteria on admission?

Older than 55
WBC>16
Glucose >200
LDH>350
AST>250

Acute/chronic pancreatitis

58

What is the first step in treating GERD?

Lifestyle modification

59

Steatorrhea should make you think of what dx?

Pancreatitis

60

Describe Courvoisier's sign

Nontender palpable gallbladder which may indicate pancreatic neoplasm

61

What tumor marker may be used to follow pancreatic cancer?

CA-19-9

62

A pt c/o periumbilical pain which has now moved over McBurney's point. What is the most likely dx?

Appendicitis

63

Describe the psoas sign

The pt is supine and attempts to raise the right leg against resistance

64

What is the term for painful swallowing?

Odynophahia

65

Describe how to perform the obturator sign.

The pt is supine and attempts to flex and internally rotate the right hip

66

What is the best imaging study for acute appendicitis?

CT

67

What 2 blood tests can be used to dx celiac?

IgA endomysial antibody and IgA tTG antibody

68

How much fiber should you normally get in a day?

About 30 grams

69

What tx should be started for asymptomatic diverticulosis?

None

70

Is surgery curative for Crohn's or ulcerative colitis?

Ulcerative colitis

71

What causes Mallory-Weiss tears?

Forced vomiting or retching (often involving alcohol)

72

A colonoscopy that shows cobblestone or skip lesions should make you think of what dx?

Crohn's disease

73

What class of medication is the first line to tx inflammatory bowl disease in the maintenance phase?

5-ASA products:
Sulfasalazine
Mesalamine

74

Currant jelly stool should make you think of what dx?

Intussusception

75

Severe abdominal pain :30 after a meal should make you think of what dx?

Intestinal ischemia

76

What is the most common cause of lower GI bleed?

Diverticulosis

77

What is the most common location of colorectal cancer?

Cecum about 38%

78

Colorectal pts are almost all older than what age?

90% are older than 50

79

An epigastric olive-shaped mass should make you think of what dx?

Pyloric stenosis

80

An elevated serum amylase and lipase should make you think of what dx?

Pancreatitis

81

Under routine circumstances when should pts begin getting screening colonoscopies?

Age 50

82

What is the #1 cause of small bowel obstruction?

Postoperative adhesions

83

Air fluid levels on abdominal x-ray should make you think of what dx?

Bowel obstruction

84

What is more likely to pass into the scrotum, a direct or indirect hernia?

Indirect

85

A string sign on barium swallow should make you think of what dx?

Pyloric stenosis

86

What is the first line tx for an anal fissure?

Fluid and fiber

87

What 2 things that an anal fissure off midline might suggest?

Crohn's, syphilis, HIV, neoplasm

88

What medical tx is given for a gastrinoma?

Proton pump inhibitors

89

What is the term for an abscess in the sacrococcygeal cleft?

Pilonidal disease

90

How do you tretH. Pylori infection?

PPI + 2 antibiotics,
Commonly omeprazole & clarithromycin & amoxicillin

Or
PPI & metronidazole & TCN

91

Painless bright red blood per rectum should make you think of what dx?

Hemorrhoids

92

A pt on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?

Folate

93

What is the most common anorectal problem affecting pts over 50?

Hemorrhoids

94

A gastrinoma is also known as what syndrome?

Zollinger-Ellison syndrome

95

Salivary amylase breaks down what macronutrient?

Carbohydrates

96

What is the medical term for feeling like there is a lump in your throat?

Globus

97

What is the most common vessel blocked with intestinal ischemia?

Superior mesenteric artery

98

Describe Grey-Turner's sign

Flank ecchymosis often related to pancreatitis

99

What are the first 3 steps of managing pancreatitis?

NPO
Pain control
Fluids

100

A pt presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely dx?

Gastric volvulus

101

What is the most common cause of a folate deficiency?

Alcoholism

102

Should diverticulitis always be admitted?

No, mild cases can be treated as outpatients with rest and clear fluids

103

Which NSAID has the highest rate of peptic ulceration?

Naproxen

104

What is the diagnostic test of choice for Zenker's diverticulum?

Barium swallow will show the diverticulum

105

What is the leading cause of iron deficiency anemia?

Chronic GI bleed

106

At what age and how often should fecal occult blood tests be performed as a screening tool?

Beginning at age 50, and they should be performed annually.

107

How often should pts with pernicious anemia have a screening endoscopy performed?

Every 5 yrs looking for signs of gastric carcinoma

108

Are one half of all adult hernias direct or indirect inguinal hernias?

Indirect inguinal hernias make up 50% of all adult hernias.

109

How is celiac disease most commonly diagnosed?

Endoscopic biopsy

110

Define pellagra

Niacin (B3) deficiency

111

An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely dx?

Cytomegalovirus

112

Which are more painful--hemorrhoids above or below the dentate line?

Below, internal hemorrhoids are not painful.

113

An abdominal exam with pain out of proportion to the exam should make you think of what dx?

Intestinal ischemia

114

Does adenocarcinoma arise from the proximal or distal esophagus

Distal