IM shelf Flashcards
Focal nodular hyperplasia
Benign liver lesion due to an aberrant congenital artery. It is usually found incidentally in young women age 20-50 yo and is marked by the presence of a stellate central scar and radiating fibrous bands. Usually solitary, and <5cm- seen as a hyperdense lesion on triphasic, helical CT scan. Tx is rarely required.
heavy alcohol use, acute epigastric pain radiating to the back, elevated lipase, and enlarged pancreas
Acute pancreatitis
The most common benign liver tumor, often found incidentally during imaging. CT scan will reveal centripetal enhancement and no central scar.
Hepatic hemangioma
Benign liver tumors that often arise in the right lobe of the liver in women on OCP (possibly due to effects of estrogen on hepatocyte, although studies have been inclusive). It is possible to develop hemorrhage or malignant transformation Will see triphasic CT scan
hepatic adenomas
Malignant liver tumor that usually asises in the setting of chronic liver disease (ex. cirrhosis, viral hepatitis). Patients are often asymptomatic but may develop weight loss or early satiety, elevated AFP.
hepatocellular carcinoma
liver metastasis
common site of metz of pancreatic, colorectal, breast carcinomas. multiple lesions are more common
During mechanical ventilation, oxygenation is determined by the …. and ….?
FIO2 and PEEP.
the lowest feasible FIO2 (ideally <60%) should be set to prevent oxygen toxicity. As FIO2 is lowered, a compensatory increase in PEEP (10 or more cm H2O) may be required to maintain adequate oxygenation by recruiting collapsed alveoli and keeping them open.
Although decreasing the PEEP would address hyperoxia, it could result in widespread alveolar derecruitment with increased intrapulmonary shunting and markedly worsened oxygenation. Lowering the FiO2 is safer because it carries no risk of precipitating derecruitment.
PaCO2 is determined mainly by … and …?
respiratory rate and tidal volume
multifocal atrial tachycardia
MAT is a supraventricular tachyarrhythmia that likely occurs due to disturbances such as:
- RAE, catecholamine surge (sepsis), or electrolyte imbalance. Most commonly seen in elderly (>70yo) w/ acute exacerbation of underlying pulmonary disease (ex. COPD), due to ectopic atrial foci driven by acute illness. Physical exam - irregular rhythm with tachy. ECG shows distinct P waves of 3+ different morphologies, irregular PR intervals, and an atrial rate of >100/min.
Tx- mgmt of inciting distubance (ex. bronchodilators, SCS, supp Ox/ventilators)
atrial fibrilation with rapid ventricular response
> 100 bpm, irregularly irregular R-R intervals, fibrillatory waves: no organized P waves (absent P waves).
Tx- metoprolol, in pocket flecainide, amiodarone, direct current cardioversion
