other Flashcards
appendicitis highest to lower LR+
LRQ pain
migrating pain from perimbulical to RLQ
fever
psoas sign
pain before vimit
rebound tender
rigidity
anorexia
appendicitis treat
antibiotics or surgery
bowel obstruction higher to lower LR+
constipation
ab distention
pain decrease after vomit
bowel obstruction combined signs with higher LR+
distention associated with increased bowel sounds, vomit, constipation, or prior surgery
increased bowel sounds with history of prior surgery
increased bowel sounds with vomit
complete small bowel obstruction can progress to
bowel strangulation or infarction
etopic pregnancy test
serum beta hCG pregnancy test (levels plateau instead of increasing)
side for ovarian torison
70% right
pelvic inflammatory disease symptoms and test
infection so chills. fever, discharge, menstrual disturbance, cervical and adnexal tender
–> CRP and ESR for infection and endocervical culture for gonorrhoea and chlyamdia
peptic ulcer disease causes
NSAID or h pylori and older age
h pylori test
urea breath test, stool antigen test, blood test for antibodies
cholecystitis highest to lower LR_
murphy sign
RUQ pain
fever
jaundice
nephrolithiais (kidney stones)
urinary problem, nausea, vmit, back and flank pain
calcium oxalate stones most common
pancreatitis causes
alcohol
steatorrhea in which condition
chronic pancreatitis
IBS vs functional diarrhea or constripation
IBS has pain/ visceral hypersensitivity
functional GI processes involved
- Impaired GI motility
- Altered microbiome
- Visceral hypersensitivity
- Mucosal layer alterations
IBS_D alarm features
- Unintentional weight loss
- Nocturnal diarrhea
- Tenesmus
- Passing of bright red blood in stool (haematochezia)
- High‐volume diarrhea, or very high number of bowel movements
- Suspicion of malnutrition
- Family history of colorectal cancer
what to check for in IBS-C
Digital rectal exam:
* detect stool in the rectal vault, anorectal masses, hemorrhoids, anal fissures, rectal prolapse, and rectoceles that may cause constipation
CONSTIPATION alarm features
Blood in stool
* Weight loss
* Anemia
* Family history of colon cancer, celiac disease or inflammatory bowel disease
* Acute onset at age older than 50
* Significant pain
* Vomiting, especially if recurrent
* Fever
SIBO testing
glucose > lactulose breath test
then duodenal aspirate
allergy and delayed sensitivity
and intolerance
allergy is IgE- immediate, anaphylaxis, urticaria, vomit
sensitivity is IgG- delayed
intolerance is lack enzymes i.e. lactase
ED stats
Approximately 20% of men over 20 suffer from ED, the prevalence increases significantly with advanced age
* 78% of males over the age of 75 are affected
causes of ED
It appears that ED below age 40 has a greater tendency for a psychosomatic whereas older patients are more likely to be cardiometabolic/vasculogenic origin
frequency of causes of ED
vascular 30%
psychogenic 20%
drug induced 18%
hormonal 17%
drugs causing ED
SSRI and SNRI
ED key notes
ED with the ability to have a normal morning erection implies a psychogenic cause, although the patient’s subjective assessment of his own early morning erections can be unreliable
* Sudden onset might point towards a psychogenic or drug-induced cause
- ED induced by a drug, hormonal causes or psychogenic are highly treatable, look for these causes (Harris, 2012)
- You also need to differentiate ED from other sexual disorders such as premature ejaculation and loss of libido (Miller, 2000)
hormones to check for eretile dysfunction
low testosterone (hypogonadism), high prolactin,
cholesterol, CBC/ferrtin, fasting blood sugar HBA1c, hsCRP
what to rule out for ED
