MKSAP Flashcards
(107 cards)
1
Q
PBC specific antibodies (name 3)
A
- Anti mitochondrial
- Anti-sp100
- Anti- gp210
2
Q
Rx for PBC
A
Ursodeoxyxholic acid —> improved histology and survival
3
Q
AI disease associated with PBC requiring annual checks
A
Thyroid stimulating antibodies
4
Q
Rx of acute Hep A
A
Supportive care
5
Q
Hep A route of transmission
A
Feco- oral
6
Q
Hep A post exposure prophylaxis in:
1. Age <40 years
2. Age >40 years, immunocompromised, or CLD
A
- HAV vaccine within 2 weeks
- Vaccine + HAV immunoglobulin
7
Q
Duration of fluid administration in acute pancreatitis
A
12-24 hours
8
Q
Indications for ERCP in acute pancreatitis
A
Persistent transaminitis showing ongoing biliary obstruction
9
Q
Most conning pancreatic NET associated with MEN
A
Gastrinoma —> insulinoma
10
Q
What is the first step in evaluating constipation
A
Alarm features of colon cancer:
1. Age >50
2. Acute change in bowel habits
3. Weight loss
4. Family h/o colorectal CA
5. Unexplained anemia
11
Q
What are the three types of constipation based on transit time
A
- Normal transit
- Slow transit
- Dysnergetic
12
Q
First exam to be performed for constipation
A
DRE
13
Q
Three conditions associated with PSC and how to screen them
A
- IBD —> colonoscopy at the time of diagnosis and every 1-2 years
- Cholangiocarcinoma —> CEA 19-9 and MRCP every 1-2 years
- GB carcinoma —> annual ultrasound
14
Q
6 indications for Barrett esophagus screening
A
- GERD >5 years
- Age >50 years
- Male sex
- Obese
- Tobacco use
- Family h/o Barrett esophagus or esophageal CA
15
Q
What is the duration of PPI trial for GERD
A
8 weeks
16
Q
Partial response to PPI at 8 weeks. Next step?
A
Twice daily dosing
17
Q
Alarm symptoms in GERD
A
- Weight loss
- Hematemesis/ malena
- Dysphagia
18
Q
Blood tests that suggest hereditary hemochromatosis
A
- High serum ferretin
- High transferrin saturation >45%
19
Q
Confirmatory test for verification hemochromatosis
A
Genetic testing for HFE gene mutation
20
Q
Frequency of abdominal pain for IBS diagnosis
A
1 day/week x 3 months
21
Q
Diagnostic test for microscopic colitis
A
Right and left colonoscopy with biopsy
22
Q
Identifying source of GI bleed in HD unstable patient. Most sensitive test that detects minimal bleeding?
A
CTA even better than conventional angiography
23
Q
When should colonoscopy be performed for evaluation of Lowe GI bleed?
A
If the patients is HD stable. Otherwise do CTA
24
Q
First test of choice for evaluation of lower GIB
A
CTA
25
First test of choice for evaluation of upper GI bleed
EGD
26
4 causes of upper GIB in patients with corrhosis and what is the treatment approach for each
1. Esophageal varices —> banding and ligation
2. Gastric varices —> CTA first to identify anatomy; spleenectomy, TIPS, or retrograde ballon occlusion
3. Portal HTN gastropathy —> portal HTN management
4. Prominent vascular ectasias —> APC
27
Age of colonoscopy for FAP
10
28
What are the annual screenings that FAP patients undergo? Mnemonic
T - Thyroid Us every year for papillary thyroid CA
U
C - colonoscopy every year
E - EGD at age 25 with Bx of gastric fundic polyps
D - duodenoscopy
29
Does treatment of Hep C eliminate the risk of HCC
No and screening with abdominal US should be performed every 6 months
30
Specific IBD pattern associated with PSC
Rectal soaring, mid colitis, and backwash ilitis
31
Malignancy highly associated with PSC requiring yearly surveillance
Cholangiocarcinoma requiring yearly CA 19-9 and MRCP
32
Frequency of Pap smear in patients with IBD receiving immunosuppressive meds
Annually
33
Malignancies seen in patients with IBD M. Mnemonic
C - colorectal
C - cervical
s - skin
34
Diagnostic criteria for eosinophilia esophagitis
1. Dysphagia - can be intermittent due to presence of rings, furrows, strictures
2. Biopsy with >15 eosinophils/hpf without other apparent cause - no GERD, vial or fungal infection
3. Exclusion of other causes including HES
35
Treatment of eosinophilia esophagitis
PPI + swallowed budesonide/fluticasone
36
What is narcotic bowel syndrome
Centrally mediated GI hyperalgesia of the guy characterized by worsening abdominal pain with incremental doses of opiates
37
What is Centrally mediated abdominal pain syndrome (CAPS). What are the typical presenting symptoms
Generalized constant/near constant/ frequently recurring abdominal pain which is not associated with food intake or bowel movements.
