Term
| What is the best test to run for H pylori? |
|
Definition
| Breath and fecal antigen tests |
|
|
Term
| 60 y/o pt comes in with dyspepsia, what do you do? |
|
Definition
| Endoscopy. Any pt >55 yrs with new onset of dyspepsia, needs a endoscopy |
|
|
Term
| What is the study of choice to diagnose gastroduodenal ulcers, erosive esophagitis, and upper gastrointestinal malignancy? |
|
Definition
|
|
Term
| What is Boerhaave syndrome? |
|
Definition
|
|
Term
| What is Mallory-Weiss syndrome? |
|
Definition
| Bleeding secondary to a mucosal tear at the gastroesophageal junction |
|
|
Term
| Irritation of what nerves can cause singultus? |
|
Definition
|
|
Term
| What med will tx singultus? |
|
Definition
| Chlorpromazine (Thorazine) oral or IM |
|
|
Term
| Can you give laxatives for chronic, long term tx? |
|
Definition
| Yes, there is no evidence that long term use of these meds causes harm |
|
|
Term
| What is the tx for fecal impaction? |
|
Definition
| Enemas or digital disruption |
|
|
Term
|
Definition
|
|
Term
| When do you start a diagnostic workup for someone who an non-inflammatory diarrhea? |
|
Definition
|
|
Term
| What is acute diarrhea usually caused by? |
|
Definition
| Bacterial toxins or drugs |
|
|
Term
| Bacterial pathogens can no longer be attributed to the cause of diarrhea after how many days? |
|
Definition
|
|
Term
| What meds are contraindicated in acute diarrhea because of an increase risk of toxic megacolon? |
|
Definition
| Anticholinergics (Lomotil) |
|
|
Term
| What is the preferred antidiarrheal agents? |
|
Definition
Loperimide
Pepto Bismol (Bismuth Subsalicylate) |
|
|
Term
| Empiric treatment may be considered in patients with non–hospital-acquired diarrhea with moderate to severe fever, tenesmus, or bloody stools or the presence of fecal lactoferrin. What is the empiric Abx tx? |
|
Definition
|
|
Term
| What is one of the main medications that can cause chronic diarrhea? |
|
Definition
|
|
Term
| What stool softeners should be avoided in renal insufficiency pts? |
|
Definition
| Ones containing Magnesium |
|
|
Term
| Painless large-volume bleeding usually suggests what? |
|
Definition
|
|
Term
| What is the most common cause of ascites? |
|
Definition
| Portal HTN, secondary to chronic liver disease |
|
|
Term
| What is the first diagnostic test done for a pt with ascites? |
|
Definition
| Abdominal U/S --> Abdominal paracentesis |
|
|
Term
| Patients with esophageal dysphagia often are evaluated first with what? |
|
Definition
| Radiographic barium study to differentiate between mechanical lesions and motility disicular. |
|
|
Term
| What is the empiric treatment for GERD? |
|
Definition
|
|
Term
| What is the treatment of Barrett's Esophagus, and how often should you do a endoscopy? |
|
Definition
PPI
Endoscopy every 3 years |
|
|
Term
| What is the most serious complication of Barrett's esophagus? |
|
Definition
| Esophageal adenocarcinoma |
|
|
Term
| What is the treatment of Barrett's Esophagus, and how often should you do a endoscopy? |
|
Definition
PPI
Endoscopy every 3 years |
|
|
Term
| What is the most serious complication of Barrett's esophagus? |
|
Definition
| Esophageal adenocarcinoma |
|
|
Term
| A patient has started to develop gradual solid food dysphagia months to years. What do you need to do to work this patient up? |
|
Definition
Endoscopy and biopsy.
