GI Scenarios Flashcards
(34 cards)
Pts with GERD are at risk for:
a) candidate esophagitis
b) Zener diverticulum
c) Barrett esophagus
d) esophageal varices
e) achalasia
c: Pts with GERD are at risk for Barrett esophagus, which is a metaplasia linked to chronic reflux-induced injury to the squamous epithelium. It may lead to esophageal adenocarcinoma. Therefore, screening endoscopy may be recommended. Candidate esophagitis is likely to be found in immunosuppressed pts, uncontrolled diabetics, and those being tx with systemic steroids or abx. A Zenker diverticulum is a protrusion of the pharyngeal mucosa that develops at the pharyngoesophageal junction. Symptoms include dysphagia and regurgitation. IT is not a complication of GERD. Esophageal varies develop in pts secondary to portal HTN. They are associated with cirrhosis and may result in serious upper GI bleeding.
Hepatitis D infection requires confection with
a) Hep A
b) Hep B
c) HepC
d) Hep E
e) Hep G
b: Hepatitis D appears to be a virus infecting a virus. It is a defective RNA virus that can exist only in the presence of Hep B. When there is confection, the illness produced more severe than an infection with Hep B alone..
Which of the following is a risk factor for non-healing of a duodenal ulcer?
a) age >50
b) high-fat diet
c) cigarette smoking
d) chronic stress
e) alcohol use
c: Cigarette smoking is known to RETARD ULCER HEALING. Alcohol, dietary factors, and stress do NOT appear to cause or exacerbate ulcer disease. Ulcers occurs more frequently in the age range 30-55, but age is not implicated in non healing.
Which of the following conditions is associated with perifollicular hemorrhages, ecchymoses of legs, bleeding gums, loose teeth, and GI bleeding?
a) Peutz-Jeghers syndrome
b) Osler-Weber-Rendu Syndrome
c) scurvy
d) neurofibromatosis
e) Blue Rubber-Bled Nevus
c: Scurvy is caused by the lack of dietary vitamin C. It will cause perifollicuar hemorrhages, ecchymosis of the legs, bleeding gums, loose teeth, and GI bleeding. Melanin spots on the lips, buccal mucosa, and tongue with bleeding polypoid lesion in the small intestines are referred to as Peutz-Jeghers syndrome. Rendu-Osler-Weber is associated with telangiectasias on the face and buccal mucosa and similar lesions in the GI tract. Neurofibromatosis is associated with cafe au late pigmentation, pedunculated fibromas, and fibromas in the GI tract that may bleed. Rubber-bleb nevus syndrome is associated with cavernous hemangiomas of the skin and similar lesions in the small intestines.
In a pt with Hep C infection, which of the following medical conditions would be considered a contraindication to starting the pt on Interferon?
a) HTN
b) hyperlipidemia
c) diabetes
d) migraine headaches
e) systemic lupus erythematosus
e: Interferon is c/i in pts with autoimmune diseases. Interferon is also c/i in pts with severe liver disease and history of cardiac arrhythmia. It should be used with caution in pts with major depressive disorders, cytopenia, hyperthyroidism, and severe renal insufficiency.
A middle-aged woman presents with elevated cholestatic liver enzyme levels. She is not taking any meds, does not drink alcohol, and does not complain of abdominal pain. She has not had any previous biliary tract surgery. Which of the following is the most likely dx?
a) primary biliary cirrhosis
b) pancreatitis
c) cholecystitis
d) fatty liver
e) primary sclerosing cholangitis
a: Primary biliary cirrhosis affects women typically between 40-60. IT is often discovered incidentally when the serum alkaline phosphatase level is found to be elevated. Many pts do not have pain, which is more common in cholecystitis or pancreatitis. Primary sclerosing cholangitis is more likely to occur in a pt with known inflammatory bowel disease.
An adult pt presents with acute onset of watery, non bloody, voluminous diarrhea accompanied by nausea and vomiting. Which of the following organisms is the most likely cause?
a) Clostridium difficile
b) enterotoxigenic E. coli
c) Salmonella typhi
d) Shigella flexneri
e) Campylobacter jejuni
b: Large volume, watery, non bloody diarrhea accompanied by nausea and vomiting characterizes small bowel diarrhea caused by a toxin-producing bacteria s/a E. coli or a virus. Infection with Salmonella, Shigella, C diff, and Campylobacter results in an inflammatory diarrhea characterized by small volume, often bloody diarrhea without prominent nausea.
