Review Flashcards
1
Q
What artery supply, presses on the left renal vein and is responsible of nutcracker syndrome?
A
Superior mesenteric artery
2
Q
Chief cells produce what?
A
Pepsinogen
3
Q
Parietal cells produce what?
A
Intrinsic factor and hydrochloric acid
4
Q
Enterochomaffinlike (ECL)/endocrine cells produce what?
A
Histamine
5
Q
Mucus cells produce what?
A
Mucus and bicarbonate
6
Q
D cells produce what?
A
Somatostatin
7
Q
G cells produce what?
A
Gastrin
8
Q
Serosa layer is what?
A
Outer connective layer
9
Q
Serosa layer function
A
Secretes water fluid that prevents friction
10
Q
Submucosa
A
Connective tissue that provides GI tract with dispensability and elasticity
11
Q
Submucosa contains
A
Submucosa plexus-nerve network and large blood and lymph vessels
12
Q
Muscularis externa
A
Major smooth muscle
13
Q
Muscularis externa - inner
A
Contraction decreases diameter of lumen
14
Q
Muscularis externa - outer
A
Contraction shortens length of GI tract
15
Q
Muscularis externa - myenteric plexus
A
Nerve network, helps regulate gut activity
16
Q
Mucosa
A
Lines luminal surface
17
Q
Mucosa - contents
A
Mucus membranes (cells) Laminate propria (lymph) Muscularis mucosa (muscle)
18
Q
Gastrin
A
Stimulates acid and enzyme secretion
19
Q
Secretin
A
inhibits gastric secretion and motility
20
Q
Cholecystokinin (CCK)
A
Stimulates pancreas to digest enzymes, slows digestion in stomach, causes gallbladder and liver to release contents, reduces feeling of hunger
21
Q
Amylase
A
Breaks down starches/carbohydrates
22
Q
Protease
A
Breaks down proteins
23
Q
Lipase
A
Breaks down fats/triglycerides
24
Q
Direct Bilirubin elevated with?
A
Conjugated, should NOT leak through healthy hepatocytes into the blood
- hepatocyte damage, hepatitis, and cholylithiasis
25
Indirect Bilirubin elevated with?
Unconjugated, bound to albumin
| - high RBC metabolism, hemolytic anemia, and Gilbert syndrome
26
When would pancreatic enzymes would they be elevated?
Acute pancreatitis - elevated lipase
27
What lab test do you order for a pancreas?
Order lipase, not amylase
28
Pancreatic cancer: what portion?
Head and neck
29
Greasy fatty floating stools, diabetic, social drinker what lab test is elevated?
Elevated A1c
30
Risk factors for acute pancreatitis
Alcohol, gallstones, hypertriglycerides, ERCP, trauma, drugs
31
HepB - Surface HBsAG
+ = virus is present
32
Surface HBsAB or Anti-HBs
Past exposure/immunity
| + in vaccinated people or who have cleared the virus
33
Core: Anti-HBc IgM
Acute or recent infection, cleared HBsAg but haven’t developed HBsAb
34
Core: HBcAB or Anti-HBc IgG
Exposure to infection
35
HCV Ab or Anti-HCV
Past exposure or ongoing infection
36
Elevated AST
Alcohol
37
elevated ALT
Hep
38
Prison tattoos, has Hep C no tx yet what labs would you find with cirrhosis?
Thrombocytopenia ——may see anemia
Hypoalbuminemia
Elevated PT/INR
39
Risk factors for hepatocellular carcinomas
Cirrhosis, hepatitis, elevated alpha fetoprotein
40
Pt comes in with 3rd bout, aching pain, ate McDonald’s what is your diagnosis and PE finding?
Cholecystitis OR Biliary colic
| PE findings: RUQ radiating to R shoulder
41
Fats enter the duodenum, called?
Micelles
42
Ascending cholangitis - Charcot triad
Fever, RUQ pain, Jaundice
43
Ascending cholangitis- Reynold pentad
Charcot triad + hypotension + mental status change
44
Warning signs, red flags for abdominal problem
+ ve physical sign, history, and lab support
- colicky pain
- weight loss
- awakens at night
- growth retardation
- abdominal scars
45
Current jelly stool
Intussusception
46
Intussusception first line treatment
Barium enema
47
15-month failure to thrive you suspect celiac what test do you do to confirm celiac disease?
Do biopsy
48
S/Sx of Crohn: mouth to anus
Toxic megacolon, growth failure, fistula, oral aphthous ulcers, arthritis, erythema nodosum, clubbing, episcleritis, gallstones and renal stones
49
S/Sx of UC: colon
Cramping, diarrhea, rectal bleeding, chronic Sx’s, primary sclerosis cholangitis, uveitis, pyoderma gangrenosum
50
Sick kid, can tolerate oral fluids what do you do?
Give oral fluids
51
15 year old hiking trip, has diarrhea....Dx?
Giardiasis
52
Best imaging for abdominal issues
CT scan
53
Gold Standard test for GERD in peds
24 hr esophageal pH monitoring
54
S/SX for intussusception
Currant jelly stool and sausage mass
55
S/SX for pyloric stenosis
Projectile vomiting immediately after eating, olive shaped mass, barium swallow = string
56
S/SX for appendicitis
Fecalith obstruction and RLQ pain, fever, anorexia
57
Kid eats and immediately vomits
Pyloric stenosis
58
What questions to ask for reflux disease
Problems swallowing
59
65 yo smoker, c/o dyspepsia, weight loss, early satiety, and occasional n/v. What would be the initial diagnostic method of choice?
Upper GI endoscopy
60
Different meds that cause pill induced esophagitis
NSAIDs, doxy, potassium chloride
61
No penetrating tears
Malloy Weiss
62
50 year old alcoholic male, dysphasia concerned about carcinoma what red flags?
Iron deficiency ——-> anemia
| Unintentional weight loss, hoarseness, cervical adenopathy, hypercalcemia
63
Different levels of dysphasia
Orphangeal or esophageal
64
Neuromuscular dysphagia - orophangeal
CVA, MS, thyroid, CP, head trauma, Bell’s palsy
65
Structural dysphagia - orophangeal
Tumors, Zenkers diverticulum, thyroidomegaly, webs, cleft palate
66
Neuromuscular dysphagia - esophageal
Achalasia, spams, nutcracker esophagus, scleroderma
67
Structural dysphagia - esophageal
Peptic stricture, rings and webs, diverticula, carcinoma, FB, GERD
68
Esophageal webs is associated with what?
Iron deficiency anemia and disappears with resolution of anemia
69
Test findings for Achalsaia?
Bird beak on imaging
70
Pt with HTN 160/95, c/o chest pain, "i'm sure I am having a heart attack", normal EKG, what differential do you consider?
GERD
71
1st and 2nd line tx for GERD
Lifestyle medication and PPI (ie omeprazole)
72
Hematemesis, dark coffee ground stool, n/v bright red blood vomit, least helpful step to take?
IV H2 blockers
73
Diagnostic study for a perforated peptic ulcer?
Upright abdominal plain film chest XR
74
75 yo male presents with acute onset of periumbilical pain, started 2hrs ago and now more intense and painful, n/v, no HTN, states he was recently diagnosed with A.fib, what is his diagnosis?
Arterial embolism or thrombosis in abdominal vasculature
75
Ligament of Treitz separates?
Separates upper and lower GI
76
DDx for hematemesis?
Mallory Weiss tear
Hiatal hernia
Barretts esophagus
Esophageal varices
77
Elderly male in acute distress, family reported he felt acute, ripping in chest 2 hrs ago
Dissecting or ruptured aorta
78
Pt with pain radiating R flank to teste, nausea, tachy, pale, unable to sit still dx with renal colic/urolithiasis how would you treat?
Analgesia (Ketorolac), antiemetics (Metoclopramide) , and fluids (IV/PO)
79
Diverticulitis pain is located where?
LLQ relieved by defecation
80
Upright flat XR showing pt c/o vague abdominal discomfort c/o bloating and nausea w/ multiple areas of hallows air-filled loops and stair-step appearance is indicative of what?
Ileus
81
Coughing up bright red blood: MCC ulcer
Peptic ulcer
82
Stress ulcer - stress of being in IC unit on vent, throws off bodies chemistry, what tx do you give to pt?
Put on IV H2 blockers (Rinitidine)
83
MCC of erosive gastritis
NSAIDs
84
MCC appendicitis
Fecalith
85
19 yr old RLQ pain Guarding and leukocyte elevated immediately think —— appendicitis, what test do you order
CT of abdomen and pelvis
86
LLQ at 73 yrs old Male what do you dx him with?
Diverticulitis
87
Crampy LL pain, loose bloody stools, mild tenderness, sigmoid colonoscopy reveals, inflamed extending circumferential and symmetrically lesions, you dx what?
UC
88
64 yo female, nausea, diffused abdominal pain, severe 7/10 pain on visual analog pain scale, relieved with meals, 30 pack yr smoking, hx of peripheral vascular disease, HTN, CAD, bilateral claudication, low leukocytes, everything else is normal, what do you dx?
Mesenteric ischemia
89
73 yr old with diverticulitis what test do you order?
CT with triple contrast
90
Cause of diverticula disease
The condition has peak incidence of occurrence in sixth, seventh, and eighth decades of life.
herniation of mucosa and submucosa through the muscularis
91
% of Diverticular disease
33% of patients will have a second attack.
92
Sxs of Diverticular disease
LLQ pain, relieved by defecation
93
Treatment of Diverticular disease
Diet, increase fiber, exercise +/- abx tx in mild - severe cases
94
A 35-year-old female presents to your clinic complaining of onset of severe midepigastric pain, weight loss, and vomiting following meals. Between meals she is asymptomatic. This has been going on for the past 2 years ever since she purposefully lost 30 lb to attain a healthy weight for her height. Unfortunately, she has continued to lose weight because of the postprandial pain and vomiting. On her examination you notice a midepigastric bruit, what do you dx her?
Superior mesenteric artery syndrome
95
Crohn’s disease, what do you not use?
Avoid oral feedings during acute exacerbation to decrease colonic activity and NSAIDS
96
Tx for Crohn’s
```
Aminoscalicylates: mesalamine
Steroids
Increase fiber and decrease fat
Psychotherapy
Surgery
```
97
63 yo pt w/ hx of inflammatory pain is taking celecoxib instead of indomethacin why?
COX2 inhibitors dont cause GI bleed
98
Strategies to reduce gastrointestinal toxicity?
Anti-inflammatory dose instead of prescription dose
99
Prednisone 20 mg daily for 3 months, weight gain —— caused by prednisone what do you do?
Bring the dose down by 5mg every week
100
Dx of UC no maintenance meds, c/o severe LLQ pain and diarrhea how do you treat?
Steroid enema
101
When to use mesalamine
IBD and prevent remission of UC
102
Large dose of OTC meds for arthritis now has tinnitus
Stop talking aspirin/OTC meds
103
Pt takin oxy w/APAP, what drug would not be indicated dangerous and would provide pain relief?
NSAIDS
104
What drug do you not give to children?
Aspirin
105
What drug is used for inflammatory pain and most likely suppressing the hypothalamic pituitary axis
Oral prednisone
106
30 yo infrequent dyspepsia, what to take to smooth his stomach, doesn’t cause belching, might help constipation
Magnesium hydroxide
107
Positive h. Pyloric test - triple treatment
PPI and amoxicillin and clarithromycin
| -metronidazole for allergies
108
H. pylori quad treatment
PPI + bismuth + metronidazole + tetracycline
109
Metoclpramide and promethazine ASEs
TD
| HA, somnolence, fatigue
110
1st line for dyspepsia
Antacids: calcium carbonate
111
Ondansetron administered IV, given pre why?
