Deck 3 COPY COPY COPY Flashcards
signs of greater trochanteric bursitis
chronic lateral hip pain, pain worse with hip flexion or lying on lateral side, focal tenderness on the trochanter
what is the pleural fluid like in esophageal perf
high amylase (from saliva) and maybe some food particles
in zollinger ellison why is there fat malabsorption
the increased acid from the stomach secretions cause pancreatic enzyme inactivation
best way to decrease poor pulmonary outcomes in rib fracture
proper pain control
where are toddlers fractures located
distal tibia and its a spiral fracture
signs of duodenal hematoma
billous emesis, blunt abdominal trauma, gastric dilation with scant gas
risk factors for rectus sheath hematoma
abdominal trauma or forceful abdominal contractions from coughing, anticoag therapy, older age, female
signs of rectus sheath hematoma
acute onset abdominal pain with leukocytosis, blood loss anemia, palpable abdominal mass
aspiration pneumonitis signs
tachy, new pulmonary infiltrates, abrupt onset dyspnea,
legg-calves-perths
ideopathic avascular necrosis of the femur
TRALI signs
respiratory distress and non cardiogenic pulmonary edema, bilateral pulmonary infiltrates
ABX for lung abcses
ampicillin-sulbactam or a imipenem or clinda
what does the biliary tree look like on cholangiagram for primary sclerosing cholangitis
stricturing/dilation of intrahepatic &/or extrahepatic bile ducts on cholangiography
who gets primary sclerosing cholangiitis
people with crohns or IBD
clinical features of a thyroid storm
fever, tachy, agitation, coma, lid leg, nausea,
signs of granulomatosis with polyangiitis
renal involvement, nose bleeds, lower airway bleeds in alveoli
what is osler-webber-rendu syndrome
hemorrhagic telangectasias
signs of AVMs
nose bleeds, brain bleeds, recurrent epistaxis, chronic bleeds (GI)
dx of a person with RUQ pain on OCPs and hypotension
hepatic adenoma rupture
signs of acute cholangitis
RUQ pain, hypotension, increase tbili, fever, jaundice
anion gap in sepsis
high anion gap from increased lactate
what is used as an indicator for priority of liver transplants
MELD-Na score
what marker is used for pancreatic cancer
CA19-9
RUQ pain, fever, and air in gallbladder wall dx
emphysematous cholecystitis
leg exam of femoral neck fracture
shortened leg, externally rotated
where can retropharngeal abbcesses travel to
mediastinum
pre-op management of pheo
alpha blocker and then beta blocker
what is SVR like in hypovolemic shock
it is increased bc CO is decreased
etiology of perianal abscess
infection of an occluded anal crypt gland
imanagement of a pt with clear lower limb ischemia from trauma
urgent surgery
post surgery colitis etiology
ischemic colotis at the watershed zones
what are the watershed zones in the colon
rectosignmoid juction and splenic flexure
signs of peritonitis
guarding, rigid, distention, inability to tolerate sitting upright
slow onset joint effusion and catching sensation dx
meniscal tear
G6PD exacerbation Hb and indirect bili levels
low Hb and high bili
what is gilbert syndrome
this is decreased activity of the UDP glucuronyltransferase
when is gilberts caught
typically in times of injury or stress to the body with infection
what is a baker cyst
this is extrusion of fluid from the joint space to the semimembraneous/gastroc bursa
signs of baker cyst rupture
acute popping sensation, acute calf pain, warmth, eccymosis distal to medial malleolus in the shape of a crescent
CT scan signs of acute diverticulitis
colonic wallt thickening
what muscle is helpful for dividing planes of axillary nodes
pec minor
signs of catecholamine surge
pale, tachy, extreme hypertensin
what can exacerbate a pheo
injury, illness, anesthesia induction
post amputation stump pain with slight palpation dx
likely a neuroma
indications for emergency thoracotomy post chest tube
> 1500 ml initial output OR continued h
first line treatment of mild UC
mesalamine (5-aminosalycilic acid)
new onset ascites with cirrhosis workup
abdominal US
greatest risk of acute glenohumeral dislocation
redislocation
is more or less Cl reabsorbed during acidosis
less is reabsorbed aka it is excreted bc the body wants to remain electro neutral so there is decreased Cl reabsorption as more HCO3 is reabosorbed
CA19-9 level in cholangiocarcinoma
elevated
if a patient is draining pancreatic fluid what is their acid/base status
they will become acidodic because they are losing base
is calcium citrate soluble
yace
normal pH of urine
> 5.5
uric acid stone pH urine
<5.5
etiology of post cholecystectomy diarrhea
bile acid diarrhea from excess bile dumping into the colon causing irritation and then diarrhea
treatment of bile acid diarrhea
cholestyramine (bile acid binding resin)
late complications of cholecystectomy
recurrent CBD stone, stricture, sphincter of ODDI dysfunction
what does prominent V waves mean on JVP waveform
this is pathopneumonic for Tricuspid regurg
primary causes of tricuspid regurg
myxomatous degeneration of the chordae tendinae
pathophys of tricuspid regurg from LV failure
chronic dilation of the RV causes stretching of the chordae tendinae so they have increased tension and cant close properly
pain sequence of patients with bowel perf
1) sudden sharp pain at perf 2) after perf-2 hours: temporary relief 3) generalized peritonitis +/- sepsis
whats the most important prognostic factor for cancers
tumor stage
signs of urethral stricture
high postvoid volume, weak stream
treatment of proctatitis
fluoroquinolone
why do patients get hypercalcemia with immobilization
this is because as you are sitting there is increased osteoclastic bone resorption and then this causes elevated Ca and then there is suppressed PTH b
management of sigmoid volvulus
endoscopic untwisting
clinical signs of dumping syndrome
occurs within 15-30 mins after eating, tachy, flushing, nausea, vomiting, diarrhea, cramps
signs of bacterial overgrowth in the small intestine
frequent watery loose stools, excess gas, decreased B12 (bacteria eat it up)
treatment of bacterial overgrowth in small intestine
ABX
NEXUS criteria for needing CT imaging to remove C-collar
intoxication, somnolence, neuro deficit, spinal tenderness, altered mental status, distracting injury
do you see filling defect in a fat embolism
no bc its microvascular occlusion
triad of fat embolism
alterened mental status, respiratory distress, petechial rash
most common skin cancer to result from a burn/ulcer
SCC
liver abscess following diverticulitis trtment management
percutatneous drainage
what is a keratocanthoma
this is a rapidly growing nodule with ulceration & keratin plug
presentation of tarsal tunnel syndrome
Burning pain, numbness, or paresthesia of the medial ankle, heel, sole and toes
etiology of tarsal tunnel syndrome
compression of the tibial nerve under the flexor retinaculum in the medial ankle
what is pes planus
this is flat feet essentially flat arches
tinnel sign
tapping on the tibial nerve in the posterior medial malleolus
what is ludwig angina
this is cellulitis of the sublingual and submandibular space
what is the immediate risk of ludwig angina
airway obstruction
how do you diagnose colovesical fistula
CT scan with rectal contrast
signs of colovesical fistula
bubbly urine, turbid, mixed flora in the urine on microscopy
lung imaging pulmonary fibrosis
subpleural honeycombing, reticular opacities
clinical signs of pulmonary fibrosis
Chronic progressive dyspnea, nonproductive cough, fatigue, Fine “Velcro” inspiratory crackles, digital clubbing
what antibiotic is best for encapsulated bacteria and is broad spectrum
amox clav
signs of complicated SBO and management
fever, hemodynamic instability (hypotension, tachycardia), guarding, leukocytosis, and significant metabolic acidosis –> take to surgery
for patients with blunt cardiac trauma do you use TE-echo or regular echo (stable vs. unstable)
stable- reg echo // unstable- TE-echo
what are indications for immediate laparotomy following blunt abdominal trauma
hemodynamic instability, peritonitis, evisceration, impalement
are internal hemorrhoids painful
no
what ABX should be avoided in a patient with aortic aneurysm
fluoroquinolone, bc of collagen
treatment of anal fissure
High-fiber diet & adequate fluid intake, Stool softeners, Sitz baths, Topical anesthetics & vasodilators (eg, nifedipine, nitroglycerin)
what is evisceration
this is when there is rectus abdominis dehiscence and then bowel herniatrion
what is leriche syndrome
this is a triad of bilateral leg claudication, absent femoral/popliteal pulses, and impotence due to
etiology of leriche syndrome
aortoiliac occlusion
primary hyperparathyroidism dx findings
elevated PTH, elevated Ca, low phosphorous
presentation of primary hyperparathyroidism
most ppl asymptomatic, mild nonspecific sx, renal stones, etc.
how to dx primary hyperparathyroidism
parathyroid imaging and parathyroidectomy
most common cause primary hyperparathyroidism
parathyroid adenoma
most common bugs for septic bursitis
skin flora
LA size, LV size and LV ejection fraction in acute mitral regurg
all normal except ejection fraction might be slightly increased bc the end systolic volume is less
signs of nasal septal perforation
whistling during respiration and
common post op complication after rhinoplasty
nasal septal perforation
what do you injure falling on your lateral ankle
you invert your foot so you injure your anterior talofibular ligament
do you need xray for likely ATFL injury
no
treatment of ATFL injury
conservative management with ice, braces and crutches
burn patients with organ dysfunction etiology
hypoperfusion or just dysfunction due to infection etc. do not assume there is a bowel obstruction first
how to dx osteomyelitis
bone biopsy unless BCX are positive and there are imaging findings
how do you dx gallstones
abdominal U/S
causes of noninfective endocarditis
cancer or hypercoagualbe state
signs of back pain being malignancy
worse at night, not relieved by rest or ibuprofen
if a chest tube is persistenly leaking what should you do
a broncoscopy because there is likely a tracheal injury allowing air in
what ABX for calculous cholecystitis
pip-tazobac
soft signs for arterial injury
diminished pulses, unexplained hypotension, stable hematoma, associated neuro defecit
what to do if only soft signs for arterial injury
do more imaging
hard signs for arterial injury
distal limb ischemia, absent pulses, active hemorrhage, bruit or thrill at site of injury
sounds of mitral stenosis
diastolic rumble and early diastolic murmur
CT signs of pulmonary contusion
peripheral anterior ground glass opacities (blood)
triad of fat embolism
pulmonary distress, neuro changes, and petechial rash
etiology of supporative sialdadentitis
salivary gland stasis causes retrograde seeding of bacteria
clinical signs of supporative parotitis
Firm, erythematous pre/postauricular swelling, systemic findings, elderly paitents
etiologies of paralytic ileus
abdominal surgery, opioid use, inflammation, ischemia, electrolyte abnormalities
imaging of paralytic ileus
uniformly dilated bowel wtih no air fluid levels, NO transition piont,
when do you have to do valve repair before surgery
if they are having sx of the valve impiarment
what two cancers are associated with RB1 mutation
osteosarc and retinoblastoma
what mutation is associated wtih ewings
chromosome 22 translocation
lytic bone lesion in the distal femur with “sunburst” periosteal reaction (concentric layers of reactive bone
osteosarc
