Exam 7 (final content) Flashcards
In acute abdomen, the location of pain suggests the origin.
Pain in the epigastric region suggests foregut.
Pain in the periumbilical region suggests midgut.
And pain in the hypogastric/suprapubic region suggests hundgut.
Name the organs than make up the foregut, midgut, and hindgut.
Foregut: stomach, pancreas, duodenum, and biliary tree
Midgut: small bowel and right and transverse colon
Hindgut: left colon, sigmoid, and rectum
On abdomen exam [ABSENCE OF/HIGH PITCHED] sounds is consistent with ileus and [ABSENCE OF/HIGH PITCHED] sounds suggests small intestine obstruction
- ABSENCE of sounds is consistent with ileus
- HIGH PITCHED sounds suggests small intestine obstruction
Mesenteric lymphadenitis is most often caused by …
Viral gastroenteritis
This self-limited condition causes pain in the RLQ of the abdomen, can mimic appendicitis, and is often found on CT/US while looking for appendicitis
- Mesenteric lymphadenitis
- Imaging would show enlarged lymph nodes
Your patient presents with diffuse, severe abdominal tenderness. They have guarding and rigidity and are laying in bed with their hips and knees flexed, trying to be as still as possible and flinch with pain if you touch the bed.
Bowel sounds are absent.
What is the best imaging for the most likely diagnosis, and what would be seen?
- Peritonitis
- CT is best imaging modality
- Shows thickened peritoneal wall
(may see free air under diaphragm if peritonitis due to perforation)
What lab values are elevated in appendicitis?
- CRP elevated (helps differ from constipation quickly)
- WBC elevated
Symptoms of appendicitis
- Cramping or aching pain in periumbilical region
- Becomes more localized (and sharp!) to RLQ within 12-24 hours
- Nausea (vomiting AFTER pain)
- Anorexia
- Fever
Best imaging for appendicitis
CT is better than ultrasound
Patients with a history of these two things are at increased risk of pancreatitis
- ETOH
- Gall stones
Symptoms of pancreatitis
- Severe epigastric pain radiating to the back
- Anorexia and n/v
- Relieved by sitting and leaning forwards
What lab values are elevated in pancreatitis?
- Lipase elevated (most specific, up faster, and stays up longer)
- Amylase and WBC also elevated
Best imaging method for pancreatitis
CT more often than ultrasound
Diverticulitis is usually limited to this area of the GI system
Left and sigmoid colon
Your patient, who is older, presents with cramping LLQ abdominal tenderness, is positive for rebound tenderness and guarding, has chills and fever, and has absent bowel sounds.
What is the gold standard imaging for the most likely diagnosis?
- Diverticulitis
- CT is gold standard
What is the most common cause of small intestine obstruction?
Adhesions (after surgery)
Symptoms of small intestine obstruction
- Nausea
- Bilious vomiting
- Sudden, sharp abdominal pain (most painful!)
Your patient presents with so much abdominal pain that they are unable to tell you their symptoms!
Physical exam reveals:
- abdominal distension
- hyperactive and high-pitched bowel sound early on
- later they become decreased
What is the first imaging you would order?
- Small intestine obstruction
- Abdominal x-rays performed first
- Show dilated loops of bowel with air fluid levels
Symptoms of (acute form) mesenteric ischemia
- Sudden onset of very severe abdominal pain
(may have n/v, diarrhea, GI bleeding, hypotension, tachycardia, fever, and hypovolemia)
Imaging of choice in mesenteric ischemia
CT angiogram
(lactate elevated in later stages)
A patient who presented with sudden upper abdominal tenderness and back pain now appears to be in hypovolemic shock. What might you feel on physical exam if you palpate their abdomen?
- Ruptured aortic aneurysm
- Pulsatile supraumbilical mass
- If stable, can diagnose with US or CT (whichever is quicker)
What is the most life threatening gynecologic cause of acute abdomen? and what tests would you use to diagnose it?
- Ruptured ectopic pregnancy
- hCG first
- Then transvaginal ultrasound
What is the major pathogen that causes infections in cat bites?
Pasteurella multocida
What are the three pathogens associated with human bites?
- Staphylococcus
- Streptococcus
- Eikenella corrodens
Which fever is caused by streptobacillus moniliformis?
Rat-bite fever
Which animal causes the most cases of rabies in the US?
Bats (75%)
Treatment of mammalian bites is mostly done with this drug
Augmentin
(Pen G for rodent bites)
Which snakes, found in all states except Maine, Alaska, and Hawaii,, cause hypercoagulability, thrombocytopenia, decreased fibrinogen, and increased fibrin degeneration with their bites?
Pit vipers
- hematotoxic
- cause of death is hemorrhage
Which snakes, found from North Carolina, south and west to Texas, Arizona, and New Mexico, cause a neuromuscular blockade leading to flaccid paralysis with their bites?
Coral snakes
- neurototoxic
- cause of death is respiratory failure
Treatment for snake bites
- Compressive dressings and immobilization of bitten area
- Elastic band (not tourniquet!) to impede lymphatic flow
- Antivenom if within 4 hours of bite
- Correct clotting abnormalities with blood replacement, only after giving antivenin
DO NOT:
- incise wound
- put ice on it
- use suction extraction device
Which bite can be treated with a Sawyer extraction device and when?
- Black widow spiders only
- Must be within 3 minutes of bite
Describe the differences between black widow and brown recluse spider bites
Black widow:
- neurotoxin with paralysis
- dull ache, crampy pain, trismus, muscle fibrillations, tonic contractions, or lactrodectismica
Brown recluse:
- tissue necrosis, much more painful
- pain at site with ring of pallor, leading to necrosis that may take months to heal
- systemic symptoms of fever, chills, rash, nausea, vomiting, shock, renal failure, hemorrhage, DIC, or pulmonary edema
Which creature has a neurotoxin that causes the following symptoms and what is the treatment?
- tachycardia
- agitation
- hypertension
- hypersalivation
- dysphagia
- GI symptoms
- Scorpion sting
- Treat HTN and tachycardia with captopril or prazosin
- Sedative hypnotics for agitation and restlessness
Which insect bite may cause ECG changes and rhabdomyolysis?
Centipedes
(millipedes cause superficial burn)
How to treat stings of coelenterates (jelly fish, fire coral, sea anemones)?
Rinse with sea water (not freshwater!)
Treatment for echinodermata (starfish, sea urchins, and sea cucumbers) and toxic vertebrate stings
Hot water immersion
What is the first priority in initial stabilization of poisoning and drug overdose?
Airway
What are the ABCDs of initial stabilization in initial stabilization of poisoning and drug overdose?
- Airway
- Breathing
- Circulation
- Dextrose and Decontamination
Alcoholic or malnourished patients in a coma that you believe is due to poisoning or overdose should be given this vitamin
B1 - Thiamine to prevent Wernicke’s
Which medications/drugs most commonly cause seizures?
- Tricyclic antidepressants
- Cocaine and related stimulants
- Antihistamines
- Isoniazid
Treatment for rhabdomyolysis
Aggressive volume expansion with IV fluids
Which adult patient population are more at risk of acetaminophen toxicity at a lower dose?
Alcoholics
In which toxicity or poisoning situation will you be using your Rumack-Matthew nomogram?
Acetaminophen toxicity
- plot serum APAP level four hours after ingestion
- predicts toxicity and indicates whether or not the patient should be NAC’d
Treatment for acetaminophen overdose
- Oral charcoal
- NAC ‘em! (if above Rumack-Matthew toxicity line)
An elevated venous blood oxygen level over 90% suggests this diagnosis that may also cause a severe lactic acidosis and bitter almond odor
Cyanide poisoning
- give activated charcoal and immediate nitrites
Which toxicity is treated with fomepizole or ethanol to block metabolism?
- Methanol or methylene glycol
- can also give folic acid, vitamin B6, B1
- and of course they get charcoal too
Which toxicity, commonly seen in children, causes GI ulcers and bleeding, and will NOT be helped with the use of charcoal?
Iron toxicity
- give deferoxamine
Which toxicity, seen more commonly in children, can cause wrist drop, and Burton’s lines (blue-black gums) in adults?
Lead poisoning
- give IV calcium EDTA or oral succimer
This toxicity can cause EKG changes including flattened T waves, presence of U waves, and prolonged QT interval as well as confusion, lethargy, tremors, and muscle twitching
Lithium toxicity
Treatment for sedative-hypnotic agent toxicity
Flumazenil
Which condition is a 10cm or larger area of hyperpigmentation, overgrowth or epidermis, and hair follicles, usually on the shoulder or chest/back, and is most often late onset in men
Becker nevus (pigmented hairy epidermal nevus)
Name this autosomal dominant familial tumor syndrome:
- triad of intestinal polyposis, bony tumors, and soft tissue lesions
Gardner syndrome
Name this autosomal dominant familial tumor syndrome:
- multiple hamartomas
- microcephaly, facial trichilemmomas, acral fibromas
- increased risk of breast, thyroid, and GI tract, melanoma
Cowden syndrome
Name this autosomal dominant familial tumor syndrome:
- triad of fibrofolliculomas, trichodiscomas, acrochordons
- predisposition to renal cancers
Birt-Hogg Dube syndrome
Which dermatologic condition is associated with the Buttonhole sign?
Neurofibroma
Hearing loss is an early sign or symptom associated with this dermatologic condition
Neurofibromatosis (2)
Which dermatologic condition is associated with the Dimple sign?
Dermatofibroma
Which dermatologic condition is treated with intralesional steroid injections and 5-fluorouracil
Keloid and hypertrophic scar
What is the most common skin cancer, and what does it look like?
Basal cell carcinoma
- raised, rolled borders
- central ulceration
- pearly, translucent pink papules
- bleed easily
Which dermatologic condition is sometimes diagnosed with a Sezary count?
Cutaneous T-Cell Lymphoma
(but mycosis fungoides more common type)
Which condition is associated with a Herald Patch, and what follow it?
Pityriasis Rosea
- Herald patch followed 3-10 days later by a bilaterally symmetrical eruption on the trunk and upper extremities (Christmas tree pattern)
What are the symptoms of Lichen Planus?
Four P’s
- Pruritic
- Purple
- Polygonal Papules
Wrists, ankles, mouth, reticular, itchy
Symptoms of erythroderma
- Erythema and scaling >90% of body surface
- Severe pain and itching
- Systemic symptoms and dehydration, high-output cardiac failure
Symptoms of Parkinson’s disease
TRAP
- Tremor (pill rolling)
- Rigidity
- Akinesia/bradykinesia
- Postural instability
Resume slide 15 of papulosquamous
