Gastrointestinal Flashcards
(215 cards)
1
Q
Most common cause of upper GI bleed?
A
Duodenal ulcer
2
Q
___ refers to single large tortuous arteriole in submucosa; Causes bleeding due to erosion of submucosa
A
Dieulafoy
3
Q
First step of treatment for patient who develops severe upper GI bleeding?
A
ABCs … secure the airway
4
Q
Most common cause of lower GI bleed?
A
Diverticulosis
5
Q
Does Diverticulosis result in painless or painful bleeding?
A
Painless
6
Q
Additional cause of painless lower GI bleed?
A
Angiodysplasia
7
Q
Which step of workup should be avoided in patients with suspected diverticulitis?
A
Colonoscopy
8
Q
Best step of workup for patient with suspected diverticulitis?
A
CT abdomen
9
Q
9 yo male presents with recurrent painless rectal bleeding; Denies fever, skin rash; No FHX of colon CA; Colonoscopy is NML – diagnosis?
A
Meckel’s diverticulum
10
Q
First step of workup for patient with suspected lower GI bleed?
A
Insert NG tube to rule out upper GI bleed
11
Q
Best test for suspected lower GI bleed that does not respond to conservative therapy?
A
Colonoscopy
12
Q
Best initial test in patient with dysphagia?
A
Barium swallow
13
Q
Next step in workup for patient with dysphagia?
A
EGD
14
Q
Best diagnostic tool for esophageal rupture?
A
Extravasation of oral (water-soluble) contrast
15
Q
Prognosis for Schatzki’s lower esophageal ring?
A
Benign … requires dilatation
16
Q
Best diagnostic test for Zenker’s diverticulum?
A
Barium swallow … avoid EGD due to risk for esophageal perforation
17
Q
Patient presents with HX of lye ingestion 15 years age – best recommendation?
A
EGD
18
Q
Patient presents with HX of lye ingestion 15 years age – complication?
A
Squamous cell carcinoma
19
Q
72 yo male presents with 4 months of dysphagia; Upper GI shows bird-beak stricture in distal esophagus – next best step of management?
A
EGD … rule-out adenocarcinoma causing pseudo-achalasia
20
Q
Etiology of achalasia?
A
Loss of Auerbach’s plexus … failed relaxation of distal esophagus
21
Q
Achalasia in South American male who also presents with arrhythmia + CHF – diagnosis?
A
Chagas Disease
22
Q
Change to LES tone in scleroderma?
A
Loss of tone
23
Q
Management to avoid for patient with scleroderma who complains of dysphagia?
A
Endoscopy … increased risk of esophageal perforation
24
Q
Best treatment for diffuse esophageal spasm?
A
CCB, NTG
25
Condition associated with oropharyngeal dysmotility?
Dermatomyositis
26
Most effective study for evaluating suspected oropharyngeal dysmotility?
Video fluoroscopy
27
All of the following medications can cause pill esophagitis, except for one – K+ supplements, tetracyclines, NSAIDs, CCBs, ascorbic acid?
CCBs
28
Which medication might cause odynophagia in young female?
Doxycycline … taking for acne
29
Best treatment for Odynophagia in immunocompromised patients, due to Candida?
Ketoconazole
30
Best treatment for Odynophagia in immunocompromised patients, due to HSV?
Acyclovir
31
Best treatment for Odynophagia in immunocompromised patients, due to CMV?
Ganciclovir
32
Which 2 aspects of GERD are associated with risk of GERD symptoms?
Duration, frequency
33
Which symptom will NOT be caused by Barrett’s esophagus?
Dysphagia … Barrett’s esophagus is purely HISTOLOGIC, not structural narrowing of esophagus
34
Appearance of Barrett’s esophagus on EGD?
Intestinal metaplasia
35
All of the following are risk factors for SCC of esophagus, except for one – HPV, GERD, Achalasia, ETOH, Smoking?
GERD
36
Most colon cancers arise from …
Adenomas
37
There is no malignant potential associated with which type of polyp?
Hyperplastic
38
Diagnostic test for FAP?
Proctoscopy
39
In addition to increased risk for colon CA, patients with FAP are at increased risk of …
Duodenal CA … perform EGD
40
Which type of familial adenomatous condition is associated with bony prominences?
Gardner’s Syndrome
41
In addition to colon colon adenomas, what is another manifestation of Turcot Syndrome?
CNS tumors
42
Peutz-Jeghers Syndrome is associated with ___ polyps
Hamartomatous
43
Are the Hamartomatous polyps in Peutz-Jeghers Syndrome responsible for patient’s increased risk of colon CA?
No … In Peutz-Jeghers Syndrome, several adenomas are scattered among the hamartomas
44
Amsterdam Criteria for Lynch Syndrome?
Colon CA … 3 first degree relatives, 2 successive generations, 1 family member diagnosed < 50 yo
45
Best treatment for Stage 3 colon CA?
CTX
46
Best CTX for colon CA?
5-FU + Leucovorin
47
Most common type of anal CA?
Squamous cell carcinoma
48
Most common cause of anal CA?
HPV infection
49
Best treatment for anal CA?
Concurrent XRT + CTX therapy
50
Clinical presentation for anal fissure?
Bright red blood in stool, painful defecation
51
Best treatment for anal fissure?
Topical anesthetic, treat constipation
52
Best treatment for acute mesenteric ischemia?
Emergency surgery
53
Clinical presentation for ischemic colitis?
Significant rectal bleeding
54
Best treatment for ischemic colitis?
ABX, IV fluids
55
Most common locations of ischemic colitis?
Watershed areas
56
Best diagnostic test for intestinal angina?
Angiogram
57
Most common site of intestinal angina?
Splenic flexure
58
Secretory diarrhea is mediated by …
Toxins
59
At what point should secretory diarrhea be treated with ABX?
If patient becomes febrile
60
DOC for travelers diarrhea, with fever?
Single dose of ciprofloxacin
61
Alternate name for inflammatory diarrhea?
Invasive
62
Most common pathogen responsible for bloody diarrhea?
Campylobacter
63
Symptoms in Campylobacter infection mimic …
Appendicitis
64
Treatment that is contraindicated in HUS?
ABX treatment (makes symptoms worse)
65
Pathogen that causes inflammatory diarrhea with febrile seizures?
Shigella
66
DOC for Shigella inflammatory diarrhea?
TMP-SMX
67
Best treatment for entamoeba histolytica-related amebic liver abscess?
Metronidazole … (not surgical drainage)
68
RUQ pain with acute diarrhea in immigrant – diagnosis?
Entamoeba histolytica
69
Peritoneal signs with acute diarrhea – diagnosis?
Campylobacter
70
Sickle cell patient with acute diarrhea – diagnosis?
Salmonella
71
Characteristic of Cryptosporidium + Isospora belli in HIV (+) patients with watery diarrhea?
Acid-fast
72
Rash associated with celiac disease?
Dermatitis herpetiformis
73
Best treatment for Dermatitis herpetiformis?
Dapsone
74
Most common location of carcinoid tumors?
Terminal ileum, appendix
75
DOC for carcinoid syndrome?
Octreotide
76
Which vitamin deficiency is most common to develop in setting of carcinoid syndrome?
Niacin
77
Why is niacin deficiency associated with carcinoid syndrome?
Tryptophan >> Serotonin … need Tryptophan for production of niacin
78
Best test for screening H. pylori infection, as well as confirming eradication?
Urea breath test
79
Most common cause of upper GI bleeding?
Peptic ulcer disease
80
2 most common causes of Peptic ulcer disease?
H. pylori infection; NSAID use
81
Most common cause of failed H. pylori eradication?
Course of treatment did not last full 2 weeks
82
Next step of workup for non-healing gastric ulcers?
EGD + 6 biopsy samples to rule out gastric CA
83
Risk for colon CA – greater in Crohn’s Disease (CD) or Ulcerative Colitis (UC)?
