A tachycardic, febrile patient presents with bloody diarrhea and abdominal pain. X-rays show a non-obstructed dilated colon and thick haustral markings that do not extend across the whole lumen? Diagnostic signs (4)? Major complication? Treatment? Treatment if patient has IBD?
Toxic Megacolon. Fever, tachycardia >120, WBC >10.5k, and anemia. Colonic perforation. IV fluids, NG, NPO, antibiotics. IC corticosteroids. Surgery if it doesn't resolve.
If you notice foot drop and the dorsum of the first and second toes are numb, what has been damaged?
Deep Peroneal Nerve injury.
How can you tell if an anesthetic is an amide or an ester? Complications with esters?
Amide = 2 "i's" - Lidocaine, Bupivacaine, Prilocaine. Ester = 1 "i" - Cocaine, Benzocaine. Esters are degraded to PABA, which can cause an allergic reaction in patients.
What is this?
What is this?
What is this?
Acute Subdural Hemmorrhage.
What is this?
Acute subarachnoid hemmorrhage.
At what size should Thoracic Aortic Aneurysms be operated on? What about AAA?
A milky chylous pleural effusion is suggestive of?
Thoracic duct injury.
ABI < 0.9? ABI <0.6? ABI <0.4 for a patient who smokes that notices pain in their calf.
Claudication. Rest pain. Limb ischemia.
A patient complains of acid reflux pain when lying down? Two types? Treatment?
Hiatal Hernia. 1: sliding, treat symptoms. 2. Paraesophageal, requires surgery.
Normal Urine Specific gravity?
10% rule with pheochromocytoma?
10% are extra-adrenal/malignant/found in children/familial/not HTN/calcified
Drugs to treat acute rejection (4)?
Azathioprine/Mycophenylate (Imuran/Cellcept) - inhibit T cells (can't make purine). Cyclosporine/Prograf (FK-506/Tac) - can't make cytokines.
What are MEN I tumors?
Parathyroid (hyperplasia). Pituitary (prolactinoma). Pancreatic (gastrinoma, insulinoma).
What are MEN II a tumors?
Pheochromocytoma. Medullary Cancer. Parathyroid hyperplasia.
What are MEN II b tumors?
Pheochromocytoma. Medullary Cancer. Mucosal neuroma. Marfan's.
Normal Hgb level for Men? Women?
Causes of Macrocytic Anemia?
B12/Folate Deficiency (look out for issues in stomach or terminal ileum).
Causes of Microcytic Anemia?
Iron deficiency or hemoglobinopathy.
Warfarin inhibits what factors and proteins? Complications (apart from bleeding)? What coagulation test do you monitor?
Vitamin K dependent factors - II, VII, IX, X, Protein C and S. Skin necrosis. PT or INR.
What does Heparin bind to and inhibit? What coagulation test do you monitor with use?
ATIII. PTT time.
How do you know someone has an accessory spleen post splenectomy? Where should you look for it?
Absence of Howell-Jolly bodies. Splenic Hilum.
A patient with HIV develops bloody diarrhea?
Gram positive cocci in clusters are? Pairs?
Artificial heart valve implantation requires prophylactic?
Scaly skin lesions around the female the nipple? Complications?
Paget's Disease of the Breast. Patient also has underlying DCIS or Ductal Carcinoma.
A middle aged female presents with pruritis, fatigue, xanthoma, and jaundice? Lab findings?
Primary Biliary Chirrosis. Elevated GGT and ALK, presence of AMA and ANA
What cancer is it associated with Primary Sclerosing Cholangitis (PSC)? What IBD is it associated with? How is it diagnosed?
Cholangiocarcinoma. UC. ERCP (beading of intra/extra hepatic ducts) + onion skinning on histology.
Most common melanoma?
Most aggressive Melanoma?
Melanoma that presents on your palms/soles. Most common in dark skinned people?
Non invasive facial melanoma - Hutchinson's Freckle?
Which nerve is most often injured during carotid endarterectomy?
Recurrent Laryngeal (Vagus).
Cardiac causes of decompensation ~5 days after MI (3)?
Large VSD. Papillary Muscle Rupture. LV rupture.
Four components of Tetralogy of Fallot?
Large VSD. Pulmonary Stenosis. Overriding aorta. RVH.
What are the contraindications to EVAR (5)?
Narrow iliac arteries, e.g. ~8 mm
Sharply angulated iliac arteries
Short aneurysmal neck
Tapering aneurysmal neck
High likelihood of graft occluding a visceral vessel once deployed
Is asbestos exposure more likely to predispose you to adenocarcinoma or mesothelioma?
What side of the esophagus is most likely injured in booerhaave's?
Left Posterolateral side.
Complications from terminal ileum resection?
Diarrhea and B12 deficiency (macrocytic anemia)
Indications for Dialysis?
Acidosis. Electrolyte imbalances. Intoxicants. Overload (volume). Uremia.