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182 Cards in this Set
- Front
- Back
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characteristics of pericarditis
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pleuritic CP (worse in supine position)JVDpulsus paradoxuspericardial friction rubdiffuse ST elevationsfever, dyspnea, & cough
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what is an acceptable urine output in a trauma patient
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NORMAL: 30 cc per hourTRAUMA: 50cc per hour
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what are some causes of exudative pleural effusion
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malignancyTBbacterial infectionPEpancreatitis
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GI infection a/w:food poisoning with mayo
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s aureussalmonella
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GI infection a/w:rice water stools
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V. cholera
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GI infection a/w:diarrhea from pet feces
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Yersinia enterocolitica
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GI infection a/w:reheated fried rice
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B cereus
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GI infection a/w:travelers diarrhea
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ETEC
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GI infection a/w:diarrhea after antibiotics
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C diff
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GI infection a/w:diarrhea with stream ingestion
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giardiaE histolytica
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GI infection a/w: a/w neurocysticerosis
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T solium
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GI infection a/w:undercooked hamburger
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EHEC (0157:H7)
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GI infection a/w:diarrhea from sea food
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V. choleraV. parahaemolyticus
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GI infection a/w:diarrhea with poultry
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#1 salmonella#2 campylobacter
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GI infection a/w:diarrhea with pink eye
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adenovirus
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GI infection a/w:bloody diarrhea with liver abscess
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entamoeba histolytica
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GI infection a/w:diarrhea in AIDS
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cryptosporidium parvum
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GI infection a/w:dehydrated child with foul-smelling greenish diarrhea
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rotavirus
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GI infection a/w:cruise ships
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Norwalk virus
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GI infection a/w:summer months
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coxsackie & echovirus
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GI infection a/w:winter months
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rotavirus
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GI infection a/w:respiratory infection
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adenovirus
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GI infection a/w:Triad: thrombocytopenia, hemolytic anemia, acute RF
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hemolytic uremic syndrome (HUS) = E. Coli 0157:H7
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Rx for:e histolytica
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metronidazole or paramomycin
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Rx for:giardia
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hydration & metronidazole
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Rx for:salmonella
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hydrationfluoroquinilones (in immunocompromised pt's)
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Rx for:shigella
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hydrationfluoroquinilones/TMP-SMX if severe
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Rx for:campylobacter
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hydrationpossibly erythromycin
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Rx for Hep B
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IFN-a (pegylated)ANTIVIRALS:lamivudineadefovirentecavirtelbivudine
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Rx for Hep C
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IFN-a (pegylated)ribavirin
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hepatitis a/w chronic hepatitis
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Hep C
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hepatitis a/w hepatocellular carcinoma
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Hep B (check AFP levels)
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Hep status a/w:Hep BcAb (IgM)
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acute infection within the window period
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Hep status a/w:Hep BsAg BcAb (IgG)
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chronic infection
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Hep status a/w:Hep BsAb
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vaccinated
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Hep status a/w:Hep BsAb BcAb (IgG)
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recovered
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cafe au lait spots are a/w
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NF1
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px with repeated pneumonia in the same locationwhat is the next step
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CT scan of chest("same location" = red flag for for cancer causing broncho obstruction)
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what is the next step in a px with dysphagia
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barium swallow
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barium swallow showing corkscrew is a/w
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diffuse esophageal spasm
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barium swallow with birds beak is a/w
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achalasia
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Rx for diffuse esophageal spasm
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CCB (e.g. nifedipine)NitratesTCAs
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Rx for achalasia
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dilationbotox injectionmyotomy
