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MEDICINE GENERAL > THEME 5 - ACUTE MEDICINE II > Flashcards

THEME 5 - ACUTE MEDICINE II Flashcards

1
Q

Grey turner sign

A

Intra-abdominal bruising around flank - suggesting of severe acute necrotising pancreatitis

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2
Q

Cullen sign

A

Peri-umbilical discoloration - indication acute pancreatitis (or ectopic pregnancy)

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3
Q

Borborygmi

A

Rumbling of the stomach, indicating xxx

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4
Q

High pitched peristalsis

A

Usually indication tension of air or fluid in a loop of dilated bowel. May be sign of early bowel obstruction

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5
Q

Boerhaave syndrome + Tx

A

Spontaneous rupture of esophagus due to eg severe vomiting or straining
Tx surgery? Or healing conservatively by tubes?

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6
Q

Point of McBurney

A

Most tender part in appendicitis, start of appendix

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7
Q

Diverticules epidemiology of site

A

In western world most commonly left side, whereas on the right side in Asian pts

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8
Q

Hartmann/stoma indication

A
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9
Q

Type 1 resp. failure

A

Ventilation is fine, oxygenation isn’t
Hypoxemia w/ normo- or hyperocapnia

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10
Q

Type 2 reps. failure

A

“Ventilatory pump failure”
Hypoxemia w/ hypercapnia
Normal Aa-gradient (eg hypoventilation)

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11
Q

P(A)O2

A

100 mmHg

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12
Q

P(A)CO2

A

40 mmHg / 5.3 kPa

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13
Q

P(A)H20

A

47 mmHg

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14
Q

P(a)O2 (arterial circulation)

A

95 mmHg

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15
Q

P(a)CO2 (arterial circulation)

A

40 mmHg / 5.3 kPa

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16
Q

Most often site of ectopic pregnancy

A

almost 100% fallopian tubes

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17
Q

Symptoms ectopic pregnancy (3)

A

Delayed menses (75%)
Lower abd. pain (99%)
Vaginal bleeding (55%)

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18
Q

Diagnosis ectopic pregnancy

A

Transvaginal ultrasound initially (7-30% inconclusive). If inconclusive [HCG]. HCG has slower rise in ectoptic pregnancies than healthy ones

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19
Q

Treatment ectopic pregnancy

A

If not spontaneously resolved (80-93%) or severe symptoms do surgery. In case of mild symptoms, methotrexate most used

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20
Q

Manifestation GI bleeding

A

Hematemesis and/or melena

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21
Q

GI obstructions

A

Within wall; tumors, inflamm. structures, drug induced strictures, lymphomas, intussusception
Outside wall; Adhesions, tumors, hernias
Within lumen; feces, solitary gallstones

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22
Q

Upper small bowel obstruction

A

Most common site of acute obstruction - Manifests within hours, gastric and pacreaticobiliary secretions cannot progress so are vomited

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23
Q

Most common cause incomplete obstruction

A

Slowly growing colon cancer

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24
Q

Percussion and auscultation intestinal obstruction

A

Resonant center and dull sounding periphery
ausc; loud, frequent and high-pitched

