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204 Cards in this Set
- Front
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causes of acute pancreatitis? (3)
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1. pancreatic obstruction (gallstones)
2. drugs (etoh) 3. hypertrigliceremia |
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what drugs can cause pancreatitis? (5)
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1. azathioprine (imuran)-immunosupressant to tx ra
2. didanisine (ddl)-HIV 3. furosemide 4. ACE-I 5. estrogen |
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epigastric pain radiating to the mid-back, n/v
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acute pancreatitis
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ecchymoses on the flanks from necrotizing pancreatitis
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grey turner's sign
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periumbilical ecchymoses
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cullen's sign
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diagnostic procedure that increases the risk of acute pancreatitis
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ERCP
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alcoholic pt with epigastric pain initially improves but then gets worse, septic, leukocytosis and positive blood cultures
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pancreatic necrosis
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tx for pancreatic necrosis
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ct guided fluid aspiration
abx: imipenem, quinolones and flagyl |
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systemic complications of acute pancreatitis
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renal failure from hypovolemia
respiratory failure from ARDS |
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major cause of chronic pancreatitis
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etoh
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abdominal pain, weight loss, steatorrhea, diabetes
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chronic pancreatitis
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tests to dx chronic pancreatitis
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72 hour fecal fat
secretin stimulation test |
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most sensitive and specific test to dx chronic pancreatitis
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ERCP
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Most common pancreas neoplasm
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ductal adenocarcinoma
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epigastric pain, obstructive jaundice and weight loss
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ductal adenocarcinoma of the pancreas
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tumor markers elevated in pancreatic ca
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ca 19-9 and CEA
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most common causes of infectious esophagitis
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cmv
hsv candida |
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pt presents with weight loss, dysphagia and upper gi bleeding
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esophagitis
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on barium swallow, a flat large ulcer with satellite ulcers nearby
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cmv esophagitis
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on barium swallow, volcanic ulcers
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hsv esophagitis
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on barium swallow, "shaggy" mucosa
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candida esophagitis
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tx for candida esophagitis in AIDS and non-AIDS pts
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AIDS= fluconazole po or iv
non-AIDS= nystatin or clotrimazole po |
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tx for refractory hsv esphagitis
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forscarnet (foscavir) iv
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medications that can cause esophagitis (7)
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NSAIDS
tetracyclines Fe K vit C supplements alendronate quinidine |
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pt presents with trouble swallowing both fluids and solids, nasal regurgitation and coughing when swallowing. dx?
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oropharyngeal dysphagia. seen after stroke, in parkinson's, als, ms and mg
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test of choice to dx oropharyngeal dysphagia
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barium swallow w/ video-fluoroscopy
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causes of esophageal dysphagia (3)
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ca
strictures schatzki's ring |
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narrowing of the grastro-esophageal junction w/ mucosal or muscular tissue
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schatski's ring
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pt presents w/ dysphagia only with solids
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strictures
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most common esophageal motor disorder
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achalasia
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bird's beak on barium swallow
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achalasia
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pt presents w/ dysphagia w/ solids and liquids of sudden onset and weight loss. what's the dx tests of choice?
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Barium swallow and esophageal manometry
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tx for achalasia
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nifedipine before meals
botox injection pneumatic dilation |
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corkscrew appearance in the barium swallow
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diffuse esophageal spasm
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test of choice to dx mallory-weiss tears
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endoscopy
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thermal coagulation can be used to treat mallory-weiss tears. in which pt would this be contraindicated?
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esophageal varices and portal htn
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pt presents with chest pain, anorexia, weight loss, odynophagia w/ solids that developed to liquids later
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esophageal ca: adeno or squamous
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which esophageal ca is not sensitive to rxt
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adenocarcinoma
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female pt w/ iron def anemia presents w/ solid dysphagia. most likely dx?
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cervical esophageal webs
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tx for esophageal varices
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adh iv
nitro iv ocreotide iv balloon tamponade endoscopic hemostasis (toc) variceal band ligation |
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xrt and achalasia are risk factors for what type of esophageal ca?
