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33 Cards in this Set
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A 47 yOM comes to physician for eval prior to an abdominal perineal resection fro rectal Ca. In last 6 y he has had left ankle swelling. Duplex shows chrinic occlusion of left iliac and femoal veins. Most apporpiatemanagemnt for venus disease? |
low does heparin prophylaxis ( these are stable DVTs), just need to prevent new ones |
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posterior epistaxis source |
The sphenopalatine artery is the artery responsible for the most serious, posterior nosebleeds (also known as epistaxis). More than 90% of bleeds occur anteriorly and arise from Little's area, where the Kiesselbach plexus forms on the septum.[7, 8) The Kiesselbachplexus is where vessels from both the ICA (anterior and posterior ethmoid arteries) and the ECA (sphenopalatine and branches of the internalmaxillary arteries) converge. |
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12 hours after rod stabilization of a femoral fracture, 27 YO homeless ,an has sudden onset of combativeness and disorientation. HR 120, RR 24, BP 140/85. Exam shows petichiae over axila. Most likely cause? |
Fat embolism + long bone frax + petechiae |
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scleroderma px with absolute constipation + peritoneal signs and fever |
Bowel obstruction refractory to medical management, now with signs of peritoneal inflammation (guarding, rebound). FYI, the answer is almostalways laparotomy when peritoneal signs are present. |
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anterior thigh pain or knee pain in child + limping gradually + nL weight and height |
LCPD |
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a 62 YOW comes to the physisics with 3 w of progressive SOB, mild pain in right chest, and nonproductive cough. 12 lb wt loss in last 3 m. She had br ca 6 years ago s/p mastectomy. She appears cyanotic and cachectic. friction rub is heard on the right.Dx? |
- friction rub => pleurisy with effusion - no fever or hx of pneumonia => not empyema - hx of malignancy in breast ==> malignant pleural effusion "exudative" |
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transudative effusions causes |
Transudative effusionsSee the list below: 1.Atelectasis: Due to increased negative intrapleural pressure 2 Cerebrospinal fluid (CSF) leak into pleural space: Thoracic spine injury, ventriculoperitoneal (VP) shunt dysfunction 3 Heart failure 4 Hepatic hydrothorax 5 HypoalbuminemiaIatrogenic: Misplaced catheter into lung 6 Nephrotic syndrome 7 Peritoneal dialysis 8 Urinothorax: Due to obstructive uropathy |
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pancreatic abscess drainage ==> ARDS ==> Tx ? |
ABG shows patient is hypoxemic. 2 ways to increase P02 are increasing Fi02 (already at 100%) and increasingPEEP. Peep of 2.5 is pretty low, so you've got some room to maneuver. As an aside, tidal volume of 1000 for 70kgman is way high, especially for likely ARDS (which you usually treat with low tidal volume/increased PEEPventilation). But monkeying with tidal volume will not correct the patient's hypoxemia. |
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trauma --> wide mediastinum on CXR ==> BNS |
Aortic dissection 1. if offered ==> US = MRA = CTA 2. if not or equivocal results ==> aortic angio |
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nipple sensory dermatome |
T4 |
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fever + loss of weight + MS murmur that changes with position |
Atrial myxoma |
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perirectal abscess in DM px Tx |
incision and drainage |
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AF px with TIA ,,, bilateral carotid bruit,, BNS |
carotid duplex US |
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linear skull frax at frontoparietal area would lead to which type of intracranial hemorrhages ? |
epidural ,, pathway of MMA |
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ITP |
- Low Plts - ++ megakaryocytes on BM biopsy |
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A 23 YOW has left shoulder pain for 12 h after falling down stair. She has diffuse abd tenderss, an Hb f 10, and WBC of 11k. Most likely Dx? |
ruptured spleen: MOC organ to be damaged |
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HAP |
pseudomonus |
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A 1 yr old boy has persistent cough, loose stools and facial rash for 2 m. 4lb wt loss. 50th percentile for ht and 20th for wt. Temp is 37, pulse is 100 resp is 18. Ct shows tumor in panceas. Most likely Dx? |
VIPoma. especially with flushing. arises from non beta islet cells of pancreas |
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pancreatitis tx |
Hydrate first. Then probably pain management. Monitorfor electrolyte disturbances. If patient had hypercalcemia couldn't use lactated ringerbecause it has calcium in it.Hypocalcemiashouldbecorrectedifionizedcalcium isloworiftherearesignsofneuromuscularirritability(Chvostek'sorTrousseau'ssign). |
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A previosuly healthy 47 YOM comes in with 2 weeks of progressive abd swelling. PE shows distention and shifting dullness, bowel sounds are normal. There is no tenderness, masses or organomegaly. Paracentesis: 50ml milky chylous fluid. Most likely cause? |
Lymhoma Lymph obstruction leads to chylous fluid |
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symptomatic hypocalcemia |
IV calcium gluconate |
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Renal injury |
CT abdomen. Angio is invasive and doesn't give you the grade of injury or demonstrate a urine leak. CTwith arterial, venous, and delayed phasecan give you all the information you need, especially in a stable patient. Most renal injuries are managed nonoperatively. |
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management of charcot joints |
1. x rays if there is trauma 2. tx of cause 3. mechanical devices :assist weight bearing and decrease further trauma |
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APC + px |
APC gene -7 almost guaranteed cancer. Proctocolectomy when they are old enough (teens). Sigmoidoscopic surveillance and ablation of anypolyps in the retained rectum or ileal pouch should be performed every 3-6 months in patients with FAP who have undergone colonic (total orsubtotal) resection. |
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progressive ascitis + omental thickening + multiple pelvic abscesses on CT scan |
Ovarian carcinoma is the most common prototype malignancy to produce omental cakes. mieg's disease |
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a 60 YOW has a sigmoid resection and colostomy for diverticulitis with rupture. That night she becomes confused, oliguric and febrile. the area around the colostomy is indurated and crepitant. Most likely causal organism? |
Clostridium perfringens ( gas gangrene) |
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fever after endoscopy ==> BNS is |
water soluble imagine of Upper Gi to rule out perforation::> any sx of GI or respiratory or pain indicates perforation Ruptured esophagus rule out. The presence offever; pain in the neck, upper back, chest, or abdomen; dysphagia; odynophagia; dysphonia; ordyspnea following esophageal instrumentation should raise suspicion for perforation. |
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SCFE |
SCFE (slipped capital femoral epiphysis) (THINK OBESE CHILD 10-16) has a usual onset in the pubertal age range, from nine to thirteen, and is aproblem in the femoral growth plate, which causes the femoral head to change position relative to the femoral neck. It is more common inoverweight males, and is not related to trauma. Frog leg radiographs of the hip will show epiphyseal displacement (see Figure 3). Surgery is indicated to refixate the femoral neck via pinning. Pain can localize to knee (but knee will not have any inflammation etc). Posteriordisplacement of femora Iepiphysis. |
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ASX 72 YOW comes in with decreased renal fx. Elevation in Cr over last 3 days. got 2nd renal transplant from 65 YO donor 1 m ago. Most likely explanation for decr renal fxx? |
failure to surpress class II antigen recognition in the host ( rjection) |
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47 YOW comes in with a BMI of 67 , chafed skin on inner thighs, under breasts, twice requiring admission for abtx for panniculitis. Also has thick curdy vaginal discharge.Best long term management for this pt? |
gastric bypass |
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HIT 2 |
- Tx ==> stop heparin and start argatroban or fundaparinux - Sx: 1. thrombosis + echymosis 2. anaphylactoid reaction - low PLts < 50 % - Dx: serotonin release assay "start tx before dx" |
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A 67 YOW with ESRD, aterosclerodic CAD, T2DM undergoes formation of an AVF in left forearm under ax block. 24 hours later. SHe has SOB, , tacycardia, RR 38 with JVD. S3 and S4 are present. Most likely Dx? |
high output congestive heart failure ( atelectasis just doesnt cover enoguh) |
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breast biopsy |
- palpable ==> FNA or core - not palpable ==> image guided biopsy or needle localized open biopsy |
