Usmle Step 2 Ck: Gi

Front 1

What are the agents used in triple therapy?

Back 1

Amoxicillin, clarithromycin, omeprazole

Front 2

How long to pts need to have a gastric ulcer that is refractory to medical treatment in order to get an endoscope?

Back 2

more than 2 months.

Front 3

Pathognomic for ZE (location of ulcers)

Back 3

In the jejunum.

Front 4

Definition of diarrhea (how many grams + two conditions)?

Back 4

> 200 grams and inc freq and dec consistency of stool

Front 5

What is the timecourse of "acute" diarrhea?

Back 5

< 2 weeks

Front 6

What are some examples of secretive diarrhea?

Back 6

Carcinoid, VIPomas

Front 7

What are some examples of malabsorptive diarrhea?

Back 7

bacterial overgrowth, celiac dz, whipple's dz pancreatic insufficiency, muscosal abn, lactose intol

Front 8

What are some s/s of Whipple's disease?

Back 8

Fever, LAN, edema, arthritis, CNS changes, gray-brown skin pigmentation, oculomasticatory myorhythmia (eye oscillation + mastication muscle contractions)

Front 9

What is the equation for stool osmotic gap?

Back 9

Osm[stool] - (2 x (Na[stool] + K[stool]))

Osm[stool] usually equals 290

Front 10

What treatment should you absolutely NOT give for amebic colitis?

Back 10

Steroids. They can lead to perforation of the colon.

Front 11

What patient population is susceptible from developing osteomyelitis from salmonella?

Back 11

Pts with sickle-cell disease

Front 12

ABX for salmonella?

Back 12

fluoroquinolone or TMP-sulfa

Front 13

Why don't you give ABX for E. coli 157:H7?

Back 13

It will increase the risk of HUS

Front 14

What is a positive hydrogen breath test

Back 14

When lactose is ingested and you have increased breath hydrogen due to metabolism of lactose by colonic bacteria

Front 15

Where are carcinoid tumors usually located?

Back 15

ileum and appendix

Front 16

What GI d/o can give you right-sided valvular disease?

Back 16

Carcinoid syndrome

Front 17

Diagnostic test for carcinoid syndrome?

Back 17

urine 5-HIAA (serotonin metabolite)

Front 18

What is the definition of obstipation?

Back 18

No flatus, no stool

Front 19

Treatment for acute diverticulitis

Back 19

NPO (bowel rest)
NG tube
broad-spec ABX (metronidazole and a fluoroquinolone or a 2nd/3rd gen cephalosporin)

Avoid barium enema or flex sig if suspect diverticulitis

Front 20

What treatments should be avoided in the initial stages of diverticulitis?

Back 20

Barium enema
Flex sig

Front 21

SBO vs LBO: abdominal pain

Back 21

SBO is more painful

Front 22

SBO vs LBO: N/V

Back 22

Less vomiting in LBO, but more often feculent

Front 23

LBO is d/t what until proven otherwise?

Back 23

d/t cancer

Front 24

Orders for SBO

Back 24

CBC
Lactic acid
BMP
AXR
Contrast studies to det if partial or complete
CT scan

Front 25

Orders for LBO

Back 25

CBC
BMP
Lactic acid
AXR
CT scan
water contrast enema
Sig/colonoscopy if stable

Front 26

When is an abdominoperineal resection indicated for a rectal cancer?

Back 26

When the lesion is < 10 cm from the anal verge.

Front 27

What surgical procedure is done for rectal cancers < 10 cm from the anal verge?

Back 27

Low anterior resection (primary anastomosis

Front 28

When is adjuvant chemo used in colon cancer?

Back 28

When there are + nodes

Front 29

Is radiation effective for colon cancer?

Back 29

No

Front 30

Is radiation effective for rectal cancer?

Back 30

Yes

Front 31

What changes do you see in the large bowel with ulcerative colitis?

Back 31

Lead pipe bowel (loss of haustra)

Front 32

What levels of tissue are affected by UC?

Back 32

Mucosa and the submucosa

Front 33

What part of the GI tract is always affected by UC?

Back 33

The rectum

Front 34

UC: continuous or skip?

Back 34

Continuous

Front 35

What levels of tissue are affected by Crohn's?

Back 35

All. Transmural

Front 36

Is bloody diarrhea more common in UC or crohns?

Back 36

UC

Front 37

Crohn's: pertinent findings on PE (1)

Back 37

perianal fistulas

Front 38

What are some extraintestinal manifestations of UC?

Back 38

Aphthous stomatitis
Episcleritis/uveitis
Arthritis
Primary sclerosing cholangitis
Erythema nodosum
Pyoderma gangrenosum

Front 39

What are some extraintestinal manifestations of Crohn's?

