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29 Cards in this Set
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42 YOW comes with 2 d of rust colored discharge in her bra. She has no hx of serious illness and takes no meds. No fhx of br ca. Stable vitals. Exam of breast shows no abnormalities, no fluid can be expressed from nipples. Most likely dx? |
intraductal papilloma |
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42 YOM in ED after MVC where he briefly lost consciousness nd has brusing over abdomen in seatbelt pattern. 3 days later he vomits billious fluid positive for blood. He is afebrile, Abdomen is tympanic CBC lfts are normal. gastric bubble on XR. Dx? |
duodenal hematoma |
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82 YOW comes to physician with 4m of right sided HA, joint pain, malaise. Exam shows tenderness over right temporal a. Both temporal aa are palpable. ESR 87 (H). Next step? |
predisone and temporal artery biopsy immediately (Giant cell arteritis, shoot first, ask questions later) |
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After MVC, 23 YOM is brought to ED. He was unrestrained driver. BP is 150/90.He has retrosternal and interscap CP, dyspnea, hoarseness. XR shows fracture of sternum and left first rib, widening of superior mediatiunum, caudal displacement of bronch. Dx? |
Rupture of aorta: HTN + dyspnea + ELEVATION of left main stem |
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Varicoceles |
Ropy mass "bag of worms" |
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indomethacin and closure of PDA mechanism |
inhibit COX and increase NE release |
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42 YOW comes with 1w yellow eyes, nausea, R sided abdominal cramps. Had a lap choley 2m ago. Intraop cholangiogram not performed. no meds. Vitals normal. CVP exam normal. Abd exam shows RUQ tenderness w/ no distention or peroneal signs. Cause of jaundice? |
choledocholithiasis (cystic duct stone not detected w/o cholangiogram) 1. stone in CBD "micro stones" 2. oddi dysfunction |
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healthy 19 YOF brought to ED with 4 h severe abd pain . Sx began 3w ago as intermittent colicky pain. Exam 1 w ago showed 5 cm cyst. Abd exam shows tenderness with rebound and guarding in RLQ, Palpable 10 cm that is complex, cystic on u/s. Next step? |
exploratory laparoscopy or lapartomy ( point is this is ovarian torsion and IT IS NOT CT DRAINGAGE) |
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27 YOW brought to ED 30 mins after deep laceration on her back. What anaesthetic would provide the longest anaesthesia? |
Bupivacaine |
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Agents for Spinal AnesthesiaMnemonic: |
Little Boys Prefer Toys Lidocaine Bupivicaine Procaine Tetracaine |
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1- Lidocaine |
provides a short duration of anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than one hour. |
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2- Tetracaine Vs Bupivacaine: |
Tetracaine and bupivacaine are used for procedures lasting 2 to 5 hours. Tetracaine appears to provide a somewhat longer duration of anesthesia and a more profound degree of motor block than does bupivacaine. On the other hand, compared with tetracaine, bupivacaine has been demonstrated to be associated with a decreased incidence of hypotension. In addition, bupivacaine may be better than tetracaine for use in orthopedic surgical procedures since it appears to be associated with a lower incidence of tourniquet pain. |
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3- Vasoconstrictors |
can prolong the duration of spinal anesthesia of all three agents. However, the greatest duration is seen when vasoconstrictors are added to tetracaine solutions. |
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67 YOM admitted for 6w of n/v.decreased appetitie resulting in 16 kg wt loss. has distal gastrectomv for peptic ulcer 35y/a. He is cachectic with severe temporal wasting. Biopsy of a stomach mass is adenoca. What is the cause of metabolic abnormalities? |
increased serum tumor necrosis factor concentration ( causes cachexia) |
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2)A 72 year old man extubated and taken to recovery room after 4 hr operation of bleeding duodenal ulcer.ABG on an fio2 40% by face mask shows.Ph-7.24Pco2-85mm Hgpo2-60mm HgNext step in management |
Reintubate: he is not breathing well |
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52 y/o with hematochazia ,,, hemorrhoids on examination BNS |
