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Family med > deck 32 > Flashcards

deck 32 Flashcards

1
Q

other indications of peritonsillar abscess

A

muffled or “hot potato voice”

prominent unilateral lymphadenopathy

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2
Q

treatment of peritonsillar abscess

A

aspiration of abscess + IV antibiotics

may need surgery

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3
Q

explanation of weber test

A

(placing tuning fork in middle of head)
- sound materializes to affected hear with conductive hearing loss because the affected ear cannot hear the ambient noise of the room. As a result, inner ear is able to pick up the vibration better and perceives it as louder.

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4
Q

tumor type that arise within chronically, wounded, scarred or inflamed skin

A

SCC

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5
Q

tumor type that can arise within burn wounds

A

SCC called marlin ulcer

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6
Q

front of forearm

A

volar aspect

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7
Q

otosclerosis

A
  • common cause of conductive hearing loss n adults, especially those in their 20s and 30s
  • abnormal remodeling of otic capsule thought to be a possible autoimmune process
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8
Q

treatment of otosclerosis

A

hearing amplification or surgical stapedectomy

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9
Q

sepsis in burn patients, and etiologic bacteria

A
  • common from loss of skin barrier

- gram-negative organisms or fungi 5 days after burn wound

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10
Q

tell tale signs of burn wound infection

A
  • wounds progress from partial thickness to full-thickness necrosis
  • loss of skin graft
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11
Q

salivary gland enlargement in disheveled people think

A
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12
Q

major life threatening complication of retropharyngeal abscess

A

Can extend through alar fascia into “danger space” transmitting infection into posterior mediastinum and resulting in acute necrotizing mediastinhtis.

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13
Q

labs to order to test for acute hep B infection

A

HBsAg + anti-HBc (they are both elevated during initial infection and anti-HBc will remain elevated during the window period)

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14
Q

major RFs for c diff

A

recent abx use + age over 65 + gastric acid suppression

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15
Q

other impt lab finding with celiac’s

A

IDA

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16
Q

IgA deficiency in celiac’s

A

common

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17
Q

malabsorption in crohn’s?

A

not common

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18
Q

features of chronic pancreatitis on presentation

A
  • chronic epigastric abdominal pain that can radiate to the back and is partially relived by sitting upright or leaning forward
  • diarrhea, steatorrhea, weight loss from malabsorption
  • ## can cause diabetes due to pancreatic endocrine failure with glucose intolerance
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19
Q

diagnosis of chronic pancreatitits

A

CT (looking for calcifications)
(in contrast to widespread inflammation, CP causes patchy inflammation and fibrosis so malaise and lipase can be normal or only slightly elevated)

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20
Q

signs/symptoms of SIBO

A

abdominal pain, diarrhea, bloating, excess flatulence, malabsorption, weight loss, anemia, and nutritional deficiencies

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21
Q

gold standard for diagnosis of SIBO

A

endoscopy with jejunal aspirate

22
Q

when to order upper GI endoscopy for patients with GERD

A

alarm symptoms = dysphagia, odynophagia, weight loss, anemia, GI bleeding, recurrent vomiting OR are men over 50 with chronic symptoms and cancer RFs

23
Q

esophageal spasm presentation

A

intermittent chest pain + dysphagia for solids and liquids

24
Q

esophageal spasm treatment

A

CCBs

25
Q

diagnosis of esophageal spasm

A

esophagram: “corkscrew” pattern
manometry: intermittent peristalsis, multiple simultaneous contractions
Endoscopy normal

26
Q

treatment of duodenal ulcers from H pylori

A

abx + PPI

27
Q

pseudoachalasia

A

narrowing of the distal esophagus secondary to causes other than denervation (eg, esophageal cancer)
- clues= weight loss + rapid symptom onset + presentation at age over 60

28
Q

porcelain gallbladder on CT

A

circle with calcified rim with central bile-filled dark area

29
Q

porcelain gallbladder sequela

A

increased risk of gallbladder adenocarcinoma

30
Q

porcelain gallbladder

A
  • results from chronic cholecystitis

- chronic inflammation and irritation lead to deposition of calcium salts intramurally in gallbladder

31
Q

porcelain gallbladder presentation

A

asymptomatic person w/ firm contender RUQ mass

32
Q

retroperitoneal hematoma presentation

A

elderly patient with back pain on warfarin with evidence of internal hemorrhaging

33
Q

courvoisier sign

A
  • nontender, distended gallbladder
  • cancer in head of pancreas (where most pancreatic cancer tumors present) –> backup of bile –> intra and extra hepatic biliary duct dilation.
  • usually no pain
34
Q

dysphagia classification

A

oropharyngeal or esophageal
- oropharyngeal presents with difficulty initiating swallowing + cough, choking, nasal regurgitation (etiologies = stroke, advanced dementia, malignancy, MG)

35
Q

test for oropharyngeal dysphagia

A

barium swallow

36
Q

dysphagia algorithm

A

determine if oropharyngeal or esophageal –> if esophageal then determine if mechanical or motility

37
Q

motility vs. mechanical obstruction

A
  • dysphagia with solids and liquids at onset suggests motility disorder
  • dysphagia with solids progressing to liquids suggests mechanical obstruction
38
Q

how to figure out etiology of pancreatitis

A

if you suspect gallstones get US

- if common bile duct disease suspected –> ERCP

39
Q

perforated ulcer presentation

A

sudden onset severe epigastric pain spreading over the entire abdomen, presenting with diffuse pain

40
Q

pathophys of pt with hepatic encephalopathy on diuretics

A
  • develop low intravascular volume despite having total volume overload –> this leads to a metabolic alkalosis with hypokalemia
41
Q

initial treatment of hepatic encephalopathy w/ hypokalemia

A

volume resuscitation + repletion of hypokalemia (hypokalemia can exacerbate HE because intracellular potassium is excreted and replaced by hydrogen ions to maintain electroneutrality –> this causes increased NH3 production (glutamine production) in renal tubular cells

42
Q

other lab features of alcoholic hepatitis

A

elevated bilirubin &/or INR + leukocytosis, predominantly neutrophils

43
Q

vitals with alcoholic hepatitis

A

fever

44
Q

exam with alcoholic hepatitis

A

tender hepatomegaly

45
Q

alcoholic hepatitis acute or chronic?

A

can be acute due to an acute increase in consumption

46
Q

surveillance for cirrhotic patients

A

screening endoscopy to exclude varies, indicate risk of vatical hemorrhage, and determine strategies for primary prevention of variceal hemorrhage

47
Q

management of esophageal varices

A
  • endoscopic vatical ligation OR administration of nonselective beta blocker (propranolol or nadolol), which reduce portal venous pressure by blocking adrenergic vasodilatory response of mesenteric arterioles, resulting in unopposed alpha-adrenergic tone, vasoconstriction, and reduced portal blood flow.
  • choice depends on size of varices
48
Q

next step following IDA diagnosis

A

test for occult blood in stool (look for a cause of blood loss)

49
Q

firm, solitary lymph nodes in head and neck think

A
  • metastatic disease from SCC

- vast majority of head and neck cancer is SCC

50
Q

nocturia in sickle cell disease or trait patient think…

A

hyposthenuria (impairment in kidney’s ability to concentrate urine. RBC sickling in the vasa recta of inner medulla, which impairs countercurrent exchange and free water reabsorption)

51
Q

how to differentiate CML from leukemia reaction

A

leukocyte alkaline phosphatase (low in CML)

Family med (48 decks)

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