CVD (framingham), bladder or bowel incontiencen. sleep apnea
overt GI bleed vs occult
overt: hematemesis (blood in vomit), melena, hematochezia
occult- microscopic
fecal occult blood test
fecal immunochemical test
and
guaiac based feacal occult blood test
CBC for go bleed and anemia
hemoglobin
mean corpuscular volume
hematocruit
also ferritin
most common type of polyps
adenomatous
and can give rise to adenocarcinoma
diverticulitis high LR
LLQ pain, no vomit, CRP
crohns test vs UC
stool lactoferrin > ileocosnoscopy > fecal calprotectin
ilocolonscopy > lactoferrin > fecal calprtoectin
ulcerative colitis
finger clubbing
risks of UC
salmonella, c dif, camplylobactera
crohns risk
NSAIDs , birth control, smoking, anxtiobitoics
colorectal cancer high LR
age + change in bowel habit _ blood seen with or on stool
colorectal cancer test
FIT > gFOBT
fecal immunochemical test better than guacici
dyspepsia bc of
GERD or IBS
peptic ulcer causes
h pylori and NSAIDs mainly
3 types of diarrhea
watery (secretory, osmotic, functional)
fatty (maldigestive, malabnsorptive)
inflammatory (aka exudative)
inflammatory diarrhea
elevated WBC, pus, occult or frank blood
c dificile diarrhea aka
pseudomembranous
diarrhea alarm symptoms
- blood in stools (either as hematochezia or melena)
- more than 10% unintentional weight loss
- disease that wakes the patient up during the night
- fever
- new onset of signs and symptoms after 50 yrs of age
- fHx of colorectal cancer, inflammatory bowel disease (IBD) or celiac disease
- unexplained anemia
- elevated white blood cell count (WBCs)
- abdominal mass
labs for IBS-D
- CBC, BMP (FBG, Ca, Electrolytes (Na, K, CO2, Cl), BUN, Creatinine), CRP;
consider anti-tTG IgA, total IgA, O&P, fecal calprotectin, TSH, LFTs
carb malabosprtion/ intolerance
lack enzymes to digest carbs
do hydrogen breath test
lactose> fructose
bile acid malabsorption diarrhea
diarrhea caused from either hepatic overproduction of bile acids or their malabsorption in the terminal ileum
bile acid diarrhea test
SeHCAT > C4
c dificicle test
ewznyme imnmunosay EIA toxin A + B
c dificile risk
hospital, antibiotics
celiac
dermatitis herpetiformis
IgA tTG
IgG deaminated gliadin peptide has higher LR but not used
celiac high to low LR
symptoms since childhood
35
3.18
0.73
flatulence / gas
76
1.33
0.56
weight loss
49
1.14
0.89
loss of appetite
20
1.05
0.99
diarrhea
71
0.90
1.38
nausea
20
0.77
1.08
abdominal pain
celiac effects on tissue
- long crypts
- flattened villi
- lymphocyte infiltration
non celiac gluten sensitivity testing for diagnosisng
gluten challenge
anorexia symptoms
thin appearance/ marked weight loss, amenorrhea, arrhythmia, bradycardia, brittle hair/nails, edema, hyperkeratosis, hypotension, lanugo, osteoporosis
anorexia BMI
mild: BMI ≥ 17 kg/m2
- moderate: BMI 16 - 16.99 kg/m2
- severe: BMI 15 - 15.99 kg/m2
- extreme: BMI < 15 kg/m2
bulimia and anorexia test
- UA (specific gravity, pH, ketones +/- protein - hydration status, kidney function)
- body temperature (low), hypotension (incl. orthostatic)
- ECG, CBC, electrolytes (Na, K, Cl), P, Mg, amylase, lipase, TSH, free T3, free
T4 - bone density
bulimia levels of severity
mild: an average of 1-3 episodes per week
- moderate: an average of 4-7 episodes per week
- severe: an average of 8-13 episodes per week
- extreme: an average of 14 or more episodes per week
SCOFF screening for eating disorders
- DoyoumakeyourselfSICKbecauseyoufeeluncomfortablyfull?
- DoyouworryyouhavelostCONTROLoverhowmuchyoueat?
- HaveyourecentlylostmorethanONEstone(14lbs/6kg)ina3-monthperiod? 4. DoyoubelieveyourselftobeFATwhenotherssayyouaretoothin?
- WouldyoousaythatFOODdominatesyourlife?
myocardial infarction high to low lr
radiating to both arms
radiation to right arm
s3 sound
hypotension
radiating to left arm
myocaridits
JVP, S3, edema, murmurs
myocarditis investigations
- Serum cardiac biomarkers (troponin)
- Echocardiogram
- Chest x-ray
peri and myocarditis could be from
infection or drugs etc
Pericarditis
Pleural effusion may accompany pericarditis, including cardiac tamponade:
* Jugular venous distention (Sensitivity 100%)
* Tachycardia (Sensitivity 100%)
* Pulsus paradoxus >12mmHg (LR+, 5.9; LR−, 0.03)
aortic disection
asymmetric pulses or BP in upper limbs
pulmonary embolism risk
fracture or replacement or surgery
ischemic heart disease risk factors
Hypertension
* Dyslipidemia
* Diabetes mellitus
* Smoking
* Unhealthy diet
* Physical inactivity
* High waist circumference
* High BMI
ishcmeic heart disease stable vs unstable angina
*
*
Chest pain described as crushing, pressure, squeezing, or tightness
Stable angina: deep, poorly localized chest, arm, or neck pain or pressure associated with physical exertion or emotional stress, relieved within 5 minutes with rest or sublingual nitroglycerin
Unstable angina: above symptoms that occur and/or persist even with rest and medication = Medical emergency
most significant risk factor for cerebrovascular (stroke or TIA)
hypertensions
symptoms for TIA or stroke
Symptoms (TIA and minor stroke)
* Sudden loss of motor function
* Sudden severe headache with no known cause
* Sudden trouble seeing in one or both eyes
* Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
Signs (see following slides)
* Sudden confusion, trouble speaking or understanding speech
* Sudden trouble walking, dizziness, loss of balance or coordination
peripheral vascular disease
Symptoms
* Intermittent claudication (exercise-induced muscle pain) (LR+ 3.3)
* May present in calf, thigh, buttocks, feet unilaterally or bilaterally
* Pain comes on suddenly, often described as achy, and resolves after about 10 minutes rest
* Lower extremity pain at rest (may wake from sleep)
* Often worse when patient reclined, lower limb elevated, most often
felt in toes and feet
* Sensory changes in lower limb (numbness)
* Lower extremity muscle fatigue
Signs
* Skin & nails exam
* Ulcers or nonhealing wounds
* Skin may feel cool, show pallour, or bluish colour
* Nails may appear brittle, hypertrophic, ridged
* Pulses
* Upper extremity blood pressure
* Ankle-brachial Index (<=0.9 abnormal)
Asymptomatic
* Intermittent claudication (exercise-induced muscle pain) (LR+ 3.3)
* Palpate brachial, radial, femoral, popliteal, dorsalis pedis, and posterior
tibial arteries (any abnormality LR+ 3.1)
* Femoral artery bruit (LR+ 4.8)
Patients presenting w/ leg pain
* Cool skin on lower extremities (LR+ 5.90)
* At least 1 lower limb artery bruit (LR+ 5.60; LR- 0.39)
* Any palpable pulse abnormality on lower leg (LR+ 4.70; LR- 0.38)
deep vein thrombosis
- Active cancer (1 point)
- Bedridden recently >3 days or major surgery within 12
- Calf swelling >3cm compared to other leg (2 points)
- Collateral (nonvaricose) superficial veins present (1 point)
- Entire leg swollen (1 point)
- Localized tenderness along deep venous system (1
point) - Pitting edema, confined to symptomatic leg (1 point)
- Paralysis, paresis, or recent plaster immobilization of lower extremity (1 point)
- Previously documented DVT (1 point)
- Alternative diagnosis to DVT as likely or more likely (-2 points)
heart failure score’
Age >= years
1
Sudden onset of dyspnea
2
Onset of dyspnea at night
1
Orthopnea
1
Prior congestive heart failure episode
2
History of COPD
-2
History of myocardial infarction
1
Crackles on examination
2
Leg edema
1
ST segment abnormality on ECG
1
Atrial fibrillation/flutter on ECG
1
