PPP ROSH- MSK/GI Flashcards
Components of CREST Syndrome
What two PE findings may be seen w/ this condition
? monitoring is needed for Pts on DMARD therapy
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasias
Madonna finger- distal finger tapering
Rat bit necrosis- distal ulcers
CBC- s/e of marrow suppression
Ottawa Ankle Rules
Define Maisonneuve Fx
MC soft tissue tumor of the hand
Bone pain posterior to distal 6cm of Lat/Med Malleolus
Inability to bear weight x 4 steps at evaluation
Navicular pain
Pain at base of fifth metatarsal
Spiral Fx of proximal 1/3 of fibula w/ tibiofibular syndesmosis and interosseous membrane tear
Ganglion- MC d/t repetitive movement
Define Myofascial Pain Syndrome
How are Pts Tx
Rotator impingements are associated w/ ? two positive PE findings
Trigger points w/ painful spots in palpable taut bands of muscle
Cyclobenzaprine- muscle relaxer
Hawkins, Neers
What are the muscles and movements of the rotator cuff
Pseudogout lab results
What x-ray finding is associated w/ this Dx
Supraspinatus- abduction
Ingraspinatus- external rotation
Teres minor- external rotation
Subscapularis- internal rotation
Pos birefringent Ca pyrophosphate dihydrate rhomboids
Chondrocalcinosis
Anti-SSA/Ro is associated w/ ? conditions
Anti-La/SS-B is associated w/ ? condition
Anticentromere is associated w/ ? condition
Lupus Sjogrens Neonate heart block
Sjogrens
CREST syndrome
Anti-dsDNA is associated w/ ? condition
Anit-Jo1 is associated w/ ? condition
Anti-Smith is associated w/ ? condition
Lupus
Inflammatory myopathy
Lupus
Antitopoisomerase SCL-70 is associated w/ ? condition
Antihistone is associated w/ ? conditions
What are the two ANCA autoantibodies associated w/
Systemic sclerosis
Drug induced lupus
cANCA- granulomatosis
pANCA- micro/eosinophilic polyangitis
Rheumatoid factor is associated w/ ? conditions
Anti-smooth muscle Ab is associated w/ ? condition
Antimitochondrial antibody is associated w/ ? condition
RA, Mixed CT d/o, Sjogrens
Chronic immune hepatitis
Primary biliary cholangitis
What are the three classifications of osteoporosis
What causes mallet finger
What condition occurs if this goes untreated
1: post-menopause d/t lack of estrogen
2: Age >75y/o, Loss Zinc/Ca
Secondary: chronic dz/meds (type seen in men)
Force DIP flexion rupturing extensor tendon at insertion on distal phalanx
Swan neck- PIP hyperextension, DIP flexion
Best initial screening test for SLE
What markers are Dx
What med is the best management for SLE
ANA
Anti-double strand DNA and Anti-Smith
Hydroxychloroquine- s/e retinal toxicity= annual Opto
What medication is used for active lupus nephritis
What marker is MC elevated w/ this form of lupus
S/Sxs of patellofemoral pain syndrome
Cyclophosphamide
Anti-double stranded DNA
Pain worse w/ loaded flexion: stair, jump, theater sign
Next step of knee OA after PO meds fail to control Sxs
First choice for mild-mod back pain
What is used for pain refractory to first choice
Intra-articular cortisone and lidocaine injections
NSAIDs
Muscle relaxors: Cyclobenzaprine
? Ab triad is seen w/ scleroderma
What are the three urate lowering meds for gout
What two meds are c/i during Tx
ANA w/ Anticentromere (limited) and Anti-SCL 70 (progressive)
Allopurinol/Febuxostat: dec production
Probenacid: inc excretion
Pegloticase: converts uric acid to allantoin
ASA, Loops, Thiazides
MOA of Colchicine during gout Tx
MCC of acute compartment syndrome and where is the MC location
Dx criteria for Compartment Syndrome
Inhibits microtubule formation for neutrophil migration
Fxs- anterior leg, Volar forearm
30-40mmHg (norm: 0-10)
Delta: DBP - Compartment pressure= ≤30
What are the 6 Ps of Compartment Syndrome
How is Pseudogout Tx
How can Meniscus injury be detected on PE and what image is preferred
Paresthesia Pallor Pulse Poikilothermia Paralysis PooP
Pain Color Sensation Pulse Temp Paralyzed
NSAID (Colchicine if c/i)
+Thesally, pain on medial joint line; MRI
What is the “Unhappy Triad”
Suspected Ca mets to bone is imaged w/ ?
