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Flashcards in Associations 4 Deck (153):
1

Malabsorption presentation

Weight loss, bloating, diarrhea
Possible steatorrhea, glossitis (B12), dermatitis (zinc), edema

2

Diarrhea w/ Down Syndrome and dermatitis herpetiformis (very itchy bumps and blisters on knees, elbows, back, butt)

Celiac disease

3

Where is ethanol absorbed

Stomach

4

Where is B12 absorbed

Terminal ileum (needs intrinsic factor, made by parietal cells in stomach)

5

Diarrhea w/ megaloblastic anemia

Tropical sprue (folic acid replacement)

6

Weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathy, new heart murmur

Whipple disease (Tropheryma whippelii)

7

Whipple disease dx

Jejunal biopsy shows foamy macrophages on PAS stain and villous atrophy (also PCR)

8

MC adult chronic diarrhea

Lactose deficiency

9

MC childhood acute diarrhea

Rotavirus

10

Secretory diarrhea causes

Normal stool osmotic gap (<50)
IBS
Laxative abuse
VIPomas, gastrinomas, medullary thyroid cancer
Carcinoid tumors
Ileum resection
Enterotoxic bacteria

11

Osmotic diarrhea causes

Solute collecting in bowel lumen (increased stool osmotic gap, >50 or >125)
Malabsorption syndrome
Pancreatic insufficiency
Lactose intolerance
Excess sorbitol, lactulose, milk of Mg
Laxative abuse

12

Inflammatory diarrhea causes

AI inflammatory process or chronic infection

13

Pediatric diarrhea causes

Infection (rotavirus, adenovirus)
Antibiotics (macrolides)
Immunosuppression

14

Stool osmotic gap calculation

290 - 2(Na + K)
125 is probably osmotic diarrhea

15

IBS symptoms

At least 12 wks of symptoms in previous year
Pain relieved w/ defecation
Change in frequency/form of stool
Diarrhea/constipation
Straining, mucus, incomplete feeling, bloating, urgency

16

Not characteristic of IBS

Anorexia
Weight loss
Malnutrition
Progressively worsening pain
Pain that prevents sleep

17

MCC SBO

Adhesions
Bulges (hernias)
Cancer (neoplasms)
Volvulus, intussusception, Crohn's, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis

18

MCC large bowel obstruction

Neoplasm
Diverticulitis, volvulus, congenital stricture

19

MC benign small bowel tumor

Leiomyoma

20

MC malignant small bowel tumor

Adenocarcinoma

21

CT w/ pneumatosis coli (air in bowel wall) and bowel wall thickening

Ischemic colitis

22

Abdominal pain out of proportion to exam

Acute mesenteric ischemia

23

Signs of appendicitis

McBurney's point tenderness
Psoas sign (pain on hip extension)
Rovsing sign (pain w/ RLQ palpation)
Obturator sign (pain w/ hip IR)

24

Causes of ileus

Recent surgery (MC by far)
Infection, ischemia, DM, opioid use

25

Timeline for postop ileus

Small intestine: <24 hrs
Stomach: 2-3 days
Large intestine: 3-5 days

26

"Double bubble" sign + bird's beak sign

Volvulus

27

Carcinoid tumor symptoms

Only if outside GI tract
Be FDR
Bronchospasm
Flushing
Diarrhea
Right-sided valvular heart disease (TC/Pulm)
Increased 5-HIAA in urine, serum serotonin

28

MC locations carcinoid tumor

Bronchopulmonary tree
Ileum
Rectum
Appendex (MC tumor of appendix)

29

Bright red painless bleeding from anus

Internal hemorrhoids (above pectinate line)

30

Bright red painful bleeding from anus

External hemorrhoids (below pectinate line)
Anal fissure

31

Older person + LLQ pain + fever

Diverticulitis until proven otherwise

32

CT shows increased soft tissue density, colonic diverticula, bowel wall thickening, possible abscess

