@_@_@...HY Facts For CK...@_@_@ - savi

[ArchivalUser]

1.Patients with DM, CRF and multiple organ failure can develop acalculous cholecystitis. Acalculous cholecystitis is characterized by the absence of gallstones and sometimes even biliary sludge. These patients may not present with classical signs of cholecystitis, because of associated diabetes mellitus and multiple organ failure. U/S may fail to show evidence of gallstones or obvious signs of cholecystitis. A CT scan of the abdomen and pelvis will reveal a thickened gallbladder wall, pericholecystic fluid, gas within the gallbladder wall, and evidence of surrounding inflammation.

2.After abdominal aortic aneurysm repair and blood in the stool =>suspect ischemic colitis => do sigmoidoscopy/colonoscopy to assess colon viability, if CT scan is inconclusive, do not use Barium enema=>can cause perforation.


3. In SLE => non-erosive arthritis; In RA =>erosive arthritis: indication for starting Methotrexate


4. Kallmann's syndrome-46,XX = anosmia, hypogonadotropic hypogonadism, absent pubic, axillary hair, absent breasts, amenorrhea.

5. Juvenile angiofibroma is a highly vascular fibrous tumor that classically affects adolescent males and appears to be related to androgenic stimulation. It manifests with recurrent epistaxis.
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[ArchivalUser]

1. Mutation of an X-linked gene coding for a tyrosine kinase is the underlying molecular mechanism leading to X-linked agammaglobulinemia of Bruton, a syndrome characterized by inability of pre-B cell precursors to mature into B-lymphocytes. Humoral immune deficiency thus manifests


2. Mutations of the autosomal gene encoding adenosine deaminase represent the most common cause of the recessive form of severe combined immunodeficiency disease (SCID), encompassing a heterogeneous group of conditions characterized by deficiency of both T- and B-cell mechanisms. SCID may be autosomal dominant, autosomal recessive, or X-linked. Mutations of the X-linked gene coding for a cytokine receptor subunit represent the most common cause of the autosomal dominant form of SCI.


3. Children with hypospadias are prone to urinary tract infections and other urinary tract anomalies. Don't forget U/A and Sono.


4. One of the most important reasons for steatorrhea in newborns is bile acid deficiency. Bile acids are very important in normal absorption of fat, which constitutes a major portion of an infant's calories intake. Unfortunately, the bile acid pool in neonates is very small when compared with that in adults. In addition, neonates often lose an excessive amount of bile acids in their stools. This results in physiologic steatorrhea because of poor absorption of fat. Preterm infants, have an even smaller bile acid pool and are more likely to have steatorrhea because of poor fat absorption. This will result in poor weight gain. The solution to this problem is to substitute medium-chain triglycerides (MCTs) in the formula for long-chain triglycerides (LCTs), because, unlike LCTs, MCTs do not require bile acids for absorption.


5. Inhalant abuse such as model glue, correction fluid, spray paint, and gasoline, to achieve an altered mental state. It is a common health problem in adolescence. The effect of inhaling a large quantity of hydrocarbons has been described as "quick drunk" because it resembles alcoholic intoxication. Initially, euphoria develops; then, lightheadedness and agitation. Disorientation, ataxia, and dizziness might develop with increasing intoxication. In extreme cases, generalized weakness, hallucinations, and nystagmus can occur. Abusers often show deterioration in school performance, disturbance of family relationships, and increased risk-taking behaviors.
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[ArchivalUser]

1. Encephalopathy is the major chronic morbidity following chronic inhalant abuse. Also, keep in mind that a good history is essential because there is no drug screen test that can detect inhalant hydrocarbons.


2. Atrial myxoma=>systemic signs, dyspnea, like mitral stenosis, but no opening snap, murmur changes with position=>high risk of embolization


3. A 2 month old infant can lift its head to 45 degrees, eyes follow to the midline, vocalizes, smiles and has a state of half-waking consciousness.


