deck 32

Question 1

other indications of peritonsillar abscess

Answer 1

muffled or “hot potato voice”

prominent unilateral lymphadenopathy

Question 2

treatment of peritonsillar abscess

Answer 2

aspiration of abscess + IV antibiotics

may need surgery

Question 3

explanation of weber test

Answer 3

(placing tuning fork in middle of head)
- sound materializes to affected hear with conductive hearing loss because the affected ear cannot hear the ambient noise of the room. As a result, inner ear is able to pick up the vibration better and perceives it as louder.

Question 4

tumor type that arise within chronically, wounded, scarred or inflamed skin

Answer 4

SCC

Question 5

tumor type that can arise within burn wounds

Answer 5

SCC called marlin ulcer

Question 6

front of forearm

Answer 6

volar aspect

Question 7

otosclerosis

Answer 7

• common cause of conductive hearing loss n adults, especially those in their 20s and 30s
• abnormal remodeling of otic capsule thought to be a possible autoimmune process

Question 8

treatment of otosclerosis

Answer 8

hearing amplification or surgical stapedectomy

Question 9

sepsis in burn patients, and etiologic bacteria

Answer 9

• common from loss of skin barrier

- gram-negative organisms or fungi 5 days after burn wound

Question 10

tell tale signs of burn wound infection

Answer 10

• wounds progress from partial thickness to full-thickness necrosis
• loss of skin graft

Question 11

salivary gland enlargement in disheveled people think

Question 12

major life threatening complication of retropharyngeal abscess

Answer 12

Can extend through alar fascia into “danger space” transmitting infection into posterior mediastinum and resulting in acute necrotizing mediastinhtis.

Question 13

labs to order to test for acute hep B infection

Answer 13

HBsAg + anti-HBc (they are both elevated during initial infection and anti-HBc will remain elevated during the window period)

Question 14

major RFs for c diff

Answer 14

recent abx use + age over 65 + gastric acid suppression

Question 15

other impt lab finding with celiac’s

Answer 15

IDA

Question 16

IgA deficiency in celiac’s

Answer 16

common

Question 17

malabsorption in crohn’s?

Answer 17

not common

Question 18

features of chronic pancreatitis on presentation

Answer 18

• chronic epigastric abdominal pain that can radiate to the back and is partially relived by sitting upright or leaning forward
• diarrhea, steatorrhea, weight loss from malabsorption
• ## can cause diabetes due to pancreatic endocrine failure with glucose intolerance

Question 19

diagnosis of chronic pancreatitits

Answer 19

CT (looking for calcifications)
(in contrast to widespread inflammation, CP causes patchy inflammation and fibrosis so malaise and lipase can be normal or only slightly elevated)

Question 20

signs/symptoms of SIBO

Answer 20

abdominal pain, diarrhea, bloating, excess flatulence, malabsorption, weight loss, anemia, and nutritional deficiencies

Question 21

gold standard for diagnosis of SIBO

Answer 21

endoscopy with jejunal aspirate

Question 22

when to order upper GI endoscopy for patients with GERD

Answer 22

alarm symptoms = dysphagia, odynophagia, weight loss, anemia, GI bleeding, recurrent vomiting OR are men over 50 with chronic symptoms and cancer RFs

Question 23

esophageal spasm presentation

Answer 23

intermittent chest pain + dysphagia for solids and liquids

Question 24

esophageal spasm treatment

Answer 24

CCBs

Question 25

diagnosis of esophageal spasm

Answer 25

esophagram: "corkscrew" pattern manometry: intermittent peristalsis, multiple simultaneous contractions Endoscopy normal

Question 26

treatment of duodenal ulcers from H pylori

Answer 26

abx + PPI

Question 27

pseudoachalasia

Answer 27

narrowing of the distal esophagus secondary to causes other than denervation (eg, esophageal cancer) - clues= weight loss + rapid symptom onset + presentation at age over 60

Question 28

porcelain gallbladder on CT

Answer 28

circle with calcified rim with central bile-filled dark area

Question 29

porcelain gallbladder sequela

Answer 29

increased risk of gallbladder adenocarcinoma

Question 30

porcelain gallbladder

Answer 30

- results from chronic cholecystitis | - chronic inflammation and irritation lead to deposition of calcium salts intramurally in gallbladder

Question 31

porcelain gallbladder presentation

Answer 31

asymptomatic person w/ firm contender RUQ mass

Question 32

retroperitoneal hematoma presentation

Answer 32

elderly patient with back pain on warfarin with evidence of internal hemorrhaging

Question 33

courvoisier sign

Answer 33

- nontender, distended gallbladder - cancer in head of pancreas (where most pancreatic cancer tumors present) --> backup of bile --> intra and extra hepatic biliary duct dilation. - usually no pain

Question 34

dysphagia classification

Answer 34

oropharyngeal or esophageal - oropharyngeal presents with difficulty initiating swallowing + cough, choking, nasal regurgitation (etiologies = stroke, advanced dementia, malignancy, MG)

Question 35

test for oropharyngeal dysphagia

Answer 35

barium swallow

Question 36

dysphagia algorithm

Answer 36

determine if oropharyngeal or esophageal --> if esophageal then determine if mechanical or motility

Question 37

motility vs. mechanical obstruction

Answer 37

- dysphagia with solids and liquids at onset suggests motility disorder - dysphagia with solids progressing to liquids suggests mechanical obstruction

Question 38

how to figure out etiology of pancreatitis

Answer 38

if you suspect gallstones get US | - if common bile duct disease suspected --> ERCP

Question 39

perforated ulcer presentation

Answer 39

sudden onset severe epigastric pain spreading over the entire abdomen, presenting with diffuse pain

Question 40

pathophys of pt with hepatic encephalopathy on diuretics

Answer 40

- develop low intravascular volume despite having total volume overload --> this leads to a metabolic alkalosis with hypokalemia

Question 41

initial treatment of hepatic encephalopathy w/ hypokalemia

Answer 41

volume resuscitation + repletion of hypokalemia (hypokalemia can exacerbate HE because intracellular potassium is excreted and replaced by hydrogen ions to maintain electroneutrality --> this causes increased NH3 production (glutamine production) in renal tubular cells

Question 42

other lab features of alcoholic hepatitis

Answer 42

elevated bilirubin &/or INR + leukocytosis, predominantly neutrophils

Question 43

vitals with alcoholic hepatitis

Answer 43

fever

Question 44

exam with alcoholic hepatitis

Answer 44

tender hepatomegaly

Question 45

alcoholic hepatitis acute or chronic?

Answer 45

can be acute due to an acute increase in consumption

Question 46

surveillance for cirrhotic patients

Answer 46

screening endoscopy to exclude varies, indicate risk of vatical hemorrhage, and determine strategies for primary prevention of variceal hemorrhage

Question 47

management of esophageal varices

Answer 47

- endoscopic vatical ligation OR administration of nonselective beta blocker (propranolol or nadolol), which reduce portal venous pressure by blocking adrenergic vasodilatory response of mesenteric arterioles, resulting in unopposed alpha-adrenergic tone, vasoconstriction, and reduced portal blood flow. - choice depends on size of varices

Question 48

next step following IDA diagnosis

Answer 48

test for occult blood in stool (look for a cause of blood loss)

Question 49

firm, solitary lymph nodes in head and neck think

Answer 49

- metastatic disease from SCC | - vast majority of head and neck cancer is SCC

Question 50

nocturia in sickle cell disease or trait patient think...

Answer 50

hyposthenuria (impairment in kidney's ability to concentrate urine. RBC sickling in the vasa recta of inner medulla, which impairs countercurrent exchange and free water reabsorption)

Question 51

how to differentiate CML from leukemia reaction

Answer 51

leukocyte alkaline phosphatase (low in CML)