GI Flashcards
1
Q
Diagnostic step for a Meckel’s diverticulum?
A
Technetium-99 scan
2
Q
Anemia in a gastric bypass pt, what’s the dx?
A
B12 deficiency
3
Q
Oral lesions, vesicles on an erythematous base and odynophagia in an AIDS patients, what’s the dx? How do you tx?
A
HSV esophagitis; (val)acyclovir
4
Q
How do you diagnose PUD?
A
Endoscopy w/bx (EGD)
5
Q
What are the risk factors for gallstones (cholesterol)? pigmented?
A
fat, female, forty, fertile, and Native American; hemolysis, African American
6
Q
Foul smelling, difficult to flush diarrhea that slows down at night, dx?
A
osmotic diarrhea
7
Q
First step in a GI bleed? The next four things?
A
2 large bore IV’s! 1) IVF bolus; 2) type and cross and transfuse as needed; 3) IV PPI; 4) call GI for EGD
8
Q
What is the best tx for achalasia?
A
myotomy (can also do dilation though risk of perf, and botulinum toxin, though needs to be redone)
9
Q
Alternative bowel habits with pencil thin stools, dx and what’s next?
A
colon cancer; start with colonoscopy
10
Q
25 yo man with watery diarrhea, weight loss, and fistulas - dx?
A
Crohn’s disease
11
Q
40 yo woman with jaundice and no alcohol or viruses, dx? How do you diagnose? Tx?
A
primary biliary cirrhosis; biopsy (imaging is normal); transplant
12
Q
How do you localize a gastrinoma?
A
somatostatin receptor scintillography
13
Q
You do a large volume paracentesis, what should you do immediately after?
A
IV albumin
14
Q
RUQ pain, jaundice, fever, altered mental status and hypotension; dx? next step?
A
ascending cholangitis (reynold’s pentad); ERCP (first) and abx (at same time)
15
Q
What do you get if you’re worried about a GI bleed in a healthy term neonate right after delivery?
A
Apt test (a medical test used to differentiate fetal or neonatal blood from maternal blood found in a newborn’s stool or vomitus - positive means fetal blood)
16
Q
When do you give antibiotics to pancreatitis? Which one?
A
Meropenem if an FNA/bx grows an organism
17
Q
There is a GI bleed not seen on endoscopy, and they require transfusions every 3 hours, next step?
A
brisk bleed - do an arteriogram
18
Q
Colon cancer screening starts when?
A
50 in everyone, or 10 years before diagnosis in any first degree relative
19
Q
Gallstones and dilated common bile duct on ultrasound, dx?
A
choledocholithiasis
20
Q
Name 8 etiologies of cirrhosis
A
VW HAPPENs
1) viral hepatitis; 2) wilson’s disease; 3) hemochromatosis; 4) alpha-1 anti-trypsin; 5) Primary sclerosing cholangitis; 6) primary biliary cholangitis (b = bitches); 7) EtOH; 8) NASH/NAFL
21
Q
Painless rectal bleeding in a patient greater than 50 yo, dx? Tx?
A
Diverticular hemorrhage
can embolize if severe
22
Q
White blood cells and blood in diarrhea lasting 8 weeks, dx? Next step?
A
inflammatory diarrhea, get a colonoscopy
23
Q
Early satiety, weight loss, in a Japanese man, dx?
A
gastric cancer
24
Q
What do you add to the usual 5 things in GI bleed if they are cirrhotic?
A
Octreotide (for varices) and ceftriaxone (for SBP prophylaxis)
25
When do you do a colonoscopy for diverticulitis?
2-6 wks after resolution
26
Diabetes, nausea, vomiting, and abdominal pain chronically, dx?
gastroparesis
27
Continuous lesions, crypt abscesses, diagnosis?
ulcerative colitis
28
Diarrhea from a chinese food buffet line, dx?
Bacillus cereus
29
What is the bx of Barrett's esophagus going to look like?
intestinal metaplasia
30
Prophylaxis for spontaneous bacterial peritonitis?
fluoroquinolone
31
What test do you do to investigate intussusception?
Air enema
32
Burning retrosternal chest pain better with sitting up and antacids, dx?
GERD
33
What is the tx of gallstone pancreatitis?
ERCP
34
What is the diagnostic step for primary biliary cirrhosis?
biopsy only (imaging is normal)
35
What is the tx of peptic ulcer disease causing bleeding?
PPI
36
Two most common causes of pancreatitis?
1) EtOH; 2) gallstones
37
Bloody diarrhea, renal failure in a child, dx?
TTP/HUS and shiga like toxin
38
Name 5 causes of esophagitis. How does pt present?
PIECE: 1) Pill induced; 2) Infectious; 3) Eosinophilic; 4) Caustic (strong base or strong acid ingestion); 5) gErd
odynophagia or dysphagia
39
Poultry, eggs, and diarrhea, dx?
Salmonella
40
Screening for hepatocellular carcinoma? (in pts with cirrhosis or hep B)
ultrasound and AFP q6 months
41
Tx for Barrett's metaplasia?
high dose PPI
42
How do you tx diffuse esophageal spasm?
nitro spray or calcium channel blockers (smooth muscle relaxation)
43
Watery diarrhea that has no change in frequency with sleeping or NPO, dx?
secretory diarrhea (osmotic has no sleeping sxs because it is affected by diet)
44
You get an ultrasound and aren't sure if it is cholecystitis - what do you do?
HIDA scan
45
Colicky RUQ abdominal pain - what's the dx? and next step?
gallstones (cholelithiasis) - get a RUQ U/S
46
Watery diarrhea, weight loss, fistula formation, dx?
Crohn's
47
You're worried about a GI bleed in a premature neonate - what do you get?
XR
48
Caribbean farmer, negative antibodies, and blunting of intestinal villi, dx?
Tropical sprue (tx with antibiotics)
49
Familial adenomatous polyposis progression? Tx? Mutation?
polyps at 18, cancer at 28, dead at 38; prophylactic colectomy; APC gene
50
What medical tx can you offer pts with wilson's disease? What is affected in Wilsons (3)?
penicillamine; 1) basal ganglia - chorea; 2) liver = cirrhosis; 3) eyes: Kayser-Fleischer rings
51
What's special about rectal ulcerative colitis?
no risk of colon cancer, so doesn't need the screening colonoscopy or colectomy
52
How do you dx gastroparesis?
gastric emptying study (gt 60% at 2 hrs or gt 10% left at 4 hrs, then test is positive)
53
How do you tx diabetic gastroparesis?
small meals, control sugars, add pro kinetic agents (metoclopramide chronically, erythromycin for flares; domperidone outside of US)
54
Cirrhosis and COPD, dx?
alpha-1 anti-trypsin deficiency
55
What three cancers are seen with HNPCC/Lynch? What's the underlying problem?
Colorectal, endometrial, ovarian; DNA mismatch repair
56
When do you get a CT scan in pancreatitis?
When you think it's pancreatitis but the lipase is normal (equivocal)
57
Transmural tear, mediastinitis, dx?
Boerhaave's
58
Guy tries to kill himself by drinking battery acid, what do you do?
protect airway, EGD (to determine severity), maintain NPO (NEVER neutralize or induce emesis)
59
What is the tx for regular c. diff? severe c. diff?
oral metronidazole; oral vanc + IV metronidazole (attack it from both sides of GI tract - luminal and basolateral)
60
When do you go to EGD for GERD without alarm symptoms?
after 6 wks of PPI without relief
61
How do you tx severe refractory ulcerative colitis?
colectomy
62
Fatty liver on ultrasound but no alcohol or viral hepatitis, dx?
NASH/NAFL (nonalcoholic steatohepatitis/ fatty liver disease)
63
Paracentesis is done and there are 1000 white cells, 75% polys, what is it?
spontaneous bacterial peritonitis
64
You suspect Boerhaave's, what's the first step?
Gastrograffin (in other cases its usually barium, but gastrograffin is less irritating to the mediastinum if there is a perforation)
65
How do you diagnose a carcinoid tumor?
5-HIAA in the urine
66
The question is about jaundice, there is a lot of T bili but very little D bili - what's the dx?
hemolysis or hematoma
67
Paroxysmal dysphagia to large caliber food, dx? Tx?
Schatzki's ring (ring at GE junction); lysis during EGD ("steakhouse dysphagia")
68
How do you localize a gastrinoma?
Somatostatin receptor scintillography (SRS)
69
How do you diagnose acute pancreatitis?
Lipase (greater than 3x ULN)
70
What is the tx for refractory c. diff?
fidaxomicin (can also try fecal transplant)
71
See a picture of someone's eye and the vignette is about cirrhosis, dx and next step?
Wilson's disease; get a urinary copper
72
Sausage shaped mass and currant jelly diarrhea - dx?
intussusception
73
Corkscrew esophagus on barium swallow, dx? How does that pt present?
diffuse esophageal spasm; heart attack symptoms that get better with nitro (must r/o ACS first)
74
AIDS and Diarrhea, dx?
cryptosporidium (or emoeba hystolica)
75
How do you treat a crohn's flare?
steroids + Abx
76
What is the hep C tx?
Direct acting agonists
77
How do you tx spontaneous bacterial peritonitis?
ceftriaxone (cover strep and GNR)
78
What vaccinations should a pt with cirrhosis receive?
hep A and hep B!
79
Post-prandial LLQ abdominal pain relieved with bowel mvmt in old person? Young person?
think diverticular spasm (contractions of diverticula); think IBS
80
What do you do about an anal fissure in a child?
Treat constipation if present, check for IBD if older child
81
"Apple-core" lesion on a barium enema - dx?
Colon cancer (barium enema is not a screening test for colon cancer - when you find colon cancer it's already late stage)
82
Multiple shallow gastric ulcers - you're thinking?
NSAIDs (pt with chronic arthritis)
83
LLQ abdominal pain, fever, leukocytosis, greater than 50 yo, dx?
diverticulitis
84
Nocturnal asthma w/o daytime asthma, dx?
GERD
85
Diverticulitis and CT scan shows an abscess, what do you do next?
IV abx and drain
86
What is the first step in the management of GERD?
PPIs
87
Diabetes, diastolic CHF, hyperpigmentation, and cirrhosis, dx and next step?
Hemochromatosis, get a ferritin level
88
Picture of pigmented dots on their lip and vignette is about colon cancer, what's the dx?
Peutz-Jeghers
89
After a diagnosis of achalasia from barium and manometry, what is the next best step?
EGD with biopsy to rule out cancer (pseudoachalasia) - looking for absence of myenteric plexus
90
Bloody diarrhea and weight loss in a young man, dx?
Ulcerative colitis
91
What are the ultrasound findings for a cholecystitis (3)?
1) pericholecystic fluid; 2) thickening of the gallbladder wall; 3) gallstones
92
What gets absorbed in the duodenum? terminal ileum?
FIC = folate, iron, calcium; bile salts and B12
93
What would make you work up acute diarrhea and not assume it's viral (Name 4 of 7)?
1) high fever (gt/= 104); 2) blood/pus; 3) electrolyte abnormalities; 4) abx use; 5) duration gt 3 days; 6) immunosuppressed; 7) severe abdominal pain
94
What is the most common cause of diarrhea if no risk factors?
viral gastroenteritis
95
Bx of achalasia will show what?
Absence of myenteric (Auerbach) plexus
96
Beads on a string on MRCP, dx?
Primary sclerosing cholangitis
97
Gnawing epigastric pain that radiates to the back, changes with food, what's the dx?
Peptic ulcer disease
98
Prophylaxis for a stress ulcer for a pt in the ICU on the ventilator?
PPI
99
Diarrhea after antibiotic use, dx?
C. diff
100
Umbilical ecchymosis and pancreatitis, what's the sign?
Cullen's
101
Bloody diarrhea after uncooked hamburgers, dx?
e coli O157:H7
102
RUQ pain, jaundice, and fever is what diagnosis? How do you tx?
Charcot's triad = cholangitis; ERCP emergently and IV Abx (cipro + metronidazole)
103
Best test for celiac sprue?
EGD with bx showing blunting of intestinal villi
104
What is the case of cyclic vomiting syndrome?
THC
105
Pt needs NSAIDs, but has ulcers, what are your options?
add misoprostol (if cardiac risk) or switch to celecoxib (if no cardiac risk)
106
What antibiotics for ascending cholangitis (2 options)?
