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Mosby 17 Flashcards

1
Q

Elderly Diseases: Urinary incontinence - stress

Symptoms

Associated disease

Postovoid residual

A

Small volume incontinence with sneezing, laughing, coughing, etc.

Can have ass’d pelvic organ prolapse

Normal postvoid residual

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2
Q

Elderly Diseases: Urinary incontinence - urge

Description

Associatied

Postvoid

A

Uncontrolled urge to void

“I get the sudden urge to pee so quickly I can’t make it to the bathroom”

Can be related to CNS disorder

Normal postvoid residual

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3
Q

Elderly Diseases: Urinary incontinence - Overflow

Symptoms

Associated symptoms

Postvoid

A

Small volume incontinence 2/2 uring leaking around an obstructionBPH: pressure builds in bladder until it is slowly squeezed through the narrowed urethra

Sx: dribbling, nocturia, incomplete emptying

Neurogenic bladder: Bladder can’t contract well, so pressure builds in the bladder until it starts to leak out

High postvoid residual

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4
Q

Elderly Diseases: Urinary incontinence - Functional

Symptoms

Postvoid volume

A

In pt with a disability that prevents them from getting to the bathroom in time or prevents them from knowing they need to pee (E.g. severe dementia)

They would be able to make it to the bathroom if they didn’t have the disability

Normal postvoid residual

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5
Q

Elderly Diseases: Fecal incontinence

Three causes

A

Three major causes

Fecal impaction- “overflow incontinence”; diarrhea moves around the hard stool

Underlying disease

Neurogenic disorders

Stroke, dementia, degeneration of nerves to the area leading to loss of sphincter tone

PE: Can see decreased sphincter tone on DRE

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6
Q

Peds Diseases: Intussusception

What is it?

Population and ass

Presentation

Physical

Diagnosis

A

Prolapse of one part in intestine into another leading to obstruction

Common cause of obstruction in kids

Most commonly 2/2 lymph node hyperplasia or Meckel diverticulum

In adults, most commonly 2/2 cancer

Classic sx: Colicky abdominal pain (kid doubled over in pain) with “red currant jelly” stools

PE: sausage shaped mass in R or LUQ

Dx AND Tx: air contrast enema

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7
Q

Peds Diseases: Pyloric Stenosis

Symptoms

Association

Physical exam

A

Hypertrophy of pylorus

Sx: projectile vomiting in a few week old infant with failure to thrive

Ass’d with erythromycin use and more common in first born males

PE: Olive shaped RUQ mass

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8
Q

Peds Diseases: Meconium Ileus

What is it

Symptoms

Diagnosis

Other possible diagnosis

A

Distal intestinal obstruction due to thick inspissated meconium “clogging” up the system

Failure to pass meconium within first 24 hours

Most commonly in cystic fibrosis

Sx: obstructive sx (vomiting, abdominal distention)

Major differential diagnosis includes Hirschprungs disease

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9
Q

Peds Diseases: Biliary Atresia

What is it

Symptoms

Diagnosis

Treatment

A

Congenital obstruction or absence of bile ducts leading to bile flow obstruction

Can occur postnatally (thought to be infectious) or embryonic

Sx of cholestasis (jaundice, clay colored stools, dark urine) in first few weeks of life

Dx: US

Tx: Most often requires liver transplant (esp. if internal ducts are affected)

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10
Q

Peds Diseases: Meckel Diverticulum

What is it

Rule of 2

Cause

Symptoms

What can cause

A

Outpouching of ileum

Rule of 2’s: 2 in. long, withing 2 feet from terminal ileum, presents by 2 years of age, in 2% of population

2/2 incomplete obliteration of the vitelline duct

Sx: painless rectal bleeding

Can cause intussusception

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11
Q

Peds Diseases: Necrotizing enterocolitis

Decscription

Symptoms

X-Ray

A

Intestinal necrosis occurring in premature infants

Sx: failure to thrive, vomiting, bloody stools, peritoneal signs, very sick premie

AXR: pneumatosis intestinalis (air in bowel wall)

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12
Q

Peds Diseases: Neuroblastoma

What is it

Symptoms

Comparison to wilms tumor

A

Malignancy of peripheral sympathetic nervous system

Most commonly in adrenal medulla

Sx: most commonly asymptomatic abdominal mass, but can cause different mass-related local symptoms based on location

Crosses midline (vs. Wilms tumor)

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13
Q

Peds Diseases: Wilms Tumor

What is it

Population

Syndrome

Symptoms

A

Most common intraabdominal tumor in kids

In 2-3 year olds

Mostly sporadic, but can be familial

WAGR syndrome: Wilms tumor, aniridia, GU abnormalities, mental retardation

Sx: Painless abdominal mass (typically doesn’t cross midline), may have hematuria

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14
Q

Peds Diseases: Hirschprung Disease

What is it

Presnetation in older kids

Sign

A

Lack of parasympathetic ganglion cells in distal colonColon can’t relax in this area

Failure to pass meconium in first 24 hours

Accumulation of stool proximal to defect

Can present in older kids as severe constipation

“Blast” sign: digital rectal exam causes explosive release of stool

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15
Q

Peds Diseases: Hemolytic Uremic Syndrome

Triad

Populatuion

Symptoms

A

Triad of hemolytic anemia, thrombocytopenia, uremia

One of the most common cause of acute renal failure in kids less than 4

Most common cause in E. coli O157:H7 (in bad hamburger meat classically)

Sx: typically have a preceding URI or gastroenteritis; dehydration, edema, petechiae, hepatosplenomegaly, oliguria

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16
Q

Adult: Acute Diarrhea

Most common cause

Associated factors

Symptoms

A

Most commonly viral

Most common bacterial gastroenteritites: Salmonella, campylobacter

Common associations:

Traveler: Enterotoxigenic E. Coli

Camping: Giardia, entamoeba

HIV: Cryptosporidium

Undercooked beef with bloody urine: E. coli O157:H7

Cruise: Norwalk virus

Bloody diarrhea: invasive organisms like campylobacter, shigella, salmonella

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17
Q

Adult: GERD

What is it

Symptoms

Associated symptoms

Other diagnosis

A

Reflux of gastric contents into esophagus

Sx: burning post-prandial chest pain, worse with laying down

Ass’d cough, sour taste in throat, hoarseness

On differential diagnosis of chest pain (including killers like MI, PE, etc.)

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18
Q

Adult: Irritable Bowel Syndrome

Criteria

Absent symptoms

Correlation Symptoms

A

Rome CriteriaRecurrent abdominal pain or discomfort for at least 3 days/month for 3 months with 2 of following:

Relief with defecation

Change in stool frequency

Change in stool form (diarrhea/constipation)

None of the alarm symptoms of inflammatory bowel syndrome

No bloody diarrhea or weight loss

Can be correlated with stress

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19
Q

Adult: Hiatal Hernia with Esophagitis

What is it

Similar to

Symptoms

Treatment

A

Part of the stomach passes though the esophageal hiatus leading to loss of the “functional” LES

Similar symptoms to GERD

Can incarcerate like any hernia: Sx: sudden vomiting, pain, complete dysphagia

Tx is surgical

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20
Q

Adult: Duodenal Ulcer

Cause

Symptoms

A

Almost always 2/2 H. pylori

Can cause GI bleed (hematemesis, melena, hematochezia, anemic sx) or perforate (presents like an acute abdomen)

Anterior more likely to perf, posterior more likely to hemorrhage

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21
Q

Adult: Crohn’s Disease and Ulcerative Colitis

comparison

A

This will be high yield for years to come (know the differences between these two)

Some high yield differences

Crons

  • Entire GI tract involved (mouth to anus)- perianal skin tags, mouth ulcers, etc.
  • Fistula likely
  • Extraintestinal symptoms common
  • Diarrhea less frequently bloody

UC

  • Only colon affected
  • Fistula not likely
  • Extraintestinal symptoms common
  • Diarrhea more frequently bloody
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22
Q

Adult: Stomach Cancer

Symptoms

A

Vague sx: wt loss, early satiety, dysphagia, epigastric pain

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23
Q

Adult: Diverticular disease

symptoms

diverticulosis vs. diverticulitis

A

Outpouching of colon (most commonly sigmoid)

Diverticulosis- Presence of diverticula in the colon

Most common symptom- GI bleed (hematochezia, melena)

Diverticulitis- Inflammation of a diverticulum

Most common symptoms- LLQ pain, anorexia, N/V, diarrhea/constipation

Common in older population

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24
Q

Adult: Colon Cancer

Main symptoms

Symptoms

A

Any adult with anemia has colon cancer until proven otherwise!

Sx: Depends on location- Bleeding sx more likely if proximal, obstructive sx or change in stool caliber more likely with distal lesions

Look at risk factors on P. 492 and Screening on P. 525

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25
Q

Adult: Hepatitis

Most common cause

Symptoms

Leads to

A

Most commonly 2/2 viral infection, alcohol, drugs, toxins

Sx: Asx → jaundice, anorexia, clay colored stools, abdominal pain

Can be acute or chronic and can lead to cirrhosis

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26
Q

Adult: Cirrhosis

What is it

Associated with

Symptoms

A

Fibrosis and alteration of liver architecture

Nodular; enlarged, then shrunken

Most commonly caused by hep C and alcohol

Sx of decreased liver function (e.g. problems with coagulation), portal hypertension (e.g. ascites, esophageal varices, caput medusa, etc.)

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27
Q

Adult:Hepatocellular Carcinoma

Arises from cirrhosis

Symptoms

A

Most commonly arises 2/2 cirrhosis

Similar liver symptoms to other liver pathology: jaundice, anorexia, clay colored stools, abdominal pain

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28
Q

Adult: Cholelithiasis

Symptoms

A

Presence of stones in the gall bladder

Can be Asx → biliary colic (recurring postprandial RUQ abd pain that may last a couple hours then resolve)

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29
Q

Adult: Cholecystitis

What is it

Symptoms

A

Inflammation of gall bladder, most commonly 2/2 obstruction of cystic duct with a gall stone

Sx: Persistent RUQ pain, fever, anorexia, N/V

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30
Q

Nonalcoholic Fatty Liver Disease

What is it

Associated with

Symptoms

What it can lead to

A

Spectrum of liver disease from steatosis (reversible) to cirrhosis (nonreversible)

(Obviously) not related to alcohol intake

Common in obese people with metabolic syndrome

Same liver symptoms as many of the above diseases: jaundice, anorexia, clay colored stools, abdominal pain; However, most commonly asx until it has progressed significantly

Can lead to hepatocellular carcinoma

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31
Q

Adult: Acute Pancreatitis

Most common cause alcohol and gall stones

Symptoms

Labs

Importance?

A

Most common causes: alcohol and gall stones

Sx: epigastric pain radiating to the back, esp after a fatty meal

Labs: amylase, lipase (lipase more sensitive)

Can be deadly

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32
Q

Pyelonephritis

What is it

Risks

Symptoms

A

Infection of the kidney; most commonly ascending

Risks: diabetes frequent UTIs, GU abnormality, sexual activity

Sx: Dysuria; fever, chills, flank pain/CVA tenderness (vs. cystitis)

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33
Q

Chronic pancreatits

Symptoms

A

Same causes as in acute pancreatitis; alcohol most common

Sx: Constant unremitting abd pain, weight loss, steatorrhea

34
Q

Spleen laceration/rupture

Trauma relations

Symptoms

A

Most commonly injured organ in abdominal trauma

Sx: LUQ pain radiating to L shoulder (Kehr sign), hypovolemic sx

Spleen bleeds a lot

35
Q

Acute glomerulonephritis

What is it

Symptoms

A

Often 2/2 immune complexes

Many causes including immune mediated, post-streptococcal (kid with strep throat)

Sx: flank pain, hematuria/tea colored urine, HTN, edema (esp. periorbital)

