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Family Med Review
| Term | Definition |
|---|---|
| Anticonvulsants used to treat fibromyalgia | gabapentin (Neurontin) & pregabalin (Lyrica) |
| Tricyclic muscle relaxants used to treat fibromyalgia | cyclobenzaprine (Flexeril) inhibits excitatory neurotransmission |
| Tricyclic antidepressants used to treat fibromyalgia | amitriptyline (Elavil) & nortriptyline (Pamelor) |
| SNRIs used to treat fibromyalgia | duloxetine (Cymbalta) & venlafaxine (Effexor) |
| GABA v. glutamate, which are inhibitory neurotransmitters and which are excitatory? | GABA is inhibitory; glutamate is excitatory |
| Baclofen MOA | Increases inhibitory neurotransmissions --> GABA pathways (CNS inhibitor) |
| Tizanidine MOA | Decrease excitatory neurotransmission (glutamate) |
| Dantrolene MOA | Direct smooth muscle relaxation via inhibition of calcium channels **gold standard for tx of malignant hyperthermia** |
| What is methocarbamol? | Muscle relaxant |
| Heberden's nodes | in the DIPs with osteoarthritis |
| Bouchard's nodes | in the PIPs with osteoarthritis |
| Celebrex generic name | celecoxib (NSAID) |
| Celexa generic name | citalopram (SSRI) |
| How do steroids increase blood sugar? | Liver releases more glucose when steroids are present; may also decrease peripheral cell sensitivity to insulin |
| hydroxychloroquine | immunosuppressive and anti-parasite drug used for malaria **safe to use in pregnancy** |
| hydroxyzine brand name | Vistaril or Atarax |
| hydralazine | vasodilator used to treat high blood pressure |
| What do you monitor when using methotrexate? | blood count, liver, kidneys (CBC, LFTs, BMP) **Pregnancy category X** |
| What specialist is necessary for hydroxychloroquine use? | Opthalmologist - yearly eye exams for *retinopathy* |
| Gold standard test for diagnosis of RA | Anti-CCP |
| HLA allele associated with RA? | HLA-DRB1 |
| Most common cause of non-autoimmune inflammatory arthritis? | Gout |
| Cause of gout? | Purine metabolism to uric acid which deposits in joints |
| Which class of drugs is known to induce hyperuricemia/gout flares? | Thiazide diuretics |
| Uric acid level over what is hyperuricemia? | 6-7 |
| What are the 4 ureate-lowering therapies? | Allopurinol, febuxostat, probenecid, pegloticase |
| What is the full name and abbreviation of pseudogout? | CPPD - calcium pyrophosphate deposition |
| How do urate crystals from gout appear under microscopy? | Needle-shaped and negatively birefingent (yellow when parallel to microscope ray) |
| In a patient with gout, what will you see on ultrasound? | "double contour sign" caused by crystal deposition overlying cartilage |
| How long to prescribe steroids/NSAIDs for acute gout attack? | At least 7-10 days to prevent rebound attack |
| When to start urate-lowering therapy in gout patients? | More than 2 flares in 6 months, tophaceous gout, uric acid kidney stones, stage 3 or greater kidney disease |
| Where is CPPD commonly noted? | Weight-bearing joints - hips, knees, shoulder (knee is most common) |
| How do CPPD crystals appear under microscopy? | Rhomboid-shaped with positive birefringence (blue when parallel to microscope ray) |
| What will you see on x-ray with CPPD? | Joint cartilage calcification (chondrocalcinosis) |
| Generally speaking, what causes CPPD? | Any metabolic disease that causes a dysregulation of calcium |
| Generally speaking, what types of infections trigger reactive arthritis? | GI and GU |
| What is the classic triad of symptoms for reactive arthritis? | can't see, can't pee, can't climb a tree (conjunctivitis, urethritis, and arthritis) |
| Which bacterial infectious organisms are known to trigger reactive arthritis? Viral? | Shigella, salmonella, campylobacter, and chlamydia HIV |
| Which HLA allele is associated with reactive arthritis? | HLA-B27 |
| How long should the course of ABX be for reactive arthritis? | 3-6 months |
| 50% of patients with RA and lupus also have which other rheum condition? | Sjogren syndome |
| Classic derm rash for lupus? | Malar rash |
| Which test is 100% sensitive to lupus? | ANA |
| What is the pharmacologic cornerstone tx for lupus? | Hydroxychloroquine (Plaquenil) |
| What does a CMP include that a BMP does not? | bicarb, liver enzymes, bilirubin, total protein, albumin |
| What is included in a BMP? | glucose, calcium, potassium, sodium, carbon dioxide, chloride, BUN & creatinine |
| Is amylase or lipase more specific to the pancreas? | Lipase |
| What is the classic CT finding for pancreatitis? | Pancreatic fat stranding |
| What is the imaging test of choice for pancreatitis? | Ultrasound (to evaluate the biliary tract) |
