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Surgery shelf high yield > from UT review > Flashcards

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

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2
Q

what are three indicators of poor nutritional status that would make you want to delay surgery?

A

albumin 20%, transferrin

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3
Q

what are three indicators of poor nutritional status that would make you want to delay?

A

albumin 20%, transferrin

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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

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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

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6
Q

when should you recommend smokers stop smoking prior to surgery?

A

8 wks

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7
Q

what does Goldman’s Index do?

A

tells you who is at greatest risk from surgery

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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

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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

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10
Q

How do you check if someone has CHF before surg?

A

ejection fraction. if

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11
Q

What are first 6 criteria for Goldman’s index (tells you who’s at greatest risk for surgery)

A
  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
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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

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13
Q

what else should be checked before surg related to AS (aortic stenosis)

A
  1. Listen for murmur– late systolic- systolic ejection murmur, crescendo-decrescendo murmur that radiates to carotids. Increase w/squatting, decrease with decr preload
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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

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15
Q

what should your INR be before operating?

A
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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

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17
Q

pts w/CKD on dialysis need to be dialized when?

A

24 hrs before

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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

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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

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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

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21
Q

what is pressure support vent?

A

pt rules rate but a boost of pressure is given (8-20)

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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

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23
Q

what is CPAP?

A

cont. positive airway pressure– pt must breathe on own but + pressure given all the time

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24
Q

What is PEEP?

A

Positive end expiratory pressure– given at end of cycle to keep alveoli open (5-20)

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25
Q

what is the best test to evaluate management of pt on vent?

A

ABG– check pa02 and paCO2

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26
Q

what is the best test to evaluate management of pt on vent?

A

ABG

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27
Q

If person is on a vent and ABG shows Pa02 is high, you should…

A

lower Fi02– bc free radicals can form–> increase damage

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28
Q

If person is on a vent and ABG shows Pa02 is high, you should…

A

lower Fi02

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29
Q

If person is on a vent and ABG shows PaC02 is high (pH is low), you should…

A

increase rate or TV

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30
Q

which is a more eficient change? rate or TV?

A

TV is a more efficient change– bc increased rate = increased deadspace (Minute ventilation equation)

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31
Q

steps to checking type of acidosis

A
  1. check pH–> respiratory acidosis
    – if HC03 is low and PaCO2 is low —> metabolic acidosis –> metabolic acidosis
  2. Check AG (Na- [Cl+HCO3])
    – nl = 8-12
    Gap: MUDPILES
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32
Q

steps to checking type of alkalosis

A
  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
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33
Q

steps to checking type of alkalosis

A
  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
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34
Q

what are three indicators of poor nutritional status that would make you want to delay?

A

albumin 20%, transferrin

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35
Q

how would you maximize someone’s nutrition?

A

enteral feedings (NOT TPN!)

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36
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

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37
Q

what are common causes hyperchloremic (>20) metabolic alkalosis?

A

Conn’s (hyper aldo) & Bartter’s, Gittleman’s

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38
Q

If smoker, what should you watch post-op as waking up from anesthesia?

A

O2 sat– don’t go to 100 bc used to retaining C02, need signal to breathe (possible BS per schwarzstein)

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39
Q

what are common causes of metabolic acidosis?

A 
MUDPILES
Methanol
uremia
DKA
Propylene glycol
isoniazide
lactic acidosis (MOST COMMON)
ethylene glycol
salicylates
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40
Q

Causes of Non gap metabolic acidosis

A

diarrhea (pooping out bicarb –> metabolic acidosis), diuretics, renal tubular acidoses (RTAs) (I

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41
Q

How do you check if someone has CHF before surg?

A

ejection fraction. if

How well did you know this?
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42
Q

What are first 6 criteria for Goldman’s index (tells you who’s at greatest risk for surgery)

A
  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
How well did you know this?
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43
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

How well did you know this?
1
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2
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5
Perfectly
44
Q

what else should be checked before surg related to AS (aortic stenosis)

A
  1. Listen for murmur– late systolic- systolic ejection murmur, crescendo-decrescendo murmur that radiates to carotids. Increase w/squatting, decrease with decr preload
How well did you know this?
1
Not at all
2
3
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45
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

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46
Q

what should your INR be before operating?

A
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47
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

How well did you know this?
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48
Q

pts w/CKD on dialysis need to be dialized when?

A

24 hrs before

How well did you know this?
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49
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

How well did you know this?
1
Not at all
2
3
4
5
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50
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

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51
Q

what is an assist control vent?

A

set TV & rate, but if pt takes a breath, vent gives the volume

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52
Q

what is pressure support vent?

A

pt rules rate but a boost of pressure is given (8-20)

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53
Q

when is pressure support vent particularly important?

A

imp for weaning

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54
Q

what is CPAP?

A

cont. positive airway pressure– pt must breathe on own but + pressure given all the time

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55
Q

What is PEEP?

A

Positive end expiratory pressure– given at end of cycle to keep alveoli open (5-20)

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56
Q

when is PEEP used most often?

A

ARDS and CHF

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57
Q

what is the best test to evaluate management of pt on vent?

A

ABG

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58
Q

how do you treat hypokalemia (Paralysis, ST depression, U waves happens)?

A

Give K (but don’t forget to moniter renal func!!! can become hyperkalemic quickly), max 40 mEq/hr

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59
Q

Peaked T waves, prolonged PR and QRS, sine waves = assoc w/which electrolyte derangement?

A

increased K

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60
Q

Txt for hyperkalemia (Peaked T waves, prolonged PR and QRS, sine waves)

A

Give Ca-gluconate then insulin + glucose, kayexalate, albuterol (B-agonist) and Na-bicarb. Last resort: dialysis!

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61
Q

In pt when ca is too high or too low, what is next best step?

A

EKG– look at QT interval, assess risk for torsades

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62
Q

which is a more eficient change? rate or TV?

A

TV isa more efficient change– bc increased rate = increased deadspace (Minute ventilation equation)

How well did you know this?
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2
3
4
5
Perfectly
63
Q

steps to checking type of acidosis

A
  1. check pH–> respiratory acidosis
    – if HC03 is low and PaCO2 is low —> metabolic acidosis –> metabolic acidosis
  2. Check AG (Na- [Cl+HCO3])
    – nl = 8-12
    Gap: MUDPILES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

steps to checking type of alkalosis

A
  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
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65
Q

If pH

A

-> respiratory acidosis (with metabolic comp)

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66
Q

what are risks of TPN?

