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233 Cards in this Set
- Front
- Back
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Standing causes the click and murmur of mitral valve prolapse to come close to S1 because:
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there is less venous return of blood to the heart and smaller stroke volume
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Tensemus refers to:
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painful urge to defecate without stooling
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Irritable bowel syndrome is best described as :
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an intrinsic abnormality in bowel motility
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Asymptomatic microhematuria in an African American male or female requires:
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sickle cell screen
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Which of the following is LEAST expected in fibromyalgia?
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Vascular type headaches
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What are expected findings in fibromyalgia?
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lack of restorative sleep
multiple tender points chronic fatigue |
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what distinguishes alpha-thalasemia minor from iron deficiency?
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Ferritin concentration
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Lactase deficiency would LEAST likely result in:
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a stool osmolality that is similar to plasma
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The differentiation of IBS from ulcerative colitis is BEST made by?
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Endoscopic examination
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Leukopenia in an asymptomatic African American male or female is most likely due to?
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an increase in peripheral blood marginating pool
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T/F
The HbS was only 28% in this patient rather than the usual of 40% in sickle cell trait, because of alpha-thalasemia, the alpha-globulin chains prefer binding with normal beta-globulin chains rather than those with the sickle cell trait |
True
alpha-thalasemia lessens the severity of sickle cell disease as well |
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T/F
in lactase deficiency, stool electrolytes when subtracted from a measured Posm, have a difference that is > 100 mOsm/kg. |
True
it is an osmotic diarrhea hence it is more hypotonic in relation to the Posm |
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how do you calculate stool electrolytes?
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2 X (stool Na+ + stool K+)
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T/F
In lactase deficiency, fasting would have no effect on reducing the volume of diarrhea while in secretory diarrhea fasting reduces the volume of diarrhea |
False the reverse is true:
fasting has its greatest effect on reducing osmotic diarrhea: in lactase deficiency fasting would HAVE effect on reducing the volume of diarrhea, while in secretory diarrhea fasting has no effect on the volume of diarrhea |
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T/F
Sigmoidoscopy reveals friable, bleeding muscosa in patients with IBS. |
False
friable bleeding mucosa would be seen in UC sigmoidoscopy reveals no significant findings |
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T/F
the gold standard for diagnosing lactase deficiency is a biopsy of small intestine and measurement of brush border enzymes. |
False
the gold standard is the hydrogen breath test, the latter coming from metabolism of the lactose by the colonic bacteria |
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T/F
you would expect the systolic click and murmur to move closer to S1 with Valsalva maneuver and sustained clenching |
False
sustained clenching of the fist increases LV volume, hence moving the click and murmur closer to S2 Valsalva does move the click and murmur closer to S1 owing to a decrease in LV volume |
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T/F
The patient should be on prophylactic antibiotics to prevent infective endocarditis. |
False
asymptomatic MVP does not need prophylaxis but symptomatic disease does |
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T/F
sickle cell trait has an increased incidence of micro/macro hematuria, urinary tract infection during pregnancy, and sudden death with severe exercise |
True
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T/F
Lab findings in fibromyalgia include a high serum CK |
False
it is not myositis, hence the CK enzyme is not elevated |
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T/F
Calcium channel blockers or b-blockers are commonly given to patients with symptomatic MVP |
True
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T/F
differences between alpha-thalasemia minor and iron deficiency are noted in the RDW, RBC count, and ferritin levels |
True
RBC and ferritin is low RDW high in iron deficiency RBC is high, Ferritin & RDW normal in alpha thal |
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what is the pathogenesis of alcoholic hepatitis?
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genetic disposition is likely
Due to acetaldehyde damage to hepatocytes stimulation of collagen synthesis around the central vein Perivenular fibrosis |
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what are the microscopic findings in alcoholic hepatitis?
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fatty change with neutrophil infiltration
Mallory bodies |
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what is a mallory body?
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damaged cytokeratin intermediate filaments in hepatocytes Perivenular fibrosis
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what are the clinical findings in alcoholic hepatitis?
