Git Flashcards
(121 cards)
1
Q
defect in achlasia
A
loss of inhibitory neurons in LES that are responsible for blocking the impulses that cause contraction
2
Q
pattern of dysphagia in achlasia
A
progressive to both solids and liquids simultaneously
3
Q
pattern of dysphagia in esophagial ca
A
to solids that progresses to liquids
4
Q
when is there dysphagia to both liquids and solids
A
in motility disorder
in growing obstruction:first solids than liquids
5
Q
which is the gold std/most accurate test for achlasia
A
manometry
6
Q
barrium esophagraphy shows____in achlasia
A
bird beak
7
Q
best initial therapy for achlasia
A
pneumatic dilation
8
Q
Tt of achlasia
A
- pneumatic dilation
- botulinum injection
- myotomy
9
Q
disadvantage of botulinum toxin
A
repeated injections needed
10
Q
complication of myotomy in achlasia
A
reflux
11
Q
eosophageal SCC and adenoca found in which regions of esophagus
A
SCC-proximal 2/3
ADENO- distal1/3
12
Q
best initial diagnosis of esophageal ca via
A
endoscopy as Dx is biopsy based
13
Q
best initial diagnosis of esophageal ca via
A
endoscopy as Dx is biopsy based
14
Q
chemotherapeutic drug used for git malignancy
A
5FU
15
Q
defect in esophagus of scleroderma
A
decreases motility
open tube which neither contracts nor relax
atrophy and fibrosis of smooth muscle
16
Q
most accurate test for dysphagia in scleroderma
A
motility studies
17
Q
diff bw nutcracker esophagus and DES
A
they are same except the difference in manometric pattern
18
Q
dysphagia pattern in DES
A
intermittent chest pain and dysphagia
at any time(not always with swallowing as in esophagitis)
19
Q
dysphagia pattern in DES
A
intermittent chest pain and dysphagia
at any time(not always with swallowing as in esophagitis)
20
Q
barium studies in esophagial spasm shows
A
corkscrew pattern
21
Q
most accurate test for DES/nutcracker esophagus
A
manometry
also in achlasia
22
Q
Tt of nutcracker/DES
A
CCB/nitrates
23
Q
DES can be confused with
A
prinzmetal angina
sublingual nitroglycerin relieves chest pain in both
24
Q
diagnosis of rings/webs made by
A
barium
25
Tt of rings/webs
PVS-Fe
both pneumatic dilation
26
cause of the pain of esophagitis
since it occurs only on swallowing so causes by rubbing of food against an inflamed esophagus
27
main risk factors for candida esophagitis
HIV AIDS(<200/mm3 :CD4)
diabetes mellitus
28
common pills causing esophagitis
```
fe
vitC
K
dronates
tetracyclines
quinine
```
29
if the patient is HIV + , we assume esophagitis due to
candida
give fluconazole(diagnostic as well as therapeutic)
if no imp then endoscopy with biopsy to R/o other causes.
30
characteristic features of zenkers diverticulum
express undigested food(eg on pillow)
halitosis
31
Dx of zenkers via
barium
32
mallory weis
nontransmural tears in lower esophagus and proximal stomach ass with retching/vomiting
33
most common presentation of mallory weis synd
upper git bleed(malena)
no dysphagia/odynophagia
34
criterion for endoscopy foe epigastric pain
all patients above 45yrs whether alarm symtoms present or not.
below 45 yrs : only if alarm symptoms present and if symptoms not resolving
alarm sym:wt loss, dysphagia, bleeding
35
LES is not an anatomic sphincter
yes
not found in cadaver
36
epigastric pain in GERD can be differentiated from others by
```
sore throat
metallic taste
hoarseness
cough
wheezing
```
37
most accurate test for gerd
24 hr PH monitering
38
is endoscopy useful in Dx of gerd
no
normal endoscopy does not exclude reflux
39
all PPIS/ H2 blockers are equal in efficacy
yes
40
tt of H.pylori
PPI+amoxicillin+ clarithromycin
if not tted then
PPI + metronidazole + tetracycline
41
features of ulcers of ZES
Recurrent
large
multiple
distal portion of duodenum
resistant to routine therapy
ass with diarrhoea and steatorrhoea
42
the most accurate test for metastatic ZES
endoscopic U/S
then somatostatin receptor scintigraphy
43
Dx of gastroparesis
gastric emptying study with rdiolabelled
44
ASCA anti saccharomyces cerevisae Ab positive in
crohns ds(neg in UC)
45
fistulising CD tt
infliximab( inhibits TNF)
46
main SE of infliximab
reactivation of Tb(do PPD)
arthralgia
47
mainstay of tt in IBD
mesalamine
48
acute exacerbation in IBD tted by
steroids
best BUDESONIDE(less systemic toxicity)
49
perianal IBD tted by
ciprofloxacin and metronidazole
50
why antibiotics are CI in EHEC diarrhoea
HUS happen when org dies
platelet transfusion also CI even if low
51
MCC of infectious diarrhoea
campylobactor
| salmonella
52
presence of leukocytes in stool indicates
intestinal invasion
blood may not be present..appears 24-36 hrs after...(exception : E.histolytica)
53
best emperic therapy for infectious diarrhoea
ciprofloxacin (other FQs) +/- metronidazole
54
___ antibiotic is highly ass with C.diff
clindamycin
55
c.diff is largely a nosocomial ds
yes
56
c.diff is largely a nosocomial ds
yes
57
cause of c.diff diarrhoea.