? type of c/c is common in autoimmune mediated inflammation
Medial meniscus, ACL, MCL
MRI > CT myelography
Pain worse w/ rest, improved w/ movement
EMED recs
Know when to intubate GCS- calculate Sickle cell chest pain/occlusive crisis w/ dec Hgb EENT Anterior should dislocation- nerve damaged? When to do Ex-Lap Dental emergency Ectopic pregnancy Spont abortion/Placenta preva Emergency before/after 20wks gestation Consults- OB GenSurg Disposition- admit, IV ABX, serial exams
Define Dimple Sign
Why are these a surgical emergency
How are they Tx
Transverse groove at medial joint line indicating posterolateral knee dislocation
Irreducable w/ manual reducation: medial femoral condyle button holed through medial capsule, MC invaginated in joint
Surgical emergency: open reduction
? nerve/artery is MC damaged w/ tibiofemoral dislocations
Define Saturday Night Palsy
What sensory deficit is associated w/ this condition
N: Common Peronial/Fibular nerve
A: Popliteal artery
Prolonged external compression w/ wrist flexion causing inability to extend wrist against resistance
Superficial branch numbness: dorsal first web space
? nerve is responsible for pinching movement between thumb and index finger
What is the function of the peroneal nerve
Anterior/Posterior hip dislocation presentations
Anterior Interosseous branch of median nerve
Superficial branch: Foot eversion
Deep branch: foot dorsiflexion, toe extension
P: internal rotation w/ shortening
A: external rotation w/ lengthening
Polymyalgia Rheumatica presentation
? other Dx is commonly co-existant
How are PR Pts Tx
Morning stiffness w/ shoulder/hip weakness and ESR >50
CGA
CCS
Best PE test for assessing ACL stability
Colchicine needs to be avoided in ? gout Pts
How is olecranon bursitis Tx
Lachman- bend 20-30*, pull tibia aneriorly
Dec GFR/renal failure
Compression, Ice, NSAIDs
How can olecranon bursitis be differed from a joint effusion on PE
How is osteomyelitis and septic arthritis differed on PE
What imaging modality is preferred to Dx osteomyelitis
Effusion: pain w/ full extension
Bursitis: normal PROM
Preserved ROM
MRI- shows defect 2wks prior to x-rays
MC microbe involed in cat bites
What ABX is used for Tx
? microbes MC lead to Reactive Arthritis
Pasteurella multocida
Amp-Sulbactam
Campylobacter, Shigella, Salmonella, Yersinia, Chlamydia
How are stable ankle Fxs Tx
What causes Cauda Equina to occur
What is the most sensitive clinic sign for this condition
Weight bearing cast x 4-6wks
Compression of conus medullaris
Urine retention
How many pressure points for Fibromyalgia Dx
Function of Flexor Digitorum Superficialis
Function of Flexor Pollicus Longus
11 of 18
Medial humoral epicondyle to PIP/MCP for flexion
Thumb flexion
Function of Palmaris Longus
Function of Flexor Carpi Ulnaris
Function of Flexor Digitorum Profundus
Wrist flexion
Hand adduction
DIP flexion
Function of Flexor Carpi Radialis
What nerve innervates the FDS
Bicep reflex nerve
Flexion and hand abduction
Median
C5/6
Tricep reflex nerve
Brachioradialis reflex nerve
Patellar reflex nerve
C7
C6
L4
Dorsal web of first/second toe innervated by ?
Achilles reflex nerve
What muscles insert at the Pes Anserinus
L5
S1
Goose foot: gracilus, sartorius, semitendinous
Gracilis origin, insertion, innervation
What other knee injury needs to be r/o in a Pes Anserinus injury
O’Brien test is AKA ? and tests for ?
Inferior ramus, Medial tibial shaft, L2-4 via obturator nerve
MCL- insertion site near bursa
Active Compression- SLAP/glenohumeral joint tears
? nutritional deficiency presents w/ malar rash like SLE
What PE test is used to assess for Achilles rupture
How are Pt managed prior to surgery
Pellagra- B3 deficiency
Thompson squeeze- most reliable indicator
Splint in plantar flexion w/ non-weight bearing
Lisfranc is ? type of injury
How are these isolated for Dx on PE
What type of mechanisms leads to this injury
Tarsometatarsal joint Fx/dislocation from cuneiform
Stabilize hindfoot, forefoot rotation
Plantar flexion
MCC of acute hemarthroses in sport injuries
Joint aspirate w/ ? WBC levels indicate septic or inflammatory
How does glucose content help differ
ACL tear
Inflammation: 2-50K; Septic: >50K
Inflammation: >25; Septic <25
What Dx causes tender, nodular lesions in starburst pattern w/ erythema on shins
What types of plaques can Pt develop
What is the preferred Tx for Polymyositis
Polyarteritis Nodosa: necrotizing vasculitis of small/medium arteries
Livedo reticularis- starburst and pathognemonic
Pred
What type of Ca is associated w/ dermatomysoitis in women
How is Osgood-Schlatter Tx
What causes Bankart Lesion
Ovarian
Tylenol and activity as tolerated
Posterior humeral head hitting anterior gleniod rim w/ arm abducted and externally rotated causing Fx
? biomarker is most specific for RA
What 3 infections can present w/ elevated RF
? is the MC hand infection
Anti-cyclic citrullinated peptide Abs
Hep C Malaria Rubella
Paronychia- infection of lateral nail fold
What are two possible complications from paronychias
Dx test for Sjogrens
What lab markers may be positive in these pts
Progression to felon, Osteomyelitis of distal phalynx
Schirmer
Anti-Ro/La and RF
What is used to measure spinal deformities
What test is used to r/o SLE
Define De Quervain Tendinopathy
Cobb angle: top of first vertebrae involved, bottom of last vertebrae involved, >10*= Dx
ANA
Abductor pollicis longus/Extensor pollicis brevis inflammation d/t overuse/post-partum
? test is used for De Quervains Tendinopathy Dx
How are Pts Tx
What nerve innervates the ligaments involved
Finkelstein
NSAIDs, thumb spica spint, steroid injections
Deep branch of radial nerve
Kanavel Criteria for Flexor Tenosynovitis
Triad characteristics of septic arthritis
? derm manifestation of reactive arthritis may be seen on PE
Tenderness along flexor tendon
Finger swelling
Pain w/ passive extension
Flexed posture
Pain Swelling Fever
Brown/Red papules that become hyperkeratotic and crusted over on palm/soles after Chlamydia
? PE finding is a c/i to manually reduce a tibiofemoral dislocation
? lab marker is used as a marker of muscle injury during Rhabdo and used for Dx
? is the MC non-spine complication or Ankylosing Spondlyitis
Dimple sign
Creatine kinase (CK-MB is more specific to cardiac muscle)
Anterior Uveitis- unilateral pain, photophobia, blurred vision
How is Bipartite Patella differed from Patella Fx on x-ray
? body position leads to the MC type of shoulder dislocation
? nerve is MC injured during shoulder dislocations
Bipartitie- rounded/smooth edges
Anterior: abducted, externally rotated, extended
Axillary- lateral sensation, deltoid contraction
? two PE tests suggest rotator cuff injury
? TB med can induce Lupus-like syndrome
? drugs are used for the Tx of osteoporosis by slowing bone loss
Drop arm, Empty can
Isoniazid
BisPhos: -dronates
Calcitonin
SERM: Raloxifene
Monoclonal: Denosumab
? med is used for osteoporosis Tx to reduce bone formation
After initiating BisPhos therapy, when is the next f/u DEXA scan done
Dupuytren contracture is associated w/ ? Dx
Teriparatide (PTH)
2yrs
DM
Define Syndesmotic Ankle Sprain
What is seen on x-ray
How are these Tx
High ankle sprain: pain w/ external rotation and dorsiflexion (Kleger test) w/ partial syndesmosis tear
Diastasis between tib/fib
Grade 1: immobilize, non-weight bearing
2/3: surgery
MC microbe seen w/ nail puncture induced osteomyelitis and how is it Tx
Normally what is the MC microbe of osteomyelitis
How is Lumbago Tx
Pseudomonas- Cipro
Staph A
Activity within pain limitations
Define Boutonniere deformity
Ankle sprain classifications by grade
? ABX is used for human bite infection prophylaxis
PIP flexion, DIP hyperextension
1: tender swelling, micro tears of colagen
2: dec ROM, possible instability; immobilize and PT
3: swelling, tenderness w/ instability e/ complete tear/rupture
Augmentin
The MC microbes seen w/ dog bites
? medication is used for systemic stimulation in Pts w/ Sjogrens
Two DDx for non-traumatic subungual hematomas
Staph A, Pasteurella multocida, Strep viridian
Pilocarpine
Melanoma, Kaposi
Define HSP
What are Pts at risk for
What lab result aids w/ Dx
MC vasculitis of child hood; IgA mediated lower extremity palpable purpura, arthritis, abdominal pain and renal involvement
Intussusception > Nephrotic syndrome
Normal platelet count
Landmarks above/below snuff box
Pos snuff box tenderness w/ negative x-ray needs w/ d/c education
Scaphoid Fx are more likely to necrose w/ ? fx location
EPL/EPB/APL
Repeat x-ray 10-14d, remain in thumb-spica splint
Proximal, inc likelihood d/t blood supply via distal pole
What RA presentation differs it from OA
RA induced effusions will have ? results
What is needed to confirm a Dx of scoliosis
Constitutional Sxs
Low glucose, low pH, high LDH
Radiographs to measure Cobb angle
? lab result will be almost universally elevated in Pts w/ osteomyelitis
What radiographic finding indicates this Dx
MC Fx carpal bone
Inc ESR
Periosteal elevation w/ inflammation
Scaphoid
? joints of the hand are spared w/ RA
Define Colles Fx
Plantar fasciitis is common w/ ? foot abnormality
DIP spared
Distal radial Fx from FOOWrist
Cavus foot
Define Tarsal Tunnel Syndrome
What lab results will be seen in UA during rhabdo
What two carpals bone articulate w/ radius
Posterior tibial nerve entrapment under flexor retinaculum
Inc K, Ph; Dec Ca- MC
Scaphoid, Lunate
If Pt presents w/ L4-L5 herniation, what nerve root is compressed
? hyperlipid medicine can exacerbate gout
This med is also an exacerbation to ? population Dx
One above- L4
Niacin
DM- hyperglycemia
Lab results seen after muscle biopsy to Dx polymyositis
How are Frozen Shoulder’s Tx
Urate crystals are the product of ? metabolism
Inc aldolase and Creatine Kinase
PT, NSAID, injections
Purines
MC cause of hip disability in adolescents
What c/c can Pts present w/
What PE finding will be seen
SCFE M: 12-16y/o F: 10-14y/o
Hip pain referred to thigh/knee
Dec internal rotation
Name of x-ray line used for Dx SCFE
Fasciotomy’s are most effective if done w/in ? time frame
First step in ganglion cyst management
Klein line
<6hrs from injury
Aspiration
? drug is safe for RA Tx during pregnancy
MC presenting complaint for men w/ osteoporosis
Pos anterior drawer test after ankle injury means ?