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painful hepatosplenomegaly
fever, neutrophilic leukocytosis, ascites, hepatic encephalopathy May progress to alcoholic cirrhosis |
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describe the laboratory findings in alcoholic hepatitis
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1. absolute neutrophilic leukocytosis
2. serum AST > ALT 3. Increased serum ALP and GGT 4. Serum GGT disproportionately increased to ALP 5. thrombocytopenia in some cases 6. Hypoglycemia in some cases |
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what is the treatment for alcoholic hepatitis?
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Mandatory to stop drinking
Corticosteriods helpful in some cases |
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Describe Wernicke's encephalopathy.
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Alcoholics frequently have low thiamine levels.
In glycolysis pyruvate is converted in acetyl CoA by pyruvate dehydrogenase using thiamine as a cofactor. In given glucose, the already low levels of thiamine will be used up, thus precipitating acute Wernickes encephalopathy. Characterized by confusion, agitation, and nystagmus. It is a clinical maxim to always give thiamine first to an alcoholic before infusing glucose |
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how is hydrostatic pressure involved in the pathogenesis of ascites?
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increased hydrostatic pressure from portal vein (Portal HTN), since portal vein cannot empty blood into cirrhotic liver with regenerative nodules
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how does oncotic pressure cause pitting edema related to ascites?
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decreased oncotic pressure (hypoalbuminemia)
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how does hepatic lymph formation contribute to the formation of ascites?
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increased hepatic lymph formation due to intrasinusoidal obstruction (fibrosis) with subsequent leakage from the capsular surface
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how does secondary hyperaldosteronism contribute to ascites formation?
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decreased degradation of aldosterone in cirrhosis
stimulation of aldosterone by a decreased effective arterial blood volume - reduced return of venous blood to right heart due to pitting edema and ascites |
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what is the pathogenesis behind a spider angioma?
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the inability to degrade estrogen and 17-ketosteroids by the cirrhotic liver
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what does hyperestriginsm in a male cause?
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gynecomastia
spider angiomata on the skin female distribution of hair erythema of the palms |
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what are esophageal varices caused from?
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Esophageal varices are due to portal hypertension, the most common cause of which is cirrhosis of the liver
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what is the MCC of esophageal varices?
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Portal Hypertension
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describe the pathogenesis of eosphageal varices?
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Cirrhosis is of the liver is the MCC of esophageal varices.
The left gastric vein is a tributary of the portal vein, therefore increased portal vein pressure is transmitted into the left gastric vein causing it to dilate and rupture |
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T/F
alphafetoprotein should be elevated with heptocellular carcinoma |
True
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T/F
AFP level = 400 ng/ml are pathognomonic of hepatocellular carcinoma |
True
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T/F Hepatitis B and C serologies should always be ordered in the presence of HCC.
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True
to see if they contribute to the pathogenesis of the cancer |
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T/F
HCC can produce hypoglycemia. |
True
HCC can ectopically secrete an insulin like factor and produce hypoglycemia |
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T/F
Erythropoietin can sometimes be secreted from HCC and produce poycythemia. |
TRUE
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Which of the following is NOT considered a finding is alcoholic liver?
fatty change lymphocytic infiltrate mallory bodies perivenular fibrosis regenerative nodules |
Lymphocytic infiltrate
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Formications is associated with:
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peripheral neuropathy
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which of the anemias is NOT associated with alcohol abuse?
- folate deficiency - sideroblastic anemia - toxic effect of erythropoesis - hemolysis secondary to ankyrin deficiency |
hemolysis secondary to ankyrin deficiency
- this characterizes hereditary spherocytosis |
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A low specific gravity in alcoholics is due to:
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inhibition of ADH by alcohol with loss of free water
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Hyperuricemia in alcoholics is due to:
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competition of uric acid with lactate and b-hydroxybutyrate ions for secretion in the urine
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The most common cause of macrocytic anemia in alcoholics is:
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folate deficiency
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The presence of bilirubin in the urine and absence of urobilinogen implies problems with?
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the excretion of bilirubin in bile
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AST is higher than ALT in alcoholic related liver disease because it is...
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located in the mitochondria
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GGT is higher than alkaline phosphatase in alcoholic related liver disease because it is:
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synthesized in the cytochrome system
- located in the smooth ER |
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is the anion gap increased/decreased in alcoholics?