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px with bad breathe, regurgitation of food eaten days ago
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zenkers diverticulum
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besides heart burn, what is the MC symptom of GERD
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persistant cough
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What is Barrett's Esophagus & why is it important
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esophageal epithelium has undergone "intestinal metaplasia": normally squamous epithelium --> columnar epitheliumBarrett's is a RF for adenocarcinoma
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MC type of esophageal cancer in US
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adenocarcinoma
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Compare Mallory-Weiss syndrome to Boerhaave syndrome
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MALLORY-WEISS SYNDROME:mucosal laceration/teardistal esophagusminor injury with some bleeding/hematemesisBOERHAAVE SYNDROME:perforation/rupture of distal esophaguslife-threatening injury: lots of bleeding
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imaging study used to Dx DVT
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compressive venous US
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Rx for coccidiomycosis
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fluconazole
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what is the most effective treatment for duodenal ulcer not due to ZES
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H PYLORI TRIPLE THERAPY:Amoxicillin/metronidazoleClarithromycinPPI
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what is the Rx for gastric cancer
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distal 1/3 = subtotal gastrectomyproximal 2/3 = total gastrectomyadjuvant chemo and radiation
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what are the 3 areas of enlarged nodes from metastatic gastric cancer
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VIRCHOW'S NODE:left supraclavicular nodea/w GI malignancySISTER MARY JOSEPH'S NODE:periumbilical nodea/w any GI malignancya/w some GYN cancersKRUKENBERG'S TUMOR:ovarian tumora/w GI malignancya/w breast malignancy
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px with duodenal ulcer has been refractory to PPIswhat 2 tests will help Dx
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Dx: ZESfasting serum gastrin levelsecretin stimulation test(secretin normally inhibits gastrin secretion; not so in ZES)
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compare gastric vs duodenal ulcer
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GASTRIC ULCER:pain soon after eating"s" for soon & stomachDUODENAL ULCER:delayed pain (2-4 hours post-prandial)"d" for delayed & duodenal
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what is used to Dx urethral injury
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retrograde cysturethralgram
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infection of branching rods in mouth
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actinomyces israelli
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cuban immigrant with malabsorption and megaloblastic anemia
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tropical sprue
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Rx for tropical sprue
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Folate and tetracyclines
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MCC of malabsorption in px with + sudan stain and normal D-xylose test
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pancreatic insufficiency(i.e. fat malabsorption with normal carbohydrate absorption)
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Rx for whipples disease
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TMP-SMX or ceftriaxone
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what tumors cause secretory diarrhea
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VIPomagastrinomacarcinoidmedullary thyroid cancer
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MCC of adult chronic diarrhea
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lactose intolerance
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what are the SE's of corticosteroids
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immunosuppressionosteoporosisthinning skinacneinsomniamania/psychosiscataractsmoon-shape facies, buffalo hump, abdominal striae
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Dxhypoxemia, pulmonary edema, normal pulmonary capillary wedge pressure
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ARDS
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MC foodborne bacterial GI tract infection |
campylobactersalmonella
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symptoms of basilar skull fracture
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raccoon eye (orbital bruising)battle sign (bruising over mastoid process)hemotympanum (bleeding behind TM)CSF from nose or ear
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what are some symptoms of IBS
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change in frquency of stoolchange in stool formrelief with defecation
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Rx for crohns
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5-ASA (e.g. mesalamine, sulfasalazine)azathioprineanti-TNF-a agents (e.g. infliximab, adalimumab)steroids
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next step in a px with severe abdominal pain and AXR shows free air in abdomen
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exploratory laparotomy
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IBD a/w fissures and fistulas
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crohns
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antibodies a/w crohns and UC
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crohns = ASCA+UC = pANCA+
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MCC of small bowel obstruction
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adhesionsbulge (hernia)cancer (tumors)
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how can small bowel obstruction be Dx
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dilated loops on plain film abdominal series"ladder-like" appearance on CT scan
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signs of small bowel obstruction
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painhyperactive high pitched sounds
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MC benign small bowel tumor
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leiomyoma
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MC malignant small bowel tumor
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adenocarcinoma
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MCC of large bowel obstruction
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neoplasm
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initial Rx for child presenting with acute asthma attack
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short-acting B2-agonist (e.g. albuterol or levalbuterol)IV steroids (takes 4 hrs to "kick-in")oxygen (if SaO2 < 92%)
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a normalizing PCO2 in a patient with an asthma exacerbation may indicate
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IMPENDING RESPIRATORY FAILURE:normally asthma pt's blow off lots of CO2 (tachypnea)blow off less CO2 --> normalizes --> NOT ventilating well --> sign of muscle fatigue
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what is the most accurate test to Dx appendicitis
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CT scan
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a women with appendicitis presentation should have what done before going to surgery
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B-HCG (r/o ectopic pregnancy)
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what is the classic characteristic of acute mesenteric ischemia
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extreme pain out of proportion to exam
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px presents with vomiting and abdominal pain and distention, AXR shows two areas with distended airDx and Rx
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volvuluscolonoscopy
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what is seen on CT in a px suspected of having ischemic colitis
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bowel wall thickeningair within bowel wall (aka pneumatosis coli)
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classic time frame that post op ileus resolves in the small bowel, stomach, & colon |
small bowel: 1 day (<24hrs)stomach: 2 - 3 dayscolon: 3 -5 days
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Dxpx with dyspnea, hilar lymphadenopathy and hypercalcemia
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sarcoidosis
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what characteristics favor an isolated pulmonary malignant nodule
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smoker>45 yonew lesionold lesion with incr'd sizeabsence/irregular calcificationsirregular marginssize > 2 cm
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what is the Rx for normal pressure hydrocephalus
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VP shunt (shunts CSF from ventricles to peritoneum)
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Rx for pseudotumor cerebri
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acetozolamideweight lossserial LP (refractory cases)VP shunt
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what are the indications for a px to be admitted with diverticulitis
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immunocompromisedelderlysignigicant comorbiditieshigh feversignificant leukocytosisunable to tolerate PO intake
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risk factor for diverticulosis
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> 60 y/olow fiber, high fat diet
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Rx for diverticulitis
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bowel rest x 3 daysbroad spectrum AB's to cover G-'s & anaerobes(e.g. Metronidazole + Ciprofloxacin)
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Rx for diverticulitis with abscess formation
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percutaneous drainage of abscessIVF'sbowel restIV antibiotics
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Rx for carcinoid syndorme
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somatostatin (shuts down 5-HT production)
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Rx for carcinoid syndrome that is refractory to octreotide
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Octreotide + IFN-alpha
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next step in management in a patient younger than 50 yo with bright red blood only seen on toilet paper
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most likely dx: hemorrhoidsDx'c test: anoscopy
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MCC of acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissue
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pilonidal cyst
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MCC of recurrent LLQ abdominal pain that improves with defecation
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diverticulosis
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how are anal fissures managed
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stool softenersnifedipine, diltiazem, bethanacholbotoxpartial sphicterotomy
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immunodeficiency a/w increased risk of anaphylactic transfusion reaction
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selective IgA def
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px with silicosis are at higher risk for
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TB
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px with severe diffuse abdominal pain with AXR that shows free air under diaphragm, next step
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emergency laparotomy
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recommendations for colonoscopy if:1-2 tubular adenomas < 1cm
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5 years
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recommendations for colonoscopy if:3-9 or more tubular adenomas < 1 cm
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3 years
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recommendations for colonoscopy if:tubular adenoma 1+ cm
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3 years
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recommendations for colonoscopy if:villous adenoma or high-grade dysplasia
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3 years
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recommendations for colonoscopy if:> 10 adenomas
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< 3 years
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recommendations for colonoscopy if:FH of colon cancer
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10 years prior to the age that the youngest family member was dx'd with colon cancer (e.g. Father dx'd at age 53, colonoscopy should begin at age 43)
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tumor marker for cancer in the colon
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CEA
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gene responsible for familial adenomatous polyposis
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APC
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next steppx in ER has thrown up two basin full of blood, is drunk and tachycardic
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IVF's
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Dx px with new onset iron def in 70 yo
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colon cancer until ruled otherwise
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MC etologies for upper GI bleeds
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PUD (MCC)mallory Weiss tearsesophageal varicesAVM'stumorserosions
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MC etiologies of lower GI Bleeds
