april 20 Flashcards
clinical features of a hypermetabolic state following severe burn?
- increased gluconeogenesis & insulin resistance
- increased basal metabolic rate/body temp
- increased protein & lipid catabolism - lean muscle wasting
oliguria = < ____ ml of urine over 24 hours
500
management of a duodenal hematoma?
- bowel rest, nasogastric decompression, and parenteral nutrition
- drainage/surgery only required if hematoma persists after a few weeks
what is emphysematous cholecystitis?
cholecystitis caused by gas forming organisms such as clostridium
complications of emphysematous cholecystitis?
hemolysis, gangrene, necrosis, perforation and septic shock
treatment of emphysematous cholecystitis?
- emergency cholecystectomy
- broad spectrum antibiotics
presentation of emphysematous cholecystitis?
- rever, RUQ pain, nausea/vomiting
- crepitus in abdominal wall adjacent to gallbladder
when the head of the humerus is anteriorly displaced, the deltoid appears…
flattened
which nerve is commonly injured in antierior dislocation injuries?
axillary nerve
how do you treat a malignant pericardial effusion?
Acute: pericardiocentesis, cytologic fluid analysis
Chronic: prolonged drainage (pericardial window)
do varicoceles transilluminate?
no
does an inguinal hernia transilluminate?
no
does a spermatocele transilluminate?
yes
do hydroceles transillluminate?
yes
why can mechanical ventilation in a hypovolemic patient cause decreased cardiac output?
increase in intrathoracic pressure can collapse venous capacitance and cutoff venous return to the heart
treatment of adhesive capsulitis?
gentle range of motion exercises
- NSAIDS
- corticosteroid injection
unilateral bloody discharge with no masses found =
intraductal papilloma
serous/bloody nipple discharge + a palpable mass =
invasive ductal carcinoma
XRAY shows free air under the diaphgram suggesting ulcer rupture… next step?
EMERGENCY SURGICAL EXPLORATION
what type of scan should be used to assess for a cervical spine injury?
CT scan
why is XRAY not the recommended scan for assessing for a cervical spine injury?
not sensitive enough
Patients with high risk injury for cervical spine injury always require…
imaging
A patient has a low risk type injury for cervical spine injury. What criteria indicate that they require a scan?
- intoxicated
- alterations in mental status
- spinal tenderness
- neurological
- distracting injury
what conditions predispose patients to small intestinal bacterial overgrowth?
- anatomical abnormalities such as surgery/strictures
- motility disorders (scleroderma, diabetes)
presentation of SIBO?
- diarrhea, weight loss, bloating, flatulance
- anemia, malabsorption, etc
diagnostic tests for SIBO?
jejunal aspirate OR carbohydrate breath testing (lactulose, glucose)
Dumping syndrome is a complication of..
gastric bypass
path of dumping syndrome ?
carbohydrate rich foods are rapidly emptied into the small bowel, -> osmotic fluid shift from plasma to intestine ->abdominal pain and diarrhea
symptoms associated with dumping syndrome?
hyperechoic breast mass on ultrasound is usually…
benign
what causes a complicated parapneumonic effusion?
bacterial invasion of pleural space
pH of a complicated parapneumonic effusion?
low (<7.2)
glucose of a complicated parapneumonic effusion?
low (<60)
WBCs in a complicated parapneumonic effusion?
> 50 000
protiein in a complicated parapneumonic effusion?
high
is CMV pneumonitis acute or indolent in onset?
acute
is pneumocystitis pneumoniia acute or indolent in onset?
insidious
crescent sign is seen in…
ruptured popliteal cyst
what is crescent sign?
an arch of bruising
symptoms of a ruptured popliteal cyst?
posterior knee and calf pain, tenderness and swelling of the calf, crescent sign
Whats an infectious complication of steroid injection into a joint?
septic bursitis
diagnosis of septic bursitis?
bursal fluid aspiration (xray if suspected fracture or foreign body)
treatment of septic bursitis
systemic antibiotics / drainage
pain on medial / lateral squeezing of the calcaneous =
stress fracture
zone of lucency or sclerosis in the poster calcaneous on XRAY =
calcaneous stress fracture
