Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AAClinical school conditions > CPC 8 acute abdo > Flashcards

CPC 8 acute abdo Flashcards

1
Q

What stimulates the acute phase response?

A

Cytokines IL-1, IL-6 and TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the acute phase response increase (blood results)

A

CRP and fibrinogen, increased ESR, fever, increased leukocytes and negative nitrogen balance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does a CRP of 100-200 suggest

A

Marked inflammation, bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does a CRP of more than 200 suggest?

A

Severe bacterial infection or extensive trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is pyelonephritis?

A

Suppurative inflammation of the kidney, with neutrophils within the tuules and interstitioum, although glomeruli are only involved in severe disease. Generally there are yellow-white cortical abscesses and surrounding hyperaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some complications of pyelonephritis

A

Pyonephritis
Peri-nephric abscess
Papillary necrosis,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of papillary necrosis - acronym

A

POST CARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of papillary necrosis, POST CARDS

A 
Pyelonephritis
Obstruction of the urogenital tract
Sickle cell disease
Tuberculosis
Chronic liver disease
Analgesia/alcohol abuse
Rejection of renal transplant
Diabetes mellitus
Systemic vasculitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

First line investigations for suspected pyelonephritis

A

MSU and blood cultures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for uncomplicated pyelonephritis

A

Ciprofloxacin for 7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you treat an infection which is resistant to several antibiotics i.e. has extended spectrum beta lactamase?

A

With meropenem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the components of human bile?

A

bile salts (primary and secondary), phospholipids, cholesterol, protein, bilirubin and electrolytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Discuss the pathogenesis of gall stones

A

Cholesterol supersaturation in bile (with mucin hypersecretion
gall bladder hypomotility
and increased intetinal conversion to deoxycholate also involved.)
Crystal nucleation
Stone growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of gall stones?

A

Cholesterol and pigment. Cholesterol is most common in western populations, while pigment stones are predominantly in others.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What populations are susceptible to cholesterol stones?

A

Western populations. Forty, fat, female, fertile, also those who have just had rapid weight loss and or have inborn errors of bile acid metabolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What populations are risk factors for pigment stones?

A

Chronic hemolytic syndromes, biliary infection, ileal disease (crohn’s, resection or bypass), cystic fibrosis with pancreatic insufficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where does gallstone pain radiate?

A

Epigastric pain radiating to the back (in waves if in CBD), vomiting. If gall stone ileus, also pain and distension. If in bile duct, jaundice.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigation do you do for a suspected bile duct stone?

A

EUS is best, but MRCP if this is not available. US not really good for duct stones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complications of gallstones?

A

Biliary sepsis
Gall bladder empyema
Gall stone ileus
Acute cholecystitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What organisms cause biliary sepsis (mostly)

A

E. coli and bacteroides fragilis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What immune cells are mostly involved in gall bladder empyema?

A

Neutrophils.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment for biliary sepsis which is mild and community acquired?

A

Co-amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the treatment for biliary sepsis which is mild and community acquired with penicillin allergy?

A

ciprofloxacin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the treatment for biliary sepsis which is hospital acquired MRSA positive?

A

Vancomycin (for MRSA) and Piperacillin-Tazobactam (for anaerobes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment for biliary sepsis which is hospital acquired MRSA positive in penicillin allergic patient?

A

vancomycin, ciprofloxacin and metronidazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What causes acute cholecystitis?

A

Diabetes mellitus, gallstones, sepsis, immunosuppression and trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the appearance of a gallbladder with cholecystitis?

A

Fibrinous exudate on external surface
Subserosal haemorrhage
Gallbladder wall is thickened, oedematous and hyperaemic
Neutrophilic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the most common cause of chronic cholecystitis?

