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128 Cards in this Set

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constipation Tx
1.increase fiber 30g/d
2.increase fluids
3.bulk-forming, emollient laxatives
pain in testicle
referred pain of ureteral obstruction
AAA Tx
good IV acccess, type, cross
severe abdominal pain out-of-proportion to exam
mesenteric ischemia
MI + gnawing abdominal pains after eating + wt loss
chronic mesenteric ischemia
HIV + odynophagia + esophagitis
candida/CMV/herpes
full-thickness tear esophagus
(Tx)
Boerhaave's syndrome
(surgery)
partial-thickness tear esophagus
Mallory-Weiss syndrome
drugs,hormones lowering LES tone
1.CCB
2.nitrates
3.estrogen
4.progesterone
high-grade Barrett's Tx
resection
non-high-grade Barrett's Tx
lifetime endoscopy
Barrett's does/doesn't regress
doesn't
early satiety + vomiting + wt loss
gastric outlet obstruction
free air under diaphragm
perforation
duodenal ulcer blood type association
type O
secretin
gastrin inhibitor
PUD surgery indication
refractory to meds 12 wks
gastric ulcer blood type association
type A
all/some gastric ulcers are biopsied
ALL
drugs causing pancreatitis
1.furosemide
2.thiazides
3.estrogen
4.antiretrovirals
gastric varices indicates...
splenic vein thrombosis (pancreatitis complication)
pancreatitis
<48 hrs
1-4 wks
4-6 wks
pleural effusion (high amylase)
pseudocyst
abscess
chronic pancreatitis Tx
1.pain control
2.abstain alcohol/fatty foods
3.pancreatic enzyme supplement
CCK release stimulated by...
1.fats
2.amino acids
cholesterol stones commonly seen in...
1.rapid wt loss
2.OCT
3.ileal disease
cholecystitis dx test
HIDA (nl = gallbladder outline in 1 hr) (abnl = no outline)
cholecystitis tx
1.gall bladder removal (definitive)
2.pain control
3.2nd/3rd gen ceph
acalculous cholecystitis = increased/decreased M&M?
increased M&M
ascending cholangitis dx test
ERCP
ascending cholangitis tx
1.ERCP
2.fluids, vasopressors
3.antibiotics
PSC Tx
liver transplant
dupuytren's contracture
cirrhosis
alcoholic cirrhosis + vomiting Tx
1.fluids
2.octreotide
cirrhosis + ascites Tx
spironolactone
most sensitive serum marker for alcohol binging
GGT
hepatic encephalopathy Tx
1.lactulose
2.protein restrict
3.neomycin
4.empiric abx
PBC Tx
liver transplant
most common cause of portal HTN worldwide
schistosomiasis
acute variceal bleeds mortality rate
50%
early liver dz - protein intake
late liver dz - protein intake
early liver dz - high protein
late liver dz - low protein
most common SBP bug
e.coli
azotemia + Na retention + oliguria
hepatorenal syndrome
hepatorenal syndrome dx
1.urine Na < 10
2.hypoNa
hepatorenal syndrome tx
none
HBV Tx
lamivudine
HCV Tx
ribavirin + IFN
liver transplant match needs
1.size
2.ABO
painless rectal bleeding
diverticulosis
most common cause of massive lower GI bleeds in age>60
diverticulosis
most common cause of nosocomial enteric infection
c.difficil
pseudomembranous colitis complication
toxic megacolon
inflammatory bowel sx improve with...
nicotine
aphtous ulcers
Crohn's
lead pipe colon
ulcerative colitis
early appendicitis = visceral/parietal pain?
visceral pain (dull, periumbilical)
late appendicitis = visceral/parietal pain?
parietal pain (RUQ tenderness)
pain in associated dermatomes = visceral/parietal pain?
parietal pain
peritonitis Sx
1.rebound tenderness
2.involuntary guarding
45 y.o. obese female
c/o fever, RUQ pain, nausea worse after eating fatty foods
cholecystitis
26 y.o. female
c/o severe LLQ pain,
vaginal bleeding,
light-headedness,
last menstruation 6 wks ago
ectopic pregnancy
28 y.o. female
c/o diffuse abd pain,
nausea,
confusion,
stained glass class
lead poisoning
elderly + abd pain

always consider...?
vascular causes
1.AAA
2.mesenteric ischemia
3.MI
30 y.o. HIV female
dysphagia,
intranuclear inclusions (bx)
CMV esophagitis
30 y.o. HIV female
dysphagia,
vesicles, discrete erosions on EGD
HSV, VZV esophagitis
30 y.o. diabetic female,
dysphagia,
nodular filling on barium esophagram
Candida esophagitis
Candida esophagitis Tx
fluconazole PO
HSV esophagitis Tx
acyclovir IV
CMV esophagitis Tx
ganciclovir IV
esophageal rupture mortality rate
50%
Boerhaave's syndrome - common site
weak (L) posterolateral wall of distal esophagus
Boerhaave's syndrome - etiology
1.forceful vomiting
2.cough
3.trauma
Mallory-Weiss syndrome - etiology
forceful vomiting
subQ & mediastinal emphysema due to...
full-thickness tear
45 y.o. obese female
fever + RUQ pain + nausea + pain worse after eating fatty foods

Dx?
cholecystitis
28 y.o. female
diffuse abd pain + nausea + confusion
working as stained-glass class

Dx?
lead poisoning
abd pain
hypotension
atherosclerosis Hx
pulsatile mass

Dx?
AAA
63 y.o. obese male
pain in "kidney" for 3 days
MI x2 Hx
No back tenderness

Dx?
AAA
52 y.o. woman
3 mos early satiety + wt loss + vomiting
gastric outlet obstruction
amylase levels in renal insufficiency
persistently elevated
drugs causing pancreatitis
1.thiazides
2.furosemide
3.estrogen
4.antiretrovirals
Ranson's criteria
mortality risk for pancreatitis
Ranson's criteria
risk factors
1.age > 55
2.BS > 200
3.WBC > 16K
4.SGOT > 250
5.LDH > 700
sentinel loop
distention and/or
air-fluid levels near site of abd distention
gastric varices w/o esophageal varices

dx?
splenic vein thrombosis due to pancreatitis
cholecystitis dx test
HIDA
(+) = no gallbladder outline
(-) = gallbladder outline in 1 hr
Dupuytren's contracture commonly seen in...
cirrhosis
Dupuytren's contracture
palmar fascia contraction --> 4th finger flexion
alcoholic cirrhosis + blood vomit is fluid resuscitated

next step?
octreotide
acetaminophen toxicity Tx
acetylcysteine
carcinoid tumor mets
1.regional LNs
2.liver (graver Px)
3.lung
carcinoid tumor prevalence
1/3rd of all primary gut neoplasms
flushing,hypotension
diarrhea
R) valvular dz

dx?
carcinoid syndrome
carcinoid tumor dx tests
1.>10mg/24hr urine 5-HIAA
2.elevated serum & urine 5-HT
3.abdominal CT
carcinoid tumor Tx
1.surgery excision
2.radiation
3.antihormonal Tx
carcinoid syndrome Px
3 yr median survival
diverticulosis pathophysiology
muscular wall defect
most common site of diverticulosis
sigmoid colon
(narrowest area of colon - highest pressures)
70 y.o. male
low-fiber diet

at risk for?
diverticulosis
diverticulosis Tx
bleeding scan & embolization
surgery (if refractory)
diverticulitis etiology
fecal material impaction in diverticular neck
80 y.o. male
fever
high WBC
sigmoid mass (not always)
LLQ pain
diverticulitis
diverticulitis Tx
1.NPO, IVF, pain control
2.abx
vancomycin MOD
NEVER PO
except for c.difficle
35 y.o. female
fever
crampy, diffuse abd pain
watery diarrhea
hx pneumonia

dx?
c.difficle
pseudomembranous colitis dx tests
1.toxin in stool
2.fecal leukocytes
3.sigmoidoscopy
pseudomembranous colitis Tx
1.vancomycin PO
2.metronidazole PO
long colon loop
"thumbprinting" (bowel-wall edema)

dx?
pseudomembranous colitis
irritable bowel syndrome
alteration in bowel motility
irritable bowel syndrome dx
r/o other causes of diarrhea
% pts w/(-) FOBT + colon CA
50%
polyp found on colonoscopy

next step?
1.bx, polypectomy
2.f/u colonoscopy 3 yrs
20 y.o. vomiting pt

next step?
1.2 large-bore IVs
2.EGD
endocarditis bugs associated w/colon CA
1.strep bovis
2.clostridium septicum
HNPCC inheritance pattern
autosomal dominant
FPC (familial polyposis coli) Tx
total colectomy
polyposis coli
supernumerary teeth
osteomas
fibrous dysplasia (skull)

dx?
Gardner's syndrome
multiple polyposis (small intestine)
multiple pigmented melanin macules (oral mucosa)

dx?
Peutz-Jeghers syndrome
80 y.o. male
anemia
high CEA, elevated LFTs
pencil-thin stools
L) colon CA + liver mets
IBD Tx
1.sulfasalazine
2.meselamine
3.corticosteroids
4.abx
5.immunomodulators
sulfasalazine components
5-ASA + sulfapyridine
sulfasalazine used to Tx...
1.IBD (5-ASA)
2.RA (sulfapyridine)
inflammation of bowel muscoa only
bloody diarrhea
rectal pain
ulcerative colitis
inflammation of all bowel-wall layers
fistulas, abscesses
tender RLQ mass
granulomas
Crohn's disease
skip lesions
Crohn's disease
continuous lesions
lead pipe colon
ulcerative colitis
uveitis
erythema nodosum
colitic arthritis
Crohn's disease
OK to give HBV vaccine in pregnant woman?
yes.
medical resident
fever
jaundice
fatigue 2 wks
returning fr/India trip
hep E