Rapid Style Questions Flashcards
(248 cards)
1
Q
What is the most common cause of acute cholecystitis?
A
Gallstones obstructing the cystic duct
2
Q
Which physical exam finding is classically associated with acute cholecystitis?
A
Murphy’s Sign
Murphy’s Sign: RUQ pain/tenderness with deep palpation during inspiration (halts inspiration)
3
Q
What is the first-line imaging modality for suspected acute cholecystitis?
A
Abdominal Ultrasound
Transabdominal gallbladder US is best test to detect gallstones and evaluate GB disease
* Ultrasonographic Murphy sign: local abdominal tenderness over GB
* Pericholecystic fluid and GB wall thickening indicates acute inflammation
Classically CT scans are done in the ED, but they are not first-line nor the best test in diagnosing acute cholecystitis
4
Q
Why is a transabdominal ultrasound superior to CT scans in diagnosing acute cholecystitis?
A
- Visualization of Gallbladder Wall and Structures: US is superior when visualizing the GB and detecting its thickening, which is a key indicator of acute cholecystitis
- Reproduction of Murphy’s Sign
- Non-invasive and is a quick test in the ED
5
Q
Although labs can be normal in acute cholecystitis, what are some common labatory findings?
A
- Elevated WBC
- LFT’s normal to slightly elevated
- Elevated bilirubin and alk phos
- Lipase
6
Q
What is the initial management for a patient presenting with acute cholecystitis?
A
IV Fluids, antibiotics, and pain control
7
Q
What surgical procedure is commonly performed for acute cholecystitis?
A
Laparoscopic Cholecystectomy
Earlier is better, within 24-48 hours is ideal
8
Q
Which antibiotic is commonly used for treating acute cholecystitis?
A
Piperacillin-tazobactam or ceftriaxone w/metronidazole
9
Q
What complication occurs when the gallbladder wall becomes ischemic and necrotic?
A
Gangrenous cholecystitis
10
Q
What is the role of a HIDA scan in diagnosing acute cholecystitis?
A
To confirm diagnosis when ultrasound findings are equivocal
11
Q
What finding on ultrasound is indicative of acute cholecystitis?
A
Gallbladder wall thickening, pericholecystic fluid, and a positive Murphy’s sign
Positive Murphy’s sign reproduced during exam
12
Q
What is a non-surgical alternative procedure for acute cholecystitis when surgery is contraindicated?
A
Percutaneous cholecystostomy
A percutaneous cholecystostomy is a minimally invasive procedure used to drain the gallbladder, typically performed in patients with acute cholecystitis who are not candidates for immediate surgery.
13
Q
What is the common pathogen of acute cholecystitis?
What is the typical duration of abx treatment?
A
E. coli
5-7 days post surgery
14
Q
What imaging finding is described as a “porcelain gallbladder” and why is it significant?
A
Calcification of the gallbladder wall, significant because it can be associated with an increased risk of gallbladder cancer
15
Q
What is the name of the condition where a stone obstructs the common bile duct, often presenting with jaundice?
A
Choledocholithiasis
16
Q
What is the typical cause of chronic cholecystitis?
What are common symptoms of chronic cholecystitis?
A
Repeated episodes of acute cholecystitis or chronic irritation caused by gallstones
Intermittent RUQ pain, nausea, and bloating (especially after fatty meal
17
Q
What is the typical imaging finding in chronic cholecysitits?
A
Thickened gallbladder wall and presence of gallstones
18
Q
Are LFT’s elevated in chronic cholecystitis?
A
No, they are usually normal as well as white blood cell counts
These can be normal or elevated in acute cholecystitis
19
Q
What is the definitive treatment for chronic cholecystitis?
A
Cholecystectomy (surgical removal of the gallbladder)
20
Q
Are men or women more affected by chronic cholecystitis?
A
Women (Middle-aged)
21
Q
What is a common complication of untreated chronic cholecystitis?
A
- Gallbladder cancer
- Gallstone ileus
22
Q
How does chronic cholecystitis differ from acute cholecystitis in terms of presentation?
A
Chronic cholecystitis presents with intermittent and less severe symptoms compared to the acute, severe pain and systemic symptoms of acute cholecystitis
23
Q
What dietary modification can help manage symptoms of chronic cholecystitis?
