Amboss pearls Flashcards
most likely causal organism for: Reheated food/ Rice
Bacillus cereus
most likely causal organism for:
bloody diarrhea of 2 incubation days after eating contaminated food (raw poultry or unpasteurized milk or contact w infected animals lk dogs
Campylobacter jejuni
most likely causal organism for: inflammatory diarrhea +-bloody after contaminated milk or pork.
+- tenderness in the right lower quadrant “pseudo appendicitis”
Couple days of incubation .
Nausa vomit 2 hours after ingestion
Yersinia enterocolitica
most likely causal organism for: bloody diarrhea +-N/V
Raw beef, vegetables, milk
2-10d incubation period
Escherichia coli EHEC
most likely causal organism for:
1-3h after ingestion N/V
Mayonnaise, canned meats
Staphylococcus aureus
most likely causal organism for:
1-4 wk incub period. Loose stools +mucus+bright red blood. Painful defectation. Abdominal pain. cramps. anorecxia wl6 fever,
Entamoeba histolytica
most likely causal organism for:
high-grade fever, severe vomiting, and inflammatory (watery-bloody) diarrhea
(poultry, poorly pasteurized eggs, and milk
incubation period is 6–48 hours
Salmonella enteritidis
most likely causal organism for:
heat-labile Enterotoxins
watery diarrhea
abdominal cramping, nausea, and possibly vomiting
incubation period of 9 hours to 3 days
most common cause of traveler’s diarrhea.
Enterotoxigenic Escherichia coli
most likely causal organism for:
bloody diarrhea. It has an incubation period of 1–3 days
Shigella dysenteriae
most likely causal organism for:
16–72 hours after ingestion of undercooked seafood
most common cause of diarrhea in Japan
Vibrio parahaemolyticus
Vibrio parahaemolyticus Tx
usually supportive, but administering doxycycline or fluoroquinolones may be considered in severe cases
Kehr’s sign
pain to the left shoulder as a result of irritation of the left hemidiaphragm. Occurs because both left phrenic nerve, which innervates the left hemidiaphragm, and the left supraclavicular nerves, which innervate the skin over the shoulder, have common cranial nerve roots (C3 and C4). Most common cause is splenic injury.
Cystic fibrosis CxFx
(chronic sinopulmonary disease, exocrine pancreatic insufficiency
frequent infections +-respiratory
Cystic fibrosis Dx
. Sweat chloride test, or quantitative pilocarpine iontophoresis, is the gold standard
Defective chloride channels lead to elevated chloride in sweat gland secretions; levels > 60 mmol/L on two or more occasions are diagnostic for this condition
Cystic fibrosis Patho
CFTR (cystic fibrosis transmembrane conductance regulator) gene mutations (the most common mutation is DeltaF508). The mutated CFTR gene encodes defective chloride channels in the cell membrane of exocrine glands, leading to hyperviscosity of secretions, blockage of exocrine glands and, subsequently, chronic inflammation with permanent organ damage
more specific marker to detect alcohol use disorder.
and the most sensitive marker
, carbohydrate-deficient transferrin (CDT)
It is the optimal AUD marker because it can be detected even weeks after chronic alcohol use.
γ-GT the most sensitive marker for acute consumption
lead poisoning: Cx Fx
intestinal colic (cramping abdominal pain), anemia (fatigue, pale conjunctivae), and radial nerve palsy (weakened wrist extension)
is an occupational hazard for battery factory workers is
chronic lead poisoning
Chronic lead poisoning cx fx
peripheral neuropathy, abdominal colic, anemia, and Burton’s line
Dermatitis Herpetiformis Dx
microabscesses in the papillatu dermis are seen on light microscopy.
Inmmunofluorescense shows deposits of IgA at the tips of dermail papillae
most common parasite from this source: undercooked meat
Trichinella spiralis
most common parasite from this source: freshwater snails
Schistosoma mansoni
most common parasite from this source: undercooked fish
Clonorchis sinensis
most common parasite from this source: foxes, dogs, cats.
Echinococcus granulosus
Li-Fraumeni syndrome Patho
autosomal dominant condition caused by a mutation in the p53 tumor suppressor gene.
Li-Fraumeni syndrome Cx Fx
multiple malignancies (e.g., sarcomas, adrenal gland and breast cancer, leukemia)
Turcot syndrome =
FAP or Lynch Sx+CNS malignancy
Peutz-Jeghers syndrome patho
autosomal dominant condition associated with a mutation in the STK11 gene
Peutz-Jeghers syndrome
hamartomatous polyps throughout the gastrointestinal tract (predominantly in the jejunum) and mucocutaneous hyperpigmentation of the lips, buccal mucosas, palms, and soles.
increased risk of colorectal CA and extraintestinal too!
Toxic megacolon etiologies
Infectious colitis
Bacterial: C. difficile (pseudomembranous colitis), Salmonella, Shigella, Campylobacter infections
Parasitic: Trypanosoma cruzi (Chagas disease), E. histolytica (amebic dysentery) infections
Inflammatory colitis: Ulcerative colitis, Crohn disease
chest pain, tachycardia, tachypnea, and crepitus over the chest .
Is Cx Fx for?
Esophageal perforation.
Hx of very recent endoscopy is frequent too.
progressive hepatic dysfunction and cholestasis. + Hx of liver transplant =
CxFx of Chronic transplant rejection
Chronic>6m
acute <6
accelerated coronary artery disease. + Hx of heat transplantation=
Chronic transplant rejection
4-cm liver mass with a central hypoattenuated scar on a CT scan, which is diagnostic of
Focal nodular hyperplasia
refractory peptic ulcer disease with multiple ulcerations and steatorrhea (foul-smelling, lightly-colored stools). These features suggest:
Gastrinoma or
Zollinger-Ellison syndrome
gastrinoma should raise suspicion for
Multiple endocrine neoplasia
MEN 1
The acute-onset, severe flank pain, microhematuria on dipstick, and hyperechoic mass on ultrasonography further indicate a
kidney stone.
