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Quarter 4 > clin med III > Flashcards

clin med III Flashcards

1
Q

Supine view of abdominal x ray

A

“KUB”, often the initial test

Supine: DISTENTION

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2
Q

Upright view of abdominal x ray

A

air-fluid levels

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3
Q

CXR shows what for abdominal evaluation

A

sub diaphragmatic air with perforation

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4
Q

Abdominal US

A

Cholelithiasis
Cholecystitis
Hepatic steatosis (fat in liver)

Hepatobiliary dz (Liver or bile)

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5
Q

CT A/P WITH contrast (Iodine)

A

Pancreatitis
Diverticulitis
Appendicitis, etc

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6
Q

When to order a CT A/P WITHOUT contrast

A

if Kidney stone is suspected, do NOT use contrast

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7
Q

HIDA scan

A

“gall bladder scan”
biliary dysfunction
EF < 35% is abnormal

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8
Q

Barium study

A

Esophogram
UGI series
SBFT
Enema

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9
Q

Barium studies are good for

A

Lumen and Peristalsis evaluation

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10
Q

If suspected perforation, what alteration do you make to barium studies?

A

Do NOT use barium, instead use water soluble Gastrografin

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11
Q

EGD “Scope”

A 
Esophagitis
Barrett's esophagus
PUD (peptic ulcer dz)
Celiac
CA
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12
Q

ERCP/MRCP

A

Pancreatobiliary disorders

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13
Q

ERCP complication we are concerned about

A

acute PANCREATITIS

this is invasive and therapeutic

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14
Q

MRCP

A

non-invasive
just visualization
may come before ERCP

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15
Q

Colonoscopy/flexible sigmoidoscopy

A

Colon CA (Screening!!)
IBD
Diverticulosis

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16
Q

Screening for Colon CA

A

Colonoscopy/ flexible sigmoidoscopy

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17
Q

When is colonoscopy contra-indicated?

A

Active diverticulitis

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18
Q

Flex sigmoidoscopy only assesses

A

distal colon

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19
Q

GERD

A

usually a clinical dx

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20
Q

Tx for GERD

A

Lifestyle and diet
H2 blocker
PPR

Endoscopy if alarm features or if not improving w meds

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21
Q

Barretts esoph

A

Squamous epith is replaced with columnar epith in distal esoph

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22
Q

Barretts esoph tx

A

Depends on severity

-Aggressive PPI vs maintenance reimaging vs SURGERY (Endoscopic eradication therapy- ablation or resection)

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23
Q

Barrett most common in

A

White males 55YO

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24
Q

2 main types of Esophageal CA

A

Adenocarcinoma

Squamous cell

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25
Q

Barretts esoph is a precursor for

A

Adenocarcinoma
poor prognosis
watch for alarm features to catch early

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26
Q

Esophagitis

A

Reflux esophagitis is most common

subtypes: infectious, pill, eisonophilic, radiation

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27
Q

Tx of GERD

A

Start with H2 blockers, then change to PPI if needed. once on PPI, can increase dose to BID.

Then, EGD if still not improving

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28
Q

Name of the stomach wrap surgery for GERD

A

Nissen Fundoplication

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29
Q

RED flags of GERD prompting a further workup

A 
Dysphagia
Odynophagia
GI bleed
Wt loss
Anemia
No response to tx
New onset dyspepsia (heartburn) in those >60YO
prior antireflux surgery
Hx of CA
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30
Q

Barium esophogram

A

not typically used for GERD

shows HERNIA and STRICTURES

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31
Q

EGD/ scope/ endoscopy

A

best to evaluate MUCOSAL INJURY

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32
Q

Esoph impedance testing

A

bolus transit

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33
Q

Manometry

A

Peristalsis and LES function

Motility disorders

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34
Q

What is GERD

A

LES transiently relaxing, allowing backflow of stomach contents

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35
Q

Classic sx of GERD

A

Heartburn (pyrosis): Hallmark*

Regurgitation

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36
Q

Extra-esoph manifestations of GERD

A 
Bronchospasm/wheezing
Hoarseness
Chronic cough
Loss of dental enamel
CP
Dyspagia
hypersalivate
globus sensation (lump in throat)
Odynophagia
Nausea
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37
Q

Jackhammer hyperocontractile and DES (spasm)

A

Dysphagia and CP

Tx: CCB, TCA

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38
Q

Achalasia

A

Dysphagia and CP

Manometry needed for diagnosis*

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39
Q

Achalasia: what 3 tests should we be thinking about?

