Term
|
Definition
1. CC
2. HPI/ROS
3. PMH/PSH
4. Allergy
5. SocHx, FamHx, SexHx
6. PE
7. Labs
8. Images
9. Biopsy or Other Tests/Exams
10. Tx |
|
|
Term
|
Definition
GGBM-BRUNCHES
1. General
2. GI
3. Blood (bleeding, ascler pain)
4. Bone/muscle/movement pain aches
5. Breast
6. Resp
7. Urinary
8. Neuro/Psych
9. CV
10. HEENT
11. Endo
12. Skin
13. Sex Organs |
|
|
Term
|
Definition
fatigue
wt loss
appetite change
fever/chills |
|
|
Term
|
Definition
1. NV
2. BMs
3. abdo pain
4. eating habits or difficulties |
|
|
Term
|
Definition
1. bleeding or coag disorders
2. bruising
3. leg pain with walking |
|
|
Term
|
Definition
1. pain with movement
2. joint bone or mm aches |
|
|
Term
|
Definition
1. pain
2. lumps
3. discharge
4. changes
5. self-exams or mammography
6. breast feeding |
|
|
Term
| Respiratory questions in ROS |
|
Definition
1. SOB
2. Chest pain
3. Cough, wheeze
4. resp fatigue |
|
|
Term
|
Definition
1. difficulty
2. pain
3. urine appearance |
|
|
Term
|
Definition
1. Tingling
2. Headaches
3. Changes in Mental statue
4. depression
5. anxiety |
|
|
Term
|
Definition
1. SOB
2. Chest pain
3. Edema
4. probs sleeping flat
5. palpitations |
|
|
Term
|
Definition
1. heat cold tolerance
2. weight changes |
|
|
Term
|
Definition
1. pain during sex
2. periods
3. menarche and menopause onset
4. children, breast feeding |
|
|
Term
| most common breast cancer type |
|
Definition
|
|
Term
|
Definition
palpation guided
US guided
stereotactic (Xray esp) |
|
|
Term
| When do you do sentinal ln dissection? |
|
Definition
| if INVASIVE cancer. NOT in DCIS. |
|
|
Term
| when do you do neoadjuvant breast ca chemo? |
|
Definition
| if INVASIVE and very large and ER or PR or HER2 positive |
|
|
Term
|
Definition
cancer (ductal or lobular and invasive v noninvasive + inflammatory)
fibroadenoma
fibrocystic change
cyst or infection
fat necrosis or hematoma |
|
|
Term
| management of fibroadenoma |
|
Definition
if over age of 35 take out
if younger monitor and remove if it doesnt regress or gets bigger
remove if fam hx of breast cancer |
|
|
Term
|
Definition
|
|
Term
| pre-req to surgical tx of breast lump |
|
Definition
|
|
Term
|
Definition
| mammography or breast biopsy in past. gyne surgeries |
|
|
Term
| labs in breast lump case? |
|
Definition
CBC of menstruating + fatigue
CA-15 to monitor |
|
|
Term
| what types of calcifications are more malignant |
|
Definition
|
|
Term
| most common location of breast CA |
|
Definition
|
|
Term
| what are the benign calcifications of breast? |
|
Definition
| fat necrosis (coarse) vascular (hx of vasc disease) |
|
|
Term
| ddx with bloody discharge from nipple |
|
Definition
intraductal papilloma
breast cancer
trauma (hematoma) |
|
|
Term
| imaging for bloody discharge from nipple |
|
Definition
US
mammo
galactogram (ductography) |
|
|
Term
|
Definition
malignant (papillary, medullary, anaplastic, follicular)
benign (hyperplastic and colloid)
hyperfxning (graves, toxic nodular goiter, toxic adenoma, subacute thyroiditis, thyroid storm)
hypofxning (radiatin, hashimoto)
thyroiditis (subacute, acute, reidels) |
|
|
Term
|
Definition
| thyroid hormone levels, calcitonin, calcium |
|
|
Term
|
Definition
US + doppler (calcifictions, hypoechogenetcity, vascularity)
fiberoptic laryngoscopy if really big or throat sx prior to surgery
CT and mRI to check LN if cancer posi in FNA |
|
|
Term
|
Definition
| remove and then radioactive iodine +HRT |
|
|
Term
| tx nodule with compression sx |
|
Definition
|
|
Term
|
Definition
meds first, then surgery if meds fail
surgery if over 4cm |
|
|
Term
|
Definition
| remove with frozen section |
|
|
Term
|
Definition
| meds and radioactive iodine first then surgery |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| BB, nal and lugol soln and steroids |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| propthiouracil and methimazole |
|
|
Term
|
Definition
| steroids, surgery if compression or no improvement |
|
|
Term
| how much of thyroid do you take out? |
|
Definition
if small papillary take out one lobe + isthmus.