A pt has had problems with prolonged diarrhea. Stool cx grow out Cryptosporidium. It is important to:
a) test pt for HIV
b) check family members for the organism
c) perform a colonoscopy
d) perform blood cultures
e) isolate the pt
a: Chronic diarrhea from cryptosporidiosis may be indicative of underlying immunodeficiency. Pts with a positive cx should be checked for HIV. Rarely do pts with intact immune systems have problems with this organism, so checking family members would not be useful. Isolation also is not indicated. Blood cultures and colonoscopy study would not offer increased information with this dx.
Which of the following best describes Hep C virus (HCV)?
a) incubation pd 5-7 days
b) Hep C & D infections must be acquired simultaneously
c) Less likely than Hep B to cause chronic hepatitis
d) A DNA virus with similarities to rotavirus
e) The risk of maternal-neonatal transmission is low.
E: The maternal-neonatal transmission with Hep C is LOW! Hep C is an RNA virus that is similar to flaviviruses. The incubation pd averages 6-7 WEEKS, ad is MORE LIKELY to become chronic hepatitis than Hep B. Confection with Hep D occurs with Hep B, no Hep C!
Which of the following is a characteristic finding on CT of the abdomen in a pt with acute diverticulitis?
a) toxic megacolon
b) air-fluid levels
c) soft tissue inflammation of the pericolic fat
d) thinning of the colon wall
e) paucity of bowel gas in the colon
c: CT findings consistent with diverticulitis include soft tissue thickening of the pericolic fat (98%), diverticula, and thickening of the bowel wall. In immunosuppressed pts, findings may include intraperitoneal and exztraperitoneal gases without fluid or abscess formation.
Which of the following agents is a significant cause of pill-induced esophagitis?
a) fluoxetine
b) omeprazole
c) ibuprofen
d) Vitamin D
e) ciprofloxacin
c: The MC cause of pill-induced esophagitis are NSAIDs. Other commonly prescribed meds causing esophageal injury include slow release of potassium chloride, iron sulfate, quinine sulfate, and alendronate sodium
The most common malignant tumor of the esophagus in the African American male population is
a) adenocarcinoma
b) leiomyoma
c) small cell carcinoma
d) squamous cell carcinoma
e) granular cell tumor
d: Men are more likely than women to get esophageal cancer. The MC esophageal malignancy in the African American population is squamous cell carcinoma. Risk factors include excessive alcohol and tobacco use. Adenocarcinoma is more common in WHITES and is thought to be a complication of GERD.
In Western society, diverticulosis most often occurs in which portion of the colon?
a) transverse
b) sigmoid
c) descending
d) ascending
e) equally common in all parts of the colon
b: Diverticulosis may arise anywhere in the lg intestine, from the cecum to the end of the sigmoid colon. In Western societies, diverticula most often occur in the sigmoid colon where there is greatest intraluminal pressure.
Which of the following statements concerning GERD is NOT true?
a) may exacerbate asthma symptoms
b) behavioral interventions include weight loss and eating smaller meals
c) mild to moderate symptoms are treated with H2 receptor agonists (eg ranitidine or cimetidine) or PPI’s
d) barium esophagography is recommended in most pts
d: Barium esophagography has a limited role in the diagnostic management of pts with GERD. IT may be used in pts with severe dysphagia to evaluate the degree of stricture. Asthma, chronic cough, chronic laryngitis, sore throat, and atypical cp are increasingly being recognized as atypical manifestations of GERD and reflux may be a causative or exacerbating factor.
What is the MC drug to cause acute liver failure?
a) estradiol
b) ketoconazole
c) lisinopril
d) acetaminophen
e) methotrexate
d: A number of drugs may cause acute liver failure but acetaminophen toxicity is the most common of acute hepatic failure. Suicide attempts account for a significant portion of acetaminophen induced hepatic failure. All of the drugs listed can cause acute liver failure.
Which of the following is indicated to confirm the dx of celiac sprue in a pt with a positive serological testing?
a) stool for fecal fat
b) barium enema
c) intestinal bx
d) antimitochondrial antibodies
e) food challenge
c: Intestinal bx is the most specific test in establishing the dx of celiac sprue in a pt who has a positive test for IgA endomysial antibody. Classic symptoms of malabsorption are more common in infants but less common in adults. Stool for fecal fat would be a nonspecific finding. Antimitochondrial antibodies are seen in pts with primary billiary cirrhosis.
