s9

Question 1

Ear barotrauma?

Answer 1

In case of rapid descent or accent(plane take-off and landing)
People with URTI are at risk because it affects ET opening and balancing pressure–TM rapture
Lead to persistent Hear loss and pain
Management is reassurance and follows up

Question 2

horsness of voice,chest pain sfter Blunt CT?

Answer 2

Compresion of RLN by psudoanurythm

Question 3

3 points for PE?

Answer 3

Other diagnoses unlikely

Diagnosed DVT

Question 4

1.5 point?

Answer 4

Previous hx of DVT/PE
Tachycardia
Recent surgery or immobilization

Question 5

1 point?

Answer 5

Hemoptysis

Cancer

Question 6

X-Ray of chronic osteomylitis?

Answer 6

Lytic lesion of trabucular and corticar
Surrounding sclerosis
Periosteal thickness

Question 7

AAA and rapture relation?

Answer 7

75% of AAR patients will have no Hx of AAA

Question 8

ABI?

Answer 8

SBP of DPA/PTA divided by BA

Question 9

Interpretation?

Answer 9

<=0.9 —PAD diagnosis
0.91-1.3 —Normal
>1.3—-Calcified/Non compresible vessel

Question 10

gallstone ileus CM?

Answer 10

MC in older women
Intermittent tumbling Abdominal pain
SBO at ilium Several days later
Cholecystitis is a risk(Form biliary enteric adhesion) that lead to fistula

Question 11

Diagnosis?

Answer 11

CT(Air in biliary three, thickened gall bladder wall and visualize abstraction stone)

Question 12

management?

Answer 12

Removal of stone

Simultaneous cholecystectomy

Question 13

Is toxic megacolon secondary to C>Difficele infection CM?

Answer 13

Severe systemic toxicity(e.g Hypotension, fever, tachycardia, lethargy)
Abdominal pain and distension(Hx of Diarroha before TM develop)
Radiologic evidence of colonic dilation(>3 for SB,>6 for Colon and > 9 for cecum)

Question 14

Tx?

Answer 14

Bowel rest
NG tube
Agresive AB administaration
If lack response consider CT/Subtotal colectomy

Question 15

Varicocele and infertility?

Answer 15

Increase T0–Testicular atrophy, Reduced sperm production, and motility.

Question 16

management of hepatic adenoma?

Answer 16

asymptomatic & size <5 CM–Stop OCP

symptomatic or size >5 CM—-Surgical Resection

Question 17

Spontaneous rapture in liver adenoma and hemangioblastoma?

Answer 17

Spontaneous rupture is rare in hemangioblastoma

Question 18

return of consciousness after anesthesia?

Answer 18

15 min

at least protective reflex-like gag reflex return within 30-60 min

Question 19

cause of delaying in anesthesia?

Answer 19

1-Drug related
2-Metabolic disorder
3-Neurologic disorder

Question 20

Drug-related?

Answer 20

Preoperative drug intake(opiates, BDZ, Illicit drug AntiCH and anti histamin)
Prolonged anesthesia
High dose anesthesia

Question 21

metabolic?

Answer 21

Hypo/Hyperthermia
Hypo/Hyperglycemia
Hyponatremia
Liver disease

Question 22

Neurologic disorder?

Answer 22

Intraoperative stroke
Seizure
ICP

Question 23

characteristics of delayed emergence from anesthesia?

Answer 23

defined as not regaining consciousness after 30-60 from the last dose of anesthesia or relaxant give.
Post intubation(Hypoxic respiratory failure, bradycardia, bradypnea, and persistence LOC)

Question 24

What about post intubation larengial spasm?

Answer 24

Can cause hypoxic, hypercapnic RF but the patient will be tachypneic, stridor, and will have tachycardia.

Question 25

Treatment of SDH?

Answer 25

small--conservative | Large--Evacuation

Question 26

osteosarcoma-related genetic defect?

Answer 26

``` RB1 mutation(Retinoblastoma) TP53(soft tissue sarcoma, acute leukemia, breast cancer, brain cancer, and adrenal cortical tumors/SABL) ```

Question 27

Osteosarcoma d/t from Brodie abscess and benign bone cyst which both may have cystic lesion surrounded by reactive osteosclerosis?

Answer 27

``` Brodie abscess(Elongated cystic lesion) a benign bone cyst-like Unicameral cyst(Have regular border) ```

Question 28

bursa function?

Answer 28

Cystic space fond b/n tendon and bony prominence--Help to reduce friction

Question 29

Cause of inflammation?

Answer 29

repetitive pressure acute trauma Crystal-like gout Extension of joint infection

Question 30

Management?

Answer 30

aspiration(WBC count,Gram stain) to r/o infection | NSAID if infection r/o.

Question 31

Bursa located around patela?

Answer 31

suprapatellar--B/N QF tendon and femoral condyl Prepatellar subcutaneous--B/SKIN and patella Infrapatellar Subcutaneous --B/N skin and patellar ligament in anterior tibial condyle area Deep infrapatellar:B/N tibia and pattelar ligament

Question 32

Postoperative atelectasis CM?

Answer 32

MC in 2-5 post-op day Thoracoabdominal and abdominal surgery increase the risk Hypoxia--Compensatory hyperventilation (Low pco2 and respiratory alkalosis) Reduce lung volume

Question 33

Pathophysiology?

Answer 33

Shallow breathing(decrease alveoli recruitment) and impaired cough( cause small airway mucus plugging).

Question 34

management?

Answer 34

``` Adequate pain control Deep breathing exercise Directed coughing Early mobilization Incentive spirometry ```

Question 35

Diaphragmatic paralysis CM?

Answer 35

``` Shallow and fast breathing Orthopnea Hypoxia If severe--RF Common in thoracic surgery and spinal manipulation in surgery or compression from mass like a tumor that results in phrenic nerve injury But if unilateral asymptomatic ```

Question 36

Autonomic Dysreflexia in Spinal Cord Injury?

Answer 36

Lesion above T6 --Loss of modulating parasympathetic modulatory response after factor lead sympathetic activation---persistent sympathetic activation below lesion after sympathetic nervous system activating stimuli like urinary retention, constipation, and pressure ulcer

Question 37

CM?

Answer 37

Above lesion--Normal PSN activation---Bradycardia and vasodilation( facial flushing) Below lesion---No PSN response--Persistent splanchnic and peripheral artery constriction---Persistent HTN Symptom decrease after trigger treated

Question 38

Management?

Answer 38

``` Keep patient upright(Induce orthostatic BP drop) Treat the triggering event Treat HTN(nitrate) ```

Question 39

pathophysiology of blunt cardiac injury?

Answer 39

Rapid deceleration/direct chest trauma---shearing/compression and rapid Pressure change

Question 40

CM?

Answer 40

Arrhythmia in all types (usually asymptomatic) MI from CA dissection/thrombosis Myocardial contusion--Myocardial dysfunction Parture of septum/valve and ventricular well Cardiac tamponade

Question 41

Confirmatory test?

Answer 41

24-48 hr ECG monitoring(fatal arrhythmia mainly occur at this time) ECHO(especially when having HF symptoms, hypotension)--to r/o valvular/septal injury and myocardial contusion.