Online Med Ed Flashcards
1
Q
Minute ventilation equation
A
TV X RR
2
Q
Goal for ET CO2
A
40 = adequate tube placement
3
Q
Blood pressure in shock
A
MAP under 60
SBP under 90
4
Q
Urine output in shock
A
less than 0.5 cc/kg/hr
5
Q
MAP equation
A
CO x SVR
6
Q
CO equation
A
HR x SV
7
Q
Stroke volume equation
A
preload x contractility
8
Q
What causes shock by altering SVR (4)
A
sepsis
anaphylaxis
anesthesia
spinal trauma
9
Q
What causes shock by altering preload
A
hemorrhage obstruction (TPTX, pericardial tamponade, PE)
10
Q
What causes shock by altering preload?
A
MI
contusion
CHF
11
Q
Escalating steps in airway treatment
A
O2 –> bag valve mask –> ETT –> cric (ED) –> trach (OR)
12
Q
What form of shock causes FLAT neck veins?
A
most = engorged, flat in hemorrhage due to loss of volume
13
Q
Shock + tracheal deviation –> next step
A
needle decompression
this is tension pneumo
14
Q
JVD + pulses paradoxus –> next step
A
needle decompression
this is tamponade
15
Q
Structures in zone 1 of neck
A
esophagus trachea arteries
16
Q
structures in zone 3 of neck
A
arteries
17
Q
Interventions in trauma to each zone of the neck
A
3- arteriogram
2- straight to surgery
1- ateriogram, esophagram, bronchoscopy
18
Q
Penetrating neck injury –> decision to operate depends on?
A
hard signs
hard signs –> opeate
soft signs –> angio
asx –> observe
19
Q
What are “hard signs”
A
gurgling, stridor, loss of airway
expanding hematoma, pulsatile bleeding, shock
stroke
20
Q
What are “soft signs”
A
dysphonia/dysphagia
subQ air or emphysema
mild hard signs
21
Q
Spinal cord- main pathways in anterior/middle/posterior sections of spinal cord
A
posterior- DCLMS (proprioception and vibratory sense)
middle- motor
anterior- ALS (pain and temp)
22
Q
Cord lesions- which symptoms are ipsilateral? contralateral?
A
ipsi- proprioception and motor
pain and temp- contra (cross at level of entry)
23
Q
Anterior cord injury:
defecit and typical cause?
A
lose all but proprioception
spinal artery occlusion
24
Q
central cord injury:
typical deficit and cause?
A
loss of pain and temp in cape like distribution
hyperextension/ syringomyelia
25
cord compression:
| symptoms & dx/ tx
focal neuro symptoms
urinary or bowel dysfunction
treatment: dexa
dx: MRI
26
Two signs of basilar skull fractures
battlers eyes
| clear rhinorrhea
27
Epidural hematoma
| dx and tx
lens shaped well defined hematoma on CT
| emergent craniotomy
28
Subdural hematoma
| dx and tx
same as epidural but hematoma is crescent shaped
29
What must be done before subdural hematoma craniotomy
correct INR/ give FFP and platelets
30
How to decrease ICP
hyperventilate
mannitol
elevate bed
31
Diffuse axonal injury:
cause
dx
tx
angular injury
grey white blurring on CT
no treatment, fatal
32
Treatment for broken ribs
pain control x 6 weeks (otherwise get PNA)
33
hemothorax dx and tx
horizontal shadow on CXR
| thoracostomy (rapid bleeding to OR)
34
Sucking chest wound treatment
occlusive dressing
35
Expect underlying organ damange in what blunt injuries
scapular fracture
sternal fracture
flail chest
36
Flail chest see sx and tx// assc condition
multiple broken ribs, paradoxical motion
use binder, weights
risk pulm contusion
37
Pulmonary contusion appearance on xray & tx
- 24-48 hours later get white out on xray
- give colloids, blood, albumin
- diurese
38
Appropriate ventilation in case of pulmonary contusion
high PEEP to push fluid back into capillaries
39
Myocardial contusiuon:
| treatment and risk
MONA BASH
| risk tamponade
40
When to take knife wound to abdomen to OR
peritoneal signs, shock, evisceration
41
Blunt trauma to abdomen eval
FAST and CT
42
MC abdominal bleed
liver lac
| compress pacreatoduodenal ligament
43
ruptured spleen intervention
just resect
44
sign of ruptured diapgraghm
