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PNCE > GI > Flashcards

GI Flashcards

1
Q

acute cholecystitis sx

A

fat female fertile forty, hypoactive bowel sounds
RUQ/epigastric pain, F, leukocytosis, N/V
+ Murphys sign
+ boas sign

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2
Q

acute cholecystitis test

A

initial: RUQ US TOC
gold: HIDA scan
leukocytosis w/ left shift

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3
Q

acute cholecystitis tx

A

admit and supportive
IV ceftriaxone + metronidazole
cholecystectomy

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4
Q

chronic cholecystitis etiology

A

recurrent acute cholecystitis

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5
Q

chronic cholecystitis tx

A

emergent cholecystectomy

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6
Q

emphysematous cholecystitis

A

form of acute cholangitis assoc w/ DM, vascular compromise, immunosuppression
F, RUQ, N/V, crepitus abd wall
emergent surgery and parenteral zosyn

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7
Q

cholangitis what is

A

bacterial infx of biliary tract secondary to obstruction

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8
Q

cholangitis MCC

A

choledocholithiasis (E. coli)

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9
Q

cholangitis sx

A

charcots triad (F, RUQ, jaundice)
Reynolds pentad (Charcots + septic shock _ AMS)

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10
Q

cholangitis labs

A

initial: US
cholangiography gold (ERCP)

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11
Q

cholangitis tx

A

emergency tx
IV (amp-sul)
catheter drainage/ ERCP

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12
Q

cholangitis complications

A

hepatic abscess: most serious, high M&M rate

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13
Q

cholelithiasis patho

A

gallstones present within bladder

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14
Q

cholelithiasis sx

A

fat, forty, female, fertile, fair, estrogen, OCP
asx, biliary colic, RUQ
pain after meal or at night
boas sign

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15
Q

cholelithiasis test

A

abd US TOC

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16
Q

cholelithiasis tx

A

asx: no tx, supportive
recurrent: cholecystectomy

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17
Q

choledocholithiasis location

A

gallstone in CBD

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18
Q

choledocholithiasis sx

A

asx for years
RUQ/epigastric pain, jaundice

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19
Q

choledocholithiasis test

A

elevated total/ direct bill
CIT: RUQ US
gold: ERCP for Dx and tx

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20
Q

choledocholithiasis tx

A

ERCP w/ spincterotomy and stone extraction w/ stent

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21
Q

complication of CBD stones

A

cholangitis
obstructive jaundice
acute pancreatitis
biliary colic
biliary cirrhosis

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22
Q

primary biliary cholangitis patho

A

autoimmune T cell mediated attack on bile ducts
progressive destruction of intrahepatic ducts

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23
Q

primary biliary cholangitis sx

A

fatigue, pruritus, jaundice, RUQ, WL
xanthomas, xanthalasma, hyperpigmentation

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24
Q

primary biliary cholangitis marker

A

+ AMA (antimitochondrial ab)

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25
Q

primary biliary cholangitis tx

A

1st line: ursodiol
pruritus: chilestyramine
advanced liver failure: liver transplant

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26
Q

primary biliary cholangitis complications

A

malabsorption
liver cirrhosis
portan HTN
osteoporosis

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27
Q

primary sclerosing cholangitis patho

A

progressive chronic inflammation of both intra and extra hepatic ducts

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28
Q

primary biliary cholangitis sx

A

pruritus, jaundice, fatigue
late: hepatomegaly, portal HTN, liver failure
itchy hands

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29
Q

primary biliary cholangitis association

A

male w/ hx of UC
HLA association

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30
Q

primary biliary cholangitis test

A

inc ALP w/ inc GGT
MRCP or ERCP
liver bx: onion skin scarring and fibrosis of bile ducts
gold: ERCP

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31
Q

primary biliary cholangitis marker

A

+ pANCA

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32
Q

primary biliary cholangitis tx

A

supplementation of fat soluble vitamins
tacrolimus, ursodiol
pruritus: cholestyramine
ERCP
liver transplant: only curative option

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33
Q

MC site of abscess/ fistula

A

posterior rectal wall

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34
Q

anal fissure MC location

A

posterior midline

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35
Q

anal fissure test

A

clinical
DRE/anoscopy never performed

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36
Q

anal fissure tx

A

1st line: stool softener, topical lido
2nd line: topical nitroglycerin or CCB (nifedipine)
alternative: botox, surgery

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37
Q

diverticulitis MC location

A

sigmoid colon

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38
Q

MCC lower GI bleed

A

diverticulitis

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39
Q

diverticulosis sx

A

painless rectal bleeding

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40
Q

diverticulosis test

A

colonoscopy gold standard

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41
Q

diverticulosis tx

A

high fiber foot
surgery

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42
Q

diverticulitis MC site

A

LLQ

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43
Q

diverticulitis sx

A

F, LLQ, leukocytosis
no bleeding
constipation > diarrhea
distension

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44
Q

diverticulitis test

A

CT w/ oral and IV contrast

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45
Q

diverticulitis test CI

A

barium enema
colonoscopy
can perforate

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46
Q

diverticulitis tx

A

cipro or bactrim + metronidazole
NPO, IVF

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47
Q

fecal impaction tx

A

initial; digital disimpaction and evacuation (warm water enema, mineral oil)
NG tube
abd massage

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48
Q

Hirschsprung disease association

A

downs syndrome

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49
Q

Hirschsprung disease sx

A

no passed meconium w/in 48h of birth
failed neural crest cell migration
poor feeding, abd dissension
biliary vomiting

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50
Q

Hirschsprung disease test

A

BIT: anorectal manometry (inc pressure)
rectal exam: explosion of gas and stool (squirt sign)
xray: complete bowel obstruction
bx definitive

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51
Q

Hirschsprung disease tx

A

surgery (resection of aganglionic segment followed by anastomosis of normal bowel to anus)

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52
Q

external hemorrhoid

A

distal to dentate line (sensate area)

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53
Q

internal hemorrhoid

A

above dentate line (insensate area)

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54
Q

hemorrhoids tx

A

1st: high fiber diet, stool softeners, sitz bath, topical analgesics, steroids
2nd line: rubber band ligation (internal), elliptical excision (thrombosed/ clotted)
3rd line: hemorrhoidectomy

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55
Q

crohns patho

A

inflammatory anywhere, thru entire length of intestinal wall (transmural)

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56
Q

crohns smoking

A

harmful

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57
Q

crohns MC area

A

terminal ileum

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58
Q

crohns association

A

HLAB27

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59
Q

crohns sx

A

RLQ, N/V/D (no gross blood), F, B12 deficiency

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60
Q

crohns test

A

endoscopy w/ bx: cobblestone appearance, skip lesions
upper GI series TOC
inc ESR/CRP
string sign

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61
Q

crohns marker

A

+ ASCA

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62
Q

crohns tx

A

1st line maintenance: mesalamine
2nd line: metronidazole
flare: systemic steroids
replace folic acid
can’t be cured

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63
Q

ulcerative colitis smoking

A

protective

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64
Q

ulcerative colitis patho

A

inflammation/ulcers in colon/rectal mucosa
continuous inflammation

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65
Q

ulcerative colitis sx

A

abd pain, LLQ, diarrhea
gross blood, tenesmus

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66
Q

ulcerative colitis test

A

sigmoidoscopy/ colonoscopy TOC, definitive
stopepipe sign (dec haustral markings)

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67
Q

ulcerative colitis marker

A

+ PANCA

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68
Q

ulcerative colitis tx

A

total colectomy; curative
acute flare: systemic steroids + mesalamine enema
maintenance: mesalamine + sulfasalazine

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69
Q

ulcerative colitis complication

A

anemia, hemorrhage, electrolyte disturbance,
strictures, toxic megacolon, inc colon cancer risk

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70
Q

IBS association

A

MDD
fibromyalgia

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71
Q

IBS rome criteria

A

abd pain >3m w/ 2+ (improvement on defecation, change in frequency)

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72
Q

IBS alarm signs

A

onset after 50yo
rectal bleeding, melena
nocturnal diarrhea, progressive abd pain,
weight loss, lab abnormalities
Fhx

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73
Q

LBO MCC

A

adhesions

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74
Q

LBO sx

A

abd. pain, distension
high pitch BS

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75
Q

LBO test

A

abd xray: distended proximal colon, no gas in rectum, air fluid levels

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76
Q

LBO tx

A

admit
NG, NPO, IV fluids, rectal tube
surgery

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77
Q

rectal polyps MC area

A

rectosigmoid

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78
Q

rectal polyps MC sx

A

rectal bleeding

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79
Q

rectal polyps tx

A

removal

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80
Q

adematous polyps high risk cancer

A

villous

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81
Q

adematous polyps low risk cancer

A

tubular

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82
Q

rectal polyps MC type

A

hyperplastic
usually no tx needed, commonly removed

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83
Q

juvenile polyps (rectal)

A

child under 10
should be removed

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84
Q

polyps assoc w/ UC

A

inflammatory polyps/ pseudopolyps

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85
Q

toxic megacolon etiology

A

IBD
pseudomembranous colitis
C. diff colitis

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86
Q

toxic megacolon sx

A

F, tachycardia, leukocytosis
bloody diarrhea, vomiting
sx of shock (AMS, hypoTN)

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87
Q

toxic megacolon test

A

abd XR: dilation >6cm, loss of haustral markings

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88
Q

toxic megacolon tx

A

ICU, NG tube, NPO, IVF, electrolytes
CS, BS abx
no improvement after 24h = colectomy
bowel decompression

