Ramahi Trauma, Lungs, Upper GI

Question 1

GCS of what requires intubation?

Answer 1

7 or below.

Question 2

If oral/nasal airway obstructed, how will you secure the airway?

Answer 2

Cricothyroidotomy.

Question 3

Hemothorax is what color on Xray? Pneumothorax? Contusion?

Answer 3

White. Black. Patchy.

Question 4

Penetrating trauma to Zone 1 of the neck. Location and Therapy?

Answer 4

Clavicle to Cricoid. Aortography.

Question 5

Penetrating trauma to Zone 2 of the neck. Location and Therapy?

Answer 5

Cricoid to angle of mandible. Doppler +/- exploratory surgery.

Question 6

Penetrating trauma to Zone 3 of the neck. Location and Therapy?

Answer 6

Angle of mandible to below the ears. Aortography and triple endoscopy.

Question 7

GSW to abdomen requires (2)?

Answer 7

Ex lap and tetanus prophylaxis.

Question 8

Stab wound and patient is hemodynamically unstable with signs of peritonitis?

Answer 8

Ex lap and tetanus prophylaxis.

Question 9

What do you do if you see air under the diaphragm?

Answer 9

Ex lap.

Question 10

What has been damaged if you notice the handlebar sign?

Answer 10

Pancreatic rupture.

Question 11

Fractures that go to the OR ASAP (5)?

Answer 11

Depressed skull, severely displaced, open, femoral neck, interochanteric.

Question 12

4 stages of pressure ulcers? Therapy for Step 1-2? Therapy for Step 3-4?

Answer 12

1. Skin blanches with pressure.
2. blister/break in the dermis.
3. destruction into the muscle.
4. Involvement of joint or bone.
   1-2: Special mattress.
   3-4: Flap reconstruction surgery if Albumin >3.5 and bacterial load <100k.

Question 13

Pleural Effusions - Two types? Light’s Criteria?

Answer 13

Exudative: Inflammatory processes (Cancer)
Transudative: Increased hydrostatic pressure or decreased oncotic pressure (Nephrotic, CHF, Cirrhotic).

Exudative if
Effusion Protein /Serum Protein >0.5
Effusion LDH/Serum LDH >0.6
Effusion LDH > 2/3 upper limit of normal Serum LDH.

Question 14

Transudative effusion that has low glucose?

Answer 14

RA.

Question 15

Transudative effusion that has high lymphocytes?

Answer 15

TB.

Question 16

Transudative effusion that is bloody

Answer 16

PE.

Question 17

A tall thin asthmatic man presents with sudden dyspnea. What is the most concerning diagnosis? Tests? Treatment?

Answer 17

Spontaneous pneumothorax. CXR. Chest Tube - surgery if bilateral.

Question 18

When does a lung abscess require surgery (3)?

Answer 18

When antibiotics don’t work, if abscess >6cm, if empyema present.

Question 19

What do popcorn calcifications in the lung indicate? What about a concentric calcification?

Answer 19

Hamartoma.

Old granuloma.

Question 20

Most common presentation of Lung Cancer (4)?

Answer 20

Cough, Dyspnea, Hemoptysis, and Weight Loss.

Question 21

Most common lung cancer in non smokers? Location? Where does it metastasize? Effusion?

Answer 21

Adenocarcinoma.
Peripheral.
Bones, brains, adrenal, liver.
Exudative effusion high in hyaluronidase.

Question 22

A patient presents with dysphagia and halatosis? Tests? Treatment?

Answer 22

Zenkel’s (false) Diverticulum. Barium swallow. Surgery.

Question 23

Acid reflux pain after eating especially when laying down (worse with GERD)? Treatment?

Answer 23

Hiatal hernia. Surgery.

Question 24

A man presents with mid epigastric pain that is worse with eating, he endorses NSAIDS? What is he also probably infected with? Tests? Treatments?

Answer 24

Gastric Ulcers. H. Pylori. Upper GI endoscopy (EGD) with biopsy (CLO test). PPI, clarithromycin & amoxicillin (surgery if it doesn’t work).

Question 25

A man presents with mid epigastric pain that improves with eating? What is he also probably infected with? Tests? Treatments?

Answer 25

Duodenal Ulcers. H. Pylori. Upper GI endoscopy (EGD) with biopsy (CLO test). PPI, clarithromycin & amoxicillin (surgery if it doesn’t work).

Question 26

A patient who has recently lost a great deal of weight develops bilious vomiting and post prandial pain? Cause? Treatment?

Answer 26

SMA Syndrome. 3rd part of Duodenum is compressed by AA and SMA. Restore weight or Roux en Y.

Question 27

Bad (lab) prognostic factors for pancreatitis (7)

Answer 27

WBC >16k, GLC >200, LDH >350, AST >250, Drop in Ca, pH, and Hematocrit.

Question 28

Splenic vein thrombosis can lead to what GI complication?

Answer 28

Gastric varices.

Question 29

A patient presents with painless jaundice. CT reveals a large adenocarcinoma in the pancreatic head. Clinical signs? Treatment (and limitations)?

Answer 29

Trousseau sign of malignancy - migratory thrombophlebitis. Whipple, as long as no metastasis to outside abdomen, or to liver, SMA, portal vein, etc.

Question 30

Diagnosis of ARDS (3)?

Answer 30

PaO2/FiO2 <18.