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Shelf Flashcards

1
Q

Tx of hemorrhagic shock in urban setting

A

Surgery THEN volume replacement

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2
Q

Subdural hematoma management

A

ICP monitor

Elevate head 30 degrees

Hyperventilate

Avoid fluid overload

Administer furosemide or mannitol

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3
Q

Rib fracture treatment

A

Local nerve block and epidural catheter

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4
Q

Pulmonary contusion

A

Pt with blunt thoracic trauma who presents with deteriorating blood gases and a white, patchy, alveolar infiltrate on CXR; also has decreased breath sounds

Can appear up to 2 days after injury but can also be on the day of

Tx: Fluid restriction; diuretics

⭐️Should also check for a comorbid aortic transection

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5
Q

Given to any patient with a penetrating injury of an extremity

A

Tetanus shot

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6
Q

Test to order on a patient who fell from a height and has a broken tibia or fibula

A

Lumbar or thoracic spine x ray

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7
Q

Marjorlin ulcer

A

SCC developed form a ️Chronic skin ulcer

Presents as a pt. With an ulcer of many years that continuously heals and breaks down

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8
Q

Tx of Breast cancer in a pregnant woman

A

Just go with surgical excision and chemo later

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9
Q

Thyroid nodules

A

Get an FNA

Lobectomy if follicular Cancer

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10
Q

Tx. Of meconium ileus

A

Gastrografin enema

  • treats and diagnoses
  • shows pellets of meconium in the terminal ileum
  • works by drawing fluid in and dissolving the meconium
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11
Q

Tx for obstructive arterial embolization

A

Emboli tommy with a fogarty catheter

-Add fasciotomy if it’s been 6 hours

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12
Q

Strabismus Tx

A

Corrective glasses

Instantly correct deficit

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13
Q

Workup for SCC of the oral mucosa

A

Triple endoscopy

  • Presents in alcoholics who have rotten teeth often as a metastatic node in the neck
  • may also show hoarseness, painless ulcers in the mouth, unilateral earaches

Tx: Resection; chemotherapy

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14
Q

BCC biopsy

A

Must make sure to get the edge of the lesion

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15
Q

Where do Branchial cleft cysts occur?

A

Along the SCM

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16
Q

Suspected in a pt. With unilateral sensory hearing loss and no history of exposure to loud noises

A

Acoustic neuroma

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17
Q

Acute epididymis

A

Severe testicular pain of sudden onset with fever and pyuria

⭐️Cord will also be tender
-unlike in testicular torsion

Tx: Antibiotics and US (to rule out torsion)

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18
Q

Wound to the head, what management is required?

A

Angiogram to assess the Vasculature

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19
Q

Exploratory laparotomy is indicated in abdominal blunt trauma if what is present?

A

Peritoneal irritation

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20
Q

Pt. With a penetrating urologic injury

A

Requires surgical exploration

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21
Q

Chemical burn Tx

A

Irrigate asap

Even before they come to the ER

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22
Q

Day 5 of post op from laparotomy and salmon-colors fluid is weeping from the wound

A

Wound dehiscence

-Wound should be tape and re operated on to prevent evisceration of abdominal contents

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23
Q

Woman with a metastatic lesion to the bone needs what workup

A

MRI

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24
Q

Tx of ureteral stones larger than 7mm

A

Shockwave lithotripsy

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25
Q

Abdominal compartment syndrome

A

️Occurs when lots of fluids or blood have been administered during a prolonged laparotomy; the abdomen cannot be closed due to tension on the tissues

  • Place a temporary mesh cover
  • Can present at PoD 2
  • May present as sutures cutting thru the tissue, hypoxia, or renal failure
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26
Q

Desired UOP for burn pt

A

1-2ml/kg/hr

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27
Q

Concern with bilateral, comminuted femoral shaft fractures

A

Shock

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28
Q

Pt with a fractured hip but also with a poorly controlled secondary condition

A

Can delay emergency surgery for 72 hrs

Conditions included COPD, a-fib, pulmonary edema, pneumonia

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29
Q

GCS

A

Eyes:

4- spontaneous

3- verbal command

2- respond to pain

1- no response

Verbal:

5- oriented

4- confused

3- inappropriate words

2- incomprehensible words

1- no speech

Motor;

6- obeys command

5- localized

4- Withdraws to pain

3- flexure

2- extension

1- none

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30
Q

Tx for prolonged pancreatic pseudo cyst

A

Endoscopic drainage

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31
Q

Pts with blunt, hemodynamically stable trauma should get what test

A

FAST

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32
Q

Uncal herniation

A

Cushing’s reflex

CN III palsy

Ipsilateral hemiparesis

Contralateral homonymous hemianopsia

Coma

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33
Q

CN III palsy

A

Mydriasis

Down and out gaze

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34
Q

Cushing’s reflex

A

HTN

Bradycardia

Respiratory depression

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35
Q

Blunt genitourinary traum

A

Usually a renal contusion ,laceration, or vascular injury; presents as CVA tenderness and hematuria

Workup: Urinalysis, CT with contrast

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36
Q

Pts with a lower sc injury need this

A

Urinary catheter

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37
Q

Pt with constant back pain, obstructive jaundice, and weight loss

A

Pancreatic tumor

  • Get a CT
  • If it’s negative, get a MRCP to rule out probs with the ampulla of vater or cholangiocarcinoma
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38
Q

Hypernatremia correction

A

Use 1/2 NS w/ D5W

-For every 3mEq/L above 149, there is 1 L of fluid loss

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39
Q

Cystosarcoma phyllodes

A

Firm, rubbery and movable mass presenting in a woman with lack of routine care in her 20s

  • grow and distort the Breast but they do not invade
  • malignant potential so they must be removed
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40
Q

Congenital diaphragmatic hernia Tx

A

Intubation, low-pressure ventilation, NG suction

⭐️If predicted to be severe at birth, treat with extra corporeal membrane oxygenation

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41
Q

Acute transplant rejection Tx

A

Steroid boluses

Antithymocyte agents

OKT3 (antilymphocyte agent)

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42
Q

Pt passing a ureteral stone who develops fevers, chill,vans flank pain

A

Obstruction progressing to an infection

⭐️EMERGENCY

Tx: Ureteral stent; percutaneous nephrostomy

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43
Q

Venous stasis ulcer

A

Develops in Pts with varicose veins

-Duplex scan for work up

Tx: Pressure stockings, debridement

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44
Q

Ogilvie Syndrome

A

Paralytic ileus of the colon in elderly, Alzheimer’s Pts who are sedentary following surgery or a broken hip

-Imaging shows a massively dilated colon

Tx: Fluid and electrolyte correction
Colonoscopy (sucks out air)
Recital tube

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45
Q

Test performed for PVD

A

Abi

  • divides the higher ankle systolic pressure by the higher brachial artery pressure
  • 1.30 indicates calcified vessels
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46
Q

Reason why you would not perform orotracheal intubation on an unstable pt

A

Severe facial trauma

  • Ok if there is cervical trauma and the neck is stabilized
  • if there is facial trauma, do a cricothyroidotomy
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47
Q

Posterior urethral injury

A

Most commonly ️Occurs at the bulbomembranous jnxn

Sx: Blood at the urethral meatus, inability to void, perineal or scrotal hematoma, high riding Prostate on DRE

Dx: Retrograde urethrogram

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48
Q

Gilbert Syndrome

A

Most common inherited disorder of bilirubin conjugation

-️Decreased UDP-glucuronsyltransferase activity

Sx: Intermittent episodes of jaundice provoked by stress like surgery, infxn, fasting, exercise

Benign in nature and requires no treatment

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49
Q

Tx of epidural hematoma

A

Emergent surgical hematoma Evacuation

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50
Q

Retroperitoneal hematoma

A

Presents in patients with a recent cardiac catheterization, Anticoagulation with heparin, sudden onset of hypotension, tachycardia, flat neck veins, and back pain

  • ️Occurs due to ️Bleeding at the arterial puncture site at the femoral artery above the inguinal ligament
  • ️Occurs within 12 hours of the procedure

Tx: Supportive

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51
Q

Timeline causes of post op fever

A

<2 hrs: Prior trauma, infection, blood product administration (febrile non hemolytic transfusion reaction), malignant hyperthermia

> 24 hours: Nosocomial infection, SSI, MI, DVT, PE

> One week: C. DIF, drug fever, PE, DVT

> One month: Viral infxn, rare infection

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52
Q

Leriche Syndrome

A

Arterial occlusion at the bifurcation of the aorta into the common Iliacus

Triad: Bilateral hip, thigh, and butt claudication, impotence, and atrophy of the bilateral lower extremities due to ️Chronic ischemia

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53
Q

Pilonidal disease

A

Edematous, infected hair follicle in the inter gluteal region becomes occluded and infxn spreads subcutaneously and forms an abscess that ruptures and causes a pilonidal sinus tract

Affects young,bourse males with sedentary lifestyles

Sx: Painful, fluctuant mass slightly above the anus in the intergluteal region, mucoid or purulent drainage

Tx: I&D

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54
Q

Treatment for variceal hemorrhage

A
  1. Place 2 large bore IV catheters
  2. Volume resuscitation, IV Octreotide, and antibiotics
  3. Urgent endoscopic therapy
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55
Q

Imaging test for penile fracture

A

Retrograde urethrogram

To evaluate suspected urethral injury

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56
Q

Primary spontaneous pneumothorax Tx

A

Small (<2 cm): Supplemental O2

Large: If hemodynamically stable ➡️ Needle aspiration or chest tube placed in the second or third intercostal space in the Midclavicular line

If unstable ➡️ Tube thoracostomy

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57
Q

Contraindications to surgery in general

A

DKA, Coma

Malnutrition (albumin <3, transferrin <200)

Smoking (stop 8 weeks before surgery)

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58
Q

Goldmans index

A

Tells you who is at the greatest risk for surgery

  1. CHF (if echo shows <35%)
  2. MI in the past 6 months
  3. Arrhythmias
  4. Age > 70
  5. Emergent surgery
  6. AOrtic stenosis
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59
Q

Assist control vent setting

A

Sets the tidal volume and and rate but if a patient takes a breath, the vent only Gives the volume

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60
Q

Pressure support on vent

A

Pts body controls the rate but a boost of pressure is given; used to wean Pts off ventilators

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61
Q

PEEP

A

Pressure given at the end of a breathing cycle to keep the alveoli open; used in ARDS and CHF

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62
Q

Causes of increased anion gap metabolic acidosis

A 
Methanol
Uremia
Diabetic Ketoacidosis
Polyethylene glycol
Infection, iron, isoniazid, inborn error of metabolism 
Lactic acidosis
Ethylene glycol
Salicylate
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63
Q

Signs of Hypokalemia

A

Paralysis, ileus, ST depression, U waves

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64
Q

Maintenance IV levels

A

First 10 kgs ➡️ 100ml/Kg/day

Next 10 ➡️ 50ml/kg/day

All above 20 ➡️ 20 ml/kg/day

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65
Q

Risks of prolonged TPN

A

Acute acalculous cholecystitis

Zinc deficiency

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66
Q

1st workup with electrical burn

A

EKG

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67
Q

What should be done on a pt. With a GCS < 8

A

Intubation

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68
Q

Neck trauma zones

A

Zone III: Above the angle of the mandible
-get an arteriography and triple endoscopy

Zone II: at the angle of the mandible-cricoid
-get Doppler us and exploratory surgery

Zone I: below the cricoid
-get an aortography

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69
Q

Fractures that go to the OR

A

Depressed skull fractures

Femoral neck fractures

Interotrochanteric fractures

Open fractures

Severe displacement

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70
Q

Causes of fever on POD 1

A

Atelectasis: treat with mobilization and incentive spirometry, is usually low grade fever

Necrotizing fasciitis: ️Occurs along Scarpa’s fascia, give IV penicillin and debride in OR

Malignant hyperthermia: give Dantrolene

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71
Q

Fever on POD 3-5

A

Pneumonia: culture sputum, a give MOXIFLOXACIN until it returns

UTI: Urine culture and broad spectrum abx

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72
Q

Fever on POD >7

A

Central line infxn: pain and tenderness at IV site
-pull line, blood cultures, antibiotics to cover staph

Cellulitis: pain at incision site with induration and drainage
-blood culture, start antibiotics

Dehiscence: pain at incision site, seepage of salmon-colored fluid
-surgical ️EMERGENCY, go to OR, antibiotics, primary c,laure of fascia

Abdominal abscess: unexplained fever
-CT with contrast, diagnostic laparotomy, drain

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73
Q

Lights criteria

A

Pulmonary effusion is transudative if…

  • LDH <200
  • LDH effusion/serum <0.6
  • protein effusion/serum <0.5
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74
Q

Benign lung nodules

A

Popcorn calcifications = hamartoma

Concentric calcification = old granuloma

Well circumscribed

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75
Q

MCC of lung cancer in nonsmokers

A

Adenocarcinoma

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76
Q

Lung cancer metastasis locations

A

Liver, bone, brain, adrenals

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77
Q

Patient with lung cancer, kidney stones, constipation

A

SCC with Paraneoplastic PTHrP

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78
Q

Patient with lung cancer, shoulder pain, Ptosis, constricted pupil, and facial edema

A

Superior sulcus syndrome from small cell carcinoma

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79
Q

Old smoker presenting with Hyponatremia, moist mucous membranes, and no JVD

A

SIADH from small cell carcinoma

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80
Q

ARDS Dx and Tx

A

PaO2/FiO2 <200

Bilateral alveolar infiltrates on CXR

PCWP <18

Tx: Mechanical ventilation with PEEP

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81
Q

Esophageal varices Tx

A

Endoscopic Sclerotherspy or banding

Do not do these prophylactic ally

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82
Q

Female athlete triad for stress fracuture

A

Low caloric intake

Hypomenorrhea/amenorrhea

Low bone density

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83
Q

Burn wound sepsis

A

Presents as fever, tachycardia, tachypnea, increased blood glucose and WBC, ️Decreased platelets, oliguria, and mental status changes

Tx: Broad spectrum abs

-Likely a gram neg org after 5 days

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84
Q

Anatomic snuffbox muscles

A

Medial- Extensor pollicis Longus

Lateral-Extensor pollicis brevis, abductor pollicis longus

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85
Q

Confirmation of a scaphoid fracture if the x ray is negative

A

MRI

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86
Q

Ileus

A

Functional defect in bowel motility without any associated obstruction; presents as N/V, distension, obstipation, and Hypoactive bowel sounds

-Common postoperative due to opiate administration, inflammatory mediator action,and hypokalemia

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87
Q

Prosthetic joint infection

A 
Early onset (within 3 months): Presents as wound drainage, erythema, swelling, fever
   -Staph aureus, GNRs, anaerobes

Delayed: Presents as joint pain,implant loosening
-Staph epidermidis, Enterococci

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88
Q

Post op Atelectasis lab values

A

Slightly basic pH

️Decreased pO2

Slightly ️Decreased pCO2

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89
Q

Dumping syndrome

A

Rapid emptying of hypertonic gastric contents; is a post-gastrectomy syndrome that occurs in many Pts

-Caused by loss of the normal action of the pyloric sphincter due to injury or surgical bypass leading to the shifting of fluid into the SI from the vascular space

Sx: Abdominal pain, diarrhea, nausea, hypotension, tachycardia, dizziness, confusion, fatigue, diaphoresis

Tx: Small meals, high carb, fiber, and protein diet (avoid sugars)

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90
Q

Acute Mesenteric ischemia

A

Can occur due to embolism from cardiac valve vegetations during endocarditis or from Pts with AFib

Sx: Sudden onset of severe periumbilical pain that is out of proportion to the expected exam, hematochezia,

Lab: Leukocytosis, elevated amylase and phosphate, metabolic acidosis, elevated lactate

Dx: CT

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91
Q

Post op infection in dehydrated old patients

A

Acute bacterial parotitis

Prevent with adequate hydration and oral hygeine

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92
Q

Complicated of AAA repair

A

Bowel ischemia

-Loss of IMA during surgery and no collateral circulation causes

Sx: abdominal pain, bloody diarrhea, fever, Leukocytosis

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93
Q

Most common complication of appendectomy

A

Infections, intrabdominal abscess with laparoscopic procedure

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94
Q

Follow up after diagnosis of a broken clavicle

A

Angiogram

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95
Q

Ischemic colitis

A

Abdominal pain and bloody diarrhea following a vascular procedure

RFs: Old age, chronic renal Disease, atherosclerotic disease, vascular surgery, MI

Sx: Mild pain and tenderness, hematochezia, diarrhea, lactic acidosis

Dx: CT shows thickened bowel wall and double halo
Colonoscopy shows mucosal pallor, petechiae, and hemorrhage

Tx: Supportive, IV antibiotics, colon resection

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96
Q

Blow to the lower abdomen

A

Consider rupture of the dome of the bladder

Leads to chemical peritonitis

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97
Q

Reynolds pentad

A

RUQ pain

Jaundice

Fever

Hypotension

AMS

Describes cholangitis

Tx: Ciprofloxacin and metronidazole

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98
Q

Think of this with gastric varices

A

Splenic vein thrombosis

And this could possibly be caused by ️Chronic pancreatitis

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99
Q

Suspected if stomach ulcers don’t resolve

A

Zollinger Ellison

-Test with a secretin stimulation test which would normally decrease Gastrin levels

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100
Q

Whipples triad

A

Fasting hypoglycemia <50

Symptoms including sweat, tremors, hunger

Relief of symptoms after glucose administration

-If you see these, it’s an insulinoma

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101
Q

RUQ pain, night sweats, palpable liver

A

Consider entamoeba histolytica

-Tx with metronidazole

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102
Q

Large livers cysts and fevers in an immigrant

A

Echinococcus

Transmitted thru dog feces

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103
Q

Traumatic splenic rupture

A

Consider with left lower rib fracture and intrabdominal hemorrhage

May also have diaphragmatic irritation

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104
Q

Most common site of carcinoid tumor

A

Appendix

Symptoms only appear when there are liver mets

Look out for diarrhea, dementia, dehydration, dermatitis

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105
Q

Volvulus Tx

A

Decompression from below if not strangulated; surgery if it doesn’t work or is strangulated

Most commonly ️Occurs in the secum or sigmoid

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106
Q

Signs of PE

A

Right heart strain

️Decreased vascular markings

Sinus tachycardia

Low co2 and O2

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107
Q

Varicocele

A

Soft scrotal mass with a bag of worms appearance
⭐️Decreases in size when laying down, increases when standing or with Valsalva

US: Retrograde venous flow, tortuous tubules, dilation of the Pampiniform plexus

⭐️More common on the left due to nutcracker syndrome

Tx: Gonadal vein ligation, scrotal support and NSAIDS if you don’t care about kids

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108
Q

Meningioma

A

Benign primary brain tumor that is usually well-circumscribed and a homogenously enhancing mass on MRI; can be calcified or appear hyper dense

Tx: Resection

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109
Q

Suspected diaphragmatic rupture

A

Check CXR for loops of bowel in the chest and shifting of the mediastinum

Will not always have bowel tho, sometimes it’s just an elevation of he left hemi diaphragm

Also follow up with a CT scan

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110
Q

Hematuria in a AAA

A

️Occurs due to the formation of an aorta Caval fistula to the IVC causing venous congestion to Retroperitoneal structures like the bladder

➡️hematuria

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111
Q

Paralytic ileus

A

Presents as abdominal pain following a traumatic injury, surgery, ischemia, and Hypokalemia

Sx: N/V, abdominal distention,constipation, obstipation, absent bowel sounds

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112
Q

Dangers of Retropharyngeal abscess

A

Thrombosis to the internal jugular and deficits in CN IX, X, XI, XII after spread to the carotid sheath

Acute necrotizing mediastinitis because the Retropharyngeal space drains here
⭐️LIFE THREATENING ️EMERGENCY

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113
Q

Tx of septic shock

A

IV fluids

  • important to restore adequate tissue perfusion
  • given as boluses

Identify underlying infxn and treat

Sx: Fever, tachycardia, hypotension, poor UOP, lactic acidosis, ️Decreased albumin

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114
Q

Compartment syndrome signs and symptoms

A

Pain out of proportion
Pain on passive stretch
Increase swelling
Parasthesia

Uncommon: ️Decreased sensation, motor weakness, paralysis, ️Decreased distal pulses

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115
Q

Mediastinal widening with a big aorta and history of blunt thoracic trauma

A

Think aortic rupture

Sx: Anxiety, tachycardia, HTN

Possible deviation of the trachea or nasogastric tube

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116
Q

Acute mediastinitis

A

Possible complication of cardiac surgery that is due to intra operative wound contamination

Sx: Fever, tachycardia, chest pain, Leukocytosis, sternal purulent wound drainage, widened mediastinum

Tx: Surgical debridement, antibiotics

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117
Q

Emphysematous cholecystitis

A

Form of acute cholecystitis where there is infection with gas producing bacteria like Clostridium

RFs: Vascular compromise, Immunosuppresion, gallstone

⭐️may detect crepitus in the RUQ

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118
Q

Torus palatinus

A

Benign bony growth located on the midline suture of the hard palate

Due to genetic and environmental factors

Usually present for a long time, is nontender, and feels bony

Can easily ulcerate with trauma and have trouble healing

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119
Q

Anal fissure Tx

A

High fiber diet

Adequate fluid intake

Stool softeners

⭐️Sitz bath

⭐️Topical anesthetics and vasodilators (nifedipine, nitroglycerin)

Lateral sphincterotomy if all else fails

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120
Q

Hint for abnormal neck masses

A

7 days= inflammation

7 months= Cancer

7 years= congenital

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121
Q

MCCo malignant tumor of the parotid

A

Mucoepidermoid carcinoma

Causes pain and CN VII palsy

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122
Q

Newborn with scaphoid abdomen and respiratory distress

A

Diaphragmatic hernia

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123
Q

Why give epinephrine with lidocaine?

A

Prevent possible systemic absorption which may cause

Tongue numbness

Seizure

Hypotension

Bradycardia

Arrhythmia

⭐️ DO NOT PUT EPI IN FINGERS TOES OR PENIS

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124
Q

Person who has trouble breathing after epidural or is bradycardia

A

“High block”

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125
Q

Pts who qualify for immediate burn excision and grafting

A

Pts with small wounds with clearly defined margins

126
Q

Interotrochanteric fracture treatment

A

ORIF and post op thrombosis prophylaxis

127
Q

Pts who qualify for immediate burn excision and grafting

A

Pts with small wounds with clearly defined margins

128
Q

Interotrochanteric fracture treatment

A

ORIF and post op thrombosis prophylaxis

129
Q

Pts who qualify for immediate burn excision and grafting

A

Pts with small wounds with clearly defined margins

130
Q

Interotrochanteric fracture treatment

A

ORIF and post op thrombosis prophylaxis

131
Q

Pts who qualify for immediate burn excision and grafting

A

Pts with small wounds with clearly defined margins

132
Q

Interotrochanteric fracture treatment

A

ORIF and post op thrombosis prophylaxis

133
Q

Pts who qualify for immediate burn excision and grafting

A

Pts with small wounds with clearly defined margins

134
Q

Interotrochanteric fracture treatment

A

ORIF and post op thrombosis prophylaxis

135
Q

Zenker diverticulum

A

Presents as ️Chronic regurgition and halitosis

️Occurs due to a pulsion diverticulum

Tx: bisect the transpharyngeal muscle

136
Q

Pt who has trouble swallowing liquids but no solids

A

Achalasia

Usually due to a loss of Auerbach’s plexus in the esophageal smooth muscle

Most common motility disorder of the esophagus

Manometers shows increased LES pressure; barium swallow shows classic birds beak

137
Q

Workup for gastric ulcer

A

Biopsy; could be Cancer

138
Q

Octreotide effect on esophageal varices

A

Lowers portal vein pressure

139
Q

Gastric cancