Step Iii, Gi

Front 1

primary sclerosing cholangitis - dx, assoc w/

Back 1

endoscopic choliangiogram, assoc w/ UC

Front 2

Can px w/ iron deficiency and vitamin D without mal absorption? Think? Dx how?

Back 2

celiac disease, malabsorption screening: a) 1anti-endomesial and B)anti-tissue transglutaminase antibody; c) gold standard small instestine biopsy

Front 3

fever, RUQ pain, and jaundice

Back 3

Charcot's triad: ascending cholangitis.

Front 4

fever, RUQ pain, and jaundice and add hypotension and confusion

Back 4

Reynolds pentad assoc with suppurative cholangitis and has a poorer prognossi

Front 5

fever, RUQ pain, and jaundice and add hypotension and confusion & persistent abdominal pain or hypotension despite fluid resus or T>39 or and mental confusion. Next step

Back 5

urgent biliary drainage

Front 6

bulky, foul smelling stools that are difficult to flush

Back 6

steatorrhea 2/2 fat malabsorption.

Front 7

This plus abdominal pain + hx of alcohol intake. Think? Dx with?

Back 7

chronic pancreatitis; dx w/ CT showing calcification, pancreatic enlargement ductal dilation, and pseudocysts

Front 8

most common cause of massive lower GI bleeding in elderly patients

Back 8

angiodysplasia or diverticulosis.

Front 9

angiodysplasia assoc w/

Back 9

aortic stenosis (ejection systolic murmur radiating to the carotids) and ESRD

Front 10

stable patients with jaundice. inpatient or outpatient workup

Back 10

can be evaluated on an outpatient basis

Front 11

acute hep b. tx? prognosis

Back 11

supportive measures "prognosis: 5% of adults will develop chronic hep B, 90% of infants will develop chronic hep B"

Front 12

Ginko medical side effects?

Back 12

has antiplatet activity and seizure

Front 13

ginseng assoc with

Back 13

stevens johnson syndrome and psychosis

Front 14

aconite adverse reaction

Back 14

is cardiotoxic may cause arrhythmias and hypotension

Front 15

kava adverse reaction

Back 15

can cause liver injury

Front 16

acute variceal bleeding assoc with what hospital complication? prevention?

Back 16

spontaneous bacterial peritonitis in 50% tx prophylactically with fluoroquinolone for 7-10 days

Front 17

hep c labs. acute infection, resolved infection. never an infection

Back 17

Acute infection: anti HCV AB may be negative in acute infection. Get HCV RNA by PCR. If positive then acute hep C infection
Resolved hep C".+anti-HCV AB -HCV RNA by PCR = Resolved hep C infection"
never an infection: ".-anti HCV AB
-HCV RNA no infection"

Front 18

hep c px

Back 18

"asymptomatic or malaise, N/RUGQ pain, and liver function test abnormalities"

Front 19

adenomatous polyps on colonoscopy. Next step?

Back 19

1-2 small <1cm tubular ademoas with no high-grade dysplasia -> f/u colonoscopy in 5 years hyperplastic polyps -> f/u colonoscopy in 10years as rarely go onto adenocarcinoma ">3 ademoas or high grade dysplasia or *villous fetures *>1cm f/u colonscopy in 3 years"

Front 20

esophageal varacies tx

Back 20

1. upper endoscopy x2 with banding +/- octreotide
2. if fails surgical shuning or transjugular intrahepatic portosystemic shunt (TIPS) should be considrered" beta blocker is rec for long term prevention

Front 21

oropharyngeal source of dysphagia dx how?

Back 21

dx with barium swallow.

Front 22

drug causes of pancreatitis

Back 22

*thiazides and furosemide
* sulfasalazine, 5-ASA
*immunosuppresents: azathioprin, l-asparaginase *seizures: valproic acid
* aids: didanosine, pentamidine *ABX: metro and tetracycline"

Front 23

lactose intolerance dx w/

Back 23

dx w/ lactose breath hydrogen test. Need to fast for 8 hours

Front 24

c diff rapid immunoassay sens/spec? if negative and high pretest probability? Tx? Failed tx. Next step?

Back 24

70-87%/100% (note stool cytotoxin test is 94-100% sensitive)
repeat immunoassay
1. metronidazole 2. vancomycin
metro. Not usually due to resistance but due to spores that linger

Front 25

young female with intermittent episode of chest pain and dysphagia, may describe pain with drinking cold beverages. ekg normal. Barium swallow shows corkscrew esophagus. Think? Manometric findings? tx?

Back 25

*diffuse esophageal spasm aka nutcracker's esophagus
* high amplitude peristaltic contractions
* ekg normal (this is how you differentiate it from prinzmetal's variant angina)
tx with ca channel blockers and nitrates

Front 26

female without pain px with food sticking in throat, halitosis, and regurgitation. Think? dx w/? tx?

Back 26

zenker's diverticulum-
rotting food in the back of the esophagus from dilation of the posterior pharyngeal constrictor muscle
dx w/ barium swallow.
Do NOT do endocopy or ng tube to avoid perforation tx with surgical resection

Front 27

reflux symptoms with loss of distal peristalsis of esophageus on manometer. Think

Back 27

scleroderma (progrressive systemic sclerosis

Front 28

odynophagia (pain with swallowing). Think? If HIV neg next step? If HIV pos, next step

Back 28

esophagitis. 2/2 herpes, candida, or CMV
HIV neg: endoscopy
HIV pos: fluconazole. If no response then endoscopy. 90% candida

Front 29

periodic retrosternal pain + difficulty swallowing solid food, prolonged and careful chewing, and swallowing small portions think

Back 29

peptic stricture 2/2 GERD due to healing ulcerative esophagitis.

Front 30

diff for isolated elevated alk phos?

Back 30

seen in infiltrative liver disease: malignancy, granulomatous disease, and infections

Front 31

chronic pancreatitis and gastric varacies is due to what

Back 31

splenic vein thrombosis

Front 32

ascites, fever, abdominal pain, or altered mental status. Think

Back 32

spontaneous bacterial peritonitis

Front 33

sudden acute abdomen, patients tend to lie still, hx of GERD. Think? Dx test? Tx/

Back 33

peritonitis 2/2 bowel perforation2/2 to gastric ulcer. Upright x-ray -> look for pneumoparitoneum emergent laparatomy

Front 34

esophageal perforation? Dx test?

Back 34

esophagram with water soluble contrast

Front 35

hx of severe colitis 2/2 to IBD, distended abdomen, tympanic, septic. Think? Next step

Back 35

toxic megacolon abdominal x-ray looking for multiple air fluid levels of bowel

Front 36

first step in work up for chronic diarrhea

Back 36

stool microscopy

Front 37

crampy epigastric pain that worsens with meals with intial negative workup. Think? dx how?

Back 37

chronic mesenteric ischemia angiography is the gold standard

Front 38

young nonsmoker with dysphagia to solids and liquids +/- aspiration/regurg of previously eaten material . Think? Path? dx? tx?

Back 38

achalasia= failure of the gastroesophageal sphincter to relax.
dx w/ barium sallow. Confirm with esophageal manometer (abnormally hig pressure at LES)
tx: pneumatic dilation or surgical mytomoy or botox injection if won't do above