radiology lecture

dont need chest ct for pneumonia should be able to use cxr, persistent pneumonia is indication for chest ct

indications

known interstitial lung disease

f/u to therapy

lung ca staging

immunocompromised

for pulmonary embolism test is CTA

aneurysm ask for contrast and noncontrast, noncontrast first to see acute blood

ascending aorta is surgical management, descending is medical management

anterior mediasinal mass differ

Teratoma

Terrible lymphoma

Thymoma

Thyroid tumors

Thoracic aorta

air bronchograms are airways traversing through consolidated lung - alveoli are filled

clinical notes

80% of all GI bleeds UGIB - dx includes PUD, varices, AVM, GAVE, gastritis

fecal antigen test for H. pylori ~100% sensitive

pepto bismo makes stool look melanic

mycobacterial infections increased in north carolina because greater numbers of them in the soil

anti dsDNA antibodies used to monitor lupus

doing an LP? send for VZV, EBV, HSV, AFB, bacterial, india ink, toxo, jc and lyme

"cant correlate response to tx of crypto meningitis by using titers, use clinical symptoms, you can follow serum titers"

tx amphotericin and fluconazole

ICP>25cm should be drained

HCV Ab takes ~12wks to seroconvert but when do are 98% sensitive

acute HAV big rise in ALT ~2months,

dont be fooled- hep B surface antibody can go away (become undetected) patient still has immunity

HBV mainly sexually transmitted disease

tx - IFNalpha2b nucleotide/side inhibitors,

pros - 1 year treatment, increased clearance

cons - subq injection, depression/psych side fx

15-40% will clear acute HCV infxn

normally transmitted parenterally (blood to blood)

test is elisa if + then look for RNA,

HCV elisa false negative w/early test and immunosuppressed

normal ALT does not rule out HCV

HCV tx PEG-IFNalpha

random fact - dysgeusia - an alteration in taste

c. diff colitis can occur 6months after abx

mammography guidelines - 40-50 nada (would need to expose 3000 women to ten years of radiation to pick one cancer)

50-60 every two years, 60+ yearly

mammography not a great screen for young denser breast tissue anyway

Mollaret's meningitis - recurrent HSV-2 mediated

"gastric ulcer bleeding is arterial- not venous"

"an ulcer in the antrum is almost never cancerous"

ulcer healing while on PPI ~90%, while on ranitidine/famotidine -85%

when you get ulcers in the antrum the problem is pyloric stenosis

risk of PUD - bleeding and perforation

Obstruction? differential - malignancy, crohn's, pancreatitis, gastric polyp, tb, gastric bezoars (foreign body)

IgG4 deficiency predisposes to atelectasis

heard on the wards-

"patient complains of losing hearing? check the ear for cockroaches"

senna/docusate - softens bowel movements

dulcolax/miralax/enema -heavy duty

"don't give epi/terbutaline for asthma exacerbation to patient w/htn and h/o cad or other risk factors, iatrogenic MI well described"

pulmonary

contraindications to permissive hypercapnia

1. pregnancy

2. increased ICP

heliox - 70/30 blend of helium and o2 allows for more laminar flow, have to reset ventilator settings

inhaled anesthetics are great bronchodilators