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agm 3 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

how to tell leukoplakia from candidiasis

A

leukoplakia doesn’t debride easily

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2
Q

what to do about leukoplakia

A

biopsy if persistent

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3
Q

what percentage of leukoplakia/erythroplakia is malignant or premalignant

A

10%

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4
Q

most common site of oral cancer

A

lower lip

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5
Q

pain with oral cancer

A

painless until metastasis

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6
Q

risk factors for oral cancer

A

tobacco, actinic radiation, syphilis

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7
Q

signs of dysphagia

A

weight loss, avoiding certain foods

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8
Q

signs suggestive of oropharyngeal dysphagia

A

aspiration, nasal regurgitation, abnormal neuro exam

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9
Q

what to do if signs suggestive of oropharyngeal dysphagia with warning signs of malignancy

A

refer to ENT for laryngoscopic eval, FEES

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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

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11
Q

voluntary phase of swallowing

A

oral phase

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12
Q

3 essential functions of oral cavity

A

production of speech, initiation of alimentation, host protection

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13
Q

what cells in salivary glands produce saliva and do they atrophy with aging

A

acinar cells, no

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14
Q

most common causes of xerostomia

A

iatrogenic, sjogrens, oral infections, gland obstructions, oral cancer

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15
Q

how many over 65 are adentulous

A

1/3

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16
Q

what medications can cause dry mouth

A

anticholinergics, antihistamines, antidepressants, diuretics, CCB

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17
Q

what factors contribute to teeth loss

A

xerostomia, lack of care, bone loss, caries, peridontal disease, poor diet

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18
Q

causes of angular chelitis

A

immune dysfunction, poor nutrition, mouth breathing, dry mouth

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19
Q

what malignancy does leukoplakia usually represent

A

SCC

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20
Q

is atrophic glossitis painful

A

no

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21
Q

causes of atrophic glossitis

A

deficiencies (B12, iron, vitamin E), medication reaction, autoimmune

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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

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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

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24
Q

what does difficulty swallowing solid foods suggest

A

obstructive problem

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25
Q

what does difficulty swallowing liquids suggest

A

neurologic problem

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26
Q

sequelae of dysphagia

A

aspiration, pain, dehydration, malnutrition, increased cancer risk, need supervision/special diet/increased time to eat

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27
Q

warning sign of laryngeal cancer

A

persistent hoarse voice non-responsive to PPI or allergy medications

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28
Q

location of SCC of esophagus

A

mid esophagus

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29
Q

location of adenocarcinoma of esophagus

A

distal esophagus

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30
Q

what is Zenker’s diverticulum

A

extrusion of esophageal mucosa between weak muscle fibers in the posterior hypopharynx

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31
Q

Zenker’s diverticulum presentation

A

transient dysphagia with aspiration, gurgling, neck mass, regurgitation, esophageal obstruction

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32
Q

Zenker’s diverticulum diagnosis

A

barium examination

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33
Q

Zenker’s diverticulum complications

A

intubation during endoscopy/NGT, bleeding

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34
Q

Zenker’s diverticulum treatment

A

consider surgical closure if symptomatic

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35
Q

what to do if hx of PUD but cannot stop NSAID/ASA

A

consider misoprostol

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36
Q

duration of treatment for PPI in gastritis/PUD

A

minimum of 8 weeks

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37
Q

gold standard for diagnosis and confirmed tx of gastritis/PUD

A

upper endoscopy

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38
Q

most common causes of gastritis

A

H Pylori (70%), viral infections, irritants (NSAIDs, ASA)

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39
Q

what processes are increased in the normal aging of the stomach

A

contact time with irritants (NSAIDs), prevalence of H Pylori, pernicious anemia, cancers

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40
Q

what processes are decreased in the normal aging of the stomach

A

clearance of liquids, sensory neuron function, mucosal blood flow, acid/pepsin/fluid secretion, cytoprotective factors

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41
Q

infectious causes of esophagitis

A

candida, H pylori, chlamydia/gonorrhea

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42
Q

chemical causes of esophagitis

A

acid reflux, caustic material

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43
Q

diagnosis of esophagitis

A

EGD

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44
Q

barrett’s pathophys

A

abnormal columnar epithelium replaces stratified squamous epithelium in distal esophagus

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45
Q

barrett’s sequelae

A

predisposes to adenocarcinoma

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46
Q

barrett’s ssx

A

usually painless

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47
Q

esophageal cancer presentation

A

progressive obstruction, dysphagia, weight loss, GI bleeds, persistent GERD

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48
Q

esophageal cancer risk factors

A

white males, obesity, tobacco, ETOH

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49
Q

esophageal cancer prognosis

A

generally poor (usually found in later stages)

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50
Q

NSAIDs typically cause ulcers in what location

A

gastric, may also be duodenal

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51
Q

is acute or chronic NSAID use more of a risk factor for gastritis

A

acute

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52
Q

pathophys of NSAID associated gastritis

A

COX-1 inhibition leads to decreased mucosal defense and inhibition of thromboxane A2 leading to reduced platelet function and risk of bleeding

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53
Q

gastritis common but atypical presentation

A

vague, low-intensity abdominal pain

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54
Q

GERD symptoms more common in elderly

A

vomiting, anorexia, belching, laryngitis, postprandial fullness, dysphagia, respiratory ssx

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55
Q

esophagitis correlation with degree of ssx

A

correlates poorly in elderly

56
Q

GERD red flag symptoms

A

weight loss, anemia, nausea/vomiting, dysphagia, anorexia, early satiety, fecal occult blood

57
Q

blood work for GERD

A

CBC, B12, folate, H pylori, chem

58
Q

diagnosis of GERD

A

mostly clinical with empiric PPI treatment

59
Q

gold standard for H Pylori diagnosis

A

urea breath test 30 minutes before and after urea liquid, rapid urease or culture on endoscopic biopsies

60
Q

major problem with H pylori serologic testing

A

remains elevated for 2 months after infection

61
Q

single most important risk factor for esophageal adenocarcinoma

A

Barrett’s esophagus (accounts for 50% of newly diagnosed cancer)

62
Q

most important risk factor for esophageal squamous cell carcinoma

A

tobacco use

63
Q

most common symptom of esophageal SCC

A

dysphagia

64
Q

hallmark of gastric cancer

A

pernicious anemia followed by weight loss

65
Q

prognosis of gastric cancer

A

poor - generally found at more advanced stage

66
Q

gastric cancer is associated with what 2 conditions

A

partial gastrectomy, H pylori

67
Q

causes of gastroparesis

A

DM, drugs, surgery, bulimia, PD (?), scleroderma, hypothyroid, smoking, cancer/cancer treatment

68
Q

surgery associated with gastroparesis

A

anything damaging the vagus nerve

69
Q

drugs associated with gastroparesis

A

narcotics, clonidine, calcium channel blockers, antidepressants, TCAs

70
Q

most common population with gastroparesis

A

women, mean age 34

71
Q

pathophys of gastroparesis

A

loss or dysfunction of interstitial cells of Cajal, which are the pacemakers of the antrum/pylorus

72
Q

presentation of gastroparesis

A

labile glucose due to erratic gastric emptying, epigastric fullness, satiety, vomiting

73
Q

gastroparesis treatment, nonpharmacological

A

small meals, increased fluids, low fat, thorough chewing, postprandial walking

74
Q

gastroparesis treatment, pharmacologic

A

erythromycin (stimulates motilin receptors), metoclopramide (dopamine receptor agonist)

75
Q

black box side effect of metoclopramide

A

tardive dyskinesia

76
Q

gastroparesis treatment, surgical

A

endoscopic injection of botox, dilation of pylorus

77
Q

what nerve mediates relaxation of LES

A

vagus

78
Q

normal transit time through esophagus

A

8-10 sec

79
Q

first-line test in patient with suspected esophageal dysphagia

A

barium esophagram

80
Q

test to diagnose achalasia

A

manometry

81
Q

most common cause of oropharyngeal dysphagia

A

neurological

82
Q

management for oropharyngeal dysphagia of neurological origin

A

speech language pathologist referral

83
Q

what is achalasia

A

incomplete LES relaxation combined with lack of peristalsis

84
Q

achalasia treatment

A

botox, endoscopic pneumatic balloon dilation or myotomy

85
Q

what is nutcracker esophagus

A

high amplitude peristaltic contractions in the distal esophagus

86
Q

pathophys of protein-losing enteropathy

A

increased intestinal leakage of plasma proteins due to mucosal injury, increased lymphatic pressure, or genetics

87
Q

diagnosis of protein-losing enteropathy

A

endoscopy with biopsy (suspect in pt with rheumatologic disease and low albumin)

88
Q

when is weight loss concerning

A

at least 5%

89
Q

sarcopenia

A

loss of muscle tissue as a natural part of the aging process

90
Q

elements of metabolic syndrome

A

obesity, hyperglycemia/hyperinsulinemia, dyslipidemia, HTN

91
Q

ssx of vitamin D deficiency

A

depression, hair loss, fatigue, muscle pain, recurrent infections, bone pain

92
Q

causes of vitamin D deficiency in elderly

A

reduced sun exposure, less ability of skin to manufacture vitamin D, decreased consumption due to meds/diet

93
Q

what is considered vitamin D sufficiency

A

> 20

94
Q

what is considered vitamin D deficiency

A

<12

95
Q

vitamin D deficiency treatment

A

50,000 IU of D2 or D3 weekly for 8 weeks or 6000 IU D2 or D3 daily to achieve level >30

96
Q

vitamin D maintenance dose

A

1500-2000 IU daily

97
Q

functions of vitamin B12

A

blood cell formation, neuro function, DNA synthesis

98
Q

dietary sources of vitamin B12

A

fish, meat, poultry, eggs, milk, milk products

99
Q

B12 deficiency ssx

A

megaloblastic anemia, fatigue, weakness, loss of bowel/bladder control, loss of appetite, weight loss

100
Q

what meds are linked to B12 deficiency

A

acid suppressants, metformin, colchicine

101
Q

cutoff for B12 deficiency

A

<200

102
Q

B12 level for sufficiency

A

> 350

103
Q

goal for B12 level

A

> 400

104
Q

B12 deficiency treatment

A

1000 mcg sublingual daily and retest in 3 months

105
Q

what to do if B12 deficiency doesn’t respond to SL treatment

A

switch to 1000 mcg IM monthly

106
Q

types of osteoporosis

A

primary and secondary

107
Q

types of primary osteoporosis

A

type 1 (menopausal) type 2 (involutional, age-related)

108
Q

causes of secondary osteoporosis

A

endocrine abnormalities, multiple myeloma

109
Q

complications of osteoporosis

A

kyphosis, compression fracture, low-velocity fractures

110
Q

what are osteoclasts

A

macrophage-like cells for bone removal

111
Q

what are osteoblasts

A

differentiate from mesenchymal cells to form bone

112
Q

when does bone remodeling occur

A

it is lifelong

113
Q

what are osteocytes

A

bone cells embedded in the matrix

114
Q

what type of bone is more metabolically active

A

trabecular bone

115
Q

what type of bone makes up the majority of skeletal mass

A

trabecular

116
Q

factors affecting bone remodeling

A

genetics, hormones, calcium, vitamin D

117
Q

what hormones affect bone remodeling

A

estrogen/androgens, PTH, calcitonin

118
Q

risk factors for osteoporosis

A

hypogonadism, FMH (?), inactivity, nulliparity, hyperthyroidism, smoking, drugs, “caucasian or asian,” short stature, age/sex, gastric/small bowel surgery, hyperparathyroidism, ETOH

119
Q

dietary sources of Ca

A

milk products, broccoli, spinach

120
Q

dietary sources of B12

A

animal meat products, beans

121
Q

dietary sources of vitamin D

A

salmon, tuna, eggs, milk, breakfast cereals, cod liver oil

122
Q

blood tests prior to treating osteoporosis

A

serum Ca, PTH, TSH, Vit D, GFR, serum creatinine, B12

123
Q

indications for DEXA scan

A

post-menopausal, suspicious radiographs, tx monitoring, risk due to meds, malabsorption syndromes, CKD, spontaneous fracture, FMH (?), kyphosis

124
Q

side effects of bisphosphonates

A

reflux, osteonecrosis of the jaw, atypical fractures, inflammatory eye disease

125
Q

bisphosphonates MOA

A

structural analogs of pyrophosphate that bind to resorptive surfaces and are taken up by osteoclasts and inhibit binding proteins needed for osteoclast function

126
Q

protein energy malnutrition definition

A

insufficient protein or energy to meet metabolic needs

127
Q

causes of protein energy malnutrition

A

poor diet, increased metabolic demands (trauma, infection, surgery), increased nutrient loss

128
Q

most common macronutrient deficiency

A

protein

129
Q

3 most common causes of malnutrition

A

depression, GI problems, cancer

130
Q

labs to obtain with weight loss

A

albumin, prealbumin, transferrin, lymphocytes

131
Q

what constitutes severe weight loss

A

15-20%

132
Q

what constitutes alarming weight loss

A

5%

133
Q

medication to enhance oral intake

A

mirtazapine

134
Q

when is osteopenia treated the same way as osteoporosis

A

if there is a fracture

135
Q

test to determine if B12 deficiency is due to pernicious anemia

A

Shillings test

136
Q

protein-losing enteropathy presentation

A

low serum proteins, edema, ascites, pleural/pericardial effusions, malnutrition

137
Q

largest insulin-sensitive tissue in body

A

skeletal muscle

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