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it is usually increased
- increase in lactic acid and b-hydroxybutyic acid |
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Target cells are not usually associated with:
- hemoglobinopathies - alcoholic liver disease - thalasemia - folate deficiency |
Target cells are present hemoglobinopathies and alcoholic related liver disease
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Which of the following is the LEAST expensive way of separating a direct toxic effect of alcohol as a cause of macrocytic anemia versus folate deficiency?
- Presence or absence of hypersegmented neutrophils - serum folate - bone marrow exam - reticulocyte count |
presence of absence of hypersegmented neutrophils
- hypersegmented neutrophils are present in folate deficiency but are absent in macrocytosis related to a direct toxic effect of alcohol |
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A white and/or red lesion in the mouth of a person who is an alcoholic and/or smoker is most likely due to....
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squamous cell dysplasia and/or cancer
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Which of the following best differentiates a fatty liver from alcoholic hepatitis?
- increase in serum triglyceride - tender hepatomegaly - absence of fever and neutrophilic leukocytes - high serum GGT levels |
Absence of fever and neutrophilic leukocytes
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what is the toxic effect of alcohol on liver tissue most closely associated with?
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acetaldehyde protein complex
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what are the main factors in the production of an alcohol-induced fatty liver?
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increased NADH
increased acetate increased synthesis of fatty acids increased production of G3P |
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T/F
Alcohol decreases b-oxidation of fatty acids |
True
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T/F
The lack of fever and neutrophilic leukocytosis in the patient suggests that a severe fatty liver is more likely present than alcoholic hepatitis |
True
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T/F
The serum ALP and GGT is increased in a patient owing to liver necrosis. |
False
ALP and GGT are synthesized by the bile duct epithelium and are not released by damaged hepatocytes. The fatty liver compresses the small bile ductules causing an intrahepatic cholestasis |
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T/F
alcohol induces SER hyperplasia in hepatocytes leading to increased synthesis of GGT enhances the cytochrome P450 system leading to increased metabolism of drugs. |
True
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T/F
The lack of nocturnal erections in patients with impotence is most often secondary to stress |
False
nocturnal erections persist lack of erection indicates an organic cause for impotence |
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T/F
the CAGE criteria are used to screen for alcohol abuse and concentrate on symptoms of dependence rather than early drinking patterns, level and pattern of alcohol abuse, and current versus lifetime problems with alcohol. Sensitivity: 82% Specificity: 87% |
True
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T/F
white and/or red patches on the oral mucosa that scrape off should be biopsied to rule out squamous dysplasia. |
False
most likely Candida if able to scrape off |
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T/F
Formication is a sensory disturbance often described as "it feels like ants are biting my leg" and is associated with peripheral neuropathy |
True
sign of demyelilnation |
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T/F
A macrocytic anemia with target cells, round RBCs, and absence of hypersegmented neutrophils separates the direct effect of alcohol on RBC membrane synthesis from true folate deficiency, where target cells are absent, RBCs are macroovalocytes, and hypersegmented neutrophils are present. |
True
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T/F
Light colored stools, bilirubinuria, and absence of urobilinogen in the urine indicate either intra- or extrahepatic cholestasis. |
True
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T/F
If a liter of normal saline with 5% dextrose was given to this patient and the patient developed confusion, ataxia, and nystagmus your first thought would be delirium tremens from alcohol withdrawal. |
False
Wernicke's encephalopathy secondary to thiamine deficiency. Giving the glucose used up the last bit of thiamine necessary to convert pyruvate to acetyl-CoA |
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T/F
Scleral icterus is only noted in conjugated hyperbilirubinemia |
False
it can occur in unconjugated and conjugated hyperbilirubinemia |
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T/F
Hypertriglyceridemia in alcoholics is due to an increase in chylomicrons. |
False
increases the glycerol 3 phosphate, the key substrate for TG synthesis in the liver. It is a type IV hyperlipoproteinemia |
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T/F
An increase in NADH from the metabolism of alcohol is responsible for the increase in TG, lactic acid, b-OHB, and decrease in blood glucose. |
True
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T/F
an increase in uric acid is synonymous with gout |
False
Gout refers to the presence of uric acid crystals in the joint |
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T/F
Increased alpha fetoprotein is a tumor marker for hepatocellular carcinoma |
True
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T/F
Hyperestrinism in cirrhosis is responsible for spider angiomata, gynecomastia, female hair distribution, and ascites. |
False
It is not responsible for ascites |
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T/F
Ascites in cirrhosis is due to portal hypertension, hypoalbunemia, increased lymphatic fluid, and secondary aldosteronism. |
True
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T/F
the left gastric vein is involved in the formation of the portal vein |
False- it empties into the portal vein
The portal vein is formed by the splenic vein and the superior mesenteric vein |
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Which of the following more likely represents a duodenal rather than a gastric ulcer?
- pain waking up a patient at night - increased association with gastric adenocarcinoma - low basal acid and maximal acid output - history of smoking |
Pain waking up a patient at night
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Melena is most commonly due to a:
- Pepto Bismol - patient taking iron supplements - gastric ulcer - duodenal ulcer |
Duodenal ulcer
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A positive stool guaiac in a patient over 50 years old who has hemorrhoids or an anal fissure:
- requires no further workup if the blood is coating the stool - is commonly associated with iron deficiency - is less likely to be significant in a woman than in a man - requires further evaluation of the upper and/or lower GI tract |
Requires further evaluation of the upper and/or lower GI tract
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Hemochromatosis:
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is more likely to be symptomatic in males than in females
- remember the TIBC is decreased because of ferritin stores are increased |
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In iron deficiency:
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ferritin is low before anemia is present
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T/F
H. pylori is the most common cause of peptic ulcer disease |
True
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T/F
H. pylori predisposes to adenocarcinoma of the stomach. |
True
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T/F
H. pylori predisposes to malignant lymphoma of the stomach |
True
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T/F
H. pylori: urease generates ammonia which damages the mucous barrier |
true
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T/F
H. pylori invades the gastric mucosal cells producing inflammation |
False
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A positive stool guaiac in a patient over 50 years old who has hemorrhoids or an anal fissure?
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requires further evaluation of the upper and/or lower GI tract
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A sentinel tag indicates the presence of:
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an anal fissure
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T/F
Pepto-Bismol produces a black stool that is positive with the stool guaiac |
False
stool guaiac is negative |
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T/F
The most common cause of melena is gastric ulcers secondary to NSAIDS |
False
duodenal ulcer followed by gastric ulcer is the most common cause |
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T/F
The black color of stool with melena is due to conversion of Hb into hematin by acid in the stomach |
True
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T/F
the most common cause of melenemesis is esophageal varices |
False
duodenal ulcer is the most common melenemesis refers to "coffee grounds" material |
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T/F
the primary target organ of hemochromatosis is the liver. |
True
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T/F
Diabetes mellitus and skin discoloration are early signs of hemochromatosis |
False
they are late signs |
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T/F
All the iron studies are increased in hemochromatosis |
False
the TIBC is decreased since increased iron stores decreased liver synthesis of transferrin |
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T/F
the most common cause of death in hemochromatosis is heart failure from restrictive cardiomyopathy |
False
pigment cirrhosis leading to hepatocellular carcinoma |
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T/F
the most common artery eroded into a duodenal ulcer is the left gastric artery |
False
gastroduodenal artery the left gastric artery is associated with gastric ulcer bleeds |
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T/F
the purpose of phlebotomy as a treatment for hemochromatosis is to purposely render the patient iron deficient |
True
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T/F
Women with hemochromatosis commonly present with sign/symptoms after menopause |
True
menses is a type of phlebotomy |
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T/F
H. pylori causes chronic atrophic gastritis, gastric and duodenal ulcers, and low grade mucosal associated malignant lymphomas of the stomach |
True
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The goal of treatment of H. pylori with antibiotic therapy is to heal the ulcer (gastric or duodenal) and to totally eradicate the bacteria
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True
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T/F
When blood coats the stool, one can accurately assume that the bleeding is related to anal disease and no further work-up is necessary |
False
never assume anything when it comes to blood in the stool |
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T/F
Smoking increases the risk of PUD, delays the healing of PUDs, and increases the recurrence rate of PUDs |
True
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T/F
the sympathetic nervous system innervation of the upper GI is through the celiac ganglion T5-T9 |
True
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T/F
the parasympathetic nervous system innervation of the upper GI is through the vagus nerve |
True
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T/F
the best screening test for hemochromatosis is serum iron. |
False
best screen is % saturation > 45% ferritin is used to follow therapy |
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T/F
Patients with hemochromatosis who begin treatment before end-organ damage occurs can have a normal life span |
True
hence the importance of early recognition |
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T/F
Duodenal ulcers are not generally biopsied because they are rarely, if ever, malignant |
True
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T/F
Gastric ulcers are more commonly associated with H. pylori than duodenal ulcers |
False
Duodenal ulcers are more commonly associated with H. pylori than gastric ulcers organisms are generally not found in the duodenal mucosa unless the condition is chronic |
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T/F
NSAIDS disrupt the mucosal barrier by blocking prostaglandins, which normally control blood flow, mucus secretion, and the secretion of bicarbonate in the mucosal barrier |
True
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T/F
AFP was ordered in this patient to rule out cirrhosis related to hemochromatosis |
False
R/O hepatocellular carcinoma |
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T/F
H. pylori is a urease producer, hence it converts urea into ammonia, which disrupts the mucosal barrier of the stomach |
True
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T/F
the stool antigen test for H. pylori is useful for screening and also to determine if treatment has been effective |
True
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T/F
Proton pump inhibitors are effective in healing acute duodenal and gastric ulcers |
True
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T/F
Omeprazole and lansoprazole are H2 blockers that inhibit hydrogen potassium ATPase |
False
they are proton pump inhibitors |
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T/F
Sucralfate blocks acid secretions and is as effective as H2-receptor blockers in healing of PUDs |
False
it provides a protective coating of the mucosa but does not block acid secretion Washington manual says it is as effective as H2-blockers |
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T/F
antacid tablets are more effective than antacid liquids in healing PUD |
False
liquids are better antacids have a slightly greater benefit in promoting healing of duodenal ulcers than gastric ulcers |
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T/F
If an NSAID is needed in this patient, Celecoxib, would be the better choice |
True
it is a COX II inhibitor with less GI effects can be taken with a PPI but must be taken with food and not in combination with ASA |
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T/F
Non-ulcer dyspepsia, when symptomatic, is associated with H. pylori in ~50% of cases and responds to treatment of H. pylori |
False
it is associated with H. pylori when dyspepsia is present, but treatment does not appear to eradicate bacteria |
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T/F
Alcohol in high concentrations damages gastric mucosal barrier, may produce gastritis, and increases the risk of gastric/duodenal ulcers. |
False
Alcohol is high concentrations damages the gastric mucosa barrier and may produce gastritis but there is no evidence suggests alcohol as a cause of gastric/duodenal ulcers |
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NSAIDS-induced ulcers/erosions are most commonly located in the cardia of the stomach
|
False
prepyloric area and antrum |
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T/F
Misoprostol is useful in the treatment of NSAID-induced gastric erosions and inflammation in combination with a PPI |
True
it is a synthetic prostaglandin E |
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what are the stages of iron deficiency?
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1. absent iron stores (no anemia)
2. decreased serum ferritin (no anemia) 3. decreased serum iron, increased TIBC, decreased % saturation (no anemia) 4. normocytic normochromic anemia 5. microcytic normochromic anemia 6. microcytic hypochromic anemia |
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what is the confirmatory test for hemochromatosis?
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a liver biopsy
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what is a confirmatory test to determine the pathogenesis of a liver when hemochromatosis is suspected?
|
a liver biopsy
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what is the leading cause of death in hemochromatosis?
|
hepatocellular carcinoma
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what is hemosiderosis?
|
acquired iron overload disease
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child presents with acute gastroenteritis with the following symptoms:
initial constipation vomiting with fever diarrhea |
Salmonella is the cause
|
|
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child presents with acute gastroenteritis:
RLQ pain with diarrhea |
cause is Yersinia
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infant presents with acute gastroenteritis with the following symptoms:
high fever with vomiting diarrhea URI |
Rotavirus
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|
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child presents with acute gastroenteritis signs & symptoms:
Abdominal distention with flatulence NO fever |
Giardia
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child presents with acute gastroenteritis:
Blood mucousy diarrhea Fever |
Shigella
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|
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child presents with complaint of acute gastroenteritis:
Green, foul smelling diarrhea fever |
Campylobacter
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MCC of acute infectious non-inflammatory diarrhea in adults
|
Norwalk virus
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MCC of acute infectious non-inflammatory diarrhea in children
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Rotavirus
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what are the MC protozoans that cause acute infectious non-inflammatory diarrhea
|
Giardia lamblia
Cryptosporidium |
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Enterotoxin ingestion of S. aureus
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diarrhea 6 hours after ingestion
|
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Enterotoxin ingestion of B. cereus
|
diarrhea 6 hours after ingestion
|
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Enterotoxin ingestion of C. perfrinigens
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diarrhea 8-16 hours after ingestion
|
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describe the diarrhea from caused by Vibrio Cholera
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profuse watery diarrhea up to 20 L/day and huge volume loss
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what protozoan causes inflammatory diarrhea
|
E. histolytica
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what virus causes inflammatory diarrhea
|
CMV
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what is the MCC of bacterial inflammatory diarrhea
|
C. difficile
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what bacteria produce a cytotoxin to produce inflammatory diarrhea
|
EHEC O157:H7
V. parahemolyticus C. difficile |
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describe osmotic diarrhea
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low volume
decreased stool volume during fasting stool osmolarity > 2(Na + K) Decreased stool pH will get better with fasting |
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in osmotic diarrhea does it get better or worse with fasting?
|
Better with fasting
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what are the MCC of osmotic diarrhea?
|
disaccharidase deficiency
laxative abuse malabsorption syndromes/surgical procedures sorbitol, mannitol, xylose, fructose containing substances Antacids |
|
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T/F
Secretory diarrhea does NOT get better with fasting. |
True
|
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T/F
Cholera causes secretory diarrhea |
True
|
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patient presents with new heart murmur, complains of facial flushing, and new onset diarrhea.
|
Carcinoid syndrome
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describe the findings in the Schillings test with pernicous anemia
|
abnormal stage 1
normal stage 2: corrects with intrinsic factor |
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desribe the findings in the Schillings test with ileal disease
|
abnormal stage 1
abnormal stage 2 No correction with oral IF Celiac disease Whipple's disease Fish tapeworm |
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describe the findings with Bacterial overgrowth determined by the Schillings test
|
Abnormal stage 1
abnormal stage 2 Normal stage 3: treated with Xifaxin S/S: nausea, bloating, diarrhea, flatus |
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describe the findings of the Schillings test with pancreatitis
|
abnormal stage 1
abnormal stage 2 Normal stage 3 corrects with addition of pancreatic enzymes |
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A diabetic patient is seen in your clinic. Their C/C is of constipation with extreme pain. Should they be given narcotics?
|
NO
patients with DM have constipation due to neuropathy and if you give them narcotics it will make the pain worse this is called Gastroparesis |
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what does it mean to have an osmotic diarrhea?
|
osmotic gap > 100 mOsm/kg
indicates loss of hypotonic loss of stool due to presence of osmotically active substances |
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describe Ranson's Criteria for Acute pancreatitis.
|
Admission if > 55 yo
WBC > 16000 Glucose > 200 LDH > 350 AST > 250 Base deficit over 4 meq/l during the 1st 48 hours you get a Hct drop > 10% BUN rise > 5 mg/dl PO2 < 60 mmHg Calcium < 8 mg/dl Fluid sequestration of 6 L |
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what is the MCC of pancreatitis?
|
stones in the common bile duct
|
|
|
Name some drugs associated with acute pancreatitis
|
EtOH
HCTZ Furosemide Sulfonamides Tetracyclines Valproic acid NSAIDS Pesticides |
|
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Name some drugs associated with acute pancreatitis
|
EtOH
HCTZ Furosemide Sulfonamides Tetracyclines Valproic acid NSAIDS Pesticides |
|
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describe the correlation between the number of signs present from Ranson's Criteria and the mortality rate in acute pancreatitis?
|
0-2: 1% mortality
3-4: 16% mortality 5-6: 40% mortality > 6: 100% mortality |
|
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describe the correlation between the number of signs present from Ranson's Criteria and the mortality rate in acute pancreatitis?
|
0-2: 1% mortality
3-4: 16% mortality 5-6: 40% mortality > 6: 100% mortality |
|
|
MC benign liver lesion
|
cavernous hemangioma
|
|
|
MC benign liver lesion
|
cavernous hemangioma
|
|
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what are the risk factors for hepatic adenomas
|
OCP
Androgens Glycogen storage disease DM |
|
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what are the risk factors for hepatic adenomas
|
OCP
Androgens Glycogen storage disease DM |
|
|
what is the 4th MCC of cancer worldwide?
|
Hepatocellular carcinoma
|
|
|
what is the 4th MCC of cancer worldwide?
|
Hepatocellular carcinoma
|
|
|
what are the risk factors for hepatic adenomas?
|
Mostly women in the 20 to 40
OCP Androgens Glycogen storage disease DM |
|
|
what is the 4th MCC of cancer worldwide?
|
HCC
|
|
|
Sclerosing cholangitis is most commonly associated with what disease?
|
Ulcerative colitis
|
|
|
The method of choice for detecting gallstones is:
|
US of gallbladder
|
|
|
What is Charcot's Triad
|
associated with cholangitis
RUQ pain Jaundice Fever/chills |
|
|
match the following with the cause of the color of gallstone:
brown black yellow |
yellow: cholesterol stone
black: hemolytic conditions brown: infection |
|
|
what are the signs of a pneumoperitoneum?
|
Gas on both sides of the bowel wall = double wall sign "Rigler's sign"
Gas outlining the falciform ligament Gas outlining the periotneal cavity = football sign |
|
|
what is the best view when looking for a pneumoperitoneum?
|
upright lateral chest xray below the diaphragm
|
|
|
what are the rules when looking for a dilated bowel?
|
SB > 3 cm
Colon > 5 cm Cecum > 8 cm |
|
|
when working up a patient for a bowel obstruction, how do you determine the difference between a SB vs. LB?
|
SB: central location, valvulae connientes: cross entire diameter of the lumen
LB: peripheral in location, haustra: extend only part way across the lumen |
|
|
describe the appearance of a nonobstructive ileus.
|
diffuse, symmetric, predominately gaseous bowel distention. Gas seen in the rectum!
|
|
|
what is a sentinel loop?
|
isolated loop of bowel paralyzed because it lays next to an inflamed intraabdominal process
|
|
|
what is the MCC of SB obstruction?
|
adhesions in the west
incarcerated hernias in developing countries |
|
|
describe a characteristic finding in small bowel obstruction.
|
Characteristic stepladder appearance or hairpin loops with air fluid levels at different heights in same loop
|
|
|
what is a gallstone ileus?
|
suspect in elderly female with SBO
large gallstones erodes through gallbladder and passes usually into duodenum Gallstone obstructs in distal ileum |
|
|
what is Rigler's triad?
|
Dilated SB loops
Air in biliary tree/gallbladder Calcified gallstone in ectopic location |
|
|
what is the MCC of LBO in elderly/bedridden?
|
Fecal impaction
- mass of stool in distal colon - following disimpaction do a BE to exclude obstructing cancer |
|
|
where is the MC location of a stone in urolithiasis?
|
85% of urinary stones are visible on plain film
most common in ureter at ureteropelvic junction, pelvic brim, UVJ Bladder stones are usually near midline |
|
|
what imaging is used for liver, biliary tree, gallbladder?
|
Ultrasound
|
|
|
what imaging is used for RP organ?
|
US/CT
US/MR if young reproductive age |
|
|
what imaging is used for GU?
|
US/CT
US/MR if young reproductive age |
|
|
what is the MC functional bowel disorder?
|
IBS
|
|
|
which serotonin receptor causes diarrhea?
|
5HT3
|
|
|
which serotonin receptor causes constipation?
|
5HT4
|
|
|
when assessing a patient for IBS ask them: does the pain/discomfort awaken you at night?
|
if yes > organic causes
if NO > functional problem |
|
|
when should the first onset of IBS occur?
|
in the 20s
|
|
|
Rome Criteria I
|
at least 3 months of continuous or recurrent symptoms of abdominal pain or discomfort that is:
relieved by defecation or associated with change in frequency of stool or associated with a change in the consistency of stool |
|
|
Rome Criteria II
|
At least 12 weeks which need not be consecutive in the past 12 months of abdominal discomfort or pain that has 2 out of the 3 features:
relieved by defecation onset associated with change in frequency of stool onset associated with change in form/appearance of stool |
|
|
what is the best form of treatment for patients with IBS?
|
explain IBS to patient (patient education)
baseline anticholinergics to help with pain and bloating |
|
|
T/F
Fiber should be given to patients with IBS |
False
Fiber is not good because of the bulking agents present in it. |
|
|
why is the sigmoid colon the area most prone to pulsion diverticuli?
|
because the sigmoid colon is the most narrow portion with the highest intraluminal pressure
|
|
|
what are common findings with R and L sided diverticuli?
|
R sided bleeds
L sided obstructs |
|
|
A patient presents with LLQ pain, that is intense and persistent. What would be initial dx?
|
Diverticular disease
|
|
|
how does diverticulitis develop?
|
develops if food or feces become lodged into one or more of the diverticula
|
|
|
T/F
Barium enema is contraindicated in Diverticulosis. |
True
|
|
|
T/F
Colonoscopy is contraindicated in Diverticulosis. |
True
|
|
|
What imaging exam should be performed after an in depth history and physical has been performed on a patient and you suspect diverticulitis?
|
Perform a CT Scan
|
|
|
T/F
Diverticulitis is pain caused by inflammation of diverticuli. Diverticulitis never causes bleeding. |
True
|
|
|
Is pain present in Diverticulosis?
|
NO pain
|
|
|
what is the 2nd MCC of death from cancer in the US
|
Colorectal cancer
|
|
|
what are the risk factors for CRC?
|
Age
Prior personal history of CR adenoma or CRC Family history of CRC IBD |
|
|
What is the gold standard for screening for CRC?
|
Colonoscopy
|
|
|
what gene is related to Familial adenomatous polyposis?
|
APC gene
|
|
|
what type of mutation is present in patients with hereditary non-polyposis colorectal cancer?
|
mismatch mutation
|
|
|
what should be the recommended treatment for patients with FAP?
|
colectomy
mean age of diagnosis of CRC is 39 years of age hundreds to thousands of adenomatous polyps |
|
|
T/F
Chronic untreated irritable bowel syndrome is not a high risk factor for CRC |
True
|
|
|
T/F
active and passive cigarette smoke has protective effect on risk of UC |
True
|
|
|
which Th cell is associated with Crohns disease?
|
Th1
|
|
|
which Th cell is associated with Ulcerative colitis?
|
Th2
|
|
|
which type of tissue damage is associated with UC?
|
Th2 cells produce cytokines such as IL4 ,5,6, 10 which promote antibody mediated immune responses
|
|
|
T/F
Granuloma formation is seen in Crohns disease |
True
|
|
|
describe UC
|
diffuse, confluent mucosal inflammation limited to the colon
- almost always affects the rectum and may extend proximally to involve part of the colon - most common symptoms: rectal bleeding, diarrhea, abdominal cramping, wight loss, fever |
|
|
describe Crohn's disease
|
chronic transmural inflammation that can affect any part of the GI tract
Ileocololitis occurs in 50% of patients Perianal disease occurs in third of patients and is more common in patients with colonic disease |
|
|
what are the common symptoms of Crohn's disease
|
abdominal pain/tenderness
chronic/nocturnal diarrhea rectal bleeding weight loss fever |
|
|
if your patient has a
+ pANCA - ASCA what is this a PPV of? |
ulcerative colitis
|
|
|
if your patient has a
- pANCA + ASCA what is this a PPV of? |
Crohn's disease
|
|
|
what type of IBD is Budesonide helpful in the induction of remission?
|
great first pass metabolism
less wel absorbed Small bowel drug --> Crohn's disease NOT helpful in UC |
|
|
what do you prescribe a patient that is unresponsive to therapy when trying to induce remission of UC?
|
Cyclosporine
|
|
|
what drugs are used in patients that have perianal disease of CD?
|
antibiotics
Metronidasole and Ciprofloxacin |
|
|
which is least likely to induce remission of active CD?
- corticosteroids - AZA/6-MP - total proctocolectomy - aminosalicylates |
total proctocolectomy
|
|
|
T/F
25% of patients with UC have family member with IBD |
True
|
|
|
T/F
Th2 cells are the primary CD4+ cells causing tissue injury in UC |
True
|
|
|
T/F
Cigarette smoking exacerbates UC |
False
|
