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s3 Flashcards

1
Q

anterior mediasternal mass with elevated B-Hcg and AFP?

A

Primary non-seminomatous germ cell tumor

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2
Q

what about teratoma?

A

Produce mediastinal mass but will not have elevated tumor marker

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3
Q

PCWP and Obstructive shock?

A

If pre pulmonary(TP, PE or Right Side H obs.)— Low/Normal PCWP
If post-Pulmonary (Aortic, LSH defect)—High PCWP

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4
Q

What type of shock can cause by aortic dissection?

A

Post-Pulmonary obstructive shock–Luminal obstruction

Hypovolemic–From bleeding

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5
Q

Testicular torsion pathophysiology?

A

MC during puberty b/c of testicular enlargement
Insufficient Tests attachment to tunica vaginalis–Trauma,exercise and Movt during sleep–Rotation of testis along spermatic cord

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6
Q

CM?

A

L.Abd/Inguinal/Testicular pain
Nausea and Vomiting(MC)
Testis will be tender, Non transilluminate high riding and horizontal lie
Elevation worsen pain
Absent cremasteric reflex
Swollen and erythematous Scrotum
May have recurrent px Sx spontaneously resolving

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7
Q

Diagnosis?

A

Dopler u/s – Decrease flow

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8
Q

Management?

A

Surgical derotation and fixation

Manual derotation if surgery unavailable

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9
Q

Cause of resistant HTN with Elevated Cr after ACEI initiation indicates?

A

Renal artery stenosis
May have lateralizing bruit and flash pulmonary edema
Present in first 2 years after transplantation

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10
Q

Causes?

A

Surgery (vascular injury and suturing)
Donor vessel atherosclerosis
Viral infection(CMV and BK)

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11
Q

Diagnosis?

A

Renal artery doppler

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12
Q

A complication of femoral artery catheterization?

A

AVF–Swelling.No mass, continuous bruit
Hematoma—mass,No bruit
Psudoanyurithm due to dissection—Bulging, Pulsatile mass, and a systolic bruit

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13
Q

Cmplicatin of AVF?

A

Lower limb edema–Due to venous HTN
Lower limb ischemia–Due to reduced arterial flow
High output failure–Due to High venous return

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14
Q

Management of AVF?

A

Small: observation or U/S guided compression
Large:Surgical repair

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15
Q

Cause of haemothorax in blunt chest trauma?

A

Small vessel injuries like lung parenchyma or ICV

A large vessel like the aorta and hilar vessel

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16
Q

Intercostal vessel injury sign?

A

Rib #(localized pain and tenderness)

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17
Q

haemothorax sign?

A

hypovolemic shock

Decrease air entry and dullness

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18
Q

Aortic vessel injury?

A

Mostly in sever injury
MC at isthmus
If at ascending–CT,MI, FND from dec.CV flow

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19
Q

Disease-associated with an umbilical hernia?

A

Hypothyroidism
Ehler-Danol
Beckwith-Widman
But frequently in normal newborn

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20
Q

Management?

A

Observation

Surgery at 5 years or complication occurs

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21
Q

What about gastroschisis and omphalocele?

A

Warrant imidiate surgery

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22
Q

What about umbilical granuloma?

A

Moist, pedunculated, red, and friable mass after stamp removal—Treat with silver nitrate

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23
Q

Wound botulism Cxs?

A

10 days after infection in a puncture wound
Usually have abscess
Fever and leukocytosis

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24
Q

CM?

