Colorectal Cancer, Gi Bleeding, Stomach, And Esophageal Disorders For Usmle Step 2

Front 1

diagnostic test for ppl w + fobt

Back 1

COLONOSCOPY

Front 2

most common site of distant spread in crc

Back 2

liver

Front 3

what type of polyps are considered to have malignant potential

Back 3

adenomatous polyps (villous > tubular)

Front 4

features of familial polyposis syndrome

Back 4

autosomal dominant
hundreds of adenomatous polyps in colon
colon always involved, duodenum usually (90%) involved

Front 5

tx for familial polyposis syndrome

Back 5

prophylactic colectomy

Front 6

clinical features of gardner's syndrome

Back 6

autosomal recessive
polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts
100% risk of colon ca

Front 7

clinical features of turcot's syndrome

Back 7

autosomal recessive
polyps + cerebellar medulloblastoma or gbm

Front 8

peutz-jeghers

Back 8

single or multiple hamartomas scattered through gi tract (mostly in small bowel and colon)
pigmented spots around lips and oral mucosa, genitalia, palmar surfaces
low malignnat potential

Front 9

complications of peutz-jeghers

Back 9

intussusception or bleeding

Front 10

familial juvenile polyposis coli

Back 10

rare, small risk for crc

Front 11

hereditary nonpolyposis crc

Back 11

no adenomatous polyps
lynch syndrome 1 and 2
early onset crc and other cancers

Front 12

#1 cause of colon obx in adults

Back 12

crc

Front 13

most life threatening presentation of crc

Back 13

colonic perforation

Front 14

presentation of a right sided colon tumor

Back 14

obx not commonly seen (lumen is wider on right)
change in bowel habits is rare
MELENA is most common type of bleed

Front 15

presentation of left sided colon tumor

Back 15

smaller lumen diameter, so can present with obx, alternating constipation and diarrhea
narrowing of stools
HEMATOCHEZIA

Front 16

which side of colon is melena more common in?
hematochezia?

Back 16

right
left

Front 17

most common presentation of rectal cancer

Back 17

hematochezia

Front 18

when should cea levels be obtaiened in crc

Back 18

before surgery

Front 19

use of radiation tx in crc

Back 19

used in rectal ca but not in colon ca

Front 20

frequency of colonoscopies in pts with h/o crc

Back 20

colonoscopy at 1 yr, then q3y

Front 21

in addition to colonoscopy, what other f/u is required in pts with crc

Back 21

ct scan of abdomen adn pelvic
cxr
do these for up to 5 yrs

check cea q 3-6 months

Front 22

recurrence rate of crc

Back 22

90% w/i 3 yrs of surgery

Front 23

what types of polyps are associated with uc

Back 23

pseudopolyps

Front 24

pathogenesis of diverticuli

Back 24

outpouching at area of weakness in colon wall, which is at the site of a bv penetration --> bleeding

Front 25

risk factors for diverticulosis

Back 25

constipation increases intralumenal pressure
family hx

Front 26

#1 location of diverticuli

Back 26

sigmoid colon

Front 27

test of choice for diverticulosis

Back 27

bariu enema

Front 28

tx of diverticulosis

Back 28

high fiber food to increase stool bulk psyllium

Front 29

complications of diverticulosis

Back 29

painless rectal bleeding
diverticulitis

Front 30

complications of diverticulitis

Back 30

bowel obx
fistula
abscess

Front 31

how to manage bleeding in diverticulosis

Back 31

usually stops on its own - no tx for these pts
if it continues, then colonoscopy should be performed to locate site of bleeding, if persistent or recurrent, surgery may be needed

Front 32

dx of diverticulitis

Back 32

ct abdomen and pelvis
abdominal xr to r/o other causes, ileus, obx, and perforation

Front 33

tx of diverticulitis for first episode

Back 33

npo
abx
surgery may be necessary if persists x 3-4 days

Front 34

examples of angiodysplasia of the colon

Back 34

avm
vascular ectasia

Front 35

dx of angiodysplasia of the colon

Back 35

colonoscopy

Front 36

tx of angiodysplasia of the colon

Back 36

colonoscopic coagulation
if bleeding persists, right hemicolectomy (cecum is most common location)

Front 37

types of acute mesenteric ischemia
which is most common

Back 37

arterial embolism *
venous thrombosis (rarest)
arterial thrombosis
nonoclusive mesenteric ischemia

Front 38

random association with angiodysplasia of the colon

Back 38

aortic stenosis

Front 39

clinical history of pt with mesenteric arterial thrombosis

Back 39

pts with h/o atherosclerotic dz at other sites
acute occlusion occurs over preexisting atherosclerotic dz (acute event can be a decrease in CO or plaque rupture)
collateral circulation has usually developed
SX are gradual and less severe than embolic causes

Front 40

clinical history of a pt with nonocclusive mesenteric ischemia

Back 40

splanchnic vasoconstriction secondary to low CO
typically seen in elderly

Front 41

overall mortality of all causes of acute mesenteric ischemia

Back 41

60%

Front 42

presentation of pt with venous thrombosis as a cause for mesenteric ischemia

Back 42

sx may be present for several days or weeks with gradual worsening

Front 43

clinical feature of acute mesenteric ischemia

Back 43

severe abdominal pain disproportionate to physical findings

Front 44

complications of acute mesenteric ischemia

Back 44

peritonitis
sepsis
shock

Front 45

dx of acute mesenteric ischemia

Back 45

mesenteric angiography
plain film of abdomen to r/o other causes

Front 46

tx of acute mesenteric ischemia

Back 46

ivf
broad spectrum abx
papaverine (vasodilator) into sma during arteriograph to relieve occlusion and vasospasm
direct infusion of thromboloytics in pts with emoblism
heparin for venous thrombosis

Front 47

signs of intestinal infarction

Back 47

hypotension, tachycardia, tachypnea, lactic acidosis, fever, change in ms, shock
CHECK LACTATE LEVEL

Front 48

causes of chronic mesenteric ischemia

Back 48

atherosclerotic occlusive dz of celial artery and sma, ima

Front 49

sx of chronic mesenteric ischemia

Back 49

abdominal angina (postprandially)

Front 50

tx of chronic mesenteric ischemia

Back 50

surgical revasularization

Front 51

tx of ogilvie's syndrome

Back 51

decompression with gentle enemas or ng suction
if not, colonoscopic decompression
surgical decompression is last resort

Front 52

complication of pseudomembranous colitis

Back 52

toxic megacolon with risk of perf
amasarca
electrolyte disturbances

Front 53

tx of pseudomembranous colitis

Back 53

metronidazole
(oral vanco if metronidazole is contraindicated - infants and pregnancy)

Front 54

most common cause of ugi bleeding

Back 54

pud (duodenal ulcer, gastric ulcer, gastritis)

Front 55

pertinent history in a pt with aorticoenteric fistula

Back 55

distant h/o aortic graft surgery, in a pt with a small gi bleed, involving the duodenum

massive, fatal hemorrhage occurs hours to weeks later

Front 56

tx of aortoenteric fistula

Back 56

endoscopy or surgery

Front 57

where is the bleeding from? test to order?
hematemesis

Back 57

ugi
endoscopy

Front 58

where is the bleeding from? test to order?
hematochezia

Back 58

lgi
first r/o hemorrhoids
colonoscopy

Front 59

where is the bleeding from? test to order?
melena

Back 59

ugi or right side fo colon
do endoscopy first, if negative, do colonoscopy

Front 60

where is the bleeding from? test to order?
occult blood

Back 60

lgi
colonoscopy
upper endoscopy if colonoscopy is -