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OMS2 - Semester 2 - BECOM Exam 1 > Dr. Stillwell > Flashcards

Dr. Stillwell Flashcards

1
Q

GGT (gamma glutamyl transferase)

A
  • SPECIFIC to the liver -> high GGT -> liver probs

- when ONLY it is elevated -> EtOH issues

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2
Q

Alcoholic Hepatitis

A
  • AST>ALT 2:1
  • hepatocyte BALLOONING degeneration
  • MALLORY HYALINE BODIES
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3
Q

Drug and Toxin induced hepatitis

A
  • acetominophen (Tylenol) most common

- Reyes syndrome -> give kid w/ viral infection aspirin -> hepatic encephalopathy

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4
Q

Nonalcoholic Steatohepatitis (NASH)

A
  • metabolic syndrome

- can lead to HCC

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5
Q

autoimmune hepatitis

A

-elevated ANA and anti-smooth muscle Abs (ASMA)

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6
Q

Primary Biliary Cirrhosis (PBC)

A
  • INTRAlobular bile ducts
  • refractory pruritus
  • anti-mitochondrial Abs + (AMA)
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7
Q

Primary Sclerosing Cholangitis (PSC)

A
  • INTRA and EXTRAhepatic bile ducts
  • p-ANCA +
  • ulcerative colitis associated
  • high risk for cholangiocarcinoma
  • beads on a string
  • ONION SKIN FIBROSIS
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8
Q

Wilson’s disease

A
  • liver disease + neurologic + psychiatric issues
  • Kayser-Fleischer rings
  • AST > ALT
  • LOW cerulloplasmin
  • Tx: PENICILLAMINE
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9
Q

Hemochromatosis

A
  • bronzing/hyperpigmentation

- risk for YERSINIA

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10
Q

alpha-1 antitrypsin deficiency

A
  • affect lungs and liver
  • young person with COPD
  • lungs -> emphysematous bullae
  • PAS + inclusions
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11
Q

what do you do if you find granulomas on biopsy?

A

do thorough work up bc it may NOT be sarcoidosis

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12
Q

Bartonella (cat scratch)

A
  • can cause hepatic granulomas

- HIV+ -> Peliosis Hepatis -> blood filled cavities/islands

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13
Q

Hepatitis A virus

A
  • RNA virus (no enveloppe)
  • fecal oral
  • incubation 4 weeks (1 month)
  • dark urine 1st -> jaundice and icterus
  • does not become chronic -> CANNOT reactivate once you get it
  • there is a vaccine (Havrix, Vaqta)
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14
Q

Hepatitis E virus

A
  • RNA virus
  • fecal oral or blood transfusions; perinatal mortality
  • incubation 4 weeks
  • urticarial rash if symptomatic
  • PREGNANT woman 3rd trimester -> hepatic failure if not immune/vaccinated
  • immunocompromised -> can get chronic HEV
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15
Q

Hepatitis B virus

A
  • DNA virus
  • mother-child transmission predominant mode -> mothers HBAgs+ are 90% likely to transmit
  • ground glass hepatocytes
  • has a vaccine
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16
Q

acute HBV

A
  • incubation 2 months
  • ptxs who recover from HBV (95% who clear HBAgs) -> NOT truly cured bc still have HBV DNA on PCR
  • SERUM SICKNESS
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17
Q

chronic HBV

A
  • neonates more likely to get chronic HBV
  • HbAgs+ is MORE infectious if they are HBe ag+ than if they have started making HBe ag+ Abs w/ a negative HBAgs test
  • can get MEMBRANOUS GN or POLYARTERITIS NODOSA or CRYOGLOBULINEMIA + bullous pemphigoid
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18
Q

window period with HBV

A

-phase b/w clearance of HBAgs and the making of HBs Abs -> only anti-HBc IgM/Ab is detectable

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19
Q

Hepatitis D virus

A
  • RNA virus
  • ALWAYS have to be dual infected w/ HBV and HDV
  • has the same HBAgs
  • DIRECT damage to hepatocytes
  • diagnose by anti-HDV Ab
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20
Q

