Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
USMLE2 Medicine 05
GI
| Question | Answer |
|---|---|
| dysphagia | diff swallowing |
| odynophagia | pain on swallowing |
| best initial test for dysphagia or odynophagia | barium swallow |
| best initial test if there is esophageal obstruction | upper endoscopy |
| Achalasia | idiopathic loss of the normal neural structure of the LES -- stays contracted. |
| progressive dysphagia to both solids and liquids simultaneously; regurgitation several hours after eating | achalasia |
| how does EtOH and tob affect achalasia | no relationship |
| dysphagia to solid foods that progresses to liquids, h/o EtOH and tob | esophageal CA |
| what are alarm sx's of achalasia? what is the next step if a pt has this? | Sound the WO BAD alarm 60+6 times! Wt loss, Odynophagia, Bleeding (FOBT+), Anemia, Dysphagia, onset >60yo, sx's >6mo. Next step is EGD (esophagogastroduodenoscopy) |
| Bird's beak on barium esophagography | achalasia |
| what is the most accurate test for achalasia? | esophageal manometry, which will show increased LES resting pressure |
| best initial therapy for achalasia | pneumatic dilation |
| Therapy for achalasia (3) in order that they would be attempted | 1. pneumatic dilation, 2. botulinum toxin injections, 3. surgical myotomy (reflux as complication in 20%) |
| describe the types of CA one sees in the esophagus and their location | proximal 2/3: squamous cell CA (ass with EtOH and tob). distal 1/3: adenoCA (ass with GERD and Barrett esophagus). |
| How to dx esophageal CA? | 1. endoscopy for bx, 2. CT to assess local spread, and 3. US to stage. |
| Tx of Esophageal CA | resection is curative; also chemo with 5-FU and radiation. |
| LES in person with h/o scleroderma | LES will neither contract nor relax - just like a constantly open tube |
| How to tx LES immobility in pt with scleroderma | PPI (omeprazole) for reflux and metoclopramide for promotility of esophagus and bowels |
| 34 yo man w no PMH complains of crushing chest discomfort and dysphagia. CP is not associated with exertion or eating, occ brought on my cold liquids. Nl EKG. Relieved with NTG. | diffuse esophageal spasm/nutcracker esophagus |
| corkscrew pattern on barium swallow | diffuse esophageal spasm/nutcracker esophagus |
| best test for diffuse esophageal spasm/nutcracker esophagus | manometry -- will show high-intensity disorganized esophageal contractions (too disorganized to move food forward) |
| tx for diffuse esophageal spasm/nutcracker esophagus | CCB (nifedipine) and nitrates |
| Schatzki's ring | narrowing of the lower part of the esophagus by a ring of tissue that can cause difficulty swallowing. |
| episodic dysphagia with solid foods, or a sensation that the food "sticks" while swallowing, no pain | Schatzki's ring |
| Plummer-Vinson Syndrome | triad of WIG. Web --> dysphagia, Iron def anemia, Glossitis |
| burning sensation with the tongue and oral mucosa, and atrophy of lingual papillae produces a smooth, shiny red tongue dorsum | Plummer-Vinson Syndrome |
| how are plummer-vinson, Schatzki's ring, and achalasia distinguished from each other? | achalasia sx's are progressive, unlike PV and SchR. PV has Fe-def anemia. |
| location of Schatzki's ring vs. Plummer-Vinson web | Sch - more distal, just proximal to the LES. PV - in the hypopharynx. |
| what CA is associated with PV syndrome? | squamous cell CA of esophagus |
| who gets PVS most commonly? | middle aged women |
| how to best dx an esophageal web? | barium swallow |
| How to tx PVS? | treat the Fe def anemia, then pneumatic dilation or surg |
| How to tx Schatzki's ring? | pneumatic dilation or surg |
| What is the most common cause of esophagitis? Who gets it? | Candida (1. HIV+, CD4<200; 2. DM pts) |
