PANCE Pearls

Question 1

Anti-motility drug tx types:

Answer 1

1-Bismuth subsalicylates:
2-Opioid Agonists:
3-Anticholinergics:

Question 2

Bismuth subsalicylates: 2

Answer 2

1- PEPTO-BISMOL

2-KAOPECTATE

Question 3

Opioid Agonists: 2

Answer 3

1- IMMODIUM
• Loperamide
• Inhibits peristalsis and increases anal sphincter tone
• Avoid in acute dysentery (bloody stools, fever)
2- LOMOTIL
• Diphenoxylate/atropine
• Inhibits peristalsis

Question 4

Anticholinergics: 1

Answer 4

DONNATOL
• Phenobarbital/atropine/hyoscyamine/scopolamine
—Antispasmodic and slows down GI motility

Question 5

Anti-emetic drug tx types:

Answer 5

1-Block Serotonin (5-HT3)- PNS & CNS

2-Block Dopamine- CNS only

Question 6

Serotonin Receptor Antagonists: 3

Answer 6

Ondansetron (Zofran)
Granisetron
Dolasetron

Question 7

Dopamine Receptor Antagonists: 3

Answer 7

1- Prochlorperazine (compazine)
2- Promethazine (phenergan)
3- Metoclopramide (reglan)
Also, Prokinetic

Question 8

S. Aureus food sources: (4)

Answer 8

• eggs
• mayo
• dairy products
• meats
• short incubation period: ~6 hr

Question 9

Bacillus cereus food sources:

Answer 9

• fried rice

* short incubation period: ~6 hr

Question 10

Raw shellfish ingested from the gulf of mexico should make you consider these organisms in gastroenteritis etiology: 2

Answer 10

V. parahemolyticus and V. vulnificus

Question 11

V. vulnificus SXS MC:

Answer 11

bacteremia and cellulitis

Question 12

MC non-foodborne bacterial cause of gastroenteritis in U.S.

Answer 12

C. jejuni (2/2 GBS w. undercooked poultry)

Question 13

MC cause on foodborne, bacterial gastroenteritis in U.S.

Answer 13

Salmonella

Question 14

avoid these drugs in enterohemorrhagic e. coli due to this complication:

Answer 14

abx; HUS

Question 15

these diarrheal syndromes may have sxs that mimic acute apendicitis: 2

Answer 15

C. jejuni
Yersinia enterocolitica (also mesenteric adenitis and gaurding)

Question 16

salmonella MC sources: 2

Answer 16

• poultry (dairy, meat, eggs)

- exotic animals (reptiles– turtle)

Question 17

blanching rose spots, intractable fever, pea soups stools and bradycardia are characteristic of this diarrheal dz:

Answer 17

Typhoid (enteric) fever 2/2 S. typhi

Question 18

DX Sigmoidoscopy in shigella reveals:

Answer 18

punctate areas of ulcerations

also, WBC >50k

Question 19

what is the main complication in Shigella enteritis in children that HCP should monitor for?

Answer 19

febrile SZ

Question 20

enterohemorrhagic e. coli MC sources: 4

Answer 20

• undercooked ground beef
• unpasteurized milk/apple cider
• contaminated water
• daycare centers

Question 21

frothy, greasy and foul diarrhea is seen with this organism:

Answer 21

G. lamblia

Question 22

G. lamblia tx in adults and kids:

Answer 22

adults: metro
kids: furazolidone

Question 23

MC cause of chronic diarrhea in pts with AIDS:

Answer 23

Cryptosporidium

Question 24

How do you dx Whipple’s dz?

Answer 24

duodenal bx and periodic acid-schiff testiing- positive macrophages, non-acid fast bacilli, dilated lacteals

Question 25

How do you tx Whipple's dz?

Answer 25

penicillin* or tetracycline 1-2 yrs

Question 26

Foods high in phenylalanine: 9

Answer 26

``` 1- aspartame (diet sodas) 2- chicken 3- cheese 4- eggs 5- fish 6- legumes 7- meats 8- milk 9- nuts ```

Question 27

chronic anal fissures can reveal this on PE:

Answer 27

skin tags

Question 28

anal fissures MC occur at this site:

Answer 28

posterior midline

Question 29

anal fissures tx:

Answer 29

1- supportive: WASH (mc resolve spontaneously) | 2- ntg topically/nifedipine ointment

Question 30

obturator hernia RF: 2

Answer 30

- multiparous women | - women with significant weight loss

Question 31

CRC factors ass. with worse prognosis: 2

Answer 31

preop CEA >5 | ulcerative patterns

Question 32

MC cause of LBO in adults

Answer 32

CRC

Question 33

MC CRC mets site

Answer 33

Liver (then lungs, lymph nodes)

Question 34

screening recommendations for CRC: avg risk vs first degree relative

Answer 34

avg risk--> initiate screening @ 50 y.o w. annual FOB and q10 yrs colonoscopy CRC in first degree relative with dx >60 y.o.--> annual FOB at 40 yo and q10 yr colonoscopy CRC in first degree relative with dx <60 y.o.--> annual FOB at 40 yo and q5 yr colonoscopy

Question 35

Crohn dx test of choice in acute dz:

Answer 35

upper GI serious with small bowel follow through

Question 36

UC dx test of choice in acute dz:

Answer 36

Flex sig (colonoscopy CI in acute dysentery 2/2 perforation risk and BE CI acute colitis 2/2 TM risk)

Question 37

IBD MC affects this population and age:

Answer 37

caucasians, 15-35 yo

Question 38

MC etiology of AMI:

Answer 38

occlusive: emboli (a. fib/MI) or thrombus (atherosclerosis)

Question 39

MC etiology of SBO

Answer 39

``` 1- post surgical adhesions (60%) 2- incarcerated hernias 3- crohns 4- cancer 5- intussception ```

Question 40

MC etiology of LBO

Answer 40

malignancy

Question 41

TX nonstrangulated SBO:

Answer 41

NPO, IVF, and bowel decompression (NG tube)

Question 42

TX strangulated SBO:

Answer 42

surgical intervention

Question 43

Celiac Dz (Sprue) MC affects:

Answer 43

females of european descent (finnish/irish)

Question 44

PE in a pt with celiac dz may show:

Answer 44

GI: diarrhea, malabsorption, bloating, steatorrhea, abd pain Skin: dermatitis herpetiformis-- itchy rash on extensor surfaces (neck, trunk, and scalp)

Question 45

celiac dz dx:

Answer 45

- endomysial IgA* Ab and transglutaminase Ab* | - Definitive DX: small bowel bx

Question 46

celiac dz tx: 3

Answer 46

1- gluten free diet-- no wheat, rye, barley (oats, rice and corn okay) 2- vitamin supplements 3- steroids if refractory