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Step 3 > Inservice Deck 2 - GI > Flashcards

Inservice Deck 2 - GI Flashcards

1
Q

Most sensitive symptom for appy?

A

RLQ pain

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2
Q

20 year old with constipation has BRPBR and painful BM. Pain lasts 1-2 hours after BM. What is the diagnosis and tx?

A

anal fissure
- not hemorrhoid, pain continues after BM

Tx - WASH
warm soaks, analgesics, stool softener, high fiber diet

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3
Q

Name a possible appropriate tx for esophageal foreign body?

A

IV glucagon

nitro/nifedipine or CO2 may also work

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4
Q

dx of patient with history of AAA repair with pain and massive hematemsis?

A

aorto enteric fistula

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5
Q

Kehr’s sign, hemolysis, and leuk may indicate?

A

splenic rupture

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6
Q

diagnostic criteria for spontaneous bacterial peritonitis?

A

ascites with PMN > 250
- diagnostic with 93% sens
WBC > 1000
- diagnostic less sens

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7
Q

abx coverage for SBP should include what main organisms?

A

gram neg (enterobacteria/enterococci) and strep pneumo

tx - 3rd gen cephalosporin or amp/sulbactam

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8
Q

most common cause of acute hepatic encephalopathy in cirrhotic?

A

GI bleed

LIVER
L - librium (or sedatives)
I - infection/sepsis
V - volume loss
E - electrolytes (hypoK, hypo Na
R - RBCs in stool (GI bleed is #1 cause
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9
Q

60 year old patient presents with AMS, exam reveals gynecomastia and spider angioma. What medication is indicated?

A

lactulose

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10
Q

Most common area of esophageal foreign body in child? In adult?

A

cricopharyngeus

lower esophageal sphincter

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11
Q

type of incision should be made when excising a thrombosed hemorrhoid?

A

elliptical

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12
Q

Risk factors associated qwith coffee bean shaped bowel on abd XR?

A

sigmoid volvulus

  • elderly, bed ridden patients or patients of any age with neuro illness with history of severe chronic constipation
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13
Q

most common type of hernia in adults?

A

indirect inguinal

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14
Q

test used to diagnose pinworm?

A

scotch tape test

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15
Q

abd pain in the elderly is more often a medical or surgical emergency?

A

surgical

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16
Q

construction worker with painless lower GI bleed and normal external exam most likely has what?

A

internal hemorrhoids

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17
Q

name a medication indicated for intractible hiccups?

A

chlorpromazine

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18
Q

What are the markerds of acute infection in hep B?

A

HbSAg and HbcAb (IgM)

core ab is seen in window period with acute infection

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19
Q

healthcare worker who has had hep B vaccine gets needlestick from HepB positive patient. What should be done next?

A

test worker for anti-HBs (antibody to HbsAg) if adequate do not treat. If inadequate administer HBIG and vaccine booster

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20
Q

Test done in ED for patient with cirrhosis, painful abd fluid wave,a nd fever?

A

paracentesis

  • fluid for WBC and diff, glucose, and protein, GM stain and cx
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21
Q

lab marker indicates poor prognosis in alcoholic hepatitis?

A

PT (> 8 sec)

indicates failing not just injured liver

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22
Q

alcoholic with vomiting, now streaked with blood has what dx? where do most of the tears occur?

A

mallory weiss tear

GE junction

23
Q

pt has epigastric pain that awakens him at night and is relieved by food. Dx?

A

duodenal ulcer

gastric ulcer worse with food

24
Q

most common presenting sx of gi angiodysplasia (AVM)

A

painless lower GI bleed

U - upper gi bleed
D - diverticulosis
R - rectal causes, hemorrhoids, fissures
A - AVM, aorto-enteric fistula
I - infection, IBD
N - neoplam
25
Q

tx for child who began vomiting 4 hours after eating at a picnic?

A

hydration, antiemetic

NO abx - likely staph

26
Q

patient presents with vomiting and diarrhea after eating oysters. Etiology?