Because what type of gallstone are most common in chronic cholecystitis?
A
Reducing Fatty Foods
Cholesterol gallstones
24
Q
What type of cholelithiasis (gallstone) is related to cirrhosis?
A
Black Stones
25
What is the best imaging test to diagnose stones in the common bile duct (choledocholithiasis)?
ERCP
26
What is the biggest risk factor associated with gastric cancer?
| What factors can reduce risk?
H. Pylori
| Chronic aspirin or NSAID use, and wine
27
What is the most common gastric cancer type?
Adenocarcinoma
28
What are Virchow's nodes?
Supraclavicular nodes seen in gastric cancer
29
What finding on physical exam strongly suggests choledocholithiasis?
Icterus (yellowing of the sclera)
30
What symptom might a patient with choledocholithiasis experience after eating a fatty meal?
Biliary colic (severe abdominal pain)
31
What is a common cause of secondary choledocholithiasis?
Migration of gallstones from the gallbladder into the common bile duct.
32
What condition must be ruled out in a patient with suspected choledocholithiasis and severe right upper quadrant pain?
| What lab findings suggest bile duct obstruction?
Acute pancreatitis
| Elevated bilirubin, particularly direct (conjugated) bili
33
On imaging in a patient with choledocholithiasis is the bile duct constricted or dilated?
| What imaging can be done if US is inconclusive?
Dilated
| Magnetic resonance cholangiopancreatography (MRCP)
34
Which symptom differentiates choledocholithiasis from uncomplicated cholelithiasis?
Jaundice
35
What serious complication can arise from choledocholithiasis if not treated?
| What is choledocholithiasis?
Cholangitis
| Gallstones in the common bile duct
36
What is the gold standard diagnostic procedure for choledocholithiasis?
Endoscopic retrograde cholangiopancreatography (ERCP)
37
What is the definition of chronic hepatitis?
| Which hepatits is most likely to progress to chronic infection?
Hepatitis lasting more than 6 months
| Hepatitis C virus (HCV)
38
What serologic marker indicates chronic hepatitis B infection?
HBsAg positive for more than 6 months
39
Which hepatitis virus is most commonly associated with hepatocellular carcinoma?
Hepatitis B (HBV)
40
What is the goal of antiviral therapy in chronic hepatitis B?
To suppress HBV DNA to undetectable levels and normalize ALT levels
41
Which direct-acting antiviral (DAA) class is used to treat chronic hepatitis C?
* NS5A inhibitors
* NS5B polymerase inhibitors
* Protease inhibitors
42
What screening test is recommended for patients with chronic hepatitis B and cirrhosis to monitor for hepatocellular carcinoma?
Liver ultrasound every 6 months
43
What serologic marker indicates immunity to hepatitis B due to vaccination?
Anti-HBs (Hepatitis B surface antibody)
44
Which hepatitis virus can lead to fulminant liver failure in pregnant women?
Hepatitis E virus (HEV)
45
Which serologic marker indicates a resolved hepatitis B infection?
Positive anti-HBs and anti-HBc with negative HBsAg
46
Which hepatitis virus is associated with the highest risk of chronic infection in neonates?
Hepatits B virus
47
What is the most common cause of acute appendicitis?
Obstruction of the appendiceal lumen, often by a fecalith
48
What is the initial symptom of acute appendicitis?
| What physical exam finding is indicative of appendcitis?
Periumbilical pain that later localizes to the right lower quadrant
| McBurney's point tenderness
49
What sign involves pain in the right lower quadrant with palpation of the left lower quadrant?
Rovsing's sign
50
What is the imaging modality of choice for diagnosing appendicitis in adults?
| What about in children and pregnant persons?
CT of abdomen and pelvis
| Ultrasound
51
What laboratory finding is commonly associated with appendicitis?
Elevated white blood cell count (leukocytosis)
52
What antibiotic prophylaxis is recommended before appendectomy?
| What is the definitive treatment for acute appendicitis?
A single dose of a broad-spectrum antibiotic such as cefoxitin or cefazolin with metronidazole
| Appendectomy
53
Is surgery indicative in a patient with appendicitis who on imaging has a fecalith present?
