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UWorld step 2 > GI UWorld > Flashcards

GI UWorld Flashcards

1
Q

difficulty initiating swallowing, coughing, choking, nasal regurgitation
dx?
what next?

A

oropharyngeal dysphagia

video fluoroscopic modified barium swallow

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2
Q

difficulty with food passing through esophagus, food gets “stuck” what 2 possibilities? and next step?

A

1)motility disorder (achalasia) dysphasia with solids and liquids
–> barium swallow followed by manometry with endoscopy

2)mechanical obstruction (malignancy) dysphagia with solids progressing to liquids
–> upper endoscopy (+/- barium swallow beforehand)

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3
Q

pt with chronic diarrhea, steatorrhea, weight loss
D-xylose test: decrease in urine and blood levels

A

Celiacs – malabsorption d/t villous atrophy

-pancreatic insufficiency would show normal d-xylose test since problem is not with absorption

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4
Q

celiacs antibodies: (2)

A

igA anti-tissue transglutaminase AB’s
IgA anti-endomysial AB’s

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5
Q

corkscrew patter on esophagram
dx
tx

A

diffuse esophageal spasms
tx: CCBs (diltiazam)

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6
Q

urease producing infection

A

h-pylori

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7
Q

upper gi bleed; placed 2 large bore IV’s, NS, and abx, what’s next?

A

IV octreotide

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8
Q

esophageal varices, treatment?

A

if not actively bleeding, nonselective b-blocker (nadolol, propranolol)

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9
Q

sudden onset odynophagia and retrosternal pain, endoscopy shows discrete circumferential deep ulcers with normal surrounding mucosa

A

pill-induced esophagitis

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10
Q

hyperbilirubinemia with elevated Alk phos: next best step?

A

ULTRASOUND of upper right quadrant

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11
Q

hyperbilirubinemia with elevated Alk phos: next best step?

A

ULTRASOUND of upper right quadrant

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12
Q

symmetric, concentric narrowing affecting distal esophagus (was dx with Barrett 6 mo ago) now has sensation of food “sticking” within chest

A

esophageal stricture

vs adenocarcinoma would be asymmetric and irregular narrowing

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13
Q

GERD management + alarming symptoms

A

upper gi endoscopy

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14
Q

painless GI bleeding with aortic stenosis

A

angiodysplasia

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15
Q

dermatitis – hyper pigmented scaly skin rash, + diarrhea (with n/v/loss of appetite), + Dementia/Depression/psychosis/memory loss

A

pellagra “rough skin”
niacin B3 deficiency

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16
Q

if concerned with peptic ulcer disease (postprandial nausea/ upper abdominal pain, NSAID use, positive stool guaiac) complicated by perforation, peritonitis (marked abdominal tenderness with guarding) what next?

A

upright x-ray of the chest - potentially sub diaphragmatic free air

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17
Q

elevated aminotransferases, hepatic encephalopathy (confusion, somnolence, flapping tremor asterixis), and synthetic liver dysfunction INR>1.5
dx?
tx?

A

acute liver failure (likely due to acetaminophen toxicity)
toxicity d/t NAPQI that glucorinidation in lier

tx: N-acetylcysteine

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18
Q

alcoholic hepatitis: jaundice, anorexia, tender hepatomegaly
what labs to look for?

A

AST:ALT>2
AST& ALT <300
decreased albumin (malnourished)
ELEVATED GGT, FERRITIN, bilirubin

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19
Q

ascites fluid characteristics: (SAAG= Peritoneal fluid albumin - serum albumin)

A
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20
Q

cirrhosis – portal hypertension due to

A

increased hydrostatic pressure within hepatic capillary beds

vs

capillary membrane permeability in portal hypertension d/t non portal hypertensive causes (malignancy, pancreatitis, nephrotic syndrome, TB)

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21
Q

elevated AST ALT and asymptomatic
dx:
tx:

A

dx: autoimmune hepatitis
hyper-gammaglobulin-emia (IgG autoantibodies)
anti-smooth muscle antibodies
anti-microsomal type 1 antibodies

tx: prednisone

22
Q

pt with cirrhosis d/t alcohol, should also undergo screening for:

A

esophageal varices so do an endoscopy

23
Q

management of ascites in cirrhosis

A

spironolactone and furosemide TOGETHER

alcohol abstinence: helps with BOTH portal htn and decreasing ascites

24
Q

pt with TB, gets RIPE, now has elevated LFTs, liver bx shows pan lobular mononuclear infiltration and hepatic cell necrosis

A

hepatitis secondary to isoniazid usage

25
Q

management of cirrhosis with esophageal varices

A

nonselective b-blocker naldolol

26
Q

management of cirrhosis with esophageal varices

A

nonselective b-blocker naldolol

27
Q

pt with hepatic encephalopathy (asterixis, ams) next best step?

