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51 Cards in this Set

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Q050. Dx: 52-yo woman presents with 3 months of early satiety, weight loss, and vomiting
A050. Gastric Outlet Obstruction
Q051. Definition: Syndrome involving a gastrin-secreting tumor in or near the pancreas
A051. Zollinger-Ellison Syndrome
Q052. Triad of Zollinger-Ellison syndrome
A052. PUD;; Elevated Gastrin levels;; Gastric Acid hypersecretion
Q053. Dx: Burning epigastric pain that is releived within 30 minutes of ingesting food; causes nighttime awakening, N/V, possible melena; What blood type is it associated with?
A053. Duodenal Ulcer; (better after eating); (blood type O)
Q054. If an ulcer is found on endoscopy, what is the test of choice to see if it is H.pylori?; After treatment of H.pylori with a PPI, what is the best test if the patient still has symptoms or to confirm eradication of the bug?
A054. if ulcer is found: Biopsy; No change after PPI: Urease Breath test
Q055. What from H.pylori decreases the gastric mucosal defenses?
A055. Urease
Q056. Dx Test for Zollinger-Ellison?
A056. Secretin stimulation test; (if gastrin levels are still high after this inhibitor, then probable ZE)
Q057. Triple therapy for H. pylori
A057. CAP:; Clarithromycin; Amoxicillin; Proton Pump inhibitor
Q058. If patient is bleeding from an ulcer, what is drug Tx after endoscopy?; (2 possible plus MOA)
A058. Sucralfate (enhances mucosal barrier); or Misoprostol (prostaglandin analog)
Q059. 45-yo Japanese male smoker presents with epigastric pain, exacerbated by eating, and weight loss
A059. Gastric Ulcer
Q060. Dx: burning epigastric pain that occurs within minutes after eating, anorexia, vomiting; What blood type is it associated with?
A060. Gastric Ulcer; (worse after eating); (blood type A)
Q061. Dx test for Gastric Ulcers
A061. Endoscopy with Biopsy; (all confirmed GU are Biopsy due to risk of CA)
Q062. Type of PUD related to an increase in acid production?
A062. Duodenal Ulcer
Q063. Type of PUD that can occur with achlorhydria?
A063. Gastric Ulcer
Q064. Best Tx for Gastritis or any ulcer of unknown etiology; (3 together)
A064. Combo:; 1. Mucosal protector (Bismuth, Sulcrafate, Misoprostol); 2. H-2 blocker or Proton pump inhibitor; 3. Antibiotics for H. pylori (amoxicillin; clarithromycin)
Q065. Dx: burning, gnawing epigastric pain usually worse with food and relieved with antacids
A065. Gastritis
Q066. Etiology of Gastritis; (8)
A066. GNASHING pain:; Gastric reflux (of bile or pancreatic secretions);; Nicotine;; Alcohol;; Stress;; H. pylori;; Ischemia;; NSAIDs;; Glucocorticoids (long-term use)
Q067. Difference b/t acute and chronic gastritis
A067. Acute: Erosive; Chronic: Non-erosive
Q068. Difference b/t the causes of the (2) types of Chronic Gastritis; where is each located in stomach?
A068. A = A's / B = Bug; Type A (Fundal): Auto-Ab to parietal cells; Anemia (pernicious); Achlorhydria;; Type B: Bug = H. pylori
Q069. what is the inflammation of the pancreas due to?; (2)
A069. - Autodigestion by proteolytic enzymes; Systemic Inflammatory Response Syndrome (SIRS) (severe cases)
Q070. Exocrine (5) and Endocrine (3) secretions of the pancreas
A070. Exocrine:; Bicarbonate;; Amylase;; Lipase;; Tyrosine;; Proteases (trypsin, carboxypeptidase, etc) Endocrine:; Glucagon;; Insulin;; Somatostatin
Q071. (2) most common causes of pancreatitis
A071. Gallstones; Alcohol
Q072. Dx: patient with a history of alcohol abuse has abdominal pain & calcifications on abd x-ray
A072. Chronic pancreatitis
Q073. Etiology of Acute Pancreatitis; (7)
A073. G-HEADS:; Gallstones;; Hypertriglycerides; HyperC;; Endoscopic Retrograde Cholangiopancreatogrophy (ECRP);; Alcohol;; Drugs;; Structural (neoplasm)
Q074. (4) drugs that can cause acute pancreatitis
A074. FEAT:; Furosemide;; Estrogen;; Antiretrovirals;; Thiazides
Q075. Dx: constant mid-epigastric or LUQ pain that radiates to the back; may improve if patient sits-up and leans forward. N/V, fever, tachypnea, abd is tender with guarding
A075. Acute pancreatitis
Q076. What is the most specific (and initial test) for Pancreatitis?; Most accurate?; If Pancreatic Necrosis is seen, what is the next step?
