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Pestana Q's Flashcards

1
Q

Airway management if patient is talking

A

Does not need to be secured

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2
Q

EMS should do what when patient is in shock and close to a trauma center

A

Take them right away

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3
Q

What type of shock is anaphylaxis

A

Vasomotor

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4
Q

Best tx of subdural hematoma

A

Monitor intracranial pressure
Elevate Head
Hyperventilate
Do no diurese to the point of lowering systemic pressure

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5
Q

Best treatment for rib fracture

A

Stop the pain so the patient can breath

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6
Q

White out on lungs days after chest wall trauma

A

Pulmonary contusion

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7
Q

If bleeding during trauma surgery, what do you give

A

10 units PRBC

10 units FFP and platelets

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8
Q

First test for urethral trauma

A

Retrograde urethrogram

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9
Q

Treatment of bullet to extremities if not near vessels

A

Tetanus prophylaxis and cleaning of wound

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10
Q

Treatment of clavicle fracture

A

figure of eight device or sling

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11
Q

Intertrochanteric fracture of right hip tx

A

ORIF and post op anticoagulation

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12
Q

Exam sign for compartment syndrome

A

Excruciating pain when toes are passively extended

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13
Q

Severe nutritional depletion shown by? Tx for operation to be possible

A

Loss of 20% body weight over past few months
Serum albumin below 3
Anergy to skin antigens
Serum Transferrin less than 200
Tx: 7-10 days of preoperative nutritional support

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14
Q

3 problems of an externally draining abdominal fistula

A

Fluid and electrolyte loss
Nutritional depletion
Erosion and digstion of belly wall

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15
Q

Treatment for metabolic alkalosis after vomiting

A

Normal saline and KCL

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16
Q

Symptoms of internal vs external hemorrhoids

A

External hurts

Internal bleeds

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17
Q

Best tx for small breast ca in 2nd trimester of pregnancy

A

Surgery, defer the rest

can do chemo

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18
Q

Best first test for a movable lump in the neck

A

FNA

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19
Q

First test in young woman with HTN and hypokalemia

A

Serum renin aldosterone

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20
Q

Most common type of esophageal atresia

A

Blind pouch in upper esophagus and fistula b/w lower esophagus and tracheobronchial tree

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21
Q

Meconium ileus x-ray apperance and diagnostic test

A

x-ray: multiple dilated loops of small bowel and ground glass appearance
dx: Gastrografin enema (also treats by drawing in fluid and dissolving the pelvis)

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22
Q

Vascular ring symptoms in newborns

A

stridor, respiratory distress, crowning respiration (where baby assumes a hyperextended position)

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23
Q

FEV1 to make lung cancer operatable

A

800 mL (per lung)

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24
Q

Tx for complete distal artery occlusion

A

Embolectomy with fogerty catheter

add fasciotomy if several hours passed before revascularization

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25
Skin cancer that is raised and waxy
Basal cell
26
Strabismus in an older child indicates
Exaggerated convergence caused by refraction difficulties, fixed by corrective lenses
27
Workup of SCC of oral mucosa
Triple endoscopy Seen in old men who smoke and drink and have rotten teeth Often first sign is metastatic node in the neck
28
What is ludwig angina
Abscess in the floor of the mouth (threat to airway)
29
Preferred tx for chronic mitral stenosis
Surgical commisuratomy or ballon valvuloplasty
30
Best test to confirm aortic dissection
Spiral CT
31
Cavernous sinus thrombosis symptoms
Diplopia (from EOM paralysis) in patients with sinusitis
32
Acute epididymitis presentation and management
Fever, pyuria, swollen testis (but testis in normal position) Do US to rule out torsion and give Ab
33
Colicky pain after a young guy drinking his first beers
Ureteropelvic junction obstruction
34
best dx for skin cancer
full thickness biopsy at the edge of the lesion
35
Branchial cleft cyst description
Anterior edge of SCM muscle | Sometimes has a opening and blind tract in the skin overlying them
36
Cystic hygroma features
large, mushy, ill defined mass as the base of the neck that occupies the entire supraclavicular area *CT before removing to be sure no mediastinal invasion*
37
What type of chemo for testicular cancer
Platinum based
38
When is acute rejection seen
5 days - 3 months | *Technical problems more common*
39
What is it when a testicle is in the canal at birth, but can easily be pulled to where it belongs
Overactive cremasteric muscle, not an undescended testicle
40
When does blunt trauma to the abdomen require and exploratory lap
When signs of peritoneal irritation (acute abdomen) devlop
41
How are penetrating urethral injuries explored
Surgery
42
RUQ mass that moves up and down in a baby most likely?
Malignant liver tumor | Afp will be elevated
43
Deep unmovable RUQ mass in baby likely
Wilms tumor or neuroblastoma | CT to figure out
44
Easiest way to biopsy breast mass
Mamographically or monographically guided multiple core biopsies
45
Genu varum normal ages
Bowlegs - up to age 3
46
Genu valbus normal ages
knock knee- up to 8
47
Dinner fork fracture
Colles fracture - fall on outstretched hand in older women, fracture of the distal radius
48
What happens when femur is driven backwards (hitting dash in car wreck)
Posterior dislocation of the hip | *Leg internal rotated*
49
What can palmar fascial nodules be felt in
Dupuytren contracture
50
Two clinical findings used to predict operative mortality in those with liver disease
1. Encephalopathy | 2. Ascites
51
3 lab findings used to predict operative mortality in pt's with liver dz
Albumin, INR, Bili
52
Child class mortalities
A: 10% B. 30% C: 80%
53
Tx of pyogenic liver abscess? likely 2/2?
Percutaneous drainage | Likely 2/2 gall bladder disease
54
When are umbilical hernias normal in children
When they are 2-5 years old
55
Test if mammogram is indeterminate
Radiographically guided core biopsy
56
What must follow lumpectomy for breast cancer
Radiotherapy
57
When to biopsy vs resect lymph nodes in breast cancer removal
If not palpable, sentinel node biopsy | If palpable, resection
58
Test for persistant headache or bone pain in women who recently had breast cancer
MRI to look for mets
59
3 possible things that can be seen in a newborn with bilious vomiting and a "double bubble"
1. Duodenal atresia 2. Annular pancreas 3. Malrotation (also will se a normal gas pattern distal)
60
Bilious vomiting and multiple air-fluid levels throughout abdomen in newborn
Intestinal atresia
61
Subdural hematoma + retinal hemorrhages in baby
Shaken baby (child abuse)
62
Chronic constrictive pericarditis presentation
DOE, hepatomegaly, ascites | Square root sign (equalization of pressures b/w heart chambers)
63
Excruciating back pain in a patient with a large AAA means
Aneurysm is already leaking
64
First manifestation of squamous cell of oral mucosa
Metastatic neck nodes
65
What should never be done on squamous cell carcinoma of the oral mucosa? what do you do instead
Never do open biopsy - will interfere with surgical approach of the tumor FNA instead
66
Two year old with any unilateral ENT signs
foreign body
67
Brain vs inner ear dizziness
Brain: unsteadiness but room stable | Inner ear: room is spinning
68
Bradycardia and Hypertension from brain mass caused by
Cushing reflex
69
Signs of brain tumor with shorter timeline likely? Best test
Think brain abscess | Use CT head (works as well as MRI and cheaper)
70
Most common reason for a newborn boy to not urinate during the first day of life
Posterior urethral valves
71
What establishes prostate Ca diagnosis
transrectal needle biopsy
72
Most common tool to take out large ureteral stones? Who can't get it
Extracoporeal shock wave lithotripsy (ESWL) | Can't do on pregnant woman, heavy bleeders, and cm large stones
73
Who gets chronic subdural hematomas? why?
Very old and severe alcoholics | Shrunken brain is rattled around the head by minor trauma, tearing venous sinuses
74
What do you do if abdominal compartment syndrome develops during ex lap
Place a temporary cover over the abdominal contents
75
High riding prostate means
Urethral injury
76
How do you diagnose a bladder injury
Retrograde cystogram, including post void films
77
Imaging for suspected posterior shoulder dislocation
Axillary or scapular lateral views
78
When can femoral shaft fractures cause shock
If bilateral and comminuted
79
What is needed for displaced ankle fractures
Open reduction and internal fixation
80
Most common herniated disk areas
L4-S1
81
Worst single predictive finding for cardiac risk before surgery
Jugular venous distension
82
Watch out for development of what in malignant hypothermia
Myoglobinuria
83
Zero urinary output usually caused by
mechanical problem, rather than a biological one
84
Best fluid for severe dehydration
D5 1/2 NS
85
What should be added to Nissen procedure if severe dysplastic changes are seen
radiofrequency ablation
86
Medical Tx for rectal fissure
Dialtezam
87
Blood per rectum in child likely? what test
Likely Mekel's | Start workup with technetium scan, looking for ectopic gastric mucosa
88
First test after US shows dilated gall bladder? Next?
CT abdomen for pancreatic cancer | If neg, ERCP to look for bile duct or ampulla cancer
89
When does a pancreatic abscess develop
Fever and leukocytosis 10 days after pancreatitis onset
90
Real problem with congenital diaphragmatic hernia? Tx
Hypoplastic lung (will still have fetal type circulation) Wait 3-4 days to allow maturation Extracorporeal membrane oxygenation
91
What is necrotizing entercolitis
Seen in premature infants when they're first fed Rapidly dropping platelet count (sign of sepsis in babies) Surg if abdominal wall erythema and air in portal vein seen
92
Only way to rule out bladder cancer
Cytoscopy
93
RCC odd features
hypercalcemia, erythrocytosis, elevated liver enzymes
94
Acute rejection tx
Anti-thymocyte serum and steroid bolus
95
Sudden chills and fever spike in renal stone indicates? tx?
Indicates obstruction and infection | Place nephrostomy tube or uretal stent
96
Venous stasis ulcer description and tx
Indurated and hyper pigmented skin over medial malleolus that isn't painful Duplex scan for workup, then physical support to keep the veins empty
97
What is Ogilvie syndrome
Paralytic ileum of colon seen after surgery in senile elderly Fluid and electrolyte revelation, then colonoscopy to suck out air and place long rectal tube
98
First step in workup for disabling intermittent claudication
doppler studies to look for ABI | If bad do CT angio or MRI angio
99
What should be suspected in adult with "mild" generalized acute abodomen
Primary peritonitis | *cultures of peritoneal fluid will only show a single organism*
100
Scalloping of ribs seen in
Coarctation of the aorta
101
Diagnostic test for Hirschsprung's
Full thickness biopsy of rectal mucosa
102
Two most common brain tumors in children
1. Medulloblastoma (cerebellar syndromes) | 2. Ependymoma (knee chest position to open flow of CSF)

Surgery (8 decks)

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