Exam 1 Flashcards
1
Q
how to tell leukoplakia from candidiasis
A
leukoplakia doesn’t debride easily
2
Q
what to do about leukoplakia
A
biopsy if persistent
3
Q
what percentage of leukoplakia/erythroplakia is malignant or premalignant
A
10%
4
Q
most common site of oral cancer
A
lower lip
5
Q
pain with oral cancer
A
painless until metastasis
6
Q
risk factors for oral cancer
A
tobacco, actinic radiation, syphilis
7
Q
signs of dysphagia
A
weight loss, avoiding certain foods
8
Q
signs suggestive of oropharyngeal dysphagia
A
aspiration, nasal regurgitation, abnormal neuro exam
9
Q
what to do if signs suggestive of oropharyngeal dysphagia with warning signs of malignancy
A
refer to ENT for laryngoscopic eval, FEES
10
Q
what to do if signs suggestive of oropharyngeal dysphagia without warning signs of malignancy
A
refer for clinical swallow eval +/- modified barium swallow
11
Q
voluntary phase of swallowing
A
oral phase
12
Q
3 essential functions of oral cavity
A
production of speech, initiation of alimentation, host protection
13
Q
what cells in salivary glands produce saliva and do they atrophy with aging
A
acinar cells, no
14
Q
most common causes of xerostomia
A
iatrogenic, sjogrens, oral infections, gland obstructions, oral cancer
15
Q
how many over 65 are adentulous
A
1/3
16
Q
what medications can cause dry mouth
A
anticholinergics, antihistamines, antidepressants, diuretics, CCB
17
Q
what factors contribute to teeth loss
A
xerostomia, lack of care, bone loss, caries, peridontal disease, poor diet
18
Q
causes of angular chelitis
A
immune dysfunction, poor nutrition, mouth breathing, dry mouth
19
Q
what malignancy does leukoplakia usually represent
A
SCC
20
Q
is atrophic glossitis painful
A
no
21
Q
causes of atrophic glossitis
A
deficiencies (B12, iron, vitamin E), medication reaction, autoimmune
22
Q
classic presentation of oropharyngeal dysphagia
A
history of stroke or oral cavity problems, sensation of choking immediately after swallowing, with associated respiratory ssx
23
Q
classic presentation of esophageal dysphagia
A
history of motility/neuromuscular disorder or mechanical esophageal problem with sensation of chest pain several seconds after swallowing and associated copious salivation
24
Q
what does difficulty swallowing solid foods suggest
A
obstructive problem
25
what does difficulty swallowing liquids suggest
neurologic problem
26
sequelae of dysphagia
aspiration, pain, dehydration, malnutrition, increased cancer risk, need supervision/special diet/increased time to eat
27
warning sign of laryngeal cancer
persistent hoarse voice non-responsive to PPI or allergy medications
28
location of SCC of esophagus
mid esophagus
29
location of adenocarcinoma of esophagus
distal esophagus
30
what is Zenker's diverticulum
extrusion of esophageal mucosa between weak muscle fibers in the posterior hypopharynx
31
Zenker's diverticulum presentation
transient dysphagia with aspiration, gurgling, neck mass, regurgitation, esophageal obstruction
32
Zenker's diverticulum diagnosis
barium examination
33
Zenker's diverticulum complications
intubation during endoscopy/NGT, bleeding
34
Zenker's diverticulum treatment
consider surgical closure if symptomatic
35
what to do if hx of PUD but cannot stop NSAID/ASA
consider misoprostol
36
duration of treatment for PPI in gastritis/PUD
minimum of 8 weeks
37
gold standard for diagnosis and confirmed tx of gastritis/PUD
upper endoscopy
38
most common causes of gastritis
H Pylori (70%), viral infections, irritants (NSAIDs, ASA)
39
what processes are increased in the normal aging of the stomach
contact time with irritants (NSAIDs), prevalence of H Pylori, pernicious anemia, cancers
40
what processes are decreased in the normal aging of the stomach
clearance of liquids, sensory neuron function, mucosal blood flow, acid/pepsin/fluid secretion, cytoprotective factors
41
infectious causes of esophagitis
candida, H pylori, chlamydia/gonorrhea
42
chemical causes of esophagitis
acid reflux, caustic material
43
diagnosis of esophagitis
EGD
44
barrett's pathophys
abnormal columnar epithelium replaces stratified squamous epithelium in distal esophagus
45
barrett's sequelae
predisposes to adenocarcinoma
46
barrett's ssx
usually painless
47
esophageal cancer presentation
progressive obstruction, dysphagia, weight loss, GI bleeds, persistent GERD
48
esophageal cancer risk factors
white males, obesity, tobacco, ETOH
49
esophageal cancer prognosis
generally poor (usually found in later stages)
50
NSAIDs typically cause ulcers in what location
gastric, may also be duodenal
51
is acute or chronic NSAID use more of a risk factor for gastritis
acute
52
pathophys of NSAID associated gastritis
COX-1 inhibition leads to decreased mucosal defense and inhibition of thromboxane A2 leading to reduced platelet function and risk of bleeding
53
gastritis common but atypical presentation
vague, low-intensity abdominal pain
54
GERD symptoms more common in elderly
vomiting, anorexia, belching, laryngitis, postprandial fullness, dysphagia, respiratory ssx
55
esophagitis correlation with degree of ssx
correlates poorly in elderly
56
GERD red flag symptoms
weight loss, anemia, nausea/vomiting, dysphagia, anorexia, early satiety, fecal occult blood
57
blood work for GERD
CBC, B12, folate, H pylori, chem
58
diagnosis of GERD
mostly clinical with empiric PPI treatment
59
gold standard for H Pylori diagnosis
urea breath test 30 minutes before and after urea liquid, rapid urease or culture on endoscopic biopsies
60
major problem with H pylori serologic testing
remains elevated for 2 months after infection
61
single most important risk factor for esophageal adenocarcinoma
Barrett's esophagus (accounts for 50% of newly diagnosed cancer)
62
most important risk factor for esophageal squamous cell carcinoma
tobacco use
63
most common symptom of esophageal SCC
dysphagia
64
hallmark of gastric cancer
pernicious anemia followed by weight loss
65
prognosis of gastric cancer
poor - generally found at more advanced stage
66
gastric cancer is associated with what 2 conditions
partial gastrectomy, H pylori
67
causes of gastroparesis
DM, drugs, surgery, bulimia, PD (?), scleroderma, hypothyroid, smoking, cancer/cancer treatment
68
surgery associated with gastroparesis
anything damaging the vagus nerve
69
drugs associated with gastroparesis
narcotics, clonidine, calcium channel blockers, antidepressants, TCAs
70
most common population with gastroparesis
women, mean age 34
71
pathophys of gastroparesis
loss or dysfunction of interstitial cells of Cajal, which are the pacemakers of the antrum/pylorus
72
presentation of gastroparesis
labile glucose due to erratic gastric emptying, epigastric fullness, satiety, vomiting
73
gastroparesis treatment, nonpharmacological
small meals, increased fluids, low fat, thorough chewing, postprandial walking
74
gastroparesis treatment, pharmacologic
erythromycin (stimulates motilin receptors), metoclopramide (dopamine receptor agonist)
75
black box side effect of metoclopramide
tardive dyskinesia
76
gastroparesis treatment, surgical
endoscopic injection of botox, dilation of pylorus
77
what nerve mediates relaxation of LES
vagus
78
normal transit time through esophagus
8-10 sec
79
first-line test in patient with suspected esophageal dysphagia
barium esophagram
80
test to diagnose achalasia
manometry
81
most common cause of oropharyngeal dysphagia
neurological
82
management for oropharyngeal dysphagia of neurological origin
speech language pathologist referral
83
what is achalasia
incomplete LES relaxation combined with lack of peristalsis
84
achalasia treatment
botox, endoscopic pneumatic balloon dilation or myotomy
85
what is nutcracker esophagus
high amplitude peristaltic contractions in the distal esophagus
86
pathophys of protein-losing enteropathy
increased intestinal leakage of plasma proteins due to mucosal injury, increased lymphatic pressure, or genetics
87
diagnosis of protein-losing enteropathy
endoscopy with biopsy (suspect in pt with rheumatologic disease and low albumin)
88
when is weight loss concerning
at least 5%
89
sarcopenia
loss of muscle tissue as a natural part of the aging process
90
elements of metabolic syndrome
obesity, hyperglycemia/hyperinsulinemia, dyslipidemia, HTN
91
ssx of vitamin D deficiency
depression, hair loss, fatigue, muscle pain, recurrent infections, bone pain
92
causes of vitamin D deficiency in elderly
reduced sun exposure, less ability of skin to manufacture vitamin D, decreased consumption due to meds/diet
93
what is considered vitamin D sufficiency
>20
94
what is considered vitamin D deficiency
<12
95
vitamin D deficiency treatment
50,000 IU of D2 or D3 weekly for 8 weeks or 6000 IU D2 or D3 daily to achieve level >30
96
vitamin D maintenance dose
1500-2000 IU daily
97
functions of vitamin B12
blood cell formation, neuro function, DNA synthesis
98
dietary sources of vitamin B12
fish, meat, poultry, eggs, milk, milk products
99
B12 deficiency ssx
megaloblastic anemia, fatigue, weakness, loss of bowel/bladder control, loss of appetite, weight loss
100
what meds are linked to B12 deficiency
acid suppressants, metformin, colchicine
101
cutoff for B12 deficiency
<200
102
B12 level for sufficiency
>350
103
goal for B12 level
>400
104
B12 deficiency treatment
1000 mcg sublingual daily and retest in 3 months
105
what to do if B12 deficiency doesn't respond to SL treatment
switch to 1000 mcg IM monthly
106
types of osteoporosis
primary and secondary
107
types of primary osteoporosis
type 1 (menopausal) type 2 (involutional, age-related)
108
causes of secondary osteoporosis
endocrine abnormalities, multiple myeloma
109
complications of osteoporosis
kyphosis, compression fracture, low-velocity fractures
110
what are osteoclasts
macrophage-like cells for bone removal
111
what are osteoblasts
differentiate from mesenchymal cells to form bone
112
when does bone remodeling occur
it is lifelong
113
what are osteocytes
bone cells embedded in the matrix
114
what type of bone is more metabolically active
trabecular bone
115
what type of bone makes up the majority of skeletal mass
trabecular
116
factors affecting bone remodeling
genetics, hormones, calcium, vitamin D
117
what hormones affect bone remodeling
estrogen/androgens, PTH, calcitonin
118
risk factors for osteoporosis
hypogonadism, FMH (?), inactivity, nulliparity, hyperthyroidism, smoking, drugs, "caucasian or asian," short stature, age/sex, gastric/small bowel surgery, hyperparathyroidism, ETOH
119
dietary sources of Ca
milk products, broccoli, spinach
120
dietary sources of B12
animal meat products, beans
121
dietary sources of vitamin D
salmon, tuna, eggs, milk, breakfast cereals, cod liver oil
122
blood tests prior to treating osteoporosis
serum Ca, PTH, TSH, Vit D, GFR, serum creatinine, B12
123
indications for DEXA scan
post-menopausal, suspicious radiographs, tx monitoring, risk due to meds, malabsorption syndromes, CKD, spontaneous fracture, FMH (?), kyphosis
124
side effects of bisphosphonates
reflux, osteonecrosis of the jaw, atypical fractures, inflammatory eye disease
125
bisphosphonates MOA
structural analogs of pyrophosphate that bind to resorptive surfaces and are taken up by osteoclasts and inhibit binding proteins needed for osteoclast function
126
protein energy malnutrition definition
insufficient protein or energy to meet metabolic needs
127
causes of protein energy malnutrition
poor diet, increased metabolic demands (trauma, infection, surgery), increased nutrient loss
128
most common macronutrient deficiency
protein
129
3 most common causes of malnutrition
depression, GI problems, cancer
130
labs to obtain with weight loss
albumin, prealbumin, transferrin, lymphocytes
131
what constitutes severe weight loss
15-20%
132
what constitutes alarming weight loss
5%
133
medication to enhance oral intake
mirtazapine
134
when is osteopenia treated the same way as osteoporosis
if there is a fracture
135
test to determine if B12 deficiency is due to pernicious anemia
Shillings test
136
protein-losing enteropathy presentation
low serum proteins, edema, ascites, pleural/pericardial effusions, malnutrition
137
largest insulin-sensitive tissue in body
skeletal muscle
