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isolis's version from 2016-07-28 22:12

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Question Answer
• Give this drug for chemo induced nauseaondansetron (serotonin receptor antagonist)
• Colon dilatation, severe bloody diarrhea, systemic findings, hx of IBDtoxic megacolon Emergency! Needs prompt IV steroids, NG decompression, abx, fluid
• Latin american dude with hx of megacolon and cardiomegaly on X raychagas disease (protozoal infection). Trypansoma cruzi
• Necrolytic migratory erythemaoccurs with glucagonoma
• Which hepatitities can cause acute liver failure?A and B
• Intestinal malabsorptio leading to weight loss and iron deficiency anemiaceliacs. Associated with type I diabetes and dermatitis herpetiformis.
• Stages of hepatic encephalopathy?1 is altered sleep patern or mild confusion, stage 2 is lethargy/moderate confusion, stage 3 is worse but still arousable, stage 4 is stuporous or coma.
• Hepatic encephalopathy precipitating causesinfection, sedatives, excessive nitrogen load (eg GI bleed)
• Multiple liver masses vs singular?multiple is metastatic likely from colon so do a colonoscopy. Single is hepatocellular carcinoma and check AFP levels
• Most appropriate diagnostic test for acute hepatitis B?HBsAg and anti-HBc b/c anti HBc will remain elevated during window period
• What is sialadenosis?nontender enlargement of submandibular glands found in patients with advanced liver disease (alcoholics or nonalcoholic cirrhosis). Also seen with malnutrition
• Why does TPN increase risk for gallstones and bile sludging?b/c causes gallbladder stasis.
• Air under diaphragm on X ray with peritoneal signsperforation
• Calcified rim in gallbladder wall with central bile-filled dark areaporcelain gallbladder, increased risk of gallbladder adenocarcinoma
• Acute liver failure most often due to which 3 causes?acute viral hepatitis, acetaminophen toxicity, and ischemic damage. Transaminsases usually acutely elevated into the thousands
• Cause of zenker's diverticulum?motor dysfunction of upper esohapgeal sphincter and esophageal dysmotility
• Cholelithiasis first step of diagnosis? Cholecystitis? Cholangitis?abdominal ultrasound first regardless. If they clearly have gallbladder sx but ultrasoundis nonconsluvie, do a HIDA scan. ERCP is the diagnostic method and treatment method you go to after ultrasound if you have biliary obstruction.
• Woman, itching, high bilirubin, AMA+PBC
• PBC is associated with this metabolic abnormalityhyperlipidmiea, and xanthelasmas, elevation of HDL out of proportion to LDL
• Patients with PBC may develop what long term complication besides cancer?metabolic bone disease/osteoporosis but not due to malabsorption, due to unknown cause
• Why can you get really hypotensive with a bad case of acute pancreatitis?pancreatic enzymes leaking into circulation causing endothelial injury and therefore increased permeability, so fluid goes into circulation and you pee it all out and get hypotensive. Treat with a lot of IV fluids
• Ulcer better with foodduodenal
• Endoscopy for PUD, what do you have to do for gastric ulcer but not duodenal?biopsy. Duodenal ulcer malignancy is rare
• Treatment for perforation after PUD?abx (ceftriaxone and metro) and laparotomy to repair
• Triple therapy for H pylori infection?PPI, clarithromycin, amoxicillin
• Most common cause of achlorhydria?Pernicious anemia. Also can be caused by surgical gastric resection
• If a bleeding source can't be found on endoscopy, what test can you do?radionuclide scan (nuclear medicine)
• Cause of diverticulosis?low fiber, high fat diet.
• Treatment for diverticulitis?fluoroquinolone (eg cipro) plus metronidazole, then do a colonoscopy after treatment.
• Clues to infectious diarrhea?white blood cells in the stool with invasive bacteria and fever, also look at travel history
• What is this and how do you treat it? Hiker, steatorrhea, protozoal cysts in stoolgiardia, metronidazole
• Treatment options for C diff?oral metro or vanco if metro isn't an option
• Fever and white cells in the stool, but no organisms?think IBD
• Treatment options for UC? Crohns ?UC can be surgery, don't do resection surgery for crohns, unless it's for strictures
• Thickness of pathology in Crohns? UC?transmural, only mucosa/submucosa
• High fever, leukocytosis, abdominal pain, rebound tenderness, dilated segment of colon on X ray. What is this and how do you treat it?this is toxic megacolon. Make patient NPO, give ceftriaxone and metro to cover GI bugs, give steroids if cause is IBD.
