from UT review Flashcards
1
Q
what is an absolute contraindication for surgery? why?
A
DKA/diabetic coma/skyhigh glucose– bc risk of ifxn is too high
2
Q
what are three indicators of poor nutritional status that would make you want to delay surgery?
A
albumin 20%, transferrin
3
Q
what are three indicators of poor nutritional status that would make you want to delay?
A
albumin 20%, transferrin
4
Q
what are indicators of liver failure that would make someone want to delay surgery
A
bilirubin >2, PT > 16 (coags = imp before surgery!), ammonia > 150, clinical signs of encephalopathy
5
Q
what are indicators of liver failure that would make someone want to delay surgery
A
bilirubin >2, PT (coags = imp before surgery!), ammonia > 150, encephalopathy
6
Q
when should you recommend smokers stop smoking prior to surgery?
A
8 wks
7
Q
what does Goldman’s Index do?
A
tells you who is at greatest risk from surgery
8
Q
what is the most important factor in Goldman’s index (tells you who’s at greatest risk from surgery)
A
CHF– greatest factor for periop death
9
Q
what is the most important factor in Goldman’s index (tells you greates risk for surgery)
A
CHF– greatest factor for periop death
10
Q
How do you check if someone has CHF before surg?
A
ejection fraction. if
11
Q
What are first 6 criteria for Goldman’s index (tells you who’s at greatest risk for surgery)
A
- CHF
- MI w/in 6 mo (surrogate for CV status)
- arrhythmia
- Old (>70 yo)
- Surgery is emergent
- AS (Aortic stenosis), poor medical condition, surgery in chest/abd
12
Q
what are you checking on pt >50 or Pt w/recent MI (w/in 6 mo)
A
EKG - if abnormal —> stress test, if abnormal —> cardiac cath —> reperfusion with stenting or revasc w/CABG
13
Q
what else should be checked before surg related to AS (aortic stenosis)
A
- Listen for murmur– late systolic- systolic ejection murmur, crescendo-decrescendo murmur that radiates to carotids. Increase w/squatting, decrease with decr preload
14
Q
MEDS to STOP before surgery
A
7-10 days ahead, preferably 2 wks: Aspirin, NSAIDS, Vitamin E (affects coags)
5 days: warfarin
metformin- lactic acidosis
15
Q
what should your INR be before operating?
A
16
Q
how should insulin dependent pts take their insulin before surg?
A
1/2 nl dose in morning because NPO after midnight the night before
17
Q
pts w/CKD on dialysis need to be dialized when?
A
24 hrs before
18
Q
why do we check BUN and Cr before surgery i people with CKD
A
bc increased risk of bleeding due to uremic toxins –> uremic platelet dysfunc, especially if BUN > 100
19
Q
what would you see in the labs if someone was bleeding due to uremic platelet dysfunc?
A
pt with CKD, BUN > 100, nl platelets but increased bleeding time
20
Q
what is pressure support vent?
A
pt rules rate but a boost of pressure is given (8-20) to help give Tidal Volume
21
Q
what is pressure support vent?
A
pt rules rate but a boost of pressure is given (8-20)
22
Q
what is CPAP?
A
cont. positive airway pressure– pt must breathe on own (must have sufficient resp drive) but + pressure given all the time to keep alvioli open
23
Q
what is CPAP?
A
cont. positive airway pressure– pt must breathe on own but + pressure given all the time
24
Q
What is PEEP?
A
Positive end expiratory pressure– given at end of cycle to keep alveoli open (5-20)
25
what is the best test to evaluate management of pt on vent?
ABG-- check pa02 and paCO2
26
what is the best test to evaluate management of pt on vent?
ABG
27
If person is on a vent and ABG shows Pa02 is high, you should...
lower Fi02-- bc free radicals can form--> increase damage
28
If person is on a vent and ABG shows Pa02 is high, you should...
lower Fi02
29
If person is on a vent and ABG shows PaC02 is high (pH is low), you should...
increase rate or TV
30
which is a more eficient change? rate or TV?
TV is a more efficient change-- bc increased rate = increased deadspace (Minute ventilation equation)
31
steps to checking type of acidosis
1. check pH--> respiratory acidosis
-- if HC03 is low and PaCO2 is low ---> metabolic acidosis --> metabolic acidosis
3. Check AG (Na- [Cl+HCO3])
-- nl = 8-12
Gap: MUDPILES
32
steps to checking type of alkalosis
1. check pH --> if > 7.4 = alkalotic
2. check bicarb and paC02
- - if HCO3 = low, and paC02 = low ---> respiratory alkalosis
- - if HCO3 = high and paCO2 = high --> metabolic alkalosis
3. Check urine Cl
- - if [Cl] = less than 20 --> vomiting/NG, antacids, diuretics
- - if [Cl] > 20 --> Conn's, Bartter's Gittleman's
33
steps to checking type of alkalosis
1. check pH --> if > 7.4 = alkalotic
2. check bicarb and paC02
- - if HCO3 = low, and paC02 = low ---> respiratory alkalosis
- - if HCO3 = high and paCO2 = high --> metabolic alkalosis
3. Check urine Cl
- - if [Cl] = less than 20 --> vomiting/NG, antacids, diuretics
- - if [Cl] > 20 --> Conn's, Bartter's Gittleman's
34
what are three indicators of poor nutritional status that would make you want to delay?
albumin 20%, transferrin
35
how would you maximize someone's nutrition?
enteral feedings (NOT TPN!)
36
what are indicators of liver failure that would make someone want to delay surgery
bilirubin >2, PT (coags = imp before surgery!), ammonia > 150, encephalopathy
37
what are common causes hyperchloremic (>20) metabolic alkalosis?
Conn's (hyper aldo) & Bartter's, Gittleman's
38
If smoker, what should you watch post-op as waking up from anesthesia?
O2 sat-- don't go to 100 bc used to retaining C02, need signal to breathe (possible BS per schwarzstein)
39
what are common causes of metabolic acidosis?
```
MUDPILES
Methanol
uremia
DKA
Propylene glycol
isoniazide
lactic acidosis (MOST COMMON)
ethylene glycol
salicylates
```
40
Causes of Non gap metabolic acidosis
diarrhea (pooping out bicarb --> metabolic acidosis), diuretics, renal tubular acidoses (RTAs) (I
41
How do you check if someone has CHF before surg?
ejection fraction. if
42
What are first 6 criteria for Goldman's index (tells you who's at greatest risk for surgery)
1. CHF
2. MI w/in 6 mo (surrogate for CV status)
3. arrhythmia
4. Old (>70 yo)
5. Surgery is emergent
6. AS (Aortic stenosis), poor medical condition, surgery in chest/abd
43
what are you checking on pt >50 or Pt w/recent MI (w/in 6 mo)
EKG - if abnormal ---> stress test, if abnormal ---> cardiac cath ---> reperfusion with stenting or revasc w/CABG
44
what else should be checked before surg related to AS (aortic stenosis)
1. Listen for murmur-- late systolic- systolic ejection murmur, crescendo-decrescendo murmur that radiates to carotids. Increase w/squatting, decrease with decr preload
45
MEDS to STOP before surgery
7-10 days ahead, preferably 2 wks: Aspirin, NSAIDS, Vitamin E (affects coags)
5 days: warfarin
metformin- lactic acidosis
46
what should your INR be before operating?
47
how should insulin dependent pts take their insulin before surg?
1/2 nl dose in morning because NPO after midnight the night before
48
pts w/CKD on dialysis need to be dialized when?
24 hrs before
49
why do we check BUN and Cr before surgery i people with CKD
bc increased risk of bleeding due to uremic toxins --> uremic platelet dysfunc, especially if BUN > 100
50
what would you see in the labs if someone was bleeding due to uremic platelet dysfunc?
pt with CKD, BUN > 100, nl platelets but increased bleeding time
51
what is an assist control vent?
set TV & rate, but if pt takes a breath, vent gives the volume
52
what is pressure support vent?
pt rules rate but a boost of pressure is given (8-20)
53
when is pressure support vent particularly important?
imp for weaning
54
what is CPAP?
cont. positive airway pressure-- pt must breathe on own but + pressure given all the time
55
What is PEEP?
Positive end expiratory pressure-- given at end of cycle to keep alveoli open (5-20)
56
when is PEEP used most often?
ARDS and CHF
57
what is the best test to evaluate management of pt on vent?
ABG
58
how do you treat hypokalemia (Paralysis, ST depression, U waves happens)?
Give K (but don't forget to moniter renal func!!! can become hyperkalemic quickly), max 40 mEq/hr
59
Peaked T waves, prolonged PR and QRS, sine waves = assoc w/which electrolyte derangement?
increased K
60
Txt for hyperkalemia (Peaked T waves, prolonged PR and QRS, sine waves)
Give Ca-gluconate then insulin + glucose, kayexalate, albuterol (B-agonist) and Na-bicarb. Last resort: dialysis!
61
In pt when ca is too high or too low, what is next best step?
EKG-- look at QT interval, assess risk for torsades
62
which is a more eficient change? rate or TV?
TV isa more efficient change-- bc increased rate = increased deadspace (Minute ventilation equation)
63
steps to checking type of acidosis
1. check pH--> respiratory acidosis
-- if HC03 is low and PaCO2 is low ---> metabolic acidosis --> metabolic acidosis
3. Check AG (Na- [Cl+HCO3])
-- nl = 8-12
Gap: MUDPILES
64
steps to checking type of alkalosis
1. check pH --> if > 7.4 = alkalotic
2. check bicarb and paC02
- - if HCO3 = low, and paC02 = low ---> respiratory alkalosis
- - if HCO3 = high and paCO2 = high --> metabolic alkalosis
3. Check urine Cl
- - if [Cl] = less than 20 --> vomiting/NG, antacids, diuretics
- - if [Cl] > 20 --> Conn's, Bartter's Gittleman's
65
If pH
-> respiratory acidosis (with metabolic comp)
66
what are risks of TPN?
acalculus cholecystitis, hyperglycemia, liver dysfxn, zinc deficiency, other 'lyte probs
67
if pH > 7.4 = & if HCO3 = high and paCO2 = high what is the acid/base status?
--> metabolic alkalosis
68
If pH
metabolic acidosis w/resp comp
69
what are common causes hyperchloremic (>20) metabolic alkalosis?
Conn's & Bartter's Gittleman's
70
what are common causes of hypochloremic (
vomiting, NG tube, antacids, diuretics
71
what are common causes of metabolic acidosis?
```
MUDPILES
Methanol
uremia
DKA
Propylene glycol
isoniazide
lactic acidosis
ethylene glycol
salicylates
```
72
Non gap metabolic acidosis
diarrhea, diuretics, renal tubular acidoses (RTAs) (I
73
Pt comes in w/confusion, HA, cherry red skin-- what are you concerned with? what test should you run? what is the txt?
CO poisoning, test carboxyhemoglobin (pulse ox is worthless because left ward shift- 02 doesn't dissoc from Hgb). Txt w/100% O2 (hyperbaric if CO-Hb is really elevated!)
74
what do you do w/hyponatremia...
1. check plasma osms-- make sure it's real (not high glucose)
2. check volume status
75
If you see clotting in a person w/edema, HTN & foamy pee think...
nephrotic syndrome (losing prots in urine-- some of the first to go are things like antithrombin III and other anti-clotting prots)
76
suspected diagnoses for hypovolemia (tachy, dry mucus memb, tenting) w/ hyponatremia?
diuretics, vomiting + free water consumption
77
what's special about ATIII deficiency as surgery students?
Heparin won't work-- can't give it to them!
78
If you see clotting in a young woman w/multiple spontaneous Abortions, think...
Lupus anticoagulant
79
If you see clotting in someone who's post-op & decreased plts and heparin was started w/in 5-14 days, think...
HIT (heparin induced thrombocytopenia)-- sometimes they won't say they gave them heparin, they'll just say they're "post-op"- code for given heparin! But if it's low platelets + clotting + post-op THINK HIT!
80
what do you treat HIT (heparin induced thrombocytopenia) with? (Ab to heparin bound to PF4)
Leparudin or agatroban (synthetic heparin)--
81
if a pt is BLEEDING with an isolated decrease in platelets, think...
ITP (idiopathic thrombocytopenic purpura)
82
if a pt is BLEEDING w/normal platelets but increased bleeding time and PTT think...
vWD (Von Willebrand's Disease)-- problem with platelet function, not number
83
if pt is bleeding with low platelets, increased PT, PTT bleeding time, low fibrinogen and high Ddimer and schistocytes, think...
DIC- caused by gram - sepsis (LPS), disseminated carcinomatosis, OB stuff
84
how do you treat hypernatremia?
