GI step 3

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pszurnicki
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274925
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GI step 3
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2014-05-20 19:22:04
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GI step 3
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  1. best initial study for achalasia, dysphagia for both liquids and solids?
    most accurate
    • barium swallow
    • most accurate is manometry
  2. best initial rx for achalasia
    when is botox injected
    myotomy or pneumatic dilation

    if pt refuses myotomy or dilation or if its refractory
  3. best initial test if youre suspecting cancer of esophagus
    scope but may be barium first
  4. rx for esophageal cancer
    • resection if no local or distant mets
    • with chemo of 5 fu
  5. best initial test for peptic strictures
    barium swallow
  6. plummer vinson stricture vs schatzki vs peptic stricture location and rx
    • plummer vison--iron def--proximal replace iron
    • schatzki--pneumatic dilation, distal also

    peptic--distal, pneumatic dilation
  7. best initial test for diffuse esophageal spasm and nutcracker esophagus
    most accurate
    • barium swallow
    • manometry
  8. rx for spasm of esophagus
    • ccb
    • nitrates
  9. rx for fibrosed esophagus in scleroderma
    ppi
  10. managment of odonophagia in a hiv neg and hiv pos pt
    • hiv neg-- endoscopy
    • hiv pos-- fluconazole
  11. rx for pill esophagitis
    sit upright for 30 mins after drinking water with pills
  12. dx of mallory weiss
    endoscopy and epi to stop bleeding
  13. mx of gerd with no other symptoms such as weighloss, blood in stool, anemia, dysphagia
    • ppi
    • otherwise do scope if "alarming" symptoms are present
  14. rx for ppi refraccotry gerd
    • fundoplicaton
    • les suturing after scope excludes other possibilites
  15. how often do ppl with gerd get scope
    5 years after diagnosis
  16. mx of barrets
    mx of low grade dysplasia
    mx of high grade dysplasia
    • ppi and scope in 3 year
    • ppi and scope 3-6 months
    • resection
  17. rx for non ulcer dyspepsia
    • ppi
    • h2
    • liquid antiacids
  18. h. pylori can cause what in the stomach
    • gastitis
    • peptic ulcers
  19. rx for h.pylori
    • ppi
    • clarithromycin
    • amoxocillin
  20. 1st rx for h.pylori fails then
    2nd rx for h.pylori fails then
    • 1st fails give flagyl and tetracycline
    • 2nd fails , evaluate for ZE syndrome
  21. 4 reasons for stress ulcer prophylaxis
    • head trauma
    • burns
    • intubation
    • coagulationa and steroid use
  22. when do treat h.pylori?
    • if there is gastritis¬†
    • or
    • peptic ulcer
  23. testing for ze
    off ppi or h2 blockes, test for gastrin level and gastric acid output
  24. most accurate test for ze
    other less acurate test for ze
    secretin stimulation test

    • endoscopic ultrasound
    • somatostatin
  25. rx for ze
    • local -resection
    • metastatic--lifelong ppi
  26. zes + hypercalcemia
    MEN
  27. when is colonoscopy done for uc or cd
    8 years after diagnosis, every 1-2 years
  28. which one has asca, anca
    • uc--anca
    • cd--asca
  29. best initial rx for cd or uc
    mesalamine
  30. rx for acute flare up
    steroids
  31. when are azathioprine and 6mp used for ibd
    for severe disease when not on steroids
  32. when are tnf agents given for cd
    in cases of fistula formation
  33. when are abx like flagyl or cipro given for cd
    if there is perianal involvement
  34. best initial test for bloody diarrhea
    most accurate
    • fecal leukocytes
    • stool culture
  35. rx for diarrhea
    • mild ---leave it
    • severe---flouroquinolones
  36. test for giardia
    stool elisa
  37. test for cryptosporidium
    modified acid fast stain
  38. rx for cryptosporidiosis
    • raise cd4
    • nizatoxanide
  39. rx for scombroid histamine fish poisoning?
    antihistamine drugs, benadrlyl
  40. best initial test for c.diff
    stool toxin assay
  41. rx for c.diff
    • metro
    • or vanco if metro fails or in severe cases
  42. dx and rx for lactose intolerance
    remove all dairy products except yogurt
  43. dx of carcinoid syndrome
    rx
    urinary 5hiaa

