Case Studies I

Question 1

How are kids weights classified?

Answer 1

Classified as normal weight, overweight or obese

Use gender specific growth charts from the CDC

Children ≥ 85th but ≤ 95% are overweight

Children ≥ 95% are obese

Question 2

Lab abnormalities, when found, are generally due to what?

Answer 2

malnutrition, weight control behaviors or medical complications

Question 3

How would a pts acid-base status present with persistent vomiting?

Answer 3

Hypokalemic hypochloremic metabolic alkalosis

Question 4

Describe anorexa nervosa

Answer 4

–Body size and shape OVERestimated

–Relentless pursuit of thinness

Question 5

What are the two subtypes of anorexia?

Answer 5

–Restrictive subtype: severely limit caloric intake

–Binge-purge subtype: intermittent overeating followed by vomiting or laxative use to lose calories

Question 6

How might bulemia nervosa present?

Answer 6

Hx of Food restriction during day; binge at night

• Diet soda common; may use excess alcohol
• Secretive eating, then shame and guilt
• Exercise unpredictable
• Vomiting most common means of eliminating extra food
• Laxatives and diet pills less common, but more common than AN

Question 7

What groups are at risk of eating disorders?

Answer 7

• 90% of those affected are female
• MSM at increased risk
• Groups at risk include athletes, models and dancers, regardless of gender

Question 8

Is there a hereditary component to BN? AN?

Answer 8

•Heritability

–AN: 48-76%

–BN: 54-85% (more)

–Female genetic vulnerability may be activated in early/mid-puberty due to neuroendocrine change

Question 9

What is the predominant risk factor for cholelithiasis?

Answer 9

age (–Prevalence is 8% in patients >40 years and 20% in individuals >60 years)

Question 10

What are the other risk factors for cholelithiasis?

Answer 10

• Obesity
• Female gender (increased risk with pregnancy)
• GB stasis (rapid weight loss; post-surgical; TPN)
• Family history
• Crohn’s disease
• Hemolytic anemias (bilirubin stones) in thalassemia, sickle cell

Question 11

How does biliary colic usually present?

Answer 11

•Pain is usually associated with nausea and vomiting

–Pain improves fairly rapidly (only lasts a couple hrs usually); mild discomfort may persist for 1- 2 days

Question 12

How common is recurrence of biliary colic?

Answer 12

•Biliary colic recurs in 50% of symptomatic patients

Question 13

What are the complications of biliary colic?

Answer 13

pancreatitis, acute cholecystitis, or ascending cholangitis

in 1–2% of patients with biliary colic annually

Question 14

What is the test of choice for biliary colic?

Answer 14

Ultrasonography (–Sn 89%, Sp 97%, LR+ 30, LR– 0.11)

• CT scan is only 79% sensitive
• Endoscopic ultrasound

– 100% sensitive

–Useful in patients with a negative transabdominal ultrasound in whom biliary colic is strongly suspected

Question 15

Question 16

How would acute cholangitis present?

Answer 16

long lasting RUQ with fever

Question 17

What signs indicate the presence of ascending cholangitis?

Answer 17

RUQ pain and fever with **onset of dark urine and rigors**

charcot triad: jaundice (most common) + temp + RUQ pain

Question 18

What is ascending cholangitis?

Answer 18

Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is an infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones

Question 19

What labs suggest ascending cholangitis?

Answer 19

Elevated ALP and bilirubin in 91% and 87%, respectively

Bacteremia 74%

Leukocytosis 73% of patients

Question 20

Question 21

Question 22

Question 23

What symptoms are most specfiic to appendicitis?

Answer 23

top to bottom

• guarding
• rebound
• vomiting
• RLQ tenderness
• fever

Question 24

Question 25

Appendicitis **CT** is the best imaging study here

Question 26

Appendicitis CT