Tieman CIS

Question 1

what do we need to worry about with swelling in the upper GI/ oral cavity?

Answer 1

airway!

Have a low threshold for intubation

Question 2

What are people probably put on for tooth infection if they have penicillin allergies?

Answer 2

clindamycin

Question 3

trismus

Answer 3

when people can’t open their mouth really wide

Question 4

respiratory rate where we think of respiratory failure?

Answer 4

30

Question 5

ace inhibitors are notorious for causing

Answer 5

angio-edema

Question 6

other drugs that cause angio-edema

Answer 6

ARBs, direct thrombin inhibitors

Question 7

guy with swelling in his lips and cheeks, what’s a differential?

Answer 7

anaphylaxis
drug-induced angio-edema
ludwig’s angina- subglottic abscess from tooth infection
hereditary angio-edema

Question 8

allergic stuff would often involve what?

Answer 8

urticria
hives
etc.

Question 9

what substance causes angio-edema in allergic?

Answer 9

histamine

Question 10

what substance causes angio-edema in drug-induced?

Answer 10

bradykinin

in hereditary, bradykinin is built up due to deficiency in C1 esterase inhibitor

Question 11

white spot in the mouth, what?

Answer 11

candida– with history of antibiotic use, esp.

leukoplakia– can’t scrape. Think of cancer.

Question 12

dysplasia vs carcinoma

Answer 12

through the basement membrane is carcinoma

Question 13

sore throat

Answer 13

think of viral pharyngitis, tonsillitis
mono (EBV)- difference is lymphadenopathy here

pus on tonsils- tonsillitis. Do a rapid strep test (group A beta-hemolytic strep usually causes strep, treat with a penicillin)

Question 14

classification of tonsils

Answer 14

Class I- still behind tonsillar pillar
Class II- up to the pillar
Class III- beyond the pillar
Class IV- to the midline

Question 15

criteria for tonsillectomy

Answer 15

chronic infections
7 in one year or 5/year for 2 years or 3/year for 3 years

Theory: most kids will outgrow the tonsillitis

we believe the tonsils have some immune function

Question 16

mass near the angle of the mandible. What lives there?

Answer 16

parotid
lymph nodes
bone tumor

Question 17

night sweats, weight loss

Answer 17

beta symptoms of lymphoma

indicate a more widespread disease

Question 18

painful mass (at angle of mandible) indicates

Answer 18

could be infection
Stone (sialolithiasis)
invasion into the facial nerve

Question 19

cutoff of size of head and neck tumors

Answer 19

2 cm is the difference between class 1 and 2

Question 20

parotid tumors- prognosis?

Answer 20

85% are benign, mixed tumors

treat by excising

Question 21

asthma and GERD

Answer 21

always think about the other when a pt presents with one (adult onset)

Question 22

GERD and weight

Answer 22

obese people get it more often

Question 23

GERD diagnosis

Answer 23

PE usually non-specific
lab usually not helpful
dx testing– usually trial of PPIs- 80% sensitivity and specificity for GERD if response in 2 weeks or less

EGD

Barium esophogram- should be done initiallly if “alarmm symptoms” present
esophageal pH monitoring and symptom recording,
esophageal motility studies

Question 24

6 months later recurrence of epigastric pain and episodes of difficult and painful swallowing.

What do we do now?

Answer 24

EGD and barium swallow

usually do them both; they give you different information

Question 25

Scope the distance of the GE juction from the incisors

Answer 25

if it’s 40 cm, that’s normal

less than that? sliding hiatal hernia

Question 26

If we know there’s GERD, shoudl we do esophageal PH monitoring or manometry?

Answer 26

no, we already know it.

use those for very complicated cases when we don’t know what’s going on

Question 27

who should get surgery for GERD?

Answer 27

young people who are well managed on medications but will likely need to be on them for the rest of their lives

Question 28

post-prandial relief indicates?

Answer 28

indicates duodenal ulcers because acid is decreased with food.

opposite– post-prandial pain suggests gastric

Not 100% true

Question 29

keep what in the back of the mind with upper abdominal pain

Answer 29

cardiovascular disease

Question 30

2 types of PUD

Answer 30

duodenal

gastric

Question 31

what does EGD stand for

Answer 31

esophogastroduodenoscopy

Question 32

what do we biopsy?

Answer 32

always gastric ulcers (along the edge of the crater)

pretty much never duodenal

Question 33

agar gel test

Answer 33

if it turns purple, there is ammonia in the specimen

= H. pylori