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Tricky Items Flashcards

1
Q

MC bacteria pneumonia

A 
*S. Pneumonia
M. Cat
H. Flu
M. Pneumonia
S. Aureus
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2
Q

Pneumonia bacteria associated with Bullous Myringitis

A 
Mycoplasma Pneumonia
(Hint: Both start with MY)
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3
Q

Rust Colored Sputum

pneumonia bacteria

A

S. Pnuemoniae

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4
Q

Treatment for Community Acquired Pneumonia

Otherwise healthy patient

A

Macrolide
or
Doxycycline

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5
Q

Treatment for Community Acquired Pneumonia

Patient with underlying disease

A

Fluoroquinolones (Resp; L/M)
or
Beta Lactam PLUS a Macrolide

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6
Q

CURB-65

A 
Confusion
Urea >7 mmol/L
Resp Rate >30
BP (SBP <90, DBP <60)
Age >65

Interpretation:
0-1 low risk, consider home
2 admission or close monitoring outpatient
3-5 Admission (severe)

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7
Q

Pneumococcal Vaccination Schedule

A

Adults > 65 and Kids < 2 (with medical conditions)

1 dose PCV13 followed by PPSV23 one year later

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8
Q

Atypical Pneumonia Bacteria

A

*M. Pneumonia
C. Pneumonia
Legionella
Moraxella

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9
Q

Atypical Pneumonia Presentation

A

low grade fever
mild pulmonary symptoms
non-productive cough, fatigue, myalgia

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10
Q

Diagnosis of atypical pneumonia

A

WBC is nromal or slightly elevated
CXR unilateral lower lung infiltrates or diffuse
Not usually detected with usual gram staining

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11
Q

Treatment Atypical Pneumonia

A

Azithromycin Or doxycycline (mycoplasma or legionella)
Tetracycline (Chlamidya)
Supportive for viral infection

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12
Q

Bacteria for Hospital Acquired Pneumonia

A

*MRSA
*Pseudomonas
S. aureus/ klebsiella/E. coli/ Enterobacter

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13
Q

Treatment for Hospital Acquired Pneumonia

A

MRSA
Pseudomonas
MRSA AND Pseudomonas (Vanc/Zosyn)

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14
Q

HIV Pneumonia Bacteria

A
  • Streptococci

* Pneumocystis Jiroveci (oppertunistic)

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15
Q

Presentation of HIV Pneumonia

A

More diffure presentation of pneumonia
OR
PJ: fever, tachypnea, dyspnea, non-productive cough

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16
Q

Treatment of Pneumocystis Jiroveci

Prophylaxis too

A

Bactrim

prophylaxis in all patients with CD4 < 200 with bactrim

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17
Q

Tuberculosis Presentation

A 
cough (becomes productive; lasts >3 weeks)
Fever
Night sweats
Anorexia/Weight loss
Hemoptysis
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18
Q

Tuberculosis Chest X-ray (Primary)

A

homogenous infiltrates
Hilar/paratracheal lymph node enlargement
atelectasis
cavitations (Progressive)

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19
Q

Tuberculosis Chest X-ray (Reactivation)

A

apical fibrocavitary disease

nodules/infiltrates

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20
Q

Gohn Complex

significance too

A

Calcified primary focus in tuberculosis

Indicated healed primary infection

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21
Q

Ranke Complex

and significance

A

Calcified primary focus and hilar lymph node

indicates healed primary tuberculosis

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22
Q

Tuberculosis definitive diagnosis

A

Cultures (6-8 weeks to grow)

DNA or RNA amplification techniques (1-2 days)

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23
Q

Lung Biopsy:

Caseating Granulomas

A

Necrotizing Granulomas

Indicates Tuberculosis

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24
Q

Treatment Tuberculosis (Latent)

A

Isolate patient until 2 weeks of treatment completed
Isoniazid for 9 months
Rifampin for 4 months
OR Rifampin + Pyrazinamide for 2 months (if in contact with resistant TB)

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25
Q

Treatment Tuberculosis (Active)

A

Isolate patient until 2 weeks of treatment completed
RIPE therapy for 2 months
(Rifampin, Isoniazid, Pyrazinamide, Ethambutol)
Plus
4 months of additional therapy based on cultures

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26
Q

Side effects of Anti-Tuerculosis Medications
Isoniazid
Rifampin
Ethambutol

A

I: hepatitis, peripheral neuropathy
R: hepatitis, flu-like symptoms, orange body fluids
E: Optic Neuritis

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27
Q

What should be given with Isoniazid and why

A

Vitamin B

to prevent peripheral neuropathy

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28
Q

MC causes of bronchitis

A

(90% Viral) rhinovirus, coronavirus, RSV

Bacteria: s. pneumo/ H. flu/ M. cat

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29
Q

Presentation of Bronchitis

A

COUGH (> 5 days; productive or non; mucus color doesn’t suggest bacterial involvement)
fever, sore throat, headache

NO tachypnea/tachycardia (because O2 exchange fine)

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30
Q

Bronchitis Diagnosis

A

CXR: Clear
Procalcitonin
(elevated if bacterial cause)

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31
Q

Treatment Viral Bronchitis

A

Supportive measures

hydration, expectorants, analgesics, anti-tussives

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32
Q

Treatment Bacterial Bronchitis

A

(#1) 2nd generation cephalosporin

(#2) Macrolide or Bactrim

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33
Q

Characteristics Small Cell Lung Cancer

A

“oat cell”
Likely to metastasize and spread early
Rarely amenable to surgery

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34
Q

Characteristics Non-Small Cell Lung Cancer

types

A

grows more slowly
more amenable to surgery
(squamous cell, large cell, adenocarcinoma)

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35
Q

Squamous Cell Lung Carcinoma Characteristics

rate, location, presentation

A

25-35%
Centrally located mass
Hemoptysis (dx via sputum increased)

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36
Q

Adenocarcinoma of the lung

rate, characteristics, location

A

MC (35-40%)
commonly metastatic to distant origins
Peripherally located

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37
Q

Large Cell Lung Carcinoma

A

large cells with rapid doubling time

may be peripherally or centrally located

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38
Q

Presentation of Lung Cancer

A 
cough (new or changing)
hemoptysis 
pain
anorexia/weight loss
asthenia
LAD
clubbing of the fingers
hepatomegaly
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39
Q

Low Dose Screening for Lung Cancer

A

Less radiation
ages 55-80
smoker for > 30 years
Has not quit smoking in the past 15 years

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40
Q

Diagnosis of Lung Cancer

A

Chest X-ray and CT (demonstrate abnormalities)
Cytologic examination of Sputum
Bronchoscopy
PET Scan
Tumor Tissue Analysis (to aid treatment selection)

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41
Q

Treatment Non-Small Cell Lung Cancer

A

Surgery

+/- adjuvant chemo or radiation to improve survival

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42
Q

Treatment Small-Cell Lung Cancer

A

Combination chemotherapy

Patients rarely live > 5 years after diagnosis

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43
Q

Solitary Pulmonary Nodule
Rate of malignancy
Etiology

A

“Coin Lesion” or mass if >3 cm
40% are malignant
more often infectious granulomas from previous infection or foreign body resection

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44
Q

Pulmonary Functioning Diagnosis of Asthma

A

FEV1/FVC <75%
Bronchodilator Administration
>12% or 200mL increase in functioning

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45
Q

Diagnostics of Asthma

A

Pulmonary Functioning Tests (fev1/fvc <75%; reversible)
Methacholine Challenge Test (dec >20%)
Chest X-ray
ABG

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46
Q

Management of Asthma

A

Peak Expiratory Flow Monitoring to help patients monitor their symptoms and know when to ask for help

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47
Q

Long Term Asthma Symptoms Management Medications

A 
Corticosteroids
Cromolyn sodium 
Long acting bronchodilators
Leukotriene modulators
theophylline
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48
Q

Short acting asthma symptoms management drugs

A

short acting beta agonists
ipratropium
systemic corticosteroids

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49
Q 
Intermittent Asthma Characteristics
-Symptoms
-Night Time Symptoms
-Rescue Inhaler Use
-Lung Functioning
(FEV1 and FEV1/FVC)
A 
Symptoms = 2 days per week
(doesnt interfere with daily activity)
Night: = 2 times monthly
Rescue: < days weekly
Fev1 >80% predicted
Fev1/FVC Normal
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50
Q 
Mild Persistent Asthma Characteristics
-Symptoms
-Night Time Symptoms
-Rescue Inhaler Use
-Lung Functioning
(FEV1 and FEV1/FVC)
A 
Symptoms > 2 days per week 
(minor daily limitation)
Night: 3-4 times monthly
Rescue: > 2 days per week (not daily or more than once on affected days)
FEV1 > 80%
FEV1/FVC Normal
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51
Q 
Moderate Persistent Asthma Characteristics
-Symptoms
-Night Time Symptoms
-Rescue Inhaler Use
-Lung Functioning
(FEV1 and FEV1/FVC)
A 
Symptoms daily
(Some limitation of daily activity)
Night: >1 time per week (not nightly)
Rescue: Daily
FEV1 <80% but >60%
FEV1/FVC decreased 5%
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52
Q 
Severe Persistent Asthma Characteristics
-Symptoms
-Night Time Symptoms
-Rescue Inhaler Use
-Lung Functioning
(FEV1 and FEV1/FVC)
A 
Continuous Symptoms
(extremely limited physical activity)
Night: Often nightly
Rescue: Several times per day
FEV1 <60%
FEV1/FVC reduced >5%
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53
Q

Step 1 Asthma Treatment

A

Rescue Inhaler (SABA PRN)

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54
Q

Step 2 Asthma Treatment

  • Preferred
  • Alternative
A

P: Low Dose ICS

Alt: Cromolyn, LTRA, Nedocromil, Theophylline

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55
Q

Step 3 Asthma Treatment

  • Preferred
  • Alternative
A

P:
-Low dose ICS + LABA
OR
-Medium dose ICS

ALt:

  • Low dose ICS +
  • LTRA OR Theophylline OR Zileuton
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56
Q

Step 4 Asthma Treatment

  • Preferred
  • Alternative
A

P:
-Medium Dose ICS + LABA

Alt:

  • Med Dose ICS +
  • LTRA OR Theophylline OR Zileuton
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57
Q

Step 5 Asthma Treatment

  • Preferred
  • Alternative
A

P:
-High dose ICS + LABA

Alt:
-Omalizumab (for patients who have allergies)

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58
Q

Step 6 Asthma Treatment

  • Preferred
  • Alternative
A

P:
-High Dose ICS + LABA + PO steroid

Alt:
-Omalizumab (for patients who have allergies)

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59
Q

What to confirm before you step up asthma treatment

A

Adherence, environmental control, co-morbid conditions

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60
Q

When to attempt step down

A

When asthma is well controlled for at least 3 months

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61
Q

High Risk Solitary Pulmonary Nodule

A

Older age (>30)
Uneven/Indistinct margins (Spiculated)
Usually > 2 cm
Rapidly progressive

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62
Q

Treatment Malignant Solitary Pulmonary Lung Nodule

A

If high probability of malignancy then resect

If unsure then it is okay to do a biopsy first

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63
Q

Low Risk/Benign Solitary Pulmonary Lung Nodule

A 
< 30 years old
Round/Oval Well demarcated/smooth edges
Up to 3cm
Surrounded by normal tissue
May be calcified
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64
Q

Management of benign/low risk solitary lung nodule

A

CT Q 3mo for 1 year
Followed by
CT Q 6mo for 2 years

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65
Q

Bronchiectasis definition

A

permanent dilation of the bronchi and damage to the bronchial wall subsequent to injury from severe infection or persistent inflammation

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66
Q

Presentation Bronchiectasis

A

Chronic purulent sputum (foul smelling)
hemoptysis
Chronic cough
recurrent pneumonia

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67
Q

Diagnosis of Bronchiectasis

A

High Resolution Chest CT- Gold Standard
(dilated tortuous airways)
CXR- tram track markings
Bronchoscopy (rule out other causes)

