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S1 Flashcards

1
Q

Respiratory distress following central venous removal?

A

Venous air embolism

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2
Q

etiology for air embolism?

A

Trauma,surgery(e.g nurosurgery)
Central venous catheter manipulation
Barotrauma(posetive pressure ventilation)

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3
Q

CM?

A

Sudden RD
Obstructive shock
Cardiac arrest
Hypoxia

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4
Q

management?

A

left lateral decubitus position/LL with tredebelerge (Reduce RVO by making embolus to attach RV lateral wall)
High flow/Hyperbaric o2–Help N2 absorption to tissue

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5
Q

pathophysiology?

A

B/c of CVP is low–susceptible for air embolus–travel to RV–RVO/PE–V/Q mismatch(hypoxia)/OS

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6
Q

prone position?

A

reduce atelectasis in case of ARDS/Persistent hypoxemia despite MV

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7
Q

semi-recumbent position?

A

help for reduction of AP in MV patients

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8
Q

Ottawa ankle rules?

A

X-ray indication for Foot/Ankle in time of Pain at the foot or ankle to differentiate # from an ankle sprain

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9
Q

x-ray of ankle required?

A

Pain at malleolar zone + Tenderness at posterior margin /TIP of M/L malleolus or unable to bear weight and to do 4 steeps(2 each)

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10
Q

X-ray of foot required?

A

midfoot zone pain + one of the Foll
1-Tenderness at navicular
2-Tenderness at base of 5 th digit
3-Unable to bear weight and Unable to do 4 steeps

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11
Q

bariatric surgery indication?

A

BMI >40
BMI > 35 with serious comorbidity(T2DM,HTN and OSA)
BMI > 30 with Tx resistant T2DM or metabolic syndrome

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12
Q

medical therapy indication?

A

BMI > 30

BMI–25-29 with wight related complication

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13
Q

drugs used?

A

orlistat
lorcaserine
Naltroxone/pupropion
Liraglutide

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14
Q

initial assessment?

A

review px attempt at weight loss/diet and Ex.habit
review psychiatric hx, coping skill and readiness to change
Review hx of cardiac pul dis

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15
Q

caloric restriction for weight loss?

A

1500-2000
if aggressive (800-1500)
< 800 nit recommended b/c of high failure risk

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16
Q

Faucher, does that suggest malignancy in peritoneal fluid analysis?

A

Persistent(repeated aspiration to r/o traumatic) hemorrhagic fluid

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17
Q

what to do if hemorrhagic?

A

Abdominal imaging
AFP
Cytologic analysis

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18
Q

MCC from malignancy?

A

Hepatocelular carcinoma

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19
Q

what bout TB?

A

Mainly straw color

Rarely bloody but will have abdominal pain and Symptom complex

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20
Q

giant cell tumor cxs?

A 
Benign
Locally destructive
MC at epiphysis of long bone
Can be associated with Paget disease
V-Ray(soap bubble with eccentric lesion)
Giant cells on biopsy
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21
Q

complication?

A

pulmonary metastasis

malignant transformation

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22
Q

management?

A

surgery

Denosumab for tumour shrinkage

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23
Q

ganglion cyst cxs?

A

mobile and non-tender
MC at the wrist but occur in UE and LE
Mucinous fluid-filled with connection with joint(transilluminate)
Common inpatient with joint disease/joint trauma

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24
Q

Management?

