Lauren Pretest/USMLE world Flashcards
What should you check for with blunt deceleration trauma
look for aortic trauma
Consequence of aortoiliac occulsion in men
impotence
What do you think of with blood in stool s/p AAA repair?
bowel ischema
What should you worry about with chronic steroid users perioperatively
adrenal insufficiency due to inability to mount stress cortisol response
What should you do before someone hospitalized with gallstone pacreatitis leave the hospital?
cholecystectomy
Neuro injury with whiplash
syringomyelia/central cord syndrome/cape-like distribution of decreased strength/pain/temp with preservation of bibration a, light touch and position sense
What do you do with an RQ (respiratory quotient) > 1? Why?
decrease carbs in diet. excess carbs increase CO2 and make it harder to wean off vent if pt is on vent
What happens post op 2-3, when patient is tachypneic with decreased breath sounds in a lung field? What is the metabolic disturbance?
Post op atelectasis, respiratory alkalosis (due to tacy), prevent with incentive spirometry
Ddx for subcutaneous emphysema in thorax (3)
rupture of esophagus (often post endoscopy), rupture of trachea or bronchus, tension pneumo ( patient in distress)
Patient has petechiae, low platelet count, respiratory distress and hypoxemia after long bone fracture. Cause?
Fat embolism
What is the pre-op prophylaxis for patient with von Willebrand Disease? Mechanism?
Desmopressin (causes release of vWF and factor VIII)
What is the most common cause of Cushing syndrome?
pharmacologic/therapeutic administration of steroids
Fever, lethargy, hypoglycemia, hyponatremia, hyperkalemia. What is happening?
adrenal insufficiency
What is the preoperative care for a patient with a pheochromocytoma?
1-3 weeks of alpha blockade
What is the treatment for thyroid storm? Prophylaxis?
beta-blockade; prophylaxis = Drops of Lugal and iodine solution for 10 days
Patient presents with tetany two weeks after TPN is started. What is the deficit?
magnesium; looks like hypcalcemia but persists after adequate replenishment of calcium stores (via TPN)
If a patient has a metabolic alkalosis, do you give them LR and why?
No, because the lactate is converted to bicarb by the liver which would worsen the metabolic alkalosis
What is the acute treatment for hyperkalemia? What is a temporary treatment of hyperkalemia? What are two definitive treatments for hyperkalemia?
Calcium gluconate (cardio-protective); insulin and glucose, kayexalate (takes hours) or dialysis.
What are the signs of abdominal compartment syndrome?
increased peak airway pressure, decreased venous return, decreased cardiac output, decreased SVR, decreased renal and hepatic blood flow, decrease cerebral perfusion pessure
Dx ZES?
elevated gastrin in the face of secretin administration
What is the treatment for a bronchial carcinoid tumor?
resection and NO chemoradiation (not sensitive to it)
Treatment for Zenker diverticulum?
excision and cricopharyngeal myotomy
What is a requirement for the development of carcinoid syndrome from a carcinoid tumor?
once there are hepatic mets
What is the treatment for gastric varices and portal hypertension in a patient who is not cirrhotic and has a healthy liver but just had pancreatitis?
splenectomy
What is an apple core sign on barium enema study and what is the treatment?
large bowel obstruction likely due to cancer, treatment is resection and colostomy
What are the indications for surgery in patients with diverticular disease?
1) hemorrhage, 2) failed medical treatment, 2) perforated with abscess, 4) perforated without abscess
How do you diagnose Hirschprung?
full thickness biopsy 2cm above dentate line, find aganglionic cells
What are the acute and chronic signs of increased intracranial pressure, respectively?
irregular respirations, bradycardia, and increased blood pressure; papilledema
What does it mean if you have RBCs in the 4th vial of an LP?
Subarachnoid hemorrhage
What is the treatment of renal cell carcinoma?
radical nephrectomy (NOT responsive to chemoradiation)
What are indications for transurethral resection of the prostate in patients with BPH?
1) recurrent UTI, 2) refractory urinary retention, 3) upper tract dilation, 4), renal insufficiency due to obstruction, 5) bladder stones
What is a limitation of Duplex studies?
cannot image proximal veins (but CAN tell the difference between acute and chronic clots)
What is the parkland formula?
4 x wt x TBSA burned
Guy with scrotal mass, has AFP and HCG, what kind of tumor is it?
Germ cell tumor. (seminoma doesn’t make AFP but it does make HCG)
Prosthetic knee infection. Early pathogens (3mo)?
S. aureus and pseudomonas. S. epidermidis
How do you treat duodenal hematomas?
NPO, TPN, NGT
Old women and men: who has primary sclerosing cholangitis and who has primary biliary cirrhosis? and what antibody does one have that the other doesn’t?
Women have BooBs and pass on mitochondria: pBc, anti-mitochondrial
Men have SCrotum: pSC, associated with UC, NEEDS liver transplant
when do you pump the bowel of toxins?
Ca channel blockers, Li, drug packets
Old, dehydrated, post-op, what are you worried about?
Parotiditis
Intubatedx5 days in SICU with fever, what are you worried about?
Parotiditis, Sinusitis, Acalculus cholecystitis
just had trauma, hypoxemia worsened by IVF with CP and dyspnea
pulmonary contusion
First sign of hypoxemia in old people
Agitation
