More Fitzgerald

Question 1

Testing for H. pylori

Answer 1

Histology (requires EGD) and Serology
Urea breath test good for early follow-up
rapid urease

Question 2

H. pylori Testing if patient on PPI

Answer 2

Histology

Serology

Question 3

H. Pylori testing if previously infected and concerned for reinfection

Answer 3

fecal antigen testing

can have false negative with recent PPI use

Question 4

Treatment of H. pylori

Answer 4

10 days of PPI, amoxicillin, and clarithromycin

Question 5

Pretreatment of H. pylori

Answer 5

7-10 days PPI plus levofloxacin plus amoxicillin

Question 6

Perforated ulcer

Answer 6

duodenal ulcers tend to perforate into pancreas causing acute pancreatitis
emergent surgical consult
begin enteric covering antibiotics

Question 7

bleeding ulcer

Answer 7

80 percent resolve spontaneously
FFP if coagulopathic
platelets if less than 50K
lavage pending GI or surgical consult

Question 8

Gerd diagnosis is based on

Answer 8

clinically diagnosed by symptoms

Pyrosis must be present with other symptoms

endoscopy if no response to PPI

Question 9

If patient fails PPI therapy with GERD

Answer 9

manometry

Question 10

Can add what if no response to PPI throughout the day

Answer 10

Add PPI before dinner

IF this doesn’t work, refer to GI

Question 11

Incubation period for Hep A and E

Answer 11

2-6 weeks

Question 12

Incubation period for Hep B and C

Answer 12

6 weeks to 6 months

Question 13

Serology for Hep A

Answer 13

Anti-HAV and Immunoglobulin IgG IgM

Question 14

Serology for Hep C

Answer 14

Anti-HCV and HCV RNA means active disease

Question 15

Hepatitis D indications

Answer 15

must have hepatitis B plus Hepatitis D IgM

Question 16

Hepatitis E

Answer 16

no serology

Question 17

Hepatitis G

Answer 17

Only serology is HGV RNA

Question 18

IgG and IgM time frame

Answer 18

IgG previously infected longer than 6 months ago

IgM based on incubation period less than 6 months

Question 19

Immune due to Hep B vaccine

Answer 19

Anti-HBs

Question 20

Acutely infected Hep B

Answer 20

HBsAg, Anti-HBc, IgM anti-HBc,

Question 21

Chronically infected

Answer 21

HBsAg, Anti-HBc No IgM

Question 22

Hepatitis B e antigen HBeAg

Answer 22

serum found during acute and chronic Hepatitis B

means virus is replicating and has high levels of HBV

Question 23

Hepatitis B e antibody HBeAB or anti-HBe

Answer 23

produced by immune system during acute HBV infection

predictor of long term clearance of HBV undergoing antiviral therapy and indicates lower levels of HBV

Question 24

Patients with hepatitis are hospitalized due to

Answer 24

complications from chronic infection or progression of chronic infection

Question 25

Treatment of hepatitis

Answer 25

``` supportive hydrate 3-4 liters a day lactulose for increased ammonia levels loop diuretics for ascites paracentesis to relieve intraabdominal pressure replace albumin losses chemotherapeutic options for hep B and C ```

Question 26

In cholecysitits, leukocytosis for more than 24-48 hours suggests

Answer 26

severe infection and possible gangrene

Question 27

in appendicitis start antibiotics

Answer 27

when decision to operate is made can feel constipation in appendicitis

Question 28

bowel obstructions caused by

Answer 28

mechanical or functional causes tumore strictures ileus due to narcotics

Question 29

clinical presentation of bowel obstruction

Answer 29

time between pain and vomiting suggests location of obstruction starts with cramping periumbilical pain

Question 30

Radiographic findings of obstruction

Answer 30

horizontal pattern in SBO frame pattern in LBO

Question 31

Management of obstruction

Answer 31

Fluids treat medically with partial obstruction surgical intervention complete obstruction

Question 32

Perforated ulcer finding

Answer 32

leukocytosis free air on radiographic findings quiet, rigid abdomen with rebound tenderness

Question 33

Autoimmune thrombocytopenia purpura

Answer 33

clotting impaired when platelets fall less than 50K Steroid therapy to boost platelets only give platelets when actively bleeding

Question 34

Aspirin induced coagulopathy

Answer 34

inactivates platelets

Question 35

HIT

Answer 35

induced by antibodies treatment is to discontinue heparin and start direct thrombin inhibitors

Question 36

uremia induced coagulopathy

Answer 36

platelets inactivated in uremic plasma treatment DDAVP

Question 37

DIC

Answer 37

``` preceded by trauma and sepsis release of thromboplastin clotting then bleeding use heparin treatment is evaluated by increased fibrinogen ```

Question 38

Anticoagulation effect of warfarin observed when

Answer 38

3-5 days

Question 39

Sideroblastic anemia

Answer 39

increased TIBC, ferritin, iron | low MCV

Question 40

Thalessemia

Answer 40

Normal iron | low MCV

Question 41

BP reduction in stoke only if BP is

Answer 41

above 185/110 if TPA is a candidate above 220/110 if TPA is not a candidate goal is to lower BP 15-25% in first 24 hours

Question 42

National institutes of health stroke scale NIHSS

Answer 42

Determines if symptoms related to stroke 0 to 42 0 means no stroke above 21 means stroke

Question 43

Myasthenia Gravis

Answer 43

autoimmune going from top down Edrophium helps symptoms prednisone for treatmentt plasmaphoresis and immune globulin

Question 44

Guillain barre

Answer 44

bottom up autonomic manifestations tachy and hypotension IVIG recovery often spontaneous

Question 45

Do not perform LP with

Answer 45

increased ICP findings | papiledema

Question 46

Autonomic dysreflexia

Answer 46

injury above T6 exaggerated response to stimulus remove stimulus

Question 47

Brown sequard syndrome

Answer 47

``` penetrating trauma ipsalateral motor and proprioception contralateral pain and temp immobilize give steroids ```

Question 48

central cord syndrome

Answer 48

cervical spinal cord hyperextension upper and lower weakness ICU monitoring for autonomic dysreflexia

Question 49

Cranial nerves

Answer 49

``` I olfactory- smell II optic- central and peripheral vision III Oculomotor- pupil response IV Trochlear- moves eye down V Trigeminal- tri forehead, cheek, jaw VI abducens- eye movement to sides VII facial- facial movements smile VIII acoustic- hearing IX glossopharyngeal- tongue movement X Vagus uvula XI spinal accessory- neck shoulders XII hypoglossal swallow, gag ```