S6

Question 1

Risk factor of upper extremity DVT?

Answer 1

Central venous catheter and PICC(peripherally inserted central catheter)
Yong athletic males(spontaneous)
Thoracic outlet obstruction

Question 2

CM?

Answer 2

Unilateral arm or forearm edema
Pain and heavy sensation
Erythema
Dilated subcutaneous Vien

Question 3

Diagnosis?

Answer 3

Compression Doupler U/S

Question 4

Management?

Answer 4

3-month anticoagulation

Question 5

How to differentiate from venous line infection?

Answer 5

Unlike venous line infection, In DVT the venous catheter insertion site is normal.In infection(phlebitis the venous line become red)

Question 6

Acute epididimitis cause?

Answer 6

Age < 35–sexualy transmited(Claymidia and Gonorhia)

Age > 35–Obstraction UT(choliform bacteria)

Question 7

CM?

Answer 7

Unilaterral/Posterior testicular pain
Epididymal edema
Pain improves with elevation
Dysuria and frequency(If due to cholioform)

Question 8

Diagnosis?

Answer 8

NAAT

Urinalysis/culture

Question 9

Management?

Answer 9

Ceftriaxone plus doxycycline or

Levofloxacin

Question 10

What to do inpatient suspected of VAP?

Answer 10

Do C-x-Ray
Take a sample from the lower part of the endotracheal tube
Start empiric therapy(G+.G-,P and MRSA) if abnormal CXR
Then decide on culture result and clinical improvement

Question 11

Negative culture?

Answer 11

Stop antibiotic and search other cause

Question 12

Positive culture and clinical improvement?

Answer 12

Adjust the empiric antibiotic

Question 13

Positive culture w/o clinical improvement?

Answer 13

High likely VAP
Asses for Pneumonia complication
Consider changing AB
Asses other cause

Question 14

VAP CM?

Answer 14

Develop after >48 hr
Fever
leukocytosis
Infiltration on x-ray
The difficulty of intubation(high RR and Low TV, deteriorating oxygenation)

Question 15

Cause of nosocomial bloodstream infection inpatient have CVC?

Answer 15

Coagulase-negative staphylococci and S.A(Major cause)

Candida in 10 %

Question 16

CM of colovesical fistula?

Answer 16

Pnumaturia
Fecaluria
Recurent UTI

Question 17

Abdominal CT?

Answer 17

CT with oral/rectal contrast no Iv contrast(thickened Bw and fistula)
Colonoscopy to r/o colonic ca

Question 18

risk factor?

Answer 18

diverticular disease
colonic Ca
chrons

Question 19

Compartment syndrome dx?

Answer 19

Intracompartment Pressure measurement(needle manometry)
Delta pressure (Diastolic blood pressure <30 at lesion site)

Question 20

atelectasis x-ray feature?

Answer 20

Lung opacification
Mediastinal shift
Narrow gap b/n ribs

Question 21

Management if due to plugging (mainly post oprative)?

Answer 21

Small plug: Pulmonary Exercise

Large: remove with bronchoscopy

Question 22

types and cause of prosthetic valve dysfunction?

Answer 22

Transvalvular regurgitation(cusp degeneration)--commonly affect bioprosthetic valve
Paravalvular leak(annular degeneration/IE--dehiscence)--commonly affect mechanical valve
Valvular stenosis(valve thrombus)

Question 23

diagnosis?

Answer 23

echocardiography

do coagulation studies additionally if stenotic

Question 24

a complication of PVD?

Answer 24

MA-HA
HF
Thrombocytopnia

Question 25

transportation of amputated extremity for repair?

Answer 25

wash with saline Cover with sterile gauze soaked with saline seal with a plastic bag Put on ICE water container(0 degre)

Question 26

what is the cause of Cervical LDP with SCC?

Answer 26

``` Metastasis from head and neck Do larengiopharengioscopy(visualize nasal,pharnex,larnex and oral cavity) ```

Question 27

CM?

Answer 27

Patients with smoking or alcoholism | LDP >1.5 and present for > 2 week

Question 28

cause of hypotension while transfusion?

Answer 28

Anaphylaxis TRALI(alcoholic, smoking, and critically ill patient) Hemolysis Infection(mainly on platelet transfusion)

Question 29

NF type 2 genetics?

Answer 29

AD usually at age 20-30 defect in NFT2 gene encoding merlin(TSG)

Question 30

CM?

Answer 30

``` Bilateral vestibular shewanoma Intracranial meningioma A spinal tumor (schwannoma, ependymoma) cataract Cutaneous tumor/plaque Peripheral neuropathy ```

Question 31

Tumour surveillance?

Answer 31

Audiogram Head and spinal MRI Ophthalmologic evaluasion

Question 32

cause of hypoxia with high A-a gradient does not respond to o2 therapy?

Answer 32

Diffuse pulmonary edema Massive PE right to left cardiac shunt

Question 33

Grave ophthalmopathy sx?

Answer 33

impaired EOM(diplopia and enable convergence) eye pain, irritation, and redness proptosis due to orbital tissue expansion

Question 34

what to do imidiateley in varicial heamorage?

Answer 34

Place two IV line

Question 35

RIB fracture location and associated injury?

Answer 35

1-3--(SCV,BP,Mediasternal vessel) 3-6--CVS 9-12--Intraabdominal(L,S,K(11,12) Any level--lung

Question 36

Risk factor for VAP?

Answer 36

``` Acid suppression Supine position Pooled subglottic secretion Paralysis and exessive sedation excessive pt movt on intubation Frequent ventilator circulation change ```

Question 37

prevention?

Answer 37

``` Minimal antiacide usage bed elevation 30-45 degrees Cont/Int subglottic suction minimize patient transport Daily sedation break ```