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56 Cards in this Set
- Front
- Back
tx of h pylori
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- ppi, amox/metronidazole, clarithromycin, bismuth
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what is wireless video endoscopy good for?
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- i.e. video pill
- looking at small bowel dz, not good for esophagus, stomach disease - better resolution than endoscopy |
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pt with pancreatitis spikes a fever?
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- obtain BCx and start on antibiotics immediately: imipenem, 3rd gen ceph, piperacillin, fluoroquinolone, metronidazole --> if no resolution in 1 wk the CT guided aspiration for culture
- increased morbidity/mortality ** HY |
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APACHE II vs Ranson's criteria?
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- APACHE > Ransons b/c Ranson's requires score to be calculated after 48hours in hospital vs APACHE that determines based on current info
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f/u test for h pylori?
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- 4 weeks later get fecal or breath test, not serology (+ for year)
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increased anatomical risk of Mallory-Weiss tear?
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- hiatal hernia
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suspect diverticulitis not responding to abx?
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- get CT scan; colonoscopy is C/I
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suspect bleeding peptic ulcer?
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- get upper endoscopy
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medications given in conjunction to banding in esophageal varices?
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- octreotide and non-selective BB (propranolol, nadolol)
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charcot's triad, Reynold's pentad?
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- fever, jaundice, RUQ pain = ascending cholangitis
- pentad: hypotension, confusion = suppurative cholangitis - tx is supportive or else biliary drainage |
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suspect bowel perf e.g. hx peptic ulcer and sudden abd pain
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- get upright CXR --> if unclear, get CT
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ogilvie's syndrome
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- aka acute colonoic pseudobstruction - dilation of cecum and R colon in absence mechanical obstruction
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pt with anemia and +FOB
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get colonoscopy to work up for colon ca
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suspect boerhaave's, what test?
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- esophagram, never upper GI endoscopy
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young pt with jaundice and RUQ pain?
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- outpt hepatic panel and 1 wk f/u, no need to admit
- ** HY |
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dissolves cholesterol gallstone
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- ursodeoxycholic acid
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markers for acute hepatitis vs chronic?
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- acute: HBsAg, IgM, HBeAg (high infectivity)
- chronic: HBsAg, anti-HBe, IgG |
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tx Hep B
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- supportive measures, no vaccine or IG
- give HBIG and HBvaccine for post exposure ppx |
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best prognostic indicators for pts with acute hep b?
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- prothrombin time - if normal = good
- <5% develop chronic - 90% infants will be chronic |
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prep for lactose breath test?
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- NPO 8 hours before
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suspect peptic ulcer dz, next step?
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- get upper endoscopy if >45 y.o. and new onset or have alarming sx
- if <45 don't need upper GI and can just do urease breatha test |
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hx celiac sprue now w/ weight loss?
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- increased risk of intestinal lymphoma esp jejunum
- poor prognosis |
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kava
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- herbal medicine associated with hepatitis, cirrhosis, liver failure
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SE ginseng
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- severe HA, SJS
- may treat schizophrenia? |
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any positive FOBT?
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- do colonoscopy
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types of esophageal cancer?
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- upper esophageal, hx of EtOH, smoking: squamous
- lower esoph, hx of barrett's: adenocarcioma |
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pt with H pylori, fails triple therapy- next step?
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- most likely abx resistance--> quadruple therapy --> pantoprazole, bisthmuth, tetracycline, metronidazole
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pt with FAP-- see many polyps on colonoscopy? next step?
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- gett upper GI to look for polyps in upper small intestine
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pt with excised polyps on screening colonoscopy, next step?
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- if <2cm and completely excised, no f/u
- if >2 then f/u colonoscopy in 3-4 months to ensure completely excised - for both repeat surveillance in 3 years |
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pt with chronic diarrhea- next step?
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- stool microscopic examination
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gold standard for dx of celiac dz?
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- small intestinal biopsy --> see villous blunting with lymphocytic and plasma cell infiltration
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histopath of Crohn's vs UC?
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- crohn's: transmural inflammation
- UC: suerficial mucosal inflammation w/ plasma cells |
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GERD pain vs duodenal ulcer pain
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- GERD: awake from sleep, worsens with emotional stress, post-prandial
- duodenal ulcer: pain on an empty stomach |
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any change in diet needed s/p cholecystectomy
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- no
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pt with chronic pancreatitis now with coffee ground emesis?
