Step 2 CK > GI > Flashcards

GI Flashcards

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1
Q

Symptom that usually= esophagus path

A

dysphagia

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2
Q

Clues that distinguish achalasia from cancer

A
  • younger person

- difficulty with solids and liquids all at once

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3
Q

Path for achalasia

A

^^ LES tone

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4
Q

First test for most esophageal disorders

A

barium swallow (but not always most ACCURATE)

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5
Q

Two esophageal diseases diagnosed by biopsy

A

cancer

barretts esophagus

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6
Q

How to treat achalasia

A
  • dilation
  • surgery
  • botox
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7
Q

Palliative treatment for esophageal cancer

A

stent placement to allow swallowing

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8
Q

Most accurate test for dx for achalasia and DES

A

manometry

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9
Q

Treatment for esophageal candidiasis

A

fluconaolze –> endoscopy if this doesn’t work to look for CMV (large)/HSV(small) ulcers

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10
Q

Tretment for DES

A

CCB

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11
Q

Meds that cause esophagitis

A

doxycycline
alendronate
KCl

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12
Q

What is Plummer Vinson Syndrome?

A

proximal rings and IDA (treat with iron)

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13
Q

Where is a schatzi ring and how does it present?

A

distal –> steakhouse dysphagia

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14
Q

Diagnosis and Treatment of Zenkers Diverticulum

A

barium swallow, there is NONE

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15
Q

How does scleroderma effect the esophagus?

A
  • unable to close sphincter
  • reflux
  • decreased LES tone
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16
Q

Treatment of scleroderma effecting esophagus

A

PPIs

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17
Q

Presentation of Mallory Weiss Tear

A

nonpenetrating tear of only mucosa

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18
Q

Which ulcer type is BETTER with food?

A

dudodenal =weight gain

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19
Q

Best empiric treatment for epigastric pain?

A

PPIs better than H2i

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20
Q

Duration of GERD needed to cause metaplasia

A

5-10 years

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21
Q

How to manage low grade esophageal dysplasia

A

PPis and rescope q6-12 months

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22
Q

When to give stress ulcer px

A

vent
burn
head trauma
coagulopathy

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23
Q

Top 2 most common causes PUD

A 
#1 H pylori 
#2 NSAIDs
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24
Q

Effect of alcohol and tobacco on ulcers?

