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Dr.s P's notes 2 Flashcards

1
Q

What is the treatment for biliary pancreatitis?

A

NPO, IVFs, supportive

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2
Q

How can you differentiate between regular pancreatitis, from hemorrhagic pancreatitis?

A

hematocrit will drop

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3
Q

What is the treatment for hemorrhagic pancreatitis?

A
  • Intensive supportive care (poor prognosis)

- Daily CT scans to check for cysts

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4
Q

What is the treatment for pancreatic abscesses?

A

Percutaneous radiological drainage

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5
Q

What is a necrosectomy?

A

Removal of dead parts of a pancreas

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6
Q

What are the symptoms of a pancreatic pseudocyst?

A

Similar to pancreatic cancer–early satiety, pressure etc

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7
Q

At what size are pancreatic pseudocysts removed?

A

greater than 6 cm or for longer than 6 weeks

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8
Q

What are the s/sx of chronic pancreatitis?

A

Diabetes
Steatorrhea
Constant abdominal pain

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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)
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10
Q

What are the four places that tumors like to met to?

A

Lung
Liver
Brain
Bone

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11
Q

What is the usual route of metastasis for adenocarcinomas?

A

lymphatics and hematogenously

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12
Q

What is the usual route of metastasis for sarcomas?

A

hematogenously

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13
Q

What is the classic side effect of bleomycin?

A

Pulmonary fibrosis

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14
Q

What is the classic side effect of adriamycin?

A

myocardial damage

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15
Q

What is the classic side effect of cyclophosphamide? treatment?

A

Hemorrhagic cystitis

Acrolein (mesna is treatment)

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16
Q

What is the classic side effect of platinum based chemotherapy drugs?

A

Neurotoxic

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17
Q

What are the characteristics of fibroadenomas?

A

Firm, rubbery mass that moves easily with palpation

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18
Q

What happens to mammary dysplasia with menopause? menstruation?

A

Disappears with menopause

Symptomatic with menstruation

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19
Q

What is the presenting symptom of intraductal papilloma?

A

Bloody nipple discharge

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20
Q

What is the treatment for breast CA in pregnancy?

A

No radiotherapy or hormonal manipulations

No chemo during the first trimester

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21
Q

What is the radiological appearance of breast cancer?

A

Irregular, spiculated mass with asymmetric density, architectural distortion, or fine microcalcifications

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22
Q

True or false: XRT usually follows a lumpectomy

A

True

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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

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24
Q

When is a mastectomy indicated for ductal carcinoma in situ?

A

If there are multiple, dispersed lesions

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25
Q

True or false: inoperability of a breast tumor is based on mets

A

False–based on local extent

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26
Q

What is the difference in medication for a ER positive breast CA for pre and postmenopausal women?

A

Pre = tamoxifen

Post - anastrozole

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27
Q

True or false: as soon as breast cancer spreads to lymph nodes, “the cat is out of the bag”

A

True

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28
Q

True or false: thyroid cancer does not affect thyroid function

A

true

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29
Q

Why is a total thyroidectomy indicated for the treatment of follicular cancer?

A

Because mets can take up I if not competing against normal thyroid tissue 9easy to detect)

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30
Q

Medullary thyroid cancer develop from what cells?

A

C cells

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31
Q

What are the three diseases of MEN1?

A

Pituitary
parathyroid
Pancreatic cancer

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32
Q

What are the three diseases of MEN2A?

A

Medullary thyroid cancer
Parathyroid
Pheochromocytoma

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33
Q

What are the three diseases of MEN2B?

A

Medullary thyroid cancer
mucosal neuromas
Pheochromocytoma

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34
Q

What is the purpose of the low dose dexamethasone suppression test?

A

If responds, r/o cushing’s

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35
Q

What is Zollinger-Ellison syndrome?

A

gastrinoma leading to wicked GERD

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36
Q

What is nesidioblastosis?

A

is a devastating hypersecretion of insulin in the newborn, requiring 95% pancreatectomy.

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37
Q

What are the PE findings of a glucagonoma?

A

mild diabetes, a touch of anemia, glossitis, and stomatitis.

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38
Q

Appropriate response to postural changes (more aldosterone when upright than when lying down) suggests what: adrenal hyperplasia, or adeoma

A

hyperplasia

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39
Q

What are the two major groups of people who get renovascular HTN?

A

Young women with fibromuscular dysplasia

Old men with arteriosclerosis

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40
Q

“tomy” suffix designates what procedure?

A

Cutting into

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41
Q

“ectomy” suffix designates what procedure?

A

to take out or resect

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42
Q

“ostomy” suffix designates what procedure?

A

to make a mouth

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43
Q

How do you name an artificial anastomosis?

A

put the two organ names together, followed by “-ostomy” (e.g. Ileotransverse colostomy)

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44
Q

“plasty” suffix designates what procedure?

A

To change the shape of something

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45
Q

“pexy” suffix designates what procedure?

A

to fix in place

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46
Q

“rrhaphy” suffix designates what procedure?

A

means to saw together (e.g. herniorrhaphy”)

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47
Q

What is the most common type of esophageal atresia?

A

Proximal atresia, with a fistula between the lower esophagus and the trachea

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48
Q

What should be done if there is anal atresia, but a patent fistula?

A

May fix, or wait until toilet training starts to fix

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49
Q

What should be done if there is anal atresia, and no patent fistula?

A

High colostomy, with fixing later

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50
Q

What technique is used to x-ray imperforate anus?

A

done with child upside down, so air will collect at the end of the atretic tract

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51
Q

Congenital diaphragmatic hernia is always on the right or the left? Why?

A

Left, since liver gets in the way on the right

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52
Q

How soon after birth should a congenital diaphragmatic hernia be repaired? Why?

A

3-4 days, since need to allow some maturation

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53
Q

Green emesis + double bubble sign on x-ray indicates what?

A

Duodenal atresia
Annular pancreas
Malrotation

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54
Q

What are the x-ray findings of intestinal atresia?

A

Multiple air fluid levels throughout the abdomen

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55
Q

When should repair of exstrophy of the bladder take place?

A

1-2 days after birth, since delayed repairs do not work

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56
Q

What are the s/sx of necrotizing enterocolitis?

A

Feeding intolerance
Abdominal distention
rapidly dropping platelet count

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57
Q

What is the treatment for necrotizing enterocolitis?

A

Broad spectrum abx, supportive

Surgery if abdominal wall erythema develops

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58
Q

What are the s/sx of meconium ileus?

A

x-rays with dilated loops of small bowel, with a ground glass appearance

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59
Q

What is the treatment for meconium ileus?

A

Gastrografin enema is both diagnostic (microcolon and inspissated pellets of meconium in the terminal ileum) and therapeutic (Gastrografin draws fluid in, dissolves the pellets).

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60
Q

At what age does hypertrophic pyloric stenosis develop? What are the classic s/sx?

A

3 weeks

nonbilious projectile vomiting, and olive-sized mass in the RUQ

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61
Q

What is the treatment for hypertrophic pyloric stenosis?

A

IVFs, and TPN, surgical correction

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62
Q

What are the s/sx of biliary atresia? When does it show up?

A

6-8 weeks

Progressive jaundice

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63
Q

What will an x-ray show with hirschsprung’s disease?

A

distended proximal colon and normal looking distal colon

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64
Q

When does intussusception usually occur?

A

6-12 months of age

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65
Q

What are the s/sx of intussusception?

A

Colicky pain, with currant jelly stools, and a vague mass on the right side of the abdomen

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66
Q

What is the treatment for intussusception?

A

Ba enema

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67
Q

Subdural hematoma plus retinal hemorrhage in a baby = ?

A

Shaken baby syndrome

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68
Q

When does an undescended testicle need to be surgically fixed?

A

By age one

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69
Q

Abdominal mass that moves up and down on a baby = ?

A

Liver tumor

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70
Q

Large, nonmoving abdominal tumor in an infant = ?

A

Wilm’s tumor

Neuroblastoma

71
Q

What are the s/sx of vascular rings?