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89
Q

toxic megacolon complications

A

perforation
blood loss
septic shock

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90
Q

esophagitis MCC

A

GERD

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91
Q

infectious esophagitis MCC

A

candida (HIV/ inhaled steroids)
2nd MCC: HSV (immunocomp, organ transplant)

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92
Q

pill esophagitis med causes

A

alendronate
doxy
NSAIDS/ASA

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93
Q

eosinophilic esophagitis

A

elevated serum IgE
stacked circular ring formation
Hx allergies, atopic dermatitis, asthma

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94
Q

pill esophagitis test

A

small well defined ulcers of varying depths

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95
Q

esophagitis sx

A

odynophagia hallmark, dysphasia
retrosternal CP, cough, reflux

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96
Q

esophagitis test

A

endoscopy w/ bx

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97
Q

CMV esophagitis test

A

single large shallow and linear ulcer

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98
Q

candida esophagitis test

A

white well circumscribed lesions and creaming longitudinal plagues

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99
Q

HSV esophagitis test

A

white lesions w/ central umbilical clearing “punched out” ulcers

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100
Q

esophagitis tx

A

reflux: PPI
pill induced: d/c med or switch to liquid. take pills w/ water and remain upright 30m
eosinophilic: PPI, topical glucocorticoid, food allergy testing

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101
Q

pill induced esophagitis tx

A

d/c med or switch to liquid. take pills w/ water and remain upright 30m

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102
Q

eosinophilic esophagitis tx

A

PPI, topical glucocorticoid, food allergy testing

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103
Q

candida esophagitis tx

A

fluconazole

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104
Q

HSV esophagitis tx

A

acyclovir
self limiting

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105
Q

CMV esophagitis tx

A

gancyclovir/ fosacarnet

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106
Q

GERD patho

A

relaxation of LES

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107
Q

GERD test

A

endoscopy w/ bx TOC
24h pH monitoring gold

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108
Q

GERD tx

A

H2, PPI

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109
Q

GERD complication

A

erosive esophagitis, gingivitis, laryngitis.
stricture, esophageal ulcer, pharyngitis
barrett esophagus, pitting of dental enamel

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110
Q

mallory weiss tear tx

A

supportive, PPI
active bleeding: surgery (EGD w/ epi, fibrin sealant, electrocoagulation, ligation)

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111
Q

boerhaave syndrome patho

A

transmural rupture of distal esophagus

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112
Q

boerhaave syndrome sx

A

severe retrosternal CP
crepitus and crunching: hammans sign

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113
Q

boerhaave syndrome test

A

initial: CXR (widened mediastinum, pleural effusion, emphysema)
confirm: CT
contrast esophogram definitive

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114
Q

boerhaave syndrome tx

A

NPO, IV abx, IV PPI
surgical repair

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115
Q

achalasia patho

A

failure of LES to relax
increased LES tone
loss of auerbachs plexus

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116
Q

achalasia worldwide etiology

A

chagas disease

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117
Q

achalasia MC etiology

A

idiopathic
2nd MCC: adenocarcinoma

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118
Q

achalasia sx

A

progressive dysphasia (solids and liquids)
episodic regurgitation

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119
Q

achalasia test

A

BIT: barium swallow (bird beak, tapered)
gold: esophageal manometry

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120
Q

achalasia tx

A

no cure
dicyclomine
nitroglycerin
CCB (nifedipine)
botox inj to LES
pneumatic balloon most effective

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121
Q

nutcracker esophagus

A

excessive contractions during peristalsis
manometry (inc pressure during peristalsis)
CCB, nitrates, botox, sildenafil

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122
Q

diffuse esophageal spasm sx

A

CP radiates to neck
dysphagia
globus

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123
Q

diffuse esophageal spasm test

A

barium swallow (corkscrew during spasm)
EGD
manometry

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124
Q

diffuse esophageal spasm tx

A

nitrates, CCB, TCA
PPI
esophagomyotomy

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125
Q

Zenker diverticulum patho

A

outpouching at pharyngeal esophageal junction
near Killian triangle, posterior hypopharynx

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126
Q

MC esophageal diverticula

A

Zenker diverticulum

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127
Q

Zenker diverticulum sx

A

foul odor (halitosis)
dysphagia, choking
regurgitation of undigested food and liquid hours after eating

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128
Q

Zenker diverticulum test

A

best: barium swallow

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129
Q

Zenker diverticulum tx

A

surgery (cricopharyngeal myotomy)

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130
Q

Plummer Vinson syndrome patho

A

upper esophageal weblike tissue d/t severe iron def anemia. MC in postmenopausal women

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131
Q

Plummer Vinson syndrome sx

A

dysphagia, angular chelitis
iron deficiency anemia
koilonychia (spoon shaped nails)
atrophic glossitis

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132
Q

Plummer Vinson syndrome test

A

EGD
CBC: iron deficiency anemia

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133
Q

Plummer Vinson syndrome tx

A

esophageal balloon dilation + PPI
iron supplementation

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134
Q

Schatzki ring patho

A

distal esophageal web in lower esophagus @ squamocolumnar junction
from ingestion of alkali acids, bleach, detergent

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135
Q

Schatzki ring sx

A

intermittent solid food dysphagia and food impaction

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136
Q

Schatzki ring test

A

barium swallow TOC

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137
Q

Schatzki ring tx

A

esophageal balloon dilation + PPI

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138
Q

esophageal varices MCC

A

cirrhosis d/t portal HTN

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139
Q

esophageal varices sx

A

sudden bright red hematemesis

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140
Q

esophageal varices test

A

EGD: red whale markings, cherry red spots (high risk of bleed)

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141
Q

esophageal varices tx

A

acute: stabilize, banding, IV octreotide (TOC)
chronic: BB, ligation
abx prophylaxis: FQ/ ceftriaxone

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142
Q

celiac dz patho

A

a-gliadin antigen reaction causing abnormal mucosa

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143
Q

celiac dz sx

A

diarrhea/ steatorrhea, weight loss, bloating, anemia
easy fx, easy bleeding
dermatitis herpetiformic: pruritic rash on extensor surfaces

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144
Q

celiac dz test

A

definitive: small bowel bx (crypt hyperplasia)
IgG anti-tissue transflutaminase
IgA anti endomysial antibody

145
Q

celiac dz tx

A

gluten free diet
iron, Ca, VitD, folate supplement

146
Q

celiac dz risk of

A

intestinal lymphoma

147
Q

lactose intolerance test

A

hydrogen breath test

148
Q

nut allergy test

A

+ IgE antibody test

149
Q

gastritis types

A

A: body
B: antrum

150
Q

chronic gastritis MCC

A

H. pylori

151
Q

acute gastritis MCC

A

NSAIDS/ASA
H. pylori

152
Q

gastritis test

A

H. pylori breath test
EGD w/ bx MAT and gold standard

153
Q

gastritis tx

A

H. pylori: clarithromycin, amoxicillin, PPI

154
Q

peptic ulcer disease MCC

A

H. pylori

155
Q

gastric ulcer sx

A

worse w/ food, weight loss
more likely to become malignant
older pts, type A blood

156
Q

duodenal ulcer sx

A

relieved by eating, weight gain
younger, smoking
type O blood

157
Q

MC peptic ulcer

A

duodenal ulcer

158
Q

peptic ulcer disease test

A

initial: urea breath test/ fecal antigen test/ serology (if didn’t take PPI for 2 weeks)
MAT: EGD w/ bx (r/o cancer)

159
Q

peptic ulcer disease tx

A

DC meds
PPI, sucralfate, nisoprostol (only NSAID ulcers)
H. pylori tx

160
Q

peptic ulcer disease complications

A

MC bleeding
ruptured peptic ulcer –> IV abx and PPT before surgery

161
Q

pyloric stenosis sx

A

2wk-2mo old
projectile non bilious vomiting after feeding followed by desire to feed
palpable olive like mass RUQ

162
Q

pyloric stenosis test

A

initial: abd US (mushroom/ target lesion/ string sign)
hypokalemia, hypochloremic, metabolic alkalosis

163
Q

pyloric stenosis tx

A

1st: hydrate/ electrolytes, metabolic abnormalities
surgery: pyloromyotomy

164
Q

pyloric stenosis complication

A

apnea
duodenal perforation
post op N/V

165
Q

duodenal atresia association

A

Down syndrome

166
Q

duodenal atresia sx

A

bilious vomiting in first 2 days of life
abd distension

167
Q

duodenal atresia test

A

US: polyhydrominos (inability to swallow and remove amniotic fluid)
xray: double bubble sign

168
Q

duodenal atresia tx

A

D/C enteral feeds
NG decompression
surgery

169
Q

Zollinger Ellison syndrome patho

A

inc gastrin, stim of parietal cells –> PUD

170
Q

Zollinger Ellison syndrome MC location

A

duodenum

171
Q

Zollinger Ellison syndrome sx

A

abd pain, chronic diarrhea/steatorrhea
heartburn, suspected in pts w/ tx resistant PUD

172
Q

Zollinger Ellison syndrome test

A

initial: EGD
confirm: inc serum gastrin concentration (gasting)
secretin stimulation test +

173
Q

Zollinger Ellison syndrome tx

A

PPI or octrotide
surgery: exploratory lap and resection
metastatic: chemo

174
Q

Zollinger Ellison syndrome MC mets

A

liver and abd lymphnodes

175
Q

gastroporesis MCC

A

DM
post surgical

176
Q

gastroporesis test

A

initial: upper endoscopy
confirm: scintigraphic gastric emptying study

177
Q

gastroporesis tx

A

prokinetic therapy: metoclopramide 1st line
antiemetics
refractory: surgery, TCA

178
Q

hepatitis A sx

A

MC in US and children. recent travel
jaundice, spiking fever, clay color stool, dark urine
RUQ pain, tender enlarged liver, splenomegaly
cervical lymphadenopathy

179
Q

hepatitis A test

A

+ anti HAV IgM= acute infx
+ anti HAV iGM= prior infx or immunization

180
Q

hepatitis A tx

A

recover in 1-2mo
routine vaccination of all children recommended

181
Q

hepatitis A vaccine

A

at 12mo

182
Q

hepatitis B RF

A

body fluids, unprotected sex
IVDU, vertical (mother)

183
Q

hepatitis B sx

A

N/V jaundice, hepatomegaly
no fever typically
splenomegaly, adenopathy

184
Q

hepatitis B vaccination

A

universal infant vaccination at birth
2mo, 6mo

185
Q

hepatitis B immunization CI

A

bakers yeast allergy

186
Q

hepatitis C transmission

A

blood borne, IVDU
sexual intercourse
perianal

187
Q

hepatitis C sx

A

anorexia, jaundice, hepatomegaly
splenomegaly, adenopathy

188
Q

hepatitis C test for

A

hepatocellular carcinoma via AFP and US

189
Q

hepatitis D increased risk of

A

hepatocellular carcinoma

190
Q

hepatitis E transmission

A

fecal oral
travel

191
Q

hepatitis E sx

A

jaundice, fever, dark urine, clay colored stools
hepatomegaly, splenomegaly, cervical lymphadenopathy
RUQ pain

192
Q

hepatitis E tx

A

self limiting
recombinant genotype 1 vaccine in endemic areas

193
Q

hepatitis labs

A

inc LFT , bilirubin, PT, and globulins

194
Q

cirrhosis causes

A

alcohol abuse
hepatitis B/C
NASH
hemochromatosis

195
Q

cirrhosis sx

A

jaundice, hepatic encephalopathy, pruritus,
ascites, varices, gynecomastia, palmar erythema
spider angioma, caput medusa

196
Q

cirrhosis test

A

initial: abd US
gold: liver bx
inc LFT, inc PT/INR

197
Q

cirrhosis tx

A

tx underlying
liver transplant
lactulose, rifaximin, neomycin

198
Q

cirrhosis screen for

A

hepatocellular carcinoma w/ Abd US Q6mo
AFP

199
Q

budd chiari

A

hepatic vein obstruction
ascites, hepatomegaly, RUQ, abd pain
US TOC

200
Q

most life threatening complication of portal HTN

A

bleeding

201
Q

portal HTN tx

A

TIPS
BB

202
Q

TIPS #1 complication

A

encephalopathy

203
Q

primary biliary cirrhosis marker

A

anti mitochondrial ab

204
Q

primary biliary cirrhosis tx

A

ursodeoxycholic acid

205
Q

MC complication of cirrhosis

A

ascites

206
Q

ascites tx

A

spironolactone
paracentesis
TIPS or shunt

207
Q

1st line tx hepatic encephalopathy

A

lactulose

208
Q

spontaneous bacterial peritonitis MCC

A

E. coli

209
Q

spontaneous bacterial peritonitis patho

A

ascites fluid infection

210
Q

spontaneous bacterial peritonitis sx

A

abd pain, F, chills, vomiting, rebound tenderness
AMS, ascites

211
Q

spontaneous bacterial peritonitis test

A

paracentesis
gram stain w/ culture
WBC >500, PMN >250

212
Q

spontaneous bacterial peritonitis tx

A

BS abx (3rd gen cef)
repeat paracentesis in 2-3d

213
Q

direct inguinal hernia

A

defect of transversals fascia
Hesselbachs triangle
medial to inferior epigastric vessels

214
Q

Hesselbachs triangle

A

rectus sheath edge medially
inferior epigastric vessel laterally
inguinal ligament inferiorly

215
Q

indirect inguinal hernia

A

deep inguinal ring/ process vaginalis
descends in scrotum/groin
lateral to inferior epigastric vessels

216
Q

MC child diarrhea

A

rotavirus

217
Q

travelers diarrhea tx

A

cipro
azithromycin
prophylaxis: FQ

218
Q

amebiasis tx

A

iodoquinol
flagyl for liver abscess

219
Q

HUS MCC

A

shiga toxin
E. coli 0157:H7

220
Q

HUS sx

A

preceding bloody diarrhea, fatigue, pallor, bruising
petechiae, oliguria

221
Q

HUS test

A

schistocytes, inc bilirubin
thrombocytopenia
AKI (inc BUN, inc Cr)

222
Q

HUS tx

A

fluid and electrolyte
blood transfusion
dialysis

223
Q

MC type of bariatric surgery

A

sleeve gastrectomy

224
Q

bariatric surgery gold standard

A

gastric bypass

225
Q

bariatric surgery criteria

A

BMI >40
no success with diet/lifestyle changes

226
Q

bariatric surgery sx

A

N/V cramps, flushing, diaphoresis, palpitations
soon after eating meal high in fats/carbs