A

don’t cause but prevent healing

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25
Appropriate followup testing after treatment for H pylori
30-60 days post treatment do breath test or stool antigen
26
What is triple therapy for H pylori?
2 abx + PPI (amox/clarithro)
27
Alternative abx if patient cannot tolerate amox or clarirtho
tetramycin or metronidazole
28
How to manage failure of treatment in GU/DU
GU- endoscopy to exclude cancer | DU- breath test or stool test --> switch abx
29
Which is assc with cancer- GU or DU?
GU
30
When to scope in NUD that doesn't improve on PPI?
over 55 or alarm symptoms
31
How does zollinger Ellison cause diarrhea?
^^gastrin = ^^ acid = inactive lipase = diarrhea
32
Best test for zollinger Ellison
gastrin response to secretin injection
33
Clue to MEN in ZE
High Ca = parathyroid = pancreatic + parathyroid = MEN
34
How to best test for mets in ZE
somatostatin receptor scintigraphy/ endoscopic US
35
How to treat ZE
local only- remove | mets- don't remove, PPIs life long
36
Dx and Tx of diabetic gastroparesis
usually clinical though nuclear emptying study is most accurate erythromycin; metaclopromide
37
Cause of diabetic gastroparesis
autonomic neuropathy- cant sense stomach stretch
38
Most common cause of upper/ lower GI bleeding
upper: ulcer lower: diverticulosis
39
Define orthostasis
10 pt rise in pulse; 20 pt drop in systolic
40
Ways to locate GI bleed
capsule, nuclear, angio | NOT CT/MRI
41
When to transfuse in GI bleed / most common blood product
HCT under 30 with PRBCs
42
When to give FFP/platelets
FFP if PT/INR ^^ and active bleed. | Platelets if plts low (under 50k) and active bleed
43
Aside from fluid/ blood what other treatment is given for GI bleeds
- PPI if upper - octreotide if varices - endoscopy - abx to prevent SBP - BBer to prevent repeat spontaneous bleed
44
Treatment of recurrent c diff
another course of metronidazole
45
What are the requirements for B12 and iron absorption
- bowel wall + pancreatic enzymes= B12 | - bowel wall= iron
46
How to dx celiac
- antigliadin - antiendomysial - endoscopy to r/o lymphoma
47
Clues to whipple assc malabsorption
- fever | - neuro/ocular findings
48
Chronic pancreatitis dx
calcifications on AXR, ACT | secretin stim = no release of bicarb rich fluid
49
How to distinguish celiacs from tropical sprue
cant do it clinically --> abs or endoscopy
50
Treatment for whipples disease? Tropical sprue?
whipples- ceftriaxone --> Bactrim | tropical sprue- Bactrim --> tetracycline
51
Purpose of dxylose testing
distinguishes bowel wall from pancreatic enzyme disorders -Dxylose normal in pancreatic disease, abnl in bowel wall disorder ie celiac
52
Dx and Tx of carcinoid
dx- 5HIAA | tx- octreotide
53
How to distinguish lactose intolerance from other forms of malabsorption?
weight loss, should get none in lactose intolerance
54
Cause of tropical sprue vs whipples disease
tropical- unknown bug whipples- t whipplei both diagnosed with endoscopy and biopsy
55
Clues to IBS
- worse at morning | - relieved by BM or change in stools
56
Treatment of IBS
loperamide (diarrhea) dicyclomine/ hyocyamine SSRI/tricyclic fiber, lubiprostone (^BM frequency)
57
Systemic effects of both IBD forms
- arthralgias - uveitis - skin changes - PSC (UC)
58
Ab for UC? CD?
UC- ANCA | CD- ASCA
59
Which IBD has skip lesions? transmural inflammation?
skip- CD | transmural- UC
60
When to start colon cancer screening in IBD
8 years post colonic involvement q1-2 years
61
Maintenance treatment for IBD? Exacerbation ?
Maintenance- mesalamine | Exacerbation- steroids (prednisone, budesonide)
62
How to wean IBD pts off steroids if have recurrence everytime you stop?
azathioprine | 6MP
63
Important px med for all IBD patients
vitamin D, Ca
64
Tx of perianal CD
metro | Cipro
65
Last resortment for fistulae/ unresponsive disease before surgery?
anti-TNFa (infliximab)
66
How to prevent diverticulosis from worsening?
fiber
67
How to dx diverticulitis
CT, notttt a scope because high risk for perf
68
Treatment of diverticulitis
NPO --> Cipro + metro --> surg if no response of perf/abscess/fistula etc
69
How to handle patient with first degree relative that has colon cancer?
start screening 10 years earlier than family member had the cancer or at 40. Do q5 if family member was younger than 40.
70
How to screen pt with HNPCC/ FAP
HNPCC- start at 25 then q1-2 years | FAP- start at 12 then q1 year
71
How to screen for colon cancer in pt with polyp
repeat q3-5 years
72
How to screen pt with personal hx of colon cancer
repeat 1 year post resection, 3 years post op, then q5
73
Polyposis syndromes aside from HNPCC/FAP: | screening?
no... | no increased screening for peutz jegher, turcot etc
74
Peutz Jegher = hamartomous colonic polyp +
^ risk breast/ gonadal/ pancreatic cancer | melanotic spots
75
Gardner syndrome = colon cancer+
osteomas/ soft tissue tumors/ desmoid tumors
76
Turcot syndrome= colon cancer+
CNS malignancy
77
Juvenile Polyposis =
hamartomatous polyps
78
Common causes of acute pancreatitis
- obstruction (stones, tumors, strictures, etc) - alcohol - trauma
79
Marker of severe pancreatic disease
low Ca; more than 30% necrosis
80
Role of MRCP/ ERCP in pancreatitis
MRCP- etiology | ERCP- treatment
81
Treatment of acute pancreatitis
NPO IVF pain control PPI
82
Treatment of pancretitis with more than 30% necrosis
bx imipenem/meropenem surgical debridement with + bx
83
Clue to hepatopulmonary syndrome
platypnea | breathing worse when upright
84
Clue to hepatorenal syndrome
SUDDEN kidney failure, usually after some bleed or diuretic use
85
Causes of SAAG LESS than 1.1
cancer infxn other than SBP nephrotic syndrome
86
Portal hypertension/ CHF ascites SAAG
more than 1.1 (more protein in the serum than the ascetic fluid)
87
What is SBP px and who gets it?
-prior SBP -variceal bleeding with ascites Bactrim or norfloxacin
88
Treatment of SBP + clue
more than 250 neutros | ceftriaxone or cefotaxime
89
Most common bug in SBP
e coli but have risk anaerobes
90
Treatment of hepatorenal syndrome
ocetrotide or midodrine
91
Treatment of varices
propanolol
92
Treatment of hepatic encephalopathy
rifamixin and lactulose
93
Treatment of hepatic ascites
spironolactone
94
Lab clue to sudden binge drinking
high GGTP
95
``` PBC: sex age antibody clue ```
female 40-50 AMA xanthelasma
96
Treatment of PBC
ursodeoxycholic acid
97
Only cause of cirrhosis for which bx is not the most accurate dx
PSC
98
PSC lab/clue
itching GGTP high MRCP beading/strictures
99
Treatment for PSC
same as PBC | ursodeoxycholic acid/ cholestyramine
100
Treatment of a1at def
replace the enzyme
101
Cause of hemochromatosis
mutation causing ^^ iron absorption in duodenum
102
Labs assc with hemochromatosis
^^AST/ALT; ^^iron and ferritin; low TIBC
103
Skin changes in hemochromatosis
bronzing + DM = bronze DM
104
Infxn assc with hemochromatosis
vibrio listeria Yersinia (feed on iron)
105
Most accurate test for hemochromatosis | Most reasonable
liver bx = accurate | genetic test + MRI = reasonable can spare pt the bx
106
Meds for hemochromatosis
all start with defer.... deferoxamine= injected, others oral also need phlebotomy
107
Both Hep A and B can be assc with what vasculitis?
Polyarteritis nodosa
108
Treatment of acute Hep C ? hep b?
inferferon, ribavirin, and EITHER telepravir or boceprevir for hep c acute hep b not treated
109
Treatment of chronic hep C ?
2 drugs... sofosbuvir + ledispavir (type 1) or ribavirin (type 2-3)
110
Number of antivirals used to treat hep B
one end of --vudine or --ovir (or interferon)
111
Effects of interferon
thrombocytopenia, leukopenia
112
Effects of ribavirin
anemia
113
Wilsons- labs
low cerulpplasmin | high Cu
114
In addition to rings/ neuro sx... what are systemic signs of wilsons disease
RTA, nephrolithiasis, hemolytic anemia (coombs negative)
115
Best initial test for Wilson disease
slit lamp exam of eyes
116
Most accurate dx for wilsons
increased cu excretion in urine after giving penicillamine **DECREASED CERULOPLASMIN ISNT MOST ACCURATE
117
Treatments for wilsons
peniclliamine Zinc= impaired Cu absorption Trientene= chelator
118
Autoimmine hepatitis ab
anti smooth muscle ab (ASMA) | NOT to be confused with AMA (PBC)
119
Treatment of autoimmune hepatitis
predisone and/or azathioprine
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