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Flashcards in MKSAP-GI Deck (39):
0

Suspect nephrolithiasis – test?

Noncontrast helical abdominal CT

1

Patient with acute abdomen – test?

Supine and upright abdominal radiographs (Although CT scan will be likely be necessary eventually)

2

Typical initial symptoms of ruptured AAA? CBC findings?

Sudden, severe pain and near syncope

Leukocytosis and anemia

3

Clinical criteria for IBS?

Rome III criteria:
1. Pain relieved with defecation
2. Change in stool frequency
3. Change in stool consistency

Also need no alarm indicators (old age, male, nocturnal awakenings, bleeding, weight loss, family history of colon cancer)

4

Patient with constipation due to IBS – first and second line treatment?

1. High-fiber diet
2. Laxative (poly ethylene glycol)

5

Patient with suspected ischemic colitis – important history? Typical colonoscopy finding?

Atherosclerosis

Thickening of the bowel wall in segmental pattern

6

Patient with suspected diverticulitis – test?

Contrast enhanced CT scan

7

Suspected HUS – test? Tx?

Peripheral blood smear; supportive

8

Suspected radiation proctitis – Sx? test and confirmatory findings?

Diarrhea and tenesmus Six weeks after radiation treatment

Flexible sigmoidoscopy sees mucosal telangiectasia, submucosal fibrosis and arterial Endarteritis

9

Suspect chronic pancreatitis – test?

Abdominal CT

10

Marker for celiac disease?

Anti-endomysial antibodies

11

Symptoms of Clostridium diff?

Diarrhea 10 to 15 times daily, fever, leukocytosis, abdominal pain

12

Treatment for salmonella gastroenteritis?

Supportive - Antibiotics slow clearance of salmonella from the stool and antidiarrheal agents increase chance of invasion

13

When to treat salmonella gastroenteritis?

1. Age 50
2. Patients with severe illness requiring hospitalization
3. Patients with atherosclerotic plaques or bone prosthesis (possible seeding)
4. Immunocompromised

14

Hepatocellular injury versus cholestatic injury?

Elevations in AST, ALT, and conjugated bilirubin

Elevation in alkaline phosphatase and small elevations in AST and a penalty

15

Diseases that can cause a mixed hepatocellular and cholestatic injury?

Hepatitis B and C

16

Gilbert syndrome a.k.a.?

Constitutional hepatic dysfunction and familial nonhemolytic jaundice

17

Effect of OCP on liver function?

Conjugated hyperbilirubinemia and elevated alkaline phosphatase

18

When to use cholecystectomy versus ursodeoxycholic acid?

If previously symptomatic vs if cannot undergo surgery (can only prevent new stone formation)

19

Acute cholangitis - tx?

Immediate broad spectrum antibiotics followed by ERCP-sphincterotomy

20

Gallstone pancreatitis - tx?

ERCP

21

Pt with pancreatitis - general management?

If pancreatic necrosis?


Jegunal Enteral tube feeds > TPN

Imipenem and debridement

22

GERD - tx? Test if unresponsive? Tx with alarm symptoms?

PPI; esophageal pH monitoring; EGD

23

Errosive esophagitis - tx?

PPI > H2-blocker

24

Pt with gastric ulcer - next step?

Biopsy

25

Functional dyspepsia? Tx?

Discomfort in epigastrum without organic cause.

PPI

26

Acute mesenteric colitis vs ischemic colitis? And tx?

Small bowl, very painful, caused by embolic event

Vs

Large bowl, bloody stool an cramping, caused by hypoperfusion

27

How to diagnose a hepatocellular CA without a biopsy?

Suggestive Ultrasound with AFP>500

28

Typical pt with non-alcoholic steatohepatitis? Diagnose with?

Obese woman with hx of HTN, HLD

US, CT, MRI

29

Treatment of hepatic encephalopathy?

Lactulose titrated to achieve 2 to 3 stools per day with a pH<6

30

UC - all treatments?

1. Masalamine
2. Other 5-aminosalicylates (-salazines)
3. Oral prednisone
4. Azathioprine and 6MP
5. Infliximab

31

Upper GI bleed - steps?

1. Fluid
2. EGD
3. If variceal veins - octreotide
Or if arterial, arteriography

32

NG tube is reliable in ruling out upper G.I. bleed if?

Aspirate contains bile (indicates tube went beyond pylorus)

33

What exposures Increase risk of acute hepatitis A?

Traveling, daycare, homosexual sex, raw shellfish

34

AST/ALT levels in acute hepatitis? Alcoholic hepatitis?
Autoimmune hepatitis?

>1000

<500

In the thousands

35

Most common blood-borne infection in the United States? Tests?

Hepatitis C

Screening test – anti-HCV antibody test
Extent of active infection – HCV RNA test

36

Definition of hepatorenal syndrome?

Kidney dysfunction in patients with portal hypertension

Also must have excluded prerenal azotemia, renal parenchymal disease and obstruction

37

Eruption of erythema nodosum preceded by?

Prodrome of fever and arthralgia

38

Findings of microscopic colitis? (Symptoms, colonoscopy, biopsy) treatment?

Symptoms – nonbloody diarrhea

Colonoscopy – normal mucosa

Biopsy – increased lymphocytes (lymphocytic colitis) or increased submucosal collagen (collagenous colitis)

Antidiarrheals - Loperamide, diphenoxylate, bismuth subsalicylate

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