GI Uworld Flashcards
(201 cards)
1
Q
What intervention provides the long term relief for Duodenal Ulcer
A
antibiotics and pantoprazole
2
Q
majority of duodenal ulcers caused by
A
H pylori or NSAIDs
3
Q
which defect in abdominal wall is not covered by membrane or skin
A
gastroschisis
4
Q
rapid periumbilical pain that is out of proportion to exam findings
A
acute mesenteric ischemia
5
Q
risk factors for acute mesenteric ischemia
A
atherosclerosis
embolic source
hypercoagulable
6
Q
lab values in acute mesenteric ischemia
A
leukocytosis
elevated amylase and phosphate levles
metabolic acidosis
7
Q
Dx acute mesenteric ischemia
A
CT angiography
8
Q
indications of worsening SBO
A
fever, hemodynamic instability (hypotension and tachy)
guarding
luekocytosis
low bicarb!! metabolic acidosis
9
Q
no Ab anti tissue transaminases but Bx shows villous atrophy
A
celiacs still
10
Q
confirm Dx pyloric stenosis
A
US
11
Q
30 yo with vomting and abdominal pain for 24 hours. crampy diffuse getting worse. BM 3 days ago
emesis is green no blood
dec appetite
distended bowel with hyperactive sounds and diffusely tender
normal electrolytes and cBC
A
SBO from adhesions is most likely
12
Q
best Dx image for pancreatic CA
A
CT
13
Q
neonate with bilious vomting
A
malrotation, volvulus
14
Q
NG tube placed in neonate with bilious vomtiing and there is no free air in stomach (aka no double bubble)
A
now do upper GI series
barium swallow
15
Q
most common cause lower GI bleeding in adults
A
diverticulosis
16
Q
painless bleeding from rectum in adult
A
diverticulosis
17
Q
reye sundrome presentaion
A
vomiting, agitation, irrational behavior
progressing lethargy, stupor and restlessness
18
Q
lab findings in reye syndrome
A
hyperammonemia normal or slighly elevated bili and alk phos long PT hypoglycemia mod t osevere inc LFTs and LDH
19
Q
microvesicular steatosis in kidneys and brain
A
reye syndrome
20
Q
when to suspect spontaneous bacterial peritonitis
A
any patient with cirrhosis and ascites accompanied by fever or change in mental status
21
Q
Abdomainl XR findings in necrotizing enterocolitis
A
air in bowel wall “train track or double line”
and portal veins
“pneumatosis intestinalis”
22
Q
pneumatosis intestinalis
A
from NEC in newborn. risk with prematurity
23
Q
what cause zenker diverticulum
A
sphincter dysfunction and esophageal dymotility
24
Q
typical GERD findings in patient, next step
A
Upper GI endoscopy
25
biggest risk factor for pancreatitis
alcohol consumptions
26
Tx appendiceal abscess
IV hydration, Antibiotics, bowel rest and interval appendectomy
27
anemia in patient taking aspirin and NSAID
likely Fe deficient from chronic bleeding
28
what happens in anemia of chronic disease
suppresion RBC production by inflammatory cytokines
29
what type of damage in reye syndrome
microvesicular fatty infiltration
30
best Dx for acute gallstone pancreatitis
RUQ US if inconclusive the ERCP
31
chronic alcoholic with cirrhosis with vague symptoms like weakness and fatigue, next step
esophageal endoscopy
| and US of liver every 6 months to look for hepatocellular carcinoma
32
when do you introduce pureed foods to infants
6 months
33
when to introduce cows milk to infants
1 year
34
why does rifaxamin help with encephalopath
decrease number of ammonia producing bacteria in colon
35
why is there steatorrhea in zollinger ellison
inactivation of pancreatic enzymes by increased stomach acid
36
crypt abscesses
UC
37
porphyria cutanea tarda
fragile skin, photosensitivity and vesicles and erosions on dorsum of hands
seen in Hep C
38
HCV patients also have what condition usually
essential mixed cryoglobulinemia
39
waxing and waning transaminase levels
Hep C
40
CF findings
recurrent infections
growth failure
steatorrhea, malabsorption ADEK
because malabsorption K can have higher susceptibility to bleeding and bruising
41
tests for CF
sweat Cl testing
fecal elastase
genotyping
42
CF patients at risk for
pancreatitis, DM and infertility
43
what meds are assoc with acute pancreatitis
```
valproic acid
diuretics: furosemid and thiazides
drugs for IBD: ASA and sulfasalazine
immuno: azathioprine
HIV: didanosine and pentamidine
antibiotics: metro and tetracycline
```
44
test for lactulose intolerance
+ H breath test
| low stool pH and increased stool osmotic gap
45
nonalcoholic fatty liver disease
middle aged obese with metabolic syndrome
bland steatosis to ecrosis to cirrhosis
macrovesicular fat deposition and peripheral displacement nuclei
46
What is nonalcoholic fatty liver disease related to
insulin R and increased peripheral lipolysis TG synthesis and hepatic uptake
47
triple bubble sign
jejunal atresia
48
what increases risk for GI atresia in utero
mom using vasoconstrictive meds or tobacco or cocaine
49
severe pancreatitis causes hypotension how
increased vascular permeability
50
most common liver mass
metastatsis
| solid or multiple
51
anti HBs +
| anti HBc +
resolved hep B infection
52
when do you have antiHBe +
recovery phase of HBV
53
what Ab if you are immune to Hep B from natural infection
IgG anti HBc and Anti HBs
54
Tx for duodenal hematoma in child
NG suction and parenteral nutrition
55
Tx for acute cholescytisis
cholecystectomy within 72 hours
56
radiology of acalculous cholecystiis
gallbladder thickening and distension
| pericholecystic fluid
57
Tx for acalculous cholecystitis
percutaneous cholecytostomy under radiologic guidance
58
Patients with acalculous cholecystitis
critically ill
59
Tx for diverticulitis with abscess formation
CT guided percutaneous drainage
60
labs in intrahepatic cholestasis of preganncy
intense pruritis
elevated bile acids
elevated LFTs
Dx of exclusion
61
associated disorder in hirschspurng
downs
62
ileal obstruction of meconium
CF
63
brick red urate crystals in diapers
sign of mild dehydration
64
Tx for breastfeeding failur jaundice in newborn
increase frequency of feedings and duration
65
3 week old with jaundice and pale stool
breast feeding well
increased direct bili
coombs negative
biliary atresia
66
how to Dx biliary atresia
intraoperative cholangiogram
67
first step in Dx biliary atresia
abnormal US to look for abnormal or absent gallbladder
68
kasai procedure
used in biliary atresia
hepatoportoenterostomy
allows time for growth and reduces the mortality assoc with hepatic transplant in same age group
69
when does physiologic jaundice resolve
in first week
70
when does breast milk jaundice occur
second week
| increased unconjugated bili up to 10-30
71
CXR findings in acute pancreatitis
```
can have any:
pleural effusion
atelectasis
elevated hemidiaphragm
pulmonary infiltrates
```
72
hepatolenticular degeneration
wilsons disease
73
what cardiac drug increases serum digoxin levels
CCBs like amiodarone, verapamil, quinidine
74
signs Sx dig toxicity
```
anorexia
n/v
abdominal pain
fatigue
confusion
weakness
color vision abnormalities
```
75
where is a mallory weiss tear
mucosal tear at the GEJ
76
Hepatorenal syndrome
dangerous complication ESRD
decreased GFR in absence of schock, proteinuria or other causes renal dysfunction
type 1 is rapid
type 2 survive 3-6 months
77
Tx for hepatorenal syndrome
renal transplant
78
painless GI bleeding
angiodysplasia most common in right colon
| so if vignette says colonoscopy years ago could not visualize ascending colon
79
angiodysplasia of colon is more common in what patients
aortic stenosis, vWdisease, renal disease
80
Tx angiodysplasia colon
cautery
81
keratomalacia
cloudy cornea
82
bilious emesis in neonate
| work up
Abdominal XR to rule out pneumoperitoneum
| then water soluble contrast enema
83
microcolon
meconium ileus
84
abnormal D xylose
low levels= celiac
| would be normal in pancreatitis because is absorbed in proximal small intestine without enzymes or brush border
85
clinical feature achalasia
chronic dysphagia, progressive solids to liquids
86
Dx acalculous cholecystitis
Abdominal US
87
neutrophilic cryptitis
both crohns and UC
88
recurrent PUD with multiple duodenal ulcers and jejunal ulcers
thickened gastric folds
suspect zollinger ellison
| gastrinoma
89
risk with hiatal hernia
adenocarcinoma of esophagus because cause gERD which inc risk for CA
90
Dx chronic pancreatitis
CT to look for pancreatic calcifications
91
management variceal hemorrhage
volume resuscitation
IV octreotide
antibiotics
92
what non antibiotics increase risk c diff
long term PPI use or histamine 2 R antagonist use
93
first step to dx acute pancreatitis
serum amylase and lipase
94
liver is black
hyper direct bili
pigment in hepatocytes
dubin johnson
95
how to confirm dubin johnson
coproporphyrin urine levels will be high
96
absent bowel sounds and dilated small and large bowel
paralytic ileus
97
man had gastroduodenoscopy showing antral ulcer and 4/7 biopsies are consistent with adenocarcionma
next step?
CT scan
98
what is panendoscopy
esophagoscopy
bronchoscopy
laryngoscopy
99
Blunt abdominal trauma and has low BP ad no peritoneal signs or anything
splenic laceration
100
Tx toxic megacolon
IV fluids
antibiotics
IV corticosteroids for IBD induced
bowel rest
101
newborn with feeding intolerance, abdominal distension and bloody stools
NEC
102
why are newborn with congenital heart disease more prone to NEC
lack of perfusion of mesentary
103
patient with acute pancreatitis likely to stones, resolves
| now what?
cholescystectomy to prevent further acute pancreatitis episodes
104
difficulty initiating swallowing
| next step
videofluoroscopuc modified barium swallow
105
recurrent right lower lobe pneumonia in elderly patient...
likely aspiration
106
child has hemi hyperplasia of body
beckwith wiedemann
107
what is the mutation in beckwith wiedemann
deregulation of imprinted gene on chrom 11p15
108
macrosomia macroglossia, hemihyperplasia
| likely to have what abdominal defect
omphalocele
| beckwith wiedemann
109
complications beckwith wiedemann
wilms tumor
| hepatoblastoma
110
congenital disorder of tryptophan absorption
hartnup
| they get pellagra
111
Acute intermittent porphyria
abdominal pain, vomiting, diarrhea
| neuro Sx of agitation, paresthesias, confusion
112
SLE like malar rash
| diarrhea
pellagra
113
week after Blunt abdominal trauma comes back with shaking chills poor appetite and deep abdominal pain
pancreatic laceration
114
if there is air in urine of a patient
evaluate for colovesical fistula
115
how to Dx colovesical fistula
abdominal CT with oral or recta contrast
do not use IV
colonoscopy to tule out malignancy
116
common cause post op ileus
opiate use
117
8 year old with extrahepatic cystic mass and normal gallbladder
biliary cyst
118
signs of biliary cyst
abdominal pain and obstructive jaundice
119
Tx biliary cyst in child
surgical resection to preven obstruction and malignant transformation
120
someone on total parenteral nutrition and has gallstones, why
gallbladder stasis
121
non caseating granulomas. which IBD
crohns
122
most common causes of cirrhosis
chronic Hep B or C
alcoholic
nonalcoholic
hemochromatosis
123
anticoagulated patient with weakness and dizziness and evidence anemia
back pain
internal hemorrhage
| retroperitoneal
124
which polyp in colon is most premalignant
villous adenoma
125
colon cancer more in sessile polyps or stalked(pedunculated)
sessile
126
26 year old with 4 weeks intermitten abdominal pain and cramps with rectal urgency and bloody diarrhea, nausea and de appetite
getting more severe
no PMH
fever and lower BP high HR
distension with diffuse tenderness and mucus mixed blood in vault. anemic with lots of leukoctyes and inc ESR
After IV fluids do abdominal XR to Dx toxic megacolon
127
vit B12 stores last how long
3-4 years
128
rotors syndrome is a defect in what
defect in hepatic excretion of bilirubin
| will have + urine dip for bilirubin with negative urobilinogen
129
panlobular mononuclear infiltration of liver
hepatic cell necrosis
130
biggest intervention to decrease risk pancreatic cancer
smoking cessation
131
Tx for PBC
ursodeoxycholic acid
| delays progression
132
Ca all around gallbladder
porcelain
| increased risk of adenocarcinoma
133
hepatic encephalopathy occurs why
livers inability to break down ammonia into urea
134
hepatic hydrothorax results in
transudative pleural effusions
135
patient with cirrhosis and large pleural effusion that wont go away with diuretics
transjugular intrahepatic portosystemic shunt
136
elevated direct bilirubin
| elevated alk phos
cholestasis
intra or extrahepatic
extra will have dilated ducts
intra does not
137
most common mets colon CA
liver
138
hard hepatomegaly and mildly elevated liver enzymes
do CT to look for malignancy
139
what helps prevent variceal bleeding
beta blockers propanolol nadolol
140
if patient with varices in esophagus has CI to beta blocker therapy
do endoscopic ligating
141
courvoisier sign
nontender! distended gallbladder at right costal margin
| seen in pancreatic cancer from back up
142
surgery for gastroschisis
single stage closure
143
surgery for omphalocele
staged closure with silastic silo
144
biopsy of colon with laxative abuse
dark brown discoloratino of colon with lymph follicles shining through as pale patches "melanosis coli"
pigment in macrophages of lamina propria
145
most important indicator of acute hepatic failure
PT will increase
146
lab values that indicate acute liver failure
increased PT and INR
bilirbuin inc
transaminases can decrease
147
signs of B2 riboflavin def
angular cheilosis, stomatitis, glossitis
normocytic anemia
seborrheic dermatitis
148
signs of scurvy
punctate hemorrhage
gingivitis
corkscrew hair
149
Lynch syndrome
HNPCC
150
Lynch syndrome II is assoc with
endometrial CA
151
rehydration for children
oral if mild
| mod-severe use normal saline
152
area commonly involved in ischemic colitis
splenic flxsure
153
presentation of achalasia but also with weight loss and rapid onset
think of malignancy causing psuedoachalasia
| do an endoscopy
154
Tx for acute cholangitis
ERCP with spincterotomy
155
acute errosive gastritis
severe hemorrhagic erosive lesions after exposure to injurious agents
156
close contacts of someone with Hep A
give Ig
157
Dx carcinoid syndrome
urinary excretion 5HIAA
CT.MRI abdomen and pelvis
octreoscan
echo
158
features carcinoid
```
episodic flushing
secretory diarrhea
cutaneous telangiectasias
bronchospasm
tricuspid regurg
```
159
risk factors for milk protein induced colitis
FMH allergies, eczema, asthma
160
what causes the ascites in portal HTN
increased hydrostatic P
161
SAAG to indicate portal HTN
>1.1
162
SAAG to indicate other causes
163
elevated AST and ALT with a ration
NAFLD
164
when to begin screening colonoscopies in patients with IBD
begin 8 years post Dx
| colonoscopy with Bx every 1-2 years
165
bowel sounds in acute ischemia
decreased
166
bowel sounds in SBO
increased
167
suspect pancreatic CA, how does jaundice affect workup
if they are jaundiced first do US
| no jaundice then do CT
168
what to give patient on warfarin if need immediate surgery
FFP
169
MEN I
primary PTH
enteropancreatic tumors
Pituitary
170
MEN2A
Medullary thyroid
Pheo
PTH hyerplasia
171
MEN2B
Medullary thyroid
Pheo
mucosal and intestinal neuromas
marfanoid
172
Tx for anal fissures after stool softeners and sitz baths
topical lidocaine and nifedipine
173
post gastrectomy complications
dumping syndrome
| loss of normal action pyloric sphincter and rapid empyting of gastric contents
174
signs of dumping syndrome
abdominal pain, diarrhea, nausea
hypotension.tachy
dizziness, confusion, fatigue diaphoresis
175
presentation emphysematous cholecystitis
fever, RUQ pain, n/v
| crepitus adjacent to gallbladder
176
Dx emphysematous cholecystitis
air fluid in gallbladder, gas in gallbladder wall
cultures with clostridium or E coli
indirect hyperbili with mildly elevated LFTs
177
tx emphysematous cholecystitis
EM cholecystectom
| broad spec antibiotics
178
zinc deficiency
alopecia
abnormal taste
bullous pustulous lesions
179
testing to H pylori
breath or stool
180
if H pylori testing is negative, next step
PPI trial for 4-6 weeks
181
what pills induce esophagitis
tetracyclines
Aspirin and NSAIDs
bisphosphonates
KCl
182
choanal atresia
newborn with cyanosis aggravated by feeding and relieved by crying
183
CHARGE syndrome
coloboma, heart defects, atresia choanae, retardation of growth, GU anomalies, ear abnormalities/deafness
184
Dx choanal atresia
failure to pass oropharynx catheter
| confirmed by CT
185
Tx MALT lymphoma
since caused by H pylori do the PPI clarithromycin and amoxicillin regimen
186
ischemic hepatopathy
rapid and massive increase in transaminases
187
pleural effusion fluid has low pH and very high amylase
| alcoholic
assume booerhave syndrome and esophageal perforation
| will have pneumomediastinum
188
cholesterol emboli
livedo reticularis
acute kidney injury
pancreatitis and mesenteric ischemia
supportive care for pancreatitis
189
immunizationf for people with HCV
Hep B and A
190
GGT and ferritin levels in alcoholic hepatitis
both are increased
191
dermatitis herpetiformis
erythematous vesicular rash over extensor surfaces elbows and knees
192
management pyloric stenosis
first IV hydratio and K replacement then surgery
193
Dx acute diverticulitis
abdominal CT with contrast
194
Dx hyperTG as cause of pancreatitis
fasting lipid profile
| lipase will be like extremely high high
195
how to Dx psoas abscess
CT of abdomen and pelvis
196
abnormal lab value in patients with only upper GI bleed
inc BUN/Cr ration from increased urea in intestinal breakdown of Hb and increased reabsorption for hypovolemia
197
19 year old Dx with FAP
need elective procto-colectomy
198
cyclical vomiting syndrome is highest in children with Hx of what
migraine HA
199
Tx for cyclical vomiting syndrome
hydration and antiemetics
200
coffee bean sign
sigmoid volvulus
201
what cause spider angiomas and palmar erythema in cirrhosis
hyperestrinism from impaired hepatic metabolism of circulating estrogens
P450 cytochrome system
