vascular accident in utero is likely to cause what kind of atresia?
jejunal or ileal atresia
triple bubble sign on XR
gas in stomach, dudodenum, and jejunum
indications for bariatric surgery
BMI > 35 with serious comorbidities
BMI > 30 with resistant DMT2 or metabolic syndrome
in chronic pancreatitis, what is the cause of pain and how do you tx it?
pancreatic exocrine insufficiency
hyperstimulation but unregulated CCK release causes pain
tx with pancreatic enzyme supplementation (lipase, protease, amylase) to reduce pancreatic hyperstimulation by CCK
what causes increased risk of sigmoid volvulus
old person with progressive solid dysphagia, no other big signs, next step?
still do EGD first
what is associated with increased severity and progression of Crohn disease?
labs in biliary atresia
elevated total and direct bili
elevated GGT (2/2 bile duct destruction) and alk phos
retic ct normal (no hemolysis occuring)
abdominal US shows triangular cord sign (fibrous remnants above the porta hepatis) or a small or absent gallbladder
late 20s, weeks of lower abdominal pain, bloody diarrhea, and fecal urgency - now more acutely has fever, abdominal distention, leukocytosis, hypotension, and tachycardia
dx? and what test to confirm?
IBD, now toxic megacolon
besides surgery, what else can cause ileus?
retroperitoneal/abdominal hemorrhage, intraabdominal inflammation (pancreatitis), intestinal ischemia, and electrolyte abnormalities
abdominal distention, obstipation, abd xr shows uniformly dilated, gas-filled loops of bowel with no transition point
acute onset abdominal pain, shock, and acute anemia s/p tx for CLL sometime in the past
insidious, continuous midepigastric pain that often radiates to the flanks or back and is sometimes worse with eating and lying down
dx and what test?
triad of elevated aminotransferases, signs of hepatic encephalopathy, and synthetic liver dysfunction (INR >1.5)
acute liver failure
which hepatitis is not associated with acute liver failure?
what type of ALF can be potentiated by chronic alcohol use?
besides cats, how can toxo be spread?
ingestion of raw or undercooked meat from animals infected with toxo
dinner fork deformity
what is fx?
what nerve is injured?
what action will be weak?
distal radius (Colles) fx
dorsal displacement of the radius results in median n compression
motor innervation to the thenar muscles (opponens, and abductor)
fatigue and sypmtoms related to more than one cytopenia
acute myeloid leukemia
fatigue, prolonged bleeding, easy bruising, pancytopenia, coagulopathy, and elevated LDH
acute promyelocytic leukemia
important cause of hypocalcemia, particularly in alcoholics
causes decreased release of PTH and PTH resistance
progressive peripheral edema, ascites, elevated JVP, and pericardial calcifications on chest XR
why might fat malabsorption occur in zollinger ellison?
inactivation of pancreatic enzymes by increased production of stomach acid may lead to malabsorption
what might make you think a parotid gland mass is malignant rather than the typical benign?
CN dysfunction - facial droop or facial numbness
ophthalmoplegia, ataxia, and areflexia; strength preserved
Miller Fisher syndrome, variant of GBS
when might VDRL be a false negative
too early in disease process
what happens to LV preload, stroke volume, and cardiac output in cardiac tamponade?
decreases LV preload, SV, and CO
pattern of liver injury with elevated transaminases and normal alk phos
should get viral hep panel
evaluation of adrenal insufficiency should include an
8 am serum cortisol and plasma ACTH
then cosyntropin stim test