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Clin Med II - Exam 3 > Ross > Flashcards

Ross Flashcards

1
Q

mc reason for ED visits

A

abd pain

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2
Q

why are elderly at higher risk for mortality and serious GI pathology

A

blunting of physiologic responses →

not spiking fever

not becoming tachycardic or hypotensive

weakened abd wall

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3
Q

elderly populations don’t develop peritoneal signs bc

A

weakened abdominal wall

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4
Q

bowel obstructions present w

A

diffuse colicky pain

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5
Q

mesenteric ischemia presents w.

A

pain out of proportion to exam

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6
Q

pancreatitis pain is located __

and radiates to __

A

epigastric

back left shoulder blade

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7
Q

appendicits pain is __ in adults

and __ in children

A

periumbilical to RLQ

rectal

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8
Q

what imaging should you order if you suspect perforation, abscess, obstruction, or mass

A

CT

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9
Q

CT should only be used as shotgun answer for

A

elderly

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10
Q

have a low threshold for CT in pt >

A

65 yo

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11
Q

GI CT’s use contrast, so you must check __

with __

A

kidney fxn

GFR

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12
Q

infectious non inflammatory diarrhea is characterized by

A

watery stools

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13
Q

infectious inflammatory diarrhea is characterized by

A

bloody pus stools

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14
Q

what pathogen is mc in outbreaks of diarrhea in close quarters like daycare, nursing homes, cruise ships

A

rotavirus

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15
Q

if you have a pt w. infectious diarrhea that recently drank from a stream, you should think (2)

A

giardia

cryptosporidium

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16
Q

toxigenic infections result in symptoms w.in

A

12 hr

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17
Q

example of toxigenic bacteria

A

s.aureus

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18
Q

non preformed bacteria result in symptoms w.in

A

24 hr

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19
Q

some bacteria cause bloody diarrhea dt invasion of

A

mucosa

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20
Q

abx for diarrhea should only be used for (5)

A

symptoms > 5 days

elderly

immunocompromised

fever >101.5

severe illness defined by dehydration

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21
Q

PUD is typically associated w. (3)

A

etoh

NSAIDs

stress

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22
Q

stress induced PUD is called

A

erosive gastritis

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23
Q

almost all non-NSAID and etoh related ulcers are dt

A

h. pylori

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24
Q

if a pt w. PUD has negative h.pylori and no hx etoh or NSAIDs, you should think

A

carcinoma

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25
Q

sx of gastric carcinoma

A

refractory PUD → non responsive to PPI trial

wt loss

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26
Q

testing for h.pylori

A

serum abs

stool antigen

urea breath test

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27
Q

best test for h.pylori

A

urea breath

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28
Q

NSAIDs inhibit

A

prostaglandins

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29
Q

principle enzyme involved w. mucosal cytoprotection

A

COX-1

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30
Q

selective NSAIDs preferentially inhibit

A

COX-2

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31
Q

test for h.pylori if (2)

A

PUD

new onset dyspepsia

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32
Q

1st line tx if pt is h.pylori (+)

A

triple therapy x 14 days:

PPI

PLUS

clarithromycin AND amoxicillin

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33
Q

after 14 days of first line tx for h.pylori, you should

A

stop treatment x 1 month → then retest

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34
Q

if still positive for h.pylori after retest, you should

A

treat again w. 2nd line

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35
Q

if still positive for h.pylori after 2nd round of tx you should (2)

A

scope

refer

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36
Q

dt h.pylori resistance in CO, many patients need to go straight to

A

quadruple therapy

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37
Q

what is quadruple therapy for h.pyori

A

PPI

PLUS

metronidazole AND TCN AND bismuth

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38
Q

pt’s > 45 yo w. dyspepsia or PUD sx need __

dt higher risk for __

A

endoscopy

gastric ca

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39
Q

what do you think when you see, intense pain, abnormal vitals, vomiting

A

perforated ulcer

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40
Q

what is the reason for abnormal vitals in perforated ulcer

A

peritonitis

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41
Q

pt w. perforated ulcer needs (2)

A

admit

surgery/GI consult

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42
Q

all pt’s w. free air on KUB need

A

surgical consult

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43
Q

if no free air on KUB, consider __ consult

before __ consult

A

GI

surgical

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44
Q

free air on KUB is a

A

surgical emergency

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45
Q

hepatitis is easily confused w.

