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First Aid Step 2 > GI > Flashcards

GI Flashcards

1
Q

Pt presents with sudden onset severe, diffuse abd pain. Exam: peritoneal signs, AXR reveals free air under diaphragm. Management?

A

Emergent laparatomy to repair perforated viscus

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2
Q

Most likely cause of acute lower GI bleed in pts > 40

A

Diverticulosis

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3
Q

Dx modality used when US equivocal for cholecystitis

A

HIDA

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4
Q

Risk factors cholithiasis

A 
Fat
Female
Fertile
Forty
Flatulent
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5
Q

Inspiratory arrest during palpation of RUQ

A

Murphys’ acute cholecystitis

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6
Q

Most common cause SBO in pts with no Hx abd surg

A

Hernia

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7
Q

Most common cause SBO in pts with Hx abd surg

A

Adhesions

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8
Q

Diarrhea bug: most common

Tx

A

Campylobacter

Erythromycin

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9
Q

Diarrhea bug: recent abx

A

C diff

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10
Q

Diarrhea bug: camping

A

Giardia

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11
Q

Diarrhea bug: Traveler’s

A

ETEC

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12
Q

Diarrhea bug: Church picnics/mayo -room temp food

-Mechanism of infection

A

S aureus

Preformed toxin

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13
Q

Diarrhea bug: Uncooked hamburgers

Tx

A

E coli O157: H7

Abx may worsen due to toxin release as bugs die so hydrate

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14
Q

Diarrhea bug: fried rice

A

Bacillus cereus

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15
Q

Diarrhea bug: poulty/eggs

A

Salmonella

Campy - 2nd most common

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16
Q

Diarrhea bug: raw seafood

A

Vibrio cholerae (COPIOUS WATERY DIARRHEA), HAV

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17
Q

Diarrhea bug: AIDS

A

Isospora
Crypotosporidium
MAC

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18
Q

Diarrhea bug: Pseudoappendicitis

A

Yersinia

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19
Q

25 yo Jewish man presents with pain and watery diarrhea after meals, Exam shows fistulas between bowel and skin and nodular lesions on tibias

A

Crohns

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20
Q

Inflammatory disease of colon with inc risk colon CA

A

UC

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21
Q

Extraintestinal manifestations of IBD

A 
Uveitis
Ankylosing spondylltis
Pyoderma gangrenosum
Erythema nodosum
Primary sclerosing cholangitis
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22
Q

Tx IBD

A

5ASA and steroids during exacerbation

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23
Q

Difference Mallory Weiss vs Boerhaave

A

Malloary: superficial in mucosa
Boerhaave: full thickness rupture

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24
Q

Charcot’s triad

A

RUQ pain
Jaundice
Fever/chills

–Signs of ascending cholangitis

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25
Reynold's pentad
Charcot's triad + Shock Mental status change --Signs of suppurative ascending cholangitis
26
Medical Tx hepatic encephalopathy
dec protein intake Lactulose Rifaximin
27
First step management acute GI bleed
ABC
28
4 yo with oliguria, petechiae, jaundice after illness with bloody diarrhea. Dx and cause
HUS 2/2 E coli O157: H7
29
Post HBV exposure Tx
HBV IVIG
30
Classic causes of drug induced hepatitis
TB meds - RIP Acetaminophen Tetracyclines
31
40 yo obese woman with elevated ALP and bilirubin, pruritis, dark urine, clay colored stools
Biliary tract obstruction
32
Hernia with highest risk of incarceration -- indirect, direct, or femoral
Femoral
33
50 yo man with Hx alcohol abuse presents with boring epigastric pain that radiates to back and relived by sitting forward. Tx?
Confirm Dx acute pancreatitis with elevated amylase and lipase NPO, IVF, O2, analgesics, time
34
Common viral causes of gastroenteritis
``` Norwalk Coxsackie A1 Echovirus ADenovirus Rotavirus in kids ```
35
Bloody diarrhea
``` Campylobacter C diff (can also be watery) EHEC - 0157: H7 Salmonella Shigella- really bad Yersinia Entamoeba histolytica ```
36
Honey, home canning bug Flaccid paralysis Tx?
C botulinum | Tx: Botulism antitoxin
37
Gray pseudomembranes on colonic mucosa | Tx
C diff Tx: metronidazole or oral vanc
38
Overcrowding, food or water | Tx
Shigella | Cipro or TMP-SMX if severe
39
Oysters, watery diarrhea within 24 hrs of eating
Vibrio parahemolyticus
40
Pork of fresh produce | RLQ pain
Yersinia enterocolitica
41
Cysts and trophozoites in stool | Tx
Giardia (camping) Entamoeba (poor sanitation | Metronidazole, Paramomycin (Enamoeba only)
42
Acid fast stain of stool shows parasites | Tx
Cryptosporidium Nitazoxanide
43
Undercooked pork, myalgias, periorbital edema, eosinophilia | Tx
Taenia spiralis | Albendazole, mebendazole if bad
44
Undercooked pork, CNS Sx | Tx
Taenia solium Praziquantel Albendazole + steroids if CNS Sx
45
Hepatitis- fecal oral, usu shellfish; self limited disease, vaccine available for travel Type of RNA/DNA
Hep A | Picornavirus - ssRNA
46
Water, fecal oral route; high maternal mortality in pregnant | Type of RNA/DNA
Hep E | Calcivirus - ssRNA
47
Spread via blood, sexual contact Complication is chronic hepatitis Type of virus Tx
Hep C Flavivirus- ssRNA IFN alpha or ribavirin
48
Spread via blood, sexual contact Risk of hepatocellular carcinoma, fulminant hepatitis, chronic hepatitis/cirrhosis Type of virus Tx
Hep B IFN alpha or antivirals like lamivudine, adefovir, entecavir Vaccine available Hepadnavirus: ds DNA
49
Requires coexistent Hep B infection Risk of severe hepatitis/cirrhosis Type of virus
Hep D Delta agent - incomplete ssRNA Tx with Hep B vaccine
50
HBsAg - surface: neg HBeAg: neg Anti-HBs (Ab): pos Anti-HBc (Ab to core): neg
Vaccinated
51
HBsAg - surface: neg HBeAg : neg Anti-HBs (Ab): neg Anti-HBc (Ab to core): Positive IgM
Acute infection window 12-20 wks after exposure
52
HBsAg - surface: Positive HBeAg : neg Anti-HBs (Ab): neg Anti-HBc (Ab to core): positive IgG
Chronic infection with leesser viral replication - good prognosis
53
HBsAg - surface: positive HBeAg : positive Anti-HBs (Ab): neg Anti-HBc (Ab to core): Positive IgM
Acute infection 4-12 wks postexposure
54
HBsAg - surface: positive HBeAg : positive Anti-HBs (Ab): neg Anti-HBc (Ab to core): pos IgG
Chronic infection with active viral replication
55
HBsAg - surface: neg HBeAg : neg Anti-HBs (Ab): Positive Anti-HBc (Ab to core): Positive IgG
Previous infection - recovered
56
Mg vs Al
Mg: diarrhea Al: constipation
57
H2 antagonists Examples mechanisms
"tidine" Reversibly block H2 to inhibit gastric acid secretion Cimetidine may cause gynecomastia and impotence
58
PPI Examples MEchanism
"prazole" | Irreversibly block parietal cell H/K ATPase to block gastric acid secretion
59
Most common cause diarrhea adult vs kids
