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Step 2 > Online Med ed--Surgery > Flashcards

Online Med ed--Surgery Flashcards

1
Q

Causes of hyperkalemia

A 
Iatrogenic
Ingestion + CKD (esp .ESRD)
low-aldosterone states
artifact (hemolysis)
ACE-i/ARB
Aldo-i
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2
Q

EKG signs and tx of unstable hyperkalemia

A

wide QRS or peaked T wave

Requires emergent therapy with (1) stabilization of cell membrane–IV Ca

(2) temporize–insulin + D5
(3) Decrease total body K–loop diuretics or K-exylate if has CKD and cant get diuretics

Chronic therapy with HD

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3
Q

Causes of hypokalemia

A

Renal vs GI

Renal–hyper-aldo
diuretics (thiazide and loop)

GI–vomiting and diarrhea

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4
Q

How much does 10meq K rais K

A

0.1

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5
Q

uric acid stones (2 causes and txs)

A

radiolucent
Gout (allupurinol)
tumor lysis syndrome (rasburicase)

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6
Q

Triad for renal cell carcinoma and complications

A

flank pain, flank mass, hematuria

NOTE: only 30% have all three

Complications
May have EPO-producing tumor–polycythemia
Bleeding–> anemia
thrombosis of renal vein

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7
Q

Cysts associated with autosomal dominant polycystic idney disease

A

non-radially oriented cysts in kidneys

liver
pancreas
berry aneurysms (should be screened)

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8
Q

Causes of respiratory acidosis

A 
hypoventilation 2/2
asthma
COPD
obesity
OSA
opiate overdose
decreased muscular strength
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9
Q

Causes of respiratory alkylosis

A

hypoxia

anxiety

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10
Q

Causes of metabolic alkalosis

A

(1) contraction alkylosis (urine chloride low) 2/2 volume depletion 2/2diuretics, emesis, dehydration

NOTE: emesis also causes gastric acid loss

(2) Non-volume responsive conditions (Barter syndrome, hyperaldo)
NOTE: high urine chloride

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11
Q

Causes of nonanion gap acidosis

A

2 categories depending on presence of urine anion gap (Na+K-Cl)

If UAG positive –> rta
If UAG negative –> diarrhea

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12
Q

Causes of metabolic acidosis

A 
Methanol
Uremia
DKA
Propylene
Isopropyl
Lactic acid
Ethylene glycol
Salicylates
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13
Q

Microcytic anemia: types

A

iron deficiency anemia
anemia of chronic disease
thalasemia
sideroblastic anemia

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14
Q

Iron deficiency anemia: Labs and tx

A

low iron
low ferritin
high TIBC

Seen in older men with colon cancer or women with menorrhagia

Tx: ferrous sulfate and senna

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15
Q

Anemia of chronic disease: Labs and tx

A

low iron
high ferritin (as this is an acute phase reactant))
low TIBC

Seen in people with chronic disease/infection

Tx: underlying disease or EPO

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16
Q

Thalessemia: Labs and tx

A

Problem is with hgb, NOT iron

nl iron, ferritin, and TIBC BUThgb electrophoresis abnl

2 types alpha and beta

Tx: deferoxamine

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17
Q

Sideroblastic anemia: labs and causes

A

high iron
nl ferritin
nl TIBC
PBS showing ringed sideroblasts

reversible causes: certain meds, alcohol, and lead

irreversible causes: B6 deficiency, MDS

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18
Q

Production anemias: 2 types

A

microcytic and macrocytic

RI < 2%

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19
Q

Causes of B12 deficiency

A

Nutritional deficiency (rare as have 3-10 years of storage)

pernicious anemia (no intrinsic factor)
crohns disease (affects distal small bowel)
gastric bypass

Can be distinguished by Schillings test

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20
Q

4 Labs to distinguish causes of normocytic anemia

A

LDH
Haptoglobin
bili
smear

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21
Q

Types of normocytic anemias

A

hemolytic (PNH, G6PD def, sickle cell, AIHA, HS)

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22
Q

Autohemolytic anemia: 2 types

A

Cold: IgM mediated associated with mycoplasma and mono and treated by avoiding cold

Warm: IgG mediated associated with autoimmune disease and cancer, and treated with steroids, rituximab, and splenectomy

NOTE: positive coombs for both

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23
Q

What to do when WBC> 60K but patient asyx

A

Assume chronic leukemia and Get diff –>

high PMNS means CML and needs tx with imatinib

high lymphocytes, then CLL and needs HSCT or chemo

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24
Q

Acute leukemias clinical presentation and labs

A

infection and fever
anemic
bleeding
bone pain

WBC may not be elevated

Get PBS to distinguish AML(pmns) from ALL(lymphs)

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25
Q

Acute myeloid leukemia

A

“young neutrophils in the bloo”

disease of older people with benzene exposure

Dx: smear and BM biopsy showing > 20% blasts

myeloperoxidase postive

Tx: if M3 (auer rods), treat with vit A. if not, chemo

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26
Q

Acute Lymphocytic Leukemia

A

“young lympocytes in the blood”

young pt

Dx with smear and postive BM biopsy for > 20% blasts that are positive for tdt

Tx with radiation

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27
Q

Chronic myeloid leukemia

A

older patient

Diff and BM biospy showing BCR-ABL translocation

Tx with imatinib

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28
Q

Chronic lymphocytic leukemia

A

patient older

dx with diff and bm bx

if asx, do nothing
if sx and old, chemo
if sx and young, HSCT

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29
Q

Post-op fever: 7 possible causes (Tx)

A

Right after–bacteremia (broad spectrum antbx)

Everything else: 5 Ws

Wind
POD#1–atelectasis (prevent with IS and getting out of bed)
POD#2–PNA (broad antbx)

Water
POD#3 UTI (antbx)

Walking
POD#5 DVT/PE (heparin to warfarin or NOAC)

Wound
POD#7 cellulitis (clinda)
POD#10-14 abscess (abx +I/D)

NOTE: 5th W is wonder drugs including anesthesia that can cause malignant hyperthermia intra-op and bactrim that could cause AIN and fever)

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30
Q

2 Electrolyte culprits for post-op AMS

A

Na and Ca

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31
Q

Causes of AMS post op (4)

A

electrolyte disturbance
sundowning in elderly
hypoxemia (think PE/PNA/ADS)
Delirium tremens (after 1 day HTN, tchy, diaphoresis then tremors 48-72hrs)

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32
Q

3 types of post-op abdominal distension + diagnosis/tx

A

(1) ileus (seen POD1-2, a functional issue) diagnosed by KUB showing diffuse dilation of small and large bowel
TX: IVF, get out of bed, give K

(2) Obstruction (seen POD 5 after ileus not getting better) diagnosed by KUB showing SBO/LBO with transition zone
TX: NG tube, surgery to target likely adhesions

(3) Olgivie Syndrome–dilated elderly colon seen on KUB
TX: rectal tube, stigmine, colonoscopy

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33
Q

5 causes of post-op fistula

A 
Foreign body
Epitheliazation
Tumor
Irridation/inflamed/inflammatory bowel
Distal obstruction

FETID

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34
Q

Risk factors with cholelithiasis

A

Fat
Female
Fertile
Forty

Also, being American indian

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35
Q

Alternative tx for cholelithiasis other than cholecystectomy

A

ursodeoxylic acid

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36
Q

Cholecystitis defintion and presentation + tx

A

gallstone(s) in cystic duct

Pt with CONSTANTRUQ pain and murphys sign

tx with IVF, abx, and urgent cholecystectomy

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37
Q

RUQ US in cholecystitis shows ___

A

(1) pericholecystic fluid
(2) thickened gb wall
(3) gallstones (sometimes wont see)

If you don;t see what you want, get HIDA

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38
Q

Choledocolithiasis definition, presentation, and tx

A

gallstone in CBD

Presents with painful jaundice with murphys sign, fever, and leukocytosis +/- pancreatitis or hepatitis

TX: NPO, IVF, IVabx, urgent ERCP to get stone and elective cholecystectomy

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39
Q

Dx of choledocolithiasis

A

RUQ US showing obstruction or CBDdilation

if negative, get MRCP or ERCP (if suspicion really high)

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40
Q

Cholangitis presentation

A

charcots triad (RUQpain, jaundice, and fever)

if also hypotensive and obtunded, reynolds pentad

NOTE: jump to emergent ERCP from RUQUS and IVabx with urgent cholecystectomy

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41
Q

Abx treatment of emergent gallbladder diseases

A

cholecytitis, choledocolithiasis, cholangitis

cipro (GNRs) + metronidazole (anaerobes)
amp-gent +metronidazole

NOT pip-tazo

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42
Q

Painless jaundice: causes

A

Prehepatic (hemolysis or hematoma) –> unconjugated

Intrahepatic (genetic, hepatitis) –> mixed unconjugated and conjugated

post-hepatic (cancer +/- strictures) –> conjugated

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43
Q

Extended gallbladder and massively dilated CBDon RUQUS indictaes ____

A

cancer/stricture

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44
Q

Presentations of obstructive jaundice

A

(1) painless jaundice
(2) wt loss and clay-colored stool
(3) distended, nonpainful gallbladder

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45
Q

Migratory thrombophlebitis =

A

Pancreatic cancer

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46
Q

Risk factors for cholangiocarcinoma

A

chronic untreated cholecystitis

PSC (MRCPshowing beads on a string)

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47
Q

Presentation of someone with obstructive jaundice, postive FOBT, and negative colonoscopy indicates ____

A

tumor of ampulla of vater

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48
Q

Progression of tx of GERD and complications

A

GERD–PPI
Barrets–high dose PPI
dysplasia–ablation
adenocarcinoma–resection

Note: nissen fundoplication is surgical tx for GERD that does not get better with PPI

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49
Q

Achalasia: presentation, diagnosis, and tx

A

presentation: dysphagia for solids

Dx: Barium swallow or manometry

Tx: botox, dilation, or *myotomy

*best initial treatment

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50
Q

Mallory weiss tear vs boorhaves

A

Mallory weiss: superficial tear, associated with cocaine and alc use, treat initially like GIbleed although is self-limited

Boorhaves: transmural tear, air in chest –> mediastinitis, hammands crunch (crepitus with heart beat), dx gastrografin swallow (not as caustic to mediastinum) –>MBS –> EGD, tx with emergent surgery

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51
Q

esophageal cancer: types

A

SCC–upper third, hot liquids and smoking

adenocarcinoma–lower third, GERD

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52
Q

Constipation vs obstipation

A

Seen as a progression in SBO: constipation (no loss of function, still peristalsis resulting in high-pitched sounds) –> obstipation (loss of function, hypoactive/no BS)

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53
Q

Imaging that shows complete vs incomplete SBO

A

CT scan

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54
Q

4 types of hernias

A

Direct inguinal (adult males)
Indirect inguinal (baby males)
Femoral (adult females)
Ventral (post-op, risk factor is dehiscence)

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55
Q

Carcinoid (gut)

A

neuroendocrine tumor found in gut or lung that releases serotonin and mets to liver

sxs: flushing, wheezing, diarrhea, right-sided cardiac fibrosis (lungs break down 5HT)

Dx: urine 5-HIAA then CTscan to identifies lesions

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56
Q

3 most common causes of acute pancreatitis

A

alcohol
gallstones
hypertriglyceridemia

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57
Q

Tx of necrotizing pancreatitis

A

carbapenams after confirmaion with FNA

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58
Q

Pancreatic pseudocyst management

A

presents with early satiety, wt loss, and abd pain

CTscan to confirm

if <6cm and <6wks: uncomplicated–>watch and wait to see if will resolve

if >6wks or >6cm: complicated–> drain

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59
Q

Complications of acute pancreatitis

A

pseudocyst
necrotization
abscess

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60
Q

Indications of colorectal cancer

A

man with IDA

advanced cancer
#stool caliber (left-sided)
alternating constipation and diarrhea (right-sided)
wt loss

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61
Q

Anal cancer: treatment

A

Regardless of stage: chemo and radiation (nigro protocol)

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62
Q

Polinoidal cyst

A

anal cyst resulting from clogged hair follicle

can lead to abscess

tx with I/D if abscess, then resection

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63
Q

Ischemic bowel: presentation

A

pain out of proportion to exam
bloody BM
Sepsis

risk factors: CAD, afib, ischemia

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64
Q

Nonspecific abdominal pain: etiologies to be suspicious for depending on h/o and risk factors

A

DKA
MI
constipation

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65
Q

5 types of leg ulcers

A

(1) Compression: from pressure points (bedridden or wheelchair bound pt) so where bone is close to skin (shoulders, heels, sacrum)
(2) Diabetic: from microvascular changes causing neuropathy, heels or balls of feet
(3) arterial insufficiency: from PAD and macrovascular in nature (hairless legsm shny/scaly skin), absent pulses, tips of toes
(4) venous stasis: CHF, cirrhosis, nephrotic syndrome –> edema, induration, and hyperpigmentation, medial malleolus
(5) Marjolin: SCC presenting as ulcer with sinus tract or old wound

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66
Q

actinic keratosis

A

on continuum of SCC. 1% transformation per year

cryo, excision

lesion characterized by erythematous base with scaling, nonpigmented (looks very similar to SCC)

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67
Q

early mucosal form of SCC

A

leukoplakia

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68
Q

Basal cell carcinoma

A

cancerous lesion with waxy borders, erythamtous, easy to bleed, and with many telactasias

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69
Q

types of melanoma

A

superficial spreading
nodular
lentigo malignant
acral lentiginous (most dangerous but most easily missed as often in unexposed areas)

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70
Q

Higher lifetime estrogen with ____

A

early menarche
late menopause
nulliparity
hormone replacement tx (but NOT OCPs)

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71
Q

Work-up of breast cancer

A

Mammogram at 50yo q2yr for general population

MRI if high risk (BRCA1/2, prior radiation)

core biopsy if mammogram or MRI positive

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72
Q

tamoxifen vs raloxifen

A

tamoxifen: works better in breast cancer tx, works as estrogen receptor agonist in uterus –> endometrial carcinoma, can also cause DVT
raloxifen: works as estrogen receptor antagonist in breast, not as many adverse effects

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73
Q

Most likely etiology to sudden-onset severe unilateral lower abdominal pain immediately following strenous or sexual activity

A

ruptured ovarian cyst

NOTE: USwill show pelvic free fluid

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74
Q

psoas sign

A

abdominal pain with hip extension, indicative of psoas abcesess

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75
Q

Features of a meningioma

A

extra-axial, well-circumscribed, dural-based, partially calcified on neuroimaging

NOTE: considered benign, although can present due to mass effect

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76
Q

Features of biceps tendinopathy/rupture

A

anterior shoulder pain

pain with lifting, carrying, or overhead reaching

NOTE: weakness is less common

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77
Q

Emphysematous cholecystitis

A

life-threatening form of acute cholecystitis that occurs more commonly in immosuppressed pts and people with DM, arising d/t infection of gb with gas-forming bacteria (clostridium, E coli)

TX with emergent cholecystectomy

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78
Q

A patient with stuttering episods of N/V, pneumobilia, hyperactive bowel sounds, and dilated loops of bowel likely has___

A

gallstone ileus (form of mechanical SBO)

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79
Q

4 types of disease patterns of multiple sclerosis

A

relapsing-remitting (majority)
primary progressive
secondary progressive
progressive relapsing

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80
Q

Central vs primary adrenal insufficiency

A

central: low ACTH, low cortisol, BUT NL aldosterone

Primary: high ACTH, low aldosterone –> hyponatremia and hyperkalemia

81
Q

Cardiac finding in digitalis toxicity

A

atrial tachycardia with AV block

82
Q

Clinical features of glucagonoma

A 
necrolytic migratory erythema
DM
GI--diarrha, anorexia, abd pain, occasional constipation
Weight loss
Neuropsychiatric sxs
Venous thrombosis

Dx with serum glacagon >500 and findings of AoCD

83
Q

Tumor lysis syndrome –>

A

hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (d/t calcium phosphate binding)

84
Q

Clinical presentation of and risk factor for mixed cryoglobulinemia

A

palpable purpura, glomerulonephritis, non-specific systemic sxs, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia

RF: most pts also have HCV

85
Q

Electrical alternans with sinus tachycardia is highly specific for ___

A

a large pericardial effusion

86
Q

Type of breathing seen in DKA

A

deep and rapid breathing

Helps individual compensate for AG metabolic acidosis

87
Q

Seborrheic keratosis

A

A benign epidermal tumor that presents in middle-aged or elderly individuals as a tan or brown rounnd lesion with a well-demarcated border and stuck-on appearance

88
Q

Corrected Ca =

A

Ca + 0.8 x (4 - albumin)

89
Q

Bloody BM in premature infant and XRay showing air in bowel have

A

necrotizing enterocolitis

90
Q

meconium plug =

A

cystic fibrosis

91
Q

Xray showing gas-filled plug in the setting of biliary emesis and failure to pass BM in infant =

A

meconium plug

92
Q

Complication of meconium plug

A

perforation

93
Q

Xray in new born showing dilated proximal colon with transition point distally with normal-lloing distal colon

A

Hirschsprung disease

94
Q

explosive diarrhea after a DRE in neonate =

A

Hirschsprungs

95
Q

US in neonate showing donut sign =

A

pyloric stenosis

96
Q

Electrolyte disturbances of pyloric stenosis

A

hypokalemic hypochloremic metabolic alkalosis

97
Q

Diagnostic imaging of biliary atresia (2)

A

US showing no ducts

HIDA showing atresia

98
Q

Snoring baby who is blue with feeding and pink with crying =

A

choanal atresia (barrier btw nose and pharynx)

99
Q

Med that can artificially elevate gastrin

A

PPI

100
Q

Throid nodules that require FNA

A

(1) those that are assoicated with high/nl TSH and are > 1cm on US
(2) those associated with low TSH (low risk) and have low radionucleotide uptake

101
Q

Labs associated with insulinoma

A

high insulin
high c-peptide
negative for sulfonyurea

102
Q

Scan used to diagnosis bad gland in primary hyperparathyroidism

A

sestanibi scan

103
Q

Conn syndrome: presentation

A

Primary hyperaldosteronism

Pt with HTN and hypokalemia

Dx: aldo:renin >20
Salt suppression test (turns off renin but not aldo)
CT/MRI
adrenal vein sampling

104
Q

5 Ps of pheochromocytoma

A 
Paroxysyms of HTN
Pressure (HTN)
Pain (HA)
Palpitations
Perspiration
105
Q

Woman with HTN and DM coming in with moon facies =

A

cushing syndrome

106
Q

left to right shunts

A

D diseases

ASD vs VSD vs PDA

NOTE: acyonotic

107
Q

right to left shunts

A

T diseases

Transposition of great vessels vs tetrology

NOTE: cyonotic on day 1

108
Q

Congenital defect in baby with mom with DM

A

transposition

109
Q

Tetrology of felo

A

endocardial cushion defect seen in pts with down;s

(1) VSD
(2) Overriding aorta
(3) Pulmonic stenosis
(4) RVH

110
Q

Bovine vs mechanical valves

A

Bovine: <10 yrs of life but need no AC

Mechanical valves: 10-29yrs, AC with wartfarin with target INR 2.5 to 3.5

111
Q

Type A vs B dissections

A 
Type A (ascending): surgery 
Type B (descending): IVbeta blockers

distinguished by CT angiogram (NOT arteriogram) or TEE

112
Q

___ and ____ are meds for symptomatic PVD

A

cilostazel

pentoxyphylline

113
Q

Amlyopia =

A

cortical blindness that is a complication of strabismus or early-life cataracts

114
Q

Strabismus =

A

lazy eye

115
Q

Infant that develops cataracts has ____

A

galactosemia

116
Q

Complications of prematurity (4)

A

retinopathy of prematurity (from high levels of Fio2)
necrotizing entercolitis
bronchopulmonary dysplasia
Intraventricular hemorrhage