227
Q

bariatric surgery tx

A

diet mods
post surgical consideration: psych eval
correct vitamin deficiencies

228
Q

MC complication bariatric surgery

A

dehydration

229
Q

phelynketonuria patho

A

excessive phenylalanine due to failure to properly metabolize
deficiency of phenylanine hydroxylase (converts phenylalanine to tyrosine)

230
Q

phelynketonuria sx

A

light complexion, musty/mousey odor, mental retardation
inc DTR, eczema

231
Q

phelynketonuria test

A

newborn screen exam
inc PKU, dec tyrosine
24wk gestation

232
Q

phelynketonuria tx

A

tyrosine
avoid high proteins/ phenylalanine

233
Q

esophageal cancer worldwide MC type

A

SCC

234
Q

esophageal cancer MC type US

A

adenocarcinoma

235
Q

esophageal cancer SCC location and MCC

A

upper/mid esophagus
chronic alcohol/tobacco use

236
Q

esophageal cancer adenocarcinoma location and MCC

A

distal 1/3 esophagus/ GE junction
GERD and barretts esophagus

237
Q

esophageal cancer sx

A

dysphagia to solids., WL, hematemesis
+/- virchows triad
hoarse voice

238
Q

esophageal cancer test

A

initial: barium swallow (apple core lesion)
definitive: endoscopy w/ bx

239
Q

esophageal cancer tx

A

esophagectomy
prognosis poor

240
Q

esophageal cancer MC mets

A

liver, lungs, bones

241
Q

gastric cancer MC type

A

adenocarcinoma

242
Q

gastric cancer sx

A

abd pain and WL
melena
virchow (supraclavicular) node
Sister Mary Joseph (umbilical lymph nodes)

243
Q

gastric cancer test

A

endoscopy w/ bx MAT: leather bottle

244
Q

gastric cancer tx

A

surgery

245
Q

krukenburg tumor

A

ovarian mets from gastric cancer

246
Q

bloomers shelf

A

palpable nodule in rectal exam
gastric cancer

247
Q

Irish sign

A

left axillary lymph node
gastric cancer

248
Q

colorectal cancer MC type

A

adenocarcinoma

249
Q

colorectal cancer MC site of distant spread for colon

A

liver

250
Q

colorectal cancer sx

A

iron deficiency anemia
abd pain, hematochezia, WL, change in bowel habits

251
Q

colorectal cancer right sided tumor sx

A

blood, iron deficiency anemia
melena, change in BM uncommon
RLQ mass

252
Q

colorectal cancer left sided tumor sx

A

obstruction and change in BM common
constipation/diarrhea
pencil stools
hematochezia

253
Q

colorectal cancer test

A

colonoscopy most sensitive and specific
+FOBT
XR: apple core lesion
CBC: iron deficiency anemia
inc CEA
CT for staging

254
Q

colorectal cancer screening

A

colonoscopy @ 50
Q10y, 5y if high risk
high risk: screen at 40yo or 10y before relatives dx
>85yo does not need colonoscopy

255
Q

colorectal cancer tx

A

surgical management only curable tx
CEA level before surgery. monitor CEA w/ tx (Q 3-6mo)

256
Q

MC site of spread for rectum

A

lung

257
Q

hepatocellular carcinoma MCC

A

viral hepatitis (B and C)

258
Q

hepatocellular carcinoma MC type

A

nonfibrolamellar: assoc w/ hepatitis B and C, cirrhosis. unresectable

259
Q

fibrolamellar hepatocellular carcinoma

A

most often resectable

260
Q

hepatocellular carcinoma RF

A

cirrhosis
hemochromatosis
Wilsons dz
smoking, DMT2

261
Q

hepatocellular carcinoma sx

A

abd pain, hepatomegaly, WL, anorexia,
fatigue, portal HTN, ascites,
jaundice, splenomegaly

262
Q

hepatocellular carcinoma test

A

initial: abd CT w/ triple phase scanning
definitive: liver bx
US: monitor high risk pts
elevation of AFP

263
Q

hepatocellular carcinoma tx

A

surgical resection
transplant
chemo/rad

264
Q

cholangiocarcinoma patho

A

tumor of intra- extra hepatic bile ducts

265
Q

cholangiocarcinoma association

A

gallstones
cholecystoenteric fistula
porcelain gallbladder

266
Q

porcelain gallbladder patho

A

intramural calcification of gallbladder wall

267
Q

cholangiocarcinoma sx

A

nonspecific jaundice, colic, WL, anorexia,
RUQ mass, palpable gallbladder
obstructive jaundice, dark urine, clay colored stools, prurutis

268
Q

cholangiocarcinoma test

A

cholangiography stent placement

269
Q

cholangiocarcinoma tx

A

difficult to resect
prognosis bad

270
Q

pancreatic cancer MC location and type

A

ductal adenocarcinoma of the head

271
Q

pancreatic cancer sx

A

vague abd pain rad to back
painless obstructive jaundice
dark urine, pale stools
WL, Courvoisier sign (palpable gallbladder)
new onset DM even though pt is thin

