Clinical Medicine Exam 3

Front 1

Best way to view esophagus

Back 1

EGD - esophago/gastro/duodenoscopy (live video 3-D ) aka upper endoscopy

Front 2

Esophagitis occurs where

Back 2

Gastro-esophageal junction (between esophagus and stomach)

Front 3

Upper GI imaging?

Back 3

XRAY w/contrast (2D)

Front 4

primary cause of inflammation of esophagus

Back 4

acid reflux

Front 5

what type of acid reflux causes esophagitis?

Back 5

CHRONIC acid reflex (acute should be compensated by body/saliva)

Front 6

Diseases that cause Esophagitis (2)

Back 6

1. CMV - ulceration of esophagus

2. Herpes varicella- inside of esophagus

Front 7

Cause of pill esophagitis (2)

Back 7

1. fosamax

2. kyphosis - hunchback - pills get stuck in esophagus

Front 8

Normal esophageal lining turns into goblet cells

Back 8

Barrett's esophagus (pre-cancer - 1 in 200 will develop cancer)

Front 9

Steps from normal esophagus to cancer

Back 9

1. Normal lining ( 1 in 1000 will develop cancer)

2. Barrett's esophagus

3. Low-grade dysplasia

4. High grade dysplasia

5. Invasive carcinoma

Front 10

Hiatal hernia occurs where?

Back 10

Between lower esophageal sphincter and diaphram

Front 11

Lifestyle modification for hiatal hernia

Back 11

[Think ways to lower abdominal pressure]

1. Smaller meals + no lay after meal

2. Raise head of bed with 2 bricks

3. Avoid tight pants/ belts

Front 12

Difficulty swallowing (food gets stuck)

Back 12

Dysphagia

Front 13

Dysphagia with liquids?

-liquids and solids?

Back 13

neurological (stroke)

- mechanical

Front 14

Sign w/dysphagia that is emergent

-dx?

- tx?

- most common with

Back 14

Drooling (complete blockage of esophagus)

- emergent EGD

- fish out or push in

- meat

Front 15

Disorder caused by absence of esophageal peristalsis and increased LES muscle tone (impaired relaxation of sphincter)

-tx?

Back 15

Achalasia aka bird's beak deformity

- tx: botox (decreases muscle tone temporarily), dilation with balloon to stretch esophagus, myotomy (cut the muscle)

Front 16

Eosinophilic esophagitis is associated with what?

-tx?

Back 16

1. Food allergies

2. Reflux context ( anti-reflux meds cause decrease in eosin eso sx)

- modified asthma inhaler medication (topical corticosteroid) (flovent - breath in mouth, swish water, let trickle down throat)

Front 17

Squeeze pressure measurement of esophagus for 24 hours

Back 17

manometery

Front 18

All esophageal and motility disorders respond to what medication

Back 18

PPI (proton pump inhibitor therapy)

(protonix, prevacid, omeprazole etc)

Front 19

Violent vomiting/wretching + hematemesis + binge alcohol abuse+ upper GI + college age

-dx?

Back 19

Mallory-weiss tear

- endoscopy

Front 20

Esophageal strictures are caused by?

- tx?

Back 20

- CHRONIC GERD

- tx: dilation, botox, PPI for life (suppress acid)

Front 21

Esophageal varices are ? caused by?

- tx?

- monitor?

- if bleeding?

Back 21

1. swollen/stick out blood vessels

1. Liver cirrhosis (hepatitis, tumor, alcoholism) and PORTAL HTN

2. Tx: banding (avoid vessel rupture)

3. EGD q6months

Front 22

Pt comes into ER vomiting blood or black tarry stool think ?

- tx options?

Back 22

Upper GI bleed aka Esophageal varices

1. Epi inject into specific vessel (vasoconstricts)

2. Tamponade (hold pressure on bleed)

3. Clip (staple close vessel)

Front 23

Emergency management of bleeding esophageal varices (6)

- long term if survives

Back 23

1. PPI cont. IV

2. somatostatin/ octreotide ( drugs to constrict to splenic vasculature)

3. IV fluids/transfusion (for active bleeders to volume expand RBC to tissues)

4. FFP (fresh frozen plasma - for clotting bleeding, counters thrombopenia)

5. Emergent endoscopy

6. TIPS (procedure to reroute blood via shunt) or surgery

- Non-specific Beta blockers (inderal)

