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Step 2 CK > GI > Flashcards

GI Flashcards

1
Q

What gene is associated with FAP?

A

APC

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2
Q

What gene is associated with Lynch Syndrome?

A

MSH1/6; MLH1

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3
Q

What gene is associated with Peutz-Jegher?

A

STK1

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4
Q

What does acetaminophen toxicity do to liver?

A

1.depletes intrahepatic glutathione
2. overaccumulation of NAPQI leads to mitochondrial damage (oxidative hepatocellular injury)

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5
Q

Adverse effect of PPIs

A

1.malabsorb Fe,Ca,Mg, B12, 2)risk of infection 3)osteoporosis, CKD, IBD 4)small bowel bacterial overgrowth

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6
Q

What are the labs of Cholangiocarcinoma (ALP, BIL) and what will you see on imaging? histological presentation?

A

ALP up, BIL up; bile duct dilation but no stone; adenocarcinoma with cuboidal/columnar cells, prominent nucleoli arranged in glandular structure; mucin and desmoplastic

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7
Q

G cells
D cellls
I cells
S cells
K cells
M cells

A

Gastrin, up H+
Somatostatin down GI secretions
Cholecystikinin pancreaticenzyme,bile HCO3up
Secretin HCO3 up, H down
GIP up insulin down H
Motilin up GI motility

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8
Q

What are the risk factors for hepatic angiosarcoma?

A

PVCs, vinyl chloride (CD31 marker)

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9
Q

If a pt needs diphenoxylate (opioid antidiarrheal), which conjugate medicine could be given to discourage opioid abuse?

A

atropine (causes adverse reactions if opoiod taken in large amounts)

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10
Q

After GI tract infection, could become lactose intolerant, what would happen to pH of stool, hydrogen breath test, and stool osm?

A

pH stool down; H+ breath up; stool osm up

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11
Q

Which gene is involved in hereditary pancreatitis?

A

trypsinogen or SPINK1 (serinpeptidase inhibitor Kazal type 1) which is a trypsinogen inhibitory

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12
Q

Which med for post chemo nausea and vomiting that is neurokinin 1 antagonist

A

Aprepitant

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13
Q

If there is a mutation in KIT receptor tyrosine kinase gene and there is syncope, flushing, hypotension, pruritus, vomiting, diarrhea, up gastrin which syndrome is this?

A

Systemic mastocytosis

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14
Q

3 drugs for Hep C tx

A

RNA dependent RNA polymerase inhibitor (sofosbuvir)
Protease inhibitors (after host makes proteins must cleave proteins with protease)–Simeprevir
NS5A inhibitor ledispravir (not sure MOA)

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15
Q

Retroperitoneal organs

A

SAD PUCKER
Suprarenal
Aorta and IVC
Duodenum (first part)
Pancreas (head and body)
Ureters
Colon (ascending colon)
Kidneys
Esophagus
Rectum (mid distal)

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16
Q

Small solitary pale nodules comprised of cords or normal appearing hepatocytes and central stellate scars, fibrous setae that surround abnormally large hepatic artery branch

A

focal nodular hyperplasia

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17
Q

osmotic laxative

A

lactulose, MgOH, polethylene glycol

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18
Q

peripheral mu opioid antagonist (for GI motility)

A

methylnaltrexone

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19
Q

fast acting laxative

A

bisacodyl, senna (abd. cramp, electrolyte disturbance)

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20
Q

What is the main HLA problem that cause celiac disease?

A

HLA DQ2/DQ8

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21
Q

treatment for DES (diffuse esophageal spasm) and nutcracker esophagus

A

TCA, sildenafil, nitrates (like Prinzmetal); PPI if needed

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22
Q

most accurate test for DES/nutcracker esophageal spasm

A

manometry

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23
Q

multiple concentric rings on endoscopy

A

esophageal esophagitis

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24
Q

TX: for esophageal esophagitis

A

eliminate allergenic foods; PPI; swallow steroid inhaler

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25
Q

pills that cause esophagitis

A

doxycycline, bisphosphonates (alendronate); KCl tablets

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26
Q

HIV CD4 count less than 100 with dysphagia, next management?

A

fluconazole + HIV therapy; if doesn’t work do endoscopy: Large ulcer CMV give gancyclovir; small ulcers HSV give acyclovir

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27
Q

Which esophageal problem is associated with iron deficiency anemia and could (rare) transform into squamous cell carcinoma?

