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OMS2 - Semester 2 - BECOM Exam 1 > Dr. Stillwell > Flashcards

Dr. Stillwell Flashcards

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1
Q

GGT (gamma glutamyl transferase)

A
  • SPECIFIC to the liver -> high GGT -> liver probs

- when ONLY it is elevated -> EtOH issues

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2
Q

Alcoholic Hepatitis

A
  • AST>ALT 2:1
  • hepatocyte BALLOONING degeneration
  • MALLORY HYALINE BODIES
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3
Q

Drug and Toxin induced hepatitis

A
  • acetominophen (Tylenol) most common

- Reyes syndrome -> give kid w/ viral infection aspirin -> hepatic encephalopathy

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4
Q

Nonalcoholic Steatohepatitis (NASH)

A
  • metabolic syndrome

- can lead to HCC

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5
Q

autoimmune hepatitis

A

-elevated ANA and anti-smooth muscle Abs (ASMA)

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6
Q

Primary Biliary Cirrhosis (PBC)

A
  • INTRAlobular bile ducts
  • refractory pruritus
  • anti-mitochondrial Abs + (AMA)
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7
Q

Primary Sclerosing Cholangitis (PSC)

A
  • INTRA and EXTRAhepatic bile ducts
  • p-ANCA +
  • ulcerative colitis associated
  • high risk for cholangiocarcinoma
  • beads on a string
  • ONION SKIN FIBROSIS
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8
Q

Wilson’s disease

A
  • liver disease + neurologic + psychiatric issues
  • Kayser-Fleischer rings
  • AST > ALT
  • LOW cerulloplasmin
  • Tx: PENICILLAMINE
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9
Q

Hemochromatosis

A
  • bronzing/hyperpigmentation

- risk for YERSINIA

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10
Q

alpha-1 antitrypsin deficiency

A
  • affect lungs and liver
  • young person with COPD
  • lungs -> emphysematous bullae
  • PAS + inclusions
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11
Q

what do you do if you find granulomas on biopsy?

A

do thorough work up bc it may NOT be sarcoidosis

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12
Q

Bartonella (cat scratch)

A
  • can cause hepatic granulomas

- HIV+ -> Peliosis Hepatis -> blood filled cavities/islands

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13
Q

Hepatitis A virus

A
  • RNA virus (no enveloppe)
  • fecal oral
  • incubation 4 weeks (1 month)
  • dark urine 1st -> jaundice and icterus
  • does not become chronic -> CANNOT reactivate once you get it
  • there is a vaccine (Havrix, Vaqta)
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14
Q

Hepatitis E virus

A
  • RNA virus
  • fecal oral or blood transfusions; perinatal mortality
  • incubation 4 weeks
  • urticarial rash if symptomatic
  • PREGNANT woman 3rd trimester -> hepatic failure if not immune/vaccinated
  • immunocompromised -> can get chronic HEV
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15
Q

Hepatitis B virus

A
  • DNA virus
  • mother-child transmission predominant mode -> mothers HBAgs+ are 90% likely to transmit
  • ground glass hepatocytes
  • has a vaccine
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16
Q

acute HBV

A
  • incubation 2 months
  • ptxs who recover from HBV (95% who clear HBAgs) -> NOT truly cured bc still have HBV DNA on PCR
  • SERUM SICKNESS
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17
Q

chronic HBV

A
  • neonates more likely to get chronic HBV
  • HbAgs+ is MORE infectious if they are HBe ag+ than if they have started making HBe ag+ Abs w/ a negative HBAgs test
  • can get MEMBRANOUS GN or POLYARTERITIS NODOSA or CRYOGLOBULINEMIA + bullous pemphigoid
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18
Q

window period with HBV

A

-phase b/w clearance of HBAgs and the making of HBs Abs -> only anti-HBc IgM/Ab is detectable

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19
Q

Hepatitis D virus

A
  • RNA virus
  • ALWAYS have to be dual infected w/ HBV and HDV
  • has the same HBAgs
  • DIRECT damage to hepatocytes
  • diagnose by anti-HDV Ab
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20
Q

Hepatitis C virus

A
  • IVDA
  • perinatal transmission at time of birth and in 5% of infants born to mothers with HCV
  • NOT passed easily through sexual contact
  • incubation period 2 months
  • genotype 1 -> most widely dispersed
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21
Q

acute HCV

A
  • develop fibrosis -> cirrhosis -> HCC
  • most undetected but still cause acute hepatitis
  • # 1 risk for liver transplant
  • Cholestati pruritus
  • most have a +HCV RNA PCR but may not have a anti-HCV Ab early on
  • worried about acute HCV -> must check HCV RNA PCR
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22
Q

chronic HCV

A
  • poor correlation with transaminase levels and liver histo
  • HCV ptxs with cirrhosis -> high risk of HCC
  • EtOH and marijuana increase risk for progression

-amount of inflammation and fibrosis is best clinical predictor of chronic HBC (use Fibroscan)

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23
Q

HCV extra hepatic manifestations

A
  • CRYOGLOBULINEMIA
  • MEMBRANOPROLIFERATIVE GN
  • PORPHYRIA CUTANEOUS TARDA
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24
Q

what do you do for any ptx with acute or chronic renal failure?

A

should have HCV and HBV testing

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25
Candida esophagitis
- most common fungal infection in immunocompromised hosts - high risk if on PPIs - with oral/esophageal Candida -> look for immunocompromised state (HIV, malignancy, DM) - cobblestone - pseudohyphae
26
oral Candida + dysphagia
likely esophageal Candida
27
Germ tube test
-differentitated C. albicans and C. dubliensis from other species
28
C. krusei
NEVER sensitive to fluconazole
29
C. auris
- hospital outbreaks | - treat with echinocandins
30
HSV esophagitis
- HSV-1 - transplants >> HIV+ - volcano ulcers - punched out ulcers - multinucleated giant cells - cowdry type A inclusions
31
CMV esophagitis
- HIV+ >> transplant ptxs - LINEAR ulcers - OWLS eye inclusion
32
acute cholecystitis
- cystic duct obstruction, enlarged GB wall (normal size is = 3mm thick) - bacteria: E. coli, Klebsiella, Enterococcus - Dx - US -> GB wall thickening (>/4mm), pericholecystic fluid, edema/double wall sign
33
chronic cholecystitis
- Rokitansky-Aschoff sinuses | - Porcelain GB -> increased risk for GB cancer
34
Acalculous cholecystitis
-ICU ptxs -> hypoperfusion of GB -> ischemia
35
cholangitis
- Charcot's triad -> fever, RUQ pain, jaundice - Dx: ERCP - Mirizzi's syndrome -> gallstone lodges in cystic duct compressing on common bile duct
36
bacteria causing liver abscess
-E. coli, Klebsiella, Enterococcus, Strep Viridans
37
fungi causing liver abscess
Candida
38
parasites causing liver abscess
Entomoeba histolytica and Echinococcus - E. histolytica -> anchovy paste and treat w/ metronidazole - Echinococcal (hytadid cyst) -> anaphylactic shock if you biopsy
39
what ptxs can you see hepatosplenic candidiasis?
AML*** | -CT full of Candida liver abscesses (also pancreatic)
40
a pos stool toxin, culture or parasite
-does NOT mean there is an invasive infection -> may just be a colonizer
41
most acute gastroenteritis infections
- VIRAL origin -> antibiotics DON'T help | - SUPPORTIVE treatment
42
Norovirus
- EPIDEMIC gastroenteritis - Cruise ships and Dorm rooms - short incubation time (1-2 days) - NOT killed by EtOH and standard hand gels -> use soap and water
43
rotavirus
- children (6 months - 2 years old) -> goes through NURSERIES - dehydration cause of death - vaccine: RotaTeq, Rotarix -> can lead to intususpeption
44
Non-typhoidal Salmonella
- cause gastroenteritis - contaminated chicken/eggs/milk - see in TURTLES - summer months - non-infectious reactive arthritis syndrome (like Chlamydia, Shigella, Campylobacter, Yersinia) -> HLA-B27 + - chronic carrier (>1 year) -> Gallstones - Tx: Supportive...quinolone or TMP/SMX if needed
45
salmonella vs. shigella
- salmonella -> BLACK | - shigella -> CLEAR
46
Typhoidal Salmonella
- cause enteric fever (typhoid fever) - traveling from ENDEMIC countries - chronic carriage -> gallstones and GB carcinoma - 1st week -> PULSE TEMP DISSOCIATION - 2nd week -> ROSE SPOTS - 3rd week -> ILEOCECAL LYMPHATIC HYPERPLASIA - Dx: Widal test -> detect serum Abs against O and H antigens - Tx: ceftriaxone or azithromycin
47
Shigella
- produces SHIGA TOXIN -> cause HUS and dysentery - Tx: SUPPORTIVE with rehydration - avoid intestinal anti-motility drugs
48
Campylobacter
- contaminated chicken or waterborne - PPIs allow it to thrive -> decrease acidity - crampy abdominal pain in PERIUMBILICAL region - CAMPY blood agar - Tx: azithromycin or quinolones
49
Yersina
- PIGS/HOGS -> undercooked raw pork - Fe loving - Thalassemias or Hemochromatosis -> bacteremia and septic shock - CIN agar -> red w/ white-rimmed colonies
50
Vibrios Parahhaemolyticus
- Seafood -> New Orleans or TX coast lines - TCBS media -> black - Tx: supportive; tetracyclines (doxy) if needed
51
Vibrios Cholera
- CHOLERA TOXIN - "rice water" stools with mucous and FISHY ODOR - TCBS media -> blue-green - SHOOTING STAR on dark field microscopy - Tx: supportive; tetracyclines if needed
52
Tropheryma Whipplei (Whipples disease)
- sewage workers | - PAS+ foamy Macs in small bowel lamina propria
53
Clostridium Difficile
- get after Clindamycin therapy - use with Quinolones -> nosocomial outbreaks - thrives with PPIs and H2 blockers - cause pseudomembranous colitis - LEUKOCYTOSIS - asymptomatic carrier with + stool test -> NO therapy - C. diff toxin -> send 3x - PCR/NAAT for toxin B gene -> send 1x - Tx: ORAL vancomycin or metronidazole
54
causes of eosinophilia
1. GI parasites -> most common worldwide | 2. Allergic rxn -> most common in developing world
55
how many samples do you want for O and P studies?
3 separate stool samples for Dx
56
Ascaris Lumbricoides
- Nematode - travel to LUNGS and reswallowed -> Loeffler Syndrome -> Charcot Leyden Crystals - oval and mammillated eggs - Tx: Albendazole or Mebendazole
57
Enterobius Vermicularis (PINWORM)
- Nematode - KIDS - 40 million infected in US - PERIANAL ITCHING - Dx: perianal SCOTCH TAPE test - eggs FLAT on one side (bean-shaped) - Tx: Albendazole or Mebendazole
58
Trichuris Trichiuria (WHIPWORM)..."trick trick"
- Nematode - Tropical - rectal prolapse with worm burden - BARREL or lemon shaped eggs with HYALINE plugs - Tx: Albendazole or Mebendazole
59
Necator Americanus and Ancylostoma Duodenale (HOOKWORMS)
- Nematode - DIRECTLY enter skin -> go to LUNGS (eosinophilia) - "ground itch" - similar to cutaneous larva migrans - GI bleed -> Fe deficiency microcytic anemia + Eosinophilia - Tx: Albendazole or Mebendazole
60
Stronglyoides Stercoralis (Strongyloidiasis)
- Nematode - Tropical - Directly enter skin -> go to LUNGS (eosinophilia) - AUTOINFECTION - immunodeficient -> fatal HYPERINFECTION SYNROME - Larva currens (running larva) on butt -> move 1 cm in 5 min...(cutaneous larva migrans moves 1-2 cm per day) - periumbilical URTiCARIA AND PURPURIC RASH - Tx: Ivermectin > Albendazole
61
Trichinella Spiralis
- Nematode - BEAR/WALRUS undercooked meat w/ encysted larva - MYALGIA + PERIORBITAL/FACIAL EDEMA (also hypothyroidism) - Eosinophilia - Tx: Albendazole or Mebendazole
62
Toxocara canis and cati (ocular/visceral larva migrans)
- Nematode - dog/cat roundworms - larva in EYE - children + eosinophilia + fever - prominent EOSINOPHILIA - Tx: Albendazole or Prednisone
63
Baylisascaris Pyocyonis
- Nematode - RACCOONS - larva migrate to NERVOUS SYSTEM -> eosinophilia + meningoencephalitis - Tx: Albendazole or Predisone
64
Angiostrongyliasis Cantonensis (rat lungworm)
- Nematode - most common cause of eosinophilic meningitis and encephalitis - Tx: Albendazole or Prednisone
65
Taenia Saginata (BEEF tapeworm)
- Cestode - undercooked BEEF - AFB + - proglottids have 12-15 uterine branches - Tx: Praziquantal
66
Taenia Solium (PORK tapeworm)
- Cestode - undercooked PORK w/ cysticerci - AFB - - eggs are thick RADIATE shell w/ hooklets and walls - ingest EGGS -> CYSTICERCOSIS (cysts in the brain) -> neurocysticercosis and SEIZURES or increased intracranial pressure - Tx: Praziquantal
67
Diphyllobothrium Latum (fish tapeworm)
- Cestode - undercooked fish - LARGEST tapeworm - vit. B12 deficiency -> MEGALOBLASTIC ANEMIA - egg with operculum - Tx: Praziquantal
68
Hymenolepis nana (Dwarf tapeworm)
- Cestode - SMALLEST tapeworm - most common in the world - complete WHOLE LIFE CYCLE IN HOST - warm countries and schoolchildren - Tx: Praziquantal
69
Liver Flukes - Trematodes
1. Fasciola hepatica -> common bile duct obstruction, pancreatitis, PSC, hepatitis 2. Clonorchis sinensis Tx: Praziquantal
70
Intestinal Flukes - Trematodes
1. Fasciolopsis buski -> vit. B12 deficiency Tx: Praziquantal
71
Giardia Lamblia
- Protozoa - chronic infection -> develop lactose intolerance -> post-infectious IBS - trophozoites looks like ghost - Tx: Metronidazole or Tinidazole
72
Entamoeba histolytica
- Protozoa - those on steroids with misdiagnosed colitis have 25% mortality rate - can cause amoebic liver abscesses and dysentery - trophozoites INGEST RBCs - FLASK-SHAPED ULCERS - Karyosome (spot in nucleus) - Tx: Metronidazole -> Paramomycin
73
Blastocystis hominis
- Protozoa - most common parasite in human stool - commensal -> no fecal leukocytes seen - large central vacuole
74
Cryptosporidium parvum
- Protozoa - water-related outbreaks of diarrhea - immunodeficient in HIV+ ptxs (low CD4) -> LIFE THREATENING or can have LONG TERM - MODIFIED ACID FAST STAINS (special stains) -> not usually diagnosed on routine O and P study - ROUND and smaller than isospora - Tx: supportive - Paramomycin or Nitazoxanide if needed
75
Isospora belli
- Protozoa - common in immunodeficient ptxs (AIDS) - sometimes associated w/ EOSINOPHILIA - larger than crypto and OVAL - MODIFIED ACID FAST STAIN (special stain) -> not diagnosed on routine O and P study - Tx: supportive - TMP-SMX if needed
76
Cyclospora cayatanensis
- Protozoa - Sx more severe/chronic in ptxs w/ AIDS and biliary diseases including acaculous cholecystitis - larger than Crypto - MODIFIED ACID FAST STAIN - Tx: TMP-SMX
77
Microsporidiosis
- acutally a FUNGI (thought to be protozoa) - more severe and symptomatic in HIV+ ptxs w/ CD <100 - Tx: Albendazole

OMS2 - Semester 2 - BECOM Exam 1 (7 decks)

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