Hepatitis C virus

A
  • IVDA
  • perinatal transmission at time of birth and in 5% of infants born to mothers with HCV
  • NOT passed easily through sexual contact
  • incubation period 2 months
  • genotype 1 -> most widely dispersed
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21
Q

acute HCV

A
  • develop fibrosis -> cirrhosis -> HCC
  • most undetected but still cause acute hepatitis
  • # 1 risk for liver transplant
  • Cholestati pruritus
  • most have a +HCV RNA PCR but may not have a anti-HCV Ab early on
  • worried about acute HCV -> must check HCV RNA PCR
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22
Q

chronic HCV

A
  • poor correlation with transaminase levels and liver histo
  • HCV ptxs with cirrhosis -> high risk of HCC
  • EtOH and marijuana increase risk for progression

-amount of inflammation and fibrosis is best clinical predictor of chronic HBC (use Fibroscan)

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23
Q

HCV extra hepatic manifestations

A
  • CRYOGLOBULINEMIA
  • MEMBRANOPROLIFERATIVE GN
  • PORPHYRIA CUTANEOUS TARDA
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24
Q

what do you do for any ptx with acute or chronic renal failure?

A

should have HCV and HBV testing

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25
Q

Candida esophagitis

A
  • most common fungal infection in immunocompromised hosts
  • high risk if on PPIs
  • with oral/esophageal Candida -> look for immunocompromised state (HIV, malignancy, DM)
  • cobblestone
  • pseudohyphae
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26
Q

oral Candida + dysphagia

A

likely esophageal Candida

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27
Q

Germ tube test

A

-differentitated C. albicans and C. dubliensis from other species

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28
Q

C. krusei

A

NEVER sensitive to fluconazole

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29
Q

C. auris

A
  • hospital outbreaks

- treat with echinocandins

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30
Q

HSV esophagitis

A
  • HSV-1
  • transplants&raquo_space; HIV+
  • volcano ulcers - punched out ulcers
  • multinucleated giant cells
  • cowdry type A inclusions
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31
Q

CMV esophagitis

A
  • HIV+&raquo_space; transplant ptxs
  • LINEAR ulcers
  • OWLS eye inclusion
32
Q

acute cholecystitis

A
  • cystic duct obstruction, enlarged GB wall (normal size is = 3mm thick)
  • bacteria: E. coli, Klebsiella, Enterococcus
  • Dx - US -> GB wall thickening (>/4mm), pericholecystic fluid, edema/double wall sign
33
Q

chronic cholecystitis

A
  • Rokitansky-Aschoff sinuses

- Porcelain GB -> increased risk for GB cancer

34
Q

Acalculous cholecystitis

A

-ICU ptxs -> hypoperfusion of GB -> ischemia

35
Q

cholangitis

A
  • Charcot’s triad -> fever, RUQ pain, jaundice
  • Dx: ERCP
  • Mirizzi’s syndrome -> gallstone lodges in cystic duct compressing on common bile duct
36
Q

bacteria causing liver abscess

A

-E. coli, Klebsiella, Enterococcus, Strep Viridans

37
Q

fungi causing liver abscess

A

Candida

38
Q

parasites causing liver abscess

A

Entomoeba histolytica and Echinococcus

  • E. histolytica -> anchovy paste and treat w/ metronidazole
  • Echinococcal (hytadid cyst) -> anaphylactic shock if you biopsy
39
Q

what ptxs can you see hepatosplenic candidiasis?

A

AML***

-CT full of Candida liver abscesses (also pancreatic)

40
Q

a pos stool toxin, culture or parasite

A

-does NOT mean there is an invasive infection -> may just be a colonizer

41
Q

most acute gastroenteritis infections

A
  • VIRAL origin -> antibiotics DON’T help

- SUPPORTIVE treatment

42
Q

Norovirus

A
  • EPIDEMIC gastroenteritis
  • Cruise ships and Dorm rooms
  • short incubation time (1-2 days)
  • NOT killed by EtOH and standard hand gels -> use soap and water
43
Q

rotavirus

A
  • children (6 months - 2 years old) -> goes through NURSERIES
  • dehydration cause of death
  • vaccine: RotaTeq, Rotarix -> can lead to intususpeption
44
Q

Non-typhoidal Salmonella

A
  • cause gastroenteritis
  • contaminated chicken/eggs/milk
  • see in TURTLES
  • summer months
  • non-infectious reactive arthritis syndrome (like Chlamydia, Shigella, Campylobacter, Yersinia) -> HLA-B27 +
  • chronic carrier (>1 year) -> Gallstones
  • Tx: Supportive…quinolone or TMP/SMX if needed
45
Q

salmonella vs. shigella

A
  • salmonella -> BLACK

- shigella -> CLEAR

46
Q

Typhoidal Salmonella

A
  • cause enteric fever (typhoid fever)
  • traveling from ENDEMIC countries
  • chronic carriage -> gallstones and GB carcinoma
  • 1st week -> PULSE TEMP DISSOCIATION
  • 2nd week -> ROSE SPOTS
  • 3rd week -> ILEOCECAL LYMPHATIC HYPERPLASIA
  • Dx: Widal test -> detect serum Abs against O and H antigens
  • Tx: ceftriaxone or azithromycin
47
Q

Shigella

A
  • produces SHIGA TOXIN -> cause HUS and dysentery
  • Tx: SUPPORTIVE with rehydration
  • avoid intestinal anti-motility drugs
48
Q

Campylobacter

A
  • contaminated chicken or waterborne
  • PPIs allow it to thrive -> decrease acidity
  • crampy abdominal pain in PERIUMBILICAL region
  • CAMPY blood agar
  • Tx: azithromycin or quinolones
49
Q

Yersina

A
  • PIGS/HOGS -> undercooked raw pork
  • Fe loving
  • Thalassemias or Hemochromatosis -> bacteremia and septic shock
  • CIN agar -> red w/ white-rimmed colonies
50
Q

Vibrios Parahhaemolyticus

A
  • Seafood -> New Orleans or TX coast lines
  • TCBS media -> black
  • Tx: supportive; tetracyclines (doxy) if needed
51
Q

Vibrios Cholera

A
  • CHOLERA TOXIN
  • “rice water” stools with mucous and FISHY ODOR
  • TCBS media -> blue-green
  • SHOOTING STAR on dark field microscopy
  • Tx: supportive; tetracyclines if needed
52
Q

Tropheryma Whipplei (Whipples disease)

A
  • sewage workers

- PAS+ foamy Macs in small bowel lamina propria

53
Q

Clostridium Difficile

A
  • get after Clindamycin therapy
  • use with Quinolones -> nosocomial outbreaks
  • thrives with PPIs and H2 blockers
  • cause pseudomembranous colitis
  • LEUKOCYTOSIS
  • asymptomatic carrier with + stool test -> NO therapy
  • C. diff toxin -> send 3x
  • PCR/NAAT for toxin B gene -> send 1x
  • Tx: ORAL vancomycin or metronidazole
54
Q

causes of eosinophilia

A
  1. GI parasites -> most common worldwide

2. Allergic rxn -> most common in developing world

55
Q

how many samples do you want for O and P studies?

A

3 separate stool samples for Dx

56
Q

Ascaris Lumbricoides

A
  • Nematode
  • travel to LUNGS and reswallowed -> Loeffler Syndrome -> Charcot Leyden Crystals
  • oval and mammillated eggs
  • Tx: Albendazole or Mebendazole
57
Q

Enterobius Vermicularis (PINWORM)

A
  • Nematode
  • KIDS
  • 40 million infected in US
  • PERIANAL ITCHING
  • Dx: perianal SCOTCH TAPE test
  • eggs FLAT on one side (bean-shaped)
  • Tx: Albendazole or Mebendazole
58
Q

Trichuris Trichiuria (WHIPWORM)…“trick trick”

A
  • Nematode
  • Tropical
  • rectal prolapse with worm burden
  • BARREL or lemon shaped eggs with HYALINE plugs
  • Tx: Albendazole or Mebendazole
59
Q

Necator Americanus and Ancylostoma Duodenale (HOOKWORMS)

A
  • Nematode
  • DIRECTLY enter skin -> go to LUNGS (eosinophilia)
  • “ground itch” - similar to cutaneous larva migrans
  • GI bleed -> Fe deficiency microcytic anemia + Eosinophilia
  • Tx: Albendazole or Mebendazole
60
Q

Stronglyoides Stercoralis (Strongyloidiasis)

A
  • Nematode
  • Tropical
  • Directly enter skin -> go to LUNGS (eosinophilia)
  • AUTOINFECTION
  • immunodeficient -> fatal HYPERINFECTION SYNROME
  • Larva currens (running larva) on butt -> move 1 cm in 5 min…(cutaneous larva migrans moves 1-2 cm per day)
  • periumbilical URTiCARIA AND PURPURIC RASH
  • Tx: Ivermectin > Albendazole
61
Q

Trichinella Spiralis

A
  • Nematode
  • BEAR/WALRUS undercooked meat w/ encysted larva
  • MYALGIA + PERIORBITAL/FACIAL EDEMA (also hypothyroidism)
  • Eosinophilia
  • Tx: Albendazole or Mebendazole
62
Q

Toxocara canis and cati (ocular/visceral larva migrans)

A
  • Nematode
  • dog/cat roundworms
  • larva in EYE
  • children + eosinophilia + fever
  • prominent EOSINOPHILIA
  • Tx: Albendazole or Prednisone
63
Q

Baylisascaris Pyocyonis

A
  • Nematode
  • RACCOONS
  • larva migrate to NERVOUS SYSTEM -> eosinophilia + meningoencephalitis
  • Tx: Albendazole or Predisone
64
Q

Angiostrongyliasis Cantonensis (rat lungworm)

A
  • Nematode
  • most common cause of eosinophilic meningitis and encephalitis
  • Tx: Albendazole or Prednisone
65
Q

Taenia Saginata (BEEF tapeworm)

A
  • Cestode
  • undercooked BEEF
  • AFB +
  • proglottids have 12-15 uterine branches
  • Tx: Praziquantal
66
Q

Taenia Solium (PORK tapeworm)

A
  • Cestode
  • undercooked PORK w/ cysticerci
  • AFB -
  • eggs are thick RADIATE shell w/ hooklets and walls
  • ingest EGGS -> CYSTICERCOSIS (cysts in the brain) -> neurocysticercosis and SEIZURES or increased intracranial pressure
  • Tx: Praziquantal
67
Q

Diphyllobothrium Latum (fish tapeworm)

A
  • Cestode
  • undercooked fish
  • LARGEST tapeworm
  • vit. B12 deficiency -> MEGALOBLASTIC ANEMIA
  • egg with operculum
  • Tx: Praziquantal
68
Q

Hymenolepis nana (Dwarf tapeworm)

A
  • Cestode
  • SMALLEST tapeworm
  • most common in the world
  • complete WHOLE LIFE CYCLE IN HOST
  • warm countries and schoolchildren
  • Tx: Praziquantal
69
Q

Liver Flukes - Trematodes

A
  1. Fasciola hepatica -> common bile duct obstruction, pancreatitis, PSC, hepatitis
  2. Clonorchis sinensis

Tx: Praziquantal

70
Q

Intestinal Flukes - Trematodes

A
  1. Fasciolopsis buski -> vit. B12 deficiency

Tx: Praziquantal

71
Q

Giardia Lamblia

A
  • Protozoa
  • chronic infection -> develop lactose intolerance -> post-infectious IBS
  • trophozoites looks like ghost
  • Tx: Metronidazole or Tinidazole
72
Q

Entamoeba histolytica

A
  • Protozoa
  • those on steroids with misdiagnosed colitis have 25% mortality rate
  • can cause amoebic liver abscesses and dysentery
  • trophozoites INGEST RBCs
  • FLASK-SHAPED ULCERS
  • Karyosome (spot in nucleus)
  • Tx: Metronidazole -> Paramomycin
73
Q

Blastocystis hominis

A
  • Protozoa
  • most common parasite in human stool
  • commensal -> no fecal leukocytes seen
  • large central vacuole
74
Q

Cryptosporidium parvum

A
  • Protozoa
  • water-related outbreaks of diarrhea
  • immunodeficient in HIV+ ptxs (low CD4) -> LIFE THREATENING or can have LONG TERM
  • MODIFIED ACID FAST STAINS (special stains) -> not usually diagnosed on routine O and P study
  • ROUND and smaller than isospora
  • Tx: supportive - Paramomycin or Nitazoxanide if needed
75
Q

Isospora belli

A
  • Protozoa
  • common in immunodeficient ptxs (AIDS)
  • sometimes associated w/ EOSINOPHILIA
  • larger than crypto and OVAL
  • MODIFIED ACID FAST STAIN (special stain) -> not diagnosed on routine O and P study
  • Tx: supportive - TMP-SMX if needed
76
Q

Cyclospora cayatanensis

A
  • Protozoa
  • Sx more severe/chronic in ptxs w/ AIDS and biliary diseases including acaculous cholecystitis
  • larger than Crypto
  • MODIFIED ACID FAST STAIN
  • Tx: TMP-SMX
77
Q

Microsporidiosis

A
  • acutally a FUNGI (thought to be protozoa)
  • more severe and symptomatic in HIV+ ptxs w/ CD <100
  • Tx: Albendazole

OMS2 - Semester 2 - BECOM Exam 1 (7 decks)

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