Yes
54
What is the name of the sign where there is pain upon passive extension of the right hip?
Psoas sign
55
What is the name of the sign where there is pain upon internal rotation of the flexed right thigh?
Obturator sign
56
What complication can arise if appendicitis is left untreated?
Perforation leading to peritonitis or abscess formation
57
What is a common differential diagnosis for appendicitis in young women?
Ovarian Cyst
Ectopic Pregnancy
58
What is the typical initial symptom of appendicitis?
| What is the treatment?
Crampy or "colicky" pain around the umbilicus
| Surgical appendectomy
59
What is the most common symptom of appendicitis in children?
Right lower quadrant pain
60
A 10-year old child presents with periumbilical pain that later localizes to the right lower quadrant. What is the most likely diagnosis?
Appendicitis
61
What is the most common complication of appendicitis in pediatric patients?
Peritonitis
62
True or False: Appendicitis can sometimes present with diarrhea in pediatric patients
True
63
At what age does colic peak?
| When does it typically end?
Peaks 2-3 months of age
| 4 months of age
64
What is the Rule of 3's in infantile colic?
Cry --> 3 hrs/day, 3d/wk, for 3 weeks
65
True or False: Constipation can lead to urinary incontinence in children.
True
66
What are the most accurate signs of moderate to severe dehydration in kids?
* Prolonged capillary refill
* Poor skin turgor
* Abnormal breathing
67
What congenital disorder is classified by the absence or complete closure of a portion of the lumen of the duodenum?
| What is seen in utero in this diagnosis?
Duodenal Atresia
| Increased levels of amniotic fluid (polyhydramnios)
68
What is the most common presenting symptom of duodenal atresia in a newborn?
Bilious vomiting
69
What is the most frequent viral cause of diarrhea in children?
Rotavirus
70
What is the hallmark presentation of Hirschsprungs Disease?
Delayed passage of meconium
71
Encopresis in children is almost always associated to what underlying condition?
Severe Constipation
72
What is the most likely etiology for diarrhea after a picnic (i.e. egg salad)?
Staph. aureus
73
What is the etiology of travelers diarrhea?
E.coli
74
Vibrio cholerae infection is associated with the consumption of what food?
Shellfish
75
Is a nighttime cough associated with GERD?
Yes, nighttime cough can indeed be associated with gastroesophageal reflux disease (GERD). In children and adults, GERD can cause a variety of respiratory symptoms, and cough is one of the more common manifestations, particularly when it occurs at night.
76
# a
True/False: Esophageal pH monitoring is the gold standard for diagnosing GERD in children of all ages.
False (It is informative but not necessarily the standard for all ages, particularly in infants where clinical presentation is often sufficient)
77
Neonatal jaundice appears when total bilirubin levels are above what value?
| At what level does neonatal hyperbili require treatment?
2mg/dL
| Levels greater than 18
78
When is a Coomb's test done?
To evaluate neonatal jaundice
79
What is the definitive diagnosis for lactose intolerance?
Lactose hydrogen breath test
80
Are gastric or duodenal peptic ulcers more common?
| What are the two biggest risk factors of peptic ulcer formation?
Duodenal
| H. Pylori and NSAID use
81
What is the most common cause of an upper gastrointestinal bleed?
| What increases the risk of bleeding?
Peptic Ulcer Disease
| NSAIDs
82
Does food exacerbate or alleviate symptoms in peptic ulcers?
Duodenal ulcer: pain is alleviated by ingesting food (mnemonic: DUDe, give me food)
Gastric ulcer: pain is exacerbated by ingesting food
83
Which risk factors should prompt a GERD patient to be screened for Barrett’s esophagus?
Presence of multiple risk factors including age ≥ 50, central obesity, chronic GERD, cigarette smoking, hernia, male gender, white race, and a confirmed history of Barrett’s esophagus or esophageal adenocarcinoma in a first-degree relative.
84
What is the most common risk factor for squamous cell carcinoma of the esophagus?
| What is the most common esophageal cancer in the U.S.?
Smoking and alcohol use
| Adenocarcinoma, and squamous cell is the most common worldwide
85
What is the screening recommendation for esophageal cancer in patients with known Barrett's Esophagus?
