Mehl. bullets IM pdf

Question 1

Bloody diarrhea + poultry consumption = mos? 2

Answer 1

Campylobacter jejuni or Salmonella spp.

Question 2

Bloody diarrhea + reactive arthritis in an adult = 4 mos?

Answer 2

Y. enterocolitica, Campylobacter, Shigella,
Salmonella

sities visi 4 mos ir sukelia bloody.

+ entamoeba if traveler

Question 3

Diarrhea + Guillain-Barre syndrome = mo?

Answer 3

Campylobacter

Question 4

Cholecystitis/Cholelithiasis Tx if Pt doesn’t want surgery?

Answer 4

ursodeoxycholic acid (ursodiol)

Question 5

!!!! In pregnancy duoti ursodeoxycholic acid (ursodiol) tam kad sumazetu akmenu formavimas (nes del nestumo yra suletejusi peristaltika). Bet siaip jeigu cholecistitis = daryti laparoskopine cholecistektomija. Same in apendicitis - galima operuoti

Answer 5

.

Question 6

High ALP + high direct bilirubin + high amylase or lipase = Dx?

Answer 6

gallstone pancreatitis = choledocholithiasis

Question 7

High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy =Dx?

Answer 7

sphincter of Oddi dysfunction

Question 8

High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy = Dx?

Answer 8

choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point)

Question 9

Dx and Tx of choledocholithiasis?

Answer 9

ERCP

Question 10

High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy = Dx?

Answer 10

pancreatic cancer

Question 11

Dx of pancreatic cancer?

Answer 11

CT abdo with contrast

Question 12

High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative = Dx?

Answer 12

cholangiocarcinoma

Question 13

High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol = Dx?

Answer 13

primary biliary cirrhosis (PBC)

Question 14

High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) = Dx?

Answer 14

primary biliary cirrhosis (PBC)

Question 15

Dx of primary biliary cirrhosis (PBC)?

Answer 15

anti-mitochondrial Abx next best step; liver biopsy is confirmatory

Question 16

High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct = Dx? Tx?

Answer 16

choledochal cyst -> do simple excision of cyst (cholangiocarcinoma not cystic + CT can be negative)

Question 17

Imaging to view liver or pancreas?

Answer 17

CT with contrast

Question 18

Recent cholecystectomy + fever + abdo pain = Dx?

Answer 18

post-op bile leak

Question 19

Trichotillomania (eating one’s hair) + GI symptoms =Dx?

Answer 19

gastric bezoar (hair ball)

Question 20

Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms = Dx?

Answer 20

small bowel obstruction (SBO)

Question 21

Crater with necrotic debris on forearm + UC = Dx?

Answer 21

pyoderma gangrenosum

Question 22

Red shins + Crohn = Dx?

Answer 22

erythema nodosum

Question 23

UC + high bilirubin + high ALP = Dx?

Answer 23

primary sclerosing cholangitis

Question 24

Tx for Crohn + UC =?

Answer 24

USMLE wants oral sulfasalazine (or mesalamine) first before oral steroids;
for perianal disease in Crohn, topical agents / enemas can be used, but they will not make you to pick.

Question 25

Primary biliary cirrhosis Dx 1st and 2nd?

Answer 25

1st = antimitochondrial abs (AMA) --> 2nd. liver biopsy

Question 26

Primary biliary cirrhosis Tx initial and later?

Answer 26

Initial = ursodeoxycholic acid (stops progression) Later in advanced = liver biopsy

Question 27

!!!!!!!!!!!!!!!!Pancreatic enzymes are normal in pancreatic cancer. !!!!!!!!!!!

Answer 27

Dx with CT of the abdomen

Question 28

Pancreatic HEAD Ca Tx?

Answer 28

Whipple procedure

Question 29

Pancreatic TAIL Ca Tx?

Answer 29

distal pancreatectomy

Question 30

Patients with pancreatectomy need pancreatic enzyme supplementation. The exam can write this as “pancrelipase.”

Answer 30

.

Question 31

Courvoisier sign is a painless, palpable gallbladder in an afebrile patient who’s jaundiced. This is pancreatic cancer until proven otherwise and is pass-level.

Answer 31

.

Question 32

Cholangiocarcinoma = CP same as pancreatic Ca + negative CT ==> next step?

Answer 32

Answer is ERCP as next best step. * Can be caused by Clonorchis sinensis (trematode).

Question 33

Choledocholithiasis Dx?

Answer 33

USMLE wants abdominal ultrasound followed by ERCP as the answer. ERCP tends to show up as what they want, but there is a Q floating around somewhere that asks for ultrasound first, so know that sequence.

Question 34

Gallstone pancreatitis new NBME what Dx first wants?

Answer 34

New 2CK NBME has CT of the abdomen as done first, prior to ERCP. This is because even though we have a stone requiring removal from the biliary tree, CT of the abdomen first looks for pancreatic fluid collection.

Question 35

Cholangitis Dx and Tx?

Answer 35

USMLE wants antibiotics + ERCP to diagnose and treat.

Question 36

Circular lesion in pancreas seen in pancreatitis = Dx?

Answer 36

pseudoabscess -> answer = ERCP to drain internally