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Royal College > GI > Flashcards

GI Flashcards

(45 cards)

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1
Q

Triad of biliary colic

A

RUQ pain
Vomiting
Jaundice

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2
Q

2 ways to diagnose lactase deficiency

A

Hydrogen urea breath test
Dietary elimination

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3
Q

How long is the contagious period for Hep A?

A

2 weeks before
7 days after onset of symptoms

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4
Q

Who needs Hep A prophylaxis

A

Household contacts
Sexual partners
Needle sharing partners
Daycare and nursing home attendees and staff

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5
Q

Prophylaxis for Hep A

A

Hep A vaccine = > 1 year
Hep A Ig = < 1 year
Ideally within 2 weeks of exposure

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6
Q

Psittacosis

A

Bird fever
Symptoms range from asymptomatic to severe (fever, pneumonia, headaches)
Tx: doxycycline

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7
Q

Legionella

A

Fresh water
Symptoms: pneumonia, cough, chest pain, fever, can get abdo pain, headache, diarrhea
Tx: cephalosporin and macrolide

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8
Q

Q fever

A

Barnyard dust
Reservoirs are cattle, sheep, goats
Symptoms: high fever, headache, cough, GI sx, arthralgias, pericarditis, hepatitis, rhabdo, HSM
Tx: doxycycline

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9
Q

Most common blood borne infection transmitted post blood transfusion

A

Hep B

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10
Q

Most common
1. extrahepatic
2. intrahepatic
causes of portal hypertension

A
  1. Portal vein thrombosis
  2. Cirrhosis
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11
Q

Clinical manifestations of portal HTN

A

GI bleeding
Splenomegaly
Ascites
Growth delay
Hepatic encephalopathy
Pulmonary complications

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12
Q

Non pharm management for GERD

A

Thickened feeds
Modify feeding volumes and frequency
2-4 week trial of extensively hydrolyzed formula (same sx as CMPA)

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13
Q

Course of pharm treatment for GERD

A

4-8 weeks
Needs reassessment

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14
Q

How to manage coin in stomach

A

Conservative management
Repeat XR in 2 weeks
Endoscopic removal if not passed in 2-4 week

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15
Q

Which antigens/antibodies are positive if an infant is immunized against Hep B

A

Surface antigen negative (is not infected)
Core antibody negative (has never seen the actual virus)
Surface antibody positive (has been immunized)
E antigen negative (virus is not actively replicating)

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16
Q

How to manage newborn born to mom who is Hep B positive

A

Hep B vaccine within 12 hours of birth
Hep Ig can be delayed up to 7 days if serology is pending, otherwise give right away

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17
Q

Red flags on constipation history/exam

A

Constipation starting at <1 mo of life
Passage of meconium > 48 hours
Family history of Hirschsprung’s
Ribbon stools
Blood in the stools without anal fissures
FTT, fever, bilious vomiting
Abnormal thyroid gland
Severe abdo distension
Perianal fistula
Abnormal position of the anus, gluteal cleft deviation
Absent anal or cremasteric reflex
Decreased lower extremity strength/tone/reflex
Sacral dimple, tuft of hair on spine
Extreme fear during anal inspection, anal scars

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18
Q

5 day bilirubin photo cut offs for
1. High risk
2. Medium risk
3. Low risk

A
  1. 250
  2. 300
  3. 350
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19
Q

Autoantibodies to check for in AIH

Study These Flashcards
A

ANA
Anti-smooth muscle Ab
Anti-liver-kidney microsomal Ab

20
Q

Wilson disease manifestations

Study These Flashcards
A

Kayser Fleisher rings
Hepatic (hepatomegaly, hepatitis, can progress to liver failure)
Neuro (school troubles, tremors, slurred speech, dystonia)
Psychiatric dysfunction
Fanconi syndrome
Hemolytic anemia

21
Q

Diagnosis of Wilson disease
Treatment

Study These Flashcards
A

Ceruloplasmin for screening, also 24 h urinary copper
Liver biopsy is gold standard
Tx: limit copper intake, D-penicillamine is chelating agent

22
Q

Treatment for H pylori

Study These Flashcards
A

14 days
Amox + clarithro + PPI
Amox + flagyl + PPI
Claritho + flagyl + PP1

23
Q

Celiac dx presentation

Study These Flashcards
A

Variable
Malabsorptive diarrhea, constipation
Poor weight gain, short stature, pubertal delay
Abdominal distension
Proximal muscle wasting
Can lead to vitamin D deficiency, hypocalcaemia, and iron deficiency
Rash (dermatitis herpetiformis)
Oral ulcers, dental enamel defects
Peripheral neuropathy
Osteoporosis

24
Q

Celiac diagnosis

Study These Flashcards
A

Screen with TTG but ALSO need total serum IgA
Confirm with biopsy of small intestine

25
Peutz Jegers syndrome
Autosomal dominant Hamartomatous polyps and mucocutaneous hyperpigmentation of lips and gums Remove all polyps Surveillance colonoscopy from 8 yrs or when symptomatic
26
Infection associated with narrowing of the terminal ileum
Yersinia
27
Cut offs for overweight vs obese
Overweight: 85th to 95th % Obese: > 95th %
28
Risk factors for rectal prolapse
CF Chronic constipation Parasites Ehlers-Danlos Meingocele Diarrhea UC Malnutrition
29
Management options for CMPA
Breastfed: cut out dairy and soy, if no response for 2 weeks then can also eliminate egg and corn Extensively hydrolyzed formula Amino acid formula
30
Diagnostic path for EoE
If not on PPI, scope, treat with PPI for 8 weeks, then rescope If already on PPI then scope Want to know if PPI responsive or not Diagnosis made if 15+ eosinophils/hpf
31
Treatment options for EoE
Consider allergy history +/- food allergy testing Diet: elimination diet Steroids: swallowed > oral
32
Infant dyschezia
10+ mins of straining or crying before stooling Stool is soft Due to difficulty coordinating increased intraabdominal pressure and relaxation of the pelvic floor Provide reassurance, no treatment needed Should resolve around 9 mo
33
Triad of choledochal cyst
Abdominal pain Cholestatic jaundice RUQ mass
34
Alagille syndrome
AD Cholestatic jaundice! Facial: broad forehead, deep-set and widely spaced eyes, long nose, pointed chin, bulbous nose Ocular abnormalities: posterior embryotoxin, microcornea, optic disc drusen, shallow anterior champer Cardiovascular anomalies: PPAS most commonly, TOF, etc Vertebral defects: butterfly vertebrae Dx: liver biopsy, genetics Most will improve over first year of life
35
Lipid panel in obesity vs familial hyperlipidemia
Obesity: elevated TG Familial: elevated LDL, tendon xanthomas
36
When to feed kids with pancreatitis
NPO while vomiting Early enteral nutrition (48-72 hours)
37
Criteria for liver failure from acetaminophen overdose
Arterial pH <7.3 (regardless of hepatic encephalopathy) OR all 3 of the following: INR > 6.5 Creatinine >300 Hepatic encephalopathy grade 3-4
38
Treatment for cyclic vomiting if 1. < 5 years 2. > 5 years
1. cyproheptadine 2. amitriptyline
39
Indications for probiotics
FGIDs (e.g. IBS) Prevention of antibiotic associated diarrhea Reduce incidence of c difficile associated diarrhea, but not for treatment Colic symptoms H pylori eradication (along with standard treatment) Prevention of atopic dermatitis (but not established)
40
SMA syndrome
Bifurcation of the superior mesenteric artery from the aorta compresses the third portion of the duodenum Obstruction = bilious vomiting, gastric distension, abdo pain From decrease in fat pad that cushions the space Anorexia, post major surgery (esp spinal fusion) Dx with UGI or CT abdo with contrast Tx: NG or GJ past obstruction until weight is gained
41
What genetic phenotype for A1AT is the most severe
ZZ M is norMal, S is so-so, Z is zero function ZZ < SZ < MZ < SS < SM < MM
42
When to avoid soy formula
On thyroxine Reduces absorption
43
Rumination syndrome
Vomiting immediately after eating, semi-purposeful and small in volume Not preceded by retching Many patients have comorbid anxiety or depression Treatment is supportive, relying on psychotherapy and CBT
44
Gastroparesis
Delayed gastric emptying in the absence of mechanical obstruction Most common cause is post-infectious (neuropathy of the autonomic ganglia via the inflammatory response) elf-resolves in 1-3 months but can take up to 2 years N/V, abdo pain, early satiety, distension, wt loss *vomiting undigested food in middle of night* Gastric emptying study is the gold standard for diagnosis Can be treated with erythromycin ethylsuccinate or metoclopramide if delayed resolution
45
Which is the best test to check for vitamin D deficiency?
25-hydroxyvitamin D

Royal College (29 decks)

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