Peptic Ulcer and Celiac Disease Overview

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Questions and Answers

Which of the following symptoms is specifically associated with Peptic Ulcer Disease?

  • Dermatitis herpetiformis
  • Epigastric pain (correct)
  • Weight loss
  • Diarrhea

What is the primary dietary management approach for Celiac Disease?

  • Paleo diet
  • High-protein diet
  • Gluten-free diet (correct)
  • Low-fat diet

Which test is most definitive for diagnosing Familial Adenomatous Polyposis (FAP)?

  • Blood test for iron levels
  • Small bowel biopsy
  • Urea breath test
  • Colonoscopy with biopsy (correct)

Which of the following treatments is primarily utilized for Ulcerative Colitis?

<p>Steroids (A)</p> Signup and view all the answers

Which symptom is distinctive for Crohn's Disease compared to Ulcerative Colitis?

<p>Fistulas (D)</p> Signup and view all the answers

Elevated levels of which specific antibodies are indicative of Celiac Disease?

<p>Transglutaminase IgA (A)</p> Signup and view all the answers

Which treatment strategy is unique for the management of Familial Adenomatous Polyposis (FAP)?

<p>Prophylactic colectomy (A)</p> Signup and view all the answers

Which test would likely be ordered to check for anemia in patients with Ulcerative Colitis?

<p>Complete Blood Count (CBC) (D)</p> Signup and view all the answers

Which of the following is NOT a common sign or symptom of Tuberculosis (TB)?

<p>Honey-colored pustules (D)</p> Signup and view all the answers

What is the recommended treatment for active Tuberculosis?

<p>A multi-drug regimen including rifampin (A)</p> Signup and view all the answers

Which diagnostic test is utilized for confirming Lyme Disease?

<p>ELISA and Western blot (A)</p> Signup and view all the answers

In the case of Herpes Zoster, what is an early recommended treatment option?

<p>Oral antivirals (C)</p> Signup and view all the answers

What describes the common cause of Cat-Scratch Disease?

<p>Bacterial infection from Bartonella henselae (B)</p> Signup and view all the answers

What is a typical sign of mucocutaneous candidiasis?

<p>White plaques (C)</p> Signup and view all the answers

Which treatment is necessary for ocular involvement in Toxoplasmosis?

<p>Systemic therapy and intravitreal therapy (A)</p> Signup and view all the answers

Which of the following is a potential complication of untreated Lyme Disease?

<p>Facial paralysis (D)</p> Signup and view all the answers

What are common diagnostic tests for Histoplasmosis?

<p>Serology for IgG/IgM antibodies and PCR (C)</p> Signup and view all the answers

What is a hallmark symptom of Impetigo?

<p>Honey-colored pustules (A)</p> Signup and view all the answers

What are the primary symptoms associated with iron deficiency anemia?

<p>Fatigue and difficulty swallowing (B)</p> Signup and view all the answers

Which diagnostic test is specifically associated with vitamin B12 deficiency?

<p>Elevated homocysteine levels (C)</p> Signup and view all the answers

Which treatment is appropriate for managing acute pancreatitis?

<p>NPO protocol with IV fluids and pain management (A)</p> Signup and view all the answers

What is the most common type of anemia related to pernicious anemia?

<p>Macrocytic anemia due to vitamin B12 deficiency (C)</p> Signup and view all the answers

Which condition is characterized by a reduction in all blood cell types?

<p>Pancytopenia (A)</p> Signup and view all the answers

What diagnostic finding is commonly associated with giant cell arteritis?

<p>Histological signs of vasculitis in temporal artery biopsy (C)</p> Signup and view all the answers

Which of the following is a common treatment for radiation retinopathy?

<p>Anti-VEGF injections (B)</p> Signup and view all the answers

What is the primary concern with chemotherapy-associated ocular toxicity?

<p>Inflammatory responses causing retinal detachment (D)</p> Signup and view all the answers

What does a blood smear reveal in a patient with iron deficiency anemia?

<p>Hypochromic microcytic red blood cells (B)</p> Signup and view all the answers

Which autoimmune condition is a leading cause of vitamin B12 deficiency?

<p>Pernicious anemia (D)</p> Signup and view all the answers

What imaging technique is used to evaluate metastatic orbital tumors?

<p>MRI (B)</p> Signup and view all the answers

What are the main symptoms of paraneoplastic ocular syndromes?

<p>Visual loss, nyctalopia, and dyschromatopsia (B)</p> Signup and view all the answers

Which treatment is recommended for managing symptoms of giant cell arteritis?

<p>High-dose steroids with gradual tapering (B)</p> Signup and view all the answers

Which autoimmune disorder is characterized by a butterfly rash and possible kidney issues?

<p>Systemic Lupus Erythematosus (A)</p> Signup and view all the answers

What is the primary ocular complication associated with Rheumatoid Arthritis?

<p>Scleritis (A)</p> Signup and view all the answers

Which test is commonly used to diagnose Sjögren’s Syndrome?

<p>Schirmer's test (C)</p> Signup and view all the answers

In Ankylosing Spondylitis, what genetic marker is often found positive?

<p>HLA-B27 (A)</p> Signup and view all the answers

Which ocular symptom is most commonly associated with Stevens-Johnson Syndrome?

<p>Conjunctivitis (C)</p> Signup and view all the answers

What is the first-line treatment for epidermal tumors like basal cell carcinoma?

<p>Surgical excision (B)</p> Signup and view all the answers

Which antibody marker is typically positive in the diagnosis of Systemic Lupus Erythematosus?

<p>Anti-Smith antibodies (A)</p> Signup and view all the answers

What is a common treatment strategy for managing uveitis in Ankylosing Spondylitis?

<p>Corticosteroids (C)</p> Signup and view all the answers

Which systemic condition causes both dry eyes and dry mouth due to gland dysfunction?

<p>Sjögren’s Syndrome (D)</p> Signup and view all the answers

Which skin cancer is typically associated with scaly and firm papules?

<p>Cutaneous Squamous Cell Carcinoma (D)</p> Signup and view all the answers

What ocular symptom can arise from Cutaneous Melanoma?

<p>Vision loss (A)</p> Signup and view all the answers

What imaging technique can be helpful in assessing chronic sinusitis?

<p>CT scan (B)</p> Signup and view all the answers

Which of the following treatments is commonly prescribed for joint pain in Rheumatoid Arthritis?

<p>Steroids (A)</p> Signup and view all the answers

What is a potential systemic treatment for the symptoms of Xanthoma?

<p>Lipid-lowering medications (D)</p> Signup and view all the answers

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Study Notes

Peptic Ulcer Disease

  • Chronic ulcers in the esophagus, stomach, or duodenum
  • Symptoms include epigastric pain (upper abdomen), indigestion (dyspepsia), gastric bleeding, coffee-ground-like vomit, melena (black stools), and anemia
  • Diagnosis involves upper GI X-ray, endoscopy (EGD) with biopsy, stool samples, antibody testing, and urea breath test
  • Treatment includes acid-suppressing drugs like Proton Pump Inhibitors (PPI) and Histamine 2 receptor antagonists (H2RA), antibiotics for H.pylori infection, and lifestyle changes such as reducing NSAID use and stress

Celiac Disease

  • Autoimmune disorder triggered by gluten, leading to intestinal damage
  • Symptoms include diarrhea, abdominal pain, bloating, nutrient deficiencies (iron, vitamins), and dermatitis herpetiformis (skin rash)
  • Diagnosis involves blood test for elevated transglutaminase or endomysial IgA, small bowel biopsy, and endoscopy (EGD)
  • Treatment involves a strict gluten-free diet and nutritional counseling

Familial Adenomatous Polyposis (FAP)

  • Genetic condition causing colon polyps, often leading to colon cancer by age 50
  • Symptoms include rectal bleeding, diarrhea, anemia, and often asymptomatic
  • Diagnosis involves genetic testing and colonoscopy with biopsy
  • Treatment involves annual colonoscopies, prophylactic colectomy, and genetic counseling for family.

Ulcerative Colitis (UC)

  • Autoimmune inflammation affecting the colon's lining
  • Symptoms include diarrhea (sometimes bloody), abdominal pain, fever, rectal pain, bloating, and weight loss
  • Diagnosis involves colonoscopy and blood tests such as CBC, low iron levels, and elevated CRP/ESR
  • Treatment includes steroids, sulfasalazine, immunosuppressants, and surgery in severe cases

Crohn’s Disease

  • Autoimmune inflammation that affects any part of the GI tract, mainly the small intestine and colon
  • Symptoms include the same as UC, plus vomiting, fistulas, pneumaturia (air in urine), pernicious anemia, and vitamin deficiencies
  • Diagnosis involves colonoscopy, EGD for upper symptoms, CBC, vitamin deficiency tests, and imaging (X-ray, CT)
  • Treatment includes steroids, immunosuppressants, monoclonal antibodies, and surgery for severe cases

