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ESUN MS2Unit6 > POM (last time ever!) > Flashcards

POM (last time ever!) Flashcards

1
Q

When will you see melana with lower GI bleed? or hematochezia with upper GI bleed?

A

When the GI motility is slow

When the GI motility is fast

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2
Q

What is the definition of occult GI bleed?

A

Small amount of bleeding that the pt is not aware

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3
Q

Clinical markers of upper and lower GI bleed?

A

Upper GI—>Hemodynamic compromise—>Shock/hypeactive bowel sound (blood is an irritant)/increase BUN (blood breakdown)
Lowe GI—>no hemodynamic compromise—>hematochezia

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4
Q

What clinical sign can you see with blood loss?

A

Orthostatic HoTN

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5
Q

Why is Ringer’s solution helpful for shock pt?

A

Shock pt has metabolic acidosis—>Ringer’s solution has lactate which would be converted to bicarb to offset the acidosis

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6
Q

Why does initial HCT after bleed does not reflex the actual value?

A

HCT depends on plasma volume—>bleeding deplete plasma volume

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7
Q

What is the normal HCT for men and women

A

Men—>45%

Women—>40%

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8
Q

Pt with GI bleed should be on ___ status?

A

NPO

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9
Q

What drug do we give pt with GI bleed?

A

IV PPI/sucralfate—>acid suppression

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10
Q

What are the prokinetics and how do they work?

A

Increase gut motility for visualization
Erythromycin—>motilin agonist
Metoclopramide—>D2 antagonist

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11
Q

When do we use antibiotic for prophylaxis when the pt is having GI bleed and why?

A

When the pt has cirrhosis—>portal HTN—>blood is bypassing liver—>bacteria is not filtered in the liver–>thus antibiotic prophylaxis is needed

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12
Q

What drug has vasoconstrictive effect on mesenteric and portal vessels, thus reduce bleeding? what other drug can be used as vasocontrictor?

A

Somatostatin analog like octreotide
Vasopressin—>stimulate V1 receptor
Used for acute bleed

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13
Q

How to approach GI bleed pt?

A

First stabilize the pt—>if stabilize—>endoscope—>if not—>interventional radiology for embolization surgery

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14
Q

Forrest classification for endoscopic risk, which one is the worst and the least dangerous?

A

Forrest I A is the worst

Forrest III is the least dangerous

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15
Q

What are the high risk marks for variceal to bleed?

A

Red wale mark/cherry red spot/hemocystic spot/diffuse erythema

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16
Q

What drugs are used as prophylaxis for varices that hasnt bled yet?

A

Non selective beta blocker—>decrease portal pressure

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17
Q

Is rebleed after a variceal bleed common?

A

mmhmm

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18
Q

When is TIPS used?

A

Refractory variceal bleed

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19
Q

What could be an underlying cause of obscure bleed? and when do you usually see that?

A

Hemobilia (bleed into biliary tree)/liver biopsy

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20
Q

What is Dieulafoy’s lesion? most commonly seen in?

A

Large submucosal artery (normally should be small)—>bleed

Stomach

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21
Q

Hiatal hernia can cause ___ lesion?

A

Cameron’s

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22
Q

What kind of bleeding does diverticulosis cause?

A

Large amount of bleeding

23
Q

What is common cause of obscure GI bleed for a older or younger pt?

A

Older—>AVM

Younger—>Meckle/lymphoma

24
Q

How much occult blood test should you do?

A

2 samples from 3 consecutive bowel movement

25
Q

What is fecal immunochemical test (FIT) do? what does it suggest if its +?

A

Have antibodies against globin—>test for fecal blood

Specific for lower GI bleed

26
Q

Cough after meal, think? cough lying down, think?

A

GERD

Post nasal drip

27
Q

What it is and what causes rhinitis medicamentosa?

A

Rebound nasal congestion from using too much nasal decongestant
Use nasal decongestant for only 3-5 days

28
Q

Tx for acute and chronic allergic rhinitis? side effects?

A

Acute—>H1 blockers (1st or 2nd gen)
Chronic—>nasal steroids (fluticason)—>bleeding
Chronic—>nasal irrigation

29
Q

How long do we give antibiotics for tonsillitis?

A

2 weeks

30
Q

What are the 2 S. pneumoniae vaccine and when to give them?

A

PCV 13—>young children

PPSV23—>adult over age 65 (before 65 if high risk)—>give PCV13 first and then PPSV23

31
Q

How long do we use antibiotic for treat UTI and what do we use to treat UTI in pregnancy?

A

3 days

Macrodantin

32
Q

What kind of cast in urine is indicative of pyelonephritis? How long should we treat it?

A

White cell cast

At least a week

33
Q

What happens in the space of Disse during cirrhosis?

A

Collage deposition from stellate cell—>defenestration of sinusoids—>increase sinusoids pressure

34
Q

Pruritus can be caused by what dysfunction in the liver or gallbladder?

A

Cholestasis—>bile acid leaks into blood

35
Q

Xanthelasma is associated with what liver disease?

A

Primary biliary cirrhosis

36
Q

How do you test for Hep C?

A

HCV antibody—>then HCV RNA

37
Q

What stage of cirrhosis if you also see ascites?

A

Decompensated cirrhosis

38
Q

What drug do you give the pt to prevent varices from bleeding?

A

non selective beta blockers

39
Q

What do you need to do for a pt with diagnosed cirrhosis?

A

Check for varcies (beta blockers if needed)
Check for HCC
Give all Hep A/B vaccinations

40
Q

What do you give the pt with bleeding varices?

A

Prophylactic antibiotics

41
Q

What do you need to check for when pt has ascites?

A 
Cell count (if it's infection)
Protein/albumin ratio
42
Q

How to you treat ascites?

A

Salt restriction

Spironolactone +/- loop

43
Q

What would cause hepatic encephalopathy?

A

TIPS

44
Q

What drug and condition would prevent the uptake of UCB into the liver?

A

Rifampin/sepsis

45
Q

What is Stauffer syndrome?

A

Renal cell carcinoma induced hepatic dysfunction—->reversible

46
Q

What are the roles of gp41 and gp120?

A

gp 120 binds to CCR5 or CXCR4—->gp 41 mediates the entry

47
Q

Which female GU cancer is associated with HIV?

A

Cervical carcinoma (high risk HPV)

48
Q

Fitz Hugh Curtis syndrome affect?

A

Perihepatitis

49
Q

When should you obtain a culture for chlamydia infection?

A

When you have to go to court (suspected child abuse/sexual assault

50
Q

Which bacteria can infect the oropharynx, gonorrhea or chlamydia? and which bacteria is more symptomatic?

A

Gonorrhea

Gonorrhea

51
Q

Which bacteria present earlier neonatal conjunctivitis, chlamydia or gonorrhea?

A

Gonorrhea presents earlier

52
Q

Which bacteria can have disseminated infection like tender pustular on palm and sole or arthritis, chlamydia or gonorrhea?

A

Gonorrhea

53
Q

What is the tx for gonorrhea?

A

Ceftriaxone and azithromycin

54
Q

TCA overdose would manifest as?

A

Coma/HoTN/seizure/wide QRS

ESUN MS2Unit6 (3 decks)

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