Evening Flashcards
(38 cards)
Severe pain w/ defecation x1 week
Hard stools for past several weeks
5mm superficial laceration posterior anal midline
Dx? Tx?
Anal fissure: moderate to severe pain (add nitro)
- conservative: sitz baths, stool softener, topical nitroglycerin
- if not heal: sphincterotomy, but fear stool incontinence
Serum Ca+ 13.4 and PTH 220. Tx?
Other symptoms?
Primary Hyperparathyroidism
- if biochemical confirmation, surgery
- do parathyroidectomy
Symptoms: stones, bones, abdominal groans, psych overtones) = nephrolithiasis, mood changes, bone pain, and pain.
Any dysphasia, 1st test = ?
Barium esophagogram
How treat Mallory-Weiss tear?
Hydration and decreased alcohol intake
usually self-limiting; no intervention required to control bleed
N/V, delirium, agitation, anxiety, eyelid lag, diaphoresis, tachycardia, hand tremor 2 hours post-op? Dx? Tx?
Thyroid Storm
- give propranolol, PTU, iodine and hydrocortisone
HA/N/V, confusion, fever, hypotension, cyanosis 2 hours post-op? Dx? Tx?
Acute adrenal insufficiency
- IV steroids
Sudden onset SOB, hypotension, tachycardia
- new onset blowing diastolic murmur
- best heard at base of heart
- IV drug user (so probably? )
Think pt w/ infective endocarditis & acute aortic regurg
- damage to leaflets of aortic valve - can’t close properly
Acute aortic regurg can also be caused by aortic dissection
Step 1 & 2 to treat DKA post-op ?
often is T1D…see w/ trauma, surgery, illness, infection, MI
IV normal saline
IV regular insulin
- insulin replacement helps correct the acidosis (decreased ketone production)
- but worry about K+ as insulin will drive this into cells
- so if K+ is >5.3, don’t worry
- if K+ is 5.3-3.3, add K+ to saline and give insulin
- if K+ is
MRI shows: Solitary ring-enhancing lesion in brain
- periventricular
- compressing ventricle w/ midline shift
- CD4+ count of 180, hx HIV
Next step? how choose?
Think primary CNS lymphoma
- this is an AIDS-defining malignancy
Stereotactic brain biopsy
- then steroids
UNLESS: impending or current brain hemorrhage, then give steroids first (they can change MRI and biopsy reading)
Lumbar puncture contraindicated in pt’s w/ CNS lesions who have ???
Contraindicated if focal neurological signs / mass effect b/c increased risk brain herniation w/ procedure.
If both absent, can do LP to check for EBV to diagnose CNS lymphoma
Next step in trauma pt w/ ecchymosis over chest + pleural effusion and stable patient?
Pleural effusion after chest trauma = hemothorax until proven otherwise
- do tube thoracostomy
If drainage is > 200mL/h in first 4 hours, indication for operative management.
Often do video-assisted thorascopic surgery
Unstable patients = emergent thoracotomy
Fibby pearl
- HTN
- HA
- Pulsatile tinnitus
also find?
Fibromuscular Dysplasia:
- disease of arterial vasculature
- aneurysms, dissections, stenoses, blockages
- young women w/ HTN & abdominal BRUIT…renal artery stenosis due to FMD
Gold standard: angiography – see string of beads (pearls)
Treat w/ antihypertensive meds + surgery
Hard stools, then severe pain w/ defecation
Anus - 5mm superficial laceration in posterior anal midline
- laceration does NOT involve underlying muscle (so just anal mucosa) . . . also occur in pregnancy
How manage?
Conservative: sitz baths, stool softeners + sever pain add nitroglycerin
Sphincterotomy: if fail conservative tx, surgery relaxes sphincter to promote healing of fissure
- feared complication is stool incontinence
Post-menopausal painless uterine bleeding
Dx? Tx?
Endometrial biopsy: look for hyperplasia or endometrial carcinoma
- risks = unopposed estrogen
Treatment: hysterectomy & salpingoophorectomy
Shoulder pain + arm/hand weakness - smoker - weight loss - atrophy hand muscles Next step?
Chest radiograph: superior sulcus lung tumor (pancoast)
- usually squamous cell; looking for lung mass
- adjacent to subclavian vessels
Tumor impinges brachial plexus
Could also see Horny Pam (ptosis, anhydrous, miosis)
CT will give more detail
Bronchoscopy + biopsy too
If suspect BPH (weak stream, dribble, enlarged prostate)
- give alpha-1 adrenergic ????
- if severe symptoms or large prostate > 40g add ???
alpha BLOCKER - terazosin (relax SM of bladder neck & prostate gland). This is 1st line
can add 5a-reductase inhibitor “Finasteride” (decrease prostate size). This is add-on.
How treat wound infection? (think day 5+)
Drainage + leaving wound packed open
Abx if regional edema + erythema
Treat rotator cuff (usually supraspinatus) injury?
Definitive diagnose?
MRI is definitive diagnostic test
Conservative: activity modify, NSAID, PT
Full-thickness tear: surgery
Mass left of umbilicus in 62yo M
- next diagnostic test?
U/S first!
- can use to confirm dx & monitor size & progression
CT scan w/ contrast can also be used
When do urinary 5-HIAA?
Suspect carcinoid syndrome
Painless hematuria + flank mass
- smoker
- mechanic (so exposure)
Dx?
Renal cell carcinoma: flank pain, painless hematuria, palpable abd/flank mass
- urinalysis, CBC, lytes, Phos, ALT
Pt w/ active GI bleed
- on warfarin (therapeutic)
Best next step?
Give IV fluids, D/c warfarin + give vitamin K + FFP to reverse coagulopathy (esp if INR > 1.5)
THEN do colonoscopy
Post-op Day 2
- dyspnea + tachycardia, increased respiratory rate
92% + clear breath sounds bilaterally
Best test? Dx?
Think pulmonary embolism
- best test is CT angiogram
Dyspnea + tachycardia + tachypnea !!!
Thyroid surgery, then
- high pitched voice but can’t raise volume of voice
- hoarse voice
high pitch + no volume = ext superior laryngeal nerve
Hoarse = recurrent laryngeal
Bilateral recurrent laryngeal = vocal cord paralysis + may require tracheostomy