| Which acute abdominal condition is associated with red currant jelly stool? | Intussusception causing bowel obstruction |
| Which acute abdominal condition is associated with a sausage-shaped mass in the right lower quadrant in children? | Intussusception |
| What will a CT of the abdomen show in patients with intussusception? | Target or donut sign |
| What lab value will be elevated in closed loop bowel obstruction with associated ischemia? | Serum lactate |
| Abdominal x-rays in the setting of bowel obstruction will show which 2 air-fluid level signs? | Bent inner tube or coffee bean sign |
| What does an Alvarado score predict the likelihood of? | Acute appendicitis |
| Which ABX are given alongside an appendectomy? | ertapenem, levofloxacin, and metronidazole |
| Where does diverticulitis most commonly present to? | The sigmoid colon |
| What is Meckel diverticulitis, and what other condition can it mimic? | Right-sided diverticulitis; appendicitis |
| What ABX do you give for diverticulitis in an outpatient setting if it is mild and a clear liquid diet alone didn't clear the symptoms? | Bactrim or cipro |
| What is the classic triad for a ruptured abdominal aortic aneurysm? | hypotension, back pain, and a palpable pulsatile mass |
| Which acute abdominal condition presents with epigastric bruit in 50% of patients? | Bowel ischemia (moreso in chronic than acute) |
| What is the gold standard imaging study for ischemic bowel? | Mesenteric angiography |
| What are the USPSTF breast cancer screening guidelines for mammograms? | Start screening at 40 with mammograms every other year until 74 |
| What inheritance pattern does BRCA1 & BRCA2 follow? | Autosomal dominant |
| What do proteins produced by BRCA1 & BRCA2 do under normal circumstances? | Repair damaged DNA prior to cell division (BRCA1 & 2 are tumor suppressor genes) |
| What are the USPSTF guidelines for cervical screening using pap smears and HPV testing? Frequency for each alone and co-testing? | Pap alone - every 3 years HPV alone - every 5 years Co-testing - every 5 years |
| Which HPV strains are usually responsible for cervical cancer? | 16 & 18 |
| What is the most common abnormal pap smear result? | ASC-US (abnormal squamous cells of undetermined significance) |
| Describe the appearance of a koilocyte under microscopy and what it indicates | cell with a perinuclear halo; indicates HPV infection |
| What is the most common symptom of cervical cancer? | Post-coital bleeding |
| What is the most effective method of emergency contraception? | Copper IUD insertion within 5-7 days after intercourse |
| How does birth control cause gallbladder problems? | Increases the amount of cholesterol produced in the liver; it concentrates and causes gallstones |
| Why is medroxyprogesterone (injectable depot birth control) usually not used for more than 2 years at a time? | May lead to calcium loss, bone weakness, and osteoporosis |
| What are the two main phases of the menstrual cycle? | Follicular and luteal |
| Which hormones are predominant in the follicular and luteal phases of the menstrual cycle, respectively? | Estrogen & progesterone |
| What does FSH cause in the ovaries during the follicular phase of the menstrual cycle? | Follicle and egg maturation |
| What effect does LH have in the ovaries during the follicular phase of the menstrual cycle? | It stimulates the maturing egg/follicle to produce estrogen |
| What effect does estrogen have on the uterus during the follicular phase of the menstrual cycle? | Builds up the endometrium |
| Does estrogen cause positive or negative feedback on the HPO axis? | Both; during the follicular phase, increasing estrogen has negative feedback on GnRH. It switches to positive feedback around the time of ovulation until a LH spike has caused ovulation |
| The follicular phase of the menstrual cycle is also called what? | The proliferative phase |
| The luteal phase of the menstrual cycle is also called what? | The secretory phase |
| GnRH pulses (> or < 1) per hour favors LH secretion? What about FSH secretion? | > 1 per hour favors LH secretion; < 1 per hour favors FSH |
| In regard to abnormal uterine bleeding, what does the acronym PALM stand for? | PALM signifies *structural* abnormalities that cause bleeding - Polyps, Adenomyosis, Leiomyoma, and Malignancy/hyperplasia |
| In regard to abnormal uterine bleeding, what does the acronym COEIN stand for? | *Non-structural* causes of AUB - Coagulopathies, Ovulatory disorders, Endometrial disorders, Iatrogenic, and Not otherwise classified |
| What is adenomyosis? | Abnormal growth of endometrial tissue in the myometrium (muscular lining of the uterus) - myometrium becomes hormonally responsive |
