Ramahi Flashcards
Tx for hyperkalemia
Ca gluconate
Insulin, albuterol, kayexalate
Dialysis
Most common lung cancer of non-smokers =
Adenocarcinoma
Most common location of lung adenocarcinoma =
Peripheral lung
Most common sites of met for lung adenocarcinoma =
Liver
Bone
Brain
Adrenals
Pleural effusion characteristics of lung adenocarcinoma =
Exudative effusion with high hyaluronidase
Location of SCC lung cancer =
Central
Paraneoplastic syndrome of SCC lung cancer =
Parathyroid like hormone causing low parathyroid levels and high calcium
Features of Pancoast Tumor
Caused by small cell SCC Shoulder pain Ptosis Constricted Pupils Facial Edema
Lambert Eaton Syndrome
Paraneoplastic syndrome from small cell carcinoma causing ptosis improving after 1 minute of upward gaze
Dx in old smoker with Na 125, moist mucus membranes, and no JVD =
SIADH from SCLC
Features of NSCLC =
Very aggressive
Peripheral location
Cavitation
Tx for small cell and non small cell lung cancer:
Small cell = chemoradiation
Non-Small Cell = surgery
Causes of ARDS:
Gram negative Sepsis Gastric Aspiration Trauma Low Perfusion Pancreatitis
Dx of ARDS:
Bilateral
PaO2/FiO2 > 200 (means it’s acute)
PCWP is <18 (meaning pulmonary edema is non-cardiac)
Tx for ARDS:
PEEP
Systolic ejection murmur, louder with squatting, and softer with valsalva:
Aortic Stenosis
Murmur for HOCM:
Systolic ejection murmur which is louder with valsalva and softer for squatting or hard-grip
What does valsalva do?
Decreases preload
Murmur features of mitral valve stenosis:
Late systolic murmur with a click
louder with valsalva and hand-drip
Softer with squatting
Features of mitral regurg murmur:
Holosystolic murmur
Radiates to axilla
Holosystolic murmur with late diastolic rumble =
VSD
Continuous machine like murmur =
PDA
Wide Fixed and Split S2 =
ASD
Rumbling diastolic murmur with an opening snap, LAE, and A-fib =
mitral stenosis
Blowing diastolic murmur with widened pulse pressure =
Aortic Regurg
Dx with bad breath and snacks left over in mouth in the morning:
Zencker’s
Zenker’s a true or false diverticulum =
False–only has mucosa
Achalasia has dysphagia to??
Liquids and solids
Dx in patient with dysphagia worse with hot and cold liquids and chest pain that feels like an MI with no regurgitation =
Diffuse esophageal spasm
Tx of diffuse esophageal spasm =
CCB or nitrates
Medical therapy for gastric varices:
Octreotide
Somatostatin
When to band esophageal varices:
Only when they are symptomatic
Acid reflux pain after eating and when lying down with no risk factors for GERD =
Look for hiatal hernia
Treatment for hiatal hernia =
Sliding = tx symptomatically Paraesophageal = treat with surgery
Work up for patient with MEG pain worse with eating and takes NSAIDs:
Gastric ulcers:
Barium swallow first
EGD with biopsy second
When surgery is indicated for gastric ulcers =
Persistence following maximal medical treatment
Blummer’s Shelf =
Mets felt on DRE
often gastric cancer
Gastric lymphoma (not MALT) associated with:
HIV patients
Dx in patient with foamy pee, enlarged rugae, and edema =
Mentrier’s Disease (protein losing enteropathy)
Gastric varices caused by:
Splenic vein thrombosis
which is common after chronic pancreatitis
H pylori most associated with which ulcers?
Duodenal
Best dx test for HP?
CLO test following EGD
Treatment of duodenal ulcers positive for HP?
PPI
Clarithromycin
Amoxicillin
for 2 wks
What to suspect if duodenal ulcer doesn’t heal with maximal therapy?
Next Steps?
ZES
Secretin stimulation test / octreotide testing
Syndrome gastrinomas are associated with?
MEN1
Features of MEN1?
Parathyroid adenoma
Pancreatic NE tumors
Pituitary
Dx in patient with bilious vomiting, post-prandial pain, and recently lost 200lbs on Biggest Loser =
SMA syndrome
Pathophys of SMA syndrome =
3rd part of duodenum compressed by AA and SMA
Tx for SMA syndrome =
restoring weight and nutrition
Can do roux-en-y
Complications of pancreatitis:
Hemorrhage
Abscess
ARDS
Pseudocyst
Whipple for panc cancer is indicated when…
No mets outside of abdomen
No extension into SMA or portal vein
No liver mets
No peritoneal mets
What is Whipple’s Triad:
Associated with insulinoma
Hypoglycemic Sx
BS < 45
Sx resolve with glucose
Labs for insulinoma:
C-peptide
Sx associated with glucagonoma:
Hyperglycemia
Diarrhea
Weight loss
Necrolytic migratory erythema
Symptoms and issue with somatostatinoma:
commonly malignant
Malabsorption
Steattorhea
(Exocrine pancreas malfunction)
VIPoma sx:
Watery Diarrhea
Flushing
Hypokalemia
Tx of VIPoma:
Octreotide
Tx of carcinoid syndrome:
Octreotide
Dx, w/u, and tx in patient with RUQ pain, fever, jaundice, decreased BP, and AMS:
Ascending cholangitis
US / ERCP
Tx with ECRP and cholecystectomy
2 most important types of choledochal cysts and how to tx:
Type 1 - Fusiform dilation or CBD; tx with excision of cyst
Type 4 - the worst kind; “Caroli’s Dz,” cysts in the intrahepatic ducts; tx with liver transplant
these are peds dz’s
Risk factors for cholangiocarcinoma:
Slerosing Cholangitis
Liver flukes
Tx for cholangiocarcinoma:
Tx with surgery +/- radiation
Sign of EtOHic hepatitis:
AST is 2x ALT
LFTs associated with viral hepatitis:
ALT > AST and both are in the 1000’s
Elevated AST and ALT following CT surgery:
Shock liver
Tx of hepatic encephalopathy:
Lactulose
Risk factors for hepatocellular carcinoma:
Chronic HepB > HepC
Cirrhosis for any reason
Aflatoxin
Carbon tetrachloride
Dx of HCC:
High AFP
Follow up with CT/MRI
Tx of HCC:
Resection if single
Rads or cryoablation for palliation of mutliple
Tx of hepatic adenoma:
Stop OCP
Resect if large, causing hemorrhage, or pregnancy is desired.
Focal nodular hyperplasia tx =
None
3 most common organisms of pyogenic liver abscess:
E coli
Bacterioides
Enterococcus
Ptn presents with RUQ pain, profuse sweating and rigors, and palpable liver:
Entamoeba histolytica
Cansoni Skin Test:
Positive skin test seen in patients with Echinococcal liver cysts due to high levels of IgE
Tx for echinococcal cysts:
Albendazole and surgery to remove entire cyst since rupture can cause anaphylaxis
Post splenectomy tx:
Aspirin if platelets high
Prophylactic PCN
3 vaccines
Signs, dx, and tx of hereditary spherocytosis:
sxs of hemolytic anemia, elevated retic count, and osmotic frag test. prone to gallstones.
spherocytes on smear,
Splenectomy
Nutritional deficit in patients with serotonin syndrome:
Niacin (5HT and niacin both made from tryptophan)
symptoms of niacin deficiency:
Diarrhea
Dementia
Dermatitis
Surgery to perform if tumor in serotonin syndrome is >2cm, at the base of the appendix, or with positive lymph nodes:
Otherwise…
Hemicolectomy
appendectomy
Threshold for treatment of Ogilvie’s =
> 10cm distension
Decompression with NG tube and neostigmine or colonic decompression
Side effect of neostigmine:
Bradycardia (cholinergic)
Imaging of sigmoid volvulus =
Coffee bean
