Tx of IBS - ANSWER Best initial therapy: *Fiber*
If fiber fails: Antispasmodic/anticholinergic agents.
First line:
1. Dicyclomine
2. Hyoscyamine
Secondline:
1. TCA's (amitriptyline)
CCS, What test should you
...
Tx of IBS - ANSWER Best initial therapy: *Fiber*
If fiber fails: Antispasmodic/anticholinergic agents.
First line:
1. Dicyclomine
2. Hyoscyamine
Secondline:
1. TCA's (amitriptyline)
CCS, What test should you order for IBS? - ANSWER 1. Stool: stool guiac, leukocytes, cultures, ova & parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? - ANSWER Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
What three metabolic conditions do most states require newborn screening? - ANSWER 1. Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - ANSWER Ciprofloxacin + Metrodinazole (they have some kind of immune modulatory effect)
Middle-aged woman with itching and xanthelesmas = primary biliary cirrhosis. What is the best initial test, and the most accurate test? - ANSWER Initial: elevated ALP, normal bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - ANSWER Primary biliary cirrhosis
Antismooth muscle antibody? - ANSWER Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - ANSWER IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? - ANSWER Initial: elevated ALP, *elevated bilirubin*
Best: ERCP (beading of biliary system)
Others: antismooth muscle antibody, ANCA positive
Treatment for both primary biliary cirrhosis and primary sclerosing cholangitis? - ANSWER Ursodeoxycholic acid
Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial test, and most accurate? - ANSWER Initial: ANA & antismooth muscle positive
Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis) with hypergammaglobulinemia
Best initial test for hemochromatosis - ANSWER Serum iron, iron binding capacity (low), ferritin (high)
Most accurate test for hemochromatosis - ANSWER MRI of liver + genetic testing for HFe gene mutation
(Spares liver biopsy)
Last two indications for amph
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