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random Flashcards

1
Q

pts w trochanteric bursitis complain of pain when

A
  • presssure applied eg sleeping on side
  • external rotation (glut med)
  • resisted abduction (glut med)

bursa where glut med knserts into greater femoral trochanter

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2
Q

leriche syndrome

A

erectile dysfunction caused by aortoiliac peripheral vascular disease

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3
Q

femoral n supplies sensation to

A

hip joint

anterior and medial thigh

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4
Q

pain in superiolateral thigh conducted by what nerves

A

lateral femoral cutaneous, iliohypogastric

nerves

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5
Q

what is a furuncle

A

a hair follicular abscess, a boil, usually caused by coag + staph aureus

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6
Q

why is nasal septum succeptible to injury and perf

A

becuase blood supply to septal cartilage is poor and limited to diffusion from mucosa

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7
Q

6 causes of basal septal perf

A 
nose picking
sarcoid
w gpa
syphillis 
tb
cocaine
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8
Q

how does nasal septal perf present

A

whistling w respiration

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9
Q

tf

phys exam of mesenteric ischemia is often relatively normal despite excruciating pain

A

t

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10
Q 
dumping syndrome
symptoms
incidence
pathogenesis
initial tx
A
  • 20-30 min postprand, ab pain n/v/d, hypot tachyc, diz conf diaph fatigue
  • ~50% incid post gastrectomy
  • pylorus absence or dysfunc, dumping hypertonic into sb, pulls in fluid, stims ANS and vasoactive peptides
  • small freq meals, complex carbs, finer and protein. few may benefit from trial of octreotide or reconstructive sx
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11
Q

VIP effects

A 
heart contractility
vasodilation
glycogenolysis
lowers arterial blood pressure
relaxes smooth muscle of trachea, stomach and gall bladder.
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12
Q

octreotide moa

A

blocks
GH, glucagon, insulin, LH, VIP

like somatostatin

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13
Q

dx dumping syndrome

A

clinical dx.
-20-30 min postprand, ab pain n/v/d, hypot tachyc, diz conf diaph fatigue
-~50% incid post gastrectomy
upper gi xr or gastric emptying study can help dx if uncertain but usually not necessary

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14
Q

top 2 most common peripheral artery aneurysms

A 
#1 popliteal
#2 femoral
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15
Q

how can femoral artery aneurysm cause anterior thigh pain?

A

by compressing the femoral nerve which runs lateral to the artery

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16
Q

which is more lateral, femoral artery or nerve?

A

femoral nerve is lateral to artery

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17
Q

when does pulmonary contusion present and what are sympx?

A

v24 hours after blunt thoracic trauma

tachyp, tachyc, hypoxia

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18
Q

pulmonary contusion on cxr or cct

A

patchy alveolar infiltrates NOT RESTRICTED BY ANATOMIC BORDERS e.g. NONLOBULAR/IRREGULAR

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19
Q

tx pulmonary contusion

A

pain control
nebs, chest PT for lung hygiene
O2, ventilatory support as needed

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20
Q

tf

pulmonary contusion always assoc w rib fractures

A

f

may or may not

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21
Q

tf

pulmonary contusion can present 2 hours after trauma

A

t

usually within minutes but up to 24 hours after blunt trauma

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22
Q

tf

ARDS can present 2 hours after blunt chest trauma

A

f
usually 24-48 hours after
pulmonary contusion can present in v24 hours and can turn into ARDS however

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23
Q

classic clinical picture (sympx) of fat embolism from long bone fracture

A 
tachyp
tachyc
hypot
AMS
thrombocytopenia
petechiae
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24
Q

what is flail chest

A

fx of 3+ consecutive ribs in 2 places each
creating detached segment of chest wall
that moves paradoxically compared to the rest of the chest wall with respiration

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25
Q

at what age is it a risk for oa

A

^50yo
can start thinking oa…
espec if prior joint injury or ligament abnorm

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26
Q

initial mgmt oa

A 
weight loss
regular moderate exercise
simple analgesics (acetaminophen)
pt then home pt quad strengthening
(lose strength w age, disuse 22 pain, -- abnormal loading, accelerated articular damage)
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27
Q

tf

arthroscopic lavage and debridement effective for oa

A

f
rct’s show ineffective
(2016 uworld)