Front 24

Clinical manifestations of GERD

Back 24

1. Heartburn

2. Regurgitation

3. Dysphagia

4. bronchospasm, laryngitis, chronic cough

5. Atyp sx: chest pain, water brash (regurg saliva), globus sensation, swallow pain, nausea

Front 25

3 Levels to block acid

Back 25

1. basic neutralizer (tums, rolaids)

2. H2 blockers ( zantac, pepcid)

3. PPI's (zoles - omeprazole, pantoprazole, nexium)

Front 26

What drug interacts with PPI's

Back 26

Plavix ( all post MI patients should be on plavix)

Front 27

GERD drug treatments

Back 27

1. antacids

2. H2 blockers

3. PPI's

4. Prokinetics

5. Mucosal protective agents

6. ABx

Front 28

2 main causes of gastritis and peptic ulcer disease (aka gastric ulcers)

Back 28

H. PYLORI and NSAID's

Front 29

Inflammation of stomach lining

- tx?

Back 29

Gastritis

- PPI's w/wo Carafate

- Triple therapy Abx for H.pylori cause

Front 30

Slow motility of GI tract specifically stomach

- associated with?

- causes what?

- tx?

Back 30

gastroparesis

1. diabetes

2. N/V

3. prokinetics (reglan)

Front 31

Indigestible mass trapped in GI system

Back 31

Bezoar

Front 32

Black tarry stool

-caused by

Back 32

Melena (caused by any active UPPER GI bleed)

Front 33

Overproduction of acid either associated with tumor gastronoma or functional over production

- dx?

Back 33

Zollinger - Ellison syndrome

Fasting gastrin level (off the charts)

Front 34

Painful sores in lining of stomach or duodenum

-tx?

Back 34

peptic ulcer disease

- PPI x 8 wks

- prevpak x 2 weeks

- clip bleeds or surgery

Front 35

Narrowing (increase muscle tone of stricture) of lower part of stomach into duodenum

-tx?

Back 35

Pyloric stenosis

similar to esophageal stricture

-infants - surgery

- adults - balloon dilation, cut muscle

Front 36

Baby comes in with projectile vomiting and palpable "olive" mass in RUQ

-associated w?

Back 36

Pyloric stenosis

- TE fissure + Hirschprung disease

Front 37

Gallstone formation in cystic duct causing blockage

- RF?

- pain location?

- gold standard dx?

- tx?

Back 37

Cholelithiasis

5 F's (female. forty. fertile. fat. fair)

-contraceptives (mimics fertile)

- family hx

-diabetes

- fast weight loss (gastric bypass)

- RUQ. epigastrum to R.shoulder blade

- ULTRASOUND

- if symptomatic? surgery remove GB

Front 38

Acute or chronic inflammation of the gallbladder from distention

- causes?

Back 38

Cholecystitis

-GALLSTONES 95%

- biliary strictures

- ischemia

- infection

- neoplasms

Front 39

Dx of acute cholecystitis w/ "hot" GB

-tx?

Back 39

1. Ultrasound - thick GB walls

2. HIDA scan WITHOUT CCK (ejection fraction - may cause rupture)

- Sx to remove GB ( do not break stones - pancreatitis= death)

Front 40

Dx of chronic cholecystitis?

- tx?

Back 40

1. Ultrasound - sludge

2. HIDA scan WITH CCK

(milder/ intermittent)

- schedule sx appt

- diet - avoid fatty foods

- bile salts

Front 41

Clinical manifestations of cholecystitis (5)

Back 41

1. Severe RUQ, epigastric pain after FATTY food

2. Peritoneal irritation (guarding)

3. N/V/F/C

4. No bowel sounds from ileus

5. Sonographic/ Murphys sign (pain inhale pressure)

Front 42

Labs for cholecystitis (2)

Back 42

1. CBC - leukocytosis. elevated WBC = pos. septic

2. LFT -

a. Bili- high conjugated bili caused by obstruction of bile duct

b. Alk phos

c. ALT/AST

Front 43

Bacterial infection of biliary system caused by obstructed bile duct

Back 43

Cholangitis - EMERGENCY - LIFE THREATENING possible sepsis/ shock

Front 44

Charcot's triad

- signs of?