Hydroxychloroquine
Vertebral compression Fx
Grade 3: tear of anterior talofibular ligament
Chronic use of ? meds place Pts at risk for vertebral compression Fxs outside of a Dx of osteoporosis
What is the straight leg raise test AKA ?
? PE test assesses the meniscus of the knee
CCS
Lasegue sign
McMurray
How are Pts w/ Greater Trochanteric Pain Syndrome Tx in sequence
Pts w/ this condition who do not respond to conservative Tx need to have ? Dx r/o
What causes GTP Syndrome
1st: NSAIDs, PT
2nd: CCS injection to bursa
Medial glute tear
Overloading of glute medius/minimus
Scleroderma Pts will most likely test positive for ? biomarker
MC joint for septic arthritis
Lab results seen w/ this Dx
+ ANA
Knee
WBC >50K, low glucose
What PE finding aids w/ Dx of Ankylosing Spondylitis
Medical Tx options for Raynauds
Allopurinol can be used to avoid acute gout attacks except for ? type
Tenderness over spine/SI joint
CCBs Sildenafil Fluoxetine
Diuretic induced gout
Mainstay of Tx for Reactive Arthritis
Three PE findings associated w/ Dermatomyositis
How are Pts Tx
High dose NSAIDs
Heliotrop rash: violet erythema around eyes
Gottron papules: thickened knuckle skin
Shawl sign
Pred, Methotrexate, Cyclophosphamide
Joint aspiration WBC results for Normal, Non-Inflamm, Inflamm, Septic and Hemorrhagic
Red flags of back pain
N: <150 Non-In: <3K Inflamm: >3K Septic: >50K Hemorrhagic; n/a
IVDA F/C/S- infection AM tenderness >30min- seroneg spondyl Retention/Anesthesia- cauda equina Tenderness- Fx Night pain/Weight loss- tumor ImmDef- infection Coagulopathy- hematoma Extremes of age Recent instrumentation- hematoma/abscess
? x-ray view should be ordered for patellofemoral instability w/ catching
Frog leg view is used to view ?
Grashey view is used to view ?
Axial/sunrise
Hip
Glenohumeral joint
Swimmers view x-ray is used to view ?
Most sensitive imaging for radiculopathy
What does xanthochromia indicate in CSF
Cervicothoracic junction
MRI > CT w/ contrast
RBCs in subarachnoid space
? underlying condition is commonly associated w/ fibromyalgia Sxs in males
What are the MC positive autoantibodies for myositis
What other two results will can also be positive
OSA
Anti-Jo 1
ANA, RF
Ottawa Ankle Rules apply to injuries that occurred ? long ago
? is the MC sprained ankle ligament
What are the Sxs associated w/ Sjogrens called and how are they Tx
<48hrs
Anterior talofibular
Sicca Sxs: pilocarpine
Non-puncture foot osteomyelitis is MCC by ? microbes and Tx w/ ?
Criteria for adolescent scoliosis
How are Pts managed
Staph/Strep: Clinda/Cephalexin
Cobb angle ≥10* and onset ≥10y/o
10-19: observed w/ f/u q6-9mon until skeletal maturity
20-29: possible brace
30-39: brace
≥40: surgery
What is the name of the grading system for assessing skeletal maturity
? two PE tests are done for suspected carpal tunnel
MC radiograph finding for Salter-Harris type 5
Risser classificaiton
Most sensitive: median compression test
Tinel tap test, Phalen compression x 60sec
Normal
Legg Calve Pertheses Dz ages compared to SCFE ages
Define Colchicine toxicity
? DMARD is preferred for Ankylosing non-responsive to NSAIDs
LCPD: 4-10, SCFE: 12-16
Automn crocus/Glory lily alkaoids- severe GI upset w/in first 24hrs of use
Infliximab
Define Sever Dz
Tx of choice for disseminated N gonorrhoeae septic arthritis
What are the main Sxs of bone maligancy
Calcaneal apophysitis- inflammed calcaneal growth plate causing pos compression test after cleat-wearing sport participation, self resolves
Ceftriaxone
Constant, deep ache at night unrelieved by rest
Primary bone tumors of 20-30y/o
Primary bone tumors of 30-50y/o
Primary bone tumors of >50y/o
Osteo-chondroma/sarcoma Osteoid osteoma Adamantinoma Giant cell Enchodondroma
Chondrosarcoma
Fibrosarcoma
Malignant histiocytoma
Lymphoma
MMyeloma
What is the next step needed for Pts w/ proximal humerus Fxs
What 3 rotator muscle insert on the greater tuberosity
When is it appropriate to refer spinal claudication/stenosis to Ortho
Distal neurovascular supply assessment
Supraspinatus Infraspinatus Teres
Neuroclaudication >12wks
What two PE tests are positive if ankle instability is present
Straight leg raise tests for radiculopathy at ? level
How is this test done
Anterior Drawer, Talar tilt
L5-S1
Sx leg raised straight; Pos= pain in back radiating past knee when raised 30-70*
Reverse straight leg raise tests for radiculopathy at ? level
How is this test done
Pos Galeazzi test indicates ? issue
L3-L4
Passive extension of hip w/ Pt prone
Development hip dysplasia d/t femoral shortening
Developmental dysplasia of the hips is more common in Pts w/ ? cervical condition
Involvement of ? structure indicates inoperable gastric Ca
Three PE signs of gastric Ca mets
Congenital torticollis, “wry neck”
Hepatic artery encasement
Virchow node
Iris node- L axillary node
Sister Mary Joseph- periumbilicular
MCC of infectious diarrhea in AIDS Pts
Primary anal fissure location and causes
Secondary anal fissure location and causes
Crypto when CD4 <100
Posterior midline:
Trauma Constipation/Diarrhea Delivery
Lateral midline:
Crohns Malignancy Communicable/Granulomatous dz
Marker of Hepatic Encephalopathy
How is this Tx
MC type of pancreatic Ca
Ammonia
Laculose, Rifaximin
Adenomacarcinoma- worst prognosis
How do pancreatic Cas present
What serum marker is associated w/ this
MCC of intestinal obstruction in Pts <2y/o
Painless jaundice
Courvoisier sign
Trousseau syndrome- hypercoagulability seen as migratory thrombophlebitis
19-9
Inussusception- cyclic cramping pain w/ vomiting and bloody stool w/ palpable mass
MC type of colorectal Ca
MC type of Ca and MCC of death in M/W
Adenocarcinoma- ab pain, bowel changes, weight loss, dec appetite and hematochezia
Men MC: Prostate Lung Colorectal
Men MC death: Lung Prostate Colorectal
Women MC: Breast Lung Colorectal
Women MC death: Lung Breast Colorectal
MC emergent surgery in pregnancy
How is pancreatitis Dx
How are esophageal varices Tx
Appendicitis
Lipase inc 3x- most specific
US to evaluate for biliary etiology
Ligation Banding Sclerotherapy
? infectious Dz can cause esophageal varices
When does candidiasis induced esophagitis occur and how is it Tx
Female athlete triad
Schistosomiasis (trematode)
CD4 <200; First line: fluconazole
D/o eating Amenorrhea Osteopenia
Small intestine infarctions MC occurs d/t ?
If surgical intervention is performed on the left lower quadrant, ? was the issue
Shigella infections can cause ? Dx and ? extraintestinal manifestation
Superior mesenteric artery emoli
Inferior mesenteric artery
Dysentery: Reactive arthritis, Seizure, Hallucinations
Lactose intolerance is d/t ?
What lab results may be seen
What causes achalasia
No lactase- glucose to galactose
Stool osmotic gap >125, pH <6
Degeneration of ganglion cells in the myenteric plexus of esophagus wall
MCC of upper GI bleeds
MCC of lower GI bleeds
Define Hamman Sign
PUDz
Diverticulosis- painless rectal bleeding
Crunching on chest auscultation d/t esophageal perf
? microbe causes ileocecitis
What is the Dx AKA ?
What post-infectious issues can develop
Yersinia enterocolitica from pigs
Pseudoappendicitis
Erythema nodosum, Reactive arthritis
Most effective Tx of esophageal strictures
What type of laxative is first line Tx for chronic constipation
Phenyketonuria needs life long diet of ?
Dilation and PPIs
Bulks- psyllium, methylcellulose
High veggie, low meat/starch- inability to convert phyalanine to tyrosine
What sweetner is avoided during PKU
Heinz bodies is associated w/ ? micro/macrocytic anemias
What lab result would show Heinz bodies
Aspartame
Micro: A-thalassemia
macro: G6PD deficiency- no glutathione (radical destroyer)
Neg Coombs test- non-immune
Define Cholecystitis
Gold standard to Dx PUD
Ascending Cholangitis Sxs
Infected gallbladder d/t stones obstructing the cystic duct
Endoscopy
Charcots: RUQ pain, Jaundice, Fever
Reynolds: +shock and AMS
Four classifications of hemorrhoid
Diverticulitis out-Pt Tx ABX
Viral hepatitis lab results
1: no protrusion
2: spontaneous reduction
3: manual reduction
4: non-reduceable, possible strangulation
Cipro w/ Metronidazole/TMP-SMX
ALT>AST
Acute Hep B infection characterized by ?
Immunization is noted by ? result
Anti-HBc-IgM
Anti-HBsAg IgG
Bulk laxative
Stool softener laxatives
Stimulant laxatives
Psyllium, Methylcellulose
Docusate
Senna Bisacodyl Castor oil
? lab result are most significant for re-feeding syndrome
Complication that can arise from UC
How is this complication Tx
Hypo-phosphatemia HypoK Thiamine deficieny and CHF
Toxic megacolon
Bowel rest and NG tube
MC type of gastric Ca and Dx method
What is the MC RF
What tumor marker will be inc in 50% of Pts w/ gastric Ca
Adenocarcinoma Dx w/ EGD
H pylori
Carcinoembryonic Ag (CEA)
Define Mallory Weiss
What is a pre-disposing RF
Define Positive Dance Sign
Longitudinal tear in distal esophagus mucosal layer
Hiatal hernia
Empty RLQ in US significant for intussusception
What causes intussusception in adults
How is ascites 2/2 P-HTN/cirrhosis Tx
What causes un/conjugated bili to rise
Malignancy
Spironolactone (reverses Na retention, conserves K and diuresis fluid), then Furosemide, then centesis
Un: hemolysis, liver dz, Con: biliary obstruction
MCC of acute gastritis
What heme abnormality may be seen
What can/not be eaten w/ Celiac dz
H pylori
Pernicious anemia d/t parietal cell destruction, IF destruction
Can: rice, corn, potato, soybeans
No: wheat, barley, rye
? GI med decreases Ca absorption
How is a Dx of lactose intolerance confirmed
Recommended Ca per day
PPIs
Lactose hydrogen breath test
1200mg/day
EGD needs to be done on all Pts w/ dyspepsia over ? age
MCC of VGE
? population has a high mortality rate d/t Hep E
≥60
Norwalk virus from cruise ships
Pregnancy 2-3rd trimester
How is cholelithiasis Tx during pregnancy
Zollinger Ellison is associated w/ ? genetic syndrome
MC PE finding for PUDz and what is the MC complication to arise from this Dz
Pain control, support
MEN-1
Epigastric tenderness; GI bleeds
Colon Ca bleeding comes from ? side while diverticulitis comes from ? side
Acute management for variceal bleeds
Chronic management includes ?
Ca: R, Diver: L
Octreotide, Banding/Sclerotherapy, Ceftriax
BB, ligation
Crohns biomarkers
Crohns derm manifestation
Crohns is AKA ?