| What is a leiomyoma? | Benign tumor arising from the myometrium (uterine fibroids) |
| What are the two most common coagulopathies? | Von Willebrand disease and platelet dysfunction |
| What is the most effective long-term medical management of heavy uterine/menstrual bleeding? | Levonorgestrel IUD |
| What is the definitive management for chronic abnormal uterine bleeding? | Hysterectomy |
| What are the options for management of acute uterine hemorrhage? | IV equine estrogen, IV TXA (tranexamic acid), high-dose oral contraceptives, uterine tamponade, uterine artery embolization, dilation and curettage |
| Leiomyoma growth is dependent upon what? | Estrogen |
| What are the big risk factors for development of leiomyomas? | Increasing age, being African-American (5x more common), nulliparity |
| What is the most common cause for hysterectomy? | Fibroids |
| Other names for leiomyomas? | Fibroids, fibromyomas, myomas |
| What will you find on physical exam in a patient with uterine adenomyosis? | Symmetrically diffusely enlarged uterus |
| What is decidua? | Endometrium of a pregnant woman |
| Clinical presentation of endometritis? | Fever, tachycardia, soft/tender uterus, and abdominal pain 2-3 days after C-section, postpartum, or postabortal |
| Tx for endometritis *post C-section*? | Clindamycin and gentamicin |
| Tx for endometritis *post-vaginal delivery*? | Ampicillin and gentamicin |
| What do you give for prophylaxis of endometritis prior to C-section? | First generation cephalosporin |
| What is the most common gynecologic cause of secondary dysmenorrhea? | Endometriosis |
| What percentage of reproductive-age women are affected by endometriosis? | 10% |
| Most common site of endometriosis? | Ovaries |
| What is the classic triad of symptoms for endometriosis? | Cyclic pre-menstrual pelvic pain, dysmenorrhea, and dyspareunia |
| What is a chocolate cyst? | Endometrioma - endometriosis involving the ovaries large enough to be considered a tumor; filled with old blood, giving it a chocolate color |
| How is endometriosis treated? | NSAIDs, ovulation suppression with birth control, ablation or re-section of ectopic endometrial tissue, total hysterectomy with bilateral salpingooophorectomy |
| What is the most common perimenopausal symptom? | Hot flashes (vasomotor instability) |
| What is the most sensitive initial test for diagnosing menopause? | FSH assay |
| What happens to hormone levels of FSH, LH, and estrogen after menopause? | FSH and LH increase; estrogen decreases |
| What is the brand name of paroxetine? | Paxil |
| Why do women with low estrogen (postmenopausal/postpartum) have UTIs with increased pH? | Loss of lactobacilli which normally converts glucose to lactic acid |
| What is another name for PCOS? | Stein-Leventhal syndrome |
| Where are granulosa cells found? | Ovaries |
| What diagnosis should a "string of pearls" appearance on U/S make you think of? | PCOS |
| Most common cause of vaginitis? | Bacterial vaginosis d/t overgrowth of gardernella vaginalis |
| S/sx of bacterial vaginosis? | Fishy odor, homogenous gray-white discharge, increased vaginal pH, clue cells on microscopy |
| Tx for bacterial vaginosis? | Metronidazole x 7 days |
| Causative organism for trichomoniasis? | Trichomonas vaginalis |
| Common pelvic exam findings in trichomoniasis? | Copious, frothy, yellow-green discharge with a strawberry cervix |
| Tx for trichomoniasis? | Metronidazole (2g x 1 dose) |
| Tx for vaginal candidiasis? | PO fluconazole |
| Most common cause of spontaneous abortion? | Chromosomal abnormalities |
| What is the most common cause of PID? | Chlamydia trachomatis |
| What is Chandelier sign indicative of? | PID |
| Tx for PID? | Ceftriaxone + Doxycycline + Metronidazole |
| What is Fitz Hugh-Curtis Syndrome? | Perihepatitis in the setting of PID |
| Acute sinusitis is less than how many weeks? | 4 weeks |
| What is hyposmia? | Decreased ability to smell through your nose |
| What are the 3 most common causative organisms of acute bacterial rhinosinusitis (ABRS)? | Strep pneumo, H. flu, and M. cat |
| What is the antibiotic of choice for acute bacterial rhinosinusitis/sinus infection? | Augmentin (amoxicillin/clavulanic acid) 2nd line - doxy |
| How long must sinusitis be present to be considered chronic? | At least 12 weeks (3 months) |
| Most common bacterial cause for chronic sinusitis? | Staph aureus |
| What is Wegener's granulomatosis? | A vasculitis/polyangitis that causes inflammation of blood vessels in the ears, nose, sinuses, throat, lungs, and kidneys |
| What is the most common fungal cause of chronic sinusitis? | Aspergillus |
| Most common type of rhinitis? | Allergic rhinitis |
| Pathophys of allergic rhinitis? | IgE-mediated mast cell histamine release d/t allergens |