A

Pressure on the tracheobronchial tree–crowing respiration, dysphagia,

72
Q

What are the characteristics common to left to right shunts?

A

Pulmonary overload

Murmur

73
Q

Do ASDs produce systolic, or diastolic murmurs?

74
Q

What is the prognosis for small VSDs? (2)

A

most are self limiting if in the muscular portion of the septum

Problematic if in the membranous portion

75
Q

What are the characteristics that are common in right to left shunts?

A

Murmur
Diminished vascular markings
Cyanosis

76
Q

When do the s/sx of tetralogy of Fallot appear?

A

5-6 years of age

77
Q

What are the heart sounds that are characteristic of Tet babies?

A

systolic ejection murmur in the left third intercostal space

78
Q

new born with cyanosis in the first 1-2 days of life is suspicious for what diagnosis?

A

transposition of the great vessels

79
Q

What is the indication for repair of the aortic valve with aortic stenosis?

A

More than 50 mmHg gradient or if symptomatic

80
Q

What are the s/sx of aortic insufficiency?

A

wide pulse pressure

diastolic heart murmur

81
Q

Young drug addicts that suddenly develop CHF is suspicious for what heart problem?

A

Acute aortic insufficiency

82
Q

What heart arrhythmia classically develops from mitral stenosis?

83
Q

Mitral regurg is most commonly caused by what?

A

Valvular prolapse

84
Q

Where does the murmur radiate to with mitral regurgitation?

A

Axilla and back

85
Q

What is the vessel of choice for a CABG?

A

Internal thoracic artery

86
Q

What is the treatment for low pulmonary wedge pressure post MI? High?

A 
Low = IVFs
High = ventricular failure
87
Q

What are the chances of a coin lesion found on a CXR is malignant in a person over the age of 50?

88
Q

What are the first two tests that should be ordered following the discovery of a coin lesion of the lung?

A

CT of the chest/liver, and sputum cytology

89
Q

What is the minimum FEV1 needed to to perform a pneumonectomy to ensure that there is enough residual lung function?

90
Q

What is subclavian steal syndrome?

A

Subclavian will steal blood from vertebral if arm is exercised 2/2 clot or stenosis at the origin of the subclavian

91
Q

What are the chances of rupture for a tender abdominal aortic aneurysm? (relatively) What is the treatment?

A

High–do surgery

92
Q

What is the Ankle-brachial-index that indicates the need for surgery?

A

Less than 0.8

93
Q

What is the surgical treatment for intermittent claudication?

A

Reversal of the saphenous or stenting

94
Q

What is the progression of the disease with claudication? (3)

A

Claudication, resting pain, ulceration and gangrene

95
Q

What is the classic presentation of a patient with bad claudication?

A

Cannot sleep 2/2 pain, so hangs legs off bed, which cause legs to have a return to color

96
Q

Urgent evaluation of an arterial embolization is needed within what timeframe to save the limb?

97
Q

What is the treatment for an arterial embolization to a limb?

A

Thrombolytics if not fully occluded

Stenting if fully occluded

98
Q

What is the treatment for type B aortic dissections?

A

BP control

99
Q

What are the two absolute contraindications for a FNA?

A
  • Hemangioma of the liver (will bleed)

- testicular mass (invariably malignant, and will seed)

100
Q

How does basal cell carcinoma usually present itself?

A

Small, raised waxy lesion, or nonhealing ulcer

101
Q

Which has a preference for the upper face: basal cell or squamous cell?

A

Basal cell

102
Q

What are the characteristics of growth and metastases for a basal cell carcinoma?

A

Slow growing, and rarely metastasizes

103
Q

What is the margin needed to basal cell carcinoma?

104
Q

What is Mohs surgery?

A

cutting basal cell carcinoma out by microscopic fractions until a clear margin is achieved

105
Q

What are the margins needed for squamous cell carcinoma?

A

0.5 ro 2 cm

106
Q

What are the ABCDEs of melanoma?