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squamous cell ca
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gold standard test to dx gerd
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ph monitoring
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test that establishes gerd as cause of reflux sx
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Bernstein's test
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life style modifications for pts w/ gerd
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1. no eating at bed time
2. no fatty, spicy foods, coffee, orange juice, sodas and tea 3. eat smaller meals 4. elevated bed 6 inches 5. stop etoh and smoking |
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mechanism of action of antiacids w/ some drugs names
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hcl buffering and increase in les pressure
ie. mylanta, maalox, tums... |
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this drug group increases les pressure and gastric emptying. give some names
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prokinetics
ie. bethanechol (urecholine)(muscarinic agonist) metoclopramide (reglan) |
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name some ppis
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omeprazole (prilosec)
lansoprazole (prevacid) pantoprazole (protonix) rabeprazole (aciphex) |
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complication of autoimmune gastritis
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pernicious anemia
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tx for h.pylori gastritis
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ppi + clarithromycin (resistant gets levaquin) + amoxicillin( pen allergic gets flagyl)
can add pepto or kaopectate |
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blood group at risk for stomach ca
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group A
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pt feels bloated, dysphagia, early satiety think...
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stomach ca
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lymph nodes involved in metastatic ca of the stomach
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left supraclavicular (virchow's node)
periumbilical (sister marie-joseph node) |
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medical tx for stomach ca
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chemo and radiation
rxt alone is ineffective |
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peptic ulcer dz caused by a gastrinoma
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zollinger-ellison syndrome
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pt presents with diarrhea, gastrin releasing tumors in pancreas and duodenum
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zollinger-ellison syndrome
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which type of ulcer presents w/ n/v, weight loss, and doesnt relieve w/ food
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gastric ulcer
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which ulcer presents w/ nocturnal epigastric pain, episodic pain that gets better w/ food
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duodenal ulcer
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which type of ulcer requires bx due to risk of malignancy
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gastric ulcers
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most common cause of upper gi bleeding
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pud
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us finding highly specific for acute cholecystitis
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pericholecystic fluid
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nonsurgical tx for cholelithiasis
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Ursodeoxycholic acid (ursodiol)
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nonsurgical tx for cholelithiasis is ineffective in which type of stones
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pigmented or bigger than 1.5 cm
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test to assess gallbladder fnx
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oral cholecystography
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types of gallbladder stones
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cholesterol
pigmented |
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in this phase the hepatitis virus can be detected but the labs are normal and there are no sx
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incubation period
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in which phase of hepatitis infection pt presents w/ nausea, anorexia, vague abdominal pain and labs show specific antibodies and elevated liver enzymes
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pre-icteric phase
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in this phase of hepatitis infection liver enzymes peak at ten times the normal levels, there's light colored stools and dark urine
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icteric phase
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type of hepatitis seen only in the presence of hepatitis B
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hepatitis D
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tx for hep C
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pegylated interferon-alpha
ribavirin |
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test to screen chronic hepatitis due to wilson's dz
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ceruloplasmin (most important copper carrier enzyme)
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nucleoside analogues for the tx of hep B
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lamivudine (zeffix,epivir)
adefovir dipivoxil (hepsera) |
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most common malignant tumors of the liver
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gi, lung and breast metastatic tumors
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most common primary malignancy of the liver
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hepatocellular ca
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causes of hepatocellular ca (3)
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etoh
hep C hemochromatosis |
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marker elevated in hepatocellular ca
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alpha-feto protein
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autosomal recessive disorder presents w/ copd and cirrhosis
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alpha-1-antitrypsin deficiency
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tx for wilson's dz
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copper chelation with
penicillamine |
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labs in hemochromatosis
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high ferritin
high hepatic iron index |
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tx for hemochromatosis
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iron chelation w/ deferoxamine
phlebotomy |
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bilirubin metabolism disorder that responds to phenobarbital
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crigler-najjar syndrome type 2
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what differentiates rotor syndrome from dubin-johnson syndrome
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there's no liver pigmentation
gallbladder can be visualized |
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ramson's criteria for pancreatitis on admission
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1. a pt older than 55 yo with
wbc count over 16,000 2. ast over 250 3. ldh over 350 4. glucose over 200 |
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what's the use of the ramson's criteria?
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determine the severity and clinical complications of the pancreatitis
3 or more criteria met predicts a complicated course of illness |
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in which type of pt care must be taken when administering Mg OH as tx for constipation?
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renal failure pt. can lead to hypermagnesemia
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lactulose and sorbitol are...?
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nonabsorbable sugar laxatives
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what pts taking nonabsorbable sugar laxatives should be warned of?