38
Typical presenting feature of acute mesenteric ischemia
Acute onset peri umbilical pain with sudden urge to defecate
39
Medication associated with microscopic colitis
NSAID
40
Medications associated with microscopic colitis
NSAID
SSRI
PPI
41
Score used to determine NAFLD severity and associated management
Fibrosis score calculator or FIB-4
1. Low risk —> weight loss and lifestyle
2. Indeterminate —> elastography for liver stiffness score
3. High risk —> hepatology and fibrous can
42
Which antibodies even thought clinically irrelevant are elevated in NAFLD
1. Anti-smooth muscle
2. ANA
43
Is NAFLD same as NASH?
No
44
Which two meds should be administered for SBP? One that we always give and the other which is always forgotten
Their gen cephalosporin and albumin
45
First step in evaluation of chronic diarrhea
Stool osmotic gap
46
Formula for stool osmotic gap
290- 2 x (stool Na + stool K)
47
Stool osmolarity gap suggesting osmotic diarrhea
>100
48
Diet for osmotic diarrhea
FODMAP
49
How to differentiate hepatic adenoma from hyperplasia
MRI with sodium contrast —> excreted in bile and therefore not seen with hepatic adenoma
50
Electrolyte derangements and vitamin Vedic I envy associated with PPI use
1. Electrolytes - hypo Mg, Ca, K
2. Vitamin B12
51
Which other bowel conditions are associated with celiac disease
IBS, microscopic colitis, SIBO, HIV
52
3 indications for Hep B treatment
1. Acute liver failure
2. Immune active phase
3. Reactivation
53
Antivirals for Hep B
Entecavir and Tenofovir
54
Drug of choice to induce and maintain remission in UC
Mesalamime or 5-ASA
55
Preferred route for 5-ASA delivery in IBD
Topical through suppository or enema as almost all of the drugs is absorbed in jejunum and only 20% is deliver to colon when administered orally
56
Which is better - confined oral and topical ASA or either of them alone?
Combined
57
I’m addition to PPI, this medication has been shown to improve chest pain symptoms in SS associated reflux disease
Low dose antidepressant- amitriptyline or trazodone
58
Differentials for granulomatous lesions in the liver
1. NHL
2. Drug toxicity
3. TB
4. Fungal
5. Brucellosis
6. Q fever
59
The only sarcoidosis that is not treated
Hepatic sarcoidosis
60
NSAID is required but patient had GI bleed before NSAID
COX-2 selective NSAID + PPI
61
How do you differentiate cardiac from cirrhotic ascites since both have SAAG >1.1
Bg total protein level of ascitic fluid
1. Cirrhotic: <2.5
2. Cardiac: >2.5
62
Most common drugs associated with DILI with chole static pattern
Amoxicillin- clavulinic acid
Valproic acid
Phenytoin
63
Should you treat HCV in a patient with depcmpensated cirrhosis
No it worsens decompensation
64
What are the indications of liver transplant referral?
1. MELD Na>15
2. Decompensated cirrhosis
65
Three constitutions associated with porphyria cutanea yards
1. Hep C (most common)
2. Alcoholic liver disease
3. Hemochromatosis
66
Rx of porphyria cutanea tarda
1. Avoid Sun
2. HCQ
3. Phlebotomy for iron overload
67
Rx of severe IC not responding to 5-ASA
Infliximab/Golimumab + Azathioprine
68
Recombinant factor Xa
Andexanet
69
6 differentials for steatorrhea
1. Pancreatitis
2. SIBO
3. Giardiasis
4. Whipples
5. Celiac
6. Tropical spruce
70
Diagnostic test for SIBO (usually performed)
Hydrogen breath test
71
Gold standard for SIBO diagnosis
Small bowel aspirate culture
72
2 scores used to determine mortality in upper GI bleed
1. Glasgow-Blatchford
2. Rockall scores
73
How to der mine need for hospital observation bs discharge in patients with bleeding ulcers
Type of ulcer and risk of rebleeding:
1. Low risk: no endoscopic intervention performed —> clean base ulcers with pigmented spots and Mallory tears —> discharge
2. High risk: endoscopic intervention performed —> bleeding ulcer, ulcer with visible non bleeding vessel, and ulcer with stuck clots —> observe for 72 hours
74
Duration of octreotide for varices l bleeding
3-5 days
75
Duration of antibiotics for cirrhosis and GI bleed
7 days regardless of other clinical factors
76
Post endoscopic management of antiplatelets for UGI bleed
1. Aspirin:
Primary prevention of CVD—> discontinue
Secondary prevention —> continue
Start the day hemostasis documented on EGD
2. PYP 12 inhibitors:
Start within 5 days of hemostasis
77
Post endoscopic AC management after UGI bleed
1. High risk (mechanical valve, valvular A.fib, recent VTE) —> within 48 hours
2. Others: within 7 days of hemostasis
78
What are the two types of pancreatic cysts and which one has malignant potential requiring follow up
1. Mucinous —> have malignant potential
2. Serous —> no malignant potential —> no follow up required
79
What is PJS
Hamartomatous Polyposis Syndrome involving the small intestines taht commonly presents as rectal bleed, bowel obstruction, and intrusive Orion
80
Which malignancies are associated with PJS
1. All GI - gastric, small bowel, colorectal
2. Gonadal - GYN and testicular
3. Breast
4. Pancreatic
81
What are the two types of gastric polyps and what is the French of repeat EGD
1. Fundic polyps with no dysplasia -> most common; benign; no follow up EGD. Should be biopsied.
2. Antral or dysplastic —> repeat EGD in 6-12 months depending on degree of dysplasia. Should be fully resected.
82
Should outline surveillance EGD be performed for gastric ulcers to document healing? What are the only indications for repeat EGD
1. No
2. Indications:
a. Suspicion for malignancy
b. No responses after 8 weeks of PPI
83
Is routine surveillance EGD indicated for gastric CA screening? What are the indications?
No. The indications are based on risk factors: history of gastric intestinal metaplasia, ethnicity (first or second gen from high incidence area), and first degree relative with gastric CA
84
Rx if functional dyspepsia
TCA
85
Timeline for development of travelers diarrhea
2 weeks
86
Rx of travelers diarrhea
Oral hydration + antibiotic (for moderate and severe disease) azuthromycin or FQs + loperamide
87
Rx of persistent H pylori (drugs and duration)
Drugs: 4 drug regimen of BOTM (bismuth, omeprazole, tetracycline, and metronidazole)
Duration: 14 days rather than the initial 10 days
88
Initial treatment of H pylori
3 drug regimen with CAO (clarithromycin, omeprazole, and amoxicillin) x 10 days
89
Rx of HSV esophagitis
Acyclovir
90
Rx of CMV esophagitis
Ganciclovir
91
Rx if candidal esophagitis
Fluconazole
92
Rx of dermatitis herpetiformis
Dapsone —> check G6PD before
93
Common meds causing pill induced esophagitis
KCL, Iron, NSAID, doxycycline, and bisphosphonates
94
Is EGD indicated in pill induced esophagitis? If so when?
Not routinely. Only for persistent symptoms.
95
What is the typical presentation of pill induced esophagitis
Dysphagia several hours to days after ingestion of offending pill
96
What is the EGD finding in eosinophilia esophagitis
Rings, furrows, and strictures
97
Dysphagia and odonophagia in candidal be viral esophagitis
Candida: more dysphagia
Viral: odynoohagia
98
Peripheral eosinophils in eosinophilia esophagitis
Absent
99
Achlasia is a —— motility disorder
Hypertonic
100
Features distinguishing achlasia from psuedoachlasia
Age > 55 with duration <1 year and associated weight loss
101
Medical therapy for achlasia not fit for surgery
CCB and nitrates
102
Rome 4 criteria for functional dyspepsia
One of four:
1. PP fullness
2. Easily satiety
3. Epigastric pain
4. Epigastric burning
In the absence of a structural, organic, or metabolic cause.
Duration: symptom onset 6 months before diagnosis with at-least 3 months of symptoms
103
Routine EGD for dyspepsia after age __
60
104
ACG recs for evaluation of dyspepsia
1. Age >60 : EGD
2. Age <60 with multiple alarm features, high risk descent, family history of malignancy: EGD
2. Age < 60 with few or no alarm features: H. Pylori testing and PPI trail
105
4 indications for H. Pylori testing
1. Active PUD
2. History of PUD without documented cure for H. Pylori
3. MALToma
4. Gastric carcinoma
106
Three types of gastric polyps and their malignant potential
1. Fundic glad polyps associated with PPI use —> no malignancy
2. Hyperplasticity : have malignant potential; >0.5 cm to be resected
3. Adenomas: should be respected and surveyors e EGD 1 yr post resection and then every 3-5 years
107
Lubiprostone, plecanatide, or linaclotide is recommended for patients with refractory irritable bowel syndrome-constipation subtype.