36
Q

Hydronephrosis

Symptoms

Pogression

A

Dilation of renal pelvis and calyces due to obstruction of urine flow

Most are asx but can cause renal colic and hematuria if an acute obstruction

Can impair renal function eventually

37
Q

Renal Abscess

Symptoms

A

Sx of pyelonephritis that do not get better with antibiotics like pyelo does

38
Q

Renal Calculi

More commonly in

Symptoms

Can lead to what

A

More common in men

Sx: flank pain radiating to groin, fever, dysuria, hematuria

Can lead to pyelo

39
Q

Acute renal failure

Labs

Locations

Urine output

A

Absolute rise in serum Cr of 0.5 – 1.0 (though there are other diagnostic criteria)

Prerenal (e.g. hypovolemia), renal (e.g. acute glomerulonephritis), or postrenal (e.g. obstruction)

Think about other sx: if pt has signs of hypovolemia (postural dizziness, fatigue, etc.) think prerenal, and so on

Can have normal urine output or be anuric/oliguric

Sx will be related to underlying cause (often Asx)

40
Q
A
41
Q

Production of the blood

A
  • Liver
    Forms blood cells by week 6
    Forms glycogen by week 9
    Forms bile by week 12
    Spleen
    Produces insulin by week 12
    Forms blood in fetus and first year of life; afterwards, lymphatic function
    Kidne
  • Make urine by 12 weeks
  • Development of new nephrons stops at 36 weeks; afterwards grows via hypertrophy
  • GFR increases linearly in childhood to adult rate
42
Q

When is GI adapted to extrauterine life

When it is fully developed

A

GI tract capable of adapting to extrauterine life by 36 weeks, but not fully developed functionally until 2-3y

43
Q

Abdominal changes during pregnancy

Abdominal wall/skin

A

Rectus abdominis separates, which can lead to diastasis recti (persistent separation of rectus muscles) after pregnancy

Skin changes: Striae, linea nigra (midline line of pigmentation) develops

44
Q

Abdominal changes during pregnancy

Intestinal tract

A

Decreased LES pressure + Decreased peristaltic velocity in esophagus→ Reflux

Constipation 2/2 increased GI transit time

45
Q

Abdominal changes during pregnancy

Gallbladder

A

Decreased emptying of GB + change in bile content → increased incidence of cholelithiasis

46
Q

Abdominal changes during pregnancy

Kidneys/Bladder

A

Enlarged uterus can lead to urinary stasis

Renal function most efficient in lateral recumbent position (Less compression of aorta and IVC)

Uterus pushes on bladder → urinary frequency

47
Q

Abdominal changes during pregnancy

Appendix

A

Displaced upward and laterally… Don’t let the location of appendicitis in pregnant women fool you!

48
Q

Abdominal changes in the elderly

A

Motility affected most (vs. secretion/absorption)

Decreased liver function

49
Q

Inspection on GI/GU exam

A
  • Striae
  • Scars
  • Umbilical lymph node- “Sister Mary Joseph Nodule” can mean metastatic pelvic/abdominal cancer
  • Contour
    • Rounded: e.g. overweight adult
    • Flat: e.g. adult with six pack
    • Scaphoid: e.g. very thin adult
  • *Clinical Pearl: distended abdomen + hypoactive bowel sounds+ no pain or mass+ Pt on diuretics or steroids → Think hypoK+
  • Ask pt to Valsalva → Can cause ventral hernias to protrude if present
50
Q

Normal frequency of bowel sounds

A

5-35/min

51
Q

Loud, long gurgles (stomach growling)

A

“Borborygmi”

52
Q

Increased sounds GI

A

gastroenteritis, early intestinal obstruction, or hunger

53
Q

High-pitched GI

A

“tinkling”: possible early obstruction

54
Q

Additional sounds GI

Bruits

Venous hum

A

Listen for in aorta, renal, iliac, and femoral arteries if concerned (e.g risk factors for atherosclerosis, HTN, etc.)