A

1) adjust K or bicarb levels with fluids or abx
2). correct blood ammonia levels with lactulose and rifaximin

28
Q

fever, nausea, RUQ pain, jaundice, hepatomegaly, LFT’s > 1000s

A

hepatitis A

29
Q

hepatitis b

A
30
Q

cirrhosis management vaccines

A
31
Q

recurrent mild jaundice, provoked by a stressor
dx:
d/t
tx

A

Gilbert syndome
decreased conjugation of bilirubin due to decreased hepatic UDP glucoronosyltransferase activity
no tx required

32
Q

increased total bilirubin, bilirubin in urine, no urobilinogen in urine, with dark granular pigment accumulation in hepatocytes

A

dubin johnson
no tx required
d/t impaired hepatocyte bilirubin excretion

33
Q

nonalcoholic fatty liver disease d/t

A

insulin resistance
which increases peripheral lipolysis in adipocytes
and trigleride syntetis
increased hepatic accumulation of fatty acids and triglyerciders

increase in free fatty acid causes increased free radicals and proinflammatory cytokines –> steatohepatitis

34
Q

ulcerative colitis, elevated alk phos, elevated bilirubin, next best step?
dx?
what would you see?

A

primary sclerosis cholangitis
next step: MRCP multifocal bile duct strictures alternating with segments of ductal dilation (beaded appearance)

35
Q

elevated alk phos and LFT’s
xray: mediastinal fullness, bilateral reticulonodular opacities in upper lungs

A

sarcoidosis
systemic granulomatous inflammation
hypercalcemia and bilateral hilar lymphadenopathy

36
Q

ascites, then fever and lethargy altered mental status, hypotension, and decreased bowel sounds concerning for:
next step?

A

spontaneous bacterial peritonitis SBP
decreased bowel sounds – paralytic ileus occurs with severe infection
do a paracentesis for dx
will see e coli or klebsiella so must use 3rd gen cephalosporin

37
Q

tremor, involuntary movements, depression, elevated LFT’s in young adult:
d/t:
labs:
tx:

A

Wilson’s disease (hepatolenticular degeneration)
impaired copper transportation –> accumulation in tissues in liver and brain
low serum ceruloplasmin, increased urinary copper excretion, kaiser flesher rings (copper deposits in cornea)
tx: remove accumulated copper (chelators: d-penicallimine, trientine) and prevent copper absorption (zinc)

38
Q

diagnosis for acute pancreatitis:

A

2/3
1) severe pain radiating to the back
2) serum amylase/lipase more than 3 times normal limit
3) abdominal imaging CT: focal or diffuse pancreatic enlargement with heterogenous enhancement wit IV contrast, or US: diffusely enlarge and hypo echoic pancreas

39
Q

alcoholic, severe pain radiating to back, hypotension, tachycardia, b/l crackles lungs

A

severe pancreatitis
d/t local release of activated pancreatic enzymes –> enter vascular system and increase VASCULAR PERMEABILITY within and around pancreas –> fluid migrates everywhere retroperitoneum.
tx: several liters of IV fluids to replace intravsular volume

40
Q

“pounding headache” wt loss, valvular heart disease with tricuspid regurgitation

A

carcinoid syndrome
episodic flushing and tachycardia give pounding headache effect

41
Q

pt with atrophic glossitis, diarrhea, abdominal pain, flatulence/bloating, and worsening burning sensation in hands and feet with decreased pinprick and vibration sensation in b/l hands and toes

A

celiac disease
autoimmune process
peripheral neuropathy

42
Q

stool osmotic gap
<50
>125

A

<50 secretory diarrhea (occurs due to toxins like vibrio cholera, hormones like VIPoma, congenital disorder like cystic fibrosis, or bile acids in post surgery patients

> 125 osmotic diarrhea (after ingestion of causative substance like milk in lactose intolerance)

43
Q

worsening epigastric pain over 2 months with 15lb weight loss, 2 years ago dx’d chronic pancreatitis
next best step?

A

pancreatic adenocarcinoma
do a CT SCAN if no jaundice

44
Q

jaundice (common bile duct obstruction, elevated alk phos and bilirubin), and steatorrhea
cancer

A

pancreatic HEAD cancer
do an ultrasound to exclude other billiary obstructions

vs no jaundice – body or tail cancer
do an abdominal CT scan

45
Q

causes of C-diff

A

advanced age, abx use or hospitalization,
GASTRIC ACID SUPPRESSORS
inflammatory bowel disease

46
Q

colon cancer screening

A
47
Q

Crohn disease

A
48
Q

ulcerative colitis vs crohns

A
49
Q

Lynch syndrome associated cancers (3)

A

colorectal cancer
ENDOMETRIAL cancer
ovarian cancer

50
Q

MALT lymphoma associated with

A

H pylori

if positive must do quadruple therapy

51
Q

colonoscopy biopsy: lymphocytic infiltration of lamina propria with thickened sub epithelial collagen band

A

microscopic colitis

52
Q

PAS - positive in lamina propria of small intestine

A

WHIPPLE DISEASE
gi + migratory polyarthropathy + myocardial or valvular involvement leading to CHF or valvular regurgitation

UWorld step 2 (16 decks)

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