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- complication of chronic pancreatitis is splenic vein thrombosis --> can get inflamed due to proximity to pancreas --> see gastric varices, portal HTN, ascites, massive splenomegaly
- note: ddx w/ portal vein thrombosis --> see gastric AND esophageal varices |
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Budd-Chiari syndrome
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- thrombosis of hepatic vein --> RUQ, hepatomegaly, jaundice, rapidly dvlp ascites
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surveillance for Budd Chiari?
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- upper GI every year
- mild dysplasia- every 6 months |
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will gastrostomy decrease risk of aspiration?
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- aka PEG
- no, but it's more comfortable for the pt |
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SE isotretinoin?
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- hyperTG -> pancreatitis
- hepatotoxicity, teratogen |
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first line choice for chronic constipation? what not to use in CKD?
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- bulk laxatives: psyllium or methylcellulose
- CKD: milk of mag --> hypermg, bisacodyl -- hypoK+ and Na overload |
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pt with colonoscopy --> has + adenoma, next step?
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- do repeat colonoscopy now b/c 30-50% will have another adenoma somewhere else
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recommended enteral feeding goals
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- 30 kcal/kg/day + 1g/kg protein
- if hx of malnutrition then 15 kcal/kg/day to prevent refeeding syndrome |
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drug induced pancreatitis
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- diuretics: furosemide, thiazides
- IBD: solfasalazine, 5-ASA - immunosuppressive: azathiorpine, L-asparaginase - depakote - AIDS: didanosine, petamidine - abx: metronidazole, tetracycline |
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pt with UC flare and tympanic abd?
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- think megacolon --> get KUB
- tx with decompression and glucocorticoids to decrease inflammation |
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most common source of diverticular bleed versus hemorroidal bleed?
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- diverticular: artery
- hemorrhoidal: venou |
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what ppx should be done with pariceal bleeds in hospital?
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- increased risk of infx - UTI, SBP, resp, bacteremia --> ppx with abx fluoroquinolone for 7-10d
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pt with +anti-HCV ab, next step?
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- confirm with HCV RAN to ddx chronic vs cleared infx
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suspect CHRONIC pancreatitis, what test?
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- CT scan to look for pancreatic calcifications
- not amylase and lipase because these will be decreased due to pancreatic fibrosis |
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indication for ppx for stress ulcer in ICU
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- coagulopathy, hx GI bleed last year, mechanical ventilation > 48 hours
- or >= 2 of the following: sepsis, ICU > 1 wk, GI blled > 6d, GC therapy - increased risk of nosocomial aspiration, PNA b/c increased gastric pH |
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fever, rash, arthralgias, hepB+
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- serum sickness-like sx is prodromal phase of hep B infec secondary to immune complexes
- can also see polyarteritis nodosa and GN (membrane nephropathy) |
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neg C diff immunoassay but high suspicion?
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- repeat immunoassay not stool culture
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pt tx with c diff, 1 wk later sx return, immunoassay +?
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- another tx of metronidazole, unlikely resistance so no need for vanc
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severe hematochezia workup?
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- stabilize patient
- nasogastric aspiration with no blood = lower gi - colonoscopy --> if neg with persistant bleeding then do small bowel studies - if colonoscopy is limited secondary to blood then do NM tagged red blood, mesenteric angiography, surg consultation |
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suveillance colonoscopy
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1. hyperplastic polyps - 10 years
2. 1-2 small (<1cm) tubular adenomas w/ no high grade dysplasia - 5 years 3. 3 or more adenomas, high grade dysplasia, villous feature, any adenoma 1cm or larger - 3 years - polyp w/ adenocarcinoma, margins not involved --> f/u in 3 months to exclude residual/recurrent then f/u 1, 4, and 9 years |
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achalasia vs scleroderma
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- achalasia: decreased or absence of peristaltic waves and increased LES tone
- scleroderm: absence of peristaltic waves in lower 2/3 and decreased LES tone |
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dysphagia vs odynophasia?
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- dysphasia: difficulty swallowing
- odynophasia: painful swallowing, think HIV, HSV, candida |