toxins A and B
| enterotoxic and cytotoxic effects
58
tt of c.diff diarrhoea
metronidazole
59
when is oral vancomycin given in c.diff
failed therapy with metro
resist to metro
allergic to metro
pregnant
<10 yr child
critically ill
60
if c.diff recurrs which antibiotic to be given
metronidazole
not vanco
61
fodaxomicin
can be used in c.diff
62
Dx of c.diff
LAMP(loop mediated isothermal amplification)
detects toxin A and B genes
earlier ELSIA was used: detects toxin
63
main symptom in IBS
pain
other:
only diarrhoea
only constipation
or both
no nocturnal symptom-as in UC/CD
pain relieved by change in bowel habbit
no constitutional symptom
64
tegaserod amd alosetron
constipation predominant IBS
diarrhoea induced IBS
both work by manipulating serotinin level
65
how does TCA work in IBS
relax bowel
treats depression
analgesic effect with neuropathic pain
66
carcinoid treated with
octreotide(somatostatin analog )
67
CF of carcinoid
diarrhoea
flushing
tachycardia
hypotension
right heart- tricuspid insufficiency, pul stenosis
rash- due to niacin deficiency
68
why is endoscopy or nasogastric tube CI in zenkers
for the risk of perforation
69
name malabsorption syndromes
most common : celiac ds and chronic pancratitis
others:
tropical sprue
whipple ds
70
what is common in all the malabsorption syn
steatorrhoea
wt loss
deficiency of fat sol vitamins
71
what is unique to celiac ds
its association with dermatitis herpetiformis ..seen in apprx 10% of people.
72
what are the distinguishing features of whipple ds to other Malabs syn
arthralgia 80%
dementia 10%
ophthaloplegia
73
most accurate test for
1. celiac
2. ch pancreatitis
3. tropical sprue
4. whipple
1. secretin/low trypsin
2. biopsy- loss of villi
3. biopsy -org
4. biopsy - specific Trophyrema whippelii
74
secretin test in ch. pancreatitis
if u place nasogastric tube into duodonem and inject secretin in blood , the pancreas ll not release bicarbonate and enz in gut.
75
trypsin and not amylase/lipase are used as a measure of ch pancreatitis.
yes
low trypsin( in acute: high)
amylase/lipase may be normal
76
why is biopsy done in celiac ds if it can be found out by serology
to rule out small bowel lymphoma
77
diff ch pancreatitis from other causes
repeated episodes of pancreatitis( from alcohol/ gallstones)
calcification
78
```
diff ch pamcreatitis and mucosal defect on the basis of the following.
D-xylose in urine
Fe
B9
B12
A,D,E,K
```
```
ch pancreatitis:
+
+
+
-
-
```
```
mucosal defect
-
-
-
-
-
```
79
antibodies seen in celiac ds
IgA------ endomysial Ab
IgA/G- tissue transglutaminase
IgA/G- deamidated gliadin peptide
80
most senistive and specific Ab in celiac ds
IgA anti-tissue transglutaminase
81
diagonsing celiac ds in IgA deficiency with Abs
IgA endomysial and transglutaminase are falsely normal
82
Rx of celiac ds
gluten free diet
dermatitis herpetiformis-dapsone
83
Rx of ch. pancreatitis
oral replacement of enz
84
Rx of tropical sprue
TMP-SMX or doxycycline
85
Rx of whipple ds
TMP-SMX or doxycycline or ceftriaxone (×1yr)
86
when is the colour of the stool is blackish
ferrous sulphate tablets
bleeding
bismuth subsalicylate
87
blood causes diarrhoea and iron tablets cause constipation
yes
88
best Dx of diverticulosis via
colonoscopy
89
best diagnosis of diverticulitis via
CT scanning
Barium and endocopy are contraindicated because of risk of perforation.
