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Associations 4 Flashcards

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1
Q

Malabsorption presentation

A

Weight loss, bloating, diarrhea

Possible steatorrhea, glossitis (B12), dermatitis (zinc), edema

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2
Q

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

A

Celiac disease

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3
Q

Where is ethanol absorbed

A

Stomach

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4
Q

Where is B12 absorbed

A

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

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5
Q

Diarrhea w/ megaloblastic anemia

A

Tropical sprue (folic acid replacement)

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6
Q

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

A

Whipple disease (Tropheryma whippelii)

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7
Q

Whipple disease dx

A

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

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8
Q

MC adult chronic diarrhea

A

Lactose deficiency

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9
Q

MC childhood acute diarrhea

A

Rotavirus

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10
Q

Secretory diarrhea causes

A 
Normal stool osmotic gap (<50)
IBS
Laxative abuse
VIPomas, gastrinomas, medullary thyroid cancer
Carcinoid tumors
Ileum resection
Enterotoxic bacteria
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11
Q

Osmotic diarrhea causes

A 
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
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12
Q

Inflammatory diarrhea causes

A

AI inflammatory process or chronic infection

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13
Q

Pediatric diarrhea causes

A

Infection (rotavirus, adenovirus)
Antibiotics (macrolides)
Immunosuppression

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14
Q

Stool osmotic gap calculation

A

290 - 2(Na + K)

125 is probably osmotic diarrhea

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15
Q

IBS symptoms

A

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

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16
Q

Not characteristic of IBS

A 
Anorexia
Weight loss
Malnutrition
Progressively worsening pain
Pain that prevents sleep
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17
Q

MCC SBO

A

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

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18
Q

MCC large bowel obstruction

A

Neoplasm

Diverticulitis, volvulus, congenital stricture

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19
Q

MC benign small bowel tumor

A

Leiomyoma

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20
Q

MC malignant small bowel tumor

A

Adenocarcinoma

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21
Q

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

A

Ischemic colitis

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22
Q

Abdominal pain out of proportion to exam

A

Acute mesenteric ischemia

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23
Q

Signs of appendicitis

A 
McBurney's point tenderness
Psoas sign (pain on hip extension)
Rovsing sign (pain w/ RLQ palpation)
Obturator sign (pain w/ hip IR)
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24
Q

Causes of ileus

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

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