UWORLD Flashcards
patient with septic shock has huuuuuuuge increase AST/ALT, little increase in total bile/alk phos
shock liver (ischemic hepatic injury)
3 criteria for acute liver failure
- hepatic encephalopathy
- PT/INR > 1.5
- elevated transaminases
What conditions make a diverticulitis “complicated”?
abscess, fistula, perforation, obstruction
How to treat diverticulitis abscesses?
<3cm - IV abs, observation
>3cm/worsening symptoms - surgery
young woman on OCPs, develops dull RUQ pain, cholesttatic symptoms, solitary hyper echoic/solid lesion in liver
hepatic adenoma
how to work up bilious emesis in neonate
- immediate x-ray
- CONTRAST studies to determine level of obstruction
Neonate (hours old) has bright green vomiting, has not had a bowel movement yet, CFTR F 508 mutation
meconium ileus
likely 2/2 CF
child with impaired adaptation to darkness, photophobia, dry sealy skin, xerosis cornea, hyperkeratosis shoulders/butocks, extensors, silver grey plaques on bulbar conjunctiva (Biltot spots)
vitA deficiency
4 week intermittent bloody diarrhea, develops more severe symptoms with fever, hypotension, and diffuse abdominal tenderness, decreased bowel sounds
toxic megacolon (likely from undx IBD) CONFIRM WITH ABDOMINAL X-RAY to see dilated bowel loops
positive urobilinogen in urine vs positive bilirubin in urine
urobilnogen - high unconj bilirubin
bilirubin - high conj bilirubin
how do dx pancreatic cancer (most sensitive test)
IMAGING
u/s or abdominal CT of U/s inconclusive
CA-19-9 tumor marker good for evaluating treatment response BUT NOT FOR SCREENING
which cause of anion gap metabolic acidosis can cause rectangular envelope shaped stones and renal acute renal failure
ethylene glycol
which cause of anion gap met acidosis can cause blindness
methanol
elderly patient with cardiac risk factors develops acute abdominal pain that worsens, becomes diffuse, associated with metabolic acidosis, elevated amylase and phosphate
acute mesenteric ischemia
acidosis is from increased lactate from ischemia
IBD with noncaseating granulomas on biopsy
chron’s
IBD associated with toxic megacolon
UC
IBD associated with pseudopolyps
UC
frequent water diarrhea (10-20 BMs per day), hypokaelima, metabolic alkalosis, dark brown discoloration of colon with pale patches of lymph follicles
laxative abuse
(melanosis coli is black discoloration)
could be VIPoma but this isn’t a/w melanosis
chronic relic pain, voiding symptoms, pain with ejaculation, negative urine culture, positive for leukocytes
chronic prostatitis (noninfectious chronic prostate inflammation)
rx long QT syndrome
beta blocker with pacemaker to prevent exertion heart rate and prevent torsades
person with churn’s s/p ideal resection presents with patchy alopecia, pustular crusting skin rash, impaired taste
zinc deficiency
person with churn’s s/p ileal resection presents with thyroid dysfunction, heart failure symptoms
selenium deficiency
person with chron’s s/p ileal resection presents with fragile hair, skin depigmentation, neurologic dysfunction…
copper deficiency
GI side effect of isoniazid
DRUG INDUCED HEPATITIS
crampy, post prandial pain, food aversion, weight loss…progressive over a year, malnutrition
chronic mesenteric ischemia
new onset hearing loss or chronic ear drainage despite abx therapy…otoscope exam shows perisperhal granulation and skin debris
cholesteatoma
can lead to hearing loss
AIDS patient, bloody diarrhea, weight loss
CMV
any AIDS pt with active CMV infection needs ocular exam to rule out CMV retinitis
AIDS patient, profuse watery diarrhea
crypto
AIDS patient, watery diarrhea, high grade fever
MAC
acute MR during MI does what to left heart vs chronic MR
acute - increases left ventricular end diastolic pressure, leading to acute pulmonary edema
chronic - increases left atrial size/compliance
How to work up patient with recurrent ulcers, even some in jejunum and thickened gastric folds
suspect gastrinoma
first do fasting serum gastrin after they’ve been off PPI for at least one week…
if greater than 1000…highly suspicious
if less than 1000…do SECRETIN STIM TEST (will stimulate gastrin secretion in gastrinoma cells…if normal, secretin will inhibit gastric G cells from producing gastrin)
African American patient, heroin user, HIV positive presents with nephrotic snydrome
FSGS
Nephrotic syndrome after recent URI
IgA nephropathy
nephrotic syndrome in patient with Hodgkin lymphoma
minimal change
how to work up patient who coughs, chokes, has nasal regurgitation when swallowing liquids or solids…hx of stroke, dementia, older patient
patient likely has oropharyngeal dysphagia
DO VIDEOFLUROSCOPIC MODIFIED BARIUM SWALLOW
how to diagnose and treat leprosy
dx- full thickness biopsy edge of lesion
rx- dapsone plus rifampin
younger patient, fever, night sweats, weight loss, diarrhea, lymphadenopathy, arthralgias, first test to get?
HIV test
do that considering others like IBD, Whipple, celiac, etc
fever, night sweats, weight loss concerning for something scarier than GI stuff
When to start doxy prophylaxis for tick bite?
after tick has been attached for >36 hours
best abx prophylaxis for bite wound
polymicrobial?
amoxicillin-clavulanate
neonate, first week of life, hugely elevated unconj bilirubin, dehydration (red urate crystals in diaper), stool doesn’t transition from meconium to yellow/green
breastfeeding failure jaundice (poor lactation, poor stooling, less bilirubin elimination, bilirubin re-enters circulation)
vs. breast milk jaundice (adequate breast feedings, peaks at 2 weeks, higher levels of b-glucouronidase which deconjugates bill)
elderly patient, otitis externa, fever, high ESR, purulent discharge, dx and rx
malignant (necrotizing) otitis externa
rx with IV cipro
usually from pseudomonas
best imaging test for diverticulitis
contrast abdominal CT
NOT A BARIUM STUDY OR COLONOSCOPY IF RISK OF PERFORATION
bilateral interstitial infiltrates, immunosuppressed, elevated LDH, dr cough, fever ,respiratory failure, no GI symptoms…dx and dx test
PCP
bronchoalveolar lavage
fever, RUQ pain, hepatomegaly, diarrhea, single sub capsular cyst in right lobe, hiking trip in developing country of liver…dx and rx
entamoeba histolytica
metronidazole
“amebic dysentery”
reduction of both passive and active range of motion, stiffness>pain, no history of injury, patient>40
adhesive capsulitis
histology of Reye syndrome
microvascular steatosis (fatty infiltration)
bone risk of patient on long term steroids
avascular necrosis