Mrs. Jones was referred for screening colonoscopy at the age of 50. She has no personal family hx of colorectal cancer. No polyps or lesions were found during the exam. She should be advised that colonoscopy should be repeated in how many years?
a) 1 year
b) 2 years
c) 3 years
d) 5 years
e) 10 years
e: In the average-risk individuals aged 50+, screening colonoscopy should be repeated every 10 years following normal exam. If individual has a first degree relative with a hx or adenomas or colorectal cancer, screening should begin earlier, generally at age 40 or 10 years younger than the age of dx of the youngest affected relative.
A non-penetrating tear of the gastroesophageal junction in association with a history of vomiting is known as:
a) Boerhaave syndrome
b) Plummer-Vinson syndrome
c) Peutz-Jeghers syndrome
d) Mallory-Weiss syndrome
e) Zollinger-Ellison syndrome
d: A mucosal tear of the gastroesophageal junction with a hx of prolonged vomiting is known as Mallory-Weiss tear syndrome. Plummer-Vinson syndrome is a congenital syndrome associated with anemia and webbing of the esophagus. Boerhaave syndrome is a rare life-threatening syndrome characterized by a full thickness tear of the esophageal wall. Zollinger-Ellison syndrome is caused by gastrin-secreting neuroendocrine tumors resulting in acid hyper secretion
The triad of “dermatitis, diarrhea, and dementia” (pellagra) results from a severe deficiency of which of the following vitamins?
a) thiamine
b) vitamin K
c) riboflavin
d) niacin
e) pyridoxine
d: Niacin deficiency is known as pellagra. It is rare in the US and is most often a complication of alcoholism or malabsorption syndrome. Clinical signs are known as the 3 Ds: dermatitis, diarrhea, and dementia.
An elderly pt is brought into the ED complaining of incontinence of liquid “like tea water” stool. He is complaining of rectal pressure and lower abdominal pain. The pain is cramping in quality and the pts abdomen is “bloated” DRE reveals hard stool in rectum. Which of the following shout be selected as the initial tx for this patient?
a) passing a NG tube
b) milk of magnesia
c) opiate analgesics for pain
d) oral sodium phosphate
e) manual disimpaction
e: Mechanical bowel obstruction in the rectum does not usually respond to oral laxatives. A NG tube would not be used for obstruction in the distal colon/rectum. One would avoid opiates in fecal impactions and other constipation problems because they tend to be more constipating. This pt needs to be disimpacted. Oral agents are unlikely to be effective against the fecal impaction and may cause complications.
The best initial diagnostic modality to dx cholelithiasis is which of the following?
a) CT scan of abdomen
b) ultrasound of abdomen
c) oral cholecystogram
d) abdominal plain film
e) MRI of abdomen
b: Ultrasound has replaced oral cholecystograms as the test of choice for dx cholelithiasis. CT is useful in the evaluation of acute abdomen but the sensitivity is poor. KUB is also not a sensitive study. MRI is expensive and not recommended.
Cullen sign is associated with:
a) diastasis recti
b) ventral hernia
c) ask injury
d) umbilical hernia
e) retroperitoneal bleeding.
e: A faint blue coloration may occur as a result of retroperitoneal bleeding. This is known as Cullen sign. Diastasis recti occurs when the rectus muscles lack a normal fibrous band that attaches them at the midline. An umbilical calculus is usually the result of poor hygiene. An umbilical hernia will occur when a weakness occurs in the abdominal wall., and a fistula in that area can tract from various organs causing d/c from the umbilicus.
Which of the following vitamins help increase the absorption of calcium in the GI tract?
a) A
b) B
c) C
d) D
e) E
D: Vitamin D increases the absorption of calcium and phosphorus in the GI tract and induces osteoclast activity, which causes an overall increase in serum calcium levels.
The presence of which of the following risk factors is an important clue in the dx of colitis due to C diff?
a) advanced age
b) non-insulin-dependent diabetes mellitus
c) travel to an underdeveloped country
d) recent hospital stay
e) attending a daycare or preschool center
d: Risk factors for the development of C diff include concurrent or recent use of antibiotics as well as a hospital or nursing home stay. C diff colonization is found in approx 3% of healthy adults. Increasing rates of infection are being noted in hospitalized pts secondary to transmission by hospital personnel.
