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50 Cards in this Set
- Front
- Back
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How do you treat persistent H.Pylori infection? or initial triple therapy fails?
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Bismuth based Quadruple therapy: PPI, bismuth, metro, tetracycline
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How do you treat UC pt whom become corticosteroid-dependent?
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Pt should be start with an immunomodulator such as azathrioprine or 6 mercptopurine with a steroid taper.
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What is the colon cancer screening for patient with IBD?
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Pt with IBD should start colon cancer (colonoscopy) screening 8 years of duration of disease and 1-2 years thereafter.
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What is the initial evaluation of patient suspected of gastronoma?
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Pt with ulcer who has a negative H.Pylori. Initial testing is the serum gastrin level. >1000pg/ml is very sensitive
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What other testing should be done in patient with suspected GERD whom lack response to initial trial PPI therapy?
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Pt with high pretest probability of GERD whom fail to respond to PPI therapy; ambulatory esophageal pH monitoring is most useful.
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How do you evaluate patient without alarming symptoms of new onset dyspepsia?
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A "test and treat" approach for H. pylori. The stool antigen test detects active infection and can also be used for eradication testing.
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What drug should be used in pt with Crohn disease whom becomes refractory to immunomodulator therapy?
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Anti-tumor necrosis factor inhibitor therapy.
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How to treat diffuse esophageal spasm?
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Esophageal spasm is often r/t GERD, so empiric therapy with acid suppression is the recommended 1st therapy.
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What are some late complication of bariatric surgery?
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one of them is intestinal bacterial overgrowth. d/t decrease absorption of simple sugar. Pt presenting with diarrhea, bloating, and features of malasorption.
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How to manage alcoholic hepatitis?
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In the absence of any infection. patient with severe alcoholic hepatitis with discriminant function score of >32 benefit from corticosteriod therapy.
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What is the treatment for achalasia when pt is not a surgical candidate?
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Botulinum toxin injection
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What is the treatment for gastric erosion/ulceration in pt who required long term NSAID?
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PPI
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How do you dx pancreatic necrosis?
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pancreatic necrosis should be suspected in pt with severe pancreatitis or worsen despite 5 days of therapy. CT scan of abdomen with contrast is the most sensitive test.
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What is the Management for interferon induced autoimmune hepatitis?
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interferon should be discontinued. The autoimmune response is not dose related.
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What is the treatment for eosinophilic esophagitis?
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Swallow topical corticosteroid shown to produce remission. PPI is not helpful!
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What is eosinophilic esophagitis?
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eosinophilic infiltration of esophageal mucosa. Clinically, presents with dysphaia or food impaction. Endoscopic findings of mucosal furrowing or raised white specks.
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How to evaluate a patient with a potential familial CRC syndrome?
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Initial genetic testing is most effective in pt with cancer rather than in a unaffected family member.W
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What is focal nodular hyperplasia?
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focal nodular hyperplasia; most common nonmalignant hepatic tumor. Usually asymptomatic. Not estrogen sensitive.
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How to mananage focal nodular hyperplasia?
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Usually asymptomatic. observation alone, if becomes symptomatic d/t mass affect, then take it out.
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How to evaluate a young patient with obscure GI bleed?
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After EGD/Colo and are negative. Consider Pertechnetate scan (Meckel scan). Meckel diverticulum is MC congenital anomaly GI tract, located near the ileoceocal valve.
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How to evaluate a patient with immediate dysphagia with initiation of swallow?
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Pt with immediate dysphagia with initiation of swallow suggest oropharyngeal rather than esophageal dysphagia. Videofluroscopy allows real time radiographic analysis of swallowing function is most sensitive for orolpharyngeal dysphagia.
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How do you evaluate for eradication of H.pylori after tx?
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Two test include; stool antigen testing and urea breath testing. The sensitivity of the urea breath testing is adverse affected by PPI. (so retest after 8 wks post PPI tx)
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How do you manage fulminant liver failure?
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The marker for liver failure are:elevated INR, rising bili, and may have encephalalopathy. About 5% acute hep B infections develope fulminant liver failure need URGENT LIVER TRANSPLANT.
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How do you evaluate patient with newly dx cirrhosis?
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signs of cirrhosis: splenomegaly, nodular liver, thrombycytopenia. 25-40% of cirrhosis have variceal bleed, so these pt needs an Upper endoscopy.
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How do you dx asymptomatic celiac disease?
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celiac disease relatively common; especially in osteoporatic males with high alkphos. The test is serum anti-tissue transflutaminase ab. Its sen/spec is about 90%
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How do you manage hepatic encephalopathy?