A

biliary tract dz

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46
Q

what can help you distinguish hepatic dz from biliary tract dz

A

liver enzymes

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47
Q

in hepatitis, __

will be elevated more than __

A

aminotransferases

alk phos

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48
Q

mc presentation of biliary dz

A

cholelithiasis w.o infxn

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49
Q

what is biliary colic

A

persistent RUQ pain lasting up to 6 hr

associated w. fatty meal

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50
Q

biliary colicky pain is associated w.

A

obstruction of cystic duct by gallstone

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51
Q

__% of pt’s w. cystic duct stone will progress to acute cholecystitis

A

30

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52
Q

what is choledocholithiasis

A

sone in common bile duct

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53
Q

complications of choledocholithiasis

A

pancreatitis

cholecystitis

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54
Q

what special test is 97% sensitive for acute cholecystitis

A

murphy’s sign

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55
Q

best imaging for cholecystitis

A

US

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56
Q

diagnostic US findings of cholecystitis

A

presence of stone

wall thickening >3 mm

pericholecystic fluid

CBD > 6 mm

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57
Q

acute appendicitis mc affects

A

teens

early 20s

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58
Q

in appendicitis, the __

becomes obstructed by a __,

causing __ (2)

A

appendiceal lumen

fecalith

bacterial overgrowth, dilation of appendix

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59
Q

what do you think when you see, umbilical pain that migrates to RLQ over hours

A

appendicitis

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60
Q

what is a likely predictor for surgery w. appendicitis

A

pain before vomiting

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61
Q

where might appendicitis pain present in a pregnant woman

A

RQU → appendix is shifted superiorly

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62
Q

what is a normal anatomical appendix variation that might cause back pain in appendicitis

A

retrocecal appendix

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63
Q

t/f psoas, obturator, and rovsing signs are sensitive and specific enough to dx appendicitis

A

F!

but they are best PE findings to point you towards appendicitis

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64
Q

imaging of choice for adult appendicitis

A

CT w. contrast

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65
Q

best imaging for peds appendicitis

A

US of RLQ

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66
Q

pre op for appendectomy

A

abx

pain management

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67
Q

mesenteric pain may be

A

generalized

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68
Q

mesenteric ischemia is mc in

A

elderly w. atherosclerotic dz

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69
Q

mesenteric ischemia is usually caused by

A

arterial emboli

thrombus in mesenteric art

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70
Q

less common cause of mesenteric ischemia

A

hypoperfusion dt hypotn

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71
Q

major rf for mesenteric ischemia

A

elderly w. afib

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72
Q

dx for mesenteric ischemia (2)

A

contrasted abd CT

labs showing leukocytosis and metabolic acidosis

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73
Q

what lab do you need to dx metabolic acidosis

A

lactate

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74
Q

tx for mesenteric ischemia

A

aggressive fluids

early abx

surgical consult

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75
Q

what is a non mechanical bowel obstruction

A

ileus

76
Q

what do you think when you see, paralyzed intestine and absent peristalsis

A

ileus

77
Q

mc cause of sbo

A

ileus

78
Q

ileus is caused by (4)

A

electrolyte imbalance

infxn

spinal cord injury

bowel surgery

79
Q

abd exam findings for functional sbo

A

hypoactive bs

mild tenderness

80
Q

mechanical sbo causes (3)

A

adhesions

hernias

cancers

81
Q

sbo pain will be

A

diffuse

82
Q

sbo pt will have abd pain, and may also have

A

distension

vomiting

83
Q

sbo pt will have decreased __

and no __ (2)

A

peristalsis

gas, feces

84
Q

auscultation findings in obstuctive sbo

A

high pitched hyperactive tinkling

85
Q

what is the problem w. plain films in sbo

A

may miss early dz

86
Q

__ is more sensitive than plain films for sbo,

and it can also __ the obstruction

A

CT

locate cause of

87
Q

tx for sbo

A

admit!

lytes/fluids

+/- NGT

surgical consult

88
Q

large bowel obstructions are commonly caused by

A

mass/ca

sometimes volvulus

89
Q

imaging for large bowel obstruction will show

A

no bowel in iliac fossa

90
Q

tx for large bowel obstruction

A

admit

surgical consult

91
Q

what do you think when you see, diffuse, non-specific pain w. slow onset over 1-2 days, that eventually localizes to LLQ

A

diverticulitis

92
Q

diverticulitis mc affects (2)

A

descending colon

sigmoid colon

93
Q

imaging choice for diverticulitis (esp w. first presentation)

A

CT w. IV contrast

94
Q

do you need to re-image every bout of diverticulitis

A

no!

