Review

Burn

80 kg 2nd, 3rd burns 40% TBSA. Initial rate

Atrial Myxoma

tumor on right side heart growing on atrial septum. Surgical excision + MVR. Diastolic murmur disappears when lying on side

Mid systolic click

Mitral valve prolapse. Apex. No treatment

Inclusion bodies on biopsy for colitis

CMV, transplant. Ganciclovir

Bleeding while on. Antidote

• ASA: platelets

• plavix: platelets, desmopressin

• coumadin: FPP, K, PCC

• Heparin: if bleeding give blood. Wait if not bleeding

• factor xa inhibitors: activated charcoal if in 2 hours

• direct thrombin inhibitors: responds to hemodialysis

chylous ascites on paracentesis

• lymphatic injury or destruction

• Lymphoma or any retroperitoneal obstruction. High TG

Pt with von wille brand

• bleeding time abnormality

• desmopressin, cryopreciptate

Tardive Dyskinesia

• 1st gen antipsychotics

• treatment with benztropine, diphenhydramine

nosebleed unresponsive from nasal packing

posterior, sphenopalatine artery

Transplant rejection

• types

• hyperacute: seconds. ABO. HLA. Immediate removal

• acute: days/months. T cell mediated. Immunosuppression/steroids. Diagnosis with biopsy to differentiate from chronic.

• chronic: months/years. Gradual fibrosis, loss of function. Retransplant

Pediatric cardiac anomalies

Local Anesthesics

• Esters (1 i) and Amides

• Esters more prone to allergic

Ophtho

• ulcerative conjunctivitis: herpes

• diabetic with cotton wool spot. Sudden eye pain: central retinal vein occlusion

• Atherosclerotic, painless: artery occlusion

• Pt with MS, painful loss of vision: optic neuritis

Carpel Tunnel

• compression median nerve

• PE: tinnel, phalen

• work up: EMG is indirect. Don't pick. Pick nerve conduction study

• treatment: nsaids, splinting, then CTR

Hidradenitis

• apocrine (arm pits, groin, but) inflammation

PDA

• treatment: indomethacin. Prostaglandins to open

• MOA: cox inhibitor

Temporal arteritis

• headache, jaw pain, eye pain, temporal artery pain

• steroids first, then biopsy

Atypical Lung

• aspergillosis: halo sign with pulmonary nodules, hemoptysis, dense consolidation on CXR

• histoplasmosis

• blastomycosis

• Coccidiomycosis

Practice Questions

• focal nodular hyperplasia: CT liver lesion with central scar

• choledochal cyst: cystic dilation of bile duct. Surgical excision

• pancreatic cystadenoma: premalignant. Distal pancreatectomy

• 12 yo fall. PE is good. Xray c spine next.

• low dose heparin or lovenox for DVT prior to surgery

• penile cancer

• Melanoma: wide local exision. Cut off fingers

• needle localized open biopsy or stereotactic if no lump palpable for breast cancer. FNA if palpable mass

• compartment syndrome: passive movement of the great toe