Deck 1 COPY COPY COPY Flashcards
what does the breath smell like of distant SBO
fecal matter from bacterial overgrowth
what does whirl sign indicate
bowel is twisted on mesentary very bad go to OR
what lab is elevated in a SBO
lactate
what electrolyte abnormality can cause intestinal ileus
K
management of intestinal ileus
nasogastric suction
first line treatment of asymptomatic cholelithiasis
lifestyle mod (low fat diet and exercise)
what is erylipseas presentation
induration, sharp borders, fever, erythema
treatment of erylipseas with systemic sx
IV cefazolin
first line treatment of ureteral stones <10mm
tamusulin (stops the ureter contractions) and dihydropyridine CCBs
do you need to repair umbilical hernia in kids
no unless its symptomaticv
livery enzymes and tbilly levels in biliary colic
all normal
signs of biliary colic
post prandial RUQ pain, nausea vomiting
etiology of biliary colic
increased intraluminal pressure due to contracting against an occluded cystic duct
early indicator of NEC in an infant
abrupt change in feeding status
what does porcelain gallbladder put a patient at increased risk of
gallladder adenocarcinoma
what does porcelain gallbladder look like on CT
a ring around the gallbladder due to calcium deposition
indications for CT in orbital trauma
pain with eye movement, inadequate exam, decreased visual acuity, severe eye pain, foreign eye body
septic shock/critical illness + GI bleed dx
stress ulcer
what is normal ankle brachial index
> .9
indications for revascularization of peripheral arteries
<.9 ankle brachial index, absent dorsalis pedis pulses
next step in blunt trauma to the kidney
CT abdomen pelvis
what is otosclerosis
bony overgrowth of the ossicles
signs of otosclerosis
hearing better in loud environments, conductive hearing loss, reddish hue behind basement membrane
CT scan of focal nodular hyperplasia
well circumscribed with central scarr
signs of buckle fracture on xray of a child
cortical bulging at metaphysis
dx of person with vertigo and dizziness with pressure changes
perilymphatic fistula
perilymphatic fistula exacerbating factors
valsalva, elevators, sneezing, etc.
cause of elevated LFTs post MI
hepatic ischmic necrosis
what needs to happen in the first hour of a suspected sepsis patient
IV fluids and IV antibiotics
types of gallstones
pigment or cholesterol stones
patient population that can have acalculous cholecystitis
HIV pts.
presentation of cholecystitis
RUQ pain, fever, radiating pain to shoulder, nausea, vomiting
insulinoma benign or malignant
benign
gastrinoma common location
wall of duodenum
when do you start to see sx from carcinoid tumors
once there is liver mets
signs of abdominal compartment syndrome
tense distended abdomen, increased ventilatory requirements, increased CVP, hypotension and tachy (due to decreased CO), decreased urine output
most common liver mass
metastatic disease
heme pos stool, iron def anemia, solitary liver mass
colorectal CA plus liver met
immediate treatment of unstable snake bite patient
antivenom and coag studies
xray signs of diaphragmatic paralysis
inspirational discordance of diaphragm elevation
dx of diaphragmatic paralysis
fluoroscopic diaphragm imaging
treatment of ischemic priapism
aspiration of corpus cavernosum and interpenile injection of phenylephrine to induce vasoconstriction
what is the major type of gastric cancer
intestinal type
pain in scrotum following trauma dx
testicular torsion
signs of medial meniscus tear
acute popping sensation at injury, joint line tenderness, normal gait, interanal and external rotation pain
steatorrhea plus hx of heavy drinking dx
chronic pancreatitis
treatment of chronic panc
panc enzyme replacement
what tests do you need to order on ascitic fluid
albumin and cell count w/diff
what imaging do trauma pts in high energy mechanistic crashes need
CT C spine
who needs ABX after abscess drainage
pts. with systemic sx or chronic illnesses predisposing them to infection risk
eval of rectal adeno ca
CT to see if mets in liver, stomach, panc etc, and total colonoscopy
for patients with no major illnesses do they need preop testing
no
nasopharyngeal carcinoma etiology
EBV infection
what is hemobilia
bleeding into the biliary tract
signs of hemobilia
melena, RUQ pain, high Tbilly, jaundice, anemia
treatment of HIT
stop the heparin and start a direct thrombin inhibitor
what is a poor prognostic lab for acute pancreatitis
blood urea nitrogen
what does elevated BUN reflect
intravascular volume depletion
immediate treatment of distal radius fractures
closed reduction on the ER
spider bite wound typical clinical course
ulcer follwed by necrosis and eschar
treatment of acute cellular rejection
increase immunosuppresion therapy
trauma blood loss cause of cardiac arrest
decreased RV preload
sebhorric keratosis clinical ID
stuck on waxy appearance shriveled black mole like thing
sebhorric keratosis management
no further management, I.e. no biopsy
treatment of osteomyelitis in sickel cell kiddos
clinda and cef
treatment of osteomyelitis in otherwise healthy kiddos
vanc or clinda
acute mediastinitis treatment
wound debridement and ABBX
signs of posterior hip dislocation
leg is shortened, internally rotated, hip is flexed and adducted
signs of fourniers gangrene
pain scrotum, hypotension, high fever, leukocytosis, perinieum with crepitus