A

Plummer-Vinson syndrome

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28
Q

TX Plummer Vinson

A

iron replacement

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29
Q

TX Schatzi ring

A

pneumatic dilation

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30
Q

TX Zenker’s diverticulum

A

surgery

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31
Q

diagnosis for achalasia, spasm and scleroderma

A

manometry

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32
Q

TX for Mallory Weiss severe or persistent bleeding

A

epinephrine injections or electrocautery

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33
Q

differential for RUQ pain

A

cholecystitis, biliary colic, cholangitis, perforated duodenal ulcer

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34
Q

differential for LUQ pain

A

splenic rupture; splenic flexture syndrome (IBD)

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35
Q

differential for RLQ pain

A

appendicitis, ovarian torsion, ectopic pregnancy, cecal diverticulitis

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36
Q

differential for LLQ pain

A

sigmoid volvulus, sigmoid diverticulitis, ovarian torsion, ectopic pregnancy

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37
Q

differential for mid epigastric pain

A

pancreatitis, aortic dissection, PUD

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38
Q

What test if you suspect Barrett’s?

A

endoscopy and biopsy

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39
Q

Barrett’s metaplasia (mild)

A

PPI and rescope 3-5 yrs

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40
Q

low grade dysplasia (Barrett’s)

A

PPI and rescope 6-12 months

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41
Q

high grade dysplasia

A

endoscopy with ablation, radiofrequency ablation or resection of mucosal

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42
Q

definitive test for gastritis

A

endoscopy + H pylori testing

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43
Q

Which neoplasm gives positive result for H pylori stool antigen?

A

MALToma

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44
Q

MCC of peptic ulcer

A

H. Pylori #2NSAIDs

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45
Q

meds for H. Pylori

A

clarithromycin + amoxicillin; if allergic to penicillin then clarithromycin + metronidazole (other meds can try if not effective tetracycline: ONLY USE FOR TETRACYCLINE be careful not pregnant/nursing/ see contraindicationis)

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46
Q

after H Pylori treatment

A

30-60 days post treatment; retest

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47
Q

Who gets stress ulcer prophylaxis?

A

head trauma pts; burn pts; intubated pts; pts with sepsis and coagulopathy

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48
Q

Do you treat asymptomatic H pylori?

A

NO

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49
Q

recurrent ulcers despite treatment?

A

inject secretin and see if gastrin levels go down; if go down (normal); if not, think gastrinoma

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50
Q

tx for gastrinoma if localized?

A

surgery

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51
Q

tx for gastrinoma if metastasized?

A

PPI for life

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52
Q

diabetic gastroparesis tx:

A

erythromycin or metaclopramide (cannot be used permanently causes dystonia and hyperprolactinemia)

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53
Q

best initial test for diabetic gastroparesis

A

upper endoscopy or abdominal CT to exclude luminal gastric mass or abdominal mass

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54
Q

most accurate test for diabetic gastroparesis

A

food bolus tagged with technetium

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55
Q

upper GI bleeding differential

A

esophagitis, gastritis, cancer, duodenitis, varices

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56
Q

lower GI bleeding differential

A

angiodysplasia, polyps, IBD, cancer, upper GI bleeding, hemorrhoids, fissures

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57
Q

Acute GI bleeding next best step of management

A

replace fluids, check Hemocrit, PLT and coag tests ; replace fluids most important than etiology

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58
Q

Tx for GI bleeding

A

1-fluid replacement

#2-packed RBC if hemocrit less than 30, esp. if pt is older or has CAD; younger pts sometimes can tolerate HCT 20-25
#3 FFP if PT or INR elevated and actively bleeding
#4 PLTs if PLT less than 50,000 and bleeding
#5 reversal of anticoagulants if needed
Xa inhibitor reversed by andexanet alfa
dabigatran reversed by idarucizumab
warfarin reversed by prothrombin complex concentrate
#5 inject epinephrine to bleeding vessels (cauterization)

59
Q

reversal of Xa inhibitor

A

andexanet alfa

60
Q

dabigatran reversal

A

idarucizumab

61
Q

warfarin reversal

A

Prothrombin complex concentrate (PCC)

62
Q

tx for esophageal and gastric varices

A

octreatide; banding; TIPS; antibiotics if ascites is present to prevent SBP (spontaneous bacterial peritonitis)

63
Q

best initial test for C. diff?

A

C diff toxin test

64
Q

most accurate test for C diff?

A

PCR

65
Q

Tx for C diff?

A

vancomycin if no response fidoximicin

66
Q

monoclonal antibody against C diff?

A

bezlotuxumab

67
Q

If all treatments fail for C diff?

A

fecal transplant

68
Q

distinguish between chronic pancreatitis and celiac disease

A

celiac has iron deficiency

69
Q

anti tissue transglutaminase can be falsely negative in what condition?

A

IgA deficiency

70
Q

three tests for celiac disease:

A

anti-tissue transglutaminase,
antiendomysial antibody
IgA antigliadin antibody

71
Q

most accurate test for celiac disease?

A

small bowel biopsy; essential to rule out LYMPHOMA

72
Q

most accurate test for chronic pancreatitis:

A

secretin stimulation test: normal pancreas releases large volume of bicarb rich fluids

73
Q

down fat absorption, fat vitamin deficiencies, arthralgias, ocular finding, dementia, seizure, fever, lymphadenopathy, which disease?

A

Whipple’s

74
Q

Tx for Whipple’s

A

ceftrioxane first; then TMP/SMX

75
Q

Tx chronic pancreatitis

A

replace enzymes

76
Q

Tx celiac

A

gluten free diet

77
Q

treatment for tropical sprue

A

TMP/SMX or doxycycline

78
Q

treatment for tropical sprue

A

TMP/SMX or doxycycline

79
Q

flushing, wheezing, diarrhea, right heart abnormalities

A

carcinoid syndrome

80
Q

diagnosis for carcinoid syndrome

A

urine 5HIAA

81
Q

Tx for carcinoid syndrome

A

octreatide to control diarrhea and symptoms

82
Q

tx for diarrhea dominant IBS

A

rifaxamin or eluxadoline

83
Q

tx for constipation dominant IBS

A

fiber, polyethylene glycole (PEG)

84
Q

ALL IBD pts have?

A

ANEMIA

85
Q

possible marker of UC

A

ANCA

86
Q

possible marker for Crohn’s

A

anti saccharomyces cervisiae antibody (ASCA)

87
Q

Tx for IBD

A

steroids (prednisone but best budesonide) for acute exacerbations; 5-ASA (mesalamine) for remission;

88
Q

Tx for UC limited to rectum:

A

Asacol (mesalamine) or Rowasa

89
Q

Tx for perianal Crohn’s

A

Pentasa (mesalamine) or ciprofloxacin+metronidazole

90
Q

What mineral and vitamin for all IBD

A

Ca and Vita D

91
Q

Tx for Crohn’s fistula?

A

anti-TNF (adalimumab, infliximab, etanercept) or anti IL 12/23 ustexinumab

92
Q

Tx for short bowel syndrome

A

vita ADEK supplement; B12, Ca, Mg, Fe, Zn supplement; avoid high fat food; loperamide to slow bowel; teduglutide GLP agonist to slow bowel

93
Q

Tx for SIBO (small intestinal bacterial overgrowth)

A

rifaximin

94
Q

tx for microscopic colitis (chronic watery diarrhea)

A

steroids (budesonide, prednisone)

95
Q

suspect diverticulitis DO NOT do what?

A

colonoscopy (might perforate); do CT scan

96
Q

Tx diverticulitis

A

ciprofloxacin + metronidazole; or ceftriaxone + metronidazole; or amoxicillin/clavunate

97
Q

MC complication of diverticulitis

A

abscess

98
Q

Feed pts with acute diverticulitis?

A

NO all diverticulitis pts. NPO

99
Q

routine colon cancer screening

A

start 50 y/o, every 10 yrs

100
Q

previous adenomatous polyp how often should have colonoscopy?

A

every 3-5 years

101
Q

previous Hx of colon cancer, how often should have colonoscopy?

A

1 year after resection; then 3 years; then 5 years

102
Q

family hx of colon cancer, how often should have colonoscopy?

A

10 years before the family member’s age of discovery of colon cancer or 40 y/o whichever is younger; repeat every 5 years if family member was younger than 60

103
Q

FAP, Gardner’s, Turcot (CNS involvement) and Juvenile polyposis how often need colonoscopy

A

start at 12 y/o; sigmoidoscopy every year, APC test

104
Q

Peutz-Jegher pts how often need colonoscopy?

A

start at 8 y/o, every 3 years

105
Q

stopping anticoags before colonoscopy? warfarin?

A

anticoags 1 day before and can resume one day after; warfarin 3-5 days before, can resume after

106
Q

Which of the following associated with worse prognosis in pancreatitis? a) increased amylase b) increased lipase c) intensity of pain d) low Ca e) CRP increased

A

d) severe pancreatitis decreases lipase which = fat malabsorption; Ca usually binds with fat in bowel but if low fat absorption= low Ca absorption

107
Q

Tx pancreatitis

A

NPO, IV fluids, analgesia, PPI (to decrease pancreatic stimulation to acid); CT/MRI if shows greater than 30% necrosis give antibiotic such as imipenem to decrease mortality; infected necrotic pancreas should be resected and surgically debrided to prevent ARDs and death

108
Q

IGG4 related pancreatitis

A

autoimmune pancreatitis: may also have +ANA and +RF, recurrent jaundice, weight loss, abdominal pain in absence of alcohol or stones) biopsy to exclude cancer!

109
Q

histology of autoimmune pancreatitis

A

lymphocytes and plasma cell infiltrates

110
Q

Tx for autoimmune pancreatitis:

A

steroids

111
Q

pancreatic cancer marker

A

Ca 19-9

112
Q

pancreatic cancer labs

A

AMY/LIP normal: ALP, GGT, BIL up

113
Q

When do you screen for liver cirrhosis with U/S

A

every 6 months

114
Q

What should you perform if you discover new ascites?

A

paracentesis if abdominal tenderness and fever; check SAAG (serum ascites albumin gradient)

115
Q

significance of SAAG

A

If SAAG less than 1.1 means infection; cancer; nephrotic syndrome
If SAAG more than 1.1 means CHF, portal HTN, hepatic vein thrombosis; or constrictive pericarditis

116
Q

What prophylaxis do all variceal bleeding with ascites need?

A

SBP prophylaxis (cefotaxime or ceftriaxone); if have SBP need lifetime prophylaxis

117
Q

Tx for encephalopathy

A

lactulose, rifaximin

118
Q

Tx for ascites/edema

A

spirinolactone and other diuretics, paracentesis for large volume

119
Q

Tx for varices

A

propranol and banding

120
Q

tx for hepatorenal syndrome

A

somatostatin (octreatide) or midodrine

121
Q

alcoholic hepatitis discriminating factor

A

4.6 * (pt’s PT-control PT) + BIL; if greater than 32 treat with steroids

122
Q

woman 40, 50 y/o; fatigue/itching; normal BIL, increase ALP; xanthomas; osteoporosis

A

PBC primary biliary cholangitis

123
Q

PBC main marker

A

anti-mitochondrial antibody

124
Q

What med can decrease fibrosis in PBC

A

obeticholic acid

125
Q

young male; IBD, pruritis, increase ALP, increase GTTp ; increase BIL

A

PSC primary sclerosing cholangitis

126
Q

most accurate test for PSC

A

MRCP/ ERCP see beading

127
Q

gene for hemochromatosis

A

HFE C282y gene mutation

128
Q

signs of hemochromatosis

A

AST/ALT increased; fatigue/joint pain (pseudogout); erectile dysfunction in men, amenorrhea in women (clogged pituitary); skin darkening, DM, cardiomyopathy

129
Q

which bacterial infections are pts with hemochromatosis more susceptible to and why?

A

Vibrio v., yersinia, Listeria because these organisms love Fe

130
Q

Tx hemochromatosis

A

phlebotomy, Fe chaltor deferasirox/deferiprone

131
Q

Before using these meds what should you check for: Anti CD 20 (rituximab, oftumumab); anti CD 52 alemtuzumab; HIV pre-exposure prophylaxis (PrEP) tenofovir and emtricitabine

A

Check for HEP B surface antigen

132
Q

ACUTE HEP C only acute hep that is treated!
ALL ADULTS need to be tested for HEP C!

A
133
Q

Tx chronic Hep C

A

sofosbuvir + ledipasvir or sofosbuvir + velpatasvir (choose this one if on test)

134
Q

Interferon SE

A

arthralgia, myalgia, anemia, depression

135
Q

ribavirin SE

A

anemia

136
Q

Most accurate test for Wilson’s?

A

increased Cu urine excretion upon give penicillamine

137
Q

Tx for Wilson’s?

A

Penicillamine and Zinc; if allergic to penicillin do not give Penicillamine; use zinc or trietine

138
Q

NASH/NAFLD can be given which antioxidant

A

Vit E

139
Q

possible TX for NASH

A

obeticholic acid

140
Q

NASH and DM cotreatment

A

pioglitazone

141
Q

MELD (Model for end stage liver disease) used to determine what?

A

who gets liver transplant first; up MELD score, faster transplant

142
Q

benign liver disease “central stellate scarring”

A

focal nodular hyperplasia

143
Q

Which benign liver disease changes with estrogen levels?

A

hepatic adenoma

Step 2 CK (4 decks)

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