A

acalculus cholecystitis, hyperglycemia, liver dysfxn, zinc deficiency, other ‘lyte probs

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67
Q

if pH > 7.4 = & if HCO3 = high and paCO2 = high what is the acid/base status?

A

–> metabolic alkalosis

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68
Q

If pH

A

metabolic acidosis w/resp comp

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69
Q

what are common causes hyperchloremic (>20) metabolic alkalosis?

A

Conn’s & Bartter’s Gittleman’s

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70
Q

what are common causes of hypochloremic (

A

vomiting, NG tube, antacids, diuretics

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71
Q

what are common causes of metabolic acidosis?

A 
MUDPILES
Methanol
uremia
DKA
Propylene glycol
isoniazide
lactic acidosis
ethylene glycol
salicylates
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72
Q

Non gap metabolic acidosis

A

diarrhea, diuretics, renal tubular acidoses (RTAs) (I

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73
Q

Pt comes in w/confusion, HA, cherry red skin– what are you concerned with? what test should you run? what is the txt?

A

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!)

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74
Q

what do you do w/hyponatremia…

A
  1. check plasma osms– make sure it’s real (not high glucose)
  2. check volume status
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75
Q

If you see clotting in a person w/edema, HTN & foamy pee think…

A

nephrotic syndrome (losing prots in urine– some of the first to go are things like antithrombin III and other anti-clotting prots)

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76
Q

suspected diagnoses for hypovolemia (tachy, dry mucus memb, tenting) w/ hyponatremia?

A

diuretics, vomiting + free water consumption

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77
Q

what’s special about ATIII deficiency as surgery students?

A

Heparin won’t work– can’t give it to them!

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78
Q

If you see clotting in a young woman w/multiple spontaneous Abortions, think…

A

Lupus anticoagulant

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79
Q

If you see clotting in someone who’s post-op & decreased plts and heparin was started w/in 5-14 days, think…

A

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!

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80
Q

what do you treat HIT (heparin induced thrombocytopenia) with? (Ab to heparin bound to PF4)

A

Leparudin or agatroban (synthetic heparin)–

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81
Q

if a pt is BLEEDING with an isolated decrease in platelets, think…

A

ITP (idiopathic thrombocytopenic purpura)

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82
Q

if a pt is BLEEDING w/normal platelets but increased bleeding time and PTT think…

A

vWD (Von Willebrand’s Disease)– problem with platelet function, not number

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83
Q

if pt is bleeding with low platelets, increased PT, PTT bleeding time, low fibrinogen and high Ddimer and schistocytes, think…

A

DIC- caused by gram - sepsis (LPS), disseminated carcinomatosis, OB stuff

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84
Q

how do you treat hypernatremia?

A

Replace w/D5W or hypotonic fluid

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85
Q

what do you worry about when correcting hypernatremia?

A

cerebral edema

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86
Q

how quickly can you correct hyper/hyponatremia?

A

btwn .5 and 1 meq/hr or between 12 & 24 meq/day

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87
Q

numbness, chvostek or troussaeu, prolonged QT interval happens with what electrolyte derangement?

A

decreased Ca

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88
Q

stones, bones, groans, psychotic overtones and shortened QT interval happens with what electrolyte derangement?

A

increased Ca

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89
Q

Burn pts are very susceptible to ifxn. how should you give someone abx after a burn?

A

topically! No PO or IV abx because breeds resistance!!

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90
Q

how do you treat hypokalemia (Paralysis, ST depression, U waves happens)?

A

Give K (Kidneys!), max 40 mEq/hr

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91
Q

Peaked T waves, prolonged PR and QRS, sine waves = assoc w/which electrolyte derangement?

A

increased K

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92
Q

Txt for hyperkalemia (Peaked T waves, prolonged PR and QRS, sine waves)

A

Give Ca-gluconate then insulin + glucose, kayexalate, albuterol and Na-bicarb. Last resort: dialysis!

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93
Q

what should someone do with a chemical burn (esp in eyeballs)?

A

irrigate > 30 min prior to ER

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94
Q

what is best first step for someone who had an electrical burn?

A

EKG– arrhythmia is most likely to kill person

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95
Q

if someone w/an electrical burn had LOC or an abnormal EKG, what should you do?

A

48 hr telemetry

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96
Q

If after a burn a urine dipstick is positive for blood but microscopic exam is negative for RBCs what is going on?

A

think rhabdo causing myoglobinuria, causing renal failure– (think ATN)

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97
Q

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?

A

rhabdo –> myoglobinuria – think ATN. Check K+ – might be too high from cells breaking open

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98
Q

what are risks of TPN?

A

acalculus cholecystitis, hyperglycemia, liver dysfxn, zinc deficiency, other ‘lyte probs

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99
Q

erythematous, painful but not peeling burn = what degree?

A

1st degree– effects epidermis

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100
Q

dark or pale burn w/no sensation is what degree burn?

A

3rd degree, through epidermis and dermis to the nerves

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101
Q

what is the concern w/circumferential burns?

A

compartment syndrome

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102
Q

loss of integrity of epidermis, very painful burn is what type?

A

2nd degree

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103
Q

how could you treat a circumferential burn to avoid compartment syndrome?

A

consider escharotomy

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104
Q

if pt comes in with singed nose hairs, wheezing, soot in mouth/nose, what should you be concerned about

A

laryngeal edema! Low threshhold for intubation!

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105
Q

if guy is stabbed in the neck and there are crackly sounds w/palmating the anterior neck tissue, what should we do?

A

fiberoptic broncoscope!! (might have airway.laryngail injury with sub q emphysema)

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106
Q

If guy has huge facial trauma, blood obscures the oral and nasal airway and GCS = 7, what should you do?

A

cricothyroidotomy (when you can’t asses airway)

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107
Q

If you see clotting in a person w/edema, HTN & foamy pee think…

A

nephrotic syndrome

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108
Q

if you have intubated a pt and find decreased breath sounds on the left, what happened?

A

you intubated the rt mainstem broncus– pull out!!

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109
Q

what’s special about ATIII deficiency?

A

Heparin won’t work

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110
Q

If you see clotting in a young woman w/multiple spontaneous Abortions, think…

A

Lupus anticoagulant

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111
Q

A pt dies suddenly after a 3rd yr medical student removes a central line. Dx? when else to suspect it?

A

Dx: air embolism.

Suspect it also when: lung trauma, vent use overzealous w/tidal volume, during heart vessel surgery

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112
Q

what do you treat HIT (heparin induced thrombocytopenia) with?

