Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MD3 Internal Medicine Teaching > Not teaching just trying not to look dumb in my SCA x > Flashcards

Not teaching just trying not to look dumb in my SCA x Flashcards

(50 cards)

Start Studying
1
Q

Diarrhoea definition

A

3 or more loose stools in 24 hours
OR
Stools more frequent for that person >14days
OR
Stool weight >200g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Time course classification of diarrhoea

A

Acute <14 days
Persistent >14 days
Chronic >30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How much of the 10L of fluid entering the GIT that most people ingest/have from secretions is reabsorbed

A

99% so 100mL is excreted in faeces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inflamm vs Non-Inflammatory diarrhoea

A

INFLAMMATORY:
- Bacteria, viral or parasite or IBD
- Mucoid or bloody stool
- Tenesmus
- Fever
- Crampy abdo pain

Infectious inflammatory:
- small vol, frequent, nil volume depletion
- C.diff, E.coli, shigella, salmonella

NON-INFLAMMATORY:
- Watery, large volume, frequent stool
- Volume depletion possible
- No tenesmus, blood, fever

A) Secretory:
- altered ion transport across mucosa so you have less absorption of fluids and electrolytes
- Enterotoxins (E.coli, rotavirus, V cholerae)
- Hormonal stuff
- Laxatives

B) Osmotic:
- Small stool volume
- From unabsorbed or poorly absorbed solute (magnesium, sorbitol, mannitol) so you have increased secretion of fluid into the gut lumen
- Improves or stops with fasting
- Maldigestion: impaired digestion in lumen or brush border e.g. lactase deficiency, pancreatic exocrine insufficiency
- Malabsorption: short bowel syndrome, mucosal disease like coeliac,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the most common causes of infectious diarrhoea

A

Watery:
- Norovirus
- Rotavirus
- E.coli
- Campylobacter

Inflamm:
- C.diff
- E.coli
- Shigella
- Salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Astrovirus

A

RNA

Mostly causes diarrhoea in young children, immunocompromised, or older institutionalised patients

Can also cause encephalitis in humans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What meds can cause diarrhoea

A

Antibiotics
B-blockers
NSAIDs
PPIs
Colchicine
Laxative overuse
Anti-arrhythmics like quinidine
Diabetic meds e..g metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does volume depletion present

A

Increased thirst
Reduced urine output
Dark urine
Lack of sweat
Orthostatic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you investigate diarrhoea

A

Dysentery
Total disability due to diarrhoea
Severe pain
Symptoms >7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What Ix do you do for diarrhoea

A

Usually just a clinical diagnosis!

Stool MCS + enteric PCR
- Do ova if persistent diarrhoea

Faecal calprotectin if ?IBD

FBC: anaemia, WCC
UECs: electrolyte disturbances, hypokalaemia, acidosis, renal dysfunction
CRP: systemic inflamm
Lactic acid: ischaemia
Antibody testing if ?AI

Abdo X-Ray/CT: good to identify complications (ileus, perforation, megacolon, obstruction)

Scope if IBD, pseudomembrane?, bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Viral vs Bacterial Diarrhoea

A

VIRAL:
- Self limiting <14 days
- Frequent symptoms: vomiting, diarrhoea, nausea
- May have fever, abdo pain and anorexia

BACTERIAL:
- High fever
- Blood
- Severe diarrhoea
- Probs faecal leucocytes and positive lactoferrin (neutrophil derived marker of intestinal inflamm) in stool = inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Viral diarrhoea top causes

A

Norovirus
Rotavirus
Astrovirus
Enteric adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do these viruses cause diarrhoea

A

Damage the mucosa so impaired fluid absorption

Histology:
- Villous shortening
- Crypt hyperplasia
- Mononuclear inflammatory infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the usual mx of viral gastroenteritis

A

Oral (with Na, K and glucose is in the WHO one) or IV rehydration

Consider an anti-emetic but don’t routinely use (don’t want to mask symptoms)
- Ondansetron or cyclizine is first line
- Metoclopromide has neuro risks (EPS)

DO NOT routinely use anti-emetics (may prolong an inflammatory/infective disease or mask symptoms)
- Loperamide 1st line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a diverticular

A

herniation of colonic mucosa through the muscular wall of the colon at a weak point
- Usually between taenia coli where the vasa recta are
- Happen when there is sustained increased intraluminal pressure (low fibre diet, chronic constipation)
- Rectum is usually spared because no taenia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the complications of diverticulosis

A

Haemorrhage
Fistula
Perforation –> peritonitis or abscess
Diverticulitis !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pathophys of diverticulitis

A

Neck of the diverticular become obstructed –> localised inflammation of mucosa –> ischaemia, bacterial translocation, trans-mural inflammation –> perforations –> abscess or peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

diverticulitis RFs

A

Age
Lack of fibre
Obesity
Sedentary lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diverticulitis presentation

A

LIF pain and tenderness
Anorexia, N, V
Diarrhoea or constipation
Can get LURT sx
Fever
Sometimes PR bleeding

Ex:
Reduced bowel sounds
Tender LIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gold standard diverticulitis Ix

A

CT! Best at confirming diagnosis and extent of the disease
- Colonic diverticulosis
- Pericolic fat stranding
- Bowel wall thickening
- Abscess?

Avoid colonoscopy initially due to perf risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diverticulitis Mx

Study These Flashcards
A

Mild: oral ABx (Augmentin, maybe Taz) and liquid diet

Worse: IV Abx (Augmentin), IVH, NBM

Surgery:
- Hartmann’s procedure: sigmoid colectomy with end colostomy formation, reverse 3mo later
- Sigmoid resection with primary anastomosis and proximal defunctioning stoma )loop ileostomy) then later close the stoma

22
Q

How do you judge which surgery you do for diverticulitis

Study These Flashcards
A

Hinchey Classification so depending on abscess to peritonitis (either purulent or faecalent)

23
Q

What are the fistulas you can get with diverticulitis

Study These Flashcards
A

Colovesical: urinary sx, suprapubic pain, cystitis sx, gass in urine (more common in men)

Colovaginal: purulent discharge

24
Q

LLQ Pain DDx

Study These Flashcards
A

Acute diverticulitis
Ulcerative colitis > Crohns
Gastroenteritis (is more likely to be umbilical though)

Females: ectopic pregnancy, ovarian pathology, fallopian tube pathology

25
Explain jaundice
- From high levels of bilirubin in the blood - Bilirubin is the breakdown product of haem so it comes from broken down RBCs - Bilirubin is conjugated in the liver so it’s water soluble and excreted via the bile into the GI tract - RBCs  haem  biliverdin  unconjugated bilirubin  conjugated in the liver - Unconjugated bilirubin  urobilinogen + stercobilinogen - In jaundice, high levels of bilirubin are excreted by the kidneys (dark urine) - Pale stool suggests an obstructive jaundice as stercobilinogen is absent from the stool (gives stool it’s colour)
26
Pathological effects of cholelithiasis
Silent Cholecystitis Mirrizi syndrome (cystic duct/hartmann's pouch) --> compresses the common hepatic duct Choledocolithiasis Gallstone ileus
27
Cholecystitis on imaging
Thickened gb wall pericholecystic fluid
28
CT can't see which GB stone
cholesterol
29
MRCP is good for
CBD stones
30
Mx of cholecystitis
Cefazolin Clear fluids only Analgesia Cholecystectomy within 72 hrs
31
Choledocolithiasis presentation
attacks of biliary colic with obstructive jaundice (pale stool, dark urine) which lasts hours or days if not relieved you get back pressure and biliary cirrhosis or liver failure
32
Ix for choledocolithiasis
FBC: WCC CRP Lipase: pancreatitis LFTs: cholestatic picture (ALP, GGT, BR) (can have increased ALT and AST if back-pressure) Abdo USS Abdo CT If CBD then fo MRCP is great Leave ERCP for therapy Percutaneous transhepatic cholangiography (PTC) only in those who can't have ERCP but need draining/stenting of bile duct
33
Mx of choledoclithiasis
Most are ABx (metronidazole) and pain relief and then cholecystectomy within 6 weeks ERCP or PTC if need stent/draining
34
Complications of choledocolithiasis
Leakage of bile Jaundice Pancreatitis Ascending cholangitis
35
Courvoisier's Law
In the presence of jaundice, if the GB is palpable then the jaundice is unlikely to be stone If obstruction causing jaundice then GB not usually distented so probably cancer So if there's jaundice and you feel the GB --> probs cancer oops unlucky
36
Ascending cholangitis presentation
Charcot's triad: jaundice, fever RUQ pain Reynold's pentad: jaundice, fever, RUQ pain, hypotension, confusion Can get obstructive symptoms
37
Ascending cholangitis mx
ERCP is gold standard Will maybe need stent Metronidazole IV Fluids Blood cultures Analgesia
38
Causes of hypothyroidism
Hashimotos (anti-TPO, anti-TG) Drugs: lithium, amiodarone, immune checkpoint inhibitors Iodine deficiency
39
Sx of hypothyroidism
Dry skin Bradycardia Slow reflexes Mental slowness Thing hair Tired Weight gain Depression Reduced lipido Goitre Puffy eyes Arthralgia Cold intolerance
40
How can phenytoin (other anti-epilepsy drugs too) cause hypothyroidism
Induces hepatic CYP450 enzyme which breaks down thyroid enzymes
41
What are 1st line epilepsy drugs
Sodium valproate- all types Lamotrigine (all but absent) Carbamazepine (tonic-clonic only) But don't treat after just the 1st seizure as only 50% end up having another
42
Phenytoin
Anti-convulsant Blocks voltage gated Na channels so takes a bigger signal to depolarise and cause AP Good for tonic-clonic and simeple partial seizures/focal seizures but not absence
43
How can you see if someone had a seziure
Prolactin increases after a tonic-clonic EEG MRI HEad to see focal areas??
44
Tonic clonic seizure
A generalised seizure so impaired consciousness, distorted electrical activity in whole or big bit of brain Tonic phase: tense muscles Clonic phase: relax and contract lots so convulse Post-ictal: altered consciousness
45
Simple partial/focal
Partial seizures only affect one part of brain Simple don't impair consciousness and they're just one part so motor or sensory or autonomic
46
Omeprazole
Inhibits the H/K ATPase in gastric parietal cells so less H+ goes into the gastric lumen so you get less HCl and therefore less GORD Another kind of drug for GORD is H2 receptor inhibitor as this activates the cAMP dependent pathway of the H/K ATPase
47
escitalopram
SSRI MOA: inhibits the serotonin reuptake transporter (SERT) so you have more serotonin in the synapse --> monoamine theory of depression For depression SEs: - QT prolongation - GI side effects: esp N - Headaches - Dry mouth - Insomnia - Sexual dysfunction - Serotonin syndrome
48
pravastatin
Inhibits HMG-CoA reductase in the biosynthesis pathway of cholesterol in the liver SEs: - Muscle pain - N - Lethargy
49
Budesonide/formaterol
Budesonide = corticosteroid Formaterol = LABA (long acting beta agonist)
50
Salbutamol
SABA (short acting beta agonist)

MD3 Internal Medicine Teaching (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions