Revision Flashcards
Effect of ACEi on potassium
increases potassium in body through decreasing excretion
Normal urine output
0.5 mL/kg/hr
Obstructive jaundice mechanism
Obstruction of the excretion of conjugated bilirubin into the gut for elimination into the feces
(bile salts accumulation doesn’t contribute to jaundice because bile salts are colorless)
Plan regarding meds for diabetic having surgery the next day
give dextrose-potassium-insulin before surgery to avoid hyperglycemia, hypoglycemia and hypokalemia
Desired glucose: 10mmol/L (above normal 5 because better in state of surgery)
Relation between obstructive jaundice and increased INR
bile is not reaching the gut, so fat soluble vitamins are not absorbed like vit K which is essential in prothrombin formation
Txt: Start regular vit K injections
Liver failure + high protein meal
mimics alcohol intoxication, altered mental status, tremor, can lead to coma
Liver deals with toxic products from protein digestion
Also, liver failure causes esophageal varices bleeding, gut absorption of this blood is toxic, same effect as high protein (impaired consciousness)
PTLKB
Particular Tumors Like Killing Bone
Prostate, thyroid, lung, kidney, breast
Fluid volume given over 24 hours for electric burns
4 mL x weight (kg) x %burn
Half of volume given over 8 hrs then other half over 16 hrs
Fluid volume given over 24 hours for flames and scalds
2 mL x weight (kg) x %burn
Malignant otitis externa
Erosive inflammatory process that happens in immunocompromised people
Presents with ear pain, headache and facial nerve palsy
Glue ear
otitis media with effusion
MEN1
Pituitary, pancreas, parathyroid
MEN2 A
Pheochromocytoma, thyroid, parathyroid
Superficial abscess organisms
Staph aureus, Strep pyogenes
Deep abscess organisms
E coli (gram neg), Bacteroides (anaerobe)
MEN2 B
Pheochromocytoma, thyroid, neuronal tumors
When are liver hemangiomas dangerous
when larger than 5 cm, they can rupture and cause intra-abdominal bleeding
De Quervain’s thyroiditis
Associated with viral infection, painful swelling of thyroid, pain exacerbated by coughing or swallowing
Inflammation initially causes release of T3/4 for 4 to 6weeks then hypothyroid state happens due to depletion
Riedel’s thyroiditis
Progressive fibrosis of thyroid, patient can become hypothyroid
Position of thoracic duct relative to esophagus
posterior and left of esophagus, passes diaphragm at T5
Which thoracic ganglion for sweating
T1 for facial sweating
T2,3 for palms
T4 for axilla
Can do intradermal botox or topical aluminum chloride
Wilm’s tumor
mutation or deletion of both copies of WT1 tumor suppressor gene on chrom 11p, “nephroblastoma”, accounts for 80% of GU tumors in kids <15 yrs, good prognosis
osteosarcoma xray sign
sunray sign
ewing’s sarcoma xray sign
onion ring sign, multiple concentric rings
chondrosarcoma xray sign
popcorn appearance, emerge from pre-existing chondromas
cardiac tamponade signs
beck’s triad: distended neck veins (increased JVP), muffled heart sounds, hypotension
+ arrhythmias
+ Kussmaul’s sign: increased venous pressure on inspiration
+ pulsus paradoxus: fading pulse during inspiration
osteomyelitis organisms
in sickle cell: Salmonella, Staph aureus
puncture with dirty nail: E coli
drug users: Pseudomonas
hartmann’s solution components
Na, Ca, Cl, lactate, K
lactate is converted to glucose through gluconeogenesis
type of suture for skin closure with risk of contamination
non-absorbable (slow healing tissue), monofilament (lower risk of infection) –> Prolene
multifilament (silk, dacron) have risk of harboring bacteria, absorbable sutures (vicryl) are used for fast healing tissues (bowels)
lesion in frontal lobe
motor disturbance in contralateral body part
lesion in dominant temporal lobe
dysphasia (language problems)
lesion in cerbellum
balance problems
lesion in parietal lobe
sensory disturbance in contralateral body part
vision problem associated with lesion in temporal lobe
upper homonymous quadrantanopia
vision problem associated with lesion in parietal lobe
inferior homonymous quadrantanopia
why are skin graft rejections rare after burns
burned tissue early on (3 days after burn) are immunosuppressed
liver injury grading
I: <10% subcapsular hematoma or laceration <1cm parenchymal depth
II: 10-50% hematoma or laceration 1-3cm depth and <10cm length
III: >50% hematoma or laceration >3cm depth
IV: laceration with parenchymal disruption involving 25-75% of a hepatic lobe or 1-3 segments
V: parenchymal disruption >75% of a hepatic lobe of >3 segments
erectile dysfunction causes
DM, drugs (PPI), vascular disease, pelvic surgery, pelvis or spinal injury, neurological disease, hormonal problem (low testosterone)
vertebral level at which spinal cord ends
adults: L1-2
neonates and kids: L3
aorta passes through diaphragm at
T12
IVC passes through diaphragm at
T8
esophagus passes through diaphrgam at
T10
full thickness burn appearance
leathery white or charred black
femoral sheath components
medial to lateral: femoral canal (empty space which allows femoral vein to expand into when venous return increases during exercise) femoral vein femoral artery (femoral nerve is not in sheath)
vitamin K is essential for activation of which clotting factors
factor 2 (prothrombin), 7, 9, 10
necrotizing fasciitis symptoms
like cellulitis but worsening rapidly with hemodynamic compromise and margin of infection advances rapidly
red/bronze discoloration, decreased sensation, hemorrhagic bullae, sepsis, thrombosis
