GI & Integumentary

Question 1

management of hyperbilirubinemia in the newborn infant

Answer 1

management of hyperbilirubinemia in the newborn infant at 35 or more weeks gestation. These guidelines focus on frequent clinical assessment of jaundice, and treatment based on the total serum bilirubin level, the infants age in hours, and risk factors. Phototherapy should not be started based solely on the total serum bilirubin level. The guidelines encourage breastfeeding 8-12 times daily in the first few days of life to prevent dehydration.

Question 2

presentation of volvulus in infant

Answer 2

3 presenations: sudden onset of bilious vomiting and abdominal pain in a neonate; as a history of feeding problems with bilious vomiting that appears to be a bowel obstruction; or less commonly, as failure to thrive with severe feeding intolerance. The classic finding on abdominal plain films is the double bubble sign, which shows a paucity of gas (airless abdomen) with two air bubbles, one in the stomach and one in the duodenum. The upper gastrointestinal contrast study is considered the gold standard for diagnosing volvulus

Question 3

what does meckels diverticulum mimic

Answer 3

most common abnormality of small intestine in kids. prone to bleeding because it may contain heterotopic gastric mucosa. Abdominal pain, distention, and vomiting may develop if obstruction has occurred, and the presentation may mimic appendicitis. Children with appendicitis have right lower quadrant pain, abdominal tenderness, guarding, and vomiting, but not rectal bleeding.

Question 4

Rotavirus

Answer 4

Rotavirus vaccine (RotaTeq) was licensed in February 2006 to protect against viral gastroenteritis. routine vaccination of infants with 3 doses to be given at 2, 4, and 6 months of age. The first dose should be given between 6 and 12 weeks of age, and subsequent doses should be given at 4- to 10-week intervals, but all three doses should be administered by 32 weeks of age. Unlike the vaccine RotaShield, which was marketed in 1999, RotaTeq is not known to increase the risk for intussusception.

Question 5

risk factor for acute pancreatitis

Answer 5

Pancreatitis associated with gallstones, extreme hypertrigliceridemia, and excessive alcohol use.

Question 6

Treatment for Helicobacter pylori infection will reduce or improve

Answer 6

Eradication of Helicobacter pylori significantly reduces the risk of ulcer recurrence and rebleeding in patients with duodenal ulcer, and reduces the risk of peptic ulcer development in patients on chronic NSAID therapy.

Question 7

first line agent for c.diff

Answer 7

oral metronidazole is now the first-line agent because of cost considerations and because of concerns about the development of vancomycin-resistant organisms. If the patient has refractory symptoms despite treatment with oral metronidazole, then oral vancomycin would be

Question 8

chlorine-resistant fecal organisms that could contaminate public drinking water.

Answer 8

Cryptosporidium oocysts and Giardia cysts are resistant to chlorine and are important causes of gastroenteritis from drinking water. Entamoeba histolytica and hepatitis A virus are also relatively chlorine resistant

Question 9

Hepatitis C screening is routinely recommended

Answer 9

Patients should be routinely screened for hepatitis C if they have a history of any of the following: intravenous drug abuse no matter how long or how often, receiving clotting factor produced before 1987, persistent alanine aminotransferase elevations, or recent needle stick with HCV-positive blood.

Question 10

PSA
alphafetoprotein
CA-125
Carcinoembryonic antigen (CEA)
Cancer antigen 27.29

Answer 10

Prostate-specific antigen -screen for prostate cancer

Alpha-fetoprotein–>marker for hepatocellular carcinoma and nonseminomatous germ cell tumor

CA-125 –>marker for ovarian cancer

Carcinoembryonic antigen (CEA)=marker for colon, esophageal & hepatic cancers. expressed in normal mucosal cells & overexpressed in adenocarcinoma, especially colon cancer.

Cancer antigen 27.29= tumor marker for breast cancers

Question 11

melanosis coli

Answer 11

melanosis coli = black/brown discoloration of colon mucosa. Resulting from the presence of dark pigment in large mononuclear cells/macrophages in the lamina propria of the mucosa. The coloration is usually most intense just inside the anal sphincter and is lighter higher up in the sigmoid colon. The condition is thought to result from fecal stasis and the use of anthracene cathartics such as cascara sagrada, senna, and danthron

Question 12

Norwalk Virus

Answer 12

cruise ships, waterborne or foodborne spread. In US these viruses are responsible for about 90% of all epidemics of nonbacterial gastroenteritis. Symptomatic treatment

Question 13

IBS

Answer 13

benign, chronic symptom complex of altered bowel habits & abdominal pain. Rome I & II criteria for diagnosing IBS:

• Relief of symptoms with defecation
• Changes in stool consistency from loose and watery to constipation
• Passage of mucus with bowel movements
• Abdominal bloating

*presence of nocturnal symptoms=red flag alerting physician to alternate diagnosis requiriing further evaluation.

Question 14

Key risk factors for hepatitis C infection

Answer 14

long-term hemodialysis, IV drug use, blood transfusion/organ transplantation before 1992, & receipt of clotting factors before 1987. Sexual transmission is low but possible, likelihood increases with multiple partners.

Question 15

best study to confirm cholelithiasis

Answer 15

Abdominal ultrasonography= best study to confirm diag because of its high sensitivity and accuracy in detecting gallstones. Plain radiography of the abdomen may reveal radiopaque gallstones, but will not reveal radiolucent stones or biliary dilatation.

Question 16

positive spot urine test for homovanillic acid (HMA) and vanillylmandelic acid (VMA) is a marker for ?