2/2 increased collateral circulation between the portal and systemic venous systems

55
Q

Normal bottom border of liver

Normal upper border of liver

A

3 cm below the costal margin

5-7th intercostal

56
Q

Changes in lower costal margin of liver

A

Abnl can be caused by liver enlargement or downward displacement of diaphragm by pulmonary disease

57
Q

Changes in upper border of liver

A

Higher: can be 2/2 ascites or abdominal mass

Lower: can be 2/2 liver atrophy or downward displacement

58
Q

Murphy’s Sign

A

Gall bladder

Deeply palpate RUQ below costal margin, have pt take a deep breath out and then in → If positive, when inflamed GB touches hand on inspiration, pt will abruptly halt inspiration

59
Q

Assessing ascites: Shifting Dullness

A

Identify borders of tympany and dullness (ascites settles to dependent part of abdomen pushing tympanytic bowel to the non-dependent part)

Then have pt lie on one side → Borders of dullness should shift to the dependent side as the ascites follows gravity downwards

60
Q

Assessing ascites: Fluid Wave

A

Have pt or assistant place edge of hand firmly along the midline of the abdomen

Place your hands on both sides of the abdomen and strike one side sharply with your fingertips → If ascetic, should feel pressure wave hit your other hand

61
Q

Aaron sign

A

Pain in epigastric region with palpation of McBurney’s point

Appendicitis

62
Q

Balance sign

A

Fixed dullness to percussion in the left flank and dullness in the right flank that disappears on change in position

Peritoneal irritation

63
Q

Blumberg sign

A

Rebound tenderness

Peritoneal irritation

64
Q

Cullen sign

A

Periumbilical ecchymosis

Hemoperitoneum, pancreatitis, ectopic pregnancy

65
Q

Dance sign

A

Absent bowel sounds in the RLQ

Intussusception

66
Q

Grey Turner sign

A

Flank Ecchymosis

Hemoperitoneum, pancreatitis

67
Q

Kehr sign

A

Abdominal pain radiating to left shoulder 2/2 diaphragm irritation

Spleen rupture, renal calculus, ectopic pregnancy

68
Q

Markle sign

A

: Pt stands and toes and then abruptly lands on heels causing abd pain

Peritoneal irritation

69
Q

McBurney sign

A

Rebound at McBurney’s point (2/3 of distance from umbilicus to ASIS)

Appendicitis

70
Q

Murphy’s sign

A

Cholecystitis

71
Q

Romberg-Howship

A

Pain down medial aspect of the thigh to the knees

Stangulated obturator hernia

72
Q

Rovsing sign

A

RLQ pain worsened with LLQ palpation

Appendicitis

73
Q

Dunphy’s sign

A

Physician surreptitiously bumps into the bed → Positive if it causes abdominal pain in the patient

74
Q

Hamburger sign

A

Pt with appendicitis should not want to eat, so ask if they are hungry (80% sensitive!)

75
Q

Psoas sign

A

Pt lays supine; ask pt to raise leg, flexing at the hip, while you push downward → Positive if it reproduces the RLQ pain; can indicate retrocecal appendix

76
Q

Obturator sign

A

Flex right leg at left hip and knee to 90 degrees and physician rotates the leg medially and laterally → Positive if it reproduces the RLQ pain; can indicate retrocecal appendix

77
Q

Rebound Tenderness GI

A

Hold hand with fingertips extended at a 90 degree angle to the abdomen and press deeply away from the area of discomfort, then rapidly withdraw your hand

If pain is worse when your hand is pulled away, then + for rebound tenderness = peritoneal irritation

78
Q

Infant Physical: Umbilical Cord

A

Thick: well nourished

Thin: not well nourished

Should have 2 arteries and 1 vein

Umbilical hernias are common and generally close spontaneously by 1-2y

79
Q

Infant Physical: Masses

A

Olive shaped, RUQ = pyloric stenosis

Sausage shaped L or RUQ = Intussusception

Midline suprapubic mass = Hirschsprung disease

80
Q

Infant Physical: Enlarged Liver

A

Common in newborn with mom with poorly controlled DM during pregnancy

ACS (7 decks)

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