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diverticulosisneoplasmsischemiahemorroidsanal fissures
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how is volume status assessed in a px with GI bleed
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BPHRurine output
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what are the HACEK organisms
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HemophilusEikenellaActinobacillusCardiobacteriumKingella
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what is the most specific test for dx chronic pancreatitis
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decreased fecal elastase
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Rx for chronic pancreatitis
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alcohol cessationpancreatic enzyme replacementpain controldietary modification (low fat, small meals)
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What are the MCC of acute pancreatitis in the US
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gall stonesalcohol (35%)
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what procedure is done to treat isolated cancer of the head of the pancreas
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whipple procedure(aka pancreaticoduodenectomy)
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tumor marker useful in the Dx of pancreatic cancer
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CA 19-9
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Ranson criteria for prognosis of acute pancreatitis at admisssion
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"GA LAW"Glucsoe > 200AST > 250LDH > 350AGE > 55WBC > 16,000
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Ranson criteria for prognosis of acute pancreatitis < 48 hrs after admission
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"CALvin & HOBBeS"[Ca2+] < 8 ng/dlHct decr'd > 10 %O2 --> PaO2 < 60 mm HGBase deficit > 4 mEq/LBUN incr'd > 5 mg/dLSequestration of fluids > 6L
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What are some causes of acute pancreatitis
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"BAD HITS"Biliary obstruction (40%)Alcohol (35%)Drugs (e.g. HIV meds, diuretics, valproic acid, azathioprine, E2's, pantamidine)Hypercalcemia/TG'sIdeopathicTraumaScorpion stings
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what are the criteria for px with COPD to qualify for home O2
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pulse ox < 88%peripheral edemapolycythemiapulm HTN
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lung cancer a/w SIADH
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small cell cancer
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What is Charcot's triad
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RUQ painjaundicefeverDx = cholangitis
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what is reynolds pentad
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RUQ painjaundicefeverHypotensionAMSDx = cholangitis
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Rx for cholecystitis
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cholecystectomy
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what type of pt is at high risk of acalculous cholecystits
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pts on TPN or in ICU
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Rx for cholangitis
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drain bile ducts (ERCP)fluid & IV antibioticscholecystectomy (LATER)
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what are the MC presenting symptoms of primary biliary cirrhosis
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fatigue and pruruitis
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Rx for primary biliary cirrhosis
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ursodeoxycholic acid (delays progression of ds & enhances survival)
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Rx for pruritis in primary biliary cirrhosis
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cholestyramine
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what is the definitive Rx for primary biliary cirrhosis
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liver transplant
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antibodies in primary biliary cirrhosis
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anti-mitochondrial
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antibodies in primary sclerosing cholangitis
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pANCA
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what is seen on imagine of primary sclerosing cholangitis
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ERCP: beads on a string
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Sign/Dx:deep palpation of RUQ causes arrest of inspiration due to pain
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murphy's sign/cholecystitis
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Sign/Dx:fever, jaundice, RUQ pain
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reynold's pentad/cholangitis
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Sign/Dx:RLQ pain on passive extension of hip
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psoas sign/appendicitis
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Sign/Dx:RLQ pain on passive internal rotation of flexed hip
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obturator's sign/appendicitis
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Sign/Dx:LUQ pain that refers to left shoulder
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kehr's sign/splenic rupture
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Sign/Dx:ecchymosis of the skin overlying the flank
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grey turner's sign/pancreatitis
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Sign/Dx: ecchymosis of skin overlying the periumbilical area |
cullen's sign/pancreatitis
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Compare location of pathology of primary biliary cirrhosis vs primary sclerosing cholangitis
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PBC: intrahepatic ducts ONLYPSC: intra & extrahepatic ducts
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MCC of travelers diarrhea
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ETEC
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initial Rx for localized non small cell lung cancer
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surgical resection + chemo
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Rx for IBD
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SMALL BOWEL ONLY:mesalemine (5-ASA)LARGE BOWEL INVOLVED:sulfasalazine (SSZ)ACUTE EXACERBATIONS:steroids
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S/Sx's of Cirrhosis
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PORTAL HTN:varices (esophageal & caput medusa)hepatosplenomegalyascitesLIVER FAILURE:decr'd conjugation (jaundice)decr'd proteins (coagulopathy & peripheral edema)incr'd toxins (encephalopathy/asterixis)incr'd estrogen (testicular atrophy, gynecomastia, spider angioma, & palmer erythema)OTHER:weaknesswt lossdigital clubbingdupuytren's contractures
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what is NASH stand for & what are the MCC's
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NASH = NonAlcoholic SteatoHepatitisMCC's (think metabolic syndrome):obesityDMhyperlipidemiainsulin resistance
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what is rx for NASH
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avoidance of alcoholwt lossaggressive control of DMTZDs (eg. pioglitazone) improve LFTs
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What is Budd-Chiari Syndrome
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thrombosis & occlusion of hepatic vein or intrahepatic/suprahepatic portion of IVC
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S/Sx's of Budd-Chiari Syndrome
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ascites (84%)hepatomegaly (76%)jaundiceRUQ pain (if acute)eventual liver failure --> hepatic encephalopathy(no fever, t/f no cholangitis; no JVD, t/f no rt-side HF)
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Dx'c tests & Rx for Budd-Chiari Syndrome
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Initial Dx'c test: ultrasoundGold Standard: hepatic venographyTx:thrombolyticsanticoagulationangioplastydiuretics
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diuretics used to Rx ascites/portal HTN
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furosemidespironolactone
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Rx for hepatic encephalopathy
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lactuloserifaximindecreased protein intake
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antibiotics used in spontaneous bacterial peritonitis
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cefotaximeceftriaxoneother 3rd Gen Ceph's
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screening test for hemochromatosis
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ferritin levels
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Rx for hemochromatosis
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phlebotomydeferoxamine (rarely)
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lab value a/w wilson disease
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serum cerruloplasmin levels (low)
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tumor marker for hepatocellular carcinoma
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AFP
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tumor marker a/w colon cancer
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CEA
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tumor marker a/w gastric cancer
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CEA
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tumor marker a/w pancreatic cancer
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CA 19-9
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tumor marker a/w ovarian cancer
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CA 125
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what is SAAG & how is it calculated
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SAAG = serum-ascites albumin gradientSAAG = [serum albumin] - [ascites albumin]
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What does SAAG indicate & what are the possible etiologies |
SAAG >/= 1.1 --> portal HTN (low albumin in ascites relative to serum) cirrhosis alcoholic hepatitis HF/constrictive pericarditis massive hepatic metastases Budd-Chiari syndrome SAAG < 1.1 --> NOT due to portal HTN (high albumin in ascites relative to serum) Nephrotic Syndrome (2nd/2 decr'd serum albumin) Infection (2nd/2 incr'd ascites albumin) Neoplasm (2nd/2 incr'd ascites albumin) |
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What labs are concerning for neoplastic cause of ascites |
SAAG > 1.1 + high ascites LDH (i.e. > 60% of serum LDH)
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Dxpx with diarrhea after meals. PE shows fistulas between bowel and skin & nodular lesions on his tibias
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crohns
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rx for prophylactic bacterial meningitis & when is it indicated
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Rifampin to close contacts of pt's with:N. Meningitidis meningitisH. Influenzae meningitis
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what pattern does jaundice develop & at what level is a known value of jaundice
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develops from the head downwardnipple line = approx. 10 mg/dL
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Dx2 year old with painless rectal bleeding
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meckels diverticulum
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what antibiotic is CI in neonates with hyperbilirubinemia and why
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ceftriaxonedisplaces bilirubin from albuminincr'd likelihood of kernicterus or encephalopathyalso: causes biliary sludging (from DIT Neuro 1)
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what characteristics help you identify pathologic newborn jaundice
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*jaundice in first 24 hours*direct (conjugated) > 20% of total bilirubin*direct (conjugated) > 2 mg/dL*total bilirubin > 15 mg/dL in term neonatesjaundice after 2-3 weeks of agerise in total bilirubin > 0.5 mg/dL/hrrise in total bilirubin >5 mg/dL/day
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Age, total bilirubin level, etiology, & tx:physiologic jaundice
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AGE: 2-3 daysTOT BILI <10ETIOLOGY: immature UDP-GTTREATMENT: resolves in 2 weeks+/- phototherapy
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Age, total bilirubin level, etiology, & tx:breast feeding jaundice
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AGE: < 1 weekTOT BILI < 15ETIOLOGY: dehydrationTREATMENT:increase feedsimprove feeding techniques
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Age, total bilirubin level, etiology, & tx:breast millk jaundice
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AGE: > 1 weekTOT BILI > 5.5ETIOLOGY: unknown factor in milkTREATMENT:resolvesswitch to formula
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What is the MC type of TE fistula
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blind upper esophageal pouch with distal esophagus attached to the trachea
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classic presenting scenario for necrotizing enterocolitis
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premature or low birth wt infant started on tube feedsincreasing abdominal distensionsigns of enterocolitis
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what are criteria for failure to thrive in a child younger than 2 y/o
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PERCENTILE:Wt < 3rd - 5th percentile for gest age (corrected if Down's or Turner's) on 2+ occasionsWt crosses 2 major percentiles downward over timeWt::length ratio < 10th percentilePERCENTAGE:Wt < 80% of ideal wt for ageOTHER:Rate of daily wt gain less than expected for age
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