A 
Asymmetry
Borders (irregular)
Color changes within lesion
Diameter over 0.5 cm
Evolution
107
Q

Lesions of melanoma beyond what depth have a terrible prognosis?

108
Q

What is the chemotherapy for metastatic melanoma?

A

interferon

109
Q

What is the prognosis with metastatic melanoma?

A

Extremely variable– some die within months, others take decades

110
Q

What are the s/sx of acute closed angle glaucoma? (4)

A

Hard eye
Halos around lights
Pain
Mid-dilated pupil that is not reactive to light

111
Q

What is the curative treatment for acute closed angle glaucoma?

A

Laser iridotomy

112
Q

What is the supportive treatment for acute closed angle glaucoma that is used prior to the opthamologist getting there? (2x diuretic, 2x adrenergics, muscarinic)

A
  • CAIs (acetazolamide)
  • Beta blockers
  • Alpha-2 agonists
  • Mannitol
  • Pilocarpine
113
Q

What are the exam findings with orbital cellulitis?

A

hot, red, TTP eye, with fixed dilated pupil

114
Q

What is the treatment for chemical burns of the eye?

A
  • Copious irrigation with normal water or saline if possible (30 + minutes)
  • Removal of anything in the eye
115
Q

What are the s/sx of retinal detachment?

A

Flashes of light

Floaters

116
Q

True or false: the number of floaters seen with retinal detachment correlates with the severity of the problem

117
Q

What is the treatment for an embolic occlusion of the retinal artery?

A

Breathe into a paper bag, and press hard on the eye and release (causes vasodilation and hopefully breakup of the clot)

118
Q

What is the treatment for a thyroglossal duct cyst?

A

Removal of the cyst, middle of the hyoid bone, and thyroid tissue at the base of the tongue

119
Q

branchial cleft cysts are found where in the neck?

A

Anterior edge of the SCM

120
Q

Where are cystic hygromas found?

A

base of the neck as an ill defined mass, that occupies the entire supraclavicular area and extends deeper into the chest

121
Q

Why is a CT scan of a cystic hygroma necessary prior to surgical removal?

A

To determine the extent of the mass in the chest

122
Q

True or false: most of the recently discovered enlarged lymph nodes are malignant

A

False–most are benign, and should be followed for a few weeks before undergoing further workup

123
Q

How does lymphoma usually present? What should be done to assess it if suspected?

A

Multiple, enlarged lymph nodes + low grade fever and night sweats

FNA is helpful to diagnose

124
Q

Squamous cell carcinoma of the mucosae are usually first manifested as what?

A

Mets to the jugular chain

125
Q

What is the classic presentation for an acoustic neuroma?

A

Adult who has unilateral sensory hearing loss

126
Q

What is the most common type of parotid gland tumor?

A

Pleomorphic adenomas

127
Q

true or false: A hard parotid mass that is painful or has produced facial nerve paralysis, is a parotid cancer.

128
Q

What is the issue with Ludwig’s angina?

A

Threat to the airway

129
Q

What is the treatment for Bell’s palsy?

A

Antivirals

130
Q

If a patient presents with facial nerve issues after trauma, what is the ddx? How can you differentiate?

A

If sudden paralysis, likely direct injury

If slow onset, then likely benign swelling that is self limiting

131
Q

What are the s/sx of cavernous sinus thrombosis?

A

diplopia in a pt suffering from frontal or ethmoid sinutisi

132
Q

What is the prognosis with juvenile nasopharyngeal angiofibroma?

A

Tumor itself it benign, but eats away at surrounding tissue

133
Q

What are the three major s/sx of Meniere’s disease?

A

Vertigo
Tinnitus
Hearing loss

134
Q

What is the treatment for Meniere’s disease?

135
Q

What is the usual symptoms of vascular disease of the brain’s blood supply if it is occlusive vs hemorrhagic?

A

Occlusive = sudden deficits w/o HA

Hemorrhagic = sudden with HA

136
Q

Thunderclap headache = ?

A

Subarachnoid hemorrhage

137
Q

What is the treatment for aneurysms in the circle of Willis?

