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Flashcards in GI 10% Deck (190):
1

HCl in the stomach is secreted by __ cells
Pepsin secreted by __ cells

-Hcl - parietal cells
-Pepsin - chief cells
-->HCl activates pepsinogen to pepsin

2

Medications that should be avoided in GERD b/c they lower esophageal sphincter pressure

Beta agonists
alpha-adrenergic antagonists
Nitrates
CCB
Anticholinergics
Theophylline
Morphine
Meperidine
Diazepam
Barbiturates

3

Tx of CMV esophagitis

IV ganciclovir

4

T/F - Somatostatin stimulates the release of GI hormones

FALSE - suppresses
ex. suppress gastrin secretion from G cells in stomach
ex. suppress CCK, VIP, insulin, pancreatic enzymes

5

T/F - Lower GI series (aka barium enema) is the test of choice in acute ulcerative colitis

FALSE - *contraindicated* because may cause toxic megacolon
-also CI if perforation is suspected

6

MC cause of esophagitis

GERD (duh)

7

esophageal findings on endoscopy - what dx?
1. large superficial shallow ulcers
2. small, deep ulcers
3. linear yellow-white plaques

1. large superficial shallow ulcers = CMV
2. small, deep ulcers = HSV
3. linear yellow-white plaques = Candida
All are infectious esophagitis, MC in immunocompromised pts

8

treatment of candida infectious esophagitis

oral fluconazole

9

Tx of HSV esophagitis

Acyclovir

10

medication classic for causing pill esophagitis

Bisphosphonates
others = NSAIDS, KCl, iron pills, BBs, CCBs

11

Multiple corrugated rings on endoscopy seen in ___

Eosinophilic esophagitis

12

gold standard to diagnose GERD

24 hr ambulatory pH monitoring
-not usually done
-1st line = endoscopy
-2nd line = esophageal manometry

13

what should be done if GERD is presenting with alarm symptoms (dysphagia, odynophagia, wt loss, bleeding)

don't just treat! Upper Endoscopy

14

loss of Auerbach's plexus leading to increased LES pressure

Difficulty with ___

Dx gold standard:

Tx:

Achalasia

Both liquid and solids

Esophageal manometry

Botox injections (temporary relief)
Nitrates, CCB, pneumatic dilation of LES
Esophagomyomectomy

15

Neurogenic dysphagia causes difficulty with ___.
Caused by injury/disease of brain stem for CN ___.

Both liquid and solids

CN 9, 10

16

"corkscrew esophagus" seen on esophagram

diffuse esophageal spasm
-chest pain w/ hot or cold liquids, foods

17

MC types Esophageal neoplasms in:
African Americans:
Smoking/ETOH:
GERD/Barrett's esophagus:
Obesity:

African Americans: Squamous cell
Smoking/ETOH: Squamous cell
GERD/Barrett's esophagus: Adenocarcinoma
Obesity: Adenocarcinoma

18

Squamous cell esophageal cancer MC in ___
Adenocarcinoma of esophagus MC in ___

SC: upper 1/3 of esophagus
AD: lower 1/3

19

Dx of esophageal neoplasm
Best initial:
Test of choice:
Staging:

Best initial: Biphasic barium esophagram
Test of choice: Endoscopy w/ bx
Staging: Endoscopic sonography, CT

20

pharyngoesophageal pouch is aka ___

Zenker's diverticulum -- dx via barium esophogram

21

T/F - Mallory Weiss tear can present with pneumomediastinum

FALSE - this is Boerhaave's syndrome - FULL thickness rupture of distal esophagus

Crepitus on chest auscultation

22

Plummer-Vinson Syndrome consists of (3)

1. dysphagia
2. esophageal webs
3. Fe def anemia
*atrophic glossitis
--this is a congenital syndrome

23

Dx test of choice for esophageal webs

barium esophagram

24

abx prophylaxis in esophageal variceal bleed to prevent infectious complications

FQs (ex. Norfloxacin)
or
Ceftriaxone

25

treatment of choice in acutely bleeding esophageal varices

endoscopic ligation
(**after IV fluids via 2 lg bore IVs and stabilization of the pt of course)

26

pharmacologic drug of choice in acutely bleeding esophageal varices

octreotide

27

__% of esophageal variceal bleeds that RE-BLEED within 1 year
--preventative treatment?

70%!! (1/3 of re-bleeds are fatal)
TX = BB's (nonselective - ex. propranolol, nadolol)
NOT used in acute bleeds

28

Budd-Chiari syndrome may cause ____

thrombosis of portal vein, leading to esophageal varices

29

MC type of hiatal hernia

Type 1 = sliding hernia
TX = same as GERD

30

How often and with what diagnostic tool should people with Barrett's esophagus be screened for cancer?

Every 3-5 years with Endoscopy

31

MC cause of gastritis

H pylori

32

Gold standard to dx gastritis

Endoscopy (shows thick, edematous erosions <0.5cm)

33

H pylori treatment

"CAP"
Clarythromycin + amoxicillin + PPI
(If allergic to penicillin --> Metronidazole)

34

T/F - Gastric ulcers are 4x more common than duodenal ulcers
--Duodenal or gastric seen in younger population?

FALSE! - Duodenal 4x more common than gastric
--Duodenal seen in younger population (30-55yo)

35

Tx of delayed gastric emptying

Prokinetic medications:
Cisapride, metoclopramide

36

(Duodenal/gastric) ulcers worsen with food, whereas (duodenal/gastric) ulcers improve with food.

GASTRIC ulcers WORSEN with food, whereas DUODENAL ulcers IMPROVE with food.

37

Tests that can confirm cure of H. pylori PUD

Stool antigen testing
Urea breath test

Accurate after 4 weeks AFTER completion of treatment

38

Gold standard to dx H pylori infection

Endoscopy (with biopsy! to rule out malignancy especially with gastric ulcers if alarm sx)
--positive urease test of biopsy specimen

39

Which of the following should NOT be used to confirm eradication of H pylori infection
A. urea breath test
B. H pylori stool antigen
C. serologic antibodies

C - serologic antibodies only used to confirm infection, can stay elevated long after eradication
-- the other 2 can be used for dx and eradication
--make sure urea breath test, pt is OFF PPIs

40

(duodenal or gastric) ulcers are typically better with meals, worse at night

duodenal
-gastric ulcers are worse esp 1-2h post meals

41

H2 receptor antagonist with lots of drug interactions

cimetidine
-b/c inhibitors CYP450 (remember C for CYP inhibitor)

42

Side effect of H2 receptor antagonists (general)
Side effect of cimetidine specifically

Inc LFTs
-- Cimetidine --> anti androgen (gynecomastia, impotence)

43

Side effect of PPIs

B12 deficiency

44

Prostaglandin E1 analog useful for preventing NSAID induced gastric ulcers

Misoprostol

45

Dx to suspect if: multiple peptic ulcers, "kissing ulcers", refractory ulcers to tx

Zollinger Ellison Syndrome
(gastrinoma)

46

best screening test for Zollinger Ellison Syndrome

fasting gastrin levels

47

Secretin test used to help diagnose ___

Zollinger Ellison Syndrome

secretin normally inhibits gastrin secretion. With this test, increased gastrin levels (>200 pg/mL) regardless of secretin administration

48

Linitis plastica

diffuse thickening of stomach wall due to gastric cancer infiltration

49

Krukenberg tumor

a malignancy in the ovary that metastasized from a primary site, classically the GI Tract (gastric adenocarcinoma MC)

50

MC type of gastric carcinoma

adenocarcinoma

51

"string sign" seen on upper GI contrast study

pyloric stenosis

(NOTE: String sign can also be seen in barium studies in Crohn's)

52

Budd Chiari Syndrome
-what is it?
-classic triad of sx?

Hepatic vein obstruction
SX = 1. ascites 2. hepatomegaly 3. RUQ abd pain

53

MC cause of gastroenteritis in US in adults? In kids?

Adults - norovirus
Kids - rotavirus

54

All of the following are causes of NON-invasive infectious diarrhea EXCEPT:
A. Staphylococcus
B. Vibrio
C. C. diff
D. Shigella
E. Enterotoxigenic E. Coli

D - Shigella causes invasive infectious diarrhea

Note: entero*hemorrhagic* E coli is a cause of invasive, NOT Enterotoxigenic

55

rice water stools leading to severe dehydration

Tx:

Vibrio cholerae (non invasive diarrhea)
*Mainstay of tx = fluid replacement

56

MC cause traveler's diarrhea
TX?

Enterotoxigenic E coli
TX = FQ (ex. cipro)

57

Abx notorious for causing C. diff

Clindamycin

58

diarrhea w/ very high lymphocytosis and pseudomembranous coliti

C. diff

59

TX of C diff (1st and 2nd line)

1st line = metronidazole
2nd line = vancomycin

60

key differentiating factor between invasive and noninvasive diarrhea

+ blood and fecal leukocytes w/ fever in invasive
---non invasive will have voluminous watery stools, vomiting

61

Tx of choice of Shigella

TMP-sulfa (Bactrim)

62

pea soup stools

Salmonella

63

diarrhea a kid gets after playing w/ pet turtle

Salmonella

64

treatment of typhoid fever/ salmonella gastroenteritis

FQs or ceftriaxone x 2 wks

65

pt w/ HA, pharyngitis --> progresses to diarrhea, intractable fever, bradycardia --> rose spots in 2nd week

Thyphoid (enteric) fever caused by Salmonella

66

MC cause of *bacterial* enteritis in US

Campylobacter (blood diarrhea)

67

"S or seagull shaped" organisms seen on stool culture

Campylobacter (GN bacteria) - also described as "comma shaped"

68

Tx of Campylobacter diarrhea

Erythromycin
FQs if severe

69

frothy, greasy diarrhea after camping
TX?

Giardia (protozoal infection)
TX = metronidazole

70

MC cause of chronic diarrhea in AIDS pts

Cryptosporidium
(no proven treatments)

71

PAS-positive macrophages on duodenal bx seen in __

Whipple's ds

72

(osmotic / secretory) diarrhea will have a HIGH osmotic gap, dec diarrhea with fasting

Osmotic

73

2 stimulant laxatives that inc Ach GI motility

Bisacodyl
Senna

74

examples of osmotic laxatives (4)

1. polyethylene glycol (Miralax)
2. Lactulose
3. sorbitol
4. Milk of Mg or Mg Citrate

75

Peginterfera alpha for Hep C contraindicated if (4)

1. autoimmune ds,
2. pregnant,
3. decompensated cirrhosis,
4. profound cytopenias

76

salmon colored esophageal mucosa

Barrett's esophagus

77

2 measurements of liver *function*

1. albumin
2. coagulation factors (prolonged PT)
(ALT/ AST are not function tests!)

78

MC cause of appendix obstruction? 2nd MC cause?

1. lymphoid hyperplasia
2 fecalith

79

what type of hernia might present with Howship-Romberg sign (aresthesias along medial thigh)

obturator
-d/t compression of obturator nerve

80

triad of 1. vomiting 2. abd pain 3. currant jelly stools

intussusception

81

___ sign = sausage shaped mass in RUQ. Associated with ___

Dance's sign
-intussusception

82

D-xylose test

Distinguishes maldigestion (pancreatic insufficiency, bile salt deficiency) from malabsorption

83

Hydrogen breath test

Test of choice in dx of Lactose Intolerance

84

2 Abs positive in celiac ds

1. Endomysial IgA Ab
2. transglutaminase Ab

85

skin disorder associated with celiac ds

dermatitis herpetiformis (pruritic, papulovesicular rash on extensor surfaces)

86

"skip lesions" with cobblestone appearance

Crohn's

87

stovepipe sign

ulcerative colitis (loss of haustral markings)

88

(UC or Crohn's) - transmural invovlement

Crohn's
-UC is mucosa and submucosa only

89

T/F - Barium enema is the diagnostic test of choice of UC (ulcerative colitis)

FALSE! contraindicated b/c might cause toxic megacolon
---> Flex sig is the dx test of choice

90

(2) 5-ASA medications used to IBD

1. mesalamine (oral or topical)
2. sulfasalazine - more side effects
--used as maintenance therapy

91

6-mercaptopurine, azathioprine, methotrexate are steroid-sparing agents in ___

IBD

92

Dx of acute Crohns

Upper GI series w/ small bowel follow through

93

Dx of intussusception in kids? In adults?

Kids: barium or air enema
Adults: CT, abd xray

94

abx for diverticulitis

cipro (or Bactrim) + metronidazole x 14d
(broad spectrum abx)

95

MC cause of acute lower GI bleeding

diverticulosis

96

definitive diagnosis for acute mesenteric ischemia = "pain out of proportion to PE"

Angiogram
(MC loss of blood to splenic flecture)

97

chronic dull abdominal pain WORSE after meals

chronic mesenteric ischemia
(d/t atherosclerosis)

98

MC type of adenoma polyp

Type of colon polyp w/ highest risk of becoming cancerous

90% of all polyps are ___.

Tubulous adenoma

Villous adenoma

Hyperplastic ( lowest risk of malignancy)

99

Tubular polyps require f/u ___

Villous polyps require f/u ___


Tubular polyps require f/u Q 5 years

Villous polyps require f/u Q 3 years

100

mainstay of chemotherapy for colon cancer

5FU

101

Peutz-Jehgers

Autosomal dominant, polyposis, mucocutaneous hypergigmentation (lips, buccal, hands)

RF for colorectal cancer

102

R or L sided colon cancer lesion?
Chronic blood loss, iron deficiency anemia

Right

Left sided: obstructive symptoms

103

1. indirect hernias are (lateral/medial) to the inf epigastric aa's and pass through ____
2. direct hernias are (lateral/medial) to the inf epigastric aa's and pass through ____

1. indirect - LATERAL, through internal inguinal ring
MOST COMMON

2. direct - MEDIAL, through external inguinal ring at Hesselbach triangle

104

(indirect/ direct) hernias go into the scrotum

indirect
-through persistent patent process vaginalis (MC in young children and adults)

105

T/F: Tx of anoreectal abscess and fistula include I&D with abx.

False. NO abx.

106

MC location for anal fissures

posterior midline

107

Anal cancer is caused by ___

HPV

108

MC cause of appendicitis

Fecalith

109

Ranson Criteria

Poor prognosis for pancreatitis

Leukocyte >16,000
Blood glucose > 200
LDH > 350
AST > 250
Arterial PO2 <60
Base deficit > 4
HYPOcalcium
Increased BUN

110

lab values in acute pancreatitis
-(hypo/ hyper) calcemia
-(inc/ dec) triglycerides
-(hypo/ hyper) glycemia

-HYPOcalcemia
-INC TGs
-HYPERglycemia

111

(amylase/ lipase) more specific for acute pancreatitis

lipase

112

Cullen and Turner's signs

signs of necrotizing hemorrhagic pancreatitis
-Cullins = periumbilical bruise
-Turners = flank bruise

113

colon cutoff sign and sentinel loop seen on abd xray

Pancreatitis
-colon cutoff = abrupt collapse of colon near pancreas
-sentinel loop = dilated small bowel loop in LUQ

114

Triad of chronic pancreatitis

1. calcifications 2. steatorrhea 3. DM

*calcifications seen on abd Xray

115

70% of pancreatic adenocarcinoma are found in the (head, body, tail)?

MC type of adenocarcinoma

head

Ductal

116

painless jaundice = ___

pancreatic cancer

117

___ sign = palpable, NONtender distended gallbladder associated w/ jaundice. Associated with _____

Courvoisier's sign
-pancreatic cancer

118

1. MC cause of small bowel obstruction
2. MC cause of large bowel obstruction

1. SBO - post surgical adhesions
2. LBO - cancer

119

Abd X-ray with air fluid levels in Step ladder pattern

Small bowel obstruction

120

Pancreatic tumor markers in pancreatic carcinoma

CEA
CA 19-9

121

Charcot's triad (3)
+
Reynolds' pentad (+2)

For Cholangitis
1. Fevers/ chills
2. RUQ pain
3. Jaundice
---> Reynolds
4. Shock (hypotension)
5. Altered mental status

122

Boas sign

- referred pain to right sub scapular area due to phrenic nerve irritation

seen in acute cholecysitis

123

porcelain gallbladder seen when?

chronic cholecystitis
-cholesterol submucosal aggregation
-*premalignant*

124

Gold standard to dx cholecysitis

HIDA scan
-although RUQ US is initial test of choice

125

Abx used in cholecsytitis (2)

3rd gen cephalosporin + metronidazole

126

Abx used in cholangitis (2)

penicillin + aminoglycoside (-mycins)

127

T/F - morphine is the pain med of choice for acute cholecysitis

False! Ass w/ sphincter of Oddi spasm
--Meperidine (Demerol) is preferred

128

Treatment of cholangitis

decompression of biliary tree via ERCP stone extraction

129

hereditary disorder with mildly reduced UGT (glucuronosyltransferase) enzyme activity

Gilbert's
-increased INDIRECT bilirubin w/ nml LFTs
(UGT normally conjugates indirect --> direct bill)
-no tx needed

130

"more severe form of Gilbert's disease"