Screening endoscopy every 3-5 years
86
Which nerve is most likely injured when patients with esophageal cancer have a hoarse voice?
The recurrent laryngeal nerve
87
What is the diagnostic test of choice in diagnosing acute diverticulitis?
| What is contraindicated due to risk of perferation?
Abdominal CT with contrast
| Barium enema or colonoscopy
88
What finding is seen on abdominal radiographs with bowel perforation?
Free air under the diaghragm
89
What bowel disease is classically associated with toxic megacolon?
Ulcerative Colitis
90
The presention of dysphagia, regurgitation of undigested food, and halitosis is consistent with what GI diagnosis?
| What is the diagnostic study of choice?
Zenker's Diverticulum
| Barium Swallow
91
What is the most common etiology of appendicitis?
Fecalith
92
Describe the special tests applicable to working up appendicitis?
* Rovsing Sign: RLQ pain with LLQ palpation
* Obturator Sign: RLQ pain with internal rotation of the hip
* Psoas Sign: RLQ pain with right hip flexion/extension (raise leg against resistance)
* McBurney’s point tenderness: point one third of the distance from the anterior superior iliac spine to the belly button
93
What finding on abdominal x-ray should make you think of bowel obstruction?
Air Fluid Levels ("string of pearls" or "stack of coins")
94
What imaging modality should be ordered immediately in the work-up of a suspected bowel obstruction?
| What is the imaging modality of choice?
Obtain plain radiographs (KUB) to quickly confirm a diagnosis of bowel obstruction, and, provided the films do not have findings that indicate the need for immediate intervention, then use computed tomography (CT) of the abdomen and pelvis to further characterize the nature, severity, and potential etiologies of the obstruction
| Abdominal CT
95
What will be seen on the KUB postive for a bowel obstruction?
| What is the treatment?
KUB shows dilated small bowel loops (< 3 cm), air-fluid levels in the small bowel with valvulae conniventes visible across the full width of the bowel, string of pearls (multiple air-fluid levels), and paucity of gas in the colon
| NG tube or surgery
96
Is vomiting more common in small bowel obstructions or large bowel obstructions?
Small Bowel Obstructions
97
What is the recommended treatment for mild-to-moderate GERD?
| What drug class is used when first line treatment fails?
Histamine 2 receptor antagonists such as cimetidine or famotidine
| PPI's (omeprazole)
98
What is the most common type of hiatal hernia and how does it commonly present?
A sliding hiatal hernia is the most common and it typically presents with GERD symptoms refractory to treatment with a PPI and symptoms worse at night
99
What is Budd Chiari Syndrome?
| What is it associated with?
a triad of abdominal pain, ascites, and hepatomegaly
| Cirrhosis
100
What is the most common complication of cirrhosis?
| How is it treated?
Ascites
| Paracentesis
101
What is the most common cause of painless rectal bleeding in the pediatric population?
Colonic Polyps
102
What is Familial adenomatous polyposis (FAP)?
| When should screening begin with patients at high risk of FAP?
## Footnote
What is the definitive and preferred treatment?
An autosomal dominant genetic predisposition that is characterized by the development of hundreds to thousands of colonic adenomatous polyps
| Yearly sigmoidography beginning at age 12
## Footnote
Prophylactic colectomy
103
How is constipation defined?
Less than 3 bowel movements per week
According to the Rome III criteria, functional constipation is defined as any two of the following features:
* Straining
* Lumpy, hard stools
* A sensation of incomplete evacuation
* Use of digital maneuvers
* A sensation of anorectal obstruction or blockage with 25 percent of bowel movements
* A decrease in stool frequency (less than three bowel movements per week)
104
What is the presentation of travelers diarrhea?
| What is the treatment?
## Footnote
What is the most common etiology?
Abrupt onset of watery diarrhea, malaise, anorexia, and abdominal cramps.
| Supportive Care
## Footnote
Enterotoxic E. Coli (ETEC)
105
What toxicity can occur with large amounts of bismuth ingestion?
Salycilate toxicity
106
Which chronic esophageal condition predisposes the development of esophageal cancer?
