Case Files Review Flashcards
Radiation tx to the liver
should not be done since the liver is highly susceptible to radiation injury
PET scan infections vs. tumors?
both will come up as positive on a PET since they take up glucose
Silent Aspiration
Complication of GERD and other patients suffering from dysphagia. Patients will aspirate stomach fluid etc into the windpipe but never cough.
Complications of GERD
Barrett’s Esophagus Peptic Stricture (esophageal stricture from gastric reflux)
Nissen Fundoplication
Surgical treatment for GERD and paraesophageal hiatal hernia in which the fundus of the stomach is wrapped around the LES.
Ranitidine
H2 blocker H2 blockers are not as effective in treating GERD symptoms as PPIs
First step in workup for middle aged woman with substernal and vague upper abdominal discomfort refractory to antacids?
Cardiac workup, before GI consult
Efficacy of Medical vs surgical management of GERD?
IT seems as though they are equally efficacious (Nissen vs PPI). However, Nissen is likely indicated when GERD is refractory to high dose PPI, but in these scenarios another dx for symptoms should be strongly considered.
Boerhaave Syndrome
Aka “spontaneous rupture of the esophagus.” Classic HPI is a patient retching which is followed by severe chest pain. May lead to pneumomediastinum, pleural effusions (usually L-sided), pneumothorax, and systemic infection.
Gastrografin
the substance used for water soluble esophograms which is best for Boerhaave Syndrome since it will not irritate the mediastinum.
Radiation tx to the liver
should not be done since the liver is highly susceptible to radiation injury
PET scan infections vs. tumors?
both will come up as positive on a PET since they take up glucose
Silent Aspiration
Complication of GERD and other patients suffering from dysphagia. Patients will aspirate stomach fluid etc into the windpipe but never cough.
Complications of GERD
Barrett’s Esophagus Peptic Stricture (esophageal stricture from gastric reflux)
Nissen Fundoplication
Surgical treatment for GERD and paraesophageal hiatal hernia in which the fundus of the stomach is wrapped around the LES.
Ranitidine
H2 blocker H2 blockers are not as effective in treating GERD symptoms as PPIs
First step in workup for middle aged woman with substernal and vague upper abdominal discomfort refractory to antacids?
Cardiac workup, before GI consult
Efficacy of Medical vs surgical management of GERD?
IT seems as though they are equally efficacious (Nissen vs PPI). However, Nissen is likely indicated when GERD is refractory to high dose PPI, but in these scenarios another dx for symptoms should be strongly considered.
Boerhaave Syndrome
Aka “spontaneous rupture of the esophagus.” Classic HPI is a patient retching which is followed by severe chest pain. May lead to pneumomediastinum, pleural effusions (usually L-sided), pneumothorax, and systemic infection.
Gastrografin
the substance used for water soluble esophograms which is best for Boerhaave Syndrome since it will not irritate the mediastinum.
Therapy for BPH
Initial Tx: alpha1-blocking; 5-alpha reductase Transurethral prostectomy
Specifc alpha blockers =
“-zosins” or “-osins”
Finasteride
5a-reductase inhibitor
First step in 72 yo patient without abdominal surgical history or hernias with 1 week history of abdominal distension and vomiting with PE suspect for distal bowel obstruction?
Perform a CT scan.
Electrolyte changes seen in ischemic bowel or extreme fluid depletion associated with a complicated bowel obstruction?
Anion gap metabolic acidosis (lactic acidosis)
Issue with elderly patients with small bowel obstruction?
they often present asymptomatically and therefore you have to rely more on studies. ** For instance, you will commonly see an elderly patient who is afebrile with a distended abdomen without many complaints, but with a metabolic acidosis and a leukocytosis.
“Early Small Bowel Obstruction” =
Bowel obstruction occurring within 30 days of an operation. Next step to these patients is either NG placement, with supportive / non-operative care, or potentially a CT scan first to potentially determine the exact cause of the issue.
Non operative treatment for small bowel obstruction:
Most patients will respong between 6-24 hours of treatment * Treatment includes: NPO, NG tube, close monitoring of fluid status, labs (CBC, electrolytes, amylase, plain radiographs of abdomen).
Signs of high grade bowel obstructions (ischemia or necrosis):
Persistent Pain Localized pain Fever Leukocytosis Elevated serum amylase Specific radiographic signs
When CT for small bowel obstruction patients is not indicated:
* Patients with simple adhesive obstruction * Absence of indictators of complicated bowel obstruction such as: Constant pain, localized pain, fever, leukocytosis, complete obstruction.
Most common disorders / illnesses associated with carpal tunnel syndrome:
* Diabetes mellitus * Hypothyroidism * Hyperthyroidism * Acromegaly * Myxedema * Pregnancy (temporary) * Autoimmune disorders * Lipomas of the canal * Bone abnormalities * Hematomas
Most common symptoms of CTS:
Numbness and pain in the digits radial fingers + half of the ring finger. Positive Tinel’s and Phalen’s tests
Treatment for CTS:
Initially medical: splint with slight extension + NSAIDs. Possibly local injection of steroids, but not more than 3 injections per year. Surgical Therapy: for persistent symptoms despite medical therapy
Conditions associated with MEN-2A and 2B?
MEN-2A: * Medullary Thyroid Cancer
Typical treatments and when they are indicated for a pneumothorax?
* Typically a chest tube alone is a fine treatment * Surgery involves resection of pleural blebs and pleurodesis. * Surgery is indicated if reexpansion has not occurred with a chest tube after 3-5 days, if there has been a recurrence or there is a very high risk of recurrence.
Typical sings of a tension pneumothorax:
* Absent breath sounds on affected side * Deviated trachea towards the non-affected side as it is getting pulled in that direction. * Hypotension * CXR is clear on affected side (hemothorax will be opacified)
Risk factors for secondary spontaneous pneumothorax:
* COPD * Older than 50 yo * Primary or secondary neoplasm * Infection (TB, pneumocystis) * Catamenial (pulmonary endometriosis) * Asthma * Sarcoidosis * Cystic fibrosis
Risk factors and mechanism for primary spontaneous pneumothorax:
* Mechanism = rupture of subpleural blebs * Risk factors = Young age, smoking, tall & thin body habitus.
Complications of flail chest?
* Lung dysfunction associated with injuries to the lungs under the flail segment * Atelectasis secondary to reduced ventilation from pain of injury.