Symptoms of a kidney stone, intermittent arthralgias, abdominal pain, and fatigue further suggest:
primary hyperparathyroidism,
primary hyperparathyroidism, occurs in ∼ 90% of individuals with :
MEN 1.
Increased levels of PTH and hypercalcemia are the main diagnostic features of
pHPT
nonbilious emesis following food intake, early satiety, weight loss, epigastric tenderness, and a succussion splash, all of which indicate
gastric outlet obstruction (GOO).
In adults, GOO is caused by _______________________ in the majority of cases.
a malignant obstruction
gastric outlet obstruction (GOO). A good initial test and a Dx confirmation test
initial: US
Conf: upper endoscopy, especialy in Gastrix CA expected.
newborn presents with bilious vomiting, a distended abdomen, and sparse bowel sounds, all of which are consistent with bowel obstruction. The findings of dilated small bowel loops on abdominal x-ray and a microcolon indicate
Meconium ileus: failure to pass the first stool
and
Cystic fibrosis is its cause in > 90% of cases.
meconium ileus Dx
Gastrografin enema and it’s the treatment too.
Neuhauser sign
radiographic finding of a mottled (“soap bubble”) appearance in the distal ileum and/or caecum as a result of meconium mixing with swallowed air, often caused by meconium ileus.
Meconium Ileus Gastrofarin findings
Neuhauser sign, microcolon, or meconium pellets.
IgG antibodies against the hepatitis B core antigen indicate:
either active or inactive chronic infection (think Core for Chronic)
The envelope antigen is only present during :
phases of viremia, which occurs in acute or active chronic infections (think Envelope for ‘Ective’).
endoscopic findings of a displaced Z-line above the diaphragmatic hiatus with no evidence of paraesophageal herniation are consistent with
type I hiatal hernia.
A pupillary diameter of > 5 mm during eye examination with a light is
abnormally large
fever, myalgia, periorbital edema, splinter hemorrhages, eosinophilia, and an increased serum creatine kinase concentration, all of which suggest
an infection with Trichinella spiralis.
The consumption of pasteurized dairy products is important for preventing infection with, _________ or ______.
each can have this symptoms ______
______
Listeria monocytogenes
CxFx: Healthy adults: self-limiting gastroenteritis (watery diarrhea)
Immunocompromised and pregnant: +flue-like symptoms.
also Brucella spp. tho it’s not frequent in the USA
flue-like symptoms.
Roundworms (like Trichenella) can be treated with anthelmintic agents such as
albendazole and mebendazole.
sclerodactyly, telangiectasias, and the Raynaud phenomenon, the combination of which suggests a diagnosis of
features of CREST syndrome, , part of the systemic sclerosis.
systemic sclerosis. what does the C of CREST stand for?
calcinosis cutis (the “C”-feature in CREST), i.e small white calcium deposits on the pressure points of the extremities
Achalasia patho
caused by progressive degeneration of the esophageal myenteric plexus, resulting in dysfunctional peristalsis,
failure to thrive, lethargy, hepatomegaly, severe fasting hypoglycemia (causing hypoglycemic seizures), hyperlipidemia, and lactic acidosis.
are seen in
von Gierke’s disease (type a). A result of Glucose 6-phosphatase deficiency
This young white man has fatigue, chronic diarrhea, abdominal pain, and thrombocytosis, which suggests
and if bloody
inflammatory bowel disease (IBD).
UC
congenital ventral wall defect that leads to intestinal herniation through the involuted right umbilical vein
Gastroschisis
Gastroschisis one good initial test (prenatal)
Alpha-fetoprotein
Gastroschisis prenatal confirmatory test
fetal ultrasound will show free-floating bowel without a membranous sac.
The most common long-term complication of caustic liquid ingestion is the development of
f esophageal strictures.
A tumor in the descending colon with hepatic metastasis would most likely be
an adenocarcinoma, the most common type of colorectal cancer.
can cause traveler’s diarrhea and typically presents with watery to bloody stools.
Enterotoxigenic Escherichia coli (ETEC)
gram-negative rod that causes infection with diarrhea in newborns
Enteropathogenic Escherichia coli
causes watery diarrhea, especially in AIDS patients.
, high-volume, watery diarrhea that has persisted for more than two weeks.
Cryptosporidium parvum
most common protozoal cause of traveler’s diarrhea, THO it is not the most common cause of diarrheal illness among travelers.
Giardia intestinalis
may be administered to treat patients with chronic hepatitis C infection (especially genotypes 2 and 3), nowadays typically as an alternative to direct-acting antivirals.
Interferon and ribavirin therapy
also can use
peginterferon alpha with ribavirin
Abdominal pain at night, especially in the epigastric region, can be a symptom of
duodenal peptic ulcer disease (PUD)
treatment In patients with uncomplicated symptomatic cholelithiasis who are poor surgical candidates long-term (6–24 months)
oral bile acid dissolution therapy with ursodeoxycholic acid (UDCA) is indicated. In addition to a low-fat diet and UDCA therapy, patients should exercise regularly and avoid lithogenic drugs (e.g., estrogen, fibrates)
poorly controlled diabetes presents with subacute flank pain (left or right), fever, and pain with extension of the hip, all of which suggest a
Psoas muscle abscess
