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S8 Flashcards

1
Q

What to do immediately after acute limb ischemia is diagnosed?

A

Stars immediately heparin

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2
Q

psudomonas arginosa folliculitis CM?

A

most cases develop within the hour to days
after swimming in inadequately chlorinated water
generally tender papule,pustule or nodule
treat with fluoroquinolone

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3
Q

what about S.Aureius?

A

MCC of folliculitis
A purulent lesion with surrounding erythema and induration
Respond to cotrimoxazole

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4
Q

Ogilvie syndrome?

A

Acute colonic pseudo-obstruction

Manifest as paralytic ilius

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5
Q

Etiology?

A

Major surgery, traumatic injury, and severe infection
Electrolyte derangement(low K,Ca and Mg)
Medication(Opiates and anticolinegics)
Neurogenic disorder(Parkinson and strock)

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6
Q

imaging?

A

x-ray–Colonic dilation with normal haustra and normal SB

CT scan: Colonic dilation with normal anatomy(haustral non dilated segment)

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7
Q

management?

A

NPO.NG tube decompression

Neostigmine if no improvement within 48 hr/local diameter > 12 CM or perforation sighn

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8
Q

Does a common tumour metastasize to the spine?

A

Breast
Prostate
Lung
Multiple myeloma

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9
Q

SX progression?

A

back pain 1-2 month–motor symptom–bowel/bladder dysfunction

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10
Q

Glucocrticoid benifit?

A

Reduce vasogenic edema caused by vessel obstruction by tumor

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11
Q

phantom limb sx?

A

Neuropathic pain(shooting and burning)
On absent limb site
The pain increased by unrelated activity like defecation
Prior major NV injury and post-op pain in.risk

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12
Q

Management?

A

Multimodal
1-pharmacotherapy: Antidepressant, antiepileptic, NMDA receptor antagonist, and analgesics
2–adjuvant–CBT, Biofeedback and minor therapy

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13
Q

managment of diverticulitis?

A

depend on whether uncomplicated or not(abscess, perforation, obstruction, and fistula_?

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14
Q

Uncomplicated ?

A

Bowel rest, Oral Ab and observation

Hospitalization and IV Ab if IC, Elderly, Very high fever, and significant leukocytosis

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15
Q

Abscess management?

A

<3-4 CM–Iv Ab but if sx persist surgery

>3-4 CM–CT guided SC drainage but if sx persist surgery

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16
Q

Surgical drainage indication?

A

Perforation with peritonitis
Obstruction
Fistula
Recurrent attack

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17
Q

Complication of pancriatic psudosist?

A

duodenal/biliary obstruction
psudoanurythm
pancreatic ascites
pleural effusion

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18
Q

management?

A

No Sx/Compl–Sx tx and NPO

Sx/complication –drainage

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19
Q

CM?

A

Nausea and Vomiting
Abd pain
Elevated amylase
Abdominal distension

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20
Q

Alpha 2 antagonist in urethral stone?

A

Dilate the spasmodic contraction of urethral smooth muscle—Facilitate passage

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21
Q

A cause for hemorrhagic shock in patients with trauma and normal chest, Negative fast and normal pericardium?

A

Pelvic fracture(pelvic X-ray routine, bleed may accumulate in retroperitoneum)
Neurologic shock due to spinal injury–But will have bradycardia and motor Sx
Adrenal injury–But occur in a patient with adrenal insufficiency

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22
Q

When a patient with a superior sulcus tumor will have pulmonary Sx?

A

When tumor advances

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23
Q

Diagnosis approach to SCC suspicion?

A

Biopsy involving deep dermis

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24
Q

Risk factor for UE DVT?

A

CV catheter
Repetitive arm movt(pinching)–Vien damage
Malignancy
Wight lifting—Scalen and SClavius muscle Htr–Vien obstruction
Thoracic outlet obstruction—Vien obstruction

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25
CM?
Acute right arm edema, heaviness, pain, and erythema. Dilated SC collateral vein in upper chest and UE PE
26
Tx?
3-month anticoagulation | Thrombolysis(if Non-CIV related)
27
Hepatic adenoma immaging?
Well demarcated hyperechoic lesion with peripheral enhancement
28
Typical patient?
Women with long term OCP usage anabolic androgen pregnancy
29
Complication?
Groweth Rapture malignant transformation
30
Management?
Surgical removal
31
Prosthetic joint infection classification?
early onset delayed onset late-onset
32
early onset?
,3 month acute pain wound infection or breakdown, and fever S.A, G -Ve rods, and anaerobes are common etiology
33
delayed onset?
3-12 month Chronic joint pain, Implant loosening, and sinus tract formation Coag -Ve staph,Enterococci and propiniobacterium species
34
Late-onset?
> 12 month Acute symptom in previously asymptomatic joint Recent infection at a distant site S.A.G-Ve rods and BHS
35
MCC for acute back pain and tenderness w/o neurologic deficit?
Vertebral compression fracture(usually will not have neurologic deficit)
36
What about Disk herniation?
Unlike VCF pain is relieved by rest (VCF exacerbated on lying back) DH---Neurologic deficite
37
Negative pressure pulmonary edema?
Upper airway obstruction--exhalation against closed glotis---High negative pulmonary pressure--Noncardiogenic pulmonary edema Can occur after extubation due to laryngeal spasm especially in head and neck surgery.
38
What to do inpatient with secondary polycythemia with no sign and sx chronic hypoxia?
Abdominal CT(to r/o liver and renal malignancy)
39
How to d/t from rotator cuff tendinopathy/impingement from tear?
T/I--pain on shoulder abduction and ER w/o weakness tear---they will have a weakness Diagnose with MRI
40
Clavicular fracture managment?
if the hard sign of vascular injury---Open reduction(I,AP,B/T and EH) If the soft sign of VI(CT angiography) If simple middle 13 fracture--Closed reduction with 8 bandage Distal 1/3 may need
41
renal abscess CM?
``` Previous Hx of 1-2 moth prior UTI Insidious onset Right flank pain Localized tenderness or mass Fatigue, Weight loss, fever, and diaphoresis UTI sx usually absent Urinalysis may suggest UTI if abscess contact with collecting tubule Elevated ESR and CRP may be present Leukocytosis and AKI sign may be present ```
42
Diagnosis?
CT | Ultrasound
43
Management?
Ab | Percutaneous drainage
44
risk factor?
Anatomic abnormality(VUR/NB) Uncontrolled DM Nephrolithiasis Tobacco usage
45
Indication for thoracotomy in hemothorax?
If initial drains >1500ml with chest tube Continuous drainage >200ml/hr for more than 2 hours Continuous need of transfusion to maintain hemodynamics
46
Pyogenic liver absces CM?
RUQ apin Fever Lukocytosis Elevated Liver enzyme
47
Imaging?
round hypoatinuated lesion
48
Cause?
Penetrating trauma Adjacent tissue infection(AC) Distant infection(IE) Through portal vein--Any GI infection
49
management?
``` Percutaneous aspiration(diagnostic and management) Ab Place drainage tube Surgery if PC drainage is not effective Blood culture ```
50
what about a Hyaditid cyst?
Asymptomatic unless enlarged and rapture | septated cystic lesion with may have calcification
51
what about amebic liver abscess?
suspect if no have a risk for PLA Live in an endemic area Diagnose using serology and stool ova
52
auscultatory finding in pulmonary contusion?
localized Rales Decrease breath sound
53
treatment?
Pain control Pulmonary hygiene(incentive respiration & PT) O2 supplementation
54
diagnosis?
ground-glass opacity on Chest CT
55
treatment of varicocele?
Yonge children and adolescent--gonadal vein ligation to prevent infertility Testicular support and NSAID for older who don't want fertility
56
referred otalgia causes?
TMJ disease Dental disease Nasopharyngeal SCC
57
Diaphragmatic injury diagnosis modality?
CT
58
cause of immidiate post oprative period?
``` within hour 1--prior infection or trauma 2-Inflammation due to surgery 3-Malignant hyperthermia 4-Anesthetic medication 5--Blood product ```
59
Drug-related fever in the postoperative period?
MC in B-lactam Present after one week Will have a rash and peripheral eosinophilia
60
Sphincter of Oddi dysfunction cause?
Functional or stenosis Inflammatory dysfunction Opioids--precipitate it
61
CM?
RUQ pain Jaundice Elevated ALT/ALP Dilated CBD in absence of stone
62
Diagnosis and management?
Sphincter Oddi manometry | Spnicterectomy for management
63
In low suspicion to abdominal injury?
Serial PE and HCT and F-UP?
64
Common site of cervical facet dislocation?
C5/6--CN6 inj---defect in wrist extension and numbness on forearm and thumb C6/7--CN 7--defect in elbow extension, wrist flection, and numbness on index and middle finger.
65
Central cervical cord syndrome CM?
early--Bilateral UE sensory sx--Due to AC lesion | Late(expanding)---Motor weakness in early UE Then LE.because UE motor neuron found medially.
66
Angiosarcoma CM?
ecchymotic/purpuric mass on the area of lymphedema/localized radiation. metastasize through B/V early The second one has a poor prognosis
67
Management?
Surgery
68
rectus abdomens hematoma risk factor?
``` forceful coughing abdominal trauma anticoagulation old age female sex ```
69
CM?
``` Acute onset abdominal pain palpable abdominal mass Blood loss anemia Leukocytosis -/+ nausea, vomiting, and fever ```
70
Management?
HS:reverse anticoagulation,follow with CBC,transfuse if anemic. HU: Angiography with surgical embolization and surgery
71
Diagnosis?
CT
72
Stress fracture CM?
Insidious onset of localized pain Point tenderness at the fracture site Possible negative x-ray in first 6 week The anterior tibia and 2nd metatarsal are commonly affected
73
Management?
Reduce weight bearing 4-6 week In middle 2nd/3rd/4th not need splint just analgesic(PCM, NSAID not recommended)--nearby tarsal act as a splint--Do splint if pain persists. 1st and 5th metatarsal splint with hard shoe
74
Is prophylactic dose heparin is preventive for PE in high-risk patients?
No
75
What is the preferred drug for PE in cancer patients?
Therapeutic dose low molecular heparin (dalteparin and enoxaparine) Oral anticoagulant, not preferred due to high risk of bleeding
76
why the SCC of the head and neck will have otalgia?
Ix--Inervate base of tognque X--inervate larynex,hypopharnex and both nerves innervate external auditory meatus
77
what to do inpatient with haematuria w/o clear reason and age >40?
Cystoscopy | CT urography to visualize kidney to help see kidney and staging if B Ca.
78
cause of hypercalcemia in cancer?
``` Metastasis(whole body scan) PHrP secretion(serum level) ```
79
Lung SCC CM?
Central mass(usually hilar area) Hypercalcemia Hypercalcemia symptom Smoking is a single MC risk factor
80
Epidermal inclusion cyst CM?
MC at face, neck, scalp, and trunk Cystic mass May have central punctum May have cheasy discharge
81
Epidermal inclusion cyst CM?
MC at face, neck, scalp, and trunk Cystic mass May have a central punctum May have cheesy discharge
82
Tracheobronchial injury sign?
may have persistent pneumothorax and pneumomediastinum despite chest tube placement bronchoscopy is diagnostic surgical repair is diagnostic the more proximal the lesion the more leak

Surgery 1 (11 decks)

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