dif to remember Flashcards

1
Q

Evaluation of dysphagia

A

History of diffic initiating swallowing with cough, chocking or nasal regurg?
YES –> likely oropharyngeal –> Videofluor modiefied barium swallow
NO –> Likely esoph dysphag:
- solid + liquids –> Motility disorder –> Barium swallow followed by pssible manometry
- solid progressing to liquids –> if history of prior radiatio, caustic injury, complex stricure, surgery then barium swallow followed by possible endoscopy, if no: upper endoscopy

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2
Q

factors that increase the risk for complications in diverticulosis

A
  1. heavy meat consumption
  2. aspirirn or NSAID use
  3. obesity
  4. smoking
    - alcohol is associated with the formation but no with the complications
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3
Q

suspected gastrinoma –>

A

endoscopy shows multiple stomach ulcers + thickened gastric folds –> check gastrin levels off PPI threapy for 1 week

  1. less than 110 –> no gastrinoma
  2. more than 1000 –> check gastric ph: more than 4 it is no gastrinoma, 4 or less to further test to localize it
  3. 100-1000 –> secretin stimulation test
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4
Q

ascites fluid characteristic - ascites albumin

A
  • more than 2/5 (high protein ascites): CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd- Chiari syndrome, fungal)
  • less than 2.5: Chirrosis, nephrotic syndrome
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5
Q

ascites fluid characteristic - serum-ascites albumin gradient

A
  • 1.1 or more: portal hypertension

- less than 1.1: no portal hypertension

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6
Q

Most signif RF for pancreatic cancer

A

smoking

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7
Q

Spontaneous bacterial peritonitis - diagnosis

A
  1. paracentesis:
    More than 250 PMNs
  2. (+) culture, ofter gram (-) (E. coli, Klebsiella)
  3. Less than 1g/dL protein
  4. serum ascites albumin gradient less than 1.1
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8
Q

elevated ALP - management

A

Check gGT:
A. normal: bone origin
B. high: biliary origin –> RUQ U/S + antimitochondrial:
- Dialated bile: ERCP
- antim (+) or abnormal hepatic parenchyma –> liver biopsy
- both normal –> consider liver biopsy, ERCP, observation

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9
Q

Red flags of GI bleeding

A
  1. change in bowel habits
  2. abd pain
  3. weight loss
  4. Iron def anemia
  5. family history of colon cancer
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10
Q

minimal bright red blood per rectum - management

A
  1. more than 50 or red flags –> colonoscopy
  2. 40-49 without flags –> sigmoidiscopy or colonoscopy
  3. younger than 40 without flags –> asnoscopy:
    - hemorrhoids –> no further
    - no source –> sigmoidoscopy or colonoscopy
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11
Q

Toxic megacolon - diagnosis is confirmed by

A

plain abd x-rays + 3 or more of the following

1. fever 2. pulse more than 120 3. WBC more than 10.5 4. anemia

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12
Q

Crohn disease vs Ulcerative colitis according to imaging (and mechanism)

A

Crohn disease –> string sign on barium swallow x-ray (due to bowel wall thickening)
Ulcerative colitis –> lead pipe appearance (due to loss of haustra)

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13
Q

Ulcerative colitis - gross morphology

A

mucosal and submucosal inflammation only, friable mucosal pseudopolyps with freely hanging mesentery, loos of haustra

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14
Q

Crohn disease - gross morphology

A

transmural inflammation (–> fistula), Cobblestone mucosa, creeping fat, bowel wall tickening - strictures, linear ulcers, fissures

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15
Q

common drugs associated with acute pancreatitis

A
  1. diuretics
  2. anti-seizures (valproic)
  3. antibiotics (tetracyclines, metronidazoles)
  4. HIV related (didanosine)
  5. drugs for IBD (5-asa, sulfasalazine)
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16
Q

hepatopulmonary syndrome

A

intrapulm vasular dilation (in chronic liver disease)

  • PLATYPNEA: dyspnea in uprirght
  • orthodeoxia: oxygen desaturaion in upright
17
Q

germline mutation for pancreatic cancer

A

BRCA, Peutz

18
Q

Spontaneous Bacterial peritonitis - proteins level

A

less than 1

19
Q

focal nodular hyperplasia

A

anomalous arteries

  • arterial flow + central scar on imaging
  • resemble to adenoma, but not associated to OCPs
20
Q

lactose intolerance - labs

A
  1. (+) hydrogen breath test
  2. (+) stool test for reducing substance
  3. low stool ph
  4. increased stool osmotic gap
21
Q

Management of Cirrhosis

A

periodic surveillance of LFT

  • Compensated: U/S for HCC ever 6 months and EGD
  • decompensated –> assess complications:
    a. variceal hemor: start beta blocker and EGD every year
    b. ascitie: low sodium, diuretics, paracentesis, no alcohol
    c. encephalopathy: lactulose
22
Q

secretory diarrhea

A

larger daily stool vomulumes and diarrhea that occurs even during fasting, reduced stool omotic gap

  • due to increased secretion of ions
  • causes: V. cholera, rotavirus, CF, early ielocolitis, POSTSURGICAL CHANGES
23
Q

GERD management

A

Men older than 50 or symptoms more than 5 years, or cancer risk factors or alarm symptoms?
A. NO – once daily PPI for 2 months –> if refractory switch to different PPI or increase PPI to 2 daily –> if controlled then continue, if not the endoscopy or ph minoring
B. YES –> endoscopy:
- esophagitis: treat it
- no esophagitis –> consider further testing for: achalasia, gastroparesis, nonacid reflux, etc –> manometry, impedance testngm gastric scintigraphy

24
Q

GERD - alarm symptoms

A
  1. melena
  2. persistent vomiting
  3. hematemesis
  4. weight loss
  5. anemia
  6. dysphagia/odynophagia
25
chronium def - manifestation
impaired glucose control in DM
26
copper deficiency - manifestation
1. brittle haie 2. skin depigmentation 3. neurologic dysfunction 4. sideroblastic anemia 5. osteoporosis
27
selenium deficiency - manifestation
1. thyroid dysfunction 2. cardiomyopathy 3. immune dysfunction
28
zinc deficiency - manifestation
1. alopecia 2. pustular skin rash (perioral region + extr_ 3. hypogonadism 4. impaired wound healing 5. impaired taste 6. immune dysfunction
29
angiodysplasia is associated with
1. advanced renal disease 2. VWF 3. aortic stenosis
30
acute liver failure - diagnostic requirements
1. severe acute liver injury (enzymes more than 1000) 2. signs of hepatic encphalopathy 3. Syntehtic liver dysfunction (INR more than 1.5)
31
features associated with severe pancreatitis
1. older than 75 2. obesity 3. alcoholism 4. CRP greater than 150 at 48h 5. Rising BUN + creatining in 48h 6. Chest x-ray with pulm infiltrates or pleural effusion 7. CT/MRI with necrosis + extrapancreatic infl
32
types of diarrhea
1. fatty 2. watary --> secretory, watery, osmotic 3. inflammatory
33
how to distinguish secretory from osmotic diarrhea
stool osmotic gap = plasma - 2 x (stool Na2+ + stool K+) - increased in osmotic - decreased in secretory