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S2 Flashcards

1
Q

Test to do the first inpatient with symptom suggestive of pancreatic Ca?

A

CT scan:Weight loss, Constant A.P,

Abdominal U/S if only have painless jaundice.wight loss and anorexia

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2
Q

Pancreatic Ca risk?

A

smoking

Chronic pancreatitis

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3
Q

DM and Pan.Ca?

A

In Pan .Ca patient 25 % will have T2DM diagnosis in the previous 2 years before Ca was diagnosed
Maybe a risk or paraneoplastic syndrome (adrenomedullin cause insulin resistance)

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4
Q

Anterior cruciate ligament injury sign?

A

Sudden pain
Pooping sound at the time of injury
Joint effusion/heamartrosis
Anterior drawing of Tibia/Lechman test-90 % sensitive

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5
Q

Mechanism of injury?

A

Sudden decrease speed
Sudden change in direction
Trauma to knee
Pivoting on stood leg

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6
Q

DIAGNOSIS?

A

MRI

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7
Q

Management?

A

RICE(Rest,Ice,compression and elevation)

+/- surgery

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8
Q

Gastric Ca CM?

A

Epigastric pain
Nausea/Vomiting
Wight loss due to early satiety
Iron deficiency nemia

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9
Q

Diagnosis?

A

Esophagogastroduodenoscopy (To see lesion and take biopsy)

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10
Q

why common in east Europe/Asia and South America?

A

Diet rich in salt and nitrous food

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11
Q

what sign indicates metastasize to the liver?

A

Elevated AST/ALT and low albumin

Hepatomegaly

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12
Q

Differential?

A

HOOK worm(A.pain.Nausea/Vomiing and IDA)
But no hepatomegaly or elevated TA/AP
There will be peripheral eosinophilia

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13
Q

Free air in retroperitoneum after blunt abdominal trauma?

A

Duodenal, ascending or descending colon injury

Duodenum is more susceptible due to the presence of attached many ligaments and proximity to vertebra

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14
Q

Other manifestation?

A

Symptom delay
Peritonitis
Flank pain

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15
Q

MC cause for peritonitis with FAST positive after blunt abdominal trauma?

A

Pancreatic laceration

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16
Q

Blunt abdominal trauma approach?

A

1) Heamodynamicaly unstable

2) Hemodynamically stable

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17
Q

1)Heamodynamicaly unstable?

A

1–peritonitis–laparotomy
2–No peritonitis and FAST positive–Laparotomy
3–No peritonitis and FAST Negative–DL/CT of A & P

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18
Q

2)Hemodynamically stable?

A

1-Peritonitis–Laparotomy (CTAP on way to OR)
2-No peritonitis but positive FAST–CTAP
3–No peritonitis but Negative FAST–CTAP/serial monitoring

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19
Q

VIT K stored for?

A

30 day in normal liver patient

7-10 days with a patient with an underlying disease

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20
Q

In which type of patient, it will occur?

A

Malabsorption (Bowel, Prolonged NPO, and broad-spectrum antibiotics)

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21
Q

What to do inpatient with hemoptysis?

A

Imaging(C-XR)–TB sugestive–Respiratory isolation
massive>600ml/day—Bronchoscopy after ABC
Hemodynamically unstable/RD/Poor Gas exchange/Massive hemoptysis–Intubation

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22
Q

other things to do?

A

Put the patient on left lateral position

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23
Q

bronchoscopy benefits?

A

aspirate blood
visualization
For procedures like ballon and cautery

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24
Q

What to do next After gastric Adenocarcinoma is diagnosed?

A

CT of A & P to determine the stage

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25
Limited stage?
Radical resection | Eradication therapy for H.Pylori
26
Advanced stage?
Chemotherapy | Palliative surgery
27
acalculous cholecystitis CM?
``` RUQ pain and tendernes/mass Fever Leukocytosis Jaundice +/- abnormal LFT ```
28
risk factor?
Severe trauma Recent surgery Server illness TPN?Prolonged fasting
29
Diagnosis?
Abdominal U/S(Cholic.sighn w/o gall stone) If nonconclusive CT/HIDA scan(more sensetive)
30
Management?
Enteric coverage Ab Cholycystostomy--Initial drainage Cholecystectomy--After the patient stable
31
HIDA scan?
During the procedure, a technician injects a tiny amount of a radioactive compound into your bloodstream. As it travels through your liver, gallbladder, and small intestine, a camera tracks its movement and takes pictures of those organs. A HIDA scan shows how well your gallbladder is working
32
Complicated parapneumonic sign?
``` PH<7.2 WBC>50,000 Glucose<60 Pus in aspirate Common in immunocompromised ```
33
management?
2-4 week AB | Chest tube
34
what to do if we found a thyroid nodule?
Asses for malignancy feature and Regional LDP
35
If have NO feature?
Thyroid U/S and TSH
36
What If U/S shows FNA is indicated?
>1 CM with Mal,F(Microcalcification. irregular border and internal vascularity All >2 cm non-cystic mass
37
If Have no above Indication?
``` Do TSH(If low RI scan(if cold nodule do FNAC and if HOT work for thyrotoxicosis) If normal or HIgh/Normal do FNAC based on above ```
38
normal TSH?
0.5-5
39
Cause of ischemic hepatitis(Shock Liver)?
Cardiac(MI,VTAC,CS) hypovolumic/Septic shock Respiratory failure
40
CM?
``` TA>1000 shortly after insult Bilirubin rise latter Zone 3 will be more affected Hepatocyte ischemic injury Recover in 7 days except in MOF patients(poor prognosis) ```
41
Non-tender, Nonflactuanat bilateral Parotid enlargement with no associated pain with eating?
Sialadenosis
42
Pathophysiology?
Chronic alcohol/bulimia/Malnutrition--Excessive secretary granule accumulation may be due to AD DM/LIVER disease--Fatty accumulation
43
management?
treat underlying cause may reduce but does not completely resolve
44
Acute mesenteric ischemia sign?
Porley localied Abd.Pain Pain out of proporsion of PF Hematocaia(late complication)
45
Risk F?
Embolic source DIC Atherosclerosis
46
lab?
Leukocytosis Elevated amylase and lipase Elevated lactate
47
what indicate infarction?
Localized peritonitis Sepsis Rectal bleeding
48
Otosclerosis?
Middle ear(stapes) damage AD Advanced in pregnancy cause CHL
49
Subphrenic abscess manifestation?
``` RUQ pain Leukocytosis Fever SOB, Hiccup, and pleural effusion MC after appendectomy Diagnose by CT ```
50
immediate things to do in Tension Pneumothorax?
Needle thoracostomy
51
risk for emphysematous cholecystitis?
DM Vascular compromise Imunosupresion
52
CM?
All cholecystitis sign Elevated UB and Mild E TA Crepitasion in the abdominal wall around gall blader
53
diagnosis?
``` Air fluid level in gall bladder Gas in gall blader wall Culture of gas-forming Clostridium or E,Coli Elevated UB and Mild E TA CT is more diagnostic ```
54
management?
Broad-spectrum AB | Immediate cholecystectomy
55
Complication?
C.P toxin--Hemolysis.Tissue necrosis and Septic shock Gangrenous GB GB perforation
56
Intracapsular femoral #?
Head and neck # | High risk of avascular necrosis
57
Extracapsular femoral #?
intrathrocantric/subtrochantric
58
How long we can delay surgical intervention for #?
72 hr | to stabilize patient
59
Cervical spondylosis and near collusion?
Neck hyperextension in narrow Cervical Chanel--spinal cord injury--Upper extremity sign/spare LE b/c fibers found medially
