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PANCE review > GI > Flashcards

GI Flashcards

1
Q

Zenkers diverticula

A

is a pouch in the mucous of the pharynx, just above the cricopharyngeal muscle

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2
Q

Symptoms of Zenkers diverticula?

A

regurgitation

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3
Q

Odynophagia

A

painful swallowing

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4
Q

Goal standard to dx Barretts?

A

Endoscopy with biopsy

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5
Q

Cell change of Barretts

A

Sqamous to columnar cells –causing adenocarcinoma

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6
Q

Tx of GERD?

A
  1. antacids 2. H2 blockers (ranitidine) 3. PPIs (omeprazole) and Nissen
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7
Q

Infectious esophagitis –you should think?

A

immunocompromised (HIV)

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8
Q

findings on PE for infectious esophagitis?

A

Ulcers

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9
Q

Deep esophageal ulcers

A

Herpes

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10
Q

Swallow esophageal ulcers

A

CMV

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11
Q

Esophageal achalasia

A

Esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus

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12
Q

gold standard test for Esophageal motility disorder

A

24 hour manometry and barium swallow

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13
Q

Medication for Esophageal motility disorder

A

CCB (nifedipine) and pro kinetics (metoclopramide) to help with emptying of the stomach in people with delayed stomach emptying.

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14
Q

main etiology of esophageal varies?

A

Portal HTN / cirrhosis

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15
Q

which has greater bleeding Mallory Weiss tear or Boeehaave’s?

A

Boehaaves- is rupture of the esophagus. May have Hamman’s sign=crunch of crepitus in the pericardium

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16
Q

1 cause of esophageal strictures?

A

GERD, can also be infection or autoimmune

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17
Q

why does caffeine and smoking lead to GERD?

A

decreases esophageal tone

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18
Q

which would you not find in nephrotic syndrome Hematuria or Hyperlipidemia?

A

No Hematuria!!!

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19
Q

Ulcer that is worse right after eating

A

peptic

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20
Q

ulcer that is better after eating

A

duodenal

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21
Q

gold standard to dx ulcers

A

endoscopy with biopsy

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22
Q

how do you eradicate h.pylori

A

triple antibiotic therapy

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23
Q

go to med for tx of ulcers

A

H2 blocker and PPI

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24
Q

at what age is pylori stenosis most common

A

4-6 week old baby

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25
Q

string sign

A

think pylori stenosis

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26
Q

the four f’s of cholelithasis

A

fat, forty, female, fertile

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27
Q

good standard of imagining for gallbladder

A

US

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28
Q

If a patient has dermatitis herpetiform, they also have?

A

celiac disease

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29
Q

define anorexia nervosa?

A

15% decrease from their ideal body weight

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30
Q

medical therapy for anorexia

A

antidepressants, mood stabilzers

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31
Q

what vitamins are higher risk for toxicity>

A

fat soluble (ADEK) storage in the attic

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32
Q

Thiamine is?

A

B1

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33
Q

4 reasons why someone may have a thiamine deficiency

A
  1. ETOH
  2. Hyperemesis gravidarum
  3. malignancy
  4. AIDS
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34
Q

why must you give thiamine before dextrose ?

A

prevent wernicke’s encephalopathy

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35
Q

what is the difference between WET beriberi and DRY beriberi

A

WET: blood:CVS and leads to cardiac failure
DRY: CNS peripheral neuropathy that can lead to Wernicke’s and finally to Korsakoff

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36
Q

Name the 3 components of wernicke’s

A
  1. confusion, ataxia, and opththamoplegia
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37
Q

opththamoplegia

A

paralysis of the muscles within or surrounding the eye, this is CN 6

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38
Q

name 3 components of korsakoff?

A

irreversible, short term memory loss, and CONFABULATION

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39
Q

symptoms of B3 (Niacin) deficiency

A

Pellagra: the 4 D’s

  1. Dermatitis
  2. Diarrhea
  3. Dementia
  4. Death
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40
Q

treatment for fissures

A

surgery

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41
Q

Tx for perianorectal abscess

A

I&D, antibiotics

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42
Q

Two precursors of anal cancer?

A

Papillomarvirus and HIV, most common type is squamous

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43
Q

why does esophageal CA spread to mediastinum?

A

the esophagus has no serosa

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44
Q

best test to stage esophageal CA?

A

Endoscopic sonography and CT

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45
Q

what is Budd Chiari syndrome

A

thrombosis of the portal vein leading to esophageal varices

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46
Q

are varices symptomatic

A

no not until they bleed, then they become life threatening

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47
Q

tx for varices? medical and surgical

A

beta blockers, stop hepatotoxic agents and use band ligation

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48
Q

medications that worsen GERD

A

NSAIDs, antibiotics, CCB, benzos, iron, anticholinergics

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49
Q

acute varices bleeding tx

A

band and use octretide

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50
Q

what two test can be used to test if h.pylori has been eradicated with triple antibiotic treatment?

A

the stool antigen test and urea breath test. The serum antibody test can be used to detect, but does not test for a cure

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51
Q

triple antibiotic therapy for h. pylori

A

amoxicillin, clarithromycin and metronidazole

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52
Q

what is zollinger ellison syndrome

A

gastrin secreting tumor (gastrinoma) causes refactory PUD

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53
Q

gastrinomas can be part of what syndrome?

A

MEN 1

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54
Q

how to dx gastrinoma

A

fasting gastrin level greater than 150 and a secretin test (give 2units and the gastrin level will increase more than 200 units

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55
Q

what is the most common CA in the world

A

Gastric adenocarcinoma

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56
Q

sign of metastatic gastric cancer

A

umbilical node (sister mary joseph) and left supra clavicle node (Virchow)

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57
Q

the stomach is the most common extra nodal site for what CA?

A

non Hodgkin lymphoma

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58
Q

pseudomembranous colitis (think)

A

c.dif

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59
Q

small bowel obstructions are caused by

A

adhesions

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60
Q

larger bowel obstructions are mostly caused by

A

CA

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61
Q

treat for bowel obstructions

A

partial: NPO, IV fluids, nasogastric suctioning
complete: surgical

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62
Q

location where volvulus most often occur?

A

cecal and sigmoid area

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63
Q

tx of volvulus

A

try endoscopic decompression or surgery

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64
Q

dx of celiac

A

IgA antiendomysial and anti tissue transglutaminase antibodies for screening. Small bowel biopsy is needed to confirm the dx

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65
Q

complications of crohns

A

fistulas, abscess, aphthous ulcers, renal stones, granulomas

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66
Q

dx of crohns

A

colonscopy is the most valuable tool for establishing the dx.

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67
Q

acute crohns attack is tx with?

A

oral steroids (prednisone)

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68
Q

is surgery curative with crohns or UC

A

UC(segmental resection is possible, but total proctocolectomy is the most common

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69
Q

where does UC start?

A

distally, at the rectum and progresses proximally

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70
Q

are toxic mega colon and CA more common with UC or crohns?

A

UC

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71
Q

name the skin manifestations associated with UC

A

erythema nodosum and pyoderma gangrenosem

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72
Q

is smoking protective of harmful with UC

A

protective

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73
Q

dx

A

colonscopy of sig, but not during acute disease

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74
Q

what is the most common cause of chronic or recurrent abdominal pain the US

A

IBS

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75
Q

population that gets intussusception?

A

children and most likely post viral

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76
Q

tx of intussusception in children vs adults

A

barium enema for kids, surgery for adults

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77
Q

dx of intussusception

A

CT

78
Q

can fever and leukocytosis occur with diverticular dz

A

yes

79
Q

tx for diverti

A

antibiotics, hospitalization for IV antibiotics, bowel rest, pain meds and nasogastric suction

80
Q

what will patient’s of both acute and chronic ischemic bowel be?

A

over the age of 50 and have signs of CV or collagen vascular dz

81
Q

dx of ischemic bowel?

A

duplex US of the mesenteric artery, confirmed by angiography

82
Q

tx of ischemic bowel

A

hydrate and operate

83
Q

describe acute ischemic bowel

A

pain out of proportion with exam

84
Q

describe chronic ischemic bowel

A

pain 10-30min have eating, relieved by squatting or lying down

85
Q

name four disorders that can cause toxic mega colon

A

UC, Crohns, pseudomembranous colitis, and infectious bugs

86
Q

X-ray finding for mega colon

A

colonic dilation

87
Q

tx mega colon

A

decompression is required or colostomy may be required

watch electrolytes

88
Q

toxic mega colon in newborns

A

hirschsprung; congenital aganglionosis of the colon

89
Q

how often should family members of familial polyposis syndrome be evaluated

A

1-2 years beginning at age 10-12

90
Q

out of hyper plastic, tubular and villous which is the highest CA risk

A

villous, then tubular, then hyper plastic

91
Q

follow up if multiple hyper plastic or tubular is found

A

5 years

92
Q

if villous is found, follow up?

A

3 years

93
Q

top 3 leading cancer deaths in the US

A
  1. lung cancer 2.skin 3. rectal
94
Q

right sided colorectal lesions cause

A

chronic blood loss, iron deficiency anemia, but obstruction is uncommon

95
Q

left sided colorectal lesion cause

A

are circumferential causing change in bowel habits and obstructive symptoms

96
Q

what is carcinoembryonic antigen used for

A

to monitor colorectal CA-not to dx

97
Q

what are pilonidal cyst

A

abscess in sacrococcygeal cleft associated with a subsequent sinus tract development

98
Q

tx anal fissure

A

sits bath, silver nitrate cream

99
Q

tx for abscess vs. fistula

A

abscess (I&D) and fistula(surgical)

100
Q

more proximal fecal impaction may indicate

A

neoplasm

101
Q

Anal CA is caused by

A

HPV

102
Q

screening of anal cancer can be done?

A

pap smear

103
Q

the most common abdominal surgical emergency

A

appenidix

104
Q

appendicitis is most often caused by

A

fecalith , but can be caused by CMV or another virus

105
Q

WBC expected by appendicitis

A

10,000 to 20,000 (anything higher think perf)

106
Q

acute pancreatitis is caused by

A

ETOH, gallstone, hyperlipidemia, drug(antiHIV), hypercalcemia

107
Q

where are pancreatitis pain radiate?

A

to the back

108
Q

dx testing for pancreatitis?

A

lipase is more sensitive and specific than amylase, use Ranson’s criteria, look for gallstones on US

109
Q

X-ray finding for pancreatitis

A

sentinel loop

110
Q

tx for acute pancreatitis

A

STOP all oral intake to prevent continued secretion of pancreatic juices, maintain fluid volume, control pain

111
Q

chronic pancreatitis contributed 90% of the time to

A

ETOH, must stop this to get better

112
Q

stool symptoms of chronic pancreatitis

A

increased fecal fat due to malabsorption that lead to steatorrhea

113
Q

what will X-ray show in chronic pancreatitis

A

calcification

114
Q

Signs of pancreatic cancer?

A

Jaundice, palpable gallbladder (courviouser’s sign) tx is a whipple and prognosis is poor

115
Q

do all people with gallstones develop symptoms

A

no, only 30%

116
Q

what are the complications of gallstones

A

cholecytitis, pancreatits, and acute cholangitis

117
Q

symptoms of acute cholecysitis (blockage of the cystic duct)

A

colic, epigastic pain, after a meal, right shoulder radiation, N/V, constipation. BUT NO JAUNDICE (unless the stone has migrated in the common duct area)

118
Q

dx cholecystitis

A

US, hepatoiminodiacetic acid (HIDA scan) and endoscopic retrograde cholangiopancreatiography )ERCP can id, locate, and note the extend of the obstruction

119
Q

what is acute cholangitis

A

an obstruction(gallstone or CA) of the common bile duct that is complicated by infection caused by ecoli, kleb or enterobacter

120
Q

what is charcot triad

A

fever, RUQ pain, and jaundice

121
Q

what is fever, RUQ pain, jaundice, mental status change, and hypotension called

A

Reynolds pentad. it indicates sepsis

122
Q

dx of acute cholangitis

A

US, WBC shift and ERCP (dx and treatment)–for drainage, surgical sphincterotomy and stone removal and stent placement once pt is stable. give antibiotics. The gallbladder should be removed once pt is recovered

123
Q

antibiotics for acute cholangitis

A

fluoroquinolone, ampicillin, gentamicin or metronizole

124
Q

what is primary sclerosing cholangitis

A

chronic thickening of the bile duct walls 80% of cases are associated with UC.

125
Q

primary sclerosing cholangitis is associated with UC and _______________

A

cholangiocarcinoma, pancreatic cancer, and colorectal cancer

126
Q

Jaundice, pruritus, weight loss are common symptoms of

A

PSC

127
Q

tx for PSC

A

use balloon dilation for stricture and stent placement, LIVER transplant is the only tx with known surivial benefit

128
Q

most common cause of acute hepatitis?

A

VIRAL, etoh is second

129
Q

bilirubin greater than 3.0 is associated with

A

scleral icterus

130
Q

chronic hep most often results from viral infection of what letters

A

B,C,D

131
Q

A&E hep are transmitted by? course?

A

fecal oral, self limiting and mild

132
Q

B, C, D hep are transmitted? course?

A

needle and mucous membrane

133
Q

hep D is only seen in conjunction with

A

hep B (more severe course)

134
Q

dx for hep

A

aminotransferase elevations, bilirubin increase

135
Q

marker for Hep A at initial incubation period and then several months later

A
  1. initial = IgM antibody (anti-HAV)

2. resolved infection = IgG

136
Q

marker for ongoing Hep B infection

A

Hep B surface antigen (HBsAg)

137
Q

marker that indicates immunity by past infection or vaccination to hep B

A

(Anti-HBs) the person has form an antibody against the surface antigen of HB

138
Q

what does HBeAg indicate

A

hep b envelope antigen (HBeAg) indicates infection that is highly contagious

139
Q

what does anti-HBe indicate

A

lower viral titer

140
Q

how do you tell the difference between the carrier state or hep b and the chronic infection of both are positive for HBsAg

A

in chronic infection there will be liver damage, increase AST and ALT. the viral load will be greater than 10 to the 5th copies

141
Q

toxic hepatitis can be caused by acetaminophen overdose, what is the recommended amount per day and tx?

A

4g and acetylcysteine

142
Q

two biggest causes of cirrhosis

A

ETOH and Hep B or C

143
Q

spontaneous peritonitis present with cirrhosis, this can lead to

A

diarrhea and renal failure, this can be treated with antibiotic

144
Q

Dx for cirrhosis

A

normal labs until late in the disease. CT, US and MRI will show nodules and helpful in grading biopsy

145
Q

what is cirrhosis?

A

irreversible fibrosis and nodular regeneration throughout the liver

146
Q

what medication can be given for ascites

A

diuretic

147
Q

bacteria that usually causes liver abscess

A

entamoba histolytic or the coliform bacteria

148
Q

primary hepatocellular carcinoma is associated with

A

hep B & C, cirrhosis

149
Q

tx of liver cancer

A

do not do needle biopsy (seeding), only resect if contained to one lobe, if this is a second CA, then tx the primary

150
Q

what lab may be elevated to help with liver CA dx?

A

alpha-fetoprotein

151
Q

incisional hernias are associated what type of incision

A

vertical

152
Q

ventral hernia

A

a weakening in the anterior abdominal wall

153
Q

congenital diaphragmatic hernia of newborn is dx and tx ?

A

cause respiratory distress due to pressure of hernia on lungs, intubation, nasogastic suction tx is surgical. Dx is made on hearing bowel sounds in the chest, x-ray shows loops of bowel involved in the hemithorax, displacement of the heart and mediastinal structures

154
Q

Phenylketonuria is a

A

rare autosomal recessive inability to metabolize protein phenylalanine (it accumulates in the CNS and causes dehydration. strict control of protein is required throughout life.

155
Q

lack of vitamin C causes what symptoms?

A

perifollicular hemorrhage, ecchymoses of the legs, bleeding gums, loose teeth and GI bleeding

156
Q

Interferon (tx for hep) is contraindicated in patients with?

A

autoimmune disease, severe liver dz and cardiac arrhythmias

157
Q

large volume of watery diarrhea

A

Ecoli or a virus

158
Q

smaller volume, but bloody diarrhea

A

is infection with Samonella, Shigella, C. dif or Camp

159
Q

chronic diarrhea from cryptosporidiosis may be indicative of

A

immunodeficiency (HIV)

