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CMS150 final (wk 9-14) > other > Flashcards

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1
Q

appendicitis highest to lower LR+

A

LRQ pain

migrating pain from perimbulical to RLQ

fever

psoas sign

pain before vimit

rebound tender

rigidity

anorexia

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2
Q

appendicitis treat

A

antibiotics or surgery

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3
Q

bowel obstruction higher to lower LR+

A

constipation
ab distention
pain decrease after vomit

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4
Q

bowel obstruction combined signs with higher LR+

A

distention associated with increased bowel sounds, vomit, constipation, or prior surgery

increased bowel sounds with history of prior surgery

increased bowel sounds with vomit

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5
Q

complete small bowel obstruction can progress to

A

bowel strangulation or infarction

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6
Q

etopic pregnancy test

A

serum beta hCG pregnancy test (levels plateau instead of increasing)

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7
Q

side for ovarian torison

A

70% right

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8
Q

pelvic inflammatory disease symptoms and test

A

infection so chills. fever, discharge, menstrual disturbance, cervical and adnexal tender

–> CRP and ESR for infection and endocervical culture for gonorrhoea and chlyamdia

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9
Q

peptic ulcer disease causes

A

NSAID or h pylori and older age

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10
Q

h pylori test

A

urea breath test, stool antigen test, blood test for antibodies

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11
Q

cholecystitis highest to lower LR_

A

murphy sign
RUQ pain
fever
jaundice

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12
Q

nephrolithiais (kidney stones)

A

urinary problem, nausea, vmit, back and flank pain

calcium oxalate stones most common

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13
Q

pancreatitis causes

A

alcohol

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14
Q

steatorrhea in which condition

A

chronic pancreatitis

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15
Q

IBS vs functional diarrhea or constripation

A

IBS has pain/ visceral hypersensitivity

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16
Q

functional GI processes involved

A
  • Impaired GI motility
  • Altered microbiome
  • Visceral hypersensitivity
  • Mucosal layer alterations
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17
Q

IBS_D alarm features

A
  • Unintentional weight loss
  • Nocturnal diarrhea
  • Tenesmus
  • Passing of bright red blood in stool (haematochezia)
  • High‐volume diarrhea, or very high number of bowel movements
  • Suspicion of malnutrition
  • Family history of colorectal cancer
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18
Q

what to check for in IBS-C

A

Digital rectal exam:
* detect stool in the rectal vault, anorectal masses, hemorrhoids, anal fissures, rectal prolapse, and rectoceles that may cause constipation

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19
Q

CONSTIPATION alarm features

A

Blood in stool
* Weight loss
* Anemia
* Family history of colon cancer, celiac disease or inflammatory bowel disease
* Acute onset at age older than 50
* Significant pain
* Vomiting, especially if recurrent
* Fever

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20
Q

SIBO testing

A

glucose > lactulose breath test

then duodenal aspirate

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21
Q

allergy and delayed sensitivity

and intolerance

A

allergy is IgE- immediate, anaphylaxis, urticaria, vomit

sensitivity is IgG- delayed

intolerance is lack enzymes i.e. lactase

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22
Q

ED stats

A

Approximately 20% of men over 20 suffer from ED, the prevalence increases significantly with advanced age
* 78% of males over the age of 75 are affected

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23
Q

causes of ED

A

It appears that ED below age 40 has a greater tendency for a psychosomatic whereas older patients are more likely to be cardiometabolic/vasculogenic origin

