Step 2 Ck - Gi

Front 1

1. 72 yo man with hx of aortic stenosis. C/o Red/Black stools x5. BP = 95/60, Pulse = 105.

What are the next steps 5 in management? State in order.

2. What Rx will you add if this patient has hx of alcoholism and Liver disease and throws up blood?

Back 1

1 a) . Fluid resuscitation - Bolus NS/LR

b) . Check CBC --> for HCT and Platelet

c) Check PT

2. Octreotide - decreases portal htn preventing esophageal varicies.
If bleeding does not correct after octreotide than do banding, if still continues --> TIPS (Transjugular Intrahepatic Portal Shunting)

Front 2

If a patient is bleeding or has to undergo surgery, at what Platelet count should the patient get platelets?

At what platelet count, there is a risk for spontaneous bleeding?

Back 2

1. < 50, 000

2. < 20,000

Front 3

What is the significance of Systolic BP < 100 or Pulse > 100.

Back 3

30% volume loss

Front 4

When do we give BB for GI bleeds?

Back 4

After the patient has been stabilized.

Front 5

Pts with Cirrhotic livers should be given (4)?

Back 5

1. spirinolactone

2. Lactulose - (superior to neomycin)

3. BB

Front 6

Low SAAG (< 1.1 ) is usually due to _____

High SAAG (>1.1) is usually due to ___-

Back 6

1. Cancer

2. Portal HTN

Front 7

1. Tx for Spontaneous bacterial peritonitis

2. How is it diagnosed?

Back 7

1. Ceftriaxone (Liver met) or Cefotaxime(met. by kid)

2. Aspirate of Ascitic fluid reveals:

> 500 WBC

> 250 Neutrophils

Front 8

1. Primary Scleorising Cholangiitis is a/w this disease?

2. How is it diagnosed?

Back 8

1. IBD

2. ERCP - Endoscopic Retrograde Cholangeopantoscopy

Front 9

What is the 1st line tx for Primary biliary cirrhosis and Primary sclerosing cholangiits?

Back 9

1. Cholestyramine

2. Ursodeoxycholic acid

Front 10

What is the tx for Hemochromotosis

a) Over absorbers

b) Over transfused

Back 10

a) Phlebotomy

b) Furoxetime

Front 11

Treatment of Wilson's ds?

Back 11

Penicillamine

Front 12

Indication for ERCP?

Back 12

For evaluation of Common Bile duct,

- Removal of stones

- dilation of strictures

- To dx sphincter of Oddi dysfxn

Front 13

Indications for HIDA scan?

Back 13

Pt shows s/s of Acute cholecystitis and U/S is non-diagnostic

Front 14

____ are rare congenital fusiform dilations or saccular saccular diverticula of the biliary tree.

Back 14

Choledochal cysts - must be surgically excised due to increased risk for cholangiocarcinoma

Front 15

_____ is the most specific test for dx of GERD?

Back 15

24 hour pH monitoring

Front 16

Melanosis coli is most commonly a/w ___

Back 16

laxative abuse (esp. Senna)

Front 17

_____ and ____ are the most sensitive and specific serological test for celiac sprue?

Back 17

Anti endomysial ab

Anti tissue transglutaminase

Front 18

1 a) Pt in late 2nd or 3rd trimester, intense pruritus.

1 b) Treatment

Back 18

1 a)Intrahepatic cholestasis

1 b) W/o Jaundice: Ursodeoxycholic acid + fat soluble vitamins

Severe (w/ Jaundice): Deliver fetus as the circulating bile salts may have an adverse affect on placental circulation

Front 19

SAAG < 1.1 is seen in

Back 19

Non-portal htn etiologies

- pancreatitis

-peritonitis

- tuberclosis

- cancer

Front 20

ALT:AST > 2. Whats the etiology

Back 20

Alcoholic hepatitis

Front 21

Defect in biliary excretion causes an increase in conjugated bilirubin. Jaundice is exacerbated by infection, pregnancy and OCP.

Back 21

Dubin- Johnson syndrome

Front 22

Defect in conjugation of bilirubin due to severe deficiency of glucoronosyltransferase. Presents in infancy.

Back 22

Crigler-Najjar

Front 23

Less profound deficiency of glucoronosyltransferase. Predominance of unconjugated bilirubin

Back 23

Gilbert disease

Front 24

Acute thrombosis of supra hepatic veins causing ascites

Back 24

Budd-Chiari syndrome

Front 25

Two most common causes of bloody diarrhea?

Back 25

1. Campylobacter jejuni

Salmonella

Less common: E. Coli and Shigella

Front 26

RUQ pain, fatigue, fever. Travel to mexico. CT shows solitary cystic lesion in the right hepatic lobe

Back 26

Amebic liver abscess due to E. histolytica

Front 27

Most common bacteria in cholangiitis

Back 27

E. Coli

Klebsiella pneumoniae

Front 28

Acute upper GI bleed with normal endoscopy

Back 28

Dieulafoy lesion - a dilated submucosal vessel which has failed to branch into capillaries. Bleeds intermittently.

Front 29

Dyspnea, edema of face, neck and upper chest

Back 29

Superior vena cava syndrome.

Portal HTN causes varicose in distal esophagus and

Front 30

The MCC of SVC syndrome is: ?

Back 30

Lung Cancer

Front 31

hypergammaglobinemia, + ANA, + Anti-Smooth muscle ab , Abnormal AST and ALT

Back 31

Autoimmune hepatitis

Front 32

SBP dx is made when ascitic fluid absolute neutrophil count gets > ______ /mm^3

Back 32

> 250

Front 33

Episodic, non-progressive dysphagia to solids. Short lived episodes. Dx ?

Back 33

Schatzki rings

Front 34

First test performed in the workup of dysphagia?

Back 34

Barium study

Front 35

_______ is done if both Barium study and endoscopy are negative ?

Back 35

Motility study

Front 36

_____ is the DOC for pruritus associated with cholestasis

Back 36

cholestyramine

Front 37

____ is the MCC of acute pancreatitis in the U.S. ?

Back 37

Impaction of gallstones in the Ampulla of Vater

Front 38

First line tx for PBC (Primary Biliary Cirrhosis)?

Back 38

Ursodeoxycholic acid (aka Ursodiol)

Note: Also used for prevention of gallstones, and for dissolution of small gallstones

Front 39

Intermittent rectal bleeding a/w passage of mucus and tenesmus. Mild diarrhea. Dx ?

Back 39

Proctitis

Front 40

Tx of Gastroparesis with diarrhea?

Back 40

Octreotide (somatostatin analogue)

Front 41

Gold standard to establish dx of Gastroparesis?

Back 41

Scintigraphic measurement of gastric emptying

Front 42

First test if a patient is suspected of having gastroparesis?

Back 42

Endoscopy

Front 43

Tx of Choice for Chronic Hep C

Back 43

Peg-Interferon + Ribavirin

Front 44

Tx of Choice for Chronic Hep B

Back 44

IFN-a + lamivudine (nucleoside analogue)

Front 45

2nd MCC of lower GI bleeding?

What is the first line of Tx for it?

Back 45

Angiodysplasia

Endoscopic ablation

Front 46

Zenker's diverticulum is a _____ diverticulum and involves _______ muscle.

Back 46

False, cricopharyngeus

Front 47

Malabsorption disease also a/w hyper pigmentation, lymphadenopathy, cardiac disease, and rheumatological disturbance.

Back 47

Whipple's disease

Front 48

Pt with AIDS and Sx of colitis (bloody diarrhea + tenesmus + abdominal pain). Most likely dx?

Back 48

CMV

Front 49

In AIDS pts with CMV, what will the colonoscopy show?

Back 49

multiple deep ulcers eroding into blood vessels

Front 50

Most common cause of non-bloody diarrhea in HIV pts?

Back 50

Cryptosporidia

- watery diarrhea, abdominal cramps, low fever

Front 51

Non-Alcoholic fatty liver disease is associated with _____ and _____.

Back 51

metabolic syndrome, insulin resistance

Front 52

Dx test for pt suspected of having ZES?

Back 52

Serum gastrin.

- Gastrin > 1000 pg/ml and gastric pH < 5 are diagnostic

- Secretin stimulation testing if serum gastrin non-diagnostic

Front 53

Gastric adenocarcinoma metastasizes mostly to (3) ?

Back 53

1. Periumbilical lymph nodes (Sister Mary Joseph Nodule)

2. Supraclavicular nodes (Virchow's nodes)

3. Ovaries (Krukenberg tumor)

Front 54

Risk factors of Gastric adenocarcinoma

Back 54

Pernicious anemia, H. Pylori, high intake of N-nitroso compounds (in salted and preserved foods)

Front 55

Dermatomyositis carries increased risk of _____ cancer in women and an increased risk ____ and ____ cancer in men and women.

Back 55

Ovarian,

Lung, colorectal (Both men and women)

Front 56

Antimicrosomal antibody titer is a/w _____ ?

Back 56

Hashimoto thyroiditis

Front 57

Pt w/ PUD dx w/ duodenal ulcer and H. pylori. Pt was started on2 wks of amox, clarithromycin, and omeprazole. Pt shows no improvement. whats the next step?

Back 57

Perform urea breath test.

If +ve, use diff abx.

Re-tx with Bismuth, metronidazole, tetracycline + PPI bid for 1-2 weeks

Front 58

What is HELLP syndrome

Back 58

Hemolysis

Elevated Liver enzymes

Low Platelets

Usually occurs in postpartum women

Front 59

What is the pentad of TTP?

2. What is the tx

Back 59

1. Severe thrombocytopenia

Microangiopathic hemolytic anemia

Neurological signs

Renal insufficiency

Fever

Schistocytes, Elevated LDH,

2. Plasmapheresis

Front 60

The most common presenting sx of Whipples is (3) ?

Back 60

Diarrhea

Wt loss

Arthralgia

Front 61

Serum chromogenin A is both sensitive and specific for ________

Back 61

Pheochromocytoma

Front 62

Pronounced P2 on inspiration is indicative of ___

Back 62

Pulmonary HTN

Front 63

_____ is the best initial test when liver or biliary tract pathology is suspected as a cause for jaundice.

Back 63

Ultrasound

Front 64

Suspected hemochromotosis (abnormal iron studies and first degree confirmed hemozygote relatives) require genetic testing for _______

mutation?

Back 64

C282Y

Front 65

The primary tx for for hemochromotosis is ____

Back 65

phlebotomy

Front 66

Pts with hemochromotosis are vulnerable to these iron loving bacteria?

Back 66

Vibrio vulnificus - from uncooked seafood

Yersinia entercolitica

Front 67

What is the effect of low albumin on Ca levels.

a) Effect on Total Calcium

b) Effect on ionized Ca

Back 67

a) Lower total Ca

b) Normal ionized Ca

Note: For every 1 gm reduction of albumin below 4 g/L, total Ca will decrease 0.8 mg/dL

Front 68

Yersinia entercolitica tends to infect the ____. Causing pain in __LQ

Back 68

Cecum, RLQ

Front 69

1. Whats the prophylaxis for people in close contact with patients infected with Hep A?

Back 69

Hep A vaccination

Front 70

When is Hep A immunoglobulin indicated

Back 70

Children < 12 yo

Immunosuppressed

Chronic liver disease

Front 71

The pathogen responsible for traveller's diarrhea?

Back 71

ETEC

Front 72

MCC of diarrhea in children?

Back 72

Rotavirus

Front 73

1st line tx for Carpel tunnel ?

Back 73

Splint therapy

Front 74

Initial therapy for Wegener's granulomatosis?

Back 74

Cyclophosphamide + Prednisone

Front 75

Anti-smooth muscle antibodies seen in: ?

Back 75

Autoimmune hepatitis

Front 76

If ACL injury, the knee in bent position can be pulled in the _____ direction.

Back 76

1. Anterior

Front 77

Anti-Ro and Anti-La antibodies seen in

Back 77

Sjogren's syndrome

Note: Anti La(SSB) antibodies is specific for Sjogren's

Front 78

Anti-Smith ab is specific for _____ ?

Back 78

SLE

Anti- ds DNA is also specific for SLE

Front 79

Anticyclic citrullinated peptide (CCP) autoantibody is specific for _____ ?

Back 79

Rheumatoid arthritis

Front 80

Anti-Jo1 ab is a marker for _____ ?

Back 80

Dermatomyositis

- Prox muscle weaknes

- heliotrope rash

- Grotton papules

Front 81

Initial drug therapy for fibromyalgia ?

Back 81

low dose tricyclics

Front 82

positive U1-RNP (ribonucleoprotein) autoantibody is a/w ______

Back 82

Mixed connective tissue disease

Front 83

Arthritis, Uveitis, non-gonococcal arthritis ?

Back 83

Reiter syndrome

Front 84

______ and ______ can be used against chlamydia infections

Back 84

Doxycycline, Azithromycin

Front 85

Pt with dysphagia. Whats the first test to perform?

Back 85

Barium swallow.

- EGD can be done after barium

Front 86

Barium swallow show cork screw pattern. Dx?

Back 86

Diffuse esophageal spasm

Front 87

Whats the tx for diffuse esophageal spasm?

Back 87

CCB, nitrates, TCA

Front 88

1. Name the diverticulum:

a) Upper posterior esophagus

b) Mid-esophagus

c) Lower esophagus

Back 88

a) Zenker's

b) Traction diverticulum

c) Epiphrenic diverticulum

Front 89

Neck mass increases in size when drinking fluid

Back 89

Zenker's

Front 90

Hernia - Tx

a) Sliding Hernia - GE jxn and stomach through diaphragm (95%)

b) Paraesophageal - Stomach protrudes through diaphragm - GE jxn remains in place - ischemic sx

Back 90

a) Reflux control

b) Surgery - due to risk for incarceration

- Gastroplexis

- Nissen

Front 91

When checking for H. Pylori, when will you NOT check IgG antibodies to H. pylori

Back 91

If Hx of H. pylori

Front 92

1. Whats causes Type A chronic gastritis and where is the anatomical site?

2. What are the associated labs

Back 92

1. Autoantibodies against parietal cells --> pernicious anemia

Fundus

2. Decreased gastric acid level

Decreased gastrin

Front 93

Which ulcers are more common: Gastric or Duodenal

Back 93

Duodenal

Front 94

What mineral/Vit deficiency might be encountered after partial gastrectomy (3)

Back 94

Iron
Ca
Vit B12

- Iron and Ca require acid to aid in digestion

Front 95

Left supraclavicular lymph node

or

Periumbilical Node is a/w ?

Back 95

Gastric cancer

Front 96

Tx of Gastric cancer =?

Back 96

If Lesion in:

1. Upper 2/3 or invasive lesion = total gastrectomy

2. Distal 1/3: Subtotal gastrectomy

For both, Chemo and radiation as well

Front 97

MCC of pancreatitis

Back 97

Alcohol and gallstones

Front 98

What is Ranson's Criteria:

a) Significance

b) List the criteria

Back 98

a) Criteria for increased mortality from acute pancreatitis on admission

b) Mneumonic = GA LAW

Glucose > 200

AST > 250

LDH > 350

Age > 55

WBC > 16,000

Front 99

Whats the Ranson's Criteria during initial 48 hours after admission

Back 99

Mneumonic = Calvin & HOBBes

Ca < 8

HCT decrease > 10%

O2 i.e. PaO2 < 60

Base deficit > 4 mEq/L

Sequestration of fluid > 6L (how much fluid have they needed)

Front 100

What is Grey Turner's sign?

What is Cullen's sign

Back 100

bluish discoloration of flank which may be seen in acute pancreatitis

Periumbilical discoloration which may be seen in acute pancreatitis

Front 101

Anytime pancreatitis has been diagnosed what additional imaging must be done

Back 101

RUQ U/S to rule out gallstones as a reason

Front 102

Most sensitive and specific test for chronic pancreatitis

Back 102

Fecal elastase

Front 103

Fecal elastase levels are _____ in chronic pancreatitis

Back 103

Low

Front 104

Aspiration of pancreatic pseudocysts show high _____ levels

Back 104

amylase

Front 105

When is drainage of pancreatic pseudocyst indicated

Back 105

If lasting > 6 weeks

Painful or rapidly growing

To debride necrotic tissue

Front 106

What are the tumor markers for pancreatic cancer

Back 106

CEA

CA 19-9

Front 107

What is the whipple procedure

Back 107

Removal of:

Pancreatic head

Duodenum

Proximal jejunum

Common bile duct

Gallbladder

Distal Stomach

Front 108

What Rx may be given in pts with endocrine pancreatic cancers ?

Back 108

1. Diazoxide - used to decrease insulin release

Octreotide (Somatostatin) - Shuts down all GI hormone and stops insulin release

Given when surgical resection is not possible

Front 109

Multiple insulinomas are seen in _______

Back 109

MEN I

- Insulinomas are almost always solitary

Front 110

1. Ethanol is absorbed in ______

2. Vit B12 is absorbed in ______

3. Folate in

4. Ca, Mg and Fe absorbed in

Back 110

1. Stomach

2. Terminal ileum

3. Duodenum

Front 111

In Celiac sprue, the following ab are present (2)

Back 111

Antiendomysial

Antigliadin

Front 112

Celiac sprue is a/w _______

Back 112

Down syndrome (5-15% have it )

Front 113

Celiac sprue is a/w this skin condition

Back 113

Dermatitis herpeteformis

Front 114

How's the definitive dx of Celiac sprue

Back 114

biopsy of Duodenal and Jejunal villi

- shows blunting or loss of villi

Front 115

Malabsorption + megaloblastic anemia. Dx = ?

Back 115

Tropical sprue

- Give folic acid to tx the megaloblastic anemia

Front 116

1. Foamy macrophages on periodic acid - schiff stain. Dx = ?

2. Tx = ?

Back 116

1. Whipple's

2. TMP-SMX for 12 months

Ceftriaxone if allergic to sulfa

Front 117

1. Abnormal Sudan stain + Normal D-xylose test.

Dx = ?

Back 117

Pancreatic insufficiency.

- D-xylose levels are checked in blood. Since it's getting absorbed therefore, fat malabsorption is not due to intestinal cause but pancreatic cause

Front 118

Upon the suspicion of malabsorption syndrome, the first test "Sudan stain" was negative

a) What is the next Test - what if it is normal?

Back 118

Stool pH

- Low stool pH => Lactase deficiency

- Normal - requires Schilling test

Front 119

Describe the Schilling test?

Back 119

Given in two stages:

1st Stage: Only radio labeled B12 by itself

- if absorbable then it means that the pt has IF and the terminal

ileum is also working fine.

2nd Stage - Give IF + B12 (if abnormal result for 1st stage

- If abnormal then deficiency of IF from either ileal disease or bacterial overgrowth

- If normal then Pernicious anemia

Front 120

Which tumors can cause secretory diarrheas?

Back 120

VIPoma

Gastrinoma

Medullary thyroid cancer

Carcinoid tumor

Also Ileal resection

Front 121

If Stool somatic gap < 50, what does it signify?

Back 121

Secretory diarrhea

Front 122

Which antacid may cause diarrhea

Back 122

Milk of Magnesium

Front 123

1. How are ASCA values different between CD and UC?

2. How are pANCA values different between CD and UC?

Back 123

1. Crohn's: ASCA mostly +ve

UC: ASCA rarely +ve

2. pANCA: rarely +ve in CD

mostly +ve in UC

Front 124

Tx of Crohn's

Back 124

5-ASA agents:

1. Mesalamine - Works throughout the bowel

2. Sulfasalazine -

- 5-ASA + abx.

- bound with abx and gets activated/split by colonic bacteria

- therefore, only works in colonic lesions

Front 125

Pt presents with acute abdominal pain, bloody diarrhea, vomiting, abdominal tenderness

Increased WBC

CT shows air within bowel wall and bowel wall thickening.

Dx = ?

Tx = ?

Back 125

Ischemic colitis

Tx = Bowel rest, IVF, abx for GI bacteria,

Surgical resection of necrotic bowel

Front 126

What are the physical diagnosis tests for appendicitis?

Back 126

1. Psoas sign = psoas pain on hip extension

2. Rovsing sign = RLQ pain w/ LLQ palpation

3. Tenderness at McBurney's point

4. Obturator sign = pain w/ internal rotation of flexed hip

Front 127

Whats the most sensitive test for appendicitis

Back 127

CT w/ contrast (oral or rectal)

- bowel wall thickening

appendicolith

abscess

phelgmon

free fluid

RLQ fat-stranding

Front 128

1. Post operative ileum usually lasts _____

a) small bowel recovers in

b) Stomach recovers in

c) Large bowel recovers in

Back 128

1) < 5 days

a) 24 hrs

b) 2-3 days

c) 3-5 days

Front 129

Barium enema of colon showing "birds beak"

Back 129

Volvulus

Front 130

Vague abdominal pain in LLQ relieved w/ defication. Painles Rectal bleeding

Back 130

Diverticulosis

Front 131

Abx for acute diverticulosis

Back 131

Fluroquinilone + Metronidazole

or
TMP-SMX + Metronidazole

Front 132

Internal hemhorrhoids arise from ______ veins

Back 132

Superior rectal veins (above pectinate line)

painless

Front 133

Whats the first line therapy for Anal fissures

Back 133

Stool softeners and topical nitroglycerin

Front 134

Painful bleeding trears in posterior wall of the anus 2/2 to trauma during defecation or anal intercourse

Back 134

Anal fissures

Front 135

- Presence of one or more cutaneous sinus tracts in the superior midline gluteal cleft

-Obstruction of sinus tract may lead to cyst and abscess formation

- Usually asymptomatic. If obstruction of sinus tract --> painful cyst with drainge forms

Dx = ?

Back 135

Pilonidal disease

Front 136

Carcinoid tumor mostly occurs in ______

Back 136

appendix

Front 137

CEA is a tumor marker in which cancers (3)

Back 137

Stomach, Pancreas and Colon cancers

Front 138

What stage of Colorectal cancer has lymph node involvement ?

Back 138

Stage III

Front 139

How is surveillance done after removing cancer.

How often?
a) CEA

b) CT Chest, Abdomen, Pelvis

c) Colonoscopy

Back 139

a) q3 months x 3 years

b) q 1 year

c) Year 1, 3, q5 years

Front 140

1. Tx of Familial adenomatous polyposis (FAP)

2. Peutz Jeghers syndrome carries a ____ risk for malignancy

Back 140

1. Subtotal colectomy

2. Low

Front 141

Pt has GI bleeding, what should be the INR level?

Back 141

Pt should be kept at INR < 1.5

Front 142

_______ decreases blood flow through the esophagus

Back 142

Octreotride

Front 143

What's the causation of Mecke;'s diverticulum?

______ can locate Meckel's diverticulum

Back 143

1. Acid secreting gastric mucosa --> ileum

2. Technetium scan

Front 144

Pt with cirrhosis and presents with GI bleed. What Rx should be given?

Back 144

BB - to prevent variceal bleed

Front 145

1. How are gallstones diagnosed

2. Most common type of gallstone

Back 145

1. U/S - gallstones visible

2. Cholestrol

Front 146

1. What is Charcot's triad? What's the dx?

2. What's the next step

Back 146

1. RUQ pain, fever, Jaundice

Cholangitis

2. Perform 1st U/S if not dx then HIDA

Front 147

Pt has cholangitis with severe symptoms, whats the tx?

Back 147

Normal Tx: IV hydration, IV abx, endoscopic biliary drainage followed by delayed cholecystectomy.

If severe = ERCP for emergency bile duct decompression

Front 148

U/S shows calcified gallbladder (porcelain gallbladder), what is the assumed dx?

Back 148

Gallbladder cancer - do biopsy

Front 149

What sign in physical diagnosis is used to look for hepatic encephalopathy

Back 149

Asteraxis

Front 150

1. To prevent variceal bleeding which Rx are given?

2. What if there is already variceal bleeding

Back 150

1. Propranolol

Nadolol

- to prevent bleeding esophageal varices

2. Vasopressin or sclerotherapy

Front 151

Why is neomycin or Rifaximin given to pts who are cirrhotic pts who have gone "over the edge"

Back 151

To kill bacteria which might produce NH4

Front 152

How to differentiate Budd-Chiari from RHF?

Back 152

Budd Chiari does not have JVD.

Front 153

Most feared complication of Ascites is _____

Back 153

1. SBP- Spontaneous Bacterial Peritonitis

Front 154

What are hallmark lab for SBP?

Back 154

Paracentesis will show:

1. > 250 PMN/uL

2. Total Protein > 1 g/dL

3. Glucose < 50 mg/dL

4. LDH > normal serum LDH

Front 155

1. Hemochromotosis is autosomal ______

2. What lab is checked if hemochromotosis is suspected

3. What the tx for it?

Back 155

1. Recessive

2. Increased serum ferritin

3. Weekly or biweekly phlebotomy

Deferoxamine for iron chelation

Front 156

1.Whats the pathophysiology of Wilson's ds?

2. What is the tx?

Back 156

1. Inability of the body to excrete Cu through the bile

2. Trientine or Penicillamine for Cu chelation

Zn supplementation - Life long

Vit B6

Front 157

1. Alpha-1 antitrypsin is autosomal ______

Back 157

1. co-dominant

Front 158

Autoimmune ds with intrahepatic bile duct destruction leading to accumulation of bile acids, cholestrol and bilirubin

Back 158

PBC - Primary biliary Cirrhosis

Hint: Look for a middle aged female with fatigue and pruritis

Front 159

1. Elevated serum anti-michocondrial ab?

2. How is it tx?

Back 159

1. PBC

2. Ursodeoxycholic acid

- delays disease progression and enhances survival (only approved therapy for PBC)

Cholestyramine - if pruritis present

Front 160

Fatigue and Pruritus in male, a/w Ulcerative colitis. May have +ve pANCA.

ERCP shows stricturing and irregulary of extra and intrahepatic bile ducts. (Pearls on string)

Back 160

Primary sclerosing cholangitis (PSC)

Front 161

Tx of PSC ?

Back 161

1. Ursodeoxycholic acid

Methotrexate

Steroids

Endoscopic stenting of strictures

Resection or liver transplant may also be required

Front 162

Kernicturus is when bili is > ____

Back 162

20

Front 163

Criggler Najjar Type ___ is fatal

Back 163

Type I

Front 164

1. Hepatic adenoma in male pt. Whats the most likely cause?

2. Whats the risk factors?

Back 164

1. Anabolic steroids

2. OCP use, anabolic steroids, Glycogen storage ds Type I and III

Front 165

Gold standard for diagnosing kidney stones?

Back 165

Noncontrast helical abdominal CT

Front 166

1. Air-fluid levels in abdominal XR are suggestive of ________,

2. Free peritoneal air is suggestive of _______

Back 166

1. Bowel obstruction

2.Perforated viscus

Front 167

1. left lower quadrant pain, fever, and elevated leukocyte count. Most likely diagnosis?

2. Whats the best imaging modality for this?

Back 167

1. Diverticulitis

2. Contrast-enhanced CT scan

Front 168

Routine stool cultures usually test for __ (3) ?

Back 168

Salmonella, Shigella, Campylobacter

Front 169

1. Acute radiation proctitis usually manifests within ______ of therapy with symptoms of _________

2. How is it dx?

Back 169

1. 6 weeks

diarrhea and tenesmus.

2. Diagnosis is established by endoscopic findings of mucosal telangiectasia, with biopsy showing submucosal fibrosis and arteriole endarteritis.

Front 170

1. Three classic findings of Chronic pancreatitis

Back 170

Abdominal pain that is usually mid-epigastric, Postprandial diarrhea, and

DM 2/2 pancreatic endocrine insufficiency.

Front 171

Pts with C. diff and associated colitis typically have diarrhea up to _____ x daily, lower abdominal pain, cramping, fever, and leukocytosis that often exceeds ______

Back 171

10 or 15

15,000/µL

Front 172

What is the indication for tx of Salmonella?

Back 172

(1) immunocompetent patients < 2 years or > 50 years to avoid the increased incidence of complications in these age groups;

(2) immunocompetent patients with severe illness requiring hospitalization;

(3) immunocompetent patients with known or suspected atherosclerotic plaques or endovascular or bone prostheses because of seeding of salmonellae to these areas during a bloodstream infection; and

(4) immunocompromised patients, such as patients with uncontrolled HIV infection or those requiring corticosteroids and other immunosuppressive agents.

Front 173

The incidental finding of indirect (unconjugated) hyperbilirubinemia in an asymptomatic patient with a normal hemoglobin level and otherwise normal liver tests is indicative of ________

Back 173

Gilbert syndrome

- Pts generally have a serum total bilirubin < 3.0 mg/dL (51.3 µmol/L), whereas the serum direct bilirubin level is <= 0.3 mg/dL

Front 174

Cholestasis due to OCP will cause these two lab findings?

Back 174

conjugated (direct) hyperbilirubinemia

elevated serum Alk Phos

Front 175

What is the Charcot's triangle?

Back 175

Acute Cholangitis.

The clinical diagnosis is based upon the presence of Charcot triad

- Fever

- Jaundice

- RUQ abdominal pain

- Finding of common bile duct obstruction

Front 176

How is acute Cholangitis treated

Back 176

ERCP

- should performed to remove impacted stones.

Front 177

Initial treatment of choice for gallstone pancreatitis

Back 177

ERCP with sphincterotomy and stone extraction

Front 178

Pancreatic necrosis is diagnosed by a contrast-enhanced CT scan that shows _____________

Back 178

nonenhancing pancreatic tissue.

Front 179

What's the gold diagnostic study for GERD?

What are it's indications

Back 179

Ambulatory esophageal pH monitoring

Typically used in patients in whom:

- the diagnosis is uncertain or

- who are unresponsive to empiric therapy

Front 180

What's criteria for biopsy of gastric ulcers?

Back 180

All gastric ulcers MUST be biopsied

Front 181

Tx of PUD due H. pylori?

Back 181

triple therapy consisting of a PPI, amoxicillin, and clarithromycin

Front 182

____________ is defined as chronic or recurrent discomfort in the epigastrium with no organic cause determined

How is tx?

Back 182

Functional dyspepsia

- Upper endoscopy is necessary to rule out organic causes, and only after this is performed can the diagnosis of functional dyspepsia be distinguished from organic dyspepsia

Empiric trial of PPI

Front 183

________ are linear gastric ulcers or erosions in the hiatal hernia sac.

These are usually an incidental finding and are seen in 5% of patients with hiatal hernias who undergo endoscopic examination, but they can cause chronic or, less often, acute blood loss.

Back 183

Cameron lesions

Front 184

What are the cancer screening guidelines for a patient with Hep B.

Back 184

U/S study +

serum α-fetoprotein level > 500 ng/mL (500 µg/L) can be diagnosed with hepatocellular carcinoma without a biopsy.

Front 185

__________ is associated with obesity, type 2 diabetes, and hyperlipidemia and is a potential cause of cirrhosis.

Back 185

Nonalcoholic steatohepatitis (NASH)

Front 186

How is SAAG calculated?

Back 186

The serum-to-ascites albumin gradient (SAAG) is calculated by:

serum albumin level - ascitic fluid albumin level

-A gradient greater than 1.1 g/dL (11 g/L) indicates that the patient has portal hypertension with a high degree of accuracy.

Front 187

_________which manifests as small, exquisitely tender nodules on the anterior tibial surface, is the most common cutaneous manifestation of inflammatory bowel disease and occurs more commonly in Crohn disease, whereas _________ is more common in ulcerative colitis

Back 187

Erythema nodosum

pyoderma gangrenosum

-begin as tender papules, pustules, or vesicles that spontaneously ulcerate and progress to painful ulcers with a purulent base and undermined, ragged, violaceous borders. esp in lower extremities

Front 188

________ is characterized by chronic watery diarrhea without bleeding; the diagnosis must be made by histologic examination of colonoscopic biopsy specimens

Back 188

Microscopic colitis

Front 189

Pancreatitis may cause _____calcemia

Back 189

Hypocalcemia - due to saponification

Front 190

______ presents as fatigue and s/s of cholestasis with high Alk Phos and bill w/ normal to mildly elevated transaminases

Back 190

PBC

Front 191

Parasternal pain precipitated by cold, hot or carbonated liquids is suggestive of ________

How is it dx?

Whats the tx

Back 191

Esophageal spasms

Manometry

CCB or nitrates before meals

Front 192

CMV usually occurs when CD4 < ____ and is tx with ______

Back 192

50, Gancyclovir

- Causes retinitis, Colitis and other GI-"itises"

- Bloody diarrhea

Front 193

________ bacterial infection can cause RUQ pain, fever and leukocytosis (Mimicking appendicitis) however, additional finding of ______ helps distinguish it from appendicitis

Back 193

Yersinia entercolitica

diarrhea

Front 194

Whats the Rx for Varcieal bleeding?

Back 194

Octreotide (somatostatin analogue) or vasopressin

+ endoscopic intervention

If both fail ==> TIPS

Front 195

Intranuclear inclusion bodies w/ a nucleus surround by halo is due to ______

Back 195

Herpes simplex

- causes multiple small shallow ulcers

Front 196

Cytoplasmic inclusion bodies

Back 196

CMV

- one or more large ulcers

Front 197

_______ vein thrombosis is a complication of chronic pancreatitis.

It presents with greater curvature variceal bleeding.

Back 197

Splenic vein thrombosis

Note: Short gastric veins from greater curvature empty into the splenic vein

Front 198

Achalasia causes ______ peristalsis and _____ resting LES pressure

Back 198

Decreased, elevated

Front 199

What is the guideline for colonoscopy in pts with UC?

Back 199

Annual Colonoscopy with multiple biopsies

- 8 years after diagnosis

Front 200

New onset exudative ascites in a women > 50 yr old is concerning for ______, given no risk factors for liver disease or other causes?

Back 200

ovarian malignancy

- Pelvic U/S or Pelvic CT should be done next

SAAG < 1.1 = Exudatative

Front 201

Pt is suspected of having Gastrinoma.

What dx studies should be done (3) :

Back 201

1) Serum gastriin ---> (If elevated) ------> Secretin stimulation test

Positive secretin stimulation test ----> Somatostatin receptor Scintography to localize and stage the tumor

Note:

- Secretin induce gastrinoma cells to produce gastrin BUT

inhibits gastrin release from normal cells

-(PPI interfere with serum gastrin but not Secretin test). Gastrin is elevated in all pts on PPI

Front 202

2 week old boy has been having non-bilious vomiting. What kind of metabolic disturbance will he have?

Back 202

Hypochloremic, hypokalemic metabolic alkalosis

Front 203

How is sphincter of Oddi dysfxn diagnosed?

Back 203

ERCP with sphincter manometry

Sphincter of Oddi dysfxn:

Post prandial RUQ pain

Normal labs, normal U/S of gallbladder and dilation of common bile duct

Front 204

What are the most common cutaneous manifestations of IBD

Back 204

Erythema nodosum

Pyoderma gangrenosum