Step 2 Gi

Front 1

Celiac Sprue:
Presentation?
Dx?
Tx?

Back 1

Diarrhea, Dermatitis Herpetiformis, growth retardation and weakness
o Dx with small bowel biopsy showing blunting of villi, Tx with avoiding gluten products
o Tx dermatitis herpetiformis w/ dapson

Front 2

Exposure to Aflatoxin increases risk for?

Back 2

hepatocellular CA

Front 3

Hemochromatosis:
Systems Effected?

Back 3

hemosiderin accumulation in kidneys, heart, liver
- Also testes, adrenals, pituitary

Front 4

Hemochromatosis:
Presentation?

Back 4

Abd pain, Diabetic Sx’s, bronzing of skin, heart failure, cirrhosis, hepatomegaly

Front 5

Hemochromatosis:
Dx?
Tx?

Back 5

o Dx w/ fasting transferrin saturation (>45-50%), confirm w/ liver biopsy
o Tx w/ weekly phlebotomy

Front 6

Pt with hemochromatosis begins having RUQ abd pain, night sweats, increased jaundice and weight loss, suspect what?

Back 6

do a CT to check for hepatocellular CA

Front 7

SBO:
Presenation?
Radiologic finding?

Back 7

N/V, abd pain and constipation
- x-ray shows air/fluid levels and dilates small bowel

Front 8

Common Cause of SBO in women?

Back 8

ovarian tumor
- MC a mucinous epithelial tumor

Front 9

Whipple disease:
Cause?

Back 9

malabsorption disease (cramps, bloating, foul-smelling stool)
- Gram + bacteria

Front 10

Whipple disease:
Common Vit deficiency and Sx's of?

Back 10

loss of night vision indicates Vit A deficiency

Front 11

C. Jejuni:
Food?
Presentation?

Back 11

Poultry
Bloody Diarrhea
MC overall infectious diarrhea
2nd MC food borne pathogen

Front 12

C. Botulinum:
Food?
Presentation?

Back 12

Honey and home Canned goods
- flaccid paralysis

Front 13

C. Diff:
Food?
Presentation?

Back 13

Abx induced
Watery diarrhea and Grey Pseudomembranes

Front 14

E. Coli:
Food?
Presentation?

Back 14

"Travelers Diarrea"
Watery diarrhea

Front 15

E. Coli O157:H7
Food?
Presentation?
Risk factor for?

Back 15

Ground beef
bloody diarrhea
risk of HUS (thrombocytopenia, hemolytic anemia, acute renal failure)

Front 16

S. Areus:
Food?
Presentation?

Back 16

vomitting then diarrhea

Front 17

Salmonella:
Food?
Presentation?

Back 17

eggs, poultry, milk
MC food borne pathogen
Bloody diarrhea

Front 18

Shigella:
Food?
Presentation?

Back 18

severe bloody diarrhea

Front 19

V. Cholerae:
Food?
Presentation?

Back 19

water/seafood
copious watery diarrhea

Front 20

V. Parahaemolyticus:
Food?
Presentation?

Back 20

oysters
watery diarrhea

Front 21

Yersinia Enterocolitica:
Food?
Presentation?

Back 21

pork
bloody diarrhea

Front 22

Hepatitis: Acute infx (4-12 weeks)
HbsAg:
HBeAg:
HbsAb:
HbcAb:
HbcAb:

Back 22

HbsAg: +
HBeAg: +
HbsAb: -
HbcAb: -
HbcAb: + IgM

Front 23

Hepatitis: Acute infx (12-20 weeks)
HbsAg:
HBeAg:
HbsAb:
HbcAb:
HbcAb:

Back 23

Window period
HbsAg: -
HBeAg: -
HbsAb: -
HbcAb: -
HbcAb: + IgM

Front 24

Hepatitis: Chronic Infx
HbsAg:
HBeAg:
HbsAb:
HbcAb:
HbcAb:

Back 24

HbsAg: +
HBeAg: +
HbsAb: -
HbcAb: -
HbcAb: + IgG

Front 25

Hepatitis: Past Infx (recovered)
HbsAg:
HBeAg:
HbsAb:
HbcAb:
HbcAb:

Back 25

HbsAg: -
HBeAg: -
HbsAb: +
HbcAb: +
HbcAb: + IgG

Front 26

Hepatitis:Vaccination
HbsAg:
HBeAg:
HbsAb:
HbcAb:
HbcAb:

Back 26

HbsAg: -
HBeAg: -
HbsAb: +
HbcAb: -
HbcAb: -

Front 27

Causes of Salivary Gland disorders?

Back 27

MC Sialothiasis (stone)
Parotid gland can be affected in Sarcoid or neoplasm

Front 28

Tx of Salivary Gland Disorders?

Back 28

Tx w/ warm compress, massage, cough drop, abx

Front 29

Acute Gastritis:
Causes?

Back 29

Erosive
rapid, NSAID use, alcohol, stress from illness, any region affected

Front 30

Chronic Gastritis: Type A
Area affected?
Tx?

Back 30

Autoimmune, decreased gastric acid and gastrin (pernicious anemia)
• Found in fundus and body, Tx w/ b12 supplement

Front 31

Chronic Gastritis: Type B
Area affected?
Tx?

Back 31

Bacterial (H. Pylori), increased gastric acid level (urea breath test)
• found in antrum and pylorus, Tx w/ quad therapy 7-14 days

Front 32

Marjolins Ulcer association?

Back 32

Squamous Cell CA

Front 33

ZE:
Cause?
Dx?

Back 33

gastrin-producing tumor found in duodenum or pancreas
Can cause PUD, increased fasting gastrin,
+ secretin-stim test

Front 34

Crohns:
Area affected?

Back 34

Entire GI tract
“Cobblestoning”, skipped areas of bowel
affects Entire bowel wall
watery diarrhea

Front 35

Crohns:
Common Presentation?

Back 35

Typically a young, thin male w/ abd pain, weight loss, fatigue, non-bloody diarrhea

Front 36

Crohns:
Antibodies present?

Back 36

+ anti-Saccharomyces cerevisiae (ASCA) antibodies

Front 37

Crohns:
RF for?

Back 37

increased risk for fistula formation

Front 38

Crohns:
Common associated conditions?

Back 38

Associated: arthritis, ankylosing spondylitis, uveitis, PSC, Toxic Megacolon, HLA-B27

Front 39

Ulcerative Colitis:
Area affected?

Back 39

rectum to distal ileum
“lead pipe”, continuous involvement
mucosa and submucosa affected
bloody diarrhea

Front 40

Ulcerative Colitis:
Common associated conditions?

Back 40

Pyoderma gangrenosum
erythema nodosum
PSC
Toxic Megacolon
OA
ankylosing spondylitis

Front 41

Ulcerative Colitis:
Tx?

Back 41

5-ASA agents (Sulfasalazine, mesalamine)

Front 42

Ileus:
Causes?
Time frame post-op?

Back 42

paralytic obstruction of bowel, infx, ischemia, surgery, DM, opioid use
o Post-operative ileus <5 days

Front 43

Volvulus:
MC area affected?
Radiologic Finding?

Back 43

rotation of bowel, MC at cecum and sigmoid colon
o Abd Xray shows “double-bubble”

Front 44

Exocrine pancreatic CA:
Area affected?
Tumor Markers found?

Back 44

Adeno, MC head of pancreas (easier to remove as well)
-increased CA19-9 and CEA markers

Front 45

Exocrine pancreatic CA:
Tx?

Back 45

Tx with Whipple procedure
(remove head pancreas, duedenum, proximal jejunum, common bile duct, gallbladder, and distal stomach)

Front 46

Endocrine pancreatic CA:
area involved?
Presentations?

Back 46

involves glandular tissue of pancreas
ZE, Insulinoma, Glucagonoma

Front 47

Acute cholecystitis:
Cause?
Dx?

Back 47

gallbladder inflm caused by obstruction of cystic duct
o US first, Gold standard to Dx is HIDA scan if US unequivocal

Front 48

Acalculous Cholecystitis found in what population?

Back 48

critically ill ICU pt’s receiving long term perenteral nutrition

Front 49

Cholangitis:
Presentation?
Cause?
Dx?

Back 49

oCharcot’s triad: RUQ pain, jaundice, fever/chills
oReynold’s pentad: RUQ pain, jaundice, shock, AMS
- infx of bile ducts due to ductal obstruction
Dx: usually clinical, can use US or CT but ERCP is diagnostic and therapeutic

Front 50

Cholangitis:
Tx?

Back 50

Tx w/ IV Abx, bile duct decompression through percutaneous drainage, open surgery or ERCP guided

Front 51

Primary sclerosing cholangitis:
Cause?
Common complications?
Associated diseases?

Back 51

cause by obliterative fibrosis of intrahepatic AND extrahepatic bile ducts ("onion skinning")
o Complications: Cholangiocarcinoma
o Associated w/: under 45, HLA-DR52, UC, Crohns, retroperitoneal and mediastinal sclerosis fibrosis

Front 52

Primary biliary cirrhosis:
Area Effected?
Presentation?
Cause?

Back 52

granulomatous destruction of intrahepatic ducts of portal triad (not extrahepatic)
o Pruritus, hepatosplenomegaly, jaundice, xanthelasma, Kayser-fleischer rings

Front 53

Primary biliary cirrhosis:
Chemistry Changes?
Marker?
Tx?

Back 53

increased GGT, alk phos, bili, cholesterol, IgM
+antimitochondrial antibodies
o Tx w/ Ursodeoxycholic acid shown to slow progress of disease, liver transplant improves survival

Front 54

Choledocholithiasis:
Presentation?
Cause?
Tx?

Back 54

+murphy’s sign,
jaundice, RUQ pain, fever, N/V, leukocytosis, increased alk phos and tot bili
o Stone blocking passage of bile, MC in common bile duct
o Tx w/ ERCP w/ sphinterectomy followed by chole

Front 55

How do you Dx a suspected Boerhaave's syndrome w/ possible perforation?

Back 55

gastrografin swallow
- it is water soluble and safer when perforation is suspected (do not use barium swallow if perforation suspected)

Front 56

MCC of GI Bleed?

Back 56

MC is PUD
o2nd MC is esophageal varices
o3rd MC is AVM
o4th MC is Mallory-weiss tears
o5th MC is malignancy

Front 57

What age do you start screening Colonoscopy in Familial Adenomatous Polyposis?

Back 57

12 (start of puberty)

Front 58

Tx for Familial Adenomatous Polyposis?

Back 58

if few polyps then polypectomy
if hundreds then total colectomy

Front 59

Gardners Syndrome:

Back 59

hundreds to thousands of adenomatous polyps, w/ osteomas (skull bone growths), dental abnormalities, desmoid abdominal tumors, and cutaneous lesions

Front 60

What is Reactive Hypoglycemia?

Back 60

pt’s w/ prior GI surgery
hypoglycemia after eating w/ normal insuling, C-peptide and proinsulin levels

Front 61

Rotor syndrome:
Dx?
Tx?

Back 61

defect in bilirubin storage, causing conjugated hyperbilirubinemia
oUrinary coproporphyrin will be elevated,
- no tx required

Front 62

Differences b/t Rotor syndrome and Dubin-Johnson Syndrome?

Back 62

both have increased biliribun levels
Dubin-Johnson syndrome has liver color change (black), and NO increase in urinary coproporphyrin

Front 63

Poor prognostic criteria of Pancreatitis?

Back 63

glucose >250, calcium <8 both poor prognosis

Front 64

MCC Pancreatitis?

Back 64

o MCC is Gallstones, 2nd MC is Alcohol, then hypertriglyceremia, recent ERCP

Front 65

MCC death in acute Pancreatitis?

Back 65

hypovolemic shock secondary to fluid sequestration

Front 66

Risk factors for Pancreatitis?

Back 66

high triglycerides, OCP use, DM

Front 67

Hepatorenal syndrome:
Presentation?
Tx?

Back 67

lethal complication of end stage liver disease
• Decreased GFR w/ failure to respond to saline bolus, caused by renal vasoconstriction due to decreased renal blood flow
• No known cure, only Liver Transplant can treat

Front 68

What type of epithelial change is present in GERD?

Back 68

Barrets Esophagus, Columnar Metaplasia

Front 69

MCC Colonic Bleeding?

Back 69

Angiodisplasia is the MCC colonic bleeding,
- divirticulosis higher in >40

Front 70

MC Viral Gastroenteritis:
Adult?
Children?

Back 70

Norwalk virus
Rotavirus

Front 71

Achalasia:
Cause?
Radiology?
Tx?

Back 71

impaired paristalsis and decreased lower esophageal sphincter relaxation due to neuron dysfunction
o Progressive dysphagia of solids then liquids, “birds beak” sign on barium swallow
o Tx w/ Nitrates/CCB at first, pneumatic dilitation long term

Front 72

Esophageal spasm:
Cause?
Radiology?
Tx?

Back 72

contractions of esophagus
- “corkscrew” on barium swallow
o Tx w/ CCB or Nitrates

Front 73

MC Esophageal CA?

Back 73

Squamous MC, Adeno less common
o Barrets: columnar metaplasia due to chronic GERD, precedes Adeno

Front 74

MC Gastric CA?

Back 74

Adeno (common) or squamous (rare)

Front 75

What two lymph nodes are associated w/ Gastric CA?

Back 75

o Virschows Node (supraclavicular) and Sister Mary Josephs node (periumbilical)

Front 76

PUD:
Causes?

Back 76

H. Pylori, NSAIDS, tobacco, alcohol, steroids

Front 77

Gastric PUD:
Presentation?
Cause?

Back 77

25%
- pain right after eating
- most caused by H. Pylori,
- high gastrin, older

Front 78

Duodenal PUD:

Back 78

75%
- pain 2-4 hours after eating
- ALL caused by H. Pylori
- normal gastrin, younger

Front 79

Other Gastric Ulcers:
Curlings?
Cushings?
Marjolins?

Back 79

- Curlings (burns)
- Cushings (intracranial injury)
- Marjolins (chronic wound, usually burn)

Front 80

Common GI problem associated w/ GERD?

Back 80

Sliding Hiatal Hernia

Front 81

Histo finding in Alcoholic Hepatitis?

Back 81

Mallory bodies (cytoplasmic inclusion bodies containing keratin)

Front 82

MC benign tumor of the liver?

Back 82

Cavernous Hemangioma

Front 83

Courvosier’s sign:

Back 83

non-tender, palpable gallbladder

Front 84

Tx regimen for Ascites 2nd to Cirrhosis?

Back 84

1st w/ sodium/water restriction, then spironolactone, then furosemide, then TIPS

Front 85

Focal Nodular Hyperplasia (FNH):
Presentation?
Cause?
Radiology?
Tx?

Back 85

tumor-like condition common in women, thought to be a reaction to injury
- “hypervascular” mass on CT
- best to observe unless the mass is growing

Front 86

HSV Oral Ulcer:
Presentation?
Tx?

Back 86

Small Deep Ulcers
multinucleated Giant cells w/ nuclear inclusions
Tx w/ Acyclovir IV

Front 87

CMV Oral Ulcer:
Presentation?
Tx?

Back 87

Large Shallow ulcers
intranuclear inclusions
Tx w/ Ganciclovir IV

Front 88

Carcinoid tumor:
Area located?
Dx?
Tx?

Back 88

MC appendix, ileum, rectum, stomach
- Dx w/ increased 5-HIAA in urine, increased serum serotonin level
- Tx w/ Octreotide

Front 89

Carcinoid syndrome:
Presentation?

Back 89

flushing, diarrhea, bronchoconstriction
- only seen w/ extra-GI involvement (MC Pancreas)

Front 90

Which IBD increases risk for Colon CA?

Back 90

both do, but UC>>Crohns

Front 91

L sided vs. R sided Colon Masses:

Back 91

R sided: major blood loss, less chance of obstruction
L sided: "apple-core" on ABX, increased chance for obstruction, changing bowel habits

Front 92

Difference b/t cholecystitis and choledocolythiasis?

Back 92

Chole: fever/leukocytosis
Choledoco: fever/leukocytosis + elevated bili and alk phos

Front 93

Choledochal Cyst:
Presentation?

Back 93

- Cystic extra-hepatic mass that causes dilatation of intra OR extra-hepatic ducts

Front 94

Course for Tx of Acute Cholycystitis?

Back 94

- Observation and supportive care, followed by Lap Chole within 72 hours if found early
- If pt is stable or there are many comorbid conditions, consider waiting 4-6 for surgery

Front 95

Hepatorenal syndrome:

Back 95

- Severe liver disease causing hypoperfusion of kidneys leading to renal failure

Front 96

Pts w/ IBD (UC) should receive colonoscopy when and why?

Back 96

8 years after Dx and every 1-2 after, due to increased risk for developing Colon CA

Front 97

Pt w/ epigastric pain that is exacerbated by eating, CXR shows intraperitoneal air, what is cause and Tx?

Back 97

Perforated peptic ulcer, tx w/ immediate surgery

Front 98

Definitive tx for Zenkers divirticulum?

Back 98

excision of the diverticulum, then Myotomy of cricopharyngeus muscle to relieve high-pressure zone

Front 99

Leading cause of SBO in children?
In Adults?

Back 99

- In children it is Hernia's
- In adults it is adhesions from previous surgery

Front 100

Mesenteric Ischemia:
Presentation?
Radiologic findings?
Gold Standard Dx?
Tx?

Back 100

- Severe abd pain out of proportion w/ exam, N/V, Bloody Stools
- AXR shows bowel wall edema ("thumbprinting"), and air within bowel (Pneumatosis intestinalis)
- Gold standard Mesenteric Angiography
- Tx w EARLY laprotomy if evidence of necrotic tissue and worsening condition, anti-coagulate or embolectomy if not as severe

Front 101

Large Bowel Obstruction:
Presentation?
Causes?
Tx?

Back 101

- TTP, extreme distension, "high-pitched" tinkly sounds, N/V, Constipation
- Colon CA (assume until proven otherwise), divirticulitis, volvulus
- Tx underlying cause (tumor), can sometimes be relieved w/ gastrografin enema or Rectal Tube but usually requires Surgery

Front 102

LBO vs SBO?

Back 102

- SBO has more Vomitting
- LBO has more abd Distension
- Both have "tinkly" BS
- SBO tx w/ NG decompression and NPO, LBO Tx w/ Rectal Tube or Gastrografin Enema

Front 103

How do you determine the degree of invasion in Rectal CA?

Back 103

- Endorectal US

Front 104

Ischemic colitis is an uncommon but possible occurrence after what abd surgery?

Back 104

- AAA repair

Front 105

Crohns:
Tx?

Back 105

5-ASA agents (Sulfasalazine, Mesalamine)
Steroids

Front 106

MC area of obstruction in Gallstone Ileus?

Back 106

- Ileocecal valve

Front 107

Dx confirmation of Gallstone Ileus?

Back 107

- Pneumobilia (gas in biliary tree)