511 Final Flashcards
1
Q
A disease only of the colon
A
Ulcerative colitis
2
Q
What is UC?
A
An inflammatory bowel disease where the mucosal surface of the colon is inflamed
3
Q
Where does UC most often occur
A
in the rectosigmoid areas
May involve entire colon
4
Q
UC is characterized by what
A
bloody and purulent diarrhea
5
Q
UC results in what changes to the intestinal wall
A
Friability, erosion and bleeding of the mucosal wall.
6
Q
What is the only “cure” for UC?
A
A total colectomy (not first treatment option)
7
Q
Who is most at risk for diverticulitis
A
obese patients
8
Q
How do some patient present with divertic
A
Bleeding not associated with pain or discomfort
9
Q
What do you see when diverticula become inflamed?
A
Usual s/s of infection (fever, chills, tachy)
10
Q
Typical presentation of divertic
A
Localized pain and tenderness of the LLQ
Anorexia, nausea, vomiting
11
Q
Why would you do a CT scan in a divertic patient
A
to rule out GYN etiologies (like cysts or tumors) as well as bowel pathology (abdominal abcesses)
12
Q
What is the best management for divertic
A
a high-fiber diet
13
Q
What is C. diff
A
a bacterial infection of the large intestine
14
Q
Where is c.diff found
A
in water, air, soil, processed foods, feces
15
Q
Symptoms of c. diff.
A
-profuse, watery, mucoid diarrhea
- may be asymptomatic
16
Q
Risk factors for c. diff
A
-Working in healthcare facility
-Long duration hospitalization
-Long-term use of antibiotics that affects normal -GI flora
-Long-term use of medications that reduce GI acidity
-Consumption of contaminated food or water
-Touching infected soil, objects and surfaces
17
Q
Symptoms of mild/mod c. diff infection
A
-watery diarrhea 3+ per day for 2+ days
-mild abdominal cramping and tenderness
18
Q
Symptoms of severe c. diff infection
A
-10-15 watery stools per day
-Strong foul odor
-acute abdomen secondary to toxic megacolon with perf.
-fever
-abdominal distention
-nausea/vomiting/dehydration requiring hospitalization
-blood or pus in stools (very severe)
19
Q
Diagnostic tests for C. diff
A
-CBC: elevated WBC
-ELISA: detects toxins
-Cell cytotoxicity assay: identifies effects of bacterial toxins on human cells
-polymerase chain reaction: detects bacterial genes
-endoscopy: pseudomembranes that suggest c-diff infection
20
Q
C. Diff treatment
A
-metronidazole
-probiotics
-colectomy in severe cases
-maintain fluids
-clear liquid diet
-starchy foods to prevent diarrhea
-avoid caffeine, spicy foods, milk, greasy foods
-GI consult
21
Q
GERD symptoms
A
-Regurgitation HS
-heartburn
-dysphasia
-water brash (reflex salivation)
-sour taste in am
-odynophagia
-belching
-coughing
-hoarseness
-wheezing at HS
22
Q
When to refer a GERD pt to endoscopy
A
if diet modifications and 6 weeks of omeprazole has not helped
23
Q
What to test with GERD
A
biopsy for h pylori
24
Q
What to avoid in GERD
A
-coffee
-alcohol
-chocolate
-peppermint
-spicy foods
25
what to change in GERD
-eat small meals
-stop smoking
-stay upright for 2 hours after meals
-elevate HOB on 6-8in blocks
-dont eat 3 hours before bed
26
What age is rotavirus most common
kids under 3
27
symptoms of rotavirus
-low grade fever
-loss of appetite
-copious watery diarrhea
-flatulence
-vomiting
-stomach cramps
28
treatment for rotavirus
-fluids
-supportive care
-antiemetics
29
Most common cause of appendicitis
fecalith: stone made of feces found in colon
30
symptoms of appendicitis
-periumbilical pain shifting to RLQ
-vomiting following pain
-small volume diarrhea
-fever/chills
-loss of appetite
31
Clinical signs of appendicitis
-Mild elevation of CBC with early L)shift
(becomes high with gangrene or perf)
-WBC/RBC in urine
-ketonuria (if prolonged vomiting)
-Obturator sign
32
Treatment for appendicitis
-surgery
-antimicrobial therapy
33
Gastroenteritis
irritation and inflammation of the stomach
