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UWorld Medicine Ultra-HY > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

Classic presentation of carcinoid syndrome

A

Diarrhea, episodic flushing, venous telangiectasias, right heart valve disease (TIPS: tricuspid insufficiency, pulmonic stenosis)

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2
Q

Serum marker for carcinoid syndrome

A

5-HIAA (5-hydroxyindoloacetic acid), a serotonin metabolite

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3
Q

Giardia: test? Treatment?

A

Test: stool antigen assay
Treatment: Metronidazole

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4
Q

Neck mass that increases with drinking: diagnosis? test?

A

Zenker diverticulum.

Test: contrast esophagram

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5
Q

Difficulty initiating swallow: diagnosis? test?

A

Oropharyngeal dysphagia.

Tetst: videofluoroscopid modified barium swallow

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6
Q

Risk factors for esophageal adenocarcinoma? SCC?

A

Adenocarcinoma: GERD (Barrett’s), smoking
SCC: Alcohol abuse, smoking

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7
Q

Brief episodes of non-cardiac chest pain with dysphagia during the episode only. Diagnosis? Best test? Initial treatment?

A

Diagnosis: Diffuse esophageal spasm
Test: manometry
Treatment: CCBs (diltiazem)

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8
Q

Initial treatment for low-grade MALT lymphoma due to H. pylori?

Second-line treatment?

A

Initial treatment: Triple therapy for H. pylori (PPI, clarithromycin, amoxicillin)
Second-line: chemotherapy

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9
Q

Three extrahepatic manifestations of hepatitis C

A
  1. Porphyria cutanea tarda (blistering 2-3 days after sun exposure, reddish urine due to porphyrins)
  2. Membranoproliferative GN (and so HTN)
  3. Mixed cryoglobulinemia (fatigue, arthralgias, palpable purpura, low C4, positive RF)
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10
Q

Labs in mixed cryoglobulinemia

A
  1. Low complement, especially C4
  2. Positive rheumatoid factor
  3. Cryoglobulins
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11
Q

Presentation of Wilson’s disease (3)

A
  1. Chronic hepatitis / cirrhosis
  2. Neurological signs: tremor, rigidity, ataxia, slurred speech, depression
  3. Kayser-Fleisher rings
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12
Q

Empiric treatment of SBP

A

3rd-generation cephalosporin (cover gut flora like E. coli and Klebsiella)

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13
Q

Screening for HCC in cirrhotics?

A

Screening US every 6 months

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14
Q

Tumor marker for HCC

A

Alpha-fetoprotein

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15
Q

Liver mass in association with long-term OCP use:

Diagnosis? Test? Treatment?

A

Diagnosis: hepatic adenoma (usually benign)
Test: US and then CT (do not perform needle biopsy, risk of bleeding)
Treatment: surgical excision

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16
Q

Primary biliary cirrhosis and primary sclerosis cholangitis: which is seen more in men, and which in women

A

PBC: women (9:1)
PSC: men (2-3:1)

17
Q

Antibody associated with primary biliary cirrhosis?

A

Anti-mitochondrial antibodies

18
Q

Treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid

19
Q

What disease is primary sclerosing cholangitis strongly associated with?

A

Ulcerative colitis

20
Q

Pattern of gastric and duodenal ulcers with respect to meals?

A

Gastric: worse during meal (acid secretion, movement during meal)
Duodenal: worse 2-3 hours after (food buffer has left unapposed acid behind), often wakes up at night

21
Q

Treatment for H. pylori associated PUD?

A

Triple therapy: PPI, clarithromycin, and amoxicillin

22
Q

Labs in Zollinger-Ellison syndrome

A

Markedly elevated serum gastrin (>1000 pg/ml) despite acidic gastric pH (<4)

(Note that lack of stomach acid (e.g. 2/2 PPI) can lead to elevated gastrin, so need to check gastric pH)

23
Q

Febrile diarrhea associated with extra-GI symptoms with small bowel biopsy showing villous atrophy and PAS-positive materials: diagnosis? cause?

A

Whipple’s disease, infection with Tropheryma whipplei

24
Q

Most common cause of colovesical fistula? Two other causes?

A

Most common: diverticulitis
Others: Crohn’s disease, colon cancer
(But NOT UC, since it is not transmural)

25
Q

Other conditions associated with angiodysplasia in the colon (3)

A
  1. Renal disease (more likely to bleed)
  2. vW disease (more likely to bleed)
  3. Aortic stenosis (disrupts vWF and may make more likely to bleed)
26
Q

Pathologic hallmark of ulcerative colitis

A

Crypt abscess

27
Q

Causes of toxic megacolon (5)

A
  1. Infection (e.g. C. diff, or CMV in AIDS)
  2. IBD
  3. Ischemic colitis
  4. Volvulus
  5. Obstructive colon cancer (less common)
28
Q

Treatment for toxic megacolon due to IBD? Due to other causes?

A

IBD: Antibiotics, NPO, IVF, plus IV corticosteroids
Other causes: the same but no steroids
Surgery may be required

29
Q

Treatment for mild/moderate C. diff? Severe?

A

Mild/moderate: oral metronidazole

Severe: oral vancomycin (+/- IV metronidazole)

30
Q

3 types of polyps that may be seen on colonoscopy

A
  1. Adenomas
  2. Hyperplastic (benign, nothing needed)
  3. Hamartomatous polyps (juvenile polyp, Peutz-Jegher polyps - not pre-malignant, but removed due to bleeding risk)
31
Q

Colon adenoma pathology that is more likely to become malignant? Shape?

A

Villous pathology more pre-malignant than tubular

Sessile more pre-melignant than pedunculated

32
Q

Cancers seen in Lynch syndrome?

A
  1. Colon cancer (HNPCC)
  2. Ovarian cancer
  3. Endometrial cancer
33
Q

Serologic marker in autoimmune hepatitis

A

Anti-smooth muscle antibody

34
Q

Watery diarrhea associated with rice

A

Bacillus cereus food poisoning

35
Q

Brief watery diarrhea with fever associated with unrefrigerated food

A

Clostridium perfingens

36
Q

Diarrhea associated with raw or undercooked shellfish

A

Vibrio vulnificus (can lead to invasive disease in immunocompromised and liver disease)

37
Q

Diarrhea that can lead to hemolytic uremic syndrome

A

Enterohemorrhagic E. coli (e.g. O157:H7)

38
Q

Bacterial diarrhea that can cause invasive, life-threatening illness in the immunocompromised or thsoe with liver disease

A

Vibrio vulnificus (associated with undercooked shellfish)

39
Q

Treatment for CACS (cancer-related anorexia/cachexia syndrome)

A

Progesterone analogs, e.g. megestrol acetate

Corticosteroids can also be used but have more side effects

UWorld Medicine Ultra-HY (13 decks)

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