Back 39

Gallstones
Nephrolithiasis
Fistulas to skin, bladder, between bowel loops

Plus UC manifestations:
Aphthous stomatitis
Episcleritis/uveitis
Arthritis
Primary sclerosing cholangitis
Erythema nodosum
Pyoderma gangrenosum

Front 40

Do you see pseudopolyps with UC or Crohn's?

Back 40

UC

Front 41

Is total colectomy curative in Crohn's? UC?

Back 41

Yes in UC, no in Crohn's - it may recur

Front 42

Which has a higher risk of malignancy, UC or Crohn's?

Back 42

UC has a much higher risk of colorectal cancer. Yearly colonoscopies after 8 years of disease.

Front 43

What is the gold standard for acute mesenteric ischemia d/t arterial occlusion?

Back 43

Mesenteric angiography

Front 44

What is the most common site of ischemic colitis?

Back 44

The splenic flexure watershed zone.

Front 45

What is the most common type of hernia in both genders? (indirect or direct)

Back 45

Indirect (through the internal and the external rings)

Front 46

Indirect hernias pass through...

Back 46

The internal and external rings

Front 47

What anatomic structure does a direct hernia pass through?

Back 47

The floor of Hesselbach's triangle

Front 48

What is the most common cause of a direct hernia?

Back 48

A defect in the transversalis fascia that increases with age.

Front 49

What types of patients get acalculous cholecystitis?

Back 49

Chronically debilitated patients, those on TPN, burn victims, trauma victims

Front 50

When you do get a HIDA scan in a patient suspected of having acute cholecystitis?

Back 50

When the US is equivocal.

Front 51

What are the hallmark lab values to be elevated in choledocholithiasis?

Back 51

ALP and t bili

Front 52

What are the most common bugs to cause acute cholangitis?

Back 52

Gram negatives: E coli, Enterobacter, Pseudomonas

Front 53

What is Charcot's triad? What is it a sign of?

Back 53

RUQ pain
Fever
Jaundice

Sign of acute cholangitis

Front 54

What is Reynold's Pentad?

Back 54

RUQ pain, jaundice, fever
MS change
Shock

suggests sepsis d/t suppurative cholangitis

Front 55

What population is most susceptible to primary sclerosing cholangitis?

Back 55

Young men with IBD (most often UC)

Front 56

What do you see on liver biopsy with primary sclerosing cholangitis?

Back 56

periductal sclerosis ("onion skinning")

Front 57

What long-term risk are patients with primary sclerosing cholangitis at risk for?

Back 57

For cholangiocarcinoma

Front 58

What are the treatments for primary sclerosing cholangitis?

Back 58

High-dose ursodeoxycholic acid, endoscopic dilaiton, and short-term stenting of bile duct structures, liver transplantation.

Front 59

At what bilirubin level do you begin to see jaundice?

Back 59

bilirubin > 2.5 mg/dL

Front 60

What lab values indicate cholestatis?

Back 60

ALP, and bilirubin +/- aminotransferases

Front 61

What lab values indicate hepatocellular injury?

Back 61

Inc AST, ALT +/- bilirubin and ALP

Front 62

What is the first question to ask in the cholestasis algorithm? What if the answer to the question is yes or no?

Back 62

Is there ductal dilation? If yes then it is biliary obstruction (stone, stricture, cancer). If no then it is intrahepatic cholestasis (medications, post-op, sepsis).

Front 63

What is the two processes of unconjugated hyperbilirubinemia? What is the DDx?

Back 63

Overproduction (hemolytic anemia)
Defective conjugation (Gilbert's syndrome <5 mg/dL, Crigler-Najjar syndrome)

Front 64

What is the etiology/DDx of conjugated hyperbilirubinemia?

Back 64

Defective excretion (Dubin-Johnson, Rotor)

Front 65

What does it indicate if the gallbladder is not visualized on HIDA scan?

Back 65

That there is cystic duct obstruction d/t acute cholecystitis.

Front 66

Which HBV serology is positive during the window period?

Back 66

The HBcAg

Front 67

What drugs are used for chronic HBV infection?

Back 67

IFN-alpha, lamivudine, or adefovir

Front 68

What drugs are used for chronic HCV infection?

Back 68

peginterferon, ribavirin

Front 69

What is Budd-Chiari syndrome?

Back 69

hepatic vein thrombosis 2/2 hypercoagulability

Front 70

What is the anastomosis that leads to esophageal varices?

Back 70

Azygous- left gastric

Front 71

What is the anastomosis that leads to hemorrhoids?

