deck 32 Flashcards
other indications of peritonsillar abscess
muffled or “hot potato voice”
prominent unilateral lymphadenopathy
treatment of peritonsillar abscess
aspiration of abscess + IV antibiotics
may need surgery
explanation of weber test
(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.
tumor type that arise within chronically, wounded, scarred or inflamed skin
SCC
tumor type that can arise within burn wounds
SCC called marlin ulcer
front of forearm
volar aspect
otosclerosis
- 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
treatment of otosclerosis
hearing amplification or surgical stapedectomy
sepsis in burn patients, and etiologic bacteria
- common from loss of skin barrier
- gram-negative organisms or fungi 5 days after burn wound
tell tale signs of burn wound infection
- wounds progress from partial thickness to full-thickness necrosis
- loss of skin graft
salivary gland enlargement in disheveled people think
major life threatening complication of retropharyngeal abscess
Can extend through alar fascia into “danger space” transmitting infection into posterior mediastinum and resulting in acute necrotizing mediastinhtis.
labs to order to test for acute hep B infection
HBsAg + anti-HBc (they are both elevated during initial infection and anti-HBc will remain elevated during the window period)
major RFs for c diff
recent abx use + age over 65 + gastric acid suppression
other impt lab finding with celiac’s
IDA
IgA deficiency in celiac’s
common
malabsorption in crohn’s?
not common
features of chronic pancreatitis on presentation
- 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
diagnosis of chronic pancreatitits
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)
signs/symptoms of SIBO
abdominal pain, diarrhea, bloating, excess flatulence, malabsorption, weight loss, anemia, and nutritional deficiencies
gold standard for diagnosis of SIBO
endoscopy with jejunal aspirate
when to order upper GI endoscopy for patients with GERD
alarm symptoms = dysphagia, odynophagia, weight loss, anemia, GI bleeding, recurrent vomiting OR are men over 50 with chronic symptoms and cancer RFs
esophageal spasm presentation
intermittent chest pain + dysphagia for solids and liquids
esophageal spasm treatment
CCBs
diagnosis of esophageal spasm
esophagram: “corkscrew” pattern
manometry: intermittent peristalsis, multiple simultaneous contractions
Endoscopy normal
treatment of duodenal ulcers from H pylori
abx + PPI
pseudoachalasia
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
porcelain gallbladder on CT
circle with calcified rim with central bile-filled dark area
porcelain gallbladder sequela
increased risk of gallbladder adenocarcinoma
porcelain gallbladder
- results from chronic cholecystitis
- chronic inflammation and irritation lead to deposition of calcium salts intramurally in gallbladder
porcelain gallbladder presentation
asymptomatic person w/ firm contender RUQ mass
retroperitoneal hematoma presentation
elderly patient with back pain on warfarin with evidence of internal hemorrhaging
courvoisier sign
- 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
dysphagia classification
oropharyngeal or esophageal
- oropharyngeal presents with difficulty initiating swallowing + cough, choking, nasal regurgitation (etiologies = stroke, advanced dementia, malignancy, MG)
test for oropharyngeal dysphagia
barium swallow
dysphagia algorithm
determine if oropharyngeal or esophageal –> if esophageal then determine if mechanical or motility
motility vs. mechanical obstruction
- dysphagia with solids and liquids at onset suggests motility disorder
- dysphagia with solids progressing to liquids suggests mechanical obstruction
how to figure out etiology of pancreatitis
if you suspect gallstones get US
- if common bile duct disease suspected –> ERCP
perforated ulcer presentation
sudden onset severe epigastric pain spreading over the entire abdomen, presenting with diffuse pain
pathophys of pt with hepatic encephalopathy on diuretics
- develop low intravascular volume despite having total volume overload –> this leads to a metabolic alkalosis with hypokalemia
initial treatment of hepatic encephalopathy w/ hypokalemia
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
other lab features of alcoholic hepatitis
elevated bilirubin &/or INR + leukocytosis, predominantly neutrophils
vitals with alcoholic hepatitis
fever
exam with alcoholic hepatitis
tender hepatomegaly
alcoholic hepatitis acute or chronic?
can be acute due to an acute increase in consumption
surveillance for cirrhotic patients
screening endoscopy to exclude varies, indicate risk of vatical hemorrhage, and determine strategies for primary prevention of variceal hemorrhage
management of esophageal varices
- 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
next step following IDA diagnosis
test for occult blood in stool (look for a cause of blood loss)
firm, solitary lymph nodes in head and neck think
- metastatic disease from SCC
- vast majority of head and neck cancer is SCC
nocturia in sickle cell disease or trait patient think…
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)
how to differentiate CML from leukemia reaction
leukocyte alkaline phosphatase (low in CML)
