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Clin Med Exam 2 > Exam 2 Learning Objectives > Flashcards

Exam 2 Learning Objectives Flashcards

1
Q

What is the clinical presentation of pyloric stenosis?

A

Progressive, projectile nonbilious vomiting; still hungry

Causes poor weight gain, abdominal distention, and rarely jaundice

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2
Q

What is the demographic most commonly affected by pyloric stenosis?

A

Most commonly occurs at ~2 months old; white males

Associated with trisomy 18, Turner syndrome, eosinophilic gastroenteritis, and epidermolysis bullosa + other GI issues

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3
Q

What imaging study is used to diagnose pyloric stenosis?

A

Ultrasound showing elongation >14mm & thickening of the pylorus >4mm

Barium upper GI series shows ‘String sign’

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4
Q

What is the treatment for pyloric stenosis?

A

IV fluid to correct dehydration & electrolytes; corrected surgically with Pyloromyotomy

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5
Q

What is the clinical presentation of tracheoesophageal fistula (TEF) with esophageal atresia?

A

Lots of oral secretions & a large air-distended stomach; cyanosis, choking, regurgitation, coughing

Delay 1st feeding until diagnostic study; CXR shows a coiled tube esophageal pouch

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6
Q

What is the VACTERL association?

A

Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula, Renal defects, Limb defects

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7
Q

What is the classic triad of intussusception?

A

Abdominal pain, Vomiting, Currant jelly stool

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8
Q

What imaging findings are associated with intussusception?

A

Abdominal ultrasound shows ‘Target Sign’; abdominal imaging can show absent bowel gas in RLQ

Palpable ‘sausage-shaped’ mass in RUQ

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9
Q

What is the treatment for volvulus?

A

Must be corrected through surgery

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10
Q

What distinguishes physiologic reflux from GERD?

A

Physiologic reflux is self-resolving; GERD involves severe emesis, abdominal pain, and failure to thrive

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11
Q

What are the common food allergies in children?

A

Peanuts, Eggs, Dairy, Soy

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12
Q

What are the clinical manifestations of anaphylaxis?

A

Cutaneous symptoms, breathing issues, cardiovascular symptoms, gastrointestinal symptoms

Management includes assessment of ABCs, giving epinephrine, O2, IV fluids

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13
Q

What is the difference between Kwashiorkor and Marasmus?

A

Kwashiorkor = Protein deficiency; Marasmus = Everything deficiency

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14
Q

What is the presentation of vitamin D deficiency?

A

Nausea, vomiting, weakness, renal failure, rickets

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15
Q

What is the management for iron deficiency in infants?

A

Ensure proper iron intake; avoid low-iron formula

Symptoms include tiredness, poor cognitive/social development, and anemia

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16
Q

What distinguishes pathologic jaundice from physiologic jaundice?

A

Pathologic jaundice has a rate of rise > 0.2 mg/dL and visible jaundice on day 1; physiologic jaundice peaks between day 3-5

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17
Q

Fill in the blank: The classic presentation of Hirschsprung disease includes failure to pass _______.

A

meconium

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18
Q

What is the treatment for Hirschsprung disease?

A

Surgery; resection of aganglionic segment with endorectal pull-through

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19
Q

What are the common symptoms of zinc deficiency?

A

Rash, poor wound healing, growth failure, anorexia

Acrodermatitis Enteropathica is an AR disorder in zinc absorption

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20
Q

What are the symptoms of folate deficiency?

A

Macrocytic anemia, poor growth, glossitis, diarrhea

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21
Q

What is the presentation of vitamin K deficiency in newborns?

A

Ecchymosis, purpura, GI bleeding, anemia, and shock from severe blood loss

Hemorrhagic disease of the newborn occurs in infants without vitamin K shot at birth

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22
Q

What is the management for cyclic vomiting?

A

Address dehydration; use of antiemetics is controversial

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23
Q

What is indirect hyperbilirubinemia?

A

Hyperbilirubinemia due to J albumin binding, hemolysis, or hemoglobinopathies

Caused by factors such as sulfa drugs and ceftriaxone, hereditary spherocytosis, Gilbert syndrome, or Crigler-Najjar Syndrome.

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24
Q

What is an ileus?

A

Obstipation and intolerance of oral intake due to nonmechanical factors disrupting GI tract motility

Can result from post-operative conditions, electrolyte disorders, medications, inflammation, or sepsis.

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25
Q

What are common causes of an ileus?

A
  • Post-operative (most common)
  • Electrolyte disorders
  • Medications
  • Gallbladder/pancreas inflammation
  • Sepsis

Neural, inflammatory, and pharmacological factors also contribute.

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26
Q

What are the clinical manifestations of an ileus?

A
  • Abdominal distension
  • Bloating
  • Nausea/vomiting
  • Delayed passage of gas
  • Inability to tolerate oral diet

Physical exam may show abdominal distension, tympany, reduced bowel sounds, and diffuse tenderness.

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27
Q

What laboratory tests are used to evaluate an ileus?

A
  • CBC (WBC, hemoglobin/hematocrit)
  • CMP (BUN, creatinine, bicarb, electrolytes)
  • Lactic Acid
  • Lipase
  • Troponin

These tests help assess for ischemia and other underlying issues.

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28
Q

What imaging findings are indicative of an ileus?

A
  • Dilated loops of small bowel and colon
  • Air in the colon and rectum without a transition zone

CT may show dilated loops of bowel without a transition point.

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29
Q

What are potential causes of small bowel obstruction?

A
  • Adhesive disease
  • Neoplasm
  • Herniation
  • Inflammatory bowel disease (IBD)
  • Volvulus

Both complete and incomplete obstructions can occur.

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30
Q

Describe the clinical manifestations of small bowel obstruction.

A
  • Abdominal pain
  • Distention
  • Bloating
  • Nausea/vomiting
  • Obstipation

Important to inquire about past abdominal surgeries and history of intra-abdominal conditions.

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31
Q

What laboratory tests are used to assess small bowel obstruction?

A
  • CBC (WBC, hemoglobin/hematocrit)
  • CMP (BUN, creatinine, bicarb, electrolytes)
  • Lactic Acid
  • Lipase
  • Troponin

Similar to tests for ileus.

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32
Q

What imaging findings suggest small bowel obstruction?

A
  • Small bowel dilation (>2.5-3 cm)
  • Lack of colonic dilation (colon diameter <6 cm)
  • Characteristic circular folds in small bowel

Supine views show dilation of multiple bowel loops.

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33
Q

What is the preferred imaging for suspected small bowel obstruction?

A

CT abdomen/pelvis with IV contrast

This helps assess bowel wall ischemia; plain radiographs may also be appropriate.

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34
Q

What is the initial treatment strategy for small bowel obstruction?

A
  • IV fluids
  • Electrolyte replacement
  • NPO
  • NG tube decompression
  • Antiemetics
  • Analgesia

Monitor for 3-5 days before considering surgery.

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35
Q

What are the potential complications of small bowel obstruction?

A
  • Bowel necrosis
  • Peritonitis
  • Perforation
  • Intra-abdominal abscess
  • Hypovolemia

Resulting from fluid and electrolyte loss due to emesis.

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36
Q

What are the potential causes of acute pancreatitis?

A
  • Gallstones
  • Alcohol ingestion
  • Hypertriglyceridemia

The acronym I GET SMASHED summarizes other causes.

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37
Q

What are the clinical manifestations of acute pancreatitis?

A
  • Persistent upper abdominal pain
  • Pain radiating to the back
  • Nausea/vomiting
  • Anorexia

Skin discoloration (Cullen’s and Grey Turner’s signs) may indicate retroperitoneal hemorrhage.

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38
Q

What laboratory findings are indicative of acute pancreatitis?

A
  • Lipase >3x upper limit of normal
  • Elevated amylase (less sensitive)
  • CBC, CMP, Lactate, Troponin

Lipase is 100% sensitive and 99% specific for pancreatitis.

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39
Q

What is the Atalanta Criteria for diagnosing acute pancreatitis?

A

Requires 2 of 3 conditions: * Upper abdominal pain suggestive of pancreatitis
* Serum lipase or amylase >3x upper limit
* Imaging findings of pancreatic inflammation.

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40
Q

What is the first-line treatment for acute pancreatitis?

A
  • Treat underlying cause
  • Fluid replacement
  • Pain control
  • OMT

Nutrition should start enterally as soon as possible.

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41
Q

What are the clinical manifestations of alcohol withdrawal?

A
  • Hallucinations
  • Agitation
  • Tremor
  • Elevated pulse
  • Sweating
  • Insomnia
  • Nausea/vomiting
  • Seizures

The timeline includes minor withdrawal, withdrawal seizures, alcoholic hallucinosis, and Delirium Tremens.

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42
Q

What is the primary treatment for alcohol withdrawal?

A
  • Benzodiazepines (e.g., chlordiazepoxide, diazepam, lorazepam)

They are used for agitation and to prevent severe withdrawal.

43
Q

What are common signs and symptoms of liver disease?

A
  • Pruritus
  • Hepatomegaly
  • Splenomegaly
  • Dark urine
  • Light stools
  • Jaundice/icterus.
44
Q

What is the difference between unconjugated and conjugated hyperbilirubinemia?

A
  • Unconjugated: elevated before liver conjugation (e.g., hemolysis)
  • Conjugated: elevated after conjugation (e.g., liver destruction)

Examples include Gilbert syndrome (unconjugated) and Dubin-Johnson syndrome (conjugated).

45
Q

How do you differentiate between hepatocellular and cholestatic patterns of liver disease?

A
  • Hepatocellular: Transaminases (ALT/AST) > Alk Phos
  • Cholestatic: Alk Phos > Transaminases

GGT is sensitive for liver disease but not helpful in differentiation.

46
Q

What is the treatment plan for viral hepatitis?

A
  • Supportive care
  • Vaccination for post-exposure
  • Liver transplant for chronic or fulminant cases

Hepatitis C can be cured with antivirals.

47
Q

What is the treatment for confirmed hepatitis B exposure?

A

Vaccine and hepatitis B immunoglobulin

If chronic or progresses to fulminant cases, liver transplant may be needed.

48
Q

What can cure hepatitis C?

A

Antivirals

49
Q

What is the management for Alcoholic Liver Disease?

A

Abstinence from alcohol, corticosteroids or pentoxifylline, assess for nutritional deficiencies

50
Q

What is the treatment for Hemochromatosis?

A

Phlebotomy

If transfusion dependent, iron chelation is necessary.

51
Q

What is the treatment for Wilson’s Disease?

A

Penicillamine

52
Q

What is the characteristic laboratory finding for acute viral hepatitis?

A

High AST/ALT levels

53
Q

What is a clinical feature of Gilbert’s Syndrome?

A

Impaired bilirubin conjugation leading to mild jaundice under physical stressors

54
Q

What causes Hemochromatosis?

A

Iron overload with multiple etiologies

55
Q

What are the signs and symptoms of Hemochromatosis?

A

LFT abnormalities, chronic liver disease, cirrhosis, cardiac enlargement, diabetes, hypogonadism, skin hyperpigmentation, fatigue, arthropathy

56
Q

What laboratory findings confirm Hemochromatosis?

A

Increased transferrin saturation, increased plasma ferritin without active inflammation

57
Q

What is the inheritance pattern of Wilson’s Disease?

A

Autosomal recessive (chromosome 13)

58
Q

What is the treatment for Autoimmune Hepatitis?

A

Corticosteroids

59
Q

What characterizes Alcoholic Steatohepatitis?

A

Acute presentation with fever, hepatomegaly, ascites, encephalopathy, AST:ALT ratio >1.5

60
Q

What are the diagnostic criteria for cirrhosis related to alcohol consumption?

A

Increased risk with men consuming >60-80 g/day and women >20 g/day for >10 years

61
Q

What are the red flag symptoms associated with dyspepsia?

A

VBAD: Vomiting, Bleeding, Abdominal mass/Abnormal weight loss, Dysphagia

62
Q

What is the ROME IV criteria for functional dyspepsia?

A

Negative workup for organic disease with symptoms like postprandial fullness, early satiety, epigastric pain

63
Q

Which patients should receive esophagogastroduodenoscopy for dyspepsia?

A

Age over 60, persistent symptoms, or specific family history

64
Q

Which test is used to confirm an active H. pylori infection?

A

Stool antigen test or urea breath test

65
Q

What is the most common cause of nonerosive gastritis?

A

H. Pylori infection

66
Q

What is the first-line therapy for peptic ulcer disease?

A

Proton pump inhibitors (PPIs)

67
Q

What is the most common form of gastric carcinoma?

A

Adenocarcinoma

68
Q

List three risk factors for gastric carcinoma.

A
  • Genetics (hereditary diffuse gastric cancer)
  • Tobacco use
  • H. pylori infection
69
Q

What clinical symptom suggests a proximal tumor in gastric cancer?

A

Dysphagia

70
Q

What symptom indicates a distal tumor in gastric cancer?

A

Early satiety

71
Q

What is the significance of Virchow’s node?

A

Left supraclavicular lymph node indicating potential abdominal malignancy

72
Q

What are the osteopathic findings associated with gastric disorders?