if large take out whole thing
if any other ca take out whole thing |
|
|
Term
| drug to give after surgery |
|
Definition
|
|
Term
|
Definition
-kidney failure causing hyperparathyroidism
-hyperplasia of parathyroids glands
-PT cancer
-active PT adenoma
-lung cancer with PTHrP |
|
|
Term
| in PT hyperplasia how many glands get bigger |
|
Definition
|
|
Term
| mm changes in hypercalcemia? neuro change? |
|
Definition
| mm weakness and soreness. confusion and fatigue and lethargy) |
|
|
Term
| urinary sx of hypercalcemia |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| remove 3-4 glands and replace on in arm |
|
|
Term
| hi pth due to kidney failure |
|
Definition
surgery if hi bone pain and pruritis
ca and vit d if no sx |
|
|
Term
|
Definition
| pth, vit d, calcium, calcitonin, AP |
|
|
Term
|
Definition
| saline, diuretics, antiarrythmics |
|
|
Term
|
Definition
| lymphoma, 2ndary CA, inflammatory, branchial cleft cyst |
|
|
Term
| PMH significant qs in neck ln mas |
|
Definition
recent infections
hx of cancers and melanoma removals
radiation to neck/chest |
|
|
Term
|
Definition
| laryngoscopy, bonchoscoppy, esophagoscopy |
|
|
Term
| management of ln enlargement |
|
Definition
if new and soft wait 2 weeks
if old do triple endoscopy then biopsy FNA |
|
|
Term
|
Definition
| radical neck dissection. all nodes clav to mandible. SCM, submandibular gland, tail of parotid, cervical plexus, CN11, IJV (2 glands, 2 nerves, a mm and a vein) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| ddx of difficulty swallowing. food stuck midchest. |
|
Definition
adenocarcinoma of esophagus
SCC of esophagus
achalasia
stricture |
|
|
Term
| directed PE in etoh with difficulty swallowing where food gets stuck midchest. |
|
Definition
| HEENT, oral, LN, assess for nutritional and fluid status...THIAMINE |
|
|
Term
| labs in etoh with difficulty swallowing where food gets stuck midchest. |
|
Definition
CBC, BMP
albumin, protein (check nutrition) |
|
|
Term
| images in etoh with difficulty swallowing where food gets stuck midchest |
|
Definition
|
|
Term
| palliative tx in esophageal cancer |
|
Definition
stents
brachytherapy (nternal radiation)
laser canalization |
|
|
Term
| ddx of pt with sausage stuck in throat |
|
Definition
adenocarcinoma, SCC
achalasia
stricture (from gerd) |
|
|
Term
| polish sausage stuck in throat with chest pain....major thing to remember to ask in ROS |
|
Definition
|
|
Term
| imaging in pt with polish sausage stuck |
|
Definition
endoscopy to move sausage out
THEN barium swallow to see status of eso |
|
|
Term
| treatment of esophageal strictures |
|
Definition
bougies to dilate stricture
nissen funduplication for antireflux
hernia repair if hernia cause of reflux |
|
|
Term
|
Definition
1. EYE: (4 sponatneous, 3 to voice, 2 to pain, 1 close)
2. VOICE: (5 normal, 4 confused, 3 inapropro words, 2 noises, 1 nothing)
3. MUSCLE: (6 normal, 5 localizes pain, 4 moves away from pain, 3 abdnormal flexion away, 2 moves towards pain/extension, 1 nothing) |
|
|
Term
| PE on pt with hematemiss and etoh and cirhhosis and unresponsive |
|
Definition
after stabilization
abdo (peritoneal signs for perf)
signs of portal hypertension |
|
|
Term
| labs in pt with cirrhosis hematemisis and etoh |
|
Definition
cbc, bmp,
lft, albumin, bilirubin, |
|
|
Term
| imaging in pt with cirrhosis hematemsis and etoh |
|
Definition
upright cxr for perf
EGD to find bleed |
|
|
Term
| tx of rupture eso varieies |
|
Definition
variceal ligation and banding
sclerotherapy
IV octreotide (splanchnic vasoconstrict to dec portal pressure)
IV vasopressin
balloon tamponade with blakemore tube
transjugular itnrahepatic portosystemic shunt
liver transplant |
|
|
Term
| dDX of 4hr hx of hematemesis. |
|
Definition
-mallory weiss tear
-esophageal varicies
-ruptured PUD
-Zollinger Ellison gastrinoma with ruptured ulcer. |
|
|
Term
| first step in pt with 4 hr hx of hematemesis and melena bp100/70 |
|
Definition
| airway, breathing, circulation (2 large bore peripheral IVs with LR and NS) type and cross |
|
|
Term
| PMH in pt with 4 hr hx of hematemesis and melena bp100/70. |
|
Definition
| PUD, Hpylori status, nsaid use |
|
|
Term
| tests in pt with 4 hr hx of hematemesis and melena bp100/70 |
|
Definition
-cbc for anemia
-lytes for metabolic alkalosis
-hpylori serology or urea breath test
-type and cross to resuss
-gastrin levels for gastrinoma
-LFT for portal HTN and varicies
-etoh level for mallory weiss tear |
|
|
Term
| in pt with 4 hr hx of hematemesis and melena bp100/70 what is your PE? |
|
Definition
-abdo for peritoneal signs of rupture
-rectal for FOBT |
|
|
Term
| what is the function of EGD in pt with 4 hr hx of hematemesis and melena bp100/70 |
|
Definition
| find source of bleed. biopsy due to risk of CA |
|
|
Term
| treatment of bleeding and ruptured PUD |
|
Definition
1. Med tx for bleeding (resuss with CBC monitor, NPO and NG tube, remove offender, add PPI or PPI with clarithro, metro/amoxi if hpylori)
2. Surg for bleeding PUD (bilroth 1 or 2 which are gastrojejunostomy 1 being end to end, highly selective vagotomy +- pyloroplasty if outlet prob.
3. surg for rupture (bilroth 1 or 2 with omental patch +- vagotomy |
|
|
Term
| ddx in pt with 10lb wt loss, RUQ pain , bloating N/V, hx of ulcer |
|
Definition
| gastric outlet syndrome due to stricture from PUD or due to tumor |
|
|
Term
| HPI questions in pt with 10lb wt loss, RUQ pain, bloating NV and hx of ulcer |
|
Definition
pain related to food
h pylori status
meds to tx h pylori
last BM |
|
|
Term
| PE in pt with 10lb wt loss, RUQ pain, bloating NV and hx of ulcer |
|
Definition
peritoneal signs
fluid/nutrition status |
|
|
Term
| labs in pt with 10lb wt loss and RUQ pain and bloating NV and hx of ulcer |
|
Definition
1. CBC-anemia for bleed
2. BMP-dehydration
3. hpylori-obstruction due to ulcer stric
4. LFT-for RUQ pain
5. albumin/proteins status - nutrition
6. rectal for FOBT |
|
|
Term
| imaging in pt with 10 lb wt loss, NV RUQ pain and bloating and hx of ulcer |
|
Definition
1. barium swallow
2. EGD to find obstruction and biopsy
3. upright CXR to look for free air |
|
|
Term
| surg tx of CA of gastric outlet |
|
Definition
| resect with bilroth reconstruction (gastrojejunostomy) |
|
|
Term
| surg tx of obstruction due to stricture due to PUD of gastric outlet |
|
Definition
1. truncal vagotomy with pyoroplasty or highly selective vagotomy
(pyloroplasty promotes emptying) |
|
|
Term
med tx of obstruction of gastric outlet
(do this before surgery) |
|
Definition
-NG decompression