1) cipro + metronidazole
or
2) amp + gent + metronidazole
107
Document eradication of H pylori with?
Stool antigen
108
How do you manage a pancreatic pseudocyst?
if less than 6 cm and 6 wks, wait; if greater than 6 cm and 6 weeks, drain
109
Painful RUQ, tenderness, jaundice, dx?
Gallstones (specifically choledocolithiasis - stones in the common bile duct)
110
How do you tx candida esophagitis?
oral fluconazole (systemic disease! nystatin swish and spit not enough)
111
Diarrhea after a picnic?
Staph aureus
112
Multiple, refractory ulcers, H. pylori negative, what's the dx?
Zollinger-Ellison (gastrinoma)
113
Inspiratory arrest on palpation of the gallbladder shows what?
Murphy's sign - positive for cholecystitis
114
There was a GI bleed two weeks ago, both the EGD and colonoscopy were negative, next step?
Pill-cam endoscopy
115
If there is no hemolysis, isolated hyperbilirubinemia (unconjugated) may indicate __, which is usually asymptomatic
Gilbert syndrome
116
Bx of esophagus reveals 30 eosinophils per high power field, what is the next step?
PPI!!! (tx eosinophilic esophagitis as GERD first; if that fails can use oral aerosolized steroids)
117
Painful bloody bowel mvmt in a child, relieved by knee-chest position, dx?
intussusception
118
Malabsorption, palpable rash on buttocks and legs, dx?
dermatitis herpetiformis - celiacs
119
Clay colored stools, painless jaundice, dx?
Cancer or stricture (can get an MRCP = MR cholangiopancreatography)
120
What is seen on bx in pt with alpha-1 anti-trypsin deficiency?
PAS+ macrophages
121
There was a GI bleed last week and it stopped, EGD was negative, next step?
Colonoscopy
122
Pt with PUD, and gastrin level 700, what do you do next?
Secretin stim test (give secretin and an increase in serum gastrin over 200 is diagnostic of ZE gastrinoma); if gastrin were gt 1600 to begin with, you would know it's a gastrinoma
123
Tx for esophageal dysplasia?
ablative therapy
124
Tx for hemochromatosis (before cirrhosis)
Phlebotomy or deferoxamine/deferasirox
125
What are colon cancer screening options?
```
Colonoscopy q10y OR
Flex sigmoidoscopy q5y + FOBT q3y OR
FOBT q1y (FOBT = fecal occult blood testing)
```
126
What's the route of transmission for Hep A? Hep B? Hep C?
Fecal Oral; vertical (asia), sex (US), drug/needles; blood (IV drugs or blood transfusion)
127
Superficial mucosal tear, self limiting GI bleed, dx?
Mallory-Weiss
128
You suspect celiac sprue, what's the first test?
Look for antibodies (anti-TTG or endomysial)
129
Halitosis, old man, regurgitates undigested food, dx? Confirmatory dx test?
Zenker's diverticulum - do a barium swallow
130
What three things should you look for in pt with necrotizing enterocolitis?
intraventricular hemorrhage (ultrasound with doppler), retinopathy of prematurity (optho exam); bronchopulmonary dysplasia
131
Flushing, wheezing, diarrhea, and right sided cardiac fibrosis, dx?
Carcinoid tumor
132
While waiting for a transplant in pts with primary sclerosing cholangitis, what medical tx can you offer?
ursodeoxycholic acid (not for PBC though)
133
40 yo woman with pruritus, dark urine, and an elevated direct bilirubin, without pain, diagnosis?
primary biliary cirrhosis
134
Dark urine and pale stools signal a diagnosis of ___.
conjugated hyperbilirubinemia
135
How do you tx severe refractory Crohn's?
Rituximab
136
Flapping tremor, altered mental status, cirrhosis, dx and next step?
Hepatic encephalopathy (asterixis) - give lactulose
137
When do you go straight to EGD for GERD without treating?
alarm symptoms: n/v, WL, anemia
138
Supraclavicular lymph node, dx?
Virchow's node, gastric cancer
139
How do you diagnose hepatocellular carcinoma?
triple phase CT scan (not a bx!)
