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Review Flashcards

1
Q

What artery supply, presses on the left renal vein and is responsible of nutcracker syndrome?

A

Superior mesenteric artery

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2
Q

Chief cells produce what?

A

Pepsinogen

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3
Q

Parietal cells produce what?

A

Intrinsic factor and hydrochloric acid

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4
Q

Enterochomaffinlike (ECL)/endocrine cells produce what?

A

Histamine

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5
Q

Mucus cells produce what?

A

Mucus and bicarbonate

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6
Q

D cells produce what?

A

Somatostatin

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7
Q

G cells produce what?

A

Gastrin

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8
Q

Serosa layer is what?

A

Outer connective layer

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9
Q

Serosa layer function

A

Secretes water fluid that prevents friction

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10
Q

Submucosa

A

Connective tissue that provides GI tract with dispensability and elasticity

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11
Q

Submucosa contains

A

Submucosa plexus-nerve network and large blood and lymph vessels

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12
Q

Muscularis externa

A

Major smooth muscle

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13
Q

Muscularis externa - inner

A

Contraction decreases diameter of lumen

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14
Q

Muscularis externa - outer

A

Contraction shortens length of GI tract

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15
Q

Muscularis externa - myenteric plexus

A

Nerve network, helps regulate gut activity

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16
Q

Mucosa

A

Lines luminal surface

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17
Q

Mucosa - contents

A 
Mucus membranes (cells)
Laminate propria (lymph)
Muscularis mucosa (muscle)
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18
Q

Gastrin

A

Stimulates acid and enzyme secretion

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19
Q

Secretin

A

inhibits gastric secretion and motility

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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

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21
Q

Amylase

A

Breaks down starches/carbohydrates

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22
Q

Protease

A

Breaks down proteins

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23
Q

Lipase

A

Breaks down fats/triglycerides

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24
Q

Direct Bilirubin elevated with?

A

Conjugated, should NOT leak through healthy hepatocytes into the blood
- hepatocyte damage, hepatitis, and cholylithiasis

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25
Q

Indirect Bilirubin elevated with?

A

Unconjugated, bound to albumin

- high RBC metabolism, hemolytic anemia, and Gilbert syndrome

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26
Q

When would pancreatic enzymes would they be elevated?

A

Acute pancreatitis - elevated lipase

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27
Q

What lab test do you order for a pancreas?

A

Order lipase, not amylase

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28
Q

Pancreatic cancer: what portion?

A

Head and neck

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29
Q

Greasy fatty floating stools, diabetic, social drinker what lab test is elevated?

A

Elevated A1c

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30
Q

Risk factors for acute pancreatitis

A

Alcohol, gallstones, hypertriglycerides, ERCP, trauma, drugs

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31
Q

HepB - Surface HBsAG

A

+ = virus is present

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32
Q

Surface HBsAB or Anti-HBs

A

Past exposure/immunity

+ in vaccinated people or who have cleared the virus

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33
Q

Core: Anti-HBc IgM

A

Acute or recent infection, cleared HBsAg but haven’t developed HBsAb

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34
Q

Core: HBcAB or Anti-HBc IgG

A

Exposure to infection

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35
Q

HCV Ab or Anti-HCV

A

Past exposure or ongoing infection

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36
Q

Elevated AST

A

Alcohol

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37
Q

elevated ALT

A

Hep

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38
Q

Prison tattoos, has Hep C no tx yet what labs would you find with cirrhosis?

A

Thrombocytopenia ——may see anemia
Hypoalbuminemia
Elevated PT/INR

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39
Q

Risk factors for hepatocellular carcinomas

A

Cirrhosis, hepatitis, elevated alpha fetoprotein

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40
Q

Pt comes in with 3rd bout, aching pain, ate McDonald’s what is your diagnosis and PE finding?

A

Cholecystitis OR Biliary colic

PE findings: RUQ radiating to R shoulder

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41
Q

Fats enter the duodenum, called?

A

Micelles

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42
Q

Ascending cholangitis - Charcot triad

A

Fever, RUQ pain, Jaundice

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43
Q

Ascending cholangitis- Reynold pentad

A

Charcot triad + hypotension + mental status change

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44
Q

Warning signs, red flags for abdominal problem

A

+ ve physical sign, history, and lab support

  • colicky pain
  • weight loss
  • awakens at night
  • growth retardation
  • abdominal scars
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45
Q

Current jelly stool

A

Intussusception

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46
Q

Intussusception first line treatment

A

Barium enema

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47
Q

15-month failure to thrive you suspect celiac what test do you do to confirm celiac disease?

