Mehl. bullets IM pdf Flashcards
Bloody diarrhea + poultry consumption = mos? 2
Campylobacter jejuni or Salmonella spp.
Bloody diarrhea + reactive arthritis in an adult = 4 mos?
Y. enterocolitica, Campylobacter, Shigella,
Salmonella
sities visi 4 mos ir sukelia bloody.
+ entamoeba if traveler
Diarrhea + Guillain-Barre syndrome = mo?
Campylobacter
Cholecystitis/Cholelithiasis Tx if Pt doesn’t want surgery?
ursodeoxycholic acid (ursodiol)
!!!! In pregnancy duoti ursodeoxycholic acid (ursodiol) tam kad sumazetu akmenu formavimas (nes del nestumo yra suletejusi peristaltika). Bet siaip jeigu cholecistitis = daryti laparoskopine cholecistektomija. Same in apendicitis - galima operuoti
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High ALP + high direct bilirubin + high amylase or lipase = Dx?
gallstone pancreatitis = choledocholithiasis
High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy =Dx?
sphincter of Oddi dysfunction
High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy = Dx?
choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point)
Dx and Tx of choledocholithiasis?
ERCP
High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy = Dx?
pancreatic cancer
Dx of pancreatic cancer?
CT abdo with contrast
High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative = Dx?
cholangiocarcinoma
High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol = Dx?
primary biliary cirrhosis (PBC)
High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) = Dx?
primary biliary cirrhosis (PBC)
Dx of primary biliary cirrhosis (PBC)?
anti-mitochondrial Abx next best step; liver biopsy is confirmatory
High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct = Dx? Tx?
choledochal cyst -> do simple excision of cyst (cholangiocarcinoma not cystic + CT can be negative)
Imaging to view liver or pancreas?
CT with contrast
Recent cholecystectomy + fever + abdo pain = Dx?
post-op bile leak
Trichotillomania (eating one’s hair) + GI symptoms =Dx?
gastric bezoar (hair ball)
Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms = Dx?
small bowel obstruction (SBO)
Crater with necrotic debris on forearm + UC = Dx?
pyoderma gangrenosum
Red shins + Crohn = Dx?
erythema nodosum
UC + high bilirubin + high ALP = Dx?
primary sclerosing cholangitis
Tx for Crohn + UC =?
USMLE wants oral sulfasalazine (or mesalamine) first before oral steroids;
for perianal disease in Crohn, topical agents / enemas can be used, but they will not make you to pick.
Primary biliary cirrhosis Dx 1st and 2nd?
1st = antimitochondrial abs (AMA) –> 2nd. liver biopsy
Primary biliary cirrhosis Tx initial and later?
Initial = ursodeoxycholic acid (stops progression)
Later in advanced = liver biopsy
!!!!!!!!!!!!!!!!Pancreatic enzymes are normal in pancreatic cancer. !!!!!!!!!!!
Dx with CT of the abdomen
Pancreatic HEAD Ca Tx?
Whipple procedure
Pancreatic TAIL Ca Tx?
distal pancreatectomy
Patients with pancreatectomy need pancreatic enzyme supplementation. The exam can write this as “pancrelipase.”
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Courvoisier sign is a painless, palpable gallbladder in an afebrile patient who’s jaundiced. This is pancreatic cancer until proven otherwise and is pass-level.
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Cholangiocarcinoma = CP same as pancreatic Ca + negative CT ==> next step?
Answer is ERCP as next best step.
- Can be caused by Clonorchis sinensis (trematode).
Choledocholithiasis Dx?
USMLE wants abdominal ultrasound followed by ERCP as the answer. ERCP tends to show up as what they want, but there is a Q floating around somewhere that asks for ultrasound first, so know that sequence.
Gallstone pancreatitis new NBME what Dx first wants?
New 2CK NBME has CT of the abdomen as done first, prior to ERCP. This is because even though we have a stone requiring removal from the biliary tree, CT of the abdomen first looks for pancreatic fluid collection.
Cholangitis Dx and Tx?
USMLE wants antibiotics + ERCP to diagnose and treat.
Circular lesion in pancreas seen in pancreatitis = Dx?
pseudoabscess -> answer = ERCP to drain internally
