Most Common Diseases Flashcards
1
Q
Emphysema vs Chronic bronchitis
A
Emphysema: DOE hallmark sx, decreased BS, barrel chest, pursed lip breathing, pink puffers, resp. Alkalosis
Chronic Bronchitis: productive cough hallmark sx, wheezes, cor pulmonae, blue bloaters, resp. ACIDOSIS
2
Q
Prevention of acute COPD exacerbation
A
- smoking cessation
- vaccines: pneumococcal and flu
- Pulm. rehab
- Avoid triggers
- Lung reduction surgery
*annual screening for lung CA w/ low-dose CT in adults 55-80 y/o
3
Q
Describe the lab values for
Primary hyperthyroidism
Subclinical hyperthyroidism
Secondary/Tertiary Hyperthyroidism
A
Primary hyperthyroidism: Low TSH + high FT4
Subclinical hyperthyroidism: Low TSH + normal FT4
Secondary/Tertiary Hyperthyroidism: Low TSH + low FT4
4
Q
Atopy predisposing risk factors
A
- Asthma
- nasal polys
- food/environmental allergies (ASA/NSAID allergy)
- eczema and allergic rhinitis
5
Q
Presentation:
diffuse, enlarged thyroid, thyroid bruits, opthalmopathy, pretibial myxedema
A
Grave’s disease (autoimmune hyperthyroidism)
6
Q
Sx of hyperthyroidism
A
- Heat intolerance
- Weight loss
- Skin warm, moist, soft, fine hair, alopecia, easy bruising
- Anxiety
- Tremors
- Diarrhea
- Tachycardia/palpitations
- Scanty periods/gynecomastia
7
Q
Describe the lab values for
Primary hypothyroidism
Subclinical hypothyroidism
Secondary/Tertiary Hypothyroidism
A
Primary hypothyroidism: Elevated TSH + low FT4
Subclinical hypothyroidism:Elevated TSH + normal FT4
Secondary/Tertiary Hypothyroidism: Elevated TSH + high FT4
8
Q
Presentation:
Increased T3/T4 secretion in a single nodule
Found most commonly in younger patients
Single nodule shows increased RAI uptake
A
Toxic adenoma (hyper)
9
Q
How do you dx COPD
A
- PFTs/Spirometry (gold standard) FEV1/FVC <70%
2. CXR: flat diaphragm, increase AP diameter, increased rib count,
10
Q
how do you differentiate between Viral, allergic, and bacterial conjunctivitis
A
Viral: preauricular lymphadenopathy, copious watery discharge, common with URIs
Allergic: cobblestone mucosa, stringy d/c
Bacterial: purulent d/c, lid crusting,
11
Q
Presentation:
common in <8y/o, lasts 7-10 days, vesicles and ulcers to pharyngeal, buccal, labial AND GINGNIVAL MUCOSA, may get on fingers from sucking, HIGH fever, significant cervical LAD
A
acute herpetic gingivostomatitis (HSV1)
12
Q
Presentation:
deep ear pain (usually worse at night), mastoid tenderness, hearing loss, CN 7 paralysis
A
Mastoiditis
Tx: IV Abx
13
Q
What hormones are the secreted by the anterior and posterior pitutary
A
Anterior (FLAT ToP): FSH, LH, ACTH, GH, TSH, Prolactin
Posterior: oxytocin, ADH
14
Q
Most common organisms of AOM
A
- Strep pneumo
- H. influenza
- Moraxella catarrhalis
- strep pyogenes
*same organisms for acute sinusitis
15
Q
Presentation:
common in kids <6y/o and usually <3y/o, vesicles and ulcers to pharyngeal, buccal, and labial mucosa NOT gingival mucosa, low grade fever, rhinorrhea
A
Herpangina
Cause: Cocksackie virus
16
Q
How do you dx and treat oral thrush
A
(oral candidiasis)
Dx: often a clinical dx, KOH smear: budding yeast/hyphae
Tx: Nyastatin, Clean bottle nipples, pacifiers in dishwasher, Breastfeeding moms should apply some to nipples to prevent reinfection
17
Q
Presentation:
Hypokalemia, muscle weakness, polyuria, fatigue, hypertension*, HA, NOT edematous
A
hyperaldosteronism (Conn’s= primary)
18
Q
Fundoscopic findings of papilledema
A
- bilateral blurred disc-cup margins
19
Q
RTC precautions for AOM
A
- no improvement in 2-3 days
- loss of language or hearing
- neck stiffness or redness behind the ear
20
Q
Dx of Hashimoto’s Disease
A
- High TSH, low FT4
- Thyroid Ab: Anti-TgAB, antimicrosomial and Anti-TOP
- Decrease radioactive uptake
- Biopsy: lymphocytes, germinal follicles
21
Q
How do you dx primary and secondary adrenocortical insufficiency
A
*Baseline AM ACTH, cortisol and renin levels
- High dose ACTH stimulation test:
- AI= no increase in cortisol levels - CRH Stimulation test:
- Primary/Addison’s= high levels of ACTH but low cortisol
- Secondary= low ACTH + low cortisol
22
Q
DDX for asthma
A
- CHF,
- PE,
- COPD,
- bronchitis,
- pneumonia,
- anaphylaxis,
- upper airway obstruction,
- pneumothorax,
- GERD
23
Q
Risk factors/education points for AOM
A
- breastfeeding is PROTECTIVE
- smoke exposure
- day care
- young
- eustachian tube dysfunction
- immunizations with PCV13 and flu shot
24
Q
Findings of allergic rhinitis vs viral rhinitis
A
Allergic: pale/violaceous boggy turbinates, nasal polyps, w/ cobblestone mucosa of the conjunctiva
Viral: erythematous turbinates
25
Describe the layers of the adrenal cortex and what hormones they release
Outer--> inner:
Zona Glomerulosa→ aldosterone
Zona Fasiculata→ Cortisol
Zona Reticularis→ Androgen/Estrogen
26
Tx of Hashimoto's Disease
Levothyroxine 1.6ug/kg/day (Goal TSH: 1-2mlU/L)
27
Classic asthma triad
1. dyspnea
2. wheezing
3. cough (esp. at night)
*clues to severity: steroid use, previous intubations/ICU/hospital admissions
28
Fundoscopic findings of diabetic retinopathy
1. microaneurysms
2. blot and dot hemorrhages
3. flame shaped hemorrhages
4. Cotton wool spots
5. Hard exudates
29
Treatment of AOM
1st line: amoxicillin 80-90mg/kg BID for 10-14 days
2nd line: Augmentin
*if PCN allergy: Erythromycin
Acetaminophen (15mg/kg/dose 4-6x/day) or ibuprofen (10mg/kg/dose 4-6x/day
30
Education points for asthma
1. Peak Flow Meters (4+ y/o) – expiration measuring device (Green, yellow, red zones/when do use meds)
2. Use of Valve or valve-mask spacers
3. Asthma action plan (Green, yellow, red zones/when do use meds)
4. Allergen control
5. Avoid tobacco smoke
6. educate on asthma as being a lifelong disease most often and controller medications are important in preventing exacerbations as well as lung remodeling
31
Treatment of COPD exacerbation
1. SABA or SAAC
2. O2
3. Systemic steroids (prednisone 20-60mg qd)
4. Abx (azithromycin)
32
Treatments of Cushing's syndrome
1. Cushing's Disease
2. Ectopic or adrenal tumor:
3. Iatrogenic steroid therapy
1. Cushing’s Disease- Transsphenoidal surgery
2. Ectopic or adrenal Tumor- Tumor removal
3. Iatrogenic steroid therapy- Gradual steroid withdrawal
33
Presentation of De Quervain's hypothyroidism
Cause: Post viral or inflammatory
SX: PAINFUL neck/thyroid
34
Describe what the following radioactive iodine thyroid tests suggest:
1. diffuse uptake:
2. decreased uptake:
3. hot nodule:
4. multiple nodules:
5. cold nodules:
1. diffuse uptake: Grave's disease or pituitary adenoma (hyper)
2. decreased uptake: thyroiditis (hypo)
3. hot nodule: toxic adenoma
4. multiple nodules: toxic multinodular goiter (hyper)
5. cold nodules: suspect malignancy
35
Long term treatment of asthma (chronic)
1. SABA
2. SABA + low dose ICS
3. SABA + medium dose ICS
4. SABA + medium dose ICS + LABA
5. SABA + high dose ICS + LABA
6. SABA + high dose ICS + LABA + oral steroids
* Montelukast (LT modifier) is good option for asthmatic w/ allergic rhinitis/ASA induced asthma
* Commonly used ICS: Flovent (fluticasone) – for all patients
* Common Combination (ICS + LABA) Inhaler: Advair Diskus (fluticasone/salmetrol)
36
Presentation:
| dysphagia, muffled "hot potato voice," difficulty handling oral secretions, uvula deviatoin to contralateral side
Peritonsillar Abscess
37
Etiologies of hyperthyroidism
1. Grave’s Disease
2. Toxic Multinodular goiter
3. TSH secreting tumor
4. Excess intake of T3, T4
5. Iatrogenic thyrotoxicosis
6. Lithium thyrotoxicosis
38
Presentation:
| focal, hard, nont-tender eyelid swelling
Chalazion
39
Presentation:
Weakness, myalgia, fatigue, abdominal pain, HA, sweating, hypoglycemia
Hyperpigmentation, orthostatic hypotension, hyponatremia, hyperkalemia, amenorrhea, loss of axillay and pubic hair
Addison's Disease (primary adrenocortical insuff.)