A

Leparudin or agatroban

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113
Q

if a pt is bleeding with an isolated decrease in platelets, think…

A

ITP (idiopathic thrombocytopenic purpura)

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114
Q

what’s next best step if pt is in hemorrhagic/hypovolemic shock (tachy, hypotensive, flat neck veins, nl CVP)

A

2 large bore periph IV- 2L NS or LR over 20 min followed by blood if we don’t see approp rise in VS

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115
Q

if pt is bleeding with low platelets, increased PT, PTT bleeding time, low fibrinogen and high Ddimer and schistocytes, think…

A

DIC- caused by gram - sepsis, carcinomatosis, OB stuff

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116
Q

how do you confirm pericardial tamponade?

A

FAST scan or just treat if strong clinical suspicion

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117
Q

what is the rule of 9s for a child?

A 
head: 19
thorax/abdo: 18
back: 18
each arm front and back: 9
each leg front and back: 14
genitalia: 1
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118
Q

what is the parkland formula for hydration s/p burn in an adult?

A

Kg x %BSA x 3-4

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119
Q

what is next best step for tension pneumo?

A

needle decompression, followed by chest tube. Don’t do CXR.

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120
Q

after a burn, what fluid should you use to replenish pts with?

A

Ringers lactate or NS

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121
Q

what do you see on a Swan-Ganz catheter in hypovolemic shock in terms of RAP/PCWP, SVR and CO?

A

RAP/PCWP decreases
SVR increases
CO decreases

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122
Q

what topical medication for s/p burns doesn’t penetrate an eschar and can cause leukopenia?

A

silver sulfadiazine

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123
Q

what topical med for s/p burns penetrates eschar but hurts like hell?

A

mafenide

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124
Q

what topical burn med doesn’t penetrate eschar and causes hypokalemia and hyponatremia?

A

silver nitrate

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125
Q

what do you see on Swan-Ganz cath in vasogenic shock in terms of RAP/PCWP, SVR and CO?

A

RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)

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126
Q

what is best first step for someone who had an electrical burn?

A

EKG

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127
Q

if someone w/an electrical burn had LOC or an abnormal EKG, what should you do?

A

48 hr telemetry

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128
Q

If after a burn a urine dipstick is positive for blood but microscopic exam is negative for RBCs what is going on?

A

myoglobinuria– think ATN

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129
Q

what do you see on Swan-Ganz cath for neurogenic shock in terms of RAP/PCWP, SVR and CO?

A

RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)

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130
Q

how do you txt neurogenic shock?

A

in adrenal insuff: txt w/dexamethasone and taper over several weeks

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131
Q

what are the criteria for compartment syndrome?

A
  1. 5 P’s: Pain, parasthesia, pallor, paralysis and poikilothermia (inability to regulate temp) and/or pulselessness
  2. Or compartment Pressure > 30 mmHg
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132
Q

what is the treatment for compartment syndrome s/p burn?

A

fasciotomy (or escharotomy)– at bedside!

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133
Q

if trauma pt comes in unconscious, what should you do?

A

intubate!!

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134
Q

if a trauma pt comes in w/a GCS

A

intubate!!

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135
Q

if a guy is stung by a bee and develops stridor and tripod posturing, what should you do?

A

intubate!!

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136
Q

if guy is stabbed in the neck, GCS = 15, but there’s an expanding mass in the lateral neck, what should you do?

A

intubate!!

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137
Q

if guy is stabbed in the neck and there are crackly sounds w/palmating the anterior neck tissue, what should we do?

A

fiberoptic broncoscope!!

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138
Q

txt for cardiogenic shock?

A

diuretics, tx the HR to 60-100, then address the rhythm. Next give vasopressor support if necessary

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139
Q

once you’ve intubated the pt, what’s the best next step?

A

check bilat breath sounds! then check pulse ox, keep it > 90%

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140
Q

if you have intubated a pt and find decreased breath sounds on the left, what happened?

A

you intubated the rt mainstem broncus– pull out!!

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141
Q

a pt has has inward mvmt of the rt ribcage upon inspiration. Dx? txt?

A

Dx: flail chest (> 3 consec rib fractures)
Txt: O2 and Pain control

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142
Q

a pt has confusion petechial rash in chest, axilla and neck and acute SOB. Dx? when to suspect it?

A

Dx: fat embolism

Suspect it: after long bone fracture (esp femur)

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143
Q

A pt dies suddenly after a 3rd yr medical student removes a central line. Dx? when else to suspect it?

A

Dx: air embolism.

Suspect it also when: lung trauma, vent use, during heart vessel surgery

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144
Q

if pt is hypotensive and tachycardic, worry about…

A

shock!

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145
Q

If pt is hypotensive, tachy w/flat neck veins and nl CVp what should you wory about?

A

shock! hypovolemic vs hemorrhagic

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146
Q

what’s next best step if pt is in hemorrhagic/hypovolemic shock (tachy, hypotensive, flat neck veins, nl CVP)

A

2 large bore periph IV- 2L NS or LR over 20 min followed by blood

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147
Q

if heart sounds are muffled, there’s JVD and electrical alternans and pulsus paradoxus– what are you worried about?

A

pericardial tamponade

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148
Q

how do you confirm pericardial tamponade?

A

FAST scan

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149
Q

what is the txt for pericardial tamponade?

A

Needle decompression, pericardial window or median sternotomy

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150
Q

if there are decreased breath sounds on one side and tracheal deviation AWAY from the collapsed lung what are you worried about?

A

tension pneumothorax

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151
Q

what is next best step for tension pneumo?

A

needle decompression, followed by chest tube. Don’t do CXR.

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152
Q

what would you expect on PE with hypovolemic shock?

A

hypotensive, TACHY, DIAPHORETIC, COOL, CLAMMY extrem

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153
Q

what do you see on a Swan-Ganz catheter in hypovolemic shock?

A

RAP/PCWP decreases
SVR increases
CO decreases

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154
Q

how do you txt hypovolemic shock?

A

crystalloid resuscitation

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155
Q

what causes vasogenic shock?

A

decreased resistance w/in capitance vessels, seen in sepsis (LPS) and anaphylaxis (histamine)

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156
Q

what is PE on person with vasogenic shock?

A

AMS, hypotension, WARM, DRY extrem (early), late looks like hypovolemic

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157
Q

what do you see on Swan-Ganz cath in vasogenic shock?

A

RAP/PCWP decreased
SVR decreased
CO increased (EF decreases)

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158
Q

how do you treat vasogenic shock?

