Pestana Flashcards by Ana Marija Sola

Patient with bad, breath, smoker and alcohol use, firm cervical lymph node

squamous cell carcinoma

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Man wakes up at night seeing floaters, bright flashes of light, and blurrying

Retinal detachment

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70 yo man comes in with posterior nose bleed

hypertensive nose bleed (posterior pack/surgery)

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Kid comes in with chemical burn of eye, the two major steps in treatment are

irrigation and pH testing prior to discharge

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Elderly patient suddenly loses vision in one eye

Retinal embolic occlusion

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60 yo man with hgbA1c of 8.5 has to squint to see TV

diabetic retinopathy

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Pt with hold, swollen, tender eyelids, fever and fixed/dilated pupils

Orbital cellulitis

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Mushy, ill-defined mass at base of neck that seems to go deeper (first step in surgical planning)

cystic hygroma, CT scan

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young person with multiple enlarged lymph nodes and fevers/night sweats

lymphoma

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recently discovered enlarged lymph node, next step?

f/u in 3-4 weeks

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two most common causes of epistaxis in 20’s-30’s and treatment

septal perforation from cocaine, juvenile nasopharyngeal angiofibroma (posterior packing; surgery)

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Patient with chronic sinusitis presents with double vision, what is dx and tx

cavernous sinus thrombosis, IV abx, CT scan, drainage

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Man wakes up in morning with full facial dropping

Bell’s palsy

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Large abscess at floor of mouth, dx and tx

Ludwig’s angina, threat to airway: I/D but also might intubate

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Gradual unilateral numbness/paralysis of forehead and face, best diagnostic test

facial nerve tumor, gadolinium enhanced MRI

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Hard painful lump in front of ear, producing facial paralysis

partoid tumor

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Painless, visible lump in front of ear,

benign parotid tumor

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Patient comes out of movie theatre and has severe front headache/eye pain, sees halos, fixed/dilated pupil

acute angle glaucoma

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Two causes of white pupil in baby, tx

retinoblastoma, congenital cataract: surgical removal

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IV drug user with holosystolic tumor that increases with inspiration

Endocarditis (tricuspid regurg)

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S4 when patient is lateral decubitus position

Causes of hypertrophy (HOCM, aortic stenosis)

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POD4 from perforated appendicitis and patient has . WBC of 15,000, what imaging test to we order?

CT scan to evaluate abscess

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3 causes of low serum K+

renal losses, GI losses, increased potassium into cells (alkalosis, epinephrine)

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FiO2 levels below __ % are considered safe

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Goal PaO2 when intubated patient

55-80

Obstructive lung pattern (FEV1/FVC<80) with DLCO (low, normal, high)

low: COPD/emphysema, normal: chronic cronchitis, high: asthma

Causes of low DLCO with normal FEV1/FVC

anemia, pulmonary embolism, pulmonary hypertension

Immunosuppressed person with fever, chest pain and hemoptysis, RUL consolidation with ground glass apperance

invasive aspergillosis

3 years of difficulty swallowing solids and liquids, regug, mild weight loss that improves when standing up.

Achalasia

Smoker and alcohol drinker with dysphagia to solids and now liquids, as well as 20 lb weight loss

Esophageal cancer

5 days after cardiac catheterization, patient has AKI, eosinophilia, bilateral purple mottling of skin

cholesterol embolization

Young man with acute left-sided chest pain, anxious and agitated, dilated pupils, ST segment depression and T-wave inversion, normal troponin. Dx and tx?

Dx: cocaine use, tx: IV diazapem

Valve most commonly involved in IV-drug use endocarditis

tricupsid valve

Patient present with chronic dysphagia (leading to aspiration), week of fever, chest pain and productive cough. X-ray shows cavity with air fluid level

Lung abscess.

Pleural effusion has low pH and low glucose, high LDH, high protein

Empyema

Large, loculated effusion in person with HIV dx/tx?

Dx: empyema, tx: long course of abx and chest tube

Blunt abdominal trauma, 3+ rib fractures, R chest moves insward on inspiration

Flail chest

Woman with no smoking history, 10 lb weight loss, hemoptysis, small (2.5 cm) irregular lesion in periphery of RUQ

adenocarcinoma

Man with long smoking history, hypercalcemia (with low phosphate) hemoptysis, cavitary, necrotic lung lesion

Squamous cell carcinoma

Patient with hemoptysis of >x ml per day or x ml per hour, requires intubation

600 per day, 100/hr, or massive hemoptysis, respiratory distress, etc

Man trapped in a burning building, has stridor, singed eyebrows and carboxyhgb of 30%. Next step in tx

Endotracheal intubation

Lung nodule greater than x cm requires additional f/u and surveillance

0.8

0.8 cm solitary lung nodule in 50 yo non-smoker with no symptoms. Appropriate management is..

F/U CT in 3 months

10 lb weight loss, night sweats, firm lymph nodes in cervical and axillary chains in a young person

hodgkin's lymphoma

Anterior mediastinal mass with beta-hcg and AFP expression, next diagnostic step

nonseminomatous germ cell tumor, FNA/testicular ultrasound

Anterior mediastinal mass with beta-hcg expression only

seminomatous germ cell tumor

young person with blistering of back skin and proximal muscle weakness (ptosis) who has a lump in the neck

thymoma

Antibiotic of choice for homeless man with poor dentition, alcohol abuse, history of aspiration pneumonia with cavitary lesion in RUQ

Clindamycin (lung abscess growing anaerobic bacteria)

treatment for a prolactinoma

bromocriptine (dopamine agonist) or trans-sphenoidal surgery

thunger clap headache and nuchal rigidity dx/tx

subarachnoid hemorrhage, MRI and clipping/coiling of anuerysm

small kid with headaches, bitemporal hemianopsia

craniopharyngioma

loss of upward gaze, tumor

pineal tumor

Person with two week history of otitis media, presents with new headache, fever, and papiledema, enhancement on CT scan

brain abscess

tx of trigeminal neuralgia (shooting, lightening-like pain with light touch)

anti-convulsants (lamotrigine, gabapentin (RFA if fails)

tx of extreme pain coming from a cold extremity that sustained a crush injury months ago

sympaphectomy (diagnosis is relief of symptoms from sympathetic nerve block)

Best imaging for diverticulutis

CT scan w/ IV contrast

Diverticulitis cutoffs for drainage or elective surgery

>3 cm=drainage, <3 cm or unresolving=elective surgery

Patient with gastric cancer undergoes gastrectomy, weeks ago and is now experiencing abdominal pain, diarrhea and nausea 20-30 mins after eating. What is next step in management?

Clinical dx: Dumping syndrome (hyperosmotic dumping). Diet changes (complex carbs, smaller meals), if that fails then would consider ocreotide and/or surgery

Person with IBD or c. dif who has fever, hypotension, tachycardia and diffuse tenderness/distension of abdomen. Dx/best imaging study

Toxic megacolon, abd xray

Diabetic man has a boil removed from his leg 2 weeks ago (or with ibd), now presents with 7 days of lower abdominal/groin pain, normal bowel sound, pain with hip extension and not with flexion

Psoas abscess

Acute pancreatitis following cardiac cath procedure is most likely due to

cholesterol emboli (can also cause AKI and livedo reticularis)

Tx of acute pancreatitis

IV fluid, and supportive care (pain control and NPO)

45 yo man with epigastric pain, diarrhea, weight loss, severe PUD. Dx?

Zollinger-Ellison (gastrinoma) Dx: endoscopy, gastrin concentration

65 yo woman with aortic stenosisCKD, and painless dark maroon-colored stools

Angiodysplasia (painless venous bleed)

Patient after AAA repair presents with sudden onset abdominal pain followed by rectal bleeding/diarrhea within 24 hrs

Ischemic colitis (best test is flexible sigmoidoscopy)

young woman with dysphagia and pain radiating to back, triggered by stress or hot/cold foods, relieved by nitroglycerin

Esophageal spasm

preferred imaging for acute mesenteric ischemia in early stages

CT angiography

Old person with afib presents with acute abdominal pain and rectal bleeding

Acute mesenteric ischemia

Young woman's CT scan shows well-circumscribed mass on liver, with increased arterial flow and central scar

focal nodular hyperplasia

Young female hospital worker hypokalemia and metabolic alkalosis with brown mucosa on colonoscopy

Laxative abuse

Patient with new onset diabetes, diarrhea, annular/red erosions with blisters over lower abdomen

Glucagonoma

Diarrhea, flushing of face, wheezing and eleveated JVP. Diagnostic test?

Carcinoid syndrome, 5-hydroxyindeoleacetic