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Biomedicine > Bio Med TCM Gastrointestinal > Flashcards

Bio Med TCM Gastrointestinal Flashcards

1
Q

diffused abdominal pain

A

acute pancreatitis, diabetic ketoacidosis, gastroenteritis, peritonitis (any cause melon sound on abdomen), sickle cell crisis, typhoid fever

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2
Q

Right or Left UQ pain

A

acute pancreatitis - esp. after consume alcohol

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3
Q

RUQ pain (hand below rib cage)

A 
*cholecystitis and *biliary colic (after eating a fatty meal start getting pain in this region), hepatitis, perforated duodenal ulcer, active pancreatitis
retrocecal appendicitis (rare) LRQ referring up to RUQ, retro = behind, cecal = colon)
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4
Q

RLQ pain

A

appendicitis, cecal diverticulitis, Meckel’s diverticulitis, Crohn’s

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5
Q

LLQ pain

A

sigmoid diverticulitis, ulcerative colitis

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6
Q

Right or Left LQ pain

A

abdominal or psoas abscess, cystitis, endometriosis, IBD, pelvic inflammatory disease (PID), renal calculi, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy,

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7
Q

Body Mass Index

Underweight

A

Below 18%

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8
Q

Body Mass Index

Healthy

A

18.5 - 24%

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9
Q

Body Mass Index

Overweight

A

25 - 30%

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10
Q

Body Mass Index

Obese

A

31 %- up

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11
Q

Antacids

A

Meds: Calcium carbonate (Tums), esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole sodium (Protonix)

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12
Q

Antihelmintic

A

for parasitic worms,

Meds: Mebendazole (vermox)

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13
Q

Antibiotic

A

Meds: amoxicillin (amoxil), ciprofloxacin (cipro), levofloxacin (levaquin)

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14
Q

Antidiabetic

A

Meds: Metformin (glucaphage), glipizide (glucotrol),

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15
Q

Antidiarrheal

A

Bismuth subsalicylate (pepto-bismol) black tongue coat

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16
Q

Primary organ nutrient absorption

A

ST - alcohol, water, some fat soluble drugs
SI - nutrients primarily
LI -reabsorption of water, electrolytes

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17
Q

Nutrient absorption accessory organs

A

Liv - Vit A&D, B12, iron

Pancreas - no real absorption but produces Alpha cells respond to low blood sugar by stimulating the Liv to release glucose

Mouth - some trace minerals and electrolytes

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18
Q

Type 1 Diabetes

A

S/s - ketoacidosis, polydipsia (poly = many, dipsia = thirst), polyuria, polyphagia (clear urine, urinating out vitamins / minerals so your body make you hungry), fatigue, parasthesia (B vitamins cause numbness/tingling distal body)
prob - hypertension, neuropathy, ulcerations, frozen shoulder, foot, mouth vagina infections from bacteria

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19
Q

Type 2 Diabetes

A

S/s - dry flushed skin, ketonic breath, nausea/vomit, cramping, polyuria (clear urine loosing potassium), blurred vision, confusion
prob - retinopathy, loss of vision, nephropathy, neuropathy, ulceration of the feet, infections
meds - metformin

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20
Q

Hypoglycemia

A

sweating, nausea, warmth, anxiety, constant hunger, *H/A, decreased body temperature (warm/cold back and forth)
meds - glucagon

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21
Q

GERD

A

lower esophageal sphincter reflux

usually high alkaline in the persons body

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22
Q

Gastritis

A

Pain, nausea, fullness, bleeding, due to NSAIDs or ethanol, smoking, proton pump inhibitor can be a cause as well as a temporary cure

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23
Q

Peptic ulcer

A

common Hispanic / African A, due to H. Pylori weaken stomach lining

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24
Q

Gastric ulcer

A

stomach bleeding ulcer - *REFER to physician ASAP w/in 72 hours

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25
Q

*Duodenal ulcer

A

H. Pylori or NSAIDs, - *consistent pain which usually awakens patient at night

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26
Q

Thrush

A 
Candida albicans (fungus) 
causes - immune compro, antibiotic or steroid, autoimmune, AIDS
meds: anti-fungals
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27
Q

Gastric Cancer

A

indigestion, anorexia, abdominal pain often metastasizes to lymph, liver, peritoneum, chest, brain **refer to physician STAT - that DAY

