Term
| diagnosis of dyspepsia - 3 |
|
Definition
| need 1 - postparandial fullness, early satiety, epigastric pain |
|
|
Term
| causes of dyspepsia - 5, which is most common |
|
Definition
| function 75%, PUD, GERD, gastritis, malignancy |
|
|
Term
|
Definition
| NSAIDS, alcohol, H. pylori |
|
|
Term
| incidence of H. pylori by age |
|
Definition
|
|
Term
| race with higher H pylori infections - 2 |
|
Definition
|
|
Term
|
Definition
| pain 2-5h postparandial, epigastric pain radiating to the back, episodic |
|
|
Term
|
Definition
| 95% duodenal ulcer/H. pylori, 75% gastric ulcer/H. pylori |
|
|
Term
| causes of functional dyspepsia - 3 |
|
Definition
| GI dysmotility, altered visceral sensation, psych disorders |
|
|
Term
| treatment of functional dyspepsia - 3 |
|
Definition
| H2 blockers, prokinetics, PPI |
|
|
Term
| work up for H. pylori and the effectiveness of each - 4 |
|
Definition
| stool test #1, urea breath test #2, Ab test (50% PPV), endoscopy with culture (PPI cause FN) |
|
|
Term
| treatment of H. pylori - 3 |
|
Definition
| prepyac = amoxicillin, clathromycin, PPI |
|
|
Term
| when do get an endoscopy - 11 |
|
Definition
| >50yo with new onset sx, GI bleeding, weight loss, anemia, dysphagia, long duration of symptoms, recurrent vomiting, palpable mass, lymphadenopathy, family history of GI cancer, jaundice |
|
|
Term
|
Definition
|
|
Term
| GERD incidence in old people |
|
Definition
|
|
Term
|
Definition
| obesity, weight gain, trauma, pregnancy, genetics, age, low SES, smoking |
|
|
Term
| typical GERD symptoms - 9 |
|
Definition
| burning, cough, halitosis, otitis, worse at night, laying down, after eating, cavities, asthma |
|
|
Term
| atypical GERD symptoms - 5 |
|
Definition
| belching, epigastric pain, bloating, nausea, dyspepsia |
|
|
Term
| complications specific to atypical GERD - 4 |
|
Definition
| gastroparesis, achalasia, PUD, gastritis |
|
|
Term
| complications of GERD - 5 |
|
Definition
| barrets, erosive esophagitis, peptic stricture, adenocarcinoma of the esophagus, pulmonary disease |
|
|
Term
| treatment of GERD first line - 10 |
|
Definition
| small frequent meals, decreased alcohol, caffeine, tomato, citris, mint, chocolate, fats, smoking, elevate head of bed |
|
|
Term
| treatment of gerd second line - 3 |
|
Definition
| OTC antacid, H2 blocker, PPI |
|
|
Term
| most effective treatment for GERD |
|
Definition
|
|
Term
| most effective treatment for esophagitis |
|
Definition
|
|
Term
|
Definition
| osteoporosis, need Ca/D, increased Fx in hip/vertebrae 60%!! in 1y |
|
|
Term
| define acute diarrhea, what causes |
|
Definition
| diarrhea <14d, usually infection and self limited |
|
|
Term
| define persistent diarrhea |
|
Definition
|
|
Term
| define chronic diarrhea, what causes it - 4 |
|
Definition
| >30d, malabsorption, IBD, IBS, secretory |
|
|
Term
| when can diarrhea be treated with expectant management and BRAT |
|
Definition
|
|
Term
| when do you need to work up diarrhea - 6 |
|
Definition
| >48h, fever, blood in stool, >6 stool/d, >70yo, immune compormised |
|
|
Term
|
Definition
| stool O/P, C. diff, stool culture, stool WBC |
|
|
Term
| #1 cause of viral diarrhea |
|
Definition
|
|
Term
| common cause of diarrhea in kids |
|
Definition
|
|
Term
| diarrhea from IV drugs, MSM, food |
|
Definition
|
|
Term
| where does giardia hide - 3 |
|
Definition
| daycare, pools, fruit salad |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| where does shigella hide - 2 |
|
Definition
|
|
Term
| what is 12% of travelers diarrhea |
|
Definition
|
|
Term
| treatment of E. coli diarrhea |
|
Definition
| cipro, alternative azithromycin |
|
|
Term
| where does campylobacter hide - 3 |
|
Definition
|
|
Term
| treatment of camplobacter |
|
Definition
|
|
Term
|
Definition
| gram positive spore forming |
|
|
Term
| #1 hospital acquired GI illness |
|
Definition
|
|
Term
| % of adults colonized with C. diff |
|
Definition
|
|
Term
|
Definition
| recent antibiotics, immune compormised |
|
|
Term
|
Definition
| watery diarrhea, toxic megacolon, pseudomembranous colitis, fever, leukocytosis |
|
|
Term
| anyone with this presentation you should check for C. diff |
|
Definition
| 3+ unformed stools within 24h of anitbiotics |
|
|
Term
| screening test for C diff |
|
Definition
|
|
Term
| diagnostic test for c diff - 3 |
|
Definition
| PCR, stool culture, cytotoxic neutralizing assay |
|
|
Term
| what do you do if someone is still on the antibiotics they need for C. diff and you cant take them off and need to treat them |
|
Definition
|
|
Term
| indications for fixadomicin - 3 |
|
Definition
| old people, severe c. diff, on other antibiotics |
|
|
Term
| MOA fixadomicin and efficacy |
|
Definition
|
|
Term
| 1st line treatment for c diff and efficacy |
|
Definition
|
|
Term
| 2nd line treatment for c diff and efficacy |
|
Definition
|
|
Term
| last resort treatment for c diff and 2 indications |
|
Definition
| fecal transplant - refractory to treatment, 3d time getting c diff |
|
|
Term
| signs of severe c diff - 8 |
|
Definition
| need 2 points - >101.3F, ileus, SBP <100, WBC 15-30 (1), WBC >30 (2), zero CT signs, 1 CT sign, 2 CT sign (2) |
|
|
Term
|
Definition
|
|
Term
| 3 signs c diff is gonna put you in the ICU |
|
Definition
| albumin <3, WBC >15, distention |
|
|
Term
|
Definition
|
|
Term
| ROMA II diagnostic criteria for IBS |
|
Definition
| 6mo duration, 1d/wk for 3mo then... need 2 - relation to pooping, change in stool frequency, change in stool appearance |
|
|
Term
| what must you rule out to call IBS - 6 |
|
Definition
| lactose intolerance, Mg supplementation, anti-cholinesterase, depression, anxiety, abuse |
|
|
Term
| work up for IBS and what each is ruling out - 8 |
|
Definition
| CBC anemia, BUN/Cr volume depletion, Stool WBC/O/P/Cx/C diff - infection, colonoscopy if persists or concerning signs |
|
|
Term
| treatment of IBS - conservative - 2 |
|
Definition
| avoid trigger, fiber 25-35mg/d |
|
|
Term
| treatment of IBS - if pain |
|
Definition
|
|
Term
| treatment of IBS - if diarrhea - 2 |
|
Definition
| loperamide, diphenyloxylate |
|
|
Term
| treatment of IBS anticholinergics - 3 |
|
Definition
| belladonna, dicyclomine, hycosamine |
|
|
Term
|
Definition
| pain, fever, diarrhea, iritis, spondylitis, sacroiliitis, sclerosing cholangitis, leukocytosis, low Hb, elevated PLT, elevated ESR |
|
|
Term
|
Definition
| lesions throughout GI tract, skip lesions, no bloody stools, strictures, apthosus, erythrma nodosum, pyoderma gangrnosum |
|
|
Term
|
Definition
| large bowel and rectum, continuous lesions, bloody stools, toxic megacolon |
|
|
Term
| complications of IBD in pregnancy |
|
Definition
| if having a flare may cause PTD, UC > chrons more likely to flare |
|
|
Term
|
Definition
| not 5ASA but everything else is but may cause PTD - azathioprine, cyclophosporin, TNFa inhibitors |
|
|
Term
| management of pregnancy with IBD |
|
Definition
| make sure has extra foalte |
|
|
Term
| does IBD affect fertility |
|
Definition
|
|
Term
| treatment of maintinence of IBD - 2 |
|
Definition
| 5ASA - sulfasalazine, mesalamine |
|
|
Term
| treatment of IBD flare 1st line |
|
Definition
|
|
Term
| treatment of IBD flare 2nd line |
|
Definition
| azathioprine immune modulator |
|
|
Term
| treatment of IBD flare 3rd line |
|
Definition
| TNFa inhibitors infliximab, induces remission when unresponsive |
|
|
Term
| normal gallbladder changes in pregnancy - 3 |
|
Definition
| increased sludge, wall thickening, and pericholecystic fluid |
|
|
Term
|
Definition
| obstructing lesions of the pancreatic and bile ducts |
|
|
Term
| indication of hepatobiliary scan |
|
Definition
| bile duct patency, gallbladder dysfunction and inflammation |
|
|
Term
|
Definition
| inflamed diverticula of the colon |
|
|
Term
|
Definition
| ruptured diverticulia of the colon |
|
|
Term
| age of most diverticulitis |
|
Definition
|
|
Term
| signs of diverticulosis - 4 |
|
Definition
| fever, LLQ pain, obstipation, leukocytosis |
|
|
Term
| location of most diverticulia |
|
Definition
| 90% are in sigmoid or descending colon |
|
|
Term
| complications of diverticulosis - 6 |
|
Definition
| abscess, phlegmon, fistula, stricture, bowel obstruction, peritonitis |
|
|
Term
| diagnosis f diverticulitis/osis - 2 |
|
Definition
| CT only option if acute 97/100 SS, colonoscopy if NOT acute could rupture |
|
|
Term
| indication for surgery for diverticulosis |
|
Definition
| required <10% of time - uncontrolled sepsis, generalized peritonitis, uncontained visceral perforation, large undrainable abscess, filaure to respond to medial therapy |
|
|
Term
| indications for thyroid screening - 5 |
|
Definition
| autoimmune disorder, family history, >50yo q3y, symptomatic, RPL |
|
|
Term
| causes of high TSH low T4 - 4 |
|
Definition
| primary hypothyroidism, ablation, euthroid sick syndrome, transient thyroiditis |
|
|
Term
| causes of high TSH normal T4 - 6 |
|
Definition
low T3 - T3 hypothyroid, subclinical hypothyroid, euthyroid sick syndrome, transient thyrotoxicosis.
positive Ab - autoimmune thyroiditis
normal Ab, normal T3 - likely no hypothyroid |
|
|
Term
| causes of high TSH and high T4 - 1 |
|
Definition
| TSH secreting pituitary adenoma |
|
|
Term
| causes of low TSH low T4 - 1 |
|
Definition
|
|
Term
| causes of low TSH normal T4 - 4 |
|
Definition
high T3 - thyrotoxicosis
normal T3 - subclinical hyperthyroid, euthyroid sick syndrome, drugs |
|
|
Term
| causes of low TSG high T4 with increased thyroid uptake - 3 |
|
Definition
diffuse uptake - graves
nodular uptake - toxic multinodular goiter
hot spot - toxic adenoma |
|
|
Term
| causes of low TSH high T4 without thyroid uptake - 4 |
|
Definition
decreased thyroglobulin - exogenous hormone
increased thyroglobulin - thyroiditis, iodine, extraglandular |
|
|
Term
| incidence of hypothyroidism in women |
|
Definition
|
|
Term
| incidence of hypothyroidism in pregnancy |
|
Definition
|
|
Term
| 4 precursor situations and their % for hypothyroidism |
|
Definition
subclinical with + TPO Ab 4%
subclinical with - TPO Ab 2.5%
no disease with + TPO Ab 2%
pregnancy with + TPO Ab 20% by 3T |
|
|
Term
| when do you treat for hypothyroidism - 4 |
|
Definition
| TSH >10 regardless of T4, HLD, elderly with memory changes, when T4 is low |
|
|
Term
| symptoms of hypothyroidism - 27 |
|
Definition
| fatigue, weakness, cold intolerance, dyspnea, increased weight, decreased cognition, slow growth, slow speech, DTR with slow relaxation, bradycardia, ascites, dry skin, hoarse, edema, puffy face, loss of lateral eyebrows, large tongue, hearing loss, diastolic HTN, myalgia, paresthesia, depression, HMB, arthralgia, delayed puberty, pleural and pericardial effusions |
|
|
Term
| in what population does hypothyroidism, regardless of T4, increase the risk of CAD morbidity and mortality and why |
|
Definition
| 65yo with TSH >10 due to increased LDL and insulin leading to LV dysfunction and increased PVR and vascular inflammation |
|
|
Term
| at what TSH do pregnancy risks happen in hypothyroidism |
|
Definition
|
|
Term
| risks of hypothyroidism in pregnancy - 8 |
|
Definition
| SAB, stillbirth, pre-e, LBW, PPH, PTL, abruption, neuropsych delays |
|
|
Term
| association of hypothyroidism with hyperemesis |
|
Definition
| low TSH and high T4 is associated with 2/3 of hyperemesis patients |
|
|
Term
| how do you start of levothyroxine - pregnancy, elderly, normal |
|
Definition
| normal 1.6 mg/kg, elderly 25 mcg, pregnancy 1-2 ug/kg (usually 100mcg) |
|
|
Term
| what medication can decrease levothyroxine effectiveness |
|
Definition
| take PNV 30min before or after |
|
|
Term
| when are TSH levels rechecked after starting levothyroxine - pregnancy, normal |
|
Definition
| pregnancy 4wk, normal 6wk |
|
|
Term
| risk factors for postpartum thyroiditis - 6 |
|
Definition
| Ab positive, thyroid disease, FHX autoimmune or thyroid disease, DM1, viral hepatitis |
|
|
Term
| incidence of PP thyroiditis |
|
Definition
|
|
Term
| incidence of PP thyroiditis in DM1 |
|
Definition
|
|
Term
| recurrence rate of PP thyroiditis |
|
Definition
|
|
Term
| clinical course of PP thyroiditis |
|
Definition
| hypothyroid for 3mo, hyperthyroid for 4-8h, resolves in 1y |
|
|
Term
| management of PP thyroiditis |
|
Definition
| TSH <10 recheck in 4-8wk, TSH >10 start on levothyroxine taper in 1y |
|
|
Term
| complication of PP thyroiditis |
|
Definition
| 1/3 develop chronic hypothyroidism |
|
|
Term
| incidence of graves/hyperthyroidism disease in pregnancy |
|
Definition
| 1% of prgnancies but 95% of hyperthyroidism in pregnancy is graves |
|
|
Term
| signs of hyperthyroidism - 12 |
|
Definition
| warm, heat intolerance, sweating, tachycardia, diarrhea, tremor, stare, lid lag, arrhythmia, CHF, osteoporosis, propotosis in graves |
|
|
Term
| risks of hyperthyroidism in pregnancy - 8 |
|
Definition
| IUGR, pre-e, fetal demise, PTD, CHF if no tx 8%, PP flare, storm 1-2%, fetal graves 1-5% |
|
|
Term
| what increases risk of fetal graves - 3 |
|
Definition
| history of ablation, needing thioamides before pregnancy, need TSI antibodies |
|
|
Term
| treatment of hyperthyroidism - 6 |
|
Definition
| BB for symptoms, MTU, PTU, radioactive iodine (definitive), thyroidectomy (definitive, for obstructive symptoms) |
|
|
Term
|
Definition
| blocks T4 production and conversion of T4 to T3 |
|
|
Term
| when is MTU safe in pregnancy, what are the risks - 4 |
|
Definition
| safe in 2-3T and breastfeeding, can cause aplasia cutis, fetal hypothyroism, esophageal and coloanal atresia in 1T |
|
|
Term
| when is PTU safe in pregnancy, what are the risks - 4 |
|
Definition
| safe in 1T and breastfeeding, in 2-3T can cause leukopenia, agranulocytosis, fetal hypothyroid, fetal goiter (which can preclude SVD) |
|
|
Term
| which thioamide requires lab monitoring and what |
|
Definition
| PTU requires monitoring of LFTs and CBC |
|
|
Term
|
Definition
|
|
Term
| pregnancy monitoring in hyperthyroidism - labs, APFT |
|
Definition
| T4 q2-4wk within 10% of the upper limit of normal, APFT 32wk, GS 28wk |
|
|
Term
| management of hyperthyroidism in a molar pregnancy |
|
Definition
| will resolve on its own, can give BB, MTU, PTU if needed for symptoms |
|
|
Term
| risks for a thyroid storm - 6 |
|
Definition
| stress, anemia, infection, pre-e, labor, CD |
|
|
Term
| signs of a thyroid storm - 5 |
|
Definition
| tachycardia, fever, arrhythmia, CNS changes, hyperautonomia |
|
|
Term
| treatment of a thyroid storm |
|
Definition
| BB/propranolol to decrease T4 to T3 and sx, thionamide to decrease new T4, iodine 12h later to decrease new T4, glucocorticoids to decrease T4 to T3 |
|
|
Term
| 2 glucocorticoids used in thyroid storm |
|
Definition
| dexamethasone, hydrocortisone |
|
|
Term
| work up of a thyroid nodule first step when TSH is high |
|
Definition
|
|
Term
| what do you do with a thyroid nodule and a hot radioisotype scan, 2 possibilities of the cause |
|
Definition
| multinodular goiter, hashimotos, treat their hyperthyroidism |
|
|
Term
| what do you do with a thyroid nodule and a cold radioisotype scan |
|
Definition
|
|
Term
| work up of a thyroid nodule first step when TSH is low |
|
Definition
|
|
Term
| when doing an US of a thyroid nodule what characteristics indicate a FNA is needed - 6 |
|
Definition
| >1cm, irregular margins, taller than wide, rim calcifications, extraglandular extension, FHX thyoid cancer |
|
|
Term
| what percent of cold nodules will be thyroid cancer |
|
Definition
|
|
Term
| causes of benign cold thyroid nodules - 3 |
|
Definition
| cyst, follicular adenoma, hurthe cell adenoma |
|
|
Term
| causes of cancerous cold thyroid nodules - 5 |
|
Definition
| primary thyroid cancer, lymphoma, breast mets, renal cell mets |
|
|
Term
| risks of TPO antibodies in pregnancy - 5 |
|
Definition
| SAB, stillbirth, LGA, PTD, maternal hypothyroidism |
|
|
Term
| risks of TSI antibodies in pregnancy - 1 |
|
Definition
|
|
Term
| which antibodies go with which thyroid disease |
|
Definition
| TPO with hashimotos, TSI with graves |
|
|
Term
| normal thyroid changes in pregnancy - 4 |
|
Definition
| increased size, decreased iodine, estrogen causes increased TBG and thus T3/4, 1T hCG causes decreased TSH in 1T |
|
|
Term
| normal thyroid levels in pregnancy |
|
Definition
| 1T 0.1-2.5, T2 0.2-3.0, 3T 0.3-3.0 |
|
|
Term
| management of abnormal TSH in pregnancy |
|
Definition
| TSH <1 evaluate for thyrotoxicosis, TSH 2.5-4.5 treat if TPO positive, TSH >4.5 treat |
|
|
Term
| recommended inodine intake daily |
|
Definition
|
|
Term
| lifetime incidence of back pain |
|
Definition
|
|
Term
| back pain % where a cause is never found |
|
Definition
|
|
Term
| rate of acute back pain that turns into chronic |
|
Definition
|
|
Term
| concerning symptoms associated with back pain - 7 |
|
Definition
| >50y0, fevers, history of cancer, night pain, immune deficiency, steroid use, trauma |
|
|
Term
| 3 physical exam things to check for lower back nerves |
|
Definition
| patellar DTR L4, foot dorsiflexion L5, foot plantar flexion S1 |
|
|
Term
| what is imaging of the back good for |
|
Definition
| not prognosis or severeity, just surgical planning |
|
|
Term
| when do you image for back pain - |
|
Definition
| progressive neuro signs, concerning risk factors, concern for cancer, cord compression, vertebral infection |
|
|
Term
| signs of cord compression - 4 |
|
Definition
| urinary retention, saddle anesthesia, neuro symptoms, progressive weakness |
|
|
Term
| best imaging for cord compression |
|
Definition
|
|
Term
| risks for vertebral infection - 4 |
|
Definition
| fever, IV drug use, GI/GU instrumentation/surgery, PID |
|
|
Term
| best imaging for vertebral infection |
|
Definition
|
|
Term
| signs of abdominal aortic aneurysm |
|
Definition
|
|
Term
| risks of abdominal aortic aneurysm - 2 |
|
Definition
| vascular disease, smoking |
|
|
Term
| risks for vertebral fracture - 3 |
|
Definition
| osteoporosis, steroids, trauma |
|
|
Term
| best imaging for vertebral fracture |
|
Definition
|
|
Term
| signs of nerve root entrapment - 3 |
|
Definition
| pain when walking, resolves with rest, transient tingling in calves |
|
|
Term
| prognosis of most herniated discs |
|
Definition
|
|
Term
|
Definition
| worse with activity, herberdines nodules on DIPs |
|
|
Term
| most common area for back OA |
|
Definition
|
|
Term
|
Definition
| degeneration and osteophyte formation |
|
|
Term
|
Definition
| slipping of a vertebrae, usually L5-S1 |
|
|
Term
| risk factor for spondylithesis |
|
Definition
|
|
Term
| signs a sciatic nerve issue is a herniated disc |
|
Definition
|
|
Term
| physical exam test for sciatic nerve |
|
Definition
|
|
Term
| best imaging for cancer of the spine |
|
Definition
|
|