antibiotic to be used when allergic to penicillin
erythromycin or clarithromycin
avoid cephalosporin if can give other antibiotics due to cross-reactivity with penicillin
arsenic, what cancer
skin, lung, bladder
in pesticides, metal smelters
UV radiation, what cancer
basal cell carcinoma (skin)
aromatic amines, what cancer
bladder
pesticides, dyes
benzene, what cancer
leukemia, lymphoma, multiple myeloma
painters, printers, mechanics, petroleum
only cranial nerve that does not arise from brain
accessory nerve 11 arises from cervical spinal cord
what part of GI tract is RADIOtherapy indicated as adjuvant therapy
rectum cancer, used to reduce size and make them operable, can be used pre-op or post-op
only chemotherapy is used for any other GI malignancy
dangerous side effect of TPN
if given without folate or B12 supplements, can cause megaloblastic anemia then pancytopenia
deep peroneal nerve injury
foot drop, numbness in 1st webspace
medial plantar nerve
sensation to 1st, 2nd, 3rd toes plantar aspect
lateral plantar nerve
sensation to 4th, 5th toes plantar aspect
ANCA positive antibodies, which disease
granulomatosis with polyangiitis (Wegener), anything polyangiitis
drug induced vasculitis is ANCA negative
SLE antibody
anti-ds DNA, ANA
rheumatoid arthritis antibody
anti-CCP
systemic sclerosis antibody
anti-centromere, anti-Scl-70
what fluid should be used to replace gastric fluid lost in NG tube
0.9% normal saline to avoid metabolic alkalosis, can add potassium chloride if hypokalemia
lactate in Hartmann’s is metabolized to bicarb which worsens alkalosis
PFTs in obstructive lung disease
FEV1:FVC <0.75
hemolytic anemia or recovery from acute hemorrhage results in what kind of anemia
macrocytic
what spinal nerve injury results in problems in ventilation
C3
phrenic nerve comes from C3-4-5, injury at C3 damages whole nerve however at C4 can cause partial innervation and ventilation
prostate cancer tumor marker
PSA
testicular cancer tumor marker
HCG
medullary thyroid cancer tumor marker
calcitonin
parathyroid cancer tumor marker
PTH
liver, testes, yolk sac cancer tumor marker (teratoma)
AFP
ovary cancer tumor marker
CA 125
pancreatic cancer tumor marker (less bowel, lung)
CA 19-9
breast cancer tumor marker (less bowel, lung)
CA 153
colon and stomach cancer tumor marker
CEA
what proteins decrease in acute phase response
albumin and transferrin
Carotid surgery complication on tongue
Hypoglossal nerve injury causing tongue muscles weakness
Outstretched hand, supracondylar fracture, loss of pronation
median nerve injury
What cells should be present for Barret’s esophagus to be diagnosed
intestinal metaplasia (squamous to columnar) + goblet cells
Pseudomyxoma peritonei
rare mucinous tumor arising from appendix (post appendectomy), accumulation of large amounts of mucinous material in abdomen
Colonic surgery injury caused by traction
spleen is torn, causes bleeding in left paracolic gutter
Hypercalcemia causes mnemonic
C alcium supplements H yperparathyroidism I atrogenic (thiazides) M ilk alkali syndrome P aget disease A acromegaly and Addison disease N eoplasia Z ollinger Ellison disease MEN1 E xcess vit D E xcess vit A S arcoidosis
Left varicocele sign of what
renal cell carcinoma, occludes renal vein
Abdominal ultrasound should be done
Abduction of shoulder
supraspinatus
Hashimoto + rapid growth of thyroid size
thyroid lymphoma (non hodgkin B cell lymphoma)
Angle of the jaw is innervated by (sensation)
Greater auricular nerve
Sensation of the rest of the whole face is by trigeminal nerve
Difference between thyroglossal cyst and dermoid cyst
thyroglossal: Below hyoid, moves when swallowing or tongue protrusion, anechoic on US (echogenicity suggests infection)
Dermoid: Above hyoid, doesnt move, heterogeneous and multiloculated on US
Foot drop after hip replacement
sciatic nerve
Curling ulcers vs cushing ulcers
curling: Stress ulcers in duodenum after burns, cause hematemesis
Cushing: Result of raised ICP (overstimulation of vagus nerve increases gastric acid secretion)
Anal fissure treatments
- Stool softeners, topical GTN
- Botulinum toxin injection
- Sphincterotomy
Exits of trigeminal nerve branches from the skull
Standing Room Only
V1: Superior orbital fissure
V2: Foramen Rotundum
V3: Foramen Ovale
Kartagener syndrome is associated with
situs inversus
Sciatic nerve roots
L4 - S3
Choanal atresia
Occluded posterior nasal airway
Cyanotic when eating
Improves when cries
Trendelenburg gait caused by injury of which nerve
superior gluteal nerve
porta hepatis contents
hepatic artery, portal vein, common hepatic duct
hematoma post thyroidectomy in which plane
pretracheal fascia (covers thyroid)
mnemonic for branches of external carotid artery
Some Attendings Like Freaking Out Potential Medical Students S: sup thyroid artery A: ascending pharyngeal L: lingual F: facial O: occipital P: post auricular M: maxillary S: sup temporal
substance used for most accurate measurement of GFR
inulin (creatinine declines with age due to decline in renal function)
mnemonic for factors affecting wound healing
DID NOT HEAL
D iabetes
I nfection, irradation
D rugs (steroids, chemo)
N utritional deficiency (vit A, C, zinc, manganese), Neoplasi O bject (foreign material) T issue necrosis
H ypoxia
E xcess tension on wound
A nother wound
L ow temperature, Liver jaundice
C fibers transmit
painful mechanothermal stimuli
A fibers transmit
A delta: pain
A gamma: painful mechanical stimuli, motor proprioception
A beta: touch and pressure
B fibers
autonomic fibers