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25
Most common cause of strangulation
External hernia
26
Volvulus
Bowel becoming twisted with its mesentery. Usually bowel, rarely small intestine
27
Symptoms bowel strangulation
abdominal tenderness, symptoms of bowel obstruction, pt more unwell than pt with simple obstruction; tachycardia and leucocytosis
28
Occlusion superior mesenteric artery (SMA) leads to ischemia of...
midgut-derived structures; jejunum, ileum and right colon
29
Signs and symptoms bowel ischemia
Out of proportion pain, maybe some tenderness, ico progress cardiovascular collapse/shock BGA; metabolic acidosis and increased [lactate]
30
Most common pathogens causing PID
Neisseria gonorrhoeae and chlamydia trachomatis
31
Clinical findings PID
Lower abdominal pain, recent dyspareunia, abnormal vaginal bleeding, increased yollowish/greenish discharge tenderness lower abd., increased temp (>38)
32
Diagnosis PID
Exclude/confirming pathogen by sampling cervix. No signs of inflammation cannot exclude dx. Normal microflora and complete absence of mucoid leucocytes excludes dx of PID
33
Treatment PID
Broad ab first line, until further specified. Check/treat partners as well
34
Ovarian torsion
complete/partial twisting of ovary on supportive tissue, thereby compromising vascularisation Often fallopian tube also involved happens more often ico ovarian mass
35
Symptoms of ovarian torsion
Sudden and severe abd. pain, can result in nausea and vomiting due to necrosis, mild fever, leucocytosis and/or increased [CRP] can occur
36
Treatment ovarian torsion
urgent diagnostic laparoscopy and untwist. Ico cyst, remove
37
Most common cause of pancreatitis
Acute; alcohol and gallstones (bc of pancreatic duct obstruction) (80%) Chronic; alcohol
38
Pathophysiology of pancreatitis
Pancreatic enzymes (trypsin) become prematurely activated, leading to autodigestion. This triggers inflammation, cell injury, and systemic complications. The inflammatory response results in edema, necrosis, and possible fibrosis, impairing pancreatic function. Possible consequences include SIRS, ARDS and shock
39
Investigation pancreatitis
Plasma amylase; increased, fall after day 3-5 Plasma lipase; longer half-life, to dx later in disease Imaging; X-rays show free gas under diaphragm (ground-glass appearance) US could maybe show biliary tree ERCP and MRCP
40
Treatment and prognosis pancreatitis
Mild; fluids and analgesics. Recovery usually rapid. ico gallstones --> cholecystectomy Severe; death due to SIRS, shock and MODS administer fluid and O2, (par)enteral feeding, monitor for complications if gallstone --> ERCP and sphincterotomy
41
Pancreatic pseudocyst
Collection of pancreatic enzymes, inflammatory fluid and necrotic debris, usually encapsulated within the lesser sac. May grow to be palpable, seen on CT
42
Recurrent high swinging fever indicatory of...
presence of an abscess
43
Pathophysiology appendicitis
Prob initiated by luminal obstruction
44
Clinical features classes appendicitis
diffuse pain, vomiting and anorexia after 12-24h localized pain
45
Other presentations of appendicitis
Irritated rectum and diarrhea, signs of UTI, involuntary right hip flexion due to irrated psoas muscle
46
What organs arise from the foregut?
Abd. esophagus, stomach, proximal half of the duodenum, liver, gallbladder, pacreas
47
What organs arise from the midgut?
Distal half of duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon
48
What organs arise from the hindgut?
Distal 1/3 of the transverse colon, descending colon, sigmoid colon, rectum, proximal half of anal canal
49
What are the organs arising from the foregut supplied by?
Celiac trunk
50
What are the organs arising from the midgut supplied by?
Superior mesenteric artery
51
What are the organs arising from the hindgut supplied by?
Inferior mesenteric artery
52
What are the 3 main branches of the celiac trunk?
Common hepatic artery, left gastric artery and splenic artery
53
What are the 5 main branches of the SMA?
Inf. pancreaticoduodenal arterty, jejunal/ileal branches, middle colic artery, right colic artery, ileocolic artery
54
What are the 3 main branches of the IMA?
Left colic artery, sigmoid arteries, sup. rectal artery
55
What size of anuerysm is indication for surgery?
Ascending --> >5.5cm (in combination with aortic valve only >5.0 cm and in Marfan patients >4.5 cm) Descending --> >6.0 cm
56
How fast does an aneursysmal thoracic aorta grow?
Ascending --> 1 mm/year Descending --> 3 mm/year
57
Aortic dissection classified by Stanford
A --> Ascending (of beide) B --> Descending
58
Aortic dissection classified by DeBakey
Type 1 --> ascending extending beyond arch Type 2 --> only ascending Type 3 --> Descending aorta Type 3b --> Descending extending below diaphragm
59
Where do most dissections occur?
65-75% ascending (tx w emergency surgery) 25-35% descending (tx initially conservative)
60
Dx ruptured aneurysm CXR (4)
Widened mediastinum, indistinct aortic knob contour, depressed left main stem bronchus, loss of aortic pulmonary window
61
Where are the most abdominal aortic aneurysms located?
95% below renal arteries
62
Symptoms ruptured abdominal aortic aneurysm (4)
Pain (abd., back and groin), vomiting/passing blood, lower limb edema, high output cardiac failure, syncope, lower limb ischemia/paralysis
63
Most common cause of acute abdominal pain in children
Gastroenteritis, appendicitis and constipation
64
What is the most common site for colic obstruction?
Sigmoid colon (23-25%)
65
Pain in parietal vs visceral peritoneum
parietal: somatic spinal nerve innervation, localized and sharp pain Alpha-delta neurons, fast transmission Visceral: Autonomic nerve innervation, midline, diffuse and dull pane C-fibers, slow transmission
66
Murhpy's sign
Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner's hand, Murphy's sign is positive
67
Rovsing's sign
If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis
68
Psoas and obturator sign in appendicitis
Psoas sign: check irritation of iliopsoas muscle, which can occur if appendix is inflamed and retrocecal Obturator sign: irritation of obturator internus muscle, due to pelvic appendix
69
Coffee bean sign
Seen on abdominal xray, indicating sigmoid volvulus
70
Pharmaceutical treatment of ectopic pregnancy
Methotrexate
71
Organs supplied by celiac trunk
liver, stomach, spleen, pancreas (partly), proximal duodenum

MEDICINE GENERAL (6 decks)

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