From USMLE CK2 Flashcards
Bowel ischemia: physical presentation?
rapid onset of severe, periumbilical pain, perhaps nausea
pain out of proportion to exam findings
HTN, tachy, decr bowel sounds.
bowel ischemia - lab findings?
leukocytosis
elevated serum lactate, amylase, phospnate
metabolic acidosis due to incr serum lactate
bowel ischemia: tx?
resuscitate
broad spectrum abx
NG tube decompression
surgery
acalculus cholecystitis: seen in what patients?
severely ill/ in ICU already
septic, mult organ failure, trauma, burns
likely due to cholestasis and GB ischemia
acalculus cholecystitis: how to dx?
s/s are vague
high suspicion in pts who are really ill
confirm with imaging - GB wall thickening, some pericholecystic fluid. looks like gallstone dz without the stones
CT: air-fluid levels, distention
acalculus cholecystitis: tx?
abx
immediate cholecystostomy (stoma/drain GB)
eventual CCY when possible for pt.
Encapsulated bacteria: what are they?
What vaccines do we give to asplenic pts?
SHiNE SKiS
Strep pneumo, H. Inf, N. Meningitidis, E Coli, salmonella, Klebsiella, Group B Strep
Asplenics are not able to opsonize/clear via spleen. Vaccinate for Strep pneumo, H Inf, N Meningitidis
Basal Cell Carcinoma: appearance? location? metastasize? margins?
Appearance: Raised waxy lesion, or nonhealing ulcer
Location: Upper part of face
Does not met - will invade
Margins: 1mm
Squamous Cell Carcinoma
Appearance: nonhealing ulcer
Location: Lower lip, lower part of face
Will metastasize
Margins: 0.5 to 2cm
Dissect nodes. May do radiation
Metastatic Malignant Melanoma: where will it met to? what is preferred chemo?
Will metastasize to anywhere. Weird cancer.
Interferon is preferred adjuvant systemic therapy
Melanoma: what margins are required?
Lesion <1mm: only local excision
Lesion 1-4mm: 2-3cm margins, aggressive node dissection
Lesion >4mm: really bad prognosis
Abdominal aortic aneurysm: what size is ok to watch? what size to we do elective repair on?
Ok to watch if 4cm or smaller.
Do elective repair if 5cm + (chance of rupture is high).
Also if it grows 1cm+ per year, do repair.
Abdominal aortic aneurysm: how are they usually treated now?
with endovascular stents
placed percutaneously.
Tender abdominal aortic aneurysm: what is prognosis?
will rupture in a day or two - immediate repair!
What parameters define severe nutritional depletion?
- loss of 20% body weight over a few months
- serum albumin under 3
- anergy to skin antigens
- serum transferrin level less than 200 mg/dL
(or combination of the above)
Pt with severe nutritional depletion needs surgery - what needs to be done?
- this pt has very high operative risk
- do preoperative nutritional support (4-5 days is helpful, 7-10 days is optimal)
Acute angle closure glaucoma: presentation?
very severe eye pain or frontal headache
typically in evening, when pupils have been dilated for a few hours.
pt may be seeing halos. Eye feels hard as a rock on PE.
Acute angle closure glaucoma: treatment?
Emergency!
get opthalmology. in meantime, give systemic carbonic anhydrase inhibitors, and give topical beta blockers and a2-selective adrenergic agonists.
can also give mannitol and pilocarpine.
Retinal detachment: presentation?
emergency
pt sees flashes of light and floaters.
floaters corresponds with extent of detachment
Retinal detachment: treatment?
laser spot welding to protect the remaining retina
what medication class is associated with medication-induced hearing loss?
loop diuretics
ie furosemide
usually requires high doses to be ototoxic, but pts with renal failure can have ototoxicity at lower doses.
Lisinopril: class?
side effects?
ACE inhibitor
SEs: cough, hyperkalemia, angioedema
aspirin: side effects?
tinnitus
at high doses can cause hearing loss
define vertigo
sensation of severe spinning, along with nausea
may be central or peripheral in cause.
