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Flashcards in GI review-Table 1 Deck (39):
1

Which of the following is not a cause of organic abdominal pain?
a. Cancer
b. IBD
c. IBS
d. Chronic mesenteric ischemia

a. Cancer
b. IBD
c. IBS
d. Chronic mesenteric ischemia

2

Which of the following is not a cause of functional abdominal pain?
a. Depression
b. Dyspepsia
c. IBS
d. Chronic pancreatitis

d. Chronic pancreatitis

3

What is the Rome criteria and what disease does it diagnose?

pain associated with changes in bowel habits relieved by defecation or accompanied by distension or bloating for IBS

4

What vitamin and mineral deficiencies are patients with a total gastrectomy or gastric bypass surgery at risk for?

(Fe, Ca, B12).

5

Your patient is a 40 year old male who was diagnosed with GERD 2 years ago. He is now complaining of difficulty swallowing. What is the most likely cause of this patient’s dysphagia?

Schatzki’s ring or esophageal web

6

a. You perform an EGD with biopsy on this patient with Schatzki’s ring or esophageal web and discover that he has low grade dysplasia Barretts esophagus. You inform the patient that with a diagnosis of Barrett’s esophagus he will need an upper endoscopy every…..?

After a dx of barrett’s esophagus (greater than 5 years or pt is over 50yo), pt will need EGD with biopsy every 2 years. With high grade dysplasia, he will need an esophagectomy.

7

With oral/pharyngeal dysphagia, which type of physician would you want to refer your patient to? And what is the best test to diagnose this problem?

ENT, barium swallow

8

What is the classic finding on barium swallow study in a patient with Achalasia?

Birds beak esophagus

9

A 70 year old woman presents to your ED with a history of forceful, bloody vomiting and is complaining of diffuse chest pain. She has a history of osteoporosis and takes Alendronate for it. What dangerous syndrome are you concerned with in this patient and how would you diagnose it?

a. Borehaave’s syndrome, could also be corrosive esophagitis causing perforation of her esophagus. Look for free air in the mediastinum on CT!!

10

Your patient is a 50 year old man who is having an upper endoscopy because of chronic epigastric pain. Upon examination, he is found to have significant esophageal varices. You test the patient for hepatitis, inquire about his alcohol consumption (none, he is a Mormon) and his BMI is 23 and he is quite physically active. Given this information, what do you think is causing his esophageal varices?

Budd-chiari syndrome

11

What medications should this patient avoid indefinitely in a pt with Budd-chiari syndrome?

NSAIDS

12

How long should your patient with PUD take a PPI?

4 weeks for DU, 8 weeks for GU

13

Can you have dyspepsia without having an ulcer?

yes

14

You have a patient with recurring PUD who has had multiple EGDs with biopsy for H pylori which have all come back negative. On each endoscopy the patient has had duodenal ulcers and has begun to have severe diarrhea. What syndrome are you suspecting in this patient and what diagnostic test will you run to confirm your suspicions?

Zollinger-Ellison syndrome, caused by an pancreatic gastrinoma (in most cases), dx with a serum gastrin level >1000pg/mL).

15

What is the gold standard for diagnosing IBD?

colonoscopy with bx

16

What’s the most common extra intestinal manifestation of IBD?

(arthritis)

17

What is the first line tx for IBD?

Aminosalicylates, metronidazole for fistulizing disease in chrons, corticosteroids for acute flair

18

How long can diarrhea last for it to still be considered acute?

19

1. Which of the following medications are not major contributors to developing C.diff?
a. Cephalosproins
b. Fluoroquinolones
c. Ampicillin
d. Amoxicillin
e. Clindamycin
f. Metronidazole

f. Metronidazole

20

What are some sx that you might see with fistulizing diverticular disease?

urinary tract symptoms, tracks into bladder, pneumaturia)

21

Your patient presents to the ER complaining of bloody stool. The patient tells you that they are constipated frequently and sometimes have to strain to defecate. You perform a rectal exam, which is unremarkable. What is the most likely cause of this patient lower GI bleed?

diverticulosis

22

Your patient presents to the ER with intermittent RUQ that has been going on for a few days and they tell you that they have had gallstones in the past. They also tell you that their eyes looked a little yellow and they felt itchy two days ago but they seem better now. What is your initial diagnostic exam in this patient?

us

23

You note a dilated common bile duct with gallstones on US, what are the next diagnostic/therapeutic exams that you need to order?

MCRP and then ERCP

24

You have a patient who presents to your ER with fever, acute jaundice, RUQ pain and hypotension. The patients husband tells you that she was saying strange things in the car as well. Her WBC, total bilirubin and alk phos are elevated. What are this patient symptoms consistent with and how will you treat her?

a. Consistent with acute suppurative cholangitis (Reynolds Pentad of sx) and she needs borad spectrum antibiotic and decompression with a percutaneous drain or ERCP and then a lap chole when she is stable.

25

1. What are Grey Turner’s and Cullen’s signs indicative of?

a. Overall, indicative of blood in the peritoneum but are generally a sign of acute pancreatitis.

26

You have a patient present to you with what you suspect to be acute pancreatitis. The patient is 57, has a WBC count of 20,000, a blood glucose of 220 and an ALT that is 3x normal. Based on these findings, how likely is it that the patient has acute severe pancreatitis?

Ranson criteria, score of 3, severe pancreatitis likely

27

You have a homeless patient who presents to you ER with hematemesis who seems intoxicated. An abdominal X-ray is performed in the work up of this patient and you see that he has strange calcifications in his epigastric area. You ask you attending if this patient has gallstones. The attending tells you that the patient does not have gallstones and sends you home to do some homework. You quickly realize your mistake and determine that the calcifications are a symptom of….?

chronic pancreatitis, usually caused by alcoholism

28

1. Which of the following GI neoplasms has the worst prognosis for the patient?
a. Colon cancer
b. Esophageal cancer
c. Gastric cancer (adenocarcinoma)
d. Rectal cancer

c. Gastric cancer (adenocarcinoma)

29

You have a patient who presents to you with acute jaundice, abdominal pain, and recent weight loss. Upon physical examination, you palpate a large gallbladder. You inquire about pain during the palpation and the patient denies any pain. What is the most likely diagnosis for this patient?

pancreatic cancer, Courvoisier sign

30

What is the most common form of hepatitis in the United States?

HEP A

31

What are the typical sequellae of hepatitis infections?

a. Prodromal phase- constitutional symptoms, flu like symptoms
b. Icteric phase- jaundice with acholic stools, liver tender and enlarged
c. Chronic phase

32

What is the most common cause of drug induced fulminant hepatitis?

acetaminophen

33

what rare disease if left untreated can cause fulminant hepatitis?

Wilson’s disease

34

What is the most common cause of chronic hepatitis in the US?

NASH

35

What is the most common cause of elevated LFTs in the US?

NAFLD

36

Which of the following is not a treatment for acute variceal bleed?
a. ABCs
b. Octreotide
c. Endoscopy with sclerotherapy/balloon tamponade
d. TIPs procedure
e. Beta blocker

e. Beta blocker

37

You have a patient with liver disease who has mild encephalopathy, ascites that responds to diuretic use, bilirubin of 4, albumin of 3 and a PT of 5. What is their Child’s score?

11, severe liver disease

38

Which IBD is p-ANCA common in?

(UC)

39

Which IBD is ASCA common in?

(Crohn’s)