A

Gallstones (90%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

General chronic cholecystitis info

A

Supersaturation of bile leads to chronic inflammation and stone formation.
⅓ have E. coli or enterococcus in bile.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Appearance of gallbladder in chronic cholecystitis

A

Thickened wall, variable chronic inflammation, sub-epithelial and sub-serosal fibrosis, outpouchings of epithelium through the wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Imaging of choice for right iliac fossa pain, fever and diarrhoea

A

CT the best, but US has less radiation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Differential diagnoses for right iliac fossa pain, fever and diarrhoea

A 
Appendicitis
Carcinoid tumour
Endometriosis
Enterobius vermicularis
Idiopathic inflammatory bowel disease. 
Ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pathophysiology of appendicitis

A

Obstruction of lumen → stasis and loss of venous outflow → bacterial proliferation, inflam.response and ischaemia → neutrophilic inflammation and necrosis.

34
Q

Appearance of appendix in appendicitis

A

Hyperaemic dilated vessels and/or fibrinious exudate on surface and/or perforation.
Neutrophilic infiltrate at least as far as muscularis propria. Serosal involvement suggests peritonitis.

35
Q

Complications of appendicitis

A 
Perforation and peritonitis 
Appendix mass
Pyelophlebitis
Portal vein thrombosis
Liver abscess
Bacteraemia
36
Q

Basic info on carcinoid tumours

A

Well differentiated neuro-endocrine tumour.

40% jejunum/ileum,

37
Q

Carcinoid syndrome symptoms

A

Flushing
Diarrhoea
Secondary restrictive cardiomyopathy.

38
Q

What would be your imaging method of choice in the 74 year old with central abdominal pain radiating to the back and down into the legs?

A

CT

39
Q

What would be your imaging of choice for suspected acute diverticulitis?

A

CT, unless young patient in which case expert US can be ok.

40
Q

Causes of acute pancreatitis acronym

A

I GET SMASHED

41
Q

Causes of acute pancreatitis I GET SMASHED

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia. 
ERCP and emboli
Drugs (azathioprine)
42
Q

Biochemistry of acute pancreatitis.

A

Increased serum amylase levels within first 24 hr
Rising serum lipases
10% have glycosuria
Hypocalcaemia secondary to deposition of calcium salts.

43
Q

Histology of pancreatitis

A 
Microvascular leak and oedema
Fat necrosis
Acute inflammation
Destruction of parenchyma
Destruction of blood vessels and interstitial haemorrhage.
44
Q

Complications of acute pancreatitis

A

ARDS
Renal failure
Pseudocyst formation
Sterile abscess.

45
Q

Hereditary pancreatitis - what genes cause it?

A

Gain of function in trypsinogen gene (PRSS1)
CFTR mutation
Loss of function of SPINK1, a trypsin inhibitor

46
Q

What are the complications of hereditary pancreatitis

A

Pancreatitic carcinoma - 40% lifetime risk.

47
Q

Chronic pancreatitis - general

A

Prolonged inflammation with irreversible injury and fibrosis

Exocrine injury occurs first, endocrine later.

48
Q

Causes of chronic pancreatitis

A

alcohol, long-standing obstruction, autoimmune pancreatitis, hereditary pancreatitis.

49
Q

What is diverticular disease?

A

Multiple outpouchings through the muscularis mucosae at taeniae coli where the vasa recta penetrate.

50
Q

What is the pathology of diverticular disease

A

Inflammation, perforation, abscess formation, fistula.

51
Q

What are the risk factors for colorectal carcinoma?

A

Diet high in refined carbs
NSAIDS are protective
FAP or HNPCC

52
Q

How does the position affect the shape of a colorectal carcinoma?

A

Exophytic in proximal, annular if distal

53
Q

Colorectal carcinoma prognosis depends on…

A

Prognosis depends on depth of invasion (vascular?) lymph node mets, differentiation and whether or not it is mucinous.

54
Q

Histology of colorectal carcinoma

A

Dysplastic glands

Stromal changes

55
Q

Pathophysiology of ischaemic colitis.

A

Acute compromise vs chronic hypoperfusion
Mucosal infarction may follow either
Transmural infaction typically follows acute vascular obstruction.

56
Q

Causes of acute obstructive ischaemic colitis.

A 
Severe atherosclerosis at the origin of the mesenteric vessels
Abdominal aortic aneurysm
Oral contraceptive pill  use
Embolisation of cardiac vegetations.
Hypercoagulable states
57
Q

Causes of intestinal hypoperfusion.

A

Cardiac failure
Shock
Dehydration
Vasocconstrictive drugs.

58
Q

Macro appearance of ischaemic colitis

A

Congested and dusky
Bloodstained contents
Perforation
Serositis with fibrin.

59
Q

Histopathology of ischaemic colitis.

A 
Mucosa haemorrhagic and ulcerated
Atrophy and sloughing of surface epithelium
Crypts regenerative
Neutrophils after reperfusion
Fibrosis if chronic.
60
Q

Ectopic pregnancy general

A

2% of confirmed pregnancies

Risk factors: appendicitis, endometriosis, previous surgery, IUCD.

61
Q

Likely causes of peritonism with epigastric pain with nausea.

A

Peptic ulceration
Acute pancreatitis
Acute cholecystitis
(be aware appendicitis, lower lobe pneumonia, MI)

62
Q

If someone has peritonism and pain, with cool peripheries, what does this mean?

A

He may have a degree of hypovolaemia - give him fluids.

63
Q

Treatment for acute pancreatitis.

A

80%-90% resolve with conservative treatment - IV fluids, nil by mouth, possible Abx.

64
Q

What is Wilson’s disease?

A

Autosomal recessive condition characterized by toxic accumulation of copper in the liver and brain. Neurological problems may manifest as dementia, tremor or dyskinesias.
Onset between 10-25 years

65
Q

Features of Wilson’s disease

A

liver: hepatitis, cirrhosis
neurological: basal ganglia degeneration, speech and behavioural problems are often the first manifestations. Also: asterixis, chorea, dementia
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails

66
Q

Diagnosis of Wilson’s disease

A

reduced serum caeruloplasmin

increased 24hr urinary copper excretion

67
Q

Treatment of Wilson’s disease

A

penicillamine (chelates copper) has been the traditional first-line treatment
trientine hydrochloride is an alternative chelating agent which may become first-line treatment in the future
tetrathiomolybdate is a newer agent that is currently under investigation
Next question

68
Q

Probable cause of painless enlarged gallbladder with mild jaundice on background of alcoholism

A

Pancreatic cancer

69
Q

Likely cause of diarrhoea 1-6 hr after exposure

A

Staphylococcus aureus, Bacillus cereus

70
Q

Likely cause of diarrhoea 12-48 h after exposure

A

Salmonella, Escherichia coli

71
Q

Likely cause of diarrhoea 48-72 h after exposure

A

Shigella, Campylobacter

72
Q

Likely cause of diarrhoea more than 7 days after exposure.

A

Giardiasis, Amoebiasis

73
Q

What is Budd-Chiari syndrome?

A

Budd–Chiari syndrome is a condition caused by occlusion of the hepatic veins that drain the liver.

74
Q

What is primary sclerosing cholangitis?

A

a biliary disease of unknown aetiology characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts

75
Q

What is primary sclerosing cholangitis associated with?

A

ulcerative colitis: 4% of patients with UC have PSC, 80% of patients with PSC have UC
Crohn’s (much less common association than UC)
HIV

76
Q

How to manage post-operative ileus

A

Nil by mouth and NG tube for stomach decompression

77
Q

Charcot’s triad for ascending cholangitis

A

Right upper quadrant pain, fever and jaundice

78
Q

Medication for renal colic

A

Diclofenac for pain relief

Alpha-adrenergic blockers to help stone pass.

79
Q

What medication can help prevent calcium renal stones?

A

Thiazide diuretics, which increase Ca++ reabsorption.

80
Q

Common features of viral hepatitis

A

nausea and vomiting, anorexia
myalgia
lethargy
right upper quadrant (RUQ) pain

AAClinical school conditions (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions