step 3 22 Flashcards
factors of solitary pulmonary nodules suggesting further workup
Large size* (greater than 0.8 cm) Advanced patient age Female sex Active or previous smoking Family or personal history of lung cancer Upper lobe location Spiculated radiographic appearance
biopsy approach for pulmonary nodules
- if central, fiberoptic bronchoscopy
- if peripheral, surgical excision percutaneoulsy
first step in SLE patient presenting with potential kidney disease
renal biopsy (there are 6 subclasses of renal disease and therapy is based on subclass. This is why you need a biopsy).
tinea capitis treatment
oral griseofulvin or oral terbinafine (need an oral to penetrate the hair follicles)
first steps with lung cancer
1) identification and staging of the tumor, 2) preoperative physiologic assessment of lung function
pericarditis presentation after MI + on EKG + on exam
pericarditis typically have pleuritic chest pain and a pericardial friction rub <4 days following an acute myocardial infarction. The characteristic ECG changes of diffuse PR depression and ST elevation may also be present, but can be masked by ECG changes of recent myocardial infarction.
- pleuritic chest pain that worsens with deep inspiration and improves with sitting up.
- pericardial friction rub
ventricular aneurysm post MI treatment
late complication, typically weeks to months, after acute MI. It is characterized by ECG findings of persistent ST-segment elevation, along with deep Q waves in the same leads. The usual presentation is progressive left ventricular enlargement causing heart failure, refractory angina, ventricular arrhythmias, or systemic arterial embolization due to mural thrombus.
most specific diagnostic finding for tamponade
Echocardiography showing early diastolic collapse of the right ventricle and right atrium
most common type of brain cancer
mets
cancers with mets to brain in order
lung, breast, unknown primary, melanoma, and colon cancer.
tumor type with predilection for early metastasis to the brain.
small cell lung cancer
osteoblastic bone mets
prostate
small cell lung
Hodgkin’s
breast (or lytic)
workup of patient with possible prostate cancer presenting with bone pain
radioisotope bone scan
pain features of bone mets
dull and aching or boring in character, and symptoms often occur at night.
workup of osteolytic mets
PET, plain film
factors most associated with request for euthanasia
A loss of sense of autonomy and dignity and the fear of future suffering
first step in coma workup and interpretation
oculovestibular testing
- if normal (gaze deviation toward stimulus), prob psychogenic coma
- if abnormal than other cause
stimulants for ADHD association with substance abuse?
none
how to preserve organs in brain dead patients
intravenous fluids and desmopressin (central DI happens in brain death)
ovarian torsion management
Laparoscopy with detorsion
postop atelectasis management
IF NO respiratory secretions then continuous positive airway pressure,
IF secretions then aggressive pulmonary hygiene, including chest physiotherapy and suctioning.
CXR with atelectasis
linear opacifications in the bilateral lung bases
SVC syndrome presentation
- high risk of malignancy (e.g., family history or smokers) and presents with dyspnea, orthopnea, neck pain and swelling, and has cervical and upper extremities venous dilatation
- Pertinent physical findings are edema and erythema of the neck (which may sometimes compromise the face), and dilated veins of the arms and neck
Nelson’s syndrome presentation
Bitemporal hemianopsia and hyperpigmentation following bilateral adrenalectomy for Cushing’s disease. Cause of pituitary enlargement is the loss of feedback by the adrenal glucocorticoids following bilateral adrenalectomy. The tumor in Nelson’s syndrome is aggressive and is treated by surgery and/or pituitary radiation. Following bilateral adrenalectomy, prophylactic pituitary radiation sometimes prevents the development of Nelson’s syndrome; however, this leads to an increased risk for hypopituitarism. Previously, bilateral adrenalectomy was the preferred treatment for Cushing’s disease; however, with the advent of better localization and improved techniques of transsphenoidal surgery, primary pituitary surgery is now the preferred treatment for Cushing’s disease.