Pancreatitis

  • Inflammation of the pancreas, either acute or chronic
  • Symptoms include abdominal pain radiating to the back, nausea, vomiting, fever, steatorrhea (fatty stool), and distention
  • Diagnosis involves elevated serum lipase/amylase levels, CT scan, and CBC showing high WBC
  • Treatment involves hospitalization with NPO (nothing by mouth) protocol, IV fluids, and pain management

Iron Deficiency Anemia

  • Low iron levels causing decreased hemoglobin production and oxygen transport
  • Symptoms include fatigue, weakness, difficulty swallowing, and cardiovascular strain
  • Diagnosis involves serum ferritin, serum iron, total iron binding capacity (TIBC), and blood smear showing microcytic red blood cells
  • Treatment involves iron supplementation (oral or IV), dietary changes, and monitoring ferritin and hemoglobin levels

Vitamin B12 Deficiency (Pernicious Anemia)

  • Autoimmune destruction of gastric parietal cells or malabsorption, leading to B12 deficiency
  • Symptoms include anemia, fatigue, neurological issues: memory loss, gait disturbances, and visual field defects (Centrocecal VF)
  • Diagnosis involves blood smear showing macrocytic red blood cells, hypersegmented neutrophils, low serum B12, elevated homocysteine and methylmalonic acid, and anti-intrinsic factor antibodies present in autoimmune pernicious anemia
  • Treatment involves B12 supplementation (oral or intramuscular), addressing underlying autoimmune issues if present, and monitoring neurological symptoms

Pancytopenia (due to B12 Deficiency)

  • A reduction in red blood cells, white blood cells, and platelets, often linked to vitamin B12 deficiency
  • Symptoms include generalized weakness, bruising, infections, pale skin, and shortness of breath
  • Diagnosis involves blood count showing low levels of all types of blood cells and bone marrow biopsy if severe
  • Treatment involves B12 supplementation, monitoring blood counts regularly, and addressing any associated autoimmune conditions

Cancer Basics

  • Uncontrolled cell division, genetic or environmental causes
  • Symptoms vary by cancer type but involve abnormal growths, fatigue, and weight loss
  • Diagnosis involves clinical exams, imaging, biopsy, and TNM staging to assess severity and prognosis
  • Treatment includes surgery, radiation, chemotherapy, targeted therapies, immunotherapy, and hormonal therapy

Radiation Retinopathy

  • A complication of radiation treatment, affecting retinal blood vessels
  • Symptoms include microaneurysms, hemorrhages, telangiectasias, macular edema, cotton-wool spots, neovascularization, and retinal detachment
  • Diagnosis involves OCT-A, Fluorescein Angiography (FA), and Fundus Autofluorescence (FAF)
  • Treatment includes anti-VEGF injections, laser photocoagulation, and prevention by using lower radiation doses, hyper-fractionation, and eye protection

Chemotherapy-Associated Ocular Toxicity

  • Eye toxicity from systemic chemotherapy
  • Symptoms include keratitis, corneal deposits, conjunctivitis, uveitis, retinal toxicity, and optic nerve toxicity
  • Diagnosis varies based on symptoms
  • Treatment depends on specific ocular toxicities

Metastatic Orbital Tumors

  • Tumors metastasizing to the eye, most commonly from breast, lung, or prostate cancer
  • Symptoms include sudden pain, diplopia, vision loss, mass on palpation, optic nerve edema, and ophthalmoplegia
  • Diagnosis involves MRI for orbital mass
  • Treatment involves oncology referral, surgery, radiation, or chemotherapy based on cancer stage

Paraneoplastic Ocular Syndromes

  • Autoimmune reaction to cancer affecting the eyes (e.g., melanoma-associated retinopathy, cancer-associated retinopathy)
  • Symptoms include vision loss, nyctalopia, dyschromatopsia (color vision issues), uveitis, macular edema, and retinal vasculitis
  • Diagnosis involves OCT, ERG (electroretinogram) showing dysfunction, and blood tests for autoantibodies
  • Treatment involves systemic steroids, immunotherapy, and referral to oncology if no cancer diagnosis is present

Giant Cell Arteritis (GCA)

  • Inflammation of the temporal arteries, often affecting vision
  • Symptoms include headache, scalp tenderness, jaw claudication, and visual disturbances or sudden vision loss (arteritic anterior ischemic optic neuropathy - AAION)
  • Diagnosis involves elevated ESR (≥50 mm/hr), often >100 mm/hr, temporal artery biopsy (TAB) showing vasculitis, and CRP levels
  • Treatment involves high-dose steroids, taper over months to years, and biologics or DMARDs for those contraindicated for long-term steroids

Systemic Lupus Erythematosus (SLE)

  • A systemic autoimmune disorder affecting multiple organs
  • Symptoms include butterfly rash, joint pain, kidney issues, and visual changes (lupus retinopathy)
  • Diagnosis involves positive ANA, Anti-dsDNA, Anti-Smith antibodies, elevated ESR, and CRP
  • Treatment involves immunosuppressive drugs, regular eye exams for lupus retinopathy, and systemic management for organ involvement

Rheumatoid Arthritis (RA)

  • Chronic autoimmune arthritis affecting the joints
  • Symptoms include joint pain, swelling, stiffness, and ocular complications: dry eye, scleritis
  • Diagnosis involves rheumatoid factor (RF), Anti-CCP antibodies, elevated CRP, and ESR
  • Treatment involves DMARDs (e.g., methotrexate), biologics, and managing ocular symptoms with artificial tears and anti-inflammatory treatments

Sjögren’s Syndrome (SS)

  • Autoimmune disorder affecting moisture-producing glands
  • Symptoms include dry eyes, dry mouth, joint pain, and fatigue
  • Diagnosis involves positive Anti-SSA/Ro, Anti-SSB/La, Schirmer's test (≤5mm in 5 minutes), and ocular staining score
  • Treatment involves artificial tears, saliva substitutes, and hydroxychloroquine for systemic symptoms

Ankylosing Spondylitis (AS)

  • A type of spondyloarthropathy primarily affecting the spine
  • Symptoms include chronic back pain, stiffness, and uveitis
  • Diagnosis involves HLA-B27 positive and X-rays showing sacroiliac joint changes
  • Treatment involves NSAIDs, biologics (e.g., TNF inhibitors), and management of uveitis with corticosteroids

Rosacea

  • Chronic inflammatory skin condition, often on the face
  • Symptoms include erythema (redness), telangiectasia, papules, pustules, and ocular symptoms: pain, dryness, tearing, conjunctival injection
  • Diagnosis involves clinical examination
  • Treatment includes topical treatments, oral antibiotics, and laser surgery for telangiectasia or phymatous changes

Stevens-Johnson Syndrome (SJS)

  • Severe, life-threatening mucocutaneous reaction, often medication-induced
  • Symptoms include skin desquamation, mucositis, fever, respiratory symptoms, and ocular effects: conjunctivitis, corneal erosions, neovascularization
  • Diagnosis involves history of medication use or infection and clinical exam
  • Treatment involves discontinuing offending medication, supportive care, and ocular management

Xanthoma/Xanthelasma

  • Lipid-laden plaques, often related to abnormal lipid levels
  • Symptoms include yellowish plaques on skin or around eyes (xanthelasma)
  • Diagnosis involves lipid profile to assess cholesterol and triglyceride levels
  • Treatment involves surgical removal of plaques and managing underlying lipid disorders

Basal Cell Carcinoma (BCC)

  • Skin cancer affecting keratinocytes in the basal layer of the epidermis
  • Symptoms include nodular: translucent nodule with telangiectasias, rolled border, pigmented or morpheaform subtypes possible
  • Diagnosis involves clinical exam, dermoscopy, and biopsy
  • Treatment involves surgical excision (Mohs surgery for high-risk cases), cryotherapy, radiation, and 5-fluorouracil cream

Cutaneous Squamous Cell Carcinoma (cSCC)

  • Cancer of squamous cells, typically in sun-exposed areas
  • Symptoms include scaly, firm papules, or plaques, ulceration possible, itching, pain, or altered sensation
  • Diagnosis involves biopsy and clinical examination
  • Treatment involves surgical excision, Mohs surgery for high-risk areas, and epidermal growth factor inhibitors for advanced cases

Cutaneous Melanoma

  • Melanoma, a cancer of melanocytes, often fatal if untreated
  • Symptoms include irregular moles (asymmetry, border irregularity, color variation) and changes in size, color, or shape of moles
  • Diagnosis involves biopsy, dermoscopy, and sentinel lymph node biopsy
  • Treatment involves surgical excision with margins, monoclonal antibodies for metastasis, and regular skin exams and follow-up

Sinusitis

  • Inflammation of the sinus epithelium, often bacterial
  • Symptoms include unilateral facial pain, headache, eye pain, toothache, post-nasal discharge, cough, inflamed nasal mucosa
  • Diagnosis involves clinical exam and imaging for severe or recurrent cases
  • Treatment involves OTC analgesia, decongestants, and antibiotics for infections lasting longer than 10 days

Cellulitis

  • Bacterial infection of the dermis and subcutaneous fat, often from Staph or Strep species
  • Symptoms include red, warm skin, localized edema, fever, chills, and can spread to deeper tissues like muscle
  • Diagnosis involves clinical exam, culture if severe
  • Treatment involves oral or IV antibiotics, surgical drainage in severe cases

Impetigo

  • Superficial bacterial infection of the skin, often in children
  • Symptoms include non-bullous: honey-colored pustules, bullous: thin-walled vesicles in warm, moist areas
  • Diagnosis is clinical
  • Treatment involves cleaning lesions, topical antibiotics, and oral antibiotics for extensive cases

Tuberculosis (TB)

  • Mycobacterium tuberculosis infection, primarily affecting the lungs
  • Symptoms include fever, fatigue, weight loss, persistent cough, pleuritic chest pain, and can spread to kidneys, spine, adrenal glands
  • Diagnosis involves tuberculin skin test (TST) or IGRA blood test, and chest X-ray to differentiate latent vs.active TB
  • Treatment involves multi-drug regimen for active TB, isoniiazid monotherapy for latent TB, and systemic TB treatment and care for eye complications for ocular TB

Cat-Scratch Disease

  • Infection from Bartonella henselae, transmitted by cat bites or scratches
  • Symptoms include vesicular lesion, unilateral lymphadenopathy, low-grade fever, muscle/joint pain
  • Diagnosis involves history of cat interaction, and serology for Bartonella antibodies
  • Treatment involves supportive care, antibiotics for severe cases, and antibiotics for ocular involvement

Lyme Disease

  • Tick-borne bacterial infection from Borrelia burgdorferi
  • Symptoms include erythema migrans (bullseye rash), headache, arthralgia, fatigue, and can progress to systemic complications
  • Diagnosis involves clinical history, ELISA, and Western blot for confirmation
  • Treatment involves doxycycline for early disease, doxycycline for disseminated disease, and IV antibiotics for severe cases

Herpes Zoster (Shingles)

  • Reactivation of varicella zoster virus (VZV), often affecting a specific dermatome
  • Symptoms include unilateral vesicular rash, severe pain, itching, malaise, facial nerve palsy, abdominal pain if visceral involvement
  • Diagnosis is clinical based on rash and history of VZV infection
  • Treatment involves oral antivirals within 72 hours, antibacterial ointments for skin lesions, and vaccination for prevention

Histoplasmosis

  • Fungal infection caused by Histoplasma capsulatum, associated with bird/bat droppings
  • Symptoms include flu-like symptoms, respiratory distress, hypoxia, and presumed ocular histoplasmosis: punched-out "histo" spots, choroidal neovascularization
  • Diagnosis involves antigen/antibody testing, biopsy for confirmation
  • Treatment involves oral/IV antifungals for systemic infection, and anti-VEGF injections and laser photocoagulation for ocular involvement

Mucocutaneous Candidiasis

  • Yeast infection from Candida albicans, affecting mouth (thrush), esophagus, or genitals
  • Symptoms include white plaques, itching, redness, discomfort
  • Diagnosis involves surface scraping, culture, or biopsy
  • Treatment involves oral/IV antifungals and treating underlying conditions

Toxoplasmosis

  • Parasitic infection caused by Toxoplasma gondii, transmitted through cat feces or undercooked meat
  • Symptoms include acquired: headache, myalgia, lymphadenopathy, congenital: hydrocephalus, brain calcifications, retinochoroiditis
  • Diagnosis involves serology for IgG/IgM antibodies, PCR for severe cases
  • Treatment involves no treatment needed for immunocompetent, pyrimethamine, sulfadiazine, leucovorin for immunocompromised, and systemic and intravitreal therapy for severe cases for ocular involvement

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