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EM Rotation 2018 > GI > Flashcards

GI Flashcards

1
Q

B12 deficiency can be caused by what type of anemia?

A

Pernicious anemia: autoimmune destruction/loss of gastric parietal cells that secrete intrinsic factor

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2
Q

A patient is complaining of “walking funny”, memory loss, and paresthesias. He also says he has not eaten anything in a few days but is having diarrhea. Lab results reveal macrocytosis (increased MCV) with hypersegmented neutrophils. What is the most common cause?

A

B12 deficiency

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3
Q

A patient is complaining of “walking funny”, memory loss, and paresthesias. He also says he has not eaten anything in a few days but is having diarrhea. Lab results reveal macrocytosis (increased MCV) with hypersegmented neutrophils. What is the best treatment for this patient?

A

IM or Oral B12

IM for pernicious anemia*

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4
Q

A patient is complaining of excessive vomiting and has voluminous, watery diarrhea. He denies any blood in his stool. Patient states he ate an egg salad made with mayonnaise; then had a milkshake for dessert. Labs reveal no fecal WBCs. What is the most likely cause of his condition?

A

S. aureus

  • self-limiting
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5
Q

What is the most common cause of gastroenteritis for adults in North America?

A

Norovirus

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6
Q

What is the most common cause of diarrhea in children?

A

Rotavirus

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7
Q

A patient is complaining of excessive vomiting and has voluminous, watery diarrhea. He denies any blood in his stool. Patient states he ate fried rice at a Chinese restaurant. Labs reveal no fecal WBCs. What is the most likely cause of his condition?

A

Bacillus cereus

  • self-limiting
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8
Q

A patient is complaining of excessive vomiting and has voluminous, “rice-water” diarrhea. She says she was in Lousiana and ate raw shellfish. What is the most common cause of this condition? How will you manage this patient?

A

Vibrio parahemolyticus = raw shellfish***

Vibrio cholera = overcrowded places

Fluid replacement is mainstay of tx
Abx = tetracyclines or fluoroquinolones

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9
Q

V. vulnificus diarrhea is associated with what?

A

Bacteremia and cellulitis

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10
Q

What is the most common cause of “travelers diarrhea”?

How do you manage this patient?

A

Enterotoxigenic E. coli

  • Fluids
  • If severe = fluoroquinolones
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11
Q

A patient is complaining of high fever, and RLQ pain with excessive vomiting and has small volumes of diarrhea. Pt says it started off with no blood then this morning it turned into bloody diarrhea. The patient states he ate what may have looked like undercooked chicken. Labs reveal fecal WBCs. Micro results reveal an “S-shaped; seagull shaped” organism. What is the most likely cause of his condition? And how do you manage it?

A

C. jejuni

-Erythromycin is 1st line*

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12
Q

What is the most common cause of bacterial enteritis in the US?

A

C. jejuni

MC antecedent event in Post-infectious Guillain-barre syndrome

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13
Q

A young patient is complaining of explosive, watery diarrhea. The patient is febrile and suddenly experiencing a seizure. WBC are >50K; a “leukmoid reaction.” Sigmoidoscoy reveals punctate areas of ulceration. What is the most common cause? And how do you manage it?

A

Shigella

  • Fluids
  • Bactrim is 1st line*
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14
Q

A patient is complaining of abdominal cramping, fever, vomiting, and mucusy-bloody diarrhea. The patient is a 9-year old boy, who upon questioning, reveals he licked his pet turtle on a dare. What is the most common cause of this condition and how will you manage it?

A

Salmonella gastroenteritis: S. typhirmurium

Fluids
If severe: Fluoroquinolone

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15
Q

“Pea soup stools” is associated with which diarrhea?

A

Salmonella typhi–typhoid fever

“rose spots” appear in 2nd week AFTER Cephalic phase

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16
Q

What 2 invasive infectious diarrheas mimic appendicitis?