• During the "window phase" which hep B markers are negative and which is positive?negative HbsAG (surface antigen) and HBsAb (antibody), IgM core antibody,
• Test for hep C? Treatment?RNA test to quantify and detect. Treat with interferon alpha and ribavirin
• This hepatitis infection is fatal in pregnant women for unknown reasonshep E, also transmitted via food/water like hep A
• Classic drugs that cause drug induced hepatitis?acetaminophen, isoniazid, other TB drugs (rifampin, pyrazinamide) and statins. First step is to stop the drug
• Markers for idiopathic autoimmune hepatitis? How do you treat?ANA or anti-smooth muscle antibodies. Steroids
• What effect can hemochromatosis have on the heart? Pancreas? Joints? How do you treat?dilated cardiomyopathy, diabetes, arthritis. Treat with phlebotomy
• Blood signs for wilson's disease? Symptoms? What is another name for this?low ceruloplasmin, serum copper might be normal. Psych manifestations because of copper deposits in basal ganglia, liver disease, possible neurological signs. Hepatolenticular disease
• Persistent abdominal pain or dyspepsia after cholecystectomy, either early on after surgery or months/years later. What is this and what should you do to diagnose it?postcholecystectomy syndrome, do ultrasound then ERCP or MRCP to visualize the causative factor (retained common bile duct, cystic duct stone, pancreatitis, etc)
• Very sick patient, has presentation similar to kidney stones, imaging shows thickened gallbladder wall, distention, and fluid around the gallbladder. What is this and how do you treat it?acalculous cholecystitis, treat with antiobiotics and percutaneous cholecystostomy followed by cholecystectomy when stable
• Diagnosis of C diff? complication?stool studies for the toxin. Toxic megacolon can happen
• What should you watch for in children after bought of bacterial diarrhea in children? What's the triad of symptoms?HUS - thrombocytopenia, hemolytic anemia, and acute renal failure. Treatment is supportive (patients may need dialysis/transfusions)
• Typical treatment regimen for IBD?5-aminosalicylic acid with or without sulfa drug
• Possible complication of ascites?spontaneous bacterial peritonitis
• Dark urine and jaundice makes you thinkconjugated bilirubin in urine and biliary tract obstruction
• What medications can cause cholestasis?bactrim, birth control pills, phenothiazines (antipsychotics) and androgens. Pregnancy too
• This drug helps with symptoms of PBC. What is definitive treatment?cholestyramine relieves itching, urosdiol reduces cholestasis and improves blood test results, may improve prognosis. Only definitive treatment is surgery
• Fever, right upper quadrant pain, jaundice. What is this and how do you treat?this is charcot's triad of cholangitis, treat with antibiotics and remove gallstones surgically or endoscopically
• Medical treatments for achalasia?calcium channel blockers or botox. Balloon dilatation then surgery is last resort. Increased risk of cancer
• Treatment for esophageal spasmcalcium channel blockers or surgery
• Masklike facies with heartburn and antinuclear antibodyscleroderma.
• Treatment for acute pancreatitis?NPO, IV fluids, and narcotics for pain.
• Steatorrhea, diabetes, calcification of pancreas and fat soluble vitamin deficiency. How do you treat this?chronic pancreatitis, abstain from alcohol, replace vitamins and pancreatic enzymes
• Treatment for mallory weiss tears vs boerhaave?mallory weiss may stop bleeding on their own or treated endoscopally, boerhaaves needs immediate surgical repair and drainage
• You use barium for all GI studies besides when what is suspected?GI perforation. You use gastrografin (eg water soluble contrast).
• Double bouble sign and Down syndromeDuodenal atresia
• Cyanosis when feeding, relieved by crying, can't pass NG tube through nose?choanal atresia
• Premature baby, fever, air in bowel walls. What is this?necrotizing enterocolitis, treat with NPO, IV fluids, abx.
• Treatment for midgut volvulus in baby?surgery
• Treatment for Meckel's diverticulum? What can this condition cause?Laparoscopic resection. Intussusception, obstruction, volvulus
• Bowel sounds in chest and respiratory distress?diaphragmatic hernia, treat with surgery
• Omphalocele vs gastroschisis?omphalocele is midline, other anomalies present. Multiple abdominal organs. Gastroschisis, right of midline, only small bowel exposed, no true hernia sac, other anomalies rare. This is worse because no covering
• These two conditions cause conjugated hyperbilirubinemia? How can you distinguish between them?rotor and dubin johnson, dubin johnson as black pigment on biopsy (DUBIN IS DARK). Gilbert is unconjugated but mild, crigler najjar is severe unconjugated
• Segments of cyanotic mucosa and hemorrhagic ulcers on colonoscopy following vascular surgery of some type. CT scan shows thickened bowel wall. Bleeding and painischemic colitis.