UC
84
Characteristic of colon CA in UC?
Multiple sites
85
Smoking – makes inflammation worse in UC or CD?
CD
86
Smoking – makes inflammation better in UC or CD?
UC
87
Location of CD?
Any portion of GI – mouth to anus
88
2 complications of CD?
Strictures, Fistula
89
Appearance of mucosa in CD?
Cobblestoning … elevation of normal mucosa
90
3 characteristics of GI inflammation in CD?
Transmural, Skip lesions, Non-caseating granuloma
91
CD represents a Type ___ HSN reaction
4
92
Extraintestinal manifestation of CD?
Pyoderma gangrenosum
93
Treatment of pyoderma gangreneosum?
Steroids
94
Ecthyma gangrenosum is associated with …
Pseudomonas infection
95
Location of UC?
Rectum, Distal
96
Histologic hallmark of UC?
Crypt abscesses (PMN inflammation)
97
Appearance of GI in UC (not ulcers)?
Loss of haustra … “lead pipe”
98
GI complication of UC?
Toxic megalcolon
99
Extraintestinal manifestation of UC?
Primary Sclerosing Cholangitis
100
When should you start colonoscopy CA screening for UC?
10 years after diagnosis, Every 2-3 years
101
DOC for UC with diarrhea, but no bleeding?
5-ASA (Sulfalazine)
102
DOC for UC with diarrhea AND bleeding?
Prednisone
103
Are Prednisone and 5-ASA (Sulfalazine) safe during pregnancy?
YES
104
DOC for mild CD?
5-ASA (Sulfalazine)
105
2 DOCs for severe CD?
Infliximab, Natalizumab
106
MOA of Infliximab?
TNFα inhibitor
107
MOA of Natalizumab?
Ig against cell adhesion molecule α4-integrin
108
UC patient with RUQ, increased LFTs?
Primary Sclerosing Cholangitis
109
Bloody diarrhea in young patient?
UC
110
Fecal soiling – CD or UC?
CD – most likely fistula
111
Hydronephrosis without stones – UC or CD?
CD … from obstruction
112
Pneumaturia – CD or UC?
CD – most likely fistula with bladder
113
3 common extraintestinal manifestations of CD?
Calcium oxalate kidney stones, B12 deficiency, Hypocalcemia (Vitamin D deficiency)
114
Appearance of UC on abdominal XR?
Loss of haustra
115
Complication of UC?
Toxic megacolon
116
HLA gene associated with Primary Sclerosing Cholangitis?
HLA-B8
117
When should patients with UC begin colonoscopy screening?
8 years after diagnosis; Repeat every 1-2 years
118
Next step of workup for UC patient who presents with low-grade dysplasia on biopsy?
Total colectomy
119
Patient presents with dermatitis, dysgeusia – ID the trace element deficiency?
Zinc
120
Patient presents with glucose intolerance, confusion, and neuropathy – ID the trace element deficiency?
Chromium
121
Patient presents with cardiomyopathy – ID the trace element deficiency?
Selenium
122
Electrolyte change associated with acute pancreatitis?
Hypercalcemia
123
Most common cause of acute pancreatitis in children?
Abdominal trauma
124
Anticonvulsant associated with acute pancreatitis?
Valproic acid
125
___ refers to periumbilical discoloration seen in setting of acute pancreatitis
Cullen’s Sign
126
___ refers to flank bruising seen in setting of acute pancreatitis
Turner’s Sign
127
First step in management of acute pancreatitis?
Make patient NPO
128
3 indications for ABX treatment in acute pancreatitis?
Infected pseudocyst, Necrotizing pancreatitis, Cholangitis
129
Clinical presentation of chronic pancreatitis?
DM + Steatorrhea … without nephropathy + retinopathy
130
Lab value that is helpful in diagnosis of chronic pancreatitis?
Low serum trypsinogen
131
Best test for diagnosis of steatorrhea in chronic pancreatitis?
Quantification of fecal fat
132
Appearance of chronic pancreatitis on XR?