A
  1. C. jejuni

2. yersinia Enerocolitica

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17
Q

A patient is complaining of watery diarrhea that has now progressed into bloody diarrhea. Patient has a low fever and is vomiting with crampy abdominal pain. What is the most common cause of this condition and how did this person become infected?

A
  1. Enerohemorrhagic E. coli (0157:H7)
  2. undercooked ground beef
    unpasteurized milk/apple cider
    daycare centers
    contaminated water
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18
Q

A patient is complaining of watery diarrhea that has now progressed into bloody diarrhea. Patient has a low fever and is vomiting with crampy abdominal pain. Microbiolgy reveals E. coli (0157:H7). Why is abx tx controversial for children?

A

Increased incidence of Hemolytic Uremic Syndrome (HUS)

-Fluid replacement and supportive measures

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19
Q

What is the cause for “backpackers diarrhea”?

A

Giardia lamblia

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20
Q

What is the tx for Backpacker’s diarrhea?

A

Guardia lambda; METRONIDAZOLE

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21
Q

What is the tx of amebiasis?

A

Metronidazole

FURAZOLIDONE in children***

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22
Q

Which organism is most commonly seen in travelers to developing nations?

A

Amebiasis : Entamoeba histolytica

*causes liver abscesses

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23
Q

Which organism commonly causes chronic diarrhea with AIDS pts?

A

Cryptosporidium

*No proven tx–HAART

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24
Q

Which organism commonly causes diarrhea with homosexual men and pts with AIDS?

A

Isospora bella

*Tx with Bactrim

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25
Q

Which malabsorption organism most commonly occurs with farmers around contaminated soil?

A

Troph. whippelii

Whipple’s disease
Duodenal Biopsy = + macrophages; dilation of lacteals*

Tx PCN***

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26
Q

A patient is complaining of weight loss and fever. During PE, you notice he is chewing gum–but there is rhythmic motion of his eye muscles while chewing his gum–what is the most common diagnosis?

A

Troph. whippelii

Whipple’s disease
Duodenal Biopsy = + macrophages; dilation of lacteals*

Tx PCN***

27
Q

How is a Small bowel obstruction diagnosed?

A

Upright radiograph: air fluid level

  • step ladder pattern
  • dilated bowel loops
28
Q

What is the MCC of Small bowel obstruction?

A
  1. post-surgical adhesions

2. Incarcerated hernias 2nd

29
Q

What is the most common cause of large bowel obstruction?

A

Malignancy

30
Q

How will a bowel obstruction present?

A

“CAVO”

Cramping
Abdominal distension
Vomiting
Obstipation

  • high pitched tinkles on auscultation
  • visible peristalsis
31
Q

How is a bowel obstruction tx?

A

NPO, IV fluids, bowel rest

**NG tube decompression

32
Q

What is Toxic Megacolon?

A

As the name implies: a MEGA COLON!

Colonic dilation >6 mn + signs of systemic toxicity

33
Q

How is Mesenteric ischemia diagnosed?

A

Angiogram

34
Q

A patient is having LLQ pain with tenderness and bloody diarrhea. Colonoscopy reveals segmental ischemic changes. What is the most likely diagnosis?

A

Ischemic colitis

35
Q

How is diverticular disease diagnosed?

A

CT scan

36
Q

What is the management for Diverticulitis?

A

Clear liquid diet,

abx: Cipro OR Bactrim + Metronidazole

37
Q

What is Charcot’s Triad?

A

Acute Cholangitis:

  1. Fever
  2. RUQ pain
  3. Jaundice
38
Q

What is Raynold’s Pentad?

A

Acute Cholangitis:

1-3: Charcot’s triad

  1. Shock
  2. Altered mental status
39
Q

What will the Labs look like for Acute Cholangitis?

A

Increased ALP with Increased GGT

Increased bilirubin

40
Q

What is the Gold std to diagnosing Acute Cholangitis?

