Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PLE TN Mastery > GI & Rheuma/Immuno > Flashcards

GI & Rheuma/Immuno Flashcards

1
Q

Most common causes of indigestion (2)

A

GERD

Functional dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Next best step after diagnosing GERD?

A

Start PPI (typical GERD does not need further work up)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most severe histologic consequence of GERD and a major risk factor for adenocarcinoma

A

Barrett’s epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is upper endoscopy the recommended INITIAL TEST in GERD?

A
  • In unexplained dyspepsia in >55 years old
  • (+) alarm factors: dysphagia, weight loss, anemia, bleeding

*R/O malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Classic symptoms of GERD

A
  • Water brash

- Substernal heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most sensitive test for diagnosis of GERD

A

24-h ambulatory pH monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gold standard for confirmation of Barret’s esophagus

A

Endoscopic biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Useful initial diagnostic test when mechanical obstruction of esophagus is suspected

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common esophageal symptom of GERD

A

Heartburn/pyrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common cause of esophageal chest pain

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Characteristic symptom of infectious esophagitis

A

Odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common cause of acute diarrhea

A

> 90% are infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common noninfectious cause of acute diarrhea

A

side effect of medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Major cause of death in acute diarrhea

A

dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to give antimotility/antisecretory agents in diarrhea?

A

Moderate/severe nonfebrile and nonbloody diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of PUD

A
  1. Bleeding
  2. Perforation
  3. Gastric outlet obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

First line treatment for H. pylori

A
  1. Triple Therapy (“OCA”): Omeprazole + Clarithromycin + Amoxicillin
  2. Quadruple (“TOMB”): Tetracycline + Omeprazole + Metronidazole + Bismuth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Has a central role in gastric epithelial defense/repair

A

Prostaglandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Key enzyme that controls the rate-limiting step in prostaglandin synthesis

A

Cyclooxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Duodenal ulcers occur most often in which part of the duodenum?

A

1st part of duodenum (>95%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 predominant causes of PUD

A
  • NSAID ingestion

- H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benign gastric ulcers are most commonly found where?

A

distal to the junction of the antrum and the acid-secreting mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most discriminating symptom in duodenal ulcer

A

pain that wakens the patient from sleep (between 12AM to 3AM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most frequent finding in gastric ulcer or duodenal ulcer

A

epigastric tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mainstay of PUD treatment (goals of treatment)

A
  • eradication of H. pylori

- prevention of NSAID-induced disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most potent acid inhibitory agents available

A

protom pump (H+,K+-ATP-ase) inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Upon diagnosing a case of acute pancreatitis, what is the next best step to confirm this diagnosis?

A

serum lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Best diagnostic work-up for abdominal ecchymosis?

A

abdominal CT scan with IV contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Cardinal symptom of pancreatitis

A

Abdominal pain, often in upper abdomen, with radiation to the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Leading cause of acute pancreatitis

A

Gallstone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

2nd most common cause of acute pancreatitis

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Periumbilical ecchymosis

A

Cullen’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Flank ecchymosis

A

Grey Turner’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Criteria for diagnosing acute pancreatitis

A

The diagnosis of acute pancreatitis is established by 2 out of 3 of the ff:

  1. typical abdominal pain in the epigastrium that may radiate to the back
  2. three-fold or greater elevation in the serum lipase and/or amylase
  3. confirmatory findings of acute pancreatitis on cross-sectional abdominal imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why is serum lipase a more reliable marker for pancreatitis than serum amylase?

A

Lipase is more specific to pancreas and remains elevated longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Early vs late pancreatitis

A

Early: <2 weeks
Late: >2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mild vs moderate vs severe pancreatitis

A

Mild: no organ failure
Moderate: transient (<48h) organ failure
Severe: persistent (>48h) organ failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Most common cause of death in acute pancreatitis

A

Hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most important intervention in acute pancreatitis

A

Safe, aggressive IV resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Supportive managment for acute pancreatitis

A
  1. NPO (bowel rest)
  2. IV fluids (to avoid hemoconcentration)
  3. Pain control (Meperidine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Level of hypertriglyceridemia that may cause pancreatitis

A

> 1000 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Charcot’s triad of cholangitis

A

“FPJ”:

  1. fever
  2. pain
  3. jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Management for gallstone pancreatitis

A

ERCP within 24-48 hours (for those with evidence of ascending cholangitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Melena indicates blood present in GIT for how long?

A

at least 14 hours and as long as 3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Most common cause of UGIB

A

Peptic ulcers

Others: variceal bleed, Mallory-Weiss tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Most common cause of LGIB

A

Hemorrhoids

Others: Diverticular disease, colonic mass, angioectasia, colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which promotility agent is given prior to endoscopy to improve endoscopic visualization?

A

Erythromycin 250mg IV, 30 mins prior to procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When to transfuse blood in a patient with active GI bleeding?

A

When Hgb <7 g/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When will a change in Hgb be observed after initial GI bleeding event?

A

Up to 72 hours after initial bleeding evente

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

When to do upper endoscopy in LGIB?

A

For active hemorrhage/hemodynamic instability (to R/O UGIB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Classic history of Mallory-Weiss tear

A

vomiting, retching, coughing preceding hematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Endoscopic therapy of choice for esophageal varices

A

Ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Responsible for majority of cases of obscure GIB

A

small intestinal sources of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Most common cause of obscure GIB in adults

A

vascular ectasias, tumors, NSAIDs

<50 yo: small bowel tumors
>50 yo:: vascular ectasia, NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Most common cause of significant LGIB in children

A

Meckel’s Diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Most common colonic cause of LGIB in children and adolescents

A

IBD and juvenile polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Test of choice of GI bleed

A

UGIB: upper endoscopy
LGIB: colonoscopy (unless with massive bleed)
Massive obscure bleed: angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Serum bilirubin level in scleral ictus

A

> 3 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Liver disease pattern wherein ALT/AST > ALP

A

Hepatocellular pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Liver disease pattern wherein ALT/AST < ALP

A

Cholestatic pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Most common and most characteristic symptom of liver disease

A

Fatigue (typically occurs after activity, afternoon fatigue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Hallmark symptom of liver disease and most reliable marker of severity

A

Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Cause of RUQ pain in liver disease

A

Stretching or irritation of Glisson’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Single most common risk factor for Hep C

A

injection drug use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Liver diseases with AST/ALT >1000 U/L

A
  • viral hepatitis
  • ischemic liver injury
  • toxin- or drug-induced liver injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Gold standard in diagnosing most liver diseases

A

Liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

AST:ALT >2 is seen in what condition?

A

alcoholic liver disease (AST > ALT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

AST:ALT <1 is seen in what condition?

A

chronic viral hepatitis, nonalcoholic fatty liver disease (AST < ALT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Prodromal phase precedes onset of jaundice by how long?

A

Prodromal phase precedes onset of jaundice by 1-2 weeks.

With onset of jaundice, constitutional symptoms disappear

70
Q

When does complete clinical and biochemical recovery in viral hepatitis occur?

A

For HAV & HEV: 1-2 months after onset

For HBV & HCV: 3-4 months after onset

71
Q

The only detectable serological marker in Hep B window period

A

anti-HBc (IgM)

72
Q

The period covering the interval between disappearance of HBsAg and appearance of anti-HBsAg

A

window period

73
Q

Major pathologic lesions in alcoholic liver disease

A
  • fatty liver
  • hepatitis
  • cirrhosis
74
Q

Management for end-stage cirrhosis in ALD

A

Liver transplantation

75
Q

When do you give steroids (prednisone) or pentoxifylline in ALD?

A

Discriminant function (DF) >32 or MELD >20

76
Q

Mainstay of treatment for hepatic encephalopathy

A

Lactulose

77
Q

Preffered site for paracentesis

A

LLQ

78
Q

Most common cause of ascites

A

Liver cirrhosis (84%)

79
Q

Initial treatment of cirrhotic ascites

A

Na restriction

*Next line: spironolactone+furosemide

80
Q

SAAG level to diagnose portal hypertension

A

SAAG >/= 1.1g/dl

81
Q

Turbid ascitic fluid is ascribed to ____

A

infection or tumor cells as cause of ascites

82
Q

White, milky fluid that indicates triglyceride level >200mg/dl is the hallmark of which type of ascites?

A

chylous ascites

83
Q

Ascites that is dark brown fluid (reflecting high bilirubin) is due to ____

A

Biliary tract perforation

84
Q

Black fluid in ascites is due to ____

A

pancreatic necrosis or metastatic carcinoma

85
Q

Ascitic glucose <50 mg/dl, ascitic LDH > serum LDH, and multiple organisms on culture indicates what?

A

Secondary peritonitis from ruptured hollow viscus

86
Q

Ascitic amylase usually >1000mg/dl is seen in which type of ascites?

A

Pancreatic ascites

87
Q

Ascitis fluid lymphocytosis, AFB smear, TB culture, and elevated ascitic adenosine deaminase is seen in which condition?