| What will you find on physical exam of allergic rhinitis? | -edematous/pale/violaceous boggy turbinates -nasal polyps -cobblestone mucosa of the conjunctiva -allergic shiners -transverse nasal bridge crease -eye/nasal itching |
| Nasal turbinate appearance in allergic v. viral rhinitis | In allergic, it will be edematous/pale/violaceous/boggy - will be beefy red in viral |
| Most effective medication for allergic rhinitis? | Intranasal steroids (fluticasosne/Flonase, mometasone, triamcinolone) |
| What is a suggested cause of aphthous ulcers? | human herpes virus 6 (HHV 6) |
| What is the most common cause of posterior blepharitis? | Meibomian gland dysfunction |
| What are the two primary causes of anterior blepharitis? | Infectious (staph aureus or viral) or seborrheic |
| What is a cholesteatoma? | Abnormal collection of skin cells in the middle ear or mastoid |
| What causes cholesteatoma? | Chronic middle ear disease or eustachian tube dysfunction |
| S/sx of cholesteatoma? | Painless yellow/brown discharge w/ a foul odor, dizziness, peripheral vertigo, tinnitus, cranial nerve palsies, conductive hearing loss |
| Causative organisms of bacterial conjunctivitis? | staph aureus, M. cat, H. flu, strep pneumo |
| Tx for bacterial conjunctivitis? | Erythromycin ointment, trimethoprim-polymyxin B, fluoroquinolones *if contact lens wearer, also cover pseudomonas - use topical Cipro* |
| Most common cause of viral conjunctivitis? | Adenovirus |
| What is chemosis? | Conjunctival edema |
| Allergic conjunctivitis is what type of hypersensitivity reaction? | Type 1; IgE-mediated mast cell degeneration with histamine release |
| Which topical H1 blocker antihistamine can be used for both viral and allergic conjunctivitis? | Olopatadine |
| What do "ice rink" lesions indicate? | Ice rink lesions are multiple linear corneal abrasions seen on fluorescein staining - indicates a foreign body stuck under eyelid |
| Greatest risk factor for corneal ulcer? | Improper contact lens wear |
| What physical exam findings can help you identify a corneal ulcer? | Ciliary injection, hazy cornea, hypopyon |
| What is hypopyon? | pus in the anterior chamber of the eye |
| Management of bacterial keratitis/corneal ulcer? | Topical fluoroquinolone (moxifloxacin) |
| What is the hallmark sign of herpes keratitis? | Dendritic corneal ulceration on fluorescein staining |
| How do you treat herpes keratitis? | Topical or oral acyclovir |
| What is dacryocystitis? | Infection of the lacrimal sac d/t obstruction of the nasolacrimal duct |
| Tx for dacryocystitis? | warm compresses and systemic ABX (clinda) or, if severe, dacryocystorhinostomy |
| Tx for both entropion and ectropion? | Lubricating eye drops, moisture shields, and surgery if needed |
| Most common source for anterior epistaxis? | Kiesselbach venous plexus |
| Most common source for posterior epistaxis? | Woodruff's plexus, sphenopalatine artery |
| Management of anterior epistaxis? | Direct pressure, topical vasoconstrictors (oxymetazoline), electrocautery or chemical cautery (silver nitrate), nasal packing |
| Management of posterior epistaxis? | Balloon catheter |
| Which type of glaucoma is an emergency? | Acute narrow angle closure |
| Risk factors for acute narrow angle glaucoma? | > 60 y/o, female, Asian, far-sighted |
| What is mydriasis? | Pupillary dilation |
| What visual changes accompany acute narrow angle closure glaucoma? | Halos around lights; peripheral vision loss (tunnel vision) |
| What tonometry pressure reading is consistent with a diagnosis of acute angle closure glaucoma? | > 21mmHg |
| Difference in presentation of narrow angle closure glaucoma vs. open angle? | Narrow angle - acute, painful, unilateral Open angle - chronic, bilateral, painless |
| Difference in risk factors for narrow angle glaucoma vs. open angle? | Narrow angle more likely in women, Asians, > 60 y/o Open angle more likely in African-Americans > 40 y/o |
| Tx for open angle glaucoma? | First line is prostaglandin analogs; also beta-blockers, alpha-2 agonists, acetazolamide |
| Most common cause of hordeolum? | Staph aureus |
| Tx for hordeolum? | 1st line is warm compresses; if prescribing ABX, use erythromycin |
| What typically causes hyphema? | Blunt or penetrating trauma to the eye |
| Management of hyphema? | Eye shield, bed rest, dim lighting, HOB elevation to at least 30 degrees; topical tetracaine for pain |
| When should you admit a hyphema patient? | If hyphema occupies 50%+ of the anterior chamber, or if the patient has increased IOP, bleeding/clotting disorder, sickle cell/trait |
| What type of nystagmus is seen in vestibular neuronitis? | Usually horizontal or rotary *away from* the affected side |
