GIGU Final

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dcmommy13
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GIGU Final
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2013-09-17 00:58:54
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Last Fernando class EVA!!!!!!!!!!!!!!!! :D
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  1. MIDTERM 1 
    :)
  2. _________: regurgitation & excessive secretions.
    • Atresia. 
    • *Esophagus fails to unite (abnormal opening).
    • *87% occur with fistulas. 
  3. ______: interconnection between the esophagus & trachea.
    • Fistula.
    • *Abnormal connection. 
    • *Goes with atresia. 

    • Upper fistula: coughing, cyanosis, regurgitation, pneumonia.
  4. Which type of atresia/fistula results in abdominal distention & colicky pain?
    • Atresia & lower fistula. 
    • *Most common. 
  5. What is the name for an all encompassing fistula?
    • H-Type: combo of atresia, atresia + lower fistula & upper fistula. 
  6. Where is the MC location for a fistula?
    At the tracheal carnia.
  7. Excessive secretions, coughing, cyanosis, aspiration pneumonia & distention of the abdomen are associated with which condition?
    Atresia/fistula.
  8. 3 ways to DX atresia/fistula?
    • 1. Nasogastric tube cannot go into stomach.
    • 2. Radiopaque catheter on x-ray. 
    • 3. Radiopaque dye on fluoroscopy (increases risk of chemical pneumonia).
  9. GERD is a common complication of atresia/fistulas. What can be done to relieve this issue?
    • Nissen fundoplication.
    • *Also used for hiatal hernia. 
  10. ________: failure of the LES to relax.
    • Achalasia. 
    • *Idiopathic. 
  11. MC age for achalasia?
    • 20-40 YO.
    • *But may occur at any age. 
    • *DX via barium x-ray. 
  12. Name 3 signs & symptoms for achalasia...
    • 1. Dysphagia. 
    • 2. Chest pain/substernal fullness.
    • 3. Regurgitation.
    • 4. Nocturnal cough.
    • 5. Insideous onset over many months or years.
    • *May have a vial component of Chaga's DX (T. Cruzi). 
  13. A "birds beak" or "rats tail" is seen with which condition?
    Achalasia.
  14. 3 DDX's for achalasia?
    • 1. Scleroderma.
    • 2. Stenosing carcinoma.
    • 3. Stricture, diffused esophageal spasm.
  15. Treatment for achalasia...
    • Eat small portions, slowly w/ liquid.
    • Chew throughly.
    • Drugs to relax smooth mm.
    • Pneumatic dilation of the sphincter.
  16. What percentage of achalasia patients undergo malignant degeneration?
    • Squamous Cell Carcinoma 5% 
    • *Other complications: aspiration pnemonia, esophagitis, lower esophageal diverticula. 
  17. 5 DDX's for Globus Hystericus...
    (sensation of lump in the throat D/T anxiety)
    • 1. Esophageal webs.
    • 2. Diffuse esophageal spasm.
    • 3. GERD.
    • 4. MM disorders.
    • 5. Malignancy.
  18. _____: dilated & tortuous superficial esophageal veins that may rupture, potentially causing death.
    • Esophageal Varices. 
    • *Upper GI bleed.
  19. Esophageal Varicies present which which type of stool?
    • Black Tarry stool. 
    • (ET = Esophageal Tarry). 
  20. What is the MCC of esophageal varicies?
    Hepatic portal hypertension (D/T cirrhosis).
  21. 4 S/S associated with Esophageal Varicies?
    • 1. Hematemesis: bright red blood <50%.
    • 2. Coffee ground vomit. 
    • 3. Substernal pain (DDX achalasia, glob. hystericus). 
    • 4. Black tarry stool (melena).
  22. Which conditions are associated with a positive Guaiac Test (stool sample)?
    • Esophageal Varicies & Gastritis. 
    • *Esophageal varicies: also DX via endoscopy & hepatic venogram. 
    • *Gastritis: also CBC for prescence of H-Pylori. 
  23. Esophageal varicies should be DDXed with which 3 upper GI bleeding conditions?
    • 1. Gastritis.
    • 2. Esophageal laceration (Mallory Wise Syndrome).
    • 3. Peptic ulcers.
  24. What percentage of patients presenting with esophageal varicies die?
    • 40-50% die with first major bleed.
    • *Survivors have a recurrence w/in first year & 50% die. 
  25. What percentage of malignant GI tumors come from the esophagus?
    • 6% 
    • *Highly malignant D/T asymptomatic presentation.
    • *Adenocarcinoma: 50-80%, in the lower 1/3.
    • *Adults 50 YO+.
    • *Squamous = foreign country. 
  26. Which tumor stage spreads to the lymphatics?
    • III.
    • I: In situ, superficial layer of epithelium.
    • II: In situ, invading (agressive) submucosa (vessels).
    • III: In nodes & deeper structures.
    • IV: Mets = affects distal organs. 
  27. What is the the survival rate for esophageal cancer?
    5 year less than 20% (most die w/in 1st year of diagnosis).
  28. Barrett's esophagus affects the ____ part of the esophagus.
    • Lower. 
    • *Complication of long standing GERD (hiatal hernia). 
    • *Risk factor for esophageal adenocarcinoma.
    • *Squamous cells replaced with pseudo columnar epithelium
  29. What % of Barrett's Esophagus results is malignant degernation?
    50% have adenocarcinoma (=80% mortality rate).
  30. What is an a/k/a for diffused esophageal spasm?
    • Corckscrew Esophagus. 
    • *Uncoordinated contractions of the esophagus.
    • *Idiopathic.
    • *Severe chest pain, dysphagia, regurgitation. 
  31. Nitroglycerine, Ca+ Channel Blockers, Botulin Toxin & Endoscopic Balloon Dilation is used to treat...
    Corkscrew Esophagus (Diffused Esophageal Spasm).
  32. What is the cause of MI?
    • Death of cardiac mm D/T ischemia. 
    • *S/S last longer than 20 min. 
    • *Diaphoresis (sweating). 
    • *Take strong ant-acid... if does not go away = MI.
  33. Which wave is altered on the ECG with a MI?
    Q-wave: due to blood flow & pressure changes.
  34. Blood tests are looking for which 2 markers for MI DX?
    • 1. Creatinine kinase.
    • 2. Troponin.
  35. What is the cause of angina pectoris?
    • Atherosclerosis of the coronary arteries. 
    • *Decreases lumen size, but no damage to heart tissue. 
  36. Which wave is altered on the ECG with Angina Pectoris?
    • ST-Segment... Also for Prinz-Metal Variant Angina.  
    • *DX via Stress Test. 
    • *Also DX via coronary angiogram. 
    • *Nitroglycerine helps. 
  37. A/k/a for Angina Inversa?
    • Prinz-Metal Variant Angina (Variant Angina). 
    • *Chest pain at rest which occurs in cycles.
    • *D/T vasoSPASM of coronary arteries. 
  38. The Ergonovine IV Provocation Test is associated with...
    Prinz-Metal Angina.
  39. GERD affects the _______ esophagus.
    Lower.
  40. Name 5 aggravating factors for GERD.
    • 1. Alcohol.
    • 2. Fatty food.
    • 3. Caffeine. 
    • 4. Nicotine.
    • 5. Hiatal hernia.
    • *Large meals, recumbency, stress, pregnancy, estrogen. 
  41. Dyspepsia & pyrosis are associated with...
    • GERD.
    • *Dyspepsia: indegestion.
    • *Pyrosis: heartburn. 
  42. A/k/a for Schatzki's Ring...
    • Esophageal Rings.
    • "low ESR" = Esophageal/Schatzki's Rings in lower esophagus. 
    • *Ring of tissue at the squamoclolumnar junction. 
    • *Usually asymptomatic. 
  43. ________: possibly congenital thin membrane in the mid to lower esophagus.
    • Esophageal webs: seen in Plummer-Vinson Syndrome. 
    • *Dysphagia, odynophagia, nasopharyngeal reflux, thoracic pain.
    • *Webs sometimes disappear when anemia is addressed. 
  44. Name 5 causes of gastritis...
    • 1. Alcohol.
    • 2. Prolonged NSAID use.
    • 3. Surgery.
    • 4. Trauma.
    • 5. Infection. 
    • *May be asymptomatic... or upper abdominal pain, nausea, vomiting, belching (eructation), bloating & loss of appetite. 
  45. What type of anemia may occur as a result of chronic gastritis?
    Pernicious anemia.
  46. _____: breach in the mucosa of the alimentary tract that extends into the submucosa or deeper.
    • Peptic ulcer: bigger than 5cm. 
    • *Most frequent in the duodenum or stomach, but can be anywhere. 
    • *H-Pylori involved. 
  47. Where is the MC location for peptic ulcers?
    • Duodenum or stomach.
  48. What is the biggest risk factor for peptic ulcers?
    NSAID's (shuts off mucus D/T blocking COX-1 which produces prostaglandins which make the mucus layer).
  49. Hematemesis, melena & epigastric pain are associated with which condition?
    Peptic ulcers.
  50. How do you test for H Pylori? (3)
    • 1. Urea breath test.
    • 2. Antibody blood test.
    • 3. Stool antigen test.
  51. How long does it generally take to treat a peptic ulcer?
    4-8 weeks.
  52. What is the second MC tumor in the world?
    • Malignant gastric tumors. 
    • *MC in men than women. 
    • *Can survive w/ treatment if stage I, II. 
  53. Name 4 environmental factors for malignant gastric tumors.
    • 1. Nitrites.
    • 2. Pickled, smoked or salted foods.
    • 3. Decreased fat, fruit & veggies. 
    • 4. Blood type A.
  54. Malignant gastric tumors need to be DDXed from...
    Gastritis.
  55. _______: 95% of hiatal hernias.
    Sliding: LES above diaphragm.
  56. ______: fundus above diaphragm.
    • Rolling: fundus above diaphragm. 
    • "Rolling is fun"
  57. ______: multiple gastrin producing tumors, usually of the pancreas or duodenum.
    • Zollinger Ellison Syndrome = Gastrin ZEG
    • *Gastrin = ^HCL = ulcers. 
    • *Recurring, does not respond to treatment. 
    • *1/4 undergo malignant degeneration & spread to the parathyroid, pituitary & adrenals. 
    • *Treated by surgically removing tumors. 
  58. _____: laceration of the distal esophagus &/or proximal stomach.
    • Mallory-Weiss Syndrome
    • *Alcoholics. 
    • *Hematemesis. 
  59. Diarrhea & sometimes ulcerative/inflammatory changes in the SI & LI is associated with...
    • Gastroenteritis: acute diarrhea.  
    • *12,000 deaths/day in developing countries. 

  60. Which gastroenteritis pathogen causes rice water stool & has an incubation period of 1-4 days?
    • Shigella. 
    • *Only 100 organisms need to cause SX.
    • *Destroys epithelium of SI & LI, rectum & cecum. 
    • *Dysentary: invades the intestinal mucosa. 
    • *Fecal oral, contaminated food. 
  61. Which gastroenteritis pathogen causes a fever & arthalgia?
    • Salmonella: fever, HA, arthalgia, pharyngitis, anorexia. 
    • *100,000/year in the US with 30 deaths/year.
    • *Found in eggs. 
    • *Food & water bourne.
    • *Incubates for 12-72 hours. 
  62. Which gastroenteritis pathogen causes your typical food poisoning?
    • Staphlococcal.
    • *Food left at room temperature.
    • *Meat, fish, custard, milk, eggs.
    • *Severe nausea, vomiting, diarrhea, HA & fever.
    • *Quick incubation, 2-8 hours. 
    • *MRSA: methicillin resistant staph aureus. 
  63. Which gastroenteritis pathogen causes drooping of the eyelid?
    • Clostridium. 
    • *Home canned foods, honey (kids <1yr). 
    • *Veggies, fish, fruits, beef, milk productions, pork & poultry. 
    • *Nausea, vomiting, abdominal, cramps, diarrhea, drooping of the eyelid (NO fever).
    • *Incubation: 18-36 hours. 
    •  
  64. Which gastroenteritis pathogen causes watery & sometimes bloody stool?
    • Campylobacter. "Bring water for camping!
    • *Comma shaped, flagellated gram-negative.
    • *Responsible for 2x the enteric DX of Salmonella. 
    • *Eggs & chicken. 
    • *Incubation 1-2 days (up to 6 days). 
    • *SX last for a week. 
    • *Guillian-Barre: jejunum & ilium.
  65. Which gastroenteritis pathogen causes Montezuma's Revenge?
    • E Coli "Traveler's Diarrhea." 
    • *Undercooked beef, unpasturized milk, contaminated water. 
    • *Severe abdominal cramps, watery diarrhea (possibly bloody), low or absent fever. 
    • *Abrupt onset. 
  66. What is the MCC of Viral Gastroenteritis in children?
    • Rotavirus: during the winter, age 6-24 months old.
    • *May result in death. 
    • *Destroys enterocytes.
    • *10 particles to cause infection. 
    • *dsRNA. 
  67. What is the 2nd MCC of Viral Gastroenteritis in children?
    Adenovirus.
  68. What is the MCC of Viral Gastroenteritis in adults?
    • Noro virus. 
    • *Abdominal pain.
    • *ssRNA.
    • *Contaminated food or water, person to person. 
  69. Kosher's Sign is associated with which condition?
    • Appendicitis: mid abdominal pain moves to the lower right quadrant. 
    • *Dunphy's Sign: LRQ pain w/ cough. 
    • *Blumberg's Sign: rebound tenderness.
    • *Rovsing's Sign: increased RLQ pain w/ deep palpation in the LLQ. 
  70. What 2 conditions need to be DDXed for appendicitis?
    • 1. Kidney DX.
    • 2. Meckle's Diverticulum.
  71. _______: a remnant diverticulum of the vitelline duct or yolk sac.
    • Meckel's Diverticulum: usually asymptomatic.
    • *2% present w/ appendicitis-like symptoms. 
    • *For females need to R/O falopain tube/ovary problems.
  72. ______: malabsorption syndrome caused by infectious agents found in tropical regions.
    • Tropical Sprue: flattening of the microvilli & inflammation of the SI. 
    • *Malabsorption = fatty shit.
    • *Diarrhea, steatorrhea, abdominal discomfort, nutritional deficiencies. 
    • *DX from deficiency of albumin, folic acid, CA+, B12 & Fe+. 
    • *Ascities D/T edema/osmopressure. 
    • *Pernicious anemia. 
  73. Which malabsorption disease is cause by Tropheryma Whipplei.
    • Whipple's DX: malabsorption, possibly affecting any organ in the body. 
    • *MC in men.
    • *Anemia, skin pigmentation, polyarthralgia/arthritis, weight loss, diarrhea. 
    • *Steatorrhea & swelling. 
  74. What is the treatment for Whipple's DX?
    • Long term antibiotics (1-2 years). 
    • *Can be fatal if not treated. 
  75. What lab is elevated with Celiac's Disease?
    • Alk Phos. 
    • *Atrophied villi upon endoscopic exam. 
  76. Which condition presents with a cracked mud appearance?
    • Celiac's Disease: malabsorption DX D/T gluten sensitivity. 
  77. Which GI condition starts at the rectum/sigmoid & goes up?
    • Ulcerative colitis: inflammatory bowel DX. 
    • *MC ages 15-30 YO. 
    • *Affects mucosa & submucosa. 
    • *Polyarthritis, AS, uveitis, sacroilitis & hepatic involvement. 
    • *Bloody diarrhea D/T destruction of the mucosa. 
    • *Lead pipe sign
    • *Increases risk of colorectal cancer. 
  78. What is the treatment for Ulcerative Colitis?
    Avoid raw fruits & veggies.
  79. A/k/a for Regional Enteritis?
    • Crohn's Disease. "Skipping Chron's
    • *Small intestine. 
    • *Skip, transmural lesions, string sign
    • *Chronic inflammatory DX affecting distal ileum & colon. 
    • You learn to skip stones by tying a rock to a string. 
  80. Which condition presents in the third decade of life w/ fistulas & noncaseating granulomas?
    • Chron's (Regional Enteritis).
    • *No specific treatment... generally grows back after surgery... so try to limit flare ups.
  81. MIDTERM 2
    :)
  82. Dilation of the colon accompanied by lack of paralysis is associated with which condition?
    • Acquired megacolon. 
    • *80% of the myenteric nerve plexus destroyed for peristalsis to disappear. 
    • *Associated with T. Cruzi. 
  83. What is the treatment for Acquired Megacolon?
    Fiber, laxitives, corticosteroids, disimpaction.
  84. Where does Hirschsprung's DX start?
    • At the anus & progresses proximally. 
    • *Congenital aganglionic myenteric plexus. 
  85. What are the S/S of Hirschsprung's DX? (2)
    • 1. Does not pass meconium in first 48 hours.
    • 2. Abdominal distention. 
    • *Treatment: surgically remove section of colon that is affected. 
  86. What quadrant does pain associated with Diverticulitis show up?
    • LLQ. 
    • *Geriatric pts. 
    • *DX via CT scan. 
  87. Where do malignant tumors of the bowel generally present?
    • Jejunum.
    • *Elevated, ridged, singular (peptic ulcers are depressed & not ridged). 
  88. What type of cancer accounts for 1/4 of cancers in the US?
    • Colorectal Cancer: left colon & constipation. 
    • *Polyps usually benign but can undergo malignant degeneration.
  89. What are 3 risk factors for colorectal cancer?
    • 1. Low fiber.
    • 2. High fat.
    • 3. Processed foods.
  90. Malignant bowel tumor S/S for the right colon?
    • Palpable tumor, occult bleeding, fatigue & weakness.
    • *Left colon = constipation. 
  91. 4 pre-hepatic icterus causing conditions...
    HOMS
    • 1. Hemolytic anemia. 
    • 2. Obstructed Portal V. 
    • 3. Malaria.
    • 3. Splenomegaly. 
    • *Unconjugated bilirubin. 
  92. Hyperslpeneism presents with ________ bilirubin.
    Unconjugated.
  93. Is pre-prehepatic obstruction associated with conjugated or unconjugated bilirubin?
    Unconjugated.
  94. 3 Causes of intrahapatic icterus?
    • 1. Gilbert's Syndrome: unconjugated (indirect) bilirubin. 
    • 2. Hepatitis: smooth & tender liver. 
    • 3. Cirrhosis
  95. What are 2 lab findings associated with intrahepatic obstruction?
    • 1. Dark urine.
    • 2. ^ serum Alk Phos, ALT, AST.
  96. Post-hepatic obstruction is due to...
    • Obstruction of the biliary tree, MC D/T gall stones.
    • *Also pancreatic cancer. 
  97. Does post-hepatic icterus present with conjugated or unconjugated bilirubin in the blood?
    Conjugated.
  98. What are 3 lab findings associated with post-hepatic icterus?
    • 1. Dark urine.
    • 2. Pale stool.
    • 3. ^ serum Alk Phos, ALT & AST. 
    • *Alk Phos: liver & bone.
    • *ALT (SGPT): liver.
    • *AST (SGOT): increased metaoblic activitiy (heart, lung, mm, kidney, brain, pancreas). 
  99. Which form of hepatic icterus causes pale stool?
    • Pale stool = Post hepatic. 
    • PO.
  100. Steatohepatitis D/T obesity is known as...
    • NASH (Non-Alcoholic Steatohepatitits)
    • *Steatohepatitis is reversible with diet changes. 
    • *Mostly asymptomatic.
    • *May undergo cirrhosis or malignant degeneration. 
  101. Is ALT or AST grater with NASH?
    • ALT
    • Obesity (Fatty) = F.ALT
  102. Which Hepatitis infection presents with clay colored stool & is D/T a picornavirus-like RNA infection?
    • Hep A: fever, abdominal pain, nausea, jaundice, dark urine, clay color stool. 
    • *Acute infection
    • *Fecal-oral
    • *2-6 week incubation
    • *Economic status = risk factor 
    • *MC asymptomatic
    • *Secreted in feces near the end of incubation
    • *IgM antibodies detected for up to 14 weeks  
  103. Which form of hepatitis has a fecal-oral transmission, dark urine & is MCly asymptomatic?
    Hep A
  104. Which hepatitis infection is spread through bodily fluids, is prominent in Asia & may lead to chronic hepatitis?
    • Heb B: DNA virus. 
    • *Incubation 4-26 weeks.
    • *Nausea, fever, body aches, vomiting, dark urine & possible progression to jaundice.
    • *Infection lasts for a few weeks.
    • *Acute: clears up spontaneously.
    • *Chronic: treat w/ anti-viral meds, Epivir, Hepsera. 
  105. Which hepatitis infection is D/T an enveloped ssRNA infection w/ a 2-26 week incubation period?
    • Hep C
    • *Major cause of liver DX worldwide.
    • *85% will have chronic liver DX. 
    • *Transmission via transfusions, inoculations & sex.
    • *Usually asymptomatic = incidental finding during routine blood tests. 
    • *May progress to hepatocellular carcinoma. 
    • *60-70% of cases are asymptomatic for first 6 months. 
  106. Which hepatitis has the worst sequelae?
    Hep C
  107. Which hepatitis is spread via blood?
    Hep C
  108. Which disease is a superinfection which leads to cirrhosis?
    • Hep D: coinfection with Hep B. 
    • **ssRNA. 
  109. Which hepatitis infection has a high mortality rate with pregnant women?
    • Hep E. 
    • *ssRNA. 
    • *Fecal-oral transmission.
  110. Is liver cirrhosis reversible, or irreversible?
    • Irreversible. 
    • *In top 10 leading causes of death.
    • *D/T alcoholism, Hep B & C, biliary DX, NASH & hemochromatosis. 
  111. Name 5 S/S of cirrhosis.
    • 1. Clubbed nails.
    • 2. Hypertrophic OA. 
    • 3. Caput medusa.
    • 4. Jaundice.
    • 5. Ascities.  
    • *Esophageal varicies D/T portal HT/. 
    • *Palmar erythmia.
    • *Spider angiomata.
    • *Muehrcke's nails: D/T hypoalbuminia. 
    • *Terry's nails: distal 1/3, D/T hypoalbuminia.
    • *Dupuytren's contracture.
    • *Gynecomastia.
    • *Hypogonadism.
    • *Spleomegaly.
  112. 3 elevated lab findings associated with cirrhosis? 2 decreased lab findings?
    • Elevated
    • 1. AST/ALT
    • 2. sGGT
    • 3. Bilirubin

    • Decreased:
    • 1. Albumin
    • 2. Prothrombin clotting factors
  113. What is the MCC of liver cancer?
    Metastatic spread from other organs.
  114. What is the name of primary liver cancer?
    • Hepatocellular carcinoma (HCC).
    • *Friction rubs & bruits heard upon auscultation. 
  115. What are the 2 major risk factors for HCC?
    • 1. Hep B
    • 2. Hep C
  116. HCC presents with elevated _____ lab findings.
    • AFP
    • *It is hard to differentiate tumor from cirrhosis = biopsy is best. 
  117. ______: benign, inherited condition which produces mild hyperbilirubinemia.
    • Gilbert's Syndrome. 
    • *Life long condition.
    • *Mis DX as chronic hepatitis. 
    • *Mild jaundice with stress, exertion or fasting. 
    • * ^ levels of unconjugated bilirubin. 
    • *Normal liver FX tests & UA
    • *No treatment. 
  118. What are the 2 types of gallstones?
    • 1. Cholesterol: large, MC. 
    • 2. Pigment/bile.
  119. What is the MC presentation for gall stones?
    • Asymptomatic.
    • *Up to 80% stay silent for a lifetime. 
  120. Which condition is caused by obstruction of the gallbladder's neck or cystic duct?
    • Acute calculus cholecystitis. 
    • *Post op, severe trauma, severe burns
    • *Chronic calculus cholecystitis: nausea, abdominal pain, belching, diarrhea. 
  121. T/F acute cholelithiasis pain radiates to the testicles in males.
    • False... it refers to the medial-inferior angle of the scapula. 
    • *Ureterolithiasis radiates to the testicles. 
  122. 3 DX signs for cholecystitis?
    GOB
    • 1. Georgievskiy-Myussi's (Phrenic Nerve) Sign: pain when pressing between the edges of the SCM. 
    • 2. Ortner's Sign: pain when tapping the right costal arch. 
    • 3. Boas's Sign: pain below right scapula.
  123. Which sign for cholecystitis presents with pain when tapping the right costal arch?
    Ortner's Sign.
  124. What is the MC treatment for cholecystitis?
    Cholecystectomy.
  125. The MCC of choledocholithiasis is...
    • Gallstones in the common bile duct. 
    • *Clay colored stool, jaundice. 
    • *MRCP for DX. 
  126. T/F Choledocholithiasis may elevate hepatic enzymes.
    • True... ^ Alk Phos, Amylase & Lipase. 
    • *May present w/ jaundice. 
  127. ERCP is used to treat which condition?
    • Choledocholithiasis. 
    • *Also used for alcohol. 
  128. What is the MCC of acute pancreatitis?
    • Gallstones. DIFFERENT THAN BOARDS!!!!!!!
    • *#2: alcoholism. 
    • *Can be reversible. 
  129. Causes of acute pancreatitis...
    I GET SMASHED
    • Iatrogenic
    • Gallstones
    • Ethanol (alcohol)
    • Trauma
    • Steroids
    • Mumps
    • Autoimmune DX
    • Scorpion or snake venom
    • Hypercalcemia/hyperlipidemia
    • ERCP: Endoscopic Retrograde CholangioPancreatography.
    • Drugs
  130. Severe epigastric pain which may radiate to the back is associated with...
    • Acute pancreatitis.
    • *Decreased by leaning forward.
    • *Nausea, vomiting, diarrhea. 
  131. What is Grunwald's Sign?
    • Ecchymosis (bruising) around the umbilicus D/T acute pancreatitis
    • *Cullen's: hemorrhagic discoloration of the umbilicus. I want to have Edward Cullen's baby. 

    *Turner's: hemorrhagic discoloration to the flank. 
  132. What is Kamenchik's Sign?
    Pain with pressure at the xiphoid D/T acute pancreatitis.
  133. What is Mayo-Robson's Sign?
    Pain at the 12th costotransverse angle D/T acute pancreatitis.
  134. What is Korte's Sign?
    • Pain at the head of pancreas (6-7 cm above umbilicus). 
  135. Which 3 blood tests are elevated with pancreatitis?
    Amylase, lipase & Alk Phos.
  136. Does pancreatic failure elevate or decrease amylase & lipase?
    Decrease.
  137. What is the primary cause of chronic pancreatitis?
    • Alcoholism.
    • *Also D/T repeated acute attacks or long standing inflammation. 
    • *NOT reversible. 
    • *May be silent until pancreatic insufficiency & DM develop.
    • *TX: anti-H3 receptor meds. 

  138. Which test is used to DX pancreatitis?
    Secretin Stimulation Test
  139. Trousseau Sign & Courvoisier Sign are associated with which condition?
    • Tumors of the Pancreas.
    • CTP
    • *Courvoisier Sign: + in 10% of cases. 
  140. What is the 4th leading cause of cancer death?
    • Tumors of the pancreas.
    • *MC = adenocarcinoma. 
    • *Tumor develops for a long time before S/S.
    • *Treatment palliative, not curative.
    • *MC @ the head of the pancreas. 
  141. Malignant obstruction of the head of the pancreas leads to...
    Obstructive jaundice.
  142. What type of DM has a juvenile onset & is associated with acute ketoacidosis?
    • IDDM Type 1
    • *8-15 YO. 
    • *Hyperglycemia.
    • *Destruction of beta cells. 
  143. IDDM Type 1 positive fasting GLU test value....
    • >125 mg/dL 
    • *Severe: Plasma GLE test 2 hours after a challenge >500 mg/dL
  144. AGE stands for...
    • Advanced
    • Glycation
    • End products
  145. Nonketotic hyperosmolar comas are associated with which type of DM?
    • NID DM T2
    • *Ketoacidosis is rare. 

    • Diagnosis is the same as type 1:
    • *Fasting >126 mg/dL
    • *OGTT >200 mg/dL
    • *High specific gravity
  146. What is the leading cause of blindness & end stage renal DX in the US?
    NID DM T2
  147. Which form of diabetes is a/k/a Central Diabetes?
    • Diabetes Insipidus: inflammation, tumor or trauma to the hypothalamus & pituitary. 
    • *Nephrogenic DI: D/T renal tubular unresponsiveness to ADH. 
    • *Does NOT present w/ polyphagia. 
    • *Transparent urine (D/T high ADH). 
  148. Which type of diabetes is DX via the water deprivation test?
    • Central Diabetes Inspidus. 
    • *Test stops when orthostatic hypotension & postural tachycardia appear, or when 5% or more of initial body weight has been lost. 
  149. Which disease of the kidney destroys parenchyma & causes renal failure?
    • Autosomal-dominant Polycystic Kidney DX (ADPKD): adults. 
    • *Affects kidney FX in the 4th-5th decade of life. 
    • *PDK-1 or 2. 
    • *Intracranial Berry Aneurysms & mitral valve prolapse. 
    • *DX: Must see at least 2 cysts in one kidney & 1 cyst on the contralateral kidney. 
  150. Which form of polycystic kidney DX results in a sponge-like kidney?
    • Autosomal-Recessive Polycystic Kidney DX (ARPKD): sponge kidney.
    • *Infants succumb rapidly... renal failure occurs early. 
    • *Leads to congenital hepatic fibrosis. 
    • Infants get sponge baths. 
  151. What are 2 S/S of polycystic kidney DX?
    • 1. Abdominal discomfort
    • 2. Hematuria
    • 3. UTI
    • 4. Palpable masses in the abdomen
    • 5. Polyuria
    • 6. HT.
  152. Polycystic kidney disease is inherited & _____.
    Fatal.
  153. What age group is affected by acute glomerulonephritis?
    • Kids 6-10 YO. 
    • *Post-infectious DX: A-beta hemolytic strep. 
    • *Inflammation of the glomeruli w/ abrupt onset of hematuria & mild proteinuria. 
    • *Nephritic syndrome = hematuria & proteinuria. 
  154. Murphy's punch is usually ______ in acute glomerulonephritis.
    • Negative: the glomeruli are tiny! 
    • *Positive w/ acute pyelonephritis. 
  155. Name 4 S/S of acute glomerulonephritis.
    • 1. Oliguria: low urine output.
    • 2. Edema: starts periorbital, then pitting around ankles. 
    • 3. Dark urine/hematuria.
    • 4. HX of strep infection.
    • *Sometimes HT. 
  156. Acute glomerulonephritis presents with what type of urine?
    • Pink urine.
    • *The glomerulus filters blood. 
  157. Which kidney syndrome results in the urinary secretion of protein, anorexia, malise & frothy urine?
    • Nephrotic Syndrome: urinary excretion of proteins >3g/day.
    • *Hypoalbuminemia. 
    • *Kidney damage. 
  158. Nephritic syndrome is the result of further kidney damage... What are the urine findings?
    • Nephritic Syndrome: pores large enough for proteins & RBC's to get through = hematuria. 
    • *IgA Nephropathy: MC nephritic syndrome... peaks at 20 YO. 
  159. 2 lab findings for acute glomerulonephritis?
    (Clue: 1 comes from the HX)
    • 1. + ASO Titer
    • 2. Azotemia: elevated BUN & serum creatinine.
  160. Define azotemia...
    Elevated BUN & serum creatinine.
  161. What is the treatment for acute glomerulonephritis?
    • Generally self-limiting. 
    • *Maintain Na+ & H2O balance. 
  162. What are the lab findings associated with Chronic Glomerulonephritis?
    • 1. BUN & Creatinine high, but not as high as acute.
    • 2. HEP
  163. ______: patchy suppurative bacterial inflammation affecting the kidneys.
    • Acute Pyelonephritis: D/T ascending UTI which has reached the pyelum or renal pelvis.
    • *Predisposing conditions: UTI, iatrogenic, DM, pregnancy, etc. 
  164. What does acute pyelonephritis present with in the urine? (2)
    • Bacteria & nitrates. 
    • *Nitrates inhibit bacterial growth, that's why they are in food. 
  165. Acute pyelonephritis presents with pain at....
    • The costovertebral angle. 
    • *Abdominal rigidity, sepsis. 
    • *MC in females up to 40 YO D/T anatomy; males increase with age D/T prostate hypertrophy. 
  166. WBC casts are associated with which condition?
    • Acute pyelonephritis.
    • *Pyelo = pus... the WBC's are all clotted up together & stuck = forms a cast. 
    • *Cloudy urine. 
  167. What are the 4 lab findings associated with acute pyelonephritis?
    • 1. Alkaline pH
    • 2. Pyuria. 
    • 3. Hematuria. 
    • 4. WBC casts.
    • *Casts are only formed in the tubules = renal involvement. 
  168. Which kidney disease requires long-term antibiotic treatment?
    • Chronic pyelonephritis: chronic tubulointestinal inflammation & renal scarring that involves the calyces & pelvis. 
    • *Get rid of obstruction & treat infection. 
  169. Chronic pyelonephritis is diagnosed by which 3 findings?
    (Clue: 1 ortho test, 2 UA findings)
    • 1. + Murphy's Punch
    • 2. Pyuria
    • 3. Bacteriuria
  170. What condition is associated with rapid, steadily increasing azotemia w/ or w/o oliguria (low urine output)?
    • Acute renal failure. 
    • *Generally temporary & benign.
    • *Prerenal, renal & postrenal. 

  171. In addition to presenting with oliguria & anemia, what are 2 lab findings for acute renal failure?
    • 1. Azotemia (BUN nitrogen). 
    • 2. Urinary sediment.
  172. Acute pyelonephritis presents with an ______ ASO titer.
    • Normal.
    • *Although pyelonephritis is caused by bacteria, it is D/T E. Coli.
    • *Glomerulonephritis has + ASO Titer. 
  173. What are 5 causes of prerenal acute renal failure?
    • 1. Cardiac failure.
    • 2. Hypotension.
    • 3. Low blood volume.
    • 4. Renal stenosis.
    • 5. Renal V thrombosis. 
    • *Renal: decreased blood flow, decreased GFR, tubular obstruction, tubular damage. 
    • *Post-renal: prostatic hypertrophy, malignancy, kidney stones. 
  174. What is the MCC of chronic renal failure?
    • Diabetic nephropathy.
    • *Urine breath, nocturia, HT. 
  175. What are the 4 stages of chronic renal failure?
    • 1. Diminished renal reserve: GFR 50%/normal.
    • 2. Renal insufficiency: GFR 20-50%/normal. Azotemia. HT. Poly/nocturia. Decreased urine concentration.
    • 3. Renal failure: GFR <20%/normal. Kidneys cannot regular vol & conc = edema, metabolic acidosis, hypocalcemia, uremia (elevated BUN). 
    • 4. End-stage renal failure: GFR <25%. Terminal stage of uremia.
  176. _____: azotemia associated w/ metabolic &/or endocrine alterations.
    • Uremia. 
    • *Uremic gastroenteritis, periphreal neuritis, pericarditis. 
  177. Broad waxy casts are associated with...
    • Chronic renal failure.
    • Surfing stoners need chronic & wax for their broad surf board. 
  178. What are the 5 lab findings associated with chronic renal failure?
    • 1. Nitrogen retention.
    • 2. Acidosis.
    • 3. Anemia.
    • 4. Elevated urea & creatinine (PLASMA). 
    • 5. Broad waxy casts.
  179. Diet management for chronic renal failure: ________ caloric intake & ________ proteins to prevent ketosis.
    • Diet management for chronic renal failure: increase caloric intake & decrease proteins to prevent ketosis. 
    • *Monitor Na+ H2O balance.
    • *Dialysis. 
  180. ______: dilation of the renal pelvis, infundibulum & calyces D/T obstruction of the ureters.
    • Hydronephrosis: causes muscular atony (decreased tone), fibrosis & loss of peristaltic activity. 
    • *Gradual loss of renal FX. 
    • *Damages kidney beyond repair. 
  181. T/F Hydronephrosis damges the kidney beyond repair.
    True.
  182. Which kidney DX results in colicky flank pain?
    • Hydronephrosis: flank mass may be palpable in infancy or childhood. 
    • *Possible kidney stones D/T stasis. 
  183. Where do nephrolithiasis occur?
    Anywhere in the urinary tract.
  184. What are the 4 types of nephrolithiasis?
    • 1. Ca+ Oxalate: 55% D/T hypercalcemia. Also associated w/ gout. 
    • 2. Magnesium Ammonium Phosphate: BIGGEST stones = stanghorn calculi... D/T infection of urea-splitting bacteria. 
    • 3. UA: gout, rapid cell turnover (lukemia). 
    • 4. Cystine: genetic defects & decreased renal absorption.
    • *All stones are seen on x-ray except for pure UA. 
  185. Which type of nephrolithiasis results in stanghorn calculi?
    Mg+ Ammonium Phosphate.
  186. What is the MC primary renal tumor in childhood?
    • Wilm's Tumor: large abdominal mass possibly bilateral.
    • *Rarely involves both kidneys (5-10%). 
    • *May cause HT. 
  187. Wilm's Tumor presents with ____ in the UA.
    Blood.
  188. 3 congenital abnormalities associated w/ Wilm's Tumor...
    • 1. WAGR Syndrome: congenital abnormalities & mental retardation. 
    • 2. Denys-Drash Syndrome: gonadal dysgenesis.
    • 3. Beckwith-Wiedemann Syndrome: enlargement of body organs.
  189. Which syndrome associated with Wilm's Tumors has enlargement of body organs?
    • BECKwith-Wiedemann Syndrome: enlarged organs, macroglossia, hemihypertrophy. 
    • You know David BECKham has a big one...
  190. Which syndrome associated with Wilm's Tumors has anaridia?
    WAGR Syndrome: anaridia (no iris), genital disorders & mental retardation.
  191. What are the most significant risk factors for tumors of the kidney? (2)
    • Adenocarcinoma: tobacco & obesity.
    • *Tumors generally silent. 
    • *If symptomatic (10%): costovertebral pain, palpable mass & hematuria.
  192. Kidney stones may be silent, but it is also true that _______ may also present with painless hematuria.
    Carcinoma of the kidney.
  193. What is the MC type of kidney adenocarcinoma?
    • 1. Clear cell: MC. In proximal tubules. 
    • 2. Papillary: in DCT. Multifocal = invades renal V. 
    • 3. Chromophobe: haloed nucleus. 
    • 4. Collecting Duct.
  194. Where are the 2 MC MET locations for kidney adenocarcinoma?
    • Lungs & bones.
    • *If isolated, cure rate is 90%. 
  195. Final Material
    :) 
  196. For DX of bacterial cystitis, the culture count has to be > ______ CFU/mL
    • >1,000 CFU/mL 
    • *Cloudy urine. 
    • *50% resolve w/o antibiotics.
    • *Cranberry juice reduces incidence. 
  197. 95% of bladder tumors are of ______ tissue origin.
    • 95% of bladder tumors are of epithelial origin. 
    • *12,000 deaths/year.
    • *Transitional cell MC.
    • *Men.
    • *Cigarettes, arylamines, schistoma infections, analgesics. 
    • *Endemic in Egypt, Sudan & Portugal D/T flatworms. 
  198. Which type of cancer presents with painless hematuria?
    Bladder Cancer.
  199. What does BCG stand for?
    Bacillus Calmette-Guerin: immuno therapy by way of TB vaccine.
  200. ______: failure of one or both testes to descend.
    • Cryptorchidism.
    • *2/3 spontaneous descend w/in first 4 months of life.
    • *Can be palpated in inguinal canal.
    • *Side of undescended testis = inguinal hernial 
    • *Associated w/ testicular cancer.
    • *HCG treatment 2-3x's/wk = possible descent.
  201. A purulent yellow-green urethral discharge is associated with which STD?
    • Gonorrheal Urethritis (The Clap).
    • *Women more susceptible. 
    • *Incubation 2-14 days. 
    • *DDX chlamydia. 
  202. Scrotal pain, sometimes referring to the abdomen D/T inflammation is associated with...
    • Epidiymitis: usually unilateral.  
    • * <35 YO = STD (G or C).
    • * >35 YO = iatrogenic. 
    • *Swelling, induration (hardening), erythema & tenderness. 
  203. What is Phren's Test & which condition is it associated with?
    • Phren's Test: lifting the affected testicle reduces pain = epidymitis.
    • *If the pain gets worse = torsion = 911. 
    • The penis is close friends (phren's) with the testicles = phren's for testicular torsion. 
  204. What % of mumps cases develop orchitis?
    • 20-25%.
    • *Children <10 YO (80%/cases). 
    • *2/3 are unilateral. 
    • *Diminished fertility if bilateral (2/3). 
    • *Orchitis occurs 4-7 days after parotid swelling. 
    • *R/O testicular torsion via Doppler US. 
  205. What are the 2 MCC's of ED?
    • Atherosclerosis & diabetes (80%). 
    • *Primary ED is rare. 
    • *Complications from prostate surgery, drugs, alcohol, psychological, neurological disorders & structural disorders. 
    • *Bulbocavernosus reflex. 
  206. _____: painful, long duration abnormal erection. 
    What are the 2 types?
    • Priapism.
    • 1. Ischemic/low flow: blood gets in but can't get out.
    • 2. Non-ischemic/High flow: MC- too much blood getting in... no pain, no necrosis.
  207. What is the MCC of priapism?
    Spinal cord trauma.
  208. What clinical test differentiates between ischemic & non-ischemic priapism?
    • Intracavernosal ABG.
    • *Treat w/ icepacks over the perineum, walking, drugs, aspiration, etc. 
  209. _______: fibrosis of the cavernous sheaths leading to deviated & sometimes painful erections
    • Peyronine's DX: MC D/T erection >4 hours.  
    • *Intromission: penis penetrates vagina. 
    • *Tumescence: swelling/erectile tissue. 
  210. _____: inability to retract foreskin to expose the glans penis.
    • Phimosis: normal in children.
    • *Treatment not necessary unless balanitis (swelling of the penis head), UTI & dermatological DX present. 
  211. ______: entrapment of the foreskin in the retracted position.
    • Paraphimosis "a tight turtleneck." 
    • *Iatrogenic. 
    • *If conservative treatment does not work, must do circumcision. 
  212. Internal hemorrhoids occur above _____, whereas external are below.
    • Pectinate line.
    • *External are prone to thrombosis & cause the most pain = painful purplish swelling. 
    • *Internal can become prolapsed & strangulated. 
  213. Which type of hemorrhoid causes hematochezia?
    • Internal hemorrhoids.
    • *Hematochezia: bleeding w/ defecation. 
    • *External = pain & thrombosis. 
  214. What grade of hemorrhoid requires manual reduction?
    Grade 3.

    • Grade 1: no prolapse.
    • Grade 2: prolapse w/ defecation, but spontaneous reduces.
    • Grade 3: requires manual reduction. 
    • Grade 4: cannot be manually reduced. 
  215. What will blood tests show for condyloma lata?
    Flat.
  216. What anal condition is caused by Treponema Pallidum?
    • Anal syphilitic warts (chancres): shows a spike on blood tests. 
    • *Transmitted by sex during the 1st & 2nd stage. 
    • *Genital ulcers, skin lesions, meningitis, aortic DX, neurologic syndromes (HA, deafness). 

    • 1st stage: 3-4 weeks later = chancre.
    • 2nd stage: 4-10 weeks later = mucus membrane lesions, fever, anorexia, lymphadenopathy, syphlitic dermatitis & condyloma lata
    • 3rd stage: cardiovascular, neurosyphilis & gummas. 
  217. What is the best blood test for anal syphilitic chancres?
    Treponemal Test (FTA-ABS).
  218. ______: chronic ovoid ulcer in the squamous epithelium of the anus.
    • Anal fissure: acute longitudinal tear. 
    • *Conservative treatment followed by possible surgery. 
  219. Perianal fissures are associated with which GI condition?
    Regional Enteritis (Chron's Disease).
  220. _______: episodic rectal pain D/T spasm of the levator ani.
    • Proctalgia fugax. 
    • *Usually lasts <20 min. 
    • *Benign condition. 
  221. ______: tube-like tract from the anal canal to the perianal skin.
    • Anal fistula. 
    • *Seen w/ Chron's & TB. 
  222. Where do perianal abscesses generally occur?
    • The anal crypt.
    • *Chron's DX, E Coli, Proetus Vulgaris. 
    • *Painful perianal swelling w/ redness & tenderness. 
  223. ______: inflammation of the anal & lower rectal mucosa possibly D/T STD or infection.
    • Proctitis: rectal bleeding. 
    • *Associated w/ anal sex.
    • *Camylobacter, shingella & salmonella. 
    • *Gonorrhea, Chlamydia, herpes & syphilis.
  224. ______: painless protrusion of the rectum through the anus.
    Rectal prolapse.
  225. ________: nonmalignant adenomatous prostate overgrowth.
    • BPH.
    • *80%/men >80 YO possibly D/T hormonal changes. 
    • *Urine flow becomes restricted... also frequent, urgent, nocturnal & dribbling. 
  226. How do you DX BPH? (3)
    • 1. Palpation = rubbery w/ loss of median furrow.
    • 2. PSA to R/O cancer, but it's elevated w/ BPH 30-50% of the time. 
    • 3. Transrectal US.
  227. What is a positive PSA test for someone under 50 YO?
    • PSA >2.5 = BPH.
    • *PSA >4 (50 YO+) = BPH.
  228. TURP is associated with which condition?
    • Transurethral Restion of the Prostate = BPH. 
    • *Alpha-adrenergic blockers help w/ voiding. 
    • *2-25% may become incontinent. 
  229. How is prostatitis DX?
    • 1. UA for WBC 
    • 2. US to R/O abscess or inflammation of seminal vesicles. 
    • 3. Cytoscopy.
  230. How is prostatic cancer graded?
    • Gleason score: graded twice, then add two scores together. 
    • *Median age/DX 72 YO.
    • *More die with it than from it. 
    • *No SX until advanced. 
  231. Findings with prostate cancer? (4)
    • 1. Stony hard nodules.
    • 2. Elevated PSA.
    • 3. Transurethral US.
    • 4. Biopsy, graded via Gleason Score. 
    • *Prostatectomy for men <70 YO. 
  232. Which side does the pt lay on for the prostate exam?
    • Left side. 
    • *ID the lateral lobes & median sulcus.
    • *Should feel rubbery.

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