    octeotride
  44. 4 causes of fat malabsorption
    • tropical spure
    • celiac
    • whipple
    • chronic pancreatitis
  45. side effects of malabsorpiton
    • vit k def, vit b12 def
    • low calcium abosprtion and high oxalaste abosritpion
  46. best initial test for fat malabsortipn
    most accurate
    • sudan black stain
    • 72 hour fecal fat
  47. best initial test for celiac
    most accurate
    • anti-gliadan, anti-endomysial
    • biopsy
  48. dxylose test needs a fucntional what for abosrioptn
    ileum
  49. why is biopsy done for celiac
    to excluse lymphoma
  50. most accurate test for tropical sprue
    rx
    small bowel biopsy

    tmp-smx and tetracyclies
  51. presentation of whipple
    most accurate test
    • eldelry with malabsorption
    • arhtirtis
    • ocular findings

    biopsy for pas bacteria or pcr for trophyemar
  52. best initial test for chronic pancreatitis
    most accurate
    xray or ct

    secretin stiluation test or fecal elastase test
  53. tests to order on ccs for ibs
    • guaiac
    • stool leukocytes
    • stool culute
    • ova
    • parasite
    • scope
    • ct abdomen
  54. best initial rx for ibs
    if that doestn work
    if that doesnt work
    • fiber
    • anti-cholingergics
    • tca are the last resort
  55. when is virtual colonscopy done
    never
  56. screen for colon cancer when one familymember has cancer
    10 year prior or age 40
  57. cancer in hnpcc or lynch syndrome
    when do you screen
    2 generations, 3 family memebrs and one premature

    age 25 every year
  58. screening for fap
    • age 12
    • once polyps are found, colectomy
  59. when is screening done for peutz jeghers, gardners, juvenile
    same as general population
  60. screening when a dysplastic polyp was found
    3-5 years later
  61. abx regimen for diverticulitis
    metro and cipro
  62. ccs case of large gi bleed
    • fluids
    • cbc and pt/inr
    • gi consult
    • ekg
    • type and cross
  63. when do you give rbc
    ffp
    platelets
    • hct<20 in young <30 in elderly
    • pt is high
    • platelets <50K and they are bleeding or going under surgery
  64. large gi bleeding and history of ulcer disease
    fluids and resusitate + ppi
  65. cirhoissi + variceal bleeding
    • octeotride
    • scope
  66. what prophylaxes against variceal bleeding
    propranolol
  67. what increases the risk of c.diff in pts and pneumonia
    ppi
  68. most accurate test for acute mesenteric ischemia
    angiography
  69. best initial rx for constipation
    • fluids
    • fiber
    • then docusate
  70. causes of constipation
    • dm
    • ferrous sulfate
    • dehydration
    • anticholingergic
    • narcotics
    • ccb
    • hypothyroid
  71. rx for dumping syndrome
    whatis dumping syndrome
    small frequent meals

    shaking, sweating, hypotension, hypoglycemia
  72. rx for diabetic gastroparesis
    • erythromycin
    • flagyl
  73. best initial test for pancreatitis
    most accurate
    lipase and amylase

    ct
  74. next step when ct shows >30%  necrosis of pancreas
    receive antibiotics and do ct-guided drainage
  75. rx for acute hep b
    hep c
    • hep b nothing
    • hep c interferon and ribavarin
  76. drug induced hepatitis gives high alt or ast?
    ast
  77. most accurate tests for hepatitis viruses
    serology for IgM and IgG
  78. rx for chronic hep c
    lamuvidine
  79. rx for chronic hep c
    • interferon
    • ribavarin
    • previr drugs
  80. who gets hep b vaccine
    • heatlh care workers
    • dialysis pts
    • gay men
    • pts with cirrhosis
  81. rx for a baby born to a mother with hep b
    hep B ivig and hep vaccine
  82. saag >1.1
    SAAG<1.1
    • portal hypertension
    • non portal hypertension
  83. primary biliary cirrhosis vs primary sclerosis chlangitis
    pbc--anti-mitochondrial antibody

    psc---anti-smooth antibody and ercp showing beading of biliary tree
  84. rx for pbc, psc
    ursodeoxycholic acid
  85. ccs order for wilson
    most accurate test
    slit lamp exam and cerrulopslamsi

    biopsy
  86. rx for wilsons
    penicilliamin or trientine
  87. best initial test for hemochromatosis
    • serum iron
    • serum ferritin
    • TIBC
  88. most accurate test for hemochromatosis
    biopsy or mri wth HFe mutation is equivalent
  89. best initial test for autoimmune hepatitis
    anti-smooth muscle antibody and spep showing high IgM
  90. best initial test for nash
    most accurate test
    • alt>ast
    • biopsy of liver

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