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Define stomatitis
Painful, ulcerations in mouth, that can last 5-7 days, can fully heal in 2 weeks.
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What are the 2 types of stomatitis?
Primary stomatitis- most common apthos (non-infectious), caused by herpies simplex/trauma
Secondary stomatitis- Infection from oppertunistic organsms or drugs suck as chemo.
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List the causes of stomatitis?
- Chemo/Radiation - cause quickly replicating cells not to form
- Immunosuppression
- Virus
- Allergey
- Decrease nutrition
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What are s/s of stomatitis?
Painfull sore, 2-5mm, yellow w/ white base
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Give another name for thrush.
Candidiasis
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What is thrush?
A yeast like fungal infection of the mouth.
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Causes of thrush.
- Antibiotics lead to super infection.
- Decrease immune status from cancer/ cancer treatments, corticosteriods, hiv, rundown body
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S/S of thrush
- Hot dry patches, cottage cheese like
- red when scraped
- can extrend all the way down the esophagus.
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How do you diagnose thrush
c/s of lesions
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how do you treat thrush
- Rinses of NaBicarb, H2O2, lidocane, TNHC rinse(aka stanford rinse)
- analgesics(opiate/nonopiate)
- Cold food/drink
- antibiotics etc.
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gastroesophageal reflex desease is also known as
GERD/ acid reflux
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What leads to Berrett's esophagus
GERD
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List causes of GERD
- Anything that delays gastric emptying, or increases gastric pressure
- age
- ng tube
- decrease in pressure of lower esophageal sphincter(estrogen/progesterone, calcium channel blockers, nitroglycerine, theophyline, diazepan, beta blockers)
- hiatal hernia
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what do theophyline, diazepan and beta blockers do?
it is an antihypertensive, but also decreamses pressure of LES, and increases GERD.
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What are s/s of GERD
- Dysphagia(difficulty swallowing)
- Odynophasia(Painful swallowing)
- Pyrosis(heart burn)
- regurgitation
- chest pain
- coughing/wheezing at night
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How do you diagnose GERD?
- Upper GI series(Xray w/ Barrium Swallow)
- 24hr PH monitoring
- Endoscope(concisious sedation) **
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How do you treat GERD?
- Antacids- 1hr ac/2-3hr pc and hs
- Histamine 2 blockers- decrease stomach acid
- Antiemetic and prokinetic or promotility agents - Shorterm use due to sideffects, tighten LES and increase gastric emptying
- Proton pump inhibiters(PPI)- blocks secretion of H+ from perital cells
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What is Berrett's esophagus
Squamous cells change to collumnar in lower esophagus from acid exsposure(increase cancer risk)
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What is the most common type of hiatal hernia
Sliding
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Fundoplication
Suturing of fundus 360 degrees around the esophagus
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What is another name for fundoplication
Laproscopic nissen fundoplication
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What is another name for Rolling Hiatal Hernia
Paraesophogeal Hernia
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What are causes of acute gastritis
Radiation therapy/ drugs (alchohol, NSAID's, ASA, Corticosteriods, Bacterial endotoxins, Corosive Substances)
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What are the causes of chronic gastritis
- A- Autoimmune
- B- H.Pylori
- Atropic - after exsposure to toxic substances
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What is EGD?
Esophagogastrodoudenocopy**
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Where is gastrin secreted?
The "G" cells in the antrum
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Contrast gastric ulcer conditions to duodenal ulcer conditions
Gastric Ulcer Conditions- Normal acid secretion / delayed stomach emptying / increased acid diffusion
Duodenal Ulcer Conditions- Increased acid secretion / Increased stomach Emptying / Normal Acid diffusion
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What is Urease and how is it secreted?
Urease is an enzyme the neutralizes acid in the stomach. Secreted by H pylori
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How do we diagnose PUD
- ALYSA test (Blood test) - detects antibodies to H pylori
- Breath test - Increased carbon from H pylore breaking down urea
- Tissue Test** - Biopsy by EGD
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What is Misoprostol
(sytotec) Synthetic Prostaglandin - take with food may cause cramping
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What is Sucrafate
Mucosal barrier fortifier
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What is the most effective treatment for H pylori
Antibiotics(tetracycline/amoxicillin) w/bismuth salts(Bismuth subsalicylate) and Flagyl (mytronidazole - an amebacide)
PPI
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What is a Vagotomy
Sniping the vagas nerve - will increase motility and secretion
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Atresia
Failure to form a continious pathway
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Fistula
Abnormal Connection between passageways
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What is another name for celiac disease?
Gluten Sensitive enteropathy
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Whats another name for Hirchsprungs Disease
Aganglionic Colon/ pseudo obstruction
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What is metal Retardation?
Decreased Intelectual skills
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What are the 2 pervasive development disorders?
Autistic Disorder - Impaired communication, imagination, responsiveness, intrest
Asperger's disorder - similar to autisim w/ later onset and decreased symptons.
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How does anxiety disorder differ in children
Mostly seperation anxiety
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What are the types of disruptive behavior disorders
oppositional defiant disorder - hostile behavior w/o violating others rights
conduct disorder - consitant violation of others rights, with out remorse
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What is Urolithiasis
Kidney Stones
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What are the 4 type of stones and their prevention?
Calcium Oxalate/ phosphate(most common) - Avoid oxalate foods such as darkgreen foods, coco, wheat, picans, okra, peanuts/decrease calcium intake if calcium phosphate stone
Struvite(bacteria formed, consists of magnesim, amonium, phosphate, incarbinate) - Check for UTI/admin antibiotics, limit phosphate(dairy, redmeat, whole grain)
Uric acid - Allopurinol, potasium citrate, sodium bicarb, decrease purine(poultry, fish, redwine)
Cystine - alkalize urine, increased hydration, ace inhibiters, decrease animal protien
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What is the diffrence between nephrotic syndrome and glomerulonephritis
Glomerulonephritis - has hematuria, no hyperlipidemia, High BP, does not respond to corticosteriods
Nephrotic syndrome - no hematuria, hyperlipademia, normal or low bp, treat with corticosteriods
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What is the value of osmolarity
285-295
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Normal range for glucose
70-100
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normal value for BUN
10-20
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Normal value for NA
135-145
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Normal value for K+
3.5-5
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Normal value for Ca
8.5-10.5
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normal value for HCO3-
22-26
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Normal value for Cl
95-105
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Normal value for Cr
0.5-1
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Formula for plasma osmolarity
POSM = (Na x2) + Glucose/18 + BUN/2.8
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When is aldosterone released and what does it do
when there is decrease kidney flow. it causes decreased Na loss and increased K+ loss
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Cause of isotonic fluid deficit
Hemorage, Diaphoresis, GI fluid loss
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Thirst shows what % fluid loss
1% - 2%
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Osmotic Diuresis
Due to increased concentration of salutes such as urea or glucose, increase osmotic pull to kidneys
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Hydrostatic Pressure
The pushing force
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Oncotic pressure
The pulling force
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What happens if Na levels are between 120-123
Nausia and malaise
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What happens if Na levels are between 115-120
Headache, Lethergy, obtundation(inability to talk right)
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What happens if Na level is less than 115
Seizures/coma
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How should sodium levels be increased
no more than 0.5/hr for a total of 12/day
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What is hydrochlorothiazide
Thiazide diuretic that increases K+ and Na excretion
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Explain reflexes in hyponatremia and hypernatremia
Hyponatremia - hypo reflexes
hypernatremia - hyper reflexes
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What is SALT
- S/s of Hypernatremia
- S- skin flushed
- A- agitation
- L- Low grade fever
- T- Thirst
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Where is K+ most prevalent
ICF
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How does metabolic alkalosis lead to hypokalemia
H+ switch with K+ inside the cell to keep it electrically neutral and takes K+ out of the vascular system
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Why do you watch Dig levels with hypokalemia
There is more space for Dig to bind with Na/K+ pumps so normal doses can be toxic
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What is high in K+
Instant coffee and salt substitutes
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What is the only way for K+ to be elimimated
by the kidneys so monitor kidney function
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Explain muscular excitability in hyperkalemia and hypokalemia
Hyperkalemia - hyper excitability
Hypokalemia - hypo excitability
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What is lasix
K+ waisting diuretic
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what is Kayexalate
(sodium polystyrene) exchanges Na for K+ in intestine, used when K+ is >6
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What does dextrose with insulin do
Puts K+ in to cells
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Explain where calcium is
99% in Bone, 1% in blood(of that 50% is bound to protien)
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How is Ca balance regulated
- Parathyroid hormone - promotes transfer of Ca from bone to plasma and augments intestinal adsorbtion
- Calcitonin(from thyroid gland) - transfers Ca from plasma to bone to lower Ca plasma levels
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How does hyperphosphatemia effect Ca
Decrease in serum Ca
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What is troussus sign
Corpal spasms from BP cuff
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What is Chvostek's sign
Twitch of facial nerve
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How do you treat hypercalcimia
- Large volumes of NS to dilute serum Ca and Increase excretion
- Calcitonin, Pamidorante, Zoledronic acid - inhibits bone resorbtion(loss)
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