A

Like food born botulism
CN palsy(MC:3,4,6,9 and 10)
Respiratory compromise due to Diaphram injury
Muscle paralysis

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25
management?
imidiate botulunium antitoxin then wound culture and serum toxin screening Antibiotic Respiratory support for RF and Debridement
26
Drug-induced hypoventilation cause?
Anesthetics Narcotics Sedatives
27
Cause of alveolar hypoventilation in post-surgery?
Subdiaphramatic Surgery | Narcotic pain medication
28
Uric acid stone pathophysiology?
Inc.Sec(MPD,Gout), Inc cons,(Hot,arid Climate and Dhn)--Increase precipitation of UA-crystal formation Low urine PH(Chr. Diharroa, Metabolic syndrome/DM)---favor UA(water Ins. than urate(Water-soluble)
29
CM?
Radiolucent Romboid shape Acidic urine
30
Treatment?
Alkalize urine using K.Citrate or potassium carbonate | Surgery usually Unescesery
31
MC stone in ADPCK disease?
Uric acid stone B/C of the kidney produce more acidic urine
32
cause of distributive shock in pituitary apoplexy?
Adrenal crisis
33
Dopamine agonist like bromocriptine S/E?
orthostatic hypotension
34
Ludwing angina?
Rapideley progressive cellulitis of sublingual and submandibular spaces. Due to extension of infection from dental molars
35
CM?
Sublingual area elevation--tongue protrude posteriorly---airway obstruction Submandibular area swelling The neck is woody and brown
36
Cardiac temponad on X-ray?
Acute: Normal Heart sailout(100-200ml for Sx)) Chronic: Globular heart saliought(>200 ml for Sx)
37
pancriaticoplural fitula fluid caracter?
Exudative in light criterion High amylase(High to serum/Pleural fluid to serum amylase ratio >1) PH:7.3-7.5 Occur in patients with chronic pancreatitis
38
management?
Bowel rest--enable PPF close endoscopic sphincterotomy of ampulla of Vater--aid fluid to drain to bowel Refractory case percutaneous drainage or surgery A chest tube is ineffective and increase recurence
39
what about borhave pleural effusion?
PH <5 | Hx of severe vomiting
40
Pancreatic cyst prevalence at age > 70%?
40 % among these only 0.01 % are malignant As a result, many managed conservatively
41
Things to consider in a pan. Cyst?
Since resection have a high risk of mortality and morbidity Identification of malignant feature is important
42
malignant feature?
Size >3 CM Solid component or calcification Main pancreatic duct involvement (i,e Dilation) Thickened or irregular cyst wall
43
What to do in a cyst with a Malignant feature?
Endoscopic U/S guided biopsy | Surgical resection may be considered in very high-risk cases
44
what about the pan. pseudocysts?
The cyst is a Round, well-circumsised fluid collection. Does not require further investigation If symptomatic(Abd, Pain) or rapid enlargement do endoscopic drainage.
45
Duodenal hematoma pathophysiology?
Blunt Abd, trauma--Injury of b/v in mucosa and submucosa--Hematoma--intestine obstruction in 24-48 hour
46
CM?
Sx mainly develop after 1 day | Epigastric discomfort, Nausea, and vomiting
47
Diagnosis?
CT scan of the abdomen(C-Shaped)
48
Management?
``` Bowel rest NG tube Decompression Total paraenteral nutrision CT or U/S serial follow up Mainely resolve in first few weeks ```
49
DPL function?
Reserved for Hemodynamically unstable patients with FAST negative and HU after resuscitation to do CT
50
FAST role D/C in H.stable and H.Unstable patient w/o peritonitis?
HU: If +--laparotomy HS: If +--Do CTAP
51
Laparotomy Ind D/c?
In HU:Peritonitis or FAST + | In HS: Onley peritonitis
52
What is a major factor related to malignant suspicion in SLN?
SIze <0.6 low risk and not require F-UP >)0.8 needs at least oservation and F-Up?
53
Factor increase probability of SLN to be malignant?
``` Size >2 CM Advanced patient age Female sex active/previous smoking Hx Personal/family Hx of Ca UL location Speculated rad.Finding(like Irregular Border) ```
54
Why is Floroquinolol C/I inpatient with Aortic aneurysm/risk of aortic aneurysm?
Activate metalloproteinase---Aortic aneurysm ruptured in AA Pt and AA formation in patients at risk Like retinal detachment and Achilles tendon rapture
55
Fournier gangreen pathophysiology?
MC perineal/genital breakdown---Colonization with polymicrobial from colonic or UG source--Infection spread In SC fat through fascial plane--Microthrombi of SC vessels---Skin necrosis
56
CM?
1-Rapidly progressive 2-Swelling, Tenderness,s and crepitation in lower abdomen, perineum, and scrotum 3-Systemic Sx like Fever and Hypotension 4-Lab: Leukocytosis,L.Acidosis,RF and coagulophaty
57
management?
Immediate surgery | Imaging not require
58
CSF rhinorrhea risk?
TBI(HI/Surgery) | Factor Increase ICP
59
CM?
Clear, Persistent, Salty or Metalic nasal discharge which increases by maneuver increase ICP
60
Diagnosis?
Test for CSF specfic protein like B-2 transferine and B-Trace protien To localize use imaging/endoscopy after intrathecal contrast injection
61
Management?
Bed rest, Head neck elevation, and avoid straining Surgical repair/Intrathecal drainage for resistant one Frequent Neurologic evaluation for meningitis screening
62
Angiography with embolization can consider in what case in BAT?
Liver and Spleen laceration confirmed by CT and it should be hemodynamically stable low grade
63
atraumatic splenic rapture cause?
HM(Leukemia/Lymphoma..) | INFn(CMV,EBV
64
What precipitate?
Use of anticoagulant
65
Management?
HS,LG--Embolization | HU,HG---Splenectomy
66
Spermatocele?
Non-Transiluminating mass at tests upper pole | Not change with Valsalva/standing
67
Distal radial collins # with minor trauma may be a sign of?
Osteoporosis
68
Wide excisional biopsy is indicated for?
melanoma | high risk/recurrent non-melanomatous lesion
69
normal S-BHCG in non Px?
Non-pregnant women: less than 5 mIU/mL. | Healthy men: less than 2 mIU/mL.
70
location of osteosarcoma?
In children: metaphysis | In adult: At the site of bone damage(PD, Radiation, and benign bone lesion)
71
X-ray feature?
``` Mixed Radiolucent and opaque lesion Periosteal elevation(Codman triangle) Cortical thickening (Sunbreast) ```
72
what bone lesion can cause periosteal elevation, thickening, and sclerosis?
Stress #(But will not have destructive, lucent area)
73
extremity vascular injury hard sign?
Pulsatile bleeding expanding heamatoma Bruit and thrill at site of injury Distant extremity ischemia sign(Absent pulse, Cool extremity)
74
Soft sign?
Hx of hemorrhage Diminished pulse Bony injury Neurologic abnormality
75
what it the importance to classify?
In presence of penetrating injury if have Hard sign: Immediate surgical exploration Soft sign: Do the Injured extremity index(Like ABI), CT scan or conventional angiography(preferd), doppler sonography
76
Splenic abscess patho?
Distant infection(IE,Cholis)--Bacteremia specially in immunocompromised
77
CM?
``` LUQ pain radiates to the back High-grade fever +/- splenomegally anorexia and weight loss Leukocytosis with left shift elevation of left diaphragm ```
78
diagnosis and Tx?
D: Abdominal CT Tx: AB and splenectomy
79
Urgent Urologic consultation for a case of stone for urethral stent and nephrostomy?
Urosepsis AKI Refractory pain
80
consultation for lithotripsy or other ablation?
Stone size >10 mm Not pass within 4-5 week warrant urologic evaluation
81
Cellulitis occur after human bite managment?
Amox-Clav(Also cover B-l prod, Anarobs, G+, and G-,Thre causative agent for human bite) Keep wound open Heal by secondary intension
82
S/E of topical/systemic CS on the eye?
Increase risk of open-angle glaucoma

Surgery 1 (11 decks)

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