117
Q

Neonatal conjunctivitis: 3 types

A

chemical: w/in 24hrs, BL, nonpurulent discharge, tx with topical erythromycin
gonorrhea: w/in2-7days, BL, purulent discharge, ppx with erythromycin until PCR comes back negative, tx ceftriaxone
chlamydia: w/in 5-14 days, starts as unilateral and mucoid but will turn BL and purulent , tx with PO erythro

118
Q

Nonreactive dilated pupil and rigid eyeball in s/o starting anti-cholinergic =

A

closed angle glaucoma

treatment with alpha-agonist

119
Q

Causes of retinal detachment (2)

A

Trauma (MVA)

HTNcrisis

120
Q

Curtain coming over vision =

A

retinal detachment

NOTE: If this happens often, amaurosis fugax (impending retinal artery occlusion/TIA)

121
Q

Retinal artery occlusion presentation and tx

A

acute, painless vision loss

TX: interarterial tPa

122
Q

Management of melanoma

A

< 0.5mm–> excisionw/ 0.5cm margins

1-2mm –> excision w/ 1cm margins + SLND biopsy

2-4mm –> excision w/ 2cm margins + SLNDbiopsy

> 0.4mm (metastatic)–> chemotherapy, radiation, and debulking

123
Q

Management of subarrachnoid hemorrhage

A

bp control
seizure ppx
bleeding control (coil or clipping)
hydrocephalus control (serial LPs)

124
Q

Preferred imaging to diagnosis brain cancer

A

MRI with contrast

125
Q

Brain tumors

A

Posterior (peds): medulloblastoma and ependymoma (4th ventricle tumor –> obstructive hydrocephalus)

Pituitary: prolactinoma, acromegaly, craniopharyngioma

Anterior (adults): meningioma and glioblastoma

126
Q

Ring-enhancing lesion in brain that crosses midline

A

glioblastoma (necrotizing so can cross midline)

127
Q

head trauma with LOC then lucid interval then neurologic deterioration

A

epidural hematoma

128
Q

A dilated, unreactive pupil on one side in s/o head trauma =

A

increased ICP and compression of ipsilateral 3rd cranial nerve and impending uncal herniation

most commonly with epidural hemorrhage

DO NOT do LP as this can precipitate uncal herniation. Get CT or MRI instead

129
Q

Cushing triad

A

elevated BP
bradycardia
respiratory irregularity

suggests elevated ICP

130
Q

Risk factors for dural venous sinus thrombosis

A 
hypercoagulable state
trauma
dehydration
pregnancy
OCPs
infections (esp sinusitis or mastoiditis)
131
Q

Leriche syndrome

A

a commbination of claudication in the buttocks, buttock atrophy, and impotence in men due to aortoiliac occlusive disease

132
Q

Baby on day 1 with oliguria and distended bladder

A

posterior urethral valves

133
Q

What never to do with baby with epi/hypo spadia

A

circumcision

134
Q

Colicky abdominal pain in teenager who drinks for first time

A

uretopelvic junctional obstruction

135
Q

w/u child with recurrent UTIS and pyelo

A

US showing hydronephrosis and vesico-ureteral gram showing reflux

likely has vesicoureteral reflux

136
Q

Non-seminomas tumor markers

A

endodermal–AFP
choriocarcinoma–beta-HCG
teratoma–look for mets

137
Q

Medications/interventions used to suppress prostate cancer

A

resection/radiation/brachytherapy then:
anti-androgens (flutanide) or
GNRH analogs (leuprolide) or
Orchiectomy

138
Q

TURP

A

transurethral resection of prostate

Used in obstructive uropathy

139
Q

Testicular torsion vs epididymitis

A

torsion: spontaneous, exquisitely painful to palpation and elevation, doppler showing decreased blood flow to testictle, tx with untwisting and BL orchipexy

Epididymitis: spontaneous, tender to palpation, relief with elevation, doppler negative, tx with antbx

140
Q

Insidious onset of an antalgic gait in a 6yo

A

legg-calves-perthes disease

NOTE: treatment with a cast

141
Q

Trasnient synovitis

A

hip pain following viral illness

TX with anti-inflammatories if no signs of infection and F/U in 2 days

142
Q

Knee pain and tibial swelling in a teenage athlete indicates ____ and can be treated with ___