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28
Q

pes anserinus pain syndrome

A

aka anserine bursitis

point tenderness medial knee just distal to joint line, oft exacerbated by contact w opposite knee when lying on side

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29
Q

most freq mechanism of knee meniscal injury

A

twisting trauma

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30
Q

acute/subacute knee joint line tenderness and catching sensation on extension

A

meniscal injury

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31
Q

moa for mcl injury

A

from lateral
severe valgus stress
or twisting

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32
Q

these may mask laxity on valgus stress test in mcl injury

A

swelling

muscle spasm

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33
Q

tf

acute effusion/hemarthrosis is common in mcl injury

A

f

not unless acl inj too

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34
Q

most sns test for dx of mcl tear and when used

A

mri
reserved for surgical candidates
but uncomplicated usually managed w rice and analg analgesics

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35
Q

rice in context of sports med

A

rest ice compression elevation can add analg usually too

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36
Q

tf

effusion/hemarthrosis expected w acl tear

A

t
acute, often dramatic
obvious on physical exam

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37
Q

tf

lcl inj uncommon

A

t

may see w high velocity trauma

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38
Q

structure often inj w mcl

and how to know if it is

A

medial miniscus

small effusion, locking catching crepitus

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39
Q

jumper’s knee
aka
describe
physical exam findings

A

patellar tendonitis
chronic overuse inj
anterior knee lain and tenderness
no ligamentous stress test abnorms

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40
Q

tf

tibial plateu fx pts can weight bear

A

f

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41
Q

tf

most mcl tear pts managed operatively

A

f
nonop rice analg if uncomplicated

if comp sx candidate get mri

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42
Q

ankle brachial index

A

higher systolic dorsalis pedis or post tib / higher systolic brachial
v.9 abnormal, diagnostic of occlusive PAD w 90%sn 95%sp in symptomatic pt
.9-1.3 normal
^1.3 calcified non-compressible arteries consider further vascular studies

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43
Q

dx occlusive pad in pt w sx of intermittent claudication (eg leg cramps w activity)

A

abi ankle brachial index
higher systolic dorsalis pedis or post tib / higher systolic brachial
v.9 abnormal, diagnostic of occlusive PAD w 90%sn 95%sp in symptomatic pt
.9-1.3 normal
^1.3 calcified non-compressible arteries consider further vascular studies

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44
Q

when and how to screen for aaa

A

abd us
men 65-75 w hx of smoking
or anyone w suspicious sx but that not considered “screening”

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45
Q

when to typically consider arterial us

A

to locate affected segment when considering interventional procedure in pt w PAD already diagnosed by ABI (v.9)

(abi mot sn and sp for diagnosis lf pad)

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46
Q

psoas abscess
pres
dx
tx

A 
ab pain radiating to groin inc w exten (psoas sign) dec w flex
subacute fev anorex weight loss
ct ap ab pelv
leuk inflam markers... esr crp?
blood and abscess cx
drain and broad spec anx
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47
Q

ab pain radiating to groin think…

A

psoas abscess

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48
Q

pathogenesis of psoas abscess

A

hematologic seeding from distant infection
or
direct extension of nearby intraabdominal imf (diverticulitis, bertebral osteomyelitis)

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49
Q

risk factors for psoas abscess

A

crohn’s
ivdu
hiv
dm

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50
Q

tf

psoas anscess should be considered on ddx for fev of unknown origin

A

t
deep infection typically presents w ab/flank lain radiating to groin but sx may be nin-specific - subacute fev anorexia weight loss - so include on ddx for fuo

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51
Q

psoas sign

A

ab pain on hip ext

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52
Q

imaging to xx osoas abscess

A

ct ap (ab pelv)

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53
Q

tf

us to dx psoas abscess

A

f

poor sn due to deep location, overlying bowel gas

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54
Q

tf

psoas abscess is on posterior abdominal wall

A

t

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55
Q

hlepful abdominal imaging for bowel obstruction free air renal calculi foreign bodies

A

xr

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56
Q

tf

recent furunculosis a risk for psoas abscess

A

t

psoas abscess can result from hematogenois spread from distant infection

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57
Q

when to get colonoscopy for psoas abscess

A

when source otherwise unexplained

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58
Q

tf

appendicitis can cause positive psoas sign

A

t
Retrocecal appendicitis can
(ab pain w hip ext)

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59
Q

septic hip vs psoas abscess

s and s

A

septic hip has pain on FLEXION and usually inflammatory signs of erythema or warmth

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60
Q

describe blood supply to scaphoid

A

radial a courses ant to radius
superficial palmar branch gives off palmar scaphoid branch to distal pole
dorsal carpal branch gives off dorsal scaphoid branch enters distal pole and proceeds to proximal pole
and other radial branches continue over and under the thumb metacarpal

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61
Q

most common carpal bone fx

A

scaphoid

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62
Q

common mechanism of scaphoid fx

A

foosh causing axial compression or wrist hyperextension

63
Q

tendons of anatomical snuff box

A

medially extensor pollicis longus

laterally abductor pollicus longus and extensor pollicis brevis

64
Q

origins insertions of extensor pollicis longus and brevis

A

epl
o mid ulna
i base of dist phalanx thumb dorsally

epb
o radius and interosseous mem
i base of proximal phalanx thumb dorsally

65
Q

tf

scaphoid fx evident on xr immediately

A

tish fish
t if displaced (operate)
f if compressede or nondisplaced may not be apparent for 7-10days so consider ct or mri to confirm or immediate thumb spica w repeat xr 7-10DAYS to confirm/ro fx and eval for osteonecrosis (DON’T just spica 6 wks w/o confirming fx, prolonged casting ci in soft tissue injury)

66
Q

tf

corticosteroid inj indicated for fx pain

A

F
can impede fx healing
(ortho use for joint inflammation or bursitis..)

67
Q

tx scaphoid fx

A

if displaced on xr, operate
if compressede or nondisplaced may not be apparent for 7-10days on xr so consider ct or mri to confirm fx or immediate thumb spica w repeat xr 7-10DAYS to confirm/ro fx and eval for osteonecrosis (DON’T just spica 6 wks w/o confirming fx, prolonged casting ci in soft tissue injury)

68
Q

normal shoulder rom w pos impimgement tests (neer, hawkins) suggests

A

rotator cuff impingement or tendonopathy

69
Q

signs of rotator cuff impingement or tendonopathy

vs tear

A

full rom w pos hawkins neers impingement tests

pain w abduction er

subacromial tenderness

(suspect tear if above plus WEAK er or abductin, ^60, espec if hx of fall or trauma)

70
Q

frozen shoulder
aka
signs

A

adhesive capsulitis
dec rom (pass and act)
more stiff than pain

71
Q

Anterior shoulder pain think…

A

biceps tendinopathy/rupture

72
Q

glenohumeral osteoarthritis
is it common
what causes it

A

not common

caused by past trauma usually

73
Q

shoulder impingement syndrome refers to

A

compression of supraspinatus tendon and subacromial bursa between humeral head and acromion eg w flexion or abduction of humerus

74
Q

tf

unadressed rotator cuff tendonopathy inc risk of tear

A

t

75
Q

borders of retropharyngeal space

A

ant buccopharyngeal fascia and constrictor muscles
post alar fascia
comminicates w parapharyngeal (lateral pharyngeal) space laterally

76
Q

life-threatening complication of retropharyngeal abscess

A

necrotizing mediastinitis
(fev cp dysp odyn urgent surg)
by draining within retropharyngeal space to superior mediastinum
or extension thru alar fascia to “danger space” (btw alar and prevertebral fasc) and drain inferiorly to posterior mediastinum down even to diaphragm
-can also extend to carotid sheath cause jug v thrombosis cnIX X XI XII deficits

77
Q

ludwig angina
define
s and s

A

rapid progressing
bilateral cellulitis of
submandibular sublingual spaces from infected molar
fev dysphag odynophag drool

