| Question | Answer |
| Fat, forty, female, fertile w/ RUQ pain | Cholelithiasis or Cholecystitis |
| Fever, RUQ pain, radiation to back | Cholecystitis |
| Elevated Alkaline phosphatase, urinary bilirubin | Cholecystitis |
| F, RUQ pain, Jaundice, gallstones & dilated common duct on US | Ascending cholangitis (Charcot’s triad) |
| Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation | Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation) |
| Elevated AST, ALT, indirect bilirubin | Hepatitis |
| Isolated elevated indirect bilirubin | Gilbert syndrome |
| Elevated indirect bilirubin w/ defective glucuronyl transferase | Crigler-Najjar Dz |
| Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility | Porphyria |
| Chronic cough, bitter taste in mouth or throat, dyspepsia | GERD |
| Multiple or constant GI ulcer pain despite medications | Zollinger-Ellison Syndrome |
| N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals | Acute pancreatitis |
| peri-umbilical or flank ecchymosis | Acute pancreatitis (Cullen & Grey Turner Sign) |
| Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles | SBO |
| Air fluid levels on upright abd plain film | SBO |
| Air under diaphragm, rigid board-like abdomen | Perforated viscus, perforated ulcer |
| >60yo F, LLQ pain | Diverticulitis. IV Abx, fluids, NPO. |
| Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial | Mesenteric ischemia |
| Neonate w/ projectile vomiting. Olive sized mass. | Pyloric stenosis |
| Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life | Tracheoesophageal fistula |
| Painless rectal bleeding in pediatrics | Meckel diverticulum |
| Alcoholic with massive hemoptysis | Esophageal varicies (Tx w/ octreotide) |
| Female with recurrent abdominal pain, alternating diarrhea, constipation; pain relieved with defecation = | IBS. TCAs (nortriptyline) good if diarrhea predominant symptom |
| Bloody Diarrhea = | Ulcerative colitis |
| Supraclavicular LAD (L > R) | Virchow node: metastatic abdominal cancer |
| Hard periumbilical nodule | Sister Mary Joseph nodule; indicates metastatic gastric and pancreatic cancers |
| PUD, Pernicious anemia (Type A Gastritis), H. pylori are RFs for: | Gastric Ca |
| Apple core lesion = | Colon Cancer |
| Elderly pt with positive hemoccult: poss dx & next step: | Colon Cancer: get colonoscopy |
| CEA to dx: | Colon Carcinoma |
| Family history of young age colon cancer, multiple polyps found on colonoscopy | Familial adenomatous polyposis (Gardner syndrome) |
| AFP to dx: | Hepatocellular carcinoma (also high alk phos), testicular seminoma (germ cell tumor) |
| CA 19-9 to dx: | Pancreatic Ca |
| CA-125 to dx: | Ovarian Carcinoma |
| Traveler’s Diarrhea is caused by: | E. coli (ETEC); tx is hydration & Cipro |
| Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history | Giardia |
| Afebrile, watery or loose stool. No blood or mucus | Viral Gastroenteritis |
| Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise | Staphylococcus aureus infectious diarrhea |
| Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea | Campylobacter jejuni (most common cause of acute bacterial diarrhea) |
| Painless rectal bleeding. Bulging perianal mass w/ straining | Internal hemorrhoids |
| Pediatric with perianal pruritis esp at night; positive cellophane tape test | Pruritis ani: Pinworms (enterobiasis). Tx is Mebendazole |
| Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods | Celiac Sprue |
| Anti-endomysial antibodies | Celiac Sprue |
| Beriberi | Thiamine (B1) deficiency; Alcoholics, Neuro Sx +/- cardiomyopathy, CHF |
| Pellagra (raw skin) | Niacin (B3) (4D’s dermatitis, diarrhea, dementia, death), bright red tongue |
| Scurvy | Vit C (easy bleeding, bruising, hair & tooth loss, joint pain and swelling) |
| Rickets; hsm, lg skull, genu varus/ valgus | Vit D (Osteomalacia) |
| Night blindness; Xerosis, Hyperkeratinization, Loss of taste, Bitot spots (white spots on conjunctiva) | Vit A deficiency; secondary causes antiseizure meds, low Ca |
| Magenta tongue | Riboflavin deficiency (B2) |
| s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding | Dumping syndrome |
| IBD and smoking | smoking decreases UC sxs; increases crohn dz sxs |
| decreased proprioception and vibratory sense, gait disturbance, possibly 2/2 deficiency of: | Vit E; secondary causes CF, biliary atresia, Cholestatic liver dz |
| Dermatitis, Neuropathy, Stomatitis, Cheilosis | vit B complex def (most often 2/2 EtOH) |
| uncommon causes of B3 def | INH use, Hartnup dz, carcinoid |
| palmar erythema, spider angiomata
| EtOH dz (folate / B12 def) |
| petechiae, purpura, peri-follicular hemorrhage | vit C def |
| B1 (thiamine)def sxs | impaired jejunal/ileal absorption; beri beri; Wernicke-Korsakoff |
| Spontaneous bacterial peritonitis (SBP) = | infected ascites |
| Hep B transmission | Sex; bloodborne (1 in 63K risk); perinatal (c-section does not lower risk): vax+HBIG |
| acute hep B eval | 1-4 mo incubation; 70% subclinical; ALT/AST 1000-2000 |
| HCV infxn sources | IVDU (most common); sex; bloodborne |
| histological pattern of advanced fibrosis in liver = | cirrhosis |
| Most common cause of abnormal liver tests | fatty liver dz |
| Asterixis = | encephalopathy assoc w/cirrhosis |
| HLA-DQ2, HLA-DQ8 association | celiac dz |
| assoc w/celiac dz | dermatitis herpetiformis; Type 1 DM; autoimmune thyroid dz; RA; Sjögren; Down syndrome; poss CHD, sarcoid, CF, IBD, autoimmune hep, MG |
| celiac dz physical exam | check for loss of enamel; mx atrophy; kyphosis; bruises; +abdominal signs |
| villous atrophy, lymphocytic infiltration of lamina propria, crypt hyperplasia, inc intraepithelial lymphocytes = | celiac dz |
| Courvoisier sign, Sister Mary Joseph nodule = | panc ca |
| Dietary requirement of Ca: | 1000-1500 mg/day |