ANCA, ASCA
Erythema nodosum- tender, erythematous nodules on bilateral shins
Regional enteritis
PE finding suggesting B12/Cobalamin deficiency
What lab results will be pos
How are UTIs in G6PD Pts Tx
Enlarged, red tongue
Inc methylmalonic acid and homocysteine
Cephalexin
What is seen on smears of G6PD blood
What tropical dz are they protected from
MCCs of SCC/Adeno Ca in esophagus
Heinz bodies, Bite cells
Malaria
SCC: Smoking, Alcohol, Adeno: Barrets
Vit A toxicity
What is the result of this toxicity
Post-hernia surgery w/ beltline numbness is d/t ? nerve
Inc ICP, Oily skin, Alopecia, Dec appetite/weight loss
Suppress osteoblast, Stims osteoclast
Iliohypogastric
What is a neuro complication arising form thiamine deficiency
How is this Tx/prevented
Ranson Criteria
Wernicke Korsakoff Syndrome- Encephalopathy Ocular dysfunction Ataxia
Thiamine before glucose
GA LAW: Glucose>200 AST>250 LDH>350 Age>55y/o WBC>16K
CHOBBS: Ca<8 Hct dec >10% O2<60 Base deficit >4 BUN inc >5 Sequesters fluid >6L
What E+ needs to be monitored after admission for pancreatitis
Triad of Disulfuram Reaction
Perforation of ? GI structure has the highest mortality and MC d/t ?
Ca
Flushing Tachycardia HOTN
Esophagus MC d/t iatrogenic cause
4Hs of Scurvy
Define IgA Vasculitits presentation
What will be seen on lab results
Hemorrhage- gum/petechiea
Hperkeratosis- rough skin, loose teeth
Hypochondriasis- irritable emotional changes
Heme abnormals- easy bruising
AKA Henoch Schonlen purpua- arthritis/arthralgia and palpable but non-blanching red/purple macules w/ abdominal cramps and bloody stools
Guiac pos stool, proteinuria, inc BUN/Cr
Histopathologic term for gastric malignancy cells
Borders of inguinal hernias
Celiac Dz can cause Pts to become ? deficient
Signet ring cell
Hesselbach Triangle: abdominus rectus, inguinal ligament, epigastric vessels
Fe
Nexus criteria
MC presentation for acute small bowel obstruction
How does the presentation of an ileus or pseudo-obstruction present differ
Neuro deficit, no focal deficit Spinal tenderness, midline AMS, normal Intoxicated Distracting injury
Colicky pain w/ distension and emesis;
No colicky pain or N/V
? vitamin deficiency presents w/ dermatitis, diarrhea and dementia?
MCC of esophageal varices in USA
How is H Pylori Tx
Niacin, Pellagra
Cirrhosis
Triple: Clarithromycin Amox (or Metro) and PPI
Quad: Bismuth Metro Tetracycline PPI
INH Tx leads to ? deficiency
Folic acid production depends on ? vitamin
First line Tx for Crohns
B6- pyridoxine
B9- folate
Mesalamine (ileitis) or Sulfasalazine (ileocolitis, colitis)
What lab results are seen w/ pyloris stenosis
Indications for H Pylori quad therapy
Lab results seen w/ Rickets
HypoCl/K w/ metabolic alkalosis
Recent macrolide use, Area w/ clarithromycin resistance, Triple therapy eradication ≤85%
Inc AlkPhos, low phosphorus/Ca
3 MCC of small bowel obstructions in order
Define Ogilvie Syndrome
How is this Tx
Adhesion, Ca, Incarcerated hernia
Pseudo-obstruction w/ dilated colon d/t autonomic dysfunction
Cecal diameter >12cm: Neostigmine- aetylcholinesterase inhibitor
Opioid induced: methylnaltrexone
S/e of using neostigmine for Tx of Ogilvie Syndrome
Hallmark histology result for celiac dz
? med is c/i in Pts w/ NSAID induced ulces
Bradycardia, Asystole
Villous atrophy
Misoprostol
? acid base d/o does salicylate toxicity cause
What medication is used to trap the aspirin and promote excretion
External PE finding suggesting IBDz
Metabolic acidosis, Resp alkalosis
Na bicarbonate
Anal skin tags
