Dr.s P's notes 2 Flashcards
1
Q
What is the treatment for biliary pancreatitis?
A
NPO, IVFs, supportive
2
Q
How can you differentiate between regular pancreatitis, from hemorrhagic pancreatitis?
A
hematocrit will drop
3
Q
What is the treatment for hemorrhagic pancreatitis?
A
- Intensive supportive care (poor prognosis)
- Daily CT scans to check for cysts
4
Q
What is the treatment for pancreatic abscesses?
A
Percutaneous radiological drainage
5
Q
What is a necrosectomy?
A
Removal of dead parts of a pancreas
6
Q
What are the symptoms of a pancreatic pseudocyst?
A
Similar to pancreatic cancer–early satiety, pressure etc
7
Q
At what size are pancreatic pseudocysts removed?
A
greater than 6 cm or for longer than 6 weeks
8
Q
What are the s/sx of chronic pancreatitis?
A
Diabetes
Steatorrhea
Constant abdominal pain
9
Q
What are the three major categories of tumors, and what part of the developing embryo does each come from?
A
Epithelial tumors (ectoderm) Sarcomas (mesoderm) Adenocarcinomas (endoderm)
10
Q
What are the four places that tumors like to met to?
A
Lung
Liver
Brain
Bone
11
Q
What is the usual route of metastasis for adenocarcinomas?
A
lymphatics and hematogenously
12
Q
What is the usual route of metastasis for sarcomas?
A
hematogenously
13
Q
What is the classic side effect of bleomycin?
A
Pulmonary fibrosis
14
Q
What is the classic side effect of adriamycin?
A
myocardial damage
15
Q
What is the classic side effect of cyclophosphamide? treatment?
A
Hemorrhagic cystitis
Acrolein (mesna is treatment)
16
Q
What is the classic side effect of platinum based chemotherapy drugs?
A
Neurotoxic
17
Q
What are the characteristics of fibroadenomas?
A
Firm, rubbery mass that moves easily with palpation
18
Q
What happens to mammary dysplasia with menopause? menstruation?
A
Disappears with menopause
Symptomatic with menstruation
19
Q
What is the presenting symptom of intraductal papilloma?
A
Bloody nipple discharge
20
Q
What is the treatment for breast CA in pregnancy?
A
No radiotherapy or hormonal manipulations
No chemo during the first trimester
21
Q
What is the radiological appearance of breast cancer?
A
Irregular, spiculated mass with asymmetric density, architectural distortion, or fine microcalcifications
22
Q
True or false: XRT usually follows a lumpectomy
A
True
23
Q
What is the treatment and f/u for large breast tumors just beneath the areola?
A
Simple total mastectomy, with no XRT needed
24
Q
When is a mastectomy indicated for ductal carcinoma in situ?
A
If there are multiple, dispersed lesions
25
True or false: inoperability of a breast tumor is based on mets
False--based on local extent
26
What is the difference in medication for a ER positive breast CA for pre and postmenopausal women?
Pre = tamoxifen
| Post - anastrozole
27
True or false: as soon as breast cancer spreads to lymph nodes, "the cat is out of the bag"
True
28
True or false: thyroid cancer does not affect thyroid function
true
29
Why is a total thyroidectomy indicated for the treatment of follicular cancer?
Because mets can take up I if not competing against normal thyroid tissue 9easy to detect)
30
Medullary thyroid cancer develop from what cells?
C cells
31
What are the three diseases of MEN1?
Pituitary
parathyroid
Pancreatic cancer
32
What are the three diseases of MEN2A?
Medullary thyroid cancer
Parathyroid
Pheochromocytoma
33
What are the three diseases of MEN2B?
Medullary thyroid cancer
mucosal neuromas
Pheochromocytoma
34
What is the purpose of the low dose dexamethasone suppression test?
If responds, r/o cushing's
35
What is Zollinger-Ellison syndrome?
gastrinoma leading to wicked GERD
36
What is nesidioblastosis?
is a devastating hypersecretion of insulin in the newborn, requiring 95% pancreatectomy.
37
What are the PE findings of a glucagonoma?
mild diabetes, a touch of anemia, glossitis, and stomatitis.
38
Appropriate response to postural changes (more aldosterone when upright than when lying down) suggests what: adrenal hyperplasia, or adeoma
hyperplasia
39
What are the two major groups of people who get renovascular HTN?
Young women with fibromuscular dysplasia
| Old men with arteriosclerosis
40
"tomy" suffix designates what procedure?
Cutting into
41
"ectomy" suffix designates what procedure?
to take out or resect
42
"ostomy" suffix designates what procedure?
to make a mouth
43
How do you name an artificial anastomosis?
put the two organ names together, followed by "-ostomy" (e.g. Ileotransverse colostomy)
44
"plasty" suffix designates what procedure?
To change the shape of something
45
"pexy" suffix designates what procedure?
to fix in place
46
"rrhaphy" suffix designates what procedure?
means to saw together (e.g. herniorrhaphy")
47
What is the most common type of esophageal atresia?
Proximal atresia, with a fistula between the lower esophagus and the trachea
48
What should be done if there is anal atresia, but a patent fistula?
May fix, or wait until toilet training starts to fix
49
What should be done if there is anal atresia, and no patent fistula?
High colostomy, with fixing later
50
What technique is used to x-ray imperforate anus?
done with child upside down, so air will collect at the end of the atretic tract
51
Congenital diaphragmatic hernia is always on the right or the left? Why?
Left, since liver gets in the way on the right
52
How soon after birth should a congenital diaphragmatic hernia be repaired? Why?
3-4 days, since need to allow some maturation
53
Green emesis + double bubble sign on x-ray indicates what?
Duodenal atresia
Annular pancreas
Malrotation
54
What are the x-ray findings of intestinal atresia?
Multiple air fluid levels throughout the abdomen
55
When should repair of exstrophy of the bladder take place?
1-2 days after birth, since delayed repairs do not work
56
What are the s/sx of necrotizing enterocolitis?
Feeding intolerance
Abdominal distention
rapidly dropping platelet count
57
What is the treatment for necrotizing enterocolitis?
Broad spectrum abx, supportive
Surgery if abdominal wall erythema develops
58
What are the s/sx of meconium ileus?
x-rays with dilated loops of small bowel, with a ground glass appearance
59
What is the treatment for meconium ileus?
Gastrografin enema is both diagnostic (microcolon and inspissated pellets of meconium in the terminal ileum) and therapeutic (Gastrografin draws fluid in, dissolves the pellets).
60
At what age does hypertrophic pyloric stenosis develop? What are the classic s/sx?
3 weeks
| nonbilious projectile vomiting, and olive-sized mass in the RUQ
61
What is the treatment for hypertrophic pyloric stenosis?
IVFs, and TPN, surgical correction
62
What are the s/sx of biliary atresia? When does it show up?
6-8 weeks
| Progressive jaundice
63
What will an x-ray show with hirschsprung's disease?
distended proximal colon and normal looking distal colon
64
When does intussusception usually occur?
6-12 months of age
65
What are the s/sx of intussusception?
Colicky pain, with currant jelly stools, and a vague mass on the right side of the abdomen
66
What is the treatment for intussusception?
Ba enema
67
Subdural hematoma plus retinal hemorrhage in a baby = ?
Shaken baby syndrome
68
When does an undescended testicle need to be surgically fixed?
By age one
69
Abdominal mass that moves up and down on a baby = ?
Liver tumor
70
Large, nonmoving abdominal tumor in an infant = ?
Wilm's tumor
| Neuroblastoma
71
What are the s/sx of vascular rings?
Pressure on the tracheobronchial tree--crowing respiration, dysphagia,
72
What are the characteristics common to left to right shunts?
Pulmonary overload
| Murmur
73
Do ASDs produce systolic, or diastolic murmurs?
systolic
74
What is the prognosis for small VSDs? (2)
most are self limiting if in the muscular portion of the septum
Problematic if in the membranous portion
75
What are the characteristics that are common in right to left shunts?
Murmur
Diminished vascular markings
Cyanosis
76
When do the s/sx of tetralogy of Fallot appear?
5-6 years of age
77
What are the heart sounds that are characteristic of Tet babies?
systolic ejection murmur in the left third intercostal space
78
new born with cyanosis in the first 1-2 days of life is suspicious for what diagnosis?
transposition of the great vessels
79
What is the indication for repair of the aortic valve with aortic stenosis?
More than 50 mmHg gradient or if symptomatic
80
What are the s/sx of aortic insufficiency?
wide pulse pressure
| diastolic heart murmur
81
Young drug addicts that suddenly develop CHF is suspicious for what heart problem?
Acute aortic insufficiency
82
What heart arrhythmia classically develops from mitral stenosis?
a-fib
83
Mitral regurg is most commonly caused by what?
Valvular prolapse
84
Where does the murmur radiate to with mitral regurgitation?
Axilla and back
85
What is the vessel of choice for a CABG?
Internal thoracic artery
86
What is the treatment for low pulmonary wedge pressure post MI? High?
```
Low = IVFs
High = ventricular failure
```
87
What are the chances of a coin lesion found on a CXR is malignant in a person over the age of 50?
80%
88
What are the first two tests that should be ordered following the discovery of a coin lesion of the lung?