-fluid and TPN for nutritional status |
|
|
Term
| pt with epigastric pain, loss of app, 30lb wt loss, tarry stools, lo Hb. DDx |
|
Definition
adenocarcinoma of stomach
gastric lymphoma |
|
|
Term
| pmh/gi questions in pt with epigastric pain, LOA,30lb wt loss and tarry stools. |
|
Definition
NV, BM (quantity and quality), h pylori status and hx of ulcers, nsaids
gastric CA risks: pernicious anemia, type A blood?, diet for nitrosamines |
|
|
Term
| PE in pt with epigastric pain, 30lb wt loss, LOA and tarry stools |
|
Definition
1. Abdo exam
2. LN exam (sister mary joseph at belly button, virchow at clavicles)
3. DRE for blumers shelf for dougless pouch mets.
4. nutrition and dehydration status |
|
|
Term
| labs in pt with epigastric pain, 30lb wt loss, LOA and tarry stools |
|
Definition
1. hpylori status
2. CBC and BMP for anemia and fluid loss
3. FOBT
4. LFT for mets |
|
|
Term
| imaging in pt with epigastric pain, 30lb wt loss, tarry stools and LOA |
|
Definition
1. EGD with biopsy
2. Abdominal CT and PET to stage and look for mets |
|
|
Term
| management of adenocarcinoma |
|
Definition
1. fluid resuss and nutrition
2. surgical resection with 5cm margin and LN dissection
3. chemo |
|
|
Term
| management of stomach lymphoma |
|
Definition
1. tx h pylori for low grade will resolve
2. rad/chemo for hi
3. surg if obstruction or bleeding or perforated or complicated |
|
|
Term
| 12 hr hx of NV. no food. bloat and pain. ddx |
|
Definition
1. obstruction (stricture or CA)
2. volvulus
3. ileus
4. gastroenteritis |
|
|
Term
| Major PE steps in anyone vomiting |
|
Definition
1. hydration status
2. VITALS
2. abdominal exam (BS, distention, peritoneal signs, pain, masses)
3. rectal (FOBT) |
|
|
Term
| labs in 12 hr hx of NV, no food, bloat and pain. |
|
Definition
CBC for infection/anemia
WBC hi if strangulation
BMP for dehydration and alkalosis
lactate for acidosis |
|
|
Term
| imaging for 12 hr hx of NV, no food, bloat and pain |
|
Definition
upright CXR for free air under diaphragm
upright abdo for dilated loops and air fluid levels
CT to show transition point |
|
|
Term
| management of SBO due to adhesions |
|
Definition
1. NPO and NGT to decompress
2. Fluid resussitation and electrolyte fix
3. foley to monitor urine
4. surg if no imp or if strangulated |
|
|
Term
| surgery in strangulated SBO |
|
Definition
1. ex lap
2. remove bad bowerl
3. primary anastomosis or divert ostomy |
|
|
Term
| what do you do with a tender inguinal hernia? |
|
Definition
|
|
Term
| relationship of direct vs indirect hernias and key bv |
|
Definition
direct are medial to inferior epigastric and out abdo wall
indirect are lateral to the inferior epigastric, thru deep inguinal ring and into testes |
|
|
Term
| ddx in pt with distention, nv, brown emesis |
|
Definition
1. obstruction (stricture or CA)
2. volvulus
3. ileus
4. enteritis |
|
|
Term
| imaging in pt with brown emesis |
|
Definition
1. upright CXR for free air
2. abdominal plain film for dilated loops and air fluid levels
3. CT to localize transition
4. barium enema to look for obstruction immediately
5. colonoscopy to look later |
|
|
Term
| management of obstructing colonic mass |
|
Definition
1. fluid resuss
2. biopsy
3. resection no matter what
4. chemo |
|
|
Term
|
Definition
UPS-CAMPY
