s9 Flashcards
Ear barotrauma?
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
horsness of voice,chest pain sfter Blunt CT?
Compresion of RLN by psudoanurythm
3 points for PE?
Other diagnoses unlikely
Diagnosed DVT
1.5 point?
Previous hx of DVT/PE
Tachycardia
Recent surgery or immobilization
1 point?
Hemoptysis
Cancer
X-Ray of chronic osteomylitis?
Lytic lesion of trabucular and corticar
Surrounding sclerosis
Periosteal thickness
AAA and rapture relation?
75% of AAR patients will have no Hx of AAA
ABI?
SBP of DPA/PTA divided by BA
Interpretation?
<=0.9 —PAD diagnosis
0.91-1.3 —Normal
>1.3—-Calcified/Non compresible vessel
gallstone ileus CM?
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
Diagnosis?
CT(Air in biliary three, thickened gall bladder wall and visualize abstraction stone)
management?
Removal of stone
Simultaneous cholecystectomy
Is toxic megacolon secondary to C>Difficele infection CM?
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)
Tx?
Bowel rest
NG tube
Agresive AB administaration
If lack response consider CT/Subtotal colectomy
Varicocele and infertility?
Increase T0–Testicular atrophy, Reduced sperm production, and motility.
management of hepatic adenoma?
asymptomatic & size <5 CM–Stop OCP
symptomatic or size >5 CM—-Surgical Resection
Spontaneous rapture in liver adenoma and hemangioblastoma?
Spontaneous rupture is rare in hemangioblastoma
return of consciousness after anesthesia?
15 min
at least protective reflex-like gag reflex return within 30-60 min
cause of delaying in anesthesia?
1-Drug related
2-Metabolic disorder
3-Neurologic disorder
Drug-related?
Preoperative drug intake(opiates, BDZ, Illicit drug AntiCH and anti histamin)
Prolonged anesthesia
High dose anesthesia
metabolic?
Hypo/Hyperthermia
Hypo/Hyperglycemia
Hyponatremia
Liver disease
Neurologic disorder?
Intraoperative stroke
Seizure
ICP
characteristics of delayed emergence from anesthesia?
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)
What about post intubation larengial spasm?
Can cause hypoxic, hypercapnic RF but the patient will be tachypneic, stridor, and will have tachycardia.
Treatment of SDH?
small–conservative
Large–Evacuation
osteosarcoma-related genetic defect?
RB1 mutation(Retinoblastoma) TP53(soft tissue sarcoma, acute leukemia, breast cancer, brain cancer, and adrenal cortical tumors/SABL)
Osteosarcoma d/t from Brodie abscess and benign bone cyst which both may have cystic lesion surrounded by reactive osteosclerosis?
Brodie abscess(Elongated cystic lesion) a benign bone cyst-like Unicameral cyst(Have regular border)
bursa function?
Cystic space fond b/n tendon and bony prominence–Help to reduce friction
Cause of inflammation?
repetitive pressure
acute trauma
Crystal-like gout
Extension of joint infection
Management?
aspiration(WBC count,Gram stain) to r/o infection
NSAID if infection r/o.
Bursa located around patela?
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
Postoperative atelectasis CM?
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
Pathophysiology?
Shallow breathing(decrease alveoli recruitment) and impaired cough( cause small airway mucus plugging).
management?
Adequate pain control Deep breathing exercise Directed coughing Early mobilization Incentive spirometry
Diaphragmatic paralysis CM?
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
Autonomic Dysreflexia in Spinal Cord Injury?
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
CM?
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
Management?
Keep patient upright(Induce orthostatic BP drop) Treat the triggering event Treat HTN(nitrate)
pathophysiology of blunt cardiac injury?
Rapid deceleration/direct chest trauma—shearing/compression and rapid Pressure change
CM?
Arrhythmia in all types (usually asymptomatic)
MI from CA dissection/thrombosis
Myocardial contusion–Myocardial dysfunction
Parture of septum/valve and ventricular well
Cardiac tamponade
Confirmatory test?
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.
