rosh review question Flashcards
Achalasia Sx: Imaging: PE: Tx:
Sx: dysphagia to solids foods and liquids
Imaging: barium swallow will show birds peak appearance
PE: absent peristalsis in the lower esophagus
Dx: esophageal manometry- increased LES pressure
Chronic pancreatitis rapid review
Most common cause: chronic excessive alcohol use CT, AXR: calcifications Glucose intolerance Abdominal pain radiating to back Malabsorption Steatorrhea
describe the different stages for pressure ulcers?
Stage 1: nonblanchable erythema, intact skin, may be painful
Stage 2: patrial thickness, shallow open ulcer
stage 3: full thickness skin loss- subcutaneous fat, slough or eschar
stage 4: bone and muscle and tendon can be exposed, undermining and tunneling
how often to reposition someone with pressure ulcers
every 10 minutes if they can do it themselves
every 2 hours if they cant
Ulcerative colitis rapid review
Sx: bloody diarrhea, crampy abdominal pain, tenesmus
PE: continuous mucosal inflammation, always involving the rectum, absence of perianal involvement
Extraintestinal findings: uveitis, erythema nodosum, sacroiliitis, ankylosing spondylitis
Complications: toxic megacolon, increased risk of colon cancer
Tx for ulcerative colitis
options depend on severity and location of disease
Mild-moderate: mesalamine, topical or oral steroids, 5-ASA
Severe: IV steroids +/- topical steroids initially, then anti-TNF or anti-integrin, colectomy for refractory cases (curative)
Varicose veins rapid review
PE
DX
Tx
Patient will be a woman
Dull ache in legs after prolonged standing
PE will show dilated, elongated subcutaneous veins
Diagnosis is made by detailed history and physical exam
Treatment is leg elevation and compression stockings
how do you diagnose esophageal diverticula, what imaging?
diagnosed by barium swallow, can do a transcutaneous ultrasound if they cant swallow
idiopathic intracranial pressure rapid review Sx: PE: Dx: Tx:
Risk Factors-female sex, obesity, meds (tetracycline, OCPs, vitamin A, steroids)
Sx: diffuse headache and visual blurring, peripheral vision loss
PE: bilateral papilledema, CN VI palsy
Elevated opening pressure on LP
Treatment is acetazolamide, serial LPs, weight loss, can use topiramate when headache is very bad
what protein can be measured to assess short term changes in nutritional status for post surgical patients
prealbumin because its half life is 2-3 days
Tx for inpatient diverticulitis
intravenous antibiotics, intravenous fluids, pain control, and dietary modification
abx options for diverticulitis?
ciprofloxacin and metronidazole,
trimethoprim-sulfamethoxazole and metronidazole
amoxicillin-clavulanate monotherapy
imaging of choice to dx diverticulitis?
CT abdomen and pelvis w/contrast
Rapid review of diverticulitis
Sx: abdominal pain that is localized to the left lower quadrant, fever, nausea, vomiting, and a change in bowel habits
PE: localized guarding, rigidity, and rebound tenderness
Diagnosis is made by CT with IV contrast: thickened bowel wall, “fat stranding,” may show complications - bowel perforation, abscess, fistula, obstruction
Tx: antibiotics (should cover gram-negative and anaerobic bacteria, bowel rest, and surgery (in severe cases)
High-fiber diet can help in prevention
subdural hematoma rapid review
Risk factors: traumatic head injury, advancing age, anticoagulant use, coagulopathy, thrombocytopenia
Caused by tearing of the bridging veins between arachnoid and dura
Sx: acute or subacute neuro sx, headache, mental status changes, seizures, or focal deficits
Dx: crescent-shaped hematoma on noncontrast CT
Management includes neurosurgical consultation, blood pressure control, reversal of anticoagulation