*Hyperpigmentation (due to increased ACTH)
40
How do you dx Grave's disease
* Low TSH, high T4
* + Thyroid-stimulating immunoglobulins Ab
* +/- Thyroid peroxidase and anti-TG Ab
* RAIU: diffuse uptake
41
Major and minor criteria for risk of asthma
Major Criteria: Parent with asthma or personal history of atopic dermatitis
*Having 1 major criteria greatly increases the chance the child does or will have asthma
Minor Criteria: Maternal history of atopic disease or allergic rhinitis or >4% eosinophilia or Hx of wheezing not associated with URI
*Having 2 minor criteria also increases the chance the child does or will have asthma
42
When do you start screening for thyroid disease
w/ TSH beginning at 35 y/o and every 5 years after
43
How do you dx Cushing's Syndrome and differentiate the causes of Cushing's syndrome
Screening:
1. LD Dexamethasone Suppression Test
- No suppression= Cushing’ Syndrome
2. 24 hour urinary free cortisol levels
- Elevated urinary cortisol = Cushing’s Syndrome
3. Salivary Cortisol levels
- Increased cortisol = Cushing’s Syndrome
Differentiating Test for causes of Cushing’s Syndrome
1. HD Dexamethasone Suppression Test
- Suppression= Cushing’s Disease
- No suppression = adrenal or ectopic ACTH producing tumor
44
Tx of acute sinusitis
amoxicillin 80-90mg/kg/BID for 10-14 days
45
With an eye complaint, always ask about:
1. photophobia-- herpatic conjunctivitis
2. eye pain-- herpatic conjunctivitis,
3. EOM--- postseptal orbital cellulitis
46
Most common cause of hypothryoidism in US
Hashimoto's Disease
47
What is Conns Disease
Primary hyperaldosteronism
48
COPD risk factors
1. smoking
2. alpha1- antitrypsin deficiency
3. pollutants
4. infections (exacerbation trigger)
5. occupational exposures
49
Treatment for acute asthma exacerbation
1. SABA (albuterol 3 puffs w/ MDI or neb q20min x 3 doses)
2. +/- short-acting anticholinergic (Ipratroprim)
3. Oral steroids* (prednisone 20-60mg or 1-2mg/kg/day max dose 60mg)
*F/u in 1-3 days
50
Etiologies of hypothyroidism
1. iodine deficiency (diet)
2. Iodine deficiency
3. Hashimoto’s thyroiditis
4. Postpartum thyroiditis
5. Pituitary hypothyroidism
6. Hypothalamic hypothyroidism
7. Cretinism (congenital due to maternal hypo or infant hypo)
8. De Quervain's -- post viral
51
Treatment of post-partum hypothyroidism
No anti-thyroid meds (should return to nl in 12-18 months w/o tx)
*ASA
52
How do you classify asthma severity
* REMEMBER RULES OF 2’S
1. Intermittent Asthma
- Use of albuterol or rescue inhaler <2x/week
- Can continue treatment
- Use of inhaler before exercise is not included in these numbers, but needing their inhaler after pretreatment is included in these numbers
- Use Step 1
2. Mild Persistent Asthma
- Use of albuterol or rescue inhaler > or = 2x/week
- Use Step 2
3. Moderate Persistent Asthma
- Nocturnal cough/wheezing >2x/month
- Use Step 3-4
4. Severe Persistent Asthma
- Symptoms all the time
- Use Step 5-6
53
most common organism that cause otitis externa and its tx
"swimmers ear"
Pseudomonas
Tx: ciprofloxacin/dexamethasone
54
Tx of hordeolum (Stye)
warm compresses +/- topical Abx ointment (bacitracin, erythromycin)
55
What is the workup of thyroid disease?
1. PE: Thyroid exam, skin exam, CV (hyper/hypo)
2. Labs:
- TSH (nl 0.5-5), T4, T3 resin uptake, FT4, total T3, Thyroid antibodies (Anti-TPO, TgAb, anti-TSH receptor)
3. Imaging:
- Thyroid scan and uptake
- US: characterize nodules and monitor change, solid vs cystic lesions
- FNA: used to evaluate solitary nodules
56
Presentation:
| decreased vision, pain with ocular movements*, proptosis, chemosis, ICP eyelid edema, erythema
Post septal orbital cellulitis
57
What is the dose of levothyroxine and the goal TSH?
Levothyroxine 1.6ug/kg/day (Goal TSH: 1-2mlU/L)
*Monitor every 6 weeks when changing dose
58
Fundoscopic findings of hypertensive retinopathy
1. arterial nicking
2. AV nicking
3. flame shaped hemorrhages
4. cotton wool spots
5. papilledema (malignant HTN)*
59
What is the presentation of epiglottitis and its most organismic common cause
drooling, dysphagia, distress, (tripod position)
Cause: Hib, S. pneumo
60
Tx of viral, allergic, and bacterial conjunctivitis
Viral: supportive, often Abx eye drops due to likely 2ndary infection
Allergic: antihistamine eye drops- Patanol,
Bacterial: topical Abx- erythromyocin, polytrim or if contact lens wearer cover pseudomonas w/ FQ or Tobrex)
61
Tx of rhinitis
1. oral antihistamines (loratadine)
2. decongestants: pseudoephedrine (IN decongestants used more than 3-5 days may cause rebound congestion)
3. IN steroids for allergic rhinitis w/ nasal polyps (Mometasone if >2y/o, Fluticasone if >4)
62
Treatment of COPD
1. smoking cessation
2. Combo: SABA + anticholinergics (Tiotroprium)
* *Ipratropium preferred over SABA in COPD**
3. add ICS (NOT AS MONOTHERAPY) *Combination (ICS + LABA) Inhaler: Advair Diskus (fluticasone/salmetrol)
4. O2 if cor pulmonale
5. Exercise!!
63
Management of thyroid nodules
1. Thyroidectomy if suspect malignancy
| 2. Observation of suspicious nodules (q 6-12 months) w/ US
64
Tx of Grave's disease
1. anti-thyroid drugs (PTU, Methimazole)
2. Beta-blockers for symptomatic relief
3. radioactive ablation
4. Thyroidectomy if no response to meds or RAI is contraindicated
65
Presentation:
central obesity, moon facies, buffalo hump, supraclavicular fat pads, muscle wasting, purple straie, HTN, acanthosis nigrican, depression, hirsutism
Cushings Syndrome
66
Presentation:
| unilateral ocular pain/redness/photophobia, excessive earing, blurred/decreased vision,
Uveitis (iritis)
Tx: steroid eye drops
67
Describe the workup of thyroid nodules
1. PE
2. Thyroid function tests (most are euthyroid)
3. FNA***
- Benign: Colloid is most common type
4. RAIU scan
- Cold= malignancy
- Hot= low suspicion
5. US: solid vs. cystic, helps with FNA
68
Dx and Tx of De Quervain's hypothyroidism
DX: Increase ESR* (Hallmark), No thyroid Ab, Decrease RAIU
TX:
No anti-thyroid meds needed- returns to normal in 12-18 months
-ASA
69
Education point for acute herpetic gingivostomatitis (HSV1)
highly contagious (mostly to young children), virus is in nasal and oral secretions, good hand-washing is important
70
Describe the staging of COPD
all FEV1/FVC <70%
Mild, I: FEV1 80% or higher of predicted
Mod, II: FEV1 50-79% of predicted
Severe, III: FEV1 30-50% of predicted
