Gastroenterology (Mksap/medstudy)

Front 1

Trouble swallowing solids (acute**)

**1-2 months

Back 1

1. Anatomic (Schatzki's- young; Cancer- old)
2. Peptic Stricture (solids---gradually---> liquids)

Front 2

Trouble swallowing solids + wt loss & anorexia

Back 2

Esophageal cancer
1. SCC-smoking, achalasia;
2. Adenocarcinoma- GERD/Barrett's esophagus

Front 3

Gradual trouble swallowing solids
- over 3 years

Back 3

Peptic Stricture

Front 4

Male w/ FamHx early colon cancer in multiple generations
CLUE: brother <40 y/o with polyps
NEXT STEP?

Back 4

Hereditary Nonpolyposis Colon Cancer (HNPCC)/Lynch Syndrome

Colonoscopy NOW!

Front 5

Stepwise Tx for Crohn's Dz

Back 5

Most Benign More Severe No Relief Mesalamine->Prednisone->Azathioprine->Infliximab
immune
suppress

Front 6

Bloody stool + abdominal cramps = what insult?
(location)

Next Step in Evaluation?

Back 6

Ischemic colitis (sigmoid --> splenic flexure)


Flex sigmoidoscopy

Front 7

Complications of ileal Crohn's Dz?

Back 7

Gallstones (cholesterol)
Kidney Stones (Ca2+)
Perforation/abscess

Front 8

Chronic diarrhea + multiple ulcers + esophagitis (heartburn)/PUD is associated with what syndrome?

Back 8

Zollinger-Ellison syndrome

Order SERUM GASTRIN

Front 9

Long term follow-up for familial polyposis coli?

Back 9

Upper endoscopy

(to look for adenocarcinoma in the duodenum)

Front 10

Treatment for failed triple therapy for H. Pylori?
(PPI + Azithro/Clarithro + Amox)

Back 10

Quadrupile therapy
(PPI + Flagyl + Amox/Tetracylcline + Bismuth)

Front 11

In a person with severe alcoholic hepatitis (Maddrey discriminant function score ≥32) and SBP, what treatment in addition to Cetriaxone should be used?

Back 11

**Pentoxifylline
Otherwise, use Steroids [contraindicated w/:GI bleed, kidney failure, or active infection (SBP)]

Front 12

What test should you do in a patient with BRBRR with suspected UGIB?

Back 12

Upper Endoscopy

Front 13

Abdominal pain after eating that leads to weight loss

Back 13

Chronic mesenteric ischemia

Front 14

Cause of painless bright red blood per rectum w/o abdominal pain?

Back 14

Diverticulosis

Lower GI Bleed Causes: "DRAIN"

Diverticulosis, Radiation colitis, Angiodysplasia, Infection/Inflammatory- UC/Crohns, Neoplasm

Front 15

Esophagel varices with Asthma should receive what treatment?

Back 15

Endoscopic variceal ligation

*Propanolol (b-blocker) contraindicated w/ asthma

Front 16

Jaundice and significant elevations of hepatic aminotransferases (greater than 15 times the upper limit of normal

Back 16

Acute viral hepatitis

Front 17

What is a complication of pancreatitis 4 weeks later?
How do you treat it if patient is assympomatic?

Back 17

Pancreatic psuedocysts
- No further tx if patient ASx
- Percutaneous or surgical drainage IF pain, fever, or anorexia

Front 18

What lab test can be used to re-classify risk of MI with patients that have an intermediate Framingham risk score (10-20%)?

Back 18

CRP
*re-classifies as HIGH or LOW risk

Front 19

hereditary spherocytosis with
1. mild asymptomatic disease- mgmt?
2. more severe disease leading to symptomatic anemia, growth retardation, skeletal changes, painful splenomegaly, or extramedullary hematopoietic tumors- mgmt?

Back 19

1. Supportive care
-close clinical follow-up, maintenance of immunizations, and continued folic acid supplementation.
2. Splenectomy

Front 20

A young patient with acute liver failure should always be suspected of having what liver disease associated w/ Hep B?