Back 71

Superior-middle/inferior rectal

Front 72

What is the anastomosis that leads to caput medusae?

Back 72

paraumbilical-inferior epigastric

Front 73

How do you calculate the SAAG?

Back 73

ascites alb - serum alb

Front 74

If the SAAG is > 1.1 then what is the ascites due to?

Back 74

To portal hypertension.
1) Presinusoidal: splenic or portal vein thrombosis, schistosomiasis
2) Sinusoidal: cirrhosis, massive hepatic metastases
3) Post sinusoidal: Right heart failure, constrictive pericarditis, Budd-Chiari syndrome

Front 75

If the SAAG is < 1.1 then what is the ascites due to?

Back 75

Due to protein leakage
1) Nephrotic syndrome
2) Tuberculosis
3) Malignancy (e.g. ovarian cancer)

Front 76

What levels of PMNs or WBCs in the peritoneal fluid indicate spontaneous bacterial peritonitis?

Back 76

Positive if > 250 PMNs/mL or > 500 WBCs

Front 77

Treatment for spontaneous bacterial peritonitis?

Back 77

IV ABX (3rd gen ceph to cover both gram + (enterococcus) and gram neg (E coli, Kleb))

Front 78

What do you use to treat hepatic encephalopathy? (4)

Back 78

dietary protein restriction
lactulose
neomycin
metronidazole

Front 79

What antibody is present in primary biliary cirrhosis?

Back 79

Anti-mitochondrial abs

Front 80

What is destroyed in primary biliary cirrhosis?

Back 80

intrahepatic bile ducts

Front 81

What is the demographic and presenting sx of primary biliary cirrhosis?

Back 81

jaundice and pruritus in middle-aged women with other AI conditions

Front 82

What cancer marker is elevated with HCC?

Back 82

AFP

Front 83

Is chemoradiation effective for HCC?

Back 83

Generally not. Used to shrink tumors, though.

Front 84

What are some of the organs that are affected by hemochromatosis? (7)

Back 84

Liver, pancreas, heart, testes, adrenals, pituitary, kidneys

Front 85

What is the inheritance pattern of hemochromatosis?

Back 85

AR

Front 86

What are some si/sx of hemochromatosis? (

Back 86

Bronze diabetes
pancreatic dysfunction
cardiac dysfunction (CHF), hepatomegaly, and testicular atrophy.

Front 87

What is the most sensitive lab test for hemochromatosis?

Back 87

fasting transferrin saturation (serum iron divided by transferrin level) > 45%

Front 88

What is the treatment for hemochromatosis?

Back 88

Deferoxamine and weekly phlebotomy

Front 89

What is the genetic defect associated with Wilson's disease? Inheritence pattern?

Back 89

AR defect on chromosome 13

Front 90

What are the si/sx of Wilson's disease?

Back 90

hemolytic anemia, liver abnormalities (jaundice), and neurologic (loss of coordination, tremor, dysphagia) as well as psychiatric abnormalities(pyschosis, anxiety, mania, depression)

Front 91

How do you make the diagnosis of Wilson's disease? (3 lab values)

Back 91

dec serum ceruloplasm, inc urinary copper excretion, inc hepatic copper

Front 92

What is the treatment for Wilson's disease?

Back 92

dietary copper restriction, penicillamine (copper chelator, administer with pyridoxine), and possibly oral zinc (increases fecal excretion of copper)

Front 93

What is Ranson's Criteria on admission?

Back 93

GA LAW

Glucose > 200 mg/dL
Age > 55
LDH > 350 IU/L
AST > 250 IU/dL
WBC > 16,000/mL

Front 94

What is Ranson's Criteria after 48 hours?

Back 94

C HOBBS

Calcium < 8.0 mg/dL
Hematocrit decreased by > 10%
Pa(O)2 < 60 mmHg
Base excess > 4 mEq/L
BUN inc by > 5 mg/dL
Sequestered fluid > 6 L

Front 95

What signs might you see on AXR with acute pancreatitis?

Back 95

"sentinel loop" "colon cuttoff" signs

Front 96

What are some treatments for acute pancreatitis?

Back 96

IVF/electrolytes, analgesia, bowel rest, NGT, O2, rest

Front 97

When are ABX indicated in pancreatitis?

Back 97

When there is necrotizing pancreatitis.

Front 98

What are some complications of acute pancreatitis?

Back 98

Pancreatic pseudocyts, fistula formation, hypocalcemia, renal failure, pleural effusion, etc

Front 99

Short-term chemo for pancreatic cancer?

Back 99

5-FU, gemcitabine