A076. most specific: Lipase (will be 2x normal); most accurate: CT scan; if necrosis: Pancreatic Biopsy
Q077. Dx: 50-yo male alcoholic presents with mid epigastric pain radiating to the back. He is leading forward on the stretcher and vomiting
A077. Acute Pancreatitis
Q078. Dx: a 66-yo female with HTN and seziures is on furosemide and valproic acid, presents with abdominal pain, back pain and fever. Her non-fasting glucose is 300
A078. Acute Pancreatitis
Q079. (4) Dx tests for pancreatitis
A079. Abdominal x-ray;; Ultrasound (gallstone cause);; ERCP (visualize sphinctor);; Contrast-Enhanced CT (shows pancreatic necrosis)
Q080. Define: Sentinel loop; what is it associated with in pancreatitis?
A080. Distention and/or air-fluid levels near a site of abdominal distention. In pancreatitis, it is secondary to pancreatitis-associated Ileus
Q081. Tx for acute Pancreatitis; (4 together)
A081. 1. IV hydration;; 2. Bowel rest – Antiemetics (NG tube for vomiting or associated ileus);; 3. Analgesics;; 4. Antibiotics (Imipenem) for suspected infection
Q082. What can occur in acute pancreatitis if left untreated in:; 1. < 48 hours; 2. 1 - 4 weeks; 3. 4 - 6 weeks
A082. 1. Pleural effusion of pancreatic fluids; 2. Pseudocyst; 3. Abscess (needs surgical drainage)
Q083. What on a physical exam will indicate splenic vein thrombosis, a complication of pancreatitis?
A083. Gastric varices; (without esophageal varices)
Q084. MCC of Chronic pancreatitis
A084. Alcohol abuse
Q085. Dx: midepigastric pain that radiates to the back; malabsorption; steatorrhea; elevated blood sugars; polyuria
A085. Chronic Pancreatitis
Q086. the Secretin Stimulation test is used to Dx what (2) problems?
A086. 1. Zollinger-Ellison syndrome; 2. Chronic Pancreatitis
Q087. *What is the only test that is specific for a Dx of Chronic Pancreatitis from the Symptom of Steatorrhea?; When is it the "Next step"?
A087. Serum Trypsinogen (which will be low); Next step: After Sudan Black confirms malabsorption and if Antigliadin and anti-endomysial Ab are normal.
Q088. Describe the (2) signs of Hemorrhagic Pancreatitis:; 1. Grey Turner's sign; 2. Cullen's sign
A088. 1. Ecchymotic appearing skin on the flank; 2. same on the periumbilical area
Q089. What lab values in a patient are Very High with Obstructive liver disease?; Parenchymal liver disease?; (2)
A089. Obstructive: Alkaline phosphatase Parenchymal:; 1. PT; 2. ALT/AST
Q090. Definition: Chronic hepatic injury assoc with hepatic necrosis, fibrosis and nodular regeneration
A090. Cirrhosis
Q091. A patient with alcoholic cirrhosis comes in vomiting blood. He is stabilized with fluid. What is the next step?
A091. Octreotide
Q092. MCC of cirrhosis in USA?; worldwide?
A092. USA: Alcohol abuse; world: Hepatitis
Q093. Dx: spider nevi, gynecomastia, loss of sexual hair, asterixis, bleeding tendency, Dupuytren's contracture, encephalopathy, portal HTN, jaundice
A093. Cirrhosis of the Liver
Q094. What are the causes in the following symptoms that are diagnostic of liver cirrhosis:; 1. Bleeding; 2. Encephalopathy; 3. Ascites, melena, edema
A094. 1. Decreased clotting factors made in the liver; 2. Increased ammonia; 3. Portal HTN
Q095. Order of the (4) liver problems (Dx names) caused by increasing alcohol consumption
A095. Alcoholic Fatty Liver -> Alcoholic Cirrhosis -> Alcoholic Hepatitis -> Necrosis
Q096. Most sensitive serum marker for recent alcohol bingeing
A096. GGT
Q097. Rx for the following Symptom in Alcoholic liver cirrhosis:; 1. Decrease inflammation (2); 2. Ascites; 3. Hepatic encephalopathy (2); 4. Esophageal varices (2)
A097. 1. Glucocorticoids and Colchicine; 2. Spironolactone; 3. Lactulose and Neomycin; 4. Beta-blocker or IV somatostatin (or banding or balloon tamponade)
Q098. (3)* metabolic diseases that cause Liver Cirrhosis. Name the test markers that would indicate the Disease as the cause
A098. Will Agitate Hepatocytes:; 1. Wilson's Disease (high serum Ceruloplasmin); 2. Alpha-1-antitrypsin deficiency (serum electrophoresis with absence of alpha-globulin); 3. Hereditary Hemachromotosis (Fasting Transferrin Saturation = high Ferritin and TIBC)
Q099. Why would the BUN be lower in liver cirrhosis?
A099. Decreased protein production
Q100. Test marker that indicates cirrhosis with hepatocellular CA
A100. Increased Alpha-fetoprotein