Newest Flashcards
1
Q
Spinal cord compression evaluation and management
A
Hx
- PC
- > any trauma
- > onset and evolution of weakness
- > bilateral or unilateral
- > axial or sciatic pain
- > pain worse with movement/sitting
- > fevers/rigors
- Sensory
- > loss of sensation
- > numbness
- > claudication
- Motor
- > weakness
- Autonomic
- > bowel or bladder incontinence/retention
- > abdo pain (ileus)
- > cold/shivering
- > dizziness (hypotension)
- > syncope (bradycardia)
- Past
- > diagnosis and treatment of prostate cancer
- > known metastases
- > stroke risk factors
- Medications
- Social
- > alcohol
- > deconditioning
Exam
- Cervical collar + spinal board
- > any trauma
- Vitals
- > febrile
- > hypotension/bradycardia
- > irregular pulse (AF)
- ASIA scoring system
- > sensory or motor impairment at any level
- > motor is 0-5
- > sensory is vibration/fine touch
- > look for saddle anaesthesia
- Reflexes
- > hyper-reflexia
- > babinski
- Straight leg raise
- > disc herniation
Investigations
- Xray spine
- > disc compression
- CXR
- MRI spine
- Al phos
- CMP
- PSA
Management
- Call for help
- > neurosurgical consult
- > tertiary transfer
- Steroids
- > IV dexamethasone then orals
- Supportive
- > start VTE prophylaxis
- > maintain BP with fluids +- pressors
- > esomeprazole for stress ulcers
- > catheterisation
- > laxatives +- bowel evacuation
- Definitive
- > laminectomy
- > radiation
2
Q
Post tonsillectomy bleeding evaluation and management
A
Hx
- PC
- > timing of bleed
- > quantity and duration
- > dizziness/orthostasis
- > increasing pain
- > fevers/rigors
- Past
- > indication for tonsillectomy
- > coagulopathy
- > easy bruising/bleeding
- > immunosuppression
- Medications
- > anti-platelet/anti-coagulant
- Social
- > vegan
Exam
- Vitals
- > pulse ox
- > shock
- Mouth
- > grayish-white eschar
- > evidence of infection
Investigations
- Blood group
- FBC
- > Hb
- > platelets
- Coags
Management
- Admit
- > overnight observation
- Supportive
- > NBM
- > sit up
- Pressure
- > direct pressure with gauze on long clamp
- > soaked in thrombin/adrenaline/lidocaine
- > suture through gauze and tape to face
- Severe
- > nebulised or IV tranexamic acid
- > nebulised adrenaline
- > endovascular embolisation
- > attempt intubation/plan for cricothyrotomy
- ENT
- > lidocaine + adrenaline
- > silver nitrate cautery
3
Q
Fish bone evaluation and management
A
Hx
- PC
- > point to level of obstruction
- > choking/gagging
- > dysphagia
- > odynophagia
- > drooling + inability to swallow
- Past
- > previous events
- > surgeries (nissen)
Exam
- Vitals
- > perforation (fever/tachycardia)
- Airway
- > stridor
- > hoarseness
- Mouth
- > tongue depressor
- Neck
- > swelling + crepitus in perforation
- Lungs
- > wheeze
- Abdo
- > peritonitis in perforation
Investigation
- Xray
- > lateral neck
- > chest (AP + lateral)
- > abdo
- CT
- > when xray negative (common for fish bone)
- Endoscopy
Management
- Perforation
- > surgery + empirical antibiotics
- Supportive
- > drooling = nasogastric tube + suction
- > nausea = ondansetron
- Stable
- > watchful waiting
- > perforation <1%
4
Q
Olecranon bursitits evaluation and management
A
Hx
- PC
- > pain worse with movement
- > may last several months
- > flare ups
- Past
- > repetitive trauma
- > penetrating injury
- > gout
- > rheumatoid
- > osteoarthritis
Exam
- Vitals
- > fever in infective
- Look
- > erythema
- > oedema
- > cellulitis
- Feel
- > warmth
- > tenderness
- Move
- > limited active movement
- > preserved passive movement
Investigations
- If infected suspected
- Aspirate
- > gram stain + culture
- > crystals
Management
- Supportive
- > rest
- > compression bandage
- > ice
- > oral paracetamol
- > oral or topical NSAIDs
- Injectables
- > reserved for resistant cases
- > methylprednisone + lidocaine every week/month
- Surgery
- > reserved for resistant cases
- > open or endoscopic bursectomy
- Infected
- > cefazolin IM
- > aspiration +- surgical debridement + lavage
