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  1. Progression of Barrett's esophagus to Ca
  2. First line tx for mild GERD
    H2 blocker
  3. Large deep ulcers in esophagus
    CMV esophagitis
  4. Tx of CMV esophagitis
  5. Several shallow ulcers in esophagus
    HSV esophagitis
  6. Tx of HSV esophagitis
  7. White-yellow linear plaques in esophagus
    candidal esophagitis
  8. main clinical feature of infectious esophagitis
    odynophagia or dysphagia
  9. Diffuculty swallowing both solids and liquids
    Neurogenic dysphagia, caused by injury or dz of CN
  10. Outpouching of posterior hypopharynx
    Zenker's diverticulum
  11. Regurgitation of undigested food and liquid into the pharynx several hours after eating
    Zenker's Diverticulum
  12. Dysphagia of solid foods:
    esophageal stenosis
  13. S/sx of achalasia
    • Slowly progressive dysphagia with episodic regurgitation and CP
    • Decreased peristalsis and increased LES
  14. Decreased LES and decreased peristalsis
  15. Dx study of choice for dysphagia
    Barium swallow=>endoscopy=>manometry
  16. m/c types of esophageal Ca
    adeno #1, SCC #2 (SCC m/c in AA)
  17. Location of esophageal adenocarcinoma
    distal 1/3
  18. location of Esophageal SCC
    proximal 2/3
  19. Esophageal Ca main feature
    progressive dysphagia for solid food associated with weight loss
  20. Mallory-Weiss tear
    linear mucosal tear in the lining of the esophagus
  21. Where do Mallory-Weiss tears occur?
    Gastroesophageal junction
  22. What parts of the stomach does H. pylori affect?
    antrum and body of stomach
  23. Gastritis sx
    Dyspepsia and abdominal pain
  24. S/sx of delayed gastric emptying
    Nausea and excessive fullness after meals
  25. Tx of delayed gastric emptying
    Cisapride and metoclopramide
  26. m/c cause of PUD
    H. pylori
  27. pain improved with food
    duodenal ulcer
  28. pain worsens with food
    Gastric ulcer
  29. m/c cause of upper GI bleed
  30. Ulcer Tx
    • 14 day tx
    • PPI + clarithromycin + amoxicillin +/- Flagyl
    • Tetracycline + PPI + Flagyl + Pepto Bismol
  31. MEN1 genetics
    autosomal dominant
  32. Refractory PUD (+ diarrhea resolved by H2 blockers or PPIs)
  33. m/c location of gastrinoma
    pancreas or duodenum
  34. hypergastrinemia
    fasting gastrin > 150
  35. ZES tx:
    PPIs, resect gastrinoma
  36. Virchow's node
    Left supraclavicular lymphadenopathy
  37. Sister Mary Joseph Nodule
    Umbilical nodule
  38. m/c finding in gastric adenocarcinomas
    IDA, ^LFTs if liver MET
  39. Gastric adenocarcinoma s/sx
    dyspepsia, weight loss with IDA and occult GI bleeding in pt > 40yo
  40. m/c extranodal site for NHL
  41. Definition of diarrhea
    three or more liquid or semisolid stools QD for at least 2-3 consecutive days
  42. secretory vs inflammatory diarrhea
    • secretory: large volume without inflammation
    • inflammatory: bloody diarrhea with fever
  43. causes of secretory diarrhea
    pancreatic insufficiency, ingestion of bacterial toxins, or laxative use
  44. causes of inflammatory diarrhea
    invasive organisms or IBD
  45. Tx of giardia
    Flagyl 250 mg BID x 10 days
  46. Three causes of purulent, bloody, cramping diarrhea
    • E coli
    • Shigella
    • Campylobacter
  47. Transmission of norovirus
    Food, water, person to person
  48. Transmission of rotavirus
    person to person
  49. Transmission of cryptosporidia
    water, outbreaks
  50. Transmission of salmonella
  51. Transmission of shigella
  52. Transmission of campylobacter
    undercooked poultry
  53. Tx of ecoli diarrhea
    Hydration, bismuth, loperamide
  54. Tx of bowel obstruction