CT of the chest/liver, and sputum cytology
89
What is the minimum FEV1 needed to to perform a pneumonectomy to ensure that there is enough residual lung function?
800 mL
90
What is subclavian steal syndrome?
Subclavian will steal blood from vertebral if arm is exercised 2/2 clot or stenosis at the origin of the subclavian
91
What are the chances of rupture for a tender abdominal aortic aneurysm? (relatively) What is the treatment?
High--do surgery
92
What is the Ankle-brachial-index that indicates the need for surgery?
Less than 0.8
93
What is the surgical treatment for intermittent claudication?
Reversal of the saphenous or stenting
94
What is the progression of the disease with claudication? (3)
Claudication, resting pain, ulceration and gangrene
95
What is the classic presentation of a patient with bad claudication?
Cannot sleep 2/2 pain, so hangs legs off bed, which cause legs to have a return to color
96
Urgent evaluation of an arterial embolization is needed within what timeframe to save the limb?
6 hours
97
What is the treatment for an arterial embolization to a limb?
Thrombolytics if not fully occluded
| Stenting if fully occluded
98
What is the treatment for type B aortic dissections?
BP control
99
What are the two absolute contraindications for a FNA?
- Hemangioma of the liver (will bleed)
| - testicular mass (invariably malignant, and will seed)
100
How does basal cell carcinoma usually present itself?
Small, raised waxy lesion, or nonhealing ulcer
101
Which has a preference for the upper face: basal cell or squamous cell?
Basal cell
102
What are the characteristics of growth and metastases for a basal cell carcinoma?
Slow growing, and rarely metastasizes
103
What is the margin needed to basal cell carcinoma?
1 mm
104
What is Mohs surgery?
cutting basal cell carcinoma out by microscopic fractions until a clear margin is achieved
105
What are the margins needed for squamous cell carcinoma?
0.5 ro 2 cm
106
What are the ABCDEs of melanoma?
```
Asymmetry
Borders (irregular)
Color changes within lesion
Diameter over 0.5 cm
Evolution
```
107
Lesions of melanoma beyond what depth have a terrible prognosis?
2 cm
108
What is the chemotherapy for metastatic melanoma?
interferon
109
What is the prognosis with metastatic melanoma?
Extremely variable-- some die within months, others take decades
110
What are the s/sx of acute closed angle glaucoma? (4)
Hard eye
Halos around lights
Pain
Mid-dilated pupil that is not reactive to light
111
What is the curative treatment for acute closed angle glaucoma?
Laser iridotomy
112
What is the supportive treatment for acute closed angle glaucoma that is used prior to the opthamologist getting there? (2x diuretic, 2x adrenergics, muscarinic)
- CAIs (acetazolamide)
- Beta blockers
- Alpha-2 agonists
- Mannitol
- Pilocarpine
113
What are the exam findings with orbital cellulitis?
hot, red, TTP eye, with fixed dilated pupil
114
What is the treatment for chemical burns of the eye?
- Copious irrigation with normal water or saline if possible (30 + minutes)
- Removal of anything in the eye
115
What are the s/sx of retinal detachment?
Flashes of light
| Floaters
116
True or false: the number of floaters seen with retinal detachment correlates with the severity of the problem
True
117
What is the treatment for an embolic occlusion of the retinal artery?
Breathe into a paper bag, and press hard on the eye and release (causes vasodilation and hopefully breakup of the clot)
118
What is the treatment for a thyroglossal duct cyst?
Removal of the cyst, middle of the hyoid bone, and thyroid tissue at the base of the tongue
119
branchial cleft cysts are found where in the neck?
Anterior edge of the SCM
120
Where are cystic hygromas found?
base of the neck as an ill defined mass, that occupies the entire supraclavicular area and extends deeper into the chest
121
Why is a CT scan of a cystic hygroma necessary prior to surgical removal?
To determine the extent of the mass in the chest
122
True or false: most of the recently discovered enlarged lymph nodes are malignant
False--most are benign, and should be followed for a few weeks before undergoing further workup
123
How does lymphoma usually present? What should be done to assess it if suspected?
Multiple, enlarged lymph nodes + low grade fever and night sweats
FNA is helpful to diagnose
124
Squamous cell carcinoma of the mucosae are usually first manifested as what?
Mets to the jugular chain
125
What is the classic presentation for an acoustic neuroma?
Adult who has unilateral sensory hearing loss
126
What is the most common type of parotid gland tumor?
Pleomorphic adenomas
127
true or false: A hard parotid mass that is painful or has produced facial nerve paralysis, is a parotid cancer.
True
128
What is the issue with Ludwig's angina?
Threat to the airway
129
What is the treatment for Bell's palsy?
Antivirals
130
If a patient presents with facial nerve issues after trauma, what is the ddx? How can you differentiate?
If sudden paralysis, likely direct injury
If slow onset, then likely benign swelling that is self limiting
131
What are the s/sx of cavernous sinus thrombosis?
diplopia in a pt suffering from frontal or ethmoid sinutisi
132
What is the prognosis with juvenile nasopharyngeal angiofibroma?
Tumor itself it benign, but eats away at surrounding tissue
133
What are the three major s/sx of Meniere's disease?
Vertigo
Tinnitus
Hearing loss
134
What is the treatment for Meniere's disease?
diuretics
135
What is the usual symptoms of vascular disease of the brain's blood supply if it is occlusive vs hemorrhagic?
Occlusive = sudden deficits w/o HA
Hemorrhagic = sudden with HA
136
Thunderclap headache = ?
Subarachnoid hemorrhage
137
What is the treatment for aneurysms in the circle of Willis?
Clipping or coiling
138
True or false: most brain tumors are metastatic, rather than primary
True
139
What is the most malignant of brain tumors? Classic finding on MRI?
Glioblastoma multiforme
| butterfly shape
140
What are the three major s/sx of increased ICP?
Blurred vision
Papilledema
Projectile vomiting
141
What is the treatment for increased ICP while waiting for surgical removal of a brain tumor?
Dexamethasone or other steroids
142
Tumors at the base of the frontal lobe produce what s/sx?
Inappropriate behavior, optic nerve atrophy on the side of the tumor, and papilledema on the other side
143
What are the three major s/sx of Foster-Kennedy syndrome?
Optic nerve atrophy ipsilateral
Papilledema contralateral
anosmia
144
What are the s/sx of craniopharyngiomas?
Bitemporal hemianopsia in a youngster
145
What is the medical therapy for a prolactinoma?
Bromocriptine (dopamine agonist)
146
What are the two initial diagnostic tests for acromegaly?
Somatomedina C and pituitary MRI
147
What are the s/sx of parinaud syndrome?
Loss of upper gaze (sunset eyes)
148
Brain tumors in children are usually found where in the skull? What is the most common type?
Posterior fossa
| Medulloblastoma is most common, followed by ependymomas
149
Children with a brain tumor in the posterior fossa can relieve their headache by assuming the knee-chest position. Why does this work?
Open the flow of cerebrospinal fluid
150
How do brain abscesses present, as opposed to a tumor?
Quickly with systemic signs of infx
151
What is the pharmacotherapy for trigeminal neuralgia?
Carbamazepine
152
What is reflex sympathetic dystrophy (Complex regional pain syndrome)?
a long term condition that occurs after crushing injury that often worsens with time. It is characterized by severe pain and sensitivity, swelling, and changes in the skin, with pain aggravated by the slightest stimulation of the skin.
153
What is the treatment for reflex sympathetic dystrophy (Complex regional pain syndrome)?
Nerve blocks and/or surgical sympathectomy
154
What is the treatment for an obstruction and infection of the urinary tract?
Decompression above the stricture, and abx
155
what level of Cr is a contraindication to an intravenous pyelogram?
2 or above
156
How do you diagnose and treat posterior urethral valves?
Voiding cystourethrogram to diagnose, and endoscopic fulguration or resection is treatment
157
How do you diagnose and treat vesicoureteral reflux?
Empiric abx until child "grows out of it"
158
What is the sequale of low implantation of a ureter?
In females, leads to a fistula between vagina and bladder
Asymptomatic in males
159
What are the symptoms of ureteropelvic junction obstruction?
Colicky pain following large diuresis
160
How do you work up painless hematuria?
CT and cystoscopy
161
What is the treatment, generally, for renal cell carcinoma?
surgery
162
What is the most common bladder cancer, and what is it highly associated with?
Transitional cell cancer
| Smoking
163
What is the MOA and use of flutamide?
Antiandrogen used in the treatment of prostate cancer
164
What is the MOA and use of leuprolide?
GnRH analog used to treat prostate cancer
165
True or false: almost all testicular cancers are malignant
True
166
What are the two hormones that are followed with testicular cancer to screen for recurrence?
beta-HCG and alpha-fetoprotein
167
What type of chemo is used for testicular cancers?
Platinum analogues
168
How are testicular cancers biopsied?
Transinguinal approach
169
What is the MOA and use of tamsulosin?
Alpha blocker used in the treatment of BPH
170
What is the MOA and use of finasteride?
5-alpha reductase inhibitor used in the treatment of BPH
171
What causes stress incontinence in women?
weak pelvic floor muscles
172
Over what stone size is advanced intervention needed in renal calculi?
3 mm
173
What is the symptom that occurs when a fistula develops between the GI tract and the urinary tract?
Pneumaturia