Barrett's Esophagus
107
What are the two most common causes of pancreatitis?
| What is the most sensitive lab test to diagnos pancreatitis?
Gallstones and alcohol use
| Lipase
108
What is Charcoat's Triad?
| What is Reynold's Pentad?
Abdominal Pain, Jaundice, Fever
Associated with cholangitis
| Charcoat Triad + Confusion, Hypotension
109
How does a distal bowel obstruction present compared to a proximal bowel obstruction?
Patients present with less vomiting and more abdominal distension
110
Describe a hiatal hernia?
| How does a Type 1 hiatal hernia present?
A hiatal hernia occurs when the upper portion of the stomach protrudes into the chest cavity due to a weakness or tear in the diaphragm or the distal esophagus slides above the diaphragm.
| Similar to GERD, it is the most common type
111
What are the layers of the GI Tract?
- Mucosa
- Submucosa
- Muscularis
- Serosa
112
Mucosa contains epithelium and glands that secrete what?
GLP-1: glucagon-like peptide
CCK: choleystokinin
113
What type of neurons are in the submucosa?
Autonomic neurons are within the Meissner's plexus
114
What enzyme is within saliva that helps to break down carbs?
salivary amylase
115
Salivary glands are innervated by what branch of the nervous system?
Parasympathetic
116
The cricopharyngeal muscle helps with what function
Closes the UES during inspiration
117
What is the Z line of the esophagus?
A demarcation line, the squamocolumnar (SC) junction or “Z-line”, represents the normal esophagogastric junction where the squamous mucosa of the esophagus and columnar mucosa of the stomach meet
118
The stomach is impermeable to water, but will absorb what?
NSAIDs and ETOH
119
What hormone will decrease motility and emptying during the intestinal phase in the stomach?
Cholecystokinin
120
What hormone will slow gastric juice release during the intestinal phase in the stomach?
Somatostatin
121
What helps to release gastric acid?
Histamine
122
Where is the vomiting center located?
Medula - will induce deep breathing and close to the epiglottis
123
What cells secrete hydrochloric acid?
Parietal cells
124
Where is bile produced?
Liver
125
Bile is released with pancreatic enzymes through what sphincter?
Sphincter of Oddi
126
What hormone stimulates bile production?
Secretin
127
What cell type makes up a bulk of the pancreas?
Acini cells
128
What breaks down starches and glycogen?
Amylase
129
What is the primary site of chemical digestion and nutrient absoprtion?
Small intestine
130
What ligament separates the duodenum from the jejunum?
Treitz ligament
131
What portion of the small intestine accepts chyme from the stomach?
Duodenum
132
Where is magnesium absorbed?
Jejunum and ilium
133
What ligament comes off the falciform to support superiorly to the diaphragm?
Coronary ligament
134
What is the functional unit of the liver?
Liver lobule
135
Where do sinusoids drain into?
Central vein --> hepatic vein --> IVC
136
What normally determines osmotic pressure?
Sodium
137
What substance results from the breakdown of proteins?
Ammonia
138
The head of the pancreas receives blood from what artery?
Superior mesenteric artery (SMA)
139
Which antibiotic is used for the treatment of diarrhea due to Clostridioides difficile?
Oral vancomycin
140
What is the recommended procedural treatment for patients with refractory grade II internal hemorrhoids who are on anticoagulants?
Sclerotherapy due to the high risk of bleeding
141
What is the most common cause of small bowel obstruction in adults?
| What is the most common cause in children?
Adhesions from previous surgeries
| Intussusception
142
What is the most common cause of large bowel obstruction?
Colorectal Cancer
143
What classic triad of symptoms is associated with bowel obstruction?
Abdominal Pain
Vomiting
Constipation (or inability to pass flatus)
144
What imaging study is typically first line to diagnose a bowel obstruction?
| What signs are you looking for?
Abdominal X-ray
| Multiple air-fluid levels and dilated loops of bowel
145
What is the initial management step for a suspected bowel obstruction?
| What electrolyte imbalance do you want to watch out for?
* Nasogastric tube insertion for decompression
* IV fluids
* NPO
| Hypokalemia
## Footnote
Bowel obstructions cause hypokalemia due to several different mechanisms including - vomiting, decreased oral intake, third-spacing (fluid can accumulate in the bowel lumen and interstitial space), and in some cases diarrhea
146
What are some common physical exam findings in bowel obstruction?