60
Cause of postamputation pain?
4
61
1) Acute stump pain?
Tissue and nerve injury | Sever pain last 1-3 week
62
2)Ischemic pain?
Swelling, Skin discoloration Wound breakdown Dec.transcutaneous 02 tension
63
3)post traumatic nuroma?
Weeks to a month after amputation Focal tenderness Altered local sensation Dec. pain with anesthetic
64
4)phantom limb pain?
Onset usually within 1 week An increase in patients with severe acute pain Intermittent cramping, Burning felt in distal limb
65
post-traumatic neuroma path and management?
inflammation--form mass in unmyelinated fiber make prosthetic device usage difficulty surgery is the definitive management TCA and antiepileptic until surgery
66
pancriatic ingury(ductal inv.) after BT CM?
``` Delayed presentation persistent abdominal pain/tenderness Persistent nausea/emesis Increase amylase over serial measurement Pancreatic fluid collection in upper abdomen ```
67
management?
small--conservative | large--repair
68
open cardiac surgery complication?
Temponad | evidenced by equalization of diastolic RAP,RVP, and PWP
69
what to do inpatient with warfarin to do surgery?
Stop warfarin immediately If INR>2 PCC(if no available FFP) IV Vit K
70
what about hemophilia patients?
Desmopressin
71
Nasopharyngeal Ca risk?
Endemic to Asia Linked to EBV reactivation smoking, salt fish diet, and genetics
72
CM?
Obs--Nasal congestion, epistaxis, and headache Mass effect--CN palsy and OM Spread--Neak mass, cervical LDP
73
Diagnosis?
Endoscopy guided biopsy
74
Management?
Radiotherapy | Chemotherapy
75
Ameobil liver abscess dxs?
serology | can affect lung
76
Flail chest?
>=3 rib in >=2 space # Difficulty information of negative pressure--RD V/Q mismatch at an area--Hypoxia Decrease air entry at site of flial chest
77
When we suspect thoracoabdominal injury?
Injury below 4th rib | All chest and abdomen should be investigated
78
Immediate indication for laparotomy in penetrating abd trauma?
Peritonitis Bowel inviseration Hemodynamic instability
79
Rare VHD manifestation i.e other than H/P/RCC?
Pancriatic nuroendocrine tumor | Endolymphatic duct tumor
80
Scaphoid # sign?
Pain at the radial wrist at the base of tumb Tenderness at anatomic snuff box Risk of osteonecrosis
81
anatomic snuffbox?
Extensor pol.Long--medially | Extensor Pol.Previs and Abd. Pol.Lomg--Laterally
82
Bacterial etiology for osteomyelitis in diabetic foot ulcer?
Contagious spread | Polymicrobial(G+,G- and anaerobes)
83
etiology of urethral stricture?
Trauma including Catheterization Radiotherapy Urethritis
84
Symptoms?
Weak/spraying symptom Incomplete voiding'Irritative Sx(urgency,freq..) Incomplete emptying
85
complication?
AUR Recurrent UTI Bladder stone
86
Diagnosis?
Postvoid residual Urethrography Cystourethroscopy
87
Management?
Dilation | Urethroplasty
88
Common CM of compartment syndrome?
Pain out proportion to the injury Pain inc. on passive stretch & not respond to narcotics Rapidly increasing and tense swelling Paraesthesia(burning or prickling sensation)--early finding)
89
Cause?
Direct trauma Prolonged extremity compression Revascularisation of ischemic limb
90
Uncommon CM?
Dec, sensation Motor weakness(hrs) Paralysis(late) Dec.Distal pulse
91
Diagnosis and Tx?
``` Measure compartment P Fasciotomy immediately (Delay Time determine prognosis) ```
92
Indication for hypertonic saline usage?
In acute Hyponatrmimia(<48 Hr): Serum Na< 130 with any sign of ICP In chronic Hyponatrimia(>48 hr):;Serum Na<120,Sever sx(Seizure) or concomitant ICSOL
93
Why was 48 hr used?
If >48 brains will adapt to new osmolarity and risk of ODS will be high

Surgery 1 (11 decks)

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