A

vibrio cholera (or vulnificus)

27
Q

6 week old presents with bloody diarrhea tinged with mucus, generalized seizure in the ED. Possible etiology?

A

shigella

28
Q

patient develops vomiting and diarrhea one wk after being tx for pneumonia. Most likely etiology?

A

c difficile

  • diagnose by stool toxin not culture
29
Q

patient with rectal pain, surrounding induration, and fever may have?

A

rectal abscess

30
Q

40 year old presents with severe vomiting, now with increasing pain. CXR is unrevealing. What is the next test to rule out esophageal rupture?

A

gastrograffin before endo

31
Q

50 year old has intermittent difficulty initiating swallowing of solids. Most likely cause?

A

achalasia

mech sx - difficulty swallowing solids and liquids vs obstructive cause - difficulty swallowing solids, then liquids later (tumor)

32
Q

patient with caustic ingestion requires what diagnostic evaluating study?

A

endoscopy

33
Q

source of melenal is where, with relationship to the ligament of treitz

A

prox to it

34
Q

GI study that can localize bleeding at rate of 0.1 ml/min

A

scintigraphy

35
Q

tx for 30 year old with sore throat and difficulty breathing, has normal oropharynx and lung exams, is febrile with otherwise normal vitals, and thumbprinting on lateral soft tissue neck?

A

epiglottis

tx - abx/iv pain control, ent consult

36
Q

backpacker gets diarrhea 2 weeks after trip. How is this diagnosed and tx?

A

giardia

ova and parasite smear on fecal sample

tx metronidazole

37
Q

HIV patient gets diarrhea after fishing on a fresh water lake. What parasite cause is associated with drinking untreated water in this patient?

A

cryptosporidium

38
Q

diagnostic test for hematuria if CT not available

A

IVP

39
Q

disposition for patient with RUQ US, fever, and pain

A

OR

40
Q

all patients who are discharged with painless lower GI bleed require what subsequent study?

A

colonoscopy

41
Q

Most likely cause of SBO in 66 year old who has only had a chole?

A

adhesions

42
Q

small vs large bowel obstruction?

A

SBO has stair step pattern and air fluid levels

LBO can see large bowel

43
Q

60 year old on digoxin present with severe abd. Pain with minimal tenderness. Dx?

A

mesenteric infarction

- pain out of proportion

44
Q

what is the next diagnostic test indicated for 60 year old with a fib and abd pain with minimal tenderness?

A

angiography

  • rule out mesenteric infarction
45
Q

25 year old female has abd pain, lower gi bleed, and joint pain. most likely dx?

A

crohns

effects joints, eyes, liver, skin

46
Q

pt presents with RUQ pain, subsequent US shows air in GB wall. Disposition?

A

emergent chole

ephysematous chole

47
Q

contracted GB with all walls outlined. Dx? Tx? risk?

A

porcelain GB

urgent surgery, cancer risk

48
Q

6 month old with intermittent severe abdominal pain requires what diagnostic tets?

A

air enema (barium)

intussusception - plain film = soft tissue mass RUQ and absent liver edge. US - telescoping bowel

49
Q

poor prognostic indicators in patient with pancreatitis?

A

at admission

GLOWS (glucose > 200, LDH > 700, > 55 years, WBC . 16,000, SGOT (AST) > 250)

48 hours: hct decr by 10%, BUN rise > 5, Ca < 8, PaO2 < 60, base deficit > 4, fluid > 6L

50
Q

tx is next indicated for patient with known alcoholic liver failure who presents with hematemesis?

A

IV octreotide

51
Q

Next step for patient who presents with a button battery stuck in the esophagus? What about in stomach?

A

prepare for immediate removal in esophagus

serial XR in stomach

52
Q

40 year old patient with history of PUD presents with early satiety, vomiting after every meal, and weight loss has what complication?

A

gastric outlet obstruction

hemorrhage, perforation, and penetration

53
Q

20 year old female presents with multiple episodes of abd pain and constipation, occasional non-bloody diarrhea. pain improves with BM. most likely etiology?

A

irritable bowel syndrome

Step 3 (30 decks)

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