* Abdominal distension
* Hyperactive bowel sounds initially, followed by hypoactive bowel sounds
147
What complication is a major concern with bowel obstruction?
Bowel ischemia and perforation
148
What finding on CT scan is suggestive of a closed-loop bowel obstruction?
A segment of bowel with a twisted appearance and a C-shaped loop
149
What is the typical presentation of a patient with a sigmoid volvulus?
Elderly patient with chronic constipation and a sudden onset of crampy abdominal pain and distension
150
What is the term for a bowel obstruction caused by gallstone migration?
Gallstone ileus
151
What is the most common initial management approach for uncomplicated small bowel obstruction?
Concervative management with bowel rest, IV fluids, and monitoring
152
What is the classic triad of symptoms for intussusception in children?
Abdominal pain, "current jelly" stools, and a palpable abdominal mass (sausage-like mass)
153
What is intussusception?
| What are the most common age groups affected?
Telescoping of one part of the intestine into an adjacent part
| Infants and young children, typically between 6 months and 3 years
154
What is the most common location for intussusception to occur?
Ileocecal region
155
What is the first line imaging modality to diagnose intussesception?
Abdominal Ultrasound (sensitivity and specificity > 95%)
Will see a target or a "doughnut" sign
156
What is the initial treatment for intussusception in a stable patient?
Air or contrast enema (can also be therapeutic)
157
What is Dance's sign?
Emptiness in the right lower quadrant seen in intussesception
158
What underlying conditions can predispose to intussusception in older children?
* Meckel's diverticulum
* Polyps
* Lymphomas
159
What is the typical presentation of "currant jelly" stools in intussusception?
Stools mixed with blood and mucus
160
What is the most common cause of intussesception in children?
Idiopathic, often with an associated viral infection leading to lymphoid hyperplasia
161
What is the typical disposition for a child after successful enema reduction of intussusception?
Observation in the hospital for 12-24 hours to monitor for recurrence
162
What is a potential risk during the enema reduction of intussusception?
Bowel perforation
163
What is the etiology of esophagitis?
- Reflux/erosive
- Infection (usually fungal)
- Pill induced esophagitis
- Eosinophilic
- Radiation induced
164
What is the most common pathogen in infectious esophagitis?
Candida
165
What is the presentation of esophagitis?
Retrosternal chest pain
Heartburn
Odynophagia
Dysphagia
166
What is the diagnosis and work-up for esophagitis?
Endoscopy and biopsy may differentiate subtypes
167
How will candidiasis appear on endoscopy?
Small, diffuse, linear, yellow-white, "cheese like" plaques adherent to mucosa
168
What is the treatment for erosive/reflux esophagitis?
H2 blocker or PPI
169
What is the treatment for candida esophagitis?
Oral fluconazole
170
What is the treatment for EoE esophagitis?
Budesonide or fluticasone
171
What needs to be avoided in patients with esophagitis?
NSAIDs
172
What is the first-line treatment for a superficial perianal abscess?
Surgical Drainage
173
A patient presents with a painful, red, swollen area near the anus. What is the most likely diagnosis?
Perianal Abscess
174
What is a common complication of an untreated perianal abscess?
Fistula Formation
175
What type of fistula is associated with Crohn's Disease?
Enterocutaneous fistula
176
What is the typical presentation of an anorectal fistula?
Recurrent perianal abscesses
177
Which surgical procedure is commonly performed to treat a simple anal fistula?
Fistulotomy
178
What is the primary characteristic of an ileus?
Paralysis of the intestinal muscles
179
Are electrolyte imbalances a common cause of postoperative ilues?
Yes
## Footnote
Postoperative ileus is a temporary impairment of bowel motility after surgery. Several factors can contribute to the development of postoperative ileus, including: electrolyte imbalance (hypokalemia), inflammation, medication, and pain
180
A patient presents with abdominal distension, vomiting, and absent bowel sounds. What is the most likely diagnosis?
Ileus
## Footnote
Absent bowel sounds helps distinguish ileus from a bowel obstruction
181
What imaging study is most helpful in diagnosing an ilues?
Abdominal X-ray
182
What is the first line treatment in a patient with ilues>
Nasogastric decompression and supportive care
183
Which electrolyte abnormality is commonly associated with ileus?
Hypokalemia
184
What is the role of prokinetic agents in the treatment of ileus?
Help stimulate bowel motility
185
What is the classic age range for the presentation of pyloric stenosis in infants?
| What symptom is the most characteristic?
3-6 weeks of life
| Projectile vomiting
186
What is the typical physical exam finding in an infant with pyloric stenosis?
Olive-shaped mass in the RUQ
187
What imaging modality is most commonly used to confirm the diagnosis of pyloric stenosis?
Ultrasound
188
What is the first line treatment for pyloric stenosis?
Pyloromyotomy
189
What is the primary cause of pyloric stenosis?
Muscle hypertrophy
190
What is the primary cause of nutritional rickets?
| What population is at highest risk?
Vitamin D deficiency
| Exclusively breastfed infants without vitamin D supplementation
191
What is the classic radiographic finding in a child with rickets?
Cupping and fraying of the metaphyses
192
What lab value is typically elevated in rickets?
Alkaline phosphatase
193
What is the most common skeletal deformity seen in rickets?
Bowing of the long bones
194
What is the most common symptom of celiac disease in children?
Chronic diarrhea
195
Which serological marker is most commonly used for screening celiac disease?
| What is the definitive method for diagnosing?
Anti-tissue transglutaminase (tTG) antibodies
| Endoscopic biopsy of the small intestine
196
Describe some of the findings of a positive celiac disease biopsy?
* Villous Atrophy: Villi of the small intestine are flattened or atrophied
* Crypt Hyperplasia: The crypts of Lieberkuhn, the glands lining the small intestine become elongated and hyperplastic
* Increased lymphocytes
197
What is the most likely complication of untreated celiac disease?
Osteoporosis
## Footnote
*This does come up frequently on EORE's and the PACKRAT
198
What is a non-gastrointestinal manifestation of celiac disease?
Dermatitis herpetiformis
199
What is Zenker diverticulum and where is it usually located?
An acquired outpouching of the esophagus which is typically found at the junction of the pharynx and esophagus
200
What is the most common presenting symptom of Zenker divericulum?
| What is a common complication?
Dysphagia
| Aspiration pneumonia
201
What diagnostic test is most commonly used to identify Zenker diverticulum?
Barium swallow study
202
What is the treatment for Zenker diverticulum?
Surgery (Diverticulectomy)
203
What anatomical defect contributes to the formation of the Zenker diverticulum?
Weakness in the cricopharyngeal muscle
204
What diagnosis is defined as a painful tear in the lining of the anus?
Anal Fissure
205
What symptom is most characteristic of an anal fissure?
Severe pain during and after bowel movements. Patient will typically refrain from defecating.
Also, bright red blood per rectum.
206
Where are anal fissures most commonly located?
Posterior midline
207
What is the first line treatment for an acute anal fissure?
| What pharmacologic treatments are typically used?
Supportive measures: Sitz baths, analgesics, high fiber diet, increased water intake, stool softeners, laxatives
| Second line: topical nitroglycerin or calcium channel blockers
208
What is the primary cause of GERD?
Incompetence of the lower esophageal sphincter (LES)
209
What is the typical symptom of GERD?
| What are some atypical signs of GERD?
Heartburn - often retrosternal and postprandial (pain can increase in the supine position)
| Hoarseness, aspiration pneumonia, wheezing, chest pain, cough (esp kids)
210
Which diagnostic test is considered the gold standard for diagnosing GERD?
Esophageal pH monitoring
*It is rarely done in clinical practice, GERD is a clinical diagnosis
211
What medication class is considered first-line for GERD?
H2 Receptor Antagonists
212
What is a potenital complication of chronic untreated GERD?
Barrett's Esophagus
213
Which symptom suggests that a patient with GERD might have developed a more serious condition like Barett's esophagus or esophageal cancer?
Dyshagia
214
Which surgical procedure may be considered for patients with severe, refractory GERD?
Fundoplication
215
What is the most common esophageal neoplasm?