Adult: lactose intolerance Kids: rotavirus
60
Type A vs Type B chronic gastritis
A: fundus, autoAB parietal cells causing pernicious anemia, dec gastrin and gastric acid B: antrum, H pylori, inc gasric acid
61
PUD: gastric vs duodenal
Food causes Gain of pain in Gastric; Decreases pain with duodenal
62
Curling vs Cushing ulcer
Curling- burn pt | Cushing- TBI
63
Why must stop PPI before gastrin testing?
Inhibits gastrin release
64
Zollinger Ellison - where, assoc
Pancreas or duodenum | MEN I
65
Virchow node
left supraclavicular LN gastric cancer
66
Sister May Joseph node
periumbilical gastric cancer
67
Krukenberg tumor
Mets to ovary
68
Weight loss, bloating, diarrhea, steatorrhea, glossitis, dermatitis,, edema
Malabsorption
69
Celiac vs tropic
Celiac responds to removal of gluten
70
Cause of Whipple diase
Tropheryma whippelii
71
How to determine osmotic gap
290-2 (Na+K) >125- osmotic diarrhea <50 secretory
72
Continuous disease, bloody diarrhea, lead pie on barium enema, + pANCA
UC
73
Entire GI tract with skip lesions, entire bowel wall, perianal fissure and fistulas
Crohns
74
Flushing, diarrhea, bronchoconstriction, TV or PV disease
Carcinoid
75
Where carcinoid tumors
Bronchopulm tree Ileum Rectum Appendix
76
Dx carcinoid
Lab: inc 5HIAA in urine Rad: Indium - 111 scintography to find tumors
77
Mets colon CA
lung an dliver
78
Hundreds of polyps in colon, near certain development of malignant neoplasm, prophy with subtotal colectomy
FAP- familial adenomatous polyposis
79
Multiple genetic mutations, cancer from normal appearing mucosa, neoplasms tend to form in proximal colon
HNPCC
80
Similar to FAP + bone and soft tissue tumors
Gardner
81
Polyps are hamartomas with low risk of malignancy, mucocutaneous pigmentation of mouth, hands, genitals
Peutz-Jeghers
82
Many colonic adneomas with malignant potenential, comorbid CNS tumors
Turcot
83
Polyps of colon, small bowel and stomach that are frequently source of GI bleding; increased risk of malignancy later in life
Juvenile polyposis
84
Ranson criteria on admission - mortality from acute pancreatitis
``` GA LAW Glc>200 AST>250 LDH>350 Age>55 WBC>1600 ```
85
CEA and CA 19-9
Pancreatic cancer
86
Whipple procedure- what removed
``` HEad of pancreas Distal stomach COmmon bile duct GB Proximal jejunum Duodenum ```
87
Complication pancreatic cancer
Trousseau - migratory thrombophlebitis
88
Whipple triad
Sx hypoglycemia while fasting Hypoglyemia Improvement with card load DO WORKUP FOR INSULINOMA
89
Labs insulinoma
Increased fasting insulin and increased C peptide
90
Endocrine pancreatic cancer usually malignant
Glucagonoma
91
Watery diarrhea- endocrine tumor
VIPoma
92
Migrator necrolytic erythema
Glucogonoma
93
Charcot triad | Next step?
RUQ pain Jaundice Fever Suspect cholangitis and do US or HIDA
94
Calcified GB may mean
Chronic cholecystitis | 10-30% of time is cancer
95
Primary sclerosing cholangitis vs primary biliary cirrhosis
PSC: male, non antimito Ab, possible + pANCA, ERCP shows pearls on a string (stricturing and irregularity of ducts) PBS: female, + antimito Ab and ANA; ERCP nothing exciting
96
Prehepatic vs posthepatic vs intrahepatic effect on bili
Pre: inc indirect Post: inc direct Intra: both or either
97
Gilbert vs Crigler Najjar I
Gilbert: jaundice with exercise, stress, fasting; ind bili 5, CNS 2/2 kernicterus Crig Naj II like gilbert- Tx phenobarb to increase glucoronosyltransferase
98
Paracentesis of ascites vs bacterial peritonitis
Ascities: protein 250, protein >1m glc normal serum LDH
99
Paracentesis shows high albumin and LDH equal to 60% serum LDH...suspect
Neoplasm
100
Tx Wilson disease
Trientine or penicillamine
101
Alpha 1 antitrypsin findings
Liver cirrhosis and pablobular emphysema with obstructive PFT pattern
102
Liver + OCP
benign neiplasm
103
Biopsy of liver CI??
Hypervascular organ - risk hemorrhage
104
Liver mets come from
Breast Colon Lung More common than primary
105
Paraneoplastic syndromes with hepatoma
``` Hypoglc Excesive RBC Refractory watery diarrhea HyperCa Variable skin lesions ```
106
Hepatitis that leads to hepatoma | Weird ither things that lead to hepatoma
HBV or HCV Aflatoxin from Aspergillus Schistosomiasis
107
String sign barium swallow, olive sized mass on palpation, projectile emesis. Labs?
