Afternoon Flashcards
(36 cards)
Neck pain + swelling Unable to fully open mouth Tongue elevated in oral cavity Pooling of oral secretions Trismus = jaw m. spasm
Strep viridans due to poor dentition
- Submandibular swelling
Can lead to airway compromise
- necessitating tracheostomy
Dx w/ CT scan - see swelling in submandibular space
3rd Trimester, sudden-onset HA
Epigastric or RUQ pain
Nausea vomiting
Schistocytes
HELLP
- Hemolysis, elevated liver enzymes
- low platelets
See bilirubin > 1.2
20+ weeks gestation
New-onset HTN
Also?
Pre-eclampsia - HTN + proteinuria \+/- end organ dysfunction > 140 mm Hg > 0.3g/24hour Protein:Creatinine ration 0.3+
Retrograde
- cystography
- urethrography
In pt w/ subrapublic pain + blood at meatus
Retrograde cystography for traumatic bladder rupture (often dome).
- occurs w/ pelvic fractures
- blunt trauma from motor vehicle accidents
Unilateral HA +/- neck pain
Right eye constricted & minimally reactive to light
Drooping of right eyelid
Difficulty moving left arm + leg
Horner’s
- so if w/ trauma, think…
- Carotid artery dissection
72yo M lower back pain Hx prostate cancer PSA 9.0 ng/mL Weight loss Tender to palpation of bony prominence
Bone mets from prostate CA until proven otherwise (likes axial skeleton)
- do technetium-99 radio nucleotide bone scan
- great for bone mets
- plain radiography next best step after bone scan
Treat acute bacterial rhino sinusitis
- make sure not viral
- should have 7+ days symptoms
- purulent d/c, fever > 39 C
Amoxicillin-clavulanate
- covers H. flu and Moraxella c. better than amoxicillin alone
If penicillin allergy, do doxy
Supportive treatment for viral (nasal irrigation w/ saline + NSAID + copious fluid intake)
Post-bastric bypass
- postprandial nausea, vomiting, diaphoresis, lightheaded, weak/fatigue/dizzy
Gastric dumping syndrome:
- confirm w/ oral glucose test
(measure glucose, crit, HR, BP)
Treat: dietary changes, no sweets, lie down after meals
Acarbose & Octreotide (prolong gastric emptying) can help
Apple core lesion on barium enema
Colon Cancer: tumor grows in lumen, partial occlusion.
Malignancy is #1 cause colonic obstruction
- left = obstruction (smaller diameter)
Ogilvie’s syndrome
Pseudo-Obstruction of colon: - serious medical problems after trauma - lack of normal colonic motility - functional obstruction (not a mechanical obstruction)
Bird’s beak colon appearance w/ barium enema
- ) Cecal volvulus: right side, colicky pain becomes constant
- ) Sigmoid volvulus: elderly, debilitated, nursing home pt, on left-side
Claudication symptoms in:
- upper 2/3 of calf
- hip
- thigh
- lower calf/feet
Upper calf = Superficial femoral
Hip = aortoiliac
Thigh = common femoral (but also at more distal areas)
Lower calf/feet = popliteal
Definitive treatment for SCFE?
Surgery - operative stabilization
Worry about osteonecrosis of femoral head - pain & stiffness after stabilization
Central fibrous stellate scar on liver lesion in young women?
Focal nodular hyperplasia
- no malignant potential
- no hemorrhagic potential
Resect only if symptomatic
Path appearance of hepatocellular carcinoma?
Exterior fibrous capsule w/ areas of necrosis interiorly
What lesion on liver correlates to OCP use?
Describe the lesion.
Benign/metastatic?
Treatment?
Hepatic adenoma:
- soft, yellow lesion w/ homogenous interior
Benign but potential for malignant transformation and significant hemorrhage
Surgical resection is necessary
VIPoma
High VIP levels: profuse watery diarrhea - hypokalemia - hypochlorydia Often distal pancreatic mass Treat: fluid + electrolyte replacement Octreotide can help control diarrhea Surgical resection can be curative If liver mets, most common, resection can help control diarrhea.
Glucagon-secreting tumor
See new-onset diabetes mellitus - pancreatic mass Migratory narcoleptic erythema of face, extremities, perineum See tumor w/ CT scan Treat w/ surgical resection
Somatostatin (octreotide)
- abdominal pain + weight loss when SST secreting tumor
- also diabetes, cholelithiasis, steatorrhea
Dx w/ CT scan; Tx w/ resection
Inhibits secretion of hormones:
- insulin
- growth hormone
- cholecystokinin
- gastrin
- glucagon
How manage small abdominal aortic aneurysm?
Yearly U/S
- surgical intervention when reaches 5.5cm
- risks: smoking, HTN
If symptomatic or aneurysm is close to 5.5cm, could consider U/S every 6 mos
Recent sinus/facial infection. Headache + lateral gaze palsy…
Cavernous sinus thrombosis
- bacterial infection w/in centrally located dural sinuses
- if bacterial infection of nasal sinus/face not treated w/ infection…
Dx: high-res CT scan
Treat w/ abx
How decrease ICP w/ breathing?
Hyperventilation decreases ICP through vasoconstriction and decrease in volume of intracranial blood.
IV mannitol dehydrates brain parenchyma - also get ICP reduction.
When give nitroprusside for blood pressure?
Nitroprusside treat hypertensive urgency
180/120 mmHg and up
What is Cushing’s Triad?
A late presentation if elevated ICP:
- hypertension
- bradycardia
- respiratory depression
