Rosh Review-
Gastroenterology with
100% correct
answers(passed)
What medication is know known to induce esophagitis?
Tx? - answer Bisphosphonates! (ALENDRENATE, RISEDRONATE)
Important patient education to remain upward for 30 minutes, and drink
with plenty of water
Tx:
Antacids to decrease mucosal irritation
Also can occur with NSAIDs, ASA, Ferrous sulfate (Iron), Antibiotics
(tetracycline, doxycycline)
What presents with progressive, painless jaundice, fatigue, weight loss,
depression, Icterus, with palpable, non-tender gallbladder, migratory
thrombophlebitis?
Dx and Tx? - answer Pancreatic Cancer!
Most common cause:
SMOKING!
,Dx:
CT
Tumor Marker--> CA19-9
Increased Direct Bilirubin (causes dark colored urine)
Tx:
Whipple** to resect head of pancreas
PANCREATICODUODENECTOMY*** = Whipple
What are the physical exam findings typically seen in pancreatic cancer? -
answer Painless Jaundice, Icterus , Dark colored urine (direct bilirubin
increased), fatigue, weight loss
Trousseaus:
Migratory thrombophlebitis
(hyper coagulability that accompanies most cancers)
Courvoisier sign:
Palpable nontender gallbladder
Virchow's Node & Sister Mary Joseph Node
What is the most common type of pancreatic cancer? - answer
Adenocarcinoma involving the head of the pancreas
What electrolyte abnormality is common in pancreatitis? - answer
Hypocalcemia!
When is Ranson's criteria performed?
,What is included in representing high mortality probability? - answer At
Admission and 48 hours after admission
LDH >350
Glucose >200
WBC >16,000
Age >55
AST >250
Calcium <8
Hematocrit fall >10%
BUN rise >5
PO2 <60
Base deficit >4
Fluid Sequestration >6
Score >7 = 100% mortality
Score >5 = 40% mortality
, What presents with fatigue, weakness, peripheral neuropathy, glossitis,
pallor?
Dx and Tx? - answer Cobalamin (B12) Deficiency!
Dx:
Methylamonic and Homocysteine levels:
BOTH ELEVATED**
(In folate, homocysteine will be normal, differentiating factor)
Peripheral Smear:
Macrocytic Anemia, Megaloblastic (hypersegmented neutrophils)
Tx:
Parenteral B12
What is the only vitamin deficiency that results in peripheral neuropathy?
- answer B12!
What presents with depression, irritability, anemia, sensory and motor
deficits ( absent reflexes, paresthesias), dementia, nausea, vomiting and
diarrhea? - answer Vitamin B12 Deficiency!
DX:
Peripheral Smear:
Megaloblastic anemia (Macrocytic, hypersegmented neutrophils)
Methylamonic acid and Homocysteine levels:
BOTH ELEVATED
Tx:
Gastroenterology with
100% correct
answers(passed)
What medication is know known to induce esophagitis?
Tx? - answer Bisphosphonates! (ALENDRENATE, RISEDRONATE)
Important patient education to remain upward for 30 minutes, and drink
with plenty of water
Tx:
Antacids to decrease mucosal irritation
Also can occur with NSAIDs, ASA, Ferrous sulfate (Iron), Antibiotics
(tetracycline, doxycycline)
What presents with progressive, painless jaundice, fatigue, weight loss,
depression, Icterus, with palpable, non-tender gallbladder, migratory
thrombophlebitis?
Dx and Tx? - answer Pancreatic Cancer!
Most common cause:
SMOKING!
,Dx:
CT
Tumor Marker--> CA19-9
Increased Direct Bilirubin (causes dark colored urine)
Tx:
Whipple** to resect head of pancreas
PANCREATICODUODENECTOMY*** = Whipple
What are the physical exam findings typically seen in pancreatic cancer? -
answer Painless Jaundice, Icterus , Dark colored urine (direct bilirubin
increased), fatigue, weight loss
Trousseaus:
Migratory thrombophlebitis
(hyper coagulability that accompanies most cancers)
Courvoisier sign:
Palpable nontender gallbladder
Virchow's Node & Sister Mary Joseph Node
What is the most common type of pancreatic cancer? - answer
Adenocarcinoma involving the head of the pancreas
What electrolyte abnormality is common in pancreatitis? - answer
Hypocalcemia!
When is Ranson's criteria performed?
,What is included in representing high mortality probability? - answer At
Admission and 48 hours after admission
LDH >350
Glucose >200
WBC >16,000
Age >55
AST >250
Calcium <8
Hematocrit fall >10%
BUN rise >5
PO2 <60
Base deficit >4
Fluid Sequestration >6
Score >7 = 100% mortality
Score >5 = 40% mortality
, What presents with fatigue, weakness, peripheral neuropathy, glossitis,
pallor?
Dx and Tx? - answer Cobalamin (B12) Deficiency!
Dx:
Methylamonic and Homocysteine levels:
BOTH ELEVATED**
(In folate, homocysteine will be normal, differentiating factor)
Peripheral Smear:
Macrocytic Anemia, Megaloblastic (hypersegmented neutrophils)
Tx:
Parenteral B12
What is the only vitamin deficiency that results in peripheral neuropathy?
- answer B12!
What presents with depression, irritability, anemia, sensory and motor
deficits ( absent reflexes, paresthesias), dementia, nausea, vomiting and
diarrhea? - answer Vitamin B12 Deficiency!
DX:
Peripheral Smear:
Megaloblastic anemia (Macrocytic, hypersegmented neutrophils)
Methylamonic acid and Homocysteine levels:
BOTH ELEVATED
Tx:
