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796 Cards in this Set
- Front
- Back
Q001. (3) causes of viral Esophagitis
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A001. HSV; VZV; CMV
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Q002. (5)* causes of Bacterial Esophagitis
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A002. My Pnew Strep Lacts Crypt:; Mycobacterium TB;; Pneumocystis Carnii;; Strep;; Lactobacillus;; Cryptospordium
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Q003. *When is a Barium Esophagram the best initial test?; when is it the most accurate?; (3)
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A003. Dysphasia (that shows no signs of obstruction...for obstruction it would be Upper Endoscopy); most accurate:; 1. Esoph Webs; 2. Esoph Rings; 3. Esoph Diverticuli
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Q004. Dx: Odynophagia (pain with swallowing), dysphagia, esophageal bleeding, N/V, chest pain, (or asymptomatic)
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A004. Infectious Esophagitis
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Q005. Dx: Infectious esophagitis with nodular filling defects on barium esophagram; Tx?
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A005. Candida; Tx: Fluconazole PO
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Q006. Causes: Infectious esophagitis with vesicles and descrete erosions on endoscopy; (2); Tx?
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A006. HSV or VZV; Tx: Acyclovir for HSV
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Q007. Dx: Infectious esophagitis with intranuclear inclusions on biopsy via endoscopy; Tx?
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A007. CMV; Tx: Ganciclovir IV
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Q008. Who should upper endoscopy screening be offered to?; (2)
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A008. 1. Patients with GERD and Symptom for > 5 years (to check for Barrett's esophagus); 2. Patients with Esophageal varices
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Q009. Dx: A Full-thickness tear usu in the weak left posterolateral wall of distal esophagus; (3) causes?
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A009. Boerhaave's Syndrome; Causes:; Forceful vomiting;; Cough;; Trauma
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Q010. Dx: A Partial-thickness tear usu in the right posterolateral wall of the distal esophagus and results in bleeding that resolves spontaneously; Cause?
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A010. Mallory-Weiss syndrome; Cause: Forceful vomiting
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Q011. medical Tx for non-bleeding Esophageal Varices
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A011. Propranolol
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Q012. What is the next step in the Tx of a patient with GERD that has persistent Symptom after 4 weeks of Tx with a PPI?
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A012. 24-hour Esophageal pH recording
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Q013. If patient has mediastinal and subcutaneous emphysema, what esophageal problem do they have?
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A013. Full-thickness tear; (Boerhaave's syndrome)
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Q014. Dx sign: "Crunching sound" heard with heartbeat; what is it due to?
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A014. "Hammon's crunch" (Mediastinal emphysema); From: Full-thickness esophageal tear (Boerhaave's syndrome)
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Q015. *What is the Diagnostic test of choice for Boerhaave's syndrome or a partial esophageal perforation?; What is the most accurate test?
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A015. Dx test: Gastrograffin (water-soluble contrast); most accurate: CT scan
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Q016. Tx for esophageal tear; (1 for each type)
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A016. Partial-thickness (Mallory-Weiss): may resolve spontaneously; Full-thickness (Boerhaave's): Surgery
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Q017. Definition: Pharyngeal or esophageal pouch due to a defect in the muscular wall of the posterior hypopharynx
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A017. Zenker's Diverticulum
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Q018. Dx: Halitosis, regurgitation of food after eating it, frequent aspiration, esophageal obstruction
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A018. Zenker's Diverticulum
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Q019. Dx test for Zenker's Diverticulosis; (2 possible); Tx (2 possible)
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A019. Tests: Barium swallow;; Endoscopy; Tx:; Surgical removal;; Cricopharyngeal myotomy
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Q020. Dx: 56-yo man complains of food feeling "stuck" on its way down and vomiting food he ate days ago
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A020. Zenker's Diverticulum
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Q021. Definition: Neurogenic disorder of esophageal motility with absence of normal peristalsis and impaired relaxation of the LES
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A021. Achalasia
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Q022. Definition: Esophageal motility disorder with frequent non- peristaltic contractions
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A022. Diffuse Esophageal Spasms; (DES)
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Q023. What esophageal problem affects 70% of people with Scleroderma?
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A023. Achalasia
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Q024. What type of problem does dysphagia to solids and liquids indicate?; (2 examples); To just solids?; (3 examples)
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A024. Solids + Liquids: Motility problem (Achalasia; DES); Solids only: Mechanical problem (Tumor; Schatzki's ring; Plummer-Vinson syndrome)
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Q025. Dx: weight loss, cough, dysphagia of both solids and liquids, "bird's beak" on CXR; Tx options?; (2 drugs and 2 procedures)
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A025. Achalasia; Tx options:; Nitroglycerin;; Local Botulinum toxin;; Balloon Dialation;; Sphinctor Myotomy
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Q026. Dysphagia to both solids and liquids, diffuse chest pain, "corkscrew" appearance on CXR; DES Drug Tx options? (2 possible)
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A026. Diffuse Esophageal Spasms (DES); Tx options:; 1. Nitroglycerin;; 2. Anticholinergics
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Q027. When is an Esophageal Manometry the test of choice?; (2)
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A027. 1. an Inconclusive Barium or upper endoscopy; 2. Description of a Motility problem (Achalasia, DES, Nutcracker esophagus)
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Q028. Etiology of Achalasia; (2)
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A028. Scarring of Auerbach's plexus from: Chagas Disease; or Ganglionic degeneration
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Q029. Definition: Hypopharyngeal webs (thin mucosal structures protruding into lumen of the esophagus) associated with iron deficiency anemia
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A029. Plummer-Vinson Syndrome
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Q030. Definition: Narrow lower esophageal ringlike outgrowth associated with dysphagia
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A030. Schatzki's Ring
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Q031. Etiology of GERD; (4)*
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A031. HIDE:; Hiatal hernia;; Incompetent LES tone; Delayed Gastric emptying;; Esopageal motility decreased
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Q032. (5)* causes of Delayed Gastric Emptying
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A032. Delayed Food GAG: DM;; Fatty foods;; Gastroparesis;; Anticholinergics;; Gastric outlet obstruction
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Q033. (8)* causes of a decreased LES tone
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A033. Coffee CAN Cause Esophageal Sphinctor Problems:; Coffee;; Chocolate;; Alcohol;; Nitrates;; Calcium channel blockers;; Estrogen;; Smoking;; Progesterone
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Q034. Differential of Chronic Cough; (3)*
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A034. GAP in breathing:; GERD;; Asthma / Chronic Bronchitis;; Post-nasal drip
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Q035. Dx: Substernal chest pain, dysphagia, hypersalivation, cough, wheezing
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A035. GERD
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Q036. What (3) lifestyle modifications should be told to patients with GERD?
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A036. Discontinue foods that lower LES tone;; Elevate head of bed;; No food < 3 hours before bed
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Q037. (2) drug Tx options for GERD; What can be done if medication doesn't work?
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A037. Proton Pump Inhibitor (1st);; H-2 Blocker; Final solution: Surgical fundoplication
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Q038. Definition: Esophageal damage, bleeding and friability due to prolonged exposure to gastric contents
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A038. Esophagitis
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Q039. (4)* complications of GERD
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A039. BEEP:; Barrett's Esophagus;; Esophagitis;; Esophageal cancer;; Peptic stricture
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Q040. (2) types of esophageal cancers and where each is formed in esophagus
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A040. Squamous: Upper 2/3 of esophagus; Adenocarcinoma: Lower 1/3 of esophagus
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Q041. Risk factors for CA of the esophagus; (7)*
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A041. ABCDEF:; Alcohol;; Barrett's esophagus;; Cigarettes;; Diverticuli (Zenker's);; Esophageal web (P-V synd), Esophagitis (reflux or irritants);; Familial
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Q042. What causes Barrett's?; What can it become?; How often should a patient with Barrett's have an upper endoscopy?
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A042. BARRett's: Becomes Adenocarcinoma, Results from Reflux; UE: Barrett's: every 2 - 3 years
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Q043. What is the Alkaline Tide?
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A043. Parietal cells secreting HCl into the gastric lumen and bicarb into the gastric venous circulation, which goes to the gastric mucous cell
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Q044. What hormones/NT stimulate parietal cells?; (3)
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A044. Holds Gastric Acid:; Histamine (H-2);; Anticholinergic (from vagus);; Gastrin
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Q045. What hormone stimulates release of Gastrin? From what cells and where?
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A045. Gastrin-releasing peptide; (from G-cells in antrum of stomach)
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Q046. What hormone inhibits Gastrin? From which cells?
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A046. Somatostatin; (from D-cells in the pancreas and GI mucosa)
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Q047. What inhibits the Gastric Bicarb secretion (from the alkaline tide) from entering the mucous gel to line the stomach?; (4)
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A047. NSAIDs;; Alcohol;; Acetazolamide;; Alpha-blockers
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Q048. What increases the thickness of the mucous gel of the stomach?; What decreases it?; (2)
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A048. Increases: Prostaglandin E; Decreases (by inhibiting PGE): NSAIDs; Steroids
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Q049. Dx: A patient has large, multiple ulcers that are recurrent and distal in origin. First test?; What are diagnostic levels?; if this Dx is still suspected and diagnostic levels of the first test are not reached, what is the next test?; what syndrome is it assoc with?
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A049. Zollinger-Ellison syndrome; First test: Gastrin Level (> 1,000pg/mL is diagnostic); Next if not at Dx level: Secretin Stimulation test (Gastrin levels will still be high); Assoc with: MEN-1
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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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Q101. Definition: Autoimmune disease causing destruction of the intrahepatic ducts
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A101. Primary Biliary Cirrhosis
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Q102. Dx: 40-yo woman with scleroderma is admitted with jaundice, pruritis and xanthomas; What is the serologic hallmark?
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A102. Primary Biliary Cirrhosis; (Anti-mitochondrial Ab)
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Q103. (2) autoimmune disorders assoc with Primary Biliary Cirrhosis
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A103. Scleroderma; Sjogren's syndrome
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Q104. What drug Tx will slow the progression of Primary Biliary Cirrhosis?; What is only cure?
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A104. Ursodiol (synthetic bile acid); Cure: Liver Transplant
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Q105. MCC of Portal HTN worldwide
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A105. Schistosomiasis
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Q106. Signs of Portal HTN; (5)*
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A106. CHASE:; Caput medusa;; Hemorrhoids;; Ascites;; Splenomegaly;; Esophageal Varices
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Q107. Tx for Portal HTN; (4)
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A107. Propranolol to reduce pressure;; Portosystemic shunt surgery;; TIPS - shunt b/t hepatic and portal veins;; Liver transplant
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Q108. Dx: Liver disease, joint pain, Diabetes, cardiomyopathy, skin hyperpigmentation and infertility. First test?; what is the confirmatory test?
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A108. Hereditary Hemochromatosis; first test: Fasting Transferrin saturation; Confirmatory: HFE Gene and C282Y mutation (eliminates the need for liver Biopsy in HH)
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Q109. GI functions of Somatostatin; (6)
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A109. Inhibits:; Visceral blood flow; Gastric acid secretion; Gastric motility; Gallbladder emptying; Pancreatic enzyme and bicarbonate secretion; Intestinal absorption of glucose, water, AA, and triglycerides
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Q110. Hepatic encephalopathy is precipitated by what?; (3)*
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A110. PIG:; Protein (dietary) increase;; Infection;; GI bleed
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Q111. Signs/Symptom of Hepatic Encephalopathy; (3)
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A111. Fetor Hepaticus (Corpse breath);; Asterixis;; Mental status change or coma
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Q112. In a patient with bleeding esophageal varices, after stabilizing IV fluids, what is the next step?
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A112. Octreotide
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Q113. Tx for Hepatic encephalopathy; (3)
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A113. Protein restriction;; Lactulose (to change NH3 to NH4 so it cant cross BBB); Neomycin (for gut bacteria that make NH3)
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Q114. MCC of Spontaneous Bacterial Peritonitis (bug)
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A114. E. coli
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Q115. Dx: Patient with ascites, fever, chills, abdominal pain with rebound, may progress to sepsis
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A115. Spontaneous Bacterial Peritonitis
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Q116. Dx test for Spontaneous Bacterial Peritonitis; Tx?
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A116. Test: Paracentesis (abdominal tap); Tx: Gram-negative coverage (Cefuroxime)
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Q117. Definition: Systemic infection of the liver due to viral agents, toxins, or alcohol
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A117. Hepatitis
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Q118. Mode of transmission of Hepatitis: A, B, C, D, E, G
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A118. A and E - fecal-oral route; B, C, D, G - sex and blood
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Q119. Which forms of hepatitis are associated with:; 1. IV drug use (2); 2. Unprotected sex; 3. Overseas travel (2)
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A119. 1. HBV and HCV; 2. HBV; 3. HAV and HEV
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Q120. What (2) toxins cause hepatitis?
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A120. Acetaminophen; Aflatoxin
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Q121. *Viral class for:; 1. HAV; 2. HBV; 3. HCV; 4. HDV; 5. HEV; Which is the only DNA virus?
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A121. Please Help Find Danielle's Cat:; 1. Picorna; 2. Hepadna; 3. Flavi; 4. Delta; 5. Calici; HBV is DNA (the rest are RNA)
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Q122. Meaning of HAV antibodies; (2)
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A122. HAV IgM = Acute infection; HAV IgG = Immunity from prior infection
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Q123. Prevention of HAV?; Tx of HAV?
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A123. Prevention: Anti-HAV Ig is 90% effective if given within (2) weeks of exposure; Tx: symptomatic
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Q124. How is hepatotoxicity from Acetaminophen prevented if detected early?
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A124. N-acetylcysteine
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Q125. Meaning of HBV antibodies in order of detection (4)*; Which signifies the "window period"?; Which indicates immunity?
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A125. SAGing BAG-E / Camels May / Spit and Gag:; HBsAg positive = infection is present; HBeAg = Chronic hepatitis; Anti-HBc IgM = infection is acute (window period); Anti-HBs IgG = past infection or vaccine (indicates immunity)
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Q126. Exposure scenarios: What is Tx to a newborn exposed with Hepatitis B?; Adult infected blood exposure?
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A126. Newborn: Give HBIG and vaccine; Other: Test for HBV, if negative give HBIG only
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Q127. Tx for HBV; What does HBV give patient a risk of developing?
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A127. Lamivudine; Risk: Hepatocellular cancer
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Q128. Meaning of "HCV antibody"
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A128. Anti-HCV IgG = indicates chronic or past infection
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Q129. Tx for HCV; (2)
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A129. Interferon; Ribavirin
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Q130. What do 25% of the chronic HCV patients develop?; (2)
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A130. Cirrhosis; and/or Hepatocellular CA
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Q131. Dx: Medical student develops fever, jaundice and fatigue 2 weeks after returning from a trip to India
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A131. Hepatitis E
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Q132. A young female is diagnosed with liver disease, but does not drink, have inflammatory bowel disease or infectious hepatitis. Next test?; if positive, what is the Dx?; What additional immune marker is assoc with it?
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A132. Next test: Anti-Smooth Muscle Ab (ASMA); Dx: Autoimmune Hepatitis; Additional immune marker: Anti-Liver/Kidney Microsome type 1 Ab (anti-LKM1 Ab)
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Q133. Indications for Liver transplantation; (5)
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A133. Cirrhosis;; Primary Sclerosing Cholangitis;; Chronic Hepatitis;; Hepatocellular CA;; Hepatic Vein Thrombosis
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Q134. What must match with donor liver?; (2)
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A134. Size and ABO; (not Rh or HLA)
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Q135. (3) medications for Immunosuppression of Liver recipients
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A135. Cyclophosphamide;; OKT3;; Tacrolimus
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Q136. What stimulates the gallbladder contraction (specifically)
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A136. Fat and Amino Acids in the proximal duodenum causes release of CCK
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Q137. Dx: Middle-aged female patient presenting with pruritis and an elevated Alkaline phosphatase with a normal Bilirubin. What is the best initial test?; what is the most accurate test?
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A137. Dx: Primary Biliary Cirrhosis; initial test: Anti-mitochondrial Ab test; most accurate: Liver Biopsy
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Q138. Risk factors for cholelithiasis; (8 F's); Two others?
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A138. Female;; Fat;; Forty;; Fertile;; Fibrosis (Cystic);; Familial;; Fasting;; F-Hgb (Sickle cell); Also: DM and Oral contraceptives
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Q139. Dx: RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness without guarding or rebound
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A139. Cholelithiasis
|
|
Q140. What labs are elevated with gallstones?
|
A140. Alkaline phoshatase; Bilirubin; (direct more then indirect)
|
|
Q141. when should HIDA scan be answered?; (2)
|
A141. 1. Gallstones and US Murphy's sign without Gallbladder edema; 2. Gallbladder edema and US Murphy's sign without Gallstones (if Dx is obvious, then do not answer HIDA scan)
|
|
Q142. First Dx test of choice for gallstones?
|
A142. Ultrasound
|
|
Q143. Out of the (3) types of gallstones, name them in least common to most.
|
A143. 1. Cholesterol (10%); 2. Pigment (20%); 3. mixed (70%)
|
|
Q144. When are Radiolucent cholesterol gallstones seen?; (3)
|
A144. rapid weight loss;; Oral contraception;; Ileal disease
|
|
Q145. When are radiodense pigment gallstones seen?
|
A145. Hemolysis
|
|
Q146. Treatment of gallstones in order; (1 med; 2 procedures)
|
A146. 1. Chenodeoxycholate; 2. Lithotripsy; 3. Cholesystectomy
|
|
Q147. Dx: Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of ULCERATIVE COLITIS and is complaining of pruritus with a negative hepatitis profile and a negative US. Next step?
|
A147. Dx: Primary Sclerosing Cholangitis; next step: ECRP
|
|
Q148. (4) bugs that can cause cholecystitis
|
A148. BEEK:; Bacteriodes; E.coli; Enterococcus; Klebsiella
|
|
Q149. Dx: RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign
|
A149. Cholecystitis
|
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Q150. Sign: the arrest of inspiration while palpating the RUQ. what is the Dx if positive?
|
A150. Murphy's sign; Dx: Acute cholecystitis
|
|
Q151. Dx test of choice for cholecystitis
|
A151. HIDA: labeled iminodiacetic acid is injected IV and taken up by hepatocytes. Normal gallbladder is outlined in 1 hour, absence of visable gallbladder = cholecystitis
|
|
Q152. What condition is an ERCP most accurate for?
|
A152. Primary Sclerosing Cholangitis
|
|
Q153. Tx for cholecystitis in order; (2 meds; 1 procedure)
|
A153. Pain control;; 2nd or 3rd generation Cephalosporin;; Cholecyctectomy
|
|
Q154. Definition: complete obstruction of the biliary outflow tract due to a stone obstructing the common bile duct, a stricture or tumor. The patient becomes septic and it is life threatening
|
A154. Ascending cholangitis
|
|
Q155. Definition: stone obstruction of the common bile duct
|
A155. Choledocholelithiasis
|
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Q156. Charot's triad of Ascending Cholangitis; Reynolds pentad?
|
A156. Charot's triad:; RUQ pain;; Jaundice;; Fever Reynold's pentad: above plus; Shock (hypotension);; Altered mental status
|
|
Q157. *Tx of choice for Ascending cholangitis
|
A157. ERCP with endoscopic sphinctorotomy
|
|
Q158. Definition: Chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and strictures of the intrahepatic and extrahepatic biliary tree. What is it associated with?
|
A158. Primary sclerosing Cholangitis; Associated with: Ulcerative Colitis
|
|
Q159. Dx: 34-yo man with a history of ulcerative colitis presents with jaundice and elevated GGT and alk-phos.
|
A159. Primary Sclerosing Cholangitis
|
|
Q160. ERCP showing "beads on a string" appearance
|
A160. Primary Sclerosing Cholangitis
|
|
Q161. Pathogenesis of cholelithiasis
|
A161. 3 types of stones:; cholesterol (from bile supersaturated with cholesterol, hypomotile gallbladder); black pigmented stones (seen in hemolytic disease and alcoholic cirrhosis), from unconjugated bili; brown stones: from biliary tract infection
|
|
Q162. clinical features of cholelithiasis
|
A162. most are asymptomatic; biliary colic
|
|
Q163. dx of cholelithiasis
|
A163. RUQ u/s
|
|
Q164. tx of cholelithiasis
|
A164. none needed unless repeated bouts of biliary colic, then tx with cholecystectomy
|
|
Q165. complications of cholelithiasis
|
A165. cholecystitis; choledocholithiasis; gallstone ileus; malignancy
|
|
Q166. pathogenesis of acute cholecystitis
|
A166. obstruction of cystic duct --> inflammation of gallbladder wall
|
|
Q167. clincal features of acute cholecystitis
|
A167. RUQ pain that may radiate to right shoulder; murphy's sign
|
|
Q168. dx of acute cholecystitis; what if initial study is negative?
|
A168. RUQ u/s: shows pericholecystic fluid; if u/s is negative, do HIDA scan to look for dye not filling gallbladder
|
|
Q169. tx of acute cholecystitis
|
A169. hydration, bowel rest, antibiotics, pain meds; cholecystectomy
|
|
Q170. complications of acute cholecystitis
|
A170. gangrenous cholecystitis; GALLBLADDER perforation; emphysematous cholecystitis; fistula with gallstone ileus
|
|
Q171. pathophysiology of gallstone ileus
|
A171. gallstone enters bowel lumen via fistula with gallbladder, gets stuck --> obstruction
|
|
Q172. pathogenesis of choledocholithiasis
|
A172. gallstone gets stuck in common biliary duct
|
|
Q173. what are the two types of stones seen in choledocholithiasis
|
A173. primary: pigmented, originate in common biliary duct; secondary: from gallbladder, then pass into common biliary duct, usually cholesterol or mixed
|
|
Q174. clinical presentation of choledocholithiasis
|
A174. most patients are asymptomatic for years; RUQ pain +/- jaundice
|
|
Q175. dx of choledocholithiasis
|
A175. ERCP (shows common biliary duct dilation)
|
|
Q176. tx of choledocholitiasis
|
A176. ERCP with sphincterotomy and stone extraction, stent placement
|
|
Q177. complications of choledocholithiasis
|
A177. cholangitis; pancreatitis; biliary cirrhosis
|
|
Q178. pathogenesis of cholangitis
|
A178. obstruction --> biliary stasis --> bacterial overgrowth and infection
|
|
Q179. clinical presentation of cholangitis
|
A179. charcot's triad (fever, RUQ pain, jaundice)
|
|
Q180. dx of cholangitis
|
A180. ERCP; hyperbilirubinemia; elevated lfts
|
|
Q181. tx of cholangitis
|
A181. iv antibiotics and IVF; once afebrile x 48 hrs, ERCP
|
|
Q182. complications of cholangitis
|
A182. hepatic abscess
|
|
Q183. risk factors for carcinoma of the gallbladder
|
A183. gallstone; fistulas; porcelain gallbladder
|
|
Q184. clinical findings of carcinoma of the gallbladder
|
A184. palpable gallbladder; jaundice; biliary colic; weight loss
|
|
Q185. tx of carcinoma of the gallbladder
|
A185. surgery, but 90% die within first year of dx
|
|
Q186. porcelain gallbladder
|
A186. transmural calcification of gallbladder, 50% risk of developing carcinoma of the gallbladder
|
|
Q187. pathogenesis of primary biliary cirrhosis
|
A187. destruction of the intrahepatic bile ducts, with portal inflammation and scarring; autoimmune disease
|
|
Q188. clinical presentation of primary biliary cirrhosis
|
A188. middle aged women with autoimmune disease; fatigue; pruritis; RUQ pain
|
|
Q189. dx of primary biliary cirrhosis
|
A189. Positive AMA; cholestatic liver function tests; elevated alkaline phosphatase; liver biopsy to confirm dx
|
|
Q190. tx for primary biliary cirrhosis
|
A190. urodeoxycholic acid slows the progression and relieves symptom; liver transplant is curative
|
|
Q191. pathogenesis of primary sclerosing cholangitis
|
A191. thickening of bile duct walls and narrowing of their lumens
|
|
Q192. clinical presentation of primary sclerosing cholangitis
|
A192. patient with ulcerative colitis, pruritis, and jaundice
|
|
Q193. dx of primary sclerosing cholangitis
|
A193. ERCP shows bead like strictures and dilations of intra and extra hepatic ducts
|
|
Q194. tx of primary sclerosing cholangitis
|
A194. ERCP + stent placement to relieve symptom; liver transplant is curative
|
|
Q195. complications of primary sclerosing cholangitis
|
A195. cholangiocarcinoma; recurrent cholangitis; portal HTN; liver failure
|
|
Q196. pathogenesis of cholangiocarcinoma
|
A196. tumor of extra or intrahepatic bile ducts; primary sclerosing cholangitis is a major risk factor
|
|
Q197. clinical presentation of cholangiocarcinoma
|
A197. 60 yo with obstruction jaundice and weight loss
|
|
Q198. dx of cholangiocarcinoma
|
A198. ERCP
|
|
Q199. tx of cholangiocarcinoma
|
A199. most tumors are unresectable; ERCP + stent placement can relieve symptoms
|
|
Q200. complications of cirrhosis
|
A200. portal HTN; hepatocellular failure
|
|
Q201. 2 most common causes of cirrhosis
|
A201. alcohol use; chronic hepatitis b and c
|
|
Q202. clinical features of portal HTN
|
A202. bleeding from varices - most life threatening; hemorrhoids; caput medusae
|
|
Q203. tx of portal HTN
|
A203. tips (transjugular intrahepatic portal systemic shunt) to lower portal pressure
|
|
Q204. what is the most common type of varices from portal HTN
|
A204. esophageal (90%) gastric (10%)
|
|
Q205. acute tx of varices
|
A205. hemodynamic stabilization (plus fluids); ligation/banding; endoscopy sclerotherapy; octreotide
|
|
Q206. long-term treatment of varices
|
A206. beta blocker to prevent rebleeding
|
|
Q207. etiologies of ascites
|
A207. increased portal HTN (hydrostatic pressure increased); decreased albumin concentration (decreases oncotic pressure)
|
|
Q208. how to differentiate the causes of ascites
|
A208. calculate the SAAG; if >1.1, then from portal HTN,; if <1.1, then from hypoalbumin state
|
|
Q209. tx for ascites
|
A209. bed rest, low sodium diet, and diuretics
|
|
Q210. pathophysiology of hepatic encephalopahthy
|
A210. ammonia accumulates because the liver is unable to detoxify it
|
|
Q211. clinical presentation of hepatic encephalopathy
|
A211. asterixis; fetor hepaticus
|
|
Q212. treatment of hepatic encephalopathy
|
A212. decreased protein diet; lactulose; neomycin (last resort) to decrease bacteria that produce ammonia
|
|
Q213. pathophysiology of hepatorenal syndrome
|
A213. decreased renal perfusion because RAAS gets activated from decreased BP in splanchnic circulation, so there is peripheral vasoconstriction --> poor renal perfusion
|
|
Q214. clinical features of hepatorenal syndrome
|
A214. azotemia; oliguria; hyponatremia; hypotension; low urine sodium
|
|
Q215. tx for hepatorenal syndrome
|
A215. octreotide + midodrine: palliative; liver transplant is the only cure
|
|
Q216. pathophysiology of spontaneous bacterial peritonitis
|
A216. portal HTN increases --> gut hypomotility, and bacterial overgrowth; bv become more permeable and bacteria enter mesenteric ln and then enter blood stream; ascites fluid becomes infected
|
|
Q217. organisms usually involved with spontaneous bacterial peritonitis
|
A217. usually monomicrobial (e coli, klebsiela, strep pneumo)
|
|
Q218. dx of spontaneous bacterial peritonitis
|
A218. pnml >250; ascites cx
|
|
Q219. tx of spontaneous bacterial peritonitis
|
A219. iv antibiotics
|
|
Q220. complications of spontaneous bacterial peritonitis
|
A220. hepatic abscess; hepatorenal syndrome; intestinal obstruction
|
|
Q221. pathophysiology of Wilson’s disease
|
A221. copper is normally excreted by the liver, but in Wilson’s disease, there is a ceruloplasmin deficiency (required for excretion) so cu builds up; cu accumulates in hepatocytes, causing them to die and release cu into plasma and accumulate in kidney, cornea, and brain
|
|
Q222. clinical features of wilson's disease
|
A222. hepatitis; cirrhosis; fulminant hepatic failure; kayser'-fleischer rings; extrapyramidal signs; psych disturbances (depression, neurosis, psychosis, personality changes)
|
|
Q223. dx of wilson's disease
|
A223. elevated aminotransferases; low ceruloplasmin levels; liver biopsy shows elevated cu
|
|
Q224. tx for wilson's disease
|
A224. chelating agents (penacillamidene - removes and detoxifies cu deposits); Zn (prevents dietary uptake of cu); liver transplant
|
|
Q225. pathophysiology of hemochromatosis
|
A225. excessive Fe absorption in intestines --> Fe accumulation
|
|
Q226. organs affected by hemochromatosis
|
A226. liver; pancreas; skin; heart; joints
|
|
Q227. clinical features of hemochromatosis
|
A227. liver disease; fatigue; arthritis; abdominal pain; cardiac arrhythmias
|
|
Q228. complications of hemochromatosis
|
A228. cirrhosis; cmp; arthritis; DM; bronzing of the skin
|
|
Q229. dx of hemochromatosis
|
A229. liver biopsy required for dx
|
|
Q230. pathogenesis of appendicitis
|
A230. lumen of appendix is most commonly blocked by hyperplasia of lymphoid tissue or fecalith; obstruction --> stasis --> bacterial overgrowth and inflammation
|
|
Q231. pathogenesis of ruptured appendix
|
A231. distension of appendix can compromise blood supply and can lead to infarction or necrosis; necrosis --> perforation and peritonitis
|
|
Q232. imaging to dx appendicitis
|
A232. CT most sensitive and specific; Ultrasound
|
|
Q233. pregnant woman with suspected appendicitis
|
A233. surgery despite risk of false positive because risks are too severe
|
|
Q234. most common site for carcinoid tumor
|
A234. appendix
|
|
Q235. location of carcinoid tumor if it is malignant
|
A235. ileal tumor
|
|
Q236. pathogenesis of acute pancreatitis
|
A236. inflammation of pancreas from autodigestion of the pancreas
|
|
Q237. causes of acute pancreatitis
|
A237. GET SMASHeD; Gallstones; EtOH; Trauma; Steroids; Mumps; Autoimmune disease; Scorpion; Hypercalcemia, Hyperlipidemia; Drugs
|
|
Q238. which is more specific in acute pancreatitis: amylase or lipase
|
A238. lipase
|
|
Q239. what is the purpose of liver function tests in acute pancreatitis
|
A239. to ID cause (esp if related to gallstones)
|
|
Q240. role of abdominal radiographs in acute pancreatitis
|
A240. used to rule out other dx; calcifications suggests chronic pancreatitis; can sometimes see sentinel loop (air filled bowel in LUQ that demonstrates localized ileus)
|
|
Q241. role of u/s in acute pancreatitis
|
A241. to ID gallstones; can be used to follow pseudocyst or abscess
|
|
Q242. which is the test of choice for dx of acute pancreatitis
|
A242. ct
|
|
Q243. indication for ERCP in acute pancreatitis
|
A243. if it is from severe gallstone pancreatitis with biliary obstruction; to id uncommon causes of acute pancreatitis if disease is recurrent
|
|
Q244. pathogenesis of pancreatic pseudocyst
|
A244. localized collection of necrotic hemorrhagic material rich in pancreatic enzymes; it lacks and epithelial lining
|
|
Q245. complications of untreated pseudocysts
|
A245. rupture infection, gastric outlet obstruction, fisual, hemorrhage and pancreatic ascites
|
|
Q246. dx of pancreatic pseudocyst
|
A246. CT
|
|
Q247. tx of pancreatic pseudocyst
|
A247. <5cm, observation; >5cm, drain
|
|
Q248. complications of acute pancreatitis
|
A248. pancreatic necrosis; pancreatic pseudocyst; hemorrhagic pancreatitis; ARDS; pancreatic ascites; pleural effusion; ascending cholangitis; pancreatic abscess
|
|
Q249. tx of acute pancreatitis
|
A249. NPO; IVF; pain control
|
|
Q250. pathogenesis of chronic pancreatitis
|
A250. continuing inflammation of pancreas, with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic ducts --> irreversible destruction of pancreas
|
|
Q251. most common cause of chronic pancreatitis
|
A251. chronic alcoholism
|
|
Q252. presentation of chronic pancreatitis
|
A252. chronic epigastric pain + calcifications on plain abdominal films; steatorrhea, DM, and pancreatic calcifications
|
|
Q253. serum and amylase levels in chronic pancreatitis
|
A253. not elevated
|
|
Q254. appearance of chronic pancreatitis on ct
|
A254. calcifications and pseudocysts an be seen
|
|
Q255. appearance of chronic pancreatitis on ERCP
|
A255. chain of lakes appearance from areas of stricture and duct dilation throughout the pancreatic ducts
|
|
Q256. complications of chronic pancreatitis
|
A256. DM; narcotic addiction; malabsorption/steatorrhea; pseudocyst formation; pancreatic ductal dilation; b12 malabsorption; pancreatic carcinoma
|
|
Q257. non surgical tx for chronic pancreatitis
|
A257. narcotics for pain; NPO; pancreatic enzymes + h2 blockers; insulin; alcohol abstinence; frequent small low-fat meals
|
|
Q258. surgical tx for chronic pancreatitis
|
A258. pancreaticojejunostomy (drains the pancreatic ducts to decompress dilated ducts); pancreatic resection
|
|
Q259. most common location for pancreatic cancer
|
A259. pancreatic head
|
|
Q260. risk factors for pancreatic cancer
|
A260. cigarette smoking (most common); chronic pancreatitis; DM; heavy Etoh use; exposure to benzidine and b-naphthylamine
|
|
Q261. purpose of h2 blockers + pancreatic enzymes in chronic pancreatitis
|
A261. pancreatic enzymes inhibit CCK release and decrease pancreatic secretion after meals; h2 blockers inhibit gastric acid secretion, preventing degradation of pancreatic enzyme supplements by gastric acid
|
|
Q262. test for dx pancreatic ca
|
A262. CT; ERCP
|
|
Q263. tumor markers for pancreatic ca
|
A263. ca 19-9; CEA
|
|
Q264. Definition: Gluten-induced enteropathy in susceptible persons affecting the small bowel
|
A264. Celiac Sprue
|
|
Q265. What HLA is Celiac sprue?; (2)
|
A265. HLA DR3; HLA DQw2
|
|
Q266. Dx: Malabsorption (diarrhea, bloating, abd pain, steatorrhea, weight loss), vitamin deficiency (high PT/INR, low iron and calcium), Rash
|
A266. Celiac sprue
|
|
Q267. Pathology Biopsy of small bowel: flattened intestinal villi, infiltration of lymphocytes, hyperplasia and lengthing of the intestinal crypts
|
A267. Celiac sprue
|
|
Q268. what does Antiendomysial Ab test?; What other test accompanies this one?; When is it performed?; What is the most accurate test for this Dx?
