First Hour Conference Intraining Exam Review November 8, 2006

First Hour ConferenceIntraining Exam

ReviewNovember 8, 2006

Gastrointestinal Emergencies

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– serologic markers

»HBsAg»HBsAB»HBcAB IgM recent infection (often

in the “window” period)»HBcAB IgG»HBeAg = very high infectivity

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– serologic markers

»HBsAg = active/infective»HBsAB = immunity»HBcAB IgM = recent infection (often

in the “window” period)»HBcAB IgG = remote infection»HBeAg = very high infectivity

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg»HBcAB IgM

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg = active/infective»HBcAB IgM = recent infection

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg = active/infective»HBcAB IgM = recent infection

Acute infection! (uncertain whether patient will become immune or chronic)

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg»HBcAB IgG

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg = active/infective»HBcAB IgG = remote infection

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAg = active/infective»HBcAB IgG = remote infection

Chronic carrier!

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBcAB IgM»all other markers negative

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBcAB IgM = recent infection»all other markers negative

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBcAB IgM = recent infection»all other markers negative

Recent infection, in the window period!

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB»HBcAB IgG

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB = immunity»HBcAB IgG = remote infection

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB = immunity»HBcAB IgG = remote infection

Past infection but now immune!

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB»all other markers negative

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB = immunity»all other markers negative

Liver

• Infectious/inflammatory disorders– Viral hepatitis

• hepatitis B– Example

»HBsAB = immunity»all other markers negative

Successful immunization!

GI Emergencies

• What is the most common cause of massive (> 40% blood volume) UGIB?

GI Emergencies

• Esophageal variceal bleeding

GI Emergencies

• What two drugs should be considered (usually use one or the other) in variceal bleeding?

GI Emergencies

• Octreotide• Vasopressin

GI Emergencies

• What additional drug should generally be used in conjunction with vasopressin to diminish side effects?

GI Emergencies

• NTG• To diminish hypertension, cardiac

and splanchnic vasoconstriction

GI Emergencies

• What is the most common cause of lower esophageal dysphagia (due to luminal narrowing)?

GI Emergencies

• Carcinoma

GI Emergencies

• What are the most common sites for FBs to lodge in the esophagus?– (one point for each)

GI Emergencies

• C6--cricopharyngeus muscle (most common sige in kids < 4yo)

• T4--at level of aortic arch• T10-11--at lower esophageal

sphincter/diaphragmatic hiatus (most common site in adults)

GI Emergencies

• At child is brought to the ED by parents stating that he swallowed an alkaline calculator battery. The child is asymptomatic. You get an xray and find it in the stomach. What do you do?

GI Emergencies

• If in stomach and child asymp., can follow with xrays to and stool checks (parents do this!) to make sure it passed

• If in esophagus, this is a true emergency requiring endoscopic retrieval

GI Emergencies

• What FBs in the stomach need to be removed endoscopically?(what characteristics of the FB)

GI Emergencies

• Sharp/pointed• Objects longer than 5 cm X 2 cm

• Sharp ones are at high risk to cause perf, usually at region of ileocecal valve

• Large ones are unlikely to pass

GI Emergencies

• What organism is often associated with peptic ulcer disease?

GI Emergencies

• Helicobacter pylori

GI Emergencies

• Which PUD medication is contraindicated in pregnancy because it is associated with spontaneous miscarriage?

GI Emergencies

• Misoprostol (synthetic PGE1 analogue; works by

stimulating local mucus and bicarb secretion, enhancing mucosal blood flow and inhibiting gastric acid secretion)

GI Emergencies

• What is the most common abdominal surgical emergency in pregnancy?

GI Emergencies

• Acute appendicitis

GI Emergencies

• In what % of cases of appendicitis is an appendecolith found on plain xray?

GI Emergencies

• 2-22% (but probably on the lower end of that)

GI Emergencies

• What is the most common cause of SBO in adults?

• What is the second most common cause?

GI Emergencies

• Most common is adhesions from prior surgeries

• Second most common is hernia

GI Emergencies

• What is the most common cause of LBO?

GI Emergencies

• Tumors

GI Emergencies

• Describe the typical patient with a sigmoid volvulus.

GI Emergencies

• Elderly, bed-ridden patients with chronic debilitating comorbid diseases or profound neuro/psychiatric conditions; patients have severe chronic constipation, leading to elongated, redundant sigmoid colon

GI Emergencies

• What is the diagnostic test of choice for patients with suspected mesenteric ischemia?

GI Emergencies

• Angiography

GI Emergencies

• Which type of hernia is least likely to incarcerate:– Direct– Indirect– Femoral

GI Emergencies

• Direct--rarely incarcerates• Indirect--frequently incarcerates,

esp. in infancy• Femoral--frequently incarcerates

GI Emergencies

• Compare Crohn’s disease vs. ulcerative colitis in terms of:– Which layers of the bowel they

typicall involve

GI Emergencies

• Compare Crohn’s disease vs. ulcerative colitis in terms of:– CD--all layers (full wall of bowel)– UC--only the mucosal and submucosal

layers of the bowel wall; muscular layers and serosa are spared usually

GI Emergencies

• Compare Crohn’s disease vs. ulcerative colitis in terms of:– Areas of GI tract involved

GI Emergencies

• Compare Crohn’s disease vs. ulcerative colitis in terms of:– CD--any area, from esophagus to

anus, though ileum is usually involved; skip/discontinuous areas common

– UC--isolated to colon and rectum (always begins in rectum); continuous and uniform involvement of bowel

GI Emergencies

• What is, overall, the most common cause of rectal bleeding?

GI Emergencies

• Hemorrhoids

GI Emergencies

• What is the “line of demarcation” that is used to distinguish between internal and external hemorrhoids?

GI Emergencies

• The dentate line

GI Emergencies

• What are the typical ages that are most commonly infected with Rotavirus?

• Same question for Norwalk virus.

GI Emergencies

• Rotavirus children 6-24 mos. • Norwalk virus school-aged

children and adults

GI Emergencies

Name the organism:• Bloody diarrhea, crampy

abdominal pain, renal failure in children

GI Emergencies

Name the organism:• E.coli 0157:H7(HUS in kids, TTP in elderly)

GI Emergencies

Name the organism:• Kids with bloody diarrhea, fevers to

105, febrile seizure

GI Emergencies

Name the organism:• Shigella

GI Emergencies

Name the organism:• Diarrhea bug that is associated

with the following high-risk groups:– Extremes of age– Immunocompromised– Splenectomized patients– Patients with sickle cell anemia

GI Emergencies

Name the organism:• Salmonella

GI Emergencies

Name the organism:• Diarrhea bug that is associated

with Guillain-Barre syndrome as a late sequela

GI Emergencies

Name the organism:• Campylobacter

GI Emergencies

Name the organism:• Diarrhea bug that mimics

appendicitis• Recent exposure to farm animals

GI Emergencies

Name the organism:• Yersinia enterocolitica

GI Emergencies

Name the organism:• Onset of GI symptoms within just a

few hours of ingesting food• Food is usually protein rich (ham,

eggs, mayonnaise)

GI Emergencies

Name the organism:• Staph aureus

GI Emergencies

Name the organism:• Onset of GI symptoms within just a

few hours of ingesting food• Food is classically fried rice

GI Emergencies

Name the organism:• Bacillus cereus

GI Emergencies

Name the organism:• Bug associated with drinking

untreated water from a well or spring

• Usually affects ISup.

GI Emergencies

Name the organism:• Aeromonas

GI Emergencies

Name the organism:• Ingestion of fish• SSx--red itchy skin, wheezing,

N/V/D, throbbing HA and abd cramps

GI Emergencies

Name the organism:• scombroid

GI Emergencies

Name the organism:• The most common intestinal

parasite in the U.S.

GI Emergencies

Name the organism:• Giardia

GI Emergencies

Name the organism:• Most common cause of chronic

diarrhea in patients with AIDS

GI Emergencies

Name the organism:• cryptosporidium

Pop-Culture Trivia

Britney Spears has (finally) filed for divorce with Kevin Federline…

Pop-Culture Trivia

What year were they married?

Pop-Culture Trivia

2004

Pop-Culture Trivia

What is the name of their newborn?(born Sept. 12, 2006)

Pop-Culture Trivia

Jayden James(first son--Sean Preston)

Pop-Culture Trivia

What was the name of Britney’s first album?

Pop-Culture Trivia

“Baby One More Time”

Pop-Culture Trivia

What movie did K-Fed appear in?

Pop-Culture Trivia

“You Got Served”

Pop-Culture Trivia

In which former former Mousketeer’s band did K-Fed serve as a backup dancer?

Pop-Culture Trivia

Justin Timberlake(also a former boyfriend)

Pop-Culture Trivia

What other current “diva” was a former Mousketeer with Britney and Justin?

Pop-Culture Trivia

Christina Aguilera

Pop-Culture Trivia

Britney has had 2 #1 songs in the U.S.

The first was “Baby One More Time.”

What was the other?

Pop-Culture Trivia

“Oops! I Did It Again”(2000)

Pop-Culture Trivia

Britney has appeared in 3 films. Name them…

One point for each.

Pop-Culture Trivia

2002 Crossroads

2002 Austin Powers in Goldmember (played the role of a Fembot/herself)

1999 Longshot (played the role of a flight attendant)