Back 20

Wilson's Dz

Front 21

Patient with chronic GERD on prn PPI who has salmon-colored esophageal mucosa with intestinal metaplasia but no dysplasia. What's the next step in mgmt?

Back 21

Repeat upper endoscopy in 1 yr. for adenocarcinoma surveillance

Front 22

Small volume bloody stooks with tenesmus?

Back 22

Infectious colitis

Front 23

Painless maroon stool?

Back 23

Diverticulosis

Front 24

Painless, watery diarrhea? Next step?

Back 24

microscopic colitis
-Flex sig with colon biopsy

Front 25

Lower GI bleed & abdominal cramps?

Back 25

Ischemic colitis
-Bowel Rest (NPO), IVFs, Metronidazole (covers anaerobes)

Front 26

Test for ischemic colitis?

Back 26

Flex sig

Front 27

How do you Dx Crohn's Dz?

Back 27

Upper and lower endoscopy + Biopsy (granulomas)

Front 28

Inherited d/o with jaundice s/p stress/illness/fasting?

Back 28

Gilbert's Disease (benign)

Front 29

Tx for achalasia in a poor surgical candidate?

Back 29

Botox to the LES
-Otherwise,
(1) Lap myotomy (better results)
(2) Pneumatic dilitation (*Perforation risk)

Front 30

Doxycycline is associated with what cause of odynophagia?

Back 30

Pill esophagitis
- Tx supportively (d/c the med)

Front 31

Tx for ashmatic GERD uncontrolled on PPI?

Back 31

Anti-reflux surgery

Front 32

Mgmt of UC

Back 32

AZ __.

Front 33

What test do you do for small adenomas?

Back 33

Repeat EGD in 1-2 years

Front 34

Complication of pancreatitis 2 weeks later?

Back 34

Pseudocyst
-Tx conservatively

Front 35

What do you do for acute food impaction?

Back 35

EGD

Front 36

Visible vessel seen in ulcer-mgmt?

Back 36

Endoscopic cauterize

Front 37

Pt w/ Zollinger-Ellison syndrome with High gastrin level, neg CT abdomen, which didn't locate a tumor. Next step?

Back 37

Endoscopic ultrasound to find the tumor
(Otherwise, high dose PPI in older pt w/ lots of underlying medical problems)

Front 38

Si/Sx of tropical sprue?

Back 38

High MCV, Low Folate, Glossitis
Tetracycline & Folate

Front 39

Treatment of tropical sprue?

Back 39

Tetracycline & Folate

Front 40

Treatment for C Dif?

Back 40

Metronidazole (po) --> Vanc (po) x14d --> Metronidazole (IV) if iles & can't tolerate po

Front 41

Hereditary telangiectasias (lips, nose, fingertips) & AVMs (stomach, duodenum),

Back 41

Osler-Weber-Rendu syndrome

Front 42

GI polyps (hamartomatous), lip/face hyperpigmentation (freckles)

Back 42

Peutz-Jehers

Front 43

Varices Mgmt- Small

Back 43

Nothing

Front 44

Varices Mgmt- Large

Back 44

B-blocker +/- Band Ligation

Front 45

Varices Mgmt- Bleeding

Back 45

Band Ligation + Abx
Sclerotherapy + Octreotide

Front 46

Colonoscopy screening- how many years for...
No polyps or Hyperplasia

Back 46

10 years

Front 47

Colonoscopy screening- how many years for...

1-2 tubular adenomas
Low Grade dysplasia

Back 47

5-10 yrs

Front 48

Colonoscopy screening- how many years for...

3-10 tubular adenomas
Adenoma > 1 cm
High Grade dysplasia/Villious

Back 48

3 yrs

Front 49

Colonoscopy screening- how many years for...

>10 Adenomas

Back 49

<3 yrs

Front 50

Colonoscopy screening- how many years for...

Sessile adenoma removed by piecemeal

Back 50

2-6 months

Front 51

Diarrhea w/ fecal leukocytes caused by what bacteria?