Replace w/D5W or hypotonic fluid
85
what do you worry about when correcting hypernatremia?
cerebral edema
86
how quickly can you correct hyper/hyponatremia?
btwn .5 and 1 meq/hr or between 12 & 24 meq/day
87
numbness, chvostek or troussaeu, prolonged QT interval happens with what electrolyte derangement?
decreased Ca
88
stones, bones, groans, psychotic overtones and shortened QT interval happens with what electrolyte derangement?
increased Ca
89
Burn pts are very susceptible to ifxn. how should you give someone abx after a burn?
topically! No PO or IV abx because breeds resistance!!
90
how do you treat hypokalemia (Paralysis, ST depression, U waves happens)?
Give K (Kidneys!), max 40 mEq/hr
91
Peaked T waves, prolonged PR and QRS, sine waves = assoc w/which electrolyte derangement?
increased K
92
Txt for hyperkalemia (Peaked T waves, prolonged PR and QRS, sine waves)
Give Ca-gluconate then insulin + glucose, kayexalate, albuterol and Na-bicarb. Last resort: dialysis!
93
what should someone do with a chemical burn (esp in eyeballs)?
irrigate > 30 min prior to ER
94
what is best first step for someone who had an electrical burn?
EKG-- arrhythmia is most likely to kill person
95
if someone w/an electrical burn had LOC or an abnormal EKG, what should you do?
48 hr telemetry
96
If after a burn a urine dipstick is positive for blood but microscopic exam is negative for RBCs what is going on?
think rhabdo causing myoglobinuria, causing renal failure-- (think ATN)
97
If after a burn a urine dipstick is positive for blood but microscopic exam is negative for RBCs what is going on? and what else should you check?
rhabdo --> myoglobinuria -- think ATN. Check K+ -- might be too high from cells breaking open
98
what are risks of TPN?
acalculus cholecystitis, hyperglycemia, liver dysfxn, zinc deficiency, other 'lyte probs
99
erythematous, painful but not peeling burn = what degree?
1st degree-- effects epidermis
100
dark or pale burn w/no sensation is what degree burn?
3rd degree, through epidermis and dermis to the nerves
101
what is the concern w/circumferential burns?
compartment syndrome
102
loss of integrity of epidermis, very painful burn is what type?
2nd degree
103
how could you treat a circumferential burn to avoid compartment syndrome?
consider escharotomy
104
if pt comes in with singed nose hairs, wheezing, soot in mouth/nose, what should you be concerned about
laryngeal edema! Low threshhold for intubation!
105
if guy is stabbed in the neck and there are crackly sounds w/palmating the anterior neck tissue, what should we do?
fiberoptic broncoscope!! (might have airway.laryngail injury with sub q emphysema)
106
If guy has huge facial trauma, blood obscures the oral and nasal airway and GCS = 7, what should you do?
cricothyroidotomy (when you can't asses airway)
107
If you see clotting in a person w/edema, HTN & foamy pee think...
nephrotic syndrome
108
if you have intubated a pt and find decreased breath sounds on the left, what happened?
you intubated the rt mainstem broncus-- pull out!!
109
what's special about ATIII deficiency?
Heparin won't work
110
If you see clotting in a young woman w/multiple spontaneous Abortions, think...
Lupus anticoagulant
111
A pt dies suddenly after a 3rd yr medical student removes a central line. Dx? when else to suspect it?
Dx: air embolism.
| Suspect it also when: lung trauma, vent use overzealous w/tidal volume, during heart vessel surgery
112
what do you treat HIT (heparin induced thrombocytopenia) with?
Leparudin or agatroban
113
if a pt is bleeding with an isolated decrease in platelets, think...
ITP (idiopathic thrombocytopenic purpura)
114
what's next best step if pt is in hemorrhagic/hypovolemic shock (tachy, hypotensive, flat neck veins, nl CVP)
2 large bore periph IV- 2L NS or LR over 20 min followed by blood if we don't see approp rise in VS
115
if pt is bleeding with low platelets, increased PT, PTT bleeding time, low fibrinogen and high Ddimer and schistocytes, think...
DIC- caused by gram - sepsis, carcinomatosis, OB stuff
116
how do you confirm pericardial tamponade?
FAST scan or just treat if strong clinical suspicion
117
what is the rule of 9s for a child?
```
head: 19
thorax/abdo: 18
back: 18
each arm front and back: 9
each leg front and back: 14
genitalia: 1
```
118
what is the parkland formula for hydration s/p burn in an adult?
Kg x %BSA x 3-4
119
what is next best step for tension pneumo?
needle decompression, followed by chest tube. Don't do CXR.
120
after a burn, what fluid should you use to replenish pts with?
Ringers lactate or NS
121
what do you see on a Swan-Ganz catheter in hypovolemic shock in terms of RAP/PCWP, SVR and CO?
RAP/PCWP decreases
SVR increases
CO decreases
122
what topical medication for s/p burns doesn't penetrate an eschar and can cause leukopenia?
silver sulfadiazine
123
what topical med for s/p burns penetrates eschar but hurts like hell?
mafenide
124
what topical burn med doesn't penetrate eschar and causes hypokalemia and hyponatremia?
silver nitrate
125
what do you see on Swan-Ganz cath in vasogenic shock in terms of RAP/PCWP, SVR and CO?
RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)
126
what is best first step for someone who had an electrical burn?
EKG
127
if someone w/an electrical burn had LOC or an abnormal EKG, what should you do?
48 hr telemetry
128
If after a burn a urine dipstick is positive for blood but microscopic exam is negative for RBCs what is going on?
myoglobinuria-- think ATN
129
what do you see on Swan-Ganz cath for neurogenic shock in terms of RAP/PCWP, SVR and CO?
RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)
130
how do you txt neurogenic shock?
in adrenal insuff: txt w/dexamethasone and taper over several weeks
131
what are the criteria for compartment syndrome?
1. 5 P's: Pain, parasthesia, pallor, paralysis and poikilothermia (inability to regulate temp) and/or pulselessness
2. Or compartment Pressure > 30 mmHg
132
what is the treatment for compartment syndrome s/p burn?
fasciotomy (or escharotomy)-- at bedside!
133
if trauma pt comes in unconscious, what should you do?
intubate!!
134
if a trauma pt comes in w/a GCS
intubate!!
135
if a guy is stung by a bee and develops stridor and tripod posturing, what should you do?
intubate!!
136
if guy is stabbed in the neck, GCS = 15, but there's an expanding mass in the lateral neck, what should you do?
intubate!!
137
if guy is stabbed in the neck and there are crackly sounds w/palmating the anterior neck tissue, what should we do?
fiberoptic broncoscope!!
138
txt for cardiogenic shock?
diuretics, tx the HR to 60-100, then address the rhythm. Next give vasopressor support if necessary
139
once you've intubated the pt, what's the best next step?
check bilat breath sounds! then check pulse ox, keep it > 90%
140
if you have intubated a pt and find decreased breath sounds on the left, what happened?
you intubated the rt mainstem broncus-- pull out!!
141
a pt has has inward mvmt of the rt ribcage upon inspiration. Dx? txt?
Dx: flail chest (> 3 consec rib fractures)
Txt: O2 and Pain control
142
a pt has confusion petechial rash in chest, axilla and neck and acute SOB. Dx? when to suspect it?
Dx: fat embolism
| Suspect it: after long bone fracture (esp femur)
143
A pt dies suddenly after a 3rd yr medical student removes a central line. Dx? when else to suspect it?
Dx: air embolism.
| Suspect it also when: lung trauma, vent use, during heart vessel surgery
144
if pt is hypotensive and tachycardic, worry about...
shock!
145
If pt is hypotensive, tachy w/flat neck veins and nl CVp what should you wory about?
shock! hypovolemic vs hemorrhagic
146
what's next best step if pt is in hemorrhagic/hypovolemic shock (tachy, hypotensive, flat neck veins, nl CVP)
2 large bore periph IV- 2L NS or LR over 20 min followed by blood
147
if heart sounds are muffled, there's JVD and electrical alternans and pulsus paradoxus-- what are you worried about?
pericardial tamponade
148
how do you confirm pericardial tamponade?
FAST scan
149
what is the txt for pericardial tamponade?
Needle decompression, pericardial window or median sternotomy
150
if there are decreased breath sounds on one side and tracheal deviation AWAY from the collapsed lung what are you worried about?
tension pneumothorax
151
what is next best step for tension pneumo?
needle decompression, followed by chest tube. Don't do CXR.
152
what would you expect on PE with hypovolemic shock?
hypotensive, TACHY, DIAPHORETIC, COOL, CLAMMY extrem
153
what do you see on a Swan-Ganz catheter in hypovolemic shock?
RAP/PCWP decreases
SVR increases
CO decreases
154
how do you txt hypovolemic shock?
crystalloid resuscitation
155
what causes vasogenic shock?
decreased resistance w/in capitance vessels, seen in sepsis (LPS) and anaphylaxis (histamine)
156
what is PE on person with vasogenic shock?
AMS, hypotension, WARM, DRY extrem (early), late looks like hypovolemic
157
what do you see on Swan-Ganz cath in vasogenic shock?
RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)
158
how do you treat vasogenic shock?
fluid resuscitation (may cause edema) and tx offending organism
159
what is neurogenic shock?
form of vasogenic shock caused by spinal cord injury, spinal anesthesia, or adrenal insufficiency (suspect in pts on steroids encountering a stressor!!) causes an acute loss of sympathetic tone.
160
what do you see on PE in neurogenic shock?
hypotensive, BRADYCARDIC, WARM, DRY etrem, absent reflexes and flaccid tone. Adrenal insuff will have hypoNa and HyperK
161
what is the workup for penetrating wound in zone 1 of the neck (from the cricoid down)
aortography
162
how do you txt neurogenic shock?
in adrenal insuff: txt w/dexamethasone and taper over several weeks
163
what is cardiocompressive shock?
cardiactamponade or other processes exerting pressure on the heart so it can't fulfill its role as a pump
164
what do you see on PE in cardio-compressive shock?
hypotensive, tachy, JVD, decreased heart sounds, nl breath sounds, pulsus paradoxus
165
if pt has a stab wound to the abdomen, but pt is stable- what do you do?
FAST exam. DPL (diagnostic peritoneal lavage) if FAST is equivocal. Exlap if either FAST or DPL are positive
166
if blunt abdo trauma pt w/hypotension/tachy, what should you do?
ex-lap
167
what is cardiogenic shock?
failure of heart as a pump-- arrhythmias or acute heart failure
168
what would you expect to see on PE in person w/cardiogenic shock?
SOB, clammy extremities, rales bilat, S3, pleural effusion, decreased breath sounds, ascites, peripheral edema
169
what would you expect to see on swan-ganz cath in termsof RAP/PCWP, SVR and CO in cardiogenic shock?
RAP/PCWP increased
SVR increased
CO decreased
170
txt for cardiogenic shock?
diuretics, tx the HR to 60-100, then address the rhythm. Next give vasopressor support if necessary
171
what would we hear/see on PE for person with a pneumothorax?
absent/decreased breath sounds on one side, hyperressonance to percussion, distended neck veins and tracheal deviation if tension pneumo
172
what would we hear on PE for person with hemothorax?
absent/decreased breath sounds on one side, dull to percussion
173
when do we take someone to the OR for hemothorax?
high output > 1.5 L immediately or greater than 200 cc/hr over first 4 hours
174
how do we txt hemothorax?
chest tube
175
"white out lung" after car accident? possible rib fractures?
pulmonary contusion
176
do people with pulm contusion go to the OR?
no- -just make sure they're coughing/clearing the airway
177
what do we do for pain control with flail chest?
nerve block
178
do we give opiates for flail chest?
no, decrease respiratory drive
179
what are the 3 categories in GCS and the highest you can get for it
eyes (4), motor (6) voice (5)
180
head trauma + LOC, what should you do?
CT!!!
181
biconcave disk on head CT after head trauma =
epidural hematoma
182
how can you tell acute from chronic subdural hematoma on a CT?
acute blood is bright, chronic is dark
183
what can cause increased ICP?
hematoma, edema and tumor
184
symptoms of increased ICP?
HA, vomiting, AMS
185
what common ortho injury is assoc w/shoulder pain s/p seizure or electrical shock?
posterior shoulder disloc
186
what common ortho injury is assoc w/arm outwardly rotated & numbness over deltoid...
ant shoulder disloc (numb bc of axillary nerve damage)
187
what common fracture is assoc w/old lady FOOSH, distal radius displaced
Colle's fracture-- dinner fork deformity
188
what are the anatomical borders of zone 3 of the neck?
upward from the angle of the mandible (includes trachea, esophagus)
189
what common fracture is assoc w/"I swear I just punched a wall"
Metacarpal neck fracture "Boxer's fracture" (usually 4-5th metacarpal) - May need K wire
190
the clavicle is most commonly broken where?
btwn middle and distal 1/3s. Need figure of 8 device
191
what is work up for penetrating wound to zone 2 of the neck? (angle of mandible down to the cricoid)
2d doppler +/- exploratory surgery (to check patency of vessels)
192
what are the anatomical borders of zone 1 of the neck?
from the cricoid down
193
what is the workup for penetrating wound in zone 1 of the neck (from the cricoid down)
aortography
194
If there's a GSW to the abdomen, what do you do?
ex lap + tetanus PPX
195
If there's a GSW and you don't know where it went, but CXR shows free air under the diaphragm, what do you do?
ex-lap!! (+ tetanus PPX)
196
if stab wound and pt is unstable, with rebound tenderness & rigidity, or w/evisceration what should you do?
ex-lap + tetanus PPX
197
if pt has a stab wound to the abdomen, but pt is stable- what do you do?
FAST exam. DPL if FAST is equivocal. Exlap if either FAST or DPL are positive
198
if blunt abdo trauma pt w/hypotension/tachy, what should you do?
ex-lap
199
blunt abdo trauma + unstable... what do you do?
ex-lap
200
blunt abdo trauma + stable... what do you do?
get a CT
201
if there's a lower rib fx + bleeding into the abdome, be concerned about...
a spleen or liver lac (depending on side of fracture)
202
if lower rib fx plus hematuria be concerned about...
kidney lac
203
if kehr sign & viscera in thorax on CXR, be concerned about...
diaphragm rupture
204
if handlebar sign, be concerned about...
pancreatic rupture
205
if stable w/epigastric pain, best test is...
abdo CT
206
if stable w/epigastric pain and retroperitoneal fluid is found on CT, consider...
duodenal rupture
207
what is the kehr sign?
referred pain to shoulder from phrenic nerve of diaphragm
208
if pt has pelvic trauma and is hypotensive and tachy (unstable!) you should...
do FAST and DPL to r/o bleeding in abdo cavity
209
how do you stop a bleed into the pelvis?
stop bleed by fixing fx --> internal if stable, external if not
210
if blood at the urethral meatus and high riding prostate consider...
pelvic fracture w/urethral or bladder injury
211
what is next best test if blood at the urethral meatus and high riding prostate?
retrograde urethrogram-- not a foley!! check urethral integrity!
212
txt for simple wound ifxn (Fever POD >7 w/ pain at incision site, induation w/drainage)?
open wound and repack, no abx necessary
213
what are you looking for on retrograde urethrogram in pt w/ blood at the urethral meatus and high riding prostate?
extravasation of dye-- take 2 views to ID trigone injury
214
if retrograde cystogram shows extraperitoneal extravasation in pt w/ blood at the urethral meatus and high riding prostate, what should you do?
bed rest + foley
215
if retrograde cystogram shows intraperitoneal extravasation in pt w/ blood at the urethral meatus and high riding prostate, what should you do?
ex-lap and surgical repair
216
what type of fractures always go to the OR? (4)
1. depressed skull fx
2. severely displaced/angulated fx
3. any open fx (sticking out bone needs cleaning)
4. femoral neck or intertrochanteric fx
217
what common fracture is assoc w/shoulder pain s/p seizure or electrical shock?
posterior shoulder disloc
218
what common fracture is assoc w/arm outwardly rotated & numbness over deltoid...
ant shoulder disloc
219
what common fracture is assoc w/old lady FOOSH, distal radius displaced
Colle's fracture
220
what common fracture is assoc w/young person FOOSH, anatomic snuff box tenderness?
scaphoid fracture
221
what common fracture is assoc w/"I swear I just punched a wall"
Metacarpal neck fracture "Boxer's fracture"- May need K wire
222
the clavicle is most commonly broken where?
btwn middle and distal 1/3s. Need figure of 8 device
223
with scaphoid fracture, what do you usually see on xray?
nothing, esp immediately
224
Fever on POD#1 most commonly caused by? how would you describe sx? how would you dx it? txt it?
1. caused by atelectasis2
| 2. sx: low fever (
225
POD 1 high fever (to 104) w/very ill appearing pt, most likely caused by...
Nec Fasc
226
what is the pattern of spread of nec Fasc?
in sub q along scarpa's fascia
227
what are the common bugs of nec fasc?
GABHS or clostridium perfringens
228
what is the txt for nec fasc?
IV PCN, Go to OR and debride skin until it bleeds
229
most common cause of VERY HIGH FEVER (> 104) on POD1 + muscle rigidity!!
malignant hyperthermia
230
malignant hyperthermia (VERY HIGH FEVER (> 104) on POD1 + muscle rigidity) is caused by...
succinylcholine or halothane
231
what is the genetic defect that causes malignant hyperthermia?
Ryanodine receptor gene defect that caues increased intracellular calcium
232
what is the txt for malignant hyperthermia?
dantrolene Na (blocks Ryanodine receptor an decreases intracellular calcium)
233
Most common cause of Fever on POD 3-5 w/productive cough, diaphoresis...
PNA
234
how to txt fever on POD 3-5 w/ productive cough, diaphoresis (PNA)
check sputum sample for culture, cover w/moxi etc to cover strep pneumo in the meantime
235
Most common cause of Fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley...
UTI
236
next best test for person w/ fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley...
UA (nitrite and LE) and culture
237
how to txt fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley...
change foley and txt w/wide spec abx until culture returns
238
Fever POD 3-5 most likely caused by what or what?
UTI or PNA
239
Fever > POD 7 w/ tenderness at central IV site?
central line ifxn
240
what to do if you suspect central line ifxn?
blood cx from the line, pull it, abx to cover staph
241
Fever POD > 7 w/ pain at incision site, edema, induation but no drainage
cellulitis
242
txt for cellulitis (assoc w/Fever POD 7 w/ pain at incision site, edema, induation but no drainage)?
blood cx, start abx
243
Fever POD >7 w/ pain at incision site, induation w/drainage?
simple wound ifxn
244
txt for simple wound ifxn (Fever POD >7 w/ pain at incision site, induation w/drainage)?
open wound and repack, no abx necessary
245
Fever POD > 7 w/pain w/ salmon colored fluid from incision?
dehiscence-- surgical emergency!
246
how do you txt dehiscence (Fever POD > 7 w/pain w/ salmon colored fluid from incision)?
surgical emergency! go to OR, iv abx, primary closure of fascia
247
unexplained Fever pod > 7
abdominal abcess
248
how do you dx abdominal abcess?
CT w/oral, IV and rectal contrast to find it. Diagnostic lap
249
Tx of abdominal abcess
Drain it! Percutaneously, IR guided or sugically!
250
what are random causes of fever > POD 7? (5)
```
thyrotoxicosis
thrombophlebitis
adrenal insufficiency
lymphangitis
sepsis
```
251
pressure ulcers are caused by...
impaired blood flow --> ischemia
252
should you culture pressure ulcers?
no-- will just get skin flora
253
rather than culturing pressure ulcers (which will just be contaminated by skin flora) you should...
check CBC and Blood Cx which can point toward bacteremia or osteomyelitis. Can also do a tissue bx to r/o marjolin's ulcer
254
best prevention of pressure ulcers?
turning q2h
255
describe stage 1 pressure ulcer
skin intact but red. Blanches w/pressure
256
describe stage 2 pressure ulcer
blister or break in the dermis
257
describe stage 3 pressure ulcer
SubQ destruction into the muscle
258
describe stage 4 pressure ulcer
involvement of joint or bone
259
stage 1-2 pressure ulcer txt:
get special mattress, barrier protection
260
stage 3-4 pressure ulcer txt
get flap reconstruction surgery
261
CXR showing peripheral cavitation and CT showing distant mets is most likely...
large cell carcinoma
262
pleural effusions where you see fluid > 1cm on lat decubitus CXR should be txt w/...
thoracentesis
263
transudative pleural effusions are most likely caused by...
CHF, nephrotic or nephrotic syndromw
264
transudative pleural effusions with low pleural glucose is most likely caused by...
RA
265
transudative pleural effusions with high lymphocytes is most likely caused by...
TB
266
transudative pleural effusions with blood, most likely caused by...
malignancy or pulmonary embolus
267
exudative pleural effusions are most likely...
papapneumonic, cancer, etc
268
if a pleural effusion is complicated (+ gram stain or culture, pH
insert chest tube for drainage
269
by light's criteria an effusion is transudative if...
LDH
270
in tall, thin young men w/sudden dyspnea (or person w/asthma or COPD/emphysema) suspect...
spontaneous pneumothorax -- subpleural bleb ruptures --> lung collapse
271
dx of spontaneous pneumothorax?
CXR
272
txt of spontaneous pneumothorax?
CXR, txt w/chest tube placement
273
indications for surgery for spontaneous pneumothorax?
ipsi or contra recurrence, bilateral pneumo, incomplete lung expansion, pilot, scuba diver or lives in a remote area
274
if surgery is recommended for person w/spontaneous pneumo (ipsi or contra recurrence, bilateral pneumo, incomplete lung expansion, pilot, scuba diver or lives in a remote area), what surgery is recommended?
VATS, pleurodesis (bleo, iodine, or talc)
275
lung abcesses are usually 2/2...
aspiration (drunk, elderly, enteral feeds)
276
lung abcesses are most often found in what areas of the lung?
posterior upper or superior lower lobes
277
Blowing diastolic murmur w/wodened pulse pressure and eponym parade?
aortic regurg
278
what are indications for surgery for lung abcess?
abx fail, abcess > 6 cm, empyema present
279
in the work up for a lung nodule, what is the first step?
find an old CXR to compare!
280
characteristics of benign nodules?
1, popcorn calcification = hamartoma (most common)
2. concentric calcification = old granuloma
3. Pt
281
txt of benign looking lung nodule?
CXR or CT scans q2mo to look for growth
282
characteristics of malignant nodules
1. pt has RF (smoker, old)
2. >3cm
3. calcification
283
tx of malignant looking nodule in the lung
remove nodule (w/bronc if central, open lung bx if peripheral)
284
pt presents w/wt loss, cough, dyspnea, hemoptysis, repeated PNA or lung collapse, suspect
lung cancer!
285
Most common lung cancer in non-smokers and women (also very commonly seen in smokers!)?
adenocarcinoma, occurs in scars of old PNA
286
where is adenocarcinoma most commonly located in the lungs, and where does it metastasize to?
peripheral cancer.
| mets to liver, bone, brain and adrenals
287
common characteristic of neoplastic effusions?
exudative w/high hyaluronidase
288
pt w/Kidney stones, constipation and malaise low PTH and central lung mass most likely has...
squamous cell carcinoma w/paraneoplastic syndrome 2/2 secretion of PTH-rP. Low PO4, High Ca
289
Pt w/shoulder pain, ptosis, constricted pupil and facial edema most likely has...
superior sulcus syndrome from small cell carcinoma (a central cancer)
290
indications for surgery w/GERD?
bleeding, stricture, Barrett's, incompetent LES, max dose PPI w/still sxs, or no want meds
291
if hematemesis occurs after vomiting w/subq emphysema, and high amylase content in pleural effusion think...
Boerhaave's (esophageal rupture)
292
how do you txt SIADH from small cell carcinoma?
fluid restric +/- 3% saline in
293
CXR showing peripheral cavitation and CT showing distant mets is most likely...
large cell carcinoma
294
Pathophys of ARDS?
inflammation --> impaired gas xchange, inflam mediator release, hypoxema
295
causes of ARDS?
sepsis, gastric aspiration, trauma, low perfusion, pancreatitis
296
Diagnosis of ARDS is dependent on (3 things)
1. Pa02/Fi02
297
txt of ARDS?
mechanical vent w/PEEP
298
Systolic ejection murmur w/crescendo/decrescendo, louder w/squatting, softer w/valsalva + parvus et tardus = what murmur?
Aortic stenosis
299
what makes aortic stenosis w/crescendo/decrescendo systolic ejection murmur louder? softer?
louder w/squatting, softer w/valsalva
300
Systolic ejection murmur louder w/vasalva, softer w/squatting or handgrip = what murmur?
HOCM
301
what makes HOCM systolic ejection murmur louder? softer?
louder w/vasalva, softer w/squatting or handgrip
302
what murmur = late systolic w/click, louder w/vasalva and handgrip, softer w/squatting?
MVP
303
MVP late systolic murmur w/click is louder with __? softer?
louder w/vasalva and handgrip, softer w/squatting
304
holosystolic murmur radiates to axilla w/left atrial enlargement (LAE) = what murmur?
mitral regurg
305
Holosystolic murmur w/late diastolic rumble in kids is ?
VSD
306
continuous machine like murmur =?
PDA
307
wide fixed and split S2 =?
ASD
308
rumbling diastolic murmur w/an opening snap, left atrial enlargement (LAE) and A-fib?
mitral stenosis
309
Blowing diastolic murmur w/wodened pulse pressure and eponym parade?
aortic regurg
310
when should you do surgery for gastric ulcer?
if lesion persists after 12 wks of txt
311
how do you txt zenker's diverticulum?
surgery
312
is zenker's diverticulum a tru or false diverticulum?
false! only contains the mucosa!