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28
Q

Melena

A

Black tarry stool due to long term stomach or duodenum bleeding

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29
Q

Rotavirus

A

*Virus: Young children, severely dehydrating, contagious via fecal oral rout *Bacteria virus
most common cause of diarrhea in children and day care workers
transmission: toys, bathroom fixtures, changing tables, diaper pails, public swimming pools
prevention: 14days

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30
Q

Adenovirus

A

4th most common childhood gastroenteritis disease *DNA virus

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31
Q

Salmonella

A

*Bacterial diarrhea due to undercooked poultry, milk, eggs or reptiles contact

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32
Q

Shigella

A

3rd most common *bacterial diarrhea in U.S. transmitted person to person

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33
Q

Escherichia coli

A

*blood in diarrhea from undercooked beef, unpasteurized milk, etc *watery diarrhea found commonly in nurseries: bacteria - so treated with antibiotic

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34
Q

Vibrio

A

diarrhea caused by undercooked seafood: bacteria

Poke bowls

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35
Q

Listeria

A

food born and usually found in cheese: bacteria

soft cheeses

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36
Q

Constipation

A

*Red flag if patient is taking opioids

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37
Q

Diarrhea (all)

A

**Red flag: long term diarrhea can lead to dehydration - decreased potassium

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38
Q

Dyspepsia

A

upper abdominal distention with postprandial fullness that is gnawing or burning, epigastric pain with nausea and vomiting
H2 blockers, proton pump inhibitors
alcohol can do this

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39
Q 
***CNT Incubation 
Hep A
Hep B
Hep C 
Hep D
Hep E
A 
Hep A = 15-50 AVG: 28
Hep B = 45-160 AVG: UNK
Hep C = 14-180 AVG: 5-10 wks
Hep D = UNK
Hep E = 15-160 AVG: 40
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40
Q

Liver Pathology

Hepatitis Transmission in A,B,C,D,E,

A 
Hep A = Fecal/oral
Hep B = Blood
Hep C = Blood
Hep D = Needle
Hep E = Water
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41
Q

Most common Hepatitis in medical field

A

Hep B

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42
Q

Most common Hepatitis in the world

A

Hep A

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43
Q

Deadliest Hepatitis

A

Hep C

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44
Q

S/S of Hep A, B, C

A

S/s = fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, dark urine, clay colored bowel movement, joint pain, jaundice

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45
Q

Hep A post exposure

A

HAV vaccine preferred over immune globulin
Note: has a vaccine but usually people end up getting better before the vaccine takes i.e. eat out and feel like you got stomach flue for about 7 days - you probably had Hep A

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46
Q

Hep B post exposure

A

**HBIG vaccine
Note: its the law to have the employee get a series of vaccines if they get stuck with a needle you can get stuck with fines and penalties, if the employee declines to get vaccine it needs to be documented. Lab test for HBV titer can be done to see if a booster is required.

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47
Q

Crohn’s Disease

A

SI is involved in 80% of cases (esophagus to anus can also be affected)
Location - right side
s/s - 75-85% have rectal bleeding, 25-35% perianal lesions
imaging - asymmetrical and segmental (skip areas) on x-ray, barium swallow
*Asymmetrical - Ulcerative colitis symmetrical

48
Q

Ulcerative Colitis

A

inflammation and ulceration of the LI bloody diarrhea, cramping pain, weight loss, electrolyte imbalance
LI primarily in the descending section
Location - left side
S/s - *rectal bleeding is alway present
*symmetrical and uninterrupted bowel wall (crohn’s asymmetrical

49
Q

Meckel’s Diverticulum

A

intestinal obstruction manifesting by cramping, abdominal pain, nausea and vomiting. abdominal pain either below or to the left of the umbilicus

  • *Adults may bleed with more of a melena result
  • Children may have bright red rectal bleeding with painless symptoms
50
Q

Appendicitis

A

*McBurney’s point - LRQ with rebound tenderness

Rovsing’s Sign - press on LLQ causing more pain on LRQ

51
Q

Diverticulosis

A

small pouch bulging outward LI - usually has low fiber diet, caused by heavy pressing due to constipation

