Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
170 Cards in this Set
- Front
- Back
|
iron deficiency + elderly male = ??
|
colon cancer until proven otherwise
|
|
|
dysphagia due to esophageal webs + glossitis + iron deficiency anemia = ??
|
Plummer-Vinson syndrome
|
|
|
surgical treatment for GERD
|
Nissen fundoplication
|
|
|
what type of cancer can Barrett's lead to?
|
adenocarcinoma
|
|
|
name the most common cause of a lower GI bleed
|
an upper GI bleed
|
|
|
medical treatment for ascites
|
decrease sodium intake + diuretics (lasix + spironolactone)
|
|
|
what do you use to determine the etiology of ascites?
|
calculate the serum ascites albumin gradient
= ascites albumin - serum albumin |
|
|
what physiologic state causes of an SAAG >1.1? what are some diagnoses?
|
due to an imbalance between hydrostatic and oncotic pressures
i.e. chronic liver disease, massive hepatic mets, CHF |
|
|
what physiologic state causes of an SAAG <1.1? what are some diagnoses?
|
protein leakage
i.e. nephrotic syndrome, TB, malignancy |
|
|
what do you need to diagnose spontaneous bacterial peritonitis in ascitic fluid? what are the likely causes? what do you use to treat it?
|
>250 PMNs/mL or >500 WBCs
likely enterococcus or klebsiella treat with 3rd generation cephalosporin |
|
|
what do you use to treat hepatic encelphalopathy?
|
lactulose and/or metronidazole
|
|
|
what do you use to monitor liver cancer progression?
|
serum AFP measurements
|
|
|
how is hereditary hemochromatosis conferred? what type of people does it affect the most? what is a common symptom at presentation?
|
autosomal recessive; northern European descent; bronze skin pigmentation
|
|
|
what are Kayser-Fleischer rings a symptom of? how do you diagnose it? how do you treat it?
|
Wilsons disease; decreased serum ceruloplasmin
treat by decreasing copper intake, penicillamine |
|
|
how do you determine the mortality secondary to acute pancreatitis?
|
Ransons criteria
|
|
|
what is the most likely cause of painless, progressive jaundice?
|
pancreatic cancer
|
|
|
most common hereditary cause of elevated unconjugated bilirubin
|
Gilberts syndrome
|
|
|
what hereditary disease causes elevated conjugated bilirubin but normal LFTs? how is it conferred?
|
Dubin-Johnsons syndrome; autosomal recessive
|
|
|
what hereditary disorder of bilirubin metabolism presents as non-hemolytic jaundice in infants?
|
Crigler-Najjar syndrome
|
|
|
which hepatitis' often go into become chronic?
|
HCV (80%), HBV (10%), HDV can when co-infected with HBV
|
|
|
what does an ALT/AST >2 indicate?
|
alcohol hepatitis
|
|
|
what do you use to treat autoimmune hepatits?
|
immunosuppressants
|
|
|
what do you use to treat chronic HBV infections?
|
interferon-alpha, lamivudine (3TC), adefovir
|
|
|
what do you use to treat chronic HCV infections?
|
ribavirin
|
|
|
what is the treatment for end-stage liver failure?
|
liver transplant
|
|
|
what is the clinical course for chronic hepatitis?
|
chronic hepatitis --> cirrhosis --> liver failure --> liver ca
|
|
|
what does HBeAb presence indicate?
|
low transmissiblity
|
|
|
what is the definition of portal hypertension?
|
a portal pressure >5mmHg greater than that of the IVC
|
|
|
what is Budd-Chiari syndrome?
|
hepatic vein thrombosis secondary to hypercoaguability
|
|
|
what are the three most common anastomoses in cirrhosis?
|
butt, gut, caput
|
|
|
what is the initial test of choice for dysphagia?
|
barium swallow study
|
|
|
what is steatorrhea? who is it most common in?
|
diarrhea that is pale, voluminous, foul-smelling; common with chronic pancreatitis
|
|
|
what is the gold standard to diagnose steatorrhea?
|
quantative estimate of stool fat
|
|
|
what is the most common cause of toxic megacolon?
|
IBD (ulcerative colitis)
|
|
|
back pain + anemia + renal dysfunction + elevated ESR = ??
|
multiple myeloma
|
|
|
what electrolyte dysfunction can cause constipation?
|
hypercalcemia
|
|
|
how do you diagnose achalasia?
|
diagnose via manometry
|
|
|
dilatation of the esophagus + air fluid level = ??
|
achalasia
|
|
|
most common cause of antibiotic associated diarrhea and how do you diagnose it?
|
clostridium difficile; via cytotoxin
|
|
|
most common side effects of digoxin
|
GI (nausea, vomiting, anorexia)
|
|
|
most common arrhythmias associated with dig toxicity
|
bidirectional v-tach, accelerated junctional rhythm
|
|
|
what does an abnormality of D-Xylase absorption that does not improve after antibiotic treatment indicate?
|
Whipples disease
|
|
|
what does an abnormality of D-Xylase absorption that does improve after antibiotic treatment indicate?
|
bacterial overgrowth
|
|
|
what vitamin deficiency does carcinoid syndrome put you at risk for?
|
niacin deficiency
|
|
|
which polyps are at risk for malignancy?
|
villious adenoma, sessile adenoma, size > 2.5cm
|
|
|
what malignant potential do hyperplastic polyps have?
|
none; no further workup needed
|
|
|
what is the treatment of choice to prevent recurrent HBV?
|
HBV immunoglobulin + lamivodine
|
|
|
if a patient has a pre-existing heart condition and presents with anemia (<10g/L hemoglobin or <30% hematocrit) and active GI bleed what is the treatment of choice?
|
packed RBCs
|
|
|
what causes Whipples disease?
|
Tropheyma Whippelii
|
|
|
what does a PAS-positive biopsy of the lamina propria of the small intestine indicate?
|
Whipples disease
|
|
|
if secretin administration stimulates gastrin what does that indicate?
|
Zollinger-Ellison syndrome
|
|
|
flushing + diarrhea + wheezing = ??
|
carcinoid syndrome
|
|
|
treatment for acute coagulopathy + active bleeding = ??
|
FFP
|
|
|
what test is used to stage newly diagnosed gastric cancer?
|
CT
|
|
|
what causes Zenkers diverticulum?
|
motor dysfunction and incoordination
|
|
|
what is the treatment for Zenkers diverticulum?
|
surgery with excision and cricopharyngeal myotomy
|
|
|
how do you diagnose Whipples?
|
via upper GI endoscopy with small bowel biopsy
|
|
|
when should you being routine screening for colon cancer with ulcerative colitis?
|
8-10 years after diagnosis
|
|
|
diarhea + hypokalemia + decreased stomach acid = ??
how do you confirm your diagnosis and locate the tumor? |
VIPoma; confirm with increased VIP in blood and locate via CT/MRI
|
|
|
what type of anemia can tropical sprue cause and why?
|
decreased B12/folate leading to megaloblastic anemia
|
|
|
low MCV + low hemoglobin = ??
|
iron-deficiency anemia
|
|
|
what test should you get with iron-deficiency in the elderly?
|
colonoscopy; iron-deficiency in the elderly is GI bleed until proven otherwise
|
|
|
what are anti-endomysial antibodies indicative of?
|
celiac sprue
|
|
|
what must you rule-out with a young patient that presents with iron deficiency anemia and malabsorption?
|
rule out celiac disease
|
|
|
elderly patient with painless rectal bleeding and aortic stenosis = ??
|
vascular ectasia, aka angiodysplasia
|
|
|
treatment protocol for ascites (4 steps)
|
1. sodium and water restriction
2. sprironolactone 3. loop diuretic (<1L diuresed per day) 4. frequent abdominal paracentesis |
|
|
duodenal ulcer treatment
|
amoxicillin, clarithromycin and PPI
|
|
|
best test for evaluating an acute episode of diverticulitis
|
CT scan
|
|
|
chronic diarrhea + anemia + elevated ESR = ?
|
must rule out inflammatory bowel disease
|
|
|
what dermatological disorder is highly correlated with celiac sprue?
|
dermatitis herpetiform
|
|
|
galactosemia leads to what type of hyperbilirubinemia?
|
conjugated hyperbilirubinemia
|
|
|
who do you see breast-fed jaundice in and how do you treat it?
|
seen in infants that are exclusively breast-fed; treat by stimulating milk production
|
|
|
what is the difference in presentation between duodenal and gastric ulcers?
|
duodenal ulcer pain improves with food, gastic ulcer pain gets worse with food
|
|
|
gastric strictures commonly occur secondary to what?
|
ingestion of caustic agents
|
|
|
most common cause of SBO
|
adhesions
|
|
|
quickest way to correct an elevated INR
|
fresh frozen plasma
|
|
|
what are muddy brown granular casts in UA?
|
acute tubular necrosis
|
|
|
pathophysiological cause of giardia-induced diarrhea
|
adhesive disks and malabsorption
|
|
|
treatment for giardia
|
metronidazole
|
|
|
portion of the bowel at highest risk for ischemic colitis
|
watershed areas, mainly splenic flexure
|
|
|
most sensitive and specific test for pancreatic exocrine failure (chronic pancreatitis)
|
fecal elastase study
|
|
|
which race is lactose intolerance most associated with?
|
Asians
|
|
|
what two tests are commonly used to diagnose lactose intolerance?
|
a positive Clintest for stool reducing substances or a positive hydrogen breath test
|
|
|
most common cause of upper GI bleed
|
PUD
|
|
|
BUN >40 + creatinine = ??
|
suggestive of upper GI bleed
|
|
|
really high BUN + mildly elevated creatinine = ??
|
suggestive of pre-renal azotemia (dehydration)
|
|
|
decreased esophageal peristalisis + poor relaxation of the LES = ??
|
achalasia
|
|
|
what do you order for complicated GERD or failure of empiric treatment?
|
EGD
|
|
|
most common complication of PUD
|
hemorrhage
|
|
|
what does a hiatal hernia pre-dispose you for?
|
hiatial hernia --> chronic GERD --> Barrett's --> adenocarcinoma
|
|
|
when a contrast study of the esophagus shows a motility disorder what should you get next?
|
EGD
|
|
|
chest pain + odynophagia for hot/cold food = ??
|
rule out esophageal spasm
|
|
|
what are non-caseating granulomas pathognomonic for?
|
Crohns
|
|
|
what is a Mallory-Weiss tear?
|
increased intragastric pressure during vomiting leading to tears in the mucosa of the cardia
|
|
|
how does TPN lead to gall stones?
|
TPN --> decreased CCK --> gall bladder stasis --> gall stones
|
|
|
fever + chills + LUQ pain + splenic fluid = ??
|
endocarditis with septic emboli to the spleen
|
|
|
what psych drug commonly causes pancreatitis?
|
valproic acid
|
|
|
painless rectal bleeding in a 2 year old
|
Meckels diverticulum
|
|
|
test to diagnose Meckel's diverticulum
|
technetium-99m pertechnetate scan
|
|
|
migratory thrombophlebitis + atypical vernous thromboses = ??
|
must rule out chronic DIC
|
|
|
test to diagnose Zollinger-Ellison syndrome
|
fasting serum gastrin levels
|
|
|
diarrhea + dermatitis + dementia = ??
|
pellegra (naicin/B3 deficiency)
|
|
|
what can massive doses of aspirin/NSAIDs cause?
|
acute erosive gastritis
|
|
|
painless obstructive jaundice + really high alkaline phosphatase = ??
|
pancreatic carcinoma
|
|
|
absence of esophageal peristaltic waves + GERD = ??
|
likely esophageal dysmotility secondary to scleroderma
|
|
|
drug of choice for C diff
|
metronidazole
|
|
|
test for Zenkers diverticulum
|
barium esophagography
|
|
|
orodynophageal dysphagia + neck mass + bad breath = ??
|
Zenkers diverticulum
|
|
|
what vitamin deficiency is a "tea and toast" diet associated with?
|
folic acid deficiency
|
|
|
what puts you at risk for peptic strictures?
|
GERD
|
|
|
recent abdominal surgery plus morphine puts you at risk for what?
|
post-operative ileus
|
|
|
what must you rule out with a patient that has hypercalcemia and recurrent peptic ulcers?
|
MEN type I
|
|
|
what test should you get for patients with dyspepsia <45 years old?
|
H pylori breath test
|
|
|
chest pain + dysphagia = ??
|
diffuse esophageal spasm
|
|
|
dark brown discoloration of the colon with lymph follicles shining through as pale patches (melanosis coli)
|
think laxative abuse
|
|
|
what is the treatment for acute/chronic anal fissures?
|
dietary modification (increase fiber and fluid intake)
|
|
|
most common location for carcinoids
|
terminal ileum
|
|
|
oocytes in the stool
|
cryptosporidium parvum
|
|
|
with ulcerative colitis when should you start screening for colon cancer?
|
start colonscopies 8 years after onset
|
|
|
most common cause of anemia in the elderly
|
iron-deficiency
|
|
|
what is the treatment for gastric MALT without metastasis
|
PPI and antibiotics
|
|
|
how long does a strict vegetarian diet take to cause B12 deficiency?
|
if a strict vegetarian, 3-4 years
|
|
|
what vitamin deficiency does long-term NPO put you at risk for?
|
vitamin K deficiency
|
|
|
symptoms seen with B12 deficiency
|
macrocytic anemia, glossitis, peripheral neuropathy
|
|
|
what do you do with familial colonic polyposis?
|
treat with a protocolectomy at the time of diagnosis
|
|
|
what would be positive during the Hep B window period?
|
anti-HBc (IgM)
|
|
|
recurrent pain during and after bowel movement = ??
|
anal fissure; diagnose via history
|
|
|
best initial treatment for anal fissure
|
stool softener and fiber supplement
|
|
|
what does asterixis indicate?
|
hepatic encephalopathy
|
|
|
what sign indicates end-stage liver disease?
|
ascites; indicates portal HTN from the years of cirrhosis
|
|
|
how do you diagnose pancreatic head CA?
|
via ERCP
|
|
|
what do you use to diagnose Zenkers diverticulum?
|
barium swallow study
|
|
|
what are the screening guidelines for colon cancer?
|
start screening at 50 if no family history; if positive family history then start screening 10 years before earliest diagnosed family member
|
|
|
most common environmental risk factor for pancreatic cancer
|
smoking
|
|
|
is colon cancer risk increased with Crohns?
|
yes, 10-20x depending on site of involvement
|
|
|
what bone disease are Crohns patients at risk for?
|
ankylosing spondylitis
|
|
|
what rash is consistent with celiac disease?
|
dermatitis herpetiformis (vesiculopapular rash on extensor surfaces)
|
|
|
what is the risk of colon cancer with ulcerative colitis and when?
|
10-20x increased risk 10 years after onset
|
|
|
what do you see on histology with alcohol hepatitis?
|
Mallory bodies; cytoplasmic inclusion bodies containing keratin
|
|
|
how is familial adenomatous polyposis transmitted and how do you manage it?
|
autosomal dominant; prophylatic colectomy
|
|
|
where is the most common site for colon adenocarcinoma?
|
proximal portion
|
|
|
what is the best initial test for giardia? what should you follow up a positive test with?
|
ELISA (very sensitive); confirm + ELISA with ova/parasite exam and string test
|
|
|
what is the second most common cause of a lower GI bleed in patients >60?
|
angiodysplasia
|
|
|
what cardiac disease are angiodysplasia patients at risk for and what is this syndromed called?
|
Heyde's syndrome; look for aortic stenosis
|
|
|
what is Reynolds pentad and what does it indicate?
|
Chacot's triad + hypotension + altered mental status = indicates sepsis
|
|
|
what is the most common cause of pancreatitis? second most common cause?
|
first - gall stones
second - alcohol |
|
|
water diarrhea + day care center exposure = ?
|
giardia
|
|
|
which cancer is the 3rd most common and 3rd most fatal?
|
colon cancer
|
|
|
what must you rule out when you palpate a stool in the vault upon DRE?
|
must rule out pelvic outlet syndrome
|
|
|
what is the best initial therapy after treating someone with a fecal impaction?
|
increased fiber and psyllium
|
|
|
young thin male + diffuse abdominal pain + weight loss + non-bloody diarrhea = ?
|
must rule out Crohns
|
|
|
describe the features of ulcerative colitis, the type of lesions, presentation, and associated risk of colon cancer
|
+rectal involvement, continuous lesions, mucosal/submucosal involvement, bloody diarrhea, risk for toxic megacolon, pseudopolyps, 10-20x risk of colon cancer
|
|
|
what part of the bowel can Crohns affect? whats the most common location? what type of lesions? which tissue is involved? what does it look like on scope? what type of diarrhea?
|
may affect any portion of GI, especially terminal ileum; skip lesions; transmural inflammation; water diarrhea; cobblestoning appearance
|
|
|
what type of antibodies do you see with Crohns?
|
+ anti-Sacchoromyces cerevisiae antibodies (ASCA)
|
|
|
what type of antibodies do you see with ulcerative colitis?
|
+ perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)
|
|
|
definitive diagnosis for acute cholescysitis
|
HIDA
|
|
|
most common location for carcinoid cancer
|
appendix
|
|
|
when does carcinoid syndrome present? where does it commonly metastasize to?
|
presents after metastasis, most commonly to liver
|
|
|
DM + vomiting undigested food several hours after meals = ??
|
likely gastroparesis secondary to diabetic neuropathy
|
|
|
medical management for diabetic gastroparesis
|
metoclopromide or erythromycin to promote motility and gastric emptying
|
|
|
"double-bubble" sign on xray
|
sigmoid volulous
|
|
|
what is Charcots triad and what does it indicate?
|
fever + jaundice + RUQ pain; indicates ascending cholangitis
|
|
|
how do you diagnose ascending cholangitis?
|
via ERCP
|
|
|
what is Barrett's esophagus?
|
columnar metaplasia of squamous cells
|
|
|
what type of cancer does Barrett's put you at risk for?
|
adenocarcinoma
|
|
|
what is Boerhaaves syndrome? who is it common in?
|
esophageal perforation due to rupture of the esophageal wall; common in young females with eating disorder
|
|
|
what is the best way to assess the success of treatment to eradicate H. pylori?
|
urea breath test
|
|
|
what is Cullen's sign?
|
periumbilical bluish discoloration indicative of pancreatitis
|
|
|
what is Grey-Turners sign?
|
flank discoloration indicative of pancreatitis
|
|
|
what is Courvoisiers sign?
|
painless palpitation of an enlarged gall bladder secondary to pancreatic cancer
|
