Download Appearance Of Seasonal Allergens

Dr. Murray
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Case #1
7 year old with
pain vomiting and
weight loss. What
would you order next?
1. CT scan
2. Endoscopy with biopsy
3. Barium enema
4. Surgical consult
5. pH probe
Dr. Pfeil
Photo Slide
Case #2
What
would you
recommend?
1. Endoscopic removal using a
retrieval basket
2. Biopsy to determine composition
3. Immediate surgical consultation
4. No intervention
5. Evaluation for blue rubber bleb
nevus syndrome
Case #3
How can you
determine whether
this girl is in
trouble?
1. Weight for age growth curve
2. Tanner staging for pubertal
maturation
3. Bone age
4. Albumin
5. Triceps skinfold thickness
6. Weight-for-height comparison curve
Case #4
• A 35 year old female patient who works
at a daycare facility presents with a
several month history of diarrhea
• Stools are loose but non-bloody
• She reports “gas” and cramping
• No weight loss, fever, or extraintestinal
symptoms
• Flexible sigmoidoscopy is unrevealing
Your next
recommendation
would be:
1. Begin mesalamine and prednisone as
empiric therapy for Crohn’s disease
2. Suggest education about irritable bowel
syndrome
3. Obtain 3 stool samples for O&P studies
4. Begin ciprofloxacin therapy for
E. Coli 0157
5. Suggest a clear liquid diet until
symptoms resolve
Case #5
Daily emesis in a
healthy 3 month
old: how should you
treat this patient?
1. Upright positioning
2. Zantac, a histamine blocking antacid
3. Thickened feedings with cereal
4. Metoclopramide (Reglan)
5. Cisapride (Propulsid)
6. Do nothing and reassure the mother
Case #6
• A 50 year old woman presents with
symptoms of a 30 pound weight loss,
diarrhea, and abdominal bloating
• Stools are loose, large in volume, and nonbloody
• Initial laboratory studies show the following:
- WBC 5.0
- MCV 79
- Ferritin 2
(normal 82-99)
- Hgb 10.9
- B12 190
(normal >220)
- Endomysial Ab positive
- Albumin 2.5
Your initial
recommendation
would be:
1. Colonoscopy
2. Stool Cx, O+P, Cdiff
3. Abdominal pelvic CT scan
4. Trial of a lactose free diet
5. Duodenal biopsies (EGD)
Case #6 (con’t.)
• Endoscopy and duodenal
reveal
- Flattened villi
- Crypt hyperplasia
- Intraepithelial
lymphocytes
What
Would you
recommend?
1. Treatment with steroids for
Crohn’s disease
2. Lactose elimination
3. Gluten elimination
4. Empiric antibiotics
5. Referral to oncology
Case #7
Fecal impaction in the
Emergency Department:
what would be the
appropriate treatment?
1. Metamucil daily
2. A senna laxative twice daily
3. Colace, a stool softener
4. 1 liter of Golytely, a lavage solution
5. Mineral oil by mouth and enema
6. Fleet’s phosphosoda enema
Case #8
What
Would you
recommend?
1. Discontinuation of herbal
laxatives
2. Immediate surgical consultation
3. Search for primary melanoma
4. Discontinuance of excess
coffee ingestion
5. Screen for toxic metals
Case #9
3 year old with pain, gas,
bloating, and night-time
vomiting. What test
would you order next?
1. Upper GI barium study
2. Liver function tests
3. Stool cultures
4. Ova and parasite exams X 3
5. Endoscopy with biopsies
Case #10
What is the
most likely
diagnosis?
1. Reflux esophagitis
2. Pill induced esophagitis
3. Herpetic infection
4. HIV infection with solitary
esophageal ulceration
5. Candida esophagitis
Case #11
16 month old with
vomiting and diarrhea:
what is the most
likely treatment?
1. Lytes, CBC, and urine
2. Gatorade, 1 ounces every 3 hours
3. Frequent sips of Isomil
4. Pedialyte, an oral rehydration
solution
5. I.V. saline, 20 cc / kg bolus
6. Imodium AD, 0,5 mg twice daily
Case #12
A 4 year old with
mild diarrhea:
what would
you advise?
1. Keep NPO until diarrhea resolves
2. Offer a soy formula
3. Pedialyte, an oral rehydration solution
4. An elemental formula
5. BRAT diet (Bananas, Rice, Applesauce
and Toast)
6. Regular diet for age
Case #13
• 13 year old girl is seen for weight loss
• 5 feet 4 inches, she has gone from
135 pounds to her current 102 pounds
• Feels fit and even participated in
soccer camp last month, but she’s
wrapped in a sweatshirt in August
• Her resting heart rate is 42
What
would you
do next?
1. CT scan of the abdomen: r/o cancer
2. Thyroid screen: r/o hypertension
3. Admit to hospital
4. Upper GI films: r/o Inflammatory
Bowel Disease
5. A psychiatric evaluation for an
eating disorder
Case #14
• A 25 year old previously healthy
college student presents with
symptoms of:
- Nausea
- Early satiety
- 10 pound weight loss
- EDG is normal
What
would you
recommend?
1. Upper GI X-ray
2. Gastric emptying study
3. Colonoscopy
4. 24 hour pH study
5. Referral to the student
counseling service
Bonus
• A 25 year old in the ICU for
2 weeks ventilated with multiple
organ system failure
• Today she vomited bright red
blood and coffee grounds
• She has no prior history of
GI complaints
What is the
most likely
diagnosis?
1. Excessive acidity
2. Gastro-esophageal reflux and
esophagitis
3. Gastric ulcer
4. Stress ulcers
5. Bile reflux gastritis
6. Mallory-Weiss tear of the cardia
In this patient,
which treatment would
be most helpful?
1. A psychiatric evaluation
2. Phenergan
3. Parenteral nutriction (TPN)
4. Enteral nutrition
5. Prilosec made up as a liquid
6. Misoprostel (Prostaglandin E2)