52
Q

Diverticulitis

A

inflamed diverticuli due to low fiber diet

Treatment liquid diet, oral antibiotics sometime surgery

53
Q

Irritable bowel Syndrome (IBS)

A

usually due to stress however etiology unknown, *gas, *bloating, *cramping, bowel changes, *constipation or diarrhea, *relief of pain post BM
Treatment; diarrhea producing foods, increase fiber, for constipation
tricyclic antidepressants

54
Q

Cholecysitis

A

complication to Cholelithiasis - localized pain RUQ with rebound and guarding tenderness, positive Murphy sign, diaphoresis, fever, hypo activity bowel (constipation)
Note: often misdiagnosed as pancreatitis (after alcohol) i.e. ask patient if they feel worse after a fatty meal!

55
Q

cholelithiasis

A

lith = stone (gallstone)
sporadic (comes and goes) pain epigastrium or RUQ, **sometimes radiating to the right scapular tip.
Pain post Prandial (after eating) intense or dull pain lasting 1-5 hours. pain constant not relieved emesis (vomiting) defecation, flatus, belching (lack of bile as we get old)

56
Q

Acute Pancreatitis

A 
Ingested medicines (ACE, Diuretic, Opioids, high triglyceride (fatty diet) high blood calcium, alcoholism 
typically after having sweets or alcohol
57
Q

Chronic Pancreatitis

A

Fat soluble vit deficiency A,D,E,K
steatorrhea, pancreatic adenocarcinoma
Note: stool can be unusually foul, greasy or light color, with oil droplets
imaging: *****CT Scan - MRI would be a followup to see if adenocarcinoma

58
Q

Pancreatic Adenocarcinoma

A

Jewish, African heritage
Cancer *Whipple procedure - treats tumors and disorders of the pancreas (operation to remove the head of the pancreas, pancreaticoduodenectomy) first part of the SI (duodenum)

59
Q

Abdominal Aortic Aneurysm

A

long term smoker (men 65-75), atheroscerosis, HBP
s/s - abdominal or back pain that feels like a ***tearing sensation, radiates to the back or legs, calmness, low blood pressure, fast pulse RED FLAG (HBP now LBP esp. pulse is fast)

60
Q

Anorexia Nervosa

A

Blotchy yellow skin, fine hair, poor memory or judgement (lack of B vit) depression (B vit and copper)
Tests: Albumin (protein), Dexa (osteoporosis), EKG(Ht), TSH (thyroid), Kid, Urine, Electrolytes, LFT (liver function)

61
Q

Bulemia

A

vomit after binge eating - falls under bulemia may not vomit up food but over exercise, may have ridges in teeth.
S/s - ridged exercise behavior, calluses on back of hands, discoloration or staining of teeth,
Flag: electrolyte imbalances (heart), rupture of esophagus, tooth decay, irregular BM
Red flag - immediate referral to GB - 72 hours if not been diagnosed yet

62
Q

Thrush causes

A

antibiotic treatment, babies, autoimmune, immune compromised, AIDS

63
Q

Irritable Bowel Disease

A

*extreme fatigue, joint pain, rectal bleeding, mostly in females. IBS little less extreme

64
Q

Giardia

A

*Parasite: day care centers, international travelers, hikers (person coming back from hiking in a foreign country with diarrhea think Giardia parasite), unfiltered or untreated water.
Transmission: uncooked food that has been contaminated, swallowing water from pools, water exposed to wildlife
Prevention: 14days

65
Q

Cyptosporidium

A

Parasite: water borne and resistant to chlorine
transmission: pool water, day care settings
Prevention: 14 days swimming in pools where children hav had diarrhea with in 14 days

66
Q

Roundworm

A

S/s: intestinal blockage, bloating, large round worms in bowel movement, vomiting or crawling from nose
Location: SI
TX: antihelminics

67
Q

Hookworm (common in U.S)

A

*loss of appetite, *weight loss, *abdominal distention, anemia, intestinal bleeding
Location: *infests billiard tract, *pancreas
TX: antihelminics

68
Q

Pinworm

A

very common in schools and daycare centers
**itchy perineum
TX: antihelminics

69
Q

Tapeworm

A

*abdominal distention, pain, diarrhea, malnutrition, *weight loss
TX: antihelminics

