More gerber content for final Flashcards
H. pylori:
1) What are the 2 noninvasive tests that have good sensitivity/specificity?
2) What noninvasive test cannot distinguish between active and past infection?
3) When do you use noninvasive tests?
1) Urea breath [pylori produces urease, labeled CO2 detected] and stool antigen
2) Serology (Blood) test
3) When the pt doesn’t need an endoscopy
1) List the 2 biopsy-based tests for H. pylori
2) What is another invasive H. pylori test?
1) Biopsy urease test + Histologic exam
2) Microbiologic Culture (Most specific, but low sensitivity)
1) What are the 3 antibodies produced w. Celiac?
2) In most patients, a Celiac Dx is established by what 2 positive tests?
3) What autoantibody test is the preferred test for celiac disease in adults?
1) Gliadin (from gluten), Endomysium, Tissue transglutaminase (tTG)
2) Celiac serology + small bowel biopsy [Upper endoscopy with duodenal]
3) tTg-IgA
1) When do you start screening for Colorectal Cancer (CRC)?
2) Any abnormal screening test for CRC (other than colonoscopy itself) requires follow-up with what?
3) What are the 3 annual CRC tests?
1) 45
2) A timely colonoscopy
3) Annual fecal occult blood testing (FOBT) using higher sensitivity tests (Hemoccult SENSA) [gFOBT]
Annual fecal immunochemical test (FIT)
Fecal DNA test (with FIT every 1–3 years)
CRC:
1) What is preferred over gFOBT?
2) What test requires a full stool sample?
3) What test is more sensitive but less specific than FIT?
4) What test do you need to avoid vit C and red meat for?
1) FIT
2) sDNA-FIT: “Cologuard”
3) sDNA-FIT: “Cologuard”
4) Guaiac-based fecal occult blood (gFOBT)
Colonoscopy should be done every ____ years starting at age 45
10
What is the new CRC test?
Blood based cfDNA test
Acute pancreatitis requires at least 2 out of what 3 things?
1) Acute onset of persistent, severe, epigastric pain often radiating to the back
2) Elevation in serum lipase or amylase to ≥3 times the upper limit of normal
3) or Characteristic findings of acute pancreatitis on imaging (contrast-enhanced CT, MRI, or transabdominal ultrasonography)
Acute pancreatitis
1) What test has a short window of detection?
2) _________ has slightly higher sensitivity than amylase for acute pancreatitis and is a good marker for alcoholic hepatitis
1) Amylase
2) Lipase
What are the tests on the BMP?
Sodium, potassium, chloride, bicarb(onate), BUN, creatinine, glucose
What tests are on the CMP?
BMP + liver function tests = CMP (comprehensive metabolic panel)
Doubling of serum creatinine suggests ___% reduction in GFR
50%
1) Normal range of HCO3 is?
2) What are the most common intracellular electrolytes?
1) 22-26 mEq/L
2) Potassium
Magnesium
Phosphate
1) What is the normal sodium range?
2) What is the normal potassium range?
1) 135 – 145 mEq/L
2) 3.5 – 5.0 mEq/L
What are the 2 extracellular compartments (collectively 1/3 of body water)
Interstitial (surrounding cells)
Plasma (intravascular)
1) Main stimulators of ADH are what?
2) What is the most powerful stimulator of aldosterone?
1) Increased plasma osmolality and decreased blood volume
2) angiotensin [RAAS]
1) When is serum osmolality always high?
2) When does hypo/hypernatremia become chronic?
1) Hypernatremia
2) > 48 hours
Quickly reversing ____________ hyponatremia can lead to neurologic complications (osmotic demyelination syndrome)
chronic
1) Severe hypertriglyceridemia or hypergammaglobulinemia throws off sodium reading and can cause what form of hyponatremia?
2) Hyperglycemia and (less common) mannitol infusion can cause what?
1) Pseudohyponatremia
2) Hypertonic (hyperosmolar) hyponatremia
What is the most common type of hyponatremia? What are its 2 types?
Hypotonic hyponatremia; ADH independent and ADH dependent
List potential causes of ADH dependent hypotonic hyponatremia
Hypovolemic hyponatremia
Hypervolemic hyponatremia
SIADH
Reset osmostat
Adrenal insufficiency and hypothyroidism
Pain
Exercise
Diuretics and other medications
What type of hyponatremia occurs with renal or extrarenal volume loss (various causes) and subsequent hypotonic fluid replacement?
ADH dependent hypotonic hypovolemic
What type of hyponatremia usually occurs in the setting of edematous states (cirrhosis, heart failure, rarely nephrotic syndrome)?
