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Internal Medicine

1. Progressive dysphagia to both solids and liquids simultaneously. 2. Dysphagia to solids that progresses to liquids. 1. achalasia 2. esophageal cancer (usually also has long hx of smoking/EtOH)
Diagnostic workup of a patients with progressive dysphagia to both solids and liquids simultaneously. Achalasia 1. barium swallow followed by esophageal manometry 2. EGD for alarm symptoms (age 60+, weight loss, +hemoccult)
1. Patient with crushing chest discomfort and dysphagia. 2. Diagnostic workup. 3. Treatment 1. Diffuse esophageal spasm 2. barium swallow may reveal nutcracker esophagus; manometric studies are diagnostic 3. Ca2+ blockers and nitrates
1. Patient with dysphagia reveals, ringed constrictions in the lower esophagus on barium swallow 2. Treatment 1. Schatzki rings 2. pneumatic dilation
1. Patient with dysphagia reveals, constrictions in the upper esophagus on barium swallow 2. Treatment 1. Plummer-Vinson syndrome 2. pneumatic dilation
1. Odynophagia in HIV positive patient 2. Odynophasia in diabetic patients 3. Treatment for both 1. Candida albicans esophagitis 2. Candida albicans esophagitis 3. fluconazole (Diflucan)
2. Odynophagia in young patient taking medications for acne. Pill esophagitis (doxycycline)
1. What is a Zenker diverticulum? 2. How is a diagnosis made? 1. outpocketing of the posterior pharyngeal constrictor muscles at the back of the pharynx 2. barium swallow
How is a diagnosis of Mallory-Weiss tear found?studys upper endoscopy
Common etiology of epigrastric pain in which all tests are found to be normal. nonulcer dyspepsia
What are the causes of epigastric pain related to the GI system (5) 1. pancreatitis 2. GERD 3. gastritis 4. gastric cancer 5. peptic ulcer
What are alarm symptoms that require an endoscopy in patients with epigastric pain? 1. dysphagia, odynophagia 2. weight oss 3. anemia, + hemoccult
What is the main physiologic problem of Zollinger-Ellison syndrome? excessive production and release of gastrin from G cells
How does the diagnostic workup differ for epigastric pain in a patient younger that 45 than a patient older than 45? 1. younger can be given a trial of H2 blockers of PPIs 2. older should be given an endoscopy
What are the four tests for H. pylori and which test does not distinguish new vs old disease? 1. serology (does not distinguish new vs old disease) 2. urea breath test 3. stool antigen 4. CLO test of the biopsy
First choice in treatment therapy for H. pylori 1. PPI 2. clarithromycin 3. amoxicillin
1. Which type of gastritis is caused by an autoimmune process? 2. Does alcohol cause gastritis, ulcers or both? 1. Type A 2. only gastritis
How do you distinguish vitamin B12 deficiency from folate deficiency in anemia? vitamin B 12 deficiency has low B12 and increased methylmalonic acid
Patient with remitting peptic ulcers and hypercalcemia. MEN1 with gastrinoma and hyperparathyroidism
How is the diagnosis of gastrinoma confirmed? 1. secretin stimulation tests (gastrin will ↑) 2. elevated gastrin levels when patient is off PPIs and H2 blockers
1. Patient with poorly controlled diabetes presents with abdominal pain and bloating. 2. Treatment 1. Gastroparesis 2. erythromycin or metoclopramide
Which antibodies are associated with: 1. Crohn's Disease 2. Ulcerative Colitis 1. anti-saccharomyces cerevisiae antibodies (ASCA) 2. anti-neutrophil cytoplasmic antibody (ANCA)
1. Main therapy for inflammatory bowel disease 2. Treatment for acute exacerbations of inflammatory bowel disease. 1. mesalamine derivatives 2. budesonide (high dose steroids)
What is the cause of a rash in carinoid syndrome? the overproduction of serotonin leads to a tryptophan deficiency and subsequently a niacin deficiency
1. Patient with diarrhea, flushing, tachycardia. 2. How do you confirm diagnosis? 3. Treatment 1. carcinoid syndrome 2. urinary 5-HIAA 3. octreotide controls diarrhea, surgical resection if tumor is localized
Where are the following absorbed: 1. iron 2. vitamin B12 1. duodenum 2. ileum
Two most common causes of fat malabsorption 1. celiac disease 2. chronic pancreatitis
Steatorrea with arthralgias Whipple disease
What test confirms the diagnosis of: 1. celiac disease 2. chronic pancreatitis 1. antigliadin, antiendomysial, antitransglutaminase antibodies may be present but biopsy with flattening of the villi is diagnostic 2. calcifications of the pancreas on x-ray and CT scan; secretin test is most accurate
