8 - GI, Resp

Question 1

GERD

• what
• tx

Answer 1

Gastric juice from stomach -> esophagus

PPIs = Nexium, Prilosec
“no protons”

Question 2

Peptic ulcer dz (PUD)

• causes
• duodenal vs gastric ulcer
• tx

Answer 2

H pylori, NSAID use (destroy COX1)

D: pain worse with empty stomach, middle of night
G: pain soon after eating

PPIs = Nexium, Prilosec
(“no protons”)

Question 3

Barrett’s esophagus

Answer 3

Metaplasia: squamous -> columnar cells

Tx: PPIs = Nexium, Prilosec
“no protons”

Question 4

IBD: Crohn’s

• etiology
• location
• morphology
• complications
• ocular findings

Answer 4

Infectious
Any portion (SKIP lesions)
COBBLESTONE mucosa, CREEPING FAT, FISTULAS (punctures thru wall and connects to other organs)
Strictures, malabsorption
Uveitis, episcleritis

“Fat old crone skipping down a cobblestone road”

Question 5

IBD: Ulcerative colitis

• etiology
• location
• morphology
• complications
• ocular findings

Answer 5

Autoimmune
Colong/rectum
Mucosal inflamm, friable pseudopolyps, crypt abscesses, ulcers
CARCINOMA
Uveitis, episcleritis

Question 6

Wilson’s dz

Answer 6

aka hepatolenticular degeneration

Copper accumulation - esp liver, brain, cornea

• cirrhosis
• basal ganglia degen, dementia
• Kayser-Fleischer ring + sunflower cataract

Tx: cuprimine
-SE: ocular myasthenia, ocular pemphigoid, optic neuritis

Question 7

Hepatitis

• fecal-oral
• chronic
• vaccines
• superinfection

Answer 7

A + E

C

A + B

D (always with B)

Question 8

Hepatitis

• blood work
• tx for C

Answer 8

High ALT/AST (not dependent on etiology/strain)

Ribaviron + interferon

Question 9

Cirrhosis

Answer 9

Fibrosis
Due to alcohol, viral hepatitis

Enlarges -> firm nodules -> shrinks

Question 10

Cholecystitis

Answer 10

Gallbladder inflammation
-stones

Overweight females of child-bearing age

Pain URQ, esp after meals
(+) Murphy’s sign

Question 11

Acute pancreatitis

Answer 11

80% due to alcohol abuse or gallstones

Pain around umbilicus radiating to back
HIGH SERUM AMYLASE + LIPASE

Question 12

Hearing loss

-most common form

Answer 12

Loss of conduction

Question 13

Vertigo

• true vertigo
• assoc dz

Answer 13

True always assoc with nystagmus

Meniere’s dz: vertigo, hearing loss, tinnitus
-improvement when cut tobacco/salt, sometimes with antihistamine use

Question 14

Concern with salivary gland issues

Answer 14

Proximity to CN7

Question 15

Temporomandibular disorder (TMJ)

Answer 15

Jaw pain (pops when eating), HA

Question 16

Ocular assoc with sleep apnea

Answer 16

FES
NTG
NAION

Question 17

COPD

• problem
• emphysema vs chronic bronchitis

Answer 17

Air trapped in lungs/can’t get out
#1 cause smoking

E: pink puffers, barrel chest, enlarged air spaces
CB: blue bloaters, hypertrophy of mucus-secr glands in bronchioles

Question 18

Pneumoconiosis

Answer 18

Restrictive lung dz
-e.g. coal worker’s, asbestos

Decr lung volumes and compliance

Question 19

TB

• testing for active vs latent
• PPD results

Answer 19

Chest x-ray
(+) active, (-) latent

Healthy 15+mm
Healthcare 10+
Immunocomp 5+

Question 20

TB

-ocular

Answer 20

Conj granulomas
Phlyctenules (3rd world = TB, 1st = staph)
Epi/scleritis
Keratitis
Bilateral chronic granulomatous uveitis
CME - most visually significant
Disc edema or papilledema

Question 21

Bacterial pneumonia

-common cause

Answer 21

Strep pneumoniae (pneumococcus)

Less common: mycoplasma (“walking pneumonia”)