Back 44

1. RUQ pain

2. Fever

3. Jaundice

-cholangitis

Front 45

Sx of ascending cholangitis

- tx?

Back 45

1. Pain, N/V/F, rigors, hypotension, altered mental status

- blood culture (bacterial) + Abx

- ERCP (remove blockage) or PTC (drain bile tube)

Front 46

Increase copper storage levels in liver

Back 46

Wilson's disease

Front 47

Increase levels of iron and RBC storage in liver

- tx?

Back 47

Hemachromatosis

- donate blood

Front 48

Increase level of GGT/GGTP with no hx of seizures?

Back 48

Acute alcohol

Front 49

Liver Lab tests

Back 49

1. Bilirubin - liver obstru/ non-liv (anemia)

2. ALT/AST (transaminases)

3. Alk phos (AP) - multi-system origin

4. Gamma glutranspep (GGT or GGTP) - alcohol/seizure

5. Serum albumin - LOW w/ chronic liver dx

6. Prothrombin time (PT) - high clot time

7. Alphafeto protein (AFP) - liver tumor / preg

8. Ammonia - chronic - hepatic enceph.

Front 50

1. High ALT. Mild AST. Normal AP/GGT

2. Mild ALT. High AST. Mild AP. High GGT

3. Normal ALT/AST. High AP. Normal GGT

Back 50

1. Viral liver

2. Alcohol

3. Not liver associated, maybe skeletal

Front 51

Inflammation of liver parenchyma leading to necrosis

Back 51

Hepatitis

Front 52

Overdose of what drug causes hepatitis

Back 52

Tylenol

Front 53

1. Acute onset of liver disease w/coagul

2. Hep. encepha. develop w/in 8 wks of onset

3. No prior liver disease

- treatment?

Back 53

Fulminate liver failure

- rapid referral to liver transplant

Front 54

Acute hepatitis is normally caused by?

Back 54

1. Viral infection (EMV, CMV, Herpes)

2. Drug related

Front 55

Short term drinking, jaundice, vomit

- tx?

Back 55

Alcoholic hepatitis

- steroids

- increase risk of mortality

Front 56

Chronic alcohol abuse, 20 grams daily, 15% develop cirrhosis

-rf?

- tx?

Back 56

Alcoholic Liver Disease

1. Female. Viral hep. Poor nutrition. Smoking

2. Wean alcohol

Front 57

1. Fecal oral route

2. Normal ASX. Rare JAM + N/V/F sx

3. Bad w/ HCV

tx?

chronic?

Back 57

Hepatitis A

- support + isolation

- no chronic

Front 58

1. Blood, body fluid, vertical (mom to baby) [chronic w/asian pts] route

2. Vary ASX to sx

-tx?

- chronic %?

Back 58

Hepatitis B

- support

- 50% become chronic

Front 59

1. ALL HEPT B. patients must be screen Q6m for ? even in absence of cirrhosis (oncongenic)

2. how?

3. Different from HCV how?

Back 59

1. Hepatocellular carcinoma (HCC)

2. Ultrasound + AFP

3. HCV screen only if cirrhosis

Front 60

Immunoglobin for acute infection

Back 60

IgM

Front 61

Immunoglobin for immunity/ previous exposure

Back 61

IgG

Front 62

Hepatitis E - high mortality ?

Back 62

Pregnancy

Front 63

TX of Hep c

Back 63

Harvoni - expensive antiviral

Front 64

Insert needle with catheter into abdominal cavity to remove ascitic fluid

Back 64

paracentesis

Front 65

Most accurate way for staging invasive cancer

Back 65

EUS - endoscopic ultrasound

Front 66

When does metastasis occur

Back 66

Stage 4 (0 otherwise)

-stage 3 if spread to organ next to it)

Front 67

Iron deficiency anemia in pt > 65+ is ?

Back 67

Colorectal cancer until proven otherwise

Front 68

sac like herniations or pockets on edges of colon

- infected/inflamed?

Back 68

diverticulosis

- diverticulitis

Front 69

Invagination of intestine on itself

Back 69

Intusseption

Front 70

Currant jelly stools

Back 70

Intusseption

Front 71

swollen veins in lower rectum causes

Back 71

hemorrhoid

Front 72

Inflammation of colon associated with C.diff

-other major cause?

Back 72

Pseudomembaneous colitis

-CLINDAMYCIN