Very severe, IV: FEV1 less than 30% of predicted w/ cor pulmonale
71
Presentation:
| painful, warm, swollen red lump on eyelid
Hordeolum (stye)
*most commonly caused by staph. aureus
72
Sx of hypothyroidism
1. Cold intolerance
2. Weight gain
3. Dry, thickened rough skin
4. Loss of outer 1/3rd of eyebrow
5. Non-pitting edema
6. Fatigue
7. Depression**
8. Constipation
9. Bradycardia
10. Menorrhagia
11. Hypoglycemia
73
Treatment of primary and secondary adrenocortical insufficiency
Glucocorticoids + Mineralocorticoids (Addison’s)
-Hydrocortisone + Fludrocortisone
Only Glucocorticoids (Secondary)
74
Presentation:
sinus pain/pressure (worse w/ bending down and leaning forward), HA, malaise, purulent sputum or nasal d/c, nasal congestion (sx last over 10-14 days)
acute sinusitis
75
Tx of Chalazion
1. eyelid hygiene
| 2. warm compresses
76
How do you dx asthma
1. Spirometry (PEFR- peak expiratory flow rate)
2. pulse ox
3. PFT (gold standard- increased RV, TLC)
4. Metacholine challenge test-- causes bronchospasm
5. CXR can r/o other causes
77
What are the pediatric doses of acetaminophen and ibuprofen
Acetaminophen (15mg/kg/dose 4-6x/day)
Ibuprofen (10mg/kg/dose 4-6x/day)
78
When are the following GI imaging the test of choice?
1. EGD:
2. upper GI series (barium swallow, esophagram):
3. Lower GI series (barium enema):
4. Colonoscopy:
5. Esophageal Monometry:
1. EGD: Mallor-Weiss tears, PUD, suspected malignancy
2. upper GI series (barium swallow, esophagram): Crohns
3. Lower GI series (barium enema): IBS (CONTRAINDICATED IN UC or suspected perf)
4. Colonoscopy: UC, lower GI bleed
5. Esophageal Monometry: achalasia, nutcracker esophagus
79
Presentation: odynophagia,*, dysphagia, retrosternal CP
esophagitis
80
Presentation:
Heartburn (pyrosis)*, increased w/ supine position, relieved w/ antacids, regurgitation, dysphagia, cough at night*, noncardiac CP
GERD
81
What are the GERD alarm symtoms
1. dysphagia
2. odynophagia
3. weight loss
4. bleeding
82
How do you dx GERD
1. clinical hx
2. Endoscopy often used 1st
3. Esophageal Monometry: decreased LES pressure (if EGD is nl)
4. 24 hr ambulatory pH monitoring **GOLD STANDARD
83
Describe the management of GERD
1. lifestyle modification: elevate head of bed 6 inches, eat smaller meals, avoid laying down 3 hrs after eating, avoid spicy, fatty, chocolate, caffeinated , peppermint, decreased EtOH intake, wt. loss, stop smoking
2. "as needed" OTC PPIs* or H2 receptor antagonists OR upper endoscopy if alarm sx are present
3. "scheduled" PPIs (choice for mod-severe GERD)
4. Nissen fundoplication if refractory
84
Presentation:
| dysphagia to both solids and liquids, malnutrition, wt. loss, CP, cough
Achalasia
85
How do you dx and tx achalasia
Dx: Esophageal manometry (GS*)-- increased LES pressure
-Birds beak appearance of LES on esophagram
TX: decreased LES pressure w/ botulinum toxin, CCB, nitrates, pneumatic dilation
86
Presentation:
| retching/vomiting, hematemesis after an ETOH binge, melena, abdominal pain, hydrophobia
Mallory-Weiss Syndrome (Tear)
*from superficial longitudinal mucosa lacerations
87
What is the number 1 risk factor for esophageal varices