Answer 16

Serum neuron-specific enolase (NSE) testing, as well as spot urine testing for homovanillic acid (HVA) and vanillylmandelic acid (VMA), should be obtained if neuroblastoma or pheochromocytoma is suspected

Question 17

surgical clearance with past history of pulmonary embolus

Answer 17

subcutaneous enoxaparin (Lovenox), 40 mg 1–2 hr prior to surgery and once a day after surgery

Question 18

Hand, foot, and mouth disease

Herpangina

Answer 18

Hand, foot, and mouth disease is a mild infection occurring in young children, and is caused by coxsackievirus A16. In addition to the oral lesions, vesicular lesions may occur on the feet and nonvesicular lesions may occur on the buttocks. A low-grade fever may also develop.

Herpangina is also caused by coxsackieviruses, but it is a more severe illness characterized by severe sore throat and vesiculo-ulcerative lesions limited to the tonsillar pillars, soft palate, and uvula, and occasionally the posterior oropharynx. Temperatures can range to as high as 41°C (106°F).

Question 19

Keratoacanthoma

Answer 19

Keratoacanthoma grows rapidly and may heal within 6 months to a year. Squamous cell carcinoma may appear grossly and histologically similar to keratoacanthoma but does not heal spontaneously.

Question 20

Xerosis

Answer 20

pathologic dryness of the skin that is especially prominent in the elderly. It is probably caused by minor abnormalities in maturation of the epidermis that lead to decreased hydration of the superficial portion of the stratum corneum. Xerosis often intensifies in winter, because of the lower humidity and cold temperatures.

Question 21

Stasis dermatitis

Answer 21

Stasis dermatitis, due to chronic venous insufficiency, appears as a reddish-brown discoloration of the lower leg.

Question 22

Lichen simplex chronicus

Answer 22

Lichen simplex chronicus, the end result of habitual scratching or rubbing, usually presents as isolated hyperpigmented, edematous lesions, which become scaly and thickened in the center.

Question 23

Rosacea

Answer 23

Rosacea is most often seen on the face as an erythematous, acneiform eruption, which flushes easily and is surrounded by telangiectasia.

Question 24

what type of biopsy is recommended if melanoma is suspected

Answer 24

Though an excisional biopsy takes longer, it is the procedure of choice when melanoma is suspected.

shave biopsy should never be done for suspected melanoma, b/c will transect the lesion and destroy evidence concerning its depth, thus making it difficult to assess the prognosis.

punch biopsy use with discretion when the lesion is too large for complete excision, or if substantial disfigurement would occur. Since this may not actually retrieve cancerous tissue from an unsampled area of a large lesion that might be malignant, it would be safest to refer such patients

Question 25

what decreases pain from infiltration of local anesthetics

Answer 25

The pain from infiltration of local anesthetics can be decreased by using a warm solution, using small needles, and performing the infiltration slowly. It is also helpful to add sodium bicarbonate to neutralize the anesthetic since they are shipped at an acidic pH to prolong shelf life. An exception to this tip is bupivicaine (Marciane, Sensorcaine) as it will precipitate in the presence of sodium bicarbonate. It also helps to inject the agent through the edges of the wound (assuming the wound is not contaminated) and to pretreat the wound with topical anesthetics.

Question 26

Acne neonatorum

Answer 26

consists of closed comedones on the forehead, nose, and cheeks, and is thought to result from stimulation of sebaceous glands by maternal and infant androgens. lesions usually resolve spontaneously within 4 months without scarring

vs. erythema toxicum neonatorum include papules, pustules, and erythema.

Question 27

cutaneous larva migrans

Answer 27

cutaneous larva migrans, a common condition caused by dog and cat hookworms. Fecal matter deposited on soil or sand may contain hookworm eggs that hatch and release larvae, which are infective if they penetrate the skin. Walking barefoot on contaminated ground can lead to infection.

Question 28

Chronic paronychia

Answer 28

Chronic paronychia= common condition in workers whose hands are exposed to chemical irritants or are wet for long periods of time. This patient is an otherwise healthy hairdresser, with frequent exposure to irritants. The patient should be advised to avoid exposure to harsh chemicals & water.
In addition, the use of strong topical corticosteroids over several weeks can greatly reduce the inflammation, allowing the nail folds to return to normal and helping the cuticles recover their natural barrier to infection. Soaking in iodine solution would kill bacteria, but would also perpetuate the chronic irritation.

Question 29

screening for melanoma

Answer 29

no randomized, controlled trials or other definitive data to indicate that screening for melanoma reduces mortality. There are, however, factors which indicate that screening would be beneficial, including the increasing prevalence of the disease and the fact that screening is time-effective and safe. If screening is performed, populations at greatest risk should be considered. Men, especially those over age 50, have the highest incidence of melanoma.

Question 30

cutaneous leishmaniasis

Answer 30

cutaneous leishmaniasis, caused by an intracellular parasite transmitted by the bite of small sandflies. Lesions develop gradually, and are often misdiagnosed as folliculitis or as infected epidermal inclusion cysts, but they fail to respond to usual skin antibiotics. Hundreds of cases have been diagnosed in troops returning from Iraq, most due to Leishmania major. Treatment is not always required, as most lesions will resolve over several months; however, scarring is frequent.

Question 31

standard therapy for scabies

Answer 31

adults and children over 5 years of age, 5% permethrin cream is standard therapy for scabies

Question 32

materials visible on plain films

Answer 32

Almost all glass is visible on radiographs if it is 2 mm or larger, and contrary to popular belief, it doesn’t have to contain lead to be visible on plain films. Many common or highly reactive materials, such as wood, thorns, cactus spines, some fish bones, other organic matter, and most plastics, are not visible on plain films.

Question 33

most common infection transmitted person-to-person in wrestlers

Answer 33

most common infection transmitted person-to-person in wrestlers is herpes gladiatorum caused by the herpes simplex virus.

Question 34

actinic keratosis

Answer 34

actinic keratosis may lead to squamous cell carcinoma with significant morbidity