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CPS Exam #1 > Case #3 > Flashcards

Case #3 Flashcards

1
Q

What is Lansoprozole for?

A

Stomach Ulcers

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2
Q

Hymenoptra =

A

Type of Bee

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3
Q

Icterus =

A

Jaundice

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4
Q

BUN =

A

Blood Urea Nitrogen

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5
Q

Atalectesis =

A

Complete or partial lung collapse

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6
Q

Calcified lymph nodes indicate –

A

Previous histoplasmosis

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7
Q

Pivotal Abdominal Exam Features to Note

A

Location
Character
Acuity
Duration

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8
Q

Symptoms associates with Abdomen

A

Nausea, Vomiting, Stool changes,

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9
Q

______ and _______ histories in women are important.

A

Sexual. Menstrual

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10
Q

In abdomen, inspect for _______. Auscultate for _____.

A

Distention. Bowel Sounds.

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11
Q

Distention may indicate…

A

Bowel obstruction

Ascites

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12
Q

No Bowel Sounds =

A

Intra-abdominal catastrophe

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13
Q

High-pitched tinkling sounds and rushes

A

Intestinal Obstruction

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14
Q

What is the last part of the abdominal exam you should do?

A

Palpation of the painful area.

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15
Q

Perineal exams for an abdominal problem?

A

Rectal
Pelvic
Testicular

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16
Q

Pathology of GallBladder DIsease.

A

Bile gets concentrated and thickened from inc. cholesterol or lack of bile.
Gallstones formed from the sludge from cho. and bile

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17
Q

Classy word for gall stone formation?

A

Choleithiasis

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18
Q

What occurs in acute choleithiasis?

A

Stone obstructs the cystic duct

Inflammation

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19
Q

What is a choledocholithiasis?

A

A calculi in the common bile duct

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20
Q

Ascending cholangitis?

A

Inflammation of the bile duct

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21
Q

Risk Factors for Gallstones? (6)

A 
Age
Women
Obesity
Fast Weight Loss
Pregnancy
Crohn's
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22
Q

Race most likely to get gallstones…

A

Native Americans

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23
Q

The Five F’s of Gallbladder Disease

A

Fair, Fat, Over 40, Fertile, Female

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24
Q

With epigastric pain…first thought with…
Short episodes, no jaundice
Persistant Pain, Bili. Normal
Persistent Pain, Increased Billi.

A

Billiary Colic
Cholecystitis
Choledocolithiasis or Pancreatitis

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25
Describe basic normal bilirubin processing.
RBC breakdown --> Unconjugated Bili --> Into Hepatocyte/Conjugation --> Conjugated Bili into Bile --> Excretion
26
With hepatocyte damage...what happens to bilirubin processing?
....--> Into hepatocyte --> some conjugated, some remains unconjugated --> both largely released back into blood
27
Dark urine indicates...
Bilirubin in the Urine | CBD Obstruction or Hepatitis
28
Difference seen in patients with CBD vs cystic duct obstruction?
In cystic obstruction, CBD is open, so no hyperbilirubinemia, dark urine, or ALT/AST
29
What does a fever with obstruction suggest?
Bacterial colonization
30
What are Rigors? What do they Suggest?
Visible Shaking/Teeth Chattering Chills | Bacteremia
31
____% of adults have asymptomatic gallstones
10
32
Gallbladder gangrene is...
Gallbladder wall with necrotic and denuded mucosa
33
What should you see in a patient with acute cholecystitis?
Thickened gallbladder wall
34
How do you distinguish between a gallbladder polyp and a gallstone on ultrasound?
No Shadow = Polyps
35
T or F. Gall Bladder polyps are typically cancerous.
False Usually found incidently They do have malignant potential
36
What are polyps typically a reflection of?
Cholesterolosis -- lipid deposits
37
How do you treat >1cm gallbladder polyps?
Cholecystectomy
38
HIDA scan can be used to assess....
Function of Gallbladder | Measures filling of the gallbladder -- if blocked, nothing in
39
What is MCRP?
Magnetic resonance cholangiopancreatography Eval common duct with mild dilations
40
What is ERCP?
Endoscopic retrograde cholangiopancreatography If patient his dilated CBD< stones, jaundice
41
Describe Biliary Colic presentation
Intense, constant dull discomfort in RUQ Assoc. w/ diaphoresis, nausea, and vomiting No relieved by flatus, BM, squatting Not worse with movement
42
What is biliary colic anyway?
Gallbladder contracts, forces a stone/sludge against the GB outlet Increased GB pressure causes pain, relaxation causes the presure to drop - Commonly seen after fatty meals
43
Cause of ascending cholangitis?
Infection from organisms ascending from duodenum
44
What is Charcot's Triad?
Fever, Abdominal Pain, Jaundice
45
What is Reynold's Pentad?
Fever, Abdominal Pain, Jaundice, Confusion, Hypotension
46
What is acute cholecystitis?
Prolonged RUQ/epigastric pain (over 4 hours) | Assoc. with fever/leukocytosis
47
How to distinguish Biliary Colic, uncomplicated gallstone, and acute chole.?
Pain over 4 hours -- Acute Chole. Poorly localized, Negative Murphy Sign -- Uncomp. gallstone HIDA to distingush Biliary and acute chole.
48
What is Murphy's Sign?
Hypersensitivity to deep palpation of subcostal area with deep breath + is patient discomfort and insp. arrest
49
What is sonographic murphy's sign?
Murphy's from before, but using ultrasound to confirm what you're pushing on
50
Untreated cholecystitis?
Gangrene Perforation Fistula Infection
51
Bacteria most likely to get GB?
E Coli
52
Most common type of major surgery in US?
Laparoscopic Cholecystectomy
53
Complications of Laparo. Cholecyst.?
Bile Duct Injury Bile Leaks Bleeding Bowel Injury
54
Two biggest commonalities in lap. chole. complications.
Patient Selection | Surgical Experience
55
Cholecystitis medical therapy?
Ursodeoxycholic acid
56
What does Ursodeoxycholic Acid (Ursodiol) do?
Taken orally to break down cholesterol stones over 1-2 years. Can only work on small stones in a functional GB.
57
Other diseases associated with GB probs?
CV disease and Diabetes
58
Best approach for gallbladder disease?
Prevention
59
Protective Factors for GB?
``` Statins Ascorbic Acid Lecithin Taurine Coffee Omega-3s ```
60
How is atelectasis often imaged?
Xray
61
What is histoplasmosis?
Infection from fungus spores in MW soil | Typically asymptomatic
62
Why is it important to confirm histoplas.?
Looks very similar to sarcoidosis. | Treatment swith immunosuppressives could be bad

CPS Exam #1 (4 decks)

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