* cirrhosis in adults
* portal vein thrombosis in children
*complication of portal vein HTN
88
Tx of esophageal varices
1. Octreotide: for acute bleeding
2. Surgical decompression/Trans jugular intrahepatic portosystemic shunt
3. Nonselective BB to prevent rebleed*
89
Most common cause of esophageal CA worldwide
Most common cause of esophageal CA in the US
```
Squamous cell (MC in upper 1/3 of esophagus)
*more common in AA
```
Adenocarcinoma (MC in lower 1/3 of esophagus)-- complication of GERD leading to barretts
90
3 most common causes of gastritis
1. helicobacter pylori
2. NSAIDS/ASA
3. Acute stress
*1 and 2 are also top causes for PUD
91
How do you dx and tx gastritis
DX: endoscopy (GS) and H. pylori testing
TX: (TRIPLE Therapy)
H. pylori +: Clarithromycin + Amoxicillin + PPI (CAP)
Quad therapy:
PPI + Bismuth subsalicylate + tetracycline + Metronidazole
H. pylori -: acid suppression/PPI*
92
Describe H. pylori testing
1. endoscopy w/ biopsy (GS)
2. Urea breath test (confirming eradication)
3. H. pylori stool antigen (confirming eradication)
4. Serologic antibodies (NOT ERADICATION)
93
Good for preventing NSAID induced ulcers but not for healing already existing uclers
Misoprostol (PGE1 analog)
94
Compare and contrast Duodenal and gastric ulcers
Duodenal:
- caused: increased DAMAGING factors (acid, pepsin, H. pylori)
- almost always benign
- better w/ meals (worse 2- hrs after)
- MC in younger pts
Gastric:
- Caused: decreased mucosal protected factors (bicarb, PGE, NSAIDS)
- 4% malignant
- worse w/ meals (esp. 1-2 hrs after)
- MC in older pts
95
with elevated bilirubin w/o elevated LFTs suspect
familial bilirubin disorders (Dubin-Johnson syndrome, Gilbert Syndrome) and hemolysis
96
neonatal jaundice w/ severe progression in the 2nd week, leading to kernicterus (bilirubin induced encephalopathy)--> increase bilirubin in CNS and basal ganglia--> deafness, hypotonia, lethargy
Dx and tx?
Crigler-Najjar Syndrome Type I
*Hereditary unconjucated (indirect) hyperbilirubinemia and no UGT activity
TX: phototherapy
97
Describe the labs patterns for:
1. Alcohol Hepatitis:
2. Viral/Toxic/inflammatory liver dz:
3. Biliary Obstruction or intrahepatic cholestasis:
4. Autoimmune hepatitis:
1. Alcohol Hepatitis: AST: ALT >2
2. Viral/Toxic/inflammatory liver dz: ALT>AST
- AST and ALT >1,000 is usually ACUTE VIRAL hepatitis
3. Biliary Obstruction or intrahepatic cholestasis: increased ALP w/ elevated GGT = hepatic source or biliary obstruction
4. Autoimmune hepatitis: elevated ALT >1,000, + ANA, + SmM Antibodies, Elevated IgG, responds to corticosteroids
98
What is the diagnostic test of choice for cholethiasis, choledocholithiasis, and acute cholecystitis
cholethiasis: US
choledocholithiasis: ERCP
acute cholecystitis: US (initial), HIDA scan (GS)
*strawberry GB = chronic cholecystitis
99
What is Charcot's triad and Reynolds Pentad?
Charcots Triad: fever, RUQ pain, jaundice
Reynolds Pentad: Charcots triad + shock + AMS
*signs of acute cholangitis
100
Labs for acute cholangitis
leukocytosis
| Cholestasis: elevated ALP and GGT, increased bilirubin
101
What is Boas and Kerr's sign?
Boas: referred pain to Rt shoulder/subscapular area (phrenic nerve irritation)= acute cholecystitis
Kerr's: referred pain to LEFT subscapular area due to phrenic nerve irritation= splenic rupture
102
```
Describe the transmission of HepA
HepB
HepC
HepD
HepE
```
HepA: feco-oral--> only viral hep associated w/ spiked fever
HepB: parenteral/sexual
HepC: parenteral (IV), (sexual not common)
HepD: requires HepB co-infection
HepE: feco-oral/ waterborne outbreaks
103
How do you dx hepatocellular carcinoma
US and elevated AFP
104
What PE signs suggest appendicitis
1. Rovsing Sign: RLQ pain with LLQ palpation
2. Obturator sign:RLQ pain w/ internal and external hip rotation with knee flexed
3. Psoas sign: RLQ pain w/ hip flexion/extension (raise leg against resistance)
4. McBurney's point tenderness"
105
Tx of the following causes of diarrhea:
1. Vibrio cholerae:
2. Enterotoxigenic E. coli (travelers):
3. C. diff:
4. Campylobacter jejuni:
5. Shigella:
6. Salmonella:
7. Giardia
8. Amebias:
1. Vibrio cholerae: tetracyclines
2. Enterotoxigenic E. coli (travelers): fluoroquinolong
3. C. diff: metronidazole or Vancomycin (severe)
4. Campylobacter jejuni: Erythromycin
5. Shigella: Trimethoprim-sulfamethoxazole
6. Salmonella: Fluoroquinolones
7. Giardia: Metronidazole
8. Amebias: metronidazole
106
Compare and contrast UC and Crohns Disease
UC:
- limited to colon, superficial
- continuous spread proximally from rectum to colon
- LLQ colicky pain
- bloody diarrhea*
- smoking DECREASES risk
- Stovepipe sign on barium study (loss of haustral markings)
- complications: toxic megacolon, PSC, colon CA
* surgery is curative
Crohns:
- skipped lesions, transmural
- MC in terminal ileum but can happen any seg. in GI tract
- RLQ pain
- NON-bloody diarrhea
- Associated w/ B12 Deficiency
- String sing on barium study
- **perianal dz (fissures, strictures, abscess, GRANULOMAS)
107
How often you screen for colon CA
1. Fecal occult blood test annually at 50y/o
2. Colonoscopy: at 50 every 10 yrs up to 75y/o
3. Flexible sigmoidoscopy: q5y
* OR START at age 40 if 1st or 2nd degree relative with CRC
108
What Ab/Ag show for:
1. Acute HepB:
2. Immunized HepB:
3. Chronic active HepB:
4. Chronic nonreplicative HepB:
5. Resolved HepB:
1. Acute HepB: +HbsAg, IgM
2. Immunized HepB: + anti-HBs
3. Chronic active HepB: + HBsAg, + HbeAg, IgG
4. Chronic nonreplicative HepB: + HBsAg, +anti-Hbe, IgG
5. Resolved HepB: +anti-HBs, , IgG
109
Primary sclerosing cholangitis is associated with what diseases?
UC and IBD
110
How do you Dx Celiac dz
1. +Endomysial IgA antibody
2. + Tissue Transglutaminas antibody
3. small bowel biopsy is definitive
111
Presentation:
| pruritic, papulovesicular rash on extensor surfaces, neck, trunk and scalp
Dermatitis herpetiformis
*associated w/ Celiac dz
112
Tx of Diverticulitis
1. clear liquid diet
| 2. Ciprofloxacin or Bactrim + Metronidazole
113
What type of hernia:
1. Protrudes at the internal inguinal ring, origin of sac is LATERAL to inferior epigastric artery
2. protrude MEDIAL to the inferior epigastric vessels within Hesselbach's triangle (Rectus abdominis, inferior epigastric vessels, pouparts ligamine)
1. Indirect inguinal hernia
| 2. direct inguinal hernia
114
3 H's of Scurvy (vit. C deficiency)
1. Hyperkeratosis- follicular papules surrounded by hemorrhage
2. hemorrhage: vascular fragility (bleeding in gums, skin (perifollicular), joints, impaired wound healing)
3. Hematologic: anemia, weak
115
Presentation of B2 deficiency (riboflavin)
Oral-ocular-genital syndrome
1. Oral: magenta colored tongue, angular cheilitis
2. Ocular: photophobia
3. Genital: scrotal dermatitis
116
Presentation of niacin/nicotinic acid (B3) deficiency
Pellagra (3 D's)
1. Diarrhea
2. dementia
3. dermatitis
117
According to the Centor criteria, who should be cultured for strep throat?
