Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
50 Cards in this Set
- Front
- Back
|
Define dyspepsia.
|
Literally, "bad digestion"
Upper abdominal pain or discomfort that is episodic or persistent Often a/w belching, bloating, heartburn, n/v |
|
|
Why do so many Latino men delay seeking healthcare?
|
Masculinity is impt. They view themselves as strong.
|
|
|
How does smoking result in dyspepsia?
|
Decreases vascularity to gastric mucosal cells, resulting in dec'd rates of mucosal healing after insult.
|
|
|
What are the atypical signs and symptoms of GERD?
|
When severe reflux reaches pharynx and mouth or is aspirated, can cause:
Asthma Chronic Cough Dental Enamel Loss Globus sensation (lump in throat) Recurrent laryngitis Non-cardiac chest pain Hoarseness |
|
|
How does the presentation of dyspepsia due to GERD differ from that due to PUD?
|
GERD: heartburn, regurgitations (burning in chest with sour/bitter taste), likely to occur after meals, on lying down or bending, with obesity, pregnancy, binding clothes/girdles
Due to PUD: Episodic or recurrent epigastric aching, "hunger like" pain; occurs 5-15 mins after eating and remains until stomach empties (HOURS) Pain may be absent while fasting Often relieved by eating, drinking milk, taking antacids, and may rebound in 90 mins-4hrs after meal a/w nausea |
|
|
Complications of GERD vs PUD
|
Gerd: Esophagitis, peptic strictures, BARRETT'S esophagitis, adenocarcinoma
PUD: Hemorrhage, perforation into peritoneal cavity or adjacent organs, ulcer scar healing or inflammation with impaired gastric emptying (gastric outlet syndrome) |
|
|
What are the alarm symptoms related to GERD/PUD? What do they suggest?
|
IMMEDIATELY REFER TO GI DOC:
Dysphagia (peptic stricture , may indicate adenocarcinoma) Onset of heartburn and regurgitation in pt >55 (Inc'd chance cancer) Early satiety (gastroparesis, gastric outlet obstruction due to stricture, cancer) Hematemesis (bleeding ulcer, Mallory-Weiss tear in esophagus) Hematochezia (blood with stool)--rapidly bleeding ulcer or mucosal erosions Iron deficiency anemia (may indicate possible bleeding from peptic ulcer, GERD-related erosion) Odynophagia (painful swallowing)--a/w infections, erosions, cancer Recurrent vomiting--gastric outlet |
|
|
What physical exam findings are associated with dyspepsia?
|
Hypotension, tachycardia (blood loss from GI bleed)
Brittle nails, cheilosis (Cracks and sores on lips)--signs of anemia Weight loss, palpable mass, signal nodes (Virchow's), acanthosis nigricans--all signs of malignancy Jaundice, positive murphy's sign--gallbladder dz Cool, pale skin, coarse hair, non-pitting edema (myxedema), delayed relaxation phase of DTR--hypothy Diarrhea, warm skin, thinning hair, lid lag, brisk DTRs, tach--hyperthy |
|
|
Why might someone with anxiety develop heartburn?
|
May self-medicate with EtOH-->GI disorders
|
|
|
Diagnose:
Epigastric abdominal pain that improves with meals |
Dyspepsia due to PUD
|
|
|
Diagnose:
Abrupt, stabbing abdominal pain radiating to back, worsens with eating Nausea, vomiting |
Acute pancreatitis
|
|
|
Diagnose:
LLQ pain, hematochezia, fever |
Diverticulitis
Tx with metro or Bactrim |
|
|
When is an upper GI series (x-ray) indicated in evaluation of GERD?
|
When diagnosing complications (esophageal stricture)
Poor utility in dx of GERD |
|
|
When is a 24-hour pH probe indicated in evaluation of GERD?
|
When dx of GERD can't easily be determined; or when pts desire referral for sx tx of GERD/hiatal hernia (fundoplication)
When heartburn, regurgitation don't improve post PPIs |
|
|
How is H. pylori diagnosed? How can you tell it's eradicated?