A

Clipping or coiling

138
Q

True or false: most brain tumors are metastatic, rather than primary

139
Q

What is the most malignant of brain tumors? Classic finding on MRI?

A

Glioblastoma multiforme

butterfly shape

140
Q

What are the three major s/sx of increased ICP?

A

Blurred vision
Papilledema
Projectile vomiting

141
Q

What is the treatment for increased ICP while waiting for surgical removal of a brain tumor?

A

Dexamethasone or other steroids

142
Q

Tumors at the base of the frontal lobe produce what s/sx?

A

Inappropriate behavior, optic nerve atrophy on the side of the tumor, and papilledema on the other side

143
Q

What are the three major s/sx of Foster-Kennedy syndrome?

A

Optic nerve atrophy ipsilateral
Papilledema contralateral
anosmia

144
Q

What are the s/sx of craniopharyngiomas?

A

Bitemporal hemianopsia in a youngster

145
Q

What is the medical therapy for a prolactinoma?

A

Bromocriptine (dopamine agonist)

146
Q

What are the two initial diagnostic tests for acromegaly?

A

Somatomedina C and pituitary MRI

147
Q

What are the s/sx of parinaud syndrome?

A

Loss of upper gaze (sunset eyes)

148
Q

Brain tumors in children are usually found where in the skull? What is the most common type?

A

Posterior fossa

Medulloblastoma is most common, followed by ependymomas

149
Q

Children with a brain tumor in the posterior fossa can relieve their headache by assuming the knee-chest position. Why does this work?

A

Open the flow of cerebrospinal fluid

150
Q

How do brain abscesses present, as opposed to a tumor?

A

Quickly with systemic signs of infx

151
Q

What is the pharmacotherapy for trigeminal neuralgia?

A

Carbamazepine

152
Q

What is reflex sympathetic dystrophy (Complex regional pain syndrome)?

A

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
Q

What is the treatment for reflex sympathetic dystrophy (Complex regional pain syndrome)?

A

Nerve blocks and/or surgical sympathectomy

154
Q

What is the treatment for an obstruction and infection of the urinary tract?

A

Decompression above the stricture, and abx

155
Q

what level of Cr is a contraindication to an intravenous pyelogram?

A

2 or above

156
Q

How do you diagnose and treat posterior urethral valves?

A

Voiding cystourethrogram to diagnose, and endoscopic fulguration or resection is treatment

157
Q

How do you diagnose and treat vesicoureteral reflux?

A

Empiric abx until child “grows out of it”

158
Q

What is the sequale of low implantation of a ureter?

A

In females, leads to a fistula between vagina and bladder

Asymptomatic in males

159
Q

What are the symptoms of ureteropelvic junction obstruction?

A

Colicky pain following large diuresis

160
Q

How do you work up painless hematuria?

A

CT and cystoscopy

161
Q

What is the treatment, generally, for renal cell carcinoma?

162
Q

What is the most common bladder cancer, and what is it highly associated with?

A

Transitional cell cancer

Smoking

163
Q

What is the MOA and use of flutamide?

A

Antiandrogen used in the treatment of prostate cancer

164
Q

What is the MOA and use of leuprolide?

A

GnRH analog used to treat prostate cancer

165
Q

True or false: almost all testicular cancers are malignant

166
Q

What are the two hormones that are followed with testicular cancer to screen for recurrence?

A

beta-HCG and alpha-fetoprotein

167
Q

What type of chemo is used for testicular cancers?

A

Platinum analogues

168
Q

How are testicular cancers biopsied?

A

Transinguinal approach

169
Q

What is the MOA and use of tamsulosin?

A

Alpha blocker used in the treatment of BPH

170
Q

What is the MOA and use of finasteride?

A

5-alpha reductase inhibitor used in the treatment of BPH

171
Q

What causes stress incontinence in women?

A

weak pelvic floor muscles

172
Q

Over what stone size is advanced intervention needed in renal calculi?

173
Q

What is the symptom that occurs when a fistula develops between the GI tract and the urinary tract?

A

Pneumaturia

A2 (26 decks)

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