SB10 Flashcards
1
Q
Courvoisier sign?
A
Painless jaundice and non-tender distended gallbladder
CM of pancreatic head tumor
2
Q
pancreatic tumour location and CM?
A
Head–courvoiser sign
Bodie and tail–Abdominal pain
3
Q
Sign of IBD?
A
Abdominal pain
Chronic diarrhea
IDA
Elevated C reactive P and ESR
4
Q
What to do?
A
Colonoscopy
5
Q
What complication occurs if gallstone obstructs ampulla of vater?
A
Obstructive jaundice
Cholangitis
Pancreatitis
6
Q
How to manage?
A
ERCP
7
Q
why CT is not good?
A
Many gallstones are radiolucent –It may miss them
8
Q
Pnumoperitomium plus acute Abd, Pain?
A
Perforated PUD
9
Q
What to do immediately after any type of knee dislocation?
A
Immediate reduction
Assess vascular injury
10
Q
How to assess vascular injury?
A
Palpation of popilital and distal pulse
Ankle-brachial index
Dopler if available
11
Q
peritonsillar abscess management?
A
Drainage of abscess
Antibiotic covering GAS and oral anaerobe
12
Q
Indicators for an upper airway burn injury?
A
Burn of the face singeing of the eyebrow Oropharyngeal inflammation Blistering or carbon deposit Carbonaceous sputum Stridor Carboxyhemoglobin >10 % Hx of confinement in a burning building
13
Q
If we found >=1 above sign?
A
early intubation is indicated
14
Q
Indication for parathyroidectomy in primary hyperparathyroidism?
A
Age < 50
Symptomatic hypercalcemia
Complication(Renal stone,nephrosclerosis,CKD and osteoporesis)
Elevated risk of complication(Serum Ca >1mg/dl over the normal value and renal exresion >400mg/day
15
Q
what to do?
A
CT
then refer to surgery
16
Q
cause?
A
PTH adenoma(MC)
PTH hyperplasia
Parathyroid ca
17
Q
Sternal wound soft tissue dehiscence w/o sternal dehiscence management?
A
CT to evaluate mediastinitis sign
emergency surgical debridement
tissue culture
Immediate IV antibiotic
18
Q
Renal vein thrombosis management?
A
If have AKI–emergency clot removal
If no AKI—anticoagulation
19
Q
Green discharge in chest tube after a thoracic injury?
A
esophageal perforation
20
Q
MAC lymphadenitis CM?
A
Necrotic LN
Violaceous discoloration of the skin
Frequent fistula formation
21
Q
Brachial cleft cyst location?
A
anterior to SCM muscle, B/N ICA, and ECA, Below mandible
remnant of 2nd Bracial cleft
Clinically detected when superinfected like in case of URTI
22
Q
laryngiocele?
A
Is outpoching of larengial mucosa Acquired(in glassblowers and trumpet players) or congenital Located in a lateral neck mass Increase with Valsalva Protrude through the thyrohyoid membrane
23
Q
mainstay of larengial papilomatosis?
A
Surgical debridement
24
Q
Management of NPH?
A
High volume lumbar puncture with placing VP/VC shunt
25
diagnosis for epiglotitis?
Direct visualization
| Lateral neck X-Ray
26
Laryngiothracheal(anterior neck tenderness) may be a sign of?
Epiglottitis
27
Evaluation and management of pharyngitis?
```
Based on this 4 criterion
1-Fever by Hx
2-Tender ACLDP
3-Tonsilar exudate
4-Absence of cough
```
28
then?
0-1--no investigation/tx
2-3--Rapid Strep Ag test
4--emperic penicilin/Rapid Streep ag test
29
What to do patient with BAT and mesenteric hematoma/contusion?
Follow inpatient b/c they are a risk for delay perforation due to progression to full-thickness injury and perforation--which warrant immediate laparotomy
30
Etiology of a meniscal tear?
Young: Rotation on a planted foot
| Old--Degeneration of meniscal cartilage
31
CM?
Acute pooping sensation
Catching/locking and Reduced ROM
Slow onset joint effusion
32
examination?
Joint line tenderness
| Pain/Caching in provocative tests
33
diagnosis?
MRI(Do if pt young, mechanical limitation or recurrent effusion)
Arthroscopy
34
Management?
Mild sx, older patient--rest and activity modification
| Persistent Sx,impaired activity--Surgery
35
Management after perforated PUD diagnosed?
```
IV PPI
Broad spectrum Ab
IV Resusitation
NG tube resection
Immidiate Laparatomy/laparascopy
```
36
Which area injury make us should suspect liver trauma?
Lower right rib(8th and 9) fracture
| Flank heamatoma
37
Relation of Serum Ca level and rabdomylolysis?
During the acute phase Hypocalcaemia and Hypophosphatemia
| During recovery/diuretic therapy---Hypercalcemia/hyperphosphatemia
38
Best management of BCC in cosmetically sensitive area like face?
Mohs electrosurgical surgery(Layer by layer incision by seeing tumour margin on microscope)
39
Cause of hypercalcemia with low PTH after ruling out of PTHrP and Vit D toxicity
```
Granulomatous lesion
Drug toxicity like thiazide
Milk Alkali syndrome
Thyrotoxicosis
Vit A toxicity
Immobilization
```
40
Immobilization induced Hypercalcemia
Develop after 4 week of immobilization (3 day in patient with CKD)
It is due to increase osteolytic bone destruction
Patient with underlining Inc. Bone destruction(young, Paget disease) are at risk
Bisphosphonate are effective treatment
41
Corrected calcium level
Corrected calcium =Measured calcium + 0.8 *(4-albumin)
Low albumin will cause low Ca level and vise versa
Since albumin not affect free serum Ca level—Not cause Sx
42
Nasal septum haematoma CM
Nasal obstruction
Fluctuant mass in nasal septum
Blood accumulate b/n perichondrium and septal cartilage
43
Management?
Incision and drainage
NSAID
Nasal Pack
Antibiotics
44
Complication?
Perforation
External nasal deformity (Saddle nose)
Can be infected after 3-5 day and may cause abscess
45
Superficial wound dhescience?
skine and SC tissue damage
Intact fascia
Abnormal SC fluid(Seroma Accumulate)--Serosangious fluid leakage
46
Management?
Regular dresing change
47
Massive PE CM?
```
Hypotension
RSHF(raised JVP, Hypotension)
RBBB on ECG--DUe to RH strain
Bradycardia
Syncope is MC Sx(unlike dyspnea and pleuritic chest pain observed in other PE)
```
48
Diagnosis?
It time permits(Do chest angiography)
| IF not try to see by Echo in bedside(poor sensitivity)
49
Management?
Fibrinolysis if surgery is not in previous 10 day
50
Medial collateral ligament injury sign?
Blow to latteral knee/twisting injury
Knee pain
Local Swelling,Joint line tenderness and echemosis
Acute joint effusion is uncommen
51
managment?
Uncomplicated---RICE(rest,Ice,compression and elevaion),antipain and return to activity when tolerated
MRI for patients considerd for surgery
52
Agitation,Tachycardia and lower abdominal/suprapubictenderness in early post op days?
Acute urinary retension
53
RIsk factor?
Male sex
Advanced age
History of BPH
Hx of nurologic disorder
Surgery(Abd,Pelvic and joint arthroplasty)
Drug like Ansthetics,opoids and AntiCH pricipitate it
54
DIagnosis?
Bladder U/S(Accumulation of >300 ml urine is indicative)
55
Managment?
Catheterization
56
Hemorrhagic stroke in young patients with recurrent localized headache history?
AVM--ICH
57
what about ICH in olds?
```
Amyloid angiopathy (Dementia patient)
Hypertensive vasculopathy (In chronic HTN patients)
```
58
Breast cyst managment algorothm?
Complex cyst---Core needle biopsy
| SImple Cyst--Asymptomatic(observe) but if Tenderness present FNAC
59
What to do after FNAC?
If bloody aspirate---Biopsy,Aditional immaging
Non bloody aspirate--If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent---Biopsy and aditional immaging
60
Conclusion?
Asy and simple--Observation
Symp and simple --FNAC
Do core needle biopsy--For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst
61
Fibrotic stricture in Chrons D CM?
Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there
62
RCC RF?
Age >50
| Risk increase with smoking
63
CM?
```
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
```
64
DXs?
CT
| partial/complete nephrectomy
65
What about hydronephrosis?
flank mass,wt loss and systemic Sx is absent
66
What immaging survay to do after ABC in high energy mechanism injury?
CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)
67
Indication for cervical immaging?
```
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
```
68
Indicaation to do thoracolumbar spine x-ray?
```
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)
```
69
Breast cyst managment algorothm?
Complex cyst---Core needle biopsy
| SImple Cyst--Asymptomatic(observe) but if Tenderness present FNAC
70
What to do after FNAC?
If bloody aspirate---Biopsy,Aditional immaging
Non bloody aspirate--If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent---Biopsy and aditional immaging
71
Conclusion?
Asy and simple--Observation
Symp and simple --FNAC
Do core needle biopsy--For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst
72
Fibrotic stricture in Chrons D CM?
Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there
73
RCC RF?
Age >50
| Risk increase with smoking
74
CM?
```
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
```
75
DXs?
CT
| partial/complete nephrectomy
76
What about hydronephrosis?
flank mass,wt loss and systemic Sx is absent
77
What immaging survay to do after ABC in high energy mechanism injury?
CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)
78
Indication for cervical immaging?
```
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
```
79
Indicaation to do thoracolumbar spine x-ray?
```
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)
```
80
Breast cyst managment algorothm?
Complex cyst---Core needle biopsy
| SImple Cyst--Asymptomatic(observe) but if Tenderness present FNAC
81
What to do after FNAC?
If bloody aspirate---Biopsy,Aditional immaging
Non bloody aspirate--If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent---Biopsy and aditional immaging
82
Conclusion?
Asy and simple--Observation
Symp and simple --FNAC
Do core needle biopsy--For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst
83
Fibrotic stricture in Chrons D CM?
Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there
84
RCC RF?
Age >50
| Risk increase with smoking
85
CM?
```
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
```
86
DXs?
CT
| partial/complete nephrectomy
87
What about hydronephrosis?
flank mass,wt loss and systemic Sx is absent
88
What immaging survay to do after ABC in high energy mechanism injury?
CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)
89
Indication for cervical immaging?
```
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
```
90
Indicaation to do thoracolumbar spine x-ray?
```
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)
```