A

Manometry: needed for diagnosis
EGD: to r/o CA
Barium swallow: shows “bird’s beak”

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40
Q

Tx of Achalasia

A

Pneumatic dilation
Heller myotomy
Meds

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41
Q

Mallory Weiss syndrome

A

Laceration in distal esoph/stomach
Alcoholism increases risk

Retching

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42
Q

Pellagra

A

a sign of Niacin (b3) deficiency

diarrhea, dermatitis, dementia

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43
Q

Thiamine (b1) deficiency

A

Beriberi (peripheral neuropathy, edema)

Wernicke-Korsakoff synd (neurolgic)

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44
Q

Beriberi and Wernicke-Korsakoff syndrome

A

Thiamine B1 deficiency

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45
Q

B2, B3, and B6 deficiency

A

B2- Riboflavin
B3- Niacin
B6- Pyridoxine

Issues w mouth: Chelitis, stomatitis, glossitis

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46
Q

Vit D deficiency

A

Rickets, osetomalacia

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47
Q

Sodium deficiency

A

Confusion, hypotension, tachycardia

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48
Q

Zinc

A

taste disturbance

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49
Q

Calcium

A

Fractures, tetany

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50
Q

Potassium, K

A

muscle cramping

EKG with U waves

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51
Q

Iron

A

Pallor
Pale conjunctiva
Pica- ice craving
Koilonychia- spoon nales

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52
Q

Too much Potassium, K

A

weakness
vomiting
EKG with PEAKED T waves

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53
Q

too much Copper

A

Golden-brown discoloration of Iris

54
Q

Tetany

A

low Ca

55
Q

Pica, koilonychia

A

low Iron

56
Q

Night blindness

A

low vit A

57
Q

Angular chelitis, stomatitis

A

low B vitamins

58
Q

Pellagra

dementia, diarrhea, dermatitis

A

low Niacin (B3)

59
Q

Beriberi and Wernicke-Korsakoff

A

low Thiamine (B1)

60
Q

Petechia/purpura

A

low Vit C and K

61
Q

Macrocytic anemia w peripheral neuropathy

A

low vit B12

62
Q

What supp do pregnant women need?

A

Folic acid to decrease neural tube defect risk

63
Q

What supp do solely breastfed infants need?

A

Vit D

64
Q

How much fiber is recommended per day?

A

25-35 g

65
Q

imp cell types of stomach

A

parietal
chief
enteroendocrine
mucous neck

66
Q

parietal cells

A

HCL, intrinsic factor

67
Q

chief cells

A

pepsinogen

68
Q

mucous neck cells

A

thin, acidic mucus

69
Q

enteroendocrine cells (G cells)

A

various hormones

G cells: gastrin

70
Q

protective features of stomach

A

bicarb rich mucus
connected w/tight junctions
stem cells replace damaged
prostaglandins

71
Q

Secretin hormone effects:

A

Decrease bile secretion
Inhibit stomach motility
Increase bicarb secretion

72
Q

Complications of PUD

A

Bleeding
Perforation
Penetration
Gastric outlet obstruction

73
Q

Sx of Bleeding complication of PUD

A

Melena, hematemesis, hematochezia

74
Q

Dx and Tx of Bleeding complication of PUD (hemorrhage)

A

Dx: EGD

Tx: IVF, PRBC, PPI AND THEN, thermal coag, hemoclip, injection therapy

75
Q

Sx of Perforation complication of PUD

A

Severe, diffuse abdominal pain

76
Q

Dx and Tx of Perforation complication of PUD

A

Dx: CXR or 2 view Abdominal X Ray (free air under diaphragm)

Tx: IVF, PPI, Abx, Surgery

77
Q

Sx of Penetration complication of PUD

A

Change in sx relating to other structures affected (usually pancreas) may be: Pain, radiating to back

78
Q

Dx and Tx of Penetration complication of PUD

A

Dx: UGI, CT scan (difficult to assess)

Tx: Varies

79
Q

Sx of Gastric outlet obstruction complication of PUD

A

Vomiting, early satiety, bloating, anorexia

80
Q

Dx and Tx of Gastric outlet obstruction complication of PUD

A

Dx: CT, other imaging, succussion splash

Tx: NG tube and gastric decompression
OR if failed
EGG w endoscopic Balloon Dilation

81
Q

PUD

A

damage to GASTRIC or DUODENAL mucosa that extends THRU into deeper layers of wall

82
Q

Risk factors for PUD

A 
Smoking
Alc use
Genetic (blood O and A, gene variations pro-inf cytokines)
Diet 
Stress/depression
83
Q

2 main pre-D for PUD

A

H.Pylori

NSAIDs

84
Q

H. Pylori

A

Common cause of PUD
Pre-D to gastric CA

Gram (-) rod
Motile flagella
Oral-oral or oral-fecal tramnsmission

85
Q

What does H. Pylori do to secretions?

A

Decrease gastric mucus and bicarb secretion

86
Q

H. Pylori Virlence factors

A

Flagella- burrow
Urease- neutralize
Adhesins- stick to epith
Inflammation- secrete gastrin, increases HCL

87
Q

Factors that increase PUD risk w/use of NSAIDs

A 
Hx of PUD/ ulcer
H. pylori 
>75YO
Increase time, dose, duration of use
Also using: steroids, other NSAIDs, ASA, SSRI, or alendronate
88
Q

Sx of PUD

A

usually Asymptomatic (70% of time)

IF SX present,
Upper abdominal pain most common

And: belching, bloating, distension –> dyspepsia/heartburn

nausea, early satiety, vomiting

89
Q

More serious sx of PUD that lead to complications

A

Hematemesis
Melena
Fatigue
Dyspnea

90
Q

Classic sx of Gastric ulcer

A

Pain worse 30 min- 1 hr after meal
Vomiting common
Hemorrhage more likely- hematemesis
Weight loss/ anorexia

91
Q

Classic sx of Duodenal ulcer

A

Pain better w meal at first, but then worse 2-3 hrs after
Less likely to hemorrhage, if so: melena
Weight gain

92
Q

PUD

ALARMING sx

A 
Bleeding
Unexplained iron deficiency anemia
Early satiety
Unintentional weight loss
Progressive dysphagia/odynopagia
Acute onset upper abdominal pain
Persistent vomiting
Fam hx UGI CA
93
Q

Physical Exam findings of PUD

A

Epigastric tenderness
RUG tenderness
Peritoneal sings
Succosion splash

Vitals: Hypotensive and tachycardic

Rectal: Melena, hemoccult (+), bright red blood per rectum

94
Q

Gold standard way to dx PUD

A

EGD!

can also do UGI

95
Q

H pylori dx

A

Biopsy during EGD most sensitive/specific
Urea breath test
Stool antigen
Serology (not used often)

96
Q

H pylori testing, For urea breath test and stool antigen test, preparations

A

No PPI for 1-2 wks prior

No Bismuth/abx for 4 wks prior

97
Q

When to confirm eradication after tx of H. Pylori?