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treat the underlying infection, discontinue diurectics. and LACTULOSE. Lactulose should be titrated to achieve 2-3 soft stood daily.
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How do you manage acalculous cholecystitis?
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Cholecystitis on imaging include: gallbaldder wall edema and presence of pericholecystic fluid. Definitive tx is CHOLECYSTECTOMY
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How do you evaluate gastroparesis?
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gastroparesis: clinical features include delayed gastric emptying after an infectious gastroenteritis. A four hour gastric scintingraphy is the test of choice for gastroparesis.
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How you treat primary biliary cirrohosis in early stages?
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primary biliary cirrohosis is a chronic progressive cholestatic disease. A positive antimitochondrial antibody >1:140 is the hallmark. Urodeoxycholic acid improves biochemical profile, reduces pruritis and decrease progression to cirrohosis.
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How is primary sclerosing cholangitis dx?
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primary sclerosing cholangitis is characterized by fibrosis, inflammation of the biliary tree. Is a choestatic picture. Often pt is asymptomatic, dx is usually made with help of ERCP.
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What is the management of gastric fundic gland polyps?
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Fundic gland polyps convey no defined cancer risk and require no follow up.
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What is the management of a simple liver cysts in a pregnant patient?
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No further intervention if patient is asymptomatic.
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How to manage recurrent abnormal LAE after liver transplantion?
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Liver biopsy is needed especially to differentiate between recurrent Hep C infection and rejection.
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What is the different between dumping syndrome and carcinoid syndrome?
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Dumping syndrome: diarrhea, nausea, bloating and tachycardia within 30min of eating, especially with liquid nutrients.
Carcinoid syndrome: flushing, diarrhea and tachycardia, diarrhea is secretory in nature and continuous, include nocturnal. |
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How do you dx microscopic colitis?
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It is characterized by chronic diarrhea without bleeding, dx must be by histologic exam by colonocopic biopsy.
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What is the most sensitive test for hepatitis C?
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The most sensitive diagnostic test for hep C is: hepatitis C viral RNA.
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How do you evaluate patient with long standing GERD?
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EGD, especially to evaluate for Barrett esophagus.
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What is the treatment for UC?
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Mesalamine, or 5 ASA are effective and is preferred in mild cases.
Azathroprine; and immunomodulator can work, but require 2-3 months for the therapeutic affect and generally reserved for pt who require corticosteroids. |
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How do yo evaluate a hematochezia in young patient (<40 yoa)?
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Flexible sigmodoscopy rather than colonoscopy. (in patient with low risk)
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How to dx chronic pancreatitis?
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H&P are not enough, + ERCP is sensitivity of 95%, will show ductal dilation, strictures and irregularities.
CT scan has sensitivity of up to 90%. MRI is not have the sen/spec of ERCP. |
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What is the primary treatment of choice for patients with cirrhosis and hepatocellular carcinoma?
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Liver transplantation
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How do you evaluated chronic mesenteric ischemia?
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chronic mesenteric ischemia is characterized by post-prandial abdominal pain. MRA is highly sensitive test for dxing chronic mesenteric ischemia.
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What is the schedule for colon cancer screening for patient with
1. high risk colon polyps (adenomas, high grade, >1cm) 2. lower risk (<1cm tubular adenomas) 3. only hyperplastic polyps. |
colonoscopy
1. q 3 yrs 2. q 5 yrs 3. q 10 yrs |
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How do you treat distal ulcerative colitis?
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usually with topical corticosteroid or mesalamine. Oral 5 ASA, sulfasalazine, oral mesalamine can be use if no responds to topical therapy.
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How to differentiate NASH(nonalcoholic steatohepatitis) and steatosis of the liver?
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Liver biopsy would differentiate the two disorders.
NASH: usually occurs in pt with dyslipidemia and DM. |
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How to evaluate peptic ulcer disease?
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Two most common causes of peptic ulcer disease are NSAID and H. pylori. They account for >90%
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How to manage diarrhea in DM autonomic dysmotility?
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Dysmotility in poorly controlled DM can be manifested as diarrhea or constipation. Treatment is supportive.
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How to dx ischemic colitis?
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Most commonly present in the elderly with artherosclerotic vascular disease. The pt usually present with abdn pain and bloody stool. Typical CT scan is thickening of the bowel wall in segmental pattern.
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What is the management of high grade esophageal dysplasia in patient with Barrett esophagus?
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Esophagectomy, produce the longest likelihood of long term cancer free.
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How to treat bile salt-induced diarrhea?
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Cholestyramine. It act as a binder and help prevent these bile salts from directily stimulating the colon.
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