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130 Cards in this Set
- Front
- Back
Menetrier disease
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Dx: hyperplastic gastropathy with enlarged rugal folds and proliferation of mucus-producing cells of the stomach
increases mucus production leads to this "protein-losing gastroenteropathy" which causes hypoalbuminemia and peripheral edema |
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"Punched out" ulcers in lower segment of the esophagus. Organism?
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Herpes Simplex Virus
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What can Vinyl Chloride (used in the rubber industry) cause?
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Angiosarcoma of the liver. It arises from blood vessels and is an extremely aggressive tumor.
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What are the most important characteristics for metastatic potential in a carcinoid tumor?
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Location and size
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What type of epithelium is the esophagus composed of?
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Nonkeratinizing squamous epithelium
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What type of epithelium is found in Barret's esophagus?
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Nonciliated columnar epithelium
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Gastric heterotopia
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small areas of normal gastric tissue found in ectopic locations, typically the small intestine
acid production can lead to ulcers which can cause GI bleeding |
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Omphalocele
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Herniation of abdominal viscera through the abdominal wall near the umbilicus
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Meconium ileus
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Seen in newborns with cystic fibrosis
Infant cannot pass meconium because viscid pancreatic secretions "get stuck" in small bowel Can lead to perforation with peritonitis |
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Primary Sclerosing Cholangitis
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Inflammation and fibrosis of bile ducts => alternating strictures and dilation with "beading" on ERCP
Associated with ulcerative colitis Triad of: Jaundice, Fever, RUQ pain |
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Wilson Disease Lab Findings
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Increased hepatic copper content
Reduced ceruloplasmin (a copper-binding protein) Increased urinary copper excretion Kayser-Fleischer rings in the iris |
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Where does Celiac disease caused the most damage
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Proximal small bowel (because gluten antigens have not been digested yet)
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Reye Syndrome
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-Follows a viral infection (ie. Varicella or chicken pox)
-Sometimes related to ingestion of aspirin (salicylates) after a viral infection -Messed up Macrophages lead to messed up metabolism leads to Liver and brain damage -Liver shows microbesicular steatosis -Brain shows edema |
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Patient complains of difficulty swallowing solids and liquids. What is an autoimmune explanation?
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Scleroderma (Progressive Systemic Sclerosis)
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Plummer-Vinson syndrome
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Triad of:
1) Dysphagia (from esophageal webs in upper esophagus) 2) Atrophic glossitis 3) Iron Deficiency Anemia |
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Zenker's Diberticulum
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False diverticulum in the upper esophagus
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Where is oral squamous cell carcinoma most commonly located within the mouth.
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#1: Floor of the mouth
#2: The tip of the tongue. |
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How do you differentiate between upper GI bleeding from esophageal varices and Mallory-Weiss tear?
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-Esophageal varices usually present with no history of hematemesis.
-Mallory Weiss patients have longitudinal tears in esophagus from repeated bouts of vomiting. |
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Sx: Jaundice + Palpable Gallbladder (which is NOT tender) + Nonspecific symptoms (ie. abdominal pain)
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Pancreatic Cancer
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Melanoma Tumor Marker
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S-100
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Hepatocellular Carcinoma Tumor Marker
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Alpha Feto-Protein and alph1-antitrypsin
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Prostatic Carcinoma Tumor Marker
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PSA and Prostatic Acid Phosphatase
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Serous Cystadenocarcinoma of the ovary Tumor Marker
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CA-125
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Gastric Adenocarcinoma
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CEA and Bombesin
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Leukoplakia
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White oral plaques with 5% chance of turning into cancer
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Melanosis Coli
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Irregular pigmentation of the colon
Benign Related to laxative use |
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Which lymph nodes do cancers of the penis/vagina/anus spread to.
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Medial portion of the medial side of the horizontal chain of the superficial group of inguinal lymph nodes.
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Patau Syndrome
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-Trisomy 13
-CHARGE syndrome (Coloboma, Heart defects, Atresia (of choanae), Retardation in growth/development, Genital abnormalities, Ear abnormalities -Hint: Choanae is posterior nasal aperture |
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Coloboma
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-Defect in midline of the eye (affects iris, optic nerve, retina, or eyelid)
-Seen in Patau Syndrome |
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VATER syndrome
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Congenital Syndrome
V: Vertebral/Vascular abnormalities A: Anal Atresia T: Tracheoesophageal fistula E: Esophageal atresia R: Renal and/or radial abnormalities |
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Prognosis for pancreatic adenocarcinoma
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Very very bad (3.5% survival for 5 years)
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Adenocarcinoma of the esophagus
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Very bad (10% overall 5 year survival rate)
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Primary Biliary Cirrhosis
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-Destruction of medium-sized intrahepatic bile ducts
-increased conjugated hyperbilirubinemia and alkaline phosphatase -Anti-mitochondrial Antibodies seen |
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Budd Chiari Syndrome
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-Occlusion of IVC or hepatic vein
-Congestive liver disease (hepatomegaly, ascites, abdominal pain, eventual liver failure) -Associated with polycythemia vera, pregnancy, hepatocellular carcinoma |
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PiZZ allele
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Mutated form of alpha-1-antitrypsin
Associated with alpha-1-antitrypsin deficiency |
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Bile Stone Classification
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1) Cholesterol Stones (Cholesterol monohydrate crystals. Females get this beause estrogen increases synthesis and uptake of cholesterol in the liver). Low calcium so radiolucent
2) Brown Stones- Calcium soaps (prevalent in Asian countries) 3) Black Stones-Calcium salts and unconjugated bilirubin (High Calcium, so radiopaque) |
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Mucin glycoproteins
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Molecular "Scaffolding" of stones (cholesterol and pigment stones)
The Glycoproteins trap cholesterol of bilirubin crystals to make crystals |
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Acute hemorrhagic pancreatitis
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-Severe local damage to pancreas (often by alcohol).
-Septic shock secondary to necrosis (hemorrhage), release of enzymes into bloodstream, fluid loss |
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Alcoholic man vomits and presents in a severely hypovolemic state. Dx?
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Acute hemorrhagic pancreatitis
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Patient with known polycythemia vera presents with hepatomegaly and ascites. Dx?
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-Budd-Chiari Syndrome (Hepatic vein obstruction, usually due to thrombosis)
-Centrilobular congestion |
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Giardia Lamblia
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-Most common protozoal infection in the small intestine
-Biopsy shows up as crescent shaped -Smear shows "face like" shape |
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Entamoeba histolytica. Where does it act?
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Affects large intestine and/or liver
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What does Naegleria fowleri cause?
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Meningoencephalitis
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What does Trichomonas vaginalis cause?
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Vaginitis
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Enzymatic fat necrosis of the pancreas. Explain.
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-Released lipase acts on mesenteric fat results in free fatty acids that combine with calcium to produce soaps (saponification)
-Soaps precipitate in areas of necrosis leading to white deposits on the pancreas "fat necrosis" |
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Shatzki Rings
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Mucosal rings in the lower esophagus (Upper esophageal rings are esophageal webs)
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Pancreatic Pseudocyst
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-Usually arising from chronic pancreatitis (often in alcoholics)
-Rupture of cyst released pancreatic enzymes leading to severe GI hemorrhage |
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When does intussusception usually present in a child's life?
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5 to 10 months of age
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When does congenital pyloric stenosis usually present in a child's life?
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3-4 weeks of age
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Meckel's diverticulum
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-Failure of the vitelline duct (omphalomesenteric duct) to atrophy completely
-It used to connect the bowel to the yolk sac |
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What does the allantois become
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Umbilical cord and placenta
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Reiter's Syndrome
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Can't see Can't pee Can't climb a tree
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Sjogren's Syndrome
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-Dry eyes, dry mouth, arthiritis
-From autoantibodies attacking exocrine glands |
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Hydatid Cyst
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Parasitic infection by echinococcus that causes cysts to form
-Rupture can lead to shock |
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Gallstone lodged in the common bile duct. What will you see?
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-Conjugated hyperbilirubinemia
-Increased urinary secretion of conjugated bilirubin (causing the urine to darken) because the conjugated bilirubin "backs up" and regurgitates into the circulation. Conjugated bilirubin is water soluble so it can be filtered by the kidney and show up in the urine (leading to tea colored urine) -Decreased secretion of conjugated bilirubin into the gut (causing decreased brown color of stool) -Decreased urobilinogen production in the gut with resulting decreased absorption and decreased urinary urobilinogen |
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Urinary urobilinogen
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-Bilirubin secreted in bile is metabolized by gut bacteria to urobilinogen
-Most urobilinogen remains in the gut and gives stool its brown color -Some urobilinogen is absorbed by the ileum and enters the enterohepatic circulation and some of this urobilinogen ends up in the urine -If there is an obstruction of the common bile duct, less urobilinogen will reach the small intestine and less will enter the hepatic portal vein and urinary urobilinogen will be decreased |
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Clindamycin
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Antibiotic that commonly causes overgrowth of Clostridium Difficile leading to pseudomembrane colitis
Tx with metronidazole (and maybe vancomycin) |
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In Zollinger-Ellison syndrome, where are most ulcers located?
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Multiple duodenal ulcers are more common than gastric ulcers (because the stomach wall can resist the acid)
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Apoprotein CII
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-Chylomicron protein that turns on liprotein lipase, VLDL, IDL, and HDL.
-Deficiency of CII is found in primary hyperlipidemia with very high chylomicron levels |
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Primary hyperlipidemia
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-Abnormal endothelial cell lipoprotein lipase (responsible for clearing TG from the chylomicron cone and thus producing easily absorbable free fatty acids and glycerol)
-Failure of lipoprotein lipase causes inability to utilize chylomicrons and their persistence in the blood stream |
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Apolipoprotein A1
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Found in HDL
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Apolipoprotein B48
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-In chylomicrons and is used to combine with TF, phospholipids, and cholesterol esters during chylomicron formation
-Structural role |
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Apolipoprotein B100
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-Found in VLDL, IDL, LDL and provides structural support
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Apolipoprotein E
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found in all lipoproteins (including chylomicrons) and helps lipoproteins bind to cell surface receptors
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How does the secretin test work on patients with Zollinger Ellison syndrome?
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Abnormal rise in Gastrin levels after the injection of secretin.
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What cancer risks are associated with celiac disease?
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Intestinal lymphoma and breast cancer
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Where is Type A and B Gastritis located?
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Type A: Fundus
Type B: Antral |
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Choledocholithiasis
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Stone in the common bile duct
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Charcot's triad is...
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1) Fever
2) Jaundice 3) RUQ Pain indicative of cholangitis (infection of the biliary tree proximal to an obstruction) |
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Mechanism of Aprepitant (Emend)
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-NK1 receptor angagonist
-Neurokinin A and Neurokinin B act on NK1 and NK2 receptors in the CNS (related to substance P) that control the emetic response. -Used for chemotherapy-induced nausea and vomiting |
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Bronabinol (Marinol)
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-Cannabinoid for chemitherapy induced N/V
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Prochlorperazine (Compazine)
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Dopamine antagonist used to treat N/V
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Lorazepam (Ativan) and diazepam (Valium)
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-Benzodiazepines that bind to GABA receptors to enhance GABAergic transmission
-Useful in anticipatory emesis and treatment of vertigo |
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Scopolamine
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-Muscarinic antagonist to treat motion sickness and preoperative nausea
-Not used to treat N/V from chemo |
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Ondansetron (Zofran) and granisetron (Kytril)
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-5-HT3 antagonists used for chemotherapy-induced N/V and for postoperative nausea
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Dexamethasone (Decadron) and methylprednisolone (Solu-Medrol)
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-Glucocorticoids used to treat N/V from chemotherapy
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Helicobacter Pylori
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-Found in duodenal ulcers
-Spiral-shaped, gram-negative rod that is oxidase-positive, catalase- positive, motile and produces urease -Tx with PPI (omeprazole or lansoparazole) + 2 antibiotics (Clarithromycin + metronidazole or amoxicillin) |
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Spontaneous Bacterial Peritonitis. Organisms involved in children vs adults?
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Children- Strep Pneumo
Adults- E. Coli |
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5-HT3 Antagonist
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-Alosetron (Lotronex) antagonizes receptors in enteric neurons leading to distention and inhibition of colonic mobility
-Used to treat "diarrhea-predominant" IBS |
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5-HT4 partial agonist
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-Tegaserod (Zelnorm) stimulates peristalsis thus enhancing gastric emptying in patients with constipation-predominant IBS
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Misoprostol
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-Stimulates PGE1 receptor to inhibit acid secretion and stimulate bicarbonate and mucus production
-Used to treat patients with NSAID induced ulcers |
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Loperamide
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Antidiarrheal
Side effect of conspitation |
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What drug do you give to stimulate appetite in AIDS, cancer, or elderly patients?
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Megestrol (Megace)- synthetic oral progestin used to stimulate appetite
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Orlistat (Xenical)
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-Manage obesity by inactivating enzymes that digest dietary fats
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Phentermine
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-Amphetamine deravitive that is anorexigenic (decreases appetite)
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Sibutramine
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-Monoamine oxidase inhibitor that blocks serotonin and norepinephrine reuptake
-Reduces appetite |
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How do you a treat an obtunded alcoholic patient with ruptured esophageal varices?
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-Use octreotide (somatostatin analog) which will decrease blood flow to the portal system thus decrease variceal bleeding
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Metoclopramide
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-Dopamine antagonist used as anti-emetic and promotes GI motility in patients with gastroparesis (ie. diabetics)
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Ursodiol
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Dissolves cholesterol gallstones
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Docusate (Colace)
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-Stool softener to help facilitate natural defecation
-Anionic surfactant that lowers the surface tension at the oil-water interface of the feces to allow water and lipids to penetrate the stool |
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Bulk-forming laxatives
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-Psyllium and methylcellulose
-Caused water retention in the bowel lumen but are themselves poorly absorbed |
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Cator oil, senna, bisacodyl
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-Irritant laxatives that decrease water reabsorption from the bowel lumen + stimulate intestinal secretion
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Mineral oil and glycerin
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-Lubricating laxatives that coat fecal contents to prevent water reabsorption from stool
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Opioid receptor agonists
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-Loperamide and diphenoxylate
-Antidiarrheal agents that increase constipation |
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Osmotic agents used to increase stool liquidity
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-Magnesium hydroxide, magnesium citrate, sorbitol, lactulose, polyethylene glycol
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What drug to treat carcinoid syndrome?
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Octreotide (somatostatin analog) that binds to the carcinoid tumor and inhibits synthesis/release of tumor hormones
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Sulfasalazine
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Treats mild-moderate ulcerative colitis
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Meclizine
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H1 antagonist to Tx motion sickness + true vertigo
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Where is the Chemoreceptor Trigger Zone (CTZ) in the brain and what types of receptors are there on it?
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1) CTZ located at the floor of the 4th ventricle
2) D2 receptors- Stimulation of D2 leads to emesis and DA blockers stop emesis 3) 5HT3 receptors- Blocked by ondasetron |
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Prochlorperazine (Compazine)
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-Phenothiazine that blocks dopamine receptors in the CTZ
-Anti-emetic |
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Sulcralfate
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-Basic aluminum salt that binds to an ulcer (used to treat duodenal ulcers)
-Constipation is the most common side effect |
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What is the relationship between metoclopromide and parkinsons disease?
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Metoclopromide blocks dopamine receptors and thus and make parkingsons disease EVEN WORSE.
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What is cimetidine's greatest side effect?
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-It is a potent hepatic enzyme inhibitor that will decrease the metabolism of other hepatically metabolized medications (ie. warfarin)
-Its therapeutic use is short/long term treatment of duodenal and gastric ulceration + GERD |
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What is the pain-medication of choice when a patient presents with acute cholecystitis (inflammation of the gallbladder)?
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Meperidine (opoid) because it is least likely to cause a spasm of the sphincter of Oddi due to its antimuscarinic properties.
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Sibutramine (Meridia)
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MAO inhibitor that blocks serotonin and norepinephrine reuptake
Reduces appetite and increase energy expenditure |
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Metronidazole side effect?
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Disulfaram like reaction when taken with alcohol (N/V, sweating, hyperventilation, tachycardia, chest pain, dyspnea, hypotension, blurred vision, facial flushing)
-Metronidazole interferes with metabolism of ethanol |
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Cisplatin
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-Antineoplastic used to Tx metastatic ovarian and testicular cancers + ovarian cancer
-Side effect of serious N/V |
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Metoclopramide
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-Prokinetic
- Treats gastroesophageal reflux + diabetic gastroparesis -Blocks dopaminergic receptors in the CTZ to treat N/V |
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Phenobarbital
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-Barbiturate used to Tx tonic-clonic seizures and status epilepticus
-If blood concentration is too high -> side effects similar to alcoholic intoxication |
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Drug of choice for "flare ups" in Crohn's disease
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Prednisone
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What drugs to treat mild to moderate UC?
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Sulfasalazine (Sulfapyridine + 5-ASA), mesalamine, olsalazine
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What is a side effect of using halothane as an anesthetic?
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"Halothane hepatitis" leading to asymptomatic elevation in seriums transaminases to fulminant hepatic necrosis
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What is the action of NSAID on the kidney?
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NSAIDS inhibit the production of prostaglandins in the afferent arteriole (prostaglandins normally vasodilate it) so with NSAID use, you would have a decrease in GFR
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CCK's effect on gastric acid secretion
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CCK, via vagal afferent pathways, stimulate somatostatin inhibition of gastric acid secretion
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CCK's actions in the gut
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1) causes gallbladder contraction + secretion of pancreatic enzymes
2) indirectly inhibits gastric acid secretion via vagal stimulation of somatostatin secretion 3) if CCK receptors are blocked, gastric acid secretion will increase |
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Diphenoxylate
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Opoid agonist to treat diarrhea
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Tizanidine
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-Spasmolytic to Tx cerebral palsy, multiple sclerosis, stroke
-Alpha-2 adrenergic agonist -Muscle relaxant |
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Ursodiol (ursodeoxycholic acid)
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-Treats gallstones
-Reduces cholesterol secretion into bile + dissolves cholesterol gallst ones |
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Ascaris Lumbricoides
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-Helminth Infection- huge cylindrical white worm caused by fecally contaminated food
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Estrogen's effect on the liver
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Upregulate LDL receptors and therefore increase cholesterol uptake in the liver
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Shigellosis
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Often caused by Shigella Sonnei
Fecal-oral spread, contaminated food or inanimate objects (not usually spread by water Debilitated armies in the past Seen in daycare settings Very serious and have to replenish fluids immediately (from the severe diarrhea) |
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Gastrochisis
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Lateral body folds fail to move ventrally and fuse midline (during 4th week of development) causing abdominal viscera to protrude from the abdominal cavity
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Omphalocele
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Normally during development, the midgut herniates into the umbilical cord and then retracts into the abdominal cavity
Failure of this process leads to an omphalocele (covered with amnion or peritoneum) |
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Most common cause of bacterial gastroenteritis in the US
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Campylobacter jejuni- 50% due to contaminated poultry products
Gram negative, oxidase positive, curved rod |
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Cholecyctokinin (CCK) Functions?
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Made by duodenal and jejunal mucosa
1) Stimulates gallbladder contraction 2) Stimulates pancreatic enzyme secretion 3) Slows gastric emptying 4) Trophic effect on the pancreas 5) Secretion of antral somatostatin which decreases gastric acid secretion |
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Orllistat (Xenical)
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manages obesity by inactivating enzymes that digest fats
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Chylomicrons. Talk about them.
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They are produced by enterocytes (intestinal epithelial cells) by using luminal TG as the source of the lipid. the Chylomicrons are secreted into the lymphatic system => systemic venous system (from thoracic duct) => serum portion of blood. Lipoprotein lipase (in the endothelium of tissue with TG needs such as skeletal muscle , cardiac muscle, breast), hydrolyzes them to more easily absorbed fatty acids.
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fluoroquinolones (Ciprofloxacin, ofloxacin, norfloxacin)
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Broad spectrum antibiotics that inhibit bacterial DNA gyrase
used to treat traveler's diarrhea (ETEC, E Coli, Shigella, Campylobacter jejuni) |
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Salpingitis
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Infection/Inflammation of the fallopian tubes
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Most common bacterial sexually transmitted disease?
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Chlamydia. It is an intracellular organism that can elicit a TH1 lymphocyte response and stimulate CD8+ cells. Type 4 hypersensitivity reaction.
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