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Pestana Notes Flashcards

1
Q

Acute epidural hematoma

A

CT scan –> stat craniotomy (otherwise fatal w/in hours)

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2
Q

Acute subdural hematoma

A

CT scan –> craniotomy to decompress

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3
Q

Chronic subdural hematoma

A

CT scan –> craniotomy to decompress (spectacular improvement)

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4
Q

Basilar skull fracture

A

CT scan & cervical Xray –> “neurosurg consult” and Abx

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5
Q

Hypovolemic shock

A 
Clinical dx (HR, BP...) --> 1. 2 lg-bore IVs, fluid rescusitation
2. Foley cath     3. IV Abx
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6
Q

Pericardial tamponade

A

Clinical dx –> pericardial window, possible thoracotomy

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7
Q

Tension pneumothorax

A

Clinical dx only!!! –> STAT thoracostomy

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8
Q

Cardiogenic shock (from MI…)

A

EKG, enzymes –> Morphine, O2, Nitroglycerin sublingual, Aspirin

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9
Q

Vasomotor shock (anaphylaxis)

A

Clinical dx –> vasopressors, fluids, (Histamine blockers?)

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10
Q

Flail chest (broken ribs)

A

Paradoxical breathing –> R/o other injuries, treat w/ fluids & support to heal the lung

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11
Q

Pulmonary contusion

A

CXR initially clear, then whites out –> colloid fluid rescusitation, respiratory support & PEEP

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12
Q

Sternal fracture

A

CXR, then EKG and transesophageal echo to r/u aorta tear –> if isolated finding, pain support only

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13
Q

(Occult) hematoma

A

CT; hypvolemic shock if >25% volume loss –> Ex Lap & repair

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14
Q

Penetrating abdominal trauma wound

A

Diagnose and treat w/ Ex Lap

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15
Q

Pelvic fracture w/ urethra or ureter damage

A

Retrograde urethrogram (NO foley!) –> surgical repair later

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16
Q

Posterior urethral injury

A

Clinically, a high-riding prostrate + retrograde urethrogram –> suprapubic catheter

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17
Q

Small, 3rd degree burn

A

Clinical dx –> early excision and grafting

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18
Q

Human bite

A

Clinical dx –> surgical exploration, washout, Abx

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19
Q

Fibroadenoma (18yo F w/ firm, rubbery mass)

A

FNA, Sonogram –> If positive for Fibroadenoma, reassure

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20
Q

Cystosarcoma phyllodes (young F, slow-growing)

A

Incisional Bx –> margin-free resection

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21
Q

Fibrocystic disease (lumps which come and go)

A

Cyst aspiration Bx –> resect if symptomatic and recurring

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22
Q

Intraductal papilloma (34yo F w/ bloody discharge)

A

Mammogram (if large) or Galactogram (if small) and Bx –> Resect if cancer ?or symptomatic

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23
Q

DCIS (69yo F w/ solitary mass)

A

Calcifications on radiography, Bx –> Excision, axillary dissection, potential systematic therapy

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24
Q

LCIS (69yo F w/ solitary mass)

A

No calcifications on radiography, Bx –> Excision (possibly bilateral), axillary dissection, potential systemic therapy

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25
Congential glaucoma (baby with big, shiny eyes)
Clinical dx first --> trabeculotomy
26
Acute glaucoma
Clinical dx (severe HA, pupils non-reactive), IOP measurement --> Diamox, Mannitol, Pilocarpin
27
Orbital cellulitis
CT scan --> I&D
28
Chemical contamination of eye
Clincal dx (rapid!) --> immediate irrigation
29
Barrett's esophagus
Endoscopy, Bx --> Surgical correction (Nissen Fundoplication)
30
Esophageal carcinoma
Barium swallow, Bx --> Surgical resection
31
Achalasia
Barium swallow, Manometry study --> Nifedipine and/or botulism toxin (to relax LES)
32
Mallory-Weiss tear (mucusal tear at GEJ)
Endoscopy --> usually self-limiting bleeding
33
Boerhaave's syndrome (full-thickness tear)
CXR and/or CT ... OR Gastrographin swallow --> stat surgical repair! ; prognosis depends on timing; mortality w/o repair is 100%
34
Bladder injury
Blood on foley insertion (therefore injury above urethra) --> Retrograde cystogram
35
Ruptured testicle (zounds!!)
Sonogram dx --> surgery if ruptured, symptomatic treatment if not
36
Penile fracture (receptive partner on top)
Clinical dx w/ penis deviating to one side --> surgical repair
37
Chemical spill on skin (e.g. Drano)
Immediate irrigation (don't wait to arrive at the ER!)
38
Extremity electric burn
Clinical dx; deep tissue destruction --> surgical debridement myoglobinuria causing renal dmg --> mannitol, IV fluids
39
Respiratory burn
Bronchoscopy dx --> Respiratory support
40
Cutaneous thermal burn causing eschar
Clinical dx w/ decreased perfusion distal to eschar --> | escharotomy
41
Carcinoid syndrome [Wheezing, flushing, diarrhea]
Increased urinary 5-HIAA (serotonin) --> Somatostatin (to decrease 5-HT secretion) Cyproheptadine (antihistamine w/ antiserotonin side effects)
42
Toxic megacolon
Xray showing a big, darn colon!, increased Temp, increased WBC --> decompression early, else surgical removal
43
Internal hemorrhoids (bleeding)
Proctosigmoidoscopic examination... to r/o cancer
44
External hemorrhoids (itching)
Proctosigmoidoscopic examination... to r/o cancer
45
Perianal fissure (bright red bleeding)
Diagnosed usually under anesthesia --> | Sphincterotomy... but also r/o cancer
46
Perianal abcess
Clinical dx: fluctuance, fever, high WBC --> | I&D... but also r/o cancer
47
Distal small bowel bleed
CT angiogram b/c endoscope likely won't reach
48
Meckel diverticulum [7yo w/ bloody bowel movements]
Radiolabeled Technetium scan --> surgical correction
49
Diverticulitis
CT scan dx --> Bowel rest
50
Acute abdomen
Clinical dx w/ extreme, diffuse peritoneal signs --> Ex Lap
51
Acute pancreatitis
Epigastric & back pain, N/V, elevated lipase/amylase --> NPO, NG suction, IV fluids
52
Acute cholecystitis
RUQ pain, fever, high WBC... Sonogram 1st, possible HIDA scan --> Lap CCY
53
Hepatic adenoma [Girl on OCPs forever]
CT scan --> Surgical resection
54
Ascending cholangitis
Fever, jaundice, RUQ pain (Charcot's triad) + CT scan (or U/S) --> Radiological percutaneous I&D ERCP Abx Cipro, Metronidazole
55
Aomebic abcess
CT scan --> Metronidazole
56
Sigmoid volvulus
Xray showing distended loops & obstruction --> Proctosigmoidoscopy or rectal tube
57
Congenital diaphragmatic hernia
Xray showing bowel in thorax --> Wait 36-48h for neonatal circulation to improve, then perform diaphragm repair
58
Meconium ileus [3d old infant]
Xray shows dilated bowel loops --> Gastrografin enema; test for CF
59
Acute epiglottitis
Lateral xrays showing a big epiglottis! --> Bag & mask, naso-tracheal intubation, Abx for H.flu
60
Cardio: ASD [Systolic murmur, fixed & split S2]
Echocardiogram --> Surgical closure
61
Cardio: VSD [Loud systolic murmur at lower left sternal border]
Echocardiogram --> Surgical closure
62
Cardio: PDA [Machine-like murmur]
Echocardiogram --> Indomethacin 1st line Surgical closure if refractory
63
Cardio: Tetrology of Fallot [Blue baby, toddler relieved by squatting]
Echocardiogram --> Surgical correction
64
Cardio: Aortic stenosis [Harsh, mid-systolic murmur]
Echocardiogram --> Surgical valve replacement if gradient >50mm Hg
65
Cardio: Aortic regurgitation [Diastolic murmur at lower left sternal border]
Echocardiogram showing LV dilation --> Surgical valve replacement
66
Cardio: Mitral stenosis [Atrial dilation --> Afib]
Echocardiogram --> Surgical repair
67
Cardio: unstable angina
Clinical hx, coronary angiogram --> Coronary revascularization; CABG or stents
68
Pulm: non-small cell lung cancer [Adenocarcinoma of the lung]
Xray for initial dx, comparing with old films if possible, then need biopsy via bronchoscopy --> Thoracotomy/wedge resection if no mets; FEV1 > 800 to survive post-op
69
Pulm: small cell lung cancer
CXR, Cushing's symptoms, biopsy via bronchoscopy --> NO surgery; chemo & radiation
70
Subclavian steal syndrome
Arm claudication & cerebellar symptoms; angiogram shows retrograde flow in vertebral artery --> Vascular surgery
71
Abdominal aortic aneurysm
>6cm pulsatile mass, CT w/ contrast --> vascular surgery
72
Transient ischemic attack
Angiogram or U/S --> Carotid endarterectomy
73
Ischemic stroke
MRI --> tPA, thrombolytics
74
Hemorrhagic stroke
CT --> Surgery to clip aneurysm if present
75
Brain tumor/mass [Slow-growing, morning headaches]
MRI 1st choice, CT 2nd choice --> Short-term mgmt: decrease ICP w/ mannitol and hyperventilation Long-term mgmt: surgical correction and/or chemotherapy
76
Prolactinoma
1st measure prolactin, 2nd do MRI --> Bromocriptine
77
Acromegaly
1st measure GH, 2nd do MRI --> Surgical resection
78
Pituitary Cushing's
Measure 24hr urine cortisol, MRI --> Dexamethasone suppression, surgical resection
79
Foster-Kennedy syndrome (Frontal lobe mass) [Anosmia, weird behavior]
MRI --> Surgical resection
80
Pineal gland tumor [Sunset gaze]
MRI --> Surgical resection
81
Developmental hip dysplasia [Baby with clicking hip on exam]
Physical exam (Xrays useless) --> Abduction splinting
82
Slipped femoral epiphysis (Legg-Calve-Perthes)
Xrays, PE showing tenderness on weight bearing --> Casting and crutches if epiphysis has not slipped, pinning plus crutches if it has
83
Septic joint
Tap that joint! (Aspirate); increased ESR and WBC --> Arthrotomy to drain, Abx
84
Osteomyelitis
Bone can (X-rays will not demonstrate for ~2 weeks) --> Abx
85
Compartment syndrome
PE showing pain and weak distal pulses --> Stat fasciotomy
86
Anterior shoulder dislocation [External rotation, axial nerve damage]
Xrays --> Reduce
87
Posterior shoulder dislocation
Xrays and PE --> Reduce
88
Stress fracture
Clinical diagnosis only --> Fix and wait 2 weeks
89
Testicular torsion
PE showing tender testicle but NON-tender cord; Sonogram --> Stat surgical correction
90
Epididymitis
PE showing tender testicle and tender cord; Sonogram --> Abx
91
Urinary obstruction & infection
Clinic dx of painful urination w/ low flow; Sonogram --> Percutaneous nephrostomy/stent, high-dose Abx
92
Pyelonephritis
Clinical dx of fever, flank pain, dysuria --> Abx, sonogram to r/o obstruction
93
Testicular cancer
Clinical dx only... no need to biopsy --> Inguinal orchiectomy

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