Avoid nausea post surgery
112
Drugs for gastric ulcers prophylaxis
Mistroprostol
| Contraindicated in pregnancy
113
What drug should you give to pt with low GI risk in pts taking Celebrex and ranitidine
Change ranitidine to omprazole
114
Signal molecule for gastric acid secretion
Histamine
115
Which prescription only, diabetic gastropharesis, hx of GERD, and nausea
Metoclopramide
116
Skin patch for motion sickness, ASEs?
Anticholintergic effects: blurred vision, dry mouth, urinary hesitancy
117
Antiemetic drugs for motion sxs; not - controlled, sedative-hypnotic class
Histamine 1 antagonists
118
Occasional but chronic diarrhea, taking sodium salicylate, pain med contain opioid, controlled diarrhea, what OTC med will work for his sxs?
Loperamide
119
An important statement with bulk-forming laxatives?
Stay hydrated 8 oz or more of water with every dose
120
Dietary/LM measures with IBS
Gradually increase dietary fiber
121
Proper dosing and proper administration of pancreatitis enzyme products
Take with meals, give 2 larger dose with meal and 1 smaller dose with snack time
- don't crush
122
4 yr old with perfused diarrhea, 4-5% loss of body weight, producing few tears how do you treat?
Oral rehydration with salt packets, little glucose, potassium
123
Primary reason to use atropine with diphenozylate (lomotil)
Reduce abuse effects
124
Pt is taking hydrocodone, having hard stool, has had 1 BM in the last 7 days that was 3 days ago most appropriate options to treat his constipation?
Polyethylene glycol - PEG
125
45 female with IBS, GI cramping and spams, what do you treat as need for her sxs?
M1 antagonist (dicyclomine and hyoscyamine)
126
MC laxative abused to lose weight?
Bisacodyl 2 tabs 3x a day
127
S/Sx of incarcerated hernia?
Painful enlargement of hernia not reducible, n/v present if bowel obstruction is present
128
S/Sx of strangulated hernia?
Ischemic incarcerated hernia w/ systemic tox, pain persists even after reduction, pain is severe enough to have pt abstain from defecation.
- Surgical emergency.
129
Meds that cause constipation?
Anticholinergic: psych meds
Opioids
Aluminum
130
What causes a Pilonidal abscess
Rupture of an infected hair follicle in the natal cleft
131
Apple core on XR indicates?
Colorectal cancer
132
A truck driver comes in complaining of pain in butt, felt a pimple and then it popped, states there was a foul smell after it popped, causing increased pain what is the dx and tx?
Pollinial abscess
| Tx: I and D in clinic
133
Location of Anal fissures?
Posterior midline
| - if located lateral = bad think HIV, syphilis
134
What is stage 1 of hemorrhoids?
Not protruding
135
What is stage 2 of hemorrhoids?
Protruding but spontaneously reduces
136
What is stage 3 of hemorrhoids?
Protruding may be able to reduce manually
137
What is stage 4 of hemorrhoids?
Protruding, unable to reduce
138
Test for pinworms?
Scotch tape test
139
Pt is a 3 yo boy presents with the painful mass in the rectal area, bright red blood with circumferential mucosal prolapse what test do you perform to check for CF?
Chloride sweat test
140
Pt comes in walking funny, rigid movement, talking funny, laughing and crying at inappropriate times, rings around eyes, what is your dx and tx?
Wilsons disease
| Tx: penicillamine or liver tx
141
Test for Celiac sprue?
IgA tTG (Tissue Transglutaminase Antibodies)
142
Pathognomonic for CF?
Meconium ileus
143
Pt is homeless, complaining of dry eyes, and difficulty seeing at night what is his dx?
Vitamin A
144
Pt is brought into the ER because he was walking funny in Walmart parking lot, talking coherently, confused, fabricated story, becomes mild confrontational, drinks 2 750 mL bottles of rum every day, has weakness in extremities worse in legs, what is your dx?
Thiamine deficiency (Koraskoff syndrome)
145
What do you always take in conjunction with INH to tx PPD?
Pyridoxine (B6)
146
What is the MCC of cyanocobalamin (B12) deficiency?
Pernicious anemia
147
What is caused in adult and in children with vitamin D deficiency?
Adults: osteomalacia
Children: rickets
148
Pt states he has been in a marine quarter, diarrhea initially watery and is experiencing blood in his stool stools, looks like someone blew their nose in it, what is your dx?
Shigellosis ---> shigella dyst, felx, boydii, sonnei
149
Pig is a reservoir for what causative agent?
Yersinia enterocolitica
150
Pt with C.diff how would you treat?
Give metronidazole, not vanco too expensive
151
Anal-oral transmits?
Amebiasis (entamoeba hystolitica)
152
List the antibiotics that cause C.Diff?
Clindamycin, ampicillin, cephalosporins, fluroquinalones
153
Tx for C.diff?
Metronidazole
154
MCC of pediatric diarrhea?
Rotavirus
155
Pt reports he was hiking 2wks ago and now is experiencing diarrhea, you dx him with giardia how do you treat?
Metronidazole
156
A group of pts come in complaining of - perfused vomiting, abdominal cramping, and diarrhea, no fever, no chills, all-consuming mayonnaise, what is your dx?
Staphylococcal food poisoning
157
Appearance of stool in pt dx with Cholera?
Rice water stools
158
Causative organism in a pt who reports eating crayfish?
Vibrio parahaemolyticus
159
Pt reports he is taking a trip to Thailand, you give him want medication to prevent getting travelers diarrhea?
Azithromycin
160
Test for appendicitis?
Obturator
Psoas
161
Test for cholecystitis?
Murphys sign
162
Test for peritoneal irritation?
Rosvings sign (indirect rebound tenderness)
McBurney's point (1/3 distance from the anterior superior iliac spine on a straight line to the umbilicus, direct rebound tenderness)
163
What injuries are associated with Grey turners sign?
- Retroperitoneal hemorrhage
- Liver, spleen kidney
- Acute pancreatitis w/ hemorrhage
- Blunt trauma
- Aortic rupture
- Ectopic hemorrhage
164
What injuries are associated with Cullen's sign?
Intra-abdominal bleeding caused by:
- Ectopic pregnancy
- Acute pancreatitis
- Blunt trauma
- Aortic rupture
165
Location of Grey Turner's sign?
Bruising of upper quadrants or flank area
166
Location of Cullen's sign?
Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
167
Both Chovstek's and Trusseau's sign indicate?
Hypocalcemia
168
Test for ascites?
Shifting dullness
Fluid Wave
169
reflux --- cellular changes ---barrett's esophagus --- carcinoma (adenocrinoma) treatment?
PPIs
| - Barrets occurs when squamous cells are replaced by columnar cells
170
S/sx of pancreatic cancer?
Early satiety/anorexia
Weight loss
Courvosier's sign
171
How do you assess and treat severe watery diarrhea in pediatrics?
Stool antigen study and/or ova and parasite study
| Tx: supportive unless stool culture comes back +
172
What makes you suspect Meckel diverticulum?
painless lower GI bleed, sxs of appendicitis but a normal appendix
173
Work up for Meckel diverticulum?
```
Meckle scan (technetium scan) and if suspicion of obstruction then CT scan
- remember rule of 2s
```
174
What is the name of the pouch of serous membrane that covers the testes?
Tunica Vaginalis
175
Oropharyngeal dysphasia occurs with liquids or solids and where?
Liquids and solids, sxs 2 seconds after swallowing
| Where: cervical region
176
Esophageal dysphasia occurs with liquids or solids and where?
Solids, sxs several seconds after swallowing and at night
| Where: retrosternal
177
6 yr old brought in by mom, vomiting, large amounts of bloody diarrhea, fevers the past day, eating the same food as everyone else, pts is homeschooled, and recently received a pet turtle from grandfather what do you dx pt with?
Salmonella bongori