You must do a biopsy to differentiate peptic stricture from esophageal carcinoma |
|
|
Term
| What is the tx of peptic stricture? |
|
Definition
| To heal the esophagitis, symptomatic relief |
|
|
Term
| What type of life style modifications can you recommend for someone with GERD before pharmacologic treatment? |
|
Definition
| Eat small meals, eliminate acidic foods, weight loss, do not lay down right after a meal, elevate head of the bed 6'' |
|
|
Term
| Pt comes in with intermittent dysphagia. Pt state states that she has no problems with liquids, but whenever she eats meat, that it sometimes feels hard to get down. What is the tx of this patient? |
|
Definition
Schatzki ring
Bougie dilator, multiple dilations may be required |
|
|
Term
| Patient notes halitosis, spontaneous regurgitation of undigested food, nocturnal choking, gurgling in the throat, and a slight protrusion in the neck. How do you diagnose this condition? |
|
Definition
Zenker Diverticulum
Barium Esophagogram |
|
|
Term
| A patient who has cirrhosis of the liver should undergo what diagnostic procedure and why? |
|
Definition
| Endoscopy to determine if varices are present |
|
|
Term
| How often should a patient with cirrhosis and no varices undergo a endoscopic evaluation? |
|
Definition
|
|
Term
| Pt states he has gradual, progressive dysphagia for solids and liquids. Regurgitation of undigested food. You do a barium esophagogram, it shows "bird's beak" distal esophagus. How do you confirm your suspected diagnosis? |
|
Definition
| Esophageal manometry confirms the diagnosis of achalasia |
|
|
Term
|
Definition
Bo-tox injections in the lower esophageal sphincter
Pneumatic dilation
Modified Heller cardiomyotomy of the LES and cardia |
|
|
Term
| What is the hallmark sign of peptic ulcer disease? |
|
Definition
|
|
Term
| What is the procedure of choice for diagnosing a pt that you believe has peptic ulcer disease? |
|
Definition
|
|
Term
| What is the tx of peptic ulcer disease? |
|
Definition
| PPI 30 min. before breakfast |
|
|
Term
| Long term use of PPIs may lead to what? |
|
Definition
| Deficiency in Vitamin B12, Iron, Calcium |
|
|
Term
| Which H2 receptor antagonist inhibits cytochrome P450 metabolism? |
|
Definition
|
|
Term
| What medication can be given prophylactically to reduce ulcers in a patient taking NSAIDs? |
|
Definition
|
|
Term
| How do you eradicate H-pylori? |
|
Definition
14 days of PPI
Amoxicillin 1gram BID (Flagly, if allergic)
Clarithromycin BID |
|
|
Term
| Pt comes in with sudden, severe generalized abdominal pain. On physical examination, patients appear ill, with a rigid, quiet abdomen and rebound tenderness. What is test would you like to do for this diagnosis? |
|
Definition
|
|
Term
| Pt has perforated ulcer, what do you see on a abdominal Xray? |
|
Definition
| Free air beneath the left and right hemidiaphragms |
|
|
Term
| This syndrome is caused by gastrin-secreting gut neuroendocrine tumors (gastrinomas)? |
|
Definition
| Zollinger-Ellison Syndrome |
|
|
Term
| What labs do you want to do on a patient that you suspect Zollinger-Ellison syndrome? |
|
Definition
| Fasting gastrin levels (normal <150) |
|
|
Term
| What meds need to be avoided before a patient does a fasting gastrin level test? |
|
Definition
| Pt should not take H2 antagonist for 24 hours or a PPI for 6 days |
|
|
Term
| What is the most important indicator for treating Zollinger-Ellison syndrome? |
|
Definition
| Whether the gastroma has metastasized to the liver |
|
|
Term
| What nutrients are malabsorbed when a pt has diarrhea? |
|
Definition
|
|
Term
| What nutrients are malabsorbed when a patient has steatorrhea? |
|
Definition
| Fat soluble vitamins, fatty acids, triglycerides, phospholipids, cholesterol |
|
|
Term
| What is the cutaneous variant of Celiac Disease? |
|
Definition
|
|
Term
| What tests should be done if Celiac disease is suspected? |
|
Definition
IgA endomysial antibody
IgA tTG antibody tests |
|
|
Term
| If a patient has positive serologic testing for Celiac disease, what is the next step in confirming the diagnosis? |
|
Definition
| Endoscopic mucosal biopsy of the distal duodenum or proximal jejunum |
|
|
Term
| What is the tx of Celiac disease? |
|
Definition
|
|
Term
| 45 y/o patient comes in with signs of malabsorption, fever of unknown origin, lymphadenopathy, seronegative arthritis, culture-negative endocarditis, or multisystemic disease, what is the cause of this disease? What is the tx? |
|
Definition
Bacillus T-Whippeli
Abx therapy |
|
|
Term
| Duodenal biopsy with periodic acid-Schiff (PAS)-positive macrophages with characteristic bacillus, makes you think of what diagnosis? |
|
Definition
|
|
Term
| How would you confirm the diagnosis of lactase deficiency? |
|
Definition
|
|
Term
|
Definition
| Neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction |
|
|
Term
| What meds commonly affect intestinal mobility? |
|
Definition
| Opiods, anticholinergics, phenothiazines |
|
|
Term
| A post-op patients c/o mild diffuse, continuous abdominal discomfort with nausea and vomiting. Generalized abdominal distention is present, bowel sounds are diminished. What will the radiographs show? What is the tx? |
|
Definition
Acute paralytic ileus
Xray shows distended gas filled loops @ the small and large intestines
CT can be used to excluse mechanical obstruction
Tx: Restriction of oral intake, and gradual liberization of the diet |
|
|
Term
| What is Ogilvie Syndrome? |
|
Definition
| Acute colonic pseudo obstruction |
|
|
Term
| Post operative pt has severe abdominal distention. Pt states he has no abdominal pain. Pt reports minimal tenderness upon palpation. What is the tx? |
|
Definition
Conservative tx
NG and rectal tube should be placed
Ambulate or roll side to side to make pt fart
DC any drugs that decrease GI motility
Enemas, if large amount of stool are seen on radiographs |
|
|
Term
| Positive psoas and obturator signs are usually indicative of what diagnosis? |
|
Definition
|
|
Term
| What imagining is appropriate in a suspected case of appendicitis? |
|
Definition
U/S or CT
CT is more accurate |
|
|
Term
| The sudden onset of lower abdominal pain in the middle of the menstrual cycle suggests what? |
|
Definition
|
|
Term
| What is the treatment of diverticular disease? |
|
Definition
| High fiber diet or fiber supplements |
|
|
Term
Pt has acute abdominal pain and fever.
Left lower abdominal tenderness and mass.
Leukocytosis, what is the tx? |
|
Definition
|
|
Term
| What is the first step in treating a patient with suspected diverticulitis? |
|
Definition
Empiric therapy and clear liquid diet
Augmentin and Cipro
Can also use, Flagyl and Bactrim until patient is afebrile |
|
|
Term
| What studies are contraindicated in possible acute diverticulitis? |
|
Definition
| Endoscopy and Colonoscopy |
|
|
Term
| What is the tx of Familial adenomatous polyposis? |
|
Definition
| Complete proctocolectomy with ileoanal anastomosis or colectomy with ileorectal anastomosis is recommended, usually before age 20 years. |
|
|
Term
| In a pt with familial adenomatous polyposis, how often should that have an endoscopy done? |
|
Definition
|
|
Term
| Pain is unusual for which type of hemorrhoids? |
|
Definition
|
|
Term
| What is the study of choice to see internal hemorrhoids? |
|
Definition
| Anorectal evaluation in the jackknife position |
|
|
Term
| How do you confirm the diagnosis of anal fissures? |
|
Definition
|
|
Term
| How do you tx anal fissures? |
|
Definition
Fiber and sitz baths
EMLA cream may provide relief |
|
|
Term
| What is a normal bilirubin level? |
|
Definition
|
|
Term
| Jaundice may not be evident until bilirubin levels reach what? |
|
Definition
|
|
Term
| Stool and urine color are normal, and there is mild jaundice. Hyperbilirubinemia with no bilirubin in the urine. What type of bilirubin is increased? |
|
Definition
|
|
Term
| Demonstration of dilated bile ducts by ultrasonography or CT indicates what? |
|
Definition
|
|
Term
| Reduced activity of glucuronyl transferase. Unconjugated (indirect) bilirubin. Benign, asymptomatic hereditary jaundice. What is the tx? |
|
Definition
Gilbert's syndrome
No tx necessary |
|
|
Term
| How do you confirm the diagnosis of anal fissures? |
|
Definition
|
|
Term
