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51 Cards in this Set

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Q700. NonUlcer Dyspepsia - What is it
A700. Abdominal pain or fullness & bloating; may be postprandial; gastric acid secretion is normal; may have abnormal gastric or small intestine motility
Q701. NonUlcer Dyspepsia - Dx
A701. Normal EGD or barium
Q702. Dumping Syndrome - What is it
A702. Rapid emptying from stomach; => shift of fluids and; distention of small intestines; associated with PUD surgery
Q703. Dumping Syndrome - History/PE
A703. Diaphoresis; lightheaded; palpitations; n/v; 30 min. postprandial; if 90 min. postprandial - CHO- or sucrose-rich meals
Q704. Dumping Syndrome - Dx
A704. Clinical History
Q705. Dumping Syndrome - Tx
A705. Restrict sweets; frequent small meals; decreased liquid intake with meals
Q706. What test(s) diagnose small bowel obstruction?
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.
Q707. What does small bowel obstruction look like on abdominal x-ray?
A707. There are multiple air-fluid levels seen throughout the bowel.
Q708. When do you use abdominal X-ray?
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.
Q709. What does a barium enima do?
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.
Q710. When is BE contraindicated?
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.
Q711. Compare BE and Colonoscopy if you are suspecting a lesion in the colon.
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.
Q712. What is Capsule Endoscopy?
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.
Q713. When do you use Capsule Endoscoopy?
A713. Capsule endoscopy is the procedure of choice for suspected small bowel bleeding that was not detected with upper or lower endoscopy.
Q714. What are Amylase/Lipase levels?
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.
Q715. When do you answer amylase and lipase levels?
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.
Q716. What is the most accurate test for acute pancreatitis?
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.
Q717. What is Antiendomysial/ Antigliadin Antibodies?
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.
Q718. When are Antiendomysial/ Antigliadin Antibodies the answer?
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.
Q719. What is the most accurate test for celiac disease?
A719. Small bowel biopsy. It must be done to exclude lymphoma as well as to diagnose the disease.
Q720. What is the Antimitochondrial Antibodies (AMA) test for?
A720. Serum screening for antimitochondrial antibodies is the best initial test to make a specific diagnosis of primary biliary cirrhosis (PBC).
Q721. When do you answer AMA?
A721. Look for a middle-aged female presenting with itching (pruritus) and an elevated alkaline phosphatase with a normal bilirubin.
Q722. What is the most accurate test for PRIMARY BILIARY CIRRHOSIS?
A722. Liver biopsy.
Q723. What is anti-Smooth Muscle Antibodies?
A723. Serum assay detection of anti-smooth muscle antibodies (ASMA) is the best initial test for atuoimmunie hepatitis.
Q724. When do you answer ASMA?
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.
Q725. What other immune markers are associates with autoimmune hepatitis?
A725. Autoimmune hepatitis is associated with antinuclear antibodies (ANA) and antibodies to liver/kidney microsome type 1 (anti-LKM1).
Q726. What is the most accurate test for autoimmune hepatitis?
A726. Liver biopsy is the most accurate test for autoimmune hepatitis and most other liver diseases.
Q727. For which clinical condition is Barium Esophagram the best initial test?
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.
Q728. For which conditions is Barium Esophagram the most accurate test?
A728. Barium esophagram is the most accurate test for esophageal rings, webs, and idverticuli.
Q729. What is the most acurate test for abnormalities detected with a barium esophagram?
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.
Q730. What is a Bernstein Test?
A730. The Bernstein test is to diagnose gastroesophageal reflux disease.
Q731. How is a Bernstein Test done?
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.
Q732. When is a Bernstein Test the right answer?
A732. The Bernstein test is always WRONG to do. When you see it in the answers as a diagnostic test, do not choose it.
Q733. What is a Bleeding Scan?
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.
Q734. When do you answer bleeding scan?
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.
Q735. What is Ceruloplasmin?
A735. Serum ceruloplasmin levels and the presence of Kayser- Fleischer rings on exam are the best initial tests for Wilson's disease.
Q736. When do you answer ceruloplasmin?
A736. Look for a patient wiht the convination of unexplained hepatic and psychiatric abnormalities with a movement disorder.
Q737. Is a high or low value abnormal?
A737. An exremely low serum ceruloplasmin level should be taken as strong evidence for the diagnosis of Wilson's disease.
Q738. What additional tests would confirm the diagnosis?
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).
Q739. When do we use colonoscopy as a screen?
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.
Q740. What is D-Xylose Test?
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.
Q741. When do you answer D-xylose testing?
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.
Q742. What is the most accurate test for malabsorption syndromes?
A742. The most accurate test of the small bowel mucosa is a biopsy to assess histology and architecture.
Q743. What disease will make D-xylose abnormal?
A743. D-xylose test is abnormal with celiac disease, tropical sprue, and Whipple's disease.
Q744. What is an endoscopic Retrograde Cholangiopancreatography (ERCP)?
A744. ERCP is a direct visualization of hte biliary tract.
Q745. For which condition is an ERCP most accurate?
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).
Q746. What are the characteristics lesion of sclerosing cholangitis?
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.
Q747. When do I answer ERCP?
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.
Q748. What is Esophageal manometry used for?
A748. Esophageal monometry isused to establish the diagnosis of dysphagia or unexplained chest pain when there is no mechanical obstruction.
Q749. How is Esophageal manometry done?
A749. Esophageal manometry consists of a transducer placed in teh esophagus to record pressure
Q750. When do you answer esoophageal manometry?
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.