|
1) igG serologic test--confirms evidence of past infection and immune response. CANNOT be used to confirm eradication after tx
2) Urease breath test: accurately detects active infection, less accurate during PPI tx (stop PPI at least 2 weeks prior); CONFIRMATORY test after poz serologic test (more $$$) 3) Fecal antigen testing: Accurately evaluates eradication after pharmacotx; more cost effective than urease breath test |
|
|
Management of GERD/PUD
|
Test and treat:
-H2RA or PPI x 4-8 weeks Rerfer for upper endoscopy/EGD to r/o significant dz if there are alarm or extra-esophageal syx; if don't repond tx after 8 weeks Lifestyle mods--avoid large meals, avoid acidic foods (citrus, tomato), EtOH, caffeine, chocolate, onions, garlic, peppermint; decrease fat intake, avoid lying down 3-4 hours after meal Also avoid CCBs, beta agonists, alpha agonists, nitrates, theophylline as they may potentiate GERD Avoid wearing tight clothing around waist Lose weight Stop smoking |
|
|
What is the treatment regimen for H pylori eradication?
|
PPI triple therapy for 10-14 days:
PPI bid (esomeprazole) Clarithromycin 500mg bid Amoxicillin 1g bid Or: PPI bid Clarithromycin 500 mg bid Metronidazole 500 mg bid or Quadruple therapy x 10-14 days (75-90% eradication rate) PPI qd or bid; OR ranitidine 150 mg bid plus Tetracycline 500 tid Metronidazole 250 tid Bismuth subsalicylate 525 qid |
|
|
Who should be tested to prove H. pylori eradication after antibiotics?
|
Those with h. pylori ulcers
THose who fail test-and-treat strategy H. pylori-associated MALT (mucoid associated lymphoid tissue) lymphoma Post-resection of early gastric cancer |
|
|
How is H. pylori eradication evaluated?
|
Fecal antigen test
If positive, re-treat w/salvage therapy for resistant infection If syx continue, get upper endoscopy/EG to r/o ulcer dz and obtain mucosal biopsy for evalun; prolonged PPI for symptomatic control If fecal antigen negative or unavailable and pt continues to have syx: Urease breathing test If neg, refer to GI for upper endoscopy/EGD and mucosal biopsy for evaluation of presistent H pylori infection |
|
|
What are the red flag signs/symptoms of severe or life-threatening abdominal pathology?
|
Abrupt onset
Shock with hypotension and tachycardia Distention Absent bowel sounds Fever, vomiting, diarrhea Weight loss Rebound tenderness Mass Ascites |
|
|
What are the three phases of domestic violence?
|
Tension-building
Crisis phase (when overt violence is likely to occur) Calm phase--when abuser might ask for forgiveness and even be affectionate |
|
|
Who is at risk for domestic violence?
|
Anyone, regardless of SES and of education.
Domestic violence is based on issues of power and control. |
|
|
Who do children tend to identify with in domestic violence households?
|
Member of the same sex
Girl may identify with victim mentality and expect to be abused later in life. Boy may feel it is okay to be an abuser and may display acting-out behavior |
|
|
What are the numbers given for obstetrical history?
|
GTPAL
Gravida (number of pregnancies) Term pregnancies Preterm Abortions (spontaneous or induced) Living children |
|
|
What does a positive psoas sign indicate?
|
Appendicitis
|
|
|
What are the signs and symptoms of pelvic inflammatory disease?
|
Abdominal or pelvic pain worse with sexual intercourse or with activities such as running or jumping, cause jarring of the pelvic organs
Cervical motion tenderness, known as a positive chandelier sign |
|
|
What are the signs and symptoms of cholecystitis?
Risk factors? |
Pain in RUQ which may radiate to right shoulder or right upper back
Premenopausal (fertile) Overweight (fat) Middle-aged (forty) Female Syx aggravated by eating fatty foods |
|
|
What does a KOH/Saline wet prep determine?
|
Trochomoniasia
Bacterial vaginosis Yeast vaginitis |
|
|
What is the preferred method for diagnosis of chlamydia and gonorrhea?
|
Chlamydia/gonorrhea DNA probe--can be performed with same sample
Both present with yellow discharge, abdominal pain, and dyspareunia |
|
|
What is the utility of RPR test?
|
Rapid plasma regain--detects syphilis
|
|
|
What are the most common complications of influenza?
|
Otitis media (10-50% of children with flu develop this)
Streptococcal pneumonia Other complications include: Lower respiratory tract infections Neurologic (asceptic meningitis, Guillain-Barre, febrile seizures) Myositis, myocarditis (rare) |
|
|
What are the risk factors for diabetes in children?
|
BMI >85th percentile
Fasting glucose >100 |
|
|
What are the criteria for diagnosing metabolic syndrome?
|
At least 3 of following:
HyperTG Low HDL Elevated fasting blood glucose Excessive waist circumference HTN |
|
|
What are the musculoskeletal complications of obesity?
|
Slipped femoral epiphysis
|
|
|
What are the GI complications of obesity?
|
Steatosis
Gallbladder disease |
|
|
What are the GYN complications of obesity in children?
|
Early menarche
PCOS |
|
|
What lung sounds indicate consolidation?
|
Egophany (Say E hear A)
Inc'd fremitus Dullness to percussion CRACKLES (occur when abnormally closed airway opens during inspiration) Whispered pectorliloquy (when pt says 1-2-3, sounds louder over areas of consolidation) |
|
|
What lung sounds do not indicate consolidation?
|
Wheezes--spasmps of bronchioles
Rhonci (like snoring sounds)--a/w larger bronchial secretions and airway narrowing |
|
|
What is the healthy BMI for children?
Overweight? Obese? |
Healthy BMI is 5-85th percentile
Overweight is 85-95th percentile Obese is 95th percentile and above |
|
|
What physical exam finding distinguishes pneumonia from influenza?
|
Crackles (also known as rales) are a cardinal feature of pneumonia, but not all children with pneumonia have crackles
Other findings: Respiratory distress or tachypnea Consolidation Focal wheezing or whistling Dec'd breath sounds in one field |
|
|
Typical vs Atypical vs Viral Pneumonia:
Causative agent Onset Age affected Unique Symptoms |
Typical: Strep pneumo, abrupt onset, no prodromal syx, young children, older adults; pleuritic chest pain
Atypical: Mycoplasma OR Chlamydia; Prodrome: HA, GI syx, arthralgias, cough, fever; young adults and adolescents; may have otalgia/otitis, diarrhea/vomiting Viral: Influenza, RSV, Adenovirus, Rhinovirus, Parainfluenza Virus; Younger children (4mos to 5 years) |
|
|
What is bronchiolitis?
|
Caused by viruses such as RSV; starts as viral illness and progresses to wheeing, cough, dyspnea, cyanosis
Infants require supportive tx--including oxygen if hypoxic--while recovering |
|
|
Who should receive rapid strep test?
|
Give 1 point for each:
Fever >38 Celsius No Cough Tonsillar exudates Tender, anterior cervical LAD Age <15 0 points if 15-45 -1 point if >45 If <1 point: Symptomatic tx If 2-3 points: Rapid test If >4 points: Throat culture or start Abx |
|
|
When is a chest x-ray indicated in the setting of pneumonia?
|
If patient is hypoxic or isn't responding to tx
All children admitted to hospital for pneumonia should have CXR |
|
|
When can anti-virals be given for flu?
|
Within first 48 hours of illness
|
|
|
What is the medical management of bronchitis?
|
90%of acute bronchitis is nonbacterial and ANTIBIOTICS are not inicated
Treatment is supportive beta-2 agonist for pts who are wheezing, not for those who are coughing only |
|
|
What is the medical management of pneumonia?
|
For children 3 months to adolescence, first-line tx for uncomplicated pneumonia is amoxicillin bc it covers strep pneumo.
For school-age children with atypical syx, use macrolide such as azitrhomycin |
|
|
What is the 5-2-1-0 diet plan?
|
5 fruits and vegetable servings
2 hours or less of television viewing per day 1 hour of physical activity per day 0 sugary drinks in house |
|
|
When should children be screened for diabetes?
|
All 10 year-olds wish:
BMI >85th percentile and risk factors for DM BMI >95th percentil without risk factors RE-check every two years |
|
|
When should children be screened with a fasting lipid profile?
|
Every child with BMI over 85th percentile
|