1. ureteral stone
2.pyelonephritis
3. SBO
3. chrons/uc
4. appendicities
5. meckels
6. psoas absess
7. yersinia enterocolitis |
|
|
Term
|
Definition
rosving (pain in PLQ when LLQ palpated)
psoas
obturator |
|
|
Term
|
Definition
|
|
Term
|
Definition
| CT with contrast if unsure |
|
|
Term
| management of appendicititis |
|
Definition
fluids resuss
atbt
surgery
peritoneal washout if perf |
|
|
Term
| ddx of appendicities if female |
|
Definition
UPS CAMPY + ob gyn issues
1. urethral stones
2. Pyelonephritis
3. sbo
4. chrons/uc
5. appendicitis
6. meckels diverticulum
7. psoas absess
8. yersinia enterocolitis
+
1. ovarian cyst rupture
2. ovarian torsion
3. ectopic pregnancy
4. PID |
|
|
Term
| additional test in female with appendicities signs |
|
Definition
1. preggo test
2. std test
3. chandelier sign
4. ultrasound
5. pelvic exam |
|
|
Term
| ddx in 65 yo with LLQ pain and decreased stools and fever 101.5 |
|
Definition
1. enteritis
2. diverticulitis
3. obstruction
4. ileus
5. volvulus |
|
|
Term
|
Definition
1. NO barium enema NO colonoscopy! Risk of RUPTURE
2. Abdominal CT to look for fat strand, absess, mass, phhlegmon |
|
|
Term
| management of diverticulitis |
|
Definition
1. if first epi and uncomplicated--iv atbt, npo and IV fluid
2. surgery if no improvement after 3 days (resection with temporary diverting ostomy and reanastomosis in 3 mo)
3. if small abscess same as above
4. if large abscess do percut drainage and laparotomy with drainage. or sigmoid resection with diverting ostomy
5. if recurrrent do elective surgery with sigmoidectomy and primary reaanastomosis |
|
|
Term
| ddx in pt with general abdo pain, llq pain in past. today peritonitis. |
|
Definition
1. perforated diverticulitis
2. acute mesenteric ischemia
3. toxic megacolon
4. appendicitis
5. perforated PUD |
|
|
Term
| PE in pt with general abdo pain, ll1 pain in past and today peritonitis |
|
Definition
|
|
Term
| PMH in pt with general abdo pain, llq pain in past and today peritonitis |
|
Definition
1. hx of PUD
2. hx of IBD
3. hx of Afib
4. diet/hx of diverticulitis |
|
|
Term
| labs in pt with peritonitis |
|
Definition
cbc
bmp
type and cross for surgery |
|
|
Term
|
Definition
|
|
Term
| manage diverticulitis with perf |
|
Definition
emergency lap
resect with diverting ostomy with hartmanns limb |
|
|
Term
| ddx in pt with 3 wk history of lessening stools and obstipation with FOBT+ |
|
Definition
1. colon cancer
2. diverticulitis stricture
3. volvulus |
|
|
Term
| labs in 3 wk hx of lessening stools and obstipation with fobt+ |
|
Definition
1. cbc for anemia and wbs
2. bmp for malabs
3. lft for mets to liver
4. cea for monitor later |
|
|
Term
| pmh in pt with increasing obstipation |
|
Definition
1. abdo surgeries
2. hx of hernia
3. family hx of colon cancer
4. colonoscopy |
|
|
Term
| imaging in pt with increasing obstipation |
|
Definition
1. plain abdo for dilation and air fluid levels
2. barium enema
3. colonoscopy
4. stage with CT |
|
|
Term
| management of colon cancer |
|
Definition
1. resect with 2cm margin and primary anastomosis
2. resect LN and bv
3. CEA every 3-6 months
4. annual CT for 5 yr |
|
|
Term
| ddx in pt with increasing abdo distention and no peritoneal signs and no bm in 3 days |
|
Definition
1. compaction
2. obstruction (stricture or CA)