A

4 wks after treatment completed

98
Q

H pylori Tx

A

Clarithro triple therapy OR
Bismuth quadruple therapy
x14 days

99
Q

Clarithromycin Triple Therapy x 14 days

A

PPI, BID
Clarithro 500 mg, BID
Amoxicllin 1000mg, BID

100
Q

Bismuth Quadruple Therapy x 14 days

A

PPI, BID
Bismuch salicylate 300 mg, QID
Metronidazole 250 mg, QID
Tetracycline 500 mg, QID

101
Q

Zollinger Ellison syndrome

A

Gastrinoma secretes too much gastrin, increased HCL levels

102
Q

Where do Zollinger Ellison gastrinomas arise from?

A

Duodenum or Pancreas

103
Q

Clinical sx of Zollinger Ellison syndrome

A

Recurrent PUD (often distal to duodenal bulb)

Upper abdominal pain

Diarrhea (steatorrhea)

104
Q

Dx of Zollinger Ellison syndrome

A

Fasting serum gastrin >1000 +

Gastric ph <2

105
Q

Tx of Zollinger Ellison syndrome

A

PPI and surgery (if possible, want to remove tumor)

106
Q

Gastric CA Risk Factors

A

Gastric ulcers
H. Pylori

two main risk factors

107
Q

Gastric CA clinical sx

A 
Most are asymptomatic
If sx, 3 main:
Weight loss
Persistent abd pain
Ulcer hx
108
Q

Late findings of Gastric CA

A

Palpable stomach mass
Succussion splash
Paraneoplastic synd

109
Q

Paraneoplastic sydnrome

A

rare disorder triggered by altered immune response to a tumor

110
Q

Dx and staging of Gastric CA

A

EGD w/biopsy
(90-95% of gastric CA are Adenocarcinoma)

TNM staging (depth tumor, nodal involvement, distant lesions)

111
Q

Signs of METS of Gastric CA

A

Virchow’s** Left supraclavicular
Sister Mary Joseph: umbilical
Irish: Left axillary

112
Q

Tx of Gastric CA

A

Early: endoscopic mucosal resection
Advanced: total/partial gastrectomy
Unresectable: Chemo vs Chemo-Rad

113
Q

Dyspepsia approoach

A

> 60YO: ALL get EGD

<60YO: get EGD IF,

  • weight loss
  • overt GI bleed
  • 2 or more alarm features
  • rapidly progress alarm feature
114
Q

Mouth to anus with skip lesions

A

Crohn’s dz

115
Q

Transmural, meaning deeper involvement

A

Crohn’s dz

116
Q

Colon only (involves rectum), distal –> proximal

A

Ulcerative colitis

117
Q

Mucosal layer only involved, meaning more superficial

A

Ulcerative colitis

118
Q

Perianal dz, anemia, unintentional weight loss, iron/b12 def, BMI underweigh

A

Crohn’s dz

119
Q

What imaging for Crohn’s dz?

A

EGD and small bowel imaging (CTE or SBFT)

120
Q

Fecal urgency, tenesmus, intermittent LLQ abd pain

A

Ulcerative colitis

121
Q

Sclerosing cholangitis is associated with:

A

Ulcerative colitis

Oder LIVER TESTS

122
Q

Lower abodminal pain, bloody diarrhea, fecal urgency/tenesmus, hypovolemia

A

Ulcerative colitis

123
Q

Complications: abscess, strictures, fistulas, perforation, obstruction, colon CA, malabsorption

A

Crohn’s dz

124
Q

Complications: Toxic megacolon, Colon CA

A

Ulcerative colitis

125
Q

GI dz associated with DM, thyroid dz, Down syndrome

A

Celiac dz

126
Q

Mucosal inflammation and villous atrophy –> MALABSORPTION

A

Celiac dz

127
Q

Typical sx: diarrhea, bloating/flatulence, weight loss

A

Celiac dz

128
Q

Extra-intestinal manifestations: “Dermatitis herpatiformis”, Iron Def Anemia, osteoporisis

A

Celiac dz

129
Q

Serologic testing

elevated rTG IgA confirmed with duodenal biopsy (villous atrohpy) on a GLUTEN containing diet

A

Celiac dz

130
Q

Complications of Celiac dz

A

Nutrient deficiency

Lymphoma

Quarter 4 (10 decks)

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