Pyloric stenosis Dec Cl and K, metabolic alkalosis
108
Billous vomiting, hematochezia, air in bowel wall | Labs
Necrotizing enterocolitis Metabolic acidosis with dec Na
109
Biopsy show no ganglia in bowel
Hirschsprung
110
Currant jelly stool, sausage like abdominal mass
Intussusception
111
Rule of 2 Meckel
``` 2% population M 2x more than F 2 ft ileocecal valve Sx <2 yrs 2 types ectopic - pancreatic or gastric ```
112
Kernicterus is when bili deposits where
Basal ganglia | Hippocampus
113
Findings that would indicate nonphysiological cause for neonatal jaundice
Jaundice within first 24 hrs of life Total bili > 15 Dir bili >2
114
FTT- what percentile
<3
115
Esophageal webs, Fe def anemia, glossitis
Plummer Vinson
116
Positive Tzanck
HSV
117
Oral ulcers, biopsy shows intranuclear and intracytoplasmic inclusions, retinitis, colitis
CMV
118
Pts with GERD should avoid
``` Caffeine Mints EtOH Onions Garlic Chocholate Nicotine ```
119
Signet ring cells on biopsy
Gastric cancer - diffuse type
120
MALT
Lymphoma 2/2 H pylori | Can Tx with abx
121
Flask shaped ulcers, water in developing country | Tx
Entamoeba histolytica Metronidazole
122
Watery diarrhea causes
``` Vibrio Rotavirus ETEC Cryptosporidium Giardia ```
123
Gallstone ileus 0how
Gallstone erodes through intestinal wall into lumen and lodges at ileocecal valve
124
Pt with hx carcinoid tumor presents with symmetric dry hyperpigmented skin lesions, persistent diarrhea, irritable??
Pellagra- niacin (B6) def 2/2 carcinoid | Tryptophan is precursor to both 5HT and Niacin - tumor takes tryptophan
125
4 D pellagra
Dermatitis Dementia Diarrhea Death
126
Ogilvie syndrome
Pseudo-obstruction of large bowel
127
S bovis...check for
colon cancer
128
Risk colon cancer
``` Increased age FAP, HNPCC FH UC>>Crohns Polyps: villous>tubular, sessile>>pedunculated High fat and low fiber ```
129
HbSAg - what does it mean
Continued presence indicates carrier state
130
HBsAb - what does it mean
Indicated immunity to HBV
131
HBcAb - what does it mean
IgM + during window period | IgG indicator of prior or current infection
132
HBeAg = what does it mean
Indicator of transmissibility - BEware
133
Bacterial cause diarrhea: GBS, HUS, TTP
Campylobacter
134
Triad Reye syndrome
Encephalopathy Fatty liver degen Transaminase elevation 2/2 ASA in kids = mito damage
135
No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA
Idiopathic AI hepatitis
136
Coagulopathy caused by cirrhosis - Tx
FFP | VIt K will not work
137
Hemochromatosis affects what organs
``` Liver Heart Skin Pancreas Joints ```
138
Bacterial cause diarrhea: GBS, HUS, TTP
Campylobacter
139
Serum ascites albumin graduent - how to determine
= serum albumin - ascites albumin
140
SAAG >1.1 vs <1.1
>1.1: RELATED TO PORTAL HTN - Presinusoidal: splenic or portal v thrombosis, schstosomiasis - Sinusoidal: Cirrhosis - Postsinusoidal: RHF, constrictive pericarditis, Budd Chiari <1.1: NOT RELATED TO PORTAL HTN - Nephrotic - TB - Peritoneal carcinomatosis (ovarian cancer)
141
Acute prerenal failur ein setting of advanced cirrhosis | UNa <10
Hepatorenal syndrome
142
Coagulopathy caused by cirrhosis - Tx
FFP | VIt K will not work
143
NASH association
IR | Metabolic syndrome`
144
Triad Reye syndrome
Encephalopathy Fatty liver degen Transaminase elevation 2/2 ASA in kids = mito damage
145
No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA
Idiopathic AI hepatitis
146
Bronze diabetes
Hemochromatosis
147
Liver disease + CNS or psych manifestation | Kayser-Flsecher rings
Think Wilson disease Copper in lentiform nucleus AKA hepatolenticular degeneration
148
Liver disease results in prolonged PTT or PT
PT
149
Ranson 48 hrs later
Serum calcium < 2.0 mmol/L (< 8.0 mg/dL) Hematocrit fall > 10% Oxygen (hypoxemia PO2 < 60 mmHg) BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration Base deficit (negative base excess) > 4 mEq/L Sequestration of fluids > 6 L
150
Tx PUD w/ H pylori
Omeprazole Amoxicillin (metro if allergic) Clarithromycin
151
Toxic megacolon criteria
``` 3 of these Fever>38C HR>120 bpm Neutrophilic leukocytosis>10500 Anemia ``` ``` At least one of the following: V depletion Altered sensorium Electrolyte changes Hypotension ```

First Aid Step 2 (22 decks)

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