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1. it'll take 3 h for med to cause an effect
2. cramping and bloating can be noted |
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possible complication when taking mineral oil
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aspiration pneumonitis
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name two emollient laxatives
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docusate (colace)
mineral oil (petrollatum) |
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name two stimulant laxatives and their use
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senna
bisacodyl (Dulcolax, Alophen) - use to tx acute constipation |
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time of stimulant laxative effect w/ oral administration vs rectal
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oral takes 12 h
rectal takes 1 h |
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condition caused by the vasa recta penetrating the circular muscle layers between the taenia coli
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diverticulosis
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sawtooth pattern seen on barium enema
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diverticulitis w/ spasms
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brigth red painless bleeding per rectum
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diverticular hemorrhage (50% of lower GI bleeds)
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condition affecting pts in the 15-25 and 55-65 age groups, it presents w/ fecal incontinence or urgency and bloody diarrhea
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ulcerative colitis
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extraperitoneal manifestations of ulcerative colitis (5)
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1. ankylosing spondylitis
2. sclerosing cholangitis 3. pyoderma gangrenosum 4. erythema nodosum 5. liver dz |
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loss of haustra markings, narrowing of the lumen and straightening of the colon. dx?
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ulcerative colitis
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name the most common aminosalicylates
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sulfasalazine (Azulfidine)
olsalazine (Dipentum) mesalamine (Asacol) balsalazide (Colazal) |
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pts in 15-25 or 55-65 age groups presenting w/ abdominal pain, weight loss, nonbloody diarrhea and aphtous ulcers in the mucosa suspect...
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chron's dz
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immunosupressant drugs shown to be effective in chron's dz
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azathioprine (Imuran)
6-mercaptoprine (Purinethol) |
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tx for chron's dz for pts who have failed immunomodulators like Imuran and Purinethol
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tnf antagonists: Infliximab
|
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criteria for the dx of IBS
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3 months of:
1. abdominal pain relieved by defecation 2. changes in frequency and consistency 3. bloating or distension of the abdomen |
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structures supplied by the celiac trunk
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1. liver and biliary tract
2. spleen 3. stomach 4. duodenum 5. pancreas |
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structures supplied by the SMA
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1. lower part of duodenum, ileum and jejunum
2. head of the pancreas 3. ascending colon 4. part of transverse colon |
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structures supplied by the IMA
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the rest of the colon from transverse and rectum
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pt w/ hx of CAD presents w/ abdominal pain. labs show leukocytosis, metabolic acidosis and high amylase and cxr show thumbprinting pattern. dx?
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arterial mesenteric ischemia
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most common ischemic injury of the GI tract
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ischemic colitis
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test for carbohydrate malabsorption
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d-Xylose test. suggests mucosal dysfunction
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malabsorption disorder where there's antigliadin and antiendomysial antibodies
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celiac sprue
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most prevalent cancer of the large intestine
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adenocarcinoma
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syndrome which predisposes to colon ca w/ mucocutaneous pigmentation and hamartomas
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Peutz-Jeghers syndrome
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syndrome that predisposes to colon ca w/ the following characteristics: supernumerary teeth, cotton-wool appearance of the jaws from osteomas, and numerous colon polyps
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gardner's syndrome
|
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explain colorectal ca screening
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1. fobt every year
2. flexible sigmoidoscy every 5 years 3. colonoscopy every 10 years (5 for high risk pts) |
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condition caused by a split in the anoderm
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anal fissure
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pt presents w/ pain with defecation and has seen blood on the toilet paper. on pe there's a linear tear w/ an white ulcerated base. dx?
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|
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tx for an anal fissure that doesnt improve w/ medical tx?
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internal anal sphincterotomy
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tender mass palpable externally on the perianal area caused by infected anal glands
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anal fistula
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hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin
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fistula-in-ano
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hemorrhoids arising above dentate line
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internal
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hemorrhoids arising below dentate line
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external
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degrees of internal hemorrhoids
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1- only bleeding
2- bleeding and prolapse that reduces by itself 3- bleeding and prolapse that requires manual reduction 4- bleeding with incarceration that cannot be reduced |
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anal mucous discharge, rectal fullness and no pain
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internal hemorrhoids
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severe rectal pain with perianal mass
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external hemorrhoids
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risk factors for anal neoplasms
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1. smoking
2. pelvic ca 3. warts |
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anal ca located at the anal canal
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epidermoid ca
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rectal mass, bleeding, pain, discharge, itching, and tenesmus
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anal ca
|
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when polyps are noted in the colon, follow up should be...
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colonoscopy q 3 y or less
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type of esophageal hernia where pt is usually asx
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paraesophageal hernia
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most effective surgery to tx hiatal hernia
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nissen fundoplication
|
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inguinal hernias that present in the first year of life
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indirect
|
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pathophysiology of direct inguinal hernia
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weakness of transversalis fascia in hesselback's triangle
|
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boundaries of the hesselbach's triangle
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medially: rectus abdominis
superior and laterally: epigastric vessels inferiorly: inguinal ligament |
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other name for inguinal ligament
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poupart's ligament
|
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hernia that usually descends to the scrotum and is hard to reduce
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indirect
|
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hernia that usually bulges when standing and reduces when supine
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direct
|
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hernias that tend to incarcerate or strangulate more
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indirect
|
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small volume bloody diarrhea, fecal urgency and lower abdominal pain
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inflammatory diarrhea
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large volume watery diarrhea, n/v and upper abdominal pain
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non-inflammatory diarrhea
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pt develops nausea, vomiting, abdominal pain and diarrhea within six hours of eating eggs with mayonnaise. what's the culprit?