272
Q

pancreatic cancer test

A

ERCP most sensitive
CT TOC
elevated bili

273
Q

pancreatic cancer tumor markers

A

CA 19-9
CEA

274
Q

pancreatic cancer tx

A

resectable: Whipple
unresectable: PTC/ ERCP w/ stent

275
Q

vitamin A deficiency alternative name

A

retinol

276
Q

leading cause of preventable blindness in children

A

vitamin A deficiency

277
Q

vitamin A deficiency sx

A

xerophthalmia
night blindness
bitot spots
immune defects

278
Q

vitamin A excess sx

A

teratogenic
alopecia
hepatotoxicity

279
Q

vitamin A sources

A

green leafy veggies
carrots, sweet potato, liver,
kidney, milk, egg yolk

280
Q

vitamin B2 deficiency different name

A

rivaflavin

281
Q

vitamin B2 deficiency sx

A

oral ocular genital syndrome
magenta tongue, angular chelitis
photophobia, corneal lesions, scrotal dermatitis

282
Q

korkoffs dementia sx

A

memory loss
confabulation
irreversible

283
Q

B1 deficiency other name

A

thiamine

284
Q

B1 deficiency etiology

A

chronic alcoholism

285
Q

dry beriberi sx

A

peripheral neuropathy
bilateral stocking glove distribution
muscle wasting

286
Q

wernicke-korsakoff syndrome sx

A

wernicke encephalopathy + Korsakoff psychosis
confusion, ataxia, nystagmus

287
Q

wet beriberi sx

A

cardiovascular
vasodilation, tachycardia, wide pulse pressure, sweating, warm skin, lactic acidosis. heart failure

288
Q

wernicke encephalopathy sx

A

encephalopathy
ocular dysfunction (lateral rectus palsy)
gait ataxia, dec DTR

289
Q

wernicke encephalopathy tx

A

IV thiamine then glucose infusion

290
Q

vitamin B6 deficiency sx

A

peripheral neuropathy
stomatitis
glossitis
flaky skin, anemia

291
Q

vitamin B6 deficiency patho

A

deficiency in pyridoxine from isoniazid
ETOH

292
Q

niacin deficiency sx

A

pellagra (raw skin)
four D: diarrhea, dementia, dermatitis, death if not tx

293
Q

niacin deficiency diet

A

meat, fish, liver, white grains, green leafy veggies

294
Q

vitamin C deficiency sx

A

3 H: hyperkeratitis, hemorrhage, hematologic
bleeding gums, pseudo paralysis, petechial hemorrhages, impaired wound healing, glossitis

295
Q

vitamin C deficiency tx sources

A

citrus, spinach, cauliflower, liver, kidney

296
Q

rickets sx

A

seizures, tetany,

297
Q

osteomalacia sx

A

potbelly, delayed milestones,
Harrison groove

298
Q

rickets/osteomalacia labs

A

dec VitD, dec Ca
dec P, inc ALP

299
Q

acute pancreatitis causes

A

gallstones
etoh abuse

300
Q

acute pancreatitis sx

A

epigastric pain radiating to back
relieved by sitting up or bending forward
F, leukocytosis, hypoTN

301
Q

acute pancreatitis hemorrhagic sx

A

Cullen sign
gray turner sign
fox sign

302
Q

acute pancreatitis test

A

inc amylase (MC), lipase (specific)
CT TOC

303
Q

acute pancreatitis tx

A

fluid resus
pain management
severe: ICU

304
Q

chronic pancreatitis sx

A

chronic pain w/ flare ups
epigastric pain rad back, steatorrhea
triad: malabsorption, inc glu, pancreatic calcifications

305
Q

chronic pancreatitis test

A

CT initial TOC
ERCP gold
amylase and lipase normal

306
Q

chronic pancreatitis tx

A

getoclopramide: gastroporesis
analgesics, NPO
pancreatojejunosomy

307
Q

pancreatic pseudocyst sx

A

acute pancreatitis hx
dull abd pain, epigstric abd mass

308
Q

pancreatic pseudocyst test

A

CT w/ contrast preferred
fluid analysis

309
Q

pancreatic pseudocyst tx

A

resolve w/ supportive care
1st line: NG, PPI, octreotide
2nd line: pseudocyst endoscopic drainage or catheter drainage
3rd line: surgery (necrosis)

310
Q

acute mesenteric ischemia sx

A

hx afib, MI, CAD
pain out of proportion
lactic metabolic acidosis

311
Q

acute mesenteric ischemia test

A

initial: CTA
mesenteric angiography gold

312
Q

acute mesenteric ischemia tx

A

supportive
surgical
arterial; papaverine (vasodilator)
venous: heparin
embolic: thrombolytic or embolectomy