Diverticulitis

33

Mild LLQ pain relieved w/ defecation

Diverticulosis

34

MCC acute lower GI bleeding >40 yo

Diverticular disease (often in sigmoid colon)

35

APC gene mutation

FAP
Gardner syndrome
Turcot syndrome

36

Hundreds of polyps in colon, APC mutation

FAP (almost definite malignancy)

37

Cancer arises from normal-appearing mucosa, neoplasms tend to form in proximal colon

Hereditary nonpolyposis CRC (HNPCC)

38

Many colonic adenomas + bone and soft tissue tumors; APC mutation

Gardner syndrome (high risk of malignancy?)

39

Hamartomas + mucocutaneous pigmentation of mouth, hands, genitals

Peutz-Jeghers syndrome (low risk of malignancy)

40

Many colonic adenomas + malignant CNS tumors

Turcot syndrome (high risk of malignancy)

41

Polyps (usu hamartomas) of colon, small bowel, stomach that are frequent source of GI bleed

Juvenile polyposis (slightly increased risk of malignancy later in life)

42

Iron-deficiency anemia in older men or postmenopausal women

CRC until proven otherwise

43

Ranson criteria on admission

Acute pancreatitis, increased mortality with 3+
(GA Law)
Glucose >200
AST >250
LDH >350
Age >55
WBC >16,000

44

Ranson criteria during initial 48 hrs

Acute pancreatitis, increased mortality with 3+
(CAlvin & HOBBS)
Calcium 10%
O2 5
Base deficit >4
Sequestration of fluid >6 L

45

Exocrine pancreatic cancer labs

CEA, CA 19-9
Possible hyperglcemia
+bilirubin (direct), alk phos

46

Trousseau syndrome

Migratory thrombophlebitis
Assoc w/ several cancers esp exocrine pancreactic ca

47

Gastrin-secreting tumor

Zollinger-Ellison syndrome
Refractory PUD

48

Insulin-secreting tumor

Insulinoma
Refractory hypoglycemia

49

Glucagon-secreting tumor

Glucagonoma
Refractory DM

50

VIP-secreting tumor

VIPoma
Watery diarrhea

51

TPN complications

Bile stasis - gallstones and acalculous cholestasis
Site for infx and sepsis

52

Female, fertile, forty, fat

Gallstones

53

Palpation of RUQ during inspiration stops inspiration secondary to pain

Murphy's sign - cholelithiasis

54

Charcot's triad

Fever, RUQ pain, jaundice
Acute cholangitis

55

Reynold's pentad

Fever, RUQ pain, jaundice (Charcot's triad)
AMS, Shock or HoTN
Acute cholangitis

56

Dx cholelithiasis vs cholecystitis vs cholangitis

US vs US/HIDA vs HIDA

57

Porcelain gallbladder on x-ray

Calcified GB - 10-30% cancer
Usu represents chronic cholecystitis
Prompt cholecystectomy

58

LUQ pain referred to L shoulder

Kehr's sign
Splenic rupture

59

PBC

Intrahepatic bile duct destruction
AI
Females
+AMA (95%), +ANA (70%)

60

PSC

Intra and extrahepatic bile duct destruction
Assoc w/ UC
Males
+pANCA (maybe), negative AMA, ANA

61

Beads/Pearls on a string on ERCP

PSC

62

Indirect bilirubin elevation causes

Unconjugated
Excess bilirubin production (hemolytic anemia, erythropoeisis disorders, internal hemorrhage resorption)
Impaired conjugation (physiologic disease of the newborn, Gilbert, Crigler-Najjar, hepatocellular disease)

63

Direct bilirubin elevation causes

Conjugated
Decreased hepatic bilirubin excretion (impaired transport - Dubin-Johnson, Rotor, hepatocellular disease, drug impairment)
Extrahepatic biliary obstruction (PBC, PSC, gallstone in bile ducts, pancreatic or biliary cancer, biliary atresia)

64

MCC cirrhosis in US

Alcohol
Hep C

65

Portal HTN symptoms

Varices (esophageal, abdominal, etc)
Ascites
Hepatomegaly
Splenomegaly

66

Cirrhosis symptoms (sorted by liver fxn)

Clears bili - Jaundice
Makes proteins (clotting factors, albumin) - coagulopathy, decreased protein carrying ability, peripheral edema
Clears toxins (ammonia) - encephalopathy, asterixis
Sex hormone conversion (increased estrogen w/ failure) - spider telangectasias, palmar erythema; gynecomastia, testicular atrophy in men
Misc - weakness, weight loss, digital clubbing, Dupuytren contractures in hands

67

Ascites + jaundice + hepatomegaly + RUQ pain

R/O Budd-Chiari syndrome (thrombosis and occlusion of hepatic vein or hepatic portion of IVC secondary to hypercoagulability)
Can look like R CHF except no JVD

68

Portal HTN - prehepatic causes

Portal vein thrombosis

69

Portal HTN - hepatic causes

Cirrhosis, schistosomiasis, parenchymal disease, granulomatous disease

70

Portal HTN - posthepatic causes

R CHF, hepatic vein thrombosis, Budd-Chiari

71

Paracentesis, SAAG > 1.1

Portal HTN (cirrhosis, alcoholic hepatitis, heart failure, constrictive pericarditis, massive hepatic metastases, Budd-Chiari)

72

Paracentesis, SAAG <1.1

High albumin in ascites (peritoneal carcinomatosis eg ovarian Ca, peritoneal TB, pancreatitis, serositis)
Low serum albumin (nephrotic syndrome)

73

Paracentesis: high albumin, LDH = 60% serum LDH

R/O neoplastic etiology

74

Paracentesis: +WBC (neutrophils), +protein, -glucose, LDH > serum LDH

R/O spontaneous bacterial peritonitis, esp if fever

75

Wilson disease cause

Impaired copper secretion in young adults (<40)
Deposits in brain (personality changes, loss of coordination, psych sx, dysphagia, tremor), liver (hepatomegaly, jaundice), cornea (Kayser-Fleischer rings)

76

Wilson disease screening

Decreased serum ceruloplasmin

77

Risk factors HCC

HBV or HCV
Cirrhosis
Hemachromatosis
Schistosomiasis
Excessive consumption of aflatoxin from Aspergillus-infected food

78

MCC liver malignancy

Mets from breast, lung, colon

79

Paraneoplastic syndromes from HCC

Hypoglycemia
Polycythemia (+EPO)
Refractory watery diarrhea
Hypercalcemia
Skin lesions

80

Cancers that cause paraneoplastic polycythemia (+EPO)

Potentially really high HCT
Pheochromocytoma
RCC
HCC
Hemangioblastoma

81

MC TEF

Esophageal atresia (blind pouch) + distal TEF

82

Projectile nonbilious emesis + olive-sized epigastric mass

Pyloric stenosis

83

MC surgery in 1st 2 months

Pyloromyotomy

84

Preterm/low birth weight w/ abdominal distention, bilious vomiting, hematochezia after starting tube feeds

Necrotizing enterocolitis

85

Bad radiological signs in necrotizing enterocolitis

Air in bowel wall (necrosis, gangrene)
Portal vein gas, free air under diaphragm (perforation)

86

Meconium ileus + obstipation + blast sign

Hirschprung disease

87

Currnt jelly stool + palpable, sausage-like abdominal mass

Intussusception

88

MCC/risk factors of intussusception

Children - Meckel's diverticulum, Henoch-Schonlein purpura, adenovirus, CF
Adults - cancer until proven otherwise

89

MCC bowel obstruction in 1st 2 years

Intussusception

90

Meckel diverticulum rule of 2s

Males 2x more than females
Within 2 feet of ileocecal valve (Meckel pet scan)
2 types ectopic tissue (gastric, pancreatic)
2% of population
Before 2 years of age

91

Criteria for failure to thrive <2 yo

Weight <10%
Rate of daily weight gain less than expected for age

92

Study to identify relative risk, examine rare exposures, confirm risk factors

Cohort (can be prospective or retrospective, takes a group with the same exposure and follows)

93

Study to identify odds ratio, identify possible risk factors, examine rare diseases

Case-control (retrospective comparison of group of patients with disease with group of healthy controls; subject to recall and selection bias)

94

Study to create hypothesis for risk factors, ID prevalence

Cross-sectional survey

95

MCC UTI/pyelonephritis

E. coli = MCC
Staph saprophyticus
Klebsiella
Proteus
(Enterbacter)

96

MCC nephrolithiasis

Calcium oxalate stones (idiopathic hypercalciuria)

97

Cause of struvite stones

UTI w/ urease+ bacteria (Proteus, Klebsiella)

98

Cause of calcium phosphate stones

Hyperparathyroidism, RTA

99

Cause of uric acid stones

Chemo drugs
Gout

100

Cause of cystine stones

Cystinuria (genetic disease)

101

Staghorn calculi

Struvite kidney stones
Cystine kidney stones

102

Radiolucent kidney stones

Uric acid stones

103

Causes of temporary hematuria

Idiopathic
UTI
Exercise
Trauma
Nephrolithiasis
Endometriosis (bladder)

104

Causes of persistent hematuria

Glomerular disease (50 yo)

105

Causes of hydronephrosis

Nephrolithiasis
BPH
Neoplasm
Posterior urethral valves
Other obstructions, anatomic defects

106

Associated w/ ADPKD

Berry aneurysms (SAH)
MVP
Mild AR
Hepatic cysts

107

MCC interstitial nephropathy

Drugs (NSAIDs, abx; allopurinol, PPIs, diuretics, etc)
Toxins (cadmium, lead, copper, mercury, mushrooms)
Infections, AI, myogobinuria, rhabdo

108

Presentation of interstitial nephropathy

Rash + fever
Increased creatinine + eosinophilia

109

MCC ARF

Drugs (ATN)

110

Prerenal causes ARF

Hypovolemia (real or sensed by kidneys)
Sepsis
Renal artery stenosis
Drug toxicity

111

Intrarenal causes ARF

ATN (drugs, toxins)
Glomerular disease
Renal vascular disease

112

Postrenal causes ARF

Obstruction (stones, tumor, adhesions, BPH)

113

FENa

(Urine Na / Serum Na) / (Urine Cr / Serum Cr)
2% = ATN/intrarenal/postrenal cause

114

BUN:Cr ratio

>20 suggests prerenal cause

115

MCC CKD

HTN or diabetes (75%)

116

MCC death in dialysis patients

CVD

117

Rash + fever + increased Cr + eosinophilia

AIN

118

RNA Type I

Distal, impaired H secretion
High urine pH (>5.3)
Low K
Possible kidney stones

119

RNA Type II

Proximal, impaired HCO3 absorption
NL urine pH (<5.3)
Low K, Low HCO3
Bone lesions (rare)

120

RTA Type IV

Hypoaldosteronism (could be caused by DM)
NL urine pH (<5.3)
High K

121

Causes of metabolic alkalosis

Vomiting
Diuretics (contraction alkalosis)
Cushing syndrome, hyperaldosteronism, adrenal hyperplasia

122

Causes of respiratory alkalosis

Hyperventilation
- High altitude
- Asthma
- ASA toxicity
- Pulmonary embolism

123

Causes of respiratory acidosis

COPD
Respiratory depression
- Narcotic OD
- NM weakness

124

Causes of +anion gap metabolic acidosis

MUDPILES
Methanol
Uremia (kidney failure)
DKA
Polyethylene glycol
Isoniazid/Iron
Lactic acidosis
Ethylene glycol/ethanol
Salicylate toxicity

