Kgastrointestinal System: Kaplan Companion To First Aid For Usmle Step 2 Ck

Front 1

Q001. (3) causes of viral Esophagitis

Back 1

A001. HSV; VZV; CMV

Front 2

Q002. (5)* causes of Bacterial Esophagitis

Back 2

A002. My Pnew Strep Lacts Crypt:; Mycobacterium TB;; Pneumocystis Carnii;; Strep;; Lactobacillus;; Cryptospordium

Front 3

Q003. *When is a Barium Esophagram the best initial test?; when is it the most accurate?; (3)

Back 3

A003. Dysphasia (that shows no signs of obstruction...for obstruction it would be Upper Endoscopy); most accurate:; 1. Esoph Webs; 2. Esoph Rings; 3. Esoph Diverticuli

Front 4

Q004. Dx: Odynophagia (pain with swallowing), dysphagia, esophageal bleeding, N/V, chest pain, (or asymptomatic)

Back 4

A004. Infectious Esophagitis

Front 5

Q005. Dx: Infectious esophagitis with nodular filling defects on barium esophagram; Tx?

Back 5

A005. Candida; Tx: Fluconazole PO

Front 6

Q006. Causes: Infectious esophagitis with vesicles and descrete erosions on endoscopy; (2); Tx?

Back 6

A006. HSV or VZV; Tx: Acyclovir for HSV

Front 7

Q007. Dx: Infectious esophagitis with intranuclear inclusions on biopsy via endoscopy; Tx?

Back 7

A007. CMV; Tx: Ganciclovir IV

Front 8

Q008. Who should upper endoscopy screening be offered to?; (2)

Back 8

A008. 1. Patients with GERD and Symptom for > 5 years (to check for Barrett's esophagus); 2. Patients with Esophageal varices

Front 9

Q009. Dx: A Full-thickness tear usu in the weak left posterolateral wall of distal esophagus; (3) causes?

Back 9

A009. Boerhaave's Syndrome; Causes:; Forceful vomiting;; Cough;; Trauma

Front 10

Q010. Dx: A Partial-thickness tear usu in the right posterolateral wall of the distal esophagus and results in bleeding that resolves spontaneously; Cause?

Back 10

A010. Mallory-Weiss syndrome; Cause: Forceful vomiting

Front 11

Q011. medical Tx for non-bleeding Esophageal Varices

Back 11

A011. Propranolol

Front 12

Q012. What is the next step in the Tx of a patient with GERD that has persistent Symptom after 4 weeks of Tx with a PPI?

Back 12

A012. 24-hour Esophageal pH recording

Front 13

Q013. If patient has mediastinal and subcutaneous emphysema, what esophageal problem do they have?

Back 13

A013. Full-thickness tear; (Boerhaave's syndrome)

Front 14

Q014. Dx sign: "Crunching sound" heard with heartbeat; what is it due to?

Back 14

A014. "Hammon's crunch" (Mediastinal emphysema); From: Full-thickness esophageal tear (Boerhaave's syndrome)

Front 15

Q015. *What is the Diagnostic test of choice for Boerhaave's syndrome or a partial esophageal perforation?; What is the most accurate test?

Back 15

A015. Dx test: Gastrograffin (water-soluble contrast); most accurate: CT scan

Front 16

Q016. Tx for esophageal tear; (1 for each type)

Back 16

A016. Partial-thickness (Mallory-Weiss): may resolve spontaneously; Full-thickness (Boerhaave's): Surgery

Front 17

Q017. Definition: Pharyngeal or esophageal pouch due to a defect in the muscular wall of the posterior hypopharynx

Back 17

A017. Zenker's Diverticulum

Front 18

Q018. Dx: Halitosis, regurgitation of food after eating it, frequent aspiration, esophageal obstruction

Back 18

A018. Zenker's Diverticulum

Front 19

Q019. Dx test for Zenker's Diverticulosis; (2 possible); Tx (2 possible)

Back 19

A019. Tests: Barium swallow;; Endoscopy; Tx:; Surgical removal;; Cricopharyngeal myotomy

Front 20

Q020. Dx: 56-yo man complains of food feeling "stuck" on its way down and vomiting food he ate days ago

Back 20

A020. Zenker's Diverticulum

Front 21

Q021. Definition: Neurogenic disorder of esophageal motility with absence of normal peristalsis and impaired relaxation of the LES

Back 21

A021. Achalasia

Front 22

Q022. Definition: Esophageal motility disorder with frequent non- peristaltic contractions

Back 22

A022. Diffuse Esophageal Spasms; (DES)

Front 23

Q023. What esophageal problem affects 70% of people with Scleroderma?

Back 23

A023. Achalasia

Front 24

Q024. What type of problem does dysphagia to solids and liquids indicate?; (2 examples); To just solids?; (3 examples)

Back 24

A024. Solids + Liquids: Motility problem (Achalasia; DES); Solids only: Mechanical problem (Tumor; Schatzki's ring; Plummer-Vinson syndrome)

Front 25

Q025. Dx: weight loss, cough, dysphagia of both solids and liquids, "bird's beak" on CXR; Tx options?; (2 drugs and 2 procedures)

Back 25

A025. Achalasia; Tx options:; Nitroglycerin;; Local Botulinum toxin;; Balloon Dialation;; Sphinctor Myotomy

Front 26

Q026. Dysphagia to both solids and liquids, diffuse chest pain, "corkscrew" appearance on CXR; DES Drug Tx options? (2 possible)

Back 26

A026. Diffuse Esophageal Spasms (DES); Tx options:; 1. Nitroglycerin;; 2. Anticholinergics

Front 27

Q027. When is an Esophageal Manometry the test of choice?; (2)

Back 27

A027. 1. an Inconclusive Barium or upper endoscopy; 2. Description of a Motility problem (Achalasia, DES, Nutcracker esophagus)

Front 28

Q028. Etiology of Achalasia; (2)

Back 28

A028. Scarring of Auerbach's plexus from: Chagas Disease; or Ganglionic degeneration

Front 29

Q029. Definition: Hypopharyngeal webs (thin mucosal structures protruding into lumen of the esophagus) associated with iron deficiency anemia

Back 29

A029. Plummer-Vinson Syndrome

Front 30

Q030. Definition: Narrow lower esophageal ringlike outgrowth associated with dysphagia

Back 30

A030. Schatzki's Ring

Front 31

Q031. Etiology of GERD; (4)*

Back 31

A031. HIDE:; Hiatal hernia;; Incompetent LES tone; Delayed Gastric emptying;; Esopageal motility decreased

Front 32

Q032. (5)* causes of Delayed Gastric Emptying

Back 32

A032. Delayed Food GAG: DM;; Fatty foods;; Gastroparesis;; Anticholinergics;; Gastric outlet obstruction

Front 33

Q033. (8)* causes of a decreased LES tone

Back 33

A033. Coffee CAN Cause Esophageal Sphinctor Problems:; Coffee;; Chocolate;; Alcohol;; Nitrates;; Calcium channel blockers;; Estrogen;; Smoking;; Progesterone

Front 34

Q034. Differential of Chronic Cough; (3)*

Back 34

A034. GAP in breathing:; GERD;; Asthma / Chronic Bronchitis;; Post-nasal drip

Front 35

Q035. Dx: Substernal chest pain, dysphagia, hypersalivation, cough, wheezing

Back 35

A035. GERD

Front 36

Q036. What (3) lifestyle modifications should be told to patients with GERD?

Back 36

A036. Discontinue foods that lower LES tone;; Elevate head of bed;; No food < 3 hours before bed

Front 37

Q037. (2) drug Tx options for GERD; What can be done if medication doesn't work?

Back 37

A037. Proton Pump Inhibitor (1st);; H-2 Blocker; Final solution: Surgical fundoplication

Front 38

Q038. Definition: Esophageal damage, bleeding and friability due to prolonged exposure to gastric contents

Back 38

A038. Esophagitis

Front 39

Q039. (4)* complications of GERD

Back 39

A039. BEEP:; Barrett's Esophagus;; Esophagitis;; Esophageal cancer;; Peptic stricture

Front 40

Q040. (2) types of esophageal cancers and where each is formed in esophagus

Back 40

A040. Squamous: Upper 2/3 of esophagus; Adenocarcinoma: Lower 1/3 of esophagus

Front 41

Q041. Risk factors for CA of the esophagus; (7)*

Back 41

A041. ABCDEF:; Alcohol;; Barrett's esophagus;; Cigarettes;; Diverticuli (Zenker's);; Esophageal web (P-V synd), Esophagitis (reflux or irritants);; Familial

Front 42

Q042. What causes Barrett's?; What can it become?; How often should a patient with Barrett's have an upper endoscopy?

Back 42

A042. BARRett's: Becomes Adenocarcinoma, Results from Reflux; UE: Barrett's: every 2 - 3 years

Front 43

Q043. What is the Alkaline Tide?

Back 43

A043. Parietal cells secreting HCl into the gastric lumen and bicarb into the gastric venous circulation, which goes to the gastric mucous cell

Front 44

Q044. What hormones/NT stimulate parietal cells?; (3)

Back 44

A044. Holds Gastric Acid:; Histamine (H-2);; Anticholinergic (from vagus);; Gastrin

Front 45

Q045. What hormone stimulates release of Gastrin? From what cells and where?

Back 45

A045. Gastrin-releasing peptide; (from G-cells in antrum of stomach)

Front 46

Q046. What hormone inhibits Gastrin? From which cells?

Back 46

A046. Somatostatin; (from D-cells in the pancreas and GI mucosa)

Front 47

Q047. What inhibits the Gastric Bicarb secretion (from the alkaline tide) from entering the mucous gel to line the stomach?; (4)

Back 47

A047. NSAIDs;; Alcohol;; Acetazolamide;; Alpha-blockers

Front 48

Q048. What increases the thickness of the mucous gel of the stomach?; What decreases it?; (2)

Back 48

A048. Increases: Prostaglandin E; Decreases (by inhibiting PGE): NSAIDs; Steroids

Front 49

Q049. Dx: A patient has large, multiple ulcers that are recurrent and distal in origin. First test?; What are diagnostic levels?; if this Dx is still suspected and diagnostic levels of the first test are not reached, what is the next test?; what syndrome is it assoc with?

Back 49

A049. Zollinger-Ellison syndrome; First test: Gastrin Level (> 1,000pg/mL is diagnostic); Next if not at Dx level: Secretin Stimulation test (Gastrin levels will still be high); Assoc with: MEN-1

Front 50

Q050. Dx: 52-yo woman presents with 3 months of early satiety, weight loss, and vomiting

Back 50

A050. Gastric Outlet Obstruction

Front 51

Q051. Definition: Syndrome involving a gastrin-secreting tumor in or near the pancreas

Back 51

A051. Zollinger-Ellison Syndrome

Front 52

Q052. Triad of Zollinger-Ellison syndrome

Back 52

A052. PUD;; Elevated Gastrin levels;; Gastric Acid hypersecretion

Front 53

Q053. Dx: Burning epigastric pain that is releived within 30 minutes of ingesting food; causes nighttime awakening, N/V, possible melena; What blood type is it associated with?

Back 53

A053. Duodenal Ulcer; (better after eating); (blood type O)

Front 54

Q054. If an ulcer is found on endoscopy, what is the test of choice to see if it is H.pylori?; After treatment of H.pylori with a PPI, what is the best test if the patient still has symptoms or to confirm eradication of the bug?

Back 54

A054. if ulcer is found: Biopsy; No change after PPI: Urease Breath test

Front 55

Q055. What from H.pylori decreases the gastric mucosal defenses?

Back 55

A055. Urease

Front 56

Q056. Dx Test for Zollinger-Ellison?

Back 56

A056. Secretin stimulation test; (if gastrin levels are still high after this inhibitor, then probable ZE)

Front 57

Q057. Triple therapy for H. pylori

Back 57

A057. CAP:; Clarithromycin; Amoxicillin; Proton Pump inhibitor

Front 58

Q058. If patient is bleeding from an ulcer, what is drug Tx after endoscopy?; (2 possible plus MOA)

Back 58

A058. Sucralfate (enhances mucosal barrier); or Misoprostol (prostaglandin analog)

Front 59

Q059. 45-yo Japanese male smoker presents with epigastric pain, exacerbated by eating, and weight loss

Back 59

A059. Gastric Ulcer

Front 60

Q060. Dx: burning epigastric pain that occurs within minutes after eating, anorexia, vomiting; What blood type is it associated with?

Back 60

A060. Gastric Ulcer; (worse after eating); (blood type A)

Front 61

Q061. Dx test for Gastric Ulcers

Back 61

A061. Endoscopy with Biopsy; (all confirmed GU are Biopsy due to risk of CA)

Front 62

Q062. Type of PUD related to an increase in acid production?

Back 62

A062. Duodenal Ulcer

Front 63

Q063. Type of PUD that can occur with achlorhydria?

Back 63

A063. Gastric Ulcer

Front 64

Q064. Best Tx for Gastritis or any ulcer of unknown etiology; (3 together)

Back 64

A064. Combo:; 1. Mucosal protector (Bismuth, Sulcrafate, Misoprostol); 2. H-2 blocker or Proton pump inhibitor; 3. Antibiotics for H. pylori (amoxicillin; clarithromycin)

Front 65

Q065. Dx: burning, gnawing epigastric pain usually worse with food and relieved with antacids

Back 65

A065. Gastritis

Front 66

Q066. Etiology of Gastritis; (8)

Back 66

A066. GNASHING pain:; Gastric reflux (of bile or pancreatic secretions);; Nicotine;; Alcohol;; Stress;; H. pylori;; Ischemia;; NSAIDs;; Glucocorticoids (long-term use)

Front 67

Q067. Difference b/t acute and chronic gastritis

Back 67

A067. Acute: Erosive; Chronic: Non-erosive

Front 68

Q068. Difference b/t the causes of the (2) types of Chronic Gastritis; where is each located in stomach?

Back 68

A068. A = A's / B = Bug; Type A (Fundal): Auto-Ab to parietal cells; Anemia (pernicious); Achlorhydria;; Type B: Bug = H. pylori

Front 69

Q069. what is the inflammation of the pancreas due to?; (2)

Back 69

A069. - Autodigestion by proteolytic enzymes; Systemic Inflammatory Response Syndrome (SIRS) (severe cases)

Front 70

Q070. Exocrine (5) and Endocrine (3) secretions of the pancreas

Back 70

A070. Exocrine:; Bicarbonate;; Amylase;; Lipase;; Tyrosine;; Proteases (trypsin, carboxypeptidase, etc) Endocrine:; Glucagon;; Insulin;; Somatostatin

Front 71

Q071. (2) most common causes of pancreatitis

Back 71

A071. Gallstones; Alcohol

Front 72

Q072. Dx: patient with a history of alcohol abuse has abdominal pain & calcifications on abd x-ray

Back 72

A072. Chronic pancreatitis

Front 73

Q073. Etiology of Acute Pancreatitis; (7)

Back 73

A073. G-HEADS:; Gallstones;; Hypertriglycerides; HyperC;; Endoscopic Retrograde Cholangiopancreatogrophy (ECRP);; Alcohol;; Drugs;; Structural (neoplasm)

Front 74

Q074. (4) drugs that can cause acute pancreatitis

Back 74

A074. FEAT:; Furosemide;; Estrogen;; Antiretrovirals;; Thiazides

Front 75

Q075. Dx: constant mid-epigastric or LUQ pain that radiates to the back; may improve if patient sits-up and leans forward. N/V, fever, tachypnea, abd is tender with guarding

Back 75

A075. Acute pancreatitis

Front 76

Q076. What is the most specific (and initial test) for Pancreatitis?; Most accurate?; If Pancreatic Necrosis is seen, what is the next step?

Back 76

A076. most specific: Lipase (will be 2x normal); most accurate: CT scan; if necrosis: Pancreatic Biopsy

Front 77

Q077. Dx: 50-yo male alcoholic presents with mid epigastric pain radiating to the back. He is leading forward on the stretcher and vomiting

Back 77

A077. Acute Pancreatitis

Front 78

Q078. Dx: a 66-yo female with HTN and seziures is on furosemide and valproic acid, presents with abdominal pain, back pain and fever. Her non-fasting glucose is 300

Back 78

A078. Acute Pancreatitis

Front 79

Q079. (4) Dx tests for pancreatitis

Back 79

A079. Abdominal x-ray;; Ultrasound (gallstone cause);; ERCP (visualize sphinctor);; Contrast-Enhanced CT (shows pancreatic necrosis)

Front 80

Q080. Define: Sentinel loop; what is it associated with in pancreatitis?

Back 80

A080. Distention and/or air-fluid levels near a site of abdominal distention. In pancreatitis, it is secondary to pancreatitis-associated Ileus

Front 81

Q081. Tx for acute Pancreatitis; (4 together)

Back 81

A081. 1. IV hydration;; 2. Bowel rest – Antiemetics (NG tube for vomiting or associated ileus);; 3. Analgesics;; 4. Antibiotics (Imipenem) for suspected infection

Front 82

Q082. What can occur in acute pancreatitis if left untreated in:; 1. < 48 hours; 2. 1 - 4 weeks; 3. 4 - 6 weeks

Back 82

A082. 1. Pleural effusion of pancreatic fluids; 2. Pseudocyst; 3. Abscess (needs surgical drainage)

Front 83

Q083. What on a physical exam will indicate splenic vein thrombosis, a complication of pancreatitis?

Back 83

A083. Gastric varices; (without esophageal varices)

Front 84

Q084. MCC of Chronic pancreatitis

Back 84

A084. Alcohol abuse

Front 85

Q085. Dx: midepigastric pain that radiates to the back; malabsorption; steatorrhea; elevated blood sugars; polyuria

Back 85

A085. Chronic Pancreatitis

Front 86

Q086. the Secretin Stimulation test is used to Dx what (2) problems?

Back 86

A086. 1. Zollinger-Ellison syndrome; 2. Chronic Pancreatitis

Front 87

Q087. *What is the only test that is specific for a Dx of Chronic Pancreatitis from the Symptom of Steatorrhea?; When is it the "Next step"?

Back 87

A087. Serum Trypsinogen (which will be low); Next step: After Sudan Black confirms malabsorption and if Antigliadin and anti-endomysial Ab are normal.

Front 88

Q088. Describe the (2) signs of Hemorrhagic Pancreatitis:; 1. Grey Turner's sign; 2. Cullen's sign

Back 88

A088. 1. Ecchymotic appearing skin on the flank; 2. same on the periumbilical area

Front 89

Q089. What lab values in a patient are Very High with Obstructive liver disease?; Parenchymal liver disease?; (2)

Back 89

A089. Obstructive: Alkaline phosphatase Parenchymal:; 1. PT; 2. ALT/AST

Front 90

Q090. Definition: Chronic hepatic injury assoc with hepatic necrosis, fibrosis and nodular regeneration

Back 90

A090. Cirrhosis

Front 91

Q091. A patient with alcoholic cirrhosis comes in vomiting blood. He is stabilized with fluid. What is the next step?

Back 91

A091. Octreotide

Front 92

Q092. MCC of cirrhosis in USA?; worldwide?

Back 92

A092. USA: Alcohol abuse; world: Hepatitis

Front 93

Q093. Dx: spider nevi, gynecomastia, loss of sexual hair, asterixis, bleeding tendency, Dupuytren's contracture, encephalopathy, portal HTN, jaundice

Back 93

A093. Cirrhosis of the Liver

Front 94

Q094. What are the causes in the following symptoms that are diagnostic of liver cirrhosis:; 1. Bleeding; 2. Encephalopathy; 3. Ascites, melena, edema

Back 94

A094. 1. Decreased clotting factors made in the liver; 2. Increased ammonia; 3. Portal HTN

Front 95

Q095. Order of the (4) liver problems (Dx names) caused by increasing alcohol consumption

Back 95

A095. Alcoholic Fatty Liver -> Alcoholic Cirrhosis -> Alcoholic Hepatitis -> Necrosis

Front 96

Q096. Most sensitive serum marker for recent alcohol bingeing

Back 96

A096. GGT

Front 97

Q097. Rx for the following Symptom in Alcoholic liver cirrhosis:; 1. Decrease inflammation (2); 2. Ascites; 3. Hepatic encephalopathy (2); 4. Esophageal varices (2)

Back 97

A097. 1. Glucocorticoids and Colchicine; 2. Spironolactone; 3. Lactulose and Neomycin; 4. Beta-blocker or IV somatostatin (or banding or balloon tamponade)

Front 98

Q098. (3)* metabolic diseases that cause Liver Cirrhosis. Name the test markers that would indicate the Disease as the cause

Back 98

A098. Will Agitate Hepatocytes:; 1. Wilson's Disease (high serum Ceruloplasmin); 2. Alpha-1-antitrypsin deficiency (serum electrophoresis with absence of alpha-globulin); 3. Hereditary Hemachromotosis (Fasting Transferrin Saturation = high Ferritin and TIBC)

Front 99

Q099. Why would the BUN be lower in liver cirrhosis?

Back 99

A099. Decreased protein production

Front 100

Q100. Test marker that indicates cirrhosis with hepatocellular CA

Back 100

A100. Increased Alpha-fetoprotein

Front 101

Q101. Definition: Autoimmune disease causing destruction of the intrahepatic ducts

Back 101

A101. Primary Biliary Cirrhosis

Front 102

Q102. Dx: 40-yo woman with scleroderma is admitted with jaundice, pruritis and xanthomas; What is the serologic hallmark?

Back 102

A102. Primary Biliary Cirrhosis; (Anti-mitochondrial Ab)

Front 103

Q103. (2) autoimmune disorders assoc with Primary Biliary Cirrhosis

Back 103

A103. Scleroderma; Sjogren's syndrome

Front 104

Q104. What drug Tx will slow the progression of Primary Biliary Cirrhosis?; What is only cure?

Back 104

A104. Ursodiol (synthetic bile acid); Cure: Liver Transplant

Front 105

Q105. MCC of Portal HTN worldwide

Back 105

A105. Schistosomiasis

Front 106

Q106. Signs of Portal HTN; (5)*

Back 106

A106. CHASE:; Caput medusa;; Hemorrhoids;; Ascites;; Splenomegaly;; Esophageal Varices

Front 107

Q107. Tx for Portal HTN; (4)

Back 107

A107. Propranolol to reduce pressure;; Portosystemic shunt surgery;; TIPS - shunt b/t hepatic and portal veins;; Liver transplant

Front 108

Q108. Dx: Liver disease, joint pain, Diabetes, cardiomyopathy, skin hyperpigmentation and infertility. First test?; what is the confirmatory test?

Back 108

A108. Hereditary Hemochromatosis; first test: Fasting Transferrin saturation; Confirmatory: HFE Gene and C282Y mutation (eliminates the need for liver Biopsy in HH)

Front 109

Q109. GI functions of Somatostatin; (6)

Back 109

A109. Inhibits:; Visceral blood flow; Gastric acid secretion; Gastric motility; Gallbladder emptying; Pancreatic enzyme and bicarbonate secretion; Intestinal absorption of glucose, water, AA, and triglycerides

Front 110

Q110. Hepatic encephalopathy is precipitated by what?; (3)*

Back 110

A110. PIG:; Protein (dietary) increase;; Infection;; GI bleed

Front 111

Q111. Signs/Symptom of Hepatic Encephalopathy; (3)

Back 111

A111. Fetor Hepaticus (Corpse breath);; Asterixis;; Mental status change or coma

Front 112

Q112. In a patient with bleeding esophageal varices, after stabilizing IV fluids, what is the next step?

Back 112

A112. Octreotide

Front 113

Q113. Tx for Hepatic encephalopathy; (3)

Back 113

A113. Protein restriction;; Lactulose (to change NH3 to NH4 so it cant cross BBB); Neomycin (for gut bacteria that make NH3)

Front 114

Q114. MCC of Spontaneous Bacterial Peritonitis (bug)

Back 114

A114. E. coli

Front 115

Q115. Dx: Patient with ascites, fever, chills, abdominal pain with rebound, may progress to sepsis

Back 115

A115. Spontaneous Bacterial Peritonitis

Front 116

Q116. Dx test for Spontaneous Bacterial Peritonitis; Tx?

Back 116

A116. Test: Paracentesis (abdominal tap); Tx: Gram-negative coverage (Cefuroxime)

Front 117

Q117. Definition: Systemic infection of the liver due to viral agents, toxins, or alcohol

Back 117

A117. Hepatitis

Front 118

Q118. Mode of transmission of Hepatitis: A, B, C, D, E, G

Back 118

A118. A and E - fecal-oral route; B, C, D, G - sex and blood

Front 119

Q119. Which forms of hepatitis are associated with:; 1. IV drug use (2); 2. Unprotected sex; 3. Overseas travel (2)

Back 119

A119. 1. HBV and HCV; 2. HBV; 3. HAV and HEV

Front 120

Q120. What (2) toxins cause hepatitis?

Back 120

A120. Acetaminophen; Aflatoxin

Front 121

Q121. *Viral class for:; 1. HAV; 2. HBV; 3. HCV; 4. HDV; 5. HEV; Which is the only DNA virus?

Back 121

A121. Please Help Find Danielle's Cat:; 1. Picorna; 2. Hepadna; 3. Flavi; 4. Delta; 5. Calici; HBV is DNA (the rest are RNA)

Front 122

Q122. Meaning of HAV antibodies; (2)

Back 122

A122. HAV IgM = Acute infection; HAV IgG = Immunity from prior infection

Front 123

Q123. Prevention of HAV?; Tx of HAV?

Back 123

A123. Prevention: Anti-HAV Ig is 90% effective if given within (2) weeks of exposure; Tx: symptomatic

Front 124

Q124. How is hepatotoxicity from Acetaminophen prevented if detected early?

Back 124

A124. N-acetylcysteine

Front 125

Q125. Meaning of HBV antibodies in order of detection (4)*; Which signifies the "window period"?; Which indicates immunity?

Back 125

A125. SAGing BAG-E / Camels May / Spit and Gag:; HBsAg positive = infection is present; HBeAg = Chronic hepatitis; Anti-HBc IgM = infection is acute (window period); Anti-HBs IgG = past infection or vaccine (indicates immunity)

Front 126

Q126. Exposure scenarios: What is Tx to a newborn exposed with Hepatitis B?; Adult infected blood exposure?

Back 126

A126. Newborn: Give HBIG and vaccine; Other: Test for HBV, if negative give HBIG only

Front 127

Q127. Tx for HBV; What does HBV give patient a risk of developing?

Back 127

A127. Lamivudine; Risk: Hepatocellular cancer

Front 128

Q128. Meaning of "HCV antibody"

Back 128

A128. Anti-HCV IgG = indicates chronic or past infection

Front 129

Q129. Tx for HCV; (2)

Back 129

A129. Interferon; Ribavirin

Front 130

Q130. What do 25% of the chronic HCV patients develop?; (2)

Back 130

A130. Cirrhosis; and/or Hepatocellular CA

Front 131

Q131. Dx: Medical student develops fever, jaundice and fatigue 2 weeks after returning from a trip to India

Back 131

A131. Hepatitis E

Front 132

Q132. A young female is diagnosed with liver disease, but does not drink, have inflammatory bowel disease or infectious hepatitis. Next test?; if positive, what is the Dx?; What additional immune marker is assoc with it?

Back 132

A132. Next test: Anti-Smooth Muscle Ab (ASMA); Dx: Autoimmune Hepatitis; Additional immune marker: Anti-Liver/Kidney Microsome type 1 Ab (anti-LKM1 Ab)

Front 133

Q133. Indications for Liver transplantation; (5)

Back 133

A133. Cirrhosis;; Primary Sclerosing Cholangitis;; Chronic Hepatitis;; Hepatocellular CA;; Hepatic Vein Thrombosis

Front 134

Q134. What must match with donor liver?; (2)

Back 134

A134. Size and ABO; (not Rh or HLA)

Front 135

Q135. (3) medications for Immunosuppression of Liver recipients

Back 135

A135. Cyclophosphamide;; OKT3;; Tacrolimus

Front 136

Q136. What stimulates the gallbladder contraction (specifically)

Back 136

A136. Fat and Amino Acids in the proximal duodenum causes release of CCK

Front 137

Q137. Dx: Middle-aged female patient presenting with pruritis and an elevated Alkaline phosphatase with a normal Bilirubin. What is the best initial test?; what is the most accurate test?

Back 137

A137. Dx: Primary Biliary Cirrhosis; initial test: Anti-mitochondrial Ab test; most accurate: Liver Biopsy

Front 138

Q138. Risk factors for cholelithiasis; (8 F's); Two others?

Back 138

A138. Female;; Fat;; Forty;; Fertile;; Fibrosis (Cystic);; Familial;; Fasting;; F-Hgb (Sickle cell); Also: DM and Oral contraceptives

Front 139

Q139. Dx: RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness without guarding or rebound

Back 139

A139. Cholelithiasis

Front 140

Q140. What labs are elevated with gallstones?

Back 140

A140. Alkaline phoshatase; Bilirubin; (direct more then indirect)

Front 141

Q141. when should HIDA scan be answered?; (2)

Back 141

A141. 1. Gallstones and US Murphy's sign without Gallbladder edema; 2. Gallbladder edema and US Murphy's sign without Gallstones (if Dx is obvious, then do not answer HIDA scan)

Front 142

Q142. First Dx test of choice for gallstones?

Back 142

A142. Ultrasound

Front 143

Q143. Out of the (3) types of gallstones, name them in least common to most.

Back 143

A143. 1. Cholesterol (10%); 2. Pigment (20%); 3. mixed (70%)

Front 144

Q144. When are Radiolucent cholesterol gallstones seen?; (3)

Back 144

A144. rapid weight loss;; Oral contraception;; Ileal disease

Front 145

Q145. When are radiodense pigment gallstones seen?

Back 145

A145. Hemolysis

Front 146

Q146. Treatment of gallstones in order; (1 med; 2 procedures)

Back 146

A146. 1. Chenodeoxycholate; 2. Lithotripsy; 3. Cholesystectomy

Front 147

Q147. Dx: Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of ULCERATIVE COLITIS and is complaining of pruritus with a negative hepatitis profile and a negative US. Next step?

Back 147

A147. Dx: Primary Sclerosing Cholangitis; next step: ECRP

Front 148

Q148. (4) bugs that can cause cholecystitis

Back 148

A148. BEEK:; Bacteriodes; E.coli; Enterococcus; Klebsiella

Front 149

Q149. Dx: RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign

Back 149

A149. Cholecystitis

Front 150

Q150. Sign: the arrest of inspiration while palpating the RUQ. what is the Dx if positive?

Back 150

A150. Murphy's sign; Dx: Acute cholecystitis

Front 151

Q151. Dx test of choice for cholecystitis

Back 151

A151. HIDA: labeled iminodiacetic acid is injected IV and taken up by hepatocytes. Normal gallbladder is outlined in 1 hour, absence of visable gallbladder = cholecystitis

Front 152

Q152. What condition is an ERCP most accurate for?

Back 152

A152. Primary Sclerosing Cholangitis

Front 153

Q153. Tx for cholecystitis in order; (2 meds; 1 procedure)

Back 153

A153. Pain control;; 2nd or 3rd generation Cephalosporin;; Cholecyctectomy

Front 154

Q154. Definition: complete obstruction of the biliary outflow tract due to a stone obstructing the common bile duct, a stricture or tumor. The patient becomes septic and it is life threatening

Back 154

A154. Ascending cholangitis

Front 155

Q155. Definition: stone obstruction of the common bile duct

Back 155

A155. Choledocholelithiasis

Front 156

Q156. Charot's triad of Ascending Cholangitis; Reynolds pentad?

Back 156

A156. Charot's triad:; RUQ pain;; Jaundice;; Fever Reynold's pentad: above plus; Shock (hypotension);; Altered mental status

Front 157

Q157. *Tx of choice for Ascending cholangitis

Back 157

A157. ERCP with endoscopic sphinctorotomy

Front 158

Q158. Definition: Chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree. What is it associated with?

Back 158

A158. Primary sclerosing Cholangitis; Associated with: Ulcerative Colitis

Front 159

Q159. Dx: 34-yo man with a history of ulcerative colitis presents with jaundice and elevated GGT and alk-phos.

Back 159

A159. Primary Sclerosing Cholangitis

Front 160

Q160. ERCP showing "beads on a string" appearance

Back 160

A160. Primary Sclerosing Cholangitis

Front 161

Q161. Pathogenesis of cholelithiasis

Back 161

A161. 3 types of stones:; cholesterol (from bile supersaturated with cholesterol, hypomotile gallbladder); black pigmented stones (seen in hemolytic disease and alcoholic cirrhosis), from unconjugated bili; brown stones: from biliary tract infection

Front 162

Q162. clinical features of cholelithiasis

Back 162

A162. most are asymptomatic; biliary colic

Front 163

Q163. dx of cholelithiasis

Back 163

A163. RUQ u/s

Front 164

Q164. tx of cholelithiasis

Back 164

A164. none needed unless repeated bouts of biliary colic, then tx with cholecystectomy

Front 165

Q165. complications of cholelithiasis

Back 165

A165. cholecystitis; choledocholithiasis; gallstone ileus; malignancy

Front 166

Q166. pathogenesis of acute cholecystitis

Back 166

A166. obstruction of cystic duct --> inflammation of gallbladder wall

Front 167

Q167. clincal features of acute cholecystitis

Back 167

A167. RUQ pain that may radiate to right shoulder; murphy's sign

Front 168

Q168. dx of acute cholecystitis; what if initial study is negative?

Back 168

A168. RUQ u/s: shows pericholecystic fluid; if u/s is negative, do HIDA scan to look for dye not filling gallbladder

Front 169

Q169. tx of acute cholecystitis

Back 169

A169. hydration, bowel rest, antibiotics, pain meds; cholecystectomy

Front 170

Q170. complications of acute cholecystitis

Back 170

A170. gangrenous cholecystitis; GALLBLADDER perforation; emphysematous cholecystitis; fistula with gallstone ileus

Front 171

Q171. pathophysiology of gallstone ileus

Back 171

A171. gallstone enters bowel lumen via fistula with gallbladder, gets stuck --> obstruction

Front 172

Q172. pathogenesis of choledocholithiasis

Back 172

A172. gallstone gets stuck in common biliary duct

Front 173

Q173. what are the two types of stones seen in choledocholithiasis

Back 173

A173. primary: pigmented, originate in common biliary duct; secondary: from gallbladder, then pass into common biliary duct, usually cholesterol or mixed

Front 174

Q174. clinical presentation of choledocholithiasis

Back 174

A174. most patients are asymptomatic for years; RUQ pain +/- jaundice

Front 175

Q175. dx of choledocholithiasis

Back 175

A175. ERCP (shows common biliary duct dilation)

Front 176

Q176. tx of choledocholitiasis

Back 176

A176. ERCP with sphincterotomy and stone extraction, stent placement

Front 177

Q177. complications of choledocholithiasis

Back 177

A177. cholangitis; pancreatitis; biliary cirrhosis

Front 178

Q178. pathogenesis of cholangitis

Back 178

A178. obstruction --> biliary stasis --> bacterial overgrowth and infection

Front 179

Q179. clinical presentation of cholangitis

Back 179

A179. charcot's triad (fever, RUQ pain, jaundice)

Front 180

Q180. dx of cholangitis

Back 180

A180. ERCP; hyperbilirubinemia; elevated lfts

Front 181

Q181. tx of cholangitis

Back 181

A181. iv antibiotics and IVF; once afebrile x 48 hrs, ERCP

Front 182

Q182. complications of cholangitis

Back 182

A182. hepatic abscess

Front 183

Q183. risk factors for carcinoma of the gallbladder

Back 183

A183. gallstone; fistulas; porcelain gallbladder

Front 184

Q184. clinical findings of carcinoma of the gallbladder

Back 184

A184. palpable gallbladder; jaundice; biliary colic; weight loss

Front 185

Q185. tx of carcinoma of the gallbladder

Back 185

A185. surgery, but 90% die within first year of dx

Front 186

Q186. porcelain gallbladder

Back 186

A186. transmural calcification of gallbladder, 50% risk of developing carcinoma of the gallbladder

Front 187

Q187. pathogenesis of primary biliary cirrhosis

Back 187

A187. destruction of the intrahepatic bile ducts, with portal inflammation and scarring; autoimmune disease

Front 188

Q188. clinical presentation of primary biliary cirrhosis

Back 188

A188. middle aged women with autoimmune disease; fatigue; pruritis; RUQ pain

Front 189

Q189. dx of primary biliary cirrhosis

Back 189

A189. Positive AMA; cholestatic liver function tests; elevated alkaline phosphatase; liver biopsy to confirm dx

Front 190

Q190. tx for primary biliary cirrhosis

Back 190

A190. urodeoxycholic acid slows the progression and relieves symptom; liver transplant is curative

Front 191

Q191. pathogenesis of primary sclerosing cholangitis

Back 191

A191. thickening of bile duct walls and narrowing of their lumens

Front 192

Q192. clinical presentation of primary sclerosing cholangitis

Back 192

A192. patient with ulcerative colitis, pruritis, and jaundice

Front 193

Q193. dx of primary sclerosing cholangitis

Back 193

A193. ERCP shows bead like strictures and dilations of intra and extra hepatic ducts

Front 194

Q194. tx of primary sclerosing cholangitis

Back 194

A194. ERCP + stent placement to relieve symptom; liver transplant is curative

Front 195

Q195. complications of primary sclerosing cholangitis

Back 195

A195. cholangiocarcinoma; recurrent cholangitis; portal HTN; liver failure

Front 196

Q196. pathogenesis of cholangiocarcinoma

Back 196

A196. tumor of extra or intrahepatic bile ducts; primary sclerosing cholangitis is a major risk factor

Front 197

Q197. clinical presentation of cholangiocarcinoma

Back 197

A197. 60 yo with obstruction jaundice and weight loss

Front 198

Q198. dx of cholangiocarcinoma

Back 198

A198. ERCP

Front 199

Q199. tx of cholangiocarcinoma

Back 199

A199. most tumors are unresectable; ERCP + stent placement can relieve symptoms

Front 200

Q200. complications of cirrhosis

Back 200

A200. portal HTN; hepatocellular failure

Front 201

Q201. 2 most common causes of cirrhosis

Back 201

A201. alcohol use; chronic hepatitis b and c

Front 202

Q202. clinical features of portal HTN

Back 202

A202. bleeding from varices - most life threatening; hemorrhoids; caput medusae

Front 203

Q203. tx of portal HTN

Back 203

A203. tips (transjugular intrahepatic portal systemic shunt) to lower portal pressure

Front 204

Q204. what is the most common type of varices from portal HTN

Back 204

A204. esophageal (90%) gastric (10%)

Front 205

Q205. acute tx of varices

Back 205

A205. hemodynamic stabilization (plus fluids); ligation/banding; endoscopy sclerotherapy; octreotide

Front 206

Q206. long-term treatment of varices

Back 206

A206. beta blocker to prevent rebleeding

Front 207

Q207. etiologies of ascites

Back 207

A207. increased portal HTN (hydrostatic pressure increased); decreased albumin concentration (decreases oncotic pressure)

Front 208

Q208. how to differentiate the causes of ascites

Back 208

A208. calculate the SAAG; if >1.1, then from portal HTN,; if <1.1, then from hypoalbumin state

Front 209

Q209. tx for ascites

Back 209

A209. bed rest, low sodium diet, and diuretics

Front 210

Q210. pathophysiology of hepatic encephalopahthy

Back 210

A210. ammonia accumulates because the liver is unable to detoxify it

Front 211

Q211. clinical presentation of hepatic encephalopathy

Back 211

A211. asterixis; fetor hepaticus

Front 212

Q212. treatment of hepatic encephalopathy

Back 212

A212. decreased protein diet; lactulose; neomycin (last resort) to decrease bacteria that produce ammonia

Front 213

Q213. pathophysiology of hepatorenal syndrome

Back 213

A213. decreased renal perfusion because RAAS gets activated from decreased BP in splanchnic circulation, so there is peripheral vasoconstriction --> poor renal perfusion

Front 214

Q214. clinical features of hepatorenal syndrome

Back 214

A214. azotemia; oliguria; hyponatremia; hypotension; low urine sodium

Front 215

Q215. tx for hepatorenal syndrome

Back 215

A215. octreotide + midodrine: palliative; liver transplant is the only cure

Front 216

Q216. pathophysiology of spontaneous bacterial peritonitis

Back 216

A216. portal HTN increases --> gut hypomotility, and bacterial overgrowth; bv become more permeable and bacteria enter mesenteric ln and then enter blood stream; ascites fluid becomes infected

Front 217

Q217. organisms usually involved with spontaneous bacterial peritonitis

Back 217

A217. usually monomicrobial (e coli, klebsiela, strep pneumo)

Front 218

Q218. dx of spontaneous bacterial peritonitis

Back 218

A218. pnml >250; ascites cx

Front 219

Q219. tx of spontaneous bacterial peritonitis

Back 219

A219. iv antibiotics

Front 220

Q220. complications of spontaneous bacterial peritonitis

Back 220

A220. hepatic abscess; hepatorenal syndrome; intestinal obstruction

Front 221

Q221. pathophysiology of Wilson’s disease

Back 221

A221. copper is normally excreted by the liver, but in Wilson’s disease, there is a ceruloplasmin deficiency (required for excretion) so cu builds up; cu accumulates in hepatocytes, causing them to die and release cu into plasma and accumulate in kidney, cornea, and brain

Front 222

Q222. clinical features of wilson's disease

Back 222

A222. hepatitis; cirrhosis; fulminant hepatic failure; kayser'-fleischer rings; extrapyramidal signs; psych disturbances (depression, neurosis, psychosis, personality changes)

Front 223

Q223. dx of wilson's disease

Back 223

A223. elevated aminotransferases; low ceruloplasmin levels; liver biopsy shows elevated cu

Front 224

Q224. tx for wilson's disease

Back 224

A224. chelating agents (penacillamidene - removes and detoxifies cu deposits); Zn (prevents dietary uptake of cu); liver transplant

Front 225

Q225. pathophysiology of hemochromatosis

Back 225

A225. excessive Fe absorption in intestines --> Fe accumulation

Front 226

Q226. organs affected by hemochromatosis

Back 226

A226. liver; pancreas; skin; heart; joints

Front 227

Q227. clinical features of hemochromatosis

Back 227

A227. liver disease; fatigue; arthritis; abdominal pain; cardiac arrhythmias

Front 228

Q228. complications of hemochromatosis

Back 228

A228. cirrhosis; cmp; arthritis; DM; bronzing of the skin

Front 229

Q229. dx of hemochromatosis

Back 229

A229. liver biopsy required for dx

Front 230

Q230. pathogenesis of appendicitis

Back 230

A230. lumen of appendix is most commonly blocked by hyperplasia of lymphoid tissue or fecalith; obstruction --> stasis --> bacterial overgrowth and inflammation

Front 231

Q231. pathogenesis of ruptured appendix

Back 231

A231. distension of appendix can compromise blood supply and can lead to infarction or necrosis; necrosis --> perforation and peritonitis

Front 232

Q232. imaging to dx appendicitis

Back 232

A232. CT most sensitive and specific; Ultrasound

Front 233

Q233. pregnant woman with suspected appendicitis

Back 233

A233. surgery despite risk of false positive because risks are too severe

Front 234

Q234. most common site for carcinoid tumor

Back 234

A234. appendix

Front 235

Q235. location of carcinoid tumor if it is malignant

Back 235

A235. ileal tumor

Front 236

Q236. pathogenesis of acute pancreatitis

Back 236

A236. inflammation of pancreas from autodigestion of the pancreas

Front 237

Q237. causes of acute pancreatitis

Back 237

A237. GET SMASHeD; Gallstones; EtOH; Trauma; Steroids; Mumps; Autoimmune disease; Scorpion; Hypercalcemia, Hyperlipidemia; Drugs

Front 238

Q238. which is more specific in acute pancreatitis: amylase or lipase

Back 238

A238. lipase

Front 239

Q239. what is the purpose of liver function tests in acute pancreatitis

Back 239

A239. to ID cause (esp if related to gallstones)

Front 240

Q240. role of abdominal radiographs in acute pancreatitis

Back 240

A240. used to rule out other dx; calcifications suggests chronic pancreatitis; can sometimes see sentinel loop (air filled bowel in LUQ that demonstrates localized ileus)

Front 241

Q241. role of u/s in acute pancreatitis

Back 241

A241. to ID gallstones; can be used to follow pseudocyst or abscess

Front 242

Q242. which is the test of choice for dx of acute pancreatitis

Back 242

A242. ct

Front 243

Q243. indication for ERCP in acute pancreatitis

Back 243

A243. if it is from severe gallstone pancreatitis with biliary obstruction; to id uncommon causes of acute pancreatitis if disease is recurrent

Front 244

Q244. pathogenesis of pancreatic pseudocyst

Back 244

A244. localized collection of necrotic hemorrhagic material rich in pancreatic enzymes; it lacks and epithelial lining

Front 245

Q245. complications of untreated pseudocysts

Back 245

A245. rupture infection, gastric outlet obstruction, fisual, hemorrhage and pancreatic ascites

Front 246

Q246. dx of pancreatic pseudocyst

Back 246

A246. CT

Front 247

Q247. tx of pancreatic pseudocyst

Back 247

A247. <5cm, observation; >5cm, drain

Front 248

Q248. complications of acute pancreatitis

Back 248

A248. pancreatic necrosis; pancreatic pseudocyst; hemorrhagic pancreatitis; ARDS; pancreatic ascites; pleural effusion; ascending cholangitis; pancreatic abscess

Front 249

Q249. tx of acute pancreatitis

Back 249

A249. NPO; IVF; pain control

Front 250

Q250. pathogenesis of chronic pancreatitis

Back 250

A250. continuing inflammation of pancreas, with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic ducts --> irreversible destruction of pancreas

Front 251

Q251. most common cause of chronic pancreatitis

Back 251

A251. chronic alcoholism

Front 252

Q252. presentation of chronic pancreatitis

Back 252

A252. chronic epigastric pain + calcifications on plain abdominal films; steatorrhea, DM, and pancreatic calcifications

Front 253

Q253. serum and amylase levels in chronic pancreatitis

Back 253

A253. not elevated

Front 254

Q254. appearance of chronic pancreatitis on ct

Back 254

A254. calcifications and pseudocysts an be seen

Front 255

Q255. appearance of chronic pancreatitis on ERCP

Back 255

A255. chain of lakes appearance from areas of stricture and duct dilation throughout the pancreatic ducts

Front 256

Q256. complications of chronic pancreatitis

Back 256

A256. DM; narcotic addiction; malabsorption/steatorrhea; pseudocyst formation; pancreatic ductal dilation; b12 malabsorption; pancreatic carcinoma

Front 257

Q257. non surgical tx for chronic pancreatitis

Back 257

A257. narcotics for pain; NPO; pancreatic enzymes + h2 blockers; insulin; alcohol abstinence; frequent small low-fat meals

Front 258

Q258. surgical tx for chronic pancreatitis

Back 258

A258. pancreaticojejunostomy (drains the pancreatic ducts to decompress dilated ducts); pancreatic resection

Front 259

Q259. most common location for pancreatic cancer

Back 259

A259. pancreatic head

Front 260

Q260. risk factors for pancreatic cancer

Back 260

A260. cigarette smoking (most common); chronic pancreatitis; DM; heavy Etoh use; exposure to benzidine and b-naphthylamine

Front 261

Q261. purpose of h2 blockers + pancreatic enzymes in chronic pancreatitis

Back 261

A261. pancreatic enzymes inhibit CCK release and decrease pancreatic secretion after meals; h2 blockers inhibit gastric acid secretion, preventing degradation of pancreatic enzyme supplements by gastric acid

Front 262

Q262. test for dx pancreatic ca

Back 262

A262. CT; ERCP

Front 263

Q263. tumor markers for pancreatic ca

Back 263

A263. ca 19-9; CEA

Front 264

Q264. Definition: Gluten-induced enteropathy in susceptible persons affecting the small bowel

Back 264

A264. Celiac Sprue

Front 265

Q265. What HLA is Celiac sprue?; (2)

Back 265

A265. HLA DR3; HLA DQw2

Front 266

Q266. Dx: Malabsorption (diarrhea, bloating, abd pain, steatorrhea, weight loss), vitamin deficiency (high PT/INR, low iron and calcium), Rash

Back 266

A266. Celiac sprue

Front 267

Q267. Pathology Biopsy of small bowel: flattened intestinal villi, infiltration of lymphocytes, hyperplasia and lengthing of the intestinal crypts

Back 267

A267. Celiac sprue

Front 268

Q268. what does Antiendomysial Ab test?; What other test accompanies this one?; When is it performed?; What is the most accurate test for this Dx?

Back 268

A268. Confirms Dx of Celiac Sprue; (also Antigliadin Ab test); Performed: After a Sudan Black stain confirms Malabsorption; Most Accurate: Small Bowel Biopsy; (must be done to Dx the disease and to RULE OUT Lymphoma)

Front 269

Q269. Definition: A pruitic rash associated with Celiac sprue, responds to Tx of topical Sulfone, resolves with regression of disease

Back 269

A269. Dermatitis Herpetiformis

Front 270

Q270. Tx for Celiac sprue

Back 270

A270. All grains are eliminated from diet except Rice and Corn; (no wheat rye or barley)

Front 271

Q271. *Patient has chronic pale, greasy, malodorous diarrhea and no evidence of infection. Initial test?

Back 271

A271. Sudan Black stain

Front 272

Q272. Pathology Biopsy: mildly flattened intestinal villi with jejunal infiltration of monocytes

Back 272

A272. Tropical sprue

Front 273

Q273. Dx: malabsorption signs, megaloblastic anemia, decreased calcium, B-12, iron, folic acid, cholesterol, albumin and magnesium

Back 273

A273. Tropical sprue

Front 274

Q274. Tx for Tropical sprue; (2)

Back 274

A274. Vitamin B-12 and Folate supplements; Tetracycline (for a few months)

Front 275

Q275. Difference b/t Whipple's disease and Sprue

Back 275

A275. Whipple's has CNS involvement

Front 276

Q276. If there is the presence of a normal jejunal Biopsy, what malabsorption disease is ruled-out?

Back 276

A276. Tropical sprue

Front 277

Q277. Dx: 54-yo farmer who has been suffering with diarrhea, weight loss, and arthralgias for the past few months is brought in by his wife for memory deficits that have been occurring for the past 3 weeks.

Back 277

A277. Whipple's disease

Front 278

Q278. Definition: devastatingly profound malabsorption syndrome due to destruction of the intestinal lamina due to a gram- negative rod of the Actinomyces genus

Back 278

A278. Whipple's Disease

Front 279

Q279. Dx: arthralgia, abdominal pain, malabsorption, fever, inc skin pigment, uveitis, confusion, CNS palsies, nystagmus, heart failure

Back 279

A279. Whipple's Disease

Front 280

Q280. *Most accurate test for Whipple's Disease; Other test?

Back 280

A280. Most accurate: PAS positive macrophages in the lamina propria;; other: PCR of peripheral blood for T. whippelii (Actinomyces strain)

Front 281

Q281. Antibiotics Tx of Whipple's Disease; (2 steps)

Back 281

A281. 1. initial course of Ceftriaxone; 2. TMP-SMZ and Tetracycline for 1 year

Front 282

Q282. Definition: Albumin lost to the GI lumen in excess

Back 282

A282. Protein-losing Enteropathy

Front 283

Q283. Dx: Diarrhea, edema, steatorrhea, low albumin

Back 283

A283. Protein-losing Enteropathy

Front 284

Q284. Dx test for Protein-losing Enteropathy

Back 284

A284. Alpha-1-Antitrypsin comparison in serum vs stool

Front 285

Q285. Similar look to gastric cancer on barium study

Back 285

A285. Menetrier's Disease

Front 286

Q286. Definition: Protein-losing enteropathy that causes mucosal thickening due to hyperplasia of glandular cells replacing chief and parietal cells leading to enlarged, tortuous rugae

Back 286

A286. Menetrier's Disease

Front 287

Q287. Dx: epigastric pain, diarrhea, edema, steatorrhea, decreased gastric acid secretion, low albumin

Back 287

A287. Menetrier's Disease

Front 288

Q288. Dx Tests for Menetrier's Disease; (2)

Back 288

A288. Endoscopy with deep mucosal Biopsy; Barium swallow will reveal large gastric folds

Front 289

Q289. Rx Tx for Menetrier's Disease; (2 plus MOA of each specific to this)

Back 289

A289. Anticholinergics (reduce width of tight junctions b/t gastric mucosal cells); H-2 Blockers (reduce protein loss)

Front 290

Q290. Definition: Stool frequency < 3 times per week

Back 290

A290. Constipation

Front 291

Q291. Etiology of Constipation; (6)*

Back 291

A291. OLD MD Farts:; Obstruction;; Low thyroid(hypothyroidism);; Disturbed colonic motility;; Medications;; DM;; Fluid and fiber intake is low

Front 292

Q292. what amount should you increase your fiber to, if your are constipated?

Back 292

A292. 30 g/day

Front 293

Q293. Definition: Neuroendocrine tumor arising from ectodermal stem cells in the gut

Back 293

A293. Carcinoid Tumor

Front 294

Q294. MC place of a Carcinoid tumor

Back 294

A294. 90% in Ileum; (most in appendix)

Front 295

Q295. What neurotransmitters and hormones does the Carcinoid tumor secrete?; (3)

Back 295

A295. Serotonin;; Bradykinin;; Histamine

Front 296

Q296. MC places of mets with Carcinoid tumor; (2: in order of frequency)

Back 296

A296. Liver;; Lung

Front 297

Q297. Etiology of Carcinoid tumor; (2)

Back 297

A297. Most are Idiopathic;; part of MEN-1

Front 298

Q298. Classic triad of Carcinoid tumor and reason for each sign. (3) other signs

Back 298

A298. 1. Flushing, Hypotension - Bradykinin; 2. Diarrhea - Serotonin; 3. Rt-sided Valvular heart Disease - Serotonin other:; Wheezing (histamine);; Bowel obstruction;; Appendicitis

Front 299

Q299. Dx test for Carcinoid tumor; (2)

Back 299

A299. 1. > 10mg/24 hour 5-HIAA; 2. elevated serum and urine 5-HT

Front 300

Q300. Tx for Carcinoid tumor; (3)

Back 300

A300. Surgical excision;; Radiation therapy;; Antihormonal therapy

Front 301

Q301. What is a 72-hour Fecal Fat test?; When is the only time it is used?

Back 301

A301. 72-hour FFT: Detects Intestinal Malabsorption; Only used: if you strongly suspect fat malabsorption and the Sudan Black stain is negative (best initial test for fat malabsorption is Sudan Black stain)

Front 302

Q302. Type of GI cancer in the:; 1. Espophagus (2); 2. Duodenum and Jejunum; 3. Ileum (3)

Back 302

A302. Esophagus: Squamous and Adenocarcinoma; Duodenum and Jejunum: Adenocarcinoma; Ileum: Carcinoid, Lipoma and Lymphoma

Front 303

Q303. Definition: Aquired condition of the colon in which sac-like protrusions of colonic mucosa herniate through a defect in the muscular layer

Back 303

A303. Diverticulosis

Front 304

Q304. MCC of massive GI bleed in patients over 60-yo

Back 304

A304. Diverticulosis

Front 305

Q305. Dx: painless rectal bleeding; underlying Cause?

Back 305

A305. Diverticulosis; inflammed diverticula erodes thru a colonic artery usually on RIGHT side

Front 306

Q306. what is the non-Rx Tx for Diverticulosis?; if refractory?

Back 306

A306. Bleeding scan and embolization;; Refractory: Surical removal

Front 307

Q307. Difference b/t True and False Diverticula; which is more common?; on the right side (ascending colon)?

Back 307

A307. True: herniation involving the full bowel wall thickness (right side and tend to bleed); False: only mucosal herniation thru muscular wall (more common)

Front 308

Q308. Dx: LLQ pain, fever, high WBC, possible sigmoid mass

Back 308

A308. Diverticulitis

Front 309

Q309. Dx test for diverticulitis; What test should never be done?

Back 309

A309. Abdominal CT; Never do Colonoscopy (risk of perforation)

Front 310

Q310. Tx for Diverticulitis; (3 hospital management and 2 sets of choices for Antibiotics Tx)

Back 310

A310. NPO, IV fluids, Pain control;; Antibiotics: FQ and Metronidazole; or Clindamycin and Gentamicin

Front 311

Q311. MC fistula associated with Diverticular Disease; how does it present?

Back 311

A311. Colovesicular; (presents with recurrent UTI)

Front 312

Q312. MCC of nosocomial pseudomembranous colitis

Back 312

A312. C. difficile

Front 313

Q313. Dx: Crampy, diffuse abdominal pain, fever, watery (occasionally bloody) diarrhea; recent URI

Back 313

A313. Pseudomembranous Colitis

Front 314

Q314. Dx: 68-yo man in the hospital for 3 weeks for pneumonia returns with new-onset diarrhea

Back 314

A314. C. difficile induced; Pseudomembranous Colitis

Front 315

Q315. When is the only time Vancomycin is given PO?; What is the other Tx for this problem?

Back 315

A315. Pseudomembranous colitis; also Tx with: Metronidazole PO

Front 316

Q316. Dx tests for Pseudomembranous Colitis; (3)

Back 316

A316. C. difficile toxin in stool;; Fecal Leukocytes;; Sigmoidoscopy (yellowish membranous plaques adhering to mucosa)

Front 317

Q317. Dx: fluctuating constipation and diarrhea, increased with stress, lack of systemic symptoms

Back 317

A317. Irritable Bowel syndrome

Front 318

Q318. Tx for IBS; (2 together)

Back 318

A318. 1. High-fiber / Low-fat diet;; 2. Antispasmotic / Antidiarrheal

Front 319

Q319. What (2) Dx must be ruled-out when giving a Dx of IBS, because they present similarly?

Back 319

A319. Giardia infection; Lactose intolerance

Front 320

Q320. Between ULCERATIVE COLITIS and Crohn's, which is:; 1. More common in Men; 2. More common in women; 3. Greater risk for Colon CA

Back 320

A320. 1. CD; 2. UC; 3. UC

Front 321

Q321. What unusual topical Tx is there for Inflammatory Bowel Disease to improve Symptoms?

Back 321

A321. Nicotine dermal patch

Front 322

Q322. IBD: Inflammation of mucosa only

Back 322

A322. UC

Front 323

Q323. IBD: bloody diarrhea, rectal pain, more acute flares

Back 323

A323. UC

Front 324

Q324. IBD: tender RLQ mass, more chronic

Back 324

A324. CD

Front 325

Q325. IBD: Inflammation involves all bowel layers

Back 325

A325. CD

Front 326

Q326. IBD: Leads to fistulas, abscesses and involves granulomas

Back 326

A326. CD

Front 327

Q327. IBD: "Lead-pipe colon"

Back 327

A327. UC

Front 328

Q328. IBD: "Cobblestone appearance"

Back 328

A328. CD

Front 329

Q329. IBD: complications include perforation, stricture and megacolon

Back 329

A329. UC

Front 330

Q330. IBD: complications include abscess, fistula, perianal disease

Back 330

A330. CD

Front 331

Q331. (2) Drugs to Tx IBD that contain 5-ASA and Sulfapyridine; Which is also used to Tx Rheumatoid Arthritis?; Which only works in the colon?; Which works in the small bowel if taken orally,but need to be given by enema if needed for colon?

Back 331

A331. Sulfasalazine: only in colon (also Tx: RA); Mesalamine: oral for small bowel and enema for colon

Front 332

Q332. Tx for Inflammatory Bowel Disease; (5)*

Back 332

A332. Inflam SCAM:; Immunomodulators;; Sulfsalazine;; Corticosteroids;; Antibiotics (Metronidazole);; Mesalamine

Front 333

Q333. Which drug class for IBD works better for UC?

Back 333

A333. Corticosteroids

Front 334

Q334. Antibiotics Tx for Crohn's Disease

Back 334

A334. Metronidazole

Front 335

Q335. Immunomodulators used in Tx of Crohn's Disease; (4)*; Which is for severe cases?; Which (2) are purine analogs?

Back 335

A335. MIA-6:; Methotrexate;; Infliximab (severe cases);; Azathioprine (purine);; 6-Mercaptopurine (purine)

Front 336

Q336. What type of precursor to colon cancer is the worst?

Back 336

A336. Villous Polyps; (Villous are the Villains)

Front 337

Q337. Place of Colon CA: signs of anemia: pallor, weakness; possible dull abdominal pain

Back 337

A337. Right Colon

Front 338

Q338. Place of Colon CA: pencil-thin stools, rectal bleeding, constipation, vomiting

Back 338

A338. Left Colon

Front 339

Q339. What is the next step if you fecal occult blood test is positive?

Back 339

A339. Colonoscopy

Front 340

Q340. At what age should annual rectal exams begin?; Fecal occult blood test?; Flexible sigmoidoscopy or colonoscopy?; What if there is a family member with a History of colon cancer?

Back 340

A340. Annual Rectals: 40 years-old; FOBT: 50 years-old; Sigmoidoscopy / Colonoscopy:beginning at 50 years-old, for every 3-5 years; History of Colon CA: at 40yo or 10 years earlier then the family member's Dx (whichever is earlier)

Front 341

Q341. Dx: 70-yo woman presents with microcytic anemia, weight loss, and a vague abdominal pain that is not related to food or time of day

Back 341

A341. Colorectal CA

Front 342

Q342. Dx lab test findings for Colon CA; (3)

Back 342

A342. Anemia (iron deficiency);; elevated CEA;; Check LFTs (inc may indicate Mets)

Front 343

Q343. What type of colon polyp is benign?; Which (2) have malignant potential?

Back 343

A343. Benign: Tubular; Malignant potential: Villious; Tubulovillous

Front 344

Q344. What is done if a polyp is found on colonoscopy?; when is the colonoscopy repeated?

Back 344

A344. perform a polypectomy/Biopsy; repeat colonoscopy: 3 years

Front 345

Q345. In Endocarditis, which two bugs are assoc with Colon CA?

Back 345

A345. Strep Bovis;; Clostridium Septicum

Front 346

Q346. Duke's Classification of Staging and Prognosis for Colon CA; (A-D and 5-year survival percent)

Back 346

A346. A: Confined to Mucosa and Submucosa - >80%; B: Invasion of Muscularis propria - 60%; C: Local node involvement - 20%; D: Distant Mets - 3%

Front 347

Q347. First step in Tx for Colon Cancer; Next?; What Dx would lead to Radiation therapy?

Back 347

A347. 1. Surgical resection (cures 50% in stage A and B);; 2. Chemotherapy;; Radiation only for Rectal involvement

Front 348

Q348. Drug regimen for Colon Cancer; (2 plus one of 2 more)

Back 348

A348. 5-FU and Levimasole (stage B and higher); plus: Oxaliplatinum or Irinotecan

Front 349

Q349. Hereditary Colon CA Syndromes; (4)*; which is the only low-moderate risk (the rest being high risk)?

Back 349

A349. Family Has Growing Polyps:; Familial Polyposis Coli;; Hereditary Non-polyposis Colon CA;; Gardner's Syndrome;; Peutz-Jeghers Syndrome (low risk)

Front 350

Q350. Definition: thousands of adenomatous polyps appear throughout the colon by age 25 and cancer hits by 40-yo. What are the genetics?

Back 350

A350. Familial Polyposis Coli; Autosomal Dominant

Front 351

Q351. Definition: condition in which 3 or more relatives of a patient and at least one first-degree relative, develops colon cancer at an early age; What are the genetics?; When and How often should a colonoscopy be performed on this individual or his/her offspring?

Back 351

A351. Hereditary Non-Polyposis Colon CA; Autosomal Dominant; Colonoscopy: Start at age 25; repeat every 1 - 2 years

Front 352

Q352. Definition: disorder characterized by polyposis coli, supernumerary teeth, osteomas and fibrous displasia of the skull and mandible; What are the genetics?

Back 352

A352. Gardner's syndrome; Autosomal Dominant

Front 353

Q353. Definition: multiple polyposis of the small intestine with multiple pigmented melanin macules in the oral mucosa or presents with freckles on lips; What other cancer is it assoc with?

Back 353

A353. Puetz-Jeghers syndrome; assoc with: GYN Cancer

Front 354

Q354. Definition: Polyposis with medulloblastoma or glioma

Back 354

A354. Turcot's syndrome

Front 355

Q355. MC complaint or presentation of Colon CA

Back 355

A355. Intermittent Rectal Bleeding

Front 356

Q356. Order of steps for resuscitation in the general approach to GI bleeds; (6)

Back 356

A356. 1. Establish IV with (2) large-bore IV caths; 2. Evaluate for Hemodynamic instability (hypotension, tachycardia); 3. Type and cross, CBC, coag study; 4. IV fluid and blood; 5. Vasopressors if BP does not respond to aggressive fluid; 6. GI and Surgical evaluation

Front 357

Q357. *When do you answer: Capsule Endoscopy?

Back 357

A357. Procedure of choice for suspected small bowel bleeding not detected in upper or lower endoscopy

Front 358

Q358. How may UGI bleeds present?; (4)

Back 358

A358. Hematemesis;; Coffee ground emesis;; Melena;; Hematochezia (BRBPR)

Front 359

Q359. How may a LGI bleed present?; (2)

Back 359

A359. Hematochezia (BRBPR);; Melena

Front 360

Q360. Etiology of UGI bleed; (5)*

Back 360

A360. Mallory's Vices Gave (her) An Ulcer:; Mallory-Weiss tear;; Varices;; Gastritis;; Arteriovenous Malformation;; Ulcer (peptic)

Front 361

Q361. Dx tests for UGI or LGI (same tests); (6)

Back 361

A361. Gastric Lavage;; Rectal exam;; CBC;; Endoscopy;; Bleeding scan;; Arteriography

Front 362

Q362. Test that detects active bleeding by infusing a radioactive colloid and watching it collect in the GI; When is this the correct answer?

Back 362

A362. Bleeding Scan; correct: Next step in patient with severe GI bleeding in whom the lower endoscopy is unable to find the source.

Front 363

Q363. Etiology of LGI bleed; (6)*

Back 363

A363. Can U Cure Aunt Di's Hemorrhoids?; Cancer or Polyps;; Upper GI bleed (Rule-out);; Colitis;; Angiodysplasia;; Diverticulosis;; Hemorrhoids

Front 364

Q364. What class (and drug example) of anti-diarrheal agents is contraindicated in diarrhea that is due to infectious agents?; Why?

Back 364

A364. Opiates (Loperamide); because they promote longer contact time b/t bacteria and intestinal mucosa

Front 365

Q365. By asking the Quantity of diarrhea, how can it help with the Diff Dx in relation to site of problem?

Back 365

A365. Small bowel: Large-volume, Watery diarrhea; Large Bowel: Small-volume diarrhea

Front 366

Q366. Bugs that cause Bloody Diarrhea; (5)*

Back 366

A366. CASES:; Campylobacter;; Amoeba (E. Histolytica);; Shigella;; E.coli;; Salmonella

Front 367

Q367. What is acute (<2 weeks) of diarrhea usually due to?

Back 367

A367. Infectious etiology

Front 368

Q368. What should the stool be tested for if infectious diarrhea is suspected?; (4); which must be done with 3 different bowel movements over 3 days?

Back 368

A368. Leukocytes;; Ova and Parasites (over 3 days);; C. Difficile;; Culture

Front 369

Q369. Bug Dx: patient vomits within 6 hours of eating something with mayonnaise

Back 369

A369. Staphylococcus

Front 370

Q370. Bug Dx: patient has vomiting/diarrhea after eating reheated rice from leftover Chinese food

Back 370

A370. Bacillus Cereus

Front 371

Q371. Bug Dx: patient has vomiting and severe watery diarrhea after eating shellfish

Back 371

A371. Vibrio Cholera

Front 372

Q372. Bug Dx: patient has flatulence and foul-smelling diarrhea after a camping trip; Tx?

Back 372

A372. Giardia Lamblia; Tx: Metronidazole

Front 373

Q373. Bug Dx: patient has watery diarrhea following a recent course of Antibiotics; Tx? (2)

Back 373

A373. C. Difficile; Tx: Oral Metronidazole or Vancomycin

Front 374

Q374. Bug Dx: causes diarrhea from contaminated water in third- world countries

Back 374

A374. Vibrio Cholera

Front 375

Q375. Bug Dx: causes diarrhea and is assoc with Guillian-Barre syndrome

Back 375

A375. Campylobacter

Front 376

Q376. Bug Dx: causes diarrhea and is assoc with raw eggs

Back 376

A376. Salmonella

Front 377

Q377. Bug Dx: causes diarrhea and is common in AIDS patient

Back 377

A377. Cryptosporidium

Front 378

Q378. Basic Tx for all acute diarrhea. (2); If it is due to bacteria, what is added to Tx? (2 possible); If it is Parasitic?

Back 378

A378. All Acute Diarrhea:; 1. Rehydration and Electrolyte replacement;; 2. Anti-motility agent (AMA only if not infectious diarrhea) Bacteria:; 1. Ciprofloxacin;; 2. Bactrim (TMP-SMX) Parasite: Flagyl (Metronidazole)

Front 379

Q379. (3) viral causes of Acute Diarrhea

Back 379

A379. Rotavirus;; Norwalk virus;; CMV

Front 380

Q380. (5)* Classes for the etiology of Chronic Diarrhea

Back 380

A380. Something Old Died In Me:; Secretory;; Osmotic;; Decreased transit;; Inflammatory;; Malabsorption

Front 381

Q381. If fecal pH is < 5.5, what does it suggest the cause of diarrhea is?

Back 381

A381. Carbohydrate Malabsorption

Front 382

Q382. *What is a D-Xylose Test?; What (3) diseases make it abnormal?

Back 382

A382. D-Xylose: Test for chronic diarrhea that helps distinguish b/t malabsorption and Chronic Pancreatitis. Low levels in Urine = problem with small bowel mucosal transport. Abnormal results in:; 1. Celiac Disease; 2. Tropical Sprue; 3. Whipple's Disease

Front 383

Q383. How is the Osmotic gap determined for diarrhea (equation)?; what do the results indicate?

Back 383

A383. OG = 290 - 2(Na + K); > 50 mOsm = Osmotic component; < 50 mOsm = Secretory (or other cause)

Front 384

Q384. What would a 24-hour fasting help distinguish b/t with regards to chronic diarrhea?

Back 384

A384. Osmotic Diarrhea - resolves with fasting; Secretory Diarrhea - does not resolve with fasting

Front 385

Q385. diagnostic test for ppl w + fobt

Back 385

A385. COLONOSCOPY

Front 386

Q386. most common site of distant spread in colorectal cancer

Back 386

A386. liver

Front 387

Q387. what type of polyps are considered to have malignant potential

Back 387

A387. adenomatous polyps (villous > tubular)

Front 388

Q388. features of familial polyposis syndrome

Back 388

A388. autosomal dominant; hundreds of adenomatous polyps in colon; colon always involved, duodenum usually (90%) involved

Front 389

Q389. tx for familial polyposis syndrome

Back 389

A389. prophylactic colectomy

Front 390

Q390. clinical features of gardner's syndrome

Back 390

A390. autosomal recessive; polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts; 100% risk of colon ca

Front 391

Q391. clinical features of turcot's syndrome

Back 391

A391. autosomal recessive; polyps + cerebellar medulloblastoma or gbm

Front 392

Q392. peutz-jeghers

Back 392

A392. single or multiple hamartomas scattered through gi tract (mostly in small bowel and colon); pigmented spots around lips and oral mucosa, genitalia, palmar surfaces; low malignant potential

Front 393

Q393. complications of peutz-jeghers

Back 393

A393. intussusception or bleeding

Front 394

Q394. familial juvenile polyposis coli

Back 394

A394. rare, small risk for colorectal cancer

Front 395

Q395. hereditary noNPOlyposis colorectal cancer

Back 395

A395. no adenomatous polyps; lynch syndrome 1 and 2; early onset colorectal cancer and other cancers

Front 396

Q396. #1 cause of colon obstruction in adults

Back 396

A396. colorectal cancer

Front 397

Q397. most life threatening presentation of colorectal cancer

Back 397

A397. colonic perforation

Front 398

Q398. presentation of a right sided colon tumor

Back 398

A398. obstruction not commonly seen (lumen is wider on right); change in bowel habits is rare; MELENA is most common type of bleed

Front 399

Q399. presentation of left sided colon tumor

Back 399

A399. smaller lumen diameter, so can present with obstruction, alternating constipation and diarrhea; narrowing of stools; HEMATOCHEZIA

Front 400

Q400. which side of colon is melena more common in?; hematochezia?

Back 400

A400. right; left

Front 401

Q401. most common presentation of rectal cancer

Back 401

A401. hematochezia

Front 402

Q402. when should CEA levels be obtained in colorectal cancer

Back 402

A402. before surgery

Front 403

Q403. use of radiation tx in colorectal cancer

Back 403

A403. used in rectal ca but not in colon ca

Front 404

Q404. frequency of colonoscopies in patients with history of colorectal cancer

Back 404

A404. colonoscopy at 1 yr, then q3y

Front 405

Q405. in addition to colonoscopy, what other f/u is required in patients with colorectal cancer

Back 405

A405. CT scan of abdomen and pelvic; CXR; do these for up to 5 yrs; check CEA q 3-6 months

Front 406

Q406. recurrence rate of colorectal cancer

Back 406

A406. 90% within 3 yrs of surgery

Front 407

Q407. what types of polyps are associated with UC

Back 407

A407. pseudopolyps

Front 408

Q408. pathogenesis of diverticuli

Back 408

A408. outpouching at area of weakness in colon wall, which is at the site of a bv penetration --> bleeding

Front 409

Q409. risk factors for diverticulosis

Back 409

A409. constipation increases intralumenal pressure; family history

Front 410

Q410. #1 location of diverticuli

Back 410

A410. sigmoid colon

Front 411

Q411. test of choice for diverticulosis

Back 411

A411. barium enema

Front 412

Q412. tx of diverticulosis

Back 412

A412. high fiber food to increase stool bulk psyllium

Front 413

Q413. complications of diverticulosis

Back 413

A413. painless rectal bleeding; diverticulitis

Front 414

Q414. complications of diverticulitis

Back 414

A414. bowel obstruction; fistula; abscess

Front 415

Q415. how to manage bleeding in diverticulosis

Back 415

A415. usually stops on its own - no tx for these patients; if it continues, then colonoscopy should be performed to locate site of bleeding, if persistent or recurrent, surgery may be needed

Front 416

Q416. dx of diverticulitis

Back 416

A416. ct abdomen and pelvis; abdominal XR to rule out other causes, ileus, obstruction, and perforation

Front 417

Q417. tx of diverticulitis for first episode

Back 417

A417. NPO; antibiotics; surgery may be necessary if persists x 3-4 days

Front 418

Q418. examples of angiodysplasia of the colon

Back 418

A418. AV malformation; vascular ectasia

Front 419

Q419. dx of angiodysplasia of the colon

Back 419

A419. colonoscopy

Front 420

Q420. tx of angiodysplasia of the colon

Back 420

A420. colonoscopic coagulation; if bleeding persists, right hemicolectomy (cecum is most common location)

Front 421

Q421. types of acute mesenteric ischemia; which is most common

Back 421

A421. arterial embolism *; venous thrombosis (rarest); arterial thrombosis; nonoclusive mesenteric ischemia

Front 422

Q422. random association with angiodysplasia of the colon

Back 422

A422. aortic stenosis

Front 423

Q423. clinical history of patient with mesenteric arterial thrombosis

Back 423

A423. patients with history of atherosclerotic disease at other sites; acute occlusion occurs over preexisting atherosclerotic disease (acute event can be a decrease in CO or plaque rupture); collateral circulation has usually developed; SYMPTOMS are gradual and less severe than embolic causes

Front 424

Q424. clinical history of a patient with nonocclusive mesenteric ischemia

Back 424

A424. splanchnic vasoconstriction secondary to low CO; typically seen in elderly

Front 425

Q425. overall mortality of all causes of acute mesenteric ischemia

Back 425

A425. 60%

Front 426

Q426. presentation of patient with venous thrombosis as a cause for mesenteric ischemia

Back 426

A426. symptoms may be present for several days or weeks with gradual worsening

Front 427

Q427. clinical feature of acute mesenteric ischemia

Back 427

A427. severe abdominal pain disproportionate to physical findings

Front 428

Q428. complications of acute mesenteric ischemia

Back 428

A428. peritonitis; sepsis; shock

Front 429

Q429. dx of acute mesenteric ischemia

Back 429

A429. mesenteric angiography; plain film of abdomen to rule out other causes

Front 430

Q430. tx of acute mesenteric ischemia

Back 430

A430. IVF; broad spectrum antibiotics; papaverine (vasodilator) into superior mesenteric artery during arteriograph to relieve occlusion and vasospasm; direct infusion of thromboloytics in patients with embolism; heparin for venous thrombosis

Front 431

Q431. signs of intestinal infarction

Back 431

A431. hypotension, tachycardia, tachypnea, lactic acidosis, fever, change in ms, shock; CHECK LACTATE LEVEL

Front 432

Q432. causes of chronic mesenteric ischemia

Back 432

A432. atherosclerotic occlusive disease of celial artery and sma, ima

Front 433

Q433. symptoms of chronic mesenteric ischemia

Back 433

A433. abdominal angina (postprandially)

Front 434

Q434. tx of chronic mesenteric ischemia

Back 434

A434. surgical revasularization

Front 435

Q435. tx of ogilvie's syndrome

Back 435

A435. decompression with gentle enemas or ng suction; if not, colonoscopic decompression; surgical decompression is last resort

Front 436

Q436. complication of pseudomembranous colitis

Back 436

A436. toxic megacolon with risk of perforation; amasarca; electrolyte disturbances

Front 437

Q437. tx of pseudomembranous colitis

Back 437

A437. metronidazole; (oral vancomycin if metronidazole is contraindicated - infants and pregnancy)

Front 438

Q438. most common cause of upper GI bleeding

Back 438

A438. pud (duodenal ulcer, gastric ulcer, gastritis)

Front 439

Q439. pertinent history in a patient with aorticoenteric fistula

Back 439

A439. distant history of aortic graft surgery, in a patient with a small GI bleed, involving the duodenum; massive, fatal hemorrhage occurs hours to weeks later

Front 440

Q440. tx of aortoenteric fistula

Back 440

A440. endoscopy or surgery

Front 441

Q441. where is the bleeding from? test to order?; hematemesis

Back 441

A441. Upper GI; endoscopy

Front 442

Q442. where is the bleeding from? test to order?; hematochezia

Back 442

A442. Lower GI; first rule out hemorrhoids; colonoscopy

Front 443

Q443. where is the bleeding from? test to order?; melena

Back 443

A443. Upper GI or right side of colon; do endoscopy first, if negative, do colonoscopy

Front 444

Q444. where is the bleeding from? test to order?; occult blood

Back 444

A444. Lower GI; colonoscopy; upper endoscopy if colonoscopy is -

Front 445

Q445. type of pain: vague, dull, poorly localized, usually midline due to bilateral innervation of organs based on embryologic origin

Back 445

A445. Visceral Pain; (Visceral is Vague); ex: early appendicitis

Front 446

Q446. type of Pain: sharp, well-localized and involves the peritoneum and is associated with rebound and guarding

Back 446

A446. Parietal Pain (Parietal is PiNPOint); ex: late appendicitis

Front 447

Q447. Referred pain: Ureteral obstruction in man

Back 447

A447. Ipsilateral testicle

Front 448

Q448. Dx: 45-yo obese woman complains of fever, RUQ pain and nausea that worsens when she eats fatty foods

Back 448

A448. Cholecystitis

Front 449

Q449. Diff Dx: Epigastric Pain; GI (3); Pancreatic (2); Aortic (2); Cardiac (3)

Back 449

A449. Gastritis; Peptic Ulcer; GERD; Acute/Chronic Pancreatitis; Ruptured Aortic Aneurysm; Dissecting Aorta; Angina, MI, Pericarditis

Front 450

Q450. Diff Dx: RUQ Pain; Hepatobiliary (4); GI (1)

Back 450

A450. Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis; Peptic Ulcer

Front 451

Q451. Diff Dx: LUQ Pain; Splenic (5); GI (1)

Back 451

A451. Spleen trauma; infarction; abscess; rupture; Mononucleosis; Gastric Ulcer

Front 452

Q452. Diff Dx: RLQ Pain; GI (3)

Back 452

A452. Small bowel obstruction;; Appendicitis;; Crohn's Disease

Front 453

Q453. Diff Dx: LLQ Pain; GI (2)

Back 453

A453. Inflammatory Bowel Disease;; Diverticulitis

Front 454

Q454. Diff Dx: Flank Pain; GU (5)

Back 454

A454. NET PP:; Nephrolithiasis;; Epididymitis;; Testicular Torsion;; Pyelonephritis;; Prostatitis

Front 455

Q455. Diff Dx Pain: Adnexal (lower abdominal) Pain; (6)

Back 455

A455. PET SOCk:; PID;; Ectopic Pregnancy;; Tubo-ovarian abscess;; Salpingitis;; Ovarian torsion;; Cystitis

Front 456

Q456. Dx: 26-yo woman has severe LLQ pain, vaginal bleeding and light-headedness. Last menstrual period was 6 weeks ago

Back 456

A456. Ectopic Pregnancy

Front 457

Q457. Diff Dx: Pain Anywhere in Abdomen; (4)

Back 457

A457. Strangulated hernia;; Large Bowel Obstruction;; Sigmoid Volvulus;; Mesenteric Ischemia

Front 458

Q458. Dx: 28-yo woman presents with diffuse abdominal pain, nausea, and confusion. She is not pregnant but takes a stained-glass class.

Back 458

A458. Lead poisoning

Front 459

Q459. Diff Dx: Abdominal wall Pain; (2)

Back 459

A459. Hernia; Rectus sheath hematoma

Front 460

Q460. Diff Dx: Metabolic/genetic-related Abdominal pain; (4)

Back 460

A460. HyperC;; Acute Intermittent Porphyria;; DKA;; Sickle cell

Front 461

Q461. Diff Dx: Viral-related Abdominal Pain; (3)

Back 461

A461. Herpes Zoster;; Mononucleosis;; HIV

Front 462

Q462. Diff Dx: Toxin-related Abdominal Pain; (2)

Back 462

A462. Heavy Metal poisoning; Black Widow Spider venom

Front 463

Q463. (3) vascular causes of abdominal pain to always consider in the elderly

Back 463

A463. MAM:; Mesenteric Ischemia;; AAA;; MI

Front 464

Q464. Diff Dx of an emergency patient with absent bowel sounds (3) or high-pitched sounds (1)

Back 464

A464. Absent: Pancreatitis;; Ischemia;; Acute Abdomen; High-pitched: Obstruction

Front 465

Q465. 63-yo obese man complains of pain in his "kidney" for 3 days. He has History of MI x 2 and no back tenderness.

Back 465

A465. AAA

Front 466

Q466. Dx: hypotension; abdominal or back pain; pulsatile mass in abdomen; History of vascular disease or atherosclerosis

Back 466

A466. AAA

Front 467

Q467. (3) Dx tests for AAA

Back 467

A467. Angiogram (gold standard); MRI or CT with contrast

Front 468

Q468. Dx: 72-yo man with History of A-fib, on digoxin and complains of severe abdominal pain out of proportion to the exam

Back 468

A468. Acute Mesenteric Ischemia

Front 469

Q469. 72-yo woman with History of MI complains of gnawing abdominal pain after eating. She lost 15 pounds in the past month.

Back 469

A469. Chronic Mesenteric Ischemia

Front 470

Q470. Cause of Acute (2) vs. Chronic Mesenteric Ischemia

Back 470

A470. Acute: Emboli (A-fib); Hypercoagulability; Chronic: Atherosclerosis

Front 471

Q471. (2) possible lab signs with Mesenteric Ischemia

Back 471

A471. Increased Lactate; Metabolic Acidosis

Front 472

Q472. Gold standard test for Mesenteric Ischemia; (2) others

Back 472

A472. Gold standard: Angiogram; others: Spiral CT with contrast, MRI

Front 473

Q473. First step for Mesenteric Ischemia; Next?

Back 473

A473. First: Maintain tissue perfusion with IV fluids until... Surgical bypass

Front 474

Q474. Cholelithiasis -; Colic results from what?; Risk factors

Back 474

A474. Colic from transient cystic duct blockage. Risk factors - female, fat, forty, fertile.

Front 475

Q475. Cholelithiasis; 3 types

Back 475

A475. 1. Cholesterol (80%) - originate from gallbladder; risk factors: obesity, rapid weight loss, Crohn's, CF, estrogens, Native Americans 2. Pigment - originate from common bile duct, calcium bilirubinate; risk factors: chronic hemolysis, biliary infections, alcohol abuse, cirrhosis 3. Mixed

Front 476

Q476. Cholelithiasis - History/PE

Back 476

A476. Postprandial abdominal pain; RUQ pain; radiates to rt. subscapular or epigastrium (can be asymptomatic); n/v; fatty food intolerance; dyspepsia; flatus; RUQ tenderness

Front 477

Q477. Cholelithiasis - Diagnosis

Back 477

A477. not XR - only 15% radiopaque; RUQ US

Front 478

Q478. Cholelithiasis - Tx

Back 478

A478. Cholecystectomy with Symptoms; ERCP - common bile duct stones; dietary modification; UDCA - if don't want surgery, effective in noncalcified cholesterol stones < 5 mm

Front 479

Q479. Cholelithasis - Complications

Back 479

A479. recurrent biliary colic; acute cholecystitis; choledocholithiasis; acute cholangitis; gallstone ileus; gallstone pancreatitis; carcinoma of the gallbladder

Front 480

Q480. Acute Cholecystitis; Results from what; Leads to what

Back 480

A480. Prolonged obstruction of cystic duct (usually stone); Distention, inflammation, infection, gangrenous, acalculous; Acalculous - in absence of cholelithiasis in TPN, trauma, burn patients.

Front 481

Q481. Acute Cholecystitis; History/PE

Back 481

A481. RUQ pain; n/v; low-grade fever; Murphy's sign

Front 482

Q482. Acute Cholecystitis; Dx

Back 482

A482. US; HIDA scan; CBC; amylase, lipase; bilirubin; LFT

Front 483

Q483. Acute Cholecystitis; Tx

Back 483

A483. IV Antibiotics; IV fluids; replete electrolytes; early cholecystectomy; preop ERCP; intraop cholangiogram

Front 484

Q484. Acute Cholecystitis; Complications

Back 484

A484. gangrene; abscess; perforation; empyema; sepsis; gallstone ileus; fistulization

Front 485

Q485. Choledocholithiasis - Results from what

Back 485

A485. gallstones in the COMMON BILIARY DUCT

Front 486

Q486. Choledocholithiasis - History/PE

Back 486

A486. biliary pain; jaundice; colic; fever; pancreatitis

Front 487

Q487. Choledocholithiasis - Dx

Back 487

A487. Increased alkaline phosphatase and total bili

Front 488

Q488. Choledocholithiasis - Tx

Back 488

A488. ERCP with stone extraction and sphincterotomy; cholecystectomy

Front 489

Q489. Acute Cholangitis; Results from what; Leads to what

Back 489

A489. Acute bacterial infection of biliary tree - from primary sclerosing cholangitis or obstruction (gallstones) as obstruction persists (usu from choledocholelith.); increased in intraluminal pressure --> reflux of bacteria to systemic circulation; Charcot's triad => Reynolds' pentad

Front 490

Q490. Acute Cholangitis; Bacteria

Back 490

A490. E Coli; Pseudomonas; Enterobacter

Front 491

Q491. Acute Cholangitis; History/PE

Back 491

A491. Charcot's triad; Reynold's pentad

Front 492

Q492. Acute Cholangitis; What is Reynold's pentad and what does it suggest

Back 492

A492. RUQ pain; jaundice; fever/chills; shock; altered mental status; suggests sepsis

Front 493

Q493. Acute Cholangitis; Dx

Back 493

A493. leukocytosis; increased alkaline phosphatase and bili; BC (to rule out sepsis); US or CT - may be useful; ERCP

Front 494

Q494. Acute Cholangitis; Tx

Back 494

A494. ICU; IV Antibiotics; IV hydration; bile duct decompression - open surgical, percutan transhepatic drain or ERCP sphincterotomy

Front 495

Q495. Diarrhea; What is it; Risk factors

Back 495

A495. > 200 gm feces/day, change in stool consistency; viral/bact. GI infection; systemic infection; sick contacts; immunosuppression; recent Antibiotics use; recent travel

Front 496

Q496. Diarrhea - What are the types (1)

Back 496

A496. Acute - < 2 wks of Symptom, infectious and self-limited, 2nd MCC - drug side effect chronic - > 2-3 wks of Symptom, disrupted secretion, malabsorption, altered motility; MCC in adults - lactase def. pediatric - usually rotavirus; can also divide as infectious, secretory, osmotic

Front 497

Q497. What are Infectious Diarrhea

Back 497

A497. - enterotoxigenic: E. coli (traveller's diarrhea); enteroinvasive: bloody diarrhea & fever; campylobacter -MC bacteria to cause diarrhea, MCC of reactive arthritis; shigella - transferred by food & water, found in daycare; salmonella - raw eggs & dairy; V. vulnificus: severe if have liver dis. Yersinia: abdominal pain, joint pain, rash, may resemble appendicitis; E. coli O157:H7, HUS; viral: MCC of infectious diarrhea

Front 498

Q498. What are secretory & osmotic diarrhea

Back 498

A498. Secretory: diarrhea > 1L; carcinoid syndrome; Zollinger-Ellison syndrome; VIPoma; phenolphthalein (laxative) osmotic - > 50 osmol/kg osmolality; lactose, fructose, sorbitol; MCC - lactase def.

Front 499

Q499. Diarrhea - Dx

Back 499

A499. - stool electrolytes - secretory vs. osmotic; fecal leukocytes – enteroinvasive, IBD; methylene blue - checks for WBC; stool Cx, O&P; giardia - string test & stool giardia Ag; cryptosporidia - modified AFB stain; NaOH - turns stool red if phenolphthalein use; colonoscopy or Biopsy

Front 500

Q500. Diarrhea - Tx

Back 500

A500. infectious - self-limited; mild - oral fluids & electrolytes; severe - IV fluids & oral Antibiotics, initial empiric- ciprofloxacin; invasive - TMP-SMX or ciprofloxacin; giardia - metro; c. diff - metro; campylobacter - erythromycin; scombroid - antihistamine; cryptosporidium - control underlying HIV with antiretrovirals

Front 501

Q501. IBS - What is it

Back 501

A501. abdominal pain; changes in bowel habits; increased with stress; relieved by BM; 1/2 of patients. have comorbid psych disorders

Front 502

Q502. IBS - History/PE

Back 502

A502. Symptoms for at least 3 mos. usually absent at night; abdominal pain; change in bowel habits; abdominal distention; stools with mucus; relief of pain with a BM

Front 503

Q503. IBS - Dx

Back 503

A503. Dx of exclusion; rule out - lactose intolerance, IBD, hypo- or hyperthyroidism; always flexible sigmoidoscopy if patient > 40 y/o

Front 504

Q504. IBS - Tx

Back 504

A504. fiber supplements; TCAs, antidiarrheals, antispasmodics; tegaserod - constipation-predominant.

Front 505

Q505. SMALL BOWEL OBSTRUCTION - History/PE

Back 505

A505. cramping - crescendo-descrendo every 5-10 min. vomiting: bilious – early, feculent - distal; partial obstruction - flatus, no stool; complete obstruction - no flatus or stool; T/D (accumulation of gas and fluid); prior surgical scars; high-pitched tinkles; peristaltic rushes; later, peristalsis disappears

Front 506

Q506. SMALL BOWEL OBSTRUCTION - Causes

Back 506

A506. adhesions from prior abdom; surgery (60%); hernias; neoplasms; intussusception; gallstone ileus; stricture from IBD; volvulus; CF

Front 507

Q507. SMALL BOWEL OBSTRUCTION - Dx

Back 507

A507. - leukocytosis - if strangulation; dehydration (vomiting); metab. alkalosis (vomiting); lactic acidosis - if necrotic bowel; need emergency surgery; radiopaque in cecum - gallstone ileus; XR - stepladder pattern; air-fluid levels

Front 508

Q508. SMALL BOWEL OBSTRUCTION - Tx

Back 508

A508. partial -, NPO, NG suction, IV hydration, correct electrolytes, Foley; surgery if complete obstruction, necrotic bowel, Symptom > 3D with no resolution; exploratory laparotomy

Front 509

Q509. Ileus; what is it; Risk factors

Back 509

A509. temp arrest of intestinal peristalsis Risk factors; recent surgery/GI procedures; immobility; hypokalemia; hypothyroidism; DM; meds (anticholinergics, opioids); After every abdominal operation for 24-48 hours Due to - sympathetic overeaction, bowel manipulation, K+ depletion (preop vomiting), peritoneal irritation from blood or peritonitis, atony of colon & stomach

Front 510

Q510. Ileus - History/PE

Back 510

A510. abdominal discomfort; n/v; no flatus or BM; abdominal distention; decreased or no bowel sounds; rectal exam if elderly to rule out fecal impaction

Front 511

Q511. Ileus - Dx

Back 511

A511. AXR - distended loops, air-fluid levels (upright); gastrografin - rule out partial obstruction; CT - rule out neoplasm

Front 512

Q512. Ileus - Tx

Back 512

A512. decrease meds that reduce; bowel motility; decrease/discont. oral feeds; NG suction; parenteral feeds; replete electrolytes

Front 513

Q513. Carcinoid Syndrome - What causes it

Back 513

A513. Carcinoid tumors; neuroendrocrine cells; enterochromaffin cells; usually from ileum, appendix

Front 514

Q514. Carcinoid Syndrome - What do they secrete

Back 514

A514. serotonin; tryptophan; tachykinin (substance P); ACTH, gastrin; secrete high levels => depletion of tryptophan => pellagra (niacin def.); levels do not get metabolized by liver due to liver mets; MC found incidentally during appendectomy

Front 515

Q515. Carcinoid Syndrome - History/PE

Back 515

A515. flushing; diarrhea; wheezing; right-sided valvular disease

Front 516

Q516. Carcinoid Syndrome - Dx

Back 516

A516. high urine levels of 5-HIAA - diagnostic; chest and abdominal CT

Front 517

Q517. Carcinoid Syndrome - Tx

Back 517

A517. octreotide (for symptoms); surgery

Front 518

Q518. Diverticular Disease - What is it

Back 518

A518. Outpouching of mucosa and submucosa that herniate in areas of high intraluminal pressure; common in sigmoid colon; MCC of acute lower GI bleeding in patients. > 40

Front 519

Q519. Diverticular Disease - Risk factors

Back 519

A519. low-fiber and high-fat diet; advanced age; connective tissue disorders (Ehlers-Danlos, Marfans)

Front 520

Q520. Diverticular Disease - History/PE

Back 520

A520. LLQ abdominal pain; abnormal bowel habits; bleeding painless and sudden; usually hematochezia; Symptom of anemia

Front 521

Q521. Diverticulitis - PE

Back 521

A521. LLQ pain; fever; n/v; perforation - complication

Front 522

Q522. Diverticular Disease - Dx

Back 522

A522. CBC (leukocytosis); AXR; colonoscopy or barium enema; avoid invasive techniques in early diverticulitis - risk of perforation; CT - check for abscess, free air after acute episode if >50 y/o; flexible sigmoidoscopy (rule out perforating colon cancer)

Front 523

Q523. Diverticular Disease - Tx for uncomplicated disease

Back 523

A523. high-fiber diet

Front 524

Q524. Diverticular Disease - Tx for bleeding

Back 524

A524. bleeding usually stops spontaneously; transfuse and hydrate; if bleeding doesn't stop - angiography with embolization; surgery

Front 525

Q525. Diverticular Disease - Tx for diverticulitis

Back 525

A525. NPO; NGT; metro and fluoroquinolone or cephalosporin if perforation - resect; anastomosis or temp colostomy

Front 526

Q526. LOWER BOWEL OBSTRUCTION - History

Back 526

A526. constipation; cramping abdominal pain; n/v; feculent vomiting; tenderness; significant distention; tympany; high-pitched tinkly BS; later, no BS

Front 527

Q527. LOWER BOWEL OBSTRUCTION - Causes

Back 527

A527. colon cancer; benign tumors; diverticulitis; volvulus; fecal impaction; assume colon ca until proven otherwise

Front 528

Q528. LOWER BOWEL OBSTRUCTION - Tx

Back 528

A528. tx obstruction with - gastrograffin enema; colonoscopy; rectal tube; surgery usually needed; tx underlying cause

Front 529

Q529. Colon and Rectal Cancer - History/PE

Back 529

A529. presents with symptom after long period of silent growth; abdominal pain and symptom based on location; right-sided lesion - stool is liquid, ca can get large before symptom, lesions commonly ulcerate => chronic blood loss, can bleed intermittently; left-sided lesion - stool more concentrated, apple-core lesions; rectal – BRBPR, rectal pain, can coexist with hemorrhoids, so rule out in all patients with rectal bleeding

Front 530

Q530. Colon and Rectal Cancer - Dx

Back 530

A530. CBC (anemia); guiac; sigmoidoscopy - left; colonoscopy/barium enema - right; US (how much invaded); CT/MRI (to stage); CXR, LFT, abdominal CT - metas

Front 531

Q531. Colon and Rectal Cancer - How does mets spread

Back 531

A531. direct; hematogenous - liver primary; lymphatic -pelvic lymph nodes

Front 532

Q532. Colon and Rectal Cancer - Tx

Back 532

A532. bowel prep - Golytely, Antibiotics; colon - resect colon, lymph, mesentery, anastomosis; rectum - if < 10cm from anal verge, abdominoperineal resection, rectum and anus resected, permanent colostomy; if > 10cm, low anterior resection, anastomosis between colon & rectum; wide local excise - low stage; also chemo - colon with nodes; also radiation - rectum; Followup with CEA, colonoscopy, LFTs, CXR, abdominal CT Duke classification; surgery - stages A&B; stages C1 & C2 - surgery and chemo, 5-FU and leucovorin

Front 533

Q533. Colon and Rectal Cancer - Risk factors

Back 533

A533. age; hereditary - FAP, Gardner's, HNPCC; APC gene, p54; Strep bovis bacteremia; family History; UC; adenomatous polyps; past History of colorectal ca; high-fat, low-fiber diet

Front 534

Q534. Colon and Rectal Cancer - Screening

Back 534

A534. DRE yearly > 50 y/o; guaiac yearly > 50 y/o; colonoscopy every 10 yrs > 50 or sigmoidoscopy every 3-5 > 50 or colonoscopy every 10 yrs > 40 with family history of ca/polyp or 10 yrs prior to age of dx of youngest family member with colorectal ca

Front 535

Q535. Dysphagia - What is it

Back 535

A535. Difficulty swallowing due to abnormalities of the oropharynx or esophagus.

Front 536

Q536. Odynophagia - What is it

Back 536

A536. Pain with swallowing due to abnormalities of the oropharynx or esophagus.

Front 537

Q537. Dysphagia; Etiologic factors; (Caused by)

Back 537

A537. Achalasia; peptic stricture; esophageal webs or rings; carcinoma; Scleroderma; spastic motility disorders; Sjogren's; meds; radiation injury

Front 538

Q538. Dysphagia - PE

Back 538

A538. examine for masses (goiter, tumor); examine for anatomical defects

Front 539

Q539. Dysphagia - Dx

Back 539

A539. oropharyngeal - cine-esophagram; esophageal - barium swallow then endoscopy, manometry, pH monitoring; odynophagia - upper endoscopy

Front 540

Q540. Dysphagia; Tx; Tx for Achalasia

Back 540

A540. Etiology dependent; achalasia - botulinum toxin, calcium channel blockers, balloon dilatation; all 3 temporizing measures; esophageal myotomy for long-term tx

Front 541

Q541. Esophageal Cancer - What is it

Back 541

A541. squamous cell ca – midesophagus from smoking and alcohol, can develop fistulas to bronchi; adenocarcinoma - barrett's esophagus, columnar metaplasia replaces squamous distal esophagus, secondary to chronic GERD

Front 542

Q542. Esophageal Cancer - Risk factors

Back 542

A542. achalasia; barrett's; cigarettes; etoh; webs; male gender

Front 543

Q543. Esophageal Cancer - History/PE

Back 543

A543. progressive dysphagia - first solids then liquids; weight loss; GERD; GI bleeding; vomiting

Front 544

Q544. Esophageal Cancer - Dx

Back 544

A544. barium swallow 1st; EGD; biopsy – confirm; (MRI/CT - evaluate for mets)

Front 545

Q545. Esophageal Cancer - Tx

Back 545

A545. surgery if local; metastatic - cisplatin, 5-FU & radiation; chemoradiation - poor prognosis; esophageal stent - palliation

Front 546

Q546. GERD - What is it

Back 546

A546. transient LES relaxation from; incompetent LES; gastroparesis; hiatal hernia

Front 547

Q547. GERD - Risk factors

Back 547

A547. increased intra-abdominal pressure (obesity, pregnancy); scleroderma; alcohol; caffeine; nicotine; chocolate; fatty foods

Front 548

Q548. GERD - History/PE

Back 548

A548. heartburn 30-90 min post meal; pain worse with reclining; pain better with antacids,; sitting, standing; sour taste ("water brash")

Front 549

Q549. GERD - Dx

Back 549

A549. Based largely on History; confirm - respond to Tx; 24hr pH monitor- gold standard; Bernstein test - confirms origin of pain

Front 550

Q550. GERD - Tx

Back 550

A550. - lifestyle - weight loss, head-of-bed elevation, stop eating 3 hrs before bed, eat small meals; monitor for barretts/adenoca, serial EGD, Biopsy; antacids - if intermittent; H2 blockers and PPI; surgery - nissen fundoplication

Front 551

Q551. GERD - Complications

Back 551

A551. esophageal ulceration; esophageal stricture; aspiration of gastric content; upper GI bleeding; Barrett's - when to do EGD, no dysplasia - every 2-5 yrs. low-grade - every 3-6 mos. high-grade - resection

Front 552

Q552. Hiatal Hernia - What are types

Back 552

A552. sliding - gastroesophageal junction and part of stomach above diaphragm due to weakening of anchors of ge junction to diaphragm, longitudinal contractions of diaphragm increased intra-abdominal pressure; paraesophageal - ge junction below diaphragm, part of fundus herniates

Front 553

Q553. Hiatal Hernia - History/PE

Back 553

A553. May be asymptomatic; with sliding, may have GERD

Front 554

Q554. Hiatal Hernia - Dx

Back 554

A554. CXR (incidental finding); barium swallow; EGD

Front 555

Q555. Hiatal Hernia - Tx

Back 555

A555. sliding - lifestyle changes; paraesoph - gastropexy

Front 556

Q556. Gastritis - What are types

Back 556

A556. Erosive (acute) - rapidly developing conditions that erode mucosa, NSAIDs, alcohol, H pylori, stress from severe illness (burns, CNS injury); hemorrhagic gastritis; alkaline gastritis; reflux gastritis chronic; type A - (10%), autoab to parietal cells, pernicious anemia, achlorhydria, increased risk of gastric ca. fundus, G cells in antrum, G cells make gastrin, gastrin stim acid secretion => hypergastrinemia; type B - (90%), H pylori, increased risk of gastric ca, antrum

Front 557

Q557. Gastritis - History/PE

Back 557

A557. may be asymptomatic; n/v; indigestion; hematemesis; melena

Front 558

Q558. Gastritis - Dx

Back 558

A558. Upper endoscopy; Type B - must confirm H. pylori, antral Biopsy - gold standard, CLO test, urease breath test, serum IgG – ELISA to confirm or rule out; only shows exposure (H pylori stool Ag)

Front 559

Q559. Gastritis - Tx

Back 559

A559. Erosive - same as for PUD; type A - need B12 for life; type B - must eradicate H. py; Decreased offending agents; antacids; sucralfate; H2 blockers; PPIs; triple therapy to tx H pylori infection: clarithromycin, amoxicillin (or metro), PPI; quadruple therapy: bismuth, metro, tetracycline, PPI or H2 blocker

Front 560

Q560. Gastric Ca - What are the types

Back 560

A560. 2 types of adenocarcinoma; intestinal: metaplasia of mucosa by intestinal-type cells, ulcerates, pyloric antrum & lesser curvature, high in Japan, risk factors - diet high in nitrites, salt, low veggies, H pylori, chronic gastritis; diffuse - younger patients, develop throughout stomach, linitis plastica - poorer prognosis

Front 561

Q561. Gastric Ca - History/PE

Back 561

A561. advanced cases:; abdominal pain; early satiety; weight loss; 5-yr survival < 10%; mets - Virchow's node, Krukenberg's tumor, Sister Mary Joseph nodule

Front 562

Q562. Gastric Ca - Dx

Back 562

A562. early - asymp, superficial,; surgically curable; endoscopy

Front 563

Q563. Gastric Ca - Tx

Back 563

A563. must have early detection and removal of tumor

Front 564

Q564. PUD - What are types

Back 564

A564. Gastric: pain greater with meals, weight loss, H pylori 70%, NSAIDs decreased mucosal protection; duodenal: pain init. decreased with food or antacids, worsens in 2-3 hrs, can radiate to back, nocturnal pain, 100% H pylori, increased acid secretion

Front 565

Q565. PUD - Risk factors

Back 565

A565. duodenal - O blood type, men, MEN I, other risk factors – corticosteroids, NSAIDs, alcohol, tobacco, Curling ulcers, Cushing ulcers; corrosives – acids, strong alkali (lye, NaOH)

Front 566

Q566. PUD - History/PE

Back 566

A566. nausea; hematemesis; coffee-ground emesis; melena or hematochezia; epigastric tenderness; if acute perforation - rebound tenderness, guarding; NSAID-associated -, GI hemorrhage & perforation; gastric - n/v, don't improve with antacids & H2-blockers; duodenal - no n/v, wake up in middle of night

Front 567

Q567. PUD - Dx

Back 567

A567. Upper endoscopy with Biopsy or barium swallow; then must test for H pylori - invasive: culture, histology, urease; noninvasive: urease breath test, serum IgG, stool Ag test

Front 568

Q568. PUD - Tx

Back 568

A568. For H. pylori - 2 wks of combination Tx; 2 Antibiotics and bismuth, H2 blocker or PPI: BMT (bismuth, metro and tetracycline); Prevpac (2 Antibiotics & PPI) - prepacked; Helidac (2 Antibiotics & bismuth) - prepacked; for NSAID-induced - H2 blocker or PPI; misoprostol - for prevention

Front 569

Q569. PUD - Complications

Back 569

A569. "HOPI"; Hemorrhage - posterior ulcers erode into gastroduodenal artery; obstruction (gastric outlet); perforation - anterior ulcer; intractable pain; long-term effects of H. pylori; PUD; MALT; chronic superficial gastritis; chronic atrophic gastritis => cancer

Front 570

Q570. ZE Syndrome - What is it

Back 570

A570. Gastrin-producing tumors; mainly in head of pancreas; can also be in duodenum, stomach or spleen; 60% are malignant => oversecretion of gastrin => high levels of HCl (from the parietal cells) => ulcers in stomach, duoden. associated with MEN I

Front 571

Q571. ZE Syndrome - History/PE

Back 571

A571. Gnawing, burning abdominal pain; n/v; diarrhea; weakness; GI bleeding; most common presentation - PUD & diarrhea or steatorrhea; if hypercalcemia - associated with MEN I

Front 572

Q572. ZE Syndrome - Dx

Back 572

A572. measure serum gastrin - increased gastrin levels; stop PPIs before testing; abnormal IV secretin confirms

Front 573

Q573. ZE Syndrome - Tx

Back 573

A573. Surgical resection if mets at presentation; (30-50%) - PPIs

Front 574

Q574. Upper GI Bleeding - History/PE

Back 574

A574. hematemesis - bright red or coffee-brown, melena; possible iron def. anemia; increased BUN; depleted volume status – tachy, light-headedness, orthostatic hypotension

Front 575

Q575. Upper GI Bleeding - Dx

Back 575

A575. NGT and lavage; endoscopy - 1st test; clinical History

Front 576

Q576. Upper GI Bleeding - Common Causes

Back 576

A576. gastritis; PUD; Mallory-Weiss tear; esophageal varices; vascular abnormalities; neoplasm; esophagitis; gastric erosions

Front 577

Q577. Upper GI Bleeding - Initial Tx

Back 577

A577. protect airway (intubation); IV fluids; transfusion

Front 578

Q578. Upper GI Bleeding - Long-term management

Back 578

A578. tx underlying cause; PUD - IV PPI; endoscopic tx for varices - bipolar electrocoagulation, injection therapy, octreotide, sclerotherapy, band ligation

Front 579

Q579. Lower GI Bleeding - History/PE

Back 579

A579. hematochezia > melena

Front 580

Q580. Lower GI Bleeding - Dx

Back 580

A580. anoscopy,; flexible sigmoidoscopy or colonoscopy; bleeding scan; NG lavage negative, rule out upper GI bleed - if pos. stool and neg. colonoscopy

Front 581

Q581. Lower GI Bleeding - Common Causes

Back 581

A581. diverticulosis- MCC in elderly; hemorrhoids - MCC in young; angiodysplasia (AVM); neoplasm; IBD; anorectal disease; mesenteric ischemia; Meckel's; infectious

Front 582

Q582. Lower GI Bleeding - Initial Tx

Back 582

A582. protect airway (intubation); IV fluids; transfusion

Front 583

Q583. Lower GI Bleeding - Long-term management

Back 583

A583. endoscopic therapy: bipolar electrocoagulation, injection therapy; angiography; surgery

Front 584

Q584. ULCERATIVE COLITIS; Prevalence; Site of involvement

Back 584

A584. Prevalence higher than Crohn's; bimodal; starts at rectum then upwards; continuous mucosa and submucosa; granular mucosa; pseudopolyps

Front 585

Q585. ULCERATIVE COLITIS - History/PE

Back 585

A585. bloody diarrhea; pus; lower abdominal cramps

Front 586

Q586. ULCERATIVE COLITIS - Extraintestinal manifestations

Back 586

A586. pyoderma gangrenosum; primary sclerosing cholangitis; colorectal ca; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum

Front 587

Q587. ULCERATIVE COLITIS - Dx

Back 587

A587. CBC; AXR; stool cultures; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx

Front 588

Q588. ULCERATIVE COLITIS - Tx

Back 588

A588. sulfasalazine; 5-ASA (mesalamine); corticosteroids; immunosuppressants; total colectomy

Front 589

Q589. Crohn's; Distribution; Site of involvement

Back 589

A589. Bimodal; any portion of GI tract; usually terminal ileum,; small intestine and colon; cobblestone (skip) lesions; transmural

Front 590

Q590. Crohn's - History/PE

Back 590

A590. watery diarrhea (most common); (bloody diarrhea only if rectum involved); abdominal pain; fistulas beteween bowel & bladder or bowel & skin; noncaseating granulomas

Front 591

Q591. Crohn's - Extraintestinal manifestations

Back 591

A591. pyoderma gangrenosum; primary sclerosing cholangitis; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum; *nephrolithiasis*

Front 592

Q592. Crohn's - Dx

Back 592

A592. CBC; AXR; stool culture; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx

Front 593

Q593. Crohn's - Tx

Back 593

A593. mesalamine; sulfasalazine not as effective; corticosteroids; immunosuppressants - 6-mercaptopurine, azathioprine; infliximab; metro - for fistulas; resection; may recur anywhere in GI tract (after resection)

Front 594

Q594. Inguinal Hernia - Types

Back 594

A594. Indirect – congenital, patent processus vaginalis, internal inguinal ring => external inguinal ring => scrotum, Most common type for both genders; Direct - through floor of Hesselbach's triangle, goes direct thru abdominal wall in aponeurosis of ext. obliq, acquired defect in transversalis fascia, increased with age

Front 595

Q595. Inguinal Hernia - What is Hesselbach's triangle

Back 595

A595. inferior epigastric artery; inguinal ligament; rectus abdominis

Front 596

Q596. Inguinal Hernia - Tx

Back 596

A596. Surgery; Direct - also correct defect in transversalis fascia; Indirect - ligate hernia sac, reduce size of internal inguinal ring

Front 597

Q597. Portal Hypertension - Definition

Back 597

A597. Portal vein pressure > 5 mmHg greater than the pressure in the IVC

Front 598

Q598. Portal Hypertension - Causes

Back 598

A598. Presinusoidal - splenic or portal vein thrombosis, schistosomiasis, granulomatous disease; Sinusoidal – cirrhosis, granulomatous disease; Postsinusoidal – RHF, constrictive pericarditis, Budd-Chiari syndrome, hepatic vein thrombosis

Front 599

Q599. Budd-Chiari Syndrome - Definition

Back 599

A599. thrombotic occlusion of IVC or hepatic vein; centrilobular congestion and necrosis => congestive liver disease (hepatomegaly, ascites, abdominal pain, liver failure); from PCV, pregnancy & hepatocellular ca

Front 600

Q600. Portal Hypertension - History/PE

Back 600

A600. History – jaundice, ascites, esophageal varices, hemorrhoids, caput medusa, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction; PE - icteric sclerae, abdominal fluid wave, shifting dullness, splenomegaly, easy bruising, spider angioma, caput medusa, palmar erythema, gynecomastia, testicular atophy

Front 601

Q601. Portal Hypertension - Dx

Back 601

A601. LFTs; alkaline phosphatase; bilirubin; albumin; PT/PTT; serum ferritin; ceruloplasmin; a1-antitrypsin; US; increased indirect hepatic vein wedge pressure; SAAG

Front 602

Q602. Portal Hypertension; What is SAAG; SAAG > 1.1; SAAG < 1.1

Back 602

A602. serum-ascites albumin gradient: serum albumin-ascitic albumin; SAAG > 1.1: portal HTN - increased pressure in portal v., chronic liver dis., hepatic mets; SAAG < 1.1: noNPOrtal HTN - nephrotic syndrome, TB, malignancy

Front 603

Q603. Portal Hypertension - Tx for ascites

Back 603

A603. restrict Na; diuretics; rule out infection & neoplasms; paracentesis - to get SAAG, CBC, cultures; tx underlying liver disease

Front 604

Q604. Portal Hypertension; Tx for spontaneous; bacterial peritonitis

Back 604

A604. Indolent infection of ascitic fluid; pos. if > 250 PMNs/ml or > 500 WBC, Culture and gram stain usually neg., IV 3rd gen. cephalosporin (covers Enterococcus, E. Coli or Klebsiella)

Front 605

Q605. Portal Hypertension - Tx for hepatorenal syndrome

Back 605

A605. Dx of exclusion; Hard to tx; Often requires dialysis

Front 606

Q606. Portal Hypertension - Tx for hepatic encephalopathy

Back 606

A606. Decreased protein consumption; lactulose; metronidazole

Front 607

Q607. Portal Hypertension - Tx for esophageal varices

Back 607

A607. Monitor for GI bleeding; B blockers; band ligation; sclerotherapy; or portocaval shunt

Front 608

Q608. Hepatocellular Ca - Risk factors for primary

Back 608

A608. US - cirrhosis; chronic HBV or HCV; worldwide - HBV, HCV, aflatoxin

Front 609

Q609. Hepatocellular Ca - History/PE

Back 609

A609. RUQ tenderness; abdominal distention; hepatomegaly; signs of chronic liver dis. – jaundice, easy bruisability, coagulopathy, nodular cirrhotic liver

Front 610

Q610. Hepatocellular Ca - Dx

Back 610

A610. US; CT; increased LFTs; significantly increased AFP; Biopsy - definitive Dx

Front 611

Q611. Hepatocellular Ca - Tx

Back 611

A611. early detection – resection or orthotopic liver transplant; neoadjuvant therapy - chemo and radiation to shrink large tumor before surgery; serial AFP - monitor recurrence

Front 612

Q612. Hemochromatosis - What is it

Back 612

A612. increased in int. iron absorption => too much deposited, accums in skin, pancreas, liver, heart, joints, kidney, pituitary, gonads, adrenals; primary - auto recessive; secondary - chronic transfusions, alcoholics

Front 613

Q613. Hemochromatosis - History/PE

Back 613

A613. DM; hypogonadism; arthritis; CHF; restrictive cardiomyopathy; cirrhosis; adrenal insufficiency; hypothyroidism, hypoparathyr. abdominal pain

Front 614

Q614. Hemochromatosis - Dx

Back 614

A614. Increased serum iron; increased % iron saturation; increased ferritin; decreased serum transferrin; fasting transferrin saturation > 45%; glucose intolerance; increased AST; increased alkaline phosphatase; liver Biopsy; MRI; C282Y mutation; hepatic iron index > 2.0

Front 615

Q615. Hemochromatosis - Tx

Back 615

A615. weekly phlebotomy (1-2 yrs.), then maintenance phlebotomy, every 2-4 months; deferoxamine (maintenance); liver transplant cures

Front 616

Q616. Hemochromatosis - Complications

Back 616

A616. cirrhosis; hepatocellular ca; cardiomegaly; CHF; DM; impotence; arthropathy; hypopituitarism

Front 617

Q617. Wilson's Disease - What is it

Back 617

A617. Hepatolenticular degeneration; Decreased synthesis of ceruloplasmin => too much copper deposited in liver, brain, cornea; auto recessive (chrom 13); usually presents 15-25 y/o

Front 618

Q618. Wilson's Disease - History

Back 618

A618. ABCD; asterixis; basal ganglia degenerates; ceruloplasmin decreased; copper deposited; cirrhosis => hepatocellular ca; choreiform movements (tremor); corneal deposits; dementia; 1st sign - neuro or psych; kayser-fleischer rings always accompany neuro or psych

Front 619

Q619. Wilson's Disease - PE

Back 619

A619. Kayser-Fleischer rings - copper in Descemet's membrane; jaundice; hepatomegaly; asterixis; choreiform movements

Front 620

Q620. Wilson's Disease - Dx

Back 620

A620. decreased serum ceruloplasmin; increased urinary copper excretion; elevated hepatic copper

Front 621

Q621. Wilson's Disease - Tx

Back 621

A621. dietary copper restriction; no shellfish, liver, legume; penicillamine (urine excretes); oral zinc (fecal excretion); cured by liver transplant

Front 622

Q622. Acute Pancreatitis - What is it

Back 622

A622. Leakage of pancreatic enzymes into pancreatic and peripancreatic tissue.

Front 623

Q623. Acute Pancreatitis - Risk factors

Back 623

A623. GET SMASHeD; gallstones; ethanol; trauma; steroids; mumps; autoimmune dis. scorpion sting; hyperlipidemia; hypercalcemia; drugs (thiazide)

Front 624

Q624. Acute Pancreatitis - History/PE

Back 624

A624. Severe epigastric pain; radiates to the back; cullen's (periumbilical); grey-turner (flank)

Front 625

Q625. Acute Pancreatitis - Dx

Back 625

A625. Increased amylase - but amylase can read normal if hypertriglyceridemia; increased lipase - more specific; decreased calcium (fat necrosis); "sentinel loop" on AXR; "colon cutoff" on AXR; US or CT - enlarged pancreas, pseudocysts, abscess, hemorrhage, necrosis

Front 626

Q626. Acute Pancreatitis - Tx

Back 626

A626. IV fluids; electolyte replacement; analgesia; NPO; NG suction; nutritional support; O2; if necrotizing - IV Antibiotics, respiratory support, surgical debridement; ERCP - if stone in COMMON BILIARY DUCT; debridement - if necrosis; CT-guided drainage – abscess, pseudocyst > 5cm lasts > 1 mo.

Front 627

Q627. Acute Pancreatitis - Complications

Back 627

A627. pseudocyst; fistulas; hypocalcemia; renal failure; pleural effusion; sepsis; chronic pancreatitis; splenic vein thrombosis; mortality - Ranson's criteria

Front 628

Q628. Acute Pancreatitis - Ranson's Criteria

Back 628

A628. GA LAW - On Admission:; Glucose > 200 mg/dl; Age > 55 yrs. LDH > 350 IU/L; AST > 250 IU/dl; WBC > 16,000/ml C HOBBS - After 48 hours:; Ca2+ < 8.0 mg/dl; Hct decreased by > 10%; O2 PaO2 < 60 mmHg; Base excess > 4 mEq/l; BUN increased > 5 mg/dl; Sequestered fluid > 6L; Mortality risk - 20% with 3-4 signs, 40% with 5-6 signs, 100% with > 7 signs

Front 629

Q629. Chronic Pancreatitis - What is it

Back 629

A629. recurrent attacks of acute => irreversible destruction => pancreatic dysfunction

Front 630

Q630. Chronic Pancreatitis - Risk factors

Back 630

A630. alcoholism (90%); gallstones; hyperparathyroidism; idiopathic; congenital - pancreas divisum, CF

Front 631

Q631. Chronic Pancreatitis - History/PE

Back 631

A631. recurrent episodes of :; persistent epigastric pain; steatorrhea; weight loss; nausea; diabetes

Front 632

Q632. Chronic Pancreatitis - Dx

Back 632

A632. Abdominal XR - calcifications; low trypsin; amylase and lipase - normal; secretin stimulation test - most sensitive; glycosuria; mild ileus on AXR and CT ("chain of lakes")

Front 633

Q633. Chronic Pancreatitis - Tx

Back 633

A633. Pancreatic enzymes replaced; med-chain triglycerides in diet; decreased fat intake; vitamins; analgesics; Puestow procedure; stop alcohol; celiac nerve block; surgery for -, intractable pain, structural causes

Front 634

Q634. Chronic Pancreatitis - Complications

Back 634

A634. chronic pain; pancreatic cancer

Front 635

Q635. Pancreatic Cancer - What is it

Back 635

A635. pancreatic head adenocarcinoma; prognosis 6 mos. or less; usually metastasis at presentation

Front 636

Q636. Pancreatic Cancer - Risk factors

Back 636

A636. smoking; chronic pancreatitis; high-fat diet; long-standing DM

Front 637

Q637. Pancreatic Cancer - History/PE

Back 637

A637. abdominal pain radiates to back; painless jaundice; loss of appetite; n/v; weight loss; Courvoisier's sign - palpable NT gallbladder; Trousseau's sign - migratory thrombophlebitis

Front 638

Q638. Pancreatic Cancer - Dx

Back 638

A638. CT; US; ERCP

Front 639

Q639. Pancreatic Cancer - Tx

Back 639

A639. Palliative; Whipple – pancreaticoduodenectomy, if no evidence of mets (10-20%); chemo - 5-FU, gemcitabine

Front 640

Q640. Jaundice; What is it; Causes

Back 640

A640. excess bilirubin in blood; pathological in adults from overload, damage to liver, inability to excrete causes; congenital (Gilbert's, Dubin-Johnson, Crigler-Najjar); hemolytic anemia; hepatitis; alcoholic cirrhosis; obstruction; pancreatic ca

Front 641

Q641. Hepatitis - History/PE

Back 641

A641. Acute Viral:; incubation period - virus multiplies & spreads, no Symptoms; prodromal period – anorexia, malaise, n/v, fever, RUQ pain, joint pain (occasionally), 3-10 days- urine darkens; icteric phase – jaundice, systemic Symptoms regress, patient feels better despite worsening jaundice, liver enlarged and tender, jaundice peaks 1-2 wks, then fades; acute usu resolves spontan in 4-8 weeks Chronic hepatitis: lasts > 6 mos. many patients asymp - esp. HCV; malaise, anorexia; jaundice - usu absent, scleral icterus; tender hepatomegaly, splenomegaly, lymphadenopathy, spider nevi, palmar erythema; autoimmune - can involve any body sys

Front 642

Q642. Chronic Hepatitis - Etiologies

Back 642

A642. HCV (80% with HCV progress); HBV (10%, cum or sin HDV prog); autoimmune hepatitis; alcoholic hepatitis; nonalcoholic steatohepatitis; right-sided heart failure; Wilson's; hemochromatosis; a1-antitrypsin deficiency; neoplasm; drug-induced disease – INH, methyldopa, acetaminophen, nitrofurantoin

Front 643

Q643. Hepatitis - Dx

Back 643

A643. WBC - normal count, relative leukocytosis; very high ALT and AST; high bilirubin; high alkaline phosphatase; hypoalbuminemia (chronic); hepatitis serology; severe cases - PT prolonged (all clotting factors except factor VIII made by liver); Biopsy; autoimmune – ANA, anti-LKM1 antibody, anti-smooth muscle antibody, antimitochondrial antibody

Front 644

Q644. Hepatitis - Tx

Back 644

A644. Etiology specific; monitor for resolution of Symptom; severe alcoholic - steroids; autoimmune -, steroids, azathioprine; chronic HBV - IFN-a, lamivudine (3TC), adefovir; chronic HCV – peginterferon, IFN-B, ribavirin; end-stage liver failure - liver transplant; fulminant hepatic failure – ICU, emergent transplant

Front 645

Q645. Hepatitis - Complications

Back 645

A645. Cirrhosis; liver failure; hepatocellular ca; mortality in 5 yrs (50%)

Front 646

Q646. Hepatitis - IgM HAVAb

Back 646

A646. IgM Ab to HAV - best test to detect active hepatitis A

Front 647

Q647. Hepatitis - HBsAg

Back 647

A647. Ag on surface of HBV; continued presence indicates carrier state

Front 648

Q648. Hepatitis - HBsAb

Back 648

A648. Ab to HBsAg; provides immunity to hep B

Front 649

Q649. Hepatitis - HBcAg

Back 649

A649. Ag associated with the core of HBV

Front 650

Q650. Hepatitis - HBcAb

Back 650

A650. Ab to HBcAg; positive during window period; indicator of recent disease

Front 651

Q651. Hepatitis - HBeAg

Back 651

A651. A second, different antigenic; determinant in the HBV core; important indicator of transmissibility (BEware)

Front 652

Q652. Hepatitis - HBeAb

Back 652

A652. Ab to e antigen; indicates low transmissibility

Front 653

Q653. Infectious Diarrhea; Campylobacter; History

Back 653

A653. Most common etiology of infectious diarrhea; Ingestion of contaminated food or water; Affects young kids and young adults; Usually last 7-10 days

Front 654

Q654. Infectious Diarrhea; Campylobacter; PE

Back 654

A654. Fecal RBCs and WBCs

Front 655

Q655. Infectious Diarrhea; Campylobacter; Comments

Back 655

A655. Rule out appendicitis and IBD

Front 656

Q656. Infectious Diarrhea; Campylobacter; Tx

Back 656

A656. Erythromycin

Front 657

Q657. Infectious Diarrhea; C. difficile; History

Back 657

A657. Recent tx with antibiotics; cephalosporins, clindamycin; Affects hospitalized adult pt; Watch for toxic megacolon

Front 658

Q658. Infectious Diarrhea; C. difficile; PE

Back 658

A658. Fever; abdominal pain; possible systemic toxicity; Fecal RBCs and WBCs

Front 659

Q659. Infectious Diarrhea; C. difficile; Comments

Back 659

A659. Most commonly in large bowel; can involve small bowel; ID C. Diff toxin in stool

Front 660

Q660. Infectious Diarrhea; C. difficile; Tx

Back 660

A660. PO metro or vanco; IV metro if can't tolerate; oral meds

Front 661

Q661. Infectious Diarrhea; Entamoeba histolytica; History

Back 661

A661. Contaminated food or water; history of travel in dev. countries; Incubation period can last up to 3 mos.

Front 662

Q662. Infectious Diarrhea; Entamoeba histolytica; PE

Back 662

A662. Severe abdominal pain; fever; Fecal RBCs and WBCs

Front 663

Q663. Infectious Diarrhea; Entamoeba histolytica; Comments

Back 663

A663. Chronic amebic colitis; mimics IBD

Front 664

Q664. Infectious Diarrhea; Entamoeba histolytica; Tx

Back 664

A664. Steroids can lead to; fatal perforation; Tx with metro

Front 665

Q665. Infectious Diarrhea; E. Coli O157:H7; History

Back 665

A665. Contaminated food - undercooked hamburger, apple cider; Affects kids and the elderly; Usually lasts 5-10 days

Front 666

Q666. Infectious Diarrhea; E. Coli O157:H7; PE

Back 666

A666. Severe abdominal pain; low-grade fever; vomiting; Fecal RBCs and WBCs

Front 667

Q667. Infectious Diarrhea; E. Coli O157:H7; Comments

Back 667

A667. Must rule out GI bleed and ischemic colitis; HUS possible complication

Front 668

Q668. Infectious Diarrhea; E. Coli O157:H7; Tx

Back 668

A668. Avoid Antibiotics therapy; resistance has increased

Front 669

Q669. Infectious Diarrhea; Salmonella; History

Back 669

A669. Contaminated poultry or eggs; Affects young kids and; the elderly; Usually lasts 2-5 days

Front 670

Q670. Infectious Diarrhea; Salmonella; PE

Back 670

A670. Prodromal headache; fever; myalgia; abdominal pain; Fecal WBCs

Front 671

Q671. Infectious Diarrhea; Salmonella; Comments

Back 671

A671. Sepsis; Sickle cell patients susceptible to osteomyelitis

Front 672

Q672. Infectious Diarrhea; Salmonella; Tx

Back 672

A672. Tx bacteremia or at-risk patients; (sickle cell) - oral quinolone or TMP-SMX

Front 673

Q673. Infectious Diarrhea; Shigella; History

Back 673

A673. Extremely contagious; transmitted between people; Affects young kids and institutionalized patients

Front 674

Q674. Infectious Diarrhea; Shigella; PE

Back 674

A674. Fecal RBCs and WBCs

Front 675

Q675. Infectious Diarrhea; Shigella; Comments

Back 675

A675. Can => severe dehydration; Can => febrile seizures in the very young

Front 676

Q676. Infectious Diarrhea; Shigella; Tx

Back 676

A676. TMP-SMX to decreased person-to-person spread

Front 677

Q677. Achalasia; Features; Secondary Causes

Back 677

A677. Increased tone; decreased or abnormal peristalsis; decreased inhib neurons in LES smooth muscle; secondary causes – Chagas, gastric carcinoma, lymphoma, scleroderma

Front 678

Q678. Achalasia - Dx

Back 678

A678. Barium swallow - always 1st; manometry; EGD - to rule out gastric carcinoma; or lymphoma

Front 679

Q679. Achalasia - Tx

Back 679

A679. Pneumatic dilation; botulinum toxin - every 2 yrs. Ca2+ chan blockers & nitrates; surgical myotomy - definitive

Front 680

Q680. Scleroderma - Features

Back 680

A680. Mid or distal esophagus; decreased or no peristalsis; LES incompetent => GERD Symptoms; progressive dysphagia

Front 681

Q681. Scleroderma - Dx

Back 681

A681. Barium swallow 1st; motility studies

Front 682

Q682. Scleroderma - Tx

Back 682

A682. Antireflux

Front 683

Q683. Diffuse Esophageal Spasm - Features

Back 683

A683. Nonperistaltic spontaneous contractions; usually due to degeneration of nerve processes; chest pain; dysphagia

Front 684

Q684. Diffuse Esophageal Spasm - Dx

Back 684

A684. Barium swallow - "corkscrew"; manometry confirms

Front 685

Q685. Diffuse Esophageal Spasm - Tx

Back 685

A685. Ca2+ chan blockers & nitrates

Front 686

Q686. Nutcracker Esophagus - Features

Back 686

A686. Increased excitatory activities => high-amplitude contractions; chest pain; dysphagia

Front 687

Q687. Nutcracker Esophagus - Dx

Back 687

A687. Manometry

Front 688

Q688. Nutcracker Esophagus - Tx

Back 688

A688. Ca2+ chan blockers & nitrates

Front 689

Q689. Familial Polyposis Syndromes; What causes it; Three Names

Back 689

A689. Caused by adenomatous polyps which transform into cancer; AD; Familial Polyposis Coli; Gardner Syndrome; Turcot Syndrome

Front 690

Q690. Familial Polyposis Syndromes; Familial Polyposis Coli; What is it

Back 690

A690. Thousands of colonic polyps; deletion in chromosome 5; 100% malignancy if total colectomy not done

Front 691

Q691. Familial Polyposis Syndromes; Gardner Syndrome; What is it

Back 691

A691. Polyps & osteomas

Front 692

Q692. Familial Polyposis Syndromes; Turcot Syndrome; What is it

Back 692

A692. Polyps & CNS tumors

Front 693

Q693. Peutz-Jeghers Syndrome; What is it

Back 693

A693. Not malignant; hamartomatous polyps in large & small intestines; mucocutaneous pigmentation

Front 694

Q694. Juvenile Polyposis Syndrome; What is it

Back 694

A694. Not malignant; hamartomatous polyps in large & small intestines

Front 695

Q695. Hereditary NoNPOlyposis Syndrome (HNPCC); What is it

Back 695

A695. Also called Lynch Syndrome; AD; mutations of several genes; colon ca from normal mucosa; cancer History in 3 first-degree relatives, 2 generations, 1 < 5 y/o; associated with ovarian & endometrial cancer

Front 696

Q696. A1-Antitrypsin Deficiency - What is it

Back 696

A696. AR => chronic hepatitis & cirrhosis; 20% of liver dis. in neonates

Front 697

Q697. A1-Antitrypsin Deficiency - History

Back 697

A697. Asymp transaminase increased in patient with emphysema

Front 698

Q698. A1-Antitrypsin Deficiency - Dx

Back 698

A698. Electrophoresis; confirm by low serum levels

Front 699

Q699. A1-Antitrypsin Deficiency - Tx

Back 699

A699. Liver transplant cures

Front 700

Q700. NonUlcer Dyspepsia - What is it

Back 700

A700. Abdominal pain or fullness & bloating; may be postprandial; gastric acid secretion is normal; may have abnormal gastric or small intestine motility

Front 701

Q701. NonUlcer Dyspepsia - Dx

Back 701

A701. Normal EGD or barium

Front 702

Q702. Dumping Syndrome - What is it

Back 702

A702. Rapid emptying from stomach; => shift of fluids and; distention of small intestines; associated with PUD surgery

Front 703

Q703. Dumping Syndrome - History/PE

Back 703

A703. Diaphoresis; lightheaded; palpitations; n/v; 30 min. postprandial; if 90 min. postprandial - CHO- or sucrose-rich meals

Front 704

Q704. Dumping Syndrome - Dx

Back 704

A704. Clinical History

Front 705

Q705. Dumping Syndrome - Tx

Back 705

A705. Restrict sweets; frequent small meals; decreased liquid intake with meals

Front 706

Q706. What test(s) diagnose small bowel obstruction?

Back 706

A706. The most accurate test for small bowel obstruction is a combination of the abdominal X-ray and the abdominal CT scan. There is no blood test to diagnose obstruction and there are no findings on endoscopy.

Front 707

Q707. What does small bowel obstruction look like on abdominal x-ray?

Back 707

A707. There are multiple air-fluid levels seen throughout the bowel.

Front 708

Q708. When do you use abdominal X-ray?

Back 708

A708. Suspected small bowel obstruction is the only use for the abdominal X-ray. Look for a patient with abdominal pain and distension; hypoactive or absent bowel sounds, possible electrolyte abnormalities such as potassium; calcium, or magnesium disorders; and failure to pass either stool or flatus. This is normal after abdominal surgery.

Front 709

Q709. What does a barium enima do?

Back 709

A709. BE creates a "contrast" picture to outline the lining of the retum and colon. BE can be used in detecting colorectal cancers, polyps, diverticulosis, and bowel obstruction and to evaluate the extent of inflammatory bowel disease.

Front 710

Q710. When is BE contraindicated?

Back 710

A710. Patient's who may have peritonitis or bowel perforation must not undergo this test because the contrast material can leak into the peritoneum through the perforation. BE is also contraindicated in diverticulitis, in which it increases the risk of perforation.

Front 711

Q711. Compare BE and Colonoscopy if you are suspecting a lesion in the colon.

Back 711

A711. Colonoscopy is superior to enema in that it can directly biopsy lesions or remove polyps. BE is NEVER the right answer to the question, "What is the most accurate test?" if colonoscopy is one of the choices.

Front 712

Q712. What is Capsule Endoscopy?

Back 712

A712. It is a capsule the size of a large pill, with a camera and a small transmitter. Once swallowed, it begins transmitting images of the inside gastrointestinal tract to a receiver worn by the patient. The doctor can review 6 hours worth of pictures for any abnormalities.

Front 713

Q713. When do you use Capsule Endoscoopy?

Back 713

A713. Capsule endoscopy is the procedure of choice for suspected small bowel bleeding that was not detected with upper or lower endoscopy.

Front 714

Q714. What are Amylase/Lipase levels?

Back 714

A714. Amylase and lipase are the initial test in the diagnosis of acute pancreatitis. Lipase is more specific for the pancreas. Amylase can be elevated from damage to the salivary glands, esophagus, or small bowel.

Front 715

Q715. When do you answer amylase and lipase levels?

Back 715

A715. Answer amylase/lipase for a patient presenting with the acute onset of severe epigastric pain radiating to the back. Such a patient may have a history of alcohol abuse or gallstones.

Front 716

Q716. What is the most accurate test for acute pancreatitis?

Back 716

A716. Abdominal CT scan. It is more accurate than Ranson's criteria. Pancreatic necrosis on a CT scan is etremely specific for severe pancreatitis and is the main indicator of the need for a pancreatic biopsy.

Front 717

Q717. What is Antiendomysial/ Antigliadin Antibodies?

Back 717

A717. Serum assay for endomysial and antigliadin antibodies are made against wheat or gluten antigens and the villous (endomysial) lining fo the small intestine. They are used to confirm the diagnosis of celiac disease.

Front 718

Q718. When are Antiendomysial/ Antigliadin Antibodies the answer?

Back 718

A718. Look for a case of robable celiac disease with oily, greasy diarrhea, foul-smelling stool without evidence of chronic pancreatitis. they are the tests to answer to confirm gluten-sensitive enteropathy after Sudan black stain has confirmed a fat malabsorption.

Front 719

Q719. What is the most accurate test for celiac disease?

Back 719

A719. Small bowel biopsy. It must be done to exclude lymphoma as well as to diagnose the disease.

Front 720

Q720. What is the Antimitochondrial Antibodies (AMA) test for?

Back 720

A720. Serum screening for antimitochondrial antibodies is the best initial test to make a specific diagnosis of primary biliary cirrhosis (PBC).

Front 721

Q721. When do you answer AMA?

Back 721

A721. Look for a middle-aged female presenting with itching (pruritus) and an elevated alkaline phosphatase with a normal bilirubin.

Front 722

Q722. What is the most accurate test for PRIMARY BILIARY CIRRHOSIS?

Back 722

A722. Liver biopsy.

Front 723

Q723. What is anti-Smooth Muscle Antibodies?

Back 723

A723. Serum assay detection of anti-smooth muscle antibodies (ASMA) is the best initial test for atuoimmunie hepatitis.

Front 724

Q724. When do you answer ASMA?

Back 724

A724. Answer ASMA when you are shown a young female with a liver disease who does not drink or have inflammatory bowel disease or infectious hepatitis.

Front 725

Q725. What other immune markers are associates with autoimmune hepatitis?

Back 725

A725. Autoimmune hepatitis is associated with antinuclear antibodies (ANA) and antibodies to liver/kidney microsome type 1 (anti-LKM1).

Front 726

Q726. What is the most accurate test for autoimmune hepatitis?

Back 726

A726. Liver biopsy is the most accurate test for autoimmune hepatitis and most other liver diseases.

Front 727

Q727. For which clinical condition is Barium Esophagram the best initial test?

Back 727

A727. Barium esophagram is, generally, the best initial test for dysphagia. This is not in scenarios where there are clear signs of obstruction, for which upper endoscoopy would be the best initial test. For achalasia, barium esophagram shows a "bird's beak" at the gastroesophageal junction. In diffuse esophageal spasm barium esophagram shows a "corkscrew" pattern at the time of spasm.

Front 728

Q728. For which conditions is Barium Esophagram the most accurate test?

Back 728

A728. Barium esophagram is the most accurate test for esophageal rings, webs, and idverticuli.

Front 729

Q729. What is the most acurate test for abnormalities detected with a barium esophagram?

Back 729

A729. In achalasia, esophageal spasm, and nutcracker esophagus, the most accurate test is manometry. With cancer, the most accurate test is endoscopy for a biopsy.

Front 730

Q730. What is a Bernstein Test?

Back 730

A730. The Bernstein test is to diagnose gastroesophageal reflux disease.

Front 731

Q731. How is a Bernstein Test done?

Back 731

A731. The Bernstein test involves the placement of a nasogastric tube into the esophagus with the tip at the end of the esophagus near the gastroesophageal junction. Dilute hydrochloric acid is instilled or dripped into the esophagus in an attempt to reproduce the symptoms of reflux disease. This is a older test that has been made obsolete by the use of empiric trials of PPIs or the 24-hour pH monitor.

Front 732

Q732. When is a Bernstein Test the right answer?

Back 732

A732. The Bernstein test is always WRONG to do. When you see it in the answers as a diagnostic test, do not choose it.

Front 733

Q733. What is a Bleeding Scan?

Back 733

A733. The bleeding scan, or technetium-labled RBC scanning, is performed in a patient with small amounts of active lower GI bleeding in which the bleeding site could not be identified with endoscopy. B; leeding scan is sensitive, but not specific. If the bleeding scan is positive, you cannot identify the precise etiology of the bleeding. Angiography is another diagnostic option for the patint with persistent, severe GI bleeding wihtout an identified source.

Front 734

Q734. When do you answer bleeding scan?

Back 734

A734. Look for a patient who presents with severe gastrointestinal bleeding in whom the lower endoscopy is unable to find a source. The bleeding continues and the patient may still require transfusions.

Front 735

Q735. What is Ceruloplasmin?

Back 735

A735. Serum ceruloplasmin levels and the presence of Kayser- Fleischer rings on exam are the best initial tests for Wilson's disease.

Front 736

Q736. When do you answer ceruloplasmin?

Back 736

A736. Look for a patient wiht the convination of unexplained hepatic and psychiatric abnormalities with a movement disorder.

Front 737

Q737. Is a high or low value abnormal?

Back 737

A737. An exremely low serum ceruloplasmin level should be taken as strong evidence for the diagnosis of Wilson's disease.

Front 738

Q738. What additional tests would confirm the diagnosis?

Back 738

A738. Twenty-four-hour urine copper excretion will be abnormally high. The most accurate test is the liver biopsy. Wilson's disease is a disease of copper overload. this is because of the inability of the liver to incorporate copper into the protein ceruloplasmin for excretion into the bile. This leads to hepatic copper accumulation and injury. This eventually spills into the bloodstream and deposits into the brain (behavior and movement changes), kidneys (renal insufficiency), and cornea (Kayser-Fleischer rings).

Front 739

Q739. When do we use colonoscopy as a screen?

Back 739

A739. General Population: Every 10 years for patients over age 50. Colonoscopy is superior to occult blood test or simoidoscopy. Single family member with colon cancer: Start at age 40 or 10 years earlier than thefamily member's diagnosis, whichever is earlier. Hereditary non-polyposis cancer syndrome (HNPCC or Lynch syndrome): Tree family members, two generations, one prmature. Premature means the cancer was before age 50. Start at age 25 and repeat every 1-2 years.

Front 740

Q740. What is D-Xylose Test?

Back 740

A740. D-xylose testing is used in determining the etiology of different malabsorption syndromes. D-xylose is used to differentiate between intestinal malabsorption and chronic pancreatitis. Celiac disease is the most common cause of intestinal malabsorption. D-xylose is a sugar that should be absorbed if the small bowel mucosa is intact. It does not require digestive pancreatic enzymes. A low D-xylose level in the urine indicates that the intestinal mucosa is defective and that D-xylose was not absorbed.

Front 741

Q741. When do you answer D-xylose testing?

Back 741

A741. Look for a patient with foul-smelling stool without blood, who has weight loss, malnutrition, fat in stool, and a positive Sudan black stain.

Front 742

Q742. What is the most accurate test for malabsorption syndromes?

Back 742

A742. The most accurate test of the small bowel mucosa is a biopsy to assess histology and architecture.

Front 743

Q743. What disease will make D-xylose abnormal?

Back 743

A743. D-xylose test is abnormal with celiac disease, tropical sprue, and Whipple's disease.

Front 744

Q744. What is an endoscopic Retrograde Cholangiopancreatography (ERCP)?

Back 744

A744. ERCP is a direct visualization of hte biliary tract.

Front 745

Q745. For which condition is an ERCP most accurate?

Back 745

A745. ERCP is the most accurate diagnostic test for stones in teh biliary system. ERCP is also the most accurate test for primary sclerosing cholangitis (PSC).

Front 746

Q746. What are the characteristics lesion of sclerosing cholangitis?

Back 746

A746. In sclerosing cholangitis there are multiple intrahepatic and / or extrahepatic strictures of the biliary tract on cholangiography; This gives the biliarry radicles a "beaded" appearance.

Front 747

Q747. When do I answer ERCP?

Back 747

A747. The strongest indication for ERCP is when the patient has high fever, chills, right upper-quadrant abdominal pain, and jaundice. ERCP is both diagnostic and therapeutic because you can remove the stone. For PSC, look for a patient with a history of ulcerative colitis complaining of pruritus and jaundice with a negative hepatitis profile and negative abdominal sonogram.

Front 748

Q748. What is Esophageal manometry used for?

Back 748

A748. Esophageal monometry isused to establish the diagnosis of dysphagia or unexplained chest pain when there is no mechanical obstruction.

Front 749

Q749. How is Esophageal manometry done?

Back 749

A749. Esophageal manometry consists of a transducer placed in teh esophagus to record pressure

Front 750

Q750. When do you answer esoophageal manometry?

Back 750

A750. Look for a case of dysphagia with an inconclusive barium radiograph or upper endoscopy. If the stem of the question clearly describes a motility problem, you do not have to do either endoscopy or barium prior to doing the manometry;; for example, achalasia, diffuse esophageal spasm, or nutcracker esophagus.

Front 751

Q751. What is fecal occult blood testing?

Back 751

A751. Fecal occult blood testing (FOBT) is the screening of normal brown stool for microscopic amounts of blood not grossly visible. Gross blood or dark stool, such as melena, does not occur until >100ml of blood has been lost in the bowel. The FOBT will detect as lettle as 5-10ml of blood.

Front 752

Q752. When is fecal occult blood testing the right answer?

Back 752

A752. FOBT is a screening test for occult blood in the stool. FOBT is an option for screening for colon cancer in those above the age of 50. In colon cancer screening the three methods of screening, are: colonoscopy every 10 years, sigmoidoscopy every 3-5 years, FOBT every year after age 50.

Front 753

Q753. What do you do for a positive fecal occult blood test?

Back 753

A753. A positive FOBT should be investigated with a colonoscopy.

Front 754

Q754. What is Fecal Leukocytes a test for?

Back 754

A754. Fecal leukocytes are used to assess the etiology of acute diarrhea.

Front 755

Q755. What diseases is Fecal Leukocytes associated with?

Back 755

A755. Invasive and inflammatory causes of iarrhea can give both blood as well as fecal leukocytes. Diseases such as Salmonella, Shigella, Campylobacter, etc., can give both blood as well as white cells in the stool.

Front 756

Q756. When do you answer fecal leukocytes?

Back 756

A756. Look for a patient with diarrhea with no blood in whom you are trying to see if there is an invasive form of diarrhea. Fecal leukocytes are not found with diarrhea secondary to viruses, most protozoans, or pre-formed toxins such as Bacillus cereus or staph.

Front 757

Q757. What is the Gastrin level?

Back 757

A757. Serum gastrin levels should be measured when you suspect Zollinger-Ellison syndrome (ZES).

Front 758

Q758. When do you answer gastrin level as the best initial test?

Back 758

A758. Look for ulcers that are large (>1cm), rcurrent, distal, and multiple. A gastrin level greater than 1,000 pg/ml is diagnostic. REMEMBER: Everyone on a PPI has a high gastrin level.

Front 759

Q759. What additional test would you like if this is not diagnostic?

Back 759

A759. The secretin stimulation test can confirm ZES when serum gastrin concentration testing is nondiagnostic. In ZES, gastrin levels do not go down with secretin.

Front 760

Q760. What disease is the syndrome part of?

Back 760

A760. ZES is associated with MEN I: Hyperharathyroidism; Pituitary adenomas; Pancreatic islet cell/gastrointestinal adenomas

Front 761

Q761. What is gastrograffin?

Back 761

A761. Gastrograffin is a water-soluble form of radio-opaque constrast material that is used when there is the possibility that there has been organ perforation and the material may leak through into the peritoneum. Gasrograffin is used as the diagnostic test of choice for Boerhaave's syndrome, or esophageal perforation, because barium going through a perforation causes inflammation.

Front 762

Q762. When do you answer gastrograffin?

Back 762

A762. Look for a patient presenting with a recent history of severe retching followerd by severe chest pain, dyspnea, shock, and possible crepitation. Initial chest X-ray would show free air in teh mediastinum or peritoneum.

Front 763

Q763. What is the most accurate test for Boerhaave's syndrome?

Back 763

A763. The most accurate test is a CT scan.

Front 764

Q764. What is HFE gene, and C282Y mutation?

Back 764

A764. The HFE gene and C282Y mutation both lead to the overabsorption of iron in teh duodenum. They are confirmatory tests for hemochromatosis. These genetic tests and an MRI can eliminate the need for liver biopsy to diagnose hemochromatosis.

Front 765

Q765. When do you answer HFE gene, or C282Y mutation?

Back 765

A765. Answer HFE gene and C282Y mutation when you are shown a patient with the characteristics of hemochromatosis and abnormal iron studies consistent with hemochromatosis. The patient will have liver disease, skin hyperpigmentation, joint pain, diabetes, and infertility. The iron and ferritin levels will be elevated and the iron- binding capacity will be markedly dimished.

Front 766

Q766. What is HIDA Scanning?

Back 766

A766. HIDA scan is used when you suspect acute cholecystitis with a nondiagnostic ultrasonography.

Front 767

Q767. When do you answer HIDA scan?

Back 767

A767. Answer HIDA scan when you see either: Gallstones without gallbladder edema and ultrasound Murphy's sign, or; Gallbladder edema and ultrasound Murphy's sign without gallstones.

Front 768

Q768. How does HIDA scan work?

Back 768

A768. HIDA is taken up by hepatocytes and excreted into bile and concentrated in teh gallbladder. If the gallbladder does not opacify, it means that there is an obstruction of the cystic duct. Leakage into the pericholecystic space suggests perforation. On a normal scan the gallbladder should opacify.

Front 769

Q769. When is the HIDA scan the most common wrong answer?

Back 769

A769. The HIDA is not recommended in critically ill patients who should be taken to the operating room. If the diagnosis is obvious, the HIDA scan is not necessary, surgery is necessary.

Front 770

Q770. What is PAS staining used for?

Back 770

A770. PAS staining on a small bowel biopsy specimen is the most accurate test for Whipple's disease.

Front 771

Q771. When do you answer PAS staining?

Back 771

A771. Look for chronic multisystem illness, initially rheumatological (80%), then with fat malabsorption (75%), fever (50%), and ocular and neurological complaints..

Front 772

Q772. How do you treat Whipple disease?

Back 772

A772. Initial course of Ceftriaxone followed by trimethoprim- sulfamethoxazole for 1 year.

Front 773

Q773. What is 24-Hour pH monitoring used for?

Back 773

A773. Twenty-four -hour esophageal pH recording is indicated to document abnormal esophageal acid exposure.

Front 774

Q774. When do you answer 24-Hour pH monitoring?

Back 774

A774. It is the appropriate test in the following scenarios:; 1) Persistent symptoms of gastroesophageal reflux disease (GERD) after at least 4 weeks of treatment with a PPI. 2) To exclude GERD in a patient with unexplained chest pain; 3) GERD sysptoms wit a negative upper endoscopy wen you are considering antireflux surgical repair. 4) To assess the efficacy of antireflux surgery; 5) To evaluate patients with laryngitis, pharyngitis, chronic cough, nonallergic asthma (reflux-induced asthma)

Front 775

Q775. For what diseases do you answer secretin stimulation testing?

Back 775

A775. Secretin stiulation is a rarely used test for two completely separate diseases: Zollinger-Ellison syndrome (ZES) and chronic pancreatitis.

Front 776

Q776. What is secretin stimulation testing?

Back 776

A776. ZES: You inject secretin intravenously and measure the level of gastrin in blood. Secretin should inhibit gastrin and lower the levels of gastrin in a normal person. In ZES, there is a failure to suppress gastrin levels. Chronic pancreatitis: Normally, secretin should induce a large release of bicarbonate from the pancreas into the duodenum and measure the release of bicarbonate from the sphincter of Oddi. With chronic pancreatitis, the pancreas is too burned out and tired to do anything.

Front 777

Q777. When do you answer secretin stimulation test?

Back 777

A777. Answer secretin stimulation testing in ZES when the patient has large, recurrent, and multiple ulcers, but has a nondiagnostic fasting serum gastrin concentration. For chronic pancreatitis, look for a patient with fat malabsorbtion with no evidence of celiac disease and a normal D-xylose test.

Front 778

Q778. Who should upper endoscopy screening be offered to?

Back 778

A778. Screening upper endoscopy should be performed in patients with gastroesophageal reflux disease (GERD) in whom the symptoms have been present for more than 5 years. You are screening to see if there is Barrett's esophagus, which is when the lower esophagus is transforming form squamous to columnar epithelium. Screening for the presence of esophageal varices should be done in those with cirrhosis.

Front 779

Q779. What is the treatment for an abnormal upper endoscopy?

Back 779

A779. Barrett's esophagus is treated with proton pump inhibitors with a repeat upper endoscopy every 2-3 years. Low-grade esophageal dysplasia is treated with PPIs with a repeat upper endoscopy in 6 months. Those with varices should receive propranolol to decrease the risk of bleeding.

Front 780

Q780. What is a 72-Hour Fecal Fat test used for?

Back 780

A780. The 72-hour fecal fat collection is an old test for intestinal malabsorption. As the name implies, you are supposed to collect 3 days' worth of stool in order to have a very sensitive test for fat malabsorption. A single test of a Sudan black stain of the stool for the presence of fat is usually sufficient.

Front 781

Q781. When do you answer 72 -hour fecal fat test?

Back 781

A781. The 72-hour fecal fat collection is the single most accurate test for fat malabsorption; however, it is virtually never done and is most often a WRONG answer on your test. The 72-hour fecal fat is the answer if you strongly suspect fat malabsorption and the Sudan black stain is negative.

Front 782

Q782. What is a string test?

Back 782

A782. The string test is an old test for giardiasis. The string test samples the duodenal mucosa without the need of endoscopy. A string is swallowed and left in place with one end in the duodenum and the other end hanging out through the patient's mouth.

Front 783

Q783. When is a string test the answer?

Back 783

A783. String test is always the WRONG answer. Stool ova and parasite testing is sufficiently sensitive and less invasive. Stool Giardia antigen testing by ELISA is the single most accurate test for Giardia and is considerably less invasive.

Front 784

Q784. What is a Sudan Black Stain?

Back 784

A784. Stool staining with Sudan black is used to detect steatorrhea as a sign of fat malabsorption.

Front 785

Q785. What is the most accurate test for fat malabsorption.

Back 785

A785. Seventy-two-hour quantitative estimation of stool fat is the most accurate test because of increased sensitivity. The 72-hour estimation is almost always the wrong answer.

Front 786

Q786. When do I answer Sudan black stain?

Back 786

A786. Answer Sudan black stain when you see a patient with chronic pale, greasy, malodorous diarrhea, and no evidence of infection.

Front 787

Q787. What is Fasting Transferrin saturation?

Back 787

A787. Serum measurement of fasting transferrin saturation is the best initial test to diagnose hereditary hemochromatosis (HH) as well as the screening test for asymptomatic family members. Fasting transferrin saturation = (serum iron/TIBC)

Front 788

Q788. When do you answer fasting transferrin saturation?

Back 788

A788. Answer fasting transferrin satruation when you see a ase of liver disease with oint pain, diabetes, cardiomyopathy, skin hyperpigmentation, and infertility.

Front 789

Q789. How would you confirm an abnormal test of fasting transferrin saturation?

Back 789

A789. Liver biopsy is the most accurate test.

Front 790

Q790. What is the pathogenesis of hereditary hemochromatosis (HH)?

Back 790

A790. The pathogenesis is genetically determined abnormal increase in intestinal absorption of iron.

Front 791

Q791. When is the optimal timing of screening for HH?

Back 791

A791. The optimal timing for screening family members is between the ages of 18 and 30, before organ damage (e.g., cirrhosis) has occurred.

Front 792

Q792. What is serum trypsinogen concentration used for?

Back 792

A792. Serum assay of trypsinogen is used when you suspect chronic pancreatitis in a patient with steatorrhea. This is the only test that is specific for steatorrhea of pancreatic origin. Trypsinogen levels are low if the fat malabsorption is form a burned-out pancreas.

Front 793

Q793. When is serum trypsinogen concentration the answer?

Back 793

A793. Answer trypsinogen level only after Sudan black stin has confirmed a fat malabsorption. Antigliadin and anti-endomysial antibodies should be normal. Low trypsinogen levels are specific but not sensitive for chronic pancretitis.

Front 794

Q794. What is the urea breath test?

Back 794

A794. Urea breath testing is the measurement of radiolabled carbon dioxide after the oral ingestion of labeled urea. H. pylori splits urea wuth urease. The labeled carbon is in the urea and is released as labeled carbon dioxide.

Front 795

Q795. When is the urea breath test used?

Back 795

A795. Urea breth testing is best used to confirm the eradication of H. pylori immediately after treatment. Serology does not rapidly improve after treatment. If an ulcer is found at endoscopy, the test of choice will be biopsy, not the urea breth test.

Front 796

Q796. When do you answer urea breath test?

Back 796

A796. Answer urea breath test with a patient with epigastric pain that does not improve or that recurs after a proton pump inhibitor and antibiotics have been given. There is no routine test of cure for H. pylori. You do not do the test if the patient feels better after treatment.