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who is at the greatest risk for a hepatic adenoma

young women on prolonged oral contraception
-most are fine
-life-threatening complications can occur like malignant transformation or rupture can occur

-consider rupture in the setting on sudden-onset, severe right upper quadrant pain and signs of hemorrhagic shock


patient with puncture wound through shoe then gets osteomyelitis

pseudomonas osteomyelitis
-usually takes > 2 weeks


if pt has penetrating abdominal trauma, hemodynamic instability, peritonitis, evisceration, or impalement... whats your next step

exploratory laparotomy


how to manage uncomplicated renal stones (< 1 cm)

hydration, analgesics, alpha blockers

-list of alpha-blockers: tamsulosin and -osin


what is a potential complication of an epidural nerve block
-pt may present with progressive motor/sensory dysfunction, localized back pain, bladder/bowel dysfunction

spinal epidural hematoma
-more common in older people taking antithrombotics
-manage with urgent MRI and neurosurgical decompression


2 main signs that should prompt surgical exploration

free air on x-ray
clinical signs of peritonitis


what is malignant hyperthermia and when/how does it present

-genetic mutation altering intracellular calcium triggered by volatile anesthetics, succinylcholine, excessive heat

-manifests as: masseter/muscle rigidity, sinus tachy, hypercarbia, rhabdo, hyperkalemia, and late you'll see hyperthermia

-can occur during or even be delayed till after youre done with anesthesia

-treat with respiratory/ventilation support, stop cessation of causative anesthetic, and dantrolene


what is a HIDA scan

aka. cholescintigraphy


most common symptom of pancreatic cancer and how do you test for it

insidious, continuous midepigastric pain that radiates to back/flanks and is worse with eating or lying down

-get abdominal CT as first step when suspected


cardiac myxoma

usually in LA
benign tumor but bits of it can embolize


tender, erythematous streaks proximal to wound

-regional tender lymphadenopathy (lymphangitis)
-systemic symptoms (fever, tachycardia)
-usually due to strep pyogenes and MSSA
-treat with cephalexin


what correlates to medullary thyroid cancer metastasis

neuroendocrine malignancy --> calcitonin secreting parafollicular C cells
calcitonin correlates to metastasis


how to manage osteoarthritis

1. non-pharm --> exercise and weight loss
2. topical or oral NSAIDs
3. surgery or chronic pain management


how does the body get rid of low molecular weight heparin

renal removal


infection w/i retropharyngeal space can drain where..

into the superior mediastinum which can cause acute necrotizing mediastinitis


what is one of the first signs of IBD

toxic megacolon
-systemic toxicity (fever, tachy, hypotension)
-bloody diarrhea
-abdominal distension/peritonitis
-marked colonic distension on imaging
-treat with bowel rest, NG suction, abx, corticosteroids if IBD is associated, surgery if unresponsive to med management


description of giant cell tumor

only epiphyseal tumor
looks like soap bubble on x-ray


acute knee pain associated with catching or reduced range of motion suggests what...
-likely with crepitus too
-acute popping sensation may occur
-slow-onset joint effusion

meniscal tear
-persistent symptoms should have eval with MRI
-may need


how to initially manage patients with large surface area (> 20%) burns

extensive burns can lead to hypovolemic shock due to large release of proinflammatory mediators that increase vascular permeability and can cause third spacing of fluid
-use parkland formula to figure out how much
-titrated to maintain adequate urine output
-put in urethral catheter to monitor


what is one of the earliest manifestations of autosomal dominant polycystic kidney disease

-likely results from cyst expansion leading to localized renal ischemia and consequent increase in renin production with activation of RAA axis
-best treated with ACE inhibitors


biggest risk factor for pancreatic cancer



3 ways to assess for a melanoma

1. ABCDE (more than 1 or 2 is suspicious) --> asymmetry, borders, color variation, diameter > 6mm, evolving appearance over time

2. 7-point checklist (> 1 major or > 3 minor criteria is suspicious) --> MAJOR: change in size, shape, develops nodularity, or color MINOR: size > 7mm, local inflammation, crusting/bleeding, sensory symptoms like itching or bleeding

3. ugly duckling sign --> one lesion significantly different from the others on the patient


if a patient has RA and then is slowly developing UMN and other nerve problems, what should come to your mind?

cervical myelopathy
-atlantoaxial instability which can be made worse if a pt needs to be intubated
-slowly progressive, spastic paraparesis involving upper and lower extremities, hyperreflexia, sensory changes, and a positive babinski sign
-hoffman sign may also be positive


patient who develops acute abdominal pain, shock, and anemia in the setting of one of the following likely has what
-hematologic malignancy
-systemic inflammatory disease

atraumatic splenic rupture


how to search for epiglotitis

get lateral neck radiograph to look for enlarge epliglotti s


50% of pts get what after a coronary artery bypass graft operation

pleural effusion, usually on the left side
-if its small, occurs shortly after surgery (post op day 1 or 2), and creates no respiratory problems then you can just observe it to make sure it goes away on its own


initial diagnostic study for hemodynamically stable pts with aortic dissection

CT angiography -- reveals intimal flap separating true and false lumens


ulcerated tonsillar lesion in pt with long smoking history

oropharyngeal squamous cell carcinoma


what are the signs of a necrotizing surgical site infection

-pain, edema, erythema spreading beyond surgical site
-systemic signs: fever, tachycardia, and hypotension
-paresthesia or anesthesia at wound edges
-purulent, cloudy-gray discharge (dishwater drainage)
-subcutaneous gas or crepitus

-treat with parenteral abx and urgent surgical debridement


patient has intraperitoneal air on x-ray what do you think

possible peptic ulcer perforation and they need surgical exploration