125

Causes of normal anion gap metabolic acidosis

Diarrhea (MCC)
RTA
Addison's/Hypoaldosteronism
TPN

126

CT chest w/ honeycomb pattern

Diffuse interstitial pulmonary fibrosis

127

Causes of SIADH

Any CNS
Pulmonary (esp PNA, SCLC)
Drugs (NSAIDs, antidepressants, antipsychotics, antineoplastic agents, carbamamzepine, ecstasy, vasopressin, DDAVP)
HIV/AIDS
Major surgery

128

Causes of hypernatremia

Dehydration
Fluid loss, skin (burns, sweating)
Fluid loss, GI (diarrhea, vomiting)
DI
Iatrogenic

129

Too rapid hydration w/ hypernatremia

Cerebral edema (correct <12 meq/24 hrs)

130

Tall peaked T waves on EKG

Hyperkalemia

131

Flat T waves/U waves on EKG

Hypokalemia

132

Overly rapid replacement of K in hypokalemia

Arrhythmias

133

Causes of hyperkalemia

Metabolic acidosis
Aldosterone deficiency
Adrenal deficiency
Tissue breakdown
Insulin deficiency
K-sparing diuretics, BB, ACE/ARB, digoxin
RTA Type IV

134

Causes of hypokalemia

Poor dietary intake
Alkalosis
Hypothermia
Vomiting, diarrhea
Hyperaldosteronism
RTA Types I and II
Insulin, diuretics (loop/TZD), albuterol, acetazolamide

135

Causes of hypercalcemia

Hyperparathyroidism
Neoplasm (PTHrP or bony destruction)
Immobilization
Thiazide diuretics
High ingestion Ca carbonate and milk (milk-alkali syndrome)
Sarcoidosis
+Vitamin A or D

136

Causes of hypocalcemia

Hypoparathyroidism
Hyperphosphatemia
Chronic renal failure
Vitamin D deficiency
Loop diuretics
Pancreatitis
Alcoholism

137

Shortened QT interval, electrolyte cause

Hypercalcemia

138

Long QT interval, electrolyte cause

Hypocalcemia

139

Chvostek / Trousseau sign

Hypocalcemia

140

Shifts K out of cells (hyperkalemia)

Low insulin
BB
Acidosis
Digoxin
Cell lysis (leukemia)

141

Shifts K into cells (hypokalemia)

Insulin
B-agonists
Alkalosis
Cell creation/proliferation

142

Risk factors bladder cancer

Smoking
Schistosomiasis (SCC, developing countries)
Cyclophosphamide
Aniline dyes, petroleum byproducts
Recurrent UTI
Male 3x > Female

143

MC cancers in males (occurrence)
Highest mortality cancers in males

Prostate, lung, colon
Lung, prostate colon

144

Urethritis + gram negative diplococci

N. gonorrhea (also seen on Thayer-Martin culture)

145

Urethritis + negative gram stain

Chlamydia (confirm w/ NAAT)

146

MC germ cell tumor of testis

Seminoma

147

Scrotal pain differential

Epididymitis (infection signs, pain decreases w/ support)
Testicular torsion (++pain, testicle elevated, pain does not change w/ support)

148

MC renal tumor in kids

Wilm's tumor

149

MC s/sx of Wilm's tumor

Palpable flank mass (MC)
Abdominal pain (30%)
HTN (25%)
Hematuria (12-25%)

150

WAGR syndrome

Wilms tumor
Aniridia
GU abnormalities
mental Retardation

151

Age for diagnosis/treatment of enuresis

Cannot be diagnosed before physical and developmental age 5
Usu don't start treatment until age 7

152

Risk of undescended testes

Testicular cancer (risk reduced but not eliminated by surgical correction)
Infertility
Bring testes into scrotum by 6-12 months for improved function (spontaneous descent usu by 6 months)

153

MC obstructive urethral lesion in newborns/infants and how to dx

Posterior urethral valves
Voiding cystourethrogram (VCUG)
Suspect in male w/ daytime incontinence at inappropriate age or male w/ UTI