313
Q

acute mesenteric ischemia avoid

A

vasopressors

314
Q

intussusception sx

A

colicky abd pain, palpable sausage shaped mass, currant jelly stool, RUQ pain
dance sign, vomiting

315
Q

intussusception test

A

BIT: US (target sign)
best confirmatory: barium/contrast enema

316
Q

intussusception tx

A

stable: IV fluids, NG, reduction via pneumatic enema (air pressure)
surgical if acutely ill or perforation

317
Q

small bowel obstruction MCC

A

surgical adhesions

318
Q

small bowel obstruction sx

A

colic abd pain, N/V, no passage of gas/feces, dissension, high pitch BS, visible peristalsis

319
Q

small bowel obstruction test

A

XR: ladder pattern (proximal dilated loops/ minimal gas)
string of pearls

320
Q

small bowel obstruction tx

A

non operative: IV fluids w/ electrolytes, NG, NPO, IV analgesica and abx
surgery if persistent or strangulation
laparotomy w/ lysis of adhesions and resection of necrotic bowel

321
Q

paralytic ileus etiology

A

opioids
post op
antidepressants, anticholinergics
hypokalemia

322
Q

paralytic ileus sx

A

distension, obstipation, minimal/absent abd pain,
absent/ dec BS

323
Q

paralytic ileus test

A

abd XR TOC: uniform distribution of gas

324
Q

paralytic ileus tx

A

IVF, NPO, NG
resolves w/ time
surgery only if sx of peritonitis

325
Q

volvulus sx

A

newborns
bilious vomiting, abd distension
blood streaked stools, melena
shock

326
Q

volvulus test

A

abd XR: double bubble sign
upper GI contrast/ contrast enema needed for dx

327
Q

malrotation and volvulus test

A

corkscrew or beaked appearance w/ dilated bowel loops

328
Q

volvulus tx

A

surgery
decompression or adds procedure

329
Q

upper GI bleed location

A

above ligament of treats

330
Q

upper GI bleed sx

A

melena
hematemesis

331
Q

upper GI bleed tx

A

TEGD w/ coagulation of bleeding vessel
ligation

332
Q

lower GI bleed location

A

below ligament of treitz

333
Q

lower GI bleed tx

A

may stop spontaneously
supportive
colonoscopy

334
Q

gilbert syndrome

A

jaundice w/ stress, etoh, illness
no tx

335
Q

Crigar najjar

A

neonatal jaundice
phototherapy –> week 2, kernicterous
liver transplant definitive tx
if asx, phenobarbital

336
Q

bilirubin (gilbert, criger, dubin)

A

gilbert and criger najjar: increase in unconjugated bili
dubin johnson: increase in conjugated bilirubin

337
Q

Dubin johnson

A

grossly black liver on bx
no tx

338
Q

rotors syndrome

A

mild dubin johnson
conjugated and nonconjugated bili
no black liver

339
Q

hemochromatosis patho

A

excessive iron absorption in intestine
autosomal recessive

340
Q

hemochromatosis sx

A

fatigue, arthritis, impotence, amenorrhea,
abd pain, arrhythmias
hyperpigmentation (bronze like)

341
Q

hemochromatosis test

A

genetic testing
confirm: iron studies and liver bx

342
Q

hemochromatosis tx

A

repeated phlebotomies TOC
advanced: liver transplant

343
Q

Wilsons disease patho

A

impairment of copper excretion into bile
autosomal recessive
ATP7B mutation

344
Q

Wilsons disease sx

A

Kayser Fleischer rings
liver disease, acute hepatitis, cirrhosis
parkinsonian like sx

345
Q

Wilsons disease test

A

liver bx (elevated copper concentration)
dec ceruloplasmin
inc urine copper

346
Q

Wilsons disease tx

A

chelating agents (d- penicillamine)
zinc

347
Q

PPI AE

A

long term: osteoporosis
pneumonia

348
Q

sucralfate AE

A

constipation

349
Q

bismuth AE

A

harmless black coating of stool

350
Q

misoprostol AE

A

diarrhea

351
Q

zofran AE

A

HA, constipation
QT prolongation

352
Q

metoclopramide AE and CI

A

acute dystonia
CI: parkinsons

353
Q

esophageal atresia patho

A

absence or closure of esophagus
MC assoc w/ tracheoesophageal fistula

354
Q

esophageal atresia sx

A

excessive oral secretions immediately after birth

355
Q

esophageal atresia test

A

inability to pass NG further than 10-15cm
fluoroscopy

356
Q

esophageal atresia tx

A

surgical ligation of fistula

357
Q

anticholinergic toxicity sx

A

xerostoma, AMS, tachycardia
urinary retention, mania, delirium
erythema, dry skin

358
Q

TCA AE

A

dry skin, dry mouth, dilated pupils, dec breath sounds
AMS, arrhythmias, hypoTN

PNCE (33 decks)

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