• Treatment of asymptomatic gallstones? Gallstones with biliary colic symptoms?no treatment, elective laparoscopic cholecystectomy
• This drug can help facilitate stone passage and reduce need for analgesicsalpha 1 blockers (eg tamsulosin or pazosin) relax the distal ureter and reduce spasm caused by the stone
• Recurrent, painless GI bleeding, often missed on colonoscopy. In older people. Characterized by dilated submucosal veins and AV malformationsangiodysplasia
• Perforated bowel can cause increase of what lab markers? This can be trickyamylase and lipase
• Bilious vomiting, hyperactive high pitched bowel sounds, air fluid levels on radiographs. What is this and how do you treat it?small bowel obstruction. Fluids and NG tube and NPO, if peritoneal signs develop, laparotomy is usually needed.
• Risk factors for emphysematous cholecystitis? Treatment?infection of gallbladder with gas forming bacteria i.e. C.diff. RF: diabetes, immunosupression, vascular compromise. Clostridium or E coli infection. Treat with broad spectrum abx and emergent cholecystectomy
• Patient with hematemesis and uncontrolled bleeding from varices should get what treatment immediately?tamponade balloon thing until TIPS or shunt surgery can be done. If bleeding is controllable, give octeotride until you can scope and band
• "Triple bubble" sign? What is this and what can cause it?jejunal atresia, due to cocaine use in mom or other vasoconstrictive drugs
• Acute cholangitis on CT or ultrasound showsdilated common bile duct
• Treatment for chronic hep C?interferon alpha and ribavirin
• Nephrotic syndrome, hepatomegaly, CHF in the setting of chronic inflammatory conditionssecondary amyloidosis, things being deposited in tissues and causing dysfuction
• Malabsorption syndrome due to anatomic or dysmotility issues with the GI tract. Presents with abdominal bloating, flatulence, and diarrhea with weight loss and nutritional deficiencies possible if severe enough.this is small intestine bacterial overgrowth. Diagnose with endoscopy to see organisms in jejunum
• Light's criteriapleural fluid / serum protein levels > 0.5, LDH ratio > 0.6, or LDH > 2/3 upper limit of normal serum LDH. These would be exudates. Pleural fluid that is transudate has a pH of 7.4-7.55, and exudative is more acidotic (7.3-7.45)
• Neutrophilic cryptitispathologic feature of both crohn's and UC
• Colicky abdominal pain, vomiting, no bowel movements or farting, distention and diffuse tenderness. Multiple air fluid levels on abdominal x raysmall bowel obstruction.
• Small bowel obstruction patient with fever, tachycardia, leukocytosis, and metabolic acidosis indicateincreased risk or impending strangulation. Need to do surgery!
• Complications of acute pancreatitispleural effusion (usually Left sided), ARDS, ileus, and renal failure
• Renal failure that does not respond to volume resuscitation. What is this and best treatment for it?hepatorenal syndrome. Liver transplant
• SAAG?1.1 or more indicates portal hypertensive etiology (eg cirrhosis or cardiac cause). Less suggests cancer, pancreatitis, nephrotic syndrome, tb etc)
• Lactose intolerance test findingspositive hydrogen breath test, positive stool test for reducing substances, low stool pH and increased stool osmotic gap
• Patient with cirrhosis and ascites who presents with abdominal discomfort, low grade fever, and/or altered mental status.spontaneous bacterial peritonitis.
• D-xylose test abnormal whenpatients have small intestinal mucosal disease.
• Hepatic hydrothorax is seen in patients with cirrhosis and have no underlying heart or pulm diseases. What do you do to treat these effusions? What if that doesn't work?diuretics, salt restriction. If that doesn’t work, TIPS procedure
• Zenker's diagnosiscontrast esophagram. Scope might perforate
• Waxing and waning liver enzymes, nonspecific symptoms (arthralgias, myalgia). What is this and what blood thing is it associated with and what are its symptoms?hepatitis C, associated with mixed cryoglobulinemia, which manifests as palpable purpura, arthralgias, and renal complications (membranoproliferative glomerulonephritis) due to circulating immune complexes that deposit in small/medium vessels. Serum complement levels usually low
• Most beneficial therapy to reduce progression of diabetic nephropathy isstrict BP control. Treat towards target of 130/80
• Chronic pancreatitis findings on CT or X ray?pancreatic calcifications
• Polyuria, polydipsia, constipation, abdominal pain, think of thisvitamin D toxicity causing hypercalcemia
• Increased risk of C diff with use of these drugs (besides abx)PPIs or antihistamines, usually to treat GERD
• Prokinetic agents used to treat gastroparesismetoclopramide, erythromycin, cisapride
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