A

Do biopsy

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48
Q

S/Sx of Crohn: mouth to anus

A

Toxic megacolon, growth failure, fistula, oral aphthous ulcers, arthritis, erythema nodosum, clubbing, episcleritis, gallstones and renal stones

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49
Q

S/Sx of UC: colon

A

Cramping, diarrhea, rectal bleeding, chronic Sx’s, primary sclerosis cholangitis, uveitis, pyoderma gangrenosum

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50
Q

Sick kid, can tolerate oral fluids what do you do?

A

Give oral fluids

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51
Q

15 year old hiking trip, has diarrhea….Dx?

A

Giardiasis

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52
Q

Best imaging for abdominal issues

A

CT scan

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53
Q

Gold Standard test for GERD in peds

A

24 hr esophageal pH monitoring

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54
Q

S/SX for intussusception

A

Currant jelly stool and sausage mass

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55
Q

S/SX for pyloric stenosis

A

Projectile vomiting immediately after eating, olive shaped mass, barium swallow = string

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56
Q

S/SX for appendicitis

A

Fecalith obstruction and RLQ pain, fever, anorexia

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57
Q

Kid eats and immediately vomits

A

Pyloric stenosis

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58
Q

What questions to ask for reflux disease

A

Problems swallowing

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59
Q

65 yo smoker, c/o dyspepsia, weight loss, early satiety, and occasional n/v. What would be the initial diagnostic method of choice?

A

Upper GI endoscopy

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60
Q

Different meds that cause pill induced esophagitis

A

NSAIDs, doxy, potassium chloride

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61
Q

No penetrating tears

A

Malloy Weiss

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62
Q

50 year old alcoholic male, dysphasia concerned about carcinoma what red flags?

A

Iron deficiency ——-> anemia

Unintentional weight loss, hoarseness, cervical adenopathy, hypercalcemia

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63
Q

Different levels of dysphasia

A

Orphangeal or esophageal

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64
Q

Neuromuscular dysphagia - orophangeal

A

CVA, MS, thyroid, CP, head trauma, Bell’s palsy

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65
Q

Structural dysphagia - orophangeal

A

Tumors, Zenkers diverticulum, thyroidomegaly, webs, cleft palate

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66
Q

Neuromuscular dysphagia - esophageal

A

Achalasia, spams, nutcracker esophagus, scleroderma

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67
Q

Structural dysphagia - esophageal

A

Peptic stricture, rings and webs, diverticula, carcinoma, FB, GERD

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68
Q

Esophageal webs is associated with what?

A

Iron deficiency anemia and disappears with resolution of anemia

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69
Q

Test findings for Achalsaia?

A

Bird beak on imaging

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70
Q

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?

A

GERD

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71
Q

1st and 2nd line tx for GERD

A

Lifestyle medication and PPI (ie omeprazole)

72
Q

Hematemesis, dark coffee ground stool, n/v bright red blood vomit, least helpful step to take?

A

IV H2 blockers

73
Q

Diagnostic study for a perforated peptic ulcer?

A

Upright abdominal plain film chest XR

74
Q

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?

A

Arterial embolism or thrombosis in abdominal vasculature

75
Q

Ligament of Treitz separates?

A

Separates upper and lower GI

76
Q

DDx for hematemesis?

A

Mallory Weiss tear
Hiatal hernia
Barretts esophagus
Esophageal varices

77
Q

Elderly male in acute distress, family reported he felt acute, ripping in chest 2 hrs ago

A

Dissecting or ruptured aorta

78
Q

Pt with pain radiating R flank to teste, nausea, tachy, pale, unable to sit still dx with renal colic/urolithiasis how would you treat?

A

Analgesia (Ketorolac), antiemetics (Metoclopramide) , and fluids (IV/PO)

79
Q

Diverticulitis pain is located where?

A

LLQ relieved by defecation

80
Q

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?

81
Q

Coughing up bright red blood: MCC ulcer

A

Peptic ulcer

82
Q

Stress ulcer - stress of being in IC unit on vent, throws off bodies chemistry, what tx do you give to pt?

A

Put on IV H2 blockers (Rinitidine)

83
Q

MCC of erosive gastritis

84
Q

MCC appendicitis

85
Q

19 yr old RLQ pain Guarding and leukocyte elevated immediately think —— appendicitis, what test do you order

A

CT of abdomen and pelvis

86
Q

LLQ at 73 yrs old Male what do you dx him with?

A

Diverticulitis

87
Q

Crampy LL pain, loose bloody stools, mild tenderness, sigmoid colonoscopy reveals, inflamed extending circumferential and symmetrically lesions, you dx what?

88
Q

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?

A

Mesenteric ischemia

89
Q

73 yr old with diverticulitis what test do you order?

A

CT with triple contrast

90
Q

Cause of diverticula disease

A

The condition has peak incidence of occurrence in sixth, seventh, and eighth decades of life.
herniation of mucosa and submucosa through the muscularis

91
Q

% of Diverticular disease

A

33% of patients will have a second attack.

92
Q

Sxs of Diverticular disease

A

LLQ pain, relieved by defecation

93
Q

Treatment of Diverticular disease

A

Diet, increase fiber, exercise +/- abx tx in mild - severe cases

94
Q

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?

A

Superior mesenteric artery syndrome

95
Q

Crohn’s disease, what do you not use?

A

Avoid oral feedings during acute exacerbation to decrease colonic activity and NSAIDS

96
Q

Tx for Crohn’s

A 
Aminoscalicylates: mesalamine
Steroids
Increase fiber and decrease fat
Psychotherapy 
Surgery
97
Q

63 yo pt w/ hx of inflammatory pain is taking celecoxib instead of indomethacin why?

A

COX2 inhibitors dont cause GI bleed

98
Q

Strategies to reduce gastrointestinal toxicity?

A

Anti-inflammatory dose instead of prescription dose

99
Q

Prednisone 20 mg daily for 3 months, weight gain —— caused by prednisone what do you do?

A

Bring the dose down by 5mg every week

100
Q

Dx of UC no maintenance meds, c/o severe LLQ pain and diarrhea how do you treat?

A

Steroid enema

101
Q

When to use mesalamine

A

IBD and prevent remission of UC

102
Q

Large dose of OTC meds for arthritis now has tinnitus

A

Stop talking aspirin/OTC meds

103
Q

Pt takin oxy w/APAP, what drug would not be indicated dangerous and would provide pain relief?

104
Q

What drug do you not give to children?

105
Q

What drug is used for inflammatory pain and most likely suppressing the hypothalamic pituitary axis

A

Oral prednisone

106
Q

30 yo infrequent dyspepsia, what to take to smooth his stomach, doesn’t cause belching, might help constipation

A

Magnesium hydroxide

107
Q

Positive h. Pyloric test - triple treatment

A

PPI and amoxicillin and clarithromycin

-metronidazole for allergies

108
Q

H. pylori quad treatment

A

PPI + bismuth + metronidazole + tetracycline

109
Q

Metoclpramide and promethazine ASEs

A

TD

HA, somnolence, fatigue

110
Q

1st line for dyspepsia

A

Antacids: calcium carbonate

111
Q

Ondansetron administered IV, given pre why?

A

Avoid nausea post surgery

112
Q

Drugs for gastric ulcers prophylaxis

A

Mistroprostol

Contraindicated in pregnancy

113
Q

What drug should you give to pt with low GI risk in pts taking Celebrex and ranitidine

A

Change ranitidine to omprazole

114
Q

Signal molecule for gastric acid secretion

115
Q

Which prescription only, diabetic gastropharesis, hx of GERD, and nausea

A

Metoclopramide

116
Q

Skin patch for motion sickness, ASEs?

A

Anticholintergic effects: blurred vision, dry mouth, urinary hesitancy

117
Q

Antiemetic drugs for motion sxs; not - controlled, sedative-hypnotic class

A

Histamine 1 antagonists

118
Q

Occasional but chronic diarrhea, taking sodium salicylate, pain med contain opioid, controlled diarrhea, what OTC med will work for his sxs?

A

Loperamide

119
Q

An important statement with bulk-forming laxatives?

A

Stay hydrated 8 oz or more of water with every dose

120
Q

Dietary/LM measures with IBS

A

Gradually increase dietary fiber

121
Q

Proper dosing and proper administration of pancreatitis enzyme products

A

Take with meals, give 2 larger dose with meal and 1 smaller dose with snack time
- don’t crush

122
Q

4 yr old with perfused diarrhea, 4-5% loss of body weight, producing few tears how do you treat?

A

Oral rehydration with salt packets, little glucose, potassium

123
Q

Primary reason to use atropine with diphenozylate (lomotil)

A

Reduce abuse effects

124
Q

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?

A

Polyethylene glycol - PEG

125
Q

45 female with IBS, GI cramping and spams, what do you treat as need for her sxs?

A

M1 antagonist (dicyclomine and hyoscyamine)

126
Q

MC laxative abused to lose weight?

A

Bisacodyl 2 tabs 3x a day

127
Q

S/Sx of incarcerated hernia?

A

Painful enlargement of hernia not reducible, n/v present if bowel obstruction is present

128
Q

S/Sx of strangulated hernia?

A

Ischemic incarcerated hernia w/ systemic tox, pain persists even after reduction, pain is severe enough to have pt abstain from defecation.
- Surgical emergency.

129
Q

Meds that cause constipation?

A

Anticholinergic: psych meds
Opioids
Aluminum

130
Q

What causes a Pilonidal abscess

A

Rupture of an infected hair follicle in the natal cleft

131
Q

Apple core on XR indicates?

A

Colorectal cancer

132
Q

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?

A

Pollinial abscess

Tx: I and D in clinic

133
Q

Location of Anal fissures?

A

Posterior midline

- if located lateral = bad think HIV, syphilis

134
Q

What is stage 1 of hemorrhoids?

A

Not protruding

135
Q

What is stage 2 of hemorrhoids?

A

Protruding but spontaneously reduces

136
Q

What is stage 3 of hemorrhoids?

A

Protruding may be able to reduce manually

137
Q

What is stage 4 of hemorrhoids?

A

Protruding, unable to reduce

138
Q

Test for pinworms?

A

Scotch tape test

139
Q

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?

A

Chloride sweat test

140
Q

Pt comes in walking funny, rigid movement, talking funny, laughing and crying at inappropriate times, rings around eyes, what is your dx and tx?

A

Wilsons disease

Tx: penicillamine or liver tx

141
Q

Test for Celiac sprue?

A

IgA tTG (Tissue Transglutaminase Antibodies)

142
Q

Pathognomonic for CF?

A

Meconium ileus

143
Q

Pt is homeless, complaining of dry eyes, and difficulty seeing at night what is his dx?

144
Q

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?

A

Thiamine deficiency (Koraskoff syndrome)

145
Q

What do you always take in conjunction with INH to tx PPD?

A

Pyridoxine (B6)

146
Q

What is the MCC of cyanocobalamin (B12) deficiency?

A

Pernicious anemia

147
Q

What is caused in adult and in children with vitamin D deficiency?

A

Adults: osteomalacia
Children: rickets

148
Q

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?

A

Shigellosis —> shigella dyst, felx, boydii, sonnei

149
Q

Pig is a reservoir for what causative agent?

A

Yersinia enterocolitica

150
Q

Pt with C.diff how would you treat?

A

Give metronidazole, not vanco too expensive

151
Q

Anal-oral transmits?

A

Amebiasis (entamoeba hystolitica)

152
Q

List the antibiotics that cause C.Diff?

A

Clindamycin, ampicillin, cephalosporins, fluroquinalones

153
Q

Tx for C.diff?

A

Metronidazole

154
Q

MCC of pediatric diarrhea?

155
Q

Pt reports he was hiking 2wks ago and now is experiencing diarrhea, you dx him with giardia how do you treat?

A

Metronidazole

156
Q

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?

A

Staphylococcal food poisoning

157
Q

Appearance of stool in pt dx with Cholera?

A

Rice water stools

158
Q

Causative organism in a pt who reports eating crayfish?

A

Vibrio parahaemolyticus

159
Q

Pt reports he is taking a trip to Thailand, you give him want medication to prevent getting travelers diarrhea?

A

Azithromycin

160
Q

Test for appendicitis?

A

Obturator

Psoas

161
Q

Test for cholecystitis?

A

Murphys sign

162
Q

Test for peritoneal irritation?

A

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
Q

What injuries are associated with Grey turners sign?

A
  • Retroperitoneal hemorrhage
  • Liver, spleen kidney
  • Acute pancreatitis w/ hemorrhage
  • Blunt trauma
  • Aortic rupture
  • Ectopic hemorrhage
164
Q

What injuries are associated with Cullen’s sign?

A

Intra-abdominal bleeding caused by:

  • Ectopic pregnancy
  • Acute pancreatitis
  • Blunt trauma
  • Aortic rupture
165
Q

Location of Grey Turner’s sign?

A

Bruising of upper quadrants or flank area

166
Q

Location of Cullen’s sign?

A

Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus

167
Q

Both Chovstek’s and Trusseau’s sign indicate?

A

Hypocalcemia

168
Q

Test for ascites?

A

Shifting dullness

Fluid Wave

169
Q

reflux — cellular changes —barrett’s esophagus — carcinoma (adenocrinoma) treatment?

A

PPIs

- Barrets occurs when squamous cells are replaced by columnar cells

170
Q

S/sx of pancreatic cancer?

A

Early satiety/anorexia
Weight loss
Courvosier’s sign

171
Q

How do you assess and treat severe watery diarrhea in pediatrics?

A

Stool antigen study and/or ova and parasite study

Tx: supportive unless stool culture comes back +

172
Q

What makes you suspect Meckel diverticulum?

A

painless lower GI bleed, sxs of appendicitis but a normal appendix

173
Q

Work up for Meckel diverticulum?

A 
Meckle scan (technetium scan) and if suspicion of obstruction then CT scan
- remember rule of 2s
174
Q

What is the name of the pouch of serous membrane that covers the testes?

A

Tunica Vaginalis

175
Q

Oropharyngeal dysphasia occurs with liquids or solids and where?

A

Liquids and solids, sxs 2 seconds after swallowing

Where: cervical region

176
Q

Esophageal dysphasia occurs with liquids or solids and where?

A

Solids, sxs several seconds after swallowing and at night

Where: retrosternal

177
Q

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?

A

Salmonella bongori

GI (16 decks)

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