Crigler Najjar Syndrome - no or little UGT activity

INDIRECT bilirubin

131

grossly black liver and isolated mild conjugated hyperbilirubinemia

Dubin Johnson Syndrome
-hepatocytes can't secrete conjugated bilirubin (gene mutation)
Increased DIRECT bilirubin
-no tx needed

132

echoic (clay colored) stools suggests ___
-would see inc (indirect/ direct) bilirubin

Biliary obstruction
-increased DIRECT (conjugated) bili
-also increased ALP and GGT

133

Most sensitive indicator of biliary injury

GGT

134

Increased ALP w/ normal GGT =

bone disease

135

Definitive tx of Primary sclerosing cholangitis

liver transplant

136

Primary sclerosing cholangitis mc associated w/ ___

Gold standard Dx:

Clinical presentation:

Ulcerative colitis

ERCP

Progressive jaundice, pruritis

137

Pattern of liver injury seen in alcoholic hepatitis

AST: ALT >2:1
(*think S for SHOTS!)

138

Pattern of liver injury: AST/ ALT >1,000

-acute viral hepatitis
-Usually active hep A, B, rarely C
-(ALT usually > AST)

139

Pattern of liver injury: ALT >1,000, + smooth mm Abs, + ANA

autoimmune hepatitis

140

Pattern of liver injury: inc AST/ ALT (but <400)

-chronic viral hepatitis
-Hep B, C, D
-(ALT usually > AST)

141

MC cause of fulminant hepatitis

acetaminophen

142

fulminant hepatitis in children w/ aspirin use during viral infection
--other sx?
--Tx?

Reye's syndrome
-rash, vomiting, encephalopathy, dilated pupils, multi-organ failure
-TX = lower ICP w/ mannitol

143

only viral hepatitis associated with spiking fevers

Hepatitis A

144

T/F: HAV, HBV, HEV are the only ones associated w/ chronic hepatitis

False. Hepatitis B, C, D

145

Transmission of
Hep A:
Hep B:
Hep C:
Hep D:
Hep E:

Hep A: feco-oral
Hep B: sexual, perinatal, percutaneous, perenteral
Hep C: parenteral (IVDU) >> sex
Hep D: parenteral, mucous membrane contact requires HBV
Hep E: feco-oral

146

Positive IgG HAV Ab with negative IgM HAV Ab indicates what?

Past exposure to hep A
(In acute hepatitis --> IgM HAV will be positive)

147

Diagnostic test for acute and chronic hepatitis C

HCV-RNA
(anti-HCV may be pos or neg in acute. in chronic, anti-HCV is pos)
(neg HCV-RNA = resolved infection)

148

treatment of chronic hep C (2)

pegylated interferon alpha-2b AND ribavirin

149

screening for HCC (hepatocellular carcinoma) if chronic Hep C with (2)

AFP
ultrasound

150

Hepatitis B serologies:
if HbsAb is present, it indicates what?

distant resolved infection OR vaccination

151

Hepatitis B serologies:
HBsAg - neg
anti-HBs Ab - neg
anti-HBc Ab - *pos (IgM)*
HBeAg - neg
Anti-HBe Ab - neg

window period of acute infection

152

Hepatitis B serologies:
HBsAg - *pos*
anti-HBs Ab - neg
anti-HBc Ab - *pos (IgM)*
HBeAg - pos/neg
Anti-HBe Ab - pos/neg

Acute hepatitis

153

Hepatitis B serologies:
HBsAg - neg
anti-HBs Ab - *pos*
anti-HBc Ab - *pos (IgG)*
HBeAg - neg
Anti-HBe Ab - neg

recovery /resolved infection
- if pt hasn't developed anti- HBs Ab in 6 months, the patient has a chronic infection

154

Hepatitis B serologies:
HBsAg -*pos*
anti-HBs Ab - neg
anti-HBc Ab - *pos (IgG)*
HBeAg - *pos*
Anti-HBe Ab - neg

Chronic *replicative* hepatitis

- If HBeAg were negative and anti-HBe Ab were positive --> This indicates chronic infection (non replicative) --> waning viral replication and decreased infectivity

155

MELD score for end stage liver disease is calculated using (3)

1. bilirubin
2. INR
3. creatinine
*measures 3 mo mortality

156

HCC is MC caused by chronic hepatitis, but can also be due to ___ exposure from ___ infection

aflatoxin exposure from Aspergillus infection

157

treatment for hepatic encephalopathy (2)

1. lactulose (converted to lactic acid by intestinal bacteria, pulls ammonia into gut)
2. neomycin (abx that decreases ammonia producing flora)

158

treatment for pruritus is cirrhosis

cholestryamine (bile acid sequestrant)

159

autosomal recessive disorder with Copper accumulation

Wilson's disease

160

cholestasis disease associated with ulcerative colitis

PSC (primary sclerosing cholangitis)

161

Hallmark antibody for PBC (primary biliary cirrhosis)

Anti-mitochondrial Ab

162

1st line treatment for PBC (primary biliary cirrhosis)

ursodeoxycholic acid (reduces progression)
-cure = liver transplant

163

Kayser Fleischer rings

corneal copper deposits seen in Wilson's ds

164

inc ALP and GGT indicate __

cholestasis
-can be seen in PBC, PSC, biliary obstruction

165

Vit D deficiency is called ___ in kids and ___ in adults
TX = ___

Rickets in kids, osteomalacia in adults
TX = Ergocalciferol (vit D)

166

vitamin __ deficiency - night blindness, squamous metaplasia

Vit A

167

Wernicke-Korsakoff's syndrome is caused by __ deficiency

Thiamin (B1) def
--alcoholics

168

3 D's of Pellagra (aka __ deficiency)

1. Diarrhea
2. Dementia
3. Dermatitis
aka Niacin (B3) deficiency

169

__ deficiency presents w/ oral-ocular-genital syndrome

Riboflavin (B2)
1. Oral - magenta colored tongue, angular cheilitis
2. Ocular - photophobia, corneal lesions
3. Genital - scrotal dermatitis

170

pernicious anemia

lack of gastric parietal cells = lack of intrinsic factor ---> B12 deficiency

171

sx of parasthesias, gait abnl, dementia, glossitis, GI problems, macrocytic anemia

B12 deficiency

172

PKU = reduced ability to metabolize ___ to ___

phenylalanine to tyrosine

173

infant presenting with vomiting, retardation, inc DTR, convulsions

PKU

174

mechanism of action of loperamide (Immodium) and diphenoxylate (Lomotil)

opioid agonists
-anti diarrheals

175

T/F - Bismuth salicylate (Pepto-Bismol) is safe in dysentery (fever, bloody diarrhea)

True
--loperamide (another anti-diarrheal) is NOT

176

cardiac side effect of anti emetics (ex. ondansetron, prochlorperazine)

QT prolongation

177

what type of hernia might present with Howship-Romberg sign (aresthesias along medial thigh)

obturator
-d/t compression of obturator nerve

178

Dilation of lacteals seen in ___

Caused by ____

Clinical manifestation:

Tx:

Whipple's disease

Tropheryma whipplei: MC in farmers around contaminated soils

Malabsorption**: weight loss, fever, lymphadenopathy, arthritis, steatorrhea

Rhythmic motion of eye muscles while chewing

PCN or tetracycline for 1-2 YEARS

179

Roux-en-Y gastric bypass sx should be given prophylactic ____ for 6 months to reduce risk of ____.

Ursodeoxycholic acid (UDCA)
gallstone

180

Nephrocalcinosis is common in pts with ____

Cystic fibrosis

181

Initial diagnostic test for C. dif

Rapid enzyme immunoassay (EIA)

182

LEFT supraclavicular adenopathy suggests ___

Intraabdominal cancer: kidney, ovary, testies, prostate

183

Celiac disease is associated with ___(2)

Down Syndrome (15%)
DM1

184

T/F: Urethritis caused by Chlamydia will have urinalysis that shows pyuria with bacteriuria on gram stain. Ucx will show bacterial growth.

FALSE. Chlaymdia will show pyuria WITHOUT bacteriuria on gram stain. NO growth on ucx.

185

Men with ED should be evaluated for ____ via ____

coronary artery disease
Thallium cardiac scintigraphy

186

Initial diagnosis of intussusception

US of abdomen

187

Rice water stool from improperly cooked shellfish

Caused by ___

Cholera

Enterotoxin actively secreted by pathogen

188

Screening recommendation of dysplasia or adenocarcinoma in pts with Barrett esophagus

Upper endoscopy q 3-5 years

189

MC presentation of Crohn disease

RLQ pain
diarrhea
weight loss

190

Newborn screening for Cystic Fibrosis uses ___

assay for immunoreactive trypsin (IRT)