what other imaging is needed for clavicle fracture
CT chest to check for blood vessel damage
if a patient is stable and has a likely PE what test is confirmatory
chest CT angio
vax’s for asplenic adult patients
meningococcus, pneumococcus, Hib
what types of polyps need more frequent screening
adematous and serrated
what is the heart countour like on CXR for cardiac tampanode
normal sillouhette
what side do you place someone who has a venous air embolism
left lateral decubitous because the air embolism travels to the right side of the heart
what are patients with extreme thermal burns at risk of
acute compartment syndrome, rhabdo, AKI
RCC presentation
paraneoplastic syndromes with elevated Ca, hematuria, intermitent fevers, weight loss
next step after clinical dx of acute limb ischemia
heparin infusion and then possible thrombectomy
kidney appearance of renal vein thrombosis
enlarged w/out hydronephrosis
what conditions lead to renal vein thrombosis
hypercoagubility (nephrotic syndrome, malignancy) or trauma
surgical complications post bariatric surgery
anastomotic leak, strictures, hernias
mallory weiss syndrome presentation
hematemesis, epigastric pain, retching
who gets mallory weiss
alcoholics, people with hiatal hernia
sx of groin hernia
intermittant groin swelling and pain aggravated by activities where the pt. is increasing abdominal pressure
imaging of a vascular ring in esophagus
deep impression on the posterior aspect of the esophagus
clinical presentation of vascular ring
sudden weight loss in child, solid food impaction, stridor
clinical features of melanoma
A: asymmetry // B: border irregularitie // C: color variation // D: diameter >6mm // E: evolving
clinical features of plantar fasciitis
pain directly on bottom of heel, increased pain with standing after rest, pain on hard surfaces
acute adrenal insufficiency etiology
adrenal hemorrhage, illness/surgery in people with chronic AI
who gets chronic adrenal insufficiency
people on glucocorticoids
signs of spontaneous pneumomediastinum
crepitus on chest examination, acute chest pain, cough, subq emphysema
what do you do if you suspect pneumomediastinum
CXR
signs of ABO incompatiblityq
reaction is about 1hr later, fever, flank pain, DIC, positive coombs test
signs of IgA antibodies against donor blood
anaphalaxis, wheezing, angioedema etc.
falling on outstreached hand (FOOSH) injury bone/nerve
colles fracture (distal radius) impacts median nerve
what do you do for a corneal abrasion
topical antibiotics no patch
signs of giant cell tumor on xray
lytic lesion in the epiphysis, soap bubble appearance
what is the cardiac index like in cardiac tampanode
it is decreased
what is the SVR like in cardiac tampanode
SVR is increased because CO is decreased
halos in visual field at night
this typically means cataracts can also be acute close angle glaucoma
nec faciitis clinical signs
often relatively minor injury, pain out of proportion to injury, signs of septic shock, swelling/edema/crepitus,
most common complication post ERCP
acute panc
first step to dx acute panc
serum lipase and amylase
signs of septic bursitis
increasing pain, swelling, fever, erythema, chills etc
management of septic bursitis
image guided needle aspiration of fluid and antibiotics
turbid green fluid from a chest tube
gastric contents
signs of esophageal perf
chest/back pain, crepitus, hammans sign, pleural effusion draining green fluid
what is neuropathic arthropathy
this is repetitive joint trauma due to impaired sensation from diabetic neuropathy can cause joint destruction and osteo/infections etc
osteitis fibrosa cystica xray findings
lytic lesions and cortical thinning
neuropathic arthropathy findings xray
diffuse bone distruction
what does wide spread PR depression indicate on telemetry
pericarditis
how to evaluate for pericardiitis
echo
clinical signs of surgical subcutaneous emphysema and management
crunchy chest, some subq air seen on chest xray, no need for furhter workup
do you want to bolus someone in hemorrhagic shock
no because it dilutes existing coagulation products (platelets etc) so you want to use blood products instead
risks of fluid resuscitation in hemorrhage
coagulopathy, metabolic acidosis, increased mortality
management of testicular cancer
inguinal orchiectomy, do not biopsy it prevents spread
management steps of osteoarthritis
weight loss and exercise, then pain management then total knee arthroplasty
when does fever show up after surgery if you have a post op infection
> 24 hours later
what organ is most frequently injured in blunt abdominal trauma
spleen
causes of schincter of oddi dysfunction
stenosis due to obsctruction or dyskinesia
tension pneumothorax xray imaging
radiolucency and the mediastinum shifts away from the pressure
what bug causes septic arthritis and what antibiotics do you use
staph and you use vanc and cef
causes of acute rotator cuff injury
acute glenohumoral dislocation
signs of rotator cuff injury
inability to abduct the shoulder, lateral shoulder pain, positive arm drop test
right sided vs. left sided colon CA presentation
Right: occult blood, iron def anemia // Left: bright red blood and stool changes, crampy pain
ileus xray
no air fluid levels just dilated loops of bowel
SBO xray
air fluid levels
