Online MedEd Flashcards
What are Borborygmi sounds and what do they signify?
High pitched crescendo sounds that are heard where there is obstruction in the small bowels (important to know that it is in the small bowl specifically)
Does Borboygmi sound signifiy complete or incomplete obstruction?
Complete obstruction
What are the 4 different types of hernias?
Explain their properties.
Direct - medial, happens in older people, goes through the transversalis fascia, at the inguinal ligament
Indirect - male babies, goes through the inguinal ring, lies at the inguinal ligament
Femoral - more common in women, it is under the inguinal ligament
Ventral hernia - post op complication, failure of the abdominal wall due to surgery, hence iatrogenic
What imaging modality is used to find carcinoid syndrome and what is its treatment
CT, resection
What is the role of surgery in UC and Crohn’s
Colectomy is curative in UC and in Crohns the only role surgery has to do fistuolotomy
What is pilonidal cyst
Abscessed hair follicle, people with hairy butt gets it, dx is clinical, treatment is I&D
What are the different types of ulcer
Stage 1 ulcer: non blanching errythema
Stage 2 ulcer: Ulcer is through the epidermis and the dermis
Stage 3 ulcer: Subcutaneous fascia is exposed
Stage 4 ulcer: Muscle and bone are exposed, may develop osteomyelitis
Explain venous stasis ulcer
Develops due to obstruction of blood outflow in the veins, ALWAYS happens at the medial malleolus.
Symptoms: Induated lesion, stasis dermatitis, patients develop hyper pigmentation at the site due to breakdown of Hb
Look at 3455
Tx: Compression stockings, leg raise, diuretics
What is a marjolin ulcer
Squamous cell carcinoma, have to biopsy it to determine this
What screening test should be done for breast cancer patients that are (1) low risk and (2) high risk
Low risk patients should use mammograms, high risk patients should use MRI
What is the second step after mammogram?
Core biopsy!
What are the stages of treating patients that are less than 30 and they have a mass in their breast
If there is a mass in someone below 30, we should wait 2 to 3 menstrual cycles to wait for it to go away, if not we do the following.
If less than 30 mammogram is not effective as the breast tissue is dense, so we do US. US will show 2 things either a mass or a cyst
Next step is FNA, if it is clear fluid or abscess we drain it and we are done. If FNA drains bloody fluid, we do mammogram and core biopsy
If there is a mass on US and if it reappears or if it has bloody fluid on FNA our index of suspicion should be high for cancer, especially if the mass recurs after excision.
What is the systemic treatment for breast cancer
- Chemo is the standard, it involves doxorubicin which causes dose dependent CHF
- Trastuzumab for HER2Neu +ve
- If ER/PR +ve, we use SERMs for premenopausal and aromatase inhibitors for post menopausal women
What does tracheoesophageal fistula signify?
VACTERL
Explain imperforate anus
Missing a butt hole, it could be mild or severe, for dx we do a cross table X ray, mild can be treated right away, severe has to be treated by doing a coleostomy now and reversing it later for toilet training
What is VACTERL
Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities
Explosive diarrhea on digital rectal exam of a toddler indicates what disease?
Hirschsprung disease
Explain Hirschsprung disease
Failure of the inhibitory neurons to migrate to the distal colon, there is absence of myenteric and auerbach plexus, patients either present as failure to pass meconium or as toddlers with overflow incontinence, tests that are done are anal monometry, contrast enema but the best test is biopsy
What are the position that a patient occupies that signifies intussusseption?
Knee chest position, it relieves pain
Intussusception on imaging?
Sausage shaped mass on X ray, tx and dx is air contrast
Explain biliary tree atresia
Congenital absence of the biliary tree, babies present with jaundice and high conjugated bilirubin, dx is phenobarbital for 1 week and then HIDA scan, tx is surgery
Explain choanal atresia
Air cannot be passed from the nose to the oropharynx due to the atresia, babies turn blue on feeding, babies also snore, dx is made by failing to pass a catheter, tx is surgery
How do you dx gastrinoma once we know that gastrin levels are elevated?
Somatostatin receptor scintigraphy (CT scan)
What are the 2 patient demographics that develop renal artery stenosis
Old men that have atherosclerosis and young women that have fibromuscular dysplasia
What is VSD associated with?
Downs syndrome
What is transposition of the great vessels associated with?
Maternal diabetes (NOT gestational diabetes, heart is already developed by 8 weeks)
What kind of defect is tetralogy of Fallot?
Endocardial cushion defect
How is aortic stenosis repaired?
What is done for palliation?
Historically done via surgery but now can be done entirely by endovascular repair by procedure called TAVI and TAVR
Balloon valvotomy is only for palliative purposes
What murmur has opening snap?
Mitral stenosis, the closer the snap to S2 the worse the murmur
What is the management of coronary artery disease in terms of surgery
What test is done to check this?
If 1 or 2 small vessels are occluded then we do stenting + clopidogrel, if 3 or more main vessels are involved (like LAD) we do CABG using LIMA (left internal mammary artery) and saphenous vein for others
Left heart cath tells us what vessels are involved
How is abdominal aortic aneurysm dx?
Abdominal US, remember arteriogram and CT scan is an incorrect answer!
Tx for AAA?
3.5 cm, screen every year, 4.5 cm every 6 months and if 5.5 cm or growing by 0.5 cm then we go to surgery
Surgery for AAA?
EVAR and surgery are equally effective
What are the 3 presenting symptoms of aortic dissection
Assymetric blood pressure in both arms, tearing chest pain that radiates to the back and widened mediastinum
Dx of AD?
CT angiogram, TEE or MRI
How is AD managed?
If type A (ascending aorta) treat it surgically, if type B (descending) treat it with IV beta blocker (esmolol)
What is the diagnostic workup for peripheral vascular disease?
ABI: ankle brachial index (compare dorsalis or tibial pulse to the brachial pulse):
- If more than 1.4 that vessel is calcified so we have to use a different vessel, we do TBI (toe to brachial index)
- Equivocal: 0.9 to 1, cant use this, we then do an exercise TBI
- Mild 0.8 to 0.9, moderate 0.4 to 0.8 and severe is less than 0.4
After this we follow with US doppler to find the lesion
Then we do a CT angio, only intervene if there is a significant improvement in lifestyle or treatment
Treatment is angioplasty, stenting or bypassing and treat medically like for CAD
Use bypass for below the knee and angioplasty and stenting for above the knee
What are the medication for claudication and what are they used for?
Symptom management only, dont improve the disease process, cilostozol and pentoxyphylline
What organisms cause infection after a total knee at < 3 months, 3 to 12 months and > 12 months
Staph Aureus
Coag negative Staph and Propionibacterium
Staph Aureus, gram negative rods and beta hemolytic Strep
Respectively
9111
What should be done after a central venous catheter placement?
CXR
What is the first step in management of people with significant amount of blood loss and hypotension?
Establishing 2 large bore catheters or IV lines
What is associated with Rb?
Osteosarcoma
How do you treat retinopathy of prematurity?
Laser ablation
How do you dx paraventricular hemorrhage?
Doppler US
How do you treat chlamydia and gonorrhea infection in a newborn?
Chlamydia with ORAL erythromycin and gonorrhea with ceftriaxone, remember gonorrhea shows up before and it has a purulent discharge, chlamydia has a mucoid discharge
What is the mnemonic for treating closed angle glaucoma?
Activate alpha and block beta
What is the treatment of orbital cellulitis?
- Determine if it is orbital or cellular cellulitis, this is done by check extra occular muscles
- If extra occular muscles intact, treat just by topical abx
- If not, do CT
- I&D to drain abscess
- If diabetic and presents with DKA, consider Mucor and treat with amphotericin B
What does cherry red spot on fovea signify in an ophtho exam
Retinal artery occlusion
Explain the management of subarachnoid hemorrhage
Explain what would you do if the patient develops hydrocephalus because of it
- Starts as thunderclap headache - ‘worst headache of my life’
- Dx can be CT scan, or lumbar puncture revealing xanthochromia
- Treatment is divided into early and late
Early on we control blood pressure using beta blockers and alpha antagonists, BP < 140/90
Late consists of preventing vasospasm using nifedipine and INCREASE BP by giving them vasopressors
If the person develops hydrocephalus we can do:
Coiling with a series of lumbar punctures
Clipping the aneurysm with VP shunt
How do you manage intracranial hemorrhage?
Need to do daily CT scans since we are looking for expanding hematoma, do craniotomy to evacuate hematoma and relieve hydrocephalus if present
How do you check for vesicoureteral reflux
By vesicouretherogram (VCUG)
What is posterior uretheral valves?
PUV is when the valves between the ureters and the bladder grow the opposite way, neonate presents with hydronephrosis and during prenatal period there is oligohydramnios, dx us US showing hydronephrosisand tx is surgery, catheter can be used to empty the bladder to relieve the obstruction
