Kaplan Flashcards
1
Q
LMWH vs fractionated heparin binding
A
LMWH more specific binding potential than unfractionated heparin
LMWH more reliable effect on aPTT
2
Q
SBO symptoms
A
suddent abdominal distention
vomiting, no gas
high pitched bowel sounds
diagnosed best with CT
3
Q
Prostatic abscess
A
40-60 years old
aerobic gram neg bacilli and S. aureus
presentation is repeat UTI that seems to resolve with antibiotics
important diagnositc clue: fluctant mass on rectal exam, exam can be variable though
treat by evacuation by transurethra or perineal route
4
Q
most accurate test for chronic pancreatitis
A
secretin stimulation test
should release a large volume of bicarb rich pancretic fluid in response to IV secretin
5
Q
signs of urethral injury
A
trauma to perineum/pelvic fracture unable to void even though has the urge when voiding no urine comes out blood at the meatus perineal, penile, scrotal hematoma high riding prostate boggy prostatic fossa loss of prostatic attachments to the urogenital diaphragm or prostate hematoma PERFORM: retrograde urethrogram, 14 french foley inject contrast, take xrays, advance if no trauma
6
Q
lower abdominal u/s
A
confirms bladder distention
says nothing about the urethra
7
Q
high grade gastric lymphoma treatment
A
chemo or radiation, usually chemo
need to assess depth of cancer to see if surgery is needed or not
if whole depth, risk of perforation during chemo so need surgery
8
Q
low grade lymphomatoid transformation (MALToma) marginal zone lymphoma treatment
A
need to eradicate H. pylori
9
Q
compartment pressure should be
A
30-40 mmHg
10
Q
bone trauma without compartment syndrome
A
expanding hematoma with no distal pulses - we know the vasculature is compromised–> surgical exploration
assess vasculature if distal pulses are not intact with CT angio
if vasculature intact, can reduce the fracture
11
Q
symptoms/treatment of incarcerted inguinal hernia
A
mild but pain is present (rare with hernia) erythema low grade fever tender mass treat with emergent surgicall repair
12
Q
complication of AAA repair
A
ischemic colitis (bloody diarrhea and leukocytosis), do a colonoscopy
Pathophys: IMA origin covered by graft, some patiets dont have good collateral from marginal artery of dummund from SMA –>ischemia of descending and sigmoid colon
Colonoscopy/flex sig: gold standard, cyanotic or shedding mucosa
Management: colonic resection with colostomy
13
Q
active bloody bowel movements
A
nasogastric eval - for source before ligament of trietz
then tagged rbc study to see where blood is pooling if first eval is negative
14
Q
most common reason for hypoxia in post op first night
A
atelectasis, get a CXR
15
Q
painless jaundice
A
pancreatic cancer
get a CT, if negative ERCP/PTC to detect smaller malignancies
16
Q
severe dehydration in alert patient
A
use 5% dextrose in 1/2NS
17
Q
NS and 3% saline used for what
A
replace hyponatremia
18
Q
Ringer’s lactate uses
A
hypovolemic shock
isotonic fluid loss
normal ion levels
composition and osmolatiry similar to that of plasma
19
Q
when do you repair an umbilical hernia in a child
A
if symptomatic (tender, vomiting, abdominal distention) when irreducible if persists after 2 years
20
Q
older man who smokes and drinks and has rotten teeth with neck mass
A
SCC with mets to node, need to biopsy with panendoscopy or FNA
21
Q
reducing ICP, noninvasive
A
raising head of bed
sedation with propofol
hyperventilation to PaCO2 of 30-35
administration of mannitol
22
Q
reducing ICP, invasive
A
burr hole decompression
craniotomy and evacuation
23
Q
drugs that can exacerbate urinary retention, esp in BPH
A
antihistamines
decongestants
nasal drops
stimulation of alpha adrenergic receptors
24
Q
classic place for bursitis to occur
A
where tendons or muscles pass over a bony prominence
25
carpal navicular bone fracture
often unrecognized
fall on outstretched hand
finding is pain with palpation over the anatomic snuff box
26
thin patient with blunt epigastric trauma, at risk for
pancreatic injury secondary to compressing pancreas against the spine
might see elevated amylase and lipase