70
Q

Trichinosis

A

*Stomach pain, *extreme fatigue, *nausea and vomiting, *diarrhea, *fever, *H/A, *chills, *muscle aches, *may have constipation, heart palms, dyspnea, mimics syphillis
TX: antihelminics

71
Q

B1

A

Thiamin

deficiency: *Beriberi, Wernicke-Korsakoff syndrome

72
Q

B2

A

Riboflavin
deficiency: cheilosis, angular stomatitis (crust side of mouth), tender tongue (red), mouth ulcers, corneal vascularization

73
Q

B3

A

Niacin
stocking sensation like wearing stockings
deficiency: pellagra (dermatitis, glossitis, GI and CNS dysfunction) Liver fire symptoms (red edged tongue) Toxicity: flushing face

74
Q

B6

A

Pyridoxine

deficiency: seizures, anemia, neuropathies, seborrheic dermatitis (looks like eczema on the face)

75
Q

B12

A

Cobalamin
deficiency: *megaloblastic anemia
Tongue = glossy/red/no taste buds (lack of taste) so not hungry

76
Q

Folate

A

Folic Acid

deficiency: *Megaloblastic anemia, * neural tube defect

77
Q

Vit C

A

ascorbic acid
collagen formation, bone/blood vessel health, wound healing
deficiency: *scurvy (bone defects), *gingivitis (gum erosion around teeth), Tongue peeled, *loose teeth, hemorrhages

78
Q

Vit A

A

Retinol
cataracts, **night blindness, skin disorders, xerophthalmia, keratomalacia, goose flesh skin (not absorbing Vit A appropriately, hepatic disfunction, liver failure

79
Q

Vit D

A

deficiency: bone, osteoarthritis (herberden’s nodes, swelling of joints, *osteomalacia, anorexia, rickets(weakening and softening of the bones because of extreme calcium loss)
toxicity: renal failure (check if deficient don’t over take supplement)
increased immunity

80
Q

Vit E

A

deficiency: **red blood cells, hemolysis, neurologic deficits, dry, scaly, leathery skin with erythema (redness), follicular hyperkeratosis (raised bumps from hair follicles), grey early, alopecia

81
Q

Vit K

A

deficiency: bleeding, osteopenia

82
Q

Common Vitamin Deficiencies

A

Protein, Vit B3 (Niacin), Folic Acid, B12 = diarrhea
Zinc = diarrhea and dysgeusia (distortion of taste)
Iron = dysphagia (difficult swallowing)

83
Q

Common Dietary Deficiencies

A

Vegan = B12 (unless eating yeast or fermented food) low calcium, iron, zinc
vegetarian = iron
fruitarian = protein, sodium (effects pancreas and muscles
very low calorie diet = wasting syndrome when in long term i.e. feeble muscle tone, brain
fad diets = protein and mineral deficiencies leading to renal, cardiac or metabolic disorders, Kid problems
Alcoholism = protein, mineral deficiencies leading to renal, cardiac, metabolic disorder

84
Q

**Manual Test and Names

A

McBurney’s point = Appendicitis, look for rebound tenderness (pressing LRQ)
Murphy’s Sign = Cholelithiasis, cholecystitis
Obturator Muscle Test = Rule out appendicitis
Psoas Sign = Rule out appendicitis
Rovsing’s sign = Rule out appendicitis (press on LLQ causing more pain on LRQ)

85
Q

A patient has a deficiency in Vit B12. You would suspect that their tongue would be.

  • smooth
  • rough and very tender
  • bleeding
  • swollen and small
A

-Smooth

reduces nerve endings which would reduce papillae of tongue

86
Q

A patient with “chicken / goose skin” would most likely have a deficiency of which vitamin?

  • B3
  • C
  • K
  • A
A
  • Vit A

Vit A deficiency treats goos bumps that do not dissipate with weather changes or pressure changes.

87
Q

Which type of ulcer commonly wakes a person up late at night?

  • peptic
  • gastric
  • duodenal
  • esophageal
A
  • Duodenal
    This area usually is covered with food or oily beverages during the day, a long fasting will commonly add more acid to this section during the fast that occurs during sleep.
88
Q

Which manual examination is most resourceful when diagnosing cholecystitis?

