Midterm Study

1. Midterm Study

2. Liver • Be able to describe the anatomy of the liver from gross to internal and the lobule. • important physiologic function the liver performs • what join together to form the common bile duct? • what two major sources deliver blood to the liver? • what is a sinusoid? Why does cancer metastasize to the liver frequently? • what vitamins are formed and stored in the liver? Why does administration of these vitamins and medications need to be carefully followed in people with hepatic disease?

3. describe storage and breakdown of glucose by the liver • describe the liver function in formation of phospholipids • what happens to osmotic pressure in the plasma in liver disease? • why do people with liver disease bruise easily? • where do plasma proteins enter the blood stream? • a thorough history will reveal what signs and symptoms, in general, in liver disease? • when are venous hums ascultated? • what causes steatorrhea? • when are AST and ALT elevated? elevated serum ammonia? decreased serum cholesterol? hypoalbuminemia?

4. what is the role of a normally functioning gallbladder? • what happens within the bile in gallbladder disease that increases likelihood of stone formation? • what innervation does the gallbladder respond to? what is the role of CCK and PCZ in relation to the GB and where is it released from? • what is secretin and what releases it? • Know the three major forms of hepatitis - A, B, and C. Know that there are other forms - not anything else about them. A, B, C - infection, symptoms, treatment • know non-viral hepatitis: common causes, symtoms, treatment esp with regard to over-dose acetaminophen as it is quite dangerous. • causes and incidence of cirrhosis • signs and symptoms - systemically of cirrhosis.

5. liver abscess • causes of pyogenic abscess

6. Fatty Liver • causes of fatty liver. • diagnosis of fatty liver. • treatments • what is the role of patient education

7. Hepatic Encephalopathy • what is it? why does it happen? what are the four stages of hepatic encephalopathy? • treatment

8. Gallbladder: know symptoms, causes, possible treatments, and worst case outcomes • cholelithiasis • choledocholelithiasis • cholangitis • cholecystitis • cholesterolosis • acalculous cholecystitis • gallstone ileus - what is it, who most commonly is diagnosed with it, what is the most common cause?

9. WOW! THAT WAS A LOT OF INFORMATION • Now that we have heard this how do we study? • Important things to know: general ear anatomy - location of external ear canal, middle ear, inner ear and what each is composed of anatomically • What are the common causes of otitis externa? • What’s the difference between acute otitis externa and chronic otitis externa?

10. More Study: • Where is otitis media located? • What are some risk factors in otitis media: TM perforation, mastoiditis.. • What are predisposing factors to OM? eg. exposure to smoking

11. Study continued... • Mastoiditis is a RED FLAG - how would you recognize it, what are signs and symptoms, when would you refer? • What happens in the disease progression of otosclerosis? Describe the Rinne/Weber test • What’s happens in Meniere’s Disease? Who is most commonly diagnosed with it and what are their signs and symptoms? List non-surgical treatments eg. Diuretics, dietary changes... • What is the difference between Acute Vestibular Labyrinthitis and bacterial labyrinthis?

12. Study MORE! • What are the two types of hearing loss? What are some common causes for hearing loss? Name some ototoxic drugs, the dB levels for prolonged noise exposure hearing loss, maternal exposures and neonatal exposures that can lead to hearing loss? • What are some causes of sudden hearing loss and why is it a medical emergency? • Motion sickness: what is the cause?

13. Study... • General anatomy of the sinuses and throat: where are sinuses? Which are which? Nasopharynx? Oropharynx? “Throat”? • Why are infections in this area (EARS, NOSE, THROAT and eventually - EYES) something to watch/be concerned about? • What is the time frame to be aware of when treating epistaxis? What are some conditions or exogenous substances that might cause an increase in bleeding time? • What are the more common causes of nasal septum perforation? • Differences between acute, chronic, allergic and hyperplastic sinusitis. • Complications that can arise from untreated sinusitis. • Physical exam findings (what is transillumination? Where might you find tenderness to palpation - TTP?)

14. and more... • what’s the difference between a nasal polyp and nasal papilloma? • Where are adenoids located? What are some complications of adenoid hyperplasia? • Causes of acute vs. viral pharyngitis. Signs and symptoms of pharyngitis. • What bacteria is most dangerous in tonsillitis? What are possible complications from untreated tonsillitis? • Location of peritonsillar vs. retropharyngeal abscess • Causes of vocal cord nodules or polyps. Why would one opt for surgical removal? What is larygneal web? • Causes of laryngitis. Treatment? Worst case scenario of no treatment/treatment? • Ddx Croup and Epiglottitis. Why do we care? Which is an emergent referral?

15. What do I need to know about GI? • it’ll be a good idea to know the general anatomy. • What is necessary to absorb vitamin B12? Where is it produced? Where is B12 absorbed? • how would you clinically differentially diagnose duodenal vs. gastric ulcer? What bacteria is commonly the infective agent in Peptic ulcer disease? • What are GERD red flags? • What are the types of hiatal hernia? What is a dangerous possible side effect of paraesophageal hernia? • What is the cause of Barrett’s esophagitis? What are the histologic changes? What can Barrett’s esophagitis transform into? • What causes esophageal varices? What is the danger present with esophageal varices? • Be able to distinguish the difference between acute and chronic gastritis: histologically, causally, symptomatically.

16. More to know... • know what IBD is, know the two forms of IBD and how each is distinguished from the other including presentation, labs and symptoms. Know methods of diagnosis eg. barium enema, barium swallow study, x-ray, biopsy... • diverticulitis vs diverticulosis • celiac disease presentation and histologic changes, the effects of the histologic changes on the patient system as a whole • Know IBS, causes and links between psychology and environment in relation to IBS. Symptomatic presentation. • gallbladder and pancreas anatomy. Know the difference between acute and chronic pancreatitis presentation. The two most common causes and the systemic effects of pancreatitis. Why can this be a medical emergency? • signs and symptoms of stomach cancer and what are thought to be causes/links to cause? • internal vs. external hemorrhoids • causes of inactive colon - eg. over-use of laxatives • symptoms of proctitis and contributing factors • problems with pilonidal cysts

17. The eye • know internal and external anatomy as it relates to disease and disease pathology/symptomatology • blepharitis, stye(hordeolum), chalazion - how do they relate? How are they treated? What are possible dangerous outcomes? • two common causes of exophthalmos? • orbital cellulitis - what is it? why is it dangerous? what is it the result of? • common causes of conjunctivitis. What is a possible causative agent that would need to be reported to public health? Treatment? Why treat quickly? • what is a corneal abrasion? does it need to be treated quickly? why? • signs and symptoms of retinal detachment? why is it an emergency?

18. what is macular degeneration? what are the forms? how is it treated? what happens to vision? who usually is diagnosed with it? • what causes cataracts? who is usually diagnosed with cataracts? • know the cranial nerves that innervate the eye muscles and how they influence ocular movement so that lesions on the “H in space” can be noted • what are the two types of glaucoma? why is glaucoma dangerous? • know: myopia, hyperopia and astigmatism definitions

19. Lungs • know structure and function of lungs? How many lobes on each lung? Whispered pectoriloqui? Egophony? Tactile fremitus? What do they mean and what do positives indicate? • How does the diaphragm work? • Again - ddx croup and epiglottitis • Two forms of COPD and how symptoms present differently? • What physiologic changes occur to cause the physical symptoms of COPD? • Organism that causes TB? Diagnosis? Risk factors in developing. Treatment?