Pestana Misses Flashcards
Post trauma pericardial tamponade
Pericardial Window …. Thoracotomy …. Ex Lap. If location of the wound strongly suggests tamponade proceed with thoracotomy
Severe Chest Pain with Shock.
Cardiogenic post MI, treat as a MI. Confirm then thrombolytics.
LL Chest Wall tenderness and ribs 8,9,10 fractured
Ruptured spleen.
Blood in the meatus or pelvic fracture
Retrograde urethrogram.
Put in a foley and get frank blood
Bladder Injury, retrograde cystogram, if that is normal get a CT scan to look at the kidneys
Guy gets hit in the nuts and has a scrotal hematoma the size of a grapefruit, next step ?
Sonogram to confirm. Only treat symptomatically.
Bent Penis,
Fracture of the tunica, urological emergency. Surgery
Human Bite on finger,
Rabies and surgical exploration.
Indolent punched out ulcer that is chronic.
Also how Basal Cell Carcinoma can persent.
Only test that can rule out breast cancer
Excesional Biopsy
Orbital Cellulitis
CT scan and surgical drainage.
Progressive Dysphagia
Barium swallow then endoscopy w/ biopsy then CT Scan
Mallory Weiss vs Borhaave
Borhaave will have severe epigastric and lower sternal pain. Gastrograffin swallow.
Mallory Weiss you work up with endoscopy.
Management of internal and external hemmhorids
Always rule out cancer first.
Management of anal fissure,
Rule out cancer… Exam under anesthesia.
Multiple unhealing anal ulcers and anal fissure
Rule out cancer. Exam under anesthesia with biopsies. Usually think churns.
If the prevalence of the disease changes what statistical variable will also change
PPV.
Variable that is unmeasured
Confounding variable
Microscopic hematuria
KUB or sonogram
Intestinal obstruction with bird beak sign
Sigmoid Volvulus
Patient on OCP’s becomes suddenly hypotensive and faints.
Ruptured hepatic adenoma.
Liver Abscess in a patient from mexico
Amebic Abscess. Give him metronidazole. Do not drain it.
Cholidocholithiasis ascending cholecystitis and a liver abscess
Pyogenic abscess. This needs drainage.
Indirect hyperbili in an old lady
Hemolytic jaundice.
Hypo K + Acidic urine + Non-Anion Gap Acidosis
RTA - 2 Inability to reabsorb Bicarb.
Non-Anion Gab Acidosis, Hypo K, Aklaline Urine
RTA - 1 Inability to secret H+ , Stones, Give Bicarm
Oligohydramlos with hepatomegaly and dilated bile ducts.
ARPKD
Pulsus Paradoxis is found in ?
COPD and panic attacks.
Chlorodiazopoxide
A bento that can treat delirium tremens
Purulant discharge out the urethra that can not be visualized on gram stain
Chylamida urethritis.
Inabiliity to stay awake early in the evening.
Advanced sleep phase disorder.
What age are stable infants given their immunizations based on ?
Chronological age.
Floating spots and blurred vision in one eye after penetrating injury to the other eye.
Sympathetic opthalmia. The breaking of the barrier of the other eye uncovers hidden antigens.
Akanthosis Nigricans
Insulin resistance, (PCOS / Diabetes / Obesity ) or GI malignancy in the elderly.
Syncope and hemodynamic collapse
Massive PE. Look for underlying malignancy. This will be accompanied by Right Ventricular dilation and hypertrophy.
Reversable airway obstruction that responds to bronchodilation with normal CO diffusion capacity.
Asthma.
Treatment of HELLP
Immeidate induction of labor.
First and second things to check when working up amenorrhea ?
bHCG, Prolactin/TSH/FSH
Obstructive type PFT’s with normal DlCO. FEV-1 returns to normal with bronchodilators.
ASTHMA
Premature ovarian failure.
Increased FSH and Estradiol before the age of 40.
Pilonodal cyst vs abscess.
Pilonodal cyst is an infected hair follicle. is over an area of high friction. Whereas an abscess will be a tender fluctuant.
Bulging eardrum and fever
Acute Otitis Media.
Middle ear effusion without inflammation.
Acute Otitis Media with effusion.
Liquid filled blister on the tympanic membrane.
Bullious Mygritis.
Meningitis and circulatory collapse with large petechiae and purpura.
Waterhouse Friedrichson Syndrome.
Systolic murmer that decreases with squatting, leg raises, and hand grip.
Hypertrophic Cardiomyopathy.
Digoxin Toxicity
Nausea, Vomiting, Decreased appetite, confusion.
Workup of digoxin Toxicity.
Digoxin Level, ECG, PT/INR,
Adverse Effects of PTU ?
Hepatic failure and ANCA associated vasculitis.
Pathophysiology of atelectus
V/Q mismatch causing dyspnea and tachypenia. The hyperventilation will cause respiratory alkylosis.
Relation between hypothyroidism and hyperprolactinemia.
Prolactin production is inhibited by dopamine and stimulated by serotonin and TRH. Increased prolactin will suppress GnRH and thus cause amenorrhea.
Hard testicular mass. Ultrasound shows high likelihood it is a tumor. Next best step ?
Radical orchiectomy. You do not biopsy scrotal cancer because this can allow the cancer to spread.
How do you treat active Toxoplasmosis in an aids patient ?
Sulfadiazine and Pyramethazine.
Respiratory Quotient of the major energy substrates
RQ: 1.0 Carbs
RQ: 0.8 Protein
RQ: 0.7 Fatty Acids
Akathasia (Ants in the pants) Treatment
Benzodiaziapine.
Febrile Nonhemolytic transfusion reaction within 1-6 Hours.
Give Leukoreduced blood products.
Furuncliosis that progresses to RLQ pain and positive psoas sign.
Psoas Abscess.
Low AFP and Low Estrol
Downs Syndrome
DD of increased maternal serum AFP
- Neural Tube Defect
- GI Tract Defect
- Multiple Gestation, Uterus will be enlarged.
Pneumococcus recommendations for HIV patients.
PCV 13 followed by PPSV23 8 years later and a booster Q5 years.
When can an AIDS patient get MMR and Varicella `
CD4 over 200 with no history of AIDS defining illness.
Chronic Chondrocalcinosis DD
Hypo Mg
Hyperparathyroidism
Hemachromatosis.
Workup of lactose intolerance
Give the patient lactose and measure H+ in the breath.
Antimitochondrial Ab
Primary Biliary Cirrhosis.
When do you give Ca-Gluconate in a patient with really high K+ ?
If they have EKG changes, K over 7, or rapidly rising K.
Patient has an enlarged prostate, how should you screen them for prostate cancer ?
Just discuss the options with the patient.
ARDS Diagnostic Criteria
PaO2 / FiO2
Carpal Tunnel in a pregnant patient
Splint
The NPV of a test varies with ?
Pretest Probability of a disease.
Treatment guidelines for patients with influenza
Neuroamidase Inhibitors if caught within 48 hours of symptom onset.
Hypothyroidism and hepatocellular injury and pulmonary fibrosis are a side affect of what drug ?
Amidarone.
Iron Intoxication
Desferoxamine
Mobile cavitary mass with progressive hemoptysis
Aspergillious.
Absent CD-55
PNH
Workup of hereditary spherocytosis
Low MCV and Increased MCHC. Eosin-5-Malenide Binding Test.
Treat with folic acid.
Classic triad of hereditary spherocytosis
Hemolysis, Splenomegaly, Jaundice.
Patient is pronounced braindead and decision needs to be made about removal of vent. Who do you ask ?
You do not need to ask anyone. Diagnosis of Braindeath is enough.
Most common site of hypertensive hemorrhage
Putamen.
Cardiac defects in turners
Coarctation of the aorta and Bicuspid aortic valve.
Pneumococcal vaccination recs in adults.
PPSV-23 alone in 19-64 for patients at low risk. PSV13-PPSV23 for patients at high risk or over 65
Long term treatment of duodenal ulcers
Pantoprazole and Triple Therapy.
Dude has syphillus and is allergic to penicillin
Doxycycline
