Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
93 Cards in this Set
- Front
- Back
crushing pain with swallowing, harder to swallow liquids than solids, uncoordinated contraction- work up?
|
1. barium swallow
def dx. manometry (motility problems) Tx- repeated dilations or surgical myotomy for achalasia |
|
esophageal cancer:
h/o smoking and etoh |
scc
(high incidence in blacks) |
|
esophageal cancer:
h/o chronic GERD |
adenocarcinoma
|
|
esophageal cancer workup
|
barium swallow
endoscopy and bx CT to see if operable |
|
prolonged, forceful vomiting with bright red blood
-w/u? |
endoscopy
photocoag with laser |
|
prolonged, forceful vomiting with sudden onset epigastric and low stern pain, fever, leukocytosis
-w/U? |
contrast swallow (gastrografin first, barium if negative)
-ER surgical repair |
|
long standing GERD sx
w/u? |
endoscopy and bx
|
|
surgical procedure for GERD
|
if dysplasia--> resection
all others --> laproscopic Nissen fundoplication |
|
what type of stomach ca is more common in the elderly?
sx? |
gastric adenocarcinoma
- anorexia, wt. loss, epigastric distress or early satiety. |
|
which stomach ca can be reversed if you get rid of H.pylori
|
lymphoma (maltoma)
|
|
colicky abd pain,
protracted vomiting, progressive abd distention, no gas or BM --w/u? --tx? |
x-ray :: distended loops of small bowel with air fluid levels
tx: NPO, NG suction, IVF |
|
small bowel ob with fever, leukocytosis, constant pain...
|
strangulated ob- compromised blood supply
tx= ER surgery |
|
small bowel ob sx + irreducible hernia that used to be reducible.
|
incarcerated hernia
** |
|
diarrhea, flushing, wheezing, Rheart damage (JVD)
|
carcinoid syndrome: seen in pts with small bowel carcinoid tumor with liver mets
|
|
w/u for carcinoid syndrome
|
24hr urine collection, look for 5-hydroxyindolacetic acid.
** |
|
1. anorexia
2. periublical pain 3. sharp, severe constant pain that localizes to RLQ 4. fever, leukocytois |
appendicitis
-ER apendectomy |
|
sx: anemia
often inelederly stools with 4+ blood w/u? tx? |
mostly likely ca of right colon
dx: colonoscopy and bx tx: right hemicolectomy and transfusions |
|
sx: bloody BM, constipation
w/u? tx? |
mostly likely ca of left colon
flexible proctosigmoidoscopic exam and bx if large ca--> preop chemo rad |
|
when is surgery an option for ulcerative colitis?
|
severe, >20 yrs, medical management not helpful. surgery removes all of affected colon, rectal mucosa too.
|
|
profuse water diarrhea, crampy abd pain, fever, leukocytosis after abx
|
--> Pseduomembranous colitis from C. diff
dx: C. diff toxin assay tx: d/c abx, metronidazole or Vanc |
|
sx: usually young F w/ pain on defecation + blood streaks on stool, start to avoid BM = constipation
|
anal fissure
tx: relax sphincter by giving stool softners, topical nitroglycerin, local Botulin toxin, forceful dilatation, lateral internal sphincterotomy. |
|
tx of ischiorectal abscess
-caution if diabetic? -other complications? |
I&D
- diabetic may get necrotizing infection -fistula in ano |
|
fecal soiling and perineal discomfort after I&D of rectal abscess
|
fistual in ano
-epithelial migration form anal crypts to skin= cordlike tracts, d/c |
|
SSC of anus:
mass out of anus and mets to inguianl nodes pop? dx? and tx? |
HIV +, homosexuals
dx: bx tx: nigro chemoradiation protocol |
|
tests for GI bleeding:
vomit blood |
upper gi endoscopy
-look at naso and oropharynx first |
|
tests for GI bleeding:
melena |
upper gi endoscopy
|
|
tests for GI bleeding:
red blood from rectum |
pass NG tube and aspirate gi contents
|
|
results for NG tube aspiration:
-no blood, fluid is white (no bile) |
- nose to pylorus clear, but duodenum may be source
--> UGIE |
|
results for NG tube aspiration:
no blood and fluid is gren (blood tinged) |
exclude entire upper gi
|
|
upper gi landmarks
|
tip of nose to ligament of treitz
|
|
h/o recent rectal bleeding but not actively bleeding now
w/u? |
UGIE if young
if old do UGIE and LGIE |
|
bloody rectum in a kid
w/u? |
meckel's so do technetium scan looking for ectopic gastric mucosia
|
|
Sx:sudden onset, constant generalized abd pain.
Pe: tenderness, gaurding, rebound, -bs W/U? |
perforation
dx: abd x-ray: free air under diaphragm |
|
sudden colicky abd pain, constant movement
|
abd obsruction
|
|
severe abd pain + blood in gut lumen
|
ischemic process
|
|
ascites + mild generalized acute abd pain
w/u? |
primary peritonitis:
- cx of ascitic fluid - tx is abx not surgery |
|
DDx for generalized acute abdomen
|
-primary peritonitis --> exploratory laparotomy
-MI --> ecg - LL PNA -->cxr -PE - pancreatitis --> amylase -urinary stones --> abd xray |
|
sx: rapid onset of epigastric pain radiating to back, n/v/ retching.
pe: ttp in upper quads w/u? and tx? |
dx: serum or urinary amylase or lipase
ct if not clear tx NPO NG suction IVF |
|
-colicky flank pain radiating to inner thigh and scrotum/labia
-inc urinary urgency and freq w/U? |
plain x ray may show stones
|
|
acute onset LLQ pain, fever, leukocytosis
w/u? tx? |
ct to confirm acute diverticulitis
NPO, IVF, abs surgery if 2 or more attacs |
|
severe abd distention in elderly
|
volvulus of sigmoid
dx with xray= air-fluid levels, parrots beak tx: proctosifmoidoscopic exam if recurrent resection |
|
serum marker for hepatocellular carcinoma
a/w- cirrhosis, and hepc |
alph fetoprotein
CEA marks metastic tumors from the colon |
|
tx of mets to liver
|
resection if on one lobe or radioablation
|
|
liver tumor a/w OCP's
dx? tx? |
heaptic adenoma
dx with CT tx er surg |
|
tender liver, fever, high wbc's
h/o acute ascending cholangitis |
-pyogenic liver abscess
dx: sonogram or CT tx: percutaneous draiange |
|
jaundice
+ elevated unconjugated bili |
hemolytic jaundice
|
|
jaundice
+ high direct and indirect bili, high high liver transaminases, high alk phos |
hepatocellualr jaundice
- hepatitis |
|
jaundice
+ high direct and indirect bili, high liver transaminases, very high alk phos |
obstructive jaundice
dx- sonogram |
|
pres: obsese, fertile, 40F withhigh alk phos, dilated ducts on sonogram and nondilated gB full of stones
tx? |
ERCP, sphincterotomy and choleystectomy
|
|
location of tumors causing jaundice:
-adenocarcinoma -cholangiocarcinoma |
-head of panc or ampulla of Vater
-CBD |
|
steps of w/u in biliary tumors
|
1. u/s (dilated inrahepatic ducts, distended thin-walled gb)
2. ct 3. percutaneous bx 4. ERCP 5. brushings of cbd for cytology tx- whipple's (pancreatoduodenectomy) |
|
which has better prognosis, ampullary cancer or CBD cancer or pancreatic cancer
|
ampullary and CBD
pancreatic is worst |
|
location of biliary colic?
sx?, dx? tx? |
cystic duct (gallstones)
sx: colicky pain in RUQ, radiating to the R shoulder, 10-30 min worse with fatty food, n/v dx; U/s tx: cholecystectomy |
|
location of cholecystitis?
dx? tx? |
cystic duct
dx:u/s: gallstones, thick waled gb, pericholecystic fluid tx: NPO, NG suction, IVF, abx |
|
if pts do not respond to initial tx of cholecystitis, what next?
|
er cholecystectomy (common in diabetics),
er percutaneous transhepatic cholecystostomy if very sick |
|
location of cholangitis?
dx? tx? |
CBD
dx: high bilis, high alk phos, really high wbc's tx: ax, er decompression of CBD by ERCP (PTC also) |
|
location of biliary pancreatitis?