A

Upper GI tract: T5-T9 levels; Middle GI tract: T10-T11 levels; Lower GI tract: T12-L2 levels

73
Q

What is the initial management strategy for a perforated ulcer disease?

A

IV fluids, NPO, IV antibiotics, exploratory laparotomy

74
Q

What is the treatment for Hinchey Stage III diverticular disease?

A

Surgery

75
Q

What is the most common symptom of erosive gastritis?

A

Abdominal pain

76
Q

What is the best diagnostic test for suspected erosive gastritis?

A

EGD (esophagogastroduodenoscopy)

77
Q

What should be done for all gastric ulcers found during endoscopy?

A

Biopsy

78
Q

What is the treatment regimen for H. Pylori?

A
  • Bismuth quadruple therapy
  • Triple therapy
79
Q

What is the expected duration for treatment of peptic ulcer disease with PPIs?

A

Complicated ulcers: 2x daily for 4 weeks, then daily for 8-12 weeks

80
Q

What is the recommended follow-up procedure for a patient 6-8 weeks after symptoms resolve?

A

Colonoscopy to rule out cancer

This is a standard procedure to ensure that any potential malignancy is detected early.

81
Q

What are the initial treatments for a patient with an abscess?

A

IV fluids and antibiotics; drain abscess first (IR)

IR stands for interventional radiology, a minimally invasive procedure.

82
Q

What is Hartmann’s procedure?

A

Sigmoidectomy with delayed colon resection

83
Q

What are the key symptoms of appendicitis?

A

RLQ pain, anorexia, fever, Rovsing’s sign, Psoas test positive

84
Q

What are the post-operative considerations for appendicitis?

A

NPO with IVF, trial diet, IV antibiotics, watch for post-op ileus, abscess, portal vein thrombosis, atelectasis leading to PNA, DVT

85
Q

What do the 5 W’s stand for in post-operative fever management?

A
  • Wind (atelectasis)
  • Water (UTI)
  • Wound (wound infection)
  • Walking (venous thromboembolism)
  • Wonder drug (drug fever)
86
Q

What is Nissen fundoplication?

A

Surgical treatment for GERD involving a 360-degree wrap of the stomach

87
Q

What are the current top 3 surgeries for morbid obesity?

A
  • Roux en Y Gastric Bypass
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
  • Vertical Sleeve Gastrectomy (VSG)
88
Q

What are some historical procedures for bariatric surgery?

A
  • LAP band
  • Intra-gastric balloon
  • Vertical Banded Gastroplasty
  • Jejunoileal bypass
  • Biliopancreatic diversion
89
Q

What is a common complication of Roux en Y Gastric Bypass?

A

Requires long-term vitamin support due to malnutrition

90
Q

What is the most common site for hernias?

A

Inguinal region

91
Q

What is the difference between incarcerated and strangulated hernias?

A

Incarcerated hernia is trapped and non-reducible; strangulated hernia is a surgical emergency with compromised blood supply

92
Q

What are the clinical presentations of an inguinal hernia?

A

Bulge in the groin, may extend into the scrotum, often with pain or discomfort

93
Q

What is the diagnostic method for hernias?

A

Physical Exam (PE), Ultrasound (U/S), CT scan

94
Q

What does ABCDE stand for in trauma care?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
95
Q

What are the classes of hypovolemic shock?

A
  • Class I: <15%
  • Class II: 15-30%
  • Class III: 30-40%
  • Class IV: >40%
96
Q

What is the main purpose of the FAST scan?

A

Evaluate for intra-abdominal hemorrhage

97
Q

What are indications for RUSH examination?

A

Any patient that looks ill, including non-trauma; assessment of hemodynamically unstable patients

98
Q

What transducer is used for a RUSH examination?

A

Large Curvilinear Probe

The indicator dot should be on the left.

99
Q

What is the significance of a diameter >5 cm in the aorta during an ultrasound?

A

> 5 cm diameter + shock = Ruptured AAA until proven otherwise

100
Q

What are the views used to evaluate for intra-abdominal free fluid?

A
  • Splenorenal view
  • Morison’s pouch
  • Pouch of Douglas
101
Q

What is McConnell Sign indicative of?

A

Possible right heart strain from pulmonary embolism or cor pulmonale

102
Q

What is the initial management for blunt abdominal trauma?

A

ABCDE’s: secure airway, breathing, circulation, then consider exploratory laparotomy

103
Q

What are the signs of compartment syndrome?

A

Oliguria, increased ventilator pressures, intra-abdominal pressures >10mmHg

Clin Med Exam 2 (1 decks)

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