    NPO, NG suctioning, IV fluids, and monitoring
  55. M/c location for volvulus
    sigmoid or cecal area
  56. Volvulus
    twisting of any portion of the bowel on itself
  57. Clinical findings of volvulus
    • crampy abd pain and distention, N/V, obstipation
    • abdominal tymphany
    • colonic distenion on upright film
  58. Tx of volvulus
    • Endoscopic decompression in many cases
    • Surgery if failure to resolve quickly
  59. Celiac sprue
    inflammation of the small bowel with the ingestion of gluten-containing foods
  60. Dx of celiac sprue
    • IgA antiendomysial and antitissue transglutaminase Abs
    • Bx to confirm dx
  61. Tx of refractory celiac
  62. M/c locations of Crohns
    terminal ileum and right colon, rectum frequently spared
  63. Complications of Crohns
    • Fistulas
    • Abscesses
    • Apthous ulcers
    • renal stones
    • predisposition to colonic Ca
  64. Complications of UC
    Toxic megacolon, colon ca
  65. Crohn's bx
    inflammation of entire bowel wall with frequent granulomas
  66. Tx of Crohns
    • Acute attacks: prednisone +/- aminosalicylates
    • Flagyl or cipro in perianal dz, fissures, or fistulae
    • Infliximab for refractory
    • Mesalamine for maintenance
  67. Other complications of UC not found in bowel
    • scleritis and episcleritis
    • arthritides
    • sclerosing cholangitis
    • erythema nodosum and pyoderma gangrenosum
  68. Tx of UC
    • topical or oral aminosalicylates and corticosteroids are the mainstays of medical tx
    • Immunomodulators for refractory dz
    • Surgery is curative
  69. M/c cause of chronic or recurrent abd pain in the US
  70. Abd pain worsened by food intake and relieved with defecation
  71. PE findings in IBS
    Generally nl, may see tender, palpable sigmoid colon and hyperresonance on percussion over the abdomen
  72. Mainstays of tx for IBS
    high fiber diet and bulking agents
  73. Intussusception
    invagination of a proximal segment of bowel into the portion just distal to it
  74. Intussusception is found most commonly in
    • children, after viral infection
    • adults, by a neoplasm
  75. Sausage like mass on abd
  76. Big diff b/w UC and Diverticulitis
    Diverticulitis has more of a sudden onset
  77. Tx of diverticulitis
    • Low-residue diet and broad spectrum abx if mild
    • Hosptialization if severe
  78. Causes of AMI
    arterial embolus, arterial thrombosis, or venous thrombosis
  79. CMI pain
    abdominal angina, with pain occuring 10-30 mins after eating, which is relieved somewhat by squatting or lying down
  80. Dx of AMI/CMI
  81. Toxic megacolon
    Extreme dilation and immobility of the colon
  82. Hirschsprung's disease
    Congenital agangliosis of the colon, leading to functional obstruction in the newborn
  83. Causes of toxic megacolon
    complication of UC, Crohn's colitis, pseudomebranous colitis, and specfic infectious causes
  84. PE findings in toxic megacolon
    • Fever, prostration, severe cramps, abdominal distention
    • Rigid abdomen and localized, diffuse, or rebound abdominal tenderness
  85. Tx of toxic megacolon
    decompression of colon
  86. Screening regimen for family members of those with FAP
    1-2 years beginning at 10-12 years of age
  87. Staging criteria for colon Ca
  88. Tumor marker in Colon Ca
  89. Difference b/w anorectal abscess and fistula
    Abscess is a result of infection, fistula is a result of abscess
  90. M/c types of abscesses
    Perirectal and perianal
  91. M/c location of anal fissure
    posterior midline
  92. Hemorrhoid staging
    • I: limited to anal canal
    • II: reduce spontaneously
    • III: requires manual reduction
    • IV: chronically protruding and risk strangulation
  93. Pilonidal cyst
    abscess in the sacrococcgeal cleft associated with sinus tract development
  94. Painful, fluctuant area at sacrococcygeal cleft
    Pilonidal cyst
  95. Signs of appendicitis
    • Psoas sign: pt is supine and attempts to raise leg against resistance
    • Obturator sign: pt is supine and attempts to flex and internall rotate the right hip with th eknee bent
    • These who inflammation adjacent to these muscles
  96. Causes of acute pancreatitis
    • m/c: cholelithiasis or alcohol abuse
    • HL, trauma, drugs, hypercalcemia, and penetrating PUD
    • HIV meds
  97. Abd pain that lessens when pt leans forward or lies in fetal position
    acute pancreatitis
  98. Most sensitive/specific test for acute pancreatitis
    serum lipase (only with elevations of threefold or greater)
  99. Ranson's criteria
    Acute pancreatitis
  100. Tx of acute pancreatitis
    • NPO
    • Restore fluid volume, parental hyperalimentation
  101. Complications of acute pancreatitis
    Pancreatic pseudocyst, renal failure, pleural effusion, hypocalcemia, and pancreatic abscess
  102. Classic triad of chronic pancreatitis
    Calcification, steatorrhea, and DM
  103. M/c cause of chronic pancreatitis
    • Alcohol abuse
    • other causes: cholelithiasis, PUD, hyperparathyroidism, and HL
  104. Tx of chronic pancreatitis
    same as acute/address underying cause
  105. Courvoisier's sign
    Jaundice and a palpable gall bladder, seen in pts with Ca of pancreatic head
  106. Tx of pancreatic Ca
    Surgical resection (Whipple- without mets)
  107. Acute cholangitis
    Common bile duct obstruction, ascending infection
  108. M/C bacteria involved in acute cholangitis
    e coli, enterococcus, Klebsiella, Enterbacter
  109. M/C cause of acute cholangitis
  110. Charcot's triad
    RUQ tenderness, jaundice, fever
  111. Reynold's pentad
    AMS and hypotension + charcots
  112. Dx of acute cholangitis
    RUQ initially, then ERCP
  113. Tx of acute cholangitis
    • Abx, fluid, electrolytes, pain management
    • abx: fluoro, amp, and gent +/-Flagyl
    • ERCP for draininage if needed
  114. Primary sclerosing cholangitis
    chronic thickening of bile duct walls of unknown etiology
  115. Primary sclerosing cholangitis is associated with what?
    cholangiocarcinoma, and pancreatic/colorectal Ca
  116. Features of Primary sclerosing cholangitis
    Jaundice and pruritis m/c, with fatigue, malaise, and weight loss seen in many pts
  117. Tx of Primary sclerosing cholangitis
    • ursodiol
    • liver transplant is the only tx with known survival benefit
  118. M/c cause of acute hep
    viral (followed by alcohol)
  119. Progression of Hep C to serious liver disease
    • only occurs in 20%
    • occurs m/c when alcohol is involved or pt is coinfected with Hep B or HIV
  120. S/sx of hep
    Fatigue, malaise, anorexia, nausea, tea-colored uring, vague abdominal discomfort
  121. Hep D is only seen with
    Hep B
  122. HBsAg
    indicates ongoing infection of disease
  123. Anti-HBs
    indicates immunity by past infection or vaccination
  124. anti-HBc
    present between disappearance of HBsAg and the appearance of anti-HBs, indicating acute hepatitis
  125. HBeAg
    indicates active infection that is highly contagious
  126. Anti-HBe
    indicates lower viral titer
  127. HepC Ab
    indicates ongoing infection
  128. Diff in labs b/w Hep B carrier or chronic infection
    chronic infection has elevated AST and ALT; viral DNA load >100,000
  129. Tx of HepA
  130. Tx of Hep B in HIV
    Tenofovir with either emtricitabine or lamivudine for Hep B, and ad efavirenz or boosted protease inhibitor for HIV infection
  131. Tx of Hep C
    pegylated interferon alpha-2a or alpha-2b with ribavrin
  132. M/c cause of liver abscess
    Entamoeba histolytic or the coliform bacteria
  133. Tx of liver abscess
    abx and percutaneous drainage or surgical incision
  134. Liver is a common met site for which Ca?
    lung and breast
  135. Liver Ca marker
    AFP (hepatic carcinoma)
  136. Benign liver neoplasms
    cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma
  137. Indirect inguinal hernia
    passage of intestine through internal inguinal ring down the inguinal canal, may pass into scrotum
  138. Direct inguinal hernia
    passage of intestine through external inguinal ring at Hesselbach's triangle, rarely enters scrotum
  139. Presentation of esophageal atresia in newborn
    Excessive salive and choking or coughing with attempts to feed
  140. Dx of esophageal atresia
    inability to pass NG tube
  141. Pyloric stenosis
    Gastric outlet is obstructed by pyloric hypertrophy
  142. Clinical features of pyloric stenosis
    Progressive nonbilious, often projectile vomiting, occurs in a child who remains hungry, generally presenting b/w 4 and 6 weeks of age
  143. Olive shaped mass
    Pyloric stenosis, may be felt to right of umbilicus in most cases, especially shortly after vomiting
  144. String sign
    pyloric stenosis
  145. Bowel atresa m/c location
  146. Hirschpring's disease cause
    Congenital absence of Meissner's and Auerbach's autonomic plexuses enervating the bowel wall
  147. Tx of Hirschprung's disease
    Surgical resection of affected bowel
  148. Beriberi
    • Thiamin deficiency
    • nervous tingling, poor coordination, edema, weakness, cardiac dysfunction
  149. Poor wound healing, petechiae, bleeding gums
    Vit C deficiency
  150. night blindness
    vit a deficiency
  151. Lactase is produced where?
    Small intestine
  152. Phenylketonuria
    Rare autosomal recessive inability to metabolize protein phenylalanine, leading to mental retardation and movement disorders
  153. Tx of phenylketonuria
    • Low-phenylalanine diet and tyrosine supplementation
    • strict control of protein for life
  154. Plummer-Vinson syndrome
    Webs associated with IDA
  155. Schatzki's ring:
    lower weblike constriction located at squamocolumnar mucosal junction
  156. corkscrew or rosary bead apperance on barium esophagraphy
    Esophageal spasm
  157. Prolonged large amplitude intermittent simulataneous esophageal contractions
    esophageal spasm
  158. tx of Zencker's diverticulum
    cricopharyngeal myotomy with or without diverticulotomy or excision
  159. coffee ground hematemesis
    esophageal varices/upper GI bleed
  160. M/C cause of infectious esophagitis
  161. Budd-Chiari syndrome
    may cause portal vein thrombosis, leading to esophageal webs
  162. Indications for PUD prophylaxis
    • Hx of ulcer + need for daily NSAID
    • Hx of bleed
    • Chronic steroid use or anticoagulation
    • significant comorbiditis
  163. Pellagra
    • Niacin deficiency
    • dermatitis, diarrhea, dementia
    • (flushing rash, GI probs, cognitive decline/neuro deficits)
  164. Wet beriberi
    • Tachycardia, sweating/hyperthermia, lactic acidosis, CHF with vasodilation
    • Thiamin deficiency
  165. Dry beriberi
    • Thiamin deficiency
    • Stocking glove neurologic deficits, neuropathy, muscle cramps
  166. Corn based diet
    • Pellegra
    • Niacin deficiency
  167. Cause of pilonidal cyst
    distended and obstructed hair follicles and rupture into subcutaneous tissues with inspissated hair
  168. Dx of pyloric stenosis
    Upper GI series
