Deck 5 Flashcards by Jessica Pederson

PJP vs. CMV pneumonitis presentation

PJP is more indolent (less acute onset) and CMV is more acute, both have diffuse interstitial infiltrates

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next step in a thyroid nodule in a patient with low TSH

radionucleotide scan

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nontender bilateral enIargement of the parotid glands

sialodenosis from malnutrition

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when to intervene surgically in infective endocarditis

acute heart failure, extension of the infection (fistula etc), recurrent septic emboli, large vegetations

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do you need a upper GI study for dx dumping syndrome

nope just clinical unless you arent super clear

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what organism is the culprit for puncture wounds

pseudomonas

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signs of SIBO

chronic watery diarrhea, bloating, flatulence

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how to dx SIBO

carbohydrate breath test

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where do most cases of ludwig angina arise from

dental infections

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signs of ankylosing spondylitis

enthesis (heel pain), back pain, SOB from trouble with chest wall expansion, dactylitis, uveitis

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complications of ankylosing spondylitis

aortic regurg, cauda equina syndrome, vertebral compression fractures

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LFTs in HCC

normal or elevated

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do you have back pain in scoliosis

not typically–> investigate other causes

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treatment of small pneumothorax

oxygen

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which is cholangitis is associated with UC

primary sclerosing cholangitis

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breast necrosis signs physical exam

skin retractions and dimpling

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breast necrosis management after biopsy

nothing, just observation

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what is the protein that binds thyroid hormone

thyroxine-binding-globulin

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precursor to thyroid hormone

thyroglobulin

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ECG cahnges for cardiac aneurysm

persistent ST elevation and deep Q waves

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what ejection fraction % is considered for surgical repair of mitral regurg

30-60% bc the regurg overestimates the actual stroke volume

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what is adhesive capsulitis

glenohumoral capsule contracture,

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clinical signs of adhesive capsulitis

increased stiffness for 2 months, then trouble lifting shoulder over head, and pain with ROM

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treatment of adhesive capsulitis

ROM exercises, NSAIDs, corticosteroids injection

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how to treat acute hyponatremia

hypertonic (3%) saline boluses

what can happen after heparin if someone starts bleeding

HIT

A-a gradient in ARDS

high

does diffuse pulmonary edema correct with supplemental O2

nope

does atelectasis, lobar pneumonia, empyema etc correct with supplemental O2

yes because it is a localized process

how do you get splenic abcess

hematogenous spread

does TB cause air fluid levels

not as common

does TB have foul smelling sputum

complications of myopia

retinal detachment, macular degeneration

what do patients need to be given who are on warfarin before they go into surgery

prothrombin complex concentrate to reverse the effects of the warfarin AND IV vitK

when do you take a patient to surgery for cholecystitis

when they have complications like emphysematous choly

treatment of purulent pericarditis

pericardiocentesis

treatment of noncomplicated calculous cholecystitis

NPO, ABX, fluids, lap chole within 72 hours

when do you get a HIDA scan

when U/S is inconclusive of gallbladder disease

treatment of chronic pancreatitis

pancreatic enzyme supplement

imaging findings of chronic pancreatitis

calcifications, pancreatic atrophy

what happens around 3 days post MI

papillary muscle rupture

primary treatment of papillary thyroid cancer

surgical resection

treatment of acute cholangitis

ERCP with spincterotomy and drainage

do you do EGD on a patient that has possible perfed ulcer

nor, do a CXR instead to see if there is free air

how to tell if ascitic fluid is from portal hypertension

SAAG (serum-fluid albumin)

do empyemas or lung abcesses have air fluid levels

abcesses

treatment of trochanteric bursitis

exercise, NSAIDs, steroid injection

how do you dx subclavian steal syndrome

you test blood pressures in each arm

which arm has lower blood pressure in subclavian steal synd

the arm with the stenosis

which skin cancer has telangectasias

basal cell CA

pathophys of fibromuscular dysplasia

multifocal fibrous and muscular thickening of the arterial wall leading to stenosis

initial management of suspected AAA rupture

point of care US, no time for CTA

petechiae/skin rash with purpura after PCI for MI

cholesterol embolization syndrome from dislodged cholesterol bits that damange vessels

wide fixed split S2

ASD

mass within a mass in the lung dx

likely aspergilloma inside a prior TB cavitation

treatment of esophagitis from GERD

PPI (omeprazole) and an antacid

labs for pancreatitis

elevated amylase and lipase specifically

what does peritonitis signs indicate

perforated hollow viscus (diverticuliits, appy, ulcer)

treatment of transitional cell carcinoma in situ

endoscropic resection

treatment of transitional cell carcinoma that invades bladder wall

partial or full cystectomy

frist step before surgery of bony mets

steriods to reduce inflammation

clinical signs of ovarian torsion

sudden onset lower abdominal pain, hypertension, tachy, fever, palpable mass

treatment of ovarian torsion

laporoscopy

physical exam of testicular torsion

testicle with abnormal lie (typically transverse), absent cremastic reflex, exquisite pain

treatment of peripheral arterial disease after conservative measures

arterial bypass

normal urine pH

6-7.5

lab values indicating refeeding syndrome

hypophosphatemia and hypomagnesia

signs of hypercalcemic crisis

somnolence, lethargy, short QT

in tension pneumo, do you do needle or intubate first

needle then intubate

where is the break if there is wrist drop

distal humerus

signs of acute congestive heart failure

tachycardia, tachypnea, hypoxia, JVD, end expiratory wheezing,

what is cor pulmonale

RHF from chronic pulmonary hypertension

at what size do AAA need operating

>5.5cm

management of smaller AAA

serial imaging

management of thrombophelbitis

source control by removiing IV and the segment of vein infected

cause of bone pain in Squamous cell lung CA patients

paraneoplastic syndrome of PTPrP which causes increased osteoclast activity and eats away at bone

lung abcess vs. empyema air fluid level

abcess HAS the air fluid level

dx imaging for intusscussception

abdominal ultrasound, then air enema with U/S

next step of management of variceal bleeding after fluids

endoscopy and variceal banding

breast mass eval in a pt. younger than 30

ultrasound

overlying skin characteristics in abcesses

fluctuance, erythema, skin changes

colors of breast cyst fluids

clear, brown, green etc

steps of thyroid CA dx

physical exam, TSH, radio scinitigraphy, FNA

treatment of hypercalcemia

normal saline infusion, bisphosphonates

what is pulsus paradoxus

drop in systolic bp during inspiration

when do you see pulsus paradoxus

pericarditis, cardiac tampenode, pneumothorax

gastrographin vs. barium for esophagraphy

gastrographin if suspected perf, barium for regular swallow bc barium can irritate the esophagus and cause mediastinitis