78
Q

epidural abscess causes

A
  • hematogenous spread eg from ivdu
  • contiguous spread from osteomyelitis of vertebrae
  • direct inoculation eg from epidural anesthesia
79
Q

metabolic derangement in ischemic colitis

A 
lactic acidosis
(matabolic acidosis)
80
Q

ct findings in ischemic colitis

A

thickened bowel wall
double halo sign
pneumatosis coli

81
Q

severity and locality of ischemic colitis

A

usually moderate severity and

lateralizes to affected side

82
Q

tf

ischemic colitis affected areas are sharply demarcated from unaffected

A

t

83
Q

ischemic colitis mgmt

A

ivf
bowel rest
abx conservative mgmt usually

unless perf or bowel gangrene…

84
Q

c diff s and s

A

fever ab pain non bloody watery diarrhea
(prob recent abx)
colonoscoply shows erythema edema occasional ulceration

85
Q

colonoscopy findings of c diff inf

A

erythema edema occasional ulceration

86
Q

rectal involvement of ischemic colitis vs ulcerative colitis

A

ischemic usually spares rectum due to collateral supply

uc always involves rectum…

87
Q

colonoscopy findings in ischemic colitis

A

cyanotic mucosa and hemorrhagic ulcerations

88
Q

normal serum albumin

A

3.5-5.5 g/dl

89
Q

normal serum alk phos

A

30-115
30-100 male
45-115 female

90
Q

normal serum ast and alt

A

8-40

91
Q

normal serum amylase

A

25-125 u/L

92
Q

pt recovers well from gallsone pancreatitis with suplortive ivf and pain control. what is next step?

A

cholecystectomy
to reduce risk of recurrent pancreatitis
(recommended for medically stable patients recovered from acute pamcreatitis)

93
Q

antihypertensives commonly assoc w pancreatitis

A

thiazides

acei’s

94
Q

when is ercp recommended for gallstone pamcreatitis

A

with cholangitis
bile duct obstruction/dilation
increasing liver enzymes

to relieve obstruction by cannulation or sphyncterotomy

95
Q

HIDA scan aka

A

hepatobiliary iminodiacetic acid scan

visialization of nuclear tracer in bile

96
Q

when to get hida scan

A

eval for cholecystitis in pts w indeterminate us findings

97
Q

pt has biliary colic but no signs of gallstones on us

next step?

A

repeat us 4 wks

can consider in pt w sx of biliary colic but no evidence of stones on initial us

98
Q

tf

early cholecystectomy is indicated in all pts medically stable enough for surgery

A

t

99
Q 
pancreatic pseudocyst
what is it
signs and symptoms
complications
dx
tx
A
  • mature thick fibrous capsule walled-off pancreatic fluid collection of enzymes tissue debris (no necrosis)
  • inc amylase from leak into serum
  • spontaneous infection, duod or biliary obstruction, pseudoaneurusym from leaking eating weakening vessel walls, pamcreatic ascites, pleural effusion
  • ct ab
  • initial expectant mgmt (npo, sx tx) if min sx no compx… endoscopic drainage if sx compx do arise, + ivabx if infected
100
Q

expected electrolyte disturbance in pt vomiting not eating or drinking

A

hypokalemic. .. loss of k in vomit

hypermatremic. .. dehydrated vomiting not eating drinking

101
Q

different kinds of sbo’s and their presentations

A

proximal - early vomiting, ab pain
middle-distal - colicky ab pain, delayed vomiting, ab distention (dilated loops on xr), hyperactive bs, constipation
simple - luminal obstruction
strangulated - loss of blood supply, peritoneal rigidity rebound tenderness, shock fever tachyc leukocytosis

102
Q

obstipation

A

complete constipation

103
Q

tf
green vomit
indicates proximal small bowel obstruction

A

f

anywhere in small bowel - mid-distal sbo’s can cause green emesis too

104
Q

by far the most common cause of sbo

A

adhesions

typically from prior abdominal surg #1 /inflammatory processes… can be congenital ladd’s bands in kids

105
Q

ladd bands

A

fibrous connection of cecum to abdominal wall, can cause duodenal obstruction in intestinal malrotation

106
Q

4 most common causes of melena in 28yo

A

pud
gastritis
esophagitis
mallory weis tear

(melena = bleed from above lig of trietz

107
Q

weight loss can precipitate what ab vasc syndrome

A

superior sma syndrome

108
Q

classic presentation of clavicle fx

A

immobile arm shoulder displaced inf post, supported by good arm, after fall onto outstretched hand or sports collision

109
Q

why should careful neurological exam accompany all clavicle fractures

A 
proximity to
subclavian a
(auscultate for bruit)
and brachial plexus
(clinical motor exam of hand)
110
Q

where is the clavicle most commonly fractures

A

midline

111
Q

tx clavicle fx

A

careful neurovascular exam (auscultate for subclavian a bruit, motor exam of limb for brachial plexus inj)

middle third brace ice rest early rom and strengthening to prevent rom loss

distal third may need orif as malunion a greater risk

112
Q

incidence of bowel ischemia after abdominal aortic aneurysm repair

A

1-7%
usually left and sigmoid
from loss of ima after aortic grafting

113
Q

if ischemic bowel after abdominal aorta surg, what part of bowel typically affected?

A

left and sigmoid colon

from lack of collateral after ima compromised

114
Q

presentation of ischemic colon

A

ab pain
bloody diarrhea
sometimes fev leuk

115
Q

how to minimize ischemic colon risk after abdominal aorta surgery

A

check sigmoid colon perfusion at conclusion of surgery

sigmoid most vulnerable to ischemia

116
Q

when does c.diff develop relative to abx use

A

4-5 days after typically

117
Q

voluminous watery diarrhea fever abdominal pain not bloody diarrhea
what bug?

A

c.diff

118
Q

bloody purulent diarrhea w tenesmus

bug?

A

e.coli
shighella
(invasive diarrhea)

119
Q

tf

bloody diarrhea is a typical feature of bowel perforation

A

f

120
Q

bowel sounds in sbo

A

hyperactive initially,

progressing to hypoactive and absent if ischemia develops

121
Q

tf

mild leukocytosis and amylase can be seen in sbo

A

t

122
Q

tx sbo

A

ngt suction
ivf
iv nutrition
(uncomplicated)

if not responding completely to above but medically stable, can do small bowel follow thru to help diagnose partial obstruction

emergency surgical exploration
if complicated w signs of inc risk of ischemia strangulation necrosis (perf, death)
-pain character, fever, hemodynamic instability (tachyc hypot) guarding leukocytosis metabolic acidosis (eg low bicarb)

123
Q

imaging choice for acute mesenteric ischemia

A

ct angiogray

124
Q

what is meant by bowel “pseudoobstruction”

A

no identifiabe mechanical cause

125
Q

normal total and direct bili

A

.1-1.0

0-.3

126
Q

mechanism of duodenal hematoma

A

blunt abdominal trauma

127
Q

pathogenesis of duodenal hematoma

A

usually blunt abdominal trauma compressing duodenum against vertebral column… blood collects between submucosal and muscular layers of duodenum causing partial or complete obstruction
in peds
due to thinner ab muscles and adipose tissue and more pliable ribs

128
Q 
duodenal hematoma
path
pres
dx
tx
A

usually blunt abdominal trauma compressing duodenum against vertebral column… blood collects between submucosal and muscular layers of duodenum causing partial or complete obstruction
in peds
due to thinner ab muscles and adipose tissue and more pliable ribs
classically present 24-36 hrs post bat w only prior sx of abdominal wall trauma now resolving but no clinical deterioration w epigastric pain and vomiting due to failure to pass gastric contents past expanding obstructing hematoma
dx CT ab
tx ng tube decompression, maybe npo w parenteral nutrition… usually resolve in 1-2 wks… maybe percutaneous or surgical drainage of hematoma if nonop management fails

129
Q

signs and symptoms of

liver laceration

A 
commonly from blunt abdominal trauma bat
ruq ttp
intraperitoneal free fluid
hemodynamic instabiliity
low blood count
130
Q

frequency
presentation
of pancreatic psuedocyst after blunt abdominal trauma

A

rare but occcasional after bat
subacutely developed days to weeks after
nausea vomiting weight loss, palpable abdominal mass

