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38 Cards in this Set
- Front
- Back
primary sclerosing cholangitis - dx, assoc w/
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endoscopic choliangiogram, assoc w/ UC
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Can px w/ iron deficiency and vitamin D without mal absorption? Think? Dx how?
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celiac disease, malabsorption screening: a) 1anti-endomesial and B)anti-tissue transglutaminase antibody; c) gold standard small instestine biopsy
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fever, RUQ pain, and jaundice
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Charcot's triad: ascending cholangitis.
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fever, RUQ pain, and jaundice and add hypotension and confusion
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Reynolds pentad assoc with suppurative cholangitis and has a poorer prognossi
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fever, RUQ pain, and jaundice and add hypotension and confusion & persistent abdominal pain or hypotension despite fluid resus or T>39 or and mental confusion. Next step
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urgent biliary drainage
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bulky, foul smelling stools that are difficult to flush
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steatorrhea 2/2 fat malabsorption.
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This plus abdominal pain + hx of alcohol intake. Think? Dx with?
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chronic pancreatitis; dx w/ CT showing calcification, pancreatic enlargement ductal dilation, and pseudocysts
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most common cause of massive lower GI bleeding in elderly patients
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angiodysplasia or diverticulosis.
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angiodysplasia assoc w/
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aortic stenosis (ejection systolic murmur radiating to the carotids) and ESRD
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stable patients with jaundice. inpatient or outpatient workup
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can be evaluated on an outpatient basis
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acute hep b. tx? prognosis
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supportive measures "prognosis: 5% of adults will develop chronic hep B, 90% of infants will develop chronic hep B"
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Ginko medical side effects?
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has antiplatet activity and seizure
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ginseng assoc with
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stevens johnson syndrome and psychosis
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aconite adverse reaction
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is cardiotoxic may cause arrhythmias and hypotension
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kava adverse reaction
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can cause liver injury
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acute variceal bleeding assoc with what hospital complication? prevention?
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spontaneous bacterial peritonitis in 50% tx prophylactically with fluoroquinolone for 7-10 days
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hep c labs. acute infection, resolved infection. never an infection
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Acute infection: anti HCV AB may be negative in acute infection. Get HCV RNA by PCR. If positive then acute hep C infection
Resolved hep C".+anti-HCV AB -HCV RNA by PCR = Resolved hep C infection" never an infection: ".-anti HCV AB -HCV RNA no infection" |
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hep c px
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"asymptomatic or malaise, N/RUGQ pain, and liver function test abnormalities"
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adenomatous polyps on colonoscopy. Next step?
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1-2 small <1cm tubular ademoas with no high-grade dysplasia -> f/u colonoscopy in 5 years hyperplastic polyps -> f/u colonoscopy in 10years as rarely go onto adenocarcinoma ">3 ademoas or high grade dysplasia or *villous fetures *>1cm f/u colonscopy in 3 years"
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esophageal varacies tx
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1. upper endoscopy x2 with banding +/- octreotide
2. if fails surgical shuning or transjugular intrahepatic portosystemic shunt (TIPS) should be considrered" beta blocker is rec for long term prevention |
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oropharyngeal source of dysphagia dx how?
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dx with barium swallow.
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drug causes of pancreatitis
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*thiazides and furosemide
* sulfasalazine, 5-ASA *immunosuppresents: azathioprin, l-asparaginase *seizures: valproic acid * aids: didanosine, pentamidine *ABX: metro and tetracycline" |
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lactose intolerance dx w/
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dx w/ lactose breath hydrogen test. Need to fast for 8 hours
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c diff rapid immunoassay sens/spec? if negative and high pretest probability? Tx? Failed tx. Next step?
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70-87%/100% (note stool cytotoxin test is 94-100% sensitive)
repeat immunoassay 1. metronidazole 2. vancomycin metro. Not usually due to resistance but due to spores that linger |
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young female with intermittent episode of chest pain and dysphagia, may describe pain with drinking cold beverages. ekg normal. Barium swallow shows corkscrew esophagus. Think? Manometric findings? tx?
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*diffuse esophageal spasm aka nutcracker's esophagus
* high amplitude peristaltic contractions * ekg normal (this is how you differentiate it from prinzmetal's variant angina) tx with ca channel blockers and nitrates |
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female without pain px with food sticking in throat, halitosis, and regurgitation. Think? dx w/? tx?
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zenker's diverticulum-
rotting food in the back of the esophagus from dilation of the posterior pharyngeal constrictor muscle dx w/ barium swallow. Do NOT do endocopy or ng tube to avoid perforation tx with surgical resection |
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reflux symptoms with loss of distal peristalsis of esophageus on manometer. Think
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scleroderma (progrressive systemic sclerosis
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odynophagia (pain with swallowing). Think? If HIV neg next step? If HIV pos, next step
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esophagitis. 2/2 herpes, candida, or CMV
HIV neg: endoscopy HIV pos: fluconazole. If no response then endoscopy. 90% candida |
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periodic retrosternal pain + difficulty swallowing solid food, prolonged and careful chewing, and swallowing small portions think
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peptic stricture 2/2 GERD due to healing ulcerative esophagitis.
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diff for isolated elevated alk phos?
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seen in infiltrative liver disease: malignancy, granulomatous disease, and infections
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chronic pancreatitis and gastric varacies is due to what
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splenic vein thrombosis
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ascites, fever, abdominal pain, or altered mental status. Think
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spontaneous bacterial peritonitis
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sudden acute abdomen, patients tend to lie still, hx of GERD. Think? Dx test? Tx/
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peritonitis 2/2 bowel perforation2/2 to gastric ulcer. Upright x-ray -> look for pneumoparitoneum emergent laparatomy
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esophageal perforation? Dx test?
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esophagram with water soluble contrast
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hx of severe colitis 2/2 to IBD, distended abdomen, tympanic, septic. Think? Next step
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toxic megacolon abdominal x-ray looking for multiple air fluid levels of bowel
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first step in work up for chronic diarrhea
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stool microscopy
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crampy epigastric pain that worsens with meals with intial negative workup. Think? dx how?
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chronic mesenteric ischemia angiography is the gold standard
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young nonsmoker with dysphagia to solids and liquids +/- aspiration/regurg of previously eaten material . Think? Path? dx? tx?
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achalasia= failure of the gastroesophageal sphincter to relax.
dx w/ barium sallow. Confirm with esophageal manometer (abnormally hig pressure at LES) tx: pneumatic dilation or surgical mytomoy or botox injection if won't do above |