  • McBurney’s Point
  • McMurray’s Test
  • Obturator’s Muscle Test
  • Murphy’s Sign
A
  • Murphy’s Sign

inspects for increased tenderness in RUQ area.

89
Q

A patient who has Abdominal Aortic Aneurysm (AAA) is most likely going to be ……

  • Male, 65-75 yrs old
  • Male, 35-45 yrs old
  • Female, 65-75 yrs old
  • Female, 35-45 yrs old
A
  • Male, 65-75 yrs old

AAA primarily focuses on patients who are chronic smokers with many of the long term effects of smoking.

90
Q

A patient with dark tarry stool as a result of an ulceration would have what diagnostic name?

  • Melinda
  • Melena
  • Monet
  • Mineu
A
  • Melena

Melena is the name for dark tarry stools

91
Q

A patient presents with severe right lower quadrant pain, nausea and vomiting, and a fever of 101 degrees. Bowel sounds are evident in all four quadrants. Her WBC count is elevated and she tests positive when you perform McBurney’s test. Your patient’s most likely diagnosis is

Irritable Bowel Disease
Cholelithiasis
Abdominal obstruction
Apendicitis

A

Apendicitis

92
Q

A 36-year-old female has come to your clinic because she has been diagnosed with Cachexia and fatigue. She wants you to make her feel better at any cost. What condition does she have?

Trichimoniasis
Epstein Barr Virus
Wasting syndrome
Norovirus

A

Wasting Syndrome

93
Q

A lack of which vitamin is associated with Pernicious Anemia?

A

B12

94
Q

Upper GI and Lower GI divided by which of the following anatomical sites?

Ligament of Treitz
Esophageal sphincter
Pyloric sphincter
Ampulla of Vater

A

Ligament of Treitz (suspensory muscle of the duodenum)

95
Q

A 24-year-old male patient enters your office. He is of northern European ancestry, and complains of chronic diarrhea with fatty streaks in his stools. He seems quite thin and complains of being tired. He claims his doctor gave him a diagnosis of dermatitis herpetiformis for his skin rash. A biopsy of his intestines revealed a flattening and loss of villi. Which condition best represents this patient?

Carcinoid syndrome
Celiac disease
Duodenal ulcers
Irritable bowel syndrome

A

Celiac disease

96
Q

Which of the following conditions is possible to be the cause of LLQ (left lower quadrant) pain?

Diverticulitis
Appendicitis
Cholecystitis
Pancreatitis

A

Diverticulitis

97
Q

It is common to prescribe colorectal cancer screening such as Fecal Occult Blood Tests for patients over the age of 50 with average risk:

Every two years
Every three years
Every year
Every six months

A

every year

98
Q

What is the incubation period for Hepatitis C?

18-60 days
15-50 days
14-180 days
40-160 days

A

14-180 days

99
Q

Your patient, who is 47 years old, is coming in with acute lower GI Bleeding. Knowing that the most common cause of acute lower GI bleeding in patients above age 40 is ________________________, you would refer out for what test?

Diverticulosis, Colonoscopy
Diverticulitis, Colonoscopy
Esophageal ulcer, Endoscopy
Colon Cancer, MRI

A

diverticulitis, colonoscopy

100
Q

A 22 year-old female patient presents to you with severe lower abdominal pain that radiates to the low back. She states that the pain came on suddenly this morning. When you examine her, she has rebound tenderness in the left lower quadrant. She reports no changes in bowel patterns and no difficulty with urination. She states that she is sexually active, and that she and her boyfriend use condoms most of the time. She says that she couldn’t be pregnant because she started spotting this morning and that she missed her period last month. What is the most likely diagnosis for this patient?

Crohn’s Disease
Appendicitis
Ectopic pregnancy
Cholecystitis

A

ectopic pregnancy

101
Q

Which of the following forms of hepatitis is transmitted along fecal-oral routes and presents the highest rate of mortality in pregnant women?

Hepatitis E 
Hepatitis C 
Hepatitis B
Hepatitis A
Hepatitis D
A

Hep E

102
Q

Which of the following forms of hepatitis have abrupt onset?

Hepatitis A, Hepatitis D
Hepatitis B, Hepatitis D
Hepatitis A, Hepatitis E
Hepatitis E, Hepatitis D

A

Hep A, Hep E

103
Q

A 45-year-old male comes into your clinic complaining of RUQ pain, nausea that comes and goes, and a strange tenderness in his costovertebral region. Which of the following conditions presents clinically as such?

Pyelonephritis
Cholecystitis
Esophageal spasm
Unstable Angina

A

Cholecystitis

104
Q

A 44-year-old female presents to you with moderately severe epigastric pain that radiates to her right shoulder. She is concerned that it may be a side effect from the Lipitor that her MD prescribed recently. The pain seems to come and go, but is worse when she eats fatty foods. What is her most likely diagnosis?

Cholelithiasis
Angina
Duodenal ulcer
Pancreatitis

A

Cholelithiasis

105
Q

A 40-year-old male patient enters your office complaining of diarrhea with a history of recent antibiotic use. Which of the following is most likely implicated?

Clostridium difficile
Parasitic infection
Virus infection
Osmotic disease

A

Clostridium difficile - spore forming bacterium (antibiotic associated diarrhea)

106
Q

Which of the following pathogens is the major cause of acute diarrhea in the U.S. during the winter months. (Note: It is found at high rates in daycare centers and kindergartens)

Rotavirus
Dengue virus
Norovirus
Cytomegalovirus

A

Norovirus

107
Q

Which of the following statements about Portal Hypertension is not true?

It can cause Caput Medusae or purple veins that can be seen around the umbilicus.
It can be caused by cirrhosis of the liver.
It is due to an increase in pressure in the Hepatic Portal artery.
It can lead to ascites.

A

It is due to an increase in pressure in the Hepatic Portal artery.

108
Q

Which of these inflammatory bowel diseases presents with oral ulcers, involves portions of the terminal ileum, colon, abdominal pain, non-bloody diarrhea, and perirectal abscess/fistula?

Crohn’s disease
Ulcerative colitis
Irritable bowel syndrome
Diverticular disease

A

Crohn’s disease

109
Q

Vaccines are available for which of the following varieties of Hepatitis?

Hepatitis A, Hepatitis D
Hepatitis A, Hepatitis B
Hepatitis B, Hepatitis C
Hepatitis D, Hepatitis E

A

HepA, HepB

110
Q

Which of the following forms of hepatitis are bloodborne?

Hepatitis A, Hepatitis D
Hepatitis A, Hepatitis C
Hepatitis D, Hepatitis E
Hepatitis B, Hepatitis C

A

HepB, HepC

111
Q

What is the expected incubation period of Hepatitis B?

45-160 days
20-90 days
15-50 days
50-90 days

A

45-160 days

112
Q

A patient taking acetaminophen should be monitored for any bleeding, bruising, nosebleeds as well as:

Right upper quadrant pain
Respiratory problems
Chest pain
Black tongue mass

A

Right upper quadrant pain

113
Q

Which of the following regions of the GI tract is the site of enzyme release for Fat digestion?

Stomach
Small Intestine
Large Intestine
Directly below the esophageal sphincter

A

SI

114
Q

Your patient of ten years, a 55-year-old female, enters the clinic frantically complaining that her HbA1c blood count scared her. You want to help her understand whether or not she has diabetes, but she left her lab work at home. For a diagnosis of diabetes to be rendered, what lab values for the HbA1c must there be?

6.5% or over
126% or over
Below 6.5%
Between 6.0% - 6.4%

A

6.5% or over

115
Q

A 56-year-old woman was recently diagnosed with osteomalacia of the knees. She spent the last four months going to various specialists so that she could get the most cutting edge approach to treatment. Last week, upon visiting your office, she complained of having abdominal pain that worsens with the consumption of food. What is the likely diagnosis?

Crohn’s disease
Gastric ulcer
Duodenal ulcer
Pellagra

A

Gastric ulcer

116
Q

Which of the following organisms can cause diarrhea and life-threatening inflammation of the colon?

Streptococcus bovis
Basillus clausii
Lactobacillus helveticus
Clostridium difficile

A

Clostridium difficile

117
Q

All of the following statements about Crohn’s disease are correct, except:

It affects only partial thickness of bowel tissue.
It can produce cramping and severe abdominal pain.
It can cause fistulae and abscesses.
It may cause significant weight loss.

A

It affects only partial thickness of bowel tissue.

Biomedicine (10 decks)

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