A

Tuberculous peritonitis

88
Q

Gold standard for evaluation when cause of ascites remains uncertain

A

Laparotomy or laparoscopy with peritoneal biopsy for histology and culture

89
Q

“Apple-core” or “napkin-ring” deformity on xray is seen in which condition?

A

Colon cancer

90
Q

Backbone of treatment of colon cancer

A

5-FU systemic therapy

91
Q

Chemotherapeutic agent that prolongs survival in colon cancer when disease has progressed while on 5-FU therapy

A

Irinotecan (topoisomerase inhibitor)

92
Q

Most common physical sign in hepatocellular cancer

A

Hepatomegaly

93
Q

Tumor marker for HCC

A

AFP

94
Q

Vascular abnormalities seen in liver ultrasound of HCC

A
  • hypervascularity

- thrombosis by tumor invasion

95
Q

Used to determine tumor size, exten, presence of vascular (portal vein) invasion in HCC

A

Triphasic CT scan of abdomen and pelvis

96
Q

Imaging criteria developed for HCC that do not require biopsy proof

A
  • nodules >1cm with arterial enhancement and portal venous washout
  • for small tumors, specified growth rates on 2 scans performed <6mos apart
97
Q

Synovial fluid described as clear, viscous, amber-colored, WBC <2000/uL, with predominance of mononuclear cells is classified as ___?

A

Non-inflammatory synovial fluid

98
Q

Synovial fluid that is turbid, yellow, WBC 2000-50,000/uL, PMN predominance, reduced viscosity is classified as ____?

A

Inflammatory synovial fluid

99
Q

Synovial fluid that is opaque, purulent, WBC >50,000/uL, PMN predominance (>755%), low viscosity is classified as __?

A

Septic synovial fluid

100
Q

Best initial diagnostic step for osteoarthritis

A

xray of affected joint

101
Q

Best initial treatment for osteoarthritis

A

Paracetamol

102
Q

Pathologic sine qua non of osteoarthritis

A

hyaline articular cartilage loss

103
Q

Most important risk factor for developing osteoarthritis

A

Age

*OA is the most common cause of chronic knee pain in persons >45 yo

104
Q

Which joints are affected in OA but not in RA

A

DIP

105
Q

Typical xray finding in osteoarthritis

A

Joint space loss or narrowing

106
Q

Joint pain is activity related and morning stiffness is <30 mins

A

OA

107
Q

Lesions of the DIP seen in OA

A

Heberden’s nodes

108
Q

Lesions of the PIP seen in OA

A

Bouchard’s noes

109
Q

Symmetric polyarthritis with stiffness worst (>1hr) in the morning but eases with physical activity

A

RA

110
Q

Initial diagnostic step for RA

A

Rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibodies

111
Q

Single most accurate test for RA

A

anti-CCP antibodies

112
Q

Initial treatment of choice for RA

A

DMARDs (Methotrexate)

113
Q

Pathologic hallmarks of RA (3)

A
  1. synovial inflammation
  2. focal bone erosions
  3. thinning of articular cartilage
114
Q

“swan neck deformity”
“Boutonnuere deformity”
“Z-line deformity”
Piano-key movement of ulnar styloid

A

RA

115
Q

Most common hematologic abnormality in RA

A

normocytic normochromic anemia

116
Q

Nodular RA + splenomegaly + neutropenia

A

Felty’s syndrome

117
Q

Most common pulmonary manifestation of RA

A

Pleuritis

118
Q

Most common valvular abnormality in RA

A

Mitral regurgitation

119
Q

Sensitivity of serum RF

A

75-80%

120
Q

Specificity of anti-CCP antibodies for RA

A

95%

121
Q

In the Classification Criteria for RA, what score indicates definite RA?

A

Score >/= 6

122
Q

Initial readiographyc finding in RA

A

Periarticular osteopenia

*Others: soft tissue swelling, joint space loss, subchondral erosions

123
Q

Synovial fluid analysis result in RA

A 
Inflammatory fluid (WBC 5,000-50,000)
Overwhelming cell type: Neutrophils
124
Q

Hydroxychloroquine (DMARD) serious side effect

A

irreversible retinal damage

125
Q

DMARDs safe in pregnancy

A

Hydroxychloroquine,

Sulfasalazine

126
Q

Best initial diagnostic for Gouty arthritis

A

diagnostic arthrocentesis

127
Q

Best initial therapy for gout

A

NSAID (those with short half-life):

- Indomethacin, naproxen, ibuprofen, diclofenac, celecoxib

128
Q

Classical presentation of gout

A

Podagra (pain in 1st metatarsophalangeal joint)