90
common presentation of diverticulosis
left lower quaderant pain
91
how to distinguish diverticulitis from diverticulosis
fever
more intense pain
increase in WBC
tenderness
92
cause of diverticulosis
MCC- low fibre diet
93
Rx of diverticulitis
ciprofloxacin + metronidazole
others
ampi/sul
pip/tazo
genta+cefotetan/cefoxitin
94
most likely cause of black coloured stool with diarrhoea
bleeding
blood acts as cathartic
95
left sided colon ca mostly presents with
obstruction and dec stool calibre
not seen with right sided(heme+ brown stool with ch anemia)
96
endocarditis by streptococcus bovis and clostridium septicum ass with
colon ca
97
what would you do if an xray finds osteomas as an incidental finding
colonoscopy
98
what would you do in a strepto.bovis endocarditis
colonoscopy(colon ca)
99
garderner syndrome
```
ass with colon ca with multiple soft tissue tumors:
osteomas
lipomas
cysts
fibrosarcoma
```
OSTEOMA PARTICILARLY IN MANDIBLE
100
peutz jeghers syn
ass with hamartomatous polyps and hyperpigmentation in skin, lips and buccal mucosa
101
turcot syn
ass with colon ca and CNS malingnancies
102
cowden syndrome
ass with colon ca
103
most accurate diagnostic test for colon ca
colonoscopy
| sigmoidoscopy detects onl 60% of ca as it cant see entire colon
104
colon ca screening
everyone >50 yrs of age
1. most accurate- COLONOSCOPY(every 10 yr)
2. sigmoidoscopy (every 1-2 yr)
3. fecal occult blood anually
105
why is colonoscopy better than sigmoidoscopy
sigmoidoscopy ll only reach the lesion upto 60 cm missing the rest 40% of ca.
106
lynch syndrome is ass strongly with ca of
colon
endometrium
ovarian
107
FAP
100%penetrance
initially adenoma (25yrs) which ll progress to ca (by 50 yrs)
108
a person presented with git bleeding with a history of abdominal aortic aneurysm repair in the past 6 mths to a yr
aortoenteric fistula
109
Rx of long term management of potal hypertension
propanolol
110
separation of upper and lower git bleeding done anatomically through
ligament of Treitz , which anatomically separates the duodenum from jejunum
111
treatment of acute bleeding due to varices
1. general measures for git bleeding
2. octreotide
3. band(sclerotherapy not used as more side effects)
4. TIPS( SE: hepatic encephalopathy)
112
how to manage case of git bleeding
Rx first and then search for eitology
1.bolus of NS/RL
2. CBC
(a) .HCT - tranfuse packed RBC if <30 %
(b) . platelets - transfuse if <50,000
3. PT- if less: fresh frozen plasma
4. NG tube
5. endoscopy:both to find site and cause of bleeding
113
melena occurs when ____ amount of blood has been lost
atleast 100mL from upper git
114
lower and upper git bleeding presents as
lower--red blood in stools
upper--black stool/ malena, hemetemesis
115
define orthostasis
>10 point rise in pulse when the patient goes from supine to the standing / sitting position.
OR >20 point drop in SP on change in position.
there should atleast be a min in the measurement of pulse / BP to allow time for normal ANS diacharge to acc position change
116
if pulse >100/min OR SP <100... .indicates how much blood loss
>30 %
117
most accurate test to determine the cause of both upper and lower git bleeding
endoscopy
118
role of nuclear bleeding scan in GI bleeding
used when endoscopy is not able to reveal the cause even when there is active bleeding.
detects low vol bleeds 0.1-0.2mL / min
RBC of patient are tagged with Tc and reinjected....tagged cells are then detected.
119
how angiography can be used for evaluation og GI bleeding
rarely used because it needs a higher vol of blood loss >0.5mL/ min
120
when both upper and lower endoscope are unrevealing in GI bleeding ..the most likely site of bleeding is
small bowel
121
capsule endoscopy
new modality to visualize small bowel which is not visualised by upper (till lig treitz)/lower (just past ileocaecal valve)endoscope.
swallows capsule with electronic camera..tramsmits thousands of images