A

Cholangiography via ERCP

41
Q

What is the management of Acute cholangitis? (5)

A

Unsyn: ampicillin/sulbactam
Zosyn: piperacillin/tazobactam

OR

Ceftriaxone + Metronidazole

OR Fluoroquinolone + Metronidazole

OR : Amp/gent

42
Q

What is the initial test of choice for diagnosing acute cholecystitis?

A

US

43
Q

What is the gold STD for diagnosing acute cholecystitis?

A

HIDA scan

44
Q

What abx are appropriate for acute cholecystitis?

A

Ceftrioxone + Metronidazole

45
Q

What does Kerr’s sign refer to?

A

Left sub scapular/shoulder pain

*Splenic rupture

46
Q

A patient is having periumbilical pain that is relieved if he leans forward or sits in the fetal position. He is an alcoholic and was diagnosed with gallstones last year. He had the mumps as a child and was also bitten by a scorpion last night. He takes a thiazide diuretic for his HTN. What will his labs most likely look like?

A

***Lipase is more specific than amylase.
Increased lipase
HYPOcalcemia: calcium binds to the fat

47
Q

A patient is having periumbilical pain that is relieved if he leans forward or sits in the fetal position. He is an alcoholic and was diagnosed with gallstones last year. He had the mumps as a child and was also bitten by a scorpion last night. He takes a thiazide diuretic for his HTN. What test do you order to diagnose this patient?

A

Abdominal CT = TOC

48
Q

A patient is having periumbilical pain that is relieved if he leans forward or sits in the fetal position. He is an alcoholic and was diagnosed with gallstones last year. He had the mumps as a child and was also bitten by a scorpion last night. He takes a thiazide diuretic for his HTN. How do you manage this patient after diagnosing with acute pancreatitis via a CT?

A

NPO, “rest the pancreas”, IV fluids, analgesia

NO MORPHINE: may be associated with increase spasm of sphincter of Oddi

USE MEPERIDINE*** (DEMEROL)

49
Q

How is fulminant hepatitis treated?

A
  1. Encephalopathy:
    - Lactulose
    - Rifaximin, Neomycin
    - Protein restriction

*liver transplantation is the ONLY definitive tx

50
Q

How is fulminant hepatitis diagnosed?

A

LABS:
Increased ammonia levels in serum
Increased PT/INR >1.5
HYPOglycemia

51
Q

What diagnostic test is preformed for Cirrhosis?

A

US

52
Q

What is given for pruritis in patients with cirrhosis?

A

Cholestiramine

53
Q

What is the most common cause for Gastritis?

A

H. pylori

2nd: NSAIDS/aspirin

54
Q

How is Gastritis diagnosed?

A

Endoscopy

55
Q

What is the most common cause for Upper GI bleed?

A

PUD

56
Q

How is PUD diagnosed?

A

Endoscopy

-if unwilling or unable: upper GI series
If a GU is seen, an endoscopy IS MANDATORY 8-12 wks later to document healing

57
Q

Where does Crohn’s dz occur more commonly?

A

Terminal ileum –RLQ pain!

58
Q

What is the test of choice in diagnosing acute Crohns dz?

A

Upper GI with a small bowel follow through

59
Q

What is the test of choice in diagnosing acute Ulcerative Colitis?

A

Flex sigmoidoscopy

DO NOT DO COLONOSCOPY!

DO NOT DO BARIUM ENEMA: CAUSES TOXIC MEGACOLON!

60
Q

What medication is best for maintenance of Inflammatory bowel dz?

A

Long acting oral Mesalamine (Pentasa): works throughout the small intestine and colon

ASA

61
Q

Which medication is better for Ulcerative colitis because it works primarily in the colon?

A

Sulfasalazine

-give folic acid with sulfasalazine*

62
Q

What medication is used for acute flares of Inflammatory bowel dz?

A

Corticosteroids

63
Q

Where is topical Mesalamine effective?

A

distal colon

EM Rotation 2018 (7 decks)

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