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
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
3
Q
Causes of hypokalemia
A
Renal vs GI
Renal–hyper-aldo
diuretics (thiazide and loop)
GI–vomiting and diarrhea
4
Q
How much does 10meq K rais K
A
0.1
5
Q
uric acid stones (2 causes and txs)
A
radiolucent
Gout (allupurinol)
tumor lysis syndrome (rasburicase)
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
7
Q
Cysts associated with autosomal dominant polycystic idney disease
A
non-radially oriented cysts in kidneys
liver
pancreas
berry aneurysms (should be screened)
8
Q
Causes of respiratory acidosis
A
hypoventilation 2/2 asthma COPD obesity OSA opiate overdose decreased muscular strength
9
Q
Causes of respiratory alkylosis
A
hypoxia
anxiety
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
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
12
Q
Causes of metabolic acidosis
A
Methanol Uremia DKA Propylene Isopropyl Lactic acid Ethylene glycol Salicylates
13
Q
Microcytic anemia: types
A
iron deficiency anemia
anemia of chronic disease
thalasemia
sideroblastic anemia
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
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
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
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
18
Q
Production anemias: 2 types
A
microcytic and macrocytic
RI < 2%
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
20
Q
4 Labs to distinguish causes of normocytic anemia
A
LDH
Haptoglobin
bili
smear
21
Q
Types of normocytic anemias
A
hemolytic (PNH, G6PD def, sickle cell, AIHA, HS)
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
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
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)
25
Acute myeloid leukemia
"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
26
Acute Lymphocytic Leukemia
"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
27
Chronic myeloid leukemia
older patient
Diff and BM biospy showing BCR-ABL translocation
Tx with imatinib
28
Chronic lymphocytic leukemia
patient older
dx with diff and bm bx
if asx, do nothing
if sx and old, chemo
if sx and young, HSCT
29
Post-op fever: 7 possible causes (Tx)
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)
30
2 Electrolyte culprits for post-op AMS
Na and Ca
31
Causes of AMS post op (4)
electrolyte disturbance
sundowning in elderly
hypoxemia (think PE/PNA/ADS)
Delirium tremens (after 1 day HTN, tchy, diaphoresis then tremors 48-72hrs)
32
3 types of post-op abdominal distension + diagnosis/tx
(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
33
5 causes of post-op fistula
```
Foreign body
Epitheliazation
Tumor
Irridation/inflamed/inflammatory bowel
Distal obstruction
```
FETID
34
Risk factors with cholelithiasis
Fat
Female
Fertile
Forty
Also, being American indian
35
Alternative tx for cholelithiasis other than cholecystectomy
ursodeoxylic acid
36
Cholecystitis defintion and presentation + tx
gallstone(s) in cystic duct
Pt with CONSTANTRUQ pain and murphys sign
tx with IVF, abx, and urgent cholecystectomy
37
RUQ US in cholecystitis shows ___
(1) pericholecystic fluid
(2) thickened gb wall
(3) gallstones (sometimes wont see)
If you don;t see what you want, get HIDA
38
Choledocolithiasis definition, presentation, and tx
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
39
Dx of choledocolithiasis
RUQ US showing obstruction or CBDdilation
if negative, get MRCP or ERCP (if suspicion really high)
40
Cholangitis presentation
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
41
Abx treatment of emergent gallbladder diseases
cholecytitis, choledocolithiasis, cholangitis
cipro (GNRs) + metronidazole (anaerobes)
amp-gent +metronidazole
NOT pip-tazo
42
Painless jaundice: causes
Prehepatic (hemolysis or hematoma) --> unconjugated
Intrahepatic (genetic, hepatitis) --> mixed unconjugated and conjugated
post-hepatic (cancer +/- strictures) --> conjugated
43
Extended gallbladder and massively dilated CBDon RUQUS indictaes ____
cancer/stricture
44
Presentations of obstructive jaundice
(1) painless jaundice
(2) wt loss and clay-colored stool
(3) distended, nonpainful gallbladder
45
Migratory thrombophlebitis =
Pancreatic cancer
46
Risk factors for cholangiocarcinoma
chronic untreated cholecystitis
PSC (MRCPshowing beads on a string)
47
Presentation of someone with obstructive jaundice, postive FOBT, and negative colonoscopy indicates ____
tumor of ampulla of vater
48
Progression of tx of GERD and complications
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
49
Achalasia: presentation, diagnosis, and tx
presentation: dysphagia for solids
Dx: Barium swallow or manometry
Tx: botox, dilation, or *myotomy
*best initial treatment
50
Mallory weiss tear vs boorhaves
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
51
esophageal cancer: types
SCC--upper third, hot liquids and smoking
adenocarcinoma--lower third, GERD
52
Constipation vs obstipation
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)
53
Imaging that shows complete vs incomplete SBO
CT scan
54
4 types of hernias
Direct inguinal (adult males)
Indirect inguinal (baby males)
Femoral (adult females)
Ventral (post-op, risk factor is dehiscence)
55
Carcinoid (gut)
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
56
3 most common causes of acute pancreatitis
alcohol
gallstones
hypertriglyceridemia
57
Tx of necrotizing pancreatitis
carbapenams after confirmaion with FNA
58
Pancreatic pseudocyst management
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
59
Complications of acute pancreatitis
pseudocyst
necrotization
abscess
60
Indications of colorectal cancer
man with IDA
advanced cancer
#stool caliber (left-sided)
alternating constipation and diarrhea (right-sided)
wt loss
61
Anal cancer: treatment
Regardless of stage: chemo and radiation (nigro protocol)
62
Polinoidal cyst
anal cyst resulting from clogged hair follicle
can lead to abscess
tx with I/D if abscess, then resection
63
Ischemic bowel: presentation
pain out of proportion to exam
bloody BM
Sepsis
risk factors: CAD, afib, ischemia
64
Nonspecific abdominal pain: etiologies to be suspicious for depending on h/o and risk factors
DKA
MI
constipation
65
5 types of leg ulcers
(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
66
actinic keratosis
on continuum of SCC. 1% transformation per year
cryo, excision
lesion characterized by erythematous base with scaling, nonpigmented (looks very similar to SCC)
67
early mucosal form of SCC
leukoplakia
68
Basal cell carcinoma
cancerous lesion with waxy borders, erythamtous, easy to bleed, and with many telactasias
69
types of melanoma
superficial spreading
nodular
lentigo malignant
acral lentiginous (most dangerous but most easily missed as often in unexposed areas)
70
Higher lifetime estrogen with ____
early menarche
late menopause
nulliparity
hormone replacement tx (but NOT OCPs)
71
Work-up of breast cancer
Mammogram at 50yo q2yr for general population
MRI if high risk (BRCA1/2, prior radiation)
core biopsy if mammogram or MRI positive
72
tamoxifen vs raloxifen
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
73
Most likely etiology to sudden-onset severe unilateral lower abdominal pain immediately following strenous or sexual activity
ruptured ovarian cyst
NOTE: USwill show pelvic free fluid
74
psoas sign
abdominal pain with hip extension, indicative of psoas abcesess
75
Features of a meningioma
extra-axial, well-circumscribed, dural-based, partially calcified on neuroimaging
NOTE: considered benign, although can present due to mass effect
76
Features of biceps tendinopathy/rupture
anterior shoulder pain
pain with lifting, carrying, or overhead reaching
NOTE: weakness is less common
77
Emphysematous cholecystitis
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
78
A patient with stuttering episods of N/V, pneumobilia, hyperactive bowel sounds, and dilated loops of bowel likely has___
gallstone ileus (form of mechanical SBO)
79
4 types of disease patterns of multiple sclerosis
relapsing-remitting (majority)
primary progressive
secondary progressive
progressive relapsing
80
Central vs primary adrenal insufficiency
central: low ACTH, low cortisol, BUT NL aldosterone
Primary: high ACTH, low aldosterone --> hyponatremia and hyperkalemia
81
Cardiac finding in digitalis toxicity
atrial tachycardia with AV block
82
Clinical features of glucagonoma
```
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
Tumor lysis syndrome -->
hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (d/t calcium phosphate binding)
84
Clinical presentation of and risk factor for mixed cryoglobulinemia
palpable purpura, glomerulonephritis, non-specific systemic sxs, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia
RF: most pts also have HCV
85
Electrical alternans with sinus tachycardia is highly specific for ___
a large pericardial effusion
86
Type of breathing seen in DKA
deep and rapid breathing
Helps individual compensate for AG metabolic acidosis
87
Seborrheic keratosis
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
Corrected Ca =
Ca + 0.8 x (4 - albumin)
89
Bloody BM in premature infant and XRay showing air in bowel have
necrotizing enterocolitis
90
meconium plug =
cystic fibrosis
91
Xray showing gas-filled plug in the setting of biliary emesis and failure to pass BM in infant =
meconium plug
92
Complication of meconium plug
perforation
93
Xray in new born showing dilated proximal colon with transition point distally with normal-lloing distal colon
Hirschsprung disease
94
explosive diarrhea after a DRE in neonate =
Hirschsprungs
95
US in neonate showing donut sign =
pyloric stenosis
96
Electrolyte disturbances of pyloric stenosis
hypokalemic hypochloremic metabolic alkalosis
97
Diagnostic imaging of biliary atresia (2)
US showing no ducts
| HIDA showing atresia
98
Snoring baby who is blue with feeding and pink with crying =
choanal atresia (barrier btw nose and pharynx)
99
Med that can artificially elevate gastrin
PPI
100
Throid nodules that require FNA
(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
Labs associated with insulinoma
high insulin
high c-peptide
negative for sulfonyurea
102
Scan used to diagnosis bad gland in primary hyperparathyroidism
sestanibi scan
103
Conn syndrome: presentation
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
5 Ps of pheochromocytoma
```
Paroxysyms of HTN
Pressure (HTN)
Pain (HA)
Palpitations
Perspiration
```
105
Woman with HTN and DM coming in with moon facies =
cushing syndrome
106
left to right shunts
D diseases
ASD vs VSD vs PDA
NOTE: acyonotic
107
right to left shunts
T diseases
Transposition of great vessels vs tetrology
NOTE: cyonotic on day 1
108
Congenital defect in baby with mom with DM
transposition
109
Tetrology of felo
endocardial cushion defect seen in pts with down;s
(1) VSD
(2) Overriding aorta
(3) Pulmonic stenosis
(4) RVH
110
Bovine vs mechanical valves
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
Type A vs B dissections
```
Type A (ascending): surgery
Type B (descending): IVbeta blockers
```
distinguished by CT angiogram (NOT arteriogram) or TEE
112
___ and ____ are meds for symptomatic PVD
cilostazel
| pentoxyphylline
113
Amlyopia =
cortical blindness that is a complication of strabismus or early-life cataracts
114
Strabismus =
lazy eye
115
Infant that develops cataracts has ____
galactosemia
116
Complications of prematurity (4)
retinopathy of prematurity (from high levels of Fio2)
necrotizing entercolitis
bronchopulmonary dysplasia
Intraventricular hemorrhage
117
Neonatal conjunctivitis: 3 types
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
Nonreactive dilated pupil and rigid eyeball in s/o starting anti-cholinergic =
closed angle glaucoma
treatment with alpha-agonist
119
Causes of retinal detachment (2)
Trauma (MVA)
HTNcrisis
120
Curtain coming over vision =
retinal detachment
NOTE: If this happens often, amaurosis fugax (impending retinal artery occlusion/TIA)
121
Retinal artery occlusion presentation and tx
acute, painless vision loss
TX: interarterial tPa
122
Management of melanoma
< 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
Management of subarrachnoid hemorrhage
bp control
seizure ppx
bleeding control (coil or clipping)
hydrocephalus control (serial LPs)
124
Preferred imaging to diagnosis brain cancer
MRI with contrast
125
Brain tumors
Posterior (peds): medulloblastoma and ependymoma (4th ventricle tumor --> obstructive hydrocephalus)
Pituitary: prolactinoma, acromegaly, craniopharyngioma
Anterior (adults): meningioma and glioblastoma
126
Ring-enhancing lesion in brain that crosses midline
glioblastoma (necrotizing so can cross midline)
127
head trauma with LOC then lucid interval then neurologic deterioration
epidural hematoma
128
A dilated, unreactive pupil on one side in s/o head trauma =
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
Cushing triad
elevated BP
bradycardia
respiratory irregularity
suggests elevated ICP
130
Risk factors for dural venous sinus thrombosis
```
hypercoagulable state
trauma
dehydration
pregnancy
OCPs
infections (esp sinusitis or mastoiditis)
```
131
Leriche syndrome
a commbination of claudication in the buttocks, buttock atrophy, and impotence in men due to aortoiliac occlusive disease
132
Baby on day 1 with oliguria and distended bladder
posterior urethral valves
133
What never to do with baby with epi/hypo spadia
circumcision
134
Colicky abdominal pain in teenager who drinks for first time
uretopelvic junctional obstruction
135
w/u child with recurrent UTIS and pyelo
US showing hydronephrosis and vesico-ureteral gram showing reflux
likely has vesicoureteral reflux
136
Non-seminomas tumor markers
endodermal--AFP
choriocarcinoma--beta-HCG
teratoma--look for mets
137
Medications/interventions used to suppress prostate cancer
resection/radiation/brachytherapy then:
anti-androgens (flutanide) or
GNRH analogs (leuprolide) or
Orchiectomy
138
TURP
transurethral resection of prostate
Used in obstructive uropathy
139
Testicular torsion vs epididymitis
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
Insidious onset of an antalgic gait in a 6yo
legg-calves-perthes disease
NOTE: treatment with a cast
141
Trasnient synovitis
hip pain following viral illness
TX with anti-inflammatories if no signs of infection and F/U in 2 days
142
Knee pain and tibial swelling in a teenage athlete indicates ____ and can be treated with ___
osteochondrosis (osgood schlatters)
TX: rest or continue with activity (doesnt matter)
143
mid-shift bone lesion with onion-skinning on xray
ewings
144
distal femur lesion with sunburst pattern
osteosarcoma
145
Moteggia vs galezzia fx
monteggia: broken ulna and displaced radius
galezzia: broken radius and displaced ulna
146
Jersey finger
sports-related tear in the flexor tendon of a finger--> cannot flex
TX: splinting and NSAIDs
147
Mallet finger
Sports-related tear of extensor tendon--> cannot extend
TX: splinting and NSAIDs
148
Inability to extend fingers and palpable nodules on palm in a male
dupuytren;s contracture (fascial disease)
TX: surgical release
149
Felon =
abscess in the finger requiring I&D
150
Causes of total hematuria
```
Renal mass (benign/malignant)
glomerulonephritis
urolithiasis
PCKD
pyelo
urothelial cancer
trauma
```
151
Causes of terminal hematuria
```
urothelial cancer
cysitis
urolithiasis
BPH
prostate cancer
```
152
Inital hematuria
urethritis
| trauma (i.e catheterization)
153
Indications for urgent exploratomy lapartomy in abdominal trauma
hemodynamic instability
peritonitis
evisceration
blood from a NGT or on rectal exam
154
Pt who presents with acute onset back pain and profound hypotensions=
ruptured AAA until proven otherwise
155
End-tidal Co2
Indicates placement of ET tube
ETCo2 = 40 indicates adequate placement
156
MAP
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
Needle decompression in tension pneumo serves to
take pressure off IVC
Later, will place tube
158
Beck;s triad
JVD, distent heart sounds, hypotension
present in pericardial tamponade
159
Sucking chest wound: presentation and TX
dyspnea following penetrating chest wound
tension pneumo forms
TX: non-occlusive dressing (taped on 3 sides) + eventual thoracostomy
160
Paradoxical movement of one portion of chest wall
when rib portion falls inward during inspiration
occurs with flail chest (>/= 2 ribs with >/=2 fxs)
161
Pulmonary contusion features
Xray on day one normal, then whited out at 24-48hrs after traume
162
Pulmonary contusion: TX
Like ARDS
Avoid crystalloids (can cause pulmonary edema)
fluid resuscitation with colloids
PEEP
diuresis eventually
163
Complications of myocardial contusion
CHF
arrythmia
cardiogenic shock
pericardial tamponade
164
Best initial test if suspect aortic dissection
CT angio
NOTE: only use angio if CTangio negative but you have very high suspicion
165
Management of someone with head trauma with nl CT and GCSof 15
send home with instructions to look out for red flags
166
Diffuse axonal injury: features
can occur after MVA resulting in spinning out of control and angular head trauma
CT scan showing grey-white matter blurring
167
Management for different types of neck trauma: old/zone way
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
Hard signs of hemodynamic instability in a patient with penetrating neck trauma
airway: gurgling, stridor, loss of airway completely
vascular: expanding hematoma, pulsatile arterial bleeding, stroke, or shock
169
Soft signs
dysphonia, dysphagia, subq emphysema, non-expanding hematoma
170
Brown sequard syndrome
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
Anterior cord lesion
loss of motor, pain/temp
keep prop/vibration
172
Pt presenting after MVA with pelvic fx and high-riding prostate
uretheral injury --> get retrograde urethrogram
173
positive hip rocking sign =
pevlic fx
174
Management of caustic ingestion
observation and serial cxrays with later EGD
175
What is the next step of someone who survives an electrical strike?