313
dysphagia to liquids and solids, think...
achalasia
314
txt achalasia (dysphagia to liquids and solids) w/... (4)
1. Calcium channel blockers (CCB)- like nifedipine
2. nitrates ( isosorbide dinitrate and nitroglycerin)
3. botox
4. heller myotomy
315
achalasia (dysphagia to liq + solids) = assoc w what 2 dz?
chagas dz and esophageal cancer
316
dysphagia worse w/hot & cold liquids + chest pain that feels like mI w/NO regurg =?
diffuse esophageal spasm
317
how do you txt diffuse esophageal spasm (dysphagia worse w/hot & cold liquids + chest pain that feels like mI w/NO regurg)?
calcium chan blockers (CCB) like nifedipine or nitrates (isosorbide dinitrate and nitroglycerin)
318
epigastric pain worse after eating or when laying down, assoc w/ cough, wheeze and hoarse =
GERD
319
most sensitive test for GERD?
- 24 hr pH monitoring.
| - do endoscopy if "danger signs" present. Tx w/behav mod 1st, then antacids, H2 blocker
320
what is dieulafoy's
massive hematemsis bc the mucosal artery erodes into the stomach
321
how do you txt GERD?
Tx w/behav mod 1st, then antacids, H2 blocker, PPI
322
indications for surgery w/GERD?
bleeding, stricture, Barrett's, incompetent LES, max dose PPI w/still sxs, or no want meds
323
if hematemesis occurs after vomiting w/subq emphysema, think
Boerhaave's
324
if gross hematemesis unprovoked in a cirrhotic w/pHTN, think...
Gastric varices
325
If progressive dysphagia w/wgt loss think...
esophageal carcinoma
326
next best test if you suspect boerhaave syndrome?
CXR, gastrograffin esophagrom. NO endoscopy!!
327
what test is contraindicated in boerhaave syndrome?
endoscopy!!!
328
if pt is in hypovolemic shock s/p esophageal varices you should...
do ABC
NG lavage
medical txt w/octreotide or SS balloon
tamponade only if you need to stabilize for transport
329
txt of boerhaave syndrome?
surgical repair if full thickness
330
txt of choice for esophageal varices?
endoscopic sclerotherapy or banding
331
Should you prophylactically band asymptomatic varices?
no! Give BB
332
what is txt of SMA syndrome?
restore weight/nutrition. Can do Roux-en-Y
333
most common esophageal cancer/location in people w/long standing GERD?
adenocarcinoma in the distal 1/3
334
Best 1st test for suspected esophageal cancer?
barium swallow, then endoscopy w/Bx, then staging CT
335
acid reflux pain after eating, when laying down = assoc w/?
hiatal hernia
336
type 1 hiatal hernia?
sliding GE jxn herniates into thorax. Worse for GERD. Tx sxs
337
Type 2 hiatal hernia
paraesophageal. Abd pain, obstruction, strangulation --> needs surgery!
338
does type 1 or type 2 hernia need surgery?
T2. T1 can be txt w/meds for GERD
339
middle epigastric pain worse w/eating?
gastric ulcers
340
gastric ulcers = assoc w/what 3 RF?
H. pylori, NSAIDS, steroids
341
work up for gastric ulcers?
double contrast barium swalow- punched out lesion w/regular margins. EGD w/bx can tell H-pylori, malignant or benign
342
tx adenocarcinoma of the panc w'wipple IF... (3)
1. no mets outside abdomen,
2. no extension into SMA or portal vein
3. no liver or peritoneal mets
343
what kind of gastric cancer is most common, especially in Japan?
adenocarcinoma
344
what is a Krukenberg tumor?
Gastric CA that has met to the ovaries
345
where is virchow's node?
in the L supraclavicular fossa
346
Lymphoma is often assoc w/...
HIV (check this fact from slide 41 of PDF)
347
what is Blummer's shelf?
mets in the pelvic cul de sac felt on digital rectal exam (DRE) (assoc with gastric cancer?)
348
Where is the Sister Mary Joseph node?
umbilical node (important for gastric ca?)
349
MALT-lymphoma is associated w/...
H pylori
350
what is mentriers? What finding on endoscopy is characteristic?
a protein losing erteropathy-- look for enlarged ruggae
351
Gastric varices are indicative of...
splenic vein thrombosis
352
tx for VIPoma?
octreotide can help sx
353
middle epigastric pain that gets better w/eating is assoc w/what?
duodenal ulcers
354
biggest RF for duod ulcers?
H pylori -- 95%
355
txt of healthy pts
trial of H2 block or PPI
356
Dx of duodenal ulcers?
blood, stool or breath test for h pylori but endoscopy w/bx = best b/c it can exclude cancer
357
Tx of duodenal ulcers w/H-pylori and how do you make sure h-pylori is gone afterwards?
PPI, clarithromycin & amoxicillin x2wks. Breath or stool test can be test of cure.
358
what should we suspect if middle epigastric pain/ulcers don't resolve w/txt?
zollinger-ellinson syndrome
359
best test for zollinger-ellison syndrome?
secretin stim test (find innap high gastrin)
360
txt for zollinger ellison syndrome?
surgical resection of pancreatic/duodenal tumor
361
if someone is dx with zollinger ellison syndrome, what else should you look for?
Pituitary and parathyroid probs-- think MEN 1
362
a pt has bilious vomiting and post-prandial pain. He recently lost 200 lbs on "biggest loser" Be concerned about...
SMA syndrome (acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation)
363
pathophys of SMA syndrome
acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation
364
what is txt of SMA syndrome?
restore weight/nutrition. Can do Roux-en-Y
365
Middle epigastric pain straight through to the back-- most likely...
pancreatitis
366
most common etiologies of pancreatitis?
ETOH and gallstones
367
txt cholangiocarcinoma w...
surgery + rad
368
Txt of pancreatitis?
NG suction, NPO, IV rehydration and observation
369
Bad prognostic factors for pt w/pancreatitis? (13)
1. old
2. WBC > 16k
3. Glc > 200
4. LDH > 350
5. AST > 250
6. drop in Hct
7. decreased Ca
8. acidosis
9. hypoxemia
10. pseudocyst (no cells)
11. hemorrhage
12. abcess
13. ARDS
370
chronic pancreatitis is assoc w/? (3)
chronic MEG pain, DM, malabsorption (steatorrhea)
371
chronic pancreatitis can cause splenic cein thrombosis what can lead to,,,
gastric varices
372
If in the head of the panc, adenocarcinoma of the pancreas can cause courvoisier's sign which is...
large non-tender GB, itching and jaundice
373
what is trousseau's sign?
migratory thrombophlebitis-- assoc w/ adenocarcinoma of the panc
374
tx adenocarcinoma of the panc w'wipple IF... (3)
1. no mets outside abdomen,
2. no extension into SMA or portal vein
3. no liver or peritoneal mets
375
what is whipple's triad (assoc w/ insulinoma)
Sxs (sweat, tremors, hunger, seizures) + BGL
376
what are sxs of insulinoma?
same as low glucose!-- sweat, tremors, hunger, seizures
377
labs c/w insulinoma?
insulin increased
c-peptide inc
pro-insulin inc
378
sxs of glucagonoma?
hyperglycemia, diarrhea, wt loss
379
rash characteristic of glucagonoma?
necrolytic migratory erythema
380
somatistainoma are assoc w/?
malabsorption (seatorrhea) etc from exocrine panc malfxn
381
are somatistainoma usually malig or benign?
malig
382
VIPoma sxs?
watery diarrhea, hypokalemia, dehydration, flushing
383
VIPoma looks similar to what syndrome?
carcinoid
384
tx for VIPoma?
octreotide can help sx
385
most likely dx w/ RUQ pain into the back, n/v, Fever, worse s/p fatty foods?
acute cholecystitis
386
best 1st test?
US
387
txt?
cholecystectomy? perc cholecystostomy if unstable (CHECK THIS-- now it mt be abx!)
388
RUQ pain, high bili and high alk phos =?
choledocolithiasis
389
dx of choledocolythiasis?
US will show CBD stone (or lg dilitation of CBD?)
390
txt for choledocolithiasis?
chole +/- ERCP to remove stone
391
rupture of enchinococcus liver cyst (pt from mexico presents w/RUQ pain and lg liver cysts found on US) will cause...
anaphylaxis
392
what is Charcot's triad? Assoc w/?
RUQ pain, F, jaundice-- ascending cholangitis
393
what is Reynold's pentad? assoc w/?
RUQ pain, fever, jaundice, ↓BP, AMS-- ascending cholangitis
394
txt ascending cholangitis w/?
fluids & broad spectrum abx, ERCP and stone removal
395
describe T1 choledochal cysts...
fusiform dilation of CBD
396
how do you txt T1 choledochal cysts (fusiform dilation of CBD)?
excision
397
T5 choledochal cysts = assoc w/what dz? what is txt?
Caroli's Dz. Cysts in intrahepatic ducts-- needs liver transplant!
398
cholangiocarcinoma is rare. RF for it are (3)
Primary sclerosing Cholangitis (UC)
Liver flukes
thorothrast exposure
399
txt cholangiocarcinoma w...
surgery + rad
400
Hepatitis where AST = 2x ALT =?
Alcoholic hep (reversible)
401
hepatitis where AST > ALT high (1000s) = ?
Viral hep
402
AST & ALT high s/p hemorrhage, surg or sepsis is most likely...
shock liver
403
cirrhosis and portal htn txt with...
SS and VP vasoconstrict to decrease portal pressure
| Bblockers also decrease portal pressure
404
do you need to treat esophageal varices prophylactically?
no, but band/burn them once they bleed once
405
TIPS relieves portal HTN BUT worsens...
hepatic encephalopathy
406
txt hepatic encephalopathy w/...
lactulose (helps rid body of ammonia)
407
RF for hepatocellular carcinoma?
chronic HepB carrier > Hep C
cirrhosis for any reasons
aflatoxin or carbon tetrachloride exposure?
408
Dx hepatocellular ca w/?
high AFP (in 70%), CT/MRI
409
txt of hepatocellular ca?
surgically remove solitary mass, use rads or cryoablation for pallation of multiple
410
women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock =?
hepatic adenoma
411
how do you dx hepatic adenoma (women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock)?
US or MRI
412
Txt of hepatic adenoma (women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock)?
D/c OCPs, resect if lg or pregnancy is desired
413
2nd Most common benign liver tumor. It's more common in W > M, but less likely to rupture than hepatic adenomas?
focal nodular hyperplasia
414
most common bugs causing bacterial abcess on the liver?
E. Coli, bacteriodes, enterococcus
415
tx of bact abcess on the liver?
surgical drainage and IV abx
416
RUQ pain, profuse sweating and rigors, palpable liver =?
liver abcess 2/2 entamoeba histolytica
417
txt for liver cyst 2/2 entamoeba histolytica?
metronidazole. Don't drain it!
418
pt from mexico presents w/RUQ pain and lg liver cysts found on US =?
echinococcus
419
mode of eccinococcus transmission?
hydatid cyst paracyte from dog feces
420
lab findings common w/ eccinococcus ifxn (pt from mexico presents w/RUQ pain and lg liver cysts found on US)
eosinophilia and + casoni skin test
421
what is the casoni skin test?
immediate hypersensitivity skin test used in the diagnosis of hydatid disease of enchinococcus (pt from mexico presents w/RUQ pain and lg liver cysts found on US)
422
how do you txt enchinococcus (pt from mexico presents w/RUQ pain and lg liver cysts found on US)?
albendazole and surgery to remove entire cyst. RUPTURE CAUSES ANAPHYLAXIS!!
423
rupture of enchinococcus liver cyst (pt from mexico presents w/RUQ pain and lg liver cysts found on US) will cause...
anaphylaxis
424
s/p splenectomy, what should you do for post-ob thrombocytosis > 1mil?
give aspirin
425
what ppx should you give s/p splenectomy?
prophylactic PCN + S. pneumo, H. flu and N meningitidis vaccines
426
ITP should be considered in cases of...
1. isolated thrombocytopenia (with bleeding gums, petechiae, nosebleeds)
2. decreased plt count/inc megakaryocytes in marrow
3. NO SPLENOMEGALY
427
how should ITP be txt?
steroids 1st. If relapse, splenectomy
428
what should be considered in pt w/isolated thrombocytopenia (with bleeding gums, petechiae, nosebleeds), decreased plt count/inc megakaryocytes in marrow, & NO SPLENOMEGALY
ITP!
429
what should you consider in pt w/ sxs of hemolytic anemia (jaundice, inc indirect bili, LDH, decreased hapto, elevated ritic count) + spherocytes on smear and + osmotic fragility test?
hereditary spherocytosis
430
pts w/hereditary spherocytosis are prone to...
gallstones
431
how should you txt pt w/hereditary spherocytosis?
splenectomy (accessory spleen too)
432
what dx should be considered w/L lower rib fx, intra abdo hemorrhage, +/- kehr's sign (irritates L diaphragm --> pain in L shoulder via phrenic nerve)?
splenic fracture
433
Kehr's sign in the left shoulder is considered a classical symptom of...
splenic rupture