129
Q

(+) negatively birefringent needle-shaped monosodium urate crystals

A

gout

130
Q

(+) positively birefringent rhomboid-shaped calcium pyrophosphate dehydrate (CPPD) crystals

A

pseudogout

131
Q

Most common type of arthritis

A

OA

132
Q

Commonly affected joints in OA

A
  • spine (cervical/ lumbosacral)
  • hip
  • knee
  • 1st MTP
133
Q

Simplest effective treatment for OA

A

Avoid activities that precipitate pain

134
Q

Most common form of chronic inflammatory arthritis and often results in joint damage and disability

A

RA

135
Q

Most frequently involved joints in RA

A
  • wrists
  • MCP
  • PIP
  • DIP (if with coexisting OA)
136
Q

Frequent hallmark of RA and leads to decreased ROM, reduced grip, and trigger finger

A

Flexor tendon tenosynovitis

137
Q

Defined as either keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth) with another CTD, such as RA

A

Sjorgen Syndrome

138
Q

Most frequent site of cardiac involvement in RA

A

Pericardium

139
Q

Most common cause of death in those with RA

A

Cardiovascular disease

140
Q

Most useful for confirming an inflammatory arthritis (vs OA), while at the same time excluding infection of gout

A

synovial fluid analysis

141
Q

Offers greatest sensitivity for detecting synovitis and joint effusions, and early bone/bone marrow changes

A

MRI

142
Q

Early sign of inflammatory joint disease and can predict subsequent development of erosions

A

Bone marrow edema

143
Q

Population most affected by gout

A

Middle-aged to elderly men and postmenopausal women

144
Q

Most common early clinical manifestation of gout

A

Acute arthritis; usually only 1 joint is affected (metatarsophalangeal joint of 1st toe is often involved)

145
Q

Most commonly used hypouricemic agent and is the best drug to lower urate in overproducers, stone formers, and renal disease

A

Allopurinol

146
Q

Joint most commonly affected in calcium pyrophosphate deposition disease (CPPD)

A

Knee

147
Q

Drugs for uric acid undersecreter

A
  • probenecid
  • benzbromaronr
  • sulfinpyrazone
148
Q

Drugs for uric acid overproducer

A
  • allopurinol

- febuxostat

149
Q

Best initial diagnostic test for SLE

A

ANA (antinuclear antibody)

*(+) in >98% of patiens with SLE

150
Q

Most specific diagnostic test for SLE

A

Anti-dsDNA (70%) or Anti-Sm (25%)

151
Q

What diagnostic test correlates with SLE disease activity?

A

Anti-dsDNA

152
Q

SLE in pregnancy should be controlled with ___?

A

hydroxychloroquine +/- prednisone or prednisolone

153
Q

Mainstay tx for non-life threatening SLE

A

analgesics and antimalarials

154
Q

Mainstay tx for life-threatening SLE

A

systemic glucocorticoids PO/IV

155
Q

Antihistone antibodies are frequently positive in which type of lupus

A

Drug-induced lupus

156
Q

Most serious manifestation of SLE

A

Lupus nephritis

157
Q

Leading cause of mortality in the 1st decade of SLE

A

nephritis and infection

158
Q

Most common acute rash of SLE

A

Butterfly rash

159
Q

Most SLE px have intermittent polyarthritis, most commonly in __

A

hands, wrists, knees

160
Q

Most common chronic dermatitis in lupus (lesions: circular, slightly raised, scaly hyperpigmented erythematous rims and depigmented, atrophic centers)

A

Discoid LE

161
Q

Most common manifestation of diffuse CNS lupus

A

cognitive dysfunction

162
Q

Most common pulmonary manifestation in SLE

A

pleuritis +/- pleural effusion

163
Q

Most common cardiac manifestation in SLE

A

pericarditis

164
Q

Most serious cardiac manifestation in SLE

A

Myocarditis, Libman-Sacks endocarditis

165
Q

Endocardial involvement in SLE can lead to valvular insufficiencies, most commonly of the ___

A

mitral or aortic valves

166
Q

Most common hematologic manifestation in SLE

A

anemia (normo, normo)

167
Q

Most common musculoskeletal manifestation in SLE

A

arthralgia/myalgia

168
Q

Most common cutaneous manifestation in SLE

A

photosensitivity

169
Q

Most important auto-antibody to detect in SLE

A

ANA

170
Q

Medications approved for use in SLE

A
  • NSAIDs
  • salicylates
  • hydroxychloroquine
  • oral steroids
  • IV methylprednisolone
171
Q

SLE with worst prognosis

A

Crescentic lupus nephritis

PLE TN Mastery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions