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MTBs Step 2CK > GI > Flashcards

GI Flashcards

1
Q

Achalasia

dx? sx? tx?

A

inability of the LES to relax due to loss of nerve plexus

sx: young nonsmoker who has dysphagia to both solids and liquids
dx: barium swallow or esophageal manometry
tx: pneumatic dilation, heller myotomy, botulinum toxin injection

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2
Q

young nonsmoking male who just got back from a mission trip to south american. presents with dysphagia to both solids and liquids. dx?

A

chagas disease! causing achalasia

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3
Q

Esophageal cancer

sx? pt population? dx?

A

sx: dysphagia to solids first then liquids
pt: >50 yoa smokers or drinkers
dx: endoscopy

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4
Q

tx of esophageal cancer

A

resection + 5FU

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5
Q

Plummer-Vinson Syndrome

sx? tx?

A

PROXIMAL stricture in esophagus due to iron deficiency anemia.
tx: iron replacemnt

F>M, increased risk of cancer

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6
Q

Schatzki’s Ring(peptic stricture)

sx? tx?

A

repeat acid reflux causes stricture = DISTAL

  • steak-house syndrome
    tx: pneumatic dilation
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7
Q

Zenker Diverticulum

sx? dx? tx?

A

true diverticulum, dysphagia with horrible bad breath + regurge of undigested food.

dx: barium study showing outpouching
tx: surgical resection

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8
Q

Spastic Esophagus aka nutcracker esophagus

sx? dx?

A

severe chest pain often occuring without risk factors for heart disease, comes and goes, triggered by drinking cold beverages
dx: manometry

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9
Q

Spastic Esophagus aka nutcracker esophagus

tx?

A

CCB + nitrates

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10
Q

Odynophagia in HIV negative person. whatcha gonna do?

A

endoscopy

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11
Q

Odynophagia in HIV + person. whatcha gonna do?

A

fluconazole, if no response then esophagitis

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12
Q

mallory weiss tear dx and tx?

A

dx: endoscopy
tx: self resolving or epinephrine

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13
Q

1st line tx for GERD

A

PPI(omeprazole, lansoprazol)

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14
Q

what type of cancer can barretts esophagus lead to?

A

adenocarcinoma

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15
Q

tx for barretts esophagus

A

PPI & repeat endo every 2-3 years

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16
Q

tx of low grade esophageal dysplasia

A

PPI & repeat endo in 3-6 months

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17
Q

Duodenal Ulcer pain gets —– with food.

A

better

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18
Q

Peptic Ulcer pain gets —– with food.

A

worse

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19
Q

Pt age>— and has epigastric pain must be scoped.

A

45

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20
Q

tx of Hpylori. what if resistance?

A

tx: PPI + Clarithromycin + Amoxicillin
resistant: Metronidazole & tetracyclin + PPI

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21
Q

52 year old man with epigastric discomfort. +Hpylori, upper endoscopy shows no gastritis, no ulcer disease, bx shows Hpylori. tx?

A

PPI alone! no ulcer = no need to tx Hpylori.

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22
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma

sx?

A

Diarrhea(acid inactivates lipase), Ab pain, Anemia, Heme + stools,elevated gastrin, elevated gastric acid, large ulcer, multiple ulcers, ulcers distal to ligament of treitz, recurrent dispite Hpylori tx

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23
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma

dx?

A
  1. U/S
  2. Nuclear Somatostatin Scan = pt with ZES have increased number of somatostatin receptors
  3. Secretin supression = should decrease gastrin, if not = ZES
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24
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma

tx?

A

resection + PPI

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25
Q

what should u be thinking if you see Zollinger-Ellison Syndrome(ZES)/Gastrinoma + hypercalcemia?

A

MEN2!

2b: Pheo, Medullary thryoid, mucosal tumors

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26
Q

tx of diabetic gastroparesis

A

erythromycin

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27
Q

diabetic with NV, bloating, constipation, early satiety, succusion splash. dx?

A

diabetic gastroparesis

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28
Q

screening colonoscopy with IBD

A

start 8-10 years after dx and repeat every 1-2 years

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29
Q

UC vs CD

which is more often bloody?

A

UC

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30
Q

Extraintestinal manifestations of IBD?

A

joint pain, eye shit, erythema nodosum, pyoderma gangrenosum, sclerosing cholangitis

31
Q

Tx of IBD

A

Mesalamine > sulfasalazine, steroids

severe: azathioprine & 6MP, Infliximab

32
Q

tx of severe IBD

A

severe: azathioprine & 6MP, Infliximab

33
Q

tx of C.diff

A

metronidazole

34
Q

when do you give somthign else for C.diff? what do you give?

A

once metro has failed x2 then give oral vancomycin

35
Q

lactose Intolerance

sx? dx? tx?

A

episodic diarrhea, flatulence

dx: stool-osmolality test
tx: remove milk shit from diet

36
Q

Carcinoid Syndrome

sx? dx? tx?

A

flushing, episodes of hypotension, wheezing, diarrhea, CV murmer(tricuspid valve)

dx: urinary 5-HIAA level
tx: octreotide

37
Q

what murmer is associated with carcinoid syndrome?

A

tricuspid valve

38
Q

4 common shits that cause malabsorption

A

celiac dz, tropical sprue, chronic pancreatitis, whipple dz

39
Q

Celiac Disease

cause? sx?