* each 1 pt
1. Sore throat
2. fever (>38C/100.4F)
3. pharyngotonsilar exudates
4. tender anterior cervical LAD
5. absence of cough/URI sx
0-1: no abx or throat culture
2-3: throat culture
3-4: give Abx
*if rapid strep is neg. must culture
118
tx of Strep throat
1. Penicillin G or VK 1st line (amoxicillin)
| 2. macrolides if PCN allergy for 10 days
119
education points for strep throat
1. normal course of illness is 3-5 days
2. need to complete Abx despite feeling better
3. Complications: rheumatic fever, glomerulonephritis, peritonsilar abcess
120
Compare and contrast the hallmark presentation of nephrotic and nephritic (glomerulonephritis) syndrome
NephrOTic:
1. proteinuria
2. hypoalbuminemia
3. hyperlipidemia
4. edema
NephrITic:
1. Proteinuria
2. HTN*
3. Azotemia*
4. Oliguria*
5. hematuria* (RBC casts)
121
How do you dx nephrotic syndrome
1. 24 hour urine protein collection (GS) >3.5/day= nephrotic syndrome
2. UA: proteinuria, oval fat bodies “maltese cross shaped”
3. Hypoalbuminemia, hyperlipidemia,
122
Presentation of nephrotic syndrome
1. edema (periorbital or scrotum)
2. Dypsnea
3. transudative pleural effusion
4. DVTS, frothy urine
123
Presentation of nephritic syndrome
1. hematuria
2. HTN
3. azotemia
4. olgiuria
5. fever, abdominal/flank pain
6. less edema
124
UA and biopsy of nephrotic and nephritic syndrome
Nephrotic: proteinuria >3.5g/day, fatty casts*, oval fat bodies "maltese cross"
-hypocellular
Nephritic: proteinuria <3.5g/day, hematuria, RBC casts*
- hypercellular
- crescent shaped
125
Describe what disease the following casts suggest:
1. RBC casts:
2. Muddy brown (granular) or epithelial cell casts:
3. WBC casts:
4. Narrow waxy casts:
5. Broad waxy casts:
6. hyaline casts:
1. RBC casts: acute glomerulonephritis, vasculitis
2. Muddy brown (granular) or epithelial cell casts: acute tubular necrosis (ATN)
3. WBC casts: acute interstitial nephritis, pyelonephritis
4. Narrow waxy casts: chronic ATN/glomerulonephritis
5. Broad waxy casts: ESRD
6. hyaline casts: nonspecific- may be normal
126
most common organism that causes pyelonephritis/cystitis
E. coli
| Staph saprophyticus: especially in sexually active women
127
How do you dx pyelonephritis
UA: pyuria (WBC >5), + lekuocyte esterase, WBC casts (pyelo), +nitrates, hematuria, increased pH
dipstick: + leukocyte esterase, nitrates, hematuria
Urine culture* definitive dx: over 100,00 WBC on clean catch specimen (epithelial squamous cells = contamination)
128
DDX for pyelonephritis
cystitits, vaginitis, urethritis, UTI
129
how do you tx pyelonephritis
fluoroquinolone PO or IV, aminoglycoside x14d
130
tx for BPH
1. observe- avoid anithistmaines and anticholinergics
2. 5-A reductase inhibitors (finasteride, dutasteride)
3. A1 blockers (tamsulosin, doxazosin)
4. Surgical transurethral resection of prostate (TURP)
131
describe the 4 main types of kidney stones
1. Calcium oxalate (MC)- high protein and salt in take inhibit Ca reabsorption (radiopaque)
2. Uric acid- high protein foods
3. Struvite stones (Mg ammonium phosphate)- staghorn calculi-- caused by proteus, kelbsiella, pseudomonas)--radiopaque-- alkaline urine
4. cystine
132
how do you dx kidney stones?
1. UA-- pH, gross hematuria, nitrates (infectious)
2. noncontrast CT abdomen/pelvis*
3. renal US
4. KUB radiograms (only calcium and struvite stones are radiopaque)
5. IVP (GS)
133
kidney stones ___ mm have 80% chance of passing.
| Tx with __
less than 5mm
tx: IV fluids, anaglesic, antiemetics, tamsulosin
134
describe the 2 types of priapism
1. Ischemic (low flow)- decreased venous outflow-- may lead to compartment syndrome (MC*)
2. non-ischemic (high flow)- due to increased arterial inflow, commonly related to trauma
135
SIGECAPS
```
sleep change
interest loss
guilt
energy poor
concentration poor
appetite
psychomotor
suicidal
```
*Depression