Calcifications
133
Appearance of chronic pancreatitis on ERCP?
Chain of lakes
134
Most common type of pancreatic CA?
Adenocarcinoma
135
Condition associated with Gastrinoma?
Zollinger-Ellison, MEN1 Syndrome
136
Are most insulinomas benign or malignant?
Benign
137
Metabolic disturbance associated with VIPoma?
Non-AG metabolic acidosis
138
Triad of clinical symptoms seen in setting of VIPoma?
Watery diarrhea, hypokalemia, hypotension
139
1st test to order for suspected cholecystitis?
US
140
What is the most sensitive test for suspected cholecystitis?
HIDA scan
141
HIDA scan finding that suggests cholecystitis?
Non-visualization of gallbladder, with visualization of CBD
142
Best treatment of CBD stones?
ERCP
143
Epidemiology of acalculus cholecystitis?
Ill, hospitalized patients
144
Diagnostic finding for acalculus cholecystitis on US/CT?
Thickened gallbladder wall
145
Best treatment for acalculus cholecystitis?
Cholecystectomy
146
Patient presents with abdominal XR showing gallbladder with calcified outline (porcelain gallbladder) – best treatment (open vs. laparoscopic cholecystectomy)?
Open cholecystectomy … most likely malignancy
147
34 yo female presents with 1-week HX of fatigue, jaundice, fever; HX of autoimmune hypothyroidism; Labs show elevated AST, elevated ALT, mildly-elevated total bilirubin; Hepatitis panel is NML – diagnosis?
Autoimmune hepatitis
148
What is the serology test that will most likely help diagnose autoimmune hepatitis?
ANA, Anti-Smooth muscle Ig
149
Route of transmission for Hepatitis A?
Fecal-oral
150
Best treatment for Hepatitis A?
Supportive care
151
Of patients with Hepatitis B, ___% will develop chronic disease
5%
152
2 extrahepatic manifestations of Hepatitis B?
Membranous nephropathy, Polyarteritis nodosa
153
Best treatment for infant born to mother who is (+) for HBsAg?
HB Ig + Vaccine immediately
154
Best treatment for patient exposed to Hepatitis B via blood?
HB Ig + Vaccine
155
Best treatment for patient exposed to Hepatitis B via sexual contact?
HB Ig
156
Best treatment for patient exposed to Hepatitis B via household contact?
HB Ig
157
2 indications for Hepatitis B treatment?
Elevated ALT, Moderate fibrosis on liver biopsy
158
DOC regimen for Hepatitis B?
IFNa + Tenofovir/Entecavir
159
2 contraindications to IFNa treatment of Hepatitis B?
Depression, Decompensated liver cirrhosis
160
Which drug should be included in HAART therapy for patient with HIV + Hepatitis B?
Tenofovir
161
Of patients with Hepatitis C, ___% will develop chronic disease
75-85%
162
How should patients with asymptomatic Hepatitis C be screened for hepatocellular carcinoma?
US
163
3 extrahepatic manifestations of Hepatitis C?
Mixed cryoglobulinemia, Membranoproliferative glomerulonephritis, Porphyria cutanea tarda
164
3 components of treatment for Hepatitis C?
IFNa, Ribavirin, NS3/4A protease inhibitors
165
NS3/4A protease inhibitors contain suffix “___”
-previr
166
NS3/4A protease inhibitors are active against which genotype of Hepatitis C?
HCV genotype 1
167
2 contraindications to IFNa treatment of Hepatitis C?
Depression, Cytopenia
168
1 contraindication to Ribavirin?
Pregnancy (teratogenic)
169
Route of transmission for Hepatitis E?
Fecal-oral
170
Complication of Hepatitis E?
Fulminant liver failure in pregnant females
171
Serologic test that can be used to diagnose Primary Biliary Cholangitis?
Anti-Mitochondrial Ig
172
3 treatments for Primary Biliary Cholangitis?