A

osteochondrosis (osgood schlatters)

TX: rest or continue with activity (doesnt matter)

143
Q

mid-shift bone lesion with onion-skinning on xray

A

ewings

144
Q

distal femur lesion with sunburst pattern

A

osteosarcoma

145
Q

Moteggia vs galezzia fx

A

monteggia: broken ulna and displaced radius
galezzia: broken radius and displaced ulna

146
Q

Jersey finger

A

sports-related tear in the flexor tendon of a finger–> cannot flex

TX: splinting and NSAIDs

147
Q

Mallet finger

A

Sports-related tear of extensor tendon–> cannot extend

TX: splinting and NSAIDs

148
Q

Inability to extend fingers and palpable nodules on palm in a male

A

dupuytren;s contracture (fascial disease)

TX: surgical release

149
Q

Felon =

A

abscess in the finger requiring I&D

150
Q

Causes of total hematuria

A 
Renal mass (benign/malignant)
glomerulonephritis
urolithiasis
PCKD
pyelo
urothelial cancer
trauma
151
Q

Causes of terminal hematuria

A 
urothelial cancer
cysitis
urolithiasis
BPH
prostate cancer
152
Q

Inital hematuria

A

urethritis

trauma (i.e catheterization)

153
Q

Indications for urgent exploratomy lapartomy in abdominal trauma

A

hemodynamic instability
peritonitis
evisceration
blood from a NGT or on rectal exam

154
Q

Pt who presents with acute onset back pain and profound hypotensions=

A

ruptured AAA until proven otherwise

155
Q

End-tidal Co2

A

Indicates placement of ET tube

ETCo2 = 40 indicates adequate placement

156
Q

MAP

A

Keep > 60 for cerebral perfusion

MAP = CO x SVR = Hr x SV x SVR

SV: preload (think tension pneumo and pericardial tamp) x contractility (think myocardial contusion, MI)

157
Q

Needle decompression in tension pneumo serves to

A

take pressure off IVC

Later, will place tube

158
Q

Beck;s triad

A

JVD, distent heart sounds, hypotension

present in pericardial tamponade

159
Q

Sucking chest wound: presentation and TX

A

dyspnea following penetrating chest wound

tension pneumo forms

TX: non-occlusive dressing (taped on 3 sides) + eventual thoracostomy

160
Q

Paradoxical movement of one portion of chest wall

A

when rib portion falls inward during inspiration

occurs with flail chest (>/= 2 ribs with >/=2 fxs)

161
Q

Pulmonary contusion features

A

Xray on day one normal, then whited out at 24-48hrs after traume

162
Q

Pulmonary contusion: TX

A

Like ARDS

Avoid crystalloids (can cause pulmonary edema)

fluid resuscitation with colloids
PEEP
diuresis eventually

163
Q

Complications of myocardial contusion

A

CHF
arrythmia
cardiogenic shock
pericardial tamponade

164
Q

Best initial test if suspect aortic dissection

A

CT angio

NOTE: only use angio if CTangio negative but you have very high suspicion

165
Q

Management of someone with head trauma with nl CT and GCSof 15

A

send home with instructions to look out for red flags

166
Q

Diffuse axonal injury: features

A

can occur after MVA resulting in spinning out of control and angular head trauma

CT scan showing grey-white matter blurring

167
Q

Management for different types of neck trauma: old/zone way

A

zone 1: lower neck, get arteriogram, esophagram, and bronch

zone 2: surgery

zone 3: arteriogram

NOTE: new way just involves going straight to CT angio if HDS but with “soft signs”

168
Q

Hard signs of hemodynamic instability in a patient with penetrating neck trauma

A

airway: gurgling, stridor, loss of airway completely
vascular: expanding hematoma, pulsatile arterial bleeding, stroke, or shock

169
Q

Soft signs

A

dysphonia, dysphagia, subq emphysema, non-expanding hematoma

170
Q

Brown sequard syndrome

A

hemisection of spinal cord, resulting in loss of motor and vibration/prop ipsilaterally and pain/temp contralaterally in addition to flaccid paralysis (LMN) at the level of the lesion and then spastic paralysis (UMN) below

171
Q

Anterior cord lesion

A

loss of motor, pain/temp

keep prop/vibration

172
Q

Pt presenting after MVA with pelvic fx and high-riding prostate

A

uretheral injury –> get retrograde urethrogram

173
Q

positive hip rocking sign =

A

pevlic fx

174
Q

Management of caustic ingestion

A

observation and serial cxrays with later EGD

175
Q

What is the next step of someone who survives an electrical strike?

