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80 Cards in this Set
- Front
- Back
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What infectious agent most likely corresponds to the following statement?
- Food poisoning as a result of mayonnaise sitting out too long - Rice water stools - Diarrhea transmitted from pet feces - Food poisoning resulting from reheated rice |
Food poisoning as a result of mayonnaise sitting out too long
- Staph aureus preformed toxins Rice water stools - Vibrio cholera, ETEC Diarrhea transmitted from pet feces - Yersinia enterocolitica Food poisoning resulting from reheated rice - Bacillus cereus |
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What infectious agent most likely corresponds to the following statement?
- Most common cause of 'traveler's diarrhea' - Diarrhea after a course of antibiotics - Diarrhea + recent ingestion of water from a stream - Mild intestinal infection that can become neurocysticerosis - Food poisoning from undercooked hamburger |
Most common cause of 'traveler's diarrhea'
- ETEC Diarrhea after a course of antibiotics - Clostridium difficile Diarrhea + recent ingestion of water from a stream - Giardia lamblia Mild intestinal infection that can become neurocysticercosis - Taenia solium Food poisoning from undercooked hamburger - E. coli 0157:H7 |
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What infectious agent most likely corresponds to the following statement?
- Diarrhea from seafood - Bloody diarrhea from poulty - Diarrhea + pink-eye - Bloody diarrhea -> liver abscess - Diarrhea in an AIDS patient - Dehydrated child with greenish diarrhea in winter months |
Diarrhea from seafood
- Vibrio cholera, Vibrio parahaemolyticus Bloody diarrhea from poultry - Salmonella, Campylobacter jejuni Diarrhea + pink-eye - Adenovirus Bloody diarrhea -> liver abscess - Entamoeba histolytica Diarrhea in an AIDS patient - Cryptosporidium Dehydrated child with greenish diarrhea in winter months - Rotavirus |
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How does the treatment for cure of Hepatitis B differ from that of Hepatitis C?
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Hepatitis B:
- Interferon-alpha or antiviral (lamivudine, adefovir, entecavir, telbivudine) Hepatitis C: Pegylated interferon + Ribavirin |
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What anatomical structures in the GI tract are highlighted by the following radiologic studies?
- Barium swallow - Gastric emptying study - Small bowel follow through (SBFT) - Barium enema |
Barium swallow
- Esophagus, LES, stomach Gastric emptying study - Stomach, pyloric sphincter, duodenum Small bowel follow through (SBFT) - Stomach to terminal ileum Barium enema - Colon and appendix |
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What is the difference between Mallory-Weiss and Boerhaave's syndrome?
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Mallory-Weiss
- Mucosal laceration of the esophageal Boerhaave's syndrome - Esophageal perforation |
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What surgical term matches the following description?
- Surgical connection to the stomach to the skin of the abdominal wall for feeding - Surgical connection of the ileum to the skin of the abdominal wall - Surgical connection of the colon to the skin of the abdominal wall - Visualization of the peritoneal cavity using a laparoscope - Surgical incision into the abdominal cavity |
Surgical connection to the stomach to the skin of the abdominal wall for feeding
- Gastrostomy Surgical connection of the ileum to the skin of the abdominal wall - Ileostomy Surgical connection of the colon to the skin of the abdominal wall - Colostomy Visualization of the peritoneal cavity using a laparoscope - Laparoscopy Surgical incision into the abdominal cavity - Laparatomy |
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What are the different types of esophageal diverticulum?
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Zenkers (upper esophagus)
Traction (middle esophagus) Epiphrenic (lower esophagus) |
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What is the treatment for the following diarrheal illnesses?
- Entamoebia histolytica - Giardia lamblia - Salmonella - Shigella - Campylobacter |
Entamoebia histolytica
- Metronidazole Giardia lamblia - Metronidazole Salmonella - Supportive first-line - Quinolone, TMP-SMX Shigella - Quinolone, TMP-SMX Campylobacter - Erythromycin |
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What type of current or past Hepatitis B exposure is present in each of the following scenarios?
1. Hep BsAg: Negative Hep BsAb: Negative Heb BcAb: Positive 2. Hep BsAg: Positive Hep BsAb: Negative Heb BcAb: Positive 3. Hep BsAg: Negative Hep BsAb: Positive Heb BcAb: Negative 4. Hep BsAg: Negative Hep BsAb: Positive Heb BcAb: Positive |
1. Hep BsAg: Negative
Hep BsAb: Negative Heb BcAb: Positive Acute-infection Window period 2. Hep BsAg: Positive Hep BsAb: Negative Heb BcAb: Positive Chronic active infection 3. Hep BsAg: Negative Hep BsAb: Positive Heb BcAb: Negative Vaccination 4. Hep BsAg: Negative Hep BsAb: Positive Heb BcAb: Positive - Recovery from past infection |
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How does the treatment for diffuse esophageal spasm differ from that of achalasia?
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Both can be treated with Nifedipine, Nitrates
Diffuse esophageal spasm - Use TCA to reduce chest pain symptoms Achalasia - Pneumatic dilation - Botox injections - Myotomy |
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What is the treatment for Hepatitis C virus infection?
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Ribavirin
Pegylated interferon-alpha |
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What is the next step after H&P in the work-up of a patient complaining of dysphagia?
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Barium swallow
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An EGD with biopsy in a 65 year old male reveals gastric cancer. What is the next step in the management?
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CT scan of abdomen and pelvis to determine stage, metastasis
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What is the next step in the management of a patient with recurrent duodenal ulcers seen on at least two EGDs?
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Check for serum gastrin level to rule out ZE syndrome
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What presenting features help you to distinguish a gastric ulcer from a duodenal ulcer?
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Gastric ulcers are painful after eating.
Duodenal ulcers are relieved by eating, and are painful 2-4 hours after eating. |
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What is the most effective treatment in the management of duodenal ulcers not due to ZE syndrome?
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Treat for H. pylori with triple therapy.
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What Chem 7 lab abnormality is often elevated in patients with an upper GI bleed?
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BUN will be elevated.
Bacteria in gut breakdown hemoglobin and increase BUN. |
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What are Ranson's criteria in determining the prognosis in patients with acute pancreatitis?
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On Admission: GA LAW
- Glucose > 200 - Age > 55 - LDH > 350 - AST > 250 - WBC > 16,000 During initial 48 hours after admission: Calvin & HOBBeS - Ca < 8 - Hct decrease > 10% - O2 (PaO2) < 60 mmHg - BUN increase > 5 - Base deficit > 4 - Sequestration of fluid > 6L |
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What are the most common causes of acute pancreatitis?
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Alcohol, Gall stones
Trauma, hypertriglyceridemia, hypercalcemia, drugs |
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What are the tumor markers for pancreatic cancer?
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CEA and CA 19-9
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What is the one regimen used in the treatment of H. pylori?
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PPI + Clarithromycin + Amoxicillin or Metronidazole x 7-14 days
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What is the treatment for gastric cancer?
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Depends on location
Distal third: subtotal gastrectomy Middle or upper third: total gastrectomy Either case: Chemo + radiation therapy |
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What is the treatment for pancreatic cancer in the head of the pancreas?
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Whipple procedure + Chemotherapy
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What is the most sensitive and specific lab test for the diagnosis of chronic pancreatitis?
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Low fecal-elastase level
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What is the treatment for chronic pancreatitis?
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Stop alcohol use, opioid analgesia, enzyme supplementation. Surgery may be required to repair ductal damage.
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What treatments are available for managing Crohn's disease?
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- 5-ASA agents (e.g. Mesalamine, Sulfasalazine) - usual initial therapy for mild disease
- Azathioprine or Mercaptopurine > Methotrexate - Anti TNF-alpha agents (e.g. infliximab, adalimumab) - Steroids +/- antibiotics for acute exacerbations |
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What are the most common causes of small bowel obstruction?
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A- Adhesions from previous surgeries (about 75% of cases)
B- Bulge for hernia (second most common cause) C- Cancer (most commonly metastatic colorectal cancer) Other less common causes: volvulus, intussusception, Crohn's disease, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis |
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What are the classic signs and symptoms of a small bowel obstruction (SBO)? What radiographic findings help you confirm the diagnosis?
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Si/Sx: abdominal pain/tenderness; N/V; +/- recent flatus/small BM; hyperactive (high pitched) bowel sounds; (also common is history of previous abdominal surgery -> adhesions)
Dx: Distended loops of small bowel proximal to the obstruction seen on plain film, abdominal series or CT scan of the abdomen |
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What is the most common benign small bowel tumor?
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Leiomyoma
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What is the most common malignant small bowel tumor?
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Adenocarcinoma
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What is the next step in the management of a patient that comes to the ER with severe abdominal pain and AXR shows free air in the abdomen?
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This is perforation.
Laparotomy |
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A recent Cuban immigrant with symptoms of malabsorption is found to also have megaloblastic anemia. What is the disease and treatment?
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Tropical sprue
Rx: Folate, antibiotics (Tetracycline of sulfa drug) |
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What is the classic time-frame fro which post-op ileus revolves in the different parts of the gut?
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Small bowel: 24 hours
Stomach: 48-72 hours Large bowel: 3-5 days |
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Elderly patient presents to the ER with vomiting and abdominal pain and distention. Abdominal x-ray reveals two distinct but sequential portions of bowel in the sigmoid colon that are distended with air. What is the treatment?
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Sigmoid volvulus
Decompression with colonoscopy Surgical resection if gangrenous |
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Describe the different signs that might be seen in patients with appendicitis?
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McBurney's point
Rovsings sign: Left lower palpation causes right lower pain Psoas sign: Passive hip extension causes pain Obturator sign: Pain on passive internal rotation of flexed hip |
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What is the treatment for Crohn's disease?
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5-ASA agents (Mesalamine)
Azathioprine Anti-TNF agents Steroids and antibiotics |
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What are the most common causes of small bowel obstruction?
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ABC
A: Adhesions B: Bulge (hernias) C: Cancer (colorectal mets) |
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What is the classic characteristic of acute mesenteric ischemia?
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Pain that is out of proportion to the physical exam.
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Which characteristics are and which are not associated with IBS?
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- At least 12 weeks in the year
- Abdominal pain relieved with defecation - Change in frequency of stool - Change in form of stool - A/w straining, urgency, feeling of incomplete passage, bloating/distention, mucus Not characteristic: - Anorexia - Weight loss - Malnutrition - Progressively worsening pain - Pain that prevents sleep |
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What tumors can cause a secretory diarrhea?
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VIPoma
Gastrinoma Carcinoid tumor (serotonin excess) Medullary thyroid carcinoma |
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What is the most likely cause of malabsorption in a patient with a (+) Sudan stain in the stool sample and a normal D-xylose test?
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Sudan stain looks for fat in stool (steatorrhea).
D-xylose looks for carbohydrate absorption. Pancreatic insufficiency |
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What is the treatment for Whipple disease?
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TMP-SMX, Ceftriaxone for 12 months
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What serum antibodies are seen in cases of celiac sprue?
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Antigliadin antibodies
Anti-endomysial antibodies |
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What serum lab findings might help you distinguish Crohn's from UC?
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Crohn's: Positive ASCA
UC: Positive p-ANCA |
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A 65-year old female presented to the ER with severe abdominal pain and is found to have leukocytosis and an abscess in the region of the sigmoid colon. What is the most likely predisposing lesion, and what is the next step in management?
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- Diverticulosis -> Diverticulitis -> Abscess
- CT-guided or US-guided percutaneous drainage - IV antibiotics |
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What are the classic features of carcinoid syndrome?
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Mnemonic: B FDR
Bronchospasm (10-20%) Flushing (85%) Diarrhea (80%) Right-sided valvular disease or murmurs |
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What is the treatment for carcinoid syndrome?
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- Somatostatin analog such as octreotide
- Symptom relief: - Cyproheptadine for diarrhea/anorexia - Albuterol/Theophylline for asthma symptoms - Codeine for diarrhea - If symptoms are refractory to octreotide -> Interferon-alpha combined with octreotide - Surgical resection in certain circumstances of isolated tumors - Valvular surgery for symptomatic carcinoid heart disease |
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What are the current colon cancer screening recommendations for normal risk patients?
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For the average risk patient, the following screening should start at age 50:
- Fecal occult blood test annually with stool guaiac (samples from three consecutive stools is ideal) - Colonoscopy every 10 years (or flex sig and double-contrast barium enema every 5 years) Screening should stop when a patient's life expectancy is less than 5 years. |
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What are the current recommendations for follow-up colonoscopy for patients with history of colon polyps?
Findings: - 1-2 tubular adenomas (< 1 cm) - 2 or more tubular adenomas - Tubular adenomas ≥ 1 cm - Villous adenoma or high-grade dysplasia - FH of colon cancer - > 2 cm sessile polyp - More than 10 adenomas |
Findings:
- 1-2 tubular adenomas (< 1 cm): 5 years - 2 or more tubular adenomas: 3 years - Tubular adenomas ≥ 1 cm: 3 years - Villous adenoma or high-grade dysplasia: 3 years - FH of colon cancer: 3 years - > 2 cm sessile polyp: 3-6 months - More than 10 adenomas: < 3 years |
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What is the next step in the management of a patient younger than 50 with minimal bright red blood per rectum (e.g. only seen on the toilet paper after wiping)?
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Anoscopy to look for hemorrhoids
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What is the most likely cause of acute pain and swelling of the midline sacrococcygeal skin and subcutaneous lesions?
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Pilonidal cyst
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What is the most likely cause of recurrent LLQ abdominal pain that improves after defecation?
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Diverticulosis
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What type of patient is at high risk of acalculous cholecystitis?
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Patients on TPN, or in ICU
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What is Charcot's triad and Reynold's pentad?
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Charcot's triad: A/w cholangitis
- RUQ pain - Jaundice - Fever Reynolds pentad: - Charcot's triad - Altered mental status - Hypotension |
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What is the next step in the management of a patient that is found to have a calcified gallbladder?
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Biopsy to rule out gall bladder cancer
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How does the interventional component of treatment of cholecystitis differ from that of cholangitis?
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Cholecystitis: Cholecystectomy (after 24-48 hours)
Cholangitis: Drain bile ducts first, then cholecystectomy |
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A patient with colon cancer has local lymph node involvement without distant metastasis. What stage of cancer is this?
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Stage 3
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A 60 year old male undergoes colonoscopy and is found to have 3 small tubular adenomas that are completely removed. When should he undergo his next colonoscopy?
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In 3 years
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A 40 year old male tells you that his father had colon cancer at age 55. When should this man's first colonoscopy be scheduled?
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At age 45
(10 years before first-degree relative was diagnosed) |
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What antibiotic combinations are used in the treatment of diverticulitis as an outpatient?
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Gram negatives + anaerobes
TMP-SMX with metronidazole fluoroquinolone with metronidazole Augmentin (Amoxicillin with clavulanic acid) |
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How are anal fissures managed?
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Stool softeners and increase fiber in diet
Topical nitroglycerin Topical diltiazem, nifedipine, bethanechol Botox injections Partial sphincterotomy may be performed for recurrent fissures |
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What are the most common causes of upper GI bleeds?
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PUD
Esophageal varices Mallory-weiss Boerrhaves syndrome Esophagitis and gastritis |
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What are the most common causes of lower GI bleeds?
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Internal hemorrhoids
Diverticulosis Neoplasms AVM Meckels diverticulum Ulcerative colitis Mesenteric ischemia |
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How is volume status assessed in a patient with a GI bleed?
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Heart rate
Blood pressure Urine output |
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What is the treatment for hepatic encephalopathy?
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- identify and correct the underlying precipitating factors (hypovolemia, GI bleeding, hypoxia, infection)
- Lactulose titrated to 3 soft bowel movements a day - neomycin or rifaximin antibiotics to reduce toxins formed by gut bacteria - Protein restriction to decrease nitrogen/ammonia related toxins |
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What criteria compose the Child's classification of operative mortality in patients with liver disease?
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Mnemonic: A BEAN
Ascites Bilirubin Encephalopathy Albumin Nutrition |
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What is the treatment for Spontaneous Bacterial Peritonitis (SBP)?
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Cefotaxime, ceftriaxone or other third gen cephalosporin for at least 5 days to cover for gut bacteria (E. coli, Klebsiella, and Enterococcus) and Staph and Strep.
- Albumin dosed IV maintains plasma volume -> preserves renal function -> reduces renal impairment and mortality |
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What antibiotic is contraindicated in neonates with hyperbilirubinemia and why?
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Ceftriaxone because it displaces bilirubin from albumin.
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What findings do the following signs describe and with what diseases are they associated?
- Deep palpation of RUQ -> arrest of inspiration due to pain - Charcot's triad (fever, jaundice, RUQ pain), hypotension, altered mental status - RLQ pain on passive extension of the hip - RLQ pain on passive internal rotation of the flexed hip - LUQ pain and referred left shoulder pain - Ecchymosis of the skin overlying the flank - Ecchymosis of the skin overlying the periumbilical area |
Deep palpation of RUQ -> arrest of inspiration due to pain
- Murphy's sign; Cholecystitis Charcot's triad (fever, jaundice, RUQ pain), hypotension, altered mental status - Reynolds Pentad; Cholagitis RLQ pain on passive extension of the hip - Psoas sign; Appendicitis RLQ pain on passive internal rotation of the flexed hip - Obturator sign; Appendicitis LUQ pain and referred left shoulder pain - Kehr's sign; Splenic rupture Ecchymosis of the skin overlying the flank - Grey-Turner sign; Pancreatitis Ecchymosis of the skin overlying the periumbilical area - Cullen's sign; Pancreatitis |
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What is the treatment for hepatic encephalopathy?
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Lactulose
Antibiotics: Neomycin Protein restriction |
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What are the symptoms of Budd-Chiari syndrome?
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- Ascites
- Hepatomegaly - Jaundice - RUQ pain |
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What is the most widely used screening test for hemochromatosis?
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Ferritin level
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What is the treatment for hemochromatosis?
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Repeated phlebotomy
Deferoxamine |
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What distinguished primary biliary cirrhosis from primary sclerosing cholangitis?
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PBC: Positive anti-mitochondrial antibodies, Positive ANA, females > males
PSC: Positive pANCA, males > females, a/w UC, ERCP shows classic "pearls on string" sign |
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What is the treatment for primary biliary cirrhosis?
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Ursodeoxycholic acid +/- colchicine
Liver transplant |
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What is the tumor marker for hepatocellular carcinoma? For colon cancer? For gastric cancer? For pancreatic cancer?
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Hepatocellular carcinoma: alpha-fetoprotein
Colon cancer: CEA Gastric cancer: CEA Pancreatic cancer: CEA, CA 19-9 |
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What is the most common type of TE fistula?
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Blind upper esophageal pouch
Lower esophagus connected to trachea |
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What is the classic presenting scenario for necrotizing enterocolitis?
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Premature or low birth weight infant started on tube feeds -> abdominal distention
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What are the distinguishing characteristics of physiologic jaundice, exaggerated physiologic jaundice, and breast milk jaundice?
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Physiologic jaundice: peaks at day 3-5 and <10 mg/dl
Exaggerated physiologic jaundice: peaks at 12-15 mg/dl, appears at first week of life, due to dehydration (AKA breast feeding jaundice) Breast milk jaundice: starts at or after week 1, due to substances in breast milk, may continue for weeks to months while breastfeeding. |