| How do you tx anal fissures? |
|
Definition
Fiber and sitz baths
EMLA cream may provide relief |
|
|
Term
| What is a normal bilirubin level? |
|
Definition
|
|
Term
| Jaundice may not be evident until bilirubin levels reach what? |
|
Definition
|
|
Term
| Stool and urine color are normal, and there is mild jaundice. Hyperbilirubinemia with no bilirubin in the urine. What type of bilirubin is increased? |
|
Definition
|
|
Term
| Demonstration of dilated bile ducts by ultrasonography or CT indicates what? |
|
Definition
|
|
Term
| Reduced activity of glucuronyl transferase. Unconjugated (indirect) bilirubin. Benign, asymptomatic hereditary jaundice. What is the tx? |
|
Definition
Gilbert's syndrome
No tx necessary |
|
|
Term
| How is hep A transmitted? |
|
Definition
|
|
Term
| IgG anti-HAV (in the absence of IgM anti-HAV) indicates what? |
|
Definition
| previous exposure to HAV, noninfectivity, and immunity |
|
|
Term
| What labs are elevated in Hep A? |
|
Definition
| ALT & AST (occurs early) followed by, alkaline phosphatase and bilirubin |
|
|
Term
| Detection of what immunoglobulin is an excellent test to diagnose acute hep A? |
|
Definition
|
|
Term
| How is Hep B transferred? |
|
Definition
Through blood or sex
It is carried is saliva, vagina secretions, semen |
|
|
Term
| How is Hep C transmitted? |
|
Definition
|
|
Term
| Diagnosis of Hep C is based on what? |
|
Definition
| An enzyme immunoassay (EIA) that detects antibodies to HCV |
|
|
Term
| What is the treatment of Hep C? |
|
Definition
| Peginterferon for 6-24 weeks |
|
|
Term
| Hepatitis D only effects people with what other Hepatitis? |
|
Definition
|
|
Term
| What hepatitis would be responsible for water bourne outbreaks in endemic countries? |
|
Definition
|
|
Term
| What is the most common cause for acute liver failure? |
|
Definition
|
|
Term
| Patients with chronic viral hepatitis, who are in the active viral replicating stage can be treated with what? |
|
Definition
Nucleoside
Nucleotide analog
Pegylated interferon |
|
|
Term
| What hepatitis responds to steroids? |
|
Definition
|
|
Term
| What are the most common types of autoimmune hepatitis? |
|
Definition
| Anti-nuclear antibody (ANA) or smooth muscle antibody |
|
|
Term
| What lab value is elevated the most in alcoholic liver disease? |
|
Definition
| AST is greater than ALT, but both elevated |
|
|
Term
| What is the tx of alcoholic liver disease? |
|
Definition
Stop drinking
Naltrexone or Acamprosate |
|
|
Term
| Pt has a fatty liver from alcoholic liver disease, is the fatty liver reversible is the patient stops drinking? |
|
Definition
|
|
Term
| What vitamins should be given to a patient with alcoholic liver disease? |
|
Definition
| Thiamine, zinc, folic acid |
|
|
Term
| What labs are elevated in non-alcoholic liver disease? |
|
Definition
|
|
Term
| What test is diagnostic of non-alcoholic liver disease? |
|
Definition
| Percutaneous liver biopsy |
|
|
Term
| What is the treatment for non-alcoholic liver disease? |
|
Definition
| Weight loss, exercise, dietary fat restriction |
|
|
Term
| What are the most common causes of cirrhosis in the US? |
|
Definition
|
|
Term
| A patient with cirrhosis should receive what vaccines? |
|
Definition
| HAV, HBV, Pneumococcal, Flu |
|
|
Term
| How do you treat a patient with cirrhotic ascites? |
|
Definition
1st try sodium restriction
Combo of spirinolactone and lasix may be needed |
|
|
Term
| What is the most readily identified and measurable toxin in hepatic encephalopathy? |
|
Definition
| Ammonia, not is not the sole cause of the disease |
|
|
Term
| What are the stages of encephalopathy? |
|
Definition
1) Mild confusion
2) Drowsiness
3) Stupor
4) Coma |
|
|
Term
| What is used to assess chronic liver disease? |
|
Definition
| Child-tucotte-pugh scoring system |
|
|
Term
| What test is done for anyone who has an iron overload? What diagnosis are you confirming if the test is positive? |
|
Definition
HFE mutations
Hemochromatosis |
|
|
Term
| What is the tx of hemochromatosis? |
|
Definition
Avoid foods rich in iron (such as red meat), alcohol, vitamin C, raw shellfish, and supplemental iron.