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24
Q

frequency of causes of ED

A

vascular 30%
psychogenic 20%
drug induced 18%
hormonal 17%

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25
drugs causing ED
SSRI and SNRI
26
ED key notes
ED with the ability to have a normal morning erection implies a psychogenic cause, although the patient’s subjective assessment of his own early morning erections can be unreliable * Sudden onset might point towards a psychogenic or drug-induced cause * ED induced by a drug, hormonal causes or psychogenic are highly treatable, look for these causes (Harris, 2012) * You also need to differentiate ED from other sexual disorders such as premature ejaculation and loss of libido (Miller, 2000)
27
hormones to check for eretile dysfunction
low testosterone (hypogonadism), high prolactin, cholesterol, CBC/ferrtin, fasting blood sugar HBA1c, hsCRP
27
28
what to rule out for ED
CVD (framingham), bladder or bowel incontiencen. sleep apnea
29
overt GI bleed vs occult
overt: hematemesis (blood in vomit), melena, hematochezia occult- microscopic
30
fecal occult blood test
fecal immunochemical test and guaiac based feacal occult blood test
31
CBC for go bleed and anemia
hemoglobin mean corpuscular volume hematocruit also ferritin
32
most common type of polyps
adenomatous and can give rise to adenocarcinoma
33
diverticulitis high LR
LLQ pain, no vomit, CRP
34
crohns test vs UC
stool lactoferrin > ileocosnoscopy > fecal calprotectin ilocolonscopy > lactoferrin > fecal calprtoectin
35
ulcerative colitis
finger clubbing
36
risks of UC
salmonella, c dif, camplylobactera
37
crohns risk
NSAIDs , birth control, smoking, anxtiobitoics
38
colorectal cancer high LR
age + change in bowel habit _ blood seen with or on stool
39
colorectal cancer test
FIT > gFOBT fecal immunochemical test better than guacici
40
dyspepsia bc of
GERD or IBS
41
peptic ulcer causes
h pylori and NSAIDs mainly
42
3 types of diarrhea
watery (secretory, osmotic, functional) fatty (maldigestive, malabnsorptive) inflammatory (aka exudative)
43
inflammatory diarrhea
elevated WBC, pus, occult or frank blood
44
c dificile diarrhea aka
pseudomembranous
45
diarrhea alarm symptoms
- blood in stools (either as hematochezia or melena) - more than 10% unintentional weight loss - disease that wakes the patient up during the night - fever - new onset of signs and symptoms after 50 yrs of age - fHx of colorectal cancer, inflammatory bowel disease (IBD) or celiac disease - unexplained anemia - elevated white blood cell count (WBCs) - abdominal mass
46
labs for IBS-D
- CBC, BMP (FBG, Ca, Electrolytes (Na, K, CO2, Cl), BUN, Creatinine), CRP; consider anti-tTG IgA, total IgA, O&P, fecal calprotectin, TSH, LFTs
47
carb malabosprtion/ intolerance
lack enzymes to digest carbs do hydrogen breath test lactose> fructose
48
bile acid malabsorption diarrhea
diarrhea caused from either hepatic overproduction of bile acids or their malabsorption in the terminal ileum
49
bile acid diarrhea test
SeHCAT > C4
50
c dificicle test
ewznyme imnmunosay EIA toxin A + B
51
c dificile risk
hospital, antibiotics
52
celiac
dermatitis herpetiformis IgA tTG IgG deaminated gliadin peptide has higher LR but not used
53
celiac high to low LR
symptoms since childhood 35 3.18 0.73 flatulence / gas 76 1.33 0.56 weight loss 49 1.14 0.89 loss of appetite 20 1.05 0.99 diarrhea 71 0.90 1.38 nausea 20 0.77 1.08 abdominal pain
54
celiac effects on tissue
1. long crypts 2. flattened villi 3. lymphocyte infiltration
55
non celiac gluten sensitivity testing for diagnosisng
gluten challenge
56
anorexia symptoms
thin appearance/ marked weight loss, amenorrhea, arrhythmia, bradycardia, brittle hair/nails, edema, hyperkeratosis, hypotension, lanugo, osteoporosis
57
anorexia BMI
mild: BMI ≥ 17 kg/m2 - moderate: BMI 16 - 16.99 kg/m2 - severe: BMI 15 - 15.99 kg/m2 - extreme: BMI < 15 kg/m2
58
bulimia and anorexia test
- UA (specific gravity, pH, ketones +/- protein - hydration status, kidney function) - body temperature (low), hypotension (incl. orthostatic) - ECG, CBC, electrolytes (Na, K, Cl), P, Mg, amylase, lipase, TSH, free T3, free T4 - bone density
59
bulimia levels of severity
mild: an average of 1-3 episodes per week - moderate: an average of 4-7 episodes per week - severe: an average of 8-13 episodes per week - extreme: an average of 14 or more episodes per week
