DAY3 Flashcards
moderate to severe acute abdominal pain, copious emesis, cramping pain; fever signs of dehydration, hypotension
Small Bowel Obstruction
partial SBO vs complete SBO
partial will have gas
adhesion (post surgery accounts for 60%), hernia (10 to 20%), neoplasm (10 to 20%)
etiology of SBO
leading cause of SBO in children
Hernia
signs and symptoms for nephrolithiasis (kidney stones)
flank tenderness; pain radiating to the groin; hematuria; n/v
diagnosis of kidney stones
CT scan (KUB xray has less radiation and visualizes 93%)
which type of kidney stones can only be seen by CT scan
Uric acid are radiolucent
kidney stones < …. in diameter can pass through urethra; stones < —– in diameter can be treated with extrcorporeal shock wave lithotripsy, percutaneous nephrolithotomy, or retrograde ureteroscopy
5mm and 3 cm
entrapement of the median nerve at the wrist.. paresthesias, pain and occasionally paralysis.. symptoms worsen at night or when wrists are held in flexion or extension..
Carpal Tunnel syndrome.. diagnosed with Tinel’s sign, Phalen’s sign
Tinel’s sign
tapping on the median nerve elicits tingling
Phalen’s sign
hand’s in prayer elicits pain
which fingers are impacted from carpal tunnel syndrome
1st 2nd 3rd and 1/4 4th fingers
fingers go numb, coldness, color changes from white to blue to red…inadequate blood flow, oxygen is depleted in the tissue, blood comes rushing back
Raynaud syndrome
testing the rotator cuff supraspinatus for tear
Drop Arm test
what is the test for HIV
ELISA followed by western blot for specificity
destroys CD4 and T lymphocytes, a retrovirus
HIV
how to classify AIDS
HIV infection plus CD4 count <200 plus AIDS defining conditions (pneumonia, cryptosporidons)
recurrent oral infections which present as a cluster of crusted vesicles on an erythematous base.. often triggered by sun and fever
HSV-1
labial cluster of blisters on an erythematous base
HSV-2
tx for HSV
oral or IV acyclovir
what class of drug: Fluconazole, Ketoconazole, Clotrimaole, Miconazole, Itraconazole, VOriconazole
antifungal
pruritic lesions in crops over a period of 2 to 3 days, evolving from red macules and crusting over… all over the body except palms and soles
varicella (chicken pox)
lesions cropping up along the nerve’s dermatomal distribution… outbreaks are usually preceded by intense local pain and arise as grouped blisterd
herpes zoster (shingles)
following an outbreak of herpes zoster
postherpetic neuraglia (very painful)
coagulation disorders - in boys, bleeding and arthropathy
Hemophelia A
Hemophelia B
Hemophelia C
Von Willebrand’s disease
most common inherited bleeding disorder, autosomal dominant,… treated with DDAVP (desmopressin)
heavy menstrual bleeding, excessive gum bleeding, bleeding after injuries
Hemophelia A
factor VIII deficiency - spontaneous hemorhage into tissue and joints
elongated fingers and arms
Marfan Syndrome
cyclical pelvic, rectal pain.. dysmenorhea, painful intercourse (dyspareunia)
endometriosis
diagnosis of endometriosis
laporascopy
ovaries with endometriosis
Chocolate cyst
noncyclical pain plus menorrhagia and enlarged uterus
adenomyosis (endometrial tissue in the muscle of the uterus)
retained material of conception following delivery, miscarriage, abortion of foreign body such as an IUD causing inflammation of endometrium
endometritis
most common benign neoplasm of the female genial tract
uterine leiomyoma (fibroid)
risk factors… hypertension, high cholesterol, vascular diseases, smoking, gender (males > females), age.. most are abdominal, commonly associated with atherosclerosis
aortic aneurysms
men 65 to 75 with a history of smoking should be screened…
with ultrasound for abdominal aortic aneurysms
what size of aneurysm needs surgical attention..
abdominal >5.5 cm; thoracis >6cm
aortic aneurysm are associated wtih..
atherosclerosis
tearing/ripping pain in the anterior chest in ascending disection.. interscapular back pain in descending disection..hypertension
aortic dissections
muscles of rotator cuff
supraspinatus - abducts
infraspinatus - externally rotates
teres minor - adducts, externally rotates
subscapularis - adducts, internally rotates
tests for bicipital tenosynovitis
yergason’s test/ speed test
most common rotator cuff muscle tear
supraspinatus - abduction of shoulder (test with drop arm test)
patients shoulder passively abducted to 90 degrees. patients is instructed to slowly lower arm.. patient is unable
Drop Arm Test
treatment: no food, IV hydration, analgesia, antiemetics, antibiotics with anaerobi can gram (-) coverage
Dx: fever, mild leukocytosis, CT scan with PO and IV contrast, ultrasound
RLQ pain.. mcburney point
appendicitis
acute causes of pelvic pain except…
- Appendicitis
- Ovarian torsion
- Pelvic inflammatory disease
- ectopic pregnancy
- acute pancreatitis
pancreatitis is epigastric pain…
RUQ pain…
- small bowel obstruct
- biliary colic
- apendicitis
- diverticulitis
biliary colic..
