Final Review Flashcards
Rigler’s triad
Pneomobilia, sbo, radio lucena gallstone. For gallstone ileus.
Colon cancer X-ray sign
Apple-core lesion
Acral lentiginous
Melanoma on Palm and soles
Alcohol withdrawal
1-3 d after last drink. Usually >48hr postoperative, fever, ms changes, diastolic htn, tachy, tremors, hallucinations,. Tx: serax, ativan
Cardiac analysis
Echo if valve concern. Stress cath if coronary concern
Deep Peroneal nerve damage
Anti or compartment. Foot drop. Numb dorsum of foot 1st and 2nd toes
Pcwp
High in chf, low or nl in ards
Ards criteria
Bilatwl infiltrates, Pcwp<200
5d post mi and decompensate
Papillary m rupture /MR. Vsd: new harsh loud holo systolic murmur, lv rupture
Coarctation has
Variable bp/pulses, rib notching, associate with turners
AbI
<.5 ulcer
Thoracic duct injury
Milky chylous effusion
Zenker’s
Regurgitation smelly breath. Ugi/swallow. Cut he cricopharyngeus. Diverticulum of the mucosa of pharynx just above cricopharyngeus muscle. Excessive pressure of lower pharynx. Dysphasia, regurgitate, cough , halitosis, infection
Pancreatic cancer
Painless jaundice, periumbili cal nodule, distended palpable gallbladder, left supracalvicular lad,
Pyloric stenosis tx
Pyloromyotomy
Intussusception
Kid- idiopathic, most common cause of intestinal obstruction. Knee to chest, currant jelly- stool and blood and mucus. Vomiting, lethargy, lump in abdomen. Tx and do with enema- air or gastrograf fin. Adult- tumor, so unspecific. Ab pain, constipation, many ask. Tx is surgery
Indications for dialysis
A: acidosis,mph<7.2. E: electrolytes: k with ekg changes. Temproize with ca, d50, insulin, bicarbonate, kayexalat
I: ingestions, salicylate a and ethylene glycol to prevent renal failure
O: overload in volume causing pulmonary edema
U: uremia: confusion, pericarditis, seizures, platelet dysfunction with severe bleeding
Blood in urine
Pain is a stone. No pain is cancer of renal, bladder or prostate
Renal transplant medications
Azathioprine, mycophenylate, I mural, cellcept: inhibit purine synthesis and T cells
Cyclosporine, prograf: inhibit genies for cytokines synthesis
High calcium
>
- Moans groans stones, and psychiatric overtones. Short qt. Dix hyperparathoyroidism, adenoma, hyperplasia, sarcoidosis, carcinoma
Low calcium
Trousseau/chvostek’s cheek sign. Long qt. can be caused by multiple units of blood transfusion need plt/ffp. Persistent hypotension
Hyper kalmia
5.5 wide qrs/ peak t. Deadly. C big drop - ca/bicarbonate / insulin and glu/ kayexalate/ hd/ lasix and fluid
Low potassium
Flat t long at
Insulinoma
Fasting sugar is less than 30 with high normal insulin l vl
dI
Low adh. Pee water. Polyurethane. High blood na. Brain hurt. Nephrogenic versus central - trauma, neurosurgery
Siadh
High adh. Hold water, low blood na. Can have brain pain. Causes are cancer sclc or cns disorder
Men1
Parathyroid hyperplasia. Pituitary- prolactinoma. Pancras- islet cell tumor and mc gastrinoma
Men2a
Pheo- treat first. Medullary cancer - thyroid, check calcitonin. Pth hyperplasia
Men2b
Pheo- treat first. Medullary cancer thyroid. Mucosal neuromas, marfans habitus.
Men genes
I is menin gene. II is ret protooncogene
Coumadin
Factors 2,7,9,10. Protein c and s, rversal with vit k is 6 hr. Ffp is immediate. Check pt/ inr
Heparin
Binds atiii. If for tx. Subs for prophylaxis. Check ptt. Hit ( prothrombotic, tx argatroban or lepriudin)
Splenic vein thrombosis
Sp pancreatitis. Gsdtroesophsgeal varies with nl liver. Treat with splenectomy
Accessory spleen
Absence of Howell jolly bodies s/p splenectomy. Need spleen scan. Most common location is splenic hilum
Post splenectomy sepsis. Opss
S. Pneumo- prophylaxis- penicillin, treat with vanco/cefepime, n meningitis , h influenza
Cmv
Hiv and bloody diarrhea.
Gram positive
Pairs is strep. Clusters is staph
Amoxicillin
Artificial heart valve prophylaxis
