Lastmin Flashcards
Neuropathic arthropathy
Charcot joint
Inflammation, erythema, pain and increased skin temperature (3–7 degrees Celsius) around the joint may be noticeable on examination. X-rays may reveal bone resorption and degenerative changes in the joint. These findings in the presence of intact skin and loss of protective sensation are pathognomonic of acute Charcot arthropathy.
Worrisome radiographic findings on screening mammo:
(1) breast calcifications that are (a) smaller than 2 mm, (b) punctate, microlinear, or branching,and (c) clustered along ducts or concentrated in clusters greater than five calcifications per square centimeter;
(2) stellate-shaped lesions;
(3) masses with ill-defined borders or nodular contours;
(4) solitary dominant masses that are significantly larger than any other mass in either breast;
(5) areas of increased noneffacing tissue density or distorted breast architecture.
Paraneoplastic neuro things from SMALL CELL lung cancer?
Anti-Hu, anti-Yo: The clinical cerebellar ataxia evident in patients with PCD are caused by Purkinje neuronal loss in the cerebellum. It is manifested by dysarthria, truncal, limb and gait ataxia, vertigo, nausea, vomiting, diplopia[1][6] and nystagmus
Solitary pulm nodules
- Benign looking (central calcification, round) and small can be ignored, or followup once with CXR or CT
- High-risk and/or large (>1cm) may required PET +/- biopsy
A positive FAST result …
…is defined as the appearance of a dark (“anechoic”) strip in the dependent areas of the peritoneum.
A positive result suggests hemoperitoneum; often CT scan will be performed if the patient is stable[14] or a laparotomy if unstable.
Sounds like biliary colic, but no gallstones seen on u/s. Next step?
Look at biliary tree. HIDA scan w/ IV CCK.
Your physician may order your exam with CCK to check the function of
your gallbladder. CCK is a medication that causes your gallbladder to
empty
Hernia repair in kid
involves “high ligation” of hernia sac and no repair to the abdominal wall as there is usually no defect.
Inguinal hernia repair complications? How long before heavy lifting?
injury to ilioinguinal nerve presents with loss of cremasteric reflex and numbness to ipsilateral penis, scrotum, and thigh.
Indirect are opened and ligated at internal ring
6 weeks
An older gentleman comes in with both BPH and an Inguinal Hernia. Which do you repair first (the hernia or the prostate) and why?
Correct the BPH first. You don’t want the patient straining to urinate and increasing intra-abdominal pressure. This would likely put tension on the sutures from the inguinal hernia repair and can cause a recurrence
ITP with decreasing platelet count even though they got steroid rx?
Observation is reasonable in this patient with ITP (most conservative answer), who is asymptomatic with a platelet count of 75K
Further medical or surgical treatment is appropriate if the platelet count drops below 30K or the patient becomes symptomatic (ie. bleeding)
OPSS
It occurs more commonly in children
It occurs more commonly following splenectomy for primary hematologic disorders as compared to splenectomy for trauma
LEUKEMIA, ETC.
Splenectomy for ITP is most likely to provide long-term remission in which of the following patients?
In patients with ITP the best response to splenectomy is seen in those who previously responded to corticosteroid therapy
Guy with GERD on H2 blocker who still has sx and esophagitis?
Patient should be switched to a PPI because the relapse rate associated with H2 blockers is much higher than those associated with PPI
Portal htn
Portal venous pressure should be less than 10. If above 12–>variceal bleeds
Shunts for portal htn
Non-selective shunts improve ascites & reroute blood but worsen encephalopathy
Selective shunts (splenorenal – “most physiologic”) worsen ascites but cause less encephalopathy
Hepatic encephalopathy
Reduce nitrogen load
Acutely withdraw protein/reduce protein or NPO if acute
Thorough bowel cleanse (nonabsorbable disaccharide–lactulose; neomycin/flagyl)
Consider liver transplant
Budd chiari
75% thrombosis, 25% compression
Classic triad: abdominal pain, ascites, hepatomegaly
Occurs in 1/100,000,000 humans
“nutmeg liver” without evidence of R heart failure
Imaging: “spider web” of venous collaterals (chronic form)
Rule out genetic cause of hypercoagulability: protein C/S deficiency, factor V leiden; or polycythemia
slide 135
When do you see “itching” in hepatobiliary?
Bile salts depositing in skin from obstructive jaundice
The pancreatic tumor that is most likely to be benign is a
Insulinoma
SBO causing vomiting. Electrolyte imbalances?
Mechanism: H+ secreted into stomach, HCO3- secreted into plasma. To maintain neutrality, Cl- secreted into stomach.
Vomiting: Lose H+, Na+, Cl-, water = alkalosis and volume contraction
In response: kidneys retain Na+ and H+ at the expense of K+ → hypokalemia
D5 ½ NS (0.45% NaCL) with 20meq KCL would be appropropriate for our pt. Alkalosis normally corrects itself
Gallstone ileus
ileotomy, removal of the stone, and cholecystectomy if the patient is stable
Operating on the biliary fistula doubles the mortality rate compared with simple removal of the gallstone from the intestine
A 65 year old man who is hospitalized with pancreatic carcinoma develops distention and obstipation. What is the most appropriate management?
THIS IS OGILVIE’S! Massive cecal and colonic dilation is seen in the absence of mechanical obstruction
D/C anticholingerics, narcotics, and correct metabolic disorders
HNPCC screening guideline
colonoscopy every 1-2 years beginning between 20 and 30, then every year after 40
Vomiting blood…do you do an upper GI series or an EGD?
EGD (ENDOSCOPY).
Gastric adenocarinoma. Metastatic work-up is negative. Therapy with curative intent would involve which of the following?
Distal gastrectomy followed by adjuvant chemoradiotherapy
A 53 year old man presents to the emergency room with left lower quadrant pain, fever, and vomiting. CT scan of the abdomen and pelvis reveals a thickened sigmoid colon with inflamed diverticula and a 7-cm by 8-cm rim-enhancing fluid collection in the pelvis. After percutaneous drainage and treatment with antibiotics, the pain and fluid collection resolve. He returns as an outpatient to clinic 1 month later. He undergoes a colonoscopy, which demonstrates only diverticula in the sigmoid colon. Which of the following is the most appropriate next step in this patient’s management?
Surgery for diverticulitis?
Diverticular abscesses treated with percutaneous drainage followed by definitive resectional therapy
Resect the INVOLVED SEGMENT of bowel (not the diverticulae DUH IDIOT).
PVD at locations?
a) Left aortoiliac system (dec pulses in left groin and leg)
b) Left superficial femoral artery (↓ pulses in leg)
c) Infrarenal aorta (↓ pulses in groins bilaterally)
d) Left popliteal artery (↓ ankle pulses)
Adrenal mass first step?
Functional studies: Plasma metanephrine/24hr urine VMA, metanephrine, and normetanephrine; serum K+ and serum aldosterone/renin; overnight 1mg Dexamethasone suppression test
WATCH OUT FOR CONTRAINDICATIONS TO SURGERY!
Diabetic coma, DKA
Severe liver failure: bili >2, PT >16, ammonia > 150 or encephalopathy
