uworld Flashcards
ddx for mediastinal mass with high bhcg and AFP.
4Ts: thyroid, thymoma, teratoma, terrible lymphoma. teratoma= germ cell tumor with high BHCG, ADP. seminoma has high bhcg and normal afp.
how to get airway in pt with likely cervical spine trauma
orotracheal intubation (unless there is significant facial trauma). not nasotracheal intubation- this is contraindicated in apnea/hypopneic ps and also contraindicated in pts with basilar skull fracture.
pt with seizures or TB gets pins and needles sensation around mouth
drugs like phenytoin, carbamazepine, and rifampin cause vitamin D deficiency by stimulating the P450 cytochrome system in the liver, which degrades vitamin D to inactive metabolites.
pt s/p distal gastrectomy gets sxs 20-30 min after means of n/d/cramps. dx? tx?
dumping syndrome. loss of normal action of pyloric sphincter. rapid emptying of hypertonic gastric contents into duodenum and small intestin-> fluid shifts to small intestine-> hypotension, stimulation of autonomic reflexes, release of intestinal vasoactive polypeptides. tx: change diet to small meals with less sugar.
gallstone ileus
gallstone passes through biliary enteric fistula into the small bowel causing signs and symptoms of MBO
metoclopromide
dopamine antagonist with promotility effects. odansetron- serotonin receptor antagonist-> constipation.
what antibodies cause anaphylactic drug reaction
IGA
respiratory distress and signs of noncardiogenic edema within 6 hours of blood transfusion
transfusion related acute lung injury- caused by donor anti-leukocyte antibodies
fever and chills withins 1-6 hours of transfusion
febrile nonhemolytic - caused by cytokine accumulation during blood storage
mild fever and hemolytic anemai 2-10 days after blood transfusion with positive direct coombs tests and positive new antibody screens
delayed hemolytic- caused by anamnestic antibody reponse
pt in surgery and then gets high fever (>104F), muscle rigidity, rhabdo, metabolic acidosis, and HD instability
malignant hyperthermia. usually from inhaled anesthetics.
pt with stuttering episodes of n/v, pneumobilia (air in biliary tree), hyperactive bowel sounds, and dilated loops of bowel
gallstone ileus! form of mechanical bowel obstruction. occurs when a gallstone passes though a biliary enteric fistula into the small bowel. as it advances it may cause intermittent tumbling obstruction with diffuse abdominal pain and vomiting until finally lodging int he ileum several days later.
pt has fever and RUQ and decreased bowel sounds
emphysematous cholecystitis- gallbladder infection due to gas producing organisms. causes ileus.
pt performs repetitive arm movements above should height. subacute pain on abduction.
rotator cuff tendinopathy
pt in rapid deceleration accident with CXR showing persistent pneumothorax despite chest tube placement, and pneumomediastinum, and ge gas subcutaneous emphysema.
tracheobronchial perforation secondary to blunt thoracic trauma. usually the right main bronchus. confirm fx with high resolution CT, bronchoscopy, or surgical exploration. operative repair is indicated.
mc cause of parotitis
staph aureus. form dehydration.
ankle branchial index interpretation
ratio of resting SBP at ankle to SBP in brachial artery. 1.3: suggestive of calcified and uncompressible vessels. 0.91-1: normal. ABI is more sensitive and specific than arterial duplex. usually done when considering for interventional procedures.
who is umbilical hernia seen in? what causes it.
african american, premies, ehlers danlos, beckwith-wiedemann syndrom, hypothyroidism. caused by incomplete closure of umbilical ring.
difference in imaging between tension pneumothorax and spontaneous pneumothorax
SP has absent lung markings and visible pleural line. TP has what SP has PLUS contralateral mediastinal shift, and ipsilateral hemidiphragm flattening.
pt with elevated amylase, metabolic acidosis, abdominal pain out of proportion to physical exam
acute mesenteric ischemia. acidosis from elevated serum lactate levels.
pt with mild scleral icterus after appendectomy with elevated indirect bill with normal LFT and no evidence of hemolysis.
gilbert syndrome- the most common inherited disorder of bilirubin glururonidation. decreased activity of UDP glucuronyltransferase.
pt has anterior knee pain, localized swelling, tenderness, erythema.
prepatellar bursitits. often due to staph aureus. which can infect the bursa via penetrating trauma, repetitive direction, or extension from local cellulitis.
pt s/p fracture of long bone-> dyspnea, confusion, and petechiae in upper part of body
fat embolism. tx: prompt respiratory support. use of heparin, steroids, and LMW dextran is controversial.
acute shoulder pain after forceful abduction and external rotation at the glenohumeral joint. nerve injury?
anterior hsoulder dislocation. may cause injury to axillary nerve or artery.
pt gets fracture of humeral midsahft. nerve injury?
radial nerve. or from use of improperly fitted crutches. sxs= wrist drop, sensory loss of posterior arm, forearm, o lateral dorsal hand.
pt fractures medial epicondyle of humerus. nerve injury?
ulnar nerve injury-> claww hand, snsory loss on dorsal and ventral medial hand.
pt on warfarin with INR of 2.1 w/acute GI perforation. what to do next?
need to reverse anticoaguation by infusion of FFP. giving vitamin K is not fast enough.
pt presents with a week of abdominal pain RLQ, vomiting, decreased appetite, mild fever, increase pulse, WBC count. dx? tx?
pts who present with appendicitis >5 days after the onset of symptoms have a high incidence of perforation with abscess formation. they often have a contained abscess. if pts are otherwise stable, they may be treated with IV hydration, antibiotics, bowel rest, and interval appendectomy.
Pt with recent hx of skin infection who presents with fever and abdominal pain radiating to the groin
Psoas abscess. From hematogenous spread or from direct extensions. RF: HIV, IVFU, DM, crohns. Dx: CT scan. TX: drain, get blood and abscess cultures to guide antibiotic therapy.
Pt after horseback riding has perineal tenderness, hematoma, normal prostate, bleeding from urethra
Damage to anterior urethra (urethral distal to urogenital diaphragm)
Pt after pelvic injury has suprapubic pain and an inability to void. Blood at urethral meatus, high riding prostate due to displacement of prostate by pelvic hematoma
Posterior urethral injury.
Blood gas levels in atelectasis
Hypoxemia-> hyperventilation -> hypocapnea -> respiratory alkalosis. Similar to PE.
Child falls on arm and gets supra condylar fracture. Risk of injury time
Brachial artery, median nerve. Tx: analgesia and mobilization
New military recruit gets foot pain with slow onset pain that initially occurs only with activity but now already occurs. Plain film shows hairline fx of shaft of second metatarsal. Next step?
Rest and analgesics. Fxs of the 2nd, 3rd, and 4th metatarsals are managed conservatively bc surrounding metatarsals act as splint and nonunion is uncommon
yougne rat has acute popping sensation in knee with catching locking and reduced range of motion, and slow onset joint effusion.
do MRI. meniscal tear. management: rest, activity modification. if persistent sxs:surgery.
asian man has neck swelling and epistaxis. mass in posterior nasal cavity. what is risk factor
viral infection. tis is nasopharyngeal carcinoma, an undifferentiated SCC. EBV association. EBV titer levels can be used to track progress of therapy for this malignancy. cancer also associated with smoking and chronic nitrosamine consumption.
If child falls on outstretched hand and has a displaced supracondylar fracture of the humerus, what do you worry about
Brachial artery or median nerve injury. Also compartment syndrome/volkmann ischemic contracture
What causes dumping syndrome
Loss of normal action of the pyloric sphincter bc of injury or surgical bypass
What is used to predict prognosis of coma? To dx coma?
Dx: brain stem activity (pupillary light, extra ocular or corneal reflexes)
Widening of femoral ring puts you at risk for
Femoral hernias
fever chills and deep abdominal pain
suggest a retroperiotneal abscess
