Step 2 Gi

Front 1

what three problems to you see in Plummer-vinson syndrome?

Back 1

dysphagia
iron deficiency anemia
glossitis

Front 2

what is the most common esophageal cancer world wide?

how about in the US?

what part of esophagus is each usually located?

Back 2

squamous cell---upper and middle thirds

adenocarcinoma-----lower third

Front 3

what are the associated risk factors for SCC and adenocarcinoma of the esophagus?

Back 3

SCC----alcohol and tobacco

adeno---barretts esophagus

Front 4

what kind of drug is zantac? used for what?

Back 4

an H2 blocker---generic: ranitidine
cimetidine is another


GERD

Front 5

acute gastritis...causes? types of ulcers seen?

Back 5

NSAIDs, stress, alcohol, H. pylori

curling ulcers---from burns
cushings ulcers---from CNS injury

Front 6

type A gastritis is associated with what deficiency and why? what area of the stomach is affected?

Back 6

pernicious anemia due to intrinsic factor deficiency (autoantibodies to parietal cells) so you dont get absorption of vit. B12

the body/fundus

Front 7

type B gastritis is mainly caused by what? what part of stomach is affected?

Back 7

H. pylori

antrum

Front 8

what is the triple therapy for H. pylori?

Back 8

amoxicillin
clarithromycin
omeprazole

metronidazole if they have penicillin allergy (swap for amoxil)

Front 9

when doing xray to rule out ulcer perforation where is air located if there is for gastric and duodenal ulcers?

Back 9

gastric----free air under diaphragm

duodenal---free air in retroperitoneal space

Front 10

in recurrent or refractory cases of gastric ulcers what you check and why?

Back 10

check gastrin levels to screen for zollinger-ellison syndrome

Front 11

define diarrhea

Back 11

>200g of crap a day with increased frequency or decreased consistency of crap

Front 12

what is the most common etiology of bacterial diarrhea?

Back 12

campylobacter

Front 13

what is a major offending drug for c diff?

what is treatment for it?

Back 13

clindamycin

stop offending abx, give metronidazole or vancomycin

Front 14

dude has diarrhea and endoscopy shows flask-shaped ulcers. what does he likely have and how should you NOT treat it and what should he get?

what is key in the Hx of this gue

Back 14

entamoeba histolytica infection

DONT give steroids (could cause fatal perforation)

give metronidazole instead

recent travel to developing countries

Front 15

what type of toxin does EHEC produce and what can it lead to?

Back 15

shiga-like toxin


HUS

Front 16

dude gets bloody diarrhea. he also happened to eat some raw eggs and dairy. what bug are you thinking he has?

Back 16

salmonella

Front 17

dude has dermatitis herpetiformis and diarrhea. what could be a likely end-diagnosis?

Back 17

celiac diseas

Front 18

what are the 4 D's of pellagra?

Back 18

diarrhea, dementia, dermatitis, death

Front 19

what is the Rome III diagnostic criteria for IBS?

Back 19

3 months of episodic abdominal discomfort that is
1) relieved by crapping
2) associated with change in stool frequency or consistency

Front 20

in a small bowel obstruction vs ileus, where is the air located?

Back 20

in SBO air is NOT found distal to the obstruction (air will be scant in colon)

in ileus there is distension (air present) throughout the small and large intestine

Front 21

what two labs are elevated when there is bowel ischmia

Back 21

leukocytosis

metabolic acidosis

Front 22

treatment for uncomplicated divurticulitis?

Back 22

diet counsel (MOAR FIBER)

abx (metronidazole and a floroquinolone--cipro)

Front 23

second leading cause of cancer mortality in the US?

Back 23

colon cancer

Front 24

guidelines for the three classes of risk categories for colon cancer

Back 24

No past or family history: every 10 years starting at 50, sigmoid every 5, DRE and stool guiac yearly

First degree relative: every 10 years starting at 40 or every 10 years 10 years prior to the age of the relative when they were dx'ed....whichever comes first

Ulcerative colitis: every 1-2 years 8 years after dx

Front 25

what are most gallstones made of? that makes them difficult to see with what? what is the image modality of choice?

Back 25

cholesterol

xray

Ultra sound

Front 26

what are the three labs that are increased with choledocholilithiasis?

Back 26

alk phos

total and direct bilirubin

Front 27

charcots triad? reynolds pentad? what disease are these found in?

Back 27

RUQ pain, jaundice, fever/chils

those 3 + shock, altered mental status

found in ascending cholangitis

Front 28

liver disease labs, what ones go along with these

hepatocellular injury---2
cholestasis---2
isolated hyperbilirubinemia--1

Back 28

hepatocellular---HIGH AST and ALT
cholestasis---HIGH alk phos and bilirubin
hyperbilirubinemia---HIGH bilirubin

Front 29

what two diseases are associated with non-alcoholic fatty liver disease?

Back 29

insulin resistance (DM type 2)
metabolic syndrome

Front 30

what is the hallmark finding of pancreatic cancer?

Back 30

non-tender, palpable gall bladder

courvoisier's sign

Front 31

bleeding esophageal varicies? what is the treatment?

Back 31

varceal ligation

Front 32

alcohol withdrawal sydrome...drug class of choice?

Back 32

benzodiazepine

Front 33

good lab to dx hemochromatosis?

Back 33

transferrin saturation

serum iron/TIBC

Front 34

patients with PUD and NO h. pylori should be treated with what?

Back 34

PPI

Front 35

risk factor for pancreatic cancer...male or female?

Back 35

male

Front 36

hepatomegaly...sign of acute or chronic liver disease?

Back 36

acute

Front 37

what is the most common type of colonic volvulus?

Back 37

sigmoid

Front 38

patients with primary sclerosing cholangitis are at an increased risk for what?

Back 38

cholangiocarcinoma

Front 39

which bile ducts are affected in PSC?

Back 39

extra and intrhepatic bile ducts

Front 40

old man presents with abdominal pain, cardiac and neuro symptoms (dementia) and arthralgias. he also has PAS-positive macrophages...whats he got and how do you treat it?

CAN---cardiac, arthralgias, neuro

Back 40

whipples disease

TMP-SMX---long term (12 months)

Front 41

on comlex 2 how will pancreatic carcinoma present?

Back 41

Pancreatic carcinoma for COMLEX purposes will often present in an African American male with the chief complaints of abdominal pain, weight loss, and migratory thrombophlebitis. On physical exam Courvoisier’s sign may be seen along with obstructive jaundice.

Front 42

patients has anti-smooth muscle abs...what problem do the have?

Back 42

auto-immune hepatitis

Front 43

water restriction has failed in a patient with ascites...whats next?

Back 43

spironolactone

Front 44

what test confirms cholecystitis? how about choledocholithiasis?

Back 44

HIDA scan

ERCP

Front 45

patients is having abdominal pain after eating and now avoids eating to avoid the pain, weight has been lost. likely dx? test to prove it?

Back 45

likely has mesenteric ischemia

angiogram to dx it

Front 46

salmon-colored lesions/patches on the skin plus diarrhea, fever and recent travel to a developing country...likely what?

Back 46

salmonella typhi

Front 47

this bug can cause cysts in the liver and has a gradual onset

Back 47

entamoeba histolytica

Front 48

where is the stone located in choledocholithiasis? what labs are elevated?

Back 48

in the common hepatic duct

alk phos, total and direct bilirubin

Front 49

which cells replace which cells in barretts esophagus?

Back 49

stratified epithelium are replaced with columnar epithelium

Front 50

what is the treatment for PBC? what does it do?

Back 50

ursodeoxycholic acid

decreases cholesterol synthesis and alter bile production

Front 51

dudes hands are held in extension with arms outstretched and there is asterixis (flapping tremor). what does he likely have and what is it a common side effectof?

Back 51

hepatic encephalopathy

complication of the TIPS procedure because blood now bypasses hepatocytes and there is a decrease in the clearance of toxins

Front 52

hepatic encephalopathy is thought to be due to an increase in ammonia. what is a possible drug to lower the ammonia? name another?

Back 52

neomycin and lactulose

they decrease the amount of ammonia producing bacteria in the colon

Front 53

what hormone accumulates as a result of liver cirrhosis? name two things this leads to

Back 53

estrogen

telangiectasias and gynecomastia

Front 54

how do you calculate the SAAG? what value is the threshold above which is indicative of portal HTN?

Back 54

subtract the ascites-fluid albumin from the serum albumin

1.1 g/dl

Front 55

severe abdominal pain and a benign examination of the abdomen?

Back 55

mesenteric ischemia

Front 56

treatment of choice for hep C?

Back 56

pegylated interferon
ribavirin

Front 57

what are cytoplasmic inclusions containing keratin called? what are they associated with?

hint: found in the liver

Back 57

mallory bodies

alcoholic hepatitis

Front 58

what are the three symptoms of wernickes and what causes it?

Back 58

ecephalopathy, ataxic gait, oculomotor dysfunction

chronic alcohol use

Front 59

this disease damages both the intra and extrahepatic ducts?

Back 59

PSC

Front 60

what is hepatolenticular degeneration also known as?

Back 60

wilsons disease

Front 61

leukocytosis along with ascites suggests what? what is one of the most sensitive labs values?

Back 61

spontaneous bacterial peritonitis

>500 neutrophils in peritoneal fluid

Front 62

where is the most common site for adenocarcinoma of the colon

Back 62

the proximal colon

Front 63

laxative abuse leads to which hyper/hypo K and acid/alkali?

Back 63

hypokalemia
acidosis (pooping out all your bicarb)

Front 64

what is the order of treatments options for ascites?

Back 64

water and salt restriction
spironolactone
furosemide
TIPS
surgical shunting

Front 65

supplemental ____________ is given in wilsons disease? it decreases gut absorption of copper

Back 65

zinc

Front 66

what is the most common benign tumor of the liver?

Back 66

cavernous hemangioma

Front 67

what two anti bodies will a person that had hep B from a needle stick but since recovering have?

Back 67

anti HBc
anti HBs (indicates immunity)

Front 68

dude has some active hep B going on, what anti bodies do you see?

Back 68

anti HBc (IgM)
anti HBeAg
anti HBsAg

Front 69

patient has large bowel obstruction, what should you be most worried about?

Back 69

neoplasm

Front 70

urine copper levels and serum ceruloplasmin in wilsons disease?

Back 70

HIGH urine copper

LOW ceruloplasmin

Front 71

what causes 90% of duodenal ulcers?

Back 71

H. pylori

Front 72

dude has been dx'ed with ulcerative colitis...when should he start getting colonoscopies?

Back 72

every year 8 years after the diagnosis

Front 73

when should someone with a family member that has colon cancer get colonoscopies?

Back 73

at age 40 or 10 years before the age of that family member...whichever is sooner

Front 74

when should african americans start getting colonoscopies?

Back 74

age 45

Front 75

gastroparesis is a problem that develops with what metabolic disease? what is the first line treatment?

Back 75

diabetes

metoclopramide (reglan)

Front 76

what is heydes syndrome?

Back 76

angiodysplasia of colon and aortic stenosis

Front 77

you suspect ascites and want to confirm....study of choice and why?

Back 77

US and not CT

US will tell you about hepatic vasculature and is best for detecting ascites

Front 78

if large esophageal varicies are noted what should the prophylaxis be?

Back 78

non-selective beta blockers (propranolol, nadolol)

Front 79

patient presents with symptoms worrisome for pancreatic cancer (jaundice, weight loss, abdominal pain) what is the first image modality of choice? after that?

Back 79

US

CT scan

Front 80

is jaundice associated with acute cholecystitis?

Back 80

NO

more associated with ascending cholangitis

tx it with ERCP

Front 81

anti-saccharomyces-cervisiae-antibodies is found in what disease? what class of drugs should they avoid

Back 81

crohns

avoid NSAIDs....they can cause flare ups

Front 82

diabetic dude with poor control comes in with 3 months history of nausea and vomiting....what could it be and how could you diagnose it?

what drug could treat this?

Back 82

could be gastroparesis (likely from poor diabetes control, damaging vagus nerve)

use a gastric scintography (measures gastric emptying) to dx

erythromycin...it is the most potent drug for stimulating gastric emptying (who knew, right?)

Front 83

patients with GERD and alarm symptoms (weight loss, bleeding, dysphagia) get what study done?

Back 83

endoscopy

Front 84

someone with HIV and hep B, or chronic hep B alone, can be treated how?

Back 84

interferon

antivirals, such as adefovir, tenofovir, emcitabine

Front 85

best lab for detecting acute pancreatitis?

Back 85

LIPASE

Front 86

in actue diverticulitis what tests are controindicated and which is best to do instead?

Back 86

dont: colonoscopy, barium enema

do: CT abdomen

Front 87

non-caseating granulomas are pathognomic for this disease of the bowels?

Back 87

crohns

Front 88

hepatic adenomas in women have a strong association with the use of what?

Back 88

OCPs

Front 89

toxic mega colon is a sequalae of what disease and what bacteria?

Back 89

ulcerative colitis

c diff