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GI Flashcards

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1
Q

Weight loss, anemia, Heme-positive stool

Next best test

A

Endoscopy

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2
Q

Recent travel to south america and new onset dysphagia

A

Chagas

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3
Q

Achalasia Tests
first?
best?

A

Barium esophagram
“Bird’s beak”

Best? manometry

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4
Q

Achalasia Tx:

A

Pneumatic dilation
botulinum
Heller Myotomy

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5
Q

50 y o, dysphagia, alcohol and tobacco use, >5 yr GERD

A

Esophageal Cancers

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6
Q

I think Esophageal cancer what test do I order?

A

Endoscopy

No tissue no issues

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7
Q

Tx for esophageal cancer?

A

Surgical resection

Chemo/radiation adjuvant therapy

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8
Q

Suddent onset chest pain, not related to exertion. EKG and stress r/o Cardiac origins
Dx?
Best initial test?
Accurate Test?

A

Diffuse Esophageal spasm
Esophagram
Manometry

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9
Q

Tx for DES

A

Nitrates

Calcium channel blockers

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10
Q

Difficulty swallowing
+ HIV
CD4 count

A 
Tx: fluconazole
Doesn't resolve?
Endoscopy with biopsy
HSV small vesicles Tx: acyclovir
CMV large vesicles Tx: ganciclovir and foscarnet
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11
Q

Schatzki Ring

A

Steak house syndrome

tx: pneumatic dilation

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12
Q

Plummer vinson syndrome Triad

A
  1. Dysphagia
  2. Iron Def.
  3. Glossitis
    Test: barium esophagram
    Tx: Iron def.
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13
Q

Zenker’s

A

True lumen involving all three layers person wake s up with snacks and halitosis tx. with surgery

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14
Q 
Calcinosis
Raynauds
Esophageal webs
Sclerodactyl
Telangiectasia
A

Scleroderma

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15
Q

hemoptysis after drinking

A

Mallory weiss tear
only in the muscosal layers
Dx: endoscopy tx with epinephrine injections if bleeding doesn’t resolve

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16
Q

Hemoptysis after drinking + crepitus

A

Surgical emergency

the pt has a esophageal rupture aka Boerhaave Syndrome

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17
Q

Right Upper Quadrant

A

Cholelithiasis
Biliary Colic
Cholangitis
Perforated duodenal ulcer

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18
Q

Left Upper Quadrant

A

Splenic rupture

IBD

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19
Q

Right lower Quadrant pain

A 
Ectopic pregnancy
Ovarian torsion
cecal volvulus
cecal diverticulitis
Appendicitis
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20
Q

Left Lower Quadrant pain

A

sigmoid volvulus
sigmoid divierticulitis
ovarian torsion
Ectopic pregnancy

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21
Q

Midepigastric pain

A

Pancreatitis
Aortic rupture
duodenal ulcer

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22
Q

epigastric plus Pain worse with food

A

gastric ulcer

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23
Q

Epigastric plus pain better with food

A

duodenal ulcer

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24
Q

epigastric pain + weight loss

A

cancer, gastric ulcer

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25
Epigastric Pain +tender
pancreatitis
26
epigastric pain _ Bad taste, cough, horseness
GERD
27
epigastric pain + nothing
non-ulcer dyspepsia
28
Epigastric Pain Tx:
PPI H2 Blocker Liquid antacids Misoprostol (used in NSAID gastric damage)
29
Heartburn, metallic taste, cough Dx: test?
GERD | 24 hr. pH monitoring
30
When do I do endoscopy for Barrett's
5 years after having GERD | or when there is odynophagia, weight loss, anemia, heme-pos stools
31
Barrett's Endoscopy results show Tx if it shows dysplasia? Tx if it shows Low grade dysplasia Tx if it shows high grade dysplasia
D: PPI rescope every 2-3 years LG: PPI and rescope 6-12 mo HG: Ablation with endo, photodynamic therapy, radiofreq ablation, surgical removal
32
Causes of gastritis
alcohol, NSAID, H pylori, Portal HTN, stress
33
Gastritis Test?
EGD
34
Stress ulcer prophylaxis indication
Mechanical ventilation Burn's -curling ulcers Head trauma- cushing ulcers Coagulopathy
35
PUD
Gastric and duodenal ulcers
36
MCC of PUD
H. Pylori and NSAID
37
Gastric Ulcer + H pylori
cancer in 4%
38
Duodenal ulcer + H. Pylori
no cancer.
39
Tx of H Pylori
Clarithromycin and amoxicillin | PCN allergy? metronidazol and clarithromycin
40
If H. Pylori doesn't resolve and you have a duodenal ulcer what do you do?
Tx. With metronidazol
41
If H. Pylori doesn't resolve and you have gastric ulcer | what do you do?
CANCER r/o CANCER with another endoscopy
42
Diarrhea, abdominal pain, anemia, heme-positive stool. Ulcers larger than 1 cm Multiple Past 3rd part of the duodenum
Gastrinoma
43
Persistent high gastrin levels despite injecting secretin
Most accurate test for gastrinoma
44
After diagnosis of gastrinoma what tests do you order?
Somatostatin receptor scintingraphy +endoscopic ultrasound
45
long standing diabetes stops motility in the stomach treated with erythomycin
Diabetic Gastroparesis | Succussion splash
46
``` Stabilizing Tx: Fluids pRBC FFP Platelets ```
Fluids: 1-2 L an hour pRBC: Hct 1.3 Platelets
47
What antibiotic is most associated with C Diff
clindamycin
48
Diarrhea suspecting c. diff what is the test?
stool c diff toxin | Most accurate PCR C Diff.
49
C diff. treatment
oral metronidazole
50
c diff treatment not working with first line what do you give?
vancomycin and fidaxomicin
51
Celiac disease tests best? accurate
best? anti-tissue transglutaminase | Accurate? small biopsy
52
Whipple's Disease features
arthralgias, ocular findings, neurologic abnormalities, fever, lymphadenopathy
53
Whipple's most accurate test
bowel wall biopsy showing specific organism
54
Whipple's treatment
ceftriaxone or TMP/SMX
55
Chronic pancreatitis test
secretin stim test | NG tube normal pancrea releases large volume of bicarbonate-rich fluids after IV secretin
56
Carcinoid Syndrome Tx
Octreotide
57
Lactose Intolerance initial test
stool osmolality test
58
Lactose intolerance accurate test
cessation of symptoms after diet change
59
IBS
relieved by bowel movement | Tx: fiber, antispasmodic agent, TCA, antimotility agents
60
Diverticulosis vs Diverticulitis
-litis has LLQ pain and tenderness, fever, leukocytosis, palpable mass sometimes occurs
61
Diverticulitis Tx
ciprofloxacin +metronidazole Amoxicillin/clavulanate Ticarcillin/clavulanate piperacillin/tazobactam
62
HNPCC colonoscopy
25 y.o. every 1-2 year
63
FAP colonoscopy
12 y.o. and every year
64
Previous adenomatous polyposis colonscopy?
every 3-5 years
65
Acute epigastric pain, tenderness, n/u
Pancreatitis | "like a spear to the back"
66
Around the side to my back pain?
cholecystitis
67
Worst prognostic factor for pancreatitis
low calcium
68
spontaneous bacterial peritonitis | Test? treatment?
cell count >250 neutrophils | tx: cefotaximine or ceftriaxone
69
woman in 40s, fatigue, itching, normal bili, elevated alk phos
Primary biliary cirrhosis
70
PBC accurate test?
liver biopsy
71
PBC accurate blood test?
antimitochondrial antibody
72
PBC tx?
Ursodeoxycholic acid
73
Primary Sclerosis Cholangitis
Pruritus, elevated alk phosp, GGTP, elevated bili Tx: cholestyramine/Ursodeoxycholic acid

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