check CK and Cr for rhabdmo 2/2 muscular burns
--> if positive, tx with IVFand mannitol
evaluate for posterior dislocation of shoulder
176
Fluid resuscitation equation for burns
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
Management of burn wounds
```
early movement
early graft
IVF
IV analgesia
topical antibx (mupirocin)
```
178
ethylene glycol or methanol intoxication management
fomepizole (prevents breakdown into toxic metabolites) or ethanol
179
AG metabolic acidosis and osmolar gap in pt with recent blindness
methanol intoxication
180
N/V, vertigo, tinnitus in s/o of primary respiratory alkylosis
early aspirin toxicity
181
AG metabolic acidosis, obtunded, and hyperpyrexia
late apsirin toxicity
TX with alkalinization of urine and forced diuresis
182
spO2 100% with HA, N/V, or dilirium
carbon monoxide toxicity
product of smoke inhalation
Give O2
183
cherry-red skin or blood in pt SAS
cyanide toxicity
product of smoke inhalation
Give thiosulfae
184
Symptoms of organophosphate toxicity
Acetylcholinesterase inhibitor
```
Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
```
NOTE: also can get bronchconstriction
TX atropine then pralidoxine
185
Treamtnet of acetominophen toxicity
N-acetylcysteine
186
TX anaphylaxis (3)
1:1000 epi first
H1/H2 blockers
corticosteroids
187
What electrolyte to worry about with spider bite
Ca
188
Bateria to worry about with human bite
```
gram negative bacteria
anaerobes
irrigation
amox/clav
F/U with tetanus Ig and toxoid (if >5yrs since last vaccine)
```
189
3 physical exam signs associated with acute appendicitus
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
Causes of bowel obstruction (9)
```
adhesions (from previous surgery, most common)
hernia
Crohn disease
neoplam
intusseception
volvulus
foreign bodies
intestinal atresia
carcinoid
```
191
Triad of fat embolism syndrome
confusion
petechial rash
dyspnea
w/in 5 days of fx
192
Diagnostic findings for fat embolism
ABG showing Po2 < 60mgHg
Cxray showing infiltrates
UA showing fat droplets
193
Symptoms of spinal stenosis
narrowing occurs at C2 and L1--> neck and back pain, bL leg/buttock pain and numbness, and pseudoclaudication
194
Most appropriate diagnostic test for herniated disk
MRI spine
195
Lab findings in acute mesenteric ischemia
leukocytosis
elevated amylase and phosphate levels
Metabolic acidosis (from elevated lactate)
196
Imaging findings in pancreatic head adenocarcinoma
intra- and extra-hepatic ductal dilation
197
Symptomatic sinus bradycardia: TX
IV atropine, if this doesn;t work, consider IV epi or dopamine or transcutaneous pacing
198
Pancreatic cancer: imaging
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
Multiple nodular infiltrates with cavitation in the lungs
Consequence of Infective endocarditis