1. How is diverticulosis diagnosed? 2. How is diverticulitis diagnosed? 1. colonoscopy 2. clinically symptoms (LLQ pain, fever, ↑WBC) + CT scan
What can cause a fast-negative hemoccult test? vitamin C
What age is colon cancer screening done in: 1. general population 2. FMH of colon cancer 3. FMH of Lynch Syndrome 4. Familial adenomatous polyposis 5. juvenile polyposis syndrome 1. age 50 2. age 40 or 10 years earlier than the family member 3. age 25 4. age 12 5. normal population
What would you do if an x-ray finds osteomas as an incidental finding? colonoscopy (possibly Gardner syndrome)
1. Rx for acute bleeding of esophageal varices. 2. Rx for long-term management of portal hypertension. 1. Octreotide 2. propranolol
Two most common causes of pancreatitis 1. alcohol 2. gallstones
Sign of severe pancreatitis: 1. blue discoloration around the umbilicus 2. bluish discoloration around the flanks 1. Cullen sign 2. Turner's sign
Most accurate test to determine pancreatitis. CT scan
Management of pancreatitis 1. NPO, IV fluids, NG tube 2. CT scan monitoring for necrosis → start with imipenem if found
Which diuretic is most useful in cirrhosis? Why? 1. spironolactone 2. cirrhotics have low intravascular volume (b/c it is all in third space) resulting in a high aldosterone
Antimitochondrial antibody primary biliary cirrhosis
Treatment of: 1. diverticulosis 2. diverticulitis 1. increased fiber in the diet 2. ciprofloxacin and metronidazole
What is the secretin test for diagnosis of chronic pancreatitis? 1. place a NG tube into the duodenum and inject secretin into the blood 2. pancreas will not release bicarb or enzymes in chronic pancreatitis
What is the most common cause of constipation? lack of dietary fiber and insufficient fluid intake
What is the initial management of a patients with severe GI bleeding? 1. fluid resuscitation with NS or RL 2. CBC, prothrombin time and crossmatch
How do you confirm the diagnosis of alpha-1 antitrypsin deficiency? low level of the enzyme in a person with COPD
What is the appearance of the gallbladder when the common bile duct is obstructed due to: 1. malignancy 2. cholelithiasis 1. enlarged gallbladder 2. shrunken gallbladder
Patient with chronic, intermittent diarrhea and facial flushing develops a rash on his hands. What is causing the problem? patient has carcinoid syndrome; the overproduction of serotonin is depleting tryptophan and thus niacin resulting in pellagra
1. Which type of Crigler-Najjir is more often fatal? 2. Which type is treated with phenobarbital? 1. type 1 2. type 2
Does the D-Xylose test distinguish between chronic pancreatitis and celiac disease? 1. D-Xylose is absorbed y the gut without the need to be digested 2. D-Xylose will not be absorbed in celiac disease because of bowel-wall abnormality
What are the alarm symptoms that require EGD in a patient with dysphagia? 1. age 60+ 2. weight loss 3. +hemoccult 4. anemia 5. > 6 month duration
Treatment for achalasia 1. pneumatic dilation 2. botulinum toxin 2nd 3. surgical myotomy as a last resort
What form of mesalamine is used in: 1. Crohn's disease 2. Ulcerative colitis 1. pentasa (released in both upper and lower bowel) 2. asacol (only released in large bowel)
What are the Rome criteria for irritable bowel syndrome: 1. pain relieved by a bowel movement 2. fewer symptoms at night 3. diarrhea alternating with constipation
Treatment for: 1. celiac disease 2. chronic pancreatitis 3. whipple disease 4. tropical sprue 1. gluten-free diet 2. replace enzymes 3. TMP-SMX 4. TMP-SMX
1. Most common site for colonic diverticula 2. Most common site for bleeding diverticula 1. sigmoid colon 2. right colon
What are the 3 classes of polyps? 1. hyperplastic 2. hamartomatous 3. adenomatous
Upper GI bleeding with a history of abdominal aortic aneurysm repair in past year. aortoenteric fistula
Define orthostasis: 1. > 10-point rise in pulse upon standing 2. > 20-point drop in BP upon changing position
What causes hypocalcemia in acute pancreatitis? malabsorption of fat allows fat to bind with calcium in the bowel
Treatment for spontaneous bacterial peritonitis cefotaxime or cefriaxone and albumin decreases the risk of hepatorenal syndrome
Test you would use for diagnosis of gastroenteritis in AIDs patient. 1. Cryptosporidiosis 2. modified acid-fast test
Treatment for gastroenteritis: 1. when there is hypotension or blood 2. Giargia 1. ciprofloxacin 2. metronidazole



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