Lung cancer associated w/ hypercalcemia
Squamous cell carcinoma
2/2 PTHrP release
-don’t confuse this w/ small cell, not the same!!
22 yo M w/ GSW to right calf
- normal VS, no exit wound, calf tense and TTP
- passive mov’t of great toe exacerbates calf pain
- normal pulses, cap refill, sensation
Immediate next step?
Surgical decompression
-tense, painful passive ROM = compartment syndrome risk!! needs immediate decompression
-not irrigation of wound or abx…duh need to deal w/ immediate problem
30 yo M w/ painless, progressive enlargement of left testicle over 8 mo
-no nodule, scrotum cannot be transilluminated
Dx
Dx = testicular tumor
-almost all testicular masses are malignant
- not hydrocele b/c that would transmit light (able to be transilluminated)
- not epidiymitits b/c fever and severe pain
- not indirect inguinal hernia b/c not painless and not progressive
- not spermatocele b/c that is a palpable lump in the scrotum
45 yo M w/ daily 100.9F temps and 15 lb wt loss over past 3 mo
- Hgb 10
- low-pitched, rumbling diastolic murmur heard best at apex that disappears when pt lies on his right
Dx
Dx = atrial myxoma = benign primary cardiac tumor usually (80%) in the LA on the atrial septum
- causes symptosm 2/2 mitral valve obstruction => often mimics mitral stenosis (hence the murmur)
- tumor releases cytokines and growth factors that cause constitutional symptoms (anemia, fever, wt loss)
Most common primary cardiac neoplasm
Atrial myxomas- benign tumors, most often in the LA on atrial septum
Atrial myxomas
(a) What are they?
(b) Where are they?
(c) Two sets of symptoms
Atrial myxomas
(a) Benign primary cardiac tumors
(b) 80% in the left atrium, other 20% in the right atrium
- on the atrial septum
(c) Cause symptoms by.
i. mitral valve obstruction => mimics mitral stenosis (diastolic rumbling murmur heard at the apex)
ii. growth factor and cytokine release => constitutional symptoms (fever, anemia, wt loss)
Define proctocolectomy
(a) Indications
Proctocolectomy = surgical removal of rectum and some (or all) of the colon
(a) Surgical method for ulcerative colitis and FAP ppx
60 yo F POD0 from sigmoid resection becomes confused, oliguric, and febrile
-tissues around colostomy are indurated and crepitant
Causative organism?
Clostridium perfinges
-gas gangrene! Surgery compromises blood supply, anaerobic environment is optimal for clostridial growth => necrosis w/in 24-36hrs
How to make a diagnosis of gas gangrene
Gas gangrene (2/2 clostridium species s/p bowel surgery): pain at site, signs of systemic toxicity (fever, neuro status change), gas in soft tissue (crepitus in soft tissue)
-crepitus in soft tissue = most sensitive and specific physical exam findings
Crepitus in soft tissue
= Gas gangrene 2/2 clostridium species
Most common type of hiatal hernia
Hiatal hernia, most common type = sliding hiatal hernia
-much more common that paraesophageal
Main clinical feature of VIPoma
Watery diarrhea and the resultant electrolyte abnormalities
Urinalysis results expected in pt w/ nephrolithiasis
Kidney stones => microscopic hematuria (30 RBC/hpf in sediment)
hpf = high power field
