Ongiong

Question 1

Chylous ascites

Answer 1

accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction

In adults, chylous ascites is associated most frequently with malignant conditions, particularly lymphomas

Question 2

Sever nosebleed not controlled by anterior packing is probably what artery

Answer 2

sphenopalatine artery

situated in the posterior region of the nasal cavity, and is involved in most severe epistaxis episodes

Question 3

VIPomas

Answer 3

Pancreatic endocrine tumors
MEN1
non-α, non-β islet cell pancreatic tumor that secretes VIP.

Watery Diarrhea, Hypokalemia, and Achlorhydria (WDHA
syndrome).

Question 4

Charcot foot

Answer 4

condition causing weakening of the bones in the foot that can occur in people who have significant neuropathy

bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape.

joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Question 5

squamous cell lung carcinoma and calcium

Answer 5

Parathyroid hormone-related protein secreted by cancer cells–> ↑ Ca

Question 6

Fever on POD #1-
– Most common cause, low fever (<101) and non
productive cough?

Answer 6

Atalectasis
CXR- see bilateral lower lobe fluffy infiltrates
Rx: Mobilization and incentive spirometry.

Question 7

Fever on POD #1- very ill appearing with high fever

Answer 7

Nec Fasc- In subQ along Scarpa’s fascia.

Bugs: GABHS or clostridium perfringens

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

Question 8

Fever on POD #1 High fever (>104!!) muscle rigidity.

Answer 8

Malignant Hyperthermia

Ryanodine receptor gene defect

Rx: Dantrolene Na (blocks RYR and ↓ calcium)

Question 9

Fever on POD #3-5-

– Fever, productive cough, diaphoresis

Answer 9

Pneumonia acutemed.co.uk
Check sputum sample for culture, cover w/ moxi
etc to cover strep pneumo in the mean time.

Question 10

Fever on POD #3-5- – Fever, dysuria, frequency, urgency, particularly in a
patient w/ a foley.

Answer 10

UTI

UA (nitritie and LE) and culture.

Change foley and treat w/ wide-spec abx until
culture returns.

Question 11

Fever > POD 7- Pain w/ salmon colored fluid from incision.

Answer 11

Dehiscence

Surgical emergency! Go to OR, IV abx, primary closure of fascia

Question 12

Unexplained Fever > POD 7-

Answer 12

Abdominal Abscess

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

Diagnostic lap.

Drain it! Percutaneously, IR-guided, or surgically.

Question 13

Fever > POD 7 – Pain at incision site, induration WITH drainage

Answer 13

Simple Wound Infection

Open wound and repack.

No abx necessary

Question 14

stages of pressure ulcer

Answer 14

Stage 1 = skin intact but red. Blanches w/ pressure

– Stage 2 = blister or break in the dermis

– Stage 3 = SubQ destruction into the muscle

– Stage 4 = involvement of joint or bone.

3/4- Needs OR

Question 15

Pleural Effusions –> see fluid _____ –> thoracentesis!

Answer 15

fluid >1cm needs thorocentesis

Question 16

Light’s Criteria

Answer 16

Determines transudative if:

LDH < 200
LDH eff/serum < 0.6
Protein eff/serum < 0.5

Question 17

Abscess you do not drain

Answer 17

Lung Abscess

air fluid level

Rx: Abx

Question 18

Characteristics of benign lung nodules:

Answer 18

– Popcorn calcification = hamartoma (most common)
– Concentric calcification = old granuloma
– Pt < 40, <3cm, well circumscribed
rx: close follow up

Question 19

Most common lung Ca in non-smoker

Answer 19

adenocarcinoma
perfieral Ca
Mets to adrenals

Question 20

Patient with kidney stones,

constipation and malaise low PTH +, central lung mass?

Answer 20

Squamous cell lung cancer

Question 21

Patient with lung cancer, shoulder pain, ptosis, constricted pupil, and facial edema?

Answer 21

Superior Sulcus Syndrome from Small cell carcinoma. Also a central cancer

Question 22

Lambert Eaton Syndrome and lung cancer

Answer 22

from small cell carcinoma.

Question 23

ARDS causes

Answer 23

Sepsis, gastric aspiration, trauma, low perfusion,

pancreatitis.

Question 24

ARDS Diagnosis:

Answer 24

1. ) PaO2/FiO2 < 200 (<300 means acute lung injury)
2. ) Bilateral alveolar infiltrates on CXR
3. ) PC wedge pressure is <18 means pulmonary edema is non-cardiac

Question 25

ARDS rx

Answer 25

Mechanical ventilation w/ PEEP

Question 26

HOCM murmur

Answer 26

SEM louder w/ valsalva, softer w/ squatting or handgrip.

Question 27

Continuous machine like

murmur

Answer 27

PDA

Question 28

Wide fixed and split S2 murmur

Answer 28

ASD

Question 29

Zenker’s diverticulum true or false

Answer 29

False. Only contains mucosa

Question 30

Dysphagia worse w/ hot &

cold liquids + chest pain that feels like MI w/ NO regurg

Answer 30

Diffuse esphogeal spasm.

Tx w/ CCB or nitrates

Question 31

Achalasia Rx

Answer 31

w/ CCB, nitrates, botox, or heller myotomy

Question 32

If hematemesis (blood occurs after vomiting, w/ subQ emphysema). Can see pleural effusion w/ ↑amylase

Answer 32

Boerhaave’s
Esophageal Rupture

rx: repair