Pestena 2 Flashcards
virulent peptic ulcer disease, resistant to all usual therapy, with watery diarrhea
Zollinger-Ellison
a devastating hypersecretion of insulin in the newborn,
requiring 95% pancreatectomy
Nesidioblastosis
migratory necrolytic dermatitis in a patient with mild diabetes, anemia, glossitis, and stomatitis.
glucagonoma
hypokalemia in a hypertensive
Primary hyperaldosteronism
also has modest hypernatremia and metabolic alkalosis
Primary hyperaldosteronism and renin
Aldosterone levels are high, whereas renin levels are low
baby whose x-rays show multiple dilated loops of small bowel and a ground-glass appearance in the lower abdomen
Meconium ileus in CF
Meconium ileus in CF rx
Gastrografin enema is both diagnostic (microcolon and inspissated pellets of meconium in the terminal ileum) and therapeutic (Gastrografin draws fluid in, dissolves the pellets).
should be suspected in 6- to 8-week-old babies who have persistent, progressively increasing jaundice
Biliary atresia
Physical exam shows a vague mass on the right side of the abdomen, an “empty” right lower quadrant, and “currant jelly” stools
- Intussusception
- seen in 6- to 12-month-old healthy-looking kids
- episodes of colicky ab pain, double up and squat. •pain lasts for about 1 minute, and the kid looks happy until he gets another colic
baby w/ stridor/ respiratory distress from pressure on the tracheobronchial tree and pressure on the esophagus
congenital Vascular rings
aorta “chokes” out esophagus and trachea
kids are kept alive by an atrial septal defect, ventricular septal defect, or patent ductus (or a combination), but die very soon if not corrected
Transposition of the great vessels
a low-pitched, rumbling diastolic apical heart murmur
Mitral stenosis
young drug addicts who suddenly develop congestive heart failure and a new, loud diastolic murmur at the right second intercostal space
Acute aortic insufficiency
Small cell cancer of the lung is treated with
chemotherapy and radiation
Operability of lung cancer pre op eligibility
A minimum FEV1 of 800 mL is needed
Abdominal aortic aneurysm size for repair
If it is 5- 6 cm or larger, the patient should have elective repair–> rupture risk is high
A _________abdominal aortic aneurysm is going to rupture within a day or two, and thus immediate repair is indicated
tender
Arterial embolization from a distant source s/s and rx
s/s same as compartment syndrome
- Early incomplete occlusion = clot busters. •Embolectomy w/ Fogarty catheter= complete obstructions
- fasciotomy if several hours have passed before revascularization
raised waxy lesion or as a nonhealing ulcer.
basal cell carcinoma
a nonhealing ulcer, has a preference for the lower lip
squamous cell carcinoma
orbital cellulitis
- eyelids are hot, tender, red, and swollen, and the patient is febrile-but
- key finding: pupil is dilated and fixed, and the eye has very limited motion.
patient reports seeing flashes of light and having “floaters” in the eye or “a snow storm” within the eye
retinal detachment
Emergency intervention, with laser “spot welding,” will protect the remaining retina.
Embolic occlusion of the retinal artery rx
30 min damage irreversible,
breathe into a paper bag and have someone repeatedly press hard on the eye and release while going to ER
(the idea is to vasodilate and shake the clot into a more
distal location, so that a smaller area is ischemic)
located on the midline, at the level of the hyoid
bone, and seems to be somehow connected to the tongue
Thyroglossal duct cyst
occur along the anterior edge of the sternomastoid
muscle
They are several centimeters in diameter
sometimes have a little opening and blind tract in the skin overlying them
Branchial cleft cysts
large, mushy, ill defined mass that occupies the entire supraclavicular area and seems to extend deeper into the chest
Cystic hygroma
development of diplopia in a patient suffering from sinusitis.
Cavernous sinus thrombosis
emergency that requires hospitalization, IV antibiotics, CT scans, and drainage of the affected sinuses.
Mitral stenosis for RF, initial rx
Mitral commissurotomy to open a stenotic mitral valve
allows normal urinary output to flow without difficulty, but if a large diuresis occurs, the narrow area cannot handle it.
Ureteropelvic junction (UPJ) obstruction
classic presentation is an adolescent-drinking binge for the first time in his life and develops colicky flank pain
little girl wet with urine all the time
low implantation of ureter
urine that drips into the vagina from the low-implanted
ureter
rx correction
Most testicular cancers are radio sensitive and ___________, offering many options for successful treatment in advanced, metastatic disease.
chemosensitive (platinum-based chemotherapy)
A __________ status is the only absolute
contraindication to organ donation.
positive HIV
Hyperacute rejection of transplant
- vascular thrombosis within minutes of reestablishing blood supply to the organ.
- caused by preformed antibodies
- prevented by ABO matching and lymphocytotoxic cross match, and is thus not seen clinically
Acute rejection of transplant
occurs after the first 5 day- 3 months.
Signs of organ dysfunction suggest it, and biopsy confirms it.
The first line therapy for acute rejection
is steroid boluses.
Acute rejection of heart transplant
In the case of the heart signs of functional deterioration occur too late to allow effective therapy, thus routine ventricular biopsies (by way of the jugular, superior vena cava, and right atrium) are done at set intervals.
tests for gunshot wounds to the base of the neck
arteriography
esophagogram (water-soluble, followed by barium if negative)
esophagoscopy
bronchoscopy
help decide the specific surgical approach
Penetrating trauma to the neck leads to surgical exploration in all cases where there is
an expanding hematoma
deteriorating vital signs
clear signs of esophageal or tracheal injury (coughing or spitting up blood).