ADH dependent hypotonic hypervolemic
What are examples of ADH dependent hypotonic euvolemic hyponatremia?
1) SIADH
2) Reset osmostat
3) Adrenal insufficiency and severe hypothyroidism
Thiazide diuretics induce ____________ , especially in older patients
hyponatremia
What is the first thing you should do when a pt has hypernatremia?
Assess urine output:
1) Oliguria: Reduced water intake, Nonrenal water loss, or Water shifted into cells due to gain of intracellular osmole
2) Nonoliguria: assess osmolality next (low = DI, high = osmotic diuresis)
List at least 3 factors that affect potassium
1) Aldosterone
2) Sodium
3) Acid base balance
Alkalotic states tend to do what to potassium?
Lower serum potassium levels
Increased net K+ release from cells causing hyperkalemia can be caused by what?
1) Pseudohyperkalemia
2) Tissue breakdown
3) Hyperglycemia
4) Metabolic acidosis
5) Beta blockers, etc etc
List medications that can cause hyperkalemia
ACE-i, ARBs, and NSAIDs
Spironolactone
Beta blockers
Triamterene
Which causes hyperexcitability, hypocholoremia or hyper?
Hypochloremia
What is the most common cause of true hypocalcemia?
CKD
What is the most common reason for high phosphorus?
Advanced chronic kidney disease
Torsades de pointes may be seen with what?
Hypomagnesemia
Hypo or hypermagnesmia can cause hypokalemia and hypocalcemia that are refractory to treatment until Mg is fixed?
Hypo
Decreased DTRs (earliest finding), respiratory muscle paralysis, cardiac arrest, are all Sx of?
Hypermagnesemia
What clinical manifestations relate to ATP deficiency?
Hypophosphatemia
What is the most commonly measured RF? (rheumatoid factor for RA)
IgM RF
RFs lack specificity and sensitivity for what?
RA
Negative RF value does not exclude RA
In Rheumatoid Arthritis, RFs react to abnormal synovial ________s
IgGs
ANA (generic) is very sensitive but not specific for what?
Systemic Lupus Erythematosus (SLE)
Immunologic abnormalities, especially the production of antinuclear antibodies (ANΑ), are a prominent feature of what?
Systemic Lupus Erythematosus (SLE)
Antibodies to double-stranded DNA (anti-dsDNA) and to Smith (anti-Sm) are specific ANAs, are they sensitive or specific for Systemic Lupus Erythematosus (SLE)?
specific (but not sensitive)
True or false: A negative ANA result nearly excludes SLE
True
Albumin/globulin ratio should be what?
> 1.0 (more albumin than globulin)
1) Polyclonal spike indicates what?
2) What abt monoclonal?
1) Infections/ inflammatory process
2) Cancer/ neoplastic (e.g., multiple myeloma))
When there is conjugated hyperbilirubinemia, levels in urine are increased, leading to what?
dark, tea-colored urine
If conjugated bilirubin cannot be excreted into the intestine due to extrahepatic obstruction, what can this cause?
Light stools and conjugated hyperbilirubinemia
Gilbert disease can cause what?
Impaired hepatic conjugation/ Unconjugated (Indirect) Hyperbilirubinemia
AST:ALT ratio ≥2:1 suggests ____________ hepatitis
alcoholic
GGT and ALP both rise in cholestasis, but ________ is not elevated in bone disease
GGT
1) What is normal pCO2?
2) What abt HCO3?
pCO2: 35-45 mmHg (middle of range 40)
HCO3: 22-26 mEq/L (middle of range 24)*
Is CO2 acidic or basic? What abt bicarb?
CO2 is acidic, bicarb is basic
What are the 4 main causes of HAGMA?
Ketoacidosis (diabetic/alcohol/starvation)
Uremia (severe renal dysfunction)
Lactic acidosis
Toxins (ethylene glycol [antifreeze], methanol, salicylate OD, many others)
How do you classify metabolic acidosis?
Decreased (<6 mEq)
Increased (>12 mEq) (aka, high AG, HAGMA)
Normal (6-12 mEq) (aka, hyperchloremic, nongap, NAGMA)
What type of acidosis is lactic acid? What type is hypoxic?
HAGMA; type A
What are the 3 major causes of NAGMA?
1) HCO3–loss from GI tract (ex. diarrhea)
2) Defects in renal acidification (ex. renal tubular acidosis (RTA), which may be due to hypoaldosteronism or other causes; impaired renal excretion of H+ or reabsorption of HCO3)
3) HCO3- dilution (ex. NS IVF)