A

anti-gliadin, anti-endomysial & anti-transflutaminase ab cause flattening of villi
sx: weight loss, fat malabsorption, iron malabsorption, microcytic anemia, folate malabsorption, dermatitis herpetiformis

40
Q

which malabsorption dz is associated with Dermatitis Herpetiformis?

A

celiac disease

41
Q

Tropical Sprue

sx? tx?

A

just like celiacs! but with hx of the tropics

tx: doxy or TMP/SMX

42
Q

Whipple Disease

sx? tx? dx?

A

arthralgias, neurological abnormalities(dementia & seizures), ocular findings

dx: PAS + organisms
tx: tetracycline, TMP/SMX

43
Q

tx of whipples

A

tetracycline, TMP/SMX

44
Q

IBS

sx?

A

abnormal pain relieved by bowel movements, abdominal pain that is less at night, abdominal pain w/diarrhea or constipation alternating

45
Q

IBS

tx?

A

fiber, dicyclomine or hyoscyamine(antispasmodic/anticholinergic)

46
Q

Colon cancer screening general population

A

colonoscopy starting at 50q10

47
Q

colon cancer screening when family hx

A

start 10 years before family member dx

48
Q

colon cancer screening in lynch syndrome?

A

starting at age 25q1/2

49
Q

Hereditary nonpolyposis colon cancer syndrome(Lynch Syndrome)

A

CEO:
Colon = 3 family members, 2 generations, 1 premature(<50)
E = endometrial cancer
O = Ovarian cancer

50
Q

Screening for FAP?

A

start at age 12

51
Q

Gardner’s Syndrome

A

GI & jaw tumors(osteomas)

52
Q

Peutz-Jeghers Syndrome

A

melanotic spots on lips, hamartomatous polyps

53
Q

Turcot Syndrome

A

colon, brain tumors + seizures

54
Q

screening if dysplastic colonic polyp found?

A

repeat 3-5 years after

55
Q

screening if previous colon cancer?

A

colonoscopy 1y s/p resection, 3y then q5 years

56
Q

tx of diverticulosis

A

Ciprofloxacin, metronidazole

57
Q

W/U of GI bleed

A
  1. NG tube
  2. Endoscopy
  3. Brisk? angiogram; slow?tagged RBC; no bleed?colonoscopy
58
Q

tx of active variceal bleeding?

A

octreotide

59
Q

drug to shrinkk esophageal variceals

A

propanolol

60
Q

complication from Transjugular Intrahepatic Portosystemic Shunts(TIPS)

A

used to tx esophageal varicies

*hepatic encephalopathy

61
Q

What is dumping syndrome?

A

rapid release of gastric contents into the duodenum causing osmotic draw into the bowel causing a rapid rise in glucose = shaking, sweating, weakness, hypoglycemia

62
Q

what lab can tell u how severe pancreatitis is?

A

calcium! = worsening hypocalcemia = worse shit

63
Q

tx of pancreatitis with >30% necrosis

A

imipenem + surgery

64
Q

SAAG

A

Serum Albumin - Ascites Albumin Gradient

SAAG > 1.1 = portal HTN or CHF/transudate
SAAG <1.1 = exudative

65
Q

tx of Spontaneous Bacterial Peritonitis

A

Cefotaxime or Ceftriaxone

66
Q

Primary Biliary Cirrhosis

sx?

A

PBC is for the bitches = subtle

sx: 40-50yoa, osteoporosis, xanthomas, normal bili, increased ALP, ANTI-MITOCHONDRIAL AB

67
Q

Primary Biliary Cirrhosis

tx?

A

Ursodeoxycholic acid

68
Q

Primary Sclerosis Cholangitis

sx?

A

PSC is for sons of bitches

sx: itching, elevated bilirubin & ALP, jaundice, ERCP shows beading

69
Q

Primary Sclerosis Cholangitis

tx?

A

ursodeoxycholic acid or Cholestyramine

70
Q

Wilson’s Disease

cause? sx? tx?

A

AR, decrease in ceruloplasma = decrease Cu excretion

sx: cirrhosis, Choreiform movement, neuropsychiatric abnormalities, parkinsons tremor, kayser fleischer rings
tx: penicillamine or trientine

71
Q

Hemochromatosis

sx?

A

HFe gene mutation = excess Fe absorption from duodenum.
sx: >50 yo with elevated AST, ALP, restrictive cardiomyopathy, skin darkening, jonit pain, bronze diabetes, pituitary accumulation(panhypopituitarism), Infertility, Hypatoma, Pseudogout, ED, Amenorrhea, elevated Fe & ferritin but low TIBC

72
Q

tx of hemochromatosis

A

phlebotomy or defoxamine

73
Q

Autoimmune Hepatitis

A

Autoimmune Hepatitis – often associated with other AI disease
- SX:
o elevated AST & ALT (~40s) & elevated alkaline phosphatase(ALP)(~1000s)
o Elevated bilirubin
o Extreme fatigue
- DX: bx
- TX: steroids +/- Azathioprine
- Associated with: Celiac disease, thyroiditis, vasculitits
- EX:
o 42 yo AA female with SLE, extreme fatigue, lupus is stable on hydroxychloroquine, scleral icterus, hepatosplenomegaly, urine bilirubin +, AST 48, ALT 40, ALP 1000, bili 5. Dx?

MTBs Step 2CK (20 decks)

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