bowel sounds in chest
45
Air under diaphragm --> next step
exploratory lap
46
pelvic fracture
| signs and treatment
+ hip rock test
| need ex fix risk uretheral and other injuries
47
Sign of urethral injury
blood at meatus
| high riding prostate
48
1-2-3rd degree burn skin findings
1- erythema (like sunburn)
2- blisters
3- full thickness, white, no feeling
49
Chemical burn to skin- first step in management
irrigate
50
Chemical ingection --> first step
serial exams/ EGD
51
Chemical inhalation -->
monitor O2/ feak flow
do bronch
intubate PRN
52
circumferential burns -- risk and management
risk compromising vascular supply
| cut the eschar
53
Electrical burns- labs to order
CK and Cr
54
Three risks assc with electrical burn
arrhythmia
rhabdo
posterior shoulder dislocation
55
Rule of 9s for burns
each limb= 9% of body surface
front chest/back chest and front abdomen/back= 9 each
head= 9 each side
genitals = 1
56
FLuid dose for burns
4 x kg x %BSA burnt
give half first 8 hours
half over next 16 hours
57
antidote for methanol/ethylene ingestion
fomepizole
58
acetaminophen antidote
NAC
59
salicylates antidote
alkalinize urine
60
organophosphates antidote
atropine --> 2PAM if early
61
Carbon monoxide treatment
hyperbaric O2
| **need ABG, SpO2 is normal
62
Cyanide ingestion sign and treatment
cherry red sign/ nitroprusside dosing
| thiosulfates
63
When to give rabies vaccine following dog bite
only with signs and symptoms --> give rabies Ig and vaccine
64
TReatment of bee sting without anaphylaxis
just remove pincer
65
Black widow appearance and treatment +risk
red hour glass on belly
give IV ca
risk pancreatitis
66
Brown recluse clue and treatment
attic/old boxes/in south --> get necrotic bite --> need to debride
67
Appropriate antibiotics for dog or cat bite
augmentin
68
Human bite appropriate treatment
irrigate, augmentin, Ig and tetanus toxoid
69
What xrays must be ordered for fracture
2 views, perpendicular to one another
70
when to take fracture to surgery
open, angular, comminuted
71
cause of posterior shoulder dislocation
lightning
seizures
massive trauma
72
colles fracture is at the ____
wrist
73
anterior shoulder dislocation damages what nerve?
| arm is held in what position?
axillary nerve
| adduction, external rotation (hand shake)
74
monteggia and galezzia fractures:
| define
```
monteggia= ulna broken, displaced radius
galezzua= radius broken, ulna displaced
```
75
Scahpoid fracture:
mechanism of injury
management
FOSH
| cast even with normal xray if pain at anatomic snuff box
76
boxers fracture= what digits fractures
4-5th
77
management of hip fracture
femoral head- prosthesis
intertrochanteric- plates
shaft- rods
open- washout/emergent surgery
traction always helps
78
ACL/ PCL mechanism of injury + management
anterior blow- posterior tear and vice versa
| MRI --> cast or surgery depending on need to get back on leg
79
MCL/ LCL injury mechanism + management
```
valgus stress (lateral) causes medial injury
varus stress (medial) causes lateral injury
```
MRI --> cast or surgery
80
meniscal tear presentation
knee pain and click with extension
81
stress fracture
| mechanism of injury and management
weekend warrior / tibial pain
| xray will be normal, cast and crutch anyways
82
Tib/fib fractures
| mechanism of injury and management
fall from height and massive trauma
| xray --> cast vs surgery
83
Achilles tendon
| presentation and management
gap where tendon should be
| clinic dx --> cast vs surg
84
ankle fracture: presentation
these guys CANNOT WALK don't xray unless not walking
85
carpal tunnel digits affected
1st three
86
two tests for carpal tunnel
flexion worsens= phalens
| tapping over tunnel worsens= tinels
87
What should be ruled out before diagnosing carpal tunnel?
RA
88
What is a felon and how is it treated?
abscess at pulp of finger caused by penetrating injury
need incision and drainage
89
Dequervains tenosynovitis
presentation
management
weight lifter/ mom lifting baby pain with fist-thumb-twist
no surgery just splint/NSAIDs
(inflammatory)
90
Duptuyrens Contracture
patient
presentation
management
EtOH or Scandinavian
nodules at palm preventing extension
surgical release
91
Jersey Mallet Trigger fingers: describe
Jersey- torn flexor tendon
mallet- torn extensor tendon
trigger- mallet + a POP
92
Treatment for jersey, mallet, trigger fingers
splinting
NSAIDs
intraarticular steroids
93
Developmental dysplasia of the hip:
| management
harness
94
Legg Calves Perthes
age
presentation
management
insidious antalgic age @ ~ 6 years
| cast
95
SCAFE
age
presentation
management
fat teen
hip pain
frog leg xray --> surgery
96
how to dx septic arthritis
more than 50k WBC on arthro
97
Oscgood schlatters location of swelling
tibial
| kid just needs to sit out
98
test for scoliosis
adams --> bend over look for one shoulder higher than other
99
Childhood bone tumors --> management
xray --> MRI --> bx --> resect
100
Ewings/ osteosarcoma genetic changes
t(11,22)
| Rb
101
Ewings/osteosarcoma location
ewings: shaft
osteo: distal femur
102
Ewings/ osteo appearance
osteo- sunburt
| ewings- onion skin
103
Bone cancer worrisome sign
focal bone pain without trauma
104
Special reason to operate on fracture in a kid
growth plate injured
105
BPH:
path
DRE findings
diagnosis
enlarged prostate obstructs urethra
large and smooth prostate on exam
empiric dx, do not order PSA
106
Treament BPH
a blockers for symptoms (tamsulosin)
| 5a reductase inhibitors (finasteride)
107
ED workup
night time tumescense to delineate psych from organic
108
Treatment of organic ED
pumps/ prosthesis if trauma
| PDEi if 2/2 crap blood flow
109
What cannot be given with PDEi?
nitrates
110
Prostatitis presentation
old man with pyelo symptoms
| exquisitely tender on DRE
111
Testicular torsion presentation
horizontal lie
pain on elevation
no cremasteric reflex
112
Treatment of torsion
bilateral orchipexy
113
Epididymitis
| path
STD if young (ceftriaxone + azithro)
| ecoli if old (FQ)
114
PResentation epididymitis
sudden pain
vertical lie
better with elevation
normal Doppler
115
Dx of epididymitis/ torsion
ultrasound look for flow on Doppler
116
Kidney stones diagnostic workup
non con CT --> US +/- UA
117
```
Treatment of stones:
0.5 or less cm
0.5-1.5 cm
1.5+ cm
7+ cm
```
less than 1/2 cm just fluids and pain control
1/2 cm --> 1.5 cm add CCV
1.5 and up stenting and lithotripsy
above 7 cm need surgery
118
Microhematuria in kids:
| management
watch and wait
| CT only in trauma
119
Macrohematuria in kids:
| w/ casts workup
UA and kidney biopsy
120
Macrohematuria w/o casts workup
US; cystoscopy; CT or MRI
121
Ectopic ureter presentation
female with constant leak (attaches below ext sphincter in females)
122
Ectopic ureter workup
US no hydro
VCUG no reglux
radionucleotide scan = ectopic ureter
123
Treatment of ectopic ureter
surgically re-implant
124
Constant hypo and epi spadias
```
epi= pees on EYE (dorsal, upper side)
hypo= ventral = under side
```
*don't circumcise, save foreskin for reconstruction
125
posterior urethral valve presentation
no urine output
| possible oligo on prenatal screen
126
how to dx posterior urethral valve
US shows hydro --> VCUG shows no reflux
127
how to tx posterior urethral valve
cath then surg when can
128
UPJO presentation
obstruction with increased flow (ie following heavy alcohol drinking)
129
Dx and Tx for UPJO
US shows hydro VCUG shows no reflux --> surgery
130
Vesicoureteral reflux presentation
recurrent UTI/pyelo in kid
dx = hydro on US + reflux on VCUG
treatment with suppressive abx and then surgery
131
Dx of prostate cancer
firm large nodular prostate
high PSA
++ transrectal bx
132
treatment of prostate cancer
resection --> rads --> brachy +++ meds
133
meds for prostate cancer
anti-androgen = flutamine
| GnRH analog = leuprolide
134
carcinogens assc with bladder cancer
B alanine dye; smoking
135
Bladder cancer treatment
transurethral resection
| BCG/cisplatin chemo
136
renal cell carcinoma dx/tx
nephrectomy, don't bx because risk bleeding
137
Clue to renal cell cx
erythrocytosis
138
testicular cancer
path
age
presentation
germ cell
18-25
does not transluminate
139
testicular cancer
| dx and tx
US --> orchiectomy no bx because seeding
140
Marker for:
seminoma
ylk sac
chorio
seminoma LDH
yolk sac AFP
chorio BHCG
141
SAH dx
CT --> LP --> MR/CTA
142
Early treatment of SAH
Keep BP under 140/90
| coiling/ clipping
143
Treatment of hydrocephalus
LP serial/ VP shunt
144
Late complications of SAH + management
seizures (give levitiracetam)
high ICP (give mannitol, hyperventilate)
vasospasm (give CCB and ^^^ BP)
145
IPH presentation
high BP
FND
H/A and N/V --> coma
146
Most common sources of brain mets (3) + location
lung, breast, GI
| found at grey white junction
147
How commonly are brain lesions primary?
30%, single lesion
148
Where are adult vs pediatric primary tumors located
adult- anterior fossa
| peds- posterior fossa
149
Two adult/ anterior fossa tumors
glioblastoma (butterfly crossing midline)
| meningioma (dural tail)
150
Two peds/ posterior fossa tumors + management
```
medulloblastoma = resection + rads
ependymom= resection only
```
151
Specific location of ependymoma
IV ventricle
152
craniopharyngioma appearance
calcified sella
153
Appearance of basal cell vs squamous cell vs melanoma
basal cell- pearly lesion
squamous cell- red nodule
melanoma- jet black
154
Dx and tx of basal/squamous cell
excisional biopsy
mohs for face
limb just he ex bx unless aggressive --> amputate
155
Melanoma outcome based on
depth
156
Ambylopia definition and cause
cortical blindness
| strabismus, cataracts
157
Two causes of kiddo cataracts
at birth --> TORCH
| after birth --> galactosemia
158
Retinopathy of prematurity = baby at risk for what other complications
bronchopulmonary dysplasia
IVH
necrotizing enterocolitis
159
Cause of chemical conjunctivitis in babes + appearance
```
silver nitrate (will be bilateral within **24 hours
** no pus), use emycin instead
```
160
gonorrhea conjunctivitis time of onset in babes + appearance
2-7 days, bilateral, purulent
161
chlamydia conjunctivitis time of onset in babes + appearance
5-14 days, unilateral --> bilateral
162
Closed angle glaucoma cause
1) low light --> dilation
2) no flow out
3) pressure, pain, rigid eye/ non reactive and dilated
163
Treatment of closed angle glaucoma
laser, a agonist, b blocker
164
What drug to always avoid in closed angle glaucoma patients
atropine
165
Orbital cellulitis treatment
if EOMI give abx
| if no EOMI need surg for RETROorbital abscess
166
Cause of orbital cellulitis in DM
mucormycosis
167
Retinal detachment presentation
instant floaters/ veil/ curtain
| does not come and go
168
Treatment retinal detachment
laser
169
CRAO presentation
painless acute loss of vision in one eye without other focal defects
170
Eye appearance in CRAO
cherry red spots on fovea
171
Treatment of CRAO
intra aterial tpa
| hyperventilation
172
cataracts presentation
loss of night vision
| old diabetic
173
macular degeneration two types
```
wet = 20% = can treat
dry= 80% = no treatment
```
174
Appearance of wet vs dry MD
```
wet= hemorrhages
dry= drussen/ pigment
```
175
Dx of AAA
US
176
Management of AAA based on size
3. 5 screen q12
4. 5 screen q6
5. 5 or rapidly growing need surg
177
Classic dissection presentation
widened mediastinum
| different BP in each arm
178
two patients at risk for dissection
marfans
| syphilis
179
two types of dissection
A before great vessels B after
180
Dx of dissection and treatment?
CTA/ TEE--> MRI
| operate if ascending, medical management If descending
181
PVD leg appearance
shiny
loss of hair
change in temp
182
How to dx PVD
ABI --> US --> CTA
183
ABI that is normal/ diagnostic of PVD
normal- 1-1.4
| PVD- under 0.9
184
Treatment of PVD
stent if above the knee or small
bypass for others
if cannot do surg can used cilostazol or pentoxyphylline to decrease pain
185
Medical therapy for PVD
ACEi
BBer
statin
antiplatelet
186
Acute limb ischemia three causes
cholesterol emboli after cath
clot from afib
thrombus from worsening PVD
187
Dx/ Tx acute limb ischemia
US/ angio --> embolectomy or TPA
188
3 L --> R shunt lesions
ASD
VSD
PDA
189
Three R --> L shunt lesions
transposition
tetralogy
coarctation
190
Risk assc with L --> R shunt
eisenmengers, becomes the worse R --> L shunt
191
When to repair VSD
at 1 year or with CHF
192
Transposition is assc with ?
maternal DM (at week 8 so regular not gestational)
193
Tetraology is assc with?
downs (endocardial cushion defect)
194
Aortic stenosis murmur location + dx + tx
2nd ICS (R)
echo
replace valve
195
mitral regurg location + two causes
apex --> axilla
| infection or infarction
196
Aortic Regurg 3 causes
infection
infarction
dissection
197
Location of aortic regurg murmur
4th R ICS, blowing
198
Dx and tx of AR
echo --> replacement or CABG
199
Compare bovine and mechanical valves
bovine lasts less than 10 years but doesn't need anticoag
mechanical lasts more than 10 years but needs anticoag
200
mitral stenosis murmur clue
opening snap
201
Cath findings:
when to stent
when to CABG
stent if 2 or less vessels involved
| CABG is 3 or left main
202
Vessels used for CABG
left internal mammary
| saphenous
203
High aldo manifestation
HTN and low K
204
Five causes of surgical HTN
```
Conns
RAS
Pheo
Cushings
Coarctation
```
205
Conns- define
primary hyperaldo
206
Conns dx and tx
```
aldo:renin above 20
salt suppression test failure
adrenal vein sampling
CT/MRI
resect
```
207
RAS dx
aldo : renin under 10
US w/ Doppler
angiogram
208
RAS tx
stent in young person with FMD
| medical treatment for atherosclerosis
209
Coarctation dx ad tx
angiogram --> resect and re-anastamose
210
Treatment of pheo
a block --> b block --> resect
211
Cushings evaluation
low then high
low dose dexa, acTHEN, high dose dexa
low dose = syndrome
then= primary adrenal
high= cushing disease/ ectopic tumor
212
Primary adrenal cushings --> further dx
imaging and vein sampling
213
cushing disease management
MRI and resect
214
common source of ectopic ACTH
lung cancer
215
Thyroid nodule first step in dx
TSH (low= low risk) (normal = high risk)
216
Management of thyroid nodule with normal TSH
US --> FNA is over 1 cm, W & W if under 1 cm
217
Management of low risk (low TSH) nodule
RAIU scan
| if hyperfunctioning Tx and resect, if nonfunctioning US and FNA
218
Dx of gastrinoma
gastrin level --> secretin stim --> somatostatin receptor scintography
219
Tx of gastrinoma
resect, because benign but leads to gastric cancer
220
Insulinoma dx
insulin, C peptide, sulfonylurea level
221
Glucagonoma clue
migratory necrolytic dermatitis
222
Hyperparathyroidism
| dx and tx
sestamibe scan
| resect (but will risk low Ca post op)
223
Most common type of TE fistula
type C (proximal atresia distal fistula)
224
Presentation of TE fistula
NG tube coiling
225
Imperforate anus dx
xray
226
Gastroschisis/ omphalocele location
Gastro- R sided
| Omphalocele- midline
227
Treatment for gastro/omphalocele
silo
228
Extrophy of bladder appearance
midline, no bowl, shining red structure
229
Congenital diaphragmatic hernia two types
posterior- bochladek
| anterolateral- orgagni
230
Pt presentation CDH
scaphoid abdomen
| bowel sounds in chest
231
Treatment (2) for CDH
surgery + surfactant
232
Biliary emesis --> first step in dx
xray (to look for double bubble)
233
Four causes of newborn bilious emesis
1) malrotation
2) duodenal atresia
3) annular pancreas
4) intestinal atresia
234
2 Causes of intestinal atresia
1) in utero infarct
| 2) cocaine
235
Malrotation exams beyond xray
contrast enema
| UGI series
236
Treatment for all causes bilious emesis
surgery
237
NEC presentation and dx
bloody BM with first feed, acidotic
| babygram shows pneumatosis intestinalis
238
Treatment NEC
NPO, TPN
239
Meconium ileus presentation, dx/ tx
FTPM
bilious emesis
baby gram= ground glass, loops of bowel
tx- gastrograffin
240
Hirschsprungs dx and tx
KUB and surg
241
Obstruction pain characteristics
colicky
no fever
no leukocytosis
242
Inflammatory pain characteristics
constant
fever
leukocytosis
243
Perforation pain characteristics
SAS
MOTIONLESS
constant
free air on KUB
244
Lower quadrant structures
```
colon/appendix
kidneys
ureters
testes
ovary
```
245
Structure found in both upper quadrants
lung + diaphragm
246
Anal cancer
dx
tx
anal pap
| chemo and rads, no cutting
247
How frequent are colonoscopies completed?
q10 if clean
q5 with polyps
q3 with carcinoma in situ
q1 with dysplasia
248
Familial adenomatous polyposis treatment
prophylactic colectomy
249
"Bad" polyp appearance
villous
sessile
large
250
Dx and tx of hemorrhoids
anoscopy
external- resect
internal- band
251
Anal fissure treatment
lateral internal sphincterotomy
| NG paste
252
Pilonidal cyst treatment
I&D --> surgery
253
When to start colonoscopies in UC
8 years post dx, prophylactic colectomy at first sign of dysplasia
254
Cholelithiasis dx/tx
RUQ US --> elective chole
255
Cholecystitis dx/ tx
RUQ US --> HIDA --> ERCP/elective chole
256
Choledocolithiasis dx/tx
RUQ US --> MRCP --> ERCP (urgent)/chole elective
257
Cholangitis dx/ tx
RUQ US --> STAT ERCP CHOLE LATER
258
Abx for gallbladder disease
Cipro + metro
259
How to dx pancreatitis
lipase --> only need CT if labs aren't sufficient
260
Management of pancreatitis
NPO
IVF
Analgesia
261
Pseudocyst management
drain if above 6 weeks or 6 cm
262
Chronic pancreatitis management
insulin
enzymes
pain control
263
Dx SBO
upright abdominal film
264
When to operate on SBO
complete = urgent surgery
peritoneal signs = emergent surgery
incomplete= surgery if not better in a few days
265
Initial management of all SBO
NG tube, IVF
266
Appendicitis dx/tx
clinical --> straight to surgery
267
Carcinoid syndrome= tumor must be?
metastatic/ in liver
268
Carcinoid dx/ tx
5HIAA ---> CT scan --> resect
269
When to operate on hernia
strangulated --> emergent surgery
reducible --> urgent surgery
reducible --> elective surgery
270
Achalasia:
what is absent?
dx/tx?
auerbach
| barium --> manometry --> EGD/bx --> myotomy
271
GERD spectrum management
GERD PPi
Metplasia High dose PPi
Dysplasia ablation
adenocarcinoma resect
(all can get nissen)
272
Esophageal cancer:
sx
dx/tx?
progressive dysphagia
| EGD/bx --> resection
273
Mallory Weiss tear management
supportive
274
Boerhaaves dx/treatment
air in mediastinum
| gastrograffin --> barium --> EGD --> surgery
275
Pre-hepatic jaundice two types
hemolysis
| hematoma
276
Two causes of intrahepatic jaundice
genetic
| hepatitis
277
Three causes of posthepatic jaundice
strictures
cancer
gallstones
278
Obstructive jaundice --> next step in dx?
CT scan: obstruction in biliary tree, pancreas, or ampulla of vater?
279
Obstructive jaundice in biliary tree: cause?
stone or cholangiocarcinoma
280
Clue to pancreatic cancer as cause of obstructive jaundice
migratory thrombophlebitis
281
List four stages of skin ulcers
1: erythema/epidermis
2: epidermis + dermis
3: exposed fascia
4: exposed bone & muscle (osteo)
282
Path of diabetic vs aterial insufficiency ulcers
DM- microvascular changes
| Arterial insufficiency- macrovascular
283
Location of diabetic vs arterial vs venous ulcers
diabetic- heels/balls of feet
arterial- tips of toes
venous- medial malleolus
284
Arterial insufficiency vs venous insufficiency skin appearance
arterial- shiny, hairless, pulseless
| venous- edema, pigmented
285
Marjolin ulcer is caused by?
| treatment?
SCC
| wide resection
286
Dx and tx of arterial insufficiency
ABI/arteriogram --> stent/bypass/graft
287
Mammograms- whats the board answer for now?
| When do we MRI?
50 q2
| MRI only with BRCA or prior cancer
288
Management of a breast lump in patient under 30
watch and wait x 2 cycles --> US/ FNA if still there
| FNA blood= cx, pus = abscess, fluids = cyst
289
Lump in a patient over 30 (or with prior mass/ bleeding)
mammogram and core bx
290
Which of the SERMs increases endometrial cancer risk?
tamoxifen
291
What are the systemic chemo drugs for bcx? targeted?
doxo/dauno +/-cyclophosphamide and paclitaxel
targeted- trastuzumab, tamoxifen, aromatasei
292
What severe ADR is assc with trastuzumab
CHF
293
```
Post op fever:
immediately post op
day 1
day 2
day 3
day 5
day 7
2 weeks
```
```
immediately- bacteremia
day 1- atelectasis
day 2- PNA
day 3- UTI
day 5- DVT/ PE
day 7- cellulitis
2 weeks -abscess
```
(wind, water, walking, wound)
294
Treatment of post op DVT/PE
heparin --> warfarin
295
Ddx AMS post op
1) hypoxemia
2) delirium tremens at 48-72 hours post admission
3) sundowning
4) Na/Ca changes
296
Treatment of delirium tremens
BDZ
297
Normal urine output
0.5 cc/kg/hr
298
Oliguria three types
urge + = obstruction (scan)
| urge - = mechanical (0 urine) or renal disease (some)
299
3 causes of post op abdominal distention
ileus
obstruction
ogilive syndrome
300
Ileus, obstruction, ogilive: KUB findings + which gets surgery
```
ileus= whole bowel distended
ogilive= whole LARGE bowel distended in elderly
obstruction= proximal dilation/distal narrowing
```
only obstruction gets surgery
301
ileus management
IVF, K get out of bed
302
Treatment ogilive syndrome
rectal tube
stigmine
colonoscopy
303
Evisceration management
warm saline dressing, never push back in, emergency surg
304
Cardiac reasons to avoid surgery
EF under 35%
MI in last six months
JVD
305
How to dx malnutrition
prealbumin
