Dr5IV

31/05/2022

Respiratory failure
Type 1
Type 2

30/12/2021

The most common malignant tumor in the proximal two thirds of the esophagus is squamous cell carcinoma; adenocarcinoma is the most common in the distal one third.

Alcohol, to***co, and human papillomavirus infection are risk factors for squamous cell carcinoma; Barrett esophagus due to chronic reflux (often related to obesity) is a risk factor for adenocarcinoma.

Symptoms are progressive dysphagia and weight loss.

Early-stage cancer is typically asymptomatic; initial symptoms are usually progressive dysphagia, which results from significant encroachment on the lumen, and sometimes chest discomfort.

Diagnosis is by endoscopy, followed by CT and endoscopic ultrasound for staging.

Overall, survival is poor (5-year survival: < 5%) because many patients present with advanced disease.

Treatment varies with stage and generally includes surgery with or without chemotherapy and radiation. Long-term survival is poor except for patients with local disease.

Surgery for cure is extensive and often poorly tolerated by older patients and patients with comorbidities.
Palliation may involve stenting or endoscopic laser therapy to reduce obstruction and allow oral intake.

25/12/2021

(MAS)

Key Points

About 5% of neonates with meconium passage aspirate the meconium, triggering lung injury and respiratory distress or have prenatal and postnatal physiology that predisposes them to persistent pulmonary hypertension, which can complicate meconium aspiration syndrome.
Neonates may have tachypnea, nasal flaring, retractions, cyanosis or desaturation, rales, rhonchi, and visible meconium staining in the oropharynx.

Suspect the diagnosis when respiratory distress occurs in neonates who had meconium-containing amniotic fluid.

Do chest x-ray and cultures of blood to exclude pneumonia and bacterial sepsis.
After delivery, if infants have signs of obstructed breathing, suction them using an endotracheal tube attached to a meconium aspirator.

Severe cases require mechanical ventilation and sometimes antibiotics, inhaled nitric oxide, or extracorporeal membrane oxygenation (ECMO).

24/12/2021

Key Points

Distal humeral fractures are more common among children.

Distal humeral fractures usually result from a fall on an outstretched arm or direct force; they may be associated with neurovascular injury.

These fractures can injure the radial artery or median nerve.

Check x-rays for posterior and anterior fat pads, and use the anterior humeral line and radiocapitellar line to determine whether an occult fracture is likely.

For treatment, consult an orthopedic surgeon.

For nondisplaced fractures or occult fractures, splinting
For displaced fractures, often open reduction with internal fixation (ORIF)
For clinically suspected fractures, splinting and close follow-up

Classify proximal humeral fractures based on the number of key humeral structures (anatomic neck, surgical neck, greater tuberosity, lesser tuberosity) that are displaced or angulated.
Almost 80% require only a sling.

Plain x-rays
Sometimes CT
X-rays should include at least

A true anteroposterior internal rotation view
A trans-scapular Y (oblique) view
An axillary view to assess the glenohumeral joint

Patients, particularly older patients, should start range-of-motion exercises as soon as possible.

Sometimes open reduction with internal fixation (ORIF) or prosthetic joint replacement

24/12/2021

Osteoarthritis (OA).

Key Points

the most common joint disorder, becomes particularly common with age.
Key pathophysiologic features include disruption and loss of joint cartilage and bony hypertrophy.

OA can affect particular joints (sometimes secondary to injury or another joint problem) or be generalized (often as a primary disorder).
Symptoms include gradual onset of joint pain that is worsened by weight-bearing or stress and relieved by rest, and stiffness that lessens with activity.

Confirm the diagnosis with x-ray findings such as marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, bony remodeling, and sometimes subchondral cyst formation and joint effusion.
Treat primarily with physical measures that involve rehabilitation; support devices; exercise for strength, flexibility, and endurance; patient education; and modifications in activities of daily living.

Treat adjunctively with drugs (eg, analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants) and surgery.

24/12/2021

Vulvar endometriomas

Are rare, painful cysts that result from extrauterine implantation of functioning endometrial tissue (endometriosis) in the v***a.
Rarely, endometriosis occurs in the v***a (or the va**na), sometimes producing cysts (endometriomas), often at the site of previous surgery or a wound (eg, episiotomy, laceration during childbirth).

Endometriomas usually develop in the midline. They may be painful, particularly during in*******se. During menstruation, pain increases and endometriomas may enlarge. Endometriomas are tender and may appear blue. They can rupture, causing severe pain.

Diagnosis of v***ar endometriomas is by physical examination and biopsy.

Treatment of v***ar endometriomas involves excision.

24/12/2021

Ectopic pregnancy

Key Points

The most common site for ectopic pregnancies is a fallopian tube.
Symptoms can include pelvic pain, va**nal bleeding, and/or missed me**es, but symptoms may be absent until rupture occurs, sometimes with catastrophic results.
Suspect ectopic pregnancy in any female of reproductive age with pelvic pain, va**nal bleeding, or unexplained syncope or hemorrhagic shock, regardless of history and examination findings.
If a urine pregnancy test is positive or clinical findings suggest ectopic pregnancy, determine quantitative serum beta-hCG and do pelvic ultrasonography.
Treatment usually involves surgical resection, but for certain ectopic pregnancies, methotrexate can be tried.

01/12/2021