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