UWorld Flashcards
What is a well-known Complication of GERD that results from the healing of Ulcerative Esophagitis?
Peptic Stricture (causes Obstructive Dysphagia)
What are (3) Typical Signs/Symptoms of Obstructive Dysphagia?
- Difficulty Swallowing Food followed by liquid
- Prolonged and Careful chewing
- Swallowing Small portions
What is the Mode of Transmission for Bacterial Enteritis?
Fecal-Oral
Exposure to which (2) things puts you at risk for Bacterial Enteritis?
- Farm Animals
- Contaminated Meat
What are (3) Clinical Features of Bacterial Enteritis?
- Fever
- Abdominal Pain
- Diarrhea containing Blood or Mucus
Which Diagnostic Method is considered to be the Gold Standard for diagnosing Bacterial Enteritis?
Stool Culture
What is the First-Line Treatment for Bacterial Enteritis?
Fluid Repletion (electrolyte formulation. eg, Pedialyte)
In patients with Bacterial Enteritis, antibiotics are reserved for which (2) High-Risk groups?
- Immunocompromised
- Patients with Invasive Disease (eg, Sepsis)
What Cause of Bacterial Enteritis must be Excluded in Children BEFORE treatment with antibiotics?
Escherichia coli O157:H7
What are (4) typical Presenting Signs/Symptoms in a patient with suspected Acute Calculous Cholecystitis?
- Persistent RUQ Pain
- Fever
- Leukocytosis
- Nausea/Vomiting
What is the Pathophysiology of Acute Calculous Cholecystitis?
Gallstone Obstructs the Cystic Duct (usually at Hartmann’s Pouch) ⇒ Gallbladder Wall Inflammation
A Diagnosis of Acute Calculous Cholecystitis is typically Confirmed with what INITIAL Diagnostic Test of Choice?
RUQ Ultrasound showing Choleliths with:
- Gallbladder Wall Thickening, OR
- Sonographic Murphy Sign (increased pain with the sonographic transducer compresses the gallbladder)
In patients with suspected Acute Calculous Cholecystitis who have a Negative(-) or Inconclusive(?) INITIAL Diagnostic Test of Choice:
a.) What is the SECOND-LINE Diagnostic Test of Choice to Confirm this disorder?
b.) What is the Sensitivity & Specificity of this SECOND-LINE Diagnostic Test of Choice?
a.) H*_epatobiliary _*I*_minoDiacetic _*Acid Scan (HIDA Scan)
- a.k.a. C**holescintigraphy
b.) Sensitivity & Specificity > 90%
What does a Serum-to-Ascites Albumin Gradient (SAAG) ≥ 1.1 g/dL Indicate?
The Presence of PORTAL HYPERTENSION
- The Ascites is Hepatic Lymph from backpressure which then leads to Increased Hydrostatic Pressure.
What does a Serum-to-Ascites Albumin Gradient (SAAG) < 1.1 g/dL Indicate?
NO portal hypertension
What is the most reliable Method to Differentiate the different Causes of Ascites?
Abdominal Paracentesis
What is the Equation to calculate the Serum-to-Ascites Albumin Gradient (SAAG)?
SAAG = Serum Albumin - Ascites Albumin
**NOT the ratio**
What are (3) Clinical Conditions associated with a Serum-to-Ascites Albumin Gradient (SAAG) ≥ 1.1 g/dL?
- Congestive Heart Failure (CHF)
- Cirrhosis
- Alcoholic Hepatitis
What are (5) Clinical Conditions associated with a Serum-to-Ascites Albumin Gradient (SAAG) < 1.1 g/dL?
- Peritoneal Carcinomatosis (eg, malignant carcinoma from something like ovarian cancer)
- Peritoneal Tuberculosis
- Nephrotic Syndrome
- Pancreatitis
- Serositis
An Isolated Elevation of Anti-HBc (a.k.a. Total Core Antibody; IgM and IgG) is found on Pre-screening Labs in only about 1% of Blood Donors in the U.S., but in about 10-20% in Endemic countries:
What are the only (3) Situations in which Isolated Elevation of Anti-HBc may be seen?
- During the “Window Period” of Acute HBV infection when HBsAg has fallen but Anti-HBs has not yet risen.
- + Anti-HBc IgM
- Liver Enzymes Elevated
-
Years AFTER recovery from Acute HBV infection once Anti-HBs has waned off.
- - Anti-HBc IgM
- Liver Enzymes Normal
-
After MANY years of Chronic HBV infection when HBsAg has fallen to an undetectable level.
- - Anti-HBc IgM
- + HBV DNA & chronic liver disease
What are the initial (2) Steps in the management of a patient with Isolated Elevation of Anti-HBc?
- Repeat Hepatitis Serologies (to Rule Out a False Negative result).
- Measure Anti-HBc IgM level and Liver Function Tests (to determine severity).
In a patient with a History of Alcohol Abuse who presents with Active Hematemesis and is in an Unresponsive State, what are the (3) appropriate Stabilization Steps, and which Exam should follow stabilization?
Stabilization Steps:
- Endotracheal Intubation (aspiration risk)
- Two Large-Bore IV’s (aggressive fluid resuscitation)
- Blood Type & Cross Match
Once Stabilized:
Upper Endoscopy (can be Diagnostic & Therapeutic)
In a patient with a History of Alcohol Abuse who presents with Active Hematemesis and is in an Unresponsive State, what are the (2) most likely cause of the Upper GI Bleed (hematemesis)?
- Bleeding Esophageal Varices (from Portal Hypertension caused by chronic liver disease).
- Mallory-Weiss tear.
In a patient with a History of Alcohol Abuse who presents with Active Hematemesis and is in an Unresponsive State, what Medication should be given AFTER initial Stabilization and BEFORE (while waiting for) Upper Endoscopy, and how does it work?
Octreotide (decreases Elevated Portal Venous Pressure, the cause of variceal formation)
Which Class of Medications can be used for 1° or 2° Prevention of Esophageal Variceal Hemorrhage?
Nonselective β-Blockers (β1 and β2 antagonism):
- Propranolol
- Nadolol
The Combination of what (3) Findings in a patient should increase your suspicion for Toxic Megacolon?
- History of SEVERE Colitis (especially 2/2 Inflammatory Bowel Disease).
- TOXIC signs (eg, Septic).
- Distended, Tympanic abdomen.
What is the Initial Management Step in a patient with suspected Toxic Megacolon?
Abdominal X-Ray
CT Scan is best used for Early Detection of COMPLICATIONS
When in the course of the disorder are patients with Inflammatory Bowel Disease (IBD) MOST At-Risk for developing Toxic Megacolon?
EARLY in the course of their IBD (possibly even at Initial Presentation)
What is the FIRST-LINE Treatment for Toxic Megacolon in a patient with underlying Inflammatory Bowel Disease (IBD)?
Glucocorticoids
What is the FIRST-LINE Treatment for Toxic Megacolon in a patient with Infectious Colitis?
Antibiotics