|
A268. Confirms Dx of Celiac Sprue; (also Antigliadin Ab test); Performed: After a Sudan Black stain confirms Malabsorption; Most Accurate: Small Bowel Biopsy; (must be done to Dx the disease and to RULE OUT Lymphoma)
|
|
Q269. Definition: A pruitic rash associated with Celiac sprue, responds to Tx of topical Sulfone, resolves with regression of disease
|
A269. Dermatitis Herpetiformis
|
|
Q270. Tx for Celiac sprue
|
A270. All grains are eliminated from diet except Rice and Corn; (no wheat rye or barley)
|
|
Q271. *Patient has chronic pale, greasy, malodorous diarrhea and no evidence of infection. Initial test?
|
A271. Sudan Black stain
|
|
Q272. Pathology Biopsy: mildly flattened intestinal villi with jejunal infiltration of monocytes
|
A272. Tropical sprue
|
|
Q273. Dx: malabsorption signs, megaloblastic anemia, decreased calcium, B-12, iron, folic acid, cholesterol, albumin and magnesium
|
A273. Tropical sprue
|
|
Q274. Tx for Tropical sprue; (2)
|
A274. Vitamin B-12 and Folate supplements; Tetracycline (for a few months)
|
|
Q275. Difference b/t Whipple's disease and Sprue
|
A275. Whipple's has CNS involvement
|
|
Q276. If there is the presence of a normal jejunal Biopsy, what malabsorption disease is ruled-out?
|
A276. Tropical sprue
|
|
Q277. Dx: 54-yo farmer who has been suffering with diarrhea, weight loss, and arthralgias for the past few months is brought in by his wife for memory deficits that have been occurring for the past 3 weeks.
|
A277. Whipple's disease
|
|
Q278. Definition: devastatingly profound malabsorption syndrome due to destruction of the intestinal lamina due to a gram- negative rod of the Actinomyces genus
|
A278. Whipple's Disease
|
|
Q279. Dx: arthralgia, abdominal pain, malabsorption, fever, inc skin pigment, uveitis, confusion, CNS palsies, nystagmus, heart failure
|
A279. Whipple's Disease
|
|
Q280. *Most accurate test for Whipple's Disease; Other test?
|
A280. Most accurate: PAS positive macrophages in the lamina propria;; other: PCR of peripheral blood for T. whippelii (Actinomyces strain)
|
|
Q281. Antibiotics Tx of Whipple's Disease; (2 steps)
|
A281. 1. initial course of Ceftriaxone; 2. TMP-SMZ and Tetracycline for 1 year
|
|
Q282. Definition: Albumin lost to the GI lumen in excess
|
A282. Protein-losing Enteropathy
|
|
Q283. Dx: Diarrhea, edema, steatorrhea, low albumin
|
A283. Protein-losing Enteropathy
|
|
Q284. Dx test for Protein-losing Enteropathy
|
A284. Alpha-1-Antitrypsin comparison in serum vs stool
|
|
Q285. Similar look to gastric cancer on barium study
|
A285. Menetrier's Disease
|
|
Q286. Definition: Protein-losing enteropathy that causes mucosal thickening due to hyperplasia of glandular cells replacing chief and parietal cells leading to enlarged, tortuous rugae
|
A286. Menetrier's Disease
|
|
Q287. Dx: epigastric pain, diarrhea, edema, steatorrhea, decreased gastric acid secretion, low albumin
|
A287. Menetrier's Disease
|
|
Q288. Dx Tests for Menetrier's Disease; (2)
|
A288. Endoscopy with deep mucosal Biopsy; Barium swallow will reveal large gastric folds
|
|
Q289. Rx Tx for Menetrier's Disease; (2 plus MOA of each specific to this)
|
A289. Anticholinergics (reduce width of tight junctions b/t gastric mucosal cells); H-2 Blockers (reduce protein loss)
|
|
Q290. Definition: Stool frequency < 3 times per week
|
A290. Constipation
|
|
Q291. Etiology of Constipation; (6)*
|
A291. OLD MD Farts:; Obstruction;; Low thyroid(hypothyroidism);; Disturbed colonic motility;; Medications;; DM;; Fluid and fiber intake is low
|
|
Q292. what amount should you increase your fiber to, if your are constipated?
|
A292. 30 g/day
|
|
Q293. Definition: Neuroendocrine tumor arising from ectodermal stem cells in the gut
|
A293. Carcinoid Tumor
|
|
Q294. MC place of a Carcinoid tumor
|
A294. 90% in Ileum; (most in appendix)
|
|
Q295. What neurotransmitters and hormones does the Carcinoid tumor secrete?; (3)
|
A295. Serotonin;; Bradykinin;; Histamine
|
|
Q296. MC places of mets with Carcinoid tumor; (2: in order of frequency)
|
A296. Liver;; Lung
|
|
Q297. Etiology of Carcinoid tumor; (2)
|
A297. Most are Idiopathic;; part of MEN-1
|
|
Q298. Classic triad of Carcinoid tumor and reason for each sign. (3) other signs
|
A298. 1. Flushing, Hypotension - Bradykinin; 2. Diarrhea - Serotonin; 3. Rt-sided Valvular heart Disease - Serotonin other:; Wheezing (histamine);; Bowel obstruction;; Appendicitis
|
|
Q299. Dx test for Carcinoid tumor; (2)
|
A299. 1. > 10mg/24 hour 5-HIAA; 2. elevated serum and urine 5-HT
|
|
Q300. Tx for Carcinoid tumor; (3)
|
A300. Surgical excision;; Radiation therapy;; Antihormonal therapy
|
|
Q301. What is a 72-hour Fecal Fat test?; When is the only time it is used?
|
A301. 72-hour FFT: Detects Intestinal Malabsorption; Only used: if you strongly suspect fat malabsorption and the Sudan Black stain is negative (best initial test for fat malabsorption is Sudan Black stain)
|
|
Q302. Type of GI cancer in the:; 1. Espophagus (2); 2. Duodenum and Jejunum; 3. Ileum (3)
|
A302. Esophagus: Squamous and Adenocarcinoma; Duodenum and Jejunum: Adenocarcinoma; Ileum: Carcinoid, Lipoma and Lymphoma
|
|
Q303. Definition: Aquired condition of the colon in which sac-like protrusions of colonic mucosa herniate through a defect in the muscular layer
|
A303. Diverticulosis
|
|
Q304. MCC of massive GI bleed in patients over 60-yo
|
A304. Diverticulosis
|
|
Q305. Dx: painless rectal bleeding; underlying Cause?
|
A305. Diverticulosis; inflammed diverticula erodes thru a colonic artery usually on RIGHT side
|
|
Q306. what is the non-Rx Tx for Diverticulosis?; if refractory?
|
A306. Bleeding scan and embolization;; Refractory: Surical removal
|
|
Q307. Difference b/t True and False Diverticula; which is more common?; on the right side (ascending colon)?
|
A307. True: herniation involving the full bowel wall thickness (right side and tend to bleed); False: only mucosal herniation thru muscular wall (more common)
|
|
Q308. Dx: LLQ pain, fever, high WBC, possible sigmoid mass
|
A308. Diverticulitis
|
|
Q309. Dx test for diverticulitis; What test should never be done?
|
A309. Abdominal CT; Never do Colonoscopy (risk of perforation)
|
|
Q310. Tx for Diverticulitis; (3 hospital management and 2 sets of choices for Antibiotics Tx)
|
A310. NPO, IV fluids, Pain control;; Antibiotics: FQ and Metronidazole; or Clindamycin and Gentamicin
|
|
Q311. MC fistula associated with Diverticular Disease; how does it present?
|
A311. Colovesicular; (presents with recurrent UTI)
|
|
Q312. MCC of nosocomial pseudomembranous colitis
|
A312. C. difficile
|
|
Q313. Dx: Crampy, diffuse abdominal pain, fever, watery (occasionally bloody) diarrhea; recent URI
|
A313. Pseudomembranous Colitis
|
|
Q314. Dx: 68-yo man in the hospital for 3 weeks for pneumonia returns with new-onset diarrhea
|
A314. C. difficile induced; Pseudomembranous Colitis
|
|
Q315. When is the only time Vancomycin is given PO?; What is the other Tx for this problem?
|
A315. Pseudomembranous colitis; also Tx with: Metronidazole PO
|
|
Q316. Dx tests for Pseudomembranous Colitis; (3)
|
A316. C. difficile toxin in stool;; Fecal Leukocytes;; Sigmoidoscopy (yellowish membranous plaques adhering to mucosa)
|
|
Q317. Dx: fluctuating constipation and diarrhea, increased with stress, lack of systemic symptoms
|
A317. Irritable Bowel syndrome
|
|
Q318. Tx for IBS; (2 together)
|
A318. 1. High-fiber / Low-fat diet;; 2. Antispasmotic / Antidiarrheal
|
|
Q319. What (2) Dx must be ruled-out when giving a Dx of IBS, because they present similarly?
|
A319. Giardia infection; Lactose intolerance
|
|
Q320. Between ULCERATIVE COLITIS and Crohn's, which is:; 1. More common in Men; 2. More common in women; 3. Greater risk for Colon CA
|
A320. 1. CD; 2. UC; 3. UC
|
|
Q321. What unusual topical Tx is there for Inflammatory Bowel Disease to improve Symptoms?
|
A321. Nicotine dermal patch
|
|
Q322. IBD: Inflammation of mucosa only
|
A322. UC
|
|
Q323. IBD: bloody diarrhea, rectal pain, more acute flares
|
A323. UC
|
|
Q324. IBD: tender RLQ mass, more chronic
|
A324. CD
|
|
Q325. IBD: Inflammation involves all bowel layers
|
A325. CD
|
|
Q326. IBD: Leads to fistulas, abscesses and involves granulomas
|
A326. CD
|
|
Q327. IBD: "Lead-pipe colon"
|
A327. UC
|
|
Q328. IBD: "Cobblestone appearance"
|
A328. CD
|
|
Q329. IBD: complications include perforation, stricture and megacolon
|
A329. UC
|
|
Q330. IBD: complications include abscess, fistula, perianal disease
|
A330. CD
|
|
Q331. (2) Drugs to Tx IBD that contain 5-ASA and Sulfapyridine; Which is also used to Tx Rheumatoid Arthritis?; Which only works in the colon?; Which works in the small bowel if taken orally,but need to be given by enema if needed for colon?
|
A331. Sulfasalazine: only in colon (also Tx: RA); Mesalamine: oral for small bowel and enema for colon
|
|
Q332. Tx for Inflammatory Bowel Disease; (5)*
|
A332. Inflam SCAM:; Immunomodulators;; Sulfsalazine;; Corticosteroids;; Antibiotics (Metronidazole);; Mesalamine
|
|
Q333. Which drug class for IBD works better for UC?
|
A333. Corticosteroids
|
|
Q334. Antibiotics Tx for Crohn's Disease
|
A334. Metronidazole
|
|
Q335. Immunomodulators used in Tx of Crohn's Disease; (4)*; Which is for severe cases?; Which (2) are purine analogs?
|
A335. MIA-6:; Methotrexate;; Infliximab (severe cases);; Azathioprine (purine);; 6-Mercaptopurine (purine)
|
|
Q336. What type of precursor to colon cancer is the worst?
|
A336. Villous Polyps; (Villous are the Villains)
|
|
Q337. Place of Colon CA: signs of anemia: pallor, weakness; possible dull abdominal pain
|
A337. Right Colon
|
|
Q338. Place of Colon CA: pencil-thin stools, rectal bleeding, constipation, vomiting
|
A338. Left Colon
|
|
Q339. What is the next step if you fecal occult blood test is positive?
|
A339. Colonoscopy
|
|
Q340. At what age should annual rectal exams begin?; Fecal occult blood test?; Flexible sigmoidoscopy or colonoscopy?; What if there is a family member with a History of colon cancer?
|
A340. Annual Rectals: 40 years-old; FOBT: 50 years-old; Sigmoidoscopy / Colonoscopy:beginning at 50 years-old, for every 3-5 years; History of Colon CA: at 40yo or 10 years earlier then the family member's Dx (whichever is earlier)
|
|
Q341. Dx: 70-yo woman presents with microcytic anemia, weight loss, and a vague abdominal pain that is not related to food or time of day
|
A341. Colorectal CA
|
|
Q342. Dx lab test findings for Colon CA; (3)
|
A342. Anemia (iron deficiency);; elevated CEA;; Check LFTs (inc may indicate Mets)
|
|
Q343. What type of colon polyp is benign?; Which (2) have malignant potential?
|
A343. Benign: Tubular; Malignant potential: Villious; Tubulovillous
|
|
Q344. What is done if a polyp is found on colonoscopy?; when is the colonoscopy repeated?
|
A344. perform a polypectomy/Biopsy; repeat colonoscopy: 3 years
|
|
Q345. In Endocarditis, which two bugs are assoc with Colon CA?
|
A345. Strep Bovis;; Clostridium Septicum
|
|
Q346. Duke's Classification of Staging and Prognosis for Colon CA; (A-D and 5-year survival percent)
|
A346. A: Confined to Mucosa and Submucosa - >80%; B: Invasion of Muscularis propria - 60%; C: Local node involvement - 20%; D: Distant Mets - 3%
|
|
Q347. First step in Tx for Colon Cancer; Next?; What Dx would lead to Radiation therapy?
|
A347. 1. Surgical resection (cures 50% in stage A and B);; 2. Chemotherapy;; Radiation only for Rectal involvement
|
|
Q348. Drug regimen for Colon Cancer; (2 plus one of 2 more)
|
A348. 5-FU and Levimasole (stage B and higher); plus: Oxaliplatinum or Irinotecan
|
|
Q349. Hereditary Colon CA Syndromes; (4)*; which is the only low-moderate risk (the rest being high risk)?
|
A349. Family Has Growing Polyps:; Familial Polyposis Coli;; Hereditary Non-polyposis Colon CA;; Gardner's Syndrome;; Peutz-Jeghers Syndrome (low risk)
|
|
Q350. Definition: thousands of adenomatous polyps appear throughout the colon by age 25 and cancer hits by 40-yo. What are the genetics?
|
A350. Familial Polyposis Coli; Autosomal Dominant
|
|
Q351. Definition: condition in which 3 or more relatives of a patient and at least one first-degree relative, develops colon cancer at an early age; What are the genetics?; When and How often should a colonoscopy be performed on this individual or his/her offspring?
|
A351. Hereditary Non-Polyposis Colon CA; Autosomal Dominant; Colonoscopy: Start at age 25; repeat every 1 - 2 years
|
|
Q352. Definition: disorder characterized by polyposis coli, supernumerary teeth, osteomas and fibrous displasia of the skull and mandible; What are the genetics?
|
A352. Gardner's syndrome; Autosomal Dominant
|
|
Q353. Definition: multiple polyposis of the small intestine with multiple pigmented melanin macules in the oral mucosa or presents with freckles on lips; What other cancer is it assoc with?
|
A353. Puetz-Jeghers syndrome; assoc with: GYN Cancer
|
|
Q354. Definition: Polyposis with medulloblastoma or glioma
|
A354. Turcot's syndrome
|
|
Q355. MC complaint or presentation of Colon CA
|
A355. Intermittent Rectal Bleeding
|
|
Q356. Order of steps for resuscitation in the general approach to GI bleeds; (6)
|
A356. 1. Establish IV with (2) large-bore IV caths; 2. Evaluate for Hemodynamic instability (hypotension, tachycardia); 3. Type and cross, CBC, coag study; 4. IV fluid and blood; 5. Vasopressors if BP does not respond to aggressive fluid; 6. GI and Surgical evaluation
|
|
Q357. *When do you answer: Capsule Endoscopy?
|
A357. Procedure of choice for suspected small bowel bleeding not detected in upper or lower endoscopy
|
|
Q358. How may UGI bleeds present?; (4)
|
A358. Hematemesis;; Coffee ground emesis;; Melena;; Hematochezia (BRBPR)
|
|
Q359. How may a LGI bleed present?; (2)
|
A359. Hematochezia (BRBPR);; Melena
|
|
Q360. Etiology of UGI bleed; (5)*
|
A360. Mallory's Vices Gave (her) An Ulcer:; Mallory-Weiss tear;; Varices;; Gastritis;; Arteriovenous Malformation;; Ulcer (peptic)
|
|
Q361. Dx tests for UGI or LGI (same tests); (6)
|
A361. Gastric Lavage;; Rectal exam;; CBC;; Endoscopy;; Bleeding scan;; Arteriography
|
|
Q362. Test that detects active bleeding by infusing a radioactive colloid and watching it collect in the GI; When is this the correct answer?
|
A362. Bleeding Scan; correct: Next step in patient with severe GI bleeding in whom the lower endoscopy is unable to find the source.
|
|
Q363. Etiology of LGI bleed; (6)*
|
A363. Can U Cure Aunt Di's Hemorrhoids?; Cancer or Polyps;; Upper GI bleed (Rule-out);; Colitis;; Angiodysplasia;; Diverticulosis;; Hemorrhoids
|
|
Q364. What class (and drug example) of anti-diarrheal agents is contraindicated in diarrhea that is due to infectious agents?; Why?
|
A364. Opiates (Loperamide); because they promote longer contact time b/t bacteria and intestinal mucosa
|
|
Q365. By asking the Quantity of diarrhea, how can it help with the Diff Dx in relation to site of problem?
|
A365. Small bowel: Large-volume, Watery diarrhea; Large Bowel: Small-volume diarrhea
|
|
Q366. Bugs that cause Bloody Diarrhea; (5)*
|
A366. CASES:; Campylobacter;; Amoeba (E. Histolytica);; Shigella;; E.coli;; Salmonella
|
|
Q367. What is acute (<2 weeks) of diarrhea usually due to?
|
A367. Infectious etiology
|
|
Q368. What should the stool be tested for if infectious diarrhea is suspected?; (4); which must be done with 3 different bowel movements over 3 days?
|
A368. Leukocytes;; Ova and Parasites (over 3 days);; C. Difficile;; Culture
|
|
Q369. Bug Dx: patient vomits within 6 hours of eating something with mayonnaise
|
A369. Staphylococcus
|
|
Q370. Bug Dx: patient has vomiting/diarrhea after eating reheated rice from leftover Chinese food
|
A370. Bacillus Cereus
|
|
Q371. Bug Dx: patient has vomiting and severe watery diarrhea after eating shellfish
|
A371. Vibrio Cholera
|
|
Q372. Bug Dx: patient has flatulence and foul-smelling diarrhea after a camping trip; Tx?
|
A372. Giardia Lamblia; Tx: Metronidazole
|
|
Q373. Bug Dx: patient has watery diarrhea following a recent course of Antibiotics; Tx? (2)
|
A373. C. Difficile; Tx: Oral Metronidazole or Vancomycin
|
|
Q374. Bug Dx: causes diarrhea from contaminated water in third- world countries
|
A374. Vibrio Cholera
|
|
Q375. Bug Dx: causes diarrhea and is assoc with Guillian-Barre syndrome
|
A375. Campylobacter
|
|
Q376. Bug Dx: causes diarrhea and is assoc with raw eggs
|
A376. Salmonella
|
|
Q377. Bug Dx: causes diarrhea and is common in AIDS patient
|
A377. Cryptosporidium
|
|
Q378. Basic Tx for all acute diarrhea. (2); If it is due to bacteria, what is added to Tx? (2 possible); If it is Parasitic?
|
A378. All Acute Diarrhea:; 1. Rehydration and Electrolyte replacement;; 2. Anti-motility agent (AMA only if not infectious diarrhea) Bacteria:; 1. Ciprofloxacin;; 2. Bactrim (TMP-SMX) Parasite: Flagyl (Metronidazole)
|
|
Q379. (3) viral causes of Acute Diarrhea
|
A379. Rotavirus;; Norwalk virus;; CMV
|
|
Q380. (5)* Classes for the etiology of Chronic Diarrhea
|
A380. Something Old Died In Me:; Secretory;; Osmotic;; Decreased transit;; Inflammatory;; Malabsorption
|
|
Q381. If fecal pH is < 5.5, what does it suggest the cause of diarrhea is?
|
A381. Carbohydrate Malabsorption
|
|
Q382. *What is a D-Xylose Test?; What (3) diseases make it abnormal?
|
A382. D-Xylose: Test for chronic diarrhea that helps distinguish b/t malabsorption and Chronic Pancreatitis. Low levels in Urine = problem with small bowel mucosal transport. Abnormal results in:; 1. Celiac Disease; 2. Tropical Sprue; 3. Whipple's Disease
|
|
Q383. How is the Osmotic gap determined for diarrhea (equation)?; what do the results indicate?
|
A383. OG = 290 - 2(Na + K); > 50 mOsm = Osmotic component; < 50 mOsm = Secretory (or other cause)
|
|
Q384. What would a 24-hour fasting help distinguish b/t with regards to chronic diarrhea?
|
A384. Osmotic Diarrhea - resolves with fasting; Secretory Diarrhea - does not resolve with fasting
|
|
Q385. diagnostic test for ppl w + fobt
|
A385. COLONOSCOPY
|
|
Q386. most common site of distant spread in colorectal cancer
|
A386. liver
|
|
Q387. what type of polyps are considered to have malignant potential
|
A387. adenomatous polyps (villous > tubular)
|
|
Q388. features of familial polyposis syndrome
|
A388. autosomal dominant; hundreds of adenomatous polyps in colon; colon always involved, duodenum usually (90%) involved
|
|
Q389. tx for familial polyposis syndrome
|
A389. prophylactic colectomy
|
|
Q390. clinical features of gardner's syndrome
|
A390. autosomal recessive; polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts; 100% risk of colon ca
|
|
Q391. clinical features of turcot's syndrome
|
A391. autosomal recessive; polyps + cerebellar medulloblastoma or gbm
|
|
Q392. peutz-jeghers
|
A392. single or multiple hamartomas scattered through gi tract (mostly in small bowel and colon); pigmented spots around lips and oral mucosa, genitalia, palmar surfaces; low malignant potential
|
|
Q393. complications of peutz-jeghers
|
A393. intussusception or bleeding
|
|
Q394. familial juvenile polyposis coli
|
A394. rare, small risk for colorectal cancer
|
|
Q395. hereditary noNPOlyposis colorectal cancer
|
A395. no adenomatous polyps; lynch syndrome 1 and 2; early onset colorectal cancer and other cancers
|
|
Q396. #1 cause of colon obstruction in adults
|
A396. colorectal cancer
|
|
Q397. most life threatening presentation of colorectal cancer
|
A397. colonic perforation
|
|
Q398. presentation of a right sided colon tumor
|
A398. obstruction not commonly seen (lumen is wider on right); change in bowel habits is rare; MELENA is most common type of bleed
|
|
Q399. presentation of left sided colon tumor
|
A399. smaller lumen diameter, so can present with obstruction, alternating constipation and diarrhea; narrowing of stools; HEMATOCHEZIA
|
|
Q400. which side of colon is melena more common in?; hematochezia?
|
A400. right; left
|
|
Q401. most common presentation of rectal cancer
|
A401. hematochezia
|
|
Q402. when should CEA levels be obtained in colorectal cancer
|
A402. before surgery
|
|
Q403. use of radiation tx in colorectal cancer
|
A403. used in rectal ca but not in colon ca
|
|
Q404. frequency of colonoscopies in patients with history of colorectal cancer
|
A404. colonoscopy at 1 yr, then q3y
|
|
Q405. in addition to colonoscopy, what other f/u is required in patients with colorectal cancer
|
A405. CT scan of abdomen and pelvic; CXR; do these for up to 5 yrs; check CEA q 3-6 months
|
|
Q406. recurrence rate of colorectal cancer
|
A406. 90% within 3 yrs of surgery
|
|
Q407. what types of polyps are associated with UC
|
A407. pseudopolyps
|
|
Q408. pathogenesis of diverticuli
|
A408. outpouching at area of weakness in colon wall, which is at the site of a bv penetration --> bleeding
|
|
Q409. risk factors for diverticulosis
|
A409. constipation increases intralumenal pressure; family history
|
|
Q410. #1 location of diverticuli
|
A410. sigmoid colon
|
|
Q411. test of choice for diverticulosis
|
A411. barium enema
|
|
Q412. tx of diverticulosis
|
A412. high fiber food to increase stool bulk psyllium
|
|
Q413. complications of diverticulosis
|
A413. painless rectal bleeding; diverticulitis
|
|
Q414. complications of diverticulitis
|
A414. bowel obstruction; fistula; abscess
|
|
Q415. how to manage bleeding in diverticulosis
|
A415. usually stops on its own - no tx for these patients; if it continues, then colonoscopy should be performed to locate site of bleeding, if persistent or recurrent, surgery may be needed
|
|
Q416. dx of diverticulitis
|
A416. ct abdomen and pelvis; abdominal XR to rule out other causes, ileus, obstruction, and perforation
|
|
Q417. tx of diverticulitis for first episode
|
A417. NPO; antibiotics; surgery may be necessary if persists x 3-4 days
|
|
Q418. examples of angiodysplasia of the colon
|
A418. AV malformation; vascular ectasia
|
|
Q419. dx of angiodysplasia of the colon
|
A419. colonoscopy
|
|
Q420. tx of angiodysplasia of the colon
|
A420. colonoscopic coagulation; if bleeding persists, right hemicolectomy (cecum is most common location)
|
|
Q421. types of acute mesenteric ischemia; which is most common
|
A421. arterial embolism *; venous thrombosis (rarest); arterial thrombosis; nonoclusive mesenteric ischemia
|
|
Q422. random association with angiodysplasia of the colon
|
A422. aortic stenosis
|
|
Q423. clinical history of patient with mesenteric arterial thrombosis
|
A423. patients with history of atherosclerotic disease at other sites; acute occlusion occurs over preexisting atherosclerotic disease (acute event can be a decrease in CO or plaque rupture); collateral circulation has usually developed; SYMPTOMS are gradual and less severe than embolic causes
|
|
Q424. clinical history of a patient with nonocclusive mesenteric ischemia
|
A424. splanchnic vasoconstriction secondary to low CO; typically seen in elderly
|
|
Q425. overall mortality of all causes of acute mesenteric ischemia
|
A425. 60%
|
|
Q426. presentation of patient with venous thrombosis as a cause for mesenteric ischemia
|
A426. symptoms may be present for several days or weeks with gradual worsening
|
|
Q427. clinical feature of acute mesenteric ischemia
|
A427. severe abdominal pain disproportionate to physical findings
|
|
Q428. complications of acute mesenteric ischemia
|
A428. peritonitis; sepsis; shock
|
|
Q429. dx of acute mesenteric ischemia
|
A429. mesenteric angiography; plain film of abdomen to rule out other causes
|
|
Q430. tx of acute mesenteric ischemia
|
A430. IVF; broad spectrum antibiotics; papaverine (vasodilator) into superior mesenteric artery during arteriograph to relieve occlusion and vasospasm; direct infusion of thromboloytics in patients with embolism; heparin for venous thrombosis
|
|
Q431. signs of intestinal infarction
|
A431. hypotension, tachycardia, tachypnea, lactic acidosis, fever, change in ms, shock; CHECK LACTATE LEVEL
|
|
Q432. causes of chronic mesenteric ischemia
|
A432. atherosclerotic occlusive disease of celial artery and sma, ima
|
|
Q433. symptoms of chronic mesenteric ischemia
|
A433. abdominal angina (postprandially)
|
|
Q434. tx of chronic mesenteric ischemia
|
A434. surgical revasularization
|
|
Q435. tx of ogilvie's syndrome
|
A435. decompression with gentle enemas or ng suction; if not, colonoscopic decompression; surgical decompression is last resort
|
|
Q436. complication of pseudomembranous colitis
|
A436. toxic megacolon with risk of perforation; amasarca; electrolyte disturbances
|
|
Q437. tx of pseudomembranous colitis
|
A437. metronidazole; (oral vancomycin if metronidazole is contraindicated - infants and pregnancy)
|
|
Q438. most common cause of upper GI bleeding
|
A438. pud (duodenal ulcer, gastric ulcer, gastritis)
|
|
Q439. pertinent history in a patient with aorticoenteric fistula
|
A439. distant history of aortic graft surgery, in a patient with a small GI bleed, involving the duodenum; massive, fatal hemorrhage occurs hours to weeks later
|
|
Q440. tx of aortoenteric fistula
|
A440. endoscopy or surgery
|
|
Q441. where is the bleeding from? test to order?; hematemesis
|
A441. Upper GI; endoscopy
|
|
Q442. where is the bleeding from? test to order?; hematochezia
|
A442. Lower GI; first rule out hemorrhoids; colonoscopy
|
|
Q443. where is the bleeding from? test to order?; melena
|
A443. Upper GI or right side of colon; do endoscopy first, if negative, do colonoscopy
|
|
Q444. where is the bleeding from? test to order?; occult blood
|
A444. Lower GI; colonoscopy; upper endoscopy if colonoscopy is -
|
|
Q445. type of pain: vague, dull, poorly localized, usually midline due to bilateral innervation of organs based on embryologic origin
|
A445. Visceral Pain; (Visceral is Vague); ex: early appendicitis
|
|
Q446. type of Pain: sharp, well-localized and involves the peritoneum and is associated with rebound and guarding
|
A446. Parietal Pain (Parietal is PiNPOint); ex: late appendicitis
|
|
Q447. Referred pain: Ureteral obstruction in man
|
A447. Ipsilateral testicle
|
|
Q448. Dx: 45-yo obese woman complains of fever, RUQ pain and nausea that worsens when she eats fatty foods
|
A448. Cholecystitis
|
|
Q449. Diff Dx: Epigastric Pain; GI (3); Pancreatic (2); Aortic (2); Cardiac (3)
|
A449. Gastritis; Peptic Ulcer; GERD; Acute/Chronic Pancreatitis; Ruptured Aortic Aneurysm; Dissecting Aorta; Angina, MI, Pericarditis
|
|
Q450. Diff Dx: RUQ Pain; Hepatobiliary (4); GI (1)
|
A450. Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis; Peptic Ulcer
|
|
Q451. Diff Dx: LUQ Pain; Splenic (5); GI (1)
|
A451. Spleen trauma; infarction; abscess; rupture; Mononucleosis; Gastric Ulcer
|
|
Q452. Diff Dx: RLQ Pain; GI (3)
|
A452. Small bowel obstruction;; Appendicitis;; Crohn's Disease
|
|
Q453. Diff Dx: LLQ Pain; GI (2)
|
A453. Inflammatory Bowel Disease;; Diverticulitis
|
|
Q454. Diff Dx: Flank Pain; GU (5)
|
A454. NET PP:; Nephrolithiasis;; Epididymitis;; Testicular Torsion;; Pyelonephritis;; Prostatitis
|
|
Q455. Diff Dx Pain: Adnexal (lower abdominal) Pain; (6)
|
A455. PET SOCk:; PID;; Ectopic Pregnancy;; Tubo-ovarian abscess;; Salpingitis;; Ovarian torsion;; Cystitis
|
|
Q456. Dx: 26-yo woman has severe LLQ pain, vaginal bleeding and light-headedness. Last menstrual period was 6 weeks ago
|
A456. Ectopic Pregnancy
|
|
Q457. Diff Dx: Pain Anywhere in Abdomen; (4)
|
A457. Strangulated hernia;; Large Bowel Obstruction;; Sigmoid Volvulus;; Mesenteric Ischemia
|
|
Q458. Dx: 28-yo woman presents with diffuse abdominal pain, nausea, and confusion. She is not pregnant but takes a stained-glass class.
|
A458. Lead poisoning
|
|
Q459. Diff Dx: Abdominal wall Pain; (2)
|
A459. Hernia; Rectus sheath hematoma
|
|
Q460. Diff Dx: Metabolic/genetic-related Abdominal pain; (4)
|
A460. HyperC;; Acute Intermittent Porphyria;; DKA;; Sickle cell
|
|
Q461. Diff Dx: Viral-related Abdominal Pain; (3)
|
A461. Herpes Zoster;; Mononucleosis;; HIV
|
|
Q462. Diff Dx: Toxin-related Abdominal Pain; (2)
|
A462. Heavy Metal poisoning; Black Widow Spider venom
|
|
Q463. (3) vascular causes of abdominal pain to always consider in the elderly
|
A463. MAM:; Mesenteric Ischemia;; AAA;; MI
|
|
Q464. Diff Dx of an emergency patient with absent bowel sounds (3) or high-pitched sounds (1)
|
A464. Absent: Pancreatitis;; Ischemia;; Acute Abdomen; High-pitched: Obstruction
|
|
Q465. 63-yo obese man complains of pain in his "kidney" for 3 days. He has History of MI x 2 and no back tenderness.
|
A465. AAA
|
|
Q466. Dx: hypotension; abdominal or back pain; pulsatile mass in abdomen; History of vascular disease or atherosclerosis
|
A466. AAA
|
|
Q467. (3) Dx tests for AAA
|
A467. Angiogram (gold standard); MRI or CT with contrast
|
|
Q468. Dx: 72-yo man with History of A-fib, on digoxin and complains of severe abdominal pain out of proportion to the exam
|
A468. Acute Mesenteric Ischemia
|
|
Q469. 72-yo woman with History of MI complains of gnawing abdominal pain after eating. She lost 15 pounds in the past month.
|
A469. Chronic Mesenteric Ischemia
|
|
Q470. Cause of Acute (2) vs. Chronic Mesenteric Ischemia
|
A470. Acute: Emboli (A-fib); Hypercoagulability; Chronic: Atherosclerosis
|
|
Q471. (2) possible lab signs with Mesenteric Ischemia
|
A471. Increased Lactate; Metabolic Acidosis
|
|
Q472. Gold standard test for Mesenteric Ischemia; (2) others
|
A472. Gold standard: Angiogram; others: Spiral CT with contrast, MRI
|
|
Q473. First step for Mesenteric Ischemia; Next?
|
A473. First: Maintain tissue perfusion with IV fluids until... Surgical bypass
|
|
Q474. Cholelithiasis -; Colic results from what?; Risk factors
|
A474. Colic from transient cystic duct blockage. Risk factors - female, fat, forty, fertile.
|
|
Q475. Cholelithiasis; 3 types
|
A475. 1. Cholesterol (80%) - originate from gallbladder; risk factors: obesity, rapid weight loss, Crohn's, CF, estrogens, Native Americans 2. Pigment - originate from common bile duct, calcium bilirubinate; risk factors: chronic hemolysis, biliary infections, alcohol abuse, cirrhosis 3. Mixed
|
|
Q476. Cholelithiasis - History/PE
|
A476. Postprandial abdominal pain; RUQ pain; radiates to rt. subscapular or epigastrium (can be asymptomatic); n/v; fatty food intolerance; dyspepsia; flatus; RUQ tenderness
|
|
Q477. Cholelithiasis - Diagnosis
|
A477. not XR - only 15% radiopaque; RUQ US
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Q478. Cholelithiasis - Tx
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A478. Cholecystectomy with Symptoms; ERCP - common bile duct stones; dietary modification; UDCA - if don't want surgery, effective in noncalcified cholesterol stones < 5 mm
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Q479. Cholelithasis - Complications
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A479. recurrent biliary colic; acute cholecystitis; choledocholithiasis; acute cholangitis; gallstone ileus; gallstone pancreatitis; carcinoma of the gallbladder
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Q480. Acute Cholecystitis; Results from what; Leads to what
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A480. Prolonged obstruction of cystic duct (usually stone); Distention, inflammation, infection, gangrenous, acalculous; Acalculous - in absence of cholelithiasis in TPN, trauma, burn patients.
