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109 Cards in this Set
- Front
- Back
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AFP is elevated in what cancer?
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PRIMARY LIVER (primary hepatocellular carcinoma)
Not mets to liver |
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CEA is elevated in what cancer?
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Colon cancer
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CA-19-9 is elevated in what cancer?
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Pancreatic cancer
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CA-125 is elevated in what cancer?
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ovarian
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after a 3 day cruise, a pt presents to the clinic with 2 days of abdominal pain, n/v/d, and a low-grade fever. what is the most likely dx and tx?
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viral gastroenteritis
hydration b/c it is self-limited |
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after eating rice, pt develops rapid n/v/d
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B. cereus
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pt presents to clinic after becoming progressively weak in the lower extremity. hx reveals she had eaten some chicken 5 days ago and "had a bad reaction" including some bloody diarrhea. Dx and etiology?
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guillain-Barre
Campylobacter Jejuni |
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baby presents to ER after unusual fatigue and decreased muscle tone. ROS is positive for N/V/D. parents reveal they gave the child honey last night. etiology?
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clostridium botulinum
floppy baby?? |
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pt presents to ER after 3 days of diarrhea. 2 weeks earlier pt went to dentist and was prescribed clindamycin. dx?
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C.diff
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1 day after returning home from Mexico, pt presents to ER with watery diarrhea and vomitting. top of Ddx?
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ETEC (E.coli)
travelers diarrhea |
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a 13 year old presents to ER with N/V/d which is bloody. pt's mother states that during a birthday party, the child had hamburgers and hotdogs. other kids have also had similar problems. additional workup reveals an elevated BUN and Cr and the child has developed a fever. Dx and etiology?
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E.coli O157:H7
hemolytic uremic syndrome |
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about 5 hours after a celebration, pt develops acute onset of vomitting and diarrhea. etiology of the food poisoning?
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Staph aureus
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pt has developed severe bloody diarrhea and abdominal pain. this patient is a strict vegetarian and E.coli has been ruled out. Campylobacter antigen is also ruled out. stool culture reveals no cysts in fecal material. Dx? complication?
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Shigella
shiga toxin- if correct species can cause HUS |
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pt presents with COPIOUS watery diarrhea. history is positive living at home alone and drinking from well water. pt is severely dehydrated. dx?
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vibrio cholera
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pt has developed watery diarrhea after eating oysters. Dx?
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vibrio parahaemolyticus
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pt presents to ER with excessive diarrhea described as greasy and very foul smelling. History reveals the pt was hiking and drank from a stream. etiology?
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giardia
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pt comes to ER with very bloody diarrhea. history reveals the pt traveled to africa and drank water out of a public source. stool culture reveals some cysts in the stool culture. etiology?
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entamoeba histolytica
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HIV positive patient presents with watery diarrhea...automatic top of Ddx?
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cryptosporidium
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pt ate some pork and got diarrhea. also has some altered mental status? dx? if this were beef, what etiology?
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taenia solium
beef= t.saginatum |
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which hepatitis is transmitted by sex?
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HBV
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which hepatitis is more likely to become hepatocellular carcinoma?
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HBV
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tx of HBV
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interferon alpha + lamivudine
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tx of HCV
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interferon alpha + ribavirin
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describe acute hepatitis in terms of
a) HBsAg b) HBeAg c) anti-HBs d) anti-HBe e) anti-HBc |
a) +
b) + c) - d) - e) + IgM |
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describe chronic (though active) hepatitis in terms of
a) HBsAg b) HBeAg c) anti-HBs d) anti-HBe e) anti-HBc |
a) + HBsAg is when virus is still replicating
b) + HBeAg is when virus is still replicating c) - d) - e) + IgG HBc so there was an infection at some point |
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describe past infection of hepatitis and recovery in terms of
a) HBsAg b) HBeAg c) anti-HBs d) anti-HBe e) anti-HBc |
a) -
b) - c) + d) + e) + igG when anti-HBs and anti-HBc you know there was once an infection b/c of HBc |
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describe immunity to hepatitis in terms of
a) HBsAg b) HBeAg c) anti-HBs d) anti-HBe e) anti-HBc |
a) -
b) - c) + d) - e) - (b/c core has not been exposed since no virus introduced to the body) |
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which viral hepatitis is spread via fecal-oral route?
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HAV
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dysphagia related to solids only is probably what etiology?
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structural
Webs/rings, strictures, cancer |
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what dysphagia is related to solids and liquids?
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neuromuscular
achalasia, motilitiy disorders, stroke, tight sphincters |
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how do you work-up dysphagia?
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1. barium swallow
2. EGD |
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what is achalasia and the radiologic sign associated with is?
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motility disorder in esophagus with tight lower esophogeal sphincter
bird's beak |
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what are some presenting signs of zenker's diverticulum?
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BAD BREATH
regurge of food eating days before impaired swallowing |
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what is presenting signs of GERD?
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sour taste, heart burn, chest pain
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tx protocol of GERD?
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antacids
H2- Blockers- cimetidine, ranitidine PPI- omeprazole, pantoprazole |
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complications of GERD?
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Barrett's esophagus
adenocarcinoma ulcerations |
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m/c esophogeal cancer?
a/w Barrett's? |
squamous cell CA
adenocarcinoma (columnar metaplasia)-turns into columnar |
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complications of sliding hiatal hernia? paraesophogeal?
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GERD
incarceration of stomach |
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m/c cause of gastritis?
other non-bacterial causes? |
H.Pylori
NSAIDS, alcohol, stress, auto-immune (antiparietal cell) |
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workup for H.pylori and definitively Dx by?
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positive urea breath test
positive IgG to H. pylori (always will be positive once positive) antral biopsy will confirm Dx |
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type A gastritis features?
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auto-immune (anti-parietal cells)
PERNICIOUS ANEMIA (B12 deficiency) decreased gastric acid (loss of parietal cells) probably low chlorine FUNDUS |
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type B gastritis features
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a/w H.pylori
increased gastric acid ANTRUM complication of PUD and Cancer |
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patient presents with burning epigastric pain, epigastric tenderness, and dark color stools and hematemesis. likely Dx? work up? tx?
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PUD
EGD PPI, H2 blockers, Tx of H. Pylori |
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duodenal ulcer vs. gastric ulcer?
NSAID users? |
initial relief after eating- duodenal
pain with eating- gastric NSAID users- gastric |
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Tx of H. pylori?
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clarithromycin + PPI + amoxicillin/metronidazole
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pt presents with 4 episodes of Gastric PUD, abdominal pain, and N/V. EGD reveals a mass in the duodenum. next step? likely Dx? what else do you need to look for?
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gastrin level
zollinger- Ellison syndrome check for MEN I |
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Pt presents to you with increasing weight loss, anorexia, and odd feeling or satiety following a very small meal. Physical exam reveals RRR, lungs CTA, and an isolated Left supraclavicular lymph node. dx? definitive dx? radiology sign?
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gastric Cancer- likely adenocarcinoma
egd with Bx, follow CEA radiological sign is leather bottle stomach |
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where is B12 absorbed?
Fe? folate? calcium? |
ileum
duodenum jejunum duodenum |
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how does celiac disease present? work up and definitive dx? tx?
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bloating especially after eating wheat, n/v...failure to thrive
positive anti-gliadin antibodies Bx of duodenum/jejunum shows blunted villi avoid wheat and gluten |
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what is tropical sprue?
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similar to celiac disease especially after returning from tropics. no anti-gliadin antibodies
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what is whipple's disease? patho dx?
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malabsorption syndrome caused infection of trepheryma whippelii
intestinal Bx shows PAS positive foamy macrophages |
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inability to eat dairy products is what dx? work up?
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lactose intolerence
positive lactose tolerence test (inability to increase glucose with ingestion of lactose) |
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How is chronic diarrhea worked up after infection and lactose intolerance are ruled out? m/c cause of chronic diarrhea?
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colonoscopy will rule in inflammatory bowel diseases if it is unremarkable workup for malabsorption and IBS
lactose intolerance |
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secretory diarrhea is caused by what?
osmotic? inflammatory? |
hormones or enterotoxigenic bacteria
laxatives or malabsorptions IBD or infections |
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pt presents with intermittent diarrhea and constipation with pain. pain is relieved after defacation. likely dx?
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IBS
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features of Chrohn's disease
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skip lesions and cobblestoning
transmural watery diarrhea ASCA + possible fistula formations |
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features of ulcerative colitis?
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starts at anus and works proximally
usually just mucosal and submucosal in nature ASCA - possible colon CA formation bloody diarrhea |
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m/c small bowel obstruction?
large bowel? |
adhesions then hernias
Colon CA |
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m/c cause of acute diarrhea in children?
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rotavirus
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abdominal pain out of proportion to exam raise suspicion for?
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ischemic colitis
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tx for IBD (chrons and uc)
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mesalamine
steroids biologics colectomy (uc), resection (chrons) |
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pt presents with 3 day hx of fever and increasing abdominal pain. pt has pain in llq to palpation and pain is redproduced with RLQ palpation. CBC reveals elevated WBC count. workup? dx? tx?
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first get an hcg to r/o preggo if it is a woman and then get an abdominal ct w/contrast
appendicitis appendectomy/abx |
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pt comes out of surgery and complains of not having a bowel movement in 2 days as well as decreased appetite. AXR reveals dilated colon. what is dx?
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post-op ileus
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57 y/o pt presents with abdominal pain. AXR reveals a double bubble sign. what is most likely dx?
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volvulus
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m/c cause of LLQ pain?
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diverticulitis
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tx for diverticulosis and for -itis?
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high fiber diet
metronidazole, quinolones, TMP-SMX |
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pt presents with painless bright red bleeding on the toilet paper. dx? anatomy involved?
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internal hemorrhoids
superior rectal veins |
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painful rectal bleeding with bright red blood on the Toilet paper? anatomy involved?
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external hemorrhoids
inferior rectal veins |
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pt presents with rectal pain and bright red bleeding. no hemorrhoids or source of infection is found. what other dx can be made?
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anal fissure
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rectal fissures are common in what pt population?
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those with IBD (crohns)
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pt presents with occasional bouts of diarrhea and skin flushing simultaneously. work up? dx?
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5-HIAA
serotonin carcinoid syndrome |
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pt presents for colonoscopy with current positive stool guaiac test. hx is noted for several isolated polyp removals in the past. what tumor marker may aid in ruling in or out colon cancer?
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CEA
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colonoscopy reveals several hundred polyps and a review of history reveals a strong family hx component. dx?
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familial adenomatous polyposis
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pt presents with colonic polyps + skin pigment changes in mouth. dx?
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peutz-jagher's syndrome
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colon cancer + bone involvement?
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gardner's syndrome
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colon cancer + cns tumor
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turcot's syndrome
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coffee ground emesis is indicative of what?
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upper GI bleed
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sx consistent with upper gi bleed?
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hematemesis, coffee ground emesis, melena
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sx consistent with lower GI bleed?
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hematochezia
hypotension bright red or maroon stools |
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iron def. anemia in an elder is what till proven otherwise?
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colon CA
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what are some causes of pancreatitis?
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gallstones, alcohol, high trigs, viral
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what are some lab values in pancreatitis? physical findings?
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increased amylase/lipase
hypocalcemia increase WBCs possible increased LFTs epigastric tenderness radiating to back grey-turner and cullens sign |
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increased CA 19-9 is indicative of what?
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exocrine pancreatic cancer
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pt comes in with abnormal symptoms of severe hypoglycemia. pt has never had symptoms of hypoglycemia before. fasting labs reveal hypoglycemia and an increased insulin level. Dx?
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insulinoma
endocrine pancreatic cancer |
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pt comes in with abdominal mass and watery diarrhea. mass is identified in pancreas. workup? what tops Ddx?
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increased serum VIP
VIPoma |
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a 40 year old female presents to ER with n/v and RUQ pain radiating to shoulder. she states pain is worse after meals. next step? tx?
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gallbladder abdominal US
cholecystectomy/ERCP |
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a 40 year old female presents to ER with n/v and RUQ pain radiating to shoulder. she has a positive murphy's sign. she states pain is worse after meals. US reveals mildly thickened gall bladder wall without obstructing stones. dx? next step?
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cholecystitis
HIDA scan- to see if cholecystectomy will need to be done |
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a 43 yo female presents to ER with RUQ pain and jaundice. she states she has had a fever for 3 days and the RUQ pain is worsening. WBC count is elevated. US shows mildly thickened gall bladder walls but Ejection Fraction on HIDA scan is decreased. Dx?
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Cholangitis
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a 61 year old female presents to ER with n/v and RUQ pain radiating to shoulder. she has a positive murphy's sign. she states a 25 lbs. wt loss over the past 4 months. AXR shows a calcified Gallbladder. next step?
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gall bladder Bx. (porcelain GB suggestive of cancer)
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what is the best test to detect alcoholic liver disease?
AST;ALT ratio in alcoholics? hepatitis? |
increased GGT
2:1 (B6 def. and cannot make ALT) 1:1 but both are significanly elevated |
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cirrhosis complications are what?
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ascites (no albumin, decreased Cap. Onc. Press.)
bleeding disorders (no clot factors, no platelets) asterixis, palmar erythema, spider telangectasias hepatosplenomegaly jaundice portal HTN (caput medusea, esophogeal varices, hemorrhoids) encephalopathy contractures gynecomastia |
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what is suggestive of acute liver injury? bile stasis? stone at the ampulla?
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elevated AST and ALT
elevated AST and ALT, elevated alk phos elevated AST and ALT, elevated alk phos, elevated amylase/lipase |
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pt presents with polyuria and polyphagia. on exam you not hepatomegaly and a bronze hue rash. labs reveal increased iron level and ast and alt. dx?
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hemochromatosis
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pt presents with altered personality and a wing-beating tremor. brown-green rings around the eyes are noted. workup? what is the dx?
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increased free copper
decreased ceruloplasma Wilson's Disease |
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decreased PFTs and increased LFTs, think what?
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alpha-1-antirypsin deficiency
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anti-smooth muscle antibody?
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autoimmune hepatitis
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anti-mitochondrial antibody?
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PBC
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difference in PBC and PSC?
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PSC-males
PBC-females |
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jaundice at stressful periods is what disease?
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Gilbert's Dz
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Crigler-Najjar is more serious than gilbert's dz, how?
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deficiency in glucuronosyl-tranferase is more severe
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weight loss and increased AFP raises flag for what?
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hepatocellular carcinoma
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3 day old baby presents with failure to thrive and increasing vomiting after bottle feeding. AXR shows air bubble in the stomach. dx?
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tracheoesophogeal fistula
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baby presents to clinic with failure to thrive. mom states baby projectile vomits after feeding. a palpable olive size mass is noted in epigastric area. workup? dx? definitive tx?
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abdominal US
pyloric stenosis pylorotomy |
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baby presents 4 days after birth with hematchezia and vomiting. mom reports a low birth weight. radiology studies shows air in bowel wall. dx?
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necrotizing enterocolitis
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sausage-like mass palpated in belly of child with maroon streaked stool. dx?
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intussusception
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2 year old boy presents with bloody stools. a colonoscopy is performed and a bleed is noted about 58cm proximal to ileocecal valve. dx?
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meckel diverticulum
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rotor and dubin-johnson pathology?
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cannot get conjugated bilirubin transported out of the hepatobiliary system
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m/c cause of neonatal jaundice?
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physiologic undersecretion, breast-feeding failure
ABO incompatability |
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in children failing to thrive, always suspect what?
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child abuse/neglect
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