| pt with progressive odynophagia, HIV+. how to tx? | Candida esophagitis. Tx empirically with fluconazole first, and then if no improvement, get upper endoscopy. |
| how to distinguish esophagitis pain from esophageal spasm? | esophagitis pain only happens with swallowing - mechanical friction. Spastic pain occurs intermittently sometimes without swallowing |
| young pt taking meds for acne with acute onset of odynophagia | pill esophagitis |
| Zenker diverticulum | outpocketing of the posterior pharyngeal constrictor muscles at back of pharynx |
| older pt with bad breath, diff initiating swallowing, find regurgitated food from few days before on their pillow upon waking from sleeping | Zenker diverticulum |
| how to dx Zenker diverticulum? | barium swallow. CONTRAINDICATED: endoscopy or NG tube!!! (risk of perforation) |
| Tx of Zenker diverticulum | surgical resection |
| Mallory Weiss Syndrome | nontransmural tear of lower esophagus, ass with retching and vomiting |
| pt presents with painless hematemesis and black stool (melena), h/o bulemia | Mallory Weiss tear |
| how to dx Mallory Weiss tear | upper endoscopy |
| Tx for Mallory Weiss tear | most spontaneously resolve. otherwise, can do sclerotherapy. |
| Ddx for epigastric pain (5) | epigastric Pain Causes "UGG!" Pancreatitis, Cancer - gastric, Ulcers, Gastritis, GERD. |
| H.pylori associated with what (3) | H.pylori DiGGs into the tummy. Duodenal and Gastric ulcers, Gastritis. |
| What is the most common reason for epigastric tenderness on palpation? | pancreatitis |
| how to test for H.pylori (3) | 1. serology (good negative predictive value, but can't tell if recent disease), 2. breath test, 3. stool antigen, 4. bx |
| What must you ensure if testing for H.pylori? | off PPI's and abx for 1-2 wks prior (can give false negative) |
| If testing for eradication of H.pylori after treatment, which test to use? | breath test or stool antigen (not serology) |
| Indications for endoscopy in pt with epigastric pain | 1. > 45 yo (r/o CA), or 2. alarm sx's (bleeding, wt loss, dysphagia), or 3. pt who failed trial of PPI's |
| alarm sx's in epigastric pain | sound the WO BAD alarm 60+6 times! Wt loss, Odynophagia, Bleeding (FOBT+), Anemia, Dysphagia, onset >60yo, sx's >6mo |
| what agents can cause decreased LES tone? | nicotine, EtOH, caffeine, peppermint, chocolate, anti-cholinergics |
| pt with sore throat, metallic taste in mouth, substernal CP, recurs with lying down, hoarseness, cough and wheeze | GERD |
| two types of surg to tighten LES | 1. Nissen fundoplication, 2. circular purse string suture in LES |
| indication for surg for GERD | need GERD surg if can't wear RL clothing. 1. Refractory to PPIs 2/2 side effects such as HA and diarrhea, 2. don't want to take Lifelong PPI's |
| Barrett esophagus | complication of chronic GERD, squamous epithelium in lower esophagus --> columnar epithelium |
| how to manage pt with Barrett's | repeat endoscopy q2-3y to check for dysplasia/CA |
| if low-grade dysplasia is found in Barrett's endoscopy, what to do? | repeat endoscopy in 3-6 mo --> lesion progressed or resolved |
| if high-grade dysplasia is found in Barrett's endoscopy, what to do? | distal esophagectomy to prophylax against invasive esophageal CA |
| when to do endoscopy in GERD pt? | if pt has GERD > 5y or if they develop alarm sx's |
| Tx for Barrett's | PPI's |
| What causes ulcers? | what causes ulcers: CHaos IZ IN VT (Vermont) 1. gastric CA, 2. H.pylori, 3. IBD - Crohn's, 4. Zollinger-Ellison, 4. prolonged Intubation 5. NSAIDs, 6. mechanical Ventilation, 7. Trauma/burns |
| how to distinguish between duodenal and gastric ulcers? | endoscopy |
| ulcer associated with pain on eating | gastric |
| ulcer associated with relief of pain on eating | duodenal |