3. volvulus (SB or large bowel)
4. diverticulitis |
|
|
Term
| imaging in pt with increasing abdo distention and no peritoneal signs and no bm in 3 days |
|
Definition
1. abdo xr (omega loop for sigmoid volvulus, coffee bean for cecal volvulus)
2. barium enema (birds beak)
3. sigmoidoscopy (dx and therapeutic) |
|
|
Term
| management of sigmoid volvulus |
|
Definition
1. sigmoidoscopy
2. rectal tube
3. surg if strangulated
4. elective surg if not to prevent recurrance |
|
|
Term
| management of cecal volvulus |
|
Definition
1. cecopexy (attach cecum to wall)
2. hemicolectomy if strangulated/perforated |
|
|
Term
| ddx in pt with massively bloody bm |
|
Definition
A Disgusting CHIP
AVM
Diverticulosis
Cancer
Hemorrhoid
IBD
PUD bleed |
|
|
Term
| good pmh if concerned with AVM in bowel |
|
Definition
|
|
Term
| PE in pt with massively bloody bm |
|
Definition
|
|
Term
| labs in pt with massively bloody bm |
|
Definition
cbc
bmp
type and cross
coags |
|
|
Term
| management of massively bloody bm |
|
Definition
1. fluid resuss
2. NGT to check upper gi bleed.
--if present EGD
3. Anoscopy for hemorrhoids
4. high bleeding do angio gram
5. lo bleeding wait til stop then colonoscopy
6. intermediate do tagged red cell study
7. if bleeding and requiring 6units PRBC and no improvement -- colectomy or hemi with diverting ostomy |
|
|
Term
|
Definition
1. benign (hyperplastic)
2. precancerous (villous adenoma, tubulovillous, tubular) |
|
|
Term
|
Definition
1. hyperplastic -- normal follow up every ten years
2. adenomatous follow up colonoscopy every 3 years |
|
|
Term
| ddx in pt with perianal pain after constipation and blood on tp |
|
Definition
1. hemorrhoid
2. anal fissure
3. perianal abscess |
|
|
Term
| management of anal fissure |
|
Definition
1. examin under anesthesia (usually posterior midline fissure)
2. stool softener
3. topical nitroglycerin
4. sits bath
5. botox
6. ateral internal sphincerotomy (incontinence) |
|
|
Term
| ddx: 35 yo with perianal drainage and yellow discharge. some pain. some blood in tp. |
|
Definition
1. perianal abscess
2. ischiorectal abscess
3. fissure
4. fistula
5. hemorrhoid
6. chrons abscesses |
|
|
Term
|
Definition
|
|
Term
| labs in pt with perianal drainage and yellow discharge some pain and blood on tp |
|
Definition
| 1. cbc for anemia and infectious state |
|
|
Term
| types of PUD and pain felt in relation to food |
|
Definition
gastric hurt when you eat food
duodenal feel better when you eat, then flare up an hour or 2 after |
|
|
Term
| ddx of RUQ pain after fatty meal with jaundice and distress |
|
Definition
1. cholecystitis (gb inflam) +- choledocolithiasis (stones in CBD) +- cholelithiasis (stones in gb)
2. cholangitis (inflamm of CBD)
3. pancreatic cancer
4. ampulla of vater cancer |
|
|
Term
| what might point you in the direction of cholantis |
|
Definition
|
|
Term
| labs in pt with RUQ pain after fatty meal |
|
Definition
1. CBC for anemia and wbc
2. LFT, AP, bili
3. amylase, lipase |
|
|
Term
| imaging in pt with RUQ pain |
|
Definition
| ultrasound of RUQ to look for stones and CBD dilation |
|
|
Term
| management of cholangitis with choledocolithiasis |
|
Definition
ercp to clear cbd
cholecystectomy follow up to prevent recurrence |
|
|
Term
|
Definition
|
|