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staph aureus
|
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pt eats fried rice stored in the fridge for 2 days and develops vomit and diarrhea. what's the culprit?
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bacillus cereus
|
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pt eats canned meat and develops diarrhea and epigastric pain. what's the culprit?
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clostridium botulinum
|
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rice water stools diarrhea
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vibrio cholerae
|
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drug of choice for cholera
|
tetracyclines
|
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4 y/o pt has small volume bloody diarrhea after eating chicken at the day care. what's the culprit?
|
shigella species
|
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tx for diarrhea due to shigella species
|
ceftriaxone
quinolones x 5 days for hiv + |
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diarrhea caused from eating poultry, eggs and reptiles
|
salmonella
|
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three bugs associated with diarrhea after eating chicken
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shigella
salmonella campylobacter |
|
tx for salmonella
|
3rd gen cephs
quinolones |
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tx for severe cases of campylobacter infection
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erythromycin
|
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pt ate undercooked beef and develops diarrhea, pain and vomiting. what's the culprit and what precautions should be taken regarding tx?
|
entero-hemorrhagic E. Coli 0157:H7
antibiotics can lead to HUS |
|
watery diarrhea in an HIV pt. what's the culprit?
|
Cryptosporidium parvum
|
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when should antimotilic agents should be avoided?
|
fever and bloody diarrhea
|
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mention two common antimotilic agents
|
diphenoxylate (lomotil)
loperamide (imodium) |
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most common cause of nosocomial diarrhea
|
c. difficile
|
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diarrhea after course of antibiotics
|
c. diffile pseudomembranous colitis
|
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niacin B3 deficiency causes...
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pellagra
|
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3 D's of pellagra
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diarrhea
dermatitis dementia |
|
condition caused by B1/ thiamine deficiency
|
beriberi
|
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irregular heart rate, pain in the limbs, wernicke's encephalopathy due to vitamin deficiency
|
beriberi from vit B1 deficiency
|
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vitamin that's teratogenic in early pregnancy
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vit A
|
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vit A toxicity results in...
|
hepatocellular necrosis
increased ICP |
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B2/riboflavin deficiency causes...
|
cheilosis
glossitis stomatitis |
|
mention 4 common h2 blockers
|
1. cimetidine (tagamet)
2. ranitidine (zantac) 3. famotidine (pepcid) 4. nizatidine (axid) |
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prostaglandin e1 analog used in the tx of nsaids ulcers and contraindicated in pregnancy
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misoprostol (cytotec)
|
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drug contraindicated to use with sucralfate
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h2 blocker
|
|
ramsom's criteria after 48 h (5)
|
1. > 10% hematocrit drop
2. > 5 bun increase 3.Pao2 drop of more than 60 mmhg 4. more than 4 base deficit 5. more than 6 l of sequestrated fluid |
|
Nonprogressive, episodic dysphagia to only solids, coined "steakhouse syndrome",
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SCHAZTKI RING
|
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Keratin deposits in the eye due to vit A def
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BITOT'S SPOTS
|
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Which vitamin deficiency causes xerophthalmia, night blindness and acne
|
VIT A DEF.
|
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Which vitamin def. causes fragile RBCS along with peripheral neuropathy
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VIT E
|
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Which def. causes decreased smell and taste senses
|
ZINC DEF.
|
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Most common cause of infectious diarrhea
|
CAMPYLOBACTER JEJUNI
|
|
Most common cause of viral diarrhea in adults
|
NOROVIRUS
|
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Most common cause of viral diarrhea in childs
|
ROTAVIRUS
|
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Inverted U on xrays of the abdomen
|
VOLVULUS
|
|
Meckel's diverticulum inside a hernia
|
LITTRE'S HERNIA
|
|
EEEK bugs of cholecystitis
|
E.COLI
ENTEROBACTER ENTEROCOCCUS KLEBSIELLA |
|
Most common site of volvulus
|
SIGMOID COLON
|
|
Weight loss, post-prandial abdominal pain and abdominal bruit
|
MESENTERIC ISCHEMIA
|
|
Almond scented breath
|
CYANIDE POISONING
|
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Medication that would alter a h. pylori breath test
|
PPI FALSE NEG
|
|
Medical term for gas in the bowel wall
|
PNEUMATOSIS INTESTINALIS
|
|
Most common cause of esophageal rupture
|
ESOPHAGOSCOPY
|
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Retrosternal pain w/ evidence of air in the mediastanum
|
ESOPHAGEAL RUPTURE
|
|
Diagnostic test to reveal an esophageal tear
|
CONTRAST ESOPHAGOGRAM W/ GASTROGRAFIN
|
|
This contrast agent is used in pts allergic to barium or when it's contraindicated, contains iodine and kills tapeworms
|
GASTROGRAFIN
|
|
Xray reveal air in the retroperitoneal space after blunt trauma to the abdomen. Dx?
|
RUPTURE OF THE SECOND PART OF THE DUODENUM
|
|
RLQ pain elicited by voluntary coughing suggestive of peritoneal inflammation in appendicitis
|
DUNPHY'S SIGN
|
|
RLQ pain elicited by landing on heels from standing position 74% sensitive for appendicitis
|
MARKLE SIGN
|
|
Histologic findings pathognomonic for Whipple's disease
|
ACID-SCHIFF POSITIVE MACROPHAGES W/ EVIDENCE OF ACID FAST NEGATIVE GRAM NEGATIVE BACILLI
|
|
Tx for Whipple's disease
|
CEFTRIAXONE IV FOR TWO WEEKS, THEN BACTRIM BID FOR A YEAR THEN REPEAT BX. SULFA ALLERGIC PTS GET DOXY
|
|
In an ICU pt, which could be the first sign of a GI bleed?
|
ELEVATED BUN (BLOOD ABSORBED BY THE INTESTINES IS METABOLIZED TO UREA NITROGEN)
|
|
Pt presents with paresthesias in the form of pins and needles in the extremities mainly hands, ataxic gait, proximal muscle weakness and stiffness and hyperactive dtr's..what's the dx and tx
|
SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD
TX- VIT B12 |
|
Pt presents w/ steatorrhea, macrocytic anemia and malnutrition s/p gi tract operation..dx?
|
BLIND LOOP SYNDROME 2/2 BACTERIAL OVERGROWTH
|
|
Why should Sucralfate not be used along with H2B or antacids?
|
H2B AND ANTACIDS DECREASE THE PH IN THE STOMACH AND INHIBIT THE ACCION OF SUCRALFATE WHICH NEEDS AN ACID ENVIROMENT TO WORK
|
|
Pt presents with hematemesis 2/2 esophageal varices however there's no portal hypertension. What test should be ordered and what's the tx for this condition?
|
A CT TO RULE OUT SPLENIC VEIN THROMBOSIS WHICH CAUSES THIS AND THE TX IS SPLENECTOMY
|
|
Pt complains of regurgitation of undigested food which woke him from sleep as well as trouble swallowing both solids and liquids in a non proressive fashion. Dx?
|
ACHALASIA
|
|
Pt complains of regurgitation of undigested food, grugling sounds in his neck and bad breath. Dx?
|
ZENKER'S DIVERTICULUM
|
|
Name of the area where a Zenker's Diverticulum is likely to appear?
|
KILLIAN TRIANGLE
|
|
Pt c/o trouble swallowing and hoarseness. He has lost weight and there's wheezing unilaterally. Dx?
|
ESOPHAGEAL CA
|
|
Most sensitive test to determine esophageal tumor invasion?
|
ENDOSCOPIC US
|
|
Pt c/o chest pain with diffuse radiation and trouble swallowing both solids and liquids in a episodic manner. EKG is neg and barium swallow shows a "corkscrew" pattern. What's the MLDx?
|
DIFFUSE ESOPHAGEAL SPASM
|
|
Pt c/o of food stuck in his esophagus when he eats too fast. He has a pmhx of hiatal hernia but doesn't complain of heartburn. This happens ocasionally and improves in a few minutes. MLDx?
|
SCHATZKI RING
|
|
60+ yo pt presents with painless GI bleeding that comes and goes. Pt has h/o VWF deficiency and Aortic Stenosis. MLDx? Which test confirms it?
|
DX: ANGIODYSPLASIA
TEST: ANGIOGRAPHY SHOWS DELAYED VENOUS EMPTYING |
|
Pt is on cisapride for poor gastric motility and GERD. He complains his reflux is still bothering him. Why is Cimetidine a bad idea?
|
CIMETIDINE INHIBITS CYP-450 AND IT WILL CAUSE AN ELEVATION OF CISAPRIDE CONTENT CAUSING PROLONGED QT SYNDROME AND TORSAD DE POINTES
|