95
Q

indications for CT w. diverticulitis

A

first presentation

suspect perforation or abscess

96
Q

tx for simple diverticulitis

A

PO abx

pain management

97
Q

tx for complicated diverticulitis

A

IVF

abx

bowel rest

98
Q

indications for admit w. diverticulitis

A

co-morbidities

no ability to f.u

99
Q

what divides GI bleeds into upper vs lower

A

ligament of treitz

100
Q

the ligament of treitz supports and connects the end of the __

with the beginning of the __

A

end of the duodenum

beginning of the jejunum

101
Q

hematemesis involves __ blood

and the __ GI

A

dark/black blood/coffee grounds

upper

102
Q

melena involves bleeding per __

and __ blood

A

rectum

dark/tarry

103
Q

if a pt has melanotic stools, think

A

upper GI bleed →

PUD w. perforation

esophageal varices

104
Q

any pt vomiting blood needs

A

high level of care

105
Q

if you are unsure pf GI bleed or if you suspect mallory weiss tear, consider

A

cbc

orthostatic vitals

stool guaiac

NGT

106
Q

is a mallory weiss tear superficial or deep

A

superficial

107
Q

if a pt is actively vomiting blood and has abnormal vitals, consider

A

2 IV’s

fluid resuscitation

+/- transfusion

EGD per GI

108
Q

EGD is both

A

diagnostic

and

therapeutic

109
Q

if pt is negative for orthostatic changes, stool guaiac, and blood per NGT, consider

A

PUD w.o perforation → obs for a few hours, then d.c w. GI referral

110
Q

lower GI bleeds will present w. __ blood

or __

A

bright red

hematochezia

111
Q

common causes of lower GI bleed (6)

A

hemorrhoids

polyps

ca

IBD

infectious diarrhea

colitis

112
Q

pe for lower GI should include

A

direct visualization of anus → hemorrhoids

113
Q

imaging for hemorrhoids

A

anoscopy

114
Q

mc cause of lower GI bleed

A

hemorrhoids

115
Q

what do you think when you see, engorged vascular plexus of veins

A

hemorrhoids

116
Q

internal hemorrhoids arise

A

above dentate line

117
Q

internal hemorrhoids are not covered by __

and are not __

A

mucosa

palpable

118
Q

both types of hemorrhoid present w.

A

brbpr

119
Q

tx for both types of hemorrhoids

A

stool softeners

high fiber

localized topical anesthetics

120
Q

soft hemorrhoids can be __

thrombosed hemorrhoids need __

A

reduced

removal

121
Q

hemorrroidectomy may need to be done

A

outpatient

122
Q

what do you think when you see, sharp, severe, persistent abd pain that radiates to the back w. n/v

A

pancreatitis

123
Q

labs for pancreatitis will show elevations of

A

lipase

amylase

124
Q

in pancreatitis, lipase will be elevated __ x higher than normal

A

2-3

125
Q

which is more reliable for pancreatitis, lipase or amylase

A

lipase

126
Q

pancreatitis in men is mc caused by __

and in women, it is mc caused by __

A

etoh

gallstones

127
Q

2 presentations of pancreatitis

A

acute vs chronic

128
Q

acute pancreatitis work up

A

CT w. IV contrast

aggressive fluids

admit

129
Q

considerations for admit in chronic pancreatitis

A

able to tolerate po

pain level

130
Q

what is a do not miss for cause of pancreatitis

A

obstructing stone

131
Q

what are 2 special tests for severe (hemorrhagic) pancreatitis

A

cullen’s

grey-turner

132
Q

what is ranson’s criteria used to assess

A

severity of pancreatitis

133
Q

can one lipase r.o pancreatitis

A

yes!

but not one amylase

134
Q

what is ranson’s criteria at admit

A

3 or more on admit indicates severely ill:

GALAW:

glucose > 200 mg/dl

age > 55 yo

LDH > 3350 u/l

AST > 250 u/l

WBC > 16,000 mm3

135
Q

reducible hernia only needs

A

pain management

+/- GI consult if ADLs impacted

136
Q

imaging for hernia

A

US

137
Q

what is an incarcerated hernia

A

part of abdominal wall or intestine that is trapped in the sac of the hernia

138
Q

signs of incarcerated hernia are similar to __

and include

A

sbo

139
Q

incarcerated hernias may or may not be

A

reducible

140
Q

peritoneal signs are usually associated w. a __ hernia

A

strangulated

141
Q

what is a strangulated hernia

A

blood supply to herniated section of intestine is cut off

142
Q

strangulated hernias are not __

and are a __

A

reducible

medical emergency

143
Q

what lab value will be very high with necrotic tissue (ex strangulated hernia)

A

lactate

144
Q

what other labs (besides lactate) can help you distinguish an incarcerated hernia from a strangulated hernia

A

cbc

cmp

145
Q

both incarcerated and strangulated hernias require

A

abd CT w. IV contrast

surgical consult

146
Q

femoral hernias are rare, but mc in

A

women

147
Q

pe for a femoral hernia, you show

A

mass below the inguinal ligament

148
Q

where do esophageal foreign bodies/impacted food boluses obstructions occur

A

anywhere with a narrowing:

stricture

carcinoma

lower esophageal ring

149
Q

foreign bodies are best removed via

A

endoscopy

150
Q

__ might work to tx an impacted food bolus

A

glucagon

151
Q

s.e of glucagon

A

nausea

vomiting

152
Q

after clearance of an impacted food bolus in an elderly pt, you still need to __

dt high chance of __

A

scope

recurrence

153
Q

elderly pt’s w. impacted food bolus may also need

A

obs stay

GI consult

154
Q

indication for ASAP endoscopy in non elderly pt w. impacted food bolus

A

drooling

155
Q

button battery ingestion is very dangerous and mc occurs in (2)

A

kids

puppies :(

156
Q

button batteries can cause

A

perforation

157
Q

intussusception occurs in kids up to

A

5 yo

158
Q

intussusception is telescoping of the a section of the intestines, and usually occurs post __

due to __

A

viral infxn

swollen lymph tissue (peyer’s patches)

159
Q

sx of intusussception

A

intermittent crying

blood/mucus stool → currant jelly in the diaper

160
Q

dx and tx for intusussception is

A

barium air enema

161
Q

what do you think when you see, sausage mass mid abdomen, diarrhea, currant jelly stool (mucus/blood)

A

intusussception

162
Q

pyloric stenosis occurs in what peds age group

A

birth - 5mo

163
Q

sx of pyloric stenosis

A

vomiting

wt loss

olive shaped mass mid epigastrum

visualized peristaltic waves

164
Q

dx and tx for pyloric stenosis

A

dx: US
tx: surgery

165
Q

cyclic vomiting usually occurs in

A

kids

166
Q

cyclic vomiting can be triggered by __ (2)

and can last __

A

THC, food allergies

days-weeks

167
Q

cyclic vomiting is usually a __ issue

A

SNS nerve

168
Q

work up for cyclic vomiting

A

electrogastrografic studies

GI referral

169
Q

what is cannabinoid hyperemesis syndrome

A

daily smokers feel n/v for hours

170
Q

what can alleviate cannabinoid syndrome

A

hot showers

171
Q

what do you think when you see, early satiety, nausea, and postprandial vomiting of undigested food

A

gastroparesis

172
Q

gastroparesis can be debilitating and can be caused by __

A

DM → neuromuscular dysfxn

173
Q

acute management of gastroparesis

A

anti-emetics

IVF

174
Q

management of chronic gastroparesis

A

small meals

liquid nutrition

low fat diets

175
Q

pt >50 yo w. constipation needs work up for

A

cancer

176
Q

complication of constipation in elderly

A

KUB full of stool → perforation → death

177
Q

imaging for constipation in elderly

A

xray

178
Q

what is this showing

A

constipation

small bowel w. circular folds

large bowel periphally located

179
Q

tx for elderly constipation

A

bowel softeners

increase fluid

enema

PA

180
Q

constipation > 2 weeks may need

A

scope

181
Q

opioid induced constipation you may use

A

methylnaltrexone (Relistor)

182
Q

mallory weiss tear involves a mucus tear at the __

2/2 to __

A

gastroesophageal junction

forceful vomiting

183
Q

common sx of mallory weiss tear

A

vomiting blood

184
Q

tx for mallory weiss tear

A

none → heal on their own

185
Q

what is this showing

A

cullen’s sign → bruising around umbilicus → severe pancreatitis

186
Q

what is this showing

A

gray turner’s → bruising of the flanks → severe pancreatitis

Clin Med II - Exam 3 (14 decks)

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