Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery Oral Exam > Oral Exam Cases > Flashcards

Oral Exam Cases Flashcards

1
Q

What does OPQRSTU stand for

A

onset, position, radiation, severity, timing, and relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

who gets an EKG

A

over 40 men and over 50 W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

if anticoagulation is a concern, what do you get

A

PTT and PT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who gets a cardiac workup

A

history of heart disease or symptomatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what meds do you stop 7 days out

A

NSAIs, anticoag, and ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

neck mass history

A

problems swallowing, speaking, breathing, mouth ulcers, fever chill, night sweat, weight loss, alcohol, and tobacco products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are family history questions with neck mass

A

MEN and thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is a neck mass if they have night sweats

A

lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

physical exam for neck mass

A

full PE with recta, placate liver, east and lungs, look for Hand N and look in nose, mouth easy, palpate nodes all over including in the axilla. Are the nodes firm or ovable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

imaging for neck mass

A

US and CT of head and neck CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

testing for neck mass

A

FNA, quad endo- nasophargeoscopy, laryngoscopy, bonchoscopy, escogoscopy under anesthesia with mouth exam, tipsy for these and tumors can hide in the piriform sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

surgery for neck mass

A

RND which is radical neck dissection which incused the SCN, spinal accessory nerve, internal jugular vein and submandibular gland. Post op rnd.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what do you do for an excisional biopsy of these neck mass

A

frozen section and RND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

if the neck mass is sebaceous cyst

A

close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

if the neck mass is scc

A

RND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if the neck mass is unknown primary

A

RND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if the neck mass is lymphoma

A

no srugery, chamber and rads because medical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

if the neck mass is malign melanoma

A

RND and repeat PE for melanoma above the wasit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

if the neck mass is pap thyroid

A

total thyroid and modified RND for just nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if the neck mass is adenocarcinoma of colon primary

A

chemo rads if colon is primarry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if the neck mass is aden of salivary

A

RNd and take out the gladn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what if the LN is metastatic

A

yo should remove it for local disease control anyways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thyroid histroy

A

hyperthyrod symptoms like increased energy, trouble sleeping, weight loss, diarrhea, hypothyroid symptoms like decreased energy, fatigue, eight gain, constipation, family history of endocrinopathies and MEDN, radiation exposure as child, work, dysphagia, hoarse, difficulty breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PE for thyroid

A

full PE and focus on the texture and movability of the node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

labs for thyroid

A

TSH wouldn’t want to stick it if its hot because thyroid storm. if euthyroid or increased TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

imaging for thryoid

A

US demonstrates >3mm or solid is worse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

RAU if the nodule is

A

hot. Hot nodules are less worrisome. Do this if the TSH is low. cold is worrisome and needs a biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if TSH low what do you do

A

thyroid scan, t3/T4 and functional nodule, RAI, surgery, and methimazole and PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

if the TSH is high or normal do

A

US FNA and

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the Bethseda classes

A 
Non-diagnositic- repeat FNA
Benign- no surgery
AUS/FLUS- repeat FNA
FN/FSn- lobectomy
suspicious or indeterminate- lobectomy or total thyroid
malignant- total thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

papillary thyroid Ca mets

A

nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

treatment for pap

A

total thyroidectomy and resection of is central nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

if the nodes are positive for pap

A

modified radical for all + nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the addition tx for pap

A

RAI, suppressive T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the tumor marker for recurrence of pap

A

thyroglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

follicular mets via

A

blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

tx follicular

A

total thyroidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the addition tx follicular

A

ablation plus T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the tumor marker for follicular

A

thyroglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what does medullary met by

A

blood and nods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what type of cells does medullary affect

A

c cells which are parafollicular cells that secrete calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is another name for calcitonin

A

pentagastrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is med associated with

A

MEN2a or 2B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the gene associated with MEN2

A

ret protoconcogene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

treatmend for med

A

total thyroid plus ipsilateral LN conpartment plus T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

do medullar need RAi

A

no it does not take it up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

medulllay tumor marker

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

anaplastic tx

A

no surgery just chemo and rads because it is only palliative for airway compression. locally aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

MEN1 associateion

A

parathyroid hyperplasia, pit adenoma, pancreatic adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

MENIIa

A

medually thyroid, phew, and para hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

MENIIB

A

marfanoid, med thyroid, mucosal neuromas, pheo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

men has pheo where

A

tends to be bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what can happen to a gallstone

A

nothing, block a cystic duct, block that acutely then infection, bloc CBD, empyema, hydrous GB, cholangitits, ileum, pancreatitis,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what grows if there is retrograde inflame of GB

A

ecoli, kleb, enterococcus, bacteriodes fragillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what is it called if the CBD is blocked

A

choledocolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is hydrous of the GB

A

type of acute cholecystitis, stone blocks the cystic dduct and bile pigments are reabsorbed leading to white bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are the common causes of choledoco in the uS and world

A

choledoclithaisis is US, and colorants sinuses is worldwide, cholangiocarcinoma and sclerosis cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is PSC associated with

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what drugs can treat the ascending chol

A

Unasynand zoysn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is chariots triad

A

jaundice, RUQ, fever, chills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

reynolds pentad is

A

jaundice, RUQ, and fever ,chills, mental status changes, and hemodynamic instability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

where does the ileus for the GB occur

A

it causes SBO at the illeocecal valve the fistula is causes between the GB and duodenum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

how do you fix gb ileus

A

NGT and remove stone from bowel do not need to remove the GB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what are the causes of pancreatitis

A

B- bilairy
alcohol
drugs- thiazides and roads
scorpion bite, surgery
hypercalcemia, hyperlipidemia,
iatrogenic from the ERCP, SLE, coxsackie,
trauma and tumor of the head of the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

treatment for pancreatitis

A

treat with bowel rest, IVF, NGT, and CT is diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

diagnostic tests for GB

A

ERCP for shooting dye through the sphincter of Oddi can also need a sphinctorotmty remove the CBD stone. main complication is pancreatitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

US for Gb

A

shadowing from the CBD is 6mm if dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

HIDA scan

A

test of fun, not anatomy, if decreased EF after CCK, recreating of pain, or can’t see GB (blockage of cystic duct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

PCTA

A

percutaneous transhepatic angiogrpahy, use Klatskin tumor, cholangiocarcinoma at bifurcation of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