Back 51

Shigella, Salmonella, E. coli O157:H7, Camphylobacter, Yersinia --> invasive gastroenteritis

Front 52

Diarrhea with nausea/vomiting 4-6 hrs after eating pinic food likely caused by what bacteria?

Back 52

S. aureus
*DON'T treat w/ ABx. Only IVFs.
-you ingest the toxin not the bacteria

Front 53

Pt had a colonoscopy with inadeuqate bowel prep. Colonoscopy found 3 hyperplastic polyps. Next step?

Back 53

Repeat colonoscopy NOW w/ adequate bowel prep

Front 54

Pt w/ fasting hypoglycemia and inappropriate high insulin level needs what test?

Back 54

Endoscopic ultrasound to look for insulinoma
- glc <45, insulin >5-6 uU

Front 55

Malabsoprtion syndrome associate w/ Fe def anemia

Back 55

Celiac Dz

Front 56

If IgA transglutaminase neg, what is the next step?

Back 56

EGD & Colonoscopy --> if neg --> repeat EGD w/ small bowel biopsy

Front 57

Painless, watery diarrhea- treatement?

Back 57

Microscopic colitis: Flex sig w/ colon biopsy

Front 58

IBS Dx Criteria

Back 58

Rome Criteria
1) Freq. change
2) Form change
3) Diarrhea 3d/mo. for 3 months

Front 59

Painless jaundice w/ diffusely enlarged pancreas w/ narrow pancreatic duct is the hallmark of ____.
How to you treat?

Back 59

Autoimmune pancreatitis
- Steroids

Front 60

What drugs are associated w/ microscopic colitis?

Back 60

PPI- Lansoprazole
H2blocker- Ranitidine
NSAIDs
Sertraline
Acarbose
Ticlopidine

Front 61

Mgmt of chronic Hep C with advance fibrosis

Back 61

pegINF & Ribavarin

Front 62

Pt w/ hemochromatosis has what RFs for what condition

Back 62

Age >40, Ferritin >1000
at risk for CIRRHOSIS --> do liver biopsy

Front 63

Treatment for symptomatic or organ damage from hemochromatosis

Back 63

Phlebotomy

Front 64

What lab test predicts severity of pancreatitis?

Back 64

BUN
-mortality incr 2.2% for every 5 incr in BUN in the first 24hrs

Front 65

Test if you suspect acute acalculous cholecystitis?

Back 65

Abdominal ultrasound

Front 66

Tx for constipation predominant IBS not responsive to fiber or standard laxatives

Back 66

Lubipristone
(C2 chloride channel activator --> salt H20 excreted into small intestine)

Front 67

What should you do for a pt w/ achalasia Dx by barium swallow?

Back 67

EGD to r/o obstruction

* If neg --> myotomy to relax the LES

Front 68

How often should a pt w/ UC beyond the rectum have a Cscope?

Back 68

every 1-2 yrs starting 10 yrs after Dx

Front 69

What is fulminant liver failure?
Most common cause?
MCC of death?

Back 69

Jaundice --> hepatic encephalopathy
**W/O PRE-EXISITING LIVER DZ
MCC: APAP & viruses
MCC of death: Cerebral edema --> mannitol (not w/ kidney dz) & ICP monitoring

Front 70

Next step in mgmt of pt w/ suspected recurrent GI bleed not found on initial EGD and colonoscopy?

Back 70

Repeat EGD and colonoscopy --> if neg --> capsule endoscopy

Front 71

Episodic abdominal pain, nausea, vomiting in a pt that smokes weed?

Back 71

Cannoid hyperemesis syndrome

Front 72

Pt from Asia/Africa w/ sAg+, eAg+ HBV but normal aminotransferases indicates what?

Back 72

Immune-tolerant chronic HBV
- low risk for cirrhosis/HCC as long as the aminotransferases remain normal
-monitor AST q3-6 montnhs
- do LIVER BIOPSY if liver enz get high
+inflamm/fibrosis on biopsy --> anti-viral therapy

Front 73

Pt w/ diarrhea, bloating, wt loss, B12 def but elevated folate and IgA transglutaminase Ab-...what is the cause of diarrhea?

Back 73

Small intesting bacterial overgrowth