A

fluid resuscitation (may cause edema) and tx offending organism

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159
Q

what is neurogenic shock?

A

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.

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160
Q

what do you see on PE in neurogenic shock?

A

hypotensive, BRADYCARDIC, WARM, DRY etrem, absent reflexes and flaccid tone. Adrenal insuff will have hypoNa and HyperK

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161
Q

what is the workup for penetrating wound in zone 1 of the neck (from the cricoid down)

A

aortography

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162
Q

how do you txt neurogenic shock?

A

in adrenal insuff: txt w/dexamethasone and taper over several weeks

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163
Q

what is cardiocompressive shock?

A

cardiactamponade or other processes exerting pressure on the heart so it can’t fulfill its role as a pump

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164
Q

what do you see on PE in cardio-compressive shock?

A

hypotensive, tachy, JVD, decreased heart sounds, nl breath sounds, pulsus paradoxus

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165
Q

if pt has a stab wound to the abdomen, but pt is stable- what do you do?

A

FAST exam. DPL (diagnostic peritoneal lavage) if FAST is equivocal. Exlap if either FAST or DPL are positive

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166
Q

if blunt abdo trauma pt w/hypotension/tachy, what should you do?

A

ex-lap

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167
Q

what is cardiogenic shock?

A

failure of heart as a pump– arrhythmias or acute heart failure

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168
Q

what would you expect to see on PE in person w/cardiogenic shock?

A

SOB, clammy extremities, rales bilat, S3, pleural effusion, decreased breath sounds, ascites, peripheral edema

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169
Q

what would you expect to see on swan-ganz cath in termsof RAP/PCWP, SVR and CO in cardiogenic shock?

A

RAP/PCWP increased
SVR increased
CO decreased

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170
Q

txt for cardiogenic shock?

A

diuretics, tx the HR to 60-100, then address the rhythm. Next give vasopressor support if necessary

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171
Q

what would we hear/see on PE for person with a pneumothorax?

A

absent/decreased breath sounds on one side, hyperressonance to percussion, distended neck veins and tracheal deviation if tension pneumo

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172
Q

what would we hear on PE for person with hemothorax?

A

absent/decreased breath sounds on one side, dull to percussion

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173
Q

when do we take someone to the OR for hemothorax?

A

high output > 1.5 L immediately or greater than 200 cc/hr over first 4 hours

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174
Q

how do we txt hemothorax?

A

chest tube

175
Q

“white out lung” after car accident? possible rib fractures?

A

pulmonary contusion

176
Q

do people with pulm contusion go to the OR?

A

no- -just make sure they’re coughing/clearing the airway

177
Q

what do we do for pain control with flail chest?

A

nerve block

178
Q

do we give opiates for flail chest?

A

no, decrease respiratory drive

179
Q

what are the 3 categories in GCS and the highest you can get for it

A

eyes (4), motor (6) voice (5)

180
Q

head trauma + LOC, what should you do?

A

CT!!!

181
Q

biconcave disk on head CT after head trauma =

A

epidural hematoma

182
Q

how can you tell acute from chronic subdural hematoma on a CT?

A

acute blood is bright, chronic is dark

183
Q

what can cause increased ICP?

A

hematoma, edema and tumor

184
Q

symptoms of increased ICP?

A

HA, vomiting, AMS

185
Q

what common ortho injury is assoc w/shoulder pain s/p seizure or electrical shock?

A

posterior shoulder disloc

186
Q

what common ortho injury is assoc w/arm outwardly rotated & numbness over deltoid…

A

ant shoulder disloc (numb bc of axillary nerve damage)

187
Q

what common fracture is assoc w/old lady FOOSH, distal radius displaced

A

Colle’s fracture– dinner fork deformity

188
Q

what are the anatomical borders of zone 3 of the neck?

A

upward from the angle of the mandible (includes trachea, esophagus)

189
Q

what common fracture is assoc w/”I swear I just punched a wall”

A

Metacarpal neck fracture “Boxer’s fracture” (usually 4-5th metacarpal) - May need K wire

190
Q

the clavicle is most commonly broken where?

A

btwn middle and distal 1/3s. Need figure of 8 device

191
Q

what is work up for penetrating wound to zone 2 of the neck? (angle of mandible down to the cricoid)

A

2d doppler +/- exploratory surgery (to check patency of vessels)

192
Q

what are the anatomical borders of zone 1 of the neck?

A

from the cricoid down

193
Q

what is the workup for penetrating wound in zone 1 of the neck (from the cricoid down)

A

aortography

194
Q

If there’s a GSW to the abdomen, what do you do?

A

ex lap + tetanus PPX

195
Q

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?

A

ex-lap!! (+ tetanus PPX)

196
Q

if stab wound and pt is unstable, with rebound tenderness & rigidity, or w/evisceration what should you do?

A

ex-lap + tetanus PPX

197
Q

if pt has a stab wound to the abdomen, but pt is stable- what do you do?

A

FAST exam. DPL if FAST is equivocal. Exlap if either FAST or DPL are positive

198
Q

if blunt abdo trauma pt w/hypotension/tachy, what should you do?

A

ex-lap

199
Q

blunt abdo trauma + unstable… what do you do?

A

ex-lap

200
Q

blunt abdo trauma + stable… what do you do?

A

get a CT

201
Q

if there’s a lower rib fx + bleeding into the abdome, be concerned about…

A

a spleen or liver lac (depending on side of fracture)

202
Q

if lower rib fx plus hematuria be concerned about…

A

kidney lac

203
Q

if kehr sign & viscera in thorax on CXR, be concerned about…

A

diaphragm rupture

204
Q

if handlebar sign, be concerned about…

A

pancreatic rupture

205
Q

if stable w/epigastric pain, best test is…

A

abdo CT

206
Q

if stable w/epigastric pain and retroperitoneal fluid is found on CT, consider…

A

duodenal rupture

207
Q

what is the kehr sign?

A

referred pain to shoulder from phrenic nerve of diaphragm

208
Q

if pt has pelvic trauma and is hypotensive and tachy (unstable!) you should…

A

do FAST and DPL to r/o bleeding in abdo cavity

209
Q

how do you stop a bleed into the pelvis?

A

stop bleed by fixing fx –> internal if stable, external if not

210
Q

if blood at the urethral meatus and high riding prostate consider…

A

pelvic fracture w/urethral or bladder injury

211
Q

what is next best test if blood at the urethral meatus and high riding prostate?

A

retrograde urethrogram– not a foley!! check urethral integrity!