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68
Q

Treatment Bronchiectasis

A

Chest Physiotherapy
Pneumonia (Abx 10-14 days)
Exacerbation- Bronchodilators
Lung Transplant

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69
Q

Pink Puffer

A

Emphysema Dominant

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70
Q

Blue Bloater

A

Chronic Bronchitis Dominant

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71
Q

Emphysema Characteristics and X-ray Findings

A

Quiet lungs
Thin, Barrel Chest
Pursed Lip Breathing

Decreased lung markings
Flattened Diaphragm
Hyperinflation
Small/thin appearing heart
*Subpleural Blebs
*Parenchymal bullae
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72
Q

Chronic Bronchitis Characteristics and X-ray Findings

A

Chronic Productive Cough
Noisy Lungs (Ronchi/Wheezing)
Overweight and Cyanotic

Increased lung markings at bases

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73
Q

Chronic Bronchitis Definition

A

Chronic productive cough most days for 3 months of the year for 2+ consecutive years

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74
Q

Emphysema Definition

A

enlarged air spaces due to alveolar septum damage

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75
Q

COPD Risk Factors

A

SMOKING
pollutants
eosinophilia
alpha-antitrypsin 1 deficency

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76
Q

Diagnosis of COPD

A

Chest X-ray (depends on presentation)
Pulmonary Function Testing
Genetic Screening (Alpha antitrypsin 1)

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77
Q

COPD Pylmonary Functioning Tests

A

Decreased FEV1/FVC

Not Reversible

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78
Q

Treatment COPD (Basic)

A 
Smoking Cessation
Supplmental Oxygen (O2 <88%)
Yearly vaccines (flu and pneumonia)
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79
Q

Pulmonary Hypertension Presentation

A 
Dyspnea
Angina like retrosternal chest pain
weakness
fatigue
edema, ascites
Cyanosis
Syncope
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80
Q

Pulmonary Hypertension Diagnosis

A

Chest X-ray
EKG- RVH, RV strain
*Echo- estimates pulmonary arterial pressure
*Cardiac Catheterization- mean pulmonary arterial pressure (>25 mmHg)

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81
Q

Idiopathic Fibrosing Interstitial Pneumonia Risk Factors

A 
Cigarette Smoking
Exposure (wood/metal/dust)
viruses
diabetes
GERD
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82
Q

Idiopathic Fibrosing Interstitial Pneumonia Presentation

A 
Insidious Dry cough
Exertional Dyspnea
Constitutional Symptoms (fatigue, malaise...)
Clubbing
Inspiratory Crackles
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83
Q

Idiopathic Fibrosing Interstitial Pneumonia Diagnosis

A

CXR- progressive fibrosis
CT- Patchy fibrosis, pleural honeycombing
Pulmonary Functioning Tests (Restrictive)
Bronchiolar Lavage
Biopsy

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84
Q

Idiopathic Fibrosing Interstitial Pneumonia Treatment

A

Nothing is shown to improve survival or QOL

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85
Q

Pneumoconioses Definition

A

chronic fibrotic lung disease due to inhalation of inorganic dusts/debris

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86
Q

Asbestosis

  • Occupation
  • Diagnosis
  • Complications
A

Insulation, demolition, construction
Biopsy: Asbestos Bodies
CXR: linear opacities at bases and pleural plaques
Increased risk of lung cancer (Mesothelioma)

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87
Q

Coal Workers Pneumoconioses

  • Occupation
  • Diagnosis
  • Complications
A

Coal mining
CXR: Nodular Opacities upper lung fields
Progressive massive fibrosis

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88
Q

Silicosis

  • Occupation
  • Diagnosis
  • Complications
A

mining, sand-blasting, quarry work, stone work
CXR- Nodular opacities in upper lung fields
Increased risk of TB
Progressive massive fibrosis

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89
Q

Berylliosis

  • Occupation
  • Diagnosis
  • Complications
A

High-tech fields, nuclear power, aerospace, ceramics, foundries, tool and die manufacturing
CXR: diffuse infiltrates and hilar adenopathy
Requires chronic steroids (steroid complications)

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90
Q

Pneumoconioses Presentation

A 
Usually asymptomatic (progressive; long duration)
Dyspnea
inspiratory crackles
clubbing of the fingers
cyanosis
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91
Q

Pneumoconioses Diagnosis

A

Pulmonary Functioning Tests
(Restrictive; reduced diffusing capacity)
CXR
(Varies depending on cause)

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92
Q

Pneumoconioses Management

A

*No effective treatment avilable
Supportive (O2, vaccinations, rehab)
Smoking Cessation

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93
Q

Berylliosis and Silicosis (pneumoconioses) treatment

A

Chronic Steroid Use

-Relief from alveolitis

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94
Q

Sarcoidosis Definition

A

Multiorgan disease of non-caseating granulomatous inflammation
90% have lung involvement
Increased in N. european whites and Aerican Blacks

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95
Q

Sarcoidosis Presentation

A

Cough, dyspnea (insidious), chest discomfort
malaise, fever
SX based on organ systems involved

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96
Q

Sarcoidosis Extrapulmonary symptoms

A

Erythema Nodosum

Enlargement of parotid glands, lymph nodes, liver, spleen

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97
Q

Sarcoidosis Diagnosis

A

Blood Tests
Radiographs
*Biopsy

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98
Q

Sarcoidosis Blood Tests and Results

A 
Leukopenia
Eosinophilia
Elevated ESR
Hypercalcemia
Hypercalcuria
Elevated ACE levels
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99
Q

Sarcoidosis Radiographic Findings

A

symmetrical bilateral hilar/right paratracheal lymphadenopathy
bilateral diffuse reticular infiltrates

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100
Q

Sarcoidosis Biopsy Results

Types of biopsies used

A

Transbronchial biopsy of the lung
Fine Needle Node Biopsy

Non-caseating granulomas

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101
Q

Sarcoidosis Treatment

A

No cure

90% responsive to steroids (moderate doses)

Refractory to steroids
-Immunosuppressant cytotoxic drugs

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102
Q

Treatment for GERD (Step-wise)

A

COnservative (elevate HOB, Low risk foods, X Smoking)

Antacids
H2 Blockers
PPI
Combo PPI and H2 Blocker

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103
Q

Endoscopy Results for Infectious Esophagitis

HSV, HIV, CMV, Candida

A

HSV- multiple shallow ulcers
CMV/HIV- Lg. deep ulcers
Candida- Lacy, white plaques

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104
Q

Treatment for Infectious Esophagitis

Candida, HSV, CMV

A

Candida- Fluconazole/Ketoconazole
HSV- Acyclovir
CMV- IV Ganciclovir or FOscarnet (if poor tolerability)
Should test for HIV or immunocompromised

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105
Q

Types of Esophageal Carcinoma

A

Squamous Cell Carcinoma

Adenocarcinoma

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106
Q

Risk Factors of Esophageal Cancer

A 
Smoking
Drinking Alcohol
GERD
Spicy foods
Poor oral hygiene
HPV History
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107
Q

Presentation of Esophageal Cancer

A 
Progressive Dysphagia
weight loss
hoarsness
nausea/vomiting
heartburn
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108
Q

Diagnosis of Esophageal Cancer

A 
#1 (Initial) Barium swallow
Endoscopy with Biopsy (GS)
CT/Sonogram (staging)
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109
Q

Screening for Esophageal Carcinoma

A

biannual screening if at increased risk

Achalasia, tylosis, radiation, barrets esophagus

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110
Q

Esophageal Carcinoma Treatment

A

Generally Surgery
+/- Adjuvant chemo and radiation

Possible to use combination chemo/radiation without surgery

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111
Q

Mallory Weiss Tear Definition

associated with what

A

Multiple linear tears at the gastroesophageal junction due to forceful vomiting and results in hematemesis

It is associated with alcohol use

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112
Q

Diagnosis of Mallory Weiss Tear

A

Endoscopy

visualized

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113
Q

Treatment of Mallory Weiss Tear

A

Most resolve without treatment

If resolved
PPI may be used to prevent re-bleed

If not resolved
endoscopy and injection of Epi or thermal coagulation

114
Q

Boerhaave Syndrome

A

Esophageal rupture secondary to a large bolus of food leading to hematemesis

115
Q

Esophageal Varices Definition and Causes

A

Dilation of esophageal veins due to portal hypertension (from liver damage)
Common causes include
-alcoholism, Tylenol, Hepatitis
-Budd-Chiari (thrombosis in portal system)

116
Q

Esophageal Varices Presentation

A

Generally asymptomatic until they bleed
(when they bleed they can be life threatening)

Painless upper GI bleed
(bright red or coffee grounds)
+/- Hypovolemic shock

Can be exacerbated by NSAIDs use

117
Q

Screening and Diagnosis of Esophageal Varices

A

Generally made by endoscopy

Cirrhotic patients should be screened at the time of diagnosis

118
Q

Prevention of Esophageal Varices

A

Beta-Blockers

Discontinuation of hepatotoxic drugs (ETOH,

119
Q

Prevention of Esophageal Variceal Bleeding

A

Beta-Blockers +/- Isosorbide mononitrate
Discontinuation of hepatotoxic substances (ETOH, Tylenol…)
Endoscopic Band Ligation

120
Q

Treatment of Esophageal Variceal Bleeding

A 
Hemodynamic Support (2 lg. bore IVs)
Vasopressors +Octreotide
Control Bleeding (sclerotherapy, tamponade, *band ligation...)

TIPS Procedure

121
Q

Common Causes of Gastritis

A 
Autoimmune Disease
*H. Pylori
*NSAIDs
Stress
*Alcohol
122
Q

Presentation of Gastritis

A

Dyspepsia

Abdominal Pain

123
Q

Diagnosis of Gastritis

A

Endoscopy with Biopsy (GS)

Test for H. pylori

  • Urea Breath Test (H. Pylori)
  • Fecal Antigen Testing
124
Q

Treatment of Gastritis

A

Remove offending agents

Treat the Underlying Cause

125
Q

Peptic Ulcer Disease Causes

A

Alcohol
NSAIDs
H. Pylori
Stress

126
Q

Peptic Ulcer Disease Presentation

A

Abdominal Pain (Gnawing/Burning)
Dyspepsia (Heartburn Sx)
Nausea

127
Q

Peptic Ulcer Disease Complications

A

Bleeding Peptic Ulcer

Melena

128
Q

Peptic Ulcer Disease Diagnosis

A

Endoscopy and Biopsy (GS)
Barium Studies (if endoscopy not possible)
H. Pylori Testing
(*Urea Breath Test, *Fecal Antigen Test, Serum Tests)

129
Q

Peptic Ulcer Disease Treatment

Not H. Pylori

A

Remove offending agents
Antacids
H2 Inhibitors
PPI

130
Q

Peptic Ulcer Disease Treatment

H. Pylori

A

CAP Therapy
Clarithromycin
Amoxicillin
PPI

Quadruple Therapy (If CAP fails)
Bismuth
Tetracycline
Metronidazole
PPI
131
Q

Types of Gastric Cancer

A

Zollinger-Ellison Syndrome (Gastrin Secreting)
Gastric Adenocarcinoma
Carcinoid Tumors
Gastric Lymphoma

132
Q

Zollinger-Ellison Syndrome Definition

A

Gastrin secreting tumor in the stomach or the pancreas causes increased acidity of the stomach and can lead to peptic/duodenal ulcers.

133
Q

Zollinger-Ellison Presentation

A 
PUD Symptoms (advanced/treatment resistant)
Abdominal Pain
Secretory Diarrhea (improves with H2X or PPI)
Occult/Frank Bleeding
134
Q

Diagnosis of Zollinger-Ellison

A

Fasting Gastrin level (>150)
Secretin Test
Endoscopy/CT or MRI (localize tumor)

135
Q

Secretin Tests Procedure and Interpretation for Zollinger-Ellison

A

Give 2U/Kg IV of secrtin

Increase in gastrin levels by >200

136
Q

Treatment Zollinger Ellison

A

PPI use to decrease acidity

Surgical resection of tumor when possible

137
Q

Risk Factors for Gastric Adenocarcinoma

A

Smoking
H. pylori infections
Genetics

138
Q

Gastric Adenocarcinoma Presentation

A

Dyspepsia
Weight loss
Anemia (occult bleeding)
Progressive dysphagia (impinging the esophagus)
Postprandial vomiting
LAD (Virchow node, Sister-Mary-Joseph Node)

139
Q

Gastric Adenocarcinoma Diagnosis

A

Iron Deficiency anemia (Occult bleeding)
+/- Elevated Liver Enzymes
*Endoscopy and Biopsy
CT (to determine the extent)

140
Q

Gastric Adenocarcinoma Treatment

A 
Surgical resection (curative or palliative)
-80% cure rate if not invasive or metastatic
\+/-Adjunctive Chemo or

Chemo and/or radiation (palliative)

141
Q

Gastric Lymphoma

A

most common site of metastasis from non-hodgekin lymphoma

142
Q

Presentation of Gastric Lymphoma

A

The same as Gastric Adenocarcinoma
Dyspepsia
Weight loss
Anemia (occult bleeding)
Progressive dysphagia (impinging the esophagus)
Postprandial vomiting
LAD (Virchow node, Sister-Mary-Joseph Node)

143
Q

Diagnosis of Gastric Lymphoma

A

Iron Deficiency anemia (Occult bleeding)
+/- Elevated Liver Enzymes
*Endoscopy and Biopsy
CT (to determine the extent)

144
Q

Treatment of Gastric Lymphoma

A

Surgical excision

+/- Chemo and/or radiation

145
Q

Celiac Disease Definition

A

Inflammation of the small bowel (duodenum) due to ingestion of gluten that leads to malabsorption

146
Q

Celiac Diasease Presentation

General, infants, older patients

A 
diarrhea
steatorrhea
flatulence
weight loss
weakness
abdominal distention/bloating

Infants/Children
-Failure to thrive

Older Patients (malabsorption)
-iron deficency, coagulopathy, hypocalcemia
147
Q

Celiac Disease Diagnosis

A

*Small Bowel Endoscopy and Biopsy (GS)
Serological Screening
-IgA Antiendomysial (EMA)
-Anti-Tissue Transglutaminase (Anti-TTG)

148
Q

Celiac Disease Treatment

A

Gluten Free Diet
+/- lactose free to help decrease inflammation initially
Supplementation if deficencies are present
(Folic acid, B12, calcium, vitamin D)
Prednisone (if refractory inflammation)

149
Q

IBS Diagnosis

A 
It is a diagnosis of exclusion
Stool sampling and testing
Laboratory tests
Colonoscopy
Enema (Barium)
US
CT
Endoscopy
Rome IV Criteria
150
Q

Rome IV Criteria

A

Recurrent abdominal pain at least 1 day per week in the last 3 months and 2/3

  • Related to defecation (relieved by BM)
  • Associated with change in stool frequency
  • Associated with a change in stool form (character)
151
Q

IBS Treatment

A 
Discovery and avoidance of triggers
Treatment depends on the symptoms
High fiber diet
Bulking agents
Anti-diarrheals
Prokinetics
Antidepressants (if mood related)
152
Q

Diverticulosis Vs. Diverticulitis

A

Diverticulosis is an asymptomatic outpouching of the normal colonic mucosa

Diverticulitis is inflammation or infection of a diverticulosis pouch

153
Q

Diverticulitis Presentation

A 
Sx range from mild to severe infection (peritonitis)
Sudden abdominal pain (Usually LLQ)
\+/- fever
Diverticular bleeding (hematochezia)
Altered bowel movements
Nausea/vomiting
154
Q

Diverticulitis Diagnosis

A

Blood in the stool
X-ray to rule out free air (obstruction)
CT (if unresponsive to therapy)

155
Q

Testing to avoid in acute flares involving the colon

A

Colonoscopy due to increased risk of perforation!

156
Q

Diverticulitis Treatment (Uncomplicated)

A

Low residue diet (or clear liquid diet)
Broad spectrum antibiotics (PO or IV)
Colonoscopy after 6 weeks to r/o cancer

157
Q

Antibiotics for Diverticulitis

A

FLAGYL

AND
*Ciprofloxacin
cefazolin, cefuroxime, ceftriaxone, cefotaxime, levofloxacin

158
Q

Diverticulitis Treatment (Complicated)

A

Bowel resection

159
Q

Screening for Colorectal Cancer

A

*Colonoscopy (at age 50-75 w/o RF) Q 10 years
*Flexible Sigmoidoscopy Q 5 years +FOBT Q 3 years
CT

160
Q

COlorectal Cancer Presentation (General)

A

Slow growing so asymptomatic until later in the disease

fatigue/weakness (chronic blood loss)
abdominal pain
change in bowel habits
obstruction

161
Q

Colorectal Cancer Presentation (Right)

A 
Blood loss (anemia)
Obstruction (less common than left)
162
Q

Colorectal Cancer Presentation (Left)

A

change in bowel habits (thin caliper)
Obstructive symptoms
tenesmus
Fullness

163
Q

Diagnosis

A 
Occult blood
*Colonoscopy, sigmoidoscopy
Barium enema
Carcinoembryoic antigen (CEA; follow-up not dx)
METS: CT and CXR
164
Q

Colorectal Cancer Treatment

A

Rescetion
+/- Chemotherapy (above Duke III)

Radiation may be used for rectal tumors

165
Q

Most common anal fistula

A

Intersphincteric (70%)

166
Q

Anal Fistula Presentation

A 
Non-healing anorectal abscess
Chronic purulent drainage
Firm mass
intermittent rectal pain
drainage
pruritis
167
Q

Anal Fistula Diagnosis

A

*Anoscopy

Imaging not required

  • endosonography
  • fistulography
  • CT/MRI (air or contrast)
168
Q

Anal Fistula Treatment (Simple)

A

*Fistulotomy with probing
Ligation of internal tract
Fistulectomy

169
Q

Anal Fistula Treatment (Complex)

A

Seton (loop fistulectomy)

decreased healing time and reduced risk of poor wound healing and incontinence

170
Q

Anal Abscess Treatment

A 
Surgical Drainage
Warm Water Cleansing (Sitz Baths)
Analgesics
Stool Softener
High Fiber Diet
171
Q

Anal Fissure Defintion

A

Tear in the anoderm (mc posterior midline)

172
Q

Anal Fissure Presentation

A

Pain WITH defacation (lasting hours after)
BRBPR
Pruritis
External Skin Tages (thickened skin; sentinel pile)
Hyoertrophied Pappillae

173
Q

Anal Fissure Treatment (Acute)

A 
Increased Dietary Fiber
Increased Water Intake
Sitz Baths
Topical Anesthetic
Vasodilator (NTG, Nifedipine)
Stool Softener or Laxative
174
Q

Anal Fissure Treatment (Chronic)

A 
Botox Injection
Lateral sphincterotomy (last resort; R of incontinence)
175
Q

Anal FIssure Prevention

A

Proper hygiene
High fiber diet
Adequate fluids (avoid straining during BM)
Promptly treat diarrhea

176
Q

Hemorrhoid Definition

A

Dilated veins in the anoderm/rectum

177
Q

Hemorrhoid Classification (Internal Only)

A

Stage 1- VIsible in the lumen
Stage 2- Prolapses with bowel movements but reduces automatically
Stage 3- Prolapses with bowel movements and requires manual reduction
Stage 4- Prolapses and cannot be reduced (Strangulation)

178
Q

Internal Hemorrhoid Characterictics

A

Above/Proximal to the dentate/pectinate line

Painless

179
Q

External Hemorrhoid Characteristics

A

Below/Distal to the dentate/pectinate line

Can be very painful especially if thrombosed

180
Q

Conservative Treatment for Hemorrhoids

A 
Sitz Baths
Ice
Bed Rest
Stool Softeners
High fiber/fluid diet
Topical steroids
181
Q

Treatment of Hemorrhoids (non-conservative)

A

Rubber Band Ligation
Sclerotherapy
Surgery (Definitive)

182
Q

Sclerotherapy for Hemorrhoids

A

Medium Grade internal hemorrhoids

Thrombosed symptomatic external hemorrhoids

183
Q

Low Grade Internal Hemorrhoids (Grade 1-2)

A

Conservative therapy

If conservative management fails consider intervention

184
Q

Acute Pancreatitis Causes

A

I GET SMASHED
Idiopathic

*Gallstones
*ETOH
Trauma

Steroids
Mumps
Autoimmune
Scorpion Venom
Hypercalcemia OR Hypertriglyceridemia
ERCP
Drugs
185
Q

Acute Pancreatitis Presentation

A

Gnawing Epigastric Pain (radiates to the back; decreases with leaning forward)
Nausea/Vomiting
Fever
Hemorrhage (Grey Turner or Cullen Sign)

186
Q

Grey Turner Sign and Associated Disease

A

Bruising at the flanks

Hemorrhagic sign of acute pancreatitis

187
Q

Cullen Sign and Associated Disease

A

Bruising around the umbilicus

Hemorrhagic sign of acute pncreatitis

188
Q

Acute Pancreatitis Diagnosis

A 
Lipase > Amylase
\+/- increased liver enzymes
Ultrasound to look for gallstones
CT Scan
Ranson criteria to predict severity
189
Q

Ranson Criteria Components and Interpretation

A 
Used to determine severity of acute pancreatitis
WBC <16,000
Blood Glucose > 200
LDH >350
AST >250
Arterial PO2 <60
Base Defecit > 4
Calcium Falling
BUN Rising
190
Q

Acute Pancreatitis Treatment

A

NPO
IVF
Pain Management (Opioids)
+/- Antibiotics

191
Q

Gold Standard Diagnosis for Acute Pancreatitis

192
Q

Gold Standard Diagnosis for Acute Pancreatitis

193
Q

Initial and Gold Standard Diagnosis for Chronic Pancreatitis

A

CT Scan

ERCP- “Chain of Lakes”

194
Q

Treatment of Chronic Pancreatitis (Simple)

A

NPO
IVF
Enzymes
Treat the Underlying Cause (MC ETOH)

195
Q

Treatment of Chronic Pancreatitis (Complex)

A

Surgical
-Pancreatic resection
(Whipple or pancreatojejunostomy)

196
Q

Charcot’s Triad

A

Acute Cholangitis classic symptoms

Jaundice, Fever, RUQ pain

197
Q

Reynold’s Pentad

A

Acute Cholangitis Severe Symptoms

Jaundice, fever, RUQ pain (Charcot’s Triad)
PLUS
AMS and Shock

198
Q

Initial and Gold Standard Diagnosis of Acute Cholangitis

A

Initial: US
GS: *ERCP or PTC

199
Q

Most common cause of acute cholangitis

A

Gallstones

200
Q

Treatment of acute cholangitis (stable)

A

Decompression with *ERCP (sphoncterotomy) or PTC (cath)

201
Q

Treatment of acute cholangitis (unstable)

A

Blood cultures
IVF
IV Antibiotcs
Closely monitor BP, hemodynamics, and Urinary output

202
Q

How long must someone be stable and afebrile before ERCP or PTC treatment for acute cholangitis

A

> 48 hours

203
Q

Initial and Gold Standard Diagnosis of Cholecystitis

A

Initial: Ultrasound of RUQ
GS: HIDA Scan

204
Q

Treatment of cholecystitis (asymptomatic)

A

No treatment

205
Q

Treatment of cholecystitis (symptomatic)

A

Elective cholecystectomy (for recurrent attacks)

206
Q

Diagnostic Criteria for Rheumatoid Arthritis

Categories and total score needed

A
  1. Joint Involvement (0-5 points)
  2. Serology (0-3 points)
  3. Duration of Symptoms (0-1 point)
  4. Acute Phase Reactants (0-1 point)

Need 6/10 points

207
Q

Diagnostic Criteria for Rheumatoid Arthritis

Joint Involvement Interpretation

A 
1 medium or large joint (0 points)
2-10 medium or large joints (1 point)
1-3 small joints (2 points)
4-10 small joints (3 points)
>10 joints (at least 1 small) (5 points)
208
Q

Diagnostic Criteria for Rheumatoid Arthritis

Serology

A

RF - and ACPA - (0 points)
RF or ACPA low + (2 points)
RF or ACPA high positive (3 points)

209
Q

Diagnostic Criteria for Rheumatoid Arthritis

Duration of Symptoms

A

< 6 weeks (0 points)

>6 weeks (1 point)

210
Q

Diagnostic Criteria for Rheumatoid Arthritis

Acute Phase Reactants

A

CRP and ESR not elevated (0 points)

CRP and ESR elevated (1 point)

211
Q

Treatment for Rheumatoid Arthritis

A

Physical and Occupational Therapy

  1. NSAIDs
  2. DMARDs (Started ASAP after diagnosis)
    - Methotrexate
    - Biologics
    - Non-biologics
212
Q

Common Treatment Regimen for Rheumatoid Arthritis

A

Methotrexate

PLUS another DMARD (commonly a biologic)

213
Q

Common Infections that preceed Reactive Arthritis

and their bugs

A

STDs
(Chlamidya)

Gastrointestinal Infections
(Shigella, Salmonella, Yersinia, Campylobacter)
214
Q

Treatment for Reactive Arthritis

A

Physical Therapy
NSAIDs
Sulfasalazine or Azithioprine (if NSAIDs fail)

215
Q

Joint Analysis in Gout

A

Needle like crystals

Negative Birefringent

216
Q

Acute Gout Treatment

A

Rest and Elevation

  1. NSAIDs
  2. Colchicine (less than 48 hours)
  3. Corticosteroid Injections
217
Q

Gout Chronic Management

A

Lifestyle changes (dec. ETOH, red meat, weight loss…)
Allopurinol
Febuxistat
Probenecid

Keep UA levels < 6

218
Q

Joint Analysis in Pseudogout

A

Rhomboid like crystals

Positive Birefringent

219
Q

X-Ray results in Pseudogout

A

Chondrocalcinosis

220
Q

Pseudogout Treatment

A

NSAIDs
Colchicine (< 48 hours)
Intraarticular Steroids

221
Q

Diagnostic Criteria For Lupus

A 
Rash (Malar or Discoid)
Photosensitivity
Oral Ulcers
Arthritis
Serositis (heart, lungs, peritoneal)
Renal Disease (proteinuria, cellular casts)
Positive ANA
Hematologic Disorders
Immunologic Disorders
Neurological Disorders (seizures, psychosis)
222
Q

Treatment of Lupus

A

Lifestyle Changes

  • Regular exercise
  • Smoking Cessation
  • Sun Protection
Pharmacotherapy
-NSAIDs
-Anti-malarials (hydrochloroquine, quinacrine)
-Corticosteroids
Methotrexate
223
Q

Polymyositis Definition

A

Inflammation of striated muscled

GI tract, esophagus, lungs, heart, joints…

224
Q

Presentation of Polymyositis

A

Insidious painless proximal muscle weakness
Dysphagia
Polyarthralgias
Muscle Atrophy

+/- rash (dermatomyositis)

225
Q

Diagnosis of Polymyositis

A

Elevated CPK and Aldolase

Muscle Biopsy

226
Q

Diagnostic Criteria for Polymyositis

and interpretation

A
  1. Symmetric Proximal m. weakness
  2. Elevated CPK
  3. EMG findings consistent
  4. Biopsy results consistent
  5. Characteristic Rash

Interpreted based on first 4 criteria
2/4- possible
3/4- probable
4/4- definite

227
Q

Polymyalgia Rheumatica Presentation

commonly associated with?

A 
Pain and stiffness in the neck, shoulder and pelvic girdles
Constitutional symptoms (fever, fatigue, weight loss)

30% associated with Giant Cell Arteritis
-jaw claudication, temporal pain, vision loss

228
Q

Diagnostic for Polymyalgia Rheumatica

A

ESR is Elevated (>50)

229
Q

Treatment for Polymyalgia Rheumatica

alone and if combined with GCA

A

Alone: Low dose steroids (tapered over 2 years)

PMR + GCA: HIgh dose steroids (tapered over 2 years)
-IF vision loss is present do not delay steroids for result of biopsy.

230
Q

Polyarteritis Nodosa Definition
(commonly involved locations)
(can be associated with?)

A

Inflammation of small and medium vessels
-skin, kidney, peripheral nerves, muscle and gut
Can be associated with hepatitis B

231
Q

Polyarteritis Nodosa Presentation

A

Fever
anorexia/weight loss
abdominal pain
peripheral neuropathy
arthralgias/arthritis
Skin lesions (liverdo reticularis, palpable purpura)
renal involvement (HTN, edema, oliguria, uremia)

232
Q

Skin lesions associated with Polyarteritis Nodosa

A

Liverdo Reticularis

Palpable Purpura

233
Q

Diagnosis of Polyarteritis Nodosa

GS and others

A

GS: Vessel biopsy

Others:

  • Elevated ESR/CRP
  • Proteinuria
  • Positive Hep B titer
234
Q

Treatment of Polyarteritis Nodosa

A 
*High dose steroids
Cytotoxic drugs
Immunotherapy
Treatment of Hep B
Treat the Hypertension if present
235
Q

CREST Syndrome

Symptoms and associated disease

A 
Calcinosis Crisis
Raynaud Phenomenon
Esophageal Dysfunction
Sclerodactyly
Telangiectasis

Associated with limited scleroderma

236
Q

Scleroderma Definition

A

deposition of collagen in the skin (mc) and less often in the kidneys, heart, lungs, and stomach

237
Q 
Diffuse Scleroderma
(where does it effect)
A 
skin
heart
lungs
GI tract
and kidneys
238
Q 
Limited Scleroderma
(where does it effect?)
A

skin of the

  • face
  • neck
  • distal elbows and knees
239
Q

Classic presentation of scleroderma

A 
Skin changes (mc in hands first)
polyarthralgias
esophageal dysfunction
240
Q

Diagnosis of Scleroderma

general, limited and diffuse

A

general: ANA + (90%)
- monitor kidney functioning for renal involvement
limited: Anticentromere Antibody (ACA)
diffuse: anti-SCL-70 antibody (poor prognosis)

241
Q

Scleroderma Treatment

A

There is no cure or specific treatment
Treatment is system and symptom based
-PPI for GERD
-ACE for renal disease
-CCBs and avoid triggers for Raynauds syndrome
-immunosupressive drugs for pulmonary HTN

242
Q

Sjogren Syndrome definition

associated diseases

A

autoimmune destruction of the salivary and lacrimal glands

can be associated with rheumatoid arthritis, lupus, polymyositis, or scleroderma

243
Q

Sjogren Syndrome Presentation

A

Xerostomia (dry mouth)
Xeropthalmia (dry eyes)
Keratoconjunctivitis (infx 2’ to dry eyes)
+/-enlarged parotid glands

244
Q

Sjogren Syndrome Diagnosis of associated diseases

factors

A

RF + (70%)
ANA + (60%)
Anti-Ro + (60%)
Anti-La + (40%)

245
Q

Sjogren Syndrome Diagnosis

A 
Schrimer Test (dry eyes)
-< 5mm of filter paper wet after being in the eye for 5 minutes

Biopsy of the lower lip
-lymphocytic infiltration and gland fibrosis

246
Q

Fibromyalgia Definition and Associated Disorders

A

Central pain disorder

-Can be ssociated with RA, SLE, Sjogren Syndrome, hypothyroidism and sleep apnea (men)

247
Q

Fibromyalgia Presentation

A 
Nonarticular muscle aches and pains
fatigue/sleep disturbances
mood changes (anxiety/depression/irritability)
headaches
irritable bowel syndrome
248
Q

Fibromyalgia Diagnosis

A

Pain above and below the waist
(bilateral and axial for at least 3 months)
Tenderness at 8/18 specific tender points

249
Q

Fibromyalgia Treatment

A 
Antidepressant Medications 
-TCA**, SSRIs, SNRIs
Pregabalin/Gabapentin (if antidepressants fail)
-decrease pain and improve sleep
Aerobic exercise
CBT and mildfulness
250
Q

Hyperparathyrodism Presentation

A

Classic:
Stones, Bones, Moans, and Groans

Other Symptoms:

251
Q

Acute Gout Treatment

A
  1. NSAIDs
  2. Steroids
  3. Colchicine
252
Q

Most common cause of gout

A

Underexcretion (90%)

253
Q

Maintenance of Gout (Prophylaxis)

A 
Lifestyle changes
(decreased alcohol, red meat, seafood)

Allopurinol (overproducers)
Probenecid (underexcreters)

254
Q

Medications that increase gout

A

Loop and Thiazide Diuretics

Aspirin

255
Q

Polyarteritis Nodosa is associated with what?

A

Hepatitis B

256
Q

Polyarteritis Nodosa Angiogram

A

String of pearls/beads

257
Q

Factors and viruses associated with polymyalgia rheumatica

A

HLA-DR4

Parovirus B19 and Adenovirus

258
Q

Reactive Arthritis most common Bug for prior infection

259
Q

Felty Syndrome and its significance

A

Rheumatoid Arthritis
Splenomegaly and
Neutropenia

Can lead to severe infections

260
Q

Hypoparathyroidism Presentation (acute)

A 
Tetany
Spasms
Cramps
Parasthesias
Hyperreflexia (Chovstek and Trousseau Sign)
Teeth/Nail/Hair Defects
261
Q

Hypoparathyroidism Presentation (chronic)

A 
lethargy
anxiety
parkinsonism
mental retardation
personality changes
blurred vision (cataracts)
262
Q

Diagnosis of Hypoparathyroidism

A

Low PTH
Low Serum Calcium
Increased Phosphate Levels

263
Q

EKG Changes with Hypoparathyroidism

A

Prolonged QT

T wave abnormalities

264
Q

X-ray results with Hypoparathyroidism

A

Increased bone density due to lack of PTH to call for increased serum calcium

265
Q

Hypoparathyroidism Treatment

A
  1. Calcium and Vitamin D
266
Q

Most common Type of Hyperthyroidism

A

Grave’s Disease

267
Q

Types of Hyperthyroidism

A

*Grave’s Disease
*Toxic Multinodular Goiter
Hashimoto’s
Pituitary Tumor
Pregnancy
Exogenous Thyroid Hormone
Excessive Iodine Intake
Radiograph Contrast
Amiodarone Use

268
Q

High TSH

High T3 and T4

A

Secondary Hyperthyroidism

269
Q

Low TSH

High T3 and T4

A

Primary Hyperthyroidism

270
Q

Hyperthyroidism Treatment

A

Beta Blockers (Symptomatic Control)
Polythiouracil (pregnancy) or Methimazole
Radioactive Iodine Ablation
Thyroidectomy

271
Q

Radioactive Iodine Ablation Indications for Hyperthyroidism

A

If not pregnant or nursing

Failed medical treatment

272
Q

Thyroidectomy Indications for Hyperthyroidism

A 
Large/obstructing/malignant nodules
In pregnancy (if medications fail)
273
Q

Treating Opthalmopathy in Hyperthyroidism

A

*High dose tapered prednisone
Retrobulbar radiation
Optic Nerve decompression surgery

274
Q

Thyroid Storm Presentation

A 
Fever
Tachycardia
Agitation
Sweating
Tremor
Instability
Delirium
Vomiting
Diarrhea
275
Q

Thyroid Storm Treatment

A

*Polythiouracil or Methimazole
+/- Hydrocortisone
+/- Sodium Iodide
*Beta Blocker (symptomatic relief)

276
Q

Most Common Cause of Hypothyroidism

A

Hashimoto’s Thyroiditis

277
Q

Presentation of Hypothyroidism

A 
Weakness
Dry Skin
Lethargy
Slow Speech 
Cold Intolerance
Forgetfulness
Constipation
Weight Gain
Depression
Bradycardia
Hyporeflexia
278
Q

Low TSH

Low T3 and T4

A

Secondary Hypothyroidism

279
Q

High TSH

Low T3 and T4

A

Primary Hypothyroidism

280
Q

Treatment for Hypothyroidism

A

Levothyroxine (adjust Q 4-6 weeks based on TSH)

PANCE Prep (2 decks)

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