apendicitis and diverticulits are LQ
normal weight or overweight..disturbed body image, extensive measure to avoid weight gain, binge eating
Bulimia Nervosa
percentage of anorexia nervosa patients that are women
90 to 95%
percentage under body weight for anorexia
15%
CN1 (one)
olfactory
CNII (two of them)
vision - pupil afferent
CNIII
occulomotor - move eye - pupil efferent
CNIV
trochlear - move eye
CNV
trigeminal - 3 branches
CNVI
abducens - move eye
CNVII
facial - saliva, tears, bells palsy, ant 2/3 tongue
CNVIII
vestibulocochlear - balance, hearing
CNIX
glossopharyngeal - 1/3 tongue
CNX
vagus - voice swallowing, taste, thoracic and abdomen
CNXI
accessory nerve - shoulder head viscera
CNXII
hypoglossal - tongue movement, swallowing
motor (movement) to SCM and trapezius muscles
CNXI
sensory only
CN I, II, VIII
parasympathetic nerves
CN III, VII, IX, X
not related with eye movement: Cranial nerve II Cranial nerve III Cranial nerve IV Cranial nerve VI
cranial nerve II is vision but not movement
innervation to constrict pupil and accomodate eye... CN1 CNII CNIII CNV
CNIII.. occulomotor - efferent
CN1 - hearing
CNII - vision - afferent
CNV - trigeminal
motor and sensory
CNV, CNV3
motor nerves intrinsic and extrinsic of the tongue…
CNXII — hypoglossal
taste from the anterior 2/3 of the tongue
- CNV
- CNVII
- CNIX
- CNX
CNVII - facial 2/3 tongue
taste from posterior 1/3 of tongue
- CNV
- CNVII
- CNIX
- CNX
CNIX - glossopharyngeal
which CN have taste fibers
CN VII, IX, X
inflammation of CNVII
FACIAL - paralysis of one side of the face…
innervation to most of the abdomen (parasympathetic)
CNX - vagus
trigeminal neuralgia is a disorder in CN…
CNV is trigeminal nerve
Bells palsy is disorder of CN..
CNVII is Facial
Suicide Risk assessment… SADPERSONS
S: male sex A: age <19 or >45 D: depression P: previous attempt E: excess alcohol or substance use R: rational thinking loss S: social support lacking O: organized plan N: no spouse S: sickness
which is incorrect?
- men complete suicide 3 times more than woman
- men attempt suicide 3 times more frequently
- those >75 account for 25% of completed suicides
- 2/3 of completed suicides are white males
men attempt suicide 3 times more frequently is incorect.. women attempt more but men complete more
macule vs. patch
macule is .5 FLAT
papule vs plaque
papule is ,.5cm - plaque is >.5cm ELEVATED, PALPABLE
vesicle vs bullae
vesicle is .5cm ELEVATED, FLUID FILLED
abdominal discomfort with incomplete relief with defecation, intermittent diarrhea or constipation, aggravated by psychological factors
IRRITABLE BOWEL SYNDROME - this is a functional problem
IBD
Crohn’s
Ulcerative Colitis
these are anatomical problems
upper endoscopy vs lower endoscopy
EsophagoGastroDuodenoscopy vs Colonoscopy
colonscopy visualizes…
large intestine
Coumadin (warfarin) is used for…
inhibits synthesis of Vit K.. clotting
female patient presents with myalgias, insomnia, fatigue. 11 of 18 points of triggering pain..
Fibromyalgia
Myasthenia gravis is drooping eyelids just above pupils..
Fat soluble vitamns.. FADEK
vit A, D, E, K…
antioxidant.. A, C, E
macrominerals example..
calcium, magnesium, potassium…
zinc is micronutrients.. good source is oysters
adverse effect of IBProfen (motrin, advil)
GI Bleeding
adverse effect of acetaminophen (tylenol)
hepatotoxic.. liver problems
blood pressure 220/140 with headache and papilledema (edema in eyeball)
ER reference..
proximal muscle weakness, doing the edrophomium test shows immediate relief, ptosis (eyelid drooping)
Myasthenius Gravis
instrument to examine external ear canal
otoscope
opthalmoscope - eyes
sigmoidoscope - sigmoid colon
broncoscope - lungs
laryngoscope - larynx
darkly pigmented skin - John F Kennedy
Addisons disease
side effect of lipitor (statin drugs)
myalgia muscle pain…
HmgCOA inhibitor which also inhibits COQ10
risk factor of osteoporosis
- cheese
- fish
- sun exposure
- smoking
smoking
uterine bleeding in post menopausal women…
uterine cancer
when blood pressure falls the kidney releases…..
Renin…
part of the RAAS process… renin.. angiotension 1.. angiotension 2.. aldosterone..
menorrhagia can lead to….
- pernicious anemia
- iron deficiency anemia
- vit B9 folic acid anemia
- vit b12 cobalamin anemia
iron deficiency anemia…
macrocystic anemia.. VIT B9 and VIT B12 deficiency
african american woman, butterfly malar rash, arthritis, +ANA
- RA
- SLE
- ALS
- MS
2. SLE systemic lupus.. DOPAMINE RASH Discoid rash Oral Ulcers Photosensitivity Arthritis Malar rash Immunologic criteria Neurologic symptoms Elevated ESR Renal disease ANA + Serositis Hematologic abnormalities
leading cause of blindness in the united states
diabetic retinopathy
gradual vision loss in patients with diabetes
progression can be slowed with tight glucose and BP control