Usmle Step 2: Gi Qbank

Front 1

Neuromuscular effects of hypomagnesemia

Back 1

paresthesia, hyperreflexia, muscle spasm, tetany

Front 2

major causes of glomerular hematuria after an URI

Back 2

Two causes

IgA nephropathy: less than 5d following URI

post-streptococcal glomerulonephritis: 10d following pharyngitis

Front 3

Alport's syndrome

Back 3

classically presents in young kid with recurrent episodes of hematuria and proteinuria. immunofluorescence shows no immunoglobulins or complement. electron microscopy shows alternating thinning and thickening of capillary loops and splitting of BM.

sensorineural deafness

Front 4

renal toxicity of acyclovir

Back 4

in high dose parenteral therapy, it can cause crystalluria which will cause renal tubular obstruction and lead to acute renal failure

Front 5

hepatorenal syndrome

Back 5

characterized by absence of shock, proteinuria, or other clear cause of renal failure, and failure to respond to a 1.5L nl saline bolus

thought to result from renal vasoconstriction in response to total decreased renal blood flow

tx liver transplantation; no meds proven

Front 6

bleeding in a 65 yo. evaluation?

Back 6

first with colonoscopy

radioisotope scans typically used for pts with active bleeding where colonoscopy may be limited.

colon is more common source of chronic Gi blood loss in asymptomatic pts, and therefore EGD would typically be done only after neg colonoscopy.

Front 7

multiple episodes of thrombosis without a clear precipitating factor?

Back 7

raise concern for hypercoagulability due to a genetic defect in a younger pt or a primary malignancy in an older pt

Front 8

diarrhea in poorly controlled HIV pt

Back 8

cryptosporidium parvum major cause of chronic diarrhea, particularly with CD4< 180

Front 9

evaluation of lactose intolerance

Back 9

positive hydrogen breath test, positive stool test for reducing substances, low stool pH (think lactic acid!) and increased stool osmotic gap (makes sense). No steatorrhea

Front 10

mallory weis tears

Back 10

ruptured submucosal arteries of the distal esophagus and proximal stomach 2/2 increased retching

Front 11

small intestine bacterial overgrowth

Back 11

malabsorption syndrome d/t anatomic or dysmotility disorders (scleroderma!). typically p/w abdominal bloating, flatulence, and diarrhea. weight loss and nutritional deficiencies may occur in severe cases

endoscopy with jejunal aspirate showing >10^5 oganisms/mL is gold standard for dx

Front 12

neutrophilic cryptitis

Back 12

present in both Crohn's and UC

bimodal age distribution with peaks at 20 and 60

Front 13

primary HIV

Back 13

p/w mono-like syndrome consisting of fever, night sweats, lymphadenopathy, arthralgias, and diarrhea

Front 14

GERD that requires upper GI endoscopy?

Back 14

alarm sx (dysphagia, odynophagia, weight loss, anemia, GI bleeding, or recurrent vomiting) or are men age > 50 with chronic (> 5yrs) sx and CA risk factors (eg tobacco use)

all other pts can have an empiric trial of PPI therapy and further evaluation if refractory to therapy

Front 15

sx: glucagonoma, insulinoma, gastrinoma, VIPoma

Back 15

glucagonoma: necrotizing dermatitis, weight loss, anemia, and persistent hyperglycemia

insulinoma: rare beta cell tumor that releases insulin and causes hypoglycemia

gastrinoma: cause increased gastrin release and multiple gastrin ulcers

VIPoma: severe watery diarrhea

Front 16

classic presentation for giardiasis?

Back 16

common in areas where sanitary conditions are poor.

etiology: trophozoites adhere to the mucosal surface by adhesive disks and produce malabsorption, which can sometimes be severe and may lead to weight loss.

empiric tx with course of METRONIDAZOLE

Front 17

ACD:

NSAID usage in elderly pt with s/s of anemia

Back 17

caused by suppression of RBC production by inflammatory cytokines. Commonly occurs in inflammatory arthropathies (RA, lupus) but is not a/w osteoarthritis!

with NSAIDs, think of iron deficiency anemia from chronic blood loss from the GI tract

Front 18

common drugs that cause pancreatitis

Back 18

1) diuretics: furosemide, thiazide
2) drugs for IBD: sulfasalazine, 5-ASA
3) immunosuppressive agents: azathioprine, L-asparaginase
4) drugs used by pts with a h/o seizures of bipolar disorder: VPA
5) drugs used by AIDS pts: think about didanosine, pentamidine
6) antibiotics: metronidazole and tetracycline

Front 19

mechanism by which TPN causes gallstones?

Back 19

gallbladder stasis

Front 20

visceral vs somatic pain in acute appendicitis

Back 20

initial periumbilical pain is referred pain and visceral in nature!!; however, pain shifts to the RLQ with involvement of the parietal peritoneum and becomes somatic in nature

Front 21

pt with subacute to chronic presentation of abdominal pain, tenesmus, and bloody diarrhea.

also with signs of sepsis. Next step in mgmt?

Back 21

In pts with IBD and worsening sx accompanied by signs of sepsis, toxic megacolon!!! should be considered and an ABDOMINAL RADIOGRAPH ordered to confirm dx

Front 22

Zollinger ellison syndrome

Back 22

gastrin-producing pancreatic tumor!

multiple duodenal ulcers typical, and a jejunal ulcer is almost pathognomonic for this condition.

Steatorrhea!!! may develop because increased production of stomach acid inactivates pancreatic enzymes

Front 23

minimal bright red blood per rectum and do not have any risk factors for colon CA. next step in mgmt?

Back 23

office-based anoscopy/proctoscopy, particularly in pts less than 50yo

some of most common causes include: hemorrhoids, anal fissure, polyps, proctitis, rectal ulcers and CA

Front 24

see Q. ID 4431

Back 24

shingles due to reactivation of varicella zoster virus from a dorsal root ganglion. Pts experience pain and a vesicular rash in a dermatomal distribution. Pain may precede the rash by several days, during which dx may not be apparent.

Front 25

IBD colonic mucosa shows what?

Back 25

normal colonic mucosa!

Front 26

age > 60 with bleeding mixed with stools. no abdominal pain. h/o aortic stenosis

Back 26

angiodysplasia!! common cause of recurrent or occult painless lower GI bleeding in patients age > 60yo

reported to cause lower GI bleeding in patients with AORTIC STENOSIS! and END STAGE RENAL DZ!

note: hemorrhoids should only be noted on the SURFACE of the stool and is not mixed.

Front 27

intestinal obstruction? when should you resort to surgical mgmt?

Back 27

those who develop clinical or hemodynamic instability, fail to improve after initial conservative measures, and/or develop s/s strangulation (fever, tachy, leukocytosis, and metabolic acidosis)

Front 28

toxic megacolon mgmt?

Back 28

prompt IV steroids, NG decompression and fluid mgmt

Front 29

esophageal dysmotility sx

Back 29

sticking sensation in the throat and absence of peristaltic waves in lower 2/3 of esophagus, and significant decrease in lower esophageal sphincter tone

think of scleroderma!

Front 30

whipple dz

Back 30

multi-systemic illness characterized by arthralgias, weight loss, fever, diarrhea and abdominal pain. PAS-positive! material in the lamina propria of the small intestine is a classic bx finding

Front 31

MEN types

Back 31

MEN 1: parathyroid, pituitary, and pancreatic
- remember that zollinger-ellison is a pancreatic tumor!

MEN2A: medullary thyroid, pheo, and parathyroid hyperplasia

MEN2b: medullary thyroid, pheo, marfanoid habitus, and intestinal/mucosal neuromas

Front 32

causes of peptic strictures

Back 32

GERD!, also radiation, scleroderma, and caustic ingestions

Front 33

D-xylose test

Back 33

absorbed by passive diffusion in the proximal small intestine followed by urine excretion. Pts with proximal small intestine dz (ie celiac sprue) will have an abnl D-xylose test due to impaired D-xylose absorption and urinary excretion

Front 34

extraintestinal manifestations of UC

Back 34

sclerosing cholangitis, uveitis, erythema nodosum, and spondyloarthropathy

severe complications include toxic megacolon and colon CA

routine surveillance with UC beginning 8-10 years following dx for prevention and/or early detection of colon CA

Front 35

clues to folate vs vitb12 deficiency

Back 35

folate: found in fresh green leafy veggies and liver. folic acid heat sensitive. depleted in 4-5mo

vitb12: strict vegan, store sufficient to last at least 3-4 yrs

Front 36

drugs that can cause esophagitis

Back 36

tetracyclines, aspirin and Nsaids, alendronate, potassium chloride, quinidine, and iron

Front 37

malignant obstruction of biliary system s/s?

Back 37

conjugated hyperbili, elevated alkphos

painless jaundice!, systemic sx (fatigue, weight loss)

likely etiologies include: pancreatic adenocarcinoma or cholangiocarcinoma.

next step is abdominal imaging (US or CT) with consideration for ERCP if initial testing is neg

Front 38

old person with severe epigastric pain and h/o angina. first work up?

Back 38

first do EKG to r/o MI before looking for aortic dissection or other GI pathology

MI can present with epigastric pain, especially inferior and posterior infarctions.

Front 39

endoscopic findings of prominent gastric folds, ulcer located beyond the duodenal bulb

Back 39

characteristic of zollinger ellison syndrome (gastrinoma)

all suspected pts should have FASTING SERUM GASTRIN

patients with nondiagnostic fasting serum gastrin levels should have a secretin stimulation test done

Front 40

dyspepsia workup

Back 40

aged > 55 with new onset sx of dyspepsia and those of any age with alarm sx (weight loss, dysphagia, or persistent vomiting) should be evaluated with upper endoscopy!

other pts should have H. pylori serology testing or empiric tx with PPIs

Front 41

zenker's diverticuli

Back 41

most common in elderly males and p/w dysphagia, regurgitation, foul-smelling breath, aspiration, and possibly a palpable mass.

develops immediately above upper esophageal sphincter by herniating posteriorly between the fibers of cricopharyngeal muscle. MOTOR DYSFUNCTION and incoordination are responsible for the problem.

contrast esophagram is the test of choice! for confirming dx

tx: surgical -> EXCISION AND FREQUENTLY CRICOPHARYNGEAL MYOTOMY

Front 42

suspected achalasia based on sx. next step in mgmt/

Back 42

endoscopic eval for to exclude esophageal malignancy at hte esophageal-gastric junction (which can mimic achalasia

treatment involves botulinum toxin and also nitrates/ca channel blockers

Front 43

pellagra

Back 43

niacin deficiency characterized by triad of 3Ds: diarrhea, dermatitis, and dementia and if left untreated leading to death

most commonly found among people eating corn-based diets in parts of INdia, Africa, and China

also seen in alcoholics, pts with carcinoid syndrome, and hartnup's dz

skin rash present in sun exposed areas.

Front 44

pts with carcinoid syndrome are at increased danger of developing what vitamin deficiency?

Back 44

niacin!

precursor of serotonin is tryptophan, which is an AA also utilized in synthesis of niacin.

Front 45

ischemic colitis likely to affect which areas of the bowel?

Back 45

most common in splenic flexure, bc it is supplied by end arteries. splenic flexure is a watershed line btw the territory of the superior and inferior mesenteric arteries.

two watershed zones in the colon: 1) splenic flexure and 2) recto-sigmoid junction

Front 46

tropical sprue

Back 46

pts with malabsorption, along with h/o living in endemic areas for more than one month.

involves the small intestine; the typical bx characterized by blunting of villi with infiltration of chronic inflammatory cells, including lymphocytes, plasma cells and eosinophils

Front 47

SBP

Back 47

suspected in any pt with cirrhosis and ascites who p/w low-grade fever, abdominal discomfort, or AMS. Ascitic fluid with PMNs > 250 and positive peritoneal fluid cx confirm dx

Front 48

stepwise approach for tx of ascites

Back 48

1) sodium and water restriction (< 2L/daily)
2) spironolactone
3) loop diuretic (not more than 1L/day of diuresis)
4) frequent abdominal paracentesis (2-4L/day as long as renal function is oK!! (watch out for hepatorenal syndrome)

Front 49

tumors at head of pancreas

Back 49

abdominal pain, weight loss, jaundice, distended gallbladder on exam!! characteristic findings on imaging including intra and extrahepatic biliary tract dilation!!

Front 50

octreotide vs propranolol for esophageal varices

Back 50

ocreotide: used for active variceal bleeding

Front 51

risk factors for a polyp progressing into malignancy

Back 51

villous adenoma, sessile adenoma, and size > 2.5cm

only adenomatous polyps are clearly premalignant, but < 1% of such lesions progress to malignancy.

Hyperplastic polyps are nonneoplastic and do not require further workup

Front 52

how to spot factitious diarrhea (laxative abuse)

Back 52

frequent, watery, nocturnal diarrhea.

dx confirmed with characteristic bx of dark brown discoloration of the colon with lymph follicles shining through as pale patches (melanosis coli)

Front 53

zinc deficiency

Back 53

may result from chronic TPN or malabsorption. sx include alopecia, skin lesions, abnl taste, and impaired wound healing