| Difference in clinical manifestations b/n vestibular neuronitis and labyrinthitis? | Vestibular neuronitis = continuous vertigo W/O hearing loss Labyrinthitis = continuous vertigo + unilateral hearing loss &/or tinnitus |
| How do you treat vestibular neuronitis or labyrnthitis? | Glucocorticoids and antihistamines like meclizine |
| What is the most common cause of irreversible blindness? | Macular degeneration (central vision loss) |
| What are the two types of macular degeneration? Which is more common? | Dry (atrophic, geographic) & wet (neovascular or exudative) Dry is more common; wet is more aggressive |
| What is a scotoma? | A partial loss of vision or blind spot in an otherwise healthy visual field |
| What is metamorphopsia? | Straight lines appearing bent (seen in macular degeneration pts) |
| What do you see on fundoscopy in macular degeneration pts for dry vs. wet? | Dry = drusen bodies Wet = neovascularization |
| In what condition is an Amsler grid used to help diagnose? | Macular degeneration |
| Management of dry macular degeneration? | Zinc and vitamins C & E to *slow* progression |
| Management of wet macular degeneration? | Intravitreal VEGF inhibitors |
| Difference between Meniere syndrome and Meniere disease? | Meniere syndrome is d/t an identifiable cause; Meniere disease is idiopathic |
| What are the 4 findings associated w/ Meniere's? | 1. Episodic vertigo 2. Unilateral fluctuating sensorineural hearing loss 3. Tinnitus 4. Ear fullness |
| What kind of nystagmus is seen in Meniere's? | Horizontal |
| What should you rule out before diagnosing Meniere's? | Syphilis |
| Tx for Meniere's? | First line = dietary modifications Pharm = Diuretics & antihistamines or anticholinergics Refractory = Surgery, labyrinthectomy, Gentamicin |
| Most common cause of nasal polyps? | Allergic rhinitis |
| Tx for nasal polyps? | Intranasal corticosteroids |
| Most common causative organism of otitis externa? | pseudomonas aeruginosa |
| Tx for otitis externa? | Topical ciprofloxacin-dexamethasone |
| Peak age for acute otitis media? | 6-24 months |
| Most common causative organisms of AOM? | M. cat, H. flu, and strep pneumo |
| What should happen to tympanic membrane mobility in AOM? | Decrease |
| If prescribing ABX for AOM, what is first line? | High-dose amoxicillin --> Augmentin --> cephalosporin |
| What workup should you do in children with recurrent otitis media? | Iron deficiency anemia |
| What is papilledema indicative of? | increased intracranial pressure |
| What is acetazolamide? | A diuretic that can be used to treat heart failure-related edema and glaucoma |
| Pharm agent used to tx papilledema? | Acetazolamide |
| Most common causative organisms in peritonsillar abscess? | Group A strep (strep pyogenes), staph aureus |
| Management of peritonsillar abscess? | I&D + ABX (Augmentin + clinda) |
| Risk factors for pterygium? | UV light exposure in sunny climates; sand/wind/dust exposure |
| Which side of the eye do pterygiums typically begin on? | Medial side |
| Management of pterygium? | Observation, usually; surgery if impacting vision |
| Most common type of retinal detachment? | Rhegmatogenous |
| What symptoms are typical of retinal detachment? | Flashing lights (photopsia), floaters, unilateral peripheral vision loss/curtain coming down |
| What is Shafer's sign indicative of? | Retinal detachment (clumping of brown-colored pigment in the anterior vitreous humor) |
| How to manage retinal detachment patient? | Emergent ophthalmology consult - Keep the patient supine with head turned toward the side of the detachment |
| Most common cause of central retinal artery occlusion (CRAO)? | Emboli from carotid artery atherosclerosis |
| How does CRAO present? | Sudden, painless, unilateral loss of vision |
| What will you see on fundoscopy in CRAO? | Pale retina with a cherry-red macula; boxcar appearance of retinal vessels |
| Tx for CRAO? | No consensus on optimal treatment - can try oxygen, CO2 rebreathing, fibrinolysis, acetazolamide |
| What diagnosis is associated w/ a "blood and thunder" appearance on fundoscopy? | Central retinal vein occlusion (CRVO) |
| Which condition is associated with cotton wool spots, dot & blot hemorrhages, and flame-shaped hemorrhages? | Nonproliferative diabetic retinopathy |
| Tx for proliferative diabetic retinopathy? | VEGF inhibitors |
| Which condition is associated with copper & silver wiring and AV nicking/nipping? | Hypertensive retinopathy |
| What is Wharton's duct? | Submandibular gland duct |
| What is Stenson's duct? | Parotid gland duct |
| Most common causative organism of acute bacterial sialadenitis? | Strep pneumo |
| Tx for acute bacterial sialadenitis? | Anti-staph ABX (dicloxacillin or nafcilin) |
| In conductive hearing loss, Weber will lateralize to which ear? What will Rinne show? | The affected ear; for Rinne, bone conduction > air conduction |
| 90% of anal fissures are located where? | Posterior midline of the anal canal |
| What are the two most common causes of appendicitis? | Fecalith or lymphoid hyperplasia |
| What change in s/sx do you expect to see in proximal vs. distal small bowel obstruction? | Vomiting more common in proximal obstruction; abdominal distention more common with distal |
| 3 most common causes of bowel obstruction? | Adhesions, cancer/malignancy, hernia |
| 4 hallmark symptoms of bowel obstruction? | "CAVO" - crampy abdominal pain, abdominal distension, vomiting, and obstipation |
| Tx for nonstrangulated bowel obstruction? | Bowel rest, fluid & electrolyte repletion, analgesics, NG tube decompression |
| Which infective organism is seen most frequently in cholecystitis? | E. coli |
| What is Boas sign? | Referred pain the right shoulder subscapular area during cholecystitis |
| Triad of symptoms for cholecystitis? | Continuous RUQ pain, fever, leukocytosis |
| ABX regimens for cholecystitis? | Metronidazole + cephalosporin or fluoroquinolone |
| What causes alcalculous cholecystitis? | Gallbladder stasis and ischemia |
| Most common type of gallstone? | Cholesterol |
| Most common causes of cirrhosis in the U.S.? | Chronic Hep C infection and alcoholism |
| Cirrhosis can lead to increased ammonia levels which can cause what secondary condition? | Hepatic encephalopathy |
| What is fetor hepaticus? | breath of the dead; the characteristic breath smell of patients with severe liver disease; smells like rotten eggs and garlic |
| What are the two main scoring systems for liver analysis? | Child-Pugh = used to predict mortality MELD = used to predict survival odds primarily to determine transplant candidacy |
| Management of ascites and edema in the context of cirrhosis? | First line = sodium restriction Next = diuretics (spironolactone + furosemide) Refractory = large volume paracentesis |
| Histopathologically, what type of cancer makes up > 90% of cancers in the colon and rectum? | Adenocarcinomas |
| Which ethnic group has the highest colorectal cancer rates of all in the US? | African Americans |
| Which autosomal dominant condition has a 100% chance of developing into colorectal cancer? | Familial adenomatous polyposis (FAP) |
| How should you diagnose and treat familial adenomatous polyposis? | Start annual colonoscopies at age 10; prophylactic proctocolectomy is recommended as soon as diagnosis is confirmed |
| What is the whole name for Lynch syndrome? | Hereditary Nonpolyposis Colorectal Cancer (HNPCC) |
| How to diagnose and treat HNPCC? | Start annual colonoscopies at 25 and resect colon at site of cancer |
| Which other cancers are typically seen in Lynch syndrome, besides colorectal cancer? | Endometrial, ovarian, small intestine, brain, and skin |
| What is the most common cause of large bowel obstruction in adults? | Colorectal cancer |
| What is the most common cause of occult GI bleeding in adults? | Colorectal cancer |
| What lab changes would you see with colorectal cancer on a CBC? | Iron deficiency anemia |
| What will you see on a barium enema CT in a pt with colorectal cancer? | Apple core lesion |
| What is the most commonly monitored tumor marker in colorectal cancer? | carcinoembryonic antigen (CEA) |
| What is tenesmus? | A continuous or recurrent inclination to evacuate the bowels |
| What are the two broad types of colon polyps? | Neoplastic or inflammatory |
| What are the two major types of adenomatous polyps? | Tubular and villous |
| What are the colonoscopy screening guidelines for colorectal cancer? | 45 (until 75), every 10 years |
| Colorectal screening guidelines if pt has a family member diagnosed with CRC before 60? | Begin screening at 40 or 10 years before relative was diagnosed - every 5 years |
| When should you start screening for colorectal cancer in pts with IBD? | 8-10 years after symptom onset |
| What are the 3 classic symptoms of esophagitis? | odynophagia, dysphagia, and retrosternal chest pain |
| What are the 3 most common types of infectious esophagitis? | Candidiasis, HSV, and CMV (in that order) |
| Most common strain of candida? | Candida albicans |
| How to treat esophageal candidiasis? | PO fluconazole for 2-3 weeks |
| Esophageal candidiasis is seen in HIV pts w/ CD4 counts of? | < 100 |
| What is seen on biopsy of HSV esophagitis? | Multinucleated giant cells |
| Tx for HSV esophagitis? | PO acyclovir |
| What is the more common name for human herpes virus 5? | cytomegalovirus (CMV) |
| CMV esophagitis is seen in HIV pts w/ CD4 counts of? | < 50 |
| What should all patients with CMV be screened for? | Retinitis - usually occurs w/ extra-ocular CMV infection, even if asymptomatic |
| What diagnosis is associated with "owl's eye" inclusion bodies on histo? | CMV |
| What do eosinophilic esophagitis pts typically have as a presenting complaint? | Esophageal dysfunction (dysphagia to solids and food impactions) |
| What will you see on endoscopy of an eosinophilic esophagitis pt? | Concentric rings |
| What is required on biopsy for a diagnosis of eosinophilic esophagitis? | At least 15 eosinophils per high powered field |
| Tx for eosinophilic esophagitis? Include refractory tx | First line is PPIs; if not responsive, add topical steroid (swallowed fluticasone inhaler) |
| Most common causative agent of gastritis? | H. pylori |
| What condition is associated with GERD? | Hiatal hernia |
| What is pyrosis? | Heartburn |
| What is the most common noncardiac cause of chest pain? | GERD |
| What are the alarm features of GERD? | Dysphagia, odynophagia, anorexia, unexplained weight loss, evidence of GI bleeding |
| What is the most common cause of esophagitis (including infectious and noninfectious causes)? | GERD |
| What are the 4 main complications of GERD? | Esophagitis, esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma |
| What is the most common protozoal infection in the US? | Giardia (duodenalis/lamblia/intestinalis) |
| What is the more common name for an entamoeba histolytica infection? | Amebiasis |
| Tx for giardia or amebiasis infx? | Rehydration + metronidazole |
| Internal v. external hemorrhoids in regard to bleeding and pain | Internal hemorrhoids bleed and are usually painless; external are painful but usually don't bleed |
| Tx for hemorrhoids | Topical steroids/analgesic, increase fiber & fluid intake, warm Sitz baths; if conservative fails, rubber band ligation or excision |
| Most common type of hiatal hernia? | Type 1 - sliding - GE junction slides into the mediastinum |
| What is type 2 hiatal hernia? | rolling - fundus of stomach herniates into mediastinum but GE junction remains in place |
| Management of sliding hernia? | PPIs + weight loss (if symptomatic GERD) |
| What ethnicity is most at risk for IBD? | Jews, especially Ashkenazi |
| Gender differences in IBD | UC more common in males; Crohn's more common in females |
| What is the only known condition that smoking is *protective* against? | Ulcerative colitis |
| Most common extra-intestinal manifestation of IBD? | Arthritis |
| Derm, ocular, and hematologic findings associated w/ IBD? | Erythema nodosum, anterior uveitis/iritis, and B12/iron deficiency |
| Area affected by ulcerative colitis? | rectum ALWAYS involved; limited to colon; contiguous |
| Layers impacted by UC? | Mucosa and submucosa only |
| Area impacted by Crohn's? | Any segment of the GI tract from mouth to anus |
| Which area is most commonly impacted by Crohn's? | Terminal ileum |
| Layers impacted by Crohn's? | Transmural (all) |
| Difference in s/sx of Crohn's/UC in regard to pain and stool? | UC = LLQ colicky pain with bloody diarrhea Crohn's = crampy RLQ pain most commonly with diarrhea (no blood) |
| Appearance of Crohn's on colonoscopy? | Skip lesions (not contiguous) and cobblestoning |
| Management of IBD? | 5-ASA (Mesalamine), topical/oral steroids, immunomodulators (methotrexate), biologic therapy (anti-TNF agents) |
| What is the Rome IV criteria, and what is it used to diagnose? | Used for IBS; Recurrent abdominal pain associated with at least two: related to defecation, change in stool form, change in stool frequency |
| Pathophys of acute pancreatitis | Cell injury --> production of pancreatic enzymes --> autodigestion of pancreas |
| 2 most common causes of acute pancreatitis? | Gallstones, heavy alcohol use |
| What common medication class can trigger acute pancreatitis? | Thiazides |
| Cullen's sign and Grey Turner sign and what they indicate | Bruising around the bellybutton and flanks, respectively; indicates pancreatitis |
| Which enzymes will be elevated in pancreatitis? Which is more specific? | amylase and lipase; lipase |
| How to manage acute pancreatitis? | NPO, aggressive IV fluid resuscitation, analgesics |
| What is Ranson's criteria? What's included at admission? | Used to predict mortality from acute pancreatitis; age, glucose, WBC, AST, and LDH |
| Most common causes of chronic pancreatitis? | Heavy alcohol use and cystic fibrosis |
| The triad of calcifications, steatorrhea (w/ or w/o diarrhea), and diabetes is indicative of what? | Chronic pancreatitis |
| Management of chronic pancreatitis? | Alcohol abstinence, low-fat diet, pain control, oral enzyme replacement, vitamin supplementation |
| What are the two most common causes of gastric and duodenal ulcers? | H. Pylori and NSAIDs/aspirin |
| How do NSAIDs/aspirin damage gastric mucosa? | They inhibit prostaglandins, which are responsible for the alkalinity of the mucosa |
| Zollinger-Ellison syndrome | one or more gastrinomas in the upper digestive tract --> produce gastrin --> gastrin prompts the stomach to produce acid --> peptic ulcers |
| When do duodenal ulcers hurt? | Before or 2-5 hours after meals; pain relieved with food (buffers the acid being secreted into the small intestine) |
| When do gastric ulcers hurt? | With food, esp. 1-2 hours after |
| Most common cause of upper GI bleed? | Peptic ulcer disease |
| Tx for H. Pylori + PUD | Bismuth quadruple therapy - bismuth subsalicylate + tetracycline + metronidazole + PPI |
| Most common cause of fulminant hepatitis in the US? | Acetaminophen toxicity |
| Which hepatitis strains are transmitted via fecal-oral route? | A & E |
| What is hepatitis D dependent on in order to survive & why? | Hep B - it uses Hep B's surface antigen HBsAg as its envelope protein) |
| How is hep D contracted? | IV drug use, blood or blood products |
| What other condition does a hepatitis B vaccine also protect against? | Hepatitis D |
| What strange symptom is seen with hepatitis infections? | Aversion to smoking |
| Which ethnic and age groups have the highest death rates d/t asthma? | Blacks 15-24 y/o |
| What are the 3 components of asthma? | Airway hyperreactivity, airway inflammation, and bronchoconstriction |
| Strongest risk factor for asthma? | Atopy |
| Which medications might trigger asthma? | NSAIDs, aspirin, beta blockers |
| Classic triad of s/sx for asthma? | Dyspnea, wheezing, coughing - worse at night or first thing in the morning |
| What does asthmatic wheezing sound like, and when do you hear it? | High pitched sounds during expiration |
| In what setting is pulsus paradoxus seen and what is it? | inspiratory blood pressure drop > 10mmHg seen during status asthmaticus |
| What pharmocologic agent is administered IV in life-threatening acute asthma exacerbation/ | IV mag sulfate |
| Asthma therapy | SABA --> SABA + ICS --> LABA/ICS combo inhaler + SABA |
| What is theophylline? What is its relation to smokers? | Bronchodilator that improves respiratory muscle endurance; smoking decreases theophylline levels, so smokers need more of it |
| What are the 4 first line ABX for chronic bronchitis (COPD) exacerbations? | amoxicillin, doxycycline, cephalosporin, clarithromycin |
| What will be seen on CBC and ABG for COPD pts? | Increased H&H d/t chronic hypoxia, and respiratory acidosis (hypoxemia + hypercapnia) |
| Centrilobar (proximal acinar) emphysema is seen in which pt populations? What about pancinar emphysema? | Smokers & coal worker pneumoconiosis alpha-1 antitrypsin deficiency |
| What condition is associated with alpha 1 antitrypsin deficiency? | Panacinar emphysema |
| What is COPD? | Emphysema + chronic bronchitis Emphysema is a loss of elastic recoil in the alveoli --> leads to increased air trapping |
| What can be seen on CXR with emphysema patients? | Hyperinflation, increased AP diameter, flattened diaphragms |
| Which vaccinations must COPD pts get? | Influenza and pneumococcal |
| 2 most common causes of lung cancer? | Smoking and asbestosis |
| USPSTF screening recommendations for lung cancer | Annual low-dose CT in 55-80 y/o pts with no symptoms and a 30+ pack year history who currently smokes or has quit within the last 15 years |
| Most common primary lung cancer? | Adenocarcinoma (non-small cell) |
| Where do lung adenocarcinomas arise from, and where are they located? | Arise from mucosal cells; peripherally located |
| From what do squamous cell lung carcinomas originate? What is "CCCP"? | Originate from tracheobronchial squamous cells CCCP = centrally located, cavitary lesions, hypercalcemia, and Pancoast syndrome |
| Most common solid tumor to present w/ paraneoplastic syndromes? | Small cell lung cancer |
| How do squamous cell lung carcinomas present? *Physically, in the body* | Intraluminal mass |
| Which patient populations may have atypical presentations with pneumonia? | Elderly, diabetic, and immunocompromised |
| Most common causative organism of community acquired pneumonia? | Strep pneumo |
| What causative organism should rust-colored sputum make you think of? | Strep pneumo |
| What causative organism should currant jelly sputum make you think of? | Klebsiella pneumoniae |
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rachel_robinson1026
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