34
causes of gastroenteritis
--most often from infectious agent
Bacteria accounts for 30-80%
--Dietary factors: coffee, tea, soda with caffeine, meds,
--Metabolic factors: DM, hyperthyroidism, adrenal insufficiency
35
Symptoms of gastroenteritis
-watery diarrhea
-nausea/vomiting
-abdominal pain/cramping
-low grade fever
-headache
-dehydration
36
gastroenteritis diagnostic tests
-Stool culture: for those with severe diarrhea, fever, bloody stools,
------Identifies: shigella, salmonella, Campylobacter, Aeromonas and Yersinia
-Blood Cultures: for those with s/s of typhoid or enteric fever, hospitalized, fever
-Stool exam: for those who traveled to russa, Nepal or Rocky Mnts, negative stool culture
-Bowel Bx: for those with negative stool culture
-Flexible sigmoidoscopy:
------Reserved for those with colitis that is unresponsive to abx
-------For persistent diarrhea undiagnosed with labwork
37
--------differential diagnosis for gastroenteritis
-IBS
-IBD
-Ischemic bowel
-Partial bowel obstruction
-Pelvic abscess
38
-------------s/s of h. pylori
------------
39
treatment of h. pylori
-amoxicillin, clarithromycin and omeprazole for 2 weeks
40
Salmonella symptoms start
with nausea/vomiting followed by colicky abdominal pain and bloody or mucoid diarrhea
41
Causes of diarrhea
-Osmotic:
---Occurs when osmotic gap between stool and serum is over 50 (they are usually equal implying ingestion or substance malabsorption
--------Carbohydrate malabsorption: lactose, fructose, and sorbitol
-Laxative abuse
-Celiac disease: immune reaction to gluten in wheat, barley and rye
42
differential diagnoses for diarrhea
Acute viral gastroenteritis
IBS
IBD
Ingestion of antacids containing magnesium
Lactose intolerance
Abx therapy
Laxative abuse
AIDS
Acute: abrupt onset and last for less than 1 week and Associated with N/V, fever
* Often viral causes: Acute viral gastroenteritis: most common cause
43
giardia causes
-Drinking unfiltered water (common cause for traveler’s diarrhea)
-Oral-anal intercourse
-Diarrhea for kids in day-care
44
Giardia treatment
--Quinacrine hydrochloride (atabrine) 100mg TID after meals for 5-7 days
--Metronidazole 250mg orally TID for 7-10 days (5-7?)
45
PUD is associated with what infection
h. pylroi
46
What is the hallmark of PUD
c/o buring/gnawing (hunger) sensation or pain (dyspepsia) in the epigastrium which is often relieved by food or antacids
47
REVIEW SPLENIC SEQUESTRATION
----
---------
48
Splenic sequestration is associated with what condition
sickle cell anemia
49
Symptoms of splenic sequestration
-abdominal pain
-pallor
-tachycardia
50
who should be taught the s/s of splenic sequestration
parents: it can be lifesaving
-teach s/s of anemia and enlarging spleen
51
What are two causes of macrocytic normochronic anemias
-folic acid deficiency
-b12 deficiency
52
G6PD is what
an x-linked recessive disorder in blacks that causes episodic hemolytic anemia because of an inability of RBC to deal with oxidative stress
53
What is the goal standard for dx of sickle-cell
hemoglobin electrophoresis
54
Risk factors for iron deficiency anemia
-older than 60
-poverty
-recent illness (ulcer, divertic, colitis, hemorrhoids, GI tumors)
55
s/s of IDE
-pale conjunctivae and nail beds
-tachycardia
-heart murmur
-cheilosis (fissures at angles of reddened lips)
-glossitis
-stomatitis
-splenomegaly
-koilonchia (concave finger nails with raised edge)
-esophageal webs (plummer-vinson syndrome)
-melena
-menorrhagia
56
What tests should be done on all clients with suspected iron deficiency anemia
fecal occult blood
(need to see if it is just from poor iron intake, decreased absorption or chronic blood loss)
57
treatment of IDA
-increase dietary iron first
-iron supplementation
58
What are reticulocytes
-newly maturing RBC still covered in its endothelial reticulum.