Vitamin ADEK, Ursodeoxycholate, Colchicine
173
MOA of Ursodeoxycholate in treatment of Primary Biliary Cholangitis?
Synthetic bild acid
174
Definitive treatment for Primary Biliary Cholangitis?
Liver transplantation
175
Condition associated with Primary Sclerosing Cholangitis?
Ulcerative colitis
176
Appearance of Primary Sclerosing Cholangitis on ERCP?
Beading appearance
177
Malignancy associated with Primary Sclerosing Cholangitis?
Cholangiocarcinoma
178
Temporary treatment of Primary Sclerosing Cholangitis?
Dilation of liver strictures
179
Definitive treatment of Primary Sclerosing Cholangitis?
Liver transplantation
180
Which intervention does NOT change course of disease in Primary Sclerosing Cholangitis?
Colectomy
181
Triad of clinical symptoms seen in setting of Hereditary Hemochromatosis?
Skin bronzing, Arthritis, DM
182
Appearance of wrist XR in setting of Hereditary Hemochromatosis?
Hook-shaped osteophytes, Calcifications of triangular fibrocartilage
183
Cardiac change associated with Hereditary Hemochromatosis?
Restrictive cardiomyopathy
184
Which type of CA is associated with Hereditary Hemochromatosis?
Hepatocellular carcinoma
185
Ferritin level that Is diagnostic in Hereditary Hemochromatosis?
Ferritin > 300
186
Transferrin saturation that is diagnostic in Hereditary Hemochromatosis?
Transferrin > 50%
187
Which gene is mutated in Hereditary Hemochromatosis?
HFE
188
Treatment for Hereditary Hemochromatosis?
Phlebotomy
189
Treatment for Hereditary Hemochromatosis in patient what develops anemia after phlebotomy?
Deferoxamine
190
Definitive treatment for Hereditary Hemochromatosis?
Liver transplant
191
Inheritance pattern of Wilson Disease?
AR
192
3 sites of copper deposition seen in Wilson Disease?
Liver, Brain, Eyes
193
2 most common clinical signs of Wilson Disease in adolescents?
Psychosis, Elevated LFTs
194
2 DOCs for treatment of Wilson Disease?
D-penicillamine, Zinc
195
Best treatment for patient with small varices, never bled?
Propranolol
196
Best treatment for patient with small varices, never bled; Propranolol is contraindicated?
Band ligation
197
Best treatment for patient with large varices, never bled?
Propranolol, or band ligation
198
Best treatment for patient with actively-bleeding varices?
Band ligation + IV octreotide
199
Best treatment for patient with recurrent varices, not actively-bleeding?
TIPS procedure
200
TIPS procedure stands for …
Transjugular Intrahepatic Portal Shunting
201
AE of TIPS procedure?
Increased hepatic encephalopathy
202
Benefit of TIPS procedure?
Reduces variceal bleeding + ascites
203
Downside of TIPS procedure?
No effect on mortality
204
Recommended screening for liver cirrhosis with no varices?
EGD every 2-3 years
205
Paracentesis shows bloody ascites – diagnosis?
Cancer
206
Paracentesis shows cloudy ascites – diagnosis?
Infection
207
Paracentesis shows milky ascites – diagnosis?
Lymphatic obstruction
208
Recommended sodium restriction for ascites?
< 2000 mg/day
209
Recommended albumin supplementation for paracentesis?
8g albumin per L of aspirated fluid
210
Diagnostic test that suggests Spontaneous Bacterial Peritonitis?
Ascites that shows PMNs > 250/mL
211
Clinical presentation of Spontaneous Bacterial Peritonitis?
Fever, chills, abdominal pain
212
3 most common organisms responsible for Spontaneous Bacterial Peritonitis?
E. coli, Klebsiella, Strep pneumoniae
213
Best treatment for Spontaneous Bacterial Peritonitis?
Cefotaxime + Albumin (survival benefits)
214
3 events that might precipitate hepatic encephalopathy?
GI bleeding, Hypokalemia, Alkalosis
215
Lactulose is a type of …
Disaccharide