4. The ability to lift the head to 90 degrees, eyes crossing the midline, laughing and slight awareness of the caregiver are characteristic childhood development landmarks of a 4 month old infant.
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[ArchivalUser]

1. The typical presentation of a thrombosed external hemorrhoid is an acute onset of very severe perianal pain, particularly when walking and sitting.

2. External hemorrhoids are below the dentate line. Internal hemorrhoids arise above the dentate line.

3. Thrombosed external hemorrhoid requires immediate incision and evacuation of the clot to provide symptomatic relief. Pressure by compression is usually all that is needed to control the bleeding.

4. Sitz baths, applying a topical steroid cream, and increasing fiber intake are the usual treatment for symptomatic external hemorrhoids that are not thrombosed.

5. As a rule, remember that external hemorrhoids hurt but do not bleed(opposite internal hemorrhoids.)
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[ArchivalUser]

1.Typical picture of pyloric stenosis: Projectile non-bilious vomiting is seen in virtually all patients. Patients also often develop a hypokalemic, hypochloremic, metabolic alkalosis from the persistent vomiting. If they give a child with intermittent spitting up think about pyloric stenosis.

2. Abrupt onset of colicky abdominal pain in childeren <2 years ,think about intussusception! What's the etiology? The exact cause is unknown. However, it is associated with Meckel's diverticulum, cystic fibrosis, polyps, and Henoch-Schoenlein purpura. A barium enema or air enema is both diagnostic and therapeutic.

3. In any patient with dysphagia that is progressive for only solids, it suggests a growing and obstructive lesion. The history of tobacco and alcohol use, puts a person at a much higher risk of carcinoma. The two ways to diagnose this are a barium swallow study, which will show the mucosal mass, or an upper endoscopy study to directly visualize and biopsy the lesion.

4. Esophageal manometry is used to evaluate dysphagia caused by motility disorders. These typically present with dysphagia for solids and liquids and may or may not be progressive.

5. Incarcerated or strangulated hernias in an elderly patient can cause acute abdomen, dehydration, and altered mental status.
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[ArchivalUser]

HI FOR HY SAVI

GREAT NOTE GREAT HT;

KEEP IT UP

[ArchivalUser]

1. Frequent, greasy, malodorous stools are a result of steatorrhea from chronic pancreatitis. This happens from the lack of pancreatic enzymes. Non-enteric coated pancreatic enzyme supplements with concurrent H2 blockers will deliver active enzymes to the proximal small bowel and help reduce malabsorption and steatorrhea.

2. Acute acalculous cholecystitis is characterized by fever, nausea and vomiting, right upper quadrant abdominal pain, and inspiratory arrest on palpation of the right upper quadrant (Murphy's sign). An elevated leukocyte count is usually present. Gallstones are not present and it is usually associated with trauma, burn, surgery, diabetes mellitus, and bacterial infections of the gallbladder. BUT...biliary colic, is characterized by crampy, right upper quadrant abdominal pain that may radiate to the back and often follows a meal. Nausea and vomiting may be present. Fever, chills, and leukocytosis are notably absent. Gallstones are present on an ultrasound.

3. Acute cholangitis is characterized by fever, right upper quadrant pain, and jaundice (Charcot's triad).

4. The hallmark of mesenteric ischemia is pain out of proportion to physical exam findings. Mesenteric ischemia is especially likely in a patient with known vascular disease and a history of cigarette smoking. The next diagnostic step is a mesenteric angiogram. The superior mesenteric artery is the most often compromised vessel.

5. Patients with ulcerative colitis are at high risk for toxic megacolon, which is also associated with Clostridium difficile colitis.
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[ArchivalUser]

1. Toxic megacolon presents clinically as abdominal distension and bowel motility disturbances. The next step in evaluation is an abdominal radiograph which will demonstrate a distended large bowel.

2. Spontaneous bacterial peritonitis. This diagnosis should be first on your list in any patient with ascites who presents with fevers, abdominal pain, change in mental status, or with other non-specific complaints. These patients need to have a paracentesis. This fluid is then sent to the lab for a cell count, culture, and Gram stain. The diagnosis of SBP can be made by seeing bacteria on a Gram stain, having more than 500 WBC or 250 PMNs in the cell count, or a positive peritoneal fluid culture. Patients with SBP need to be started on a third-generation cephalosporin.

3. Lead levels over 10 mg/dL are considered abnormal.

4. Fluoxetine is a serotonin reuptake inhibitor that requires 5 weeks to reach a steady state in the body and takes approximately 6-8 weeks to show an adequate response. This should be explained to patients before and during treatment to help them understand the importance of staying on the medication even though they do not feel any effects.

5. Congenital diaphragmatic hernia, which is when the abdominal contents herniate into the left hemithorax through a congenital defect in the left hemidiaphragm. This causes displacement of the heart into the right hemithorax and pulmonary hypoplasia.
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[ArchivalUser]

1. Key finding for Esophageal atresia with distal tracheoesophageal fistula usually presents with a history of polyhydramnios, cyanosis with feeding, and increased oropharyngeal secretions.

2. In a traumatic lumbar puncture even though the CSF is initially red, the supernatant of the centrifuged cerebrospinal fluid is clear. This means that the red blood cells have not yet had a chance to lyse and release their intracellular contents into the cerebrospinal fluid. BUT in subarachnoid hemorrhage there would be blood in the CSF, the supernatant of the centrifuged fluid would be xanthochromatic (yellow) due to the lysis of red blood cells and the release of their intracellular contents into the cerebrospinal fluid.

3. The symptoms of crampy abdominal pain and watery, explosive, secretory diarrhea are consistent with enterotoxic E. coli. the cause of traveler's diarrhea , tx: ciprofloxacin if symptoms persistent.

4. The symptoms of Giardiasis, which usually occur about a week after exposure, include flatus, loose stools, diarrhea, abdominal pain, bloating, and vomiting. The usual scenario for a healthy person that develops this infection is the onset of these symptoms after a camping trip. tx:metronidazole.

5. Infectious mononucleosis typically presents with a few-week history of fatigue, malaise, and a sore throat. Examination often shows pharyngeal edema, erythema, and palatal petechiae, lymphadenopathy, and splenomegaly. Hepatomegaly may also occur.
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[ArchivalUser]

1. Hyperthyroidism during pregnancy is treated with propylthiouracil, which crosses the placenta less than other medicines such as methimazole. It should be given in the lowest effective dose and tapered as the patient becomes euthyroid. Untreated severe hyperthyroidism during pregnancy has been associated with spontaneous abortion and premature labor.

2. Sudden onset of right upper quadrant pain associated with nausea and vomiting and history of right upper quadrant and epigastric pain before, associated with food intake. These symptoms are classical for a perforated peptic ulcer. In a perforated peptic ulcer, a patient can still have right upper quadrant localized tenderness, a thickened gallbladder wall, and pericholecystic fluid from the perforated ulcer. Hence, with any abdominal pain associated with signs, abdominal x-rays both erect and supine are very essential in the initial evaluation to rule out any free air.

3. The first line in treatment of panic disorder is selective serotonin reuptake inhibitors (SSRIs), a group of medications including sertraline, paroxetine, fluoxetine, and citalopram.

4. Surveillance colonoscopies are generally recommended every 6 months for 2 years beginning after 8 to 10 years duration of ulcerative colitis.

5. The presence of endocervical cells on a Pap test is regarded as evidence of adequate sampling of the transformation zone during cytologic screening of the cervix. When these cells are absent, it indicates that this area may not have been sampled. This is considered a satisfactory, but limited smear. In patients with no known risk factors (i.e., prior abnormal Pap test, multiple sexual partners, smoking) the American College of Obstetricians and Gynecologists recommends that the physician may defer to repeating the Pap test in 12 months even if the sample is not adequate.
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