59
Reticulocyte count is elevated when
when body is trying to replace lost blood, during treatment for anemias and in bone marrow disorders
60
What is MCV
"mean corpuscular volume"
-indicates average size of each blood cell
61
Normal MCV range
76-96
62
What does an increased MCV indicate
-macrocytic
-seen in megaloblastic anemias (vb12, folate), liver disease, some drugs
63
most common cause of megaloblastic anemia (pernicious anemia)
b12 deficiency
(macrocytic and normochromic)
64
Siderblastic anemia
group of disorders when the body has enough iron but is unable to use it to make hgb. As a result, iron accumulates in the mitochondria giving a ringed appearance to the neuclus
65
diagnostic test for sideroblastic anemia
prussian blue stain
66
microcytic hypocromic anemia causes and diagnosis-----------
67
what should be checked in an iron deficient anemia kid
lead level
68
Folic acid deficiency
Macrocytic anemia
-found with normal b-12 but low folate levels
-almost always due to inadequate intake
-can be caused by impaired metabolism and storage (alcoholism, drugs)
-impaired absorption
69
how does anemia of chronic disease
-low serum iron
-low TIBC
-serum transferrin normal or increased
-transferrin saturation low
70
Principle of iron supplementation
-dietary increase first
-Iron supplementation: 325 TID for 3-6 mo after normal levels restored
-IV only in oral failure
71
What is the most common cancer in children
acute lymphoblastic leukemia
72
symptoms of acute lymphoblastic leukemia
-pallor
-fatigue
-bleeding
-fever
-bone pain
-adenopathy
-arthralgias
-hepatosplenomegaly
73
how to diagnose acute lymphoblastic leukemia
cbc with differential
74
what are children who recieve radiation for acute lymphoblastic leukemia at an increase risk for
brain tumor as a secondary malignancy
(12% develope a new cancer within 20 years of being treated for the primary cancer)
75
Most common type of leukemia in the US
chronic lymphocytic leukemia
76
Median age of onset for chronic lymphocytic leukemia
70 years
77
causes of functional incontinence
-delirium
-fecal impaction
-lack of manual dexterity
-decreased mobility
-Meds: diuretics, hypotics, alcohol, narcotics, decongestents
78
symptoms of stress incont.
urine leaking with cough or sneezing
79
primary cause of stress incont.
hx of vaginal deliveries
80
Labs in urinary incont. workup
-urinalysis and culture
-serum electrolytes
-BUN
-Creatinine
-calcium (for polyuria without diuretics)
-glucose
-post void cath
81
what is overactive bladder
A syndrome of symptoms that include:
-urgency
-frequency
-nocturia
Due to the involuntary contractions of the detrusor muscle
urge incont. may or may not be a feature (1/3 do)
82
what is urge incontinence
sudden, intense urge to urinate and an involuntary loss of urine
83
how is the diagnosis of a uti made
Subjective complaint and a clean-catch sample showing bacteria (esp. more than 100k)
-Culture is gold standard but urinalyisis with microscopy is quick
84
Symptom of uti in elderly
altered mental status
85
Medication for symptom relief in UTI
pyridium: relieves burning, pain, urgency and frequency
86
Priapism
prolonged erection usually without sexual arousal
87
drug of choice for low-flow priapism
Phenyleprine (neo-synephrine) (pure alpha-agonist effects and minimal beta activity)
88
phimosis
unusually long foreskin or a foreskin that cannot be retracted over the glans during exam
-normal in uncircumcised infants
89
Who needs referral to urologist with phimosis
anyone older than infancy
90
hypospadias
opening of the penis is on the underside
91
hypospadias is common in
infants with a family history
92
how to fix hypospadias
-surgical correction by 1st grade
-these kids should not be circ.d because surgeon may need to repair later in life
93
Varicocele symptoms
-testicular pain
-"bag of worms" feeling
-soft, movable blood vessels underneath the scrotal skin on palpation
94
varicocele
an abnormal totuosity and dialation of the veins of the pampiniform plexus within the spermatic cord
95
treatment and timing for undescended testes
-orchiopexy before the age of 6
96
why do undescended testes need orchiopexy
-to promote normal spermatogenesis and hormone production
-prevent tumor formation
-leave them where they can be palpated
97
Expected drop in PSA after 6mo of finasteride (Proscar)
50% drop
98
what if PSA doesnt drop after 6mo of finasteride
consider prostate cancer
99
when can men resume sex after prostate sx
4-6 weeks.
(if sex before then, spasmodic contractions at time of ejacultation can trigger delayed bleeding)
100
not a first line treatment for BPH
saw palmetto
101
Feeling of prostate in BPH
diffusely smooth and enlarged
102
does the size of the prostate correlate to urinary symptoms
no
103
first line tx for BPH
5-alpha-reductace inhibitors
-finasteride (proscar)
-dutasteride (avodart)
104
What meds have been shown to cause ED
-antiandrogens
-antihypertensives (BB)
-symphatholytics (reserpine)
-anticholinergics
-antidepressants
-antipsychotics
-CNS depressants
-alcohol, tobacco, heroin
105
bacterial prostatitis
recurrent bacterial infection of the prostate and urinatry tract
106
age range for bacterial prostatitis
50-80
107
S/S of bacterial prostatitis
accompanied by bladder obstruction symptoms such as:
-weak stream
-hesitancy or dribbling
-hematuria
-hematospermia
-painful ejeculation
108
Most common pathogen for bacterial prostatitis
e. coli
109
most common cause of bacterial prostatitis in 20 year olds
gonorrhea
110
Differential for bacterial prostatitis
prostatic abcess
111
how should a rectal exam be done in bacterial prostatitis
-gently because vigorous manipulation can result in septicemia (prostatic massage is contraindicated)
112
Acute bacterial prostatis is always associated with what
-UTI with abrupt onset
-fevers, chills, low back pain, tenesmus, urinary complaints typical of a uti
113
Prostate cancer is associated with
human cytomegalovirus
114
latent symptoms of prostate cancer
-bone pain
-wt loss
-anemia
-SOB
-lymphedema
-lymphadenopathy
115
risk factors for prostate cancer
-1st degree relative (2x as likely)
-high fat diet (primarily animal fat)
-smoking
116
Treatment for prostate cancer
-Goserelin acetate (zoladex) IM
-leuprolide acetate (lupron) IM
(both block release of FSH and LH)
117
Carpal tunnel syndrome
inflammation of the median nerve
118
characteristic of carpal tunnel
-wrist achiness that radiates to base of thumb and palm of hand
-may be awakened at hs with pain and numbness
119
initial tx for carpal tunnel syndrome
-wrist splint
-NSAIDS
120
Who is more likely to have rotator cuff tears or degenerative arthritis
-older patients (>55)
121
Who is most likely to present with glenohumeral dislocation of the shoulder
patients less than 30
122
Who is most likely to present with fractures and dislocations of the shoulder
older than 55 years patienss
123
Who is likely to suffer from impingement syndrome
middle-aged patients
124
shoulder pain management
125
Shoulder dislocation has pain with what movement
shrugging shoulders due to excessive pressure put on the shoulders
126
CAUSES/RISK FACTORS of herniated disk
-age related degenerative changes
-smoking
-narrowed lumbar canal
-obesity
-osteoporosis
-stress
-muscle tension
-trauma
-frequent lifting without proper mechanics
-Vibration (driving, riding for long time)
127
Most common area for herniated disc
L4-L5 with weakness in great toe
128
EVALUATION OF HERNATIED DISC
-Motor and sensory function and DTR eval
-Straight leg raise to both limbs
-MRI if unclear dx and for those with neurologic symptoms
129
Herniated disc prevention
-stop smoking
-reduce weight
-good posture and body mechanics
-adherence to exercise regimen
130
Patellofemoral dysfunction:
encompasses a continuum of disorders due to overuse
131
management of patellofemoral dysfunction
conservative treatment with NSAIDs and quad strengthening exercises
132
What does the McMurray test evaluate
tears in the meniscus
133
Phalen's test
Flexing the wrist for 60s leading to painor paraesthesia in the median nerve
134
Anterior drawer test is used when
when suspected rupture of the cruciate ligaments
135
Rovsign sign
pain felt in the RLQ on palpation of the left side
(indicated acute appendicitis)
136
WORK UP OF LOW BACK PAIN
-CBC, urine, ESR, CRP to dx infectious or inflammatory
--xray to eval boney structures
-CT to identify disc rupture, stenosis, tumors
-MRI if soft tissue injury
-EMG to dx radiculopathy
137
differential diagnoses for acute and chronic low back pain
-ovarian cyst
-ankylosing spondylitis
-infection
138
S/S of lumbar spinal stenosis
-radicular complaints in legs (w/wo pain)
-Short term relief when leaning forwars (they also often lean on stuff)
-Proximal to distal progression
-Walking/prolonged standing causes pain and weakness in legs and buttocks
139
Red flags that may alert to spinal fx
-fall hx
-prolonged steroid use
-osteopenia
-osteoporosis
140
Cervical spondylosis
Degenerative arthritis
A blanket term for chronic degenerative process that affect the vertebrae and facet joints
141
s/s of cervical spondylosis
pain
stiffness
disability
142
Cervical myelopathy symptoms
-radicular of the upper extremities and weakness
-Leg weakness and gait issues, loss of bowel and bladder in severe cases
143
radicular symptoms include
pain, weakness, numbness and tingling due to narrowing of the space where nerve roots exit the spine due to stenosis, bone spurs, herniated discs.
144
Primary cause of veterbral fractures
osteoporosis
145
L4 nerve root symptoms
-weakness in the anterior tibialis
-numbness in shin
-thigh pain
-asymmetric knee relfex
146
Paresthesis over the anterior thigh just above the knee indicates what level of involvement
L4
(L3 in book)
147
HOW TO ASSESS PERIPHERAL NEUROPATHY+++++++++++++++++++
148
peripheral neuropathy is characterized
"stocking-glove"
distal sensorimotor paresthesia with diminished or variable DTR
149
Myofacial pain
Painful contractions of muscles after exertion, such as heat cramps
150
cause of myofacial pain
may be related to hyponatremia or other electrolyte imbalances.
151
common sites of myofacial pain
Usually, the gastrocnemius and hamstring muscles are involved.
152
Treatment of heat cramps includes
-passive muscle stretching,
-cessation of activities,
-transfer to a cooler environment,
-drinking cool liquids.
-Sports drinks that contain electrolytes, such as Gatorade, may be beneficial
153
Treatment for myofscial pain includes:
-indentifying and eliminating aggravating factors
-trigger point injections
-dry needling
-massage therapy.
Additional treatments include:
-muscle relaxants
-NSAIDs
-COX-2 inhibitors
-tricyclic antidepressants in cases that do not respond to other treatments.
-Narcotics and oral corticosteroids are not indicated.
