Management of cerebellar hemorrhage
- Reversal of anticoagulation
- Blood pressure management
- ICP management
- Surgical decompression if (large hemorrage, neurologic deterioration, brainstem compression)
In the context of intracranial bleeding, symptoms of headache, vomiting, and vertigo indicate bleeding in what area?
Cerebellar
Diverticulosis vs Diverticulitis
Diverticulosis - herniation of the colonic mucosa and submucosa through the muscle layers due to increased intraluminal pressure
Diverticulitis - mucosal barrier alterations can lead to microperforations and subsequent colonic wall inflammation
Most common place of diverticulitis cases?
Left lower quadrant (sigmoid colon) which is where the greatest intraluminal pressure is
Left lower quadrant pain, nausea, vomiting, change in bowel habits, mild irritative urinary symtpoms, sterile pyuria.. Diagnosis?
Acute diverticulitis
Urinary symptoms arise from irritation of the bladder from the adjacent inflamed signoid colon
Complication of Nissen fundoplication (wrapping fundus around LES to prevent GERD) that is caused by injury to the Vagus nerve
Gastroparesis - bloating, early satiety, postprandial emesis, food aversion
Use a scintigraphic gastric emptying san
Zenker diverticulum management
Zenker diverticulum - posterior outpouching of the esophagus that can cause trapped food. This can be due to abnormal spasm or diminished relaxation of the cricopharyngeal muscles during swallowing
Management - surgical division of the cricopharyngeus muscle
2 most common burn infection pathogens
Pseudomonas aeruginosa and Staph aureus
2 most appropriate antibiotics for burn wound infections
- Piperacillin-tazobactam or a cabapenem (gram negative)
- Vancomycin (MRSA)
A venous air embolism is a possible consequence of removing a central venous catheter. What position should the patient be placed in?
Left lateral decubitus. This encourages the air embolism to be constrained to the right ventricle wall instead of blocking the outflow tract to the lungs.
Reduced active and passive range of motion in the shoulder, in multiple axes. Deltoid muscle atrophy, loss of arm swing.
Diagnosis? Treatment?
Adhesive capsulitis
Treatment is range of motion exercises
Young patient, knee injury. Normal x-ray, small left knee effusion. Internal and external rotation causes a clicking and pain.
Diagnosis?
Medial/lateral meniscus tear. X-ray is normal. Next step is to get an MRI or arthroscopy.
What are indicators of worse prognosis in acute pancreatitis?
- Low serum calcium - released lipase will release FFA which will decrease serum calcium
- Evidence of 1> organ failures: Ex) high BUN shows intravascular volume depletion
Note: NOT Lipase/amylase. elevation does not correlate to worse prognosis
Diagnostic imaging of choice for appendicitis?
Women/children
Men
Women/children - ultrasound and MRI
Men - abdominal CT
Patient had a minor injury which has quickly progressed to diffuse swelling and extreme pain. Imaging shows evidence of air deep in the tissues. Vitals show fever and hypotension.
Diagnosis?
Necrotizing fasciitis
Most common culprit - streptococcus pyogenes (group A)
Microbiology
Pt was in a marine environment and developed a cut. Now the area has erythema and dark colored bullae. Pt is also septic. This can also be from ingesting oysters.
- Hemochromatosis or other liver disease is a risk factor as iron act as a catalyst.
Bug?
Vibrio vulnificus
Pt with a history of Paget disease is at risk for what kind cancer?
Osteosarcoma - primary bone cancer. Bimodal. “Pleomorphic neoplastic cells producing new woven bone”
Paget disease: Idiopathic disorder of increased bone turnover. Bone is described as having mixed osteoblastic and -clastic
phases, where bone appears heterogenous on x-ray.
Pt has multiple broken ribs and is diagnosed with flail ribs. Describe the direction of the chest wall movement with inspiration and expiration
Inspiration - chest moves inward
Expiration - chest moves out
This is due to inability to make negative intrathoracic pressure