60
SCOFF screening for eating disorders
1. DoyoumakeyourselfSICKbecauseyoufeeluncomfortablyfull? 2. DoyouworryyouhavelostCONTROLoverhowmuchyoueat? 3. HaveyourecentlylostmorethanONEstone(14lbs/6kg)ina3-monthperiod? 4. DoyoubelieveyourselftobeFATwhenotherssayyouaretoothin? 5. WouldyoousaythatFOODdominatesyourlife?
61
myocardial infarction high to low lr
radiating to both arms radiation to right arm s3 sound hypotension radiating to left arm
62
myocaridits
JVP, S3, edema, murmurs
63
myocarditis investigations
* Serum cardiac biomarkers (troponin) * Echocardiogram * Chest x-ray
64
peri and myocarditis could be from
infection or drugs etc
65
Pericarditis
Pleural effusion may accompany pericarditis, including cardiac tamponade: * Jugular venous distention (Sensitivity 100%) * Tachycardia (Sensitivity 100%) * Pulsus paradoxus >12mmHg (LR+, 5.9; LR−, 0.03)
66
aortic disection
asymmetric pulses or BP in upper limbs
67
pulmonary embolism risk
fracture or replacement or surgery
68
ischemic heart disease risk factors
Hypertension * Dyslipidemia * Diabetes mellitus * Smoking * Unhealthy diet * Physical inactivity * High waist circumference * High BMI
69
ishcmeic heart disease stable vs unstable angina
* * Chest pain described as crushing, pressure, squeezing, or tightness Stable angina: deep, poorly localized chest, arm, or neck pain or pressure associated with physical exertion or emotional stress, relieved within 5 minutes with rest or sublingual nitroglycerin Unstable angina: above symptoms that occur and/or persist even with rest and medication = Medical emergency
70
most significant risk factor for cerebrovascular (stroke or TIA)
hypertensions
71
symptoms for TIA or stroke
Symptoms (TIA and minor stroke) * Sudden loss of motor function * Sudden severe headache with no known cause * Sudden trouble seeing in one or both eyes * Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) Signs (see following slides) * Sudden confusion, trouble speaking or understanding speech * Sudden trouble walking, dizziness, loss of balance or coordination
72
peripheral vascular disease
Symptoms * Intermittent claudication (exercise-induced muscle pain) (LR+ 3.3) * May present in calf, thigh, buttocks, feet unilaterally or bilaterally * Pain comes on suddenly, often described as achy, and resolves after about 10 minutes rest * Lower extremity pain at rest (may wake from sleep) * Often worse when patient reclined, lower limb elevated, most often felt in toes and feet * Sensory changes in lower limb (numbness) * Lower extremity muscle fatigue Signs * Skin & nails exam * Ulcers or nonhealing wounds * Skin may feel cool, show pallour, or bluish colour * Nails may appear brittle, hypertrophic, ridged * Pulses * Upper extremity blood pressure * Ankle-brachial Index (<=0.9 abnormal) Asymptomatic * Intermittent claudication (exercise-induced muscle pain) (LR+ 3.3) * Palpate brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries (any abnormality LR+ 3.1) * Femoral artery bruit (LR+ 4.8) Patients presenting w/ leg pain * Cool skin on lower extremities (LR+ 5.90) * At least 1 lower limb artery bruit (LR+ 5.60; LR- 0.39) * Any palpable pulse abnormality on lower leg (LR+ 4.70; LR- 0.38)
73
73
deep vein thrombosis
* Active cancer (1 point) * Bedridden recently >3 days or major surgery within 12 * Calf swelling >3cm compared to other leg (2 points) * Collateral (nonvaricose) superficial veins present (1 point) * Entire leg swollen (1 point) * Localized tenderness along deep venous system (1 point) * Pitting edema, confined to symptomatic leg (1 point) * Paralysis, paresis, or recent plaster immobilization of lower extremity (1 point) * Previously documented DVT (1 point) * Alternative diagnosis to DVT as likely or more likely (-2 points)
74
heart failure score'
Age >= years 1 Sudden onset of dyspnea 2 Onset of dyspnea at night 1 Orthopnea 1 Prior congestive heart failure episode 2 History of COPD -2 History of myocardial infarction 1 Crackles on examination 2 Leg edema 1 ST segment abnormality on ECG 1 Atrial fibrillation/flutter on ECG 1
74
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CMS150 final (wk 9-14) (8 decks)

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