PANCE 2.0 > GI #11 > Flashcards

GI #11 Flashcards

(51 cards)

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1
Q

What bacteria causes Whipple’s Disease?

A

-Tropheryma Whipplei: gram positive non acid-fast positive rod

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2
Q

Transmission of Whipple’s Disease

A

-Contaminated soil (most commonly seen in farmers)

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3
Q

Symptoms of Whipple’s Disease

A
  • Malabsorption: chronic diarrhea, weight loss, steatorrhea, fever, LAD
  • Nondeforming arthritis: (doesn’t change shape of bones)
  • Neurologic symptoms: memory impairment, confusion, rhythmic motion of eye while chewing
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4
Q

How do you diagnose Whipple’s Disease?

A
  • Duodenal biopsy: periodic acid-Schiff (PAS)-positive macrophages
  • -Dilation of lacteals in small intestine
  • -Non-acid-fast bacilli
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5
Q

Treatment for Whipple’s Disease

A
  • ABX therapy is prolonged (1-2 years): Penicillin or Ceftriaxone followed by maintenance therapy of Bactrim orally
  • Alternative: Doxy + Hydroxychloroquine
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6
Q

What is G6PD deficiency?

A

An X-linked recessive enzymatic disorder of RBC’s that may cause episodic hemolytic anemia

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7
Q

What are some risk factors for G6PD deficiency?

A
  • Primarily males (X-linked recessive)
  • 10-15% of African American males
  • Mediterranean, African, Middle Eastern, SE Asian
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8
Q

What is the pathophysiology of G6PD deficiency?

A
  • G6PD normally catalyzes NADP to NADPH which protects the RBCs from oxidative injury
  • In this condition, decreased G6PD activity results in oxidative form of Hb (methemoglobin) which predicates as Heinz bodies
  • RBC membrane damage and fragility causes hemolysis by macrophages
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9
Q

What are some exacerbating factors for G6PD deficiency

A
  • Infection (MCC)
  • Fava beans
  • Medications: Dapsone, Primaquine, Methylene blue, Nitrofurantoin
  • Sulfa drugs at high doses
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10
Q

True or False: Most patients with G6PD deficiency are asymptomatic until oxidative stress?

A

True

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11
Q

What are some symptoms of oxidative stress in G6PD deficiency?

A
  • Symptoms begin 2-4 days after exposure
  • Back or abdominal pain
  • Anemia, jaundice, dark urine
  • Neonatal Jaundice
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12
Q

What is seen on a peripheral smear for G6PD deficiency?

A

Normocytic hemolytic anemia only during crises

  • Schistocytes (bite or fragmented cells)
  • Heinz bodies (HALLMARK)
  • -Smear is usually normal when not in acute stage
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13
Q

What is the management for G6PD deficiency attack?

A

Usually self-limited, avoid offending foods and drugs

-If severe anemia, iron and folic acid supplementation

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14
Q

Treamtent for neonatal jaundice

A

Phototherapy is first line

-Exchange transfusion if refractory

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15
Q

What is Paget Disease of the Bone (Osteitis Deformans)

A

Abnormal bone remodeling (increased osteoclastic resorption and increased osteoblastic bone formation). This leads to larger, weaker bones

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16
Q

Who is at risk for Paget Disease?

A
  • Western European descent

- > 40 years old

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17
Q

Symptoms of Paget Disease of the bone

A
  • Most asymptomatic (found incidentally due to high alkaline phosphatase on labs)
  • Bone pain (MC)
  • Skull enlargement: deafness due to compression of CNVIII
  • Headache
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18
Q

What is the hallmark lab finding for Paget Disease of the bone?

A

-Isolated markedly increased alkaline phosphatase

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19
Q

What do skull radiographs show in Paget Disease of the bone?

A

-Cotton wool appearance: sclerotic patches that are poorly defined and fluffy

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20
Q

How do you treat Paget Disease of the bone?

A
  • If asymptomatic, no treatment is needed.
  • Bisphosphonates are first line management.
  • NSAIDs for pain
  • Calcitonin
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21
Q

What is given during bisphosphonate treatment to prevent hypocalcemia?

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A

-Vitamin D and Calcium supplementation

22
Q

What is the mechanism of action of Bisphosphonates?

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A

-Inhibits osteoclast activity (decrease bone resorption and turnover)

23
Q

What is special about Aledronate and Risedronate?

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A

They inhibit both osteoclast and osteoblast activity

24
Q

Osteoblasts:
Osteoclasts:

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A

Blasts build

Clasts break down

25
What are some considerations to take into account when giving bisphosphonates?
- Take with 8 ounces of plain water as well as 1-2 hours before meals, aspirin, Ca, Mg, Al and antacids - Poor oral absorption - Calcium And Vitamin D supplementation recommended
26
What are some adverse effects of bisphosphonates
- Esophagitis (especially Aledronate) and must stay upright for 30 minutes - MSK pain - GI symptoms and Flu-like symptoms - Atypical femur fractures and osteonecrosis of the jaw (rare)
27
Contraindications for bisphosphonate use
- Esophageal disorders - CKD - Hiatal hernia, esophageal stricture, dysphagia
28
What is phenyketonuria (PKU)
Autosomal recessive disorder or amino acid metabolism associated with phenylektone neurotoxicity due to accumulation of phenylalanine in the urine and blood
29
PKU neurotoxicity is irreversible if not detected by what age?
3 years old
30
Symptoms of PKU
Presents after birth with vomiting, mental delays, irritability, convulsions, eczema, increased DTR.
31
What do children with PKU normally look like?
Blonde, blue-eyed with fair skin
32
How to diagnose a patient with PKU?
- Increased serum pheylalanine | - Urine has a musty odor (from phenyl acetic acid)
33
When can PKU screening be performed in a newborn in the US?
24 weeks gestational age
34
What is the management for a patient with PKU?
- Lifetime dietary restriction of phenylalanine (avoid foods such as milk, cheese, nuts, fish, chicken, eggs, legumes, diet soda) - Increase tyrosine supplementation
35
What are some risk factors for Vitamin C (Ascorbic Acid) Deficiency?
- Diets lacking raw citrus fruits and green vegetables - Smoking - Illicit drug use - Alcoholism - Elderly
36
Symptoms of Vitamin C Deficiency (Scurvy)
- Hyperkeratosis (follicular papules surrounded by hemorrhage). Coiled hairs. - Hemorrhage: recurrent hemorrhages in gums, skin, and joints. Impaired wound healing - Hematologic: anemia, glossitis, malaise, weakness, increased bleeding time
37
Treatment for Vitamin C deficiency
- Ascorbic acid replacement | - Heme symptoms improve in weeks, general symptoms within days
38
What is osteomalacia?
-Decreased osteoid mineralization (soft bones)
39
Etiologies of Osteomalacia
- Severe Vitamin D Deficiency (MC) | - Malabsorption
40
What is Vitamin D deficiency in children called?
Rickets
41
Symptoms of Osteomalacia
- Asymptomatic initially - Diffuse bone pain and tenderness - Muscular weakness (proximal) - Hip pain may cause waddling gait - Bowing of long bones
42
Diagnostics for Osteomalacia
- Decreased calcium, phosphate, and 25-hydroxyvitamin D levels - Increased alkaline phosphatase and PTH
43
On radiographs, what is shown with Vitamin D deficiency?
Looser lines (zones) - transverse pseudo-fracture lines
44
What is the management for osteomalacia and rickets?
-Vitamin D supplementation (Ergocalciferol)
45
Why does Vitamin D deficiency occur in children?
- Calcium needs to be high between 3 months and 3 years for growth - Decreased sunlight exposure - Prolonged breastfeeding without Vitamin D supplementation
46
Symptoms of Rickets
- Delayed fontanel closure - Growth delays - Delayed dentition - Genu Varum (lateral bowing of femur and tibia)
47
What are some functions of Vitamin A
- Vision - Immune function - Embryo development - Skin and Cellular Health
48
What are some good sources of Vitamin A
- Egg yolk - Butter - Green leafy vegetables
49
What are some symptoms of Vitamin A excess?
-Blurry vision, nausea, vomiting, vertigo, idiopathic intracranial hypertension
50
What are some risk factors for Vitamin A deficiency?
- Liver disease - ETOH - Fat-free diets (it is a fat-soluble vitamin) - Fat malabsorption (CF, bariatric surgery)
51
Symptoms of Vitamin A deficiency
- Visual changes: night blindness, xerophthalmia (dry eyes), retinopathy - Impaired immunity: delayed wound healing, dry skin, taste loss, poor bone growth - Squamous metaplasia: conjunctiva, respiratory epithelium, urinary tract - Bitot's Spots: white spots on conjunctiva
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