can see with contrast in a thin patient
27
vascular injury signs that are an indication for immediate surgical exploration
```
active hemorrhage
expanding hematoma
pulse deficit
bruit or thrill
distal ischemia (6Ps: paresthesia, poikilothermia, pulselessness, pallor, pain, paralysis)
```
28
vascular injury signs that are indication for imaging before possible surgery
```
history of hemorrhage at scene
stable, nonexpanding hematoma
proximity to major vessel
anatomically related nerve deficit
ABI
```
29
ranson criteria
```
age>55
wbc> 16000
glucose >200
AST> 250
LDH>350
```
30
bacteriuria definiion in a asymptomatic patient
>100,000 CFU/mL
31
Approaches to BPH medications
tamsulosin-a blocker, can cause OrthoHTN
finasteride- 5a-reductase inhibitor, decreases DHEA and prostatic volume
dutasteride, both 5reductase enzyme inhibitor, marked DHEA suppression, no generic form
32
nissen fundoplication
surgical procedure for medication resistant GERD or hiatal hernia
33
epididymitis presentation
```
fever
UTI with prostatitis
scrotal pain with flank pain
may have N/V
+Prehn sign
treat with elevation and antibiotics
```
34
Prehn sign
scrotal pain relieved with elevation of the scrotal contents
35
Charcots triag
for cholangitis
jaundice
fever
abdominal pain
36
reynolds pentad
```
for cholangitis
jaundice
fever
abdominal pain
shock
altered mental status
```
37
before getting surgery for carpal tunnel you must
do EMG and nerve conduction studies
38
medical treatment for hyperPTH
primary- estrogen/progesterone therapy beneficial in postmenopausal
Vitamin D in secondary hyperPTH
39
Medical treatment for DI
desmopressin (ADH analogue)
40
medical treatment for SIADH
demeclocyclin (ADH antagonist)
41
Management of placenta abruption
Deliver the fetus if there is hemodynamic instability
| if still unstable after delivery, give fluids and red blood cells
42
pyloroplasty
widens the pyloris
| used for gastroparesis, but not really anymore because of medical advancements
43
truncal vagotomy
cuts the anterior and posterior divisions of the vagus
| used for PUD, but not really anymore since advancements of medication for PUD
44
CBC changes to acute massive blood loss
Hb/Hct don't change much at the beginning because they are a concentration and blood loss is lost as a whole.
When you start equilabrating, Hb/Hct/WBC will decrease
BP is a better measurement to use for estimation of blood loss
45
unequivocal results for hip dislocation on newborn exam, next step
do ultrasound
babies dont have enough calcification for xrays
put in a pavlik abduction splint
46
hip fracture treatments
external fixation if unstabe
femoral neck - replace with prosthesis
interchocanter - ORIF, need anticoag after
shaft - rod fixation
47
malignant hyperthermia treatment
stop inhaled anesthetics
administer dantrolene
begin cooling protocol
48
heller myotomy
done for achalasia
| opens up a tight LES
49
esophageal cancer treatment options
trans hiatal esophagectomy for symptomatic cancer above the cardia junction
transthoracic resection of the lower esophagus - early cancer or high grade dysplasia at the esophagogastric junction
50
next steps in management for suspected kidney stones
xray then spiral ct without contrast
51
indications for scope with gerd symptoms
alarm symptoms: new onset >45, dysphagia/odynophagia, bleeding
>50 with GERD for >5 years
52
hemolytic vs nonhemolytics transfusion reactions
```
both have fever
hemolytics is from a mistake (ABO incompatible)
nonhemolytics from reaction to wbc
most common reacion is nonhemolytic
most common deadly reaction is hemolytic
```
53
morton neuoma
benign neuroma of third plantar interdigital nerve
54
solutions for lack of erection
traumatic - pudendal artery revascularization
physcogenic - therapy
progressive vascular disease - medications
last resort - implantable penile prosthesis
55
thoracic outlet syndrome causes
anterior scalene muscle - pinches vein inbetween muscle and clavical, relieved with surgery
cervical rib - relieve with surgery, usually young kid because a congenital problem
pancoast tumor - old smoker with associated horners
subclavian steal - cold tingling and muscle pain with posterior neuro problems
subclavian vein thrombosis - edema and venous engorement, complication of venous TOPS
arterial - absent pulses, limb ischemia
neurological - from brachial plexus impingment (paresthesia, muscular atrophy)
56
bladder obstruction from BPH symptom relief
place catheter
if meet resistance
perform suprapubic tube placement
57
most common cause of no UOP post surgery
kinked catheter
58
treatment for diffuse esophageal spasm
CCB and lifestyle modification
59
cystic testicular lesion
spermatocele versus epidiymal cyst
both benign and dont need follow up
if become symptomatic can remove surgically
60
bruit and palpable thrill over area
could be an AV fistual from trauma, used for dialysis
61
indications for immediate hemodialysis
Acidosis (severe)
Electrolytes (hyperkalemia)
intoxication with nephrotoxic substances (ethylene glycol)
62
Two typical presentations for melanoma
primary tumor eye enucleation, then 20 years later with mets in liver
missing toe
63
Two malignant tumors with eye enucleation
melanoma and retinoblastoma
64
How to monitor melanomas clinically
monitor the tumor marker, tyrosinase
65
sarcomas mets
to the lungs via bloodstream
66
acalculous cholecystitis
fever, leuko, thickened gallbladder with pericholecystic fluid
no gallstones
stasis phenomena
US and HIDA similar to calculous cholecystitis
67
Ogilvie syndrome
colonic pseudo obstruction
nonmechanical obstruction of large bowel (sym/para imbalance)
large bowel version on postop ileus
constipation or obstipation, distention
rule out obstructive carcinoma can give IV neostigmine (cholinesterase inhibitor and para agonist), need to admisinter slowely to avoid bronchospasm and brady
68
painless neck mass differential
mets (80%) from lung or bowel, medial neck
| lymphoma, less likely, lateral or axillary
69
pickwickian syndrome
obesity hypoventilation syndrome
| low oxygen an dhigh CO2
70
indication for bariatric surgery
```
motivated
BMI>40
BMI>35 with serious comorbidities
reasonable surgical risk
failure of previous weight loss regiments
```
71
overflow incontinence from BPH treatment
alpha blocker - doxazosin, terazosin, tamsulosin
| 5a-reductase - finesteride
72
stress incontinece therapy
alpha agonists, tighten sphincter
73
bladder hyperactivity
oxybutynin and tolterodine (antispasmodics
74
surgery with blood loss and decreasing UOP
give fluid challenge to see if UOP increases, if yes was dehydrated
can also draw CBC to see if need to be transfused
75
new palsy after closed reduction
try to remanipulate the injury
76
holstein lewis fracture
radial nerve palsy caused by humerus fracture in the middle third
77
nonocclusive mesenteric ischemia (NOMI)
vasoconstriction of mesenteric vessels and hypoperfusion of vessels
usually has pre exisiting arterial atherosclerosis and has abdominal pain after hypoperfusion or vasoconstriction
see string of sausage sign, no cut offs
78
acute pancreatitis
abdominal pain
N/V
Grey turner sign
common complication - abscess (2 weeks) and psudeocyst (6 weeks)
79
grey turner sign
bruising along the flanks caused by SubQ tracking of digested blood around the abdomen from the inflamed pancreas
80
short vs long arm cast
short arm -wrist immobilization
| long arm - wrist and elbow
81
ED
nocturnal erections
losing desire
losing ability to maintain
1. if no then psychogenic
2. check testosterone
3. give PDI
82
cardiogenic shock
use dobutamine
| epi if not responding
83
right vs left sided colon cancer
left - change in stool shape, blood coating stool
| right - anemia, +FOBT, no changes in stool because larger colon diameter and thinner stool consistency
84
chronic pancreatitis complication of spleen
rare - splenic vein thrombosis
splenic veins run along posterior surface of pancreas
inflammation causes thrombosis
gastric varices without concomitant esophageal varices (gastric veins drain into splenic veins)
treat with splenectomy
85
nasal polyps in a child
think about cystic fibrosis
| history of allergies in child
86
purulent malodorous discharge from nose in child
foreign body rotting
| can cause erosion and bleeding
87
STI prostatitis
usually e coli or chlamydia
need to treat for 4-6 weeks
use floro or trimeth sulfa
ofloxacin has broad coverage for mixed infections
88
wound dehiscence
clear pink fluid soaking through dressing
not red or inflammed
not distended
afebrile
tape wound, bind abdomen, avoid increases in intraabdominal pressure
89
breast lump size delinaiton
4 cm mastectomy with axillary sampling
90
SCC oropharynx risk factors
alcoholism
chronic tobacco use
HPV infection
91
hirschsprung
get barium enema for diagnosis
| then do biopsy of normal region
92
pringle maneuver
clamping portal triad in hepatoduodenal ligament
hepatic arteries, portal veing
if still bleeding means hepatic veins or IVC
93
visceral artery aneurysms
hepatic, splenic, rare finding
most found incidentally
most commonly in splenic and rupture during pregnancy
managed surgically and by transcatheter embolization
splenic aneurysms have signet ring sign on plain film
should be repaired in all child bearing aged women because of tendency to rupture
94
Diagnostic test for colovesical fistula
CT scan
95
tagged rbc scan vs technetium
tagged used for people actively bleeding
| 99m used for people who have bleed, or a kid who bled, concnern for meckles
96
what makes diverticulitis complicated
perforation, abscess, fistula formation
| needs surgical intervention
97
treatment of osgood schlatter
conservative and hard cast if necessary
| no surigcal intervention
98
SCLC para
cushing disease
not operable
chemo and rad
99
when to biopsy nodes in thyroid cancer
only when there are palpable nodes
100
hypothyroid person who has surgeru not doing well, what do you give
steroids, adrenals have not been functioning well
cant just load T4 because adrenal cant just start working
need to give steroids then fix hypothyroid
101
diagnose a PE
do a spiral CT
| not VQ scan because less accurate
102
GI bleed after 325 aspirin
still an underlying etiology, not just anticoaged
| need to look for cancer with colonoscopy
103
how to distinguish liver pyogenic vs amebic abscess on CT
you cant
do it clinically
pyogenic will be jaundice, septic, gallbladder disease
amebic will have travelled and is younger, treat with metronidazole then drain is doesnt get better
104
congenital megaureter
dilated distal ureter without evidence of obstruction
especially considered when proximal ureter dilation, pelvocaliectasis, hydronephrosis are absent
path: aperistalsis of the distal ureter
some people are asym but some progress to hydroneph and nonfunctional kidney
affects males more then females
usually unilateral
105
halitosis with a gastric ulcer
a fistula developed
106
conscious vs deep sedation
use conscious when patient hasnt fasted and doesnt need to be asleep
can use benzos
conscious - need to have fasted and a major surgery
107
ketamine side effects
hallucinations in 10-15%
| can be used to replace prop
108
anastrozole
aromatase inhibitor
for breast cancer in post menopausal women
can increase risk for fractures
109
raloxifene
SERM
preventive agent
has less risk of fractures then anastrozole
110
where to biopsy
at the interface of norma and abnormal
| so pathologist can differentiate
111
Choriocarcinoma
small cells with indistinct borders, scant cytoplasm, mitotic cells with necrosis
elevated AFP
112
embryonal carcinoma
cytotrophoblastic and syncytiotrophoblastic
resemble chorionic villi
elevated bhCG
113
seminoma
nests of large round clear cells with centrally placed cuclei and obvious nucleoli resembing primary spermatocytes
most common
tumor marker is placental alkaline phosphatase (PLAP)
114
teratoma
tissue from 3 germ layers
115
yolk sac carcinoma
papillary structures resembling glomeruli (schiller duval)
| increased AFP
116
causalgia
pain syndrome
severe pain with cold cyanotic extremity with no swelling and intact pulses
if pain disappears with sympathetic block, then diagnosis is made
treat with surgical sympathectomy
117
diagnosing stenosis
ABI
pulse volume recordings
MRA or CTA
diagnostic angiogram