A

check CK and Cr for rhabdmo 2/2 muscular burns
–> if positive, tx with IVFand mannitol

evaluate for posterior dislocation of shoulder

176
Q

Fluid resuscitation equation for burns

A

4 x kg x %body surface area (rule of nines)

50% of requirement in first 8 hours, the last 50% in the next 16hrs

177
Q

Management of burn wounds

A 
early movement 
early graft
IVF
IV analgesia
topical antibx (mupirocin)
178
Q

ethylene glycol or methanol intoxication management

A

fomepizole (prevents breakdown into toxic metabolites) or ethanol

179
Q

AG metabolic acidosis and osmolar gap in pt with recent blindness

A

methanol intoxication

180
Q

N/V, vertigo, tinnitus in s/o of primary respiratory alkylosis

A

early aspirin toxicity

181
Q

AG metabolic acidosis, obtunded, and hyperpyrexia

A

late apsirin toxicity

TX with alkalinization of urine and forced diuresis

182
Q

spO2 100% with HA, N/V, or dilirium

A

carbon monoxide toxicity

product of smoke inhalation

Give O2

183
Q

cherry-red skin or blood in pt SAS

A

cyanide toxicity

product of smoke inhalation

Give thiosulfae

184
Q

Symptoms of organophosphate toxicity

A

Acetylcholinesterase inhibitor

Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis

NOTE: also can get bronchconstriction

TX atropine then pralidoxine

185
Q

Treamtnet of acetominophen toxicity

A

N-acetylcysteine

186
Q

TX anaphylaxis (3)

A

1:1000 epi first
H1/H2 blockers
corticosteroids

187
Q

What electrolyte to worry about with spider bite

A

Ca

188
Q

Bateria to worry about with human bite

A 
gram negative bacteria
anaerobes
irrigation
amox/clav
F/U with tetanus Ig and  toxoid (if >5yrs since last vaccine)
189
Q

3 physical exam signs associated with acute appendicitus

A

rovsing sign (painin RLQ with palpation of the LLQ)

psoas sign (pain with extension of the hip; can also see with psoas abcess)

obturator sign (pain with internal rotation of the right thigh)

190
Q

Causes of bowel obstruction (9)

A 
adhesions (from previous surgery, most common)
hernia
Crohn disease
neoplam
intusseception
volvulus
foreign bodies
intestinal atresia
carcinoid
191
Q

Triad of fat embolism syndrome

A

confusion
petechial rash
dyspnea

w/in 5 days of fx

192
Q

Diagnostic findings for fat embolism

A

ABG showing Po2 < 60mgHg
Cxray showing infiltrates
UA showing fat droplets

193
Q

Symptoms of spinal stenosis

A

narrowing occurs at C2 and L1–> neck and back pain, bL leg/buttock pain and numbness, and pseudoclaudication

194
Q

Most appropriate diagnostic test for herniated disk

A

MRI spine

195
Q

Lab findings in acute mesenteric ischemia

A

leukocytosis
elevated amylase and phosphate levels
Metabolic acidosis (from elevated lactate)

196
Q

Imaging findings in pancreatic head adenocarcinoma

A

intra- and extra-hepatic ductal dilation

197
Q

Symptomatic sinus bradycardia: TX

A

IV atropine, if this doesn;t work, consider IV epi or dopamine or transcutaneous pacing

198
Q

Pancreatic cancer: imaging

A

if pt has jaundice: USfor suspected head of pancreas cancer

if no jaundice: CT scan for suspected cancer in body or tail of pancreas

199
Q

Multiple nodular infiltrates with cavitation in the lungs

A

Consequence of Infective endocarditis

Step 2 (14 decks)

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