  169. Screening schedule of pts with family dx with colon Ca after 60
    Colonscopy at 40
  170. Sx of dumping syndrome
    • cramps, diarrhea, nausea
    • palpiations, sweating
  171. Dx of lactose intolerance
    hydrogen breath test after administration of lactose
  172. APAP intoxication
    ALT/AST 15x nl
  173. Interferon is CI in pts with:
    severe liver dz, SLE/autoimmune dz, cardiac arrhythmia
  174. Meckel's Diverticulum
    a pouch on the wall of the lower part of the small bowel, which is congenital
  175. Primary biliary cirrhosis epidemiology
    primarily women b/w 40 and 60
  176. Primary biliary cirrhosis dx
    Often discovered incidentally when the serum alkaline phosphatase level is found to be elevated
  177. Boorhaeve Syndrome
    a rare life-threatening problem characterized by a full-thickness tear of the esophageal wall
  178. Most common benign esophageal neoplasm
  179. Hepatitis that responds to corticosteroids
    Autoimmune hepatitis
  180. Recommended medication to reduce risk of first variceal hemorrhage in pts with large or small varicices
  181. TX of cavernous hemangioma
    None necessary, unless sxmatic or > 10 cm
  182. Best visualization of esophageal web or ring
    barium esophagram
  183. A 57-year-old male patient has a history of cirrhosis and esophageal varices. He presents to the emergency department with a 3-hour history of hematemesis. His vital signs are as follows: BP 92/64, pulse 114, temperature 98.6?F, respiratory rate of 14. He is 5'10" and weighs 197 pounds. Labs are ordered, and his INR is 2.3. What is the best initial management in this patient?
    Infuse with FFP
  184. Tx of pyloric stenosis
  185. Which NSAID is least likely to lead to ulcer formation?
    Celecoxib (COX-2 inhibitor, doesn't touch mucosal sites)
  186. tx of hepatic encephalopathy
    lactulose to tx increase in serum ammonia
  187. Causes of pill induced esophagitis
    • NSAIDs m/c
    • alendronate
    • Fe
    • ABX
    • Vit C
    • KCl
    • Quinidine
    • Zidovudine
  188. CI to NG tubes
    • Choanal atresia
    • Significant facial trauma
    • Basilar skull fx
    • Esophageal sstricture or atresia
    • Esophageal burn
    • Zenker's
    • Recent surgery
    • Hx of gastrectomy or bariatric surgery
  189. Dx of gastric carcinoma
    Upper endoscopy
  190. Monitoring of Barret's esophagus without dysplasia
    Endoscopy q3years
  191. Most sensitive imaging modality for pancreatitis
  192. loss of peristalsis in the lower 2/3 of esophagus
  193. Confirm dx of achalasia
  194. Lab best supporting alcohol abuse
  195. Meconium should be passed within what time period?
    24-48 hours
  196. Tx of chronic viral hep
    Pegylated interferon
  197. Dx of acute cholangitis
  198. Pts on phenytoin should be supplemented with what vitamin?
    Vit D
  199. Tx of Salmonella gasteroenteritis
    Self limited, so supportive
  200. incidental finding of indirect (unconjugated) hyperbilirubinemia in an asymptomatic patient with a normal hemoglobin level and otherwise normal liver tests
    Gilbert syndrome
  201. Why ISN'T a colonoscopy done during diverticulitis
    Risk of perforation
  202. m/c cause of painless lower GI bleeding
    Diverticulosis/vascular ectasia
  203. Most appropriate screening strategy for HCC
    Liver U/S
  204. Type of hepatitis associated with obesity, T2DM, and HL
    Nonalcoholic steatohepatitis
  205. m/c sx of primary sclerosing cholangitis
    pruritus and fatigue
  206. chronic watery diarrhea without bleeding
    microscopic colitis
Card Set:
2012-08-15 15:06:37

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