131
Q

tf

pyloric stenosis a common presentation in preadolescent child

A

f

usually nausea vomiting poor feeding in 1-month-old infant

132
Q 
fever
hemodynamic instability
diminished bowel sounds
free intraperitoneal air on cxr
subacutely after blunt abdominal trauma
think...
A

delayed small bowel perforation
(eg from duodenal hematoma or mesenteric injury
w subsequent ischemia and necrosis)

133
Q

severe burn w extensive scar and chronic non-healing wound, cancer to suspect is…

A

SCC squamous cell carcinoma
aka Marjolin ulcer when arising within burn wound
(usually assoc w UV exposure but also chronically wounded inflamed scarred skin)

134
Q

define Marjolin ulcer

A

scc arising within burn wound

135
Q

pathogenesis of SCC other than UV exposure

A

UV exposure most common,
but also arising within burn wound/chronically wounded inflamed scarred skin, overlying osteomyelitis, radiotherapy scar, or venous ulcer
-arising within chronic wound tends to be more aggressive so bx and early dx important to prevent mets

136
Q

pearly telangiectatic papule, often w central ulceration

classic appearance of…

A

bcc basal cell carcinoma

137
Q

classic appearance of basal cell carinoma

A

pearly telangiectatic papule, often w central ulceration

138
Q

tf

melanoma likely to arise within scars and burns

A

f
assoc w sun exposure (like SCC)
but less likely than SCC to arise within scars or burns or chronically inflamed tissue

139
Q

classic setting of kaposi sarcoma

and appearance

A

coinfection of HIV and HHV8

begin as papules and later plaques or nodules, color change from light brown to violet, often multiple lesions

140
Q

tf

gilbert has a gender preference

A

t

male

141
Q

most common inherited disorder of bilirubin glucuronidation

A

gilbert

142
Q

pathogenesis of gilbert syndrome

A

AR or AD mut in UGT1A1 gene
dec UDP-glucuronyltransferase activity
inc unconjugated bilirubin

143
Q

unconjugated vs conjugated disorders of bilirubin metabolism

A

u go crazy
(unconjugated gilber crijler najar)
c dr rogers
(conjugated dubin johnson rotors)

144
Q

presentation of gilbert syndrome

A

intermittent mild otherwise asymptomatic jaundice
provoked by physiologic stress
(infection, fasting, exercise, surgery…)

145
Q

dx gilbert syndrome

A

unconjugated hyperbilirubinemia
normal cbc, smear and retic count
normal ast alt alk phos

146
Q 
gilbert syndrome
path
pres
dx
tx
A

-AR or AD mut in UGT1A1 gene
dec UDP-glucuronyltransferase activity
inc unconjugated bilirubin
-intermittent mild otherwise asymptomatic jaundice
provoked by physiologic stress
(infection, fasting, exercise, surgery…)
-unconjugated hyperbilirubinemia
normal cbc, smear and retic count
normal ast alt alk phos
-educate pt and family re benign nature and inheritance pattern to avoid unnecessary worry or diagnostic tests in the future

147
Q

presentation of acute viral hepatitis

A

anorexia
nausea vomiting
extremely elevated aminotransferases (^25x)

148
Q

why are halothane and other halogenated anesthetics not recommended for adults

A

hepatotoxicity that can be either
mild - mild aminotransferase ele
severe - liver necrosis, fever, jaundice, grossly eleveated aminotransferases

149
Q

iatrogenic biliary injury
most common setting
signs and symptoms

A

laparascopic cholecystectomy

jaundice fever epigastric pain

150
Q

iatrogenic biliary injury
most common setting
signs and symptoms

A

laparascopic cholecystectomy

jaundice fever epigastric pain

151
Q

what percentage of circulating blood volume can a hemithorax hold

A

about 50% of circulating blood

152
Q

define massive hemothorax

most common causes

A

^1.5L
traumatic lung laceration
intercostal artery or internal mammary artery injury

153
Q

hamman sign

A

audible crepitus on cardiac auscultation

eg w subcutaneous emphysema from tracheobronchial tear

154
Q

hamman sign

A

audible crepitus on cardiac auscultation

eg w subcutaneous emphysema from tracheobronchial tear

Surgery (22 decks)

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