140
Diarrhea, travel to mexico or caribbean, dx?
ETEC
141
Never been tx before, dyspepsia, serology H pylori positive, how do you tx?
Treat with triple therapy (clarithromycin + amoxicillin + PPI) (MTZ if penicillin allergy)
142
Patient presents with jaundice - what are the three categories of differentials?
1) hemolysis; 2) hepatocellular; 3) obstructive jaundice
143
Dysphagia, webs, and iron deficiency anemia, dx?
Plummer Vinson syndrome (progresses to esophageal cancer)
144
Bird's beak on barium swallow, diagnosis?
achalasia
145
How do you tx pancreatitis?
NPO, IVF, pain control
146
What is the best test for diagnosing cirrhosis?
Transjugular biopsy
147
Serology associated with primary sclerosing cholangitis?
p-ANCA
148
What are the imaging keywords you're looking for to diagnose necrotizing enterocolitis?
pneumatosis intestinalis (air in the wall of the bowel)
149
Colon cancer and jaw bone cancers, dx?
Gardner's
150
How do you confirm the diagnosis of H. pylori (best test)?
EGD w/biopsy
151
Old lady on oral antibiotics in a nursing home complains of odonophagia (painful swallowing), what's the dx?
pill-induced esophagitis
152
You see a picture of an electron microscopy on a malabsorption question. What's the most likely dx?
Whipple's disease (PAS positive organisms)
153
When do you start colon cancer screening for ulcerative colitis?
8 years after diagnosis (q1y)
154
HepBsAb means what? HepBcAb means what? HepBsAg means what? HepBeAg means what?
Immune; immune through exposure; infected; infectious
155
Salmon colored lesion on endoscopy of the esophagus, dx?
Barrett's
156
Colon cancer and brain tumors, dx?
Turcot
157
Tx for esophageal adenocarcinoma?
resection
158
How do you tx MALToma?
treat H pylori = triple therapy
159
Increased direct bilirubin, black liver, dx?
Rotors (Dubin Johnson is similar but no black liver)
160
3 cancers, 2 generations, 1 premature, what's the dx?
HNPCC (Lynch)
161
What is the tx for intussusception?
Air enema
162
If you wanted to confirm lactase deficiency what would you do?
Breath test
163
Skipped lesions and transmural inflammation, noncaseating granulomas, dx?
Crohn's
164
Flank ecchymosis and pancreatitis, sign?
Turner sign (Grey-Turner sign - turn on your side/flank)
165
What's the first step in diagnosing hemochromatosis? What's the definitive?
ferritin gt 1000; liver biopsy shows increased Fe
166
Iron deficiency in a man, diagnosis and next step?
colon cancer; start with colonoscopy
167
Name 4 of 7 complications of acute pancreatitis
Early (1-3 days): 1) ARDS; 2) hypocalcemia; 3) pleural effusion; 4) ascites
Mid (1-3wks): 5) infxn
Late (3-7wks): 6) abscess; 7) pseudocyst
168
If you suspect lactase deficiency what should you do?
eliminate dairy (not breath test)
169
Refractory diverticulitis (more than one episode), what do you do?
resection (hemicolectomy)
170
40 yo man with ulcerative colitis and jaundice, what is the most likely dx and how do you diagnose?
primary sclerosing cholangitis, get an MRCP (beads on a string appearance) - ERCP with bx would show onion skin fibrosis
171
What antibiotics do you use for diverticulitis?
GNR and anaerobe coverage:
cipro + MTZ
amp/gent + MTZ
172
Epigastric pain radiating to the back, better with leaning forward, dx?
pancreatitis
173
Diarrhea and camping, dx?
campylobacter
174
Iron deficiency in a post menopausal woman, dx and next step?
colon cancer, start with colonoscopy
175
Scleroderma causing esophageal dysmotility (collagen replaces muscle so LES cannot contract) - what is tx?
PPIs to tx symptoms since no cure (pt will present with relentless GERD)
Also do serology - CREST (anti-centromere) vs SS (anti-Scl-70)
176
Hep B post-exposure prophylaxis? Hep C post-exposure prophylaxis?
Hep B IVIg; Interferon