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Q481. Acute Cholecystitis; History/PE
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A481. RUQ pain; n/v; low-grade fever; Murphy's sign
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Q482. Acute Cholecystitis; Dx
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A482. US; HIDA scan; CBC; amylase, lipase; bilirubin; LFT
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Q483. Acute Cholecystitis; Tx
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A483. IV Antibiotics; IV fluids; replete electrolytes; early cholecystectomy; preop ERCP; intraop cholangiogram
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Q484. Acute Cholecystitis; Complications
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A484. gangrene; abscess; perforation; empyema; sepsis; gallstone ileus; fistulization
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Q485. Choledocholithiasis - Results from what
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A485. gallstones in the COMMON BILIARY DUCT
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Q486. Choledocholithiasis - History/PE
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A486. biliary pain; jaundice; colic; fever; pancreatitis
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Q487. Choledocholithiasis - Dx
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A487. Increased alkaline phosphatase and total bili
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Q488. Choledocholithiasis - Tx
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A488. ERCP with stone extraction and sphincterotomy; cholecystectomy
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Q489. Acute Cholangitis; Results from what; Leads to what
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A489. Acute bacterial infection of biliary tree - from primary sclerosing cholangitis or obstruction (gallstones) as obstruction persists (usu from choledocholelith.); increased in intraluminal pressure --> reflux of bacteria to systemic circulation; Charcot's triad => Reynolds' pentad
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Q490. Acute Cholangitis; Bacteria
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A490. E Coli; Pseudomonas; Enterobacter
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Q491. Acute Cholangitis; History/PE
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A491. Charcot's triad; Reynold's pentad
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Q492. Acute Cholangitis; What is Reynold's pentad and what does it suggest
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A492. RUQ pain; jaundice; fever/chills; shock; altered mental status; suggests sepsis
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Q493. Acute Cholangitis; Dx
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A493. leukocytosis; increased alkaline phosphatase and bili; BC (to rule out sepsis); US or CT - may be useful; ERCP
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Q494. Acute Cholangitis; Tx
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A494. ICU; IV Antibiotics; IV hydration; bile duct decompression - open surgical, percutan transhepatic drain or ERCP sphincterotomy
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Q495. Diarrhea; What is it; Risk factors
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A495. > 200 gm feces/day, change in stool consistency; viral/bact. GI infection; systemic infection; sick contacts; immunosuppression; recent Antibiotics use; recent travel
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Q496. Diarrhea - What are the types (1)
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A496. Acute - < 2 wks of Symptom, infectious and self-limited, 2nd MCC - drug side effect chronic - > 2-3 wks of Symptom, disrupted secretion, malabsorption, altered motility; MCC in adults - lactase def. pediatric - usually rotavirus; can also divide as infectious, secretory, osmotic
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Q497. What are Infectious Diarrhea
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A497. - enterotoxigenic: E. coli (traveller's diarrhea); enteroinvasive: bloody diarrhea & fever; campylobacter -MC bacteria to cause diarrhea, MCC of reactive arthritis; shigella - transferred by food & water, found in daycare; salmonella - raw eggs & dairy; V. vulnificus: severe if have liver dis. Yersinia: abdominal pain, joint pain, rash, may resemble appendicitis; E. coli O157:H7, HUS; viral: MCC of infectious diarrhea
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Q498. What are secretory & osmotic diarrhea
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A498. Secretory: diarrhea > 1L; carcinoid syndrome; Zollinger-Ellison syndrome; VIPoma; phenolphthalein (laxative) osmotic - > 50 osmol/kg osmolality; lactose, fructose, sorbitol; MCC - lactase def.
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Q499. Diarrhea - Dx
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A499. - stool electrolytes - secretory vs. osmotic; fecal leukocytes – enteroinvasive, IBD; methylene blue - checks for WBC; stool Cx, O&P; giardia - string test & stool giardia Ag; cryptosporidia - modified AFB stain; NaOH - turns stool red if phenolphthalein use; colonoscopy or Biopsy
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Q500. Diarrhea - Tx
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A500. infectious - self-limited; mild - oral fluids & electrolytes; severe - IV fluids & oral Antibiotics, initial empiric- ciprofloxacin; invasive - TMP-SMX or ciprofloxacin; giardia - metro; c. diff - metro; campylobacter - erythromycin; scombroid - antihistamine; cryptosporidium - control underlying HIV with antiretrovirals
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Q501. IBS - What is it
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A501. abdominal pain; changes in bowel habits; increased with stress; relieved by BM; 1/2 of patients. have comorbid psych disorders
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Q502. IBS - History/PE
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A502. Symptoms for at least 3 mos. usually absent at night; abdominal pain; change in bowel habits; abdominal distention; stools with mucus; relief of pain with a BM
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Q503. IBS - Dx
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A503. Dx of exclusion; rule out - lactose intolerance, IBD, hypo- or hyperthyroidism; always flexible sigmoidoscopy if patient > 40 y/o
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Q504. IBS - Tx
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A504. fiber supplements; TCAs, antidiarrheals, antispasmodics; tegaserod - constipation-predominant.
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Q505. SMALL BOWEL OBSTRUCTION - History/PE
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A505. cramping - crescendo-descrendo every 5-10 min. vomiting: bilious – early, feculent - distal; partial obstruction - flatus, no stool; complete obstruction - no flatus or stool; T/D (accumulation of gas and fluid); prior surgical scars; high-pitched tinkles; peristaltic rushes; later, peristalsis disappears
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Q506. SMALL BOWEL OBSTRUCTION - Causes
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A506. adhesions from prior abdom; surgery (60%); hernias; neoplasms; intussusception; gallstone ileus; stricture from IBD; volvulus; CF
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Q507. SMALL BOWEL OBSTRUCTION - Dx
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A507. - leukocytosis - if strangulation; dehydration (vomiting); metab. alkalosis (vomiting); lactic acidosis - if necrotic bowel; need emergency surgery; radiopaque in cecum - gallstone ileus; XR - stepladder pattern; air-fluid levels
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Q508. SMALL BOWEL OBSTRUCTION - Tx
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A508. partial -, NPO, NG suction, IV hydration, correct electrolytes, Foley; surgery if complete obstruction, necrotic bowel, Symptom > 3D with no resolution; exploratory laparotomy
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Q509. Ileus; what is it; Risk factors
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A509. temp arrest of intestinal peristalsis Risk factors; recent surgery/GI procedures; immobility; hypokalemia; hypothyroidism; DM; meds (anticholinergics, opioids); After every abdominal operation for 24-48 hours Due to - sympathetic overeaction, bowel manipulation, K+ depletion (preop vomiting), peritoneal irritation from blood or peritonitis, atony of colon & stomach
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Q510. Ileus - History/PE
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A510. abdominal discomfort; n/v; no flatus or BM; abdominal distention; decreased or no bowel sounds; rectal exam if elderly to rule out fecal impaction
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Q511. Ileus - Dx
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A511. AXR - distended loops, air-fluid levels (upright); gastrografin - rule out partial obstruction; CT - rule out neoplasm
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Q512. Ileus - Tx
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A512. decrease meds that reduce; bowel motility; decrease/discont. oral feeds; NG suction; parenteral feeds; replete electrolytes
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Q513. Carcinoid Syndrome - What causes it
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A513. Carcinoid tumors; neuroendrocrine cells; enterochromaffin cells; usually from ileum, appendix
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Q514. Carcinoid Syndrome - What do they secrete
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A514. serotonin; tryptophan; tachykinin (substance P); ACTH, gastrin; secrete high levels => depletion of tryptophan => pellagra (niacin def.); levels do not get metabolized by liver due to liver mets; MC found incidentally during appendectomy
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Q515. Carcinoid Syndrome - History/PE
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A515. flushing; diarrhea; wheezing; right-sided valvular disease
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Q516. Carcinoid Syndrome - Dx
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A516. high urine levels of 5-HIAA - diagnostic; chest and abdominal CT
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Q517. Carcinoid Syndrome - Tx
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A517. octreotide (for symptoms); surgery
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Q518. Diverticular Disease - What is it
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A518. Outpouching of mucosa and submucosa that herniate in areas of high intraluminal pressure; common in sigmoid colon; MCC of acute lower GI bleeding in patients. > 40
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Q519. Diverticular Disease - Risk factors
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A519. low-fiber and high-fat diet; advanced age; connective tissue disorders (Ehlers-Danlos, Marfans)
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Q520. Diverticular Disease - History/PE
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A520. LLQ abdominal pain; abnormal bowel habits; bleeding painless and sudden; usually hematochezia; Symptom of anemia
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Q521. Diverticulitis - PE
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A521. LLQ pain; fever; n/v; perforation - complication
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Q522. Diverticular Disease - Dx
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A522. CBC (leukocytosis); AXR; colonoscopy or barium enema; avoid invasive techniques in early diverticulitis - risk of perforation; CT - check for abscess, free air after acute episode if >50 y/o; flexible sigmoidoscopy (rule out perforating colon cancer)
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Q523. Diverticular Disease - Tx for uncomplicated disease
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A523. high-fiber diet
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Q524. Diverticular Disease - Tx for bleeding
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A524. bleeding usually stops spontaneously; transfuse and hydrate; if bleeding doesn't stop - angiography with embolization; surgery
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Q525. Diverticular Disease - Tx for diverticulitis
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A525. NPO; NGT; metro and fluoroquinolone or cephalosporin if perforation - resect; anastomosis or temp colostomy
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Q526. LOWER BOWEL OBSTRUCTION - History
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A526. constipation; cramping abdominal pain; n/v; feculent vomiting; tenderness; significant distention; tympany; high-pitched tinkly BS; later, no BS
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Q527. LOWER BOWEL OBSTRUCTION - Causes
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A527. colon cancer; benign tumors; diverticulitis; volvulus; fecal impaction; assume colon ca until proven otherwise
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Q528. LOWER BOWEL OBSTRUCTION - Tx
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A528. tx obstruction with - gastrograffin enema; colonoscopy; rectal tube; surgery usually needed; tx underlying cause
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Q529. Colon and Rectal Cancer - History/PE
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A529. presents with symptom after long period of silent growth; abdominal pain and symptom based on location; right-sided lesion - stool is liquid, ca can get large before symptom, lesions commonly ulcerate => chronic blood loss, can bleed intermittently; left-sided lesion - stool more concentrated, apple-core lesions; rectal – BRBPR, rectal pain, can coexist with hemorrhoids, so rule out in all patients with rectal bleeding
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Q530. Colon and Rectal Cancer - Dx
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A530. CBC (anemia); guiac; sigmoidoscopy - left; colonoscopy/barium enema - right; US (how much invaded); CT/MRI (to stage); CXR, LFT, abdominal CT - metas
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Q531. Colon and Rectal Cancer - How does mets spread
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A531. direct; hematogenous - liver primary; lymphatic -pelvic lymph nodes
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Q532. Colon and Rectal Cancer - Tx
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A532. bowel prep - Golytely, Antibiotics; colon - resect colon, lymph, mesentery, anastomosis; rectum - if < 10cm from anal verge, abdominoperineal resection, rectum and anus resected, permanent colostomy; if > 10cm, low anterior resection, anastomosis between colon & rectum; wide local excise - low stage; also chemo - colon with nodes; also radiation - rectum; Followup with CEA, colonoscopy, LFTs, CXR, abdominal CT Duke classification; surgery - stages A&B; stages C1 & C2 - surgery and chemo, 5-FU and leucovorin
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Q533. Colon and Rectal Cancer - Risk factors
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A533. age; hereditary - FAP, Gardner's, HNPCC; APC gene, p54; Strep bovis bacteremia; family History; UC; adenomatous polyps; past History of colorectal ca; high-fat, low-fiber diet
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Q534. Colon and Rectal Cancer - Screening
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A534. DRE yearly > 50 y/o; guaiac yearly > 50 y/o; colonoscopy every 10 yrs > 50 or sigmoidoscopy every 3-5 > 50 or colonoscopy every 10 yrs > 40 with family history of ca/polyp or 10 yrs prior to age of dx of youngest family member with colorectal ca
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Q535. Dysphagia - What is it
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A535. Difficulty swallowing due to abnormalities of the oropharynx or esophagus.
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Q536. Odynophagia - What is it
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A536. Pain with swallowing due to abnormalities of the oropharynx or esophagus.