A

Mostly resolve by itself

Surgery/aspiration in persistent symptom or pain

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25
dermoid cyst?
MC at the plantar surface of the digit Central punctum < 1 cm
26
what about the rheumatoid nodule?
not Transilluminate | Common at pressure area(like olcranon)
27
hypocalcemia feature?
``` perioral paraesthesia tetany muscle spasm QT prolongation seizure ```
28
normal serum phosphorus?
2.8-4.5
29
how to relate with Phyopoparatyroidism from other causes?
In hyperparathyroidism, there will be hyperphosphatemia/normal
30
Peyronie disease CM?
Pain during erection The difficulty of normal penile curvature during erection Nodule/plaque at dorsal penile surface
31
pathophysiology?
Repetitive injury(AT S>I)--wound healing by fibrosis--Fibrosis at tunica albuginia
32
management?
Mostly resolve with 1-2 week active or progressive--NSAID,pentoxifylline/intralesional Collagenase injection Surgery in refractory cases
33
CM of psoas abscess?
abdominal/flank pain radiate to the groin anorexia and weight loss subacute fever Abdominal pain with hip extension(psoas sighn)
34
Diagnosis?
Abdominopelvic CT High WBC and inflammatory marker Blood and abscess culture
35
Management?
Drainage | broad-spectrum AB
36
Cause?
From distant infection | or from intrabdominal infection
37
risk factor?
DM HIV IV drug use Crohn's disease
38
Diferencial diagnosis?
``` Rectocecal appendix(may have + psoas sighn) BUT RA--Pain on rectal examination ```
39
CM of testicular Ca?
Painless unilateral scrotal mass | may have lower abdomen drawing pain
40
diagnosis?
Firm/hard ovoid mass in tunica albuginia
41
Diagnosis?
B-HCG,LDH, and AFP may be elevated in NSGCT Ultrasound Confirm by doing inguinal orchidectomy (biopsy)
42
U/S feature?
Solid hypoechic lesion(seminoma) | Cystic area and calcification in NSGCT
43
Clinical menifestation of cholagiocarcinoma?
``` Abdominal pain Jaundice Hyperbilirubinemia(CB) sx Cholestatic liver enzyme elevation(High AP,Nor./Mi.EL TA) Right UQ mass/hepatomegaly ```
44
lab?
Elevated CEA and CA 19-9 with normal AFP
45
MC risk factor?
PBC which is common in ulcerative colitis
46
Testicular neoplasm clasification?
``` Germ cell(95%) Stromal (5%) ```
47
Stromal cell tumor?
Leyding Sertoli Granulosal Not produce Tumor marker Like HCG,AFP or
48
Leydig cell tumor pathigenesis?
Produce Testosterone primarily or Estrogen | As a result, FHS and LH suppressed
49
CM?
Hyper E.--Gynacomastia, Dec. Libido, and erectile D | Hyper T--Acne.Hirsutism
50
CM of UC?
Abdominal Pain Diharoa may be bloody Rectosigmoid Ulcer
51
Mild UC defn?
<4/day diarrhea Hematocasia is rare/intermitent Normal inflammation marker
52
Management?
5-ASA medication(mesalamine. sulfasalazine, balsalazide) Localized to rectosigmoid(suppository or enema form) Sever(Oral)
53
Moderate/severe?
>6 stool per day A rise in inflammatory marker Frequent heamatocasia Anemia
54
Management?
TNF alpha In.(Infliximab,Adalimumab,golimumab)
55
refractory case?
Protocolectomy with ilioanal anastmosis
56
corticostoroid consideration?
Chronic severe disease | Acute flare
57
de Quervain tendinopathy?
Tendinopathy of A.P longes and E.P. previs at the extensor retinaculum Repetitive use is a risk(abd, And extension) Common in women in 30-50 in 4-6 week postpartum
58
CM?
``` Tenderness at the radial side of the wrist at the base of the hand Finkelstein Test(extension on hand fist produce pain) ```
59
Management?
NSAID | SPLINT(thumb spica)
60
A complication of CO2 peritoneal inflation?
Peritoneal stretching--VN activation---Bradychardiaa.Heart block and asystole Co2 systemic absorption--peripheral vasodilation--Reflex tachycardia and hypotension CO2 embolization--Obstructive shock Vena Cava obstruction--Hypotension
61
first thing to do in diabetic foot ulcer?
X-ray to assess osteomyelitis
62
Indication?
``` Deep >=2 CM size >7-14 days stay Elevated ESR/CRP Adjacent soft-tissue infection ```
63
VHL disease?
Heamangioblastoma of retina and cerebellum Pheochromocytoma Bilateral RCC(preceded by multiple cystic lesion in kidney)
64
Colonic ischemia?
Hypotension in atherosclerosis patients/--watershed area ischemia(splenic flexure and rectosigmoid junction)
65
CM?
Moderate Abd,Pain /tenderness Hematocasia and diarrhea Leukocytosis and lactic acidosis
66
DXS?
CT: colonic wall thickening and Fat stranding | End.:Edematous friable mucosa
67
management?
Bowel rest IV Ab with enteric coverage Colonic resection if necrosis develop
68
Pregnancy and Iodine scan?
C/I in px because of high risk for congenital hypothyroidism, Intel, Disability, and malignancy in the fetus.
69
The optimal time for thyroidectomy?
Best at postpartum but it is emergency 2nd TM is best
70
what type of nutrition is recommended in critically ill patients?
early (<=48 hr) enteral feeding initiation reduce infection risk and mortality maintain gut integrity
71
what to do?
Naso or orogastric tube advance to passing pylorus if the risk of aspiration is high evidence of normal bowel functioning not required
72
indication for anticoagulation in atrial flutter?
the same as fibrillation
73
BZD withdrawal symptoms?
same as Alcohol withdrawal symptom
74
what sign indicates Strangulation in SBO?
Peritonitis sign Shock Sepsis sign
75
MCC of SBO?
Adhesion
76
Focal nodular hyperplasia of the liver?
``` incidental finding Not require Tx Contraceptive is no risk A hyperdense lesion with arterial contrast with central scar Due to vascular malformatiopn ```
77
treatment?
rarely require
78
sign of anastomotic leak?
``` the first week after the operation abdominal pain fever tachypnea tachycardia ```
79
what is the CM of epidural hematoma after Spinal anesthesia or LP?
Cauda eqina syndrome

Surgery 1 (11 decks)

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