If there is pancreatic cancer at head of the pancreas

A

whipple- pancreaticoduodenonectomy, whole, tranquil vagotomy,antrectomy, cholechojejunostomy/ A whipple is palliative because chemo and rads do nothing. Whipple is also good for cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

if cancer is in the body or tail

A

distal pancreatectomy if the pancreatic cancer is unresectable due to blood vessel involvement liver involvement or biliary obstruction do a plaintive stent with ERCP, the downside to the stent is infection because luminal obstruction in CBD and have to change it every 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

if chronic panc

A

Roux en Y choledocojejunostomy. This is a bypass from the CBD to the jejunum and it prevents alkaline gastritis, treat alkaline gastritis qiwth cholestyramine to decrease bile acid pool, or Ca2+ which chalets bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

if choronic pancreatitis obstructing pancreatic duct

A

longitudianl pancreatojejunostomy or distal pancreatiticjejunostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

melanoma history

A

asymmetry, border irregularity, color variation, diameter greater 6mm/dark enlargement/elvation. Prior personal history of melanoma or other skin lesions. Family history of melanoma or skin cancer, first sunburn at a young age, employment, possible relations with halogenated compounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

melanoma PE

A

fill PE and focus on skin and LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

melanoma labs

A

LFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

imaging for melanoma

A

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

risks for melanoma

A

fair hair, red hair, white, >20 nevi, blue eyes, easily burned, unable to tan, age, gender, tanning lamps, UVA, higher SES, immunosuppressed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

where are melanocytes found

A

them and dendritic cells are found at the DE junction of the skin, mucosa of respiratory GI and LN capsules, and substantial nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

types of melanoma

A

superficiaal spreading, nodular sclerosing, lentigo maligna, acral lentigionous common in AA, asians, hispnanic, palms/soles, nail beds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Clark staging

A

epiderma, pap dermis, junction of pap and ret dermis, reticular dermis, fat and subQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Breslow index

A

depth of vertical height; overall survival in 5 years correlates with tumor thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

palp LN present for melanoma

A

complete lymphadenecomy of the basin do an excision or fNA first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what do you need to do to map the LNE

A

SLN and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what stages get biochem for melanoma

A

Stage III and IV get interferon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

margins melanoma

A

.5cm- melanoma insitu
1 lesions over 1mm in thickness
2cm lesions >1mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

get SLN for melanoma if

A

less than .75 mm no

>1mm yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

if SLN is positive

A

get chest and abdominal CT and brain MRI. Positive staging to exclude mets with biopsies, and resect if possible and radiation for brain mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

sLN+ and negative staging

A

complete lymphadenceomy. Give IFN alpha and high dose ipilmumab.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

how do you treat advanced extremitiy melanoma

A

isolated limb perfusion and chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

diverticulitits histroy

A

PQRSTU. constitutional with chills, fever, weight loss, night sweats, change in bowel habits, constipation, diarrhea, and change in diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

diverticulitis PE

A

rectal and abdominal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

lab for diverticulitits

A

CBC for leukocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

imaging for diverticulitits

A

CT of abdomen, colonoscopy, barium enema with caution to avoid possible leak of barium into peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

treatment uncomplicated diverticulitits

A

managed medically, mild cases with outpatient treatment. Should be hospitilized for IVF, antibiotics, bowel rest, observation. clinical resolution of acute with first episdoe and greater than 50 who are not compromised do not require further things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

if immunocomp what should you tx for diverticulitits

A

Harmat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

when does diverticulitits get elective surgery

A

two plus epidsodes or under 40 with one epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

one stage operation diverticulitits elective

A

resect involved segment and primary anastoamosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

complicated diverticulitits tx

A

perforated diverticulitis with peritonitis do surgical exploration. second MCC of free air in peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

when do you give surg for diverticulitis

A

obstructon, fistula, perf, abscess that cannot be drained, sepsis, deterioration with conservative tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what are the most common causes of free air under diaphragm

A

duodenal perforation and diverticulitits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Hartmans

A

resection of involved segment with end colostomy/stapled rectal stump (subsequent reanastamosis 2-3 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

diverticular fistula for dx and tx

A

sigmoid to bladder/vagina/skin/another loop of bowel and dx with barium enema, CT, and sigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

how do you dx for colovesical and colovaginal fistula

A

cystoscopy on vaginal speculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

diverticulitis fistula tx

A

resection of sigmoid, excision of fistulous tract, repair/resection of involved organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

colorectal cancer and polyps history

A

fever,chills, weight loss, night sweats, abdominal pain, diarrhea, constipation, blood install, changes in bowel habits, family history of colon ca, colonoscopy hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

colorectal cancer and polyps PE

A

PE and abdominal and fecal occult blood test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

colorectal cancer and polyps labs

A

CBC, CMP, CEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

colorectal cancer and polyps imaging

A

EGD, colonscopy, small bowel contrast radiography, CXR, CT abdomen and pelvis to exclude metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

surgery prep for colon surgery

A

mechanical bowel prep, NPO starting at midnight, liquids only days before, non-absorbable oral abs day before can decrease risk of wound infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

for cecum what is the name for the removal

A

right hemicolectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what if there is synchronous colon cancer

A

complete colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

if locally advanced colon cancer, what is the tx

A

en bloc resection of contiguous structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

if LN are involved with colon CA

A

need to resect or T4 need FolFOx which is leucovorin, 5 FU and oxialiplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what do you have to check if anatoamosis

A

there needs to be submucosa, no tension and good blood supply on either side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what if there ia 5 days POD and tacky fever afib and hypotensive after colectomy

A

anastamotic leak and need to perf drain if possible if not, open up and if its blown then colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

how long do you give post op abx

A

only 3 doses within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what do you do for anticoagulation

A

lovanox, compression socks, sequential compression device, and ambulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

decrease PNA risk

A

incentive psiro, ambulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

decrease risk of wound infection

A

pre-and peri abx, glucose control, normothermia in the OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

rectal surgery PE

A

need endorectal US for radiologic TNM classification.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

if its in the upper 2/3 of the rectume over 10 cm above the anus

A

resect and reanastamosis with resection of the margin of 10 cm proximal and 2 cm distal to the lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

if its in the lower 1/3 surgery-T1 and well diff and under 3

A

t1 lesion well diff and under 3 cm then local eosin to the level of the elevator Dani muscles and leva the anal canal and sprinter intact for anastomosis later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

if its in the lower 1/3 surgery- and more than T1 or 3 cm

A

abdominoparineal resection- resection of the rectum and anal cancel and sphincter for low lying cancer wit ha permanent colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

T3 or T4if its in the lower 1/3 surgery-

A

need chemoraditation followed by abdominoperineal resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

screening for colon

A

every 10 years starting at 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

if there is an adenomatous polyp removed when is the next colonoscopy

A

every 3 years and then if its free after then go to 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what type of polyp increases the risk of cacncer

A

larger villous poly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

when is polypectomy curative

A

submucosal penetration ahs not occured. if invasive it needs resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is the colonoscopy schedule for FAP, HNPCC, IBD

A

colonoscopy starting at 25 with yearly FOBT, colonoscopty every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Dukes classes for Colon cancer

A

A- mucosa only
B into muscular
C LN positive
D distant mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

acute abdomen

A

sudeen sever abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what do you start with acute abdomen

A

vitals, O2, NGT, IVF, foley

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

histroy for acute abdomen

A

OPQRSTU, V, hemateesis, alcoholism. PMH, SH< FH, meds, allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

exam for acute abdomen

A

abdomniam exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

if there is positive signs of peritonitis what do you do

A

go to the OR- diffuse abdominal tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

labs for acute abdomen

A

CBC, CMP, ABG for acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

differential for acute abdomen

A

perforated ulcer, appendix, gallbladder, pancreatitis, volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

tx for ruptured ulcer

A

graham patch, highly selective vagotomy, pyloroplasty, tranquil agotomy, antrectomy inclusing ulcer for gastric ulcer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

chest pain and epigastric pain with emesis, history of alcohol, emerges, abdominal pain, exam has rebound and no radiation, decreased Bs, -ddx

A

PUD, gastritis, biliary colic, gastric volvuvlus, Mallory weiss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

tests for listed above case

A

free air, EKG wit positive tropinins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

plan for the case

A

nitro drip with swan gang to check the filling pressure, and beta blocker and antibiotics in the OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

OR for perforated duodenal ulcer

A

graham pouch with momentum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

if there is a perf gastric ulcer

A

antrectomy for gastric perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

closing the abdomen and the BP is 50…

A

use an inartistic balloon pump attached to EKG in femoral artery aorta. When n systole, the balloon is collapsed, in diastole it inflates, gives a diastolic kick to get blood into coronaries (increasing preload) and creates a suction in systole to decrease after load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

RLQ history

A

PQRSTU, fever chills, nvd, pain with urination, hematemesis, changes in bowel habits, vaginal discharge, LMP if female, sexually active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

RLQ PE

A

focus on abdominal, pelvic, and rectal exams, rebound tenderness, involuntary guarding, distention, rovsig pain RLQ when palpate LLQ, psoas, obturators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

RLQ ddx

A

GI: appendicitis meckels, mesenteric lymphadenitits, diverticulitis of cecum, IBD, gastroenteritits, valentinos apendicitis. PID, TOA, mittelschmitertz, pyelo, UTI, kidney stone, ectopic pregnancy, RLL pneumonia, pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

labs for RLQ pain

A

CBC with diff, UA , urine HCG, type and screen, CMP and amylase and lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

atypical RLQ

A

gets a CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what is the preferred testing for gyn

A

US instead of CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what is the typical progression of appendicitis

A

facecloth luminary obstructs the appendix, lymphoid hyperplasia in teens, and food matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

what does the facecloth cause in terms of obstruction

A

obstruction increases the mucus secretion and venous lymphatic congestion,and bacterial overgrowth leading to necrosis and perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

rupture appy in F can cause

A

adhesions in pelvics and serility- tell this if the case is unclear from CT and want to progress to lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

why are there QBC in the UA

A

it is from the appendix lying on the ureter and causing inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what you do if you suspect appendicitis

A

remove it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

if there is a normal appendix

A

can take a look around to look for other stuff. If normal can still remove it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

mass in the tip of the appendix

A

if less than 2 cm take out appendix and if greater than 2 cm then do right hemicolectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

tubo-ovarian abscess tx

A

unilateral salpingo-oopherectomy- with hysteretcomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

crohns in ileum- what to do

A

do not take out the appendix if the re cecums involved because it can risk developing a fistula.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

fistula causes

A

foreign body, radiation, immunocompromised/infection, epithelialization, neoplasia, distal obstruction, steroids. treat acute crohns with steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

MEckels tx

A

amputate at the base or resect the base if there is a wide width or an ulcer opposite it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

suppurative thrombophelbitits

A

pain 48 hours after vaginal delivery acute abdomen and increased WBC-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what is the etesing for suppurative thrombophelbitits

A

abdominal xr will be normal and the abdominal CT has a tubular structure in the retroperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Tx for suppurative thrombophelbitits

A

exalt finds large ovarian vein with suppurative thrombophelbitits due to ureter compressing the vein and with development of the coloniszation remove vein and give abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

acute GI bleed ABC

A

are they able to maintain airway or loss of protective reflex, intubate if concerted. Low BP suggests excessive bleeding, need 16-18 gauge needles and IVs with 2L NS followed by blood products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

if unstable with acute GI bleed- blood per NG

A

Upepr gi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

if unstable with acute GI bleed- proctoscopy +

A

rectal bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

if there is upper GI bleeding what could you do

A

EGD and fix it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

RBC scitogrpahy

A

high SN- negative do a colonoscopy if there is high volume. if bleeding stops colonscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

angiography is

A

the most specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

if the patient is stable with acute GI bleed

A

colonscopy and EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

history for acute GI bleed

A

alcoholic, previous ulcer, varices, history of AAA repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

differential for acute GI bleed

A

esophageal varices, perforated gastric or duodenal ulcer into the GDA, angiodysplasia, aortoenteric fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Labs for acute GI bleed

A

CHC with hemoglobin, CMP, LFT if alcoholic, type and cross, tox screen and blood alcohol level

176
Q

what does 1 unit of PRBC equal

A

1gm of hb

177
Q

varices tx

A

1- volume resuscitate and IV octreotide and abs
2- look at it with endoscope. if its stopped bellying do a beta blocker then band 1-2 weeks later. continued bleeding- balloon tamponade and increased risk of necrosis. Early rebleeding- repeat endoscopy therapy and need a TIPS or shunt surgery if there is recurrent hemorrhage

178
Q

sclerotherapy

A

using sodium morrhuate

179
Q

vasopressin what is the risk for varices

A

risk of MI

180
Q

portocaval shunt

A

TIPS need to do early- increased risk of encephalopathy because liver is not clearing as much hammonia

181
Q

what is the pathophysiology of cirrhotic liver

A

scar tissue impedes blood flow into the portal vein, increased pressure in the portal system gets shunted to the splenic vein, and short gastric, esophageal plexus, also in the umbilical vein, inferior rectal and retroperitoneal

182
Q

what is the pathophys of enecphalopatyh

A

gut bacteria normall detoxifid in the liver, check this by measuring arterial ammonia

183
Q

Childs Criteria

A

predicts the operative mortality- no ascetis, bill <2, no encephalopathy, alb>3.5 good nutrition, measure with transferring na pre albumin, and operative mortality is the same as if not cirrhotic.
mil ascites- bili 2-3, alb 3-3.5- nitrition no encephalotpy- additional mortality of 155 of the operation
ascite- alb<3, and encephalopathy- morality is 40% plus the risk of the operation. TIPS is places between hepatic vein and branch of portal vein to kill time before transplant

184
Q

Most common reason for transplant

A

Heptatitis C or B in world, alcohol, and quickly is becoming NASH

185
Q

red whale sign

A

the impending vatical hemorrhage

186
Q

what are the indications to shunt

A

stopped drinking, not class C, determine if blood in portal vein goes to or from the liver (retropedal is bd because increased encephalopathy, want heptofugal flow)

187
Q

how do you test for the flow of the liver

A

colo dopler of portal vein or measure portal pressure by hepatic vein wedge pressure, if <24 do NOT shunt because poor portal flow

188
Q

shunt choices

A

portocaval- highest risk of encephalopathy. Splenorecnal shnt of Warren does not help portal pressure but lowers encephalopathy because it diverts the spleen flow

189
Q

reflux dz hx

A

PQRSTU, associated with food, lying down, tight clothing, hoarseness wheeling, difficulty breathing, ffever, weight loss, chills, sweats, smoking and drinking

190
Q

reflux dz PE

A

full

191
Q

reflux dzlabs

A

CBC, CMP, cardiac enzymes if there is reason

192
Q

reflux dz imaging

A

endoscopy for erosive or barriers
barium- locate the GE junction in relation to the diaphragm. hiatal hernia or shortened esophagus, evaluates for gastric outlet obstruction shows spontaneous reflux,

193
Q

reflux dz 24 hr PH moniter-

A

correlates symptoms with episodes of reflux, stick a probe down the to the GE junction that correlates reflux symptoms with ph

194
Q

reflux dz mamomatry

A

evaluates the competency of the LES, adequacy of peristalsis, motility disease based on pressure readings

195
Q

reflux dz what else should you order

A

breathe test for pylori urease

196
Q

tx for reflux dz behavioral

A

avoid irritants, high fat meals, no ells before lying down, elevate head of bed, lose weight, stop smoking

197
Q

reflux dz tx medical

A

ntacids, ppi, prokinetic, h2 blockers

198
Q

reflux dz surgical

A

laproscopic or open surgery with persistent GERD on max of PPI. Nissan which is a 360 degree wrap of the funds around the GE junction

199
Q

50 yo F with halitosis bead breath, food getting stuck, and emesis after eating, difficulty swallowing liquids as well:
hx, test, diagnosis, treatments

A

tests- esophagoscope shows undigested food, barium swallow- dialed esophagus with corkscrew appearance and bid beak sign. manometry confirms achalas

200
Q

dx of achalasia with manometry

A

failure of the LES to relax with swallowing and increased LES pressure with inability to relax.

201
Q

tx for achalasia

A

esophagomyotomy- cut hypertensive outer muscle. ballon dilation of the sophagus, CCBs, fundoplication with toupee, botox

202
Q

my food gets stuck- test shoes esophagitis

A

esophagoscope shows grade 2 esphogitits and barrettes

203
Q

how to treat above person with barrets if its low grade

A

Nissen

204
Q

how to treat it if its high grade barretts

A

esophagastrectomy

205
Q

grading of esophagitis

A

1- erythema
2- linear ulceration
3- circular ulceration
4- stricture

206
Q

my food gets stuck part 3 he esophagoscope shows stricture and no barrels with hernia- treatment

A

Nissen and ballon dialtion for stricture

207
Q

food stuck- what risk factors do you need to ask

A

smoking, alcohol, reflux, barrettes, previous radiation, dsyphagia, weight loss, hoarseness

208
Q

what are the tests for food stuck- esophagoscope shows fun gating mass- what do you do

A

metastatic workup with CXR, lFT, bone scan, CT, EUS stage then esophagectomy then do a stomach wing to bring up intestine or colon but make sure it does not have cancer. if there is invasion, must do chemo and radiation prior to surgery

209
Q

Lung cancer histroy

A

cough, productive, hemotypsis, oarse, fever, chills, nv, weihgt loss, sweats, smoking, asbestos, family history of lung ca, previous ca anywhere else.

210
Q

PE for lung cancer

A

chest exam, LN palp and skin exam, look for pink puffer or blue bloater

211
Q

labd for lung CA

A

CBS, LFT, Po4, ABG, PFT

212
Q

what FEV1 is fine for srugery

A

800-1000 cc

213
Q

lung CA imaging

A

compare CXR, CT with contrast and chest and abdomen to look at size, location, solid or cystic, and LN for kediatonum or mets to liver or adrenal

214
Q

where does lung CA like to go

A

liver and adrenals

215
Q

what test do you do to look for distant mets

A

PET scan, and detects increased rate of glucose metabolism that occurs in malignant lesions, if you see a PET with bright spots on kidney and bladder, this does not mean there are mets, just contrast is renally excreted.

216
Q

what disqulaifies from lung surgery

A

mets, low PFT

217
Q

if there are no mets and PFt is okay what are the next steps

A

bronchoscopy- check for central lesions- if positive, no surgery
mediastonostomy- scope through the tranchemostomy incision to sample LN if + no surgery.
lobectomy is possible- only 1/3 are resectable.

218
Q

if its a central lesion, what do you do

A

probably small cell- either sample by branch and mediastinoscopy- no surgery from there

219
Q

breast Ca- hx

A

personal or family hx, pain, nipple discharge or inversion, skin changes, change with menstrual cycle, nulliparous, age at first prep (increased if over 30, age of menopause increased if over 55, OCP are protective, HRT increases risk, overweight because more estrogen.

220
Q

PE for breast Ca

A

breast exam, look for peak de orange, nipple inversion, tenderness, skin dimples. palpable mass

221
Q

BRCA1

A

breast and ovarian cancer

222
Q

BRCA2

A

male breast cancer

223
Q

labs for breast Ca

A

CBC, LFT, Ca, PO4, BRCA if young.

224
Q

imgaing breast Ca

A

bilateral mamography with US, if abdominal pain, ab CT, neuro get head CT, bone pain get bone scan, CXr for lung mets

225
Q

surgery for breast breast Ca

A

get US guided core needle buoy with 10-14 gauge.

226
Q

what is the size of t1

A

less than 2 cm

227
Q

what is the size of T2

A

205 cm

228
Q

what is the size of T3

A

> 5 cm

229
Q

if there an no nodes + then

A

no axilalry dissection, get genetic panel

230
Q

if T1/T2 with 1-2 positive nodes and is lumpectomy

A

just do radiation

231
Q

if T1/T2 with 1-2 positive nodes and is mastectomy then

A

do full azillary dissection

232
Q

if there is more than T1/T2 and more than 1-2 positive nodes then

A

axillary dissection

233
Q

what treats the T and what treats N and M

A

T is treated by surgery and NM is treated with radiation and chemo

234
Q

sentinel node

A

take the hottest, the 10% of the hottest, palpable, blue, and any with blue going to it.

235
Q

reconstruction of the breast

A

favorable tumor in frozen section need rads

236
Q

bilateral mastectomy needs

A

bilateral SLN

237
Q

in axillary dissection, which levels do you take

A

1 and 2 if you take 3 then it increases the risk of lymphedema

238
Q

who gets chemo with breast Ca

A

+LN, HR negative, Her2 +, ER+ patients with genetics of high recurrence.

239
Q

what chemo is used for breast

A

5Fu, adriamysin and cyclophosphamise

240
Q

what to neoadjuvant do

A

it decreases tumor size, allowing for respectability and BCT,

241
Q

hromonal therapy does what

A

decreases the risk of local and systemic recurrence, and opposite side cancer. Tamoxifen is for premoneopausal

242
Q

what are the risks of tamoxefen

A

increased risk of DVT, endometrial cancer, hot flashes, estrogen analog in endometrium.

243
Q

what do postmenopausal get

A

aromatase inhibitors- check FSH and LH to assure menopause and bone scan before anastrozole. Supplement with Ca and exercise myalgians and decrease in bone density so need to do weight baring exercise.

244
Q

how long do you do hormone therapy

A

5 years

245
Q

what drugs for breast Ca have cardiac risk

A

adriamycin and herceptin

246
Q

what is the order of treatment for breast

A

surgery, chemo, radiation, hormone therapy

247
Q

testicular mass history

A

trauma, pain, if yes do PQRSTU because Ca is not painful. family history and cryptorchistim. fever, chills, weight loss, night sweats

248
Q

what is the tumor of the testicle in old men

A

lymphoma so many have secondary symptoms

249
Q

PE for testicular mass

A

GU exam with transillumination, digital rectal exam, is the mass hard or soft, LN palpation

250
Q

labs for testicular mass

A

beta hcg, alpha fetoprotein, CEA, LFT

251
Q

imaging testicular mass

A

US of the scrotum tumor can have fluid around it. CXR to exclude mets

252
Q

surgery for testicular mass

A

take out that damn testicle, radical femoral orchiectomy- through the inguinal incision over the cord, take the testis, spermatic cord at the iliac ring, ligate the artery and pampiniform plexus to not seed the sumor. Do not need a forzen section. Onceits confits. look in the retroperitoneum and aggressive chemo and rads

253
Q

which is the most sensitive for radation

A

seminoma

254
Q

what are more testicular mass derive from

A

germinal epitherlium

255
Q

how is lung mets from testicular mass treated

A

chemo only

256
Q

hic hLN does it hit first

A

paraarotic LN

257
Q

where does the scrotum drain

A

femoral LN do not make an incision on the scrotum or will need to take more nodes

258
Q

75 yo with history of mental illness comes to the ER with obtunded with severe hip pain and clutched her hip and fell

A

pathologic hip fracture.

259
Q

what is the hx questions for this

A

circumstances of break, hx of factures, medical problems/medication, diet, constitutional symptom

260
Q

shows breast mass, and externally rotated him

A

breast CA

261
Q

what would long QT indicate

A

increased CA- can go to torsade

262
Q

Labs for increased Ca

A

CMP and albumin, Ca is extremely high so need PTH

263
Q

what is the first treatment for hyperCa

A

give NS and monitor UO

264
Q

if the urine calcium is high hand Ca high and path high- what

A

primary hyperparathyroid

265
Q

if Ca high, PTH high and low Caurine

A

familiar hypercalcemic hypocalciuria- asymptmatic

266
Q

imaging for patient with breast mass and fracture of hi

A

CXR, mamogram, and xr of hip

267
Q

differential for pathologic fracutre

A

Ca supplementation, hyperparathyroid, iatrogenic from thiazides, mets from breast, milk alike, pages, addisons, acromegaly, neoplasm of the bcolon, breast, protester, mm, ZE, excess D, A, sarcoid

268
Q

what is the number 1 pit tumor

A

prolactinoma

269
Q

what is the number one pancreatic utmor

A

gastrinoma

270
Q

what is the most common malignant of the familial MEN1 tumors

A

glucagonomas and gastrinoma

271
Q

treatment for hypercalcium

A

slaine loading and resuscitation with NS, and lassie to increase Ca in the urine, and rod the femor with hip replacement and breast cancer treatment

272
Q

why don’t you use LR in kidney failure or high Ca

A

it has calcium and K in the kidney failure can fuck things up

273
Q

how to treat primary hyperparathyroid

A

exploratory neck surgery give methane blue to stain the PT glands blu. if there s one big glad then its adenoma if there are 2 or more than hyperplasia. Most sensitive test during surgery is eyes. Tech 99 and gamma probe. IF there is a only 3 glands visible and are normal need to find missing most likely in thymic area.

274
Q

Pt hyperpalsia treatment

A

remove all the glands and leave 30 mg of tissue in the non-dominant forearm

275
Q

PT carcinoma

A

remove the carcinoma and ipsilateral thyroid lobe and all enlarged nodes.

276
Q

what to do if the gland is missing

A

do a lobectomy and what on path, sestamibi washout to lightup the PT glands in the OR or Ct scan to see if its in the thymus. Remove thymus if so

277
Q

tx for secondary HPTH

A

correct Ca nd phos and then renal transplant should fix it

278
Q

tertialry HPTH treatment

A

correct Ca nd phos and remove all and reimplant 30 mg into the forearm if refractory.

279
Q

what is A in trauma

A

airway if there is not patentcy- orotracheal intubation with manual inline traction performed by assistant. Angioedema from new ACE can cause airway compromise. ETI for comptose, RSI for agitated with Cspine and immobilized or patients who haven’t been NPO

280
Q

b trauma

A

breathing, bag valve mask, ambubag hyperventilate 1005 O2. Chest tubes re 32 french

281
Q

what size are chest tubes

A

32 french

282
Q

C trauma

A

2 16-18 large bore IC peripheral with rapid infusion of 1 L of LR- or 20cc per Kg in child

283
Q

when do you add a foley

A

during C if there is no blood at the mature or in heavy scrotum.

284
Q

what do you dod if there is blood at the meatus

A

then you do a retrograde urethrogram

285
Q

D trauma

A

disability- uick neuro with GCS- verbal, movement to stimulus and eye opening

286
Q

E trauma

A

exposure and encironment- remove all clothing but try to keep them warm

287
Q

Secondary survey

A

AMPLET-

allergies, medicine, past history, last meal, events around the accident, tetanus or vaccination

288
Q

what is after AMPLET

A

PE from head to toe and get an NGT if there is no evidence of basilar skull fracture

289
Q

what are the tests for trauma

A

CBC, utox, alcohol, ABD, CXR, pelix, lateral Cspine, CT/fast exam,

290
Q

what must the patient be to get a ct

A

hemodynamically stable

291
Q

where do aortic transections happen

A

isthmus near the lugamentum arteriosum or at the base of the heart

292
Q

how to do you diagnose an aortic transection

A

widened mediastinum and apical cap is lost with aortic knob and shift of the mediastinum

293
Q

if you see a wide mediastimun what do yo uneed

A

CTA if stable

294
Q

what would paraplegia plus an aortic transection indicated

A

anterior spinal artery or spine ischemia

295
Q

what are signs of a basilar skull fracture

A

battle sign which is bruising behind the ears, raccoon eyes, CSF, otorhea, rhino rhea, hemotympanum, if present, place an orogastric tube

296
Q

what is considered the abdomen

A

nipples to groin

297
Q

what signs tell you there might be abdominal trauma

A

tachy, hypotensive, abdominal tenderness

298
Q

penetrating abdomen- gunshot

A

ABCDE, primary, resuscitation, secondary, XR maybe and slap with no CT

299
Q

penetrating abdomen- stab wounds if unstable

A

OR

300
Q

if stab is stable and numb skin what first

A

locally explore

301
Q

if stab is into the peritoneum

A

lap maybe ex lap

302
Q

if the stab is not into the peritoneum

A

do not need further eval

303
Q

Blun abdominal trauma- patient arrives in C collar backboard and BP is 50- what do you do

A

primary survey, resuscitation, secondary survey, surgery if needed.

304
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: A

A

A- size 8 endotracheal tube to 22 cm so at clavicles on the CXR- CXR to check the tube placement. NG tube patients with >20% burns often get paralytic ileum which increased vomiting and aspiration risk

305
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: B

A

ventilator onOMV with 100% O2, bilateral chest tubes if pneumothroaz. If on vent for greater than 2 weeks need a track to prevent trachemoinnomanate fistula between the brachiocephalic artery

306
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material:C

A

defibrillater for vfib and epi, 2L IV saphenous vein if the arms are burned. Parkland formal.

307
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: hands turn black

A

escharotomy of the mediolateral area because there is pressure leading to compartment syndrome and to relieve the ongoing edema and restore circulation no anesthesia.

308
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: what should UO be

A

it should be 30cc/hr

309
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: labs

A

ABg 20 minutes after intubation. CBC, CMP, UA for myoglobin, carboxyhemoglobin

310
Q

if there is myoglobin in the urine what should you do

A

hydrate and alkaliazize the urine

311
Q

30 yo with second and third degree burns covering 45% of the TBSA and strider and coughing up carbonaceous material: management

A

debride and early excision of burns except deep to palms, soles, generals and face- apply topical abs

312
Q

sulamylon

A

painful and penetrates the eschar and irritates the nerve endings- metabolic acidosis because of the Ca inhibitors

313
Q

silvadene

A

transient neutropenia

314
Q

dilver nitrate

A

metabolic alkalosis due t hypoK and hypoNa turns everything black

315
Q

bacitracin

A

possible allergy

316
Q

betadine

A

can kill tissue by drying out the wound

317
Q

aceteic acid

A

can cause acidosis if poor kidneys

318
Q

what temp do burn patients needs to be kept at

A

986

319
Q

what do you use to evaluate upper airway of burn patients

A

bronchoscopy to evaluate the upper airway burns and wash out carbonaceous material to prevent atelectasis and pneumonia- diagnosistic and therapeutic

320
Q

what does flueorscene do to the burns

A

if it glows, it is perfused, if not the excision is inadequate

321
Q

3-7 days out from the burns what do you do

A

debris the deep wounds of the palms, soles, genitals, and face

322
Q

when do you do skin grafts

A

not on the night of the burn because need to resusitate the fluids first, let edema resolve around POD3 before applying skin grafts, but usually over 1 week out from the injury

323
Q

30 yo F with TAH with changes in metal status- what is the change in mental status assumed to be first

A

due to hypoxia until proven otherwise

324
Q

30 yo F with TAH with changes in metal status- A

A

intubate using size 8- the tip should be 2cm above the carina the tube should be in a round 22 cm

325
Q

30 yo F with TAH with changes in metal status- B

A

volume controled ventilation- continuous mandartoy vent- c

326
Q

what is continuous mandatory vent

A

set rate and TV and patient is ignored

327
Q

assist control

A

set rate with a demand set tidal volume- patient has effort will take in whole tidal volume

328
Q

synchronized intermittent mandartory vent

A

reate and tidal volume set with demand- they get their normal volume and will not get a forced breath in the same cycle

329
Q

CPAP

A

demadn rte and TV but the patient must initiate the breaths

330
Q

RR on vent

A

10-14 breaths. low PCO2 suggests RR should be decreased high CO2 increase the RR

331
Q

what is normal vent TV

A

6 cc/kg lean body mass

332
Q

choosing FiO2

A

choose the lowest FiO2 to hit 92% sat-

333
Q

what should you do to the FiO2 for COPD or chronic hypoxemia

A

use low concentration of O2 because that will correct low PaO2 because they are chronic retainers O2 is their only drive to breath. Too high and get toxicity

334
Q

Peep

A

at the trend of the res cycle, the glottis covers the cords AND its against the closed glottis. Upside expected to improve lung mechanics and gas exchange as it recruits alveolar units, decrease in atelectasis, improve oxygenation without increase in Fi)2. Increased iCP, and increased onemothroaz and decreased venous return

335
Q

what are the best initial vent settings

A

IMV, TV of 10-15cc kg, rate is 10 and FitO2 is 100% then wean down. Peep 5 cm. It takes aday to get oxygen toxic, but if notice they have a history of COPD then turn it down

336
Q

who gets the vent

A

PaO2<60, Pco2>60 unless COPD, loss of protective reflex, RR>33-35, clinical judgement

337
Q

30 yo F with TAH with changes in metal status- C

A

check BP and vitals

338
Q

PaO2 of 40,50,60 correlates to what on pulse ox

A

70,80,90

339
Q

at what level does the HbO2 curve shift

A

Pao2 of 60

340
Q

PE30 yo F with TAH with changes in metal status

A

look for wound infection, check for cyanosis, listen to lungs, humans, check of asymmetry of legs

341
Q

Further tests: 30 yo F with TAH with changes in metal status

A

CXR and check ET placement

342
Q

what is Westermarks sign

A

wedge shaped, hyper lucent area due to decreased pulmonary vasculature.

343
Q

what is spiral CT for

A

pe

344
Q

cor pul on EKG

A

flipped T waves and ST depression

345
Q

what would a duplex be for in 30 yo F with TAH with changes in metal status

A

to check for DVT

346
Q

30 yo F with TAH with changes in metal status- management

A

check ABG again after 20 minutes- medication need heparin to prevent further clotting. follow the PT which you want 1.5-2 time the normal with an INR off 2-3. Consider thrombolytics if the patient is unstable but cannot if there has been surgery in the past two week. Consider transfer to coumadin or the following 306 months

347
Q

30 yo F with TAH with changes in metal status- management if allergic to coumadin

A

put a filter in the Ivc just below the renal arteris

348
Q

30 yo F with TAH with changes in metal status- if there is no filter available

A

use miles clips on the IVC below which let some blood through but need to check to make sure there is an intact azygous system

349
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR-A

A

intubate and NGT

350
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR- B

A

peep as needed in case of pulmonary contusion which would look like a white out on CXR, if there is a tension penumo (JVD and anxiety) then throw with a 12 gauge needle in the second space of the midcalvicuar line- need to get all the blood out. put a chest tube in the 4th space of the midaxillary line-

351
Q

what size hemothorax do you need to thora

A

1500 cc immediately or 200 per hour for 4 hours

352
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR-C

A

2 large bore IV and foley

353
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR-labs

A

CBC, CMP, type and cross

354
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR- tests

A

CXR after chest tubes are places, chest CT if there are broke rubs, abdominal and pelvic CT

355
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR- tx

A

epidural to minimize the pain and do not do a big dose of PCA because it will decrease respiratory drive. iNect below the rib. Pulmonary toilet and diuretics, minimize fluid intake and avoid PNA

356
Q

Jockey is kicked by a horse in the left chest, dyspnea, increased RR-complication- late the BP drops to 70 with 2 boluses of fluids do not bring it back up…. tx

A

remove the spleen and do an autotransplant by chopping it into small pieces then putting it into a pocket of omentum

357
Q

65 yo with a carotid bruit on the right- history

A

asymptomatic, ask for fainting, weakness, amerces fugal, pmhx for MI or stroke

358
Q

65 yo with a carotid bruit on the right exam

A

listen for carotid bruit

359
Q

65 yo with a carotid bruit on the right- tests

A

doppler flow study

360
Q

65 yo with a carotid bruit on the right if symptomatic

A

surgery

361
Q

what percent stenosis for surgery if asymptomatic

A

80%

362
Q

65 yo with a carotid bruit on the right- preop

A

cardiac workup for EKG and stress test, or use cardiolyte and thallium if cannot use a treadmill- dilate the arteries and veins if there ischemia need to do a cath do it and fix it

363
Q

if left main is occluded what to do

A

CABG

364
Q

65 yo with a carotid bruit on the right- prep labs

A

coats if there is a history of bleeds or bruising- CBC, BMP, CXR,

365
Q

what ahoudl the anesthesiologist have on hand for 65 yo with a carotid bruit on the right

A 
prophylactic abx
heaprin 100u/kg
dopamine to keep pressure up
alpha blocker such as clonidine preop
have a nitrodrip ready for HTN crisis
366
Q

65 yo with a carotid bruit on the right what operation

A

carotid endarterectomy

367
Q

what is the pathophysiology HTN with carotid stenosis operation

A

carotid body is clamped off therefore it thinks you are in hypotension and there is no blood getting there so arenas get signal to increase catecholamines and increase the BP, and you need to turn off the carotid body by injecting ti would lidocaine to inhibit the action potential of the nerves and the carotid body stops communicating

368
Q

65 yo with a carotid bruit on the right patient wakes up and cannot move the left side of the body- what next

A

need to duplex the carotid artery and then ope nan explore to find the intimal flap and scrape off the intima at the intimate medical junction

369
Q

why do you give prophylactic antibiotics with carotid endarterectomy

A

there is mesh added dacron need it

370
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- causes

A

atherosclerosis, collagen ascualr diseas,e salmonella, syphillus, TB

371
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- other symptoms

A

vague back pain or abdominal pain

372
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- ddx

A

acute pancreatitis, aortic dissection mesenteric ischemia, mi , perforated ulcer, diverticulosis

373
Q

65 yo with known medical issues shows egg shell mass in mid abdomen-tests

A

US shows an infrarenal AA wait

374
Q

65 yo with known medical issues shows egg shell mass in mid abdomen-arteriogram

A

<5cm- low risk follow up i 3 mo
>5 cm operate
if if grown >1/2 cm in 6 months- operate

375
Q

65 yo with known medical issues shows egg shell mass in mid abdomen-preop

A

cardiac, cxr, bmp for renal function and acid base status, peripheral vascular exam, prophylactic abs with in 30 minutes iof incision, bowel prep. legation fhb eh IMA and the marginal gives out you can get translation of bacteria.

376
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- when would you go straight to surgery

A

peritoneal signs, weird BP and vitals- needs an immediate operation for rupture or leak

377
Q

65 yo with known medical issues shows egg shell mass in mid abdomen-options of surgery

A

prosthetic gradt placement wrapped in native aneursym adventitia, endovascualr repair with femoral cath placed stents for poor candidates, aortobiliac or aortobifemoral grade if the iliac are occluded or iliac aneurysms are present

378
Q

65 yo with known medical issues shows egg shell mass in mid abdomen-early complicatiosn- 1 week later shows up with blood in the stool and diarrhea and abdominal pain

A

colonic ischemia from the IMA sacrifice and durgety and lack of good collateral. Need a hart mans much, and mucous fistula and resection of the necrotic colon, and end colostmy

379
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- starts vomiting blood a few months later with decreased BP and increased HR-ddx

A

ulcer from gastric mucosal defect bleeding from underlying av malformation, esophageal varices, PUD, aortoenteric fistula

380
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- starts vomiting blood a few months later with decreased BP and increased HR- ABC

A

2 large bore 16 gague IVs in arms with 2 liter of isotonic fluid, 2 chest tubes, NGT, ET tube, foley need a UOP at .5 cc/kg/hr

381
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- starts vomiting blood a few months later with decreased BP and increased HR-aoricoenteric fistula usually from

A

graft infection

382
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- starts vomiting blood a few months later with decreased BP and increased HR-aoricoenteric fistula usually from graft infection by what

A

staph epi

383
Q

65 yo with known medical issues shows egg shell mass in mid abdomen- starts vomiting blood a few months later with decreased BP and increased HR-aoricoenteric fistula- management

A

endoscopy in the OR, look for gas bubble for the sign of graft infection- take out the infected graft, irrigate with butadiene peroxide, extra anatomic bypass with both ends of the aorta oversewn. This is from the axilla to the femoral artery then to the other femoral to stay out of the infected areas.

384
Q

60 yo whoe right leg is colder than left for one day- history

A

look of the 6Ps: pain, paralysis, pallor, paresthesia, pulselessness, palr

385
Q

60 yo who right leg is colder than left for one day-PE

A

pulses are not palp and right foot is colder than left and fib is present

386
Q

60 yo who right leg is colder than left for one day-tests

A

ABI and ABI are not accurate in the diabetics because the vessels are calcified and do not contract with the BP cuff. It is more accurate to do toe pressure. IF its below 75 then the toe is ischemic.
Doppler- no flow from the knee down on the right. No pain because of neuropathy.
EKG shows afib

387
Q

60 yo who right leg is colder than left for one day-management

A

go to the OR you do not need cardiac clearance in an emergency. anticoagulant with heparin, slow the ventricular response with digoxin which decreases the conduction of the AV node, arteriogram if possible. Put in a fogarty balloon catheter in the femoral and placate past the embolus and inflate the balloon and pull back to remove the embolus

388
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-exam

A

edema over the entire leg and palp pulses

389
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-labs

A

CMC, CMP, coats which are all normla

390
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-tests

A

doppler

391
Q

what is the pathophysiology of a venous stasis ulcer

A

DVD, destroys the veins, reanalyze the veins, poor valves will lead and venous insufficiency, increased hydrostatic pressure and increased intersitital pressure, decreased tissue perfusion of end o organ and skin

392
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-why would you biopsy it

A

could be a marjolins ulcer if there is proves run or osteomyelitits- sc. of the ulceration

393
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-treatment

A

unna boot with zinc, dressing changes, elevate to decrease interstitial pressure, compression socks, that go above the knee

394
Q

40 yo farmer with prior leg injury now has ulcers on the medial malleolus that will not heal-surgery

A

linton procedure which is a subfascial ligation of the veins

395
Q

25 yo marine recruit with BP of 210/120 HR 140 and EKG shows SVT- hx

A

any symptoms, headaches, blurry vision, drugs, family history, surgical history medications ace and beta blocker since started

396
Q

25 yo marine recruit with BP of 210/120 HR 140 and EKG shows SVT- PE

A

pulses and heart and lungs and listen for bruits all over- flank bruits

397
Q

25 yo marine recruit with BP of 210/120 HR 140 and EKG shows SVT-diagnostic workup

A

duplex of the renal arteries if hear bruits- do a hypertensive IVP and

398
Q

25 yo marine recruit with BP of 210/120 HR 140 and EKG shows SVT-on testing if the intravenous pyelogram and one kidney lights up then

A

renal artery stenosis.

399
Q

what are the two causes of RAS

A

fibromsucular dysplasia in middle age women and old men smokers with atheroscelosis

400
Q

what so you treat fibromuscular dysplasia with

A

angioplasty with percutaneous renal transluminal angioplasty and stinting if this fails you can bypass and graft interposition or endarterectomy.

401
Q

what can you not give RAS patients and why

A

they block any II and will allow the efferent arteriole to dilate

402
Q

buffalo hump, striae, central obesity, mon face, copper skin- first test

A

am and pm cortisol then high and low dose suppression tests

403
Q

what is the different between disease and syndrome

A

disease is no cortisol suppression with low does and suppression with high dose so the source is in the pit. syndrome shows no change in cortisol with the dexamethasone

404
Q

adrea adenoma treatment

A

unilateral adrenalecomy if causing symptoms

405
Q

adrenal carcinoma- size and what to do

A

surgical excision if possible and over 7

406
Q

extopic acTH tumor

A

surgical excision if possible

407
Q

what else can you do with adrenal hyperplasia bilateral from disease cushings

A

remove the pit

408
Q

coarctation of the aorta- test

A

get ABIS, CXR, echo, cardiac cath

409
Q

kids with murmur and good pulses in arsm

A

think coarctation

410
Q

how can you treat coarctation

A

resection with end to end anastamosis, subclavian artery flap, patch great, interposition graft or endovascular repair in adults only

411
Q

palpations, episodic headache , and episodes of sweating

A

pheo

412
Q

labs for pheo

A

VMA, metanephrines, nrometaneprhiens, urine/serum epi, ne

413
Q

tumor localiation for pheo

A

CT< mRI, 131 MIBG- metalodobenzelguanidine.

414
Q

if see adrenal mass on PET scan what size is worrisome

A

over 5cm

415
Q

where is the most common site of extraadreanal pheo

A

organ of zuckerandle- abdominal aorta

416
Q

what is the medical treatment for pheo

A

alpha block with pehnoxybenzamine or parson which increases the intravascular volume and dilutes the catecholamine induced vasoconstriction.

417
Q

what is the surgical treatment for pheo

A

tumor resection with early ligation of venous drainage to minimize the catecholamine release

418
Q

how to differentiate between Conns and RAS

A

give captopril and then measure the renin and aldosterone. if low renin and high aldo then its Conn. If the renin and aldosterone are both low then its RAS

419
Q

labs for COnns

A

CMP, and high aldo level, normal to decreased renin

420
Q

further testing for COnns

A

iodocholesterol scan, selective venous sampling of an adrenal in to see if one makes more than the other. if R=L then its hyperplasia not cancer or adenoma.

421
Q

what is the saline infusion test

A

decreases aldosterone levels is normal- patients with Conn have increased aldo

422
Q

treatment for COnn- preop

A

give spiro because its a receptor antagonist

423
Q

surgery for conn

A

adnemoa- unilarteral adrenelectomy- lap, unilateral hyperplasia unialteral removal, bulateral hyperplasia only do spiro

424
Q

what is the physiology of conn

A

aldosteron causes na retention for exchange of K in distal tubules, resulting in fluid retention and hypertension

425
Q

30 yo F with HTN with no risk facts and hard to control HTN- ddx

A

conn, cushing, pheo, RAS, coarctation

426
Q

30 yo F with HTN with no risk facts and hard to control HTN- labs

A

electrolytes (ca comes back at 12), albumin normal, need to check thyroid with calcitonin

427
Q

30 yo F with HTN with no risk facts and hard to control HTN-tests

A

MIBG lights up the left renal artery, CT shows mass in the left adrenal medulla, 24 hour urinary catecholamine, and VMA, EKg is normla

428
Q

30 yo F with HTN with no risk facts and hard to control HTN-preop

A

alpha blocker if you give a beta block then it will increase BP. intravascular tone will decrease so you nee to watch scan ganz to make sure wedge pressure is normal

429
Q

30 yo F with HTN with no risk facts and hard to control HTN- slain load protocol

A

infuse 2 L isotonic fluid, check wedge pressure and stop with 2 l or 18 mmhm to get good CO and IV colume

430
Q

how many adrenal veins are there

A

3 adrenal veins

431
Q

what do you need to do preop

A

type and cross

432
Q

30 yo F with HTN with no risk facts and hard to control HTN-anesthesia needs what on hand

A

pressors, good IVs for fluids

433
Q

what is the rule of 10s for pheo

A

10% malig, bilateral, familial, ex-adrenal, malignat

434
Q

how many criteria do yo uahve to have to meet MEN2A criteria

A

2 out of the 3: pheo, medullary thyroid cancer, and parathyroid hyperplasia.

435
Q

what surgery would you have to do for MEN2a first

A

have to do the pheo first because any other operation will kill them.

Surgery Oral Exam (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions