case files Flashcards
if you find malignant cells on FNA (breast) what is the next step
core needle biopsy to determine invasive vs in situ
Tamoxifen cancer side effect
tamoxifen may cause uterine cancer
Aromatase inhibitors are used for what cancers?
ER + breast cancer (post menopausal)
Inhibit peripheral conversion of androgens to estrogen
Hoarseness and wheezing in GERD
atypical
may represent silent aspiration
Barrett pathology
squamous —> columnar
what is better therapy for GERD, PPI vs H2 block?
PPI is better
H2 develops resistance
long standing gerd w/ s/s refractory to medical management need?
EGD
whats better, ppi vs surgery for gerd?
TRICK! they are about equal
surgery is ok if pateitn doesnt want meds, cant afford them, just feels like it haha
Best test as objective indicator of gERD
24 hour pH monitoring
lung complication of esophogeal rupture
pleural effusion
test for esophogeal rupture
water soluable contrast esophagram
most common cause of esophogeal rupture
iatrgenic (egd)
5α-reductase inhibitor ( conversion of
testosterone to DHT). Used for BPH and malepattern
baldness.
Finasteride
α1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for α1A,D
receptors (found on prostate) vs vascular α1B receptors.
Tamsulosin
s/e may include dizziness
Surgical rx of BPH
TURP
transurethral resection of prostate
Tests for patients w/ BPH symtpoms
Creatinie- look for renal obstruction
PSA- ↑↑ would –> biopsy
UA
DRE
First step in SBO management
NG tube decompress
Fluid resuscitate
foley
if necrosis, surgery after volume
common bileduct dilation size in choledoco
> 5 mm
Treatment of severe cholangitis
ERCP decompression
+ abx/ supportive
Bleeding from a abbarent submucosal stomach artery
dieulafoy erosion
ulcer size requiring surgery
> 3 cm
Most common cause of pediatric upper GI bleed
extrahepatic portal venous obstruction–> esophageal varices
do you do surgery for lower GI Bleeding
rarely
used only when bleed cannot be identified using all other methods
Invasive lobular carcinoma in situ
15% of breast ca
orderly row of cells
not seen well on mamogram
usually bilateral, mult lesions
Arises from ductal
atypia.
Often seen early as microcalcifications
on mammography.
Ductal carcinoma in situ
Early malignancy w/o basement membrane
penetration.
GCS eye max
max 4
GCS motor max
max 6
GCS verbal max
5
dilated pupil vs side of mass lesion
dilated side= mass lesion side
watery diarrhea categories
osmotic- lactose
secretary- vibrio (↑ secretion)
functional
Oral fluids for burns
less than 15% burn
Parkland formula and time
4 ml * kg* % burn
1/2 in first 8
1/2 in second 16 hours
what “degree” of burn is most painful
second
what degree of burn is painless
3
rx: will need grafting
Burn rx that cuases leukopenia
silver sulfadiazine
does not penetrate eschar- wont help infection
Burn treatment that penetrates the full thickness
sulfamylon
painful, may cause metabolic alk
