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Step III
Step III - GI 8
| 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 = | acute disease (Prodrome period) |
| HBsAg, HBeAg = | Incubation period |
| HBsAg, IgG HBc, HBeAg = | Chronic carrier/infection w/ active viral replication |
| HBcAB (IgG or IgM)= | Window period |
| HBsAB, HBcAB (IgG), HBeAB = | Complete recovery past infection |
| 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 |
| What are the presentations of cirrhosis | Palmar erythema/gynecomastia/splenomegaly/edema/low plts/encephalopathy/ascites/esophageal varices |
| When should paracentesis be performed on pts w/ ascites | Fever/tenderness/pain/new onset ascites |
| What does SAAG stand for | Serum to ascites albumin gradient |
| If SAAG is >1.1 then what is present | portal HTN from cirrhosis or congestive failure |
| If SAAG <1.1 then what is conclusion | Portal HTN NOT present |
| What value/measure is used to dx SBP | Cell count > 250 neutrophils |
| Tx for SBP | Cefotaxime |
| What are the different types/causes of chr liver dz/cirrhosis | Alcoholic cirrhosis/autoimmune hepatitis/primary sclerosing cholangitis/NASH/primary biliary cirrhosis/hemochromatosis/wilson’s dz |
| What drug will prevent bleeding in esophageal varices bleeding | Propranolol |
| Middle aged woman c/o RUQ pain, Itching, Fatigue and has h/o other autoimmune dz. Exam shows jaundice, xanthelasmas. Dx | Primary biliary cirrhosis |
| Best initial testing and what does it show | Blood work: alk phos, nL bili, IgM |
| Most accurate test for Primary biliary cirrhosis | Anti-mitochondrial Abs/liver bx |
| Tx for Primary biliary cirrhosis | Ursodeoxycholic acid |
| Anti-mitochondrial Abs are found in what disease | Primary biliary cirrhosis |
| What is being destroyed by immune system in Primary biliary cirrhosis | intrahepatic bile ducts |
| RUQ pain, Itching, Jaundice, Fatigue, Weight loss, Fever. Dx | Primary sclerosing cholangitis |
| What other diseases is Primary biliary cirrhosis a/w | scleroderma and CREST |
| Anti-smooth muscle Ab and (+) ANCA are found in what disease | Primary sclerosing cholangitis |
| Most accurate Diagnostic study for Primary sclerosing cholangitis uses what and shows what | Cholangiography/ERCP: “beading pattern” |
| Most accurate lab tests for Primary sclerosing cholangitis | Anti smooth muscle Abs and (+) ANCA |
| Tx for Primary sclerosing cholangitis | Ursodeoxycholic acid OR Liver transplant |
| LFTS in Primary sclerosing cholangitis is due to what | Narrowing of intr and extra hepatic ducts |
| What is MC risk factor for Primary sclerosing cholangitis | IBD (UC) |
| What is the difference in labs b/t Primary sclerosing cholangitis and Primary biliary cirrhosis | PSC: BOTH alk phos and bili ; PBC: alk phos, nL bili |
| Pt w/ Liver cirrhosis, dancing mvts, neuropysch S/S and hemolysis | Wilson’s |
| Best Initial test for Wilson’s dz | Slit lamp (Kayser Fleischer rings) >> low ceruloplasmin |
| Most accurate test for wilson’s dz | Liver bx >> urinary copper |
| Tx for Wilson’s dz | Penicillamine |
| Pt has new murmur, darkening skin, joint pain, infertile, panhypopituitaryism, DM and hepatoma. Dx | Hemochromatosis |
| Best Initial test for Hemochromatosis showing | Blood work: iron/ferritin, TIBC |
| Most accurate test for Hemochromatosis | Liver bx OR MRI liver + HFe gene mutation |
| Tx for Hemochromatosis | Phlebotomy |
| Young woman, has other autoimmune dz (Coomb positive hemolytic anemia/thyroiditis/ITP). Type of hepatitis | Autoimmune hepatx |
| Best Initial studies for Autoimmune hepatx | ANA and anti-smooth muscle Ab/SPEP (Igs)/anti-liver/kidney microsomal Ab |
| Most accurate test for Autoimmune hepatx | Liver bx |
| Tx for Hemochromatosis | Prednisone then wean off steroids w/ azathioprine |
| Type of liver cirrhosis a/w DM, obesity, hyperlipidemia | NASH |
| Initial study for NASH shows | ALT > AST |
| Most accurate test for NASH | Liver bx showing fatty infiltration |
| Tx for NASH | Tx underlying causes (DM, lipidemia, obesity) |
| Tx for cryptosporidiosis non bloody diarrhea | Nothing, use HAART to incr CD count |
| HBsAg, IgG HBc, HBeAB | Chronic carrier/infection W/O active viral replication |
| Which Hep B particle does the body make IgG and IgM against | HBc Ag |
| every carrier/chr Hep B infection has what two Hep serology markers | HBsAg + anti-HBc AB (IgG) |
| every carrier/chr Hep B infection has HBsAg + anti-HBc AB (IgG). Presence of what marker distinguishes active vs non-active viral replication? | active = HBeAg; non active = anti-HBe AB |
Created by:
DrINFJ
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