Step 3 GI Flashcards
Hepcidin 의 역할과
hereditary hemochromatosis 때 증가/ 감소?
Hepcidin은 몸에 철이 많을때 => Fe를 Machrophage나 cell inside로 keep !
hereditary Hemochromatosis 때는 iron sensing고장 => hepcidin 낮다.
hemochromatosis 있는 환자가 ED가 온다 왜?
hemochromatosis can cause secondary hypogonadism (due to iron deposition in anterior pituitary)
Tiny male speedo:
MEN 2A/ 2B 공통?
pheochromocytoma & Medullary ca
이기 뭐꼬 ,? 와 쓰노?
FUnnel plot to decrease publication bias in meta analysis
Risk factor of Barrett’s esophagus?
whIte,
over 50 age,
smoking,
central obesity(>100)
GERD for more than 5 years
이건 다 알아야함. 다른 스케치도 있으니 찾아보지
스테치바자
SAAG 1.1 above or less?
sagging towel
high SAAG (>1.1 g/dL) include congestive heart failure (Choice B), cirrhosis (Choice C), and alcoholic hepatitis (ChoiceE).
low (< 1.1 g/dL) albumin gradient include peritoneal carcinomatosis, peritoneal tuberculosis, nephrotic syndrome, pancreatitis, and serositis.
SAAG가 1.1 이상이라도 CHF 랑 LC 랑 어찌구분?
ascitis Protein 닭다리 2.5 항아리 윗쪽은 심장, 아래는 간이네.
LDL 낮추는 bile acid resin medications?
Cholestyramine (콜라 스티로폼 컵)
Colestipol (cole 스테플러)
Colesevelam (코울슬로)
Primary biliary cholangitis 는 검사 상? ab? 왜 LC까지 오나/?
MRCP: Anti-mitochondrial ab / intrahepatic biliary duct obst으로 LC
fat soluble vitamin
A Deck 은 물 위에 있네.
who shouuld repeat colonoscopy every 3 years?
3년(연)마다?
teenager 낀 (10mm) 높은 등급 (High grade dysplasia) 의 악당 (villous)이 3 개나 (3 adenoma).
Villous or tubulovillous histology
High-grade dysplasia
Size ≥10 mm
High number (eg, ≥3 adenomas) regardless of histology
repeat colonoscopy in 3 years.
년이 3…
Lactose intolerane 의 Mechanism
Lactase는 흡수가 안되서 Galactose랑 glucose로 소화시키지 못하면 설사.
WHy the ascites have high protein >2.5 when it comes to constrictive carditis?
- normal liver => normal serum protein
- The increased pressure even before the liver causes high intraheptaic pressure which push out the protein from liver, ends up leaking protein into the serum.
Budd chiari는 SAAG/ ascites protein?
목욕탕 우측 위니깐 SAAG 1.1 이상 , protein 2.5 이상
hepatic vein pressure increase 니까.
목욕탕 그림에서 SBP는 무슨 숫자
SAAG 1.1이상 / protein 2.5 이하 / Neutrophil 250 이상
immunoglobulin A anti-tissue transglutaminase ?
Celiac dz. – seal 이 옆에 있네
bilateral hilar lymphadenopathy때 electrolyte change/ Tx.
Hyper calcemia & Steroid.
HUS 때 피부 문제가 오는게 있나? GI 문제?
History of bloody diarrhea ssociated with EHEC or Shigella
Mucocutaneous bleeding Gingival bleeding, menorrhagia, petechiae, epistaxis
LIgament of treitz 넘어서 생긴 ulcer 는 어떻게 해야 하나?
ZE syndrome 확인하기 위해 Gastrin level check
Gall stone pancreatitis acute management?
ERCP 로 emergecy stone removal 안하면 사망.
Nystatin liquid suspension 은 좌약?
그냥 먹는것도 suspension 이라 하네.
Nucleosides vs neucloetide
Nucleosides contain only sugar and a base whereas Nucleotides contain sugar, base and a phosphate group as well.
A nucleotide is what occurs before RNA and DNA, while the nucleoside occurs before the nucleotide itself.
worst complication?
dengue shock syndrome
basically, 딩고 make capillary permeable => petechia / evere plasma leakage causing shock
central venous catheter + chemotherapy-induced neutropenia ; rapidly progressive, ulcerative skin lesions:
ecthyma gangrenosum.
아르테미스?
Artemisinins are potent antimalarials which are the first-line treatment for resistant malaria
어디가 portal vein 이고 어디가 hepatic?
What is this
red uvula, enlarged tonsil with white exudate, sandpaer like (scarlet fever rash like ) rash. is Streptoccoccus A
디즈니 Centor criteria is for what?
Centor criteria. 어른에서 pharyngitis 때 strep throat. 에 3점이면 검사 4점이면 empirical tx. => 3개 파이어가 떳네!
Tonsillar exudate 양쪽에 white tonsil
Tender anterior cervical adenopathy 아랫쪽양 길옆에 늘어선 가로등 LN들
Fever fireplay
Absence of cough 앱콧
what happens when bile acid cannot be absorbed well d/t short bowe
Bile acids are potent “digestive surfactants” thatpromote absorption of lipids (including fat-soluble vitamins),
2nd syphilis syptoms 은 rash 가 어디에 온다고
A widespread maculopapular rash, often involving palms and soles, is characteristic of secondary syphilis
**Condyloma lata **are flat-topped cutaneous lesions that sometimes develop on the genitals during the secondary stage of syphilis
IgA는 뭐처럼 생겼게?
사람처럼
Beer potomania
euvolemic hypotonic hyponatremia (w/ ↓ Uosm)
맥주는 소금기가 거의 없다. = low solute intake
2 things
“Don’t do DRUGS, you’ll be HISTORY”:
DRUG-induced lupus may present with anti-HISTONE antibodies (highly specific) (an ANA)
Tired & wrapped joints:
DRUG-induced lupus presents with arthralgias [painful joints and fatigue (no involvement of skin, kidneys, or CNS)
Drug induced SLE: anti-histone ab ++ / only arthritis syptom 만 있단다.
Primary adrenal inusfficency vs secondary vs tertiary AI 부족해 지는 호르몬?
Primary AI has insufficiency with Sex Hormone & Corticosteroid & Mineralocorticoid H.
하지만 adrenal galnd가 멀쩡한 secondary & tertiary 는? corticosteroid 만 문제 생김.
Adrenal insufficiency test cascade
ACTH 결과가 좀 늦다. 그 사이에 아침 cortizol test 해서 정상이 아니라 낮다면, ACTH test (cosyntropin) 주고 잠시뒤 cortizol recheck => primary and secondary 에선 cortizol 낮겠지. => ACTH 결과 도착 => 높다면 primary. 낮다면 secondary
LIthium 부작용
각각 뭘까?
GI malabsorption 때 calcium oxalate stone
AIP 는 뭐가 문제가 생겨서 오는 병?
phopho(porche) biliaminogen(billi goat) deaminase (deaminator)
AIP 때 뭐가 쌓이나?
ALA(aminolevulinic acid)
porphobilinogen
porphyria cutanea tarda 때 어떤 엔자임 문제?
“EURO PORPHE GEN 3” + discarded open cardboard box
Porphyria cutanea tarda (PCT) = ↓ uroporphyrinogen decarboxylase
뭐고 5가지 정도 이야기해라
acute intermittent porphyria
- Cytochrome P450 inducers (e.g. OCPs, anti-seizure meds, antibiotics) may precipitate AIP attack
- Smoke lines
Smoking, alcohol, infection, starvation, and fluctuating hormones from menstrual cycles may precipitate AIP attack - AIP = abdominal pain + vomiting
- porwine color urine
- psychogenic sx.
물고기 피부 때나 팔상박뒤에 오돌도돌 치료?
Urea/lactic acid-based cream is a moisturizer that may help break down the hardened protein in dry, scaly skin and relieve these symptoms.
Ichthyosis vulgaris / keratosis pilaris
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젊은 여자
Weeping + split piles + semicolon cloud
Borderline personality disorder is characterized by unstable relationships and self-image, splitting, and recurrent suicidal behaviors or threats of self-harm
손끝에 ulcer + smoking hx + thrombophlebitis 의 pathology + 어느 vessel involve?
buerger dz.
Thromboangiitis Obliterans, is a medium vessel vasculitis that is strongly associated with smoking. Classically, the disease is seen in heavy smokers who are young males between the ages of 20 through 40.
Symptoms begin with intermittent claudication (pain with muscle use) and Raynaud phenomenon (fingers blue in the cold due to vasoconstriction). More severe finding include gangrene and autoamputation of the digits. Involvement of the veins presents as superficial nodular thrombophlebitis, which refers to pain and inflammation along veins.
Pathology on biopsy reveals a segmental thrombosing vasculitis with vein and nerve involvement. Smoking cessation is not curative, but it has been shown to slow progression and severity of Buerger disease.
Find Buerger Disease and more Vasculitides among Pixorize’s visual mnemonics for the USMLE Step 1 and NBME Shelf Exams.
phenelzine ?? 언제쓰지?
Mouse 잡는 MAOinhibitor
fennel 들고 있다.
depression 때 쓰고, SE는 옆에 serotonin sysnd 마크랑 Hypertensive crisis 가 오네.
닭이나 개만지고 나서 피설사
C. jejuni
resides in the gastrointestinal tract of warm-blooded animals and is transmitted to humans primarily via ingestion of contaminated food, particularly undercooked poultry. However, direct contact with domesticated animals (eg, dogs) is another important source of transmission
RUQ pain with bloody diarrhea
Entamoeba histolytica trophozoites containing ingested RBCs in stool
inflammatory bowel disease 의 주된 치료?
**5-aminosalicylates
5-ASA 아싸! 아싸! 아싸 !아싸 !아싸! 유재석씨 UC 어그로를 끌었다 chron!!**
Octerotide 사용 indication?
octagone stop sign
인데… sTop somaToSTOPtin
STOP release of various splanchnic vasodilatory hormones (VIP, gastrin, glucagon, CCK, GH) 여러가지 녀석을 STOp 시킨다.
Fecal immunochemical test (FIT) 로 colon cancer screening from what age and how often?
CRC screening in average-risk patients → FIT or gFOBT every year
Bud- chiari is hepatic vein or protal vein?
SAAG 1.1 over or under ?
ascites protein 2.5 over or under?
목욕탕 우측 이니까 1.1 이상
something wrong?
Eosinophilioc esophagitis
5개쯤 이야기 해봐라.
Primary biliary cholangitis 는 intrahepatic duct.
UDCA… 황소자리 우루사가 main treatment
LC and cancer.
Anti-mitochondiral Ab
Jaundice/ xanthelasma/ pruritis
GERD/ dyspepsia/ new constipation 이런 것들은 흔하지만 alarming sign있다면 endos/ colono 검사 해야지.
5개 이상 나열하라.
GI bleeding (even occult blood +), wt loss, dysphagia, odynophaiga, IDA, family h/o associated GI cancer.
H.pylori tx. 가 penicillin allergy 있다면
원래 3제 요법 : PPI + clarithro + amoxicillin
penicillin allergy 환자는 amoxi => Metronidazole
ammo 없어? 군기빠진놈! 헬기말고 지하철 타고 가라.
PPI + Clearithro + Metronidazol
피검사 결과에 특징
눈에 이걸 뭐라고 ?
Tx?
LAB: copper 증가 & ceruloplasmin 감소
KF ring
Pencillamin: 페니는 구리로 되어 있다!!!!!!
Penicillamine can chelate heavy metals such as copper, lead, and mercury
wilson 은 신경학적 심리적으로 어떤 증상?
dementia, 구리가 몸에 들어가니 cog wheel ridigity = > parkinson , tremor
wilson 에서는 serum ceruloplasmin이 어떻게 ?
Dropped cerulean blue shorts
in Wilson disease, serum ceruloplasmin (normally transports copper in blood) is LOW → increased free serum copper → copper deposits in tissues
당뇨 gastroparesis 때 쓰는 약과 기전과 부작용
antagonizing or blocking D2 receptor signaling
metalclawpramide 는 Dress shoe 에 토해버림- D2 Rc blocker
D2 block 하면 dopamine 부족하므로 parkinson 같은 증상으로서 - 혀내밀기 : tardive dyskinesia
PBS vs PSC 위치 다른점?
**
primary sclerosing cholangitis 에서 histology
양파 수프: Fibrous obliteration of bile ducts with concentric periductal deposition of connective tissue (onion skin–like pattern )
**
gross하게 봐서는 prox이 막히므로 beads on a string** 양상으로 보임.
cf) PBC는 Florid duct lesion (**granulomatous destruction **of small bile ducts)
.
Kid in clear capsule
eosinophilic esophagitis = associated with dysphagia, food impaction, esophageal rings, strictures, furrows; increased eosinophils on biopsy
선천적으로 bil conjugation 능력이 감소된 2개?
