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Osler, part 2 Flashcards

1
Q

HPI of pancreatic CA

A

Gradual onset
Pain in lower back or epigastric, straight through to back
Fairly constant, worse at night
Dull, gnawing, visceral quality
Better when sitting up or leaning forward or fetal position +/- worse with eating/laying supine

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2
Q

Related sx of pancreatic CA

A 
Wt loss
Anorexia
Generalized malaise and weakness
New onset DM
Jaundice (early sign of pancreatic head due to bile duct obstruction)
Pruritis
Acholic stools
Dark urine
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3
Q

PE of pancreatic CA

A 
Courvoisier's sign: Palpable, nontender, distended GB associated with jaundice
\+/- hepatomegaly
\+/- RUQ mass
Cachexia
\+/- superficial thrombophlebitis
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4
Q

Signs of metastasis of pancreatic CA

A 
Abdominal mass
Ascites
L supraclavicular LAD (Virchow's node)
Periumbilical mass (Sister Mary Joseph's node)
Palpable rectal shelf
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5
Q

Grey Turner’s sign

A

Bruising of the flanks
Appears as blue discoloration
Sign of retroperitoneal hemorrhage

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6
Q

Workup for pancreatic CA

A

MRI
CT with IV contrast
ERCP: useful if obstructive jaundice, or sx without evidence of mass on CT
EUS (endoscopic u/s): clarification of small (<2 cm) lesions in neg/equivocal CT findings
CA 19-9: post-op monitoring
Tissue dx not necessary unless neoadjuvant therapy is planned

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7
Q

Purpose of Nissen fundoplication

A

Treats refractory GERD to prevent Barrett’s esophagus

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8
Q

Pre-op evaluation of Nissen fundoplication

A 
Most important test is upper endoscopy
Esophageal manometry
pH testing
UGI series
Esophagogram
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9
Q

HPI of GERD

A 
In chest/throat
Burning
Severity around 5
Comes and goes
Wheezing, CP, dysphagia
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10
Q

Sx of GERD- refractory

A 
Sore throat
Hoarseness
Trouble swallowing
Cough
Noncardiac CP
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11
Q

Indications for TURP or open simple prostatectomy

A

Acute urinary retention
Persistent or recurrent UTIs
Significant hemorrhage or recurrent hematuria
Bladder calculi secondary to bladder outlet obstruction
Significant sx from bladder outlet obstruction that are not responsive to medical or minimally invasive therapy
Renal insufficiency secondary to chronic bladder outlet obstruction

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12
Q

S/sx of prostate CA

A 
Urinary frequency
Urgency
Nocturia
Hesitancy
Hematuria- uncommon presentation
Hematospermia- uncommon presentation
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13
Q

Major RF for prostate CA

A

Smoking

1st degree relatives also a RF

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14
Q

Labs/diagnostics for prostate CA

A

PSA levels

Prostate bx guided by TRUS

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15
Q

RFs for prostate CA

A

AA > whites
Genetic- BRCA2 mutation
Smoking
Diet- high red meat diet

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16
Q

USPSTF guidelines for prostate CA

A

Decisions about screening should be make on an individual basis after consultation with a provider (C Recommendation)
Recommends against PSA-based screening past the age of 70 (D recommendation)

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17
Q

Labs and decision making process for thyroid nodules- initial

A

Check TSH and T3/4

Order u/s

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18
Q

Labs and decision making process for thyroid nodules- low TSH

A

Order iodine uptake
If no increase uptake, then order FNA
If increased, so no FNA
Indeterminant: get FNA

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19
Q

Labs and decision making process for thyroid nodules- high or nl TSH

A

Cystic nodules need no further testing
Spongiform > 2 cm
Hyperechoic >1.5 cm
Hypoechoic >1 cm need FHx of thyroid CA

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20
Q

What should be done for thyroid nodules if you did not do an FNA?

A

F/u in 6-12 mos

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21
Q

In anaplastic thyroid CA, what is the tx?

A

Needs palliative surgery only

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22
Q

What categories of FNA bx are considered to be surgical?

A

FN/SFN
SFM
MGT

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23
Q

Labs for toxic multinodular goiter

A

Low TSH
High T3/T4
Order U/s
TSAb

24
Q

When to do surgery for toxic multinodular goiter

A

If meds don’t work or if having ocular sx

25
Sx of nonfunctioning goiter
Hoarseness Dysphagia Discomfort (esp when lying down) SOB
26
Indications for tonsillectomy- absolute
Enlarged obstruction, dysphagia, sleep d/o, cardiopulm complications Peritonsillar abscess unresponsive to medical management/drainage Tonsillitis + febrile seizures Tonsils requiring bx to define tissue pathology
27
Indications for tonsillectomy- relative
Persistent/foul taste or breath d/t chronic tonsillitis Chronic/recurrent tonsillitis (seven in one year, five each in two years, or three each in three years) d/t strep, unresponsive to beta lactamase Unilateral tonsillar hypertrophy, neoplasm
28
Surgical workup for tonsillectomy
``` Coagulation parameters -FHx --If neg- no coags needed --If pos, coags needed If malignancy- XR, CT, or MRI Antibodies for streptolysin-O (ASLO) Histology- only if CA suspected ```
29
Presentation of MI
May present as nl MI that we've learned, may also be a "silent" presentation (ex. women, diabetics, elderly) Retrosternal CP radiating to jaw, down left arm, SOB
30
Labs/tests for potential CABG pt
``` EKG- T wave inversion is 1st sign Troponins CBC CMP Lipid profile CXR ```
31
Cath lab results and CABG
``` Do a CABG if: 50% stenosis found in LCA -3-vessel dz Proximal LAD stenosis Failure of PCI CABG is better for diabetic pts than stenting ```
32
RFs of aortic stenosis
HTN DM Smoking Hypercholesterolemia
33
Presentation of aortic stenosis
Usually asx until the development of syncope, angina and dyspnea/CHG when aortic valve is <1.0 cm Narrowed valve leads to hypertrophied left ventricle
34
PE of aortic stenosis
Systolic ejection murmur that is harsh/rumbling crescendo-decrescendo Murmur increases with squatting/leg raise, sitting and leaning forward. Decreases with valsalva/standing Pulsus parvus et tardus: small, delayed carotid pulse Narrowed pulse pressure S4 Hand-grip maneuver- murmur will decrease
35
Disease that can cause aortic regurgitation
``` Rheumatic heart dz Endocarditis Bicuspid valve dz Aortic root dz Aortic dissection RA SLE Myxomatous disease ```
36
PE of aortic regurgitation
Diastolic decrescendo blowing murmur heard at LUSB Murmur increases with squatting, sitting forward, and handgrip. Decreases with Valsalva, standing. May radiate to LSB. Austin-Flint murmur: bounding pulses. Wide pulse pressure
37
PE of chronic aortic regurgitation
Water hammer pulse | Swift upstroke and rapid fall of radial pulse accentuated with wrist elevation. May have S3 and rales
38
Presentation of mitral stenosis
Can present as right-sided heart failure, pulmonary HTN with hemoptysis, and a-fib
39
PE of mitral stenosis
Diastolic rumble at the apex Opening snap, loud S1 Pulses usually reduced
40
Tx of aortic stenosis
Aortic valve replacement
41
Dx of aortic stenosis
Echo and cardiac cath
42
Dx of aortic regurgitation
Echo and cath
43
Tx of aortic regurgitation
Surgery is definitive and indicated in acute and symptomatic AR or symptomatic with EF <55% Should have valve replacement
44
Dx of mitral stenosis
CXR and echo CXR: left atrial enlargement Echo: LAE, thick calcified valve, "fish mouth" shaped orifice
45
S/sx of mitral stenosis
``` DOE Orthopnea PND Palpitations CP Hemoptysis Thromboembolism All sx will increase with exercise and pregnancy ```
46
PE of mitral stenosis
RVF (JVD, hepatomegaly)
47
Diseases where mitral regurgitation will present- acute
Endocarditis Papillary muscle rupture Chordae tendinae rupture
48
Diseases where mitral regurgitation will present- chronic
MVP Rheumatic fever Marfan syndrome Cardiomyopathy
49
S/sx of mitral regurg
``` DOE PND Orthopnea Palpitations Pulmonary edema ```
50
PE of mitral regurg
Holosystolic murmur at the apex, radiates to the back or clavicular area AFib is common Diminished S1, widening of S2, laterally displaced PMI, loud palpable P2
51
Dx of mitral regurg
CXR and echo | Valve replacement must be performed if left ventricular function is too severely compromise
52
Cause of infective endocarditis
Most common d/t IV drug use, previous congenital or acquired cardiac lesions, immunocompromise, IV catheters
53
Presentation of infective endocarditis
``` Fever Weakness Night sweats Anorexia Murmur Splinter hemorrhages Osler nodes Janeway lesions Roth spots ```
54
Dx of infective endocarditis
BCx and echo revealing valvular vegetations
55
When is surgery indicated for infective endocarditis?
Reserved for prosthetic valve endocarditis, failure of medical management, life-threatening emboli, severe valvular insufficiency, obstruction, and CHF

Surgery (30 decks)

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