1. ABCs 2. CBC + coagulation 3. NGT 4. COLONOSCOPY - hemorrhoids surgery is the last resort to think of - Mocc of bleeding in adults is diverticulosis |
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Previously healthy 42 YOM comes to physician because of 2 days of right knee pain. The symptoms began when he was getting up from a low chair. His temp is. Exam of knee shows tenderness to palpation along medial joint line and joint effusion. Dx? |
torn meniscus |
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8 YOG has sensation that something is in her left eye for 1d with photophobia and decreased vision for 6h. Parents notice child frequently rubs eye. Exam shows tearing with erythema. Small vesicle with erythematous base on conjunctiva. Dx? |
herpes "viral" conjuctivitis |
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66 YOW has acute vision loss in R eye x 1 h. No pain or previous hx. T2DM, HTN. Pupil does not react to direct light but is consensual with conlat light. Movement is intact. PE: pallor of disc, macular edema, thin arterioles, thickening of retinal v. Dx? |
central retinal ARTERY occlusion - vein ==> storm appearance vs. pale disc here - vitrous hemorrhage also storm, px is diabetic - detachment of retina will appear on ophthalmoscopy |
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87 YOM has 3 episodes of pneumonia over last 6m, 1 requiring admission. Increasingly bad breath over this time period. CBC, electrolytes, LFTs all normal. CXR shows scarring of right lung base. dx? |
zenker Pharyngoesophageal diverticulum When the pharyngeal sac becomes large enough to retain contents such as mucus, pills, sputum, and food, the patient may complain of pulmonary aspiration, foul breath, gurgling in the throat, appearance of a mass in the neck, or regurgitation of food into the mouth. Marked weight loss and malnourishment can occur in patients with longstanding dysphagia. The ZD may become so large that its retained contents may push anteriorly and completely obstruct the esophagus. - Barium swallow - tx endoscopy |
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68 YOM has recurrent stridor x 2 hours. 2 y/a he underwent radiation for laryngeal cancer. Exam shows a bulky tumor involving the upper and middle neck bilaterally. ABGs on 100% O2 shows: low pH, CO2 52, O2 55, HCO3 17. Neck step? |
tracheostomy ( retention of CO2 is impendings respiratory collapse) |
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56 YOW 3m of excessive sweating nervousness, tremors, tachycardia, hunger. Sx worsenby fasting. Selective angiography shows 1 cm tumor in tail of pancreas. Dx? |
insulinoma |
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An 80 YOW with atherosclerosis and chronic Afib has severe abd pain x 4h. Exam shows mild abd pain with absent bowel sounds. Occult blood test is +.WBC: 28 k. ABG: ph 7.18, CO2 35, Po2 62. AXR shows non specific gas pattern. Next step? |
exploratory celiotomy (likely mesenteric ischemia) |
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57 YOW in ED w 1 day of fever, chills weakness. Had spleen out for ITP 10 y ago. Got blood and appropriate Immunizations at that time. Temp 102.8. P 100, RR 20, BP 80/50. crackles at right lung base. CXr shows signs of pneumonia. Best abtx? |
ceftriaxone and vanco |
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76 YOM sustained a midshaft femur fracture during MVC. In ED circumference of right thigh is 2x left thigh. Pulse is 120, RR 16, BP 80/60.Large boe IV catherter is inserted. What finding best indicates adequate resuscitation in this pt? |
urinary output of 30-40 mL UOP. Key for resuscitation is stick a foley in, follow UOP. Remember, you're not givings fluids to lower the pulse, you're giving fluids to restore end-organ perfusion. The bedside signs of end organ perfusion are UOP and mental status. |
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best way to assess for periop MI |
Stress test looks for functional heart disease (how strong is this heart? can it take stress of anesthesia and surgery?) Echo can give you EF, but doesn't tell you anything about how heart will do when stressed (unless you get a stress echo). If patient has an abnormal stress test, they will go for cath. Cath is not a screening test. |
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obese female young at high risk of developing what in 5 yrs |
cholecystitis If a woman is obese, she likely has a lot of estrogen causing gallbladder stasis + higher cholesterol levels. |
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hydradenitis suppurativa |
in sweat glands => apocrine |
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choleducal cyst |
- review tx choose reux in Y cystojujonostomy : drain |