Phlebotomies weekly
After iron and ferritin levels are normal, phlebotomies every 2-4 months |
|
|
Term
| What condition is characterized by excessive deposition of copper in the liver and brain? |
|
Definition
|
|
Term
| Kayser-Fleischer ring, what is the dignosis? |
|
Definition
|
|
Term
| What is the tx of Wilsons? |
|
Definition
| To remove excess copper before it damages the liver and brain |
|
|
Term
| What is Budd-Chiari syndrome? |
|
Definition
|
|
Term
| What is the screening test of choice for someone who you suspects has Budd-Chiari syndrome? |
|
Definition
| Contrast-enhanced, color, or dopplar flow U/S |
|
|
Term
| What is the imaging test that confirms hepatic vein obstruction? |
|
Definition
| Magnetic resonance angiography (MRA) |
|
|
Term
| What is the most common cause of hepatic abscesses in the US? |
|
Definition
|
|
Term
| What is the most common benign neoplasm of the liver? |
|
Definition
|
|
Term
| Pt comes in with infrequent episodes of steady severe pain in epigastrium or right upper quadrant with radiation to right scapula. What imaging studies would you like to do? |
|
Definition
|
|
Term
| What is the tx for someone with symptomatic gall bladder disease? |
|
Definition
| Laparoscopic cholestectomy |
|
|
Term
| Pt has right upper quadrant abdominal tenderness (often with a Murphy sign, or inhibition of inspiration by pain on palpation of the right upper quadrant) is almost always present and is usually associated with muscle guarding and rebound tenderness in what disease? What probably preceded the pain? |
|
Definition
Pain usually elicited by a fatty meal
Cholecystitis |
|
|
Term
| What is the first imaging study that should be performed in a patient you suspect Cholecystitis? |
|
Definition
Abdominal U/S
HIDA scan would follow |
|
|
Term
| Is hospitalization necessary for patients with cholecystitis? |
|
Definition
| Yes, ALL patients with cholecystitis should be hospitalized |
|
|
Term
| What is the Charcot triad? What diagnosis goes with this? |
|
Definition
pain, fever (and chills), and jaundice
Cholangitis |
|
|
Term
| Pt comes in with intense epigastic pain that radiates to the back. Pt c/o of N/V. Pt also states the pain becomes worse when walking or laying supine. She states the pain becomes better when sitting up and leaning forward. On PE the patient is negative for guarding and rebound tenderness. What is the diagnosis? |
|
Definition
|
|
Term
| Severity of acute alcoholic pancreatitis can be assessed using what criteria? |
|
Definition
|
|
Term
| What labs are elevated in pancreatitis? Which one stays elevated longer? |
|
Definition
Amylase and Lipase
Lipase remains high longer, and is more accurate |
|
|
Term
| What imaging is useful in helping diagnose pancreatitis? |
|
Definition
|
|
Term
| What is the tx of acute pancreatitis? |
|
Definition
Withhold oral foods and liquids, bed rest
Food can be started once patient is pain free and have bowel sounds, start with clear liquids |
|
|
Term
| Should patients be hospitalized in acute pancreatitis? |
|
Definition
| Nearly all patients should be, yes |
|
|
Term
| Majority of colorectal cancers arise from malignant transformation of what type of polyp? |
|
Definition
|
|
Term
| An average at-risk pt should begin colon cancer screening? |
|
Definition
| 50, colonoscopy every 10 years |
|
|
Term
| Individuals who have a family hx of colon cancer, and the cancer was diagnosed after the age of 60, what are the guidelines? |
|
Definition
| Colonoscopy at 40, then every 10 years |
|
|
Term
| Individuals who have family hx of colon cancer, and the cancer was diagnosed before the age of 60, what are the guidelines? |
|
Definition
| Colonoscopy at 40 OR 10 years before the cancer was detected, then every 5 years |
|
|
Term
| What are the 4 classifications of adenomas? |
|
Definition
| Tubular, villous, serrated, tubulovillous |
|
|
Term
| Patients with 1–2 small (< 1 cm) tubular adenomas (without villous features or high-grade dysplasia) should have their next colonoscopy when? |
