Morning Flashcards
(36 cards)
Subdural hematoma. CT or CT w/ contrast (aka CT angiogram)
non-contrast CT
Use contrast to see AV malformations & aneurysms
Surgical Wound Infection
Days 5-7 post-op
Erythema, induration, warmth, tenderness, +/- drainage
Cellulitis alone: treat w/ abs
Gets deeper into wound: irrigation, drainage + open dressing
Drug Fever
Post-op Day 7+
Hypersensitivity
Anticonvulsants common cause
Heparin - rare but bad
Vestibular Schwannoma
Unilateral: non-genetic, do hearing test; slow growing; CN VIII
Bilateral: consider NF2 esp if assoc w/ meningioma, periph neurofibromata, glioma, juvenile lenticular opacities
Claw Hand Deformity
Ulnar nerve involvement
4th & 5th digits unable to extend
Weakness w/ elbow flexion
Loss sensation lateral forearm
Musculocutaneous nerve
- courses btwn biceps & brachialis
- becomes ante brachial cutaneous nerve
Gastroschisis vs. Omphalocele
Gastroschisis: no covering (right of umbilicus)
Omphalocele: small intestine + liver extend through abdominal opening covered by peritoneum & amniotic sac
Symptomatic hepatic adenoma; treat?
Surgery
- young F who take OCP
- often solitary, hyper vascular
- RUQ pain
- 1st step = U/S
Rapid onset fever, hypotension, profuse diarrhea + whole body rasy
Toxic Shock Syndrome:
- Staph aureus
- Strep pyogenes
- local infection w/ systemic exotoxins
Severe, focal back pain radiating to back, electric
Epidural Abscess Risks: IV drug use, HIV, DM, trauma, alcoholism - Often Staph aureus - Dx w/ MRI Tx: surgical decompression + abx
Test for Mallory-Weiss/Boerhaave?
Radiographic swallow study = esophagogram
- with water-soluble contrast agent
- diatrizoic acid / Gastrogafin
Lynch Syndrome (hereditary non-polyposis colorectal cancer) – also risk for what other cancer?
Endometrial cancer
Autosomal dominant
Microsatellite instability in mismatch repair genes
Colonoscopy every year starting at age 25
(also screen for Ovarian, but this is less common)
Breastfeeding women w/ indurated, erythematous breast mass and pain…
Mastitis: abx + warm compresses
- often due to staph & strep
Hepatic encephalopathy treatment
Lactulose (build up of ammonia)
- it acidifies the GI tract, forming NH4+
- this reduces total ammonia load
Describe skin lesions possible in endocarditis?
Petechiae - distal extremities
Janeway lesions - contender erythematous merciless
Osler - Ow Ow Ow - tender subQ papules pads of fingers
Roth spots - retinal hemorrhages
Do blood culture
Plus ECHOcardiography (sonogram)
Hearing loss 3rd decade, family hx - AD
Speech recognition better in crowded rooms!
Weber test lateralizes to worst ear (conductive)
Rinne test louder on bone = conductive
Dx? Tx?
Otosclerosis: #1 cause progressive CONDUCTIVE hearing loss among adults
Tx: hearing aids for mild
stapes surgery = definitive
Asymmetric low-frequency hearing loss
Vertigo spells, tinnitus, sensation aural fullness
Meniere’s disease
- hearing waxes and wanes between spells
- can lead to permanent hearing loss
Profuse watery diarrhea
Lower abd cramping
Fever + leukocytosis
Dx? Tx?
Clostridium difficile
- oral metronidazole (but remove offending med first)
Do PCR or enzyme immunoassay for C. diff toxin
Most common abx assoc w/ C. diff?
Clindamycin, FQ’s like ciprofloxacin, broad-spectrum penicillins, cephalosporins
What do we use Azithromycin for?
Treat community-acquired respiratory tract infections (pneumonia)
What does Clindamycin cover?
Anaerobs, strep & staph
What does TMP-SMX treat?
UTI’s and methicillin-resistant Staph aureus MRSA
How treat severe C. diff infections?
Oral Vancomycin
- toxic megacolon, ileus, WBC>15k, T>101.3, hypotension
IV vanco NO effect on C. diff as does not get into colon in significant enough quantities
Pain with passive movement of the knee?
Septic arthritis Dx w/ arthrocentesis - w/ synovial fluid analysis - usually NOT include crystals - expect to see many poly leukocytes - usually Staph or Strep Crystals - think gout or pseudogout