160
Q

CT finding of diverticulitis

A

soft tissue thickening of the pericolic fat and a thickening of the bowel wall

161
Q

Markle sign or jar sign

A

rebound tenderness, pt stands and drops heels to the ground

162
Q

Pellagra is what type of deficiency

A

Niacin

163
Q

3 D’s of pellagra

A

dermatitis, diarrhea, and dementia

164
Q

mechanical impaction is treated

A

manual disimpaction

165
Q

are anal fissure seen in both UC and crohns

A

no only Crohns

166
Q

what is seen on X-ray of perforated ulcer

A

free air under the diaphragm

167
Q

pain during defecation with occasional blood on TP

A

anal fissure

168
Q

factors that contribute to stress ulcers forming the first 72 hours of hospital stay

A

critical ill, burns, trama and sepsis

169
Q

where are femoral hernias palpated

A

below the femoral ligament

170
Q

is primary biliary cirrhosis associated with direct or indirect bilirubin

A

direct

171
Q

acute onset of LUQ pain that radiates to the back and mid-epigastric is tender to palpation, vomting, fever, and tacky pulse

A

pancreatitis

172
Q

tx for mild to mod ulcerative pancolitis

A

sulfasalazine

173
Q

most common travelers diarrhea is adults

A

E. coli

174
Q

how to test for giardiasis ( the most common intestinal protozoal infection in children in the US)

A

ova and parasite in stool or the giardia antigen in the stool

175
Q

putum cultures revealing Mycobacterium tuberculosis are the gold standard in diagnosis of pulmonary TB. Typically sputum samples are obtained in the morning on three consecutive days.

A

bismuth (Pepto-Bismol) coats the stomach and inhibits pepsin action.

176
Q

Which of the following types of anemia may be present in patients with Celiac disease?

A

Iron deficiency anemia

177
Q

Which of the following is the definitive therapy in an infant whose rectal biopsy reveals absence of ganglion cells?

A

Colostomy or resection of the aganglionic segment is the definitive therapy for an infant with Hirschsprung’s disease.

178
Q

Which of the following antibiotic regimens is indicated in the treatment of a patient with cholecystitis?

A

Ceftriaxone and Metronidazole

179
Q

Which of the following is the most common cause of gastric outlet obstruction?

A

cancer

180
Q

he patient undergoes colonoscopy as part of the evaluation, which shows irritation and mild ulcerative lesions in the terminal ileum as well as the splenic flexure. Both lesions appear to have a cobblestone-like pattern to them. Which of the following is the most likely diagnosis?

A

crohn’s dz

181
Q

Which of the following is the antibiotic of choice for an adult patient with stool positive cultures indicating Shigella infection?
A.

A

Ciprofloxacin

182
Q

What is the appropriate treatment for volvulus?

A

Rigid/flex sigmoidoscopy

183
Q

infant’s vomit as bilious. You immediately order a KUB radiograph which reveals ‘double bubble sign’ and confirms your diagnosis of which of the following?

A

Duodenal atresia

184
Q

Which of the following is the next step in the management of a patient who has elevated bilirubin levels on his routine annual lab work and a history of Gilbert’s syndrome?

A

This is a congenital disease that often goes undiscovered for many years. In this condition, the patient’s liver has a difficult time processing bilirubin. This is completely benign and will resolve on its own, no medical therapy is necessary, and patients should be provided with reassurance.

185
Q

A 56 year old male presents to the emergency department due to altered mentation and confusion. Physical exam reveals hyperreflexia and cerebellar ataxia. You also notice a musty breath odor and the patient has a positive asterixis sign. Which of the following medications would be most appropriate at this time?

A

This patients has a history consistent with hepatic encephalopathy. The primary toxin associated with this condition is ammonia. Lactulose functions to lower levels of ammonia in the blood.

186
Q

Which of the following best describes the term “tenesmus”?

A

Rectal urgency and straining in an empty colon

187
Q

preferred imaging for possible blow out fracture?

A

CT

188
Q

what is a positive asterixis sign?

A

wrists in extension, provider pushes further into extension, causing a flapping the fingers (THE FLAPPING TREMOR)

189
Q

name two conditions with a positive asterixis sign

A

renal and hepatic encephalopathy

190
Q

hepatic encephalopathy symptoms

A

hyperreflexia, positive asterixis sign, cerebellar ataxia, confusion

191
Q

toxin involved in encephalopathy?

A

ammonia toxicity. Tx is LACTULOSE

192
Q

Which of the following Vitamin deficiencies is most likely to present with poor wound healing?

A

vitamin C

PANCE review (19 decks)

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