POM (last time ever!)

Question 1

When will you see melana with lower GI bleed? or hematochezia with upper GI bleed?

Answer 1

When the GI motility is slow

When the GI motility is fast

Question 2

What is the definition of occult GI bleed?

Answer 2

Small amount of bleeding that the pt is not aware

Question 3

Clinical markers of upper and lower GI bleed?

Answer 3

Upper GI—>Hemodynamic compromise—>Shock/hypeactive bowel sound (blood is an irritant)/increase BUN (blood breakdown)
Lowe GI—>no hemodynamic compromise—>hematochezia

Question 4

What clinical sign can you see with blood loss?

Answer 4

Orthostatic HoTN

Question 5

Why is Ringer’s solution helpful for shock pt?

Answer 5

Shock pt has metabolic acidosis—>Ringer’s solution has lactate which would be converted to bicarb to offset the acidosis

Question 6

Why does initial HCT after bleed does not reflex the actual value?

Answer 6

HCT depends on plasma volume—>bleeding deplete plasma volume

Question 7

What is the normal HCT for men and women

Answer 7

Men—>45%

Women—>40%

Question 8

Pt with GI bleed should be on ___ status?

Answer 8

NPO

Question 9

What drug do we give pt with GI bleed?

Answer 9

IV PPI/sucralfate—>acid suppression

Question 10

What are the prokinetics and how do they work?

Answer 10

Increase gut motility for visualization
Erythromycin—>motilin agonist
Metoclopramide—>D2 antagonist

Question 11

When do we use antibiotic for prophylaxis when the pt is having GI bleed and why?

Answer 11

When the pt has cirrhosis—>portal HTN—>blood is bypassing liver—>bacteria is not filtered in the liver–>thus antibiotic prophylaxis is needed

Question 12

What drug has vasoconstrictive effect on mesenteric and portal vessels, thus reduce bleeding? what other drug can be used as vasocontrictor?

Answer 12

Somatostatin analog like octreotide
Vasopressin—>stimulate V1 receptor
Used for acute bleed

Question 13

How to approach GI bleed pt?

Answer 13

First stabilize the pt—>if stabilize—>endoscope—>if not—>interventional radiology for embolization surgery

Question 14

Forrest classification for endoscopic risk, which one is the worst and the least dangerous?

Answer 14

Forrest I A is the worst

Forrest III is the least dangerous

Question 15

What are the high risk marks for variceal to bleed?

Answer 15

Red wale mark/cherry red spot/hemocystic spot/diffuse erythema

Question 16

What drugs are used as prophylaxis for varices that hasnt bled yet?

Answer 16

Non selective beta blocker—>decrease portal pressure

Question 17

Is rebleed after a variceal bleed common?

Answer 17

mmhmm

Question 18

When is TIPS used?

Answer 18

Refractory variceal bleed

Question 19

What could be an underlying cause of obscure bleed? and when do you usually see that?

Answer 19

Hemobilia (bleed into biliary tree)/liver biopsy

Question 20

What is Dieulafoy’s lesion? most commonly seen in?

Answer 20

Large submucosal artery (normally should be small)—>bleed

Stomach

Question 21

Hiatal hernia can cause ___ lesion?

Answer 21

Cameron’s

Question 22

What kind of bleeding does diverticulosis cause?

Answer 22

Large amount of bleeding

Question 23

What is common cause of obscure GI bleed for a older or younger pt?

Answer 23

Older—>AVM

Younger—>Meckle/lymphoma

Question 24

How much occult blood test should you do?

Answer 24

2 samples from 3 consecutive bowel movement

Question 25

What is fecal immunochemical test (FIT) do? what does it suggest if its +?

Answer 25

Have antibodies against globin--->test for fecal blood | Specific for lower GI bleed

Question 26

Cough after meal, think? cough lying down, think?

Answer 26

GERD | Post nasal drip

Question 27

What it is and what causes rhinitis medicamentosa?

Answer 27

Rebound nasal congestion from using too much nasal decongestant Use nasal decongestant for only 3-5 days

Question 28

Tx for acute and chronic allergic rhinitis? side effects?

Answer 28

Acute--->H1 blockers (1st or 2nd gen) Chronic--->nasal steroids (fluticason)--->bleeding Chronic--->nasal irrigation

Question 29

How long do we give antibiotics for tonsillitis?

Answer 29

2 weeks

Question 30

What are the 2 S. pneumoniae vaccine and when to give them?

Answer 30

PCV 13--->young children | PPSV23--->adult over age 65 (before 65 if high risk)--->give PCV13 first and then PPSV23

Question 31

How long do we use antibiotic for treat UTI and what do we use to treat UTI in pregnancy?

Answer 31

3 days | Macrodantin

Question 32

What kind of cast in urine is indicative of pyelonephritis? How long should we treat it?

Answer 32

White cell cast | At least a week

Question 33

What happens in the space of Disse during cirrhosis?

Answer 33

Collage deposition from stellate cell--->defenestration of sinusoids--->increase sinusoids pressure

Question 34

Pruritus can be caused by what dysfunction in the liver or gallbladder?

Answer 34

Cholestasis--->bile acid leaks into blood

Question 35

Xanthelasma is associated with what liver disease?

Answer 35

Primary biliary cirrhosis

Question 36

How do you test for Hep C?

Answer 36

HCV antibody--->then HCV RNA

Question 37

What stage of cirrhosis if you also see ascites?

Answer 37

Decompensated cirrhosis

Question 38

What drug do you give the pt to prevent varices from bleeding?

Answer 38

non selective beta blockers

Question 39

What do you need to do for a pt with diagnosed cirrhosis?

Answer 39

Check for varcies (beta blockers if needed) Check for HCC Give all Hep A/B vaccinations

Question 40

What do you give the pt with bleeding varices?

Answer 40

Prophylactic antibiotics

Question 41

What do you need to check for when pt has ascites?

Answer 41

``` Cell count (if it's infection) Protein/albumin ratio ```

Question 42

How to you treat ascites?

Answer 42

Salt restriction | Spironolactone +/- loop

Question 43

What would cause hepatic encephalopathy?

Answer 43

TIPS

Question 44

What drug and condition would prevent the uptake of UCB into the liver?

Answer 44

Rifampin/sepsis

Question 45

What is Stauffer syndrome?

Answer 45

Renal cell carcinoma induced hepatic dysfunction---->reversible

Question 46

What are the roles of gp41 and gp120?

Answer 46

gp 120 binds to CCR5 or CXCR4---->gp 41 mediates the entry

Question 47

Which female GU cancer is associated with HIV?

Answer 47

Cervical carcinoma (high risk HPV)

Question 48

Fitz Hugh Curtis syndrome affect?

Answer 48

Perihepatitis

Question 49

When should you obtain a culture for chlamydia infection?

Answer 49

When you have to go to court (suspected child abuse/sexual assault

Question 50

Which bacteria can infect the oropharynx, gonorrhea or chlamydia? and which bacteria is more symptomatic?

Answer 50

Gonorrhea | Gonorrhea

Question 51

Which bacteria present earlier neonatal conjunctivitis, chlamydia or gonorrhea?

Answer 51

Gonorrhea presents earlier

Question 52

Which bacteria can have disseminated infection like tender pustular on palm and sole or arthritis, chlamydia or gonorrhea?

Answer 52

Gonorrhea

Question 53

What is the tx for gonorrhea?

Answer 53

Ceftriaxone and azithromycin

Question 54

TCA overdose would manifest as?

Answer 54

Coma/HoTN/seizure/wide QRS