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55 Cards in this Set

  • Front
  • Back
what is SBP?
what are the signs?
spontaneous bacterial paratinitis.
- fever, pain, decreased mental status
- often minimal symps- malaise, anorexia.

- caused by e. coli, klebsiella, strep pneumo.

- Rx is a 3rd generation cephalosporin
what is the difference between spontaneous and 2ry bacterial paratenitis?
spontaneous- from infected ascites
secondary- perfed bowel (surgical emergency)
how does one differentiate ascites?
albumin- 1.1. above is more likely hydrostatic- RHF, cirrhosis/pulm htn, budd-chiari, hepatic mets, myxedema
below 1.1- TB, cancer, pancreatitis, nephrotic syndrome
what are risk factors for liver disease?
alcohol- 80 grams of alcohol daily for 10-20 yrs (8 beers, 1/2 bottle of hard liqour)
viral- C and B, transfusions, needle sharing, cocaine, tattoos, acupuncture. homos, injection drug users, dialysis, HIV
biliary disease
cardiac disease
autoimmune hepatitis
Genes- hemochromatosis, Wilson's, alpha-antitrypsin deficiency)
Non-alcoholic steatohepatitis.
what is non-alcoholic steatohepatitis?
condition characterized by lobular inflammation and some degree of pericellular fibrosis.
what is hemochromatosis?
AR disorder- increased iron absorption, depostiion of iron in certain organs.
liver, heart, gonadal failure. pancreatic failure, skin pigmentation.

(2ry- from thalassemia)
What is wilson's disease?
AR disorder of copper excretion- increased accumulation of copper in the liver and brain. Pts may present w/ fulminant or chronic hepatitis, cirrhosis, psychiatric involvment or neuro disease
what is alpha anti-trypsin disease?
AR disorder characterized by abnormal alleles of antitrypsin- causes emphysema and asymptomatic cirrhosis
what causes ascites?
pulm htn
decreased albumin
increased na resorption from kidney

malignancy (pancreas, ovary)
Nephrotic syndrome
Cardiac failure
peritoneal tuberculosis
peritoneal mesothelioma
what are esophageal varices?
collateral veins in GE junction- causes hematemisis, melena.
(need to confirm w/ endoscopy since gastritis, PUD are also common w/ cirrhosis)
what is hepatic encephalopathy?
confusion, personality changes, asterixis. may be caused by nh4 levels. may be due to aminobutyric acid.
what is asterixis?
bilateral flapping tremor of the wrist, metacarpophalangeal, and hip joint. also seen in tongue, foot, skeletal muscle
what are common PEX findings in cirrhosis?
splenomegaly, internal hemorrhoids, and caput medusae

skin- jaundice, spinder telangiectases, clubbing, palmar erythema, dupuytren's contracture (permanent flexion of the 2rd or fourth metacarpal.
what labs are seen in cirrhosis?
hyponatremia (increased ADH)
decreased BUN (malunutrition, decreased protein production)
decreased albumin
increased bili
Heme- increased PT, macrocytic anemia, thrombocytopenia
what is the Rx for ascites?
na restriction
diuretics- k sparing.
large volume paracentesis
peritoneovenous shunt- peritoneum-venacaval shunt. (thrombosis, infection, DIC can all occur)
how do you treat esophageal varices
replace the blood
vasopressin- constrict portal blood flow and controls bleeding
- sclerotherapy- band ligation; immediate treatment reduces rebleeding rates.

- TIPS- transhepatic IVC-> portal shunt
what si the treatment of hepatic encephalopathy
correction of infection, GI bleed, excess dietary protein, hpokalemia, hypovolemia, alkalosis, and drugs.
lactulose- (decrease ammonia absorption
- neomycin- broad-spectrum antibiotic- decreases ammonia production from GI tract.
what is the common agent in CAP?
strep pneumo
how do you treat CAP?
what are the two nervous systems involved in controlling the heart?
sympathetic nervous system
What is the role of cocaine and B-blockers?
beta-blockers can allow unapposed alpha. which can cause vaso-constriction-> hypertension.
what are the types of adenomas in colon cancer?
tubular- 80-85%
tubulovillous- 8-16%
villous- 3-15%

only 5% change into cancer
What are the factors associated w/ malignant transformation of a polyp?
increasing size- 2cm (10%)
Villous histology
what are the two key events to cause colon cancer?
activation of the ras oncogene
inactivation of the APC, dcc and p53 genes.
what causes DNA damage in colon cancer?
endogenous- oxidizing and alkylating products of cellular metabolism
exogenous- carcinogens, viruses, rads
what are risk factors for colon cancer?
hx of polyps
Personal history of another malignancy
Family Hx of colon cancer

Diet- high animal fat
low fiber
refined sugar
what is the role of fecal occult blood testing in colon cancer screening?
sensitivity and specificity of 50%
- inexpensive, easy to do.
poor sensitivity and specificity; does not localize upper vs. lower
what is the roal of sigmoidoscopy in colon cancer screening?
60 com flexible scope
- direct visualization, safer than colonoscopy, performed in the office, no anesthesia.

- doesn't look at the proximal colon.
what is the role of barium enema for screening of colon cancer?
sensitivity of 80-90% for lesions > 1cm.
50-75% for less than 1cm. Allows visualization of the proximal and distal colon. minimal discomfort. can't biopsy
what is the role of colonoscopy in colon cancer screening?
goald standard.
high cost, increased risk
what are the screening guidelines for colon ca?
start at age 50; flex sig fecal occult, dre every 3-5 yrs. or colonoscopy every 10

if w/ UC- colonoscopy after 8-10 yrs of disease, surveillance every 1-2 yrs

adenomatous polyps- 3-5 yrs after excission. every 1-3 if multiple large, villous, or malignant polyps

FAP- genetic couseling, screening; flex sig by age 10

HNPCC- colonoscopy by age 35-40- 10 yrs younger, surveillance every 3-5 yrs.
what is virchow's triad?
stasis, alt in blood vessels, hypercoagulability
what are some forms of stasis that contribue to PEs?
heart failure
chronic venous stasis
what are some alterations in blood vessels that contribute to PE?
fractures or surgery of lower extremity
major trauma
what can cause hypercoagulability?
postpartum period
oral contraceptives
deficiencies of protein S, C, antithrombin III
lupus anticoagulant
activated protein C resistance (factor V leiden
Prothrombin gene mutations
what are the symps of PE?
sudden onset of unexplained dyspnea
Pleuriticchest pain
other presentations syncopy, SVTs, and worsening of underlying heart failure or lung disease.
what is seen on PEX of a PE?
may have right sided heart strain- loud pulmonic component of second heart sound
right ventricular heave
what is teh DDx for PE?

hypotension- MI w/ shock
tension pneumo
what can be seen on CXR in PE?
increased lung lucency in the area of the embolus
abrupt cutoff of vessel
wedge-shaped pleural-based infiltrate
Pleural effusion which if sampled by thoacentesis is often hemorrhagic.
What are well's criteira?
clinical DVT symps
Other Dx less likely than PE
HR >100
Previous DVT/PE
> 6 means
what are the indications for an IVC filter?
contraindication to anticoagulation
thrombosis despite antigcoag
large burden of thrombosis in LE that could be fatal if embolized.
What ar ethe causes of atrial fibrillation?
Pulmonary disease- infection
Ischemia, Hypertension
Rheumatic heart disease
What can cause Torsades de Pointes?
Other meds (tricyclics)
Intracranial bleed
No known cause
Type I antidyrhythmics
Electrolyte abnlties
Syndrome of prolonged QT
What is the Rx for Torsades?
Overdrive pacing
Beta blockers for prolonged QT syndrome
What are the common causes of pericarditis
Viral- happens after recent viral URI
Bacterial- TB, strep, staph
Mets- lung or breast
MI- Immediate post-mi- 24 hrs of a transmural infarct. Drssler's syndrome- pericarditis occurring one wk to months after an MI due to an autoimmune response to infarcted myocardium
Uremia- chronic renal failure
Drugs- hydralazine, procainamide, isoniazid
Collagen vascular tissue- SLE, scleroderma
Trauma- postpericardiotomy syndrome
What is ITP?
Immune mediated thrombocytopenia
development of antibodies against platelet surface antiget.
what is the treatment of ITP?
corticosteroids, IvIg, platelet transfusion
what is the TTP pentad?
Fat RN
Renal dysfunction
Neurologic dysfunction. (altered mental status)
what is the etiology of TTP?
antiplatelet agents, chemo, contraceptives
autoimmune disorders
what is the diagnosis of TTP?
Hemolysis: schistocytes on perpheral smear, decreaseed haptoglobin, elevated LDH, elevated total bili
Renal failure: elevated BUN, Cr
Fever, confusion
normal PT, PTT
what is the treatment of TTP?
may give FFP
What is DIC?
acquired coag defect that results in consumption of coag factors I, V, VIII, and XIII-> bleeding and thrombosis
what is the etiology of DIC?
obstetric problems- dead fetus, abruptio placentae, 2nd trimester abortion, amniotic fluid embolism

spesis- RMSF, HUS, malaria
Local tissue damage- snake bites, burns, frostbite

Chronic illness: Malignancy, liver disease
what are the signs and symps of DIC?
mucosal bleeding
chronic DIC may only have lab abnlties
what is the Dx of TTP?
increased PT, aPTT, and TT
Decreased fibrinogen
Presence of fibrin split products
hemolysis on peripheral smear.