Squamous cell (in the mid to upper third of the esophagus)
216
What are risk factors of adenocarcinoma esophageal neoplasms?
Barrett's esophagus (complication of GERD), smoking, and high BMI
217
What is etiology of gastritis?
Inflammation of the superficial lining of the stomach mucosa
218
What is the most common cause of gastritis?
| What are some other causes?
H. pylori
| NSAIDs (second m/c), acute stress, ETOH, medications, pernicious anemia
219
What is the diagnostic test of choice for gastritis?
Uppoer endoscopy with biopsy
*should also test for H. pylori
220
A patient presents with GERD like symptoms that are refractory to PPI treatment. What is the most likely diagnosis?
Hiatal hernia
221
What demographic is most commonly affected by rectal prolapse?
Elderly women
222
A palpable mass protruding the anus would be consistent with what diagnosis?
Rectal Prolapse
223
What underlining genetic condition is related to an acute rectal prolapse in children?
Cystic Fibrosis
224
What is the initial management step for an acute rectal prolapse?
| What surgical procedure is often performed to correct rectal prolapse?
Manual reduction of the prolapse
| Rectopexy
225
What is the most common cause of cirrhosis?
Chronic Hepatitis C is the most common cause
226
What biological process requires albumin?
Albumin is needed for transport of hormones, fats, nutrients. It also helps maintain intravascular and osmotic pressure.
227
Bilirubin is a byproduct of what?
Breakdown of RBCs
228
What is the pathology of cirrhosis?
Inflammation and fibrosis of the liver
Fibrosis will block the flow of bile or blood within the liver lobule which leads to hepatic impairment ---> Jaundice and portal HTN
229
What is the major complication of cirrhosis that involves the accumulation of fluid in the abdomen?
Ascites
230
Which scoring system is used to assess the severity of cirrhosis?
Child-Pugh score (calculates 1 and 2 year survival)
Places a score based on:
* Total Bili
* Serum albumin
* PT INR
* Acites
* Hepatic encephalopathy
231
Which dietary recommendation is often advised for patients with cirrhosis and ascites?
Low-sodium diet to reduce ascites
232
A patient with cirrhosis should be screened for hepatocellular carcinoma how frequently?
Every 6 months via US
233
List three common causes of constipation in adults?
* Low fiber diet
* Insufficient fluid intake
* Physical inactivity
234
What dietary recommendation is commonly given to help alleviate constipation?
Increase dietary fiber intake
235
Which OTC is commonly used first-line for constipation?
Bulk-forming laxatives, such as psyllium husk (Metamucil)
236
Name two potential complications of chronic constipation?
* Hemorrhoids
* Anal fissures
237
What is a common side effect of opioid medications related to the GI system?
Constipation
238
Name a commonly used osmotic laxative for treating constipation?
Polyethylene glycol (Miralax)
239
What is the recommended daily fiber intake for adults to help prevent constipation?
25-30 grams per day
240
Which medical conditions are commonly associated with constipation as a symptom?
* Hypothyroidism
* Diabetes
* Irritable bowel syndrome (IBS)
* Depression
* Parkinson's Disease
* MS
* Hyper/hypocalcemia
* Celiac Disease
* Spinal cord injury
241
What is a Mallory-Weiss tear?
| What is the most common cause?
A tear in the mucous membrane at the junction of the esophagus and stomach
| Forceful or prolonged vomiting or retching
242
What symptom is most commonly associated with Mallory-Weiss tears?
Hematemesis (vomiting blood)
243
Which diagnostic test is most commonly used to confirm a Mallory-Weiss tear?
Upper endoscopy (EGD)
244
Name the most common risk factor for a Mallory-Weiss tear?
Alcohol abuse/Binge Drinking
245
What is hyperemesis gravidarum?
A severe form of nausea and vomiting during pregnancy that can lead to dehydration, weight loss, and electrolyte imbalances
246
What is cyclic vomiting syndrome (CVS)?
A disorder characterized by recurrent, severe episodes of vomiting with no apparent cause
247
Which medication is commonly used to treat severe cases of hyperemesis?
Ondansetron (Zofran)
248
Name a neurological condition that can cause hyperemesis?
Mirgraine