| ulcer associated with tenderness to palpation | consider perforation |
| Tx of H.pylori-related ulcer | H.Pylori is cured in CA or Tennessee (TM). PPI + clarithromycin + amoxicillin OR PPI + tetracycline + metronidazole; 10-14d |
| Best way to dx ulcer dz | endoscopy |
| If pt fails one course of treatment to eradicate H.Pylori, what do you do next? | Tx with different abx and add bismuth subsalicylate |
| Indications for surg in PUD | Need PUD surg if pt BRPs Goo. 1. Bleeding continues, UGIB not fixable by endoscopy, 2. refractory ulcers, 3. perforation, 4. gastric outlet obstruction |
| Causes of gastritis Type B | (increased acid production) Gassy B subscribes to HEN TV. H.pylori, EtOH, NSAIDs, trauma/burns, mechanical ventilation |
| Causes of gastritis Type A | (autoimmume/atrophy of gastric mucosa/decreased HCL production) Vit B12 deficiency - pernicious anemia |
| pt with super high gastrin levels | consider achlrohydria (no HCl production). HCl usu inhibits gastrin release from G cells |
| What is MALT and what is its associated with cancer? | mucosal-associated lymphoid tissue. MALT --> metaplasia --> dysplasia --> gastric CA |
| asymptomatic GI bleed (hematemesis or melena) | consider gastritis |
| epigastric pain if not pancreatitis | consider erosive severe gastritis |
| how to dx pernicous anemia? | anti-parietal cell Abs and anti-IF Abs |
| how to tx pernicious anemia? | B12 replacement. oral --> SL --> injection |
| Zollinger-Ellison | excessive production of gastrin by gastrinoma (G cells in the stomach). G cells --> gastrin --> parietal cells --> HCl |
| gastrinoma associated with what other disease? | MEN I (pan pit pth). Gastrinoma is a type of gastro-pancreatic tumor! |
| ulcer that is recurrent after therapy, multiple in number, and occur in the distal duodenum or resistant to routine therapy | consider Zollinger Ellison Syndrome |
| diarrhea x6mo, h/o ulcer disease resistant to tx, hypercalcemia | MEN I. pancreatic tumor (gastrinoma --> ulcer), pit, PTH (hyperCa) |
| how to diagnose Zollinger Eliison Syndrome? | gastrin levels (pt must stop PPIs/H2 blockers several days before since suppression of HCl --> increased gastrin, which will give false positive) |
| secretin stiumlation test | tests for gastrinoma. secretin usually suppresses gastrin release from G cells. If administrer secretin and gastrin levels still high--> abnormal, positive test. |
| causes of increased gastrin levels | GAZTRin 1. chronic gastritis, 2. pernicious anemia, 3. Zollinger Ellison (gastrinoma), 4. hyper thyroidism, 5. renal failure |
| how to tx gastrinoma? | if localized, surgically remove (curative), if metastatic, suppress with PPI's. |
| how to figure out if gastrinoma is metastatic? | most sensitive test: endoscopic U/S. (can also use less effective nuclear test, U/S, CT, and MRI; good positive predictive value, but not good negative predictive value because not as sensitive) |
| most common cause of gastroparesis | DM |
| pt with early satiety, post-prandial nausea, increased abdominal fullness, h/o DM, poor glycemic control, and peripheral neuropathy | consider gastroparesis |
| If suspect gastroparesis in DM, what should you do? | endoscopy to exclude other etiologies, then use erythromycin or metoclopramide (rarely need gastric emptying scan to dx) |
| pt with sweating, shaking, palpitations, and lightheadedness shortly after a meal | dumping syndrome |
| what causes dumping syndrome? | 1. chyme (hypertonic) --> duodenum --> osmotic pull into the duodenum --> decreased intravascular volume --> sx's. 2. glucose peak after eating --> insulin --> hypoglycemia. |
| how to tx dumping syndrome? | no cure. eat multiple small meals |
Created by:
christinapham
Popular USMLE sets