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Step 2 DIT > Associations 4 > Flashcards

Associations 4 Flashcards

1
Q

Malabsorption presentation

A

Weight loss, bloating, diarrhea

Possible steatorrhea, glossitis (B12), dermatitis (zinc), edema

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2
Q

Diarrhea w/ Down Syndrome and dermatitis herpetiformis (very itchy bumps and blisters on knees, elbows, back, butt)

A

Celiac disease

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3
Q

Where is ethanol absorbed

A

Stomach

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4
Q

Where is B12 absorbed

A

Terminal ileum (needs intrinsic factor, made by parietal cells in stomach)

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5
Q

Diarrhea w/ megaloblastic anemia

A

Tropical sprue (folic acid replacement)

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6
Q

Weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathy, new heart murmur

A

Whipple disease (Tropheryma whippelii)

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7
Q

Whipple disease dx

A

Jejunal biopsy shows foamy macrophages on PAS stain and villous atrophy (also PCR)

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8
Q

MC adult chronic diarrhea

A

Lactose deficiency

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9
Q

MC childhood acute diarrhea

A

Rotavirus

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10
Q

Secretory diarrhea causes

A 
Normal stool osmotic gap (<50)
IBS
Laxative abuse
VIPomas, gastrinomas, medullary thyroid cancer
Carcinoid tumors
Ileum resection
Enterotoxic bacteria
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11
Q

Osmotic diarrhea causes

A 
Solute collecting in bowel lumen (increased stool osmotic gap, >50 or >125)
Malabsorption syndrome
Pancreatic insufficiency
Lactose intolerance
Excess sorbitol, lactulose, milk of Mg
Laxative abuse
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12
Q

Inflammatory diarrhea causes

A

AI inflammatory process or chronic infection

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13
Q

Pediatric diarrhea causes

A

Infection (rotavirus, adenovirus)
Antibiotics (macrolides)
Immunosuppression

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14
Q

Stool osmotic gap calculation

A

290 - 2(Na + K)

125 is probably osmotic diarrhea

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15
Q

IBS symptoms

A

At least 12 wks of symptoms in previous year
Pain relieved w/ defecation
Change in frequency/form of stool
Diarrhea/constipation
Straining, mucus, incomplete feeling, bloating, urgency

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16
Q

Not characteristic of IBS

A 
Anorexia
Weight loss
Malnutrition
Progressively worsening pain
Pain that prevents sleep
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17
Q

MCC SBO

A

Adhesions
Bulges (hernias)
Cancer (neoplasms)
Volvulus, intussusception, Crohn’s, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis

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18
Q

MCC large bowel obstruction

A

Neoplasm

Diverticulitis, volvulus, congenital stricture

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19
Q

MC benign small bowel tumor

A

Leiomyoma

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20
Q

MC malignant small bowel tumor

A

Adenocarcinoma

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21
Q

CT w/ pneumatosis coli (air in bowel wall) and bowel wall thickening

A

Ischemic colitis

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22
Q

Abdominal pain out of proportion to exam

A

Acute mesenteric ischemia

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23
Q

Signs of appendicitis

A 
McBurney's point tenderness
Psoas sign (pain on hip extension)
Rovsing sign (pain w/ RLQ palpation)
Obturator sign (pain w/ hip IR)
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24
Q

Causes of ileus

A 
Recent surgery (MC by far)
Infection, ischemia, DM, opioid use
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25
Q

Timeline for postop ileus

A

Small intestine: <24 hrs
Stomach: 2-3 days
Large intestine: 3-5 days

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26
Q

“Double bubble” sign + bird’s beak sign

A

Volvulus

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27
Q

Carcinoid tumor symptoms

A

Only if outside GI tract
Be FDR
Bronchospasm
Flushing
Diarrhea
Right-sided valvular heart disease (TC/Pulm)
Increased 5-HIAA in urine, serum serotonin

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28
Q

MC locations carcinoid tumor

A

Bronchopulmonary tree
Ileum
Rectum
Appendex (MC tumor of appendix)

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29
Q

Bright red painless bleeding from anus

A

Internal hemorrhoids (above pectinate line)

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30
Q

Bright red painful bleeding from anus

A 
External hemorrhoids (below pectinate line)
Anal fissure
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31
Q

Older person + LLQ pain + fever

A

Diverticulitis until proven otherwise

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32
Q

CT shows increased soft tissue density, colonic diverticula, bowel wall thickening, possible abscess

A

Diverticulitis

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33
Q

Mild LLQ pain relieved w/ defecation

A

Diverticulosis

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34
Q

MCC acute lower GI bleeding >40 yo

A

Diverticular disease (often in sigmoid colon)

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35
Q

APC gene mutation

A

FAP
Gardner syndrome
Turcot syndrome

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36
Q

Hundreds of polyps in colon, APC mutation

A

FAP (almost definite malignancy)

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37
Q

Cancer arises from normal-appearing mucosa, neoplasms tend to form in proximal colon

A

Hereditary nonpolyposis CRC (HNPCC)

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38
Q

Many colonic adenomas + bone and soft tissue tumors; APC mutation

A

Gardner syndrome (high risk of malignancy?)

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39
Q

Hamartomas + mucocutaneous pigmentation of mouth, hands, genitals

A

Peutz-Jeghers syndrome (low risk of malignancy)

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40
Q

Many colonic adenomas + malignant CNS tumors

A

Turcot syndrome (high risk of malignancy)

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41
Q

Polyps (usu hamartomas) of colon, small bowel, stomach that are frequent source of GI bleed

A

Juvenile polyposis (slightly increased risk of malignancy later in life)

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42
Q

Iron-deficiency anemia in older men or postmenopausal women

A

CRC until proven otherwise

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43
Q

Ranson criteria on admission

A 
Acute pancreatitis, increased mortality with 3+ 
(GA Law)
Glucose >200
AST >250
LDH >350
Age >55
WBC >16,000
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44
Q

Ranson criteria during initial 48 hrs

A 
Acute pancreatitis, increased mortality with 3+ 
(CAlvin & HOBBS)
Calcium 10%
O2 5
Base deficit >4
Sequestration of fluid >6 L
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45
Q

Exocrine pancreatic cancer labs

A

CEA, CA 19-9
Possible hyperglcemia
+bilirubin (direct), alk phos

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46
Q

Trousseau syndrome

A

Migratory thrombophlebitis

Assoc w/ several cancers esp exocrine pancreactic ca

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47
Q

Gastrin-secreting tumor

A

Zollinger-Ellison syndrome

Refractory PUD

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48
Q

Insulin-secreting tumor

A

Insulinoma

Refractory hypoglycemia

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49
Q

Glucagon-secreting tumor

A

Glucagonoma

Refractory DM

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50
Q

VIP-secreting tumor

A

VIPoma

Watery diarrhea

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51
Q

TPN complications

A

Bile stasis - gallstones and acalculous cholestasis

Site for infx and sepsis

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52
Q

Female, fertile, forty, fat

A

Gallstones

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53
Q

Palpation of RUQ during inspiration stops inspiration secondary to pain

A

Murphy’s sign - cholelithiasis

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54
Q

Charcot’s triad

A

Fever, RUQ pain, jaundice

Acute cholangitis

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55
Q

Reynold’s pentad

A

Fever, RUQ pain, jaundice (Charcot’s triad)
AMS, Shock or HoTN
Acute cholangitis

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56
Q

Dx cholelithiasis vs cholecystitis vs cholangitis

A

US vs US/HIDA vs HIDA

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57
Q

Porcelain gallbladder on x-ray

A

Calcified GB - 10-30% cancer
Usu represents chronic cholecystitis
Prompt cholecystectomy

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58
Q

LUQ pain referred to L shoulder

A

Kehr’s sign

Splenic rupture

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59
Q

PBC

A

Intrahepatic bile duct destruction
AI
Females
+AMA (95%), +ANA (70%)

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60
Q

PSC

A

Intra and extrahepatic bile duct destruction
Assoc w/ UC
Males
+pANCA (maybe), negative AMA, ANA

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61
Q

Beads/Pearls on a string on ERCP

A

PSC

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62
Q

Indirect bilirubin elevation causes

A 
Unconjugated
Excess bilirubin production (hemolytic anemia, erythropoeisis disorders, internal hemorrhage resorption)
Impaired conjugation (physiologic disease of the newborn, Gilbert, Crigler-Najjar, hepatocellular disease)
63
Q

Direct bilirubin elevation causes

A

Conjugated
Decreased hepatic bilirubin excretion (impaired transport - Dubin-Johnson, Rotor, hepatocellular disease, drug impairment)
Extrahepatic biliary obstruction (PBC, PSC, gallstone in bile ducts, pancreatic or biliary cancer, biliary atresia)

64
Q

MCC cirrhosis in US

A

Alcohol

Hep C

65
Q

Portal HTN symptoms

A

Varices (esophageal, abdominal, etc)
Ascites
Hepatomegaly
Splenomegaly

66
Q

Cirrhosis symptoms (sorted by liver fxn)

A

Clears bili - Jaundice
Makes proteins (clotting factors, albumin) - coagulopathy, decreased protein carrying ability, peripheral edema
Clears toxins (ammonia) - encephalopathy, asterixis
Sex hormone conversion (increased estrogen w/ failure) - spider telangectasias, palmar erythema; gynecomastia, testicular atrophy in men
Misc - weakness, weight loss, digital clubbing, Dupuytren contractures in hands

67
Q

Ascites + jaundice + hepatomegaly + RUQ pain

A

R/O Budd-Chiari syndrome (thrombosis and occlusion of hepatic vein or hepatic portion of IVC secondary to hypercoagulability)
Can look like R CHF except no JVD

68
Q

Portal HTN - prehepatic causes

A

Portal vein thrombosis

69
Q

Portal HTN - hepatic causes

A

Cirrhosis, schistosomiasis, parenchymal disease, granulomatous disease

70
Q

Portal HTN - posthepatic causes

A

R CHF, hepatic vein thrombosis, Budd-Chiari

71
Q

Paracentesis, SAAG > 1.1

A

Portal HTN (cirrhosis, alcoholic hepatitis, heart failure, constrictive pericarditis, massive hepatic metastases, Budd-Chiari)

72
Q

Paracentesis, SAAG <1.1

A

High albumin in ascites (peritoneal carcinomatosis eg ovarian Ca, peritoneal TB, pancreatitis, serositis)
Low serum albumin (nephrotic syndrome)

73
Q

Paracentesis: high albumin, LDH = 60% serum LDH

A

R/O neoplastic etiology

74
Q

Paracentesis: +WBC (neutrophils), +protein, -glucose, LDH > serum LDH

A

R/O spontaneous bacterial peritonitis, esp if fever

75
Q

Wilson disease cause

A

Impaired copper secretion in young adults (<40)
Deposits in brain (personality changes, loss of coordination, psych sx, dysphagia, tremor), liver (hepatomegaly, jaundice), cornea (Kayser-Fleischer rings)

76
Q

Wilson disease screening

A

Decreased serum ceruloplasmin

77
Q

Risk factors HCC

A 
HBV or HCV
Cirrhosis
Hemachromatosis
Schistosomiasis
Excessive consumption of aflatoxin from Aspergillus-infected food
78
Q

MCC liver malignancy

A

Mets from breast, lung, colon

79
Q

Paraneoplastic syndromes from HCC

A 
Hypoglycemia
Polycythemia (+EPO)
Refractory watery diarrhea
Hypercalcemia
Skin lesions
80
Q

Cancers that cause paraneoplastic polycythemia (+EPO)

A 
Potentially really high HCT
Pheochromocytoma
RCC
HCC
Hemangioblastoma
81
Q

MC TEF

A

Esophageal atresia (blind pouch) + distal TEF

82
Q

Projectile nonbilious emesis + olive-sized epigastric mass

A

Pyloric stenosis

83
Q

MC surgery in 1st 2 months

A

Pyloromyotomy

84
Q

Preterm/low birth weight w/ abdominal distention, bilious vomiting, hematochezia after starting tube feeds

A

Necrotizing enterocolitis

85
Q

Bad radiological signs in necrotizing enterocolitis

A

Air in bowel wall (necrosis, gangrene)

Portal vein gas, free air under diaphragm (perforation)

86
Q

Meconium ileus + obstipation + blast sign

A

Hirschprung disease

87
Q

Currnt jelly stool + palpable, sausage-like abdominal mass

A

Intussusception

88
Q

MCC/risk factors of intussusception

A

Children - Meckel’s diverticulum, Henoch-Schonlein purpura, adenovirus, CF
Adults - cancer until proven otherwise

89
Q

MCC bowel obstruction in 1st 2 years

A

Intussusception

90
Q

Meckel diverticulum rule of 2s

A

Males 2x more than females
Within 2 feet of ileocecal valve (Meckel pet scan)
2 types ectopic tissue (gastric, pancreatic)
2% of population
Before 2 years of age

91
Q

Criteria for failure to thrive <2 yo

A

Weight <10%

Rate of daily weight gain less than expected for age

92
Q

Study to identify relative risk, examine rare exposures, confirm risk factors

A

Cohort (can be prospective or retrospective, takes a group with the same exposure and follows)

93
Q

Study to identify odds ratio, identify possible risk factors, examine rare diseases

A

Case-control (retrospective comparison of group of patients with disease with group of healthy controls; subject to recall and selection bias)

94
Q

Study to create hypothesis for risk factors, ID prevalence

A

Cross-sectional survey

95
Q

MCC UTI/pyelonephritis

A 
E. coli = MCC
Staph saprophyticus
Klebsiella
Proteus
(Enterbacter)
96
Q

MCC nephrolithiasis

A

Calcium oxalate stones (idiopathic hypercalciuria)

97
Q

Cause of struvite stones

A

UTI w/ urease+ bacteria (Proteus, Klebsiella)

98
Q

Cause of calcium phosphate stones

A

Hyperparathyroidism, RTA

99
Q

Cause of uric acid stones

A

Chemo drugs

Gout

100
Q

Cause of cystine stones

A

Cystinuria (genetic disease)

101
Q

Staghorn calculi

A

Struvite kidney stones

Cystine kidney stones

102
Q

Radiolucent kidney stones

A

Uric acid stones

103
Q

Causes of temporary hematuria

A 
Idiopathic
UTI
Exercise
Trauma
Nephrolithiasis
Endometriosis (bladder)
104
Q

Causes of persistent hematuria

A

Glomerular disease (50 yo)

105
Q

Causes of hydronephrosis

A 
Nephrolithiasis
BPH
Neoplasm
Posterior urethral valves
Other obstructions, anatomic defects
106
Q

Associated w/ ADPKD

A

Berry aneurysms (SAH)
MVP
Mild AR
Hepatic cysts

107
Q

MCC interstitial nephropathy

A

Drugs (NSAIDs, abx; allopurinol, PPIs, diuretics, etc)
Toxins (cadmium, lead, copper, mercury, mushrooms)
Infections, AI, myogobinuria, rhabdo

108
Q

Presentation of interstitial nephropathy

A

Rash + fever

Increased creatinine + eosinophilia

109
Q

MCC ARF

A

Drugs (ATN)

110
Q

Prerenal causes ARF

A

Hypovolemia (real or sensed by kidneys)
Sepsis
Renal artery stenosis
Drug toxicity

111
Q

Intrarenal causes ARF

A

ATN (drugs, toxins)
Glomerular disease
Renal vascular disease

112
Q

Postrenal causes ARF

A

Obstruction (stones, tumor, adhesions, BPH)

113
Q

FENa

A

(Urine Na / Serum Na) / (Urine Cr / Serum Cr)

2% = ATN/intrarenal/postrenal cause

114
Q

BUN:Cr ratio

A

> 20 suggests prerenal cause

115
Q

MCC CKD

A

HTN or diabetes (75%)

116
Q

MCC death in dialysis patients

A

CVD

117
Q

Rash + fever + increased Cr + eosinophilia

A

AIN

118
Q

RNA Type I

A

Distal, impaired H secretion
High urine pH (>5.3)
Low K
Possible kidney stones

119
Q

RNA Type II

A

Proximal, impaired HCO3 absorption
NL urine pH (<5.3)
Low K, Low HCO3
Bone lesions (rare)

120
Q

RTA Type IV

A

Hypoaldosteronism (could be caused by DM)
NL urine pH (<5.3)
High K

121
Q

Causes of metabolic alkalosis

A

Vomiting
Diuretics (contraction alkalosis)
Cushing syndrome, hyperaldosteronism, adrenal hyperplasia

122
Q

Causes of respiratory alkalosis

A

Hyperventilation

  • High altitude
  • Asthma
  • ASA toxicity
  • Pulmonary embolism
123
Q

Causes of respiratory acidosis

A

COPD
Respiratory depression
- Narcotic OD
- NM weakness

124
Q

Causes of +anion gap metabolic acidosis

A 
MUDPILES
Methanol
Uremia (kidney failure)
DKA
Polyethylene glycol
Isoniazid/Iron
Lactic acidosis
Ethylene glycol/ethanol
Salicylate toxicity
125
Q

Causes of normal anion gap metabolic acidosis

A

Diarrhea (MCC)
RTA
Addison’s/Hypoaldosteronism
TPN

126
Q

CT chest w/ honeycomb pattern

A

Diffuse interstitial pulmonary fibrosis

127
Q

Causes of SIADH

A 
Any CNS
Pulmonary (esp PNA, SCLC)
Drugs (NSAIDs, antidepressants, antipsychotics, antineoplastic agents, carbamamzepine, ecstasy, vasopressin, DDAVP)
HIV/AIDS
Major surgery
128
Q

Causes of hypernatremia

A 
Dehydration
Fluid loss, skin (burns, sweating)
Fluid loss, GI (diarrhea, vomiting)
DI
Iatrogenic
129
Q

Too rapid hydration w/ hypernatremia

A

Cerebral edema (correct <12 meq/24 hrs)

130
Q

Tall peaked T waves on EKG

A

Hyperkalemia

131
Q

Flat T waves/U waves on EKG

A

Hypokalemia

132
Q

Overly rapid replacement of K in hypokalemia

A

Arrhythmias

133
Q

Causes of hyperkalemia

A 
Metabolic acidosis
Aldosterone deficiency
Adrenal deficiency
Tissue breakdown
Insulin deficiency
K-sparing diuretics, BB, ACE/ARB, digoxin
RTA Type IV
134
Q

Causes of hypokalemia

A 
Poor dietary intake
Alkalosis
Hypothermia
Vomiting, diarrhea
Hyperaldosteronism
RTA Types I and II
Insulin, diuretics (loop/TZD), albuterol, acetazolamide
135
Q

Causes of hypercalcemia

A 
Hyperparathyroidism
Neoplasm (PTHrP or bony destruction)
Immobilization
Thiazide diuretics
High ingestion Ca carbonate and milk (milk-alkali syndrome)
Sarcoidosis
\+Vitamin A or D
136
Q

Causes of hypocalcemia

A 
Hypoparathyroidism
Hyperphosphatemia
Chronic renal failure
Vitamin D deficiency
Loop diuretics
Pancreatitis
Alcoholism
137
Q

Shortened QT interval, electrolyte cause

A

Hypercalcemia

138
Q

Long QT interval, electrolyte cause

A

Hypocalcemia

139
Q

Chvostek / Trousseau sign

A

Hypocalcemia

140
Q

Shifts K out of cells (hyperkalemia)

A 
Low insulin
BB
Acidosis
Digoxin
Cell lysis (leukemia)
141
Q

Shifts K into cells (hypokalemia)

A

Insulin
B-agonists
Alkalosis
Cell creation/proliferation

142
Q

Risk factors bladder cancer

A 
Smoking
Schistosomiasis (SCC, developing countries)
Cyclophosphamide
Aniline dyes, petroleum byproducts
Recurrent UTI
Male 3x > Female
143
Q

MC cancers in males (occurrence)

Highest mortality cancers in males

A

Prostate, lung, colon

Lung, prostate colon

144
Q

Urethritis + gram negative diplococci

A

N. gonorrhea (also seen on Thayer-Martin culture)

145
Q

Urethritis + negative gram stain

A

Chlamydia (confirm w/ NAAT)

146
Q

MC germ cell tumor of testis

A

Seminoma

147
Q

Scrotal pain differential

A 
Epididymitis (infection signs, pain decreases w/ support)
Testicular torsion (++pain, testicle elevated, pain does not change w/ support)
148
Q

MC renal tumor in kids

A

Wilm’s tumor

149
Q

MC s/sx of Wilm’s tumor

A

Palpable flank mass (MC)
Abdominal pain (30%)
HTN (25%)
Hematuria (12-25%)

150
Q

WAGR syndrome

A

Wilms tumor
Aniridia
GU abnormalities
mental Retardation

151
Q

Age for diagnosis/treatment of enuresis

A

Cannot be diagnosed before physical and developmental age 5

Usu don’t start treatment until age 7

152
Q

Risk of undescended testes

A 
Testicular cancer (risk reduced but not eliminated by surgical correction)
Infertility
Bring testes into scrotum by 6-12 months for improved function (spontaneous descent usu by 6 months)
153
Q

MC obstructive urethral lesion in newborns/infants and how to dx

A

Posterior urethral valves
Voiding cystourethrogram (VCUG)
Suspect in male w/ daytime incontinence at inappropriate age or male w/ UTI

Step 2 DIT (23 decks)

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