|
Definition
|
|
Term
| Patients with 3–10 adenomas, an adenoma > 1 cm, or an adenoma with villous features or high-grade dysplasia should have their next colonoscopy when? |
|
Definition
|
|
Term
| Patients with more than 10 adenomas should have a repeat colonoscopy when? |
|
Definition
|
|
Term
| This condition characterized by hamartomatous polyps throughout the gastrointestinal tract (most notably in the small intestine) as well as mucocutaneous pigmented macules on the lips, buccal mucosa, and skin. What is this condition? |
|
Definition
|
|
Term
| Peutz-Jeghers syndrome is an autosomal_________condition? |
|
Definition
|
|
Term
| Consensus definition of irritable bowel syndrome is abdominal discomfort or pain that has two of the following three features, what are they? |
|
Definition
(1) relieved with defecation,
(2) onset associated with a change in frequency of stool,
(3) onset associated with a change in form (appearance) of stool |
|
|
Term
| A pt with IBS diarrhea, should undergo what testing? |
|
Definition
| Serologic testing for Celiac disease |
|
|
Term
| What pharmocological tx can be used for IBS? |
|
Definition
Anticholinergics - hyoscyamine
Loperamide for diarrhea
Osmotic laxitives - milk of mag, polyetholyne glycol
Lactulose and sorbitol are poorly tolerated in IBS pts
Tricyclic antidepressants
SSRIs maybe for overall well being |
|
|
Term
| What is the tx for antibiotic associated colitis? |
|
Definition
Stop Abx
Start metronidazole, if resistant Vancomycin |
|
|
Term
| What is the imaging study of choice for antibiotic associated colitis? |
|
Definition
|
|
Term
| For pts with antibiotic associated colitis whose WBC >15,000 or a rise of >1.5 in serum creatinine should be tx with what? |
|
Definition
ORAL vancomycin
IV should not be used, because it does not penetrate the bowel |
|
|
Term
| Which inflammatory bowel disease only involves the colon? |
|
Definition
|
|
Term
| What inflammatory bowel disease has patchy transmural inflammation involving any segment of the gastrointestinal tract from the mouth to the anus? |
|
Definition
|
|
Term
| How do you treat inflammatory bowel disease? |
|
Definition
Sulfasalazine, coadminister folate
Methotrexate can also be used (especially in Crohns) |
|
|
Term
| What drugs are used for corticosteroid dependent inflammatory bowel disease patients? |
|
Definition
|
|
Term
| This inflammatory bowel disease is a chronic lifelong illness characterized by exacerbations and periods of remission? |
|
Definition
|
|
Term
| This inflammatory bowel disease has bloody diarrhea? |
|
Definition
|
|
Term
| What is the tx of pilonidal disease? |
|
Definition
Good hygiene and observations
I&D
Excision |
|
|
Term
Define these hernias:
Reducible
Incarcerated
Strangulated |
|
Definition
Reducible: Contents can be restored to their anatomic location
Incarcerated: An irreducible hernia
Strangulated: An incarcerated hernia with vascular compromise of the herniated contents. |
|
|
Term
| Which type of inguinal hernia passes through Hesslebach's triangle? |
|
Definition
|
|
Term
| Presence of HBsAg signifies what? |
|
Definition
|
|
Term
| Anti-HBsAg with no other markers usually indicates what? |
|
Definition
|
|
Term
| What is the window period in Hep B? |
|
Definition
| Time when no surface antigen or antibody, but anti core |
|
|
Term
| Anti surface and anti core represents what? |
|
Definition
|
|
Term
| Anti core antibodies represents what? |
|
Definition
|
|
Term
| Anti Surface antigens represents what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How do you tx cholangitis? |
|
Definition
Quinolones, ampicillin, and gentamycin
Electrolyte replacement and fluid |
|
|
Term
| What is the most common type of inguinal hernia? Least common? |
|
Definition
Indirect - most common
Femoral - least common |
|
|
Term
| How do you tx phenylketonuria? |
|
Definition
| Low-phenylalanine diet and tyrosine supplementation |
|
|