154
first degree ankle sprain
ligaments are stretched but not torn
155
second degree ankle sprain
most common
-painful tearing of the ligament
156
third degree ankle sprain
most severe
-ligament is torn completely
157
muscle strains can be causes by
not properly warming up prior to exercise
(always suggest stretching and warm up exercises prior to full routine)
158
treatment for a muscle strain
-NSAID
-low back strengthening exercises (depending on pain level, dont over do it)
159
cervical neck sprain s/s
-pain most common presenting symptom
-headache (occipital for months)
160
ANKLE SPRAIN S?S+++++++++++++++++P
161
Patients with wounds should be asked about what vaccination
Tetanus (give booster if more than 5 years since)
162
Suture removal for face
4-6d
163
Suture removal for scalp
6-10 days
164
Suture removal for trunk
7-10 days
165
Suture removal for arms
10-14 days (same as legs)
166
Suture removal for legs
10-14 days (same as arms)
167
Suture removal for joints
14 days
168
when can dermabond be used
on clean superficial lacerations less than 6cm and in low tension areas
169
Who needs prophylactic abx for wounds
-DM
-vascular compromise
170
initial abx treatment of choice in laceration prophylactic
Parental administration of:
-ampicillin/sulbactam,
-cephalexin,
-ceftriaxone
171
secondary abx treatment for laceratin
Oral:
-amoxicillin/clavulanate
-cephalexin
-cefdroxil.
If the patient has allergies to penicillin or cephalosporins, the clinician should consider prescribing doxycycline, with or without clindamycin, or ciprofloxacin.
172
Patient teaching with wounds and bites
watch for:
-red streaks
-increased warmth at the wound site
-increasing pain
-foul odor
-increased drainage from the bite wound
—all of which should trigger the patient to seek urgent assessment in the clinic or ED.
173
Pain management for animal bite is commonly provided with analgesic agents such as:
-NSAIDs
-acetaminophen (Tylenol).
If nonnarcotic oral agents are ineffective and the patient is in severe pain:
-ketorolac (Toradol) 30 to 60 mg may be effective.
174
How to clean a lacerated wound
Saline irrigation or even soapy water is preferred over dilute povidone-iodine (Betadine) solution, because povidone-iodine can be irritating and cytotoxic to lacerated tissue. The clinician should avoid hydrogen peroxide (H2O2), because it can be irritating to the wound.
175
What to assess in puncture wounds
assessed for:
-skin integrity
-vascular and neurological function
-range of motion
176
Flexor tendon injuries usually require:
primary wound closure by an orthopedic specialist
There is a high morbidity associated with flexor tendon injuries.
177
abscess care
-must drain or it wont heal
-pack or dont
-abx or not (bactrum, clinda or doxy for MSRA if so)
-change dressing daily or PRN for saturation
-apply warm compress
178
L5 nerve root involvement symptoms
-weakness in great toe extension
-numbness on top of foot and first web space
-posterolateral thigh and calf pain
179
S1 nerve root involvement symptoms
-weakness in great toe flexor, gastrocsoleus with inability to sustain tiptoe walking
-numbness in lateral foot
-posterior calf pain
-asmmetrical ankle reflex
180
Red flags of low back pain trauma
-sports injury
-fall from height
-MVA ACCIDENT
-coughing
-sneezing
-heavy lifting
181
Red flags low back pain tumor
-advanced age (over 50)
-fevers
-night sweats (Severe)
-pain when lying flat
-severe pain at hs
-Unintended wt loss (greater than 10% in 6mo)
182
Red flags low back pain infection
-pain at hs
-hx of bacterial infection
-hx of spinal procedure
-IV substance abuse
-immunocompromised
-immigrant backgroung
-recent travel
-hx of malignant pathology
183
differentials for shoulder pain
younger: traumatic injuries or instablility such as glenohumeral dislocations and AC joint separations
middle aged: impingement and rotator cuff tears
-Old: rotator cuff tears or degenerative arthritis, fractures, dislocations