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Q537. Dysphagia; Etiologic factors; (Caused by)
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A537. Achalasia; peptic stricture; esophageal webs or rings; carcinoma; Scleroderma; spastic motility disorders; Sjogren's; meds; radiation injury
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Q538. Dysphagia - PE
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A538. examine for masses (goiter, tumor); examine for anatomical defects
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Q539. Dysphagia - Dx
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A539. oropharyngeal - cine-esophagram; esophageal - barium swallow then endoscopy, manometry, pH monitoring; odynophagia - upper endoscopy
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Q540. Dysphagia; Tx; Tx for Achalasia
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A540. Etiology dependent; achalasia - botulinum toxin, calcium channel blockers, balloon dilatation; all 3 temporizing measures; esophageal myotomy for long-term tx
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Q541. Esophageal Cancer - What is it
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A541. squamous cell ca – midesophagus from smoking and alcohol, can develop fistulas to bronchi; adenocarcinoma - barrett's esophagus, columnar metaplasia replaces squamous distal esophagus, secondary to chronic GERD
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Q542. Esophageal Cancer - Risk factors
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A542. achalasia; barrett's; cigarettes; etoh; webs; male gender
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Q543. Esophageal Cancer - History/PE
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A543. progressive dysphagia - first solids then liquids; weight loss; GERD; GI bleeding; vomiting
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Q544. Esophageal Cancer - Dx
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A544. barium swallow 1st; EGD; biopsy – confirm; (MRI/CT - evaluate for mets)
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Q545. Esophageal Cancer - Tx
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A545. surgery if local; metastatic - cisplatin, 5-FU & radiation; chemoradiation - poor prognosis; esophageal stent - palliation
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Q546. GERD - What is it
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A546. transient LES relaxation from; incompetent LES; gastroparesis; hiatal hernia
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Q547. GERD - Risk factors
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A547. increased intra-abdominal pressure (obesity, pregnancy); scleroderma; alcohol; caffeine; nicotine; chocolate; fatty foods
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Q548. GERD - History/PE
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A548. heartburn 30-90 min post meal; pain worse with reclining; pain better with antacids,; sitting, standing; sour taste ("water brash")
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Q549. GERD - Dx
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A549. Based largely on History; confirm - respond to Tx; 24hr pH monitor- gold standard; Bernstein test - confirms origin of pain
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Q550. GERD - Tx
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A550. - lifestyle - weight loss, head-of-bed elevation, stop eating 3 hrs before bed, eat small meals; monitor for barretts/adenoca, serial EGD, Biopsy; antacids - if intermittent; H2 blockers and PPI; surgery - nissen fundoplication
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Q551. GERD - Complications
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A551. esophageal ulceration; esophageal stricture; aspiration of gastric content; upper GI bleeding; Barrett's - when to do EGD, no dysplasia - every 2-5 yrs. low-grade - every 3-6 mos. high-grade - resection
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Q552. Hiatal Hernia - What are types
|
A552. sliding - gastroesophageal junction and part of stomach above diaphragm due to weakening of anchors of ge junction to diaphragm, longitudinal contractions of diaphragm increased intra-abdominal pressure; paraesophageal - ge junction below diaphragm, part of fundus herniates
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Q553. Hiatal Hernia - History/PE
|
A553. May be asymptomatic; with sliding, may have GERD
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Q554. Hiatal Hernia - Dx
|
A554. CXR (incidental finding); barium swallow; EGD
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Q555. Hiatal Hernia - Tx
|
A555. sliding - lifestyle changes; paraesoph - gastropexy
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Q556. Gastritis - What are types
|
A556. Erosive (acute) - rapidly developing conditions that erode mucosa, NSAIDs, alcohol, H pylori, stress from severe illness (burns, CNS injury); hemorrhagic gastritis; alkaline gastritis; reflux gastritis chronic; type A - (10%), autoab to parietal cells, pernicious anemia, achlorhydria, increased risk of gastric ca. fundus, G cells in antrum, G cells make gastrin, gastrin stim acid secretion => hypergastrinemia; type B - (90%), H pylori, increased risk of gastric ca, antrum
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Q557. Gastritis - History/PE
|
A557. may be asymptomatic; n/v; indigestion; hematemesis; melena
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Q558. Gastritis - Dx
|
A558. Upper endoscopy; Type B - must confirm H. pylori, antral Biopsy - gold standard, CLO test, urease breath test, serum IgG – ELISA to confirm or rule out; only shows exposure (H pylori stool Ag)
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Q559. Gastritis - Tx
|
A559. Erosive - same as for PUD; type A - need B12 for life; type B - must eradicate H. py; Decreased offending agents; antacids; sucralfate; H2 blockers; PPIs; triple therapy to tx H pylori infection: clarithromycin, amoxicillin (or metro), PPI; quadruple therapy: bismuth, metro, tetracycline, PPI or H2 blocker
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Q560. Gastric Ca - What are the types
|
A560. 2 types of adenocarcinoma; intestinal: metaplasia of mucosa by intestinal-type cells, ulcerates, pyloric antrum & lesser curvature, high in Japan, risk factors - diet high in nitrites, salt, low veggies, H pylori, chronic gastritis; diffuse - younger patients, develop throughout stomach, linitis plastica - poorer prognosis
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Q561. Gastric Ca - History/PE
|
A561. advanced cases:; abdominal pain; early satiety; weight loss; 5-yr survival < 10%; mets - Virchow's node, Krukenberg's tumor, Sister Mary Joseph nodule
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Q562. Gastric Ca - Dx
|
A562. early - asymp, superficial,; surgically curable; endoscopy
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Q563. Gastric Ca - Tx
|
A563. must have early detection and removal of tumor
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Q564. PUD - What are types
|
A564. Gastric: pain greater with meals, weight loss, H pylori 70%, NSAIDs decreased mucosal protection; duodenal: pain init. decreased with food or antacids, worsens in 2-3 hrs, can radiate to back, nocturnal pain, 100% H pylori, increased acid secretion
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Q565. PUD - Risk factors
|
A565. duodenal - O blood type, men, MEN I, other risk factors – corticosteroids, NSAIDs, alcohol, tobacco, Curling ulcers, Cushing ulcers; corrosives – acids, strong alkali (lye, NaOH)
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Q566. PUD - History/PE
|
A566. nausea; hematemesis; coffee-ground emesis; melena or hematochezia; epigastric tenderness; if acute perforation - rebound tenderness, guarding; NSAID-associated -, GI hemorrhage & perforation; gastric - n/v, don't improve with antacids & H2-blockers; duodenal - no n/v, wake up in middle of night
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Q567. PUD - Dx
|
A567. Upper endoscopy with Biopsy or barium swallow; then must test for H pylori - invasive: culture, histology, urease; noninvasive: urease breath test, serum IgG, stool Ag test
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Q568. PUD - Tx
|
A568. For H. pylori - 2 wks of combination Tx; 2 Antibiotics and bismuth, H2 blocker or PPI: BMT (bismuth, metro and tetracycline); Prevpac (2 Antibiotics & PPI) - prepacked; Helidac (2 Antibiotics & bismuth) - prepacked; for NSAID-induced - H2 blocker or PPI; misoprostol - for prevention
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Q569. PUD - Complications
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A569. "HOPI"; Hemorrhage - posterior ulcers erode into gastroduodenal artery; obstruction (gastric outlet); perforation - anterior ulcer; intractable pain; long-term effects of H. pylori; PUD; MALT; chronic superficial gastritis; chronic atrophic gastritis => cancer
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Q570. ZE Syndrome - What is it
|
A570. Gastrin-producing tumors; mainly in head of pancreas; can also be in duodenum, stomach or spleen; 60% are malignant => oversecretion of gastrin => high levels of HCl (from the parietal cells) => ulcers in stomach, duoden. associated with MEN I
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Q571. ZE Syndrome - History/PE
|
A571. Gnawing, burning abdominal pain; n/v; diarrhea; weakness; GI bleeding; most common presentation - PUD & diarrhea or steatorrhea; if hypercalcemia - associated with MEN I
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Q572. ZE Syndrome - Dx
|
A572. measure serum gastrin - increased gastrin levels; stop PPIs before testing; abnormal IV secretin confirms
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Q573. ZE Syndrome - Tx
|
A573. Surgical resection if mets at presentation; (30-50%) - PPIs
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Q574. Upper GI Bleeding - History/PE
|
A574. hematemesis - bright red or coffee-brown, melena; possible iron def. anemia; increased BUN; depleted volume status – tachy, light-headedness, orthostatic hypotension
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Q575. Upper GI Bleeding - Dx
|
A575. NGT and lavage; endoscopy - 1st test; clinical History
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Q576. Upper GI Bleeding - Common Causes
|
A576. gastritis; PUD; Mallory-Weiss tear; esophageal varices; vascular abnormalities; neoplasm; esophagitis; gastric erosions
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Q577. Upper GI Bleeding - Initial Tx
|
A577. protect airway (intubation); IV fluids; transfusion
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Q578. Upper GI Bleeding - Long-term management
|
A578. tx underlying cause; PUD - IV PPI; endoscopic tx for varices - bipolar electrocoagulation, injection therapy, octreotide, sclerotherapy, band ligation
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Q579. Lower GI Bleeding - History/PE
|
A579. hematochezia > melena
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Q580. Lower GI Bleeding - Dx
|
A580. anoscopy,; flexible sigmoidoscopy or colonoscopy; bleeding scan; NG lavage negative, rule out upper GI bleed - if pos. stool and neg. colonoscopy
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Q581. Lower GI Bleeding - Common Causes
|
A581. diverticulosis- MCC in elderly; hemorrhoids - MCC in young; angiodysplasia (AVM); neoplasm; IBD; anorectal disease; mesenteric ischemia; Meckel's; infectious
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Q582. Lower GI Bleeding - Initial Tx
|
A582. protect airway (intubation); IV fluids; transfusion
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Q583. Lower GI Bleeding - Long-term management
|
A583. endoscopic therapy: bipolar electrocoagulation, injection therapy; angiography; surgery
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Q584. ULCERATIVE COLITIS; Prevalence; Site of involvement
|
A584. Prevalence higher than Crohn's; bimodal; starts at rectum then upwards; continuous mucosa and submucosa; granular mucosa; pseudopolyps
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Q585. ULCERATIVE COLITIS - History/PE
|
A585. bloody diarrhea; pus; lower abdominal cramps
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Q586. ULCERATIVE COLITIS - Extraintestinal manifestations
|
A586. pyoderma gangrenosum; primary sclerosing cholangitis; colorectal ca; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum
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Q587. ULCERATIVE COLITIS - Dx
|
A587. CBC; AXR; stool cultures; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx
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Q588. ULCERATIVE COLITIS - Tx
|
A588. sulfasalazine; 5-ASA (mesalamine); corticosteroids; immunosuppressants; total colectomy
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Q589. Crohn's; Distribution; Site of involvement
|
A589. Bimodal; any portion of GI tract; usually terminal ileum,; small intestine and colon; cobblestone (skip) lesions; transmural
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Q590. Crohn's - History/PE
|
A590. watery diarrhea (most common); (bloody diarrhea only if rectum involved); abdominal pain; fistulas beteween bowel & bladder or bowel & skin; noncaseating granulomas
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Q591. Crohn's - Extraintestinal manifestations
|
A591. pyoderma gangrenosum; primary sclerosing cholangitis; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum; *nephrolithiasis*
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Q592. Crohn's - Dx
|
A592. CBC; AXR; stool culture; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx
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Q593. Crohn's - Tx
|
A593. mesalamine; sulfasalazine not as effective; corticosteroids; immunosuppressants - 6-mercaptopurine, azathioprine; infliximab; metro - for fistulas; resection; may recur anywhere in GI tract (after resection)
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Q594. Inguinal Hernia - Types
|
A594. Indirect – congenital, patent processus vaginalis, internal inguinal ring => external inguinal ring => scrotum, Most common type for both genders; Direct - through floor of Hesselbach's triangle, goes direct thru abdominal wall in aponeurosis of ext. obliq, acquired defect in transversalis fascia, increased with age
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Q595. Inguinal Hernia - What is Hesselbach's triangle
|
A595. inferior epigastric artery; inguinal ligament; rectus abdominis
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Q596. Inguinal Hernia - Tx
|
A596. Surgery; Direct - also correct defect in transversalis fascia; Indirect - ligate hernia sac, reduce size of internal inguinal ring
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Q597. Portal Hypertension - Definition
|
A597. Portal vein pressure > 5 mmHg greater than the pressure in the IVC
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Q598. Portal Hypertension - Causes
|
A598. Presinusoidal - splenic or portal vein thrombosis, schistosomiasis, granulomatous disease; Sinusoidal – cirrhosis, granulomatous disease; Postsinusoidal – RHF, constrictive pericarditis, Budd-Chiari syndrome, hepatic vein thrombosis
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Q599. Budd-Chiari Syndrome - Definition
|
A599. thrombotic occlusion of IVC or hepatic vein; centrilobular congestion and necrosis => congestive liver disease (hepatomegaly, ascites, abdominal pain, liver failure); from PCV, pregnancy & hepatocellular ca
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Q600. Portal Hypertension - History/PE
|
A600. History – jaundice, ascites, esophageal varices, hemorrhoids, caput medusa, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction; PE - icteric sclerae, abdominal fluid wave, shifting dullness, splenomegaly, easy bruising, spider angioma, caput medusa, palmar erythema, gynecomastia, testicular atophy
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Q601. Portal Hypertension - Dx
|
A601. LFTs; alkaline phosphatase; bilirubin; albumin; PT/PTT; serum ferritin; ceruloplasmin; a1-antitrypsin; US; increased indirect hepatic vein wedge pressure; SAAG
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Q602. Portal Hypertension; What is SAAG; SAAG > 1.1; SAAG < 1.1
|
A602. serum-ascites albumin gradient: serum albumin-ascitic albumin; SAAG > 1.1: portal HTN - increased pressure in portal v., chronic liver dis., hepatic mets; SAAG < 1.1: noNPOrtal HTN - nephrotic syndrome, TB, malignancy
|
|
Q603. Portal Hypertension - Tx for ascites
|
A603. restrict Na; diuretics; rule out infection & neoplasms; paracentesis - to get SAAG, CBC, cultures; tx underlying liver disease
|
|
Q604. Portal Hypertension; Tx for spontaneous; bacterial peritonitis
|
A604. Indolent infection of ascitic fluid; pos. if > 250 PMNs/ml or > 500 WBC, Culture and gram stain usually neg., IV 3rd gen. cephalosporin (covers Enterococcus, E. Coli or Klebsiella)
|
|
Q605. Portal Hypertension - Tx for hepatorenal syndrome
|
A605. Dx of exclusion; Hard to tx; Often requires dialysis
|
|
Q606. Portal Hypertension - Tx for hepatic encephalopathy
|
A606. Decreased protein consumption; lactulose; metronidazole
|
|
Q607. Portal Hypertension - Tx for esophageal varices
|
A607. Monitor for GI bleeding; B blockers; band ligation; sclerotherapy; or portocaval shunt
|
|
Q608. Hepatocellular Ca - Risk factors for primary
|
A608. US - cirrhosis; chronic HBV or HCV; worldwide - HBV, HCV, aflatoxin
|
|
Q609. Hepatocellular Ca - History/PE
|
A609. RUQ tenderness; abdominal distention; hepatomegaly; signs of chronic liver dis. – jaundice, easy bruisability, coagulopathy, nodular cirrhotic liver
|
|
Q610. Hepatocellular Ca - Dx
|
A610. US; CT; increased LFTs; significantly increased AFP; Biopsy - definitive Dx
|
|
Q611. Hepatocellular Ca - Tx
|
A611. early detection – resection or orthotopic liver transplant; neoadjuvant therapy - chemo and radiation to shrink large tumor before surgery; serial AFP - monitor recurrence
|
|
Q612. Hemochromatosis - What is it
|
A612. increased in int. iron absorption => too much deposited, accums in skin, pancreas, liver, heart, joints, kidney, pituitary, gonads, adrenals; primary - auto recessive; secondary - chronic transfusions, alcoholics
|
|
Q613. Hemochromatosis - History/PE
|
A613. DM; hypogonadism; arthritis; CHF; restrictive cardiomyopathy; cirrhosis; adrenal insufficiency; hypothyroidism, hypoparathyr. abdominal pain
|
|
Q614. Hemochromatosis - Dx
|
A614. Increased serum iron; increased % iron saturation; increased ferritin; decreased serum transferrin; fasting transferrin saturation > 45%; glucose intolerance; increased AST; increased alkaline phosphatase; liver Biopsy; MRI; C282Y mutation; hepatic iron index > 2.0
|
|
Q615. Hemochromatosis - Tx
|
A615. weekly phlebotomy (1-2 yrs.), then maintenance phlebotomy, every 2-4 months; deferoxamine (maintenance); liver transplant cures
|
|
Q616. Hemochromatosis - Complications
|
A616. cirrhosis; hepatocellular ca; cardiomegaly; CHF; DM; impotence; arthropathy; hypopituitarism
|
|
Q617. Wilson's Disease - What is it
|
A617. Hepatolenticular degeneration; Decreased synthesis of ceruloplasmin => too much copper deposited in liver, brain, cornea; auto recessive (chrom 13); usually presents 15-25 y/o
|
|
Q618. Wilson's Disease - History
|
A618. ABCD; asterixis; basal ganglia degenerates; ceruloplasmin decreased; copper deposited; cirrhosis => hepatocellular ca; choreiform movements (tremor); corneal deposits; dementia; 1st sign - neuro or psych; kayser-fleischer rings always accompany neuro or psych
|
|
Q619. Wilson's Disease - PE
|
A619. Kayser-Fleischer rings - copper in Descemet's membrane; jaundice; hepatomegaly; asterixis; choreiform movements
|
|
Q620. Wilson's Disease - Dx
|
A620. decreased serum ceruloplasmin; increased urinary copper excretion; elevated hepatic copper
|
|
Q621. Wilson's Disease - Tx
|
A621. dietary copper restriction; no shellfish, liver, legume; penicillamine (urine excretes); oral zinc (fecal excretion); cured by liver transplant
|
|
Q622. Acute Pancreatitis - What is it
|
A622. Leakage of pancreatic enzymes into pancreatic and peripancreatic tissue.
|
|
Q623. Acute Pancreatitis - Risk factors
|
A623. GET SMASHeD; gallstones; ethanol; trauma; steroids; mumps; autoimmune dis. scorpion sting; hyperlipidemia; hypercalcemia; drugs (thiazide)
|
|
Q624. Acute Pancreatitis - History/PE
|
A624. Severe epigastric pain; radiates to the back; cullen's (periumbilical); grey-turner (flank)
|
|
Q625. Acute Pancreatitis - Dx
|
A625. Increased amylase - but amylase can read normal if hypertriglyceridemia; increased lipase - more specific; decreased calcium (fat necrosis); "sentinel loop" on AXR; "colon cutoff" on AXR; US or CT - enlarged pancreas, pseudocysts, abscess, hemorrhage, necrosis
|
|
Q626. Acute Pancreatitis - Tx
|
A626. IV fluids; electolyte replacement; analgesia; NPO; NG suction; nutritional support; O2; if necrotizing - IV Antibiotics, respiratory support, surgical debridement; ERCP - if stone in COMMON BILIARY DUCT; debridement - if necrosis; CT-guided drainage – abscess, pseudocyst > 5cm lasts > 1 mo.