dx? tx? |
ampulla, temporarily obstructing both panc and biliary ducts
dx: sonogram tx conservative (NPO, ng tube, ivf) later elective cholecystectomy |
|
epigastric pain
+ high WBC, high glucose, low Ca2+, Hct drops, BUN incr, and metab acidosis |
acute hemorrhagic pancreatitis
-do serial CT's, may need to drain |
|
pancreatic pseudocyst (5wks post pancreatitis or trauma)
dx? |
dx w/ CT or U/s
tx: drain |
|
young F, teens, twenties
-firm rubbery breast mass, moves easily w/ palpation dx? |
dx fibroadenoma w/ u/s or FNA
|
|
tx of giant juvenile fibroadenomas
|
removal
|
|
cystosarcoma phyloodes
|
removal
|
|
fibrocystic disease
|
usually w/ menses
aspirate: if clear: no big deal, come and go if bloody, send to cytology, if mass persists or recurs after aspiration then bx |
|
bloody nipple d/c
|
intraductal papilloma
-mammogram or galactogram |
|
most common breast ca
|
invasive ductal carcinoma
-worst and most invasive |
|
tx for ductal ca in situ
|
-simple mastectomy for multicentric lesions
-lumpectomy + radiation if lesion just in one quarter of breast |
|
female who recently recovered from breast ca now has persistent HA and back pain
|
likely mets (brain or bone)
CT brain, bone scan and xray -give steroids and radiation |
|
which type of breast ca is often bilateral
|
lobular
|
|
which type of breast ca has the best prognosis?
worst? |
medullary
inflammatory worst |
|
orange peel skin of breast, painful
|
inflammatory breast ca
-do mammogram and mult core bx |
|
eczematous patches on nipple, pigment changes.
mucin filled cell in epidermis |
paget's dz
|
|
bloody or serous nipple d/c
|
intraductal papilloma
-do a mammogram |
|
leaf like projections of large bulky breast mass
(cyst) |
phyllodes tumor
|
|
thyroid nodule:
if cancerous, would pt have hypo or hyperthyroid? |
usually hypothyroid
|
|
w/u for cushing's
|
low dose dexamethasone suppression test:
-if sup at low doseage= neg -if high cortisol, try high dose -sup at high does =pit microadenoma -no supp= adrenal adenoma |
|
PUD sx hypersecretion of acid
a/w MEN dx? tx? |
dx: gastrin and glucagon levels, CT of pancrease
tx. removal and PPI |
|
migratory necrolytic dermatitis, diabetes, anemia, glossitis, stomatitis.
dx? |
labs- glucagon levels
ct- glucagonoma tx with tumor resection, somatostatin and streptozocin if metastatic and inoperable. |
|
HTN + hypokalemia
|
primary hyperaldoseronism
-renin low -check response ot postural changes tx- aldatone CT or MRI surgery |
|
HTN + HA, perspiration, palpitations, pallor
dx:? tx? |
pheochromocytoma (chromaffin cell of adrenal medulla tumor tahat secretes NE and E and DA)
dx: 24h urine= VMA or metanephrine CT scal of adrenals tx: surgery with alpha blockers: phenoxybenzamine) |
|
heart abnormality a/w HTN
|
coarctation of aorta
|
|
HTN + fibromuscular dysplasia in young women
|
renovascular HTN
dx with doppler of ranl vessels and ateriogram tx: balloon dilatation and stenting |
|
pt has severe constatn retrosternal pain after UGIE, has ferver and sweats and subq emphysema at base of nec
dx, tx? |
gastrografin swallow
then er surgical repair |
|
which types of colonic polyps are benign?
|
juvenile, peutz-jeghers, inflam, hyperplastic
|
|
the more villous the poly, the more______
|
malginant
-villous adenoma -tubular -tubulovillous |
|
polyps and their potential for malignant conversion
|
familial adenomatous polyposis
-gardner, turcot -villous adneoma HNPCC/lynch -adneomatous polyp |
|
h/o ulcerative colitis, now very sick with abd pain
|
likely toxic megacolon, ER surg
|
|
which type of hemorrhoids bleed but do not hurt?
|
internal
-external really hurt but not blood tx- need to rule out malignancy so do proctosidmoidoscopy examination (rectal, anoscopy) |
|
excruiating abd pain, then 40 min later, cannot move, abd is rigid, xray shows free air under diaphragm
|
-perforated duodenal ulcer
tx= er exploratory lapartomy |
|
liver abscess that results in bloody diarrhea, very common in MX
tx? |
entamoeba histolytica
tx- metronidizole, send serology but it takes forever, no cx |
|
dx test for alcoholic w/ constant chronic epigastric pain that radiates to the back, w/ dm, statorrhea, and calicifation in the upper abd on xray
|
ERCP-- likely chronic pancreatitis
-stop etoh -replace panc enysmes |
|
tx for breast ca in post menopausal pt that has +receptors
|
anastrozole instead of chemo
|
|
thyroid nodule w/u?
|
tsh
us fna -if fna malignant or unk --> thyroidectomy |
|
hypercalcemia, hypophosphatemia
w/u? |
pth
sestamibi scan (likely pit adenoma) |