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Step III
Step III - GI 7
| Question | Answer |
|---|---|
| Most effective non-invasive tx for Acute bleeding esophageal varices and effect | Somatostatin analog (octreotide); decr portal HTN |
| If sclerotherapy and Rx tx fails for Acute bleeding esophageal varices then what is the next tx | TIPS |
| What is the MCC complication of TIPs procedure | Hepatic encephalopathy |
| What are the causes of upper GI bleeding | Cancer/varices/gastritis/esophagitis/duodenitis/ulcer dz |
| What are the causes of lower GI bleeding | Cancer/diverticular dz/ischemic colitis/angiodysplasia/IBD/polyps |
| If endoscopy does not tell you location of bleed what can be done next | Tagged red cell scan (technetium scan) will ID location but not cause of bleed |
| What study tells you precisely what vessel is causing GI bleed | Angiography (prior to surgery for resection) |
| If upper and lower endo is not definitive for location of bleed and you wish to investigate small bowel what test is used | Capsule endoscopy |
| What are the common causes of constipation | Dehydration/CCB/narcotics/HYPOthyroid/DM/iron supplementation/anti-cholinergics/TCA |
| Pt h/o gastric surgery c/o Shaking, weakness, sweating, HYPOtension, HYPOglycemia. Dx and tx | Dumping syndrome; small frequent meals |
| Tx for diabetic gastroparesis | Erythromycin and metoclopramide |
| MOA of erythromycin in tx for gastroparesis | (+) motilin |
| Other causes of acute pancrx | Trauma/ERCP/HYPERtriglyceridemia/infection/drugs (didanosine, stavudine, azathioprine, thiazides) |
| Pt dx w/ acute pancreatitis. CT shows dilated common bile duct but no pancreatic head mass. Next step in tx | ERCP to remove stone or dilate stricture |
| What test is used to determine severity of pancreatitis and why | Trysinogen activating peptide found in urine; if trypsinogen is pre-maturely activated while in pancreas (instead of in duodenum) it can cause inflmx |
| What is Ranson’s criteria used for and what has replaced it | Operative criteria for pancreatic debridement; CT scan |
| CT scan shows >30% necrotic pancreatitis. Tx | Imipenem + CT guided biopsy |
| CT biopsy of pancreas shows infected and necrotic pancreas. Next tx | Surgical debridement |
| Hep B is a/w what other dz in 1/3 pts | PAN |
| Hep C is a/w what other condition | Cryoglobulinemia |
| Jaundice, fatigue, weight loss, dark urine. Dx | Hepatitis |
| Jaundice, fatigue, weight loss, dark urine + urticaria/fever/joint pain. Dx | Hep B/C |
| What are the levels of AST and ALT in viral vs drug induced hepatx | Viral ALT; drug AST |
| What is the difference in testing for Hep A,B,C,D,E | ACDE = serology testing; B = Surface Ag/Abs, core Abs, e Ag |
| HBsAg, IgM HBc, HBeAg = | Prodrome period of acute disease |
| HBsAg, HBeAg = | Incubation period |
| HBsAg, IgG HBc, +/- HBeAg = | Chronic carrier |
| HBcAB = | Window period |
| HBsAB, HBcAB = | Complete recovery |
| HBsAB = | immunized |
| How is chr Hep B different from acute Hep B in serology | Presence of HBsAg beyond 6 mos |
| Hep B DNA polymerase = e-Ag = Hep B PCR DNA = | active viral replication |
| Best initial test for Hep C | Hep C Ab |
| Most accurate test for det response to tx/replication/infectivity of Hep C | Hep C PCR for RNA (determines activity/replication/response to tx) |
| Most accurate test for severity of liver dz in Hep C | liver bx |
| What is the tx for chr Hep B | lamivudine/entecavir/telbivudine/IFN/adefovir |
| Which tx for chr Hep B has the most adverse effects | IFN |
| What is the tx for chr Hep C | IFN + ribavirin |
| MCC side effect of ribavirin | Anemia |
| Which adults have the strongest indication for Hep A and B vaccination | Chr liver dz/living w/ (+)HepA/B person/homosexuals/pts who receive blood chronically/IVD users |
| Who or what are the specific indicators for Hep A/B vaccine | Hep A: travelers; Hep B: dialysis pts and healthcare workers |
| Healthcare worker never got Hep B vaccine and gets stuck by pt who has chr Hep B. Tx | Give Hep B vaccine + Hep B Igs |
| Neonate born to mom w/ chr Hep B. Tx | Vaccine + Hep B Igs |
| Heatlhcare worker already immunized w/ Hep B. Gets needle stick from pt w/ Hep B. Next step | Order Hep B Ab serology for titer; if present no worry and no tx |
Created by:
DrINFJ
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