212
Q

txt for simple wound ifxn (Fever POD >7 w/ pain at incision site, induation w/drainage)?

A

open wound and repack, no abx necessary

213
Q

what are you looking for on retrograde urethrogram in pt w/ blood at the urethral meatus and high riding prostate?

A

extravasation of dye– take 2 views to ID trigone injury

214
Q

if retrograde cystogram shows extraperitoneal extravasation in pt w/ blood at the urethral meatus and high riding prostate, what should you do?

A

bed rest + foley

215
Q

if retrograde cystogram shows intraperitoneal extravasation in pt w/ blood at the urethral meatus and high riding prostate, what should you do?

A

ex-lap and surgical repair

216
Q

what type of fractures always go to the OR? (4)

A
  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
Q

what common fracture is assoc w/shoulder pain s/p seizure or electrical shock?

A

posterior shoulder disloc

218
Q

what common fracture is assoc w/arm outwardly rotated & numbness over deltoid…

A

ant shoulder disloc

219
Q

what common fracture is assoc w/old lady FOOSH, distal radius displaced

A

Colle’s fracture

220
Q

what common fracture is assoc w/young person FOOSH, anatomic snuff box tenderness?

A

scaphoid fracture

221
Q

what common fracture is assoc w/”I swear I just punched a wall”

A

Metacarpal neck fracture “Boxer’s fracture”- May need K wire

222
Q

the clavicle is most commonly broken where?

A

btwn middle and distal 1/3s. Need figure of 8 device

223
Q

with scaphoid fracture, what do you usually see on xray?

A

nothing, esp immediately

224
Q

Fever on POD#1 most commonly caused by? how would you describe sx? how would you dx it? txt it?

A
  1. caused by atelectasis2

2. sx: low fever (

225
Q

POD 1 high fever (to 104) w/very ill appearing pt, most likely caused by…

A

Nec Fasc

226
Q

what is the pattern of spread of nec Fasc?

A

in sub q along scarpa’s fascia

227
Q

what are the common bugs of nec fasc?

A

GABHS or clostridium perfringens

228
Q

what is the txt for nec fasc?

A

IV PCN, Go to OR and debride skin until it bleeds

229
Q

most common cause of VERY HIGH FEVER (> 104) on POD1 + muscle rigidity!!

A

malignant hyperthermia

230
Q

malignant hyperthermia (VERY HIGH FEVER (> 104) on POD1 + muscle rigidity) is caused by…

A

succinylcholine or halothane

231
Q

what is the genetic defect that causes malignant hyperthermia?

A

Ryanodine receptor gene defect that caues increased intracellular calcium

232
Q

what is the txt for malignant hyperthermia?

A

dantrolene Na (blocks Ryanodine receptor an decreases intracellular calcium)

233
Q

Most common cause of Fever on POD 3-5 w/productive cough, diaphoresis…

A

PNA

234
Q

how to txt fever on POD 3-5 w/ productive cough, diaphoresis (PNA)

A

check sputum sample for culture, cover w/moxi etc to cover strep pneumo in the meantime

235
Q

Most common cause of Fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley…

A

UTI

236
Q

next best test for person w/ fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley…

A

UA (nitrite and LE) and culture

237
Q

how to txt fever on POD 3-5 w/dysuria, frequency, urgency, particularly in pt w/a foley…

A

change foley and txt w/wide spec abx until culture returns

238
Q

Fever POD 3-5 most likely caused by what or what?

A

UTI or PNA

239
Q

Fever > POD 7 w/ tenderness at central IV site?

A

central line ifxn

240
Q

what to do if you suspect central line ifxn?

A

blood cx from the line, pull it, abx to cover staph

241
Q

Fever POD > 7 w/ pain at incision site, edema, induation but no drainage

A

cellulitis

242
Q

txt for cellulitis (assoc w/Fever POD 7 w/ pain at incision site, edema, induation but no drainage)?

A

blood cx, start abx

243
Q

Fever POD >7 w/ pain at incision site, induation w/drainage?

A

simple wound ifxn

244
Q

txt for simple wound ifxn (Fever POD >7 w/ pain at incision site, induation w/drainage)?

A

open wound and repack, no abx necessary

245
Q

Fever POD > 7 w/pain w/ salmon colored fluid from incision?

A

dehiscence– surgical emergency!

246
Q

how do you txt dehiscence (Fever POD > 7 w/pain w/ salmon colored fluid from incision)?

A

surgical emergency! go to OR, iv abx, primary closure of fascia

247
Q

unexplained Fever pod > 7

A

abdominal abcess

248
Q

how do you dx abdominal abcess?

A

CT w/oral, IV and rectal contrast to find it. Diagnostic lap

249
Q

Tx of abdominal abcess

A

Drain it! Percutaneously, IR guided or sugically!

250
Q

what are random causes of fever > POD 7? (5)

A 
thyrotoxicosis
thrombophlebitis
adrenal insufficiency 
lymphangitis
sepsis
251
Q

pressure ulcers are caused by…

A

impaired blood flow –> ischemia

252
Q

should you culture pressure ulcers?

A

no– will just get skin flora

253
Q

rather than culturing pressure ulcers (which will just be contaminated by skin flora) you should…

A

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
Q

best prevention of pressure ulcers?

A

turning q2h

255
Q

describe stage 1 pressure ulcer

A

skin intact but red. Blanches w/pressure

256
Q

describe stage 2 pressure ulcer

A

blister or break in the dermis

257
Q

describe stage 3 pressure ulcer

A

SubQ destruction into the muscle

258
Q

describe stage 4 pressure ulcer

A

involvement of joint or bone

259
Q

stage 1-2 pressure ulcer txt:

A

get special mattress, barrier protection

260
Q

stage 3-4 pressure ulcer txt

A

get flap reconstruction surgery

261
Q

CXR showing peripheral cavitation and CT showing distant mets is most likely…

A

large cell carcinoma

262
Q

pleural effusions where you see fluid > 1cm on lat decubitus CXR should be txt w/…

A

thoracentesis

263
Q

transudative pleural effusions are most likely caused by…

A

CHF, nephrotic or nephrotic syndromw

264
Q

transudative pleural effusions with low pleural glucose is most likely caused by…

A

RA

265
Q

transudative pleural effusions with high lymphocytes is most likely caused by…

A

TB

266
Q

transudative pleural effusions with blood, most likely caused by…

A

malignancy or pulmonary embolus

267
Q

exudative pleural effusions are most likely…

A

papapneumonic, cancer, etc

268
Q

if a pleural effusion is complicated (+ gram stain or culture, pH

A

insert chest tube for drainage

269
Q

by light’s criteria an effusion is transudative if…

A

LDH

270
Q

in tall, thin young men w/sudden dyspnea (or person w/asthma or COPD/emphysema) suspect…

A

spontaneous pneumothorax – subpleural bleb ruptures –> lung collapse

271
Q

dx of spontaneous pneumothorax?

A

CXR

272
Q

txt of spontaneous pneumothorax?

A

CXR, txt w/chest tube placement

273
Q

indications for surgery for spontaneous pneumothorax?

A

ipsi or contra recurrence, bilateral pneumo, incomplete lung expansion, pilot, scuba diver or lives in a remote area

274
Q

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?

A

VATS, pleurodesis (bleo, iodine, or talc)

275
Q

lung abcesses are usually 2/2…

A

aspiration (drunk, elderly, enteral feeds)

276
Q

lung abcesses are most often found in what areas of the lung?

A

posterior upper or superior lower lobes

277
Q

Blowing diastolic murmur w/wodened pulse pressure and eponym parade?

A

aortic regurg

278
Q

what are indications for surgery for lung abcess?

A

abx fail, abcess > 6 cm, empyema present

279
Q

in the work up for a lung nodule, what is the first step?

A

find an old CXR to compare!

280
Q

characteristics of benign nodules?

A

1, popcorn calcification = hamartoma (most common)

  1. concentric calcification = old granuloma
  2. Pt
281
Q

txt of benign looking lung nodule?

A

CXR or CT scans q2mo to look for growth

282
Q

characteristics of malignant nodules

A
  1. pt has RF (smoker, old)
  2. > 3cm
  3. calcification
283
Q

tx of malignant looking nodule in the lung

A

remove nodule (w/bronc if central, open lung bx if peripheral)

284
Q

pt presents w/wt loss, cough, dyspnea, hemoptysis, repeated PNA or lung collapse, suspect

A

lung cancer!

285
Q

Most common lung cancer in non-smokers and women (also very commonly seen in smokers!)?

A

adenocarcinoma, occurs in scars of old PNA

286
Q

where is adenocarcinoma most commonly located in the lungs, and where does it metastasize to?

A

peripheral cancer.

mets to liver, bone, brain and adrenals

287
Q

common characteristic of neoplastic effusions?

A

exudative w/high hyaluronidase

288
Q

pt w/Kidney stones, constipation and malaise low PTH and central lung mass most likely has…

A

squamous cell carcinoma w/paraneoplastic syndrome 2/2 secretion of PTH-rP. Low PO4, High Ca

289
Q

Pt w/shoulder pain, ptosis, constricted pupil and facial edema most likely has…

A

superior sulcus syndrome from small cell carcinoma (a central cancer)

290
Q

indications for surgery w/GERD?

A

bleeding, stricture, Barrett’s, incompetent LES, max dose PPI w/still sxs, or no want meds

291
Q

if hematemesis occurs after vomiting w/subq emphysema, and high amylase content in pleural effusion think…

A

Boerhaave’s (esophageal rupture)

292
Q

how do you txt SIADH from small cell carcinoma?

A

fluid restric +/- 3% saline in

293
Q

CXR showing peripheral cavitation and CT showing distant mets is most likely…

A

large cell carcinoma

294
Q

Pathophys of ARDS?

A

inflammation –> impaired gas xchange, inflam mediator release, hypoxema

295
Q

causes of ARDS?

A

sepsis, gastric aspiration, trauma, low perfusion, pancreatitis

296
Q

Diagnosis of ARDS is dependent on (3 things)

A
  1. Pa02/Fi02
297
Q

txt of ARDS?

A

mechanical vent w/PEEP

298
Q

Systolic ejection murmur w/crescendo/decrescendo, louder w/squatting, softer w/valsalva + parvus et tardus = what murmur?

A

Aortic stenosis

299
Q

what makes aortic stenosis w/crescendo/decrescendo systolic ejection murmur louder? softer?

A

louder w/squatting, softer w/valsalva

300
Q

Systolic ejection murmur louder w/vasalva, softer w/squatting or handgrip = what murmur?

A

HOCM

301
Q

what makes HOCM systolic ejection murmur louder? softer?

A

louder w/vasalva, softer w/squatting or handgrip

302
Q

what murmur = late systolic w/click, louder w/vasalva and handgrip, softer w/squatting?

A

MVP

303
Q

MVP late systolic murmur w/click is louder with __? softer?

A

louder w/vasalva and handgrip, softer w/squatting

304
Q

holosystolic murmur radiates to axilla w/left atrial enlargement (LAE) = what murmur?

A

mitral regurg

305
Q

Holosystolic murmur w/late diastolic rumble in kids is ?

A

VSD

306
Q

continuous machine like murmur =?

A

PDA

307
Q

wide fixed and split S2 =?

A

ASD

308
Q

rumbling diastolic murmur w/an opening snap, left atrial enlargement (LAE) and A-fib?

A

mitral stenosis

309
Q

Blowing diastolic murmur w/wodened pulse pressure and eponym parade?

A

aortic regurg

310
Q

when should you do surgery for gastric ulcer?

A

if lesion persists after 12 wks of txt

311
Q

how do you txt zenker’s diverticulum?

A

surgery

312
Q

is zenker’s diverticulum a tru or false diverticulum?

A

false! only contains the mucosa!

313
Q

dysphagia to liquids and solids, think…

A

achalasia

314
Q

txt achalasia (dysphagia to liquids and solids) w/… (4)

A
  1. Calcium channel blockers (CCB)- like nifedipine
  2. nitrates ( isosorbide dinitrate and nitroglycerin)
  3. botox
  4. heller myotomy
315
Q

achalasia (dysphagia to liq + solids) = assoc w what 2 dz?

A

chagas dz and esophageal cancer

316
Q

dysphagia worse w/hot & cold liquids + chest pain that feels like mI w/NO regurg =?

A

diffuse esophageal spasm

317
Q

how do you txt diffuse esophageal spasm (dysphagia worse w/hot & cold liquids + chest pain that feels like mI w/NO regurg)?

A

calcium chan blockers (CCB) like nifedipine or nitrates (isosorbide dinitrate and nitroglycerin)

318
Q

epigastric pain worse after eating or when laying down, assoc w/ cough, wheeze and hoarse =

A

GERD

319
Q

most sensitive test for GERD?

A
  • 24 hr pH monitoring.

- do endoscopy if “danger signs” present. Tx w/behav mod 1st, then antacids, H2 blocker

320
Q

what is dieulafoy’s

A

massive hematemsis bc the mucosal artery erodes into the stomach

321
Q

how do you txt GERD?

A

Tx w/behav mod 1st, then antacids, H2 blocker, PPI

322
Q

indications for surgery w/GERD?

A

bleeding, stricture, Barrett’s, incompetent LES, max dose PPI w/still sxs, or no want meds

323
Q

if hematemesis occurs after vomiting w/subq emphysema, think

A

Boerhaave’s

324
Q

if gross hematemesis unprovoked in a cirrhotic w/pHTN, think…

A

Gastric varices

325
Q

If progressive dysphagia w/wgt loss think…

A

esophageal carcinoma

326
Q

next best test if you suspect boerhaave syndrome?

A

CXR, gastrograffin esophagrom. NO endoscopy!!

327
Q

what test is contraindicated in boerhaave syndrome?

A

endoscopy!!!

328
Q

if pt is in hypovolemic shock s/p esophageal varices you should…

A

do ABC
NG lavage
medical txt w/octreotide or SS balloon
tamponade only if you need to stabilize for transport

329
Q

txt of boerhaave syndrome?

A

surgical repair if full thickness

330
Q

txt of choice for esophageal varices?

A

endoscopic sclerotherapy or banding

331
Q

Should you prophylactically band asymptomatic varices?

A

no! Give BB

332
Q

what is txt of SMA syndrome?

A

restore weight/nutrition. Can do Roux-en-Y

333
Q

most common esophageal cancer/location in people w/long standing GERD?

A

adenocarcinoma in the distal 1/3

334
Q

Best 1st test for suspected esophageal cancer?

A

barium swallow, then endoscopy w/Bx, then staging CT

335
Q

acid reflux pain after eating, when laying down = assoc w/?

A

hiatal hernia

336
Q

type 1 hiatal hernia?

A

sliding GE jxn herniates into thorax. Worse for GERD. Tx sxs

337
Q

Type 2 hiatal hernia

A

paraesophageal. Abd pain, obstruction, strangulation –> needs surgery!

338
Q

does type 1 or type 2 hernia need surgery?

A

T2. T1 can be txt w/meds for GERD

339
Q

middle epigastric pain worse w/eating?

A

gastric ulcers

340
Q

gastric ulcers = assoc w/what 3 RF?

A

H. pylori, NSAIDS, steroids

341
Q

work up for gastric ulcers?

A

double contrast barium swalow- punched out lesion w/regular margins. EGD w/bx can tell H-pylori, malignant or benign

342
Q

tx adenocarcinoma of the panc w’wipple IF… (3)

A
  1. no mets outside abdomen,
  2. no extension into SMA or portal vein
  3. no liver or peritoneal mets
343
Q

what kind of gastric cancer is most common, especially in Japan?

A

adenocarcinoma

344
Q

what is a Krukenberg tumor?

A

Gastric CA that has met to the ovaries

345
Q

where is virchow’s node?

A

in the L supraclavicular fossa

346
Q

Lymphoma is often assoc w/…

A

HIV (check this fact from slide 41 of PDF)

347
Q

what is Blummer’s shelf?

A

mets in the pelvic cul de sac felt on digital rectal exam (DRE) (assoc with gastric cancer?)

348
Q

Where is the Sister Mary Joseph node?

A

umbilical node (important for gastric ca?)

349
Q

MALT-lymphoma is associated w/…

A

H pylori

350
Q

what is mentriers? What finding on endoscopy is characteristic?

A

a protein losing erteropathy– look for enlarged ruggae

351
Q

Gastric varices are indicative of…

A

splenic vein thrombosis

352
Q

tx for VIPoma?

A

octreotide can help sx

353
Q

middle epigastric pain that gets better w/eating is assoc w/what?

A

duodenal ulcers

354
Q

biggest RF for duod ulcers?

A

H pylori – 95%

355
Q

txt of healthy pts

A

trial of H2 block or PPI

356
Q

Dx of duodenal ulcers?

A

blood, stool or breath test for h pylori but endoscopy w/bx = best b/c it can exclude cancer

357
Q

Tx of duodenal ulcers w/H-pylori and how do you make sure h-pylori is gone afterwards?

A

PPI, clarithromycin & amoxicillin x2wks. Breath or stool test can be test of cure.

358
Q

what should we suspect if middle epigastric pain/ulcers don’t resolve w/txt?

A

zollinger-ellinson syndrome

359
Q

best test for zollinger-ellison syndrome?

A

secretin stim test (find innap high gastrin)

360
Q

txt for zollinger ellison syndrome?

A

surgical resection of pancreatic/duodenal tumor

361
Q

if someone is dx with zollinger ellison syndrome, what else should you look for?

A

Pituitary and parathyroid probs– think MEN 1

362
Q

a pt has bilious vomiting and post-prandial pain. He recently lost 200 lbs on “biggest loser” Be concerned about…

A

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
Q

pathophys of SMA syndrome

A

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
Q

what is txt of SMA syndrome?

A

restore weight/nutrition. Can do Roux-en-Y

365
Q

Middle epigastric pain straight through to the back– most likely…

A

pancreatitis

366
Q

most common etiologies of pancreatitis?

A

ETOH and gallstones

367
Q

txt cholangiocarcinoma w…

A

surgery + rad

368
Q

Txt of pancreatitis?

A

NG suction, NPO, IV rehydration and observation

369
Q

Bad prognostic factors for pt w/pancreatitis? (13)

A
  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
Q

chronic pancreatitis is assoc w/? (3)

A

chronic MEG pain, DM, malabsorption (steatorrhea)

371
Q

chronic pancreatitis can cause splenic cein thrombosis what can lead to,,,

A

gastric varices

372
Q

If in the head of the panc, adenocarcinoma of the pancreas can cause courvoisier’s sign which is…

A

large non-tender GB, itching and jaundice

373
Q

what is trousseau’s sign?

A

migratory thrombophlebitis– assoc w/ adenocarcinoma of the panc

374
Q

tx adenocarcinoma of the panc w’wipple IF… (3)

A
  1. no mets outside abdomen,
  2. no extension into SMA or portal vein
  3. no liver or peritoneal mets
375
Q

what is whipple’s triad (assoc w/ insulinoma)

A

Sxs (sweat, tremors, hunger, seizures) + BGL

376
Q

what are sxs of insulinoma?

A

same as low glucose!– sweat, tremors, hunger, seizures

377
Q

labs c/w insulinoma?

A

insulin increased
c-peptide inc
pro-insulin inc

378
Q

sxs of glucagonoma?

A

hyperglycemia, diarrhea, wt loss

379
Q

rash characteristic of glucagonoma?

A

necrolytic migratory erythema

380
Q

somatistainoma are assoc w/?

A

malabsorption (seatorrhea) etc from exocrine panc malfxn

381
Q

are somatistainoma usually malig or benign?

A

malig

382
Q

VIPoma sxs?

A

watery diarrhea, hypokalemia, dehydration, flushing

383
Q

VIPoma looks similar to what syndrome?

A

carcinoid

384
Q

tx for VIPoma?

A

octreotide can help sx

385
Q

most likely dx w/ RUQ pain into the back, n/v, Fever, worse s/p fatty foods?

A

acute cholecystitis

386
Q

best 1st test?

A

US

387
Q

txt?

A

cholecystectomy? perc cholecystostomy if unstable (CHECK THIS– now it mt be abx!)

388
Q

RUQ pain, high bili and high alk phos =?

A

choledocolithiasis

389
Q

dx of choledocolythiasis?

A

US will show CBD stone (or lg dilitation of CBD?)

390
Q

txt for choledocolithiasis?

A

chole +/- ERCP to remove stone

391
Q

rupture of enchinococcus liver cyst (pt from mexico presents w/RUQ pain and lg liver cysts found on US) will cause…

A

anaphylaxis

392
Q

what is Charcot’s triad? Assoc w/?

A

RUQ pain, F, jaundice– ascending cholangitis

393
Q

what is Reynold’s pentad? assoc w/?

A

RUQ pain, fever, jaundice, ↓BP, AMS– ascending cholangitis

394
Q

txt ascending cholangitis w/?

A

fluids & broad spectrum abx, ERCP and stone removal

395
Q

describe T1 choledochal cysts…

A

fusiform dilation of CBD

396
Q

how do you txt T1 choledochal cysts (fusiform dilation of CBD)?

A

excision

397
Q

T5 choledochal cysts = assoc w/what dz? what is txt?

A

Caroli’s Dz. Cysts in intrahepatic ducts– needs liver transplant!

398
Q

cholangiocarcinoma is rare. RF for it are (3)

A

Primary sclerosing Cholangitis (UC)
Liver flukes
thorothrast exposure

399
Q

txt cholangiocarcinoma w…

A

surgery + rad

400
Q

Hepatitis where AST = 2x ALT =?

A

Alcoholic hep (reversible)

401
Q

hepatitis where AST > ALT high (1000s) = ?

A

Viral hep

402
Q

AST & ALT high s/p hemorrhage, surg or sepsis is most likely…

A

shock liver

403
Q

cirrhosis and portal htn txt with…

A

SS and VP vasoconstrict to decrease portal pressure

Bblockers also decrease portal pressure

404
Q

do you need to treat esophageal varices prophylactically?

A

no, but band/burn them once they bleed once

405
Q

TIPS relieves portal HTN BUT worsens…

A

hepatic encephalopathy

406
Q

txt hepatic encephalopathy w/…

A

lactulose (helps rid body of ammonia)

407
Q

RF for hepatocellular carcinoma?

A

chronic HepB carrier > Hep C
cirrhosis for any reasons
aflatoxin or carbon tetrachloride exposure?

408
Q

Dx hepatocellular ca w/?

A

high AFP (in 70%), CT/MRI

409
Q

txt of hepatocellular ca?

A

surgically remove solitary mass, use rads or cryoablation for pallation of multiple

410
Q

women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock =?

A

hepatic adenoma

411
Q

how do you dx hepatic adenoma (women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock)?

A

US or MRI

412
Q

Txt of hepatic adenoma (women on OCP w/palpable abd mass or spontaneous rupture of abdo mass w/hemorrhagic shock)?

A

D/c OCPs, resect if lg or pregnancy is desired

413
Q

2nd Most common benign liver tumor. It’s more common in W > M, but less likely to rupture than hepatic adenomas?

A

focal nodular hyperplasia

414
Q

most common bugs causing bacterial abcess on the liver?

A

E. Coli, bacteriodes, enterococcus

415
Q

tx of bact abcess on the liver?

A

surgical drainage and IV abx

416
Q

RUQ pain, profuse sweating and rigors, palpable liver =?

A

liver abcess 2/2 entamoeba histolytica

417
Q

txt for liver cyst 2/2 entamoeba histolytica?

A

metronidazole. Don’t drain it!

418
Q

pt from mexico presents w/RUQ pain and lg liver cysts found on US =?

A

echinococcus

419
Q

mode of eccinococcus transmission?

A

hydatid cyst paracyte from dog feces

420
Q

lab findings common w/ eccinococcus ifxn (pt from mexico presents w/RUQ pain and lg liver cysts found on US)

A

eosinophilia and + casoni skin test

421
Q

what is the casoni skin test?

A

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
Q

how do you txt enchinococcus (pt from mexico presents w/RUQ pain and lg liver cysts found on US)?

A

albendazole and surgery to remove entire cyst. RUPTURE CAUSES ANAPHYLAXIS!!

423
Q

rupture of enchinococcus liver cyst (pt from mexico presents w/RUQ pain and lg liver cysts found on US) will cause…

A

anaphylaxis

424
Q

s/p splenectomy, what should you do for post-ob thrombocytosis > 1mil?

A

give aspirin

425
Q

what ppx should you give s/p splenectomy?

A

prophylactic PCN + S. pneumo, H. flu and N meningitidis vaccines

426
Q

ITP should be considered in cases of…

A
  1. isolated thrombocytopenia (with bleeding gums, petechiae, nosebleeds)
  2. decreased plt count/inc megakaryocytes in marrow
  3. NO SPLENOMEGALY
427
Q

how should ITP be txt?

A

steroids 1st. If relapse, splenectomy

428
Q

what should be considered in pt w/isolated thrombocytopenia (with bleeding gums, petechiae, nosebleeds), decreased plt count/inc megakaryocytes in marrow, & NO SPLENOMEGALY

A

ITP!

429
Q

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?

A

hereditary spherocytosis

430
Q

pts w/hereditary spherocytosis are prone to…

A

gallstones

431
Q

how should you txt pt w/hereditary spherocytosis?

A

splenectomy (accessory spleen too)

432
Q

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)?

A

splenic fracture

433
Q

Kehr’s sign in the left shoulder is considered a classical symptom of…

A

splenic rupture

Surgery shelf high yield (1 decks)

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