|
|
Q627. Acute Pancreatitis - Complications
|
A627. pseudocyst; fistulas; hypocalcemia; renal failure; pleural effusion; sepsis; chronic pancreatitis; splenic vein thrombosis; mortality - Ranson's criteria
|
|
Q628. Acute Pancreatitis - Ranson's Criteria
|
A628. GA LAW - On Admission:; Glucose > 200 mg/dl; Age > 55 yrs. LDH > 350 IU/L; AST > 250 IU/dl; WBC > 16,000/ml C HOBBS - After 48 hours:; Ca2+ < 8.0 mg/dl; Hct decreased by > 10%; O2 PaO2 < 60 mmHg; Base excess > 4 mEq/l; BUN increased > 5 mg/dl; Sequestered fluid > 6L; Mortality risk - 20% with 3-4 signs, 40% with 5-6 signs, 100% with > 7 signs
|
|
Q629. Chronic Pancreatitis - What is it
|
A629. recurrent attacks of acute => irreversible destruction => pancreatic dysfunction
|
|
Q630. Chronic Pancreatitis - Risk factors
|
A630. alcoholism (90%); gallstones; hyperparathyroidism; idiopathic; congenital - pancreas divisum, CF
|
|
Q631. Chronic Pancreatitis - History/PE
|
A631. recurrent episodes of :; persistent epigastric pain; steatorrhea; weight loss; nausea; diabetes
|
|
Q632. Chronic Pancreatitis - Dx
|
A632. Abdominal XR - calcifications; low trypsin; amylase and lipase - normal; secretin stimulation test - most sensitive; glycosuria; mild ileus on AXR and CT ("chain of lakes")
|
|
Q633. Chronic Pancreatitis - Tx
|
A633. Pancreatic enzymes replaced; med-chain triglycerides in diet; decreased fat intake; vitamins; analgesics; Puestow procedure; stop alcohol; celiac nerve block; surgery for -, intractable pain, structural causes
|
|
Q634. Chronic Pancreatitis - Complications
|
A634. chronic pain; pancreatic cancer
|
|
Q635. Pancreatic Cancer - What is it
|
A635. pancreatic head adenocarcinoma; prognosis 6 mos. or less; usually metastasis at presentation
|
|
Q636. Pancreatic Cancer - Risk factors
|
A636. smoking; chronic pancreatitis; high-fat diet; long-standing DM
|
|
Q637. Pancreatic Cancer - History/PE
|
A637. abdominal pain radiates to back; painless jaundice; loss of appetite; n/v; weight loss; Courvoisier's sign - palpable NT gallbladder; Trousseau's sign - migratory thrombophlebitis
|
|
Q638. Pancreatic Cancer - Dx
|
A638. CT; US; ERCP
|
|
Q639. Pancreatic Cancer - Tx
|
A639. Palliative; Whipple – pancreaticoduodenectomy, if no evidence of mets (10-20%); chemo - 5-FU, gemcitabine
|
|
Q640. Jaundice; What is it; Causes
|
A640. excess bilirubin in blood; pathological in adults from overload, damage to liver, inability to excrete causes; congenital (Gilbert's, Dubin-Johnson, Crigler-Najjar); hemolytic anemia; hepatitis; alcoholic cirrhosis; obstruction; pancreatic ca
|
|
Q641. Hepatitis - History/PE
|
A641. Acute Viral:; incubation period - virus multiplies & spreads, no Symptoms; prodromal period – anorexia, malaise, n/v, fever, RUQ pain, joint pain (occasionally), 3-10 days- urine darkens; icteric phase – jaundice, systemic Symptoms regress, patient feels better despite worsening jaundice, liver enlarged and tender, jaundice peaks 1-2 wks, then fades; acute usu resolves spontan in 4-8 weeks Chronic hepatitis: lasts > 6 mos. many patients asymp - esp. HCV; malaise, anorexia; jaundice - usu absent, scleral icterus; tender hepatomegaly, splenomegaly, lymphadenopathy, spider nevi, palmar erythema; autoimmune - can involve any body sys
|
|
Q642. Chronic Hepatitis - Etiologies
|
A642. HCV (80% with HCV progress); HBV (10%, cum or sin HDV prog); autoimmune hepatitis; alcoholic hepatitis; nonalcoholic steatohepatitis; right-sided heart failure; Wilson's; hemochromatosis; a1-antitrypsin deficiency; neoplasm; drug-induced disease – INH, methyldopa, acetaminophen, nitrofurantoin
|
|
Q643. Hepatitis - Dx
|
A643. WBC - normal count, relative leukocytosis; very high ALT and AST; high bilirubin; high alkaline phosphatase; hypoalbuminemia (chronic); hepatitis serology; severe cases - PT prolonged (all clotting factors except factor VIII made by liver); Biopsy; autoimmune – ANA, anti-LKM1 antibody, anti-smooth muscle antibody, antimitochondrial antibody
|
|
Q644. Hepatitis - Tx
|
A644. Etiology specific; monitor for resolution of Symptom; severe alcoholic - steroids; autoimmune -, steroids, azathioprine; chronic HBV - IFN-a, lamivudine (3TC), adefovir; chronic HCV – peginterferon, IFN-B, ribavirin; end-stage liver failure - liver transplant; fulminant hepatic failure – ICU, emergent transplant
|
|
Q645. Hepatitis - Complications
|
A645. Cirrhosis; liver failure; hepatocellular ca; mortality in 5 yrs (50%)
|
|
Q646. Hepatitis - IgM HAVAb
|
A646. IgM Ab to HAV - best test to detect active hepatitis A
|
|
Q647. Hepatitis - HBsAg
|
A647. Ag on surface of HBV; continued presence indicates carrier state
|
|
Q648. Hepatitis - HBsAb
|
A648. Ab to HBsAg; provides immunity to hep B
|
|
Q649. Hepatitis - HBcAg
|
A649. Ag associated with the core of HBV
|
|
Q650. Hepatitis - HBcAb
|
A650. Ab to HBcAg; positive during window period; indicator of recent disease
|
|
Q651. Hepatitis - HBeAg
|
A651. A second, different antigenic; determinant in the HBV core; important indicator of transmissibility (BEware)
|
|
Q652. Hepatitis - HBeAb
|
A652. Ab to e antigen; indicates low transmissibility
|
|
Q653. Infectious Diarrhea; Campylobacter; History
|
A653. Most common etiology of infectious diarrhea; Ingestion of contaminated food or water; Affects young kids and young adults; Usually last 7-10 days
|
|
Q654. Infectious Diarrhea; Campylobacter; PE
|
A654. Fecal RBCs and WBCs
|
|
Q655. Infectious Diarrhea; Campylobacter; Comments
|
A655. Rule out appendicitis and IBD
|
|
Q656. Infectious Diarrhea; Campylobacter; Tx
|
A656. Erythromycin
|
|
Q657. Infectious Diarrhea; C. difficile; History
|
A657. Recent tx with antibiotics; cephalosporins, clindamycin; Affects hospitalized adult pt; Watch for toxic megacolon
|
|
Q658. Infectious Diarrhea; C. difficile; PE
|
A658. Fever; abdominal pain; possible systemic toxicity; Fecal RBCs and WBCs
|
|
Q659. Infectious Diarrhea; C. difficile; Comments
|
A659. Most commonly in large bowel; can involve small bowel; ID C. Diff toxin in stool
|
|
Q660. Infectious Diarrhea; C. difficile; Tx
|
A660. PO metro or vanco; IV metro if can't tolerate; oral meds
|
|
Q661. Infectious Diarrhea; Entamoeba histolytica; History
|
A661. Contaminated food or water; history of travel in dev. countries; Incubation period can last up to 3 mos.
|
|
Q662. Infectious Diarrhea; Entamoeba histolytica; PE
|
A662. Severe abdominal pain; fever; Fecal RBCs and WBCs
|
|
Q663. Infectious Diarrhea; Entamoeba histolytica; Comments
|
A663. Chronic amebic colitis; mimics IBD
|
|
Q664. Infectious Diarrhea; Entamoeba histolytica; Tx
|
A664. Steroids can lead to; fatal perforation; Tx with metro
|
|
Q665. Infectious Diarrhea; E. Coli O157:H7; History
|
A665. Contaminated food - undercooked hamburger, apple cider; Affects kids and the elderly; Usually lasts 5-10 days
|
|
Q666. Infectious Diarrhea; E. Coli O157:H7; PE
|
A666. Severe abdominal pain; low-grade fever; vomiting; Fecal RBCs and WBCs
|
|
Q667. Infectious Diarrhea; E. Coli O157:H7; Comments
|
A667. Must rule out GI bleed and ischemic colitis; HUS possible complication
|
|
Q668. Infectious Diarrhea; E. Coli O157:H7; Tx
|
A668. Avoid Antibiotics therapy; resistance has increased
|
|
Q669. Infectious Diarrhea; Salmonella; History
|
A669. Contaminated poultry or eggs; Affects young kids and; the elderly; Usually lasts 2-5 days
|
|
Q670. Infectious Diarrhea; Salmonella; PE
|
A670. Prodromal headache; fever; myalgia; abdominal pain; Fecal WBCs
|
|
Q671. Infectious Diarrhea; Salmonella; Comments
|
A671. Sepsis; Sickle cell patients susceptible to osteomyelitis
|
|
Q672. Infectious Diarrhea; Salmonella; Tx
|
A672. Tx bacteremia or at-risk patients; (sickle cell) - oral quinolone or TMP-SMX
|
|
Q673. Infectious Diarrhea; Shigella; History
|
A673. Extremely contagious; transmitted between people; Affects young kids and institutionalized patients
|
|
Q674. Infectious Diarrhea; Shigella; PE
|
A674. Fecal RBCs and WBCs
|
|
Q675. Infectious Diarrhea; Shigella; Comments
|
A675. Can => severe dehydration; Can => febrile seizures in the very young
|
|
Q676. Infectious Diarrhea; Shigella; Tx
|
A676. TMP-SMX to decreased person-to-person spread
|
|
Q677. Achalasia; Features; Secondary Causes
|
A677. Increased tone; decreased or abnormal peristalsis; decreased inhib neurons in LES smooth muscle; secondary causes – Chagas, gastric carcinoma, lymphoma, scleroderma
|
|
Q678. Achalasia - Dx
|
A678. Barium swallow - always 1st; manometry; EGD - to rule out gastric carcinoma; or lymphoma
|
|
Q679. Achalasia - Tx
|
A679. Pneumatic dilation; botulinum toxin - every 2 yrs. Ca2+ chan blockers & nitrates; surgical myotomy - definitive
|
|
Q680. Scleroderma - Features
|
A680. Mid or distal esophagus; decreased or no peristalsis; LES incompetent => GERD Symptoms; progressive dysphagia
|
|
Q681. Scleroderma - Dx
|
A681. Barium swallow 1st; motility studies
|
|
Q682. Scleroderma - Tx
|
A682. Antireflux
|
|
Q683. Diffuse Esophageal Spasm - Features
|
A683. Nonperistaltic spontaneous contractions; usually due to degeneration of nerve processes; chest pain; dysphagia
|
|
Q684. Diffuse Esophageal Spasm - Dx
|
A684. Barium swallow - "corkscrew"; manometry confirms
|
|
Q685. Diffuse Esophageal Spasm - Tx
|
A685. Ca2+ chan blockers & nitrates
|
|
Q686. Nutcracker Esophagus - Features
|
A686. Increased excitatory activities => high-amplitude contractions; chest pain; dysphagia
|
|
Q687. Nutcracker Esophagus - Dx
|
A687. Manometry
|
|
Q688. Nutcracker Esophagus - Tx
|
A688. Ca2+ chan blockers & nitrates
|
|
Q689. Familial Polyposis Syndromes; What causes it; Three Names
|
A689. Caused by adenomatous polyps which transform into cancer; AD; Familial Polyposis Coli; Gardner Syndrome; Turcot Syndrome
|
|
Q690. Familial Polyposis Syndromes; Familial Polyposis Coli; What is it
|
A690. Thousands of colonic polyps; deletion in chromosome 5; 100% malignancy if total colectomy not done
|
|
Q691. Familial Polyposis Syndromes; Gardner Syndrome; What is it
|
A691. Polyps & osteomas
|
|
Q692. Familial Polyposis Syndromes; Turcot Syndrome; What is it
|
A692. Polyps & CNS tumors
|
|
Q693. Peutz-Jeghers Syndrome; What is it
|
A693. Not malignant; hamartomatous polyps in large & small intestines; mucocutaneous pigmentation
|
|
Q694. Juvenile Polyposis Syndrome; What is it
|
A694. Not malignant; hamartomatous polyps in large & small intestines
|
|
Q695. Hereditary NoNPOlyposis Syndrome (HNPCC); What is it
|
A695. Also called Lynch Syndrome; AD; mutations of several genes; colon ca from normal mucosa; cancer History in 3 first-degree relatives, 2 generations, 1 < 5 y/o; associated with ovarian & endometrial cancer
|
|
Q696. A1-Antitrypsin Deficiency - What is it
|
A696. AR => chronic hepatitis & cirrhosis; 20% of liver dis. in neonates
|
|
Q697. A1-Antitrypsin Deficiency - History
|
A697. Asymp transaminase increased in patient with emphysema
|
|
Q698. A1-Antitrypsin Deficiency - Dx
|
A698. Electrophoresis; confirm by low serum levels
|
|
Q699. A1-Antitrypsin Deficiency - Tx
|
A699. Liver transplant cures
|
|
Q700. NonUlcer Dyspepsia - What is it
|
A700. Abdominal pain or fullness & bloating; may be postprandial; gastric acid secretion is normal; may have abnormal gastric or small intestine motility
|
|
Q701. NonUlcer Dyspepsia - Dx
|
A701. Normal EGD or barium
|
|
Q702. Dumping Syndrome - What is it
|
A702. Rapid emptying from stomach; => shift of fluids and; distention of small intestines; associated with PUD surgery
|
|
Q703. Dumping Syndrome - History/PE
|
A703. Diaphoresis; lightheaded; palpitations; n/v; 30 min. postprandial; if 90 min. postprandial - CHO- or sucrose-rich meals
|
|
Q704. Dumping Syndrome - Dx
|
A704. Clinical History
|
|
Q705. Dumping Syndrome - Tx
|
A705. Restrict sweets; frequent small meals; decreased liquid intake with meals
|
|
Q706. What test(s) diagnose small bowel obstruction?
|
A706. The most accurate test for small bowel obstruction is a combination of the abdominal X-ray and the abdominal CT scan. There is no blood test to diagnose obstruction and there are no findings on endoscopy.
|
|
Q707. What does small bowel obstruction look like on abdominal x-ray?
|
A707. There are multiple air-fluid levels seen throughout the bowel.
|
|
Q708. When do you use abdominal X-ray?
|
A708. Suspected small bowel obstruction is the only use for the abdominal X-ray. Look for a patient with abdominal pain and distension; hypoactive or absent bowel sounds, possible electrolyte abnormalities such as potassium; calcium, or magnesium disorders; and failure to pass either stool or flatus. This is normal after abdominal surgery.
|
|
Q709. What does a barium enima do?
|
A709. BE creates a "contrast" picture to outline the lining of the retum and colon. BE can be used in detecting colorectal cancers, polyps, diverticulosis, and bowel obstruction and to evaluate the extent of inflammatory bowel disease.
|
|
Q710. When is BE contraindicated?
|
A710. Patient's who may have peritonitis or bowel perforation must not undergo this test because the contrast material can leak into the peritoneum through the perforation. BE is also contraindicated in diverticulitis, in which it increases the risk of perforation.
|
|
Q711. Compare BE and Colonoscopy if you are suspecting a lesion in the colon.
|
A711. Colonoscopy is superior to enema in that it can directly biopsy lesions or remove polyps. BE is NEVER the right answer to the question, "What is the most accurate test?" if colonoscopy is one of the choices.
|
|
Q712. What is Capsule Endoscopy?
|
A712. It is a capsule the size of a large pill, with a camera and a small transmitter. Once swallowed, it begins transmitting images of the inside gastrointestinal tract to a receiver worn by the patient. The doctor can review 6 hours worth of pictures for any abnormalities.
|
|
Q713. When do you use Capsule Endoscoopy?
|
A713. Capsule endoscopy is the procedure of choice for suspected small bowel bleeding that was not detected with upper or lower endoscopy.
|
|
Q714. What are Amylase/Lipase levels?
|
A714. Amylase and lipase are the initial test in the diagnosis of acute pancreatitis. Lipase is more specific for the pancreas. Amylase can be elevated from damage to the salivary glands, esophagus, or small bowel.
|
|
Q715. When do you answer amylase and lipase levels?
|
A715. Answer amylase/lipase for a patient presenting with the acute onset of severe epigastric pain radiating to the back. Such a patient may have a history of alcohol abuse or gallstones.
|
|
Q716. What is the most accurate test for acute pancreatitis?
|
A716. Abdominal CT scan. It is more accurate than Ranson's criteria. Pancreatic necrosis on a CT scan is etremely specific for severe pancreatitis and is the main indicator of the need for a pancreatic biopsy.
|
|
Q717. What is Antiendomysial/ Antigliadin Antibodies?
|
A717. Serum assay for endomysial and antigliadin antibodies are made against wheat or gluten antigens and the villous (endomysial) lining fo the small intestine. They are used to confirm the diagnosis of celiac disease.
|
|
Q718. When are Antiendomysial/ Antigliadin Antibodies the answer?
|
A718. Look for a case of robable celiac disease with oily, greasy diarrhea, foul-smelling stool without evidence of chronic pancreatitis. they are the tests to answer to confirm gluten-sensitive enteropathy after Sudan black stain has confirmed a fat malabsorption.
|
|
Q719. What is the most accurate test for celiac disease?
|
A719. Small bowel biopsy. It must be done to exclude lymphoma as well as to diagnose the disease.
|
|
Q720. What is the Antimitochondrial Antibodies (AMA) test for?
|
A720. Serum screening for antimitochondrial antibodies is the best initial test to make a specific diagnosis of primary biliary cirrhosis (PBC).
|
|
Q721. When do you answer AMA?
|
A721. Look for a middle-aged female presenting with itching (pruritus) and an elevated alkaline phosphatase with a normal bilirubin.
|
|
Q722. What is the most accurate test for PRIMARY BILIARY CIRRHOSIS?
|
A722. Liver biopsy.
|
|
Q723. What is anti-Smooth Muscle Antibodies?
|
A723. Serum assay detection of anti-smooth muscle antibodies (ASMA) is the best initial test for atuoimmunie hepatitis.
|
|
Q724. When do you answer ASMA?
|
A724. Answer ASMA when you are shown a young female with a liver disease who does not drink or have inflammatory bowel disease or infectious hepatitis.
|
|
Q725. What other immune markers are associates with autoimmune hepatitis?
|
A725. Autoimmune hepatitis is associated with antinuclear antibodies (ANA) and antibodies to liver/kidney microsome type 1 (anti-LKM1).
|
|
Q726. What is the most accurate test for autoimmune hepatitis?
|
A726. Liver biopsy is the most accurate test for autoimmune hepatitis and most other liver diseases.
|
|
Q727. For which clinical condition is Barium Esophagram the best initial test?
|
A727. Barium esophagram is, generally, the best initial test for dysphagia. This is not in scenarios where there are clear signs of obstruction, for which upper endoscoopy would be the best initial test. For achalasia, barium esophagram shows a "bird's beak" at the gastroesophageal junction. In diffuse esophageal spasm barium esophagram shows a "corkscrew" pattern at the time of spasm.
|
|
Q728. For which conditions is Barium Esophagram the most accurate test?
|
A728. Barium esophagram is the most accurate test for esophageal rings, webs, and idverticuli.
|
|
Q729. What is the most acurate test for abnormalities detected with a barium esophagram?
|
A729. In achalasia, esophageal spasm, and nutcracker esophagus, the most accurate test is manometry. With cancer, the most accurate test is endoscopy for a biopsy.
|
|
Q730. What is a Bernstein Test?
|
A730. The Bernstein test is to diagnose gastroesophageal reflux disease.
|
|
Q731. How is a Bernstein Test done?
|
A731. The Bernstein test involves the placement of a nasogastric tube into the esophagus with the tip at the end of the esophagus near the gastroesophageal junction. Dilute hydrochloric acid is instilled or dripped into the esophagus in an attempt to reproduce the symptoms of reflux disease. This is a older test that has been made obsolete by the use of empiric trials of PPIs or the 24-hour pH monitor.
|
|
Q732. When is a Bernstein Test the right answer?
|
A732. The Bernstein test is always WRONG to do. When you see it in the answers as a diagnostic test, do not choose it.
|
|
Q733. What is a Bleeding Scan?
|
A733. The bleeding scan, or technetium-labled RBC scanning, is performed in a patient with small amounts of active lower GI bleeding in which the bleeding site could not be identified with endoscopy. B; leeding scan is sensitive, but not specific. If the bleeding scan is positive, you cannot identify the precise etiology of the bleeding. Angiography is another diagnostic option for the patint with persistent, severe GI bleeding wihtout an identified source.
|
|
Q734. When do you answer bleeding scan?
|
A734. Look for a patient who presents with severe gastrointestinal bleeding in whom the lower endoscopy is unable to find a source. The bleeding continues and the patient may still require transfusions.
|
|
Q735. What is Ceruloplasmin?
|
A735. Serum ceruloplasmin levels and the presence of Kayser- Fleischer rings on exam are the best initial tests for Wilson's disease.
|
|
Q736. When do you answer ceruloplasmin?
|
A736. Look for a patient wiht the convination of unexplained hepatic and psychiatric abnormalities with a movement disorder.
|
|
Q737. Is a high or low value abnormal?
|
A737. An exremely low serum ceruloplasmin level should be taken as strong evidence for the diagnosis of Wilson's disease.
|
|
Q738. What additional tests would confirm the diagnosis?
|
A738. Twenty-four-hour urine copper excretion will be abnormally high. The most accurate test is the liver biopsy. Wilson's disease is a disease of copper overload. this is because of the inability of the liver to incorporate copper into the protein ceruloplasmin for excretion into the bile. This leads to hepatic copper accumulation and injury. This eventually spills into the bloodstream and deposits into the brain (behavior and movement changes), kidneys (renal insufficiency), and cornea (Kayser-Fleischer rings).
|
|
Q739. When do we use colonoscopy as a screen?
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A739. General Population: Every 10 years for patients over age 50. Colonoscopy is superior to occult blood test or simoidoscopy. Single family member with colon cancer: Start at age 40 or 10 years earlier than thefamily member's diagnosis, whichever is earlier. Hereditary non-polyposis cancer syndrome (HNPCC or Lynch syndrome): Tree family members, two generations, one prmature. Premature means the cancer was before age 50. Start at age 25 and repeat every 1-2 years.
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Q740. What is D-Xylose Test?
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A740. D-xylose testing is used in determining the etiology of different malabsorption syndromes. D-xylose is used to differentiate between intestinal malabsorption and chronic pancreatitis. Celiac disease is the most common cause of intestinal malabsorption. D-xylose is a sugar that should be absorbed if the small bowel mucosa is intact. It does not require digestive pancreatic enzymes. A low D-xylose level in the urine indicates that the intestinal mucosa is defective and that D-xylose was not absorbed.
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Q741. When do you answer D-xylose testing?
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A741. Look for a patient with foul-smelling stool without blood, who has weight loss, malnutrition, fat in stool, and a positive Sudan black stain.
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Q742. What is the most accurate test for malabsorption syndromes?
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A742. The most accurate test of the small bowel mucosa is a biopsy to assess histology and architecture.
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Q743. What disease will make D-xylose abnormal?
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A743. D-xylose test is abnormal with celiac disease, tropical sprue, and Whipple's disease.
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Q744. What is an endoscopic Retrograde Cholangiopancreatography (ERCP)?
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A744. ERCP is a direct visualization of hte biliary tract.
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Q745. For which condition is an ERCP most accurate?
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A745. ERCP is the most accurate diagnostic test for stones in teh biliary system. ERCP is also the most accurate test for primary sclerosing cholangitis (PSC).
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Q746. What are the characteristics lesion of sclerosing cholangitis?
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A746. In sclerosing cholangitis there are multiple intrahepatic and / or extrahepatic strictures of the biliary tract on cholangiography; This gives the biliarry radicles a "beaded" appearance.
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Q747. When do I answer ERCP?
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A747. The strongest indication for ERCP is when the patient has high fever, chills, right upper-quadrant abdominal pain, and jaundice. ERCP is both diagnostic and therapeutic because you can remove the stone. For PSC, look for a patient with a history of ulcerative colitis complaining of pruritus and jaundice with a negative hepatitis profile and negative abdominal sonogram.
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Q748. What is Esophageal manometry used for?
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A748. Esophageal monometry isused to establish the diagnosis of dysphagia or unexplained chest pain when there is no mechanical obstruction.
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Q749. How is Esophageal manometry done?
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A749. Esophageal manometry consists of a transducer placed in teh esophagus to record pressure
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Q750. When do you answer esoophageal manometry?
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A750. Look for a case of dysphagia with an inconclusive barium radiograph or upper endoscopy. If the stem of the question clearly describes a motility problem, you do not have to do either endoscopy or barium prior to doing the manometry;; for example, achalasia, diffuse esophageal spasm, or nutcracker esophagus.
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Q751. What is fecal occult blood testing?
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A751. Fecal occult blood testing (FOBT) is the screening of normal brown stool for microscopic amounts of blood not grossly visible. Gross blood or dark stool, such as melena, does not occur until >100ml of blood has been lost in the bowel. The FOBT will detect as lettle as 5-10ml of blood.
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Q752. When is fecal occult blood testing the right answer?
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A752. FOBT is a screening test for occult blood in the stool. FOBT is an option for screening for colon cancer in those above the age of 50. In colon cancer screening the three methods of screening, are: colonoscopy every 10 years, sigmoidoscopy every 3-5 years, FOBT every year after age 50.
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Q753. What do you do for a positive fecal occult blood test?
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A753. A positive FOBT should be investigated with a colonoscopy.
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Q754. What is Fecal Leukocytes a test for?
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A754. Fecal leukocytes are used to assess the etiology of acute diarrhea.
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Q755. What diseases is Fecal Leukocytes associated with?
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A755. Invasive and inflammatory causes of iarrhea can give both blood as well as fecal leukocytes. Diseases such as Salmonella, Shigella, Campylobacter, etc., can give both blood as well as white cells in the stool.
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Q756. When do you answer fecal leukocytes?
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A756. Look for a patient with diarrhea with no blood in whom you are trying to see if there is an invasive form of diarrhea. Fecal leukocytes are not found with diarrhea secondary to viruses, most protozoans, or pre-formed toxins such as Bacillus cereus or staph.
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Q757. What is the Gastrin level?
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A757. Serum gastrin levels should be measured when you suspect Zollinger-Ellison syndrome (ZES).
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Q758. When do you answer gastrin level as the best initial test?
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A758. Look for ulcers that are large (>1cm), rcurrent, distal, and multiple. A gastrin level greater than 1,000 pg/ml is diagnostic. REMEMBER: Everyone on a PPI has a high gastrin level.
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Q759. What additional test would you like if this is not diagnostic?
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A759. The secretin stimulation test can confirm ZES when serum gastrin concentration testing is nondiagnostic. In ZES, gastrin levels do not go down with secretin.
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Q760. What disease is the syndrome part of?
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A760. ZES is associated with MEN I: Hyperharathyroidism; Pituitary adenomas; Pancreatic islet cell/gastrointestinal adenomas
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Q761. What is gastrograffin?
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A761. Gastrograffin is a water-soluble form of radio-opaque constrast material that is used when there is the possibility that there has been organ perforation and the material may leak through into the peritoneum. Gasrograffin is used as the diagnostic test of choice for Boerhaave's syndrome, or esophageal perforation, because barium going through a perforation causes inflammation.
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Q762. When do you answer gastrograffin?
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A762. Look for a patient presenting with a recent history of severe retching followerd by severe chest pain, dyspnea, shock, and possible crepitation. Initial chest X-ray would show free air in teh mediastinum or peritoneum.
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Q763. What is the most accurate test for Boerhaave's syndrome?
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A763. The most accurate test is a CT scan.
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Q764. What is HFE gene, and C282Y mutation?
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A764. The HFE gene and C282Y mutation both lead to the overabsorption of iron in teh duodenum. They are confirmatory tests for hemochromatosis. These genetic tests and an MRI can eliminate the need for liver biopsy to diagnose hemochromatosis.
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Q765. When do you answer HFE gene, or C282Y mutation?
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A765. Answer HFE gene and C282Y mutation when you are shown a patient with the characteristics of hemochromatosis and abnormal iron studies consistent with hemochromatosis. The patient will have liver disease, skin hyperpigmentation, joint pain, diabetes, and infertility. The iron and ferritin levels will be elevated and the iron- binding capacity will be markedly dimished.
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Q766. What is HIDA Scanning?
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A766. HIDA scan is used when you suspect acute cholecystitis with a nondiagnostic ultrasonography.
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Q767. When do you answer HIDA scan?
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A767. Answer HIDA scan when you see either: Gallstones without gallbladder edema and ultrasound Murphy's sign, or; Gallbladder edema and ultrasound Murphy's sign without gallstones.
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Q768. How does HIDA scan work?
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A768. HIDA is taken up by hepatocytes and excreted into bile and concentrated in teh gallbladder. If the gallbladder does not opacify, it means that there is an obstruction of the cystic duct. Leakage into the pericholecystic space suggests perforation. On a normal scan the gallbladder should opacify.
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Q769. When is the HIDA scan the most common wrong answer?
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A769. The HIDA is not recommended in critically ill patients who should be taken to the operating room. If the diagnosis is obvious, the HIDA scan is not necessary, surgery is necessary.
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Q770. What is PAS staining used for?
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A770. PAS staining on a small bowel biopsy specimen is the most accurate test for Whipple's disease.
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Q771. When do you answer PAS staining?
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A771. Look for chronic multisystem illness, initially rheumatological (80%), then with fat malabsorption (75%), fever (50%), and ocular and neurological complaints..
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Q772. How do you treat Whipple disease?
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A772. Initial course of Ceftriaxone followed by trimethoprim- sulfamethoxazole for 1 year.
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Q773. What is 24-Hour pH monitoring used for?
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A773. Twenty-four -hour esophageal pH recording is indicated to document abnormal esophageal acid exposure.
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Q774. When do you answer 24-Hour pH monitoring?
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A774. It is the appropriate test in the following scenarios:; 1) Persistent symptoms of gastroesophageal reflux disease (GERD) after at least 4 weeks of treatment with a PPI. 2) To exclude GERD in a patient with unexplained chest pain; 3) GERD sysptoms wit a negative upper endoscopy wen you are considering antireflux surgical repair. 4) To assess the efficacy of antireflux surgery; 5) To evaluate patients with laryngitis, pharyngitis, chronic cough, nonallergic asthma (reflux-induced asthma)
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Q775. For what diseases do you answer secretin stimulation testing?
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A775. Secretin stiulation is a rarely used test for two completely separate diseases: Zollinger-Ellison syndrome (ZES) and chronic pancreatitis.
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Q776. What is secretin stimulation testing?
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A776. ZES: You inject secretin intravenously and measure the level of gastrin in blood. Secretin should inhibit gastrin and lower the levels of gastrin in a normal person. In ZES, there is a failure to suppress gastrin levels. Chronic pancreatitis: Normally, secretin should induce a large release of bicarbonate from the pancreas into the duodenum and measure the release of bicarbonate from the sphincter of Oddi. With chronic pancreatitis, the pancreas is too burned out and tired to do anything.
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Q777. When do you answer secretin stimulation test?
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A777. Answer secretin stimulation testing in ZES when the patient has large, recurrent, and multiple ulcers, but has a nondiagnostic fasting serum gastrin concentration. For chronic pancreatitis, look for a patient with fat malabsorbtion with no evidence of celiac disease and a normal D-xylose test.
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Q778. Who should upper endoscopy screening be offered to?
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A778. Screening upper endoscopy should be performed in patients with gastroesophageal reflux disease (GERD) in whom the symptoms have been present for more than 5 years. You are screening to see if there is Barrett's esophagus, which is when the lower esophagus is transforming form squamous to columnar epithelium. Screening for the presence of esophageal varices should be done in those with cirrhosis.
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Q779. What is the treatment for an abnormal upper endoscopy?
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A779. Barrett's esophagus is treated with proton pump inhibitors with a repeat upper endoscopy every 2-3 years. Low-grade esophageal dysplasia is treated with PPIs with a repeat upper endoscopy in 6 months. Those with varices should receive propranolol to decrease the risk of bleeding.
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Q780. What is a 72-Hour Fecal Fat test used for?
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A780. The 72-hour fecal fat collection is an old test for intestinal malabsorption. As the name implies, you are supposed to collect 3 days' worth of stool in order to have a very sensitive test for fat malabsorption. A single test of a Sudan black stain of the stool for the presence of fat is usually sufficient.
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Q781. When do you answer 72 -hour fecal fat test?
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A781. The 72-hour fecal fat collection is the single most accurate test for fat malabsorption; however, it is virtually never done and is most often a WRONG answer on your test. The 72-hour fecal fat is the answer if you strongly suspect fat malabsorption and the Sudan black stain is negative.
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Q782. What is a string test?
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A782. The string test is an old test for giardiasis. The string test samples the duodenal mucosa without the need of endoscopy. A string is swallowed and left in place with one end in the duodenum and the other end hanging out through the patient's mouth.
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Q783. When is a string test the answer?
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A783. String test is always the WRONG answer. Stool ova and parasite testing is sufficiently sensitive and less invasive. Stool Giardia antigen testing by ELISA is the single most accurate test for Giardia and is considerably less invasive.
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Q784. What is a Sudan Black Stain?
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A784. Stool staining with Sudan black is used to detect steatorrhea as a sign of fat malabsorption.
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Q785. What is the most accurate test for fat malabsorption.
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A785. Seventy-two-hour quantitative estimation of stool fat is the most accurate test because of increased sensitivity. The 72-hour estimation is almost always the wrong answer.
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Q786. When do I answer Sudan black stain?
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A786. Answer Sudan black stain when you see a patient with chronic pale, greasy, malodorous diarrhea, and no evidence of infection.
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Q787. What is Fasting Transferrin saturation?
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A787. Serum measurement of fasting transferrin saturation is the best initial test to diagnose hereditary hemochromatosis (HH) as well as the screening test for asymptomatic family members. Fasting transferrin saturation = (serum iron/TIBC)
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Q788. When do you answer fasting transferrin saturation?
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A788. Answer fasting transferrin satruation when you see a ase of liver disease with oint pain, diabetes, cardiomyopathy, skin hyperpigmentation, and infertility.
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Q789. How would you confirm an abnormal test of fasting transferrin saturation?
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A789. Liver biopsy is the most accurate test.
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Q790. What is the pathogenesis of hereditary hemochromatosis (HH)?
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A790. The pathogenesis is genetically determined abnormal increase in intestinal absorption of iron.
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Q791. When is the optimal timing of screening for HH?
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A791. The optimal timing for screening family members is between the ages of 18 and 30, before organ damage (e.g., cirrhosis) has occurred.
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Q792. What is serum trypsinogen concentration used for?
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A792. Serum assay of trypsinogen is used when you suspect chronic pancreatitis in a patient with steatorrhea. This is the only test that is specific for steatorrhea of pancreatic origin. Trypsinogen levels are low if the fat malabsorption is form a burned-out pancreas.
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Q793. When is serum trypsinogen concentration the answer?
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A793. Answer trypsinogen level only after Sudan black stin has confirmed a fat malabsorption. Antigliadin and anti-endomysial antibodies should be normal. Low trypsinogen levels are specific but not sensitive for chronic pancretitis.
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Q794. What is the urea breath test?
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A794. Urea breath testing is the measurement of radiolabled carbon dioxide after the oral ingestion of labeled urea. H. pylori splits urea wuth urease. The labeled carbon is in the urea and is released as labeled carbon dioxide.
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Q795. When is the urea breath test used?
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A795. Urea breth testing is best used to confirm the eradication of H. pylori immediately after treatment. Serology does not rapidly improve after treatment. If an ulcer is found at endoscopy, the test of choice will be biopsy, not the urea breth test.
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Q796. When do you answer urea breath test?
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A796. Answer urea breath test with a patient with epigastric pain that does not improve or that recurs after a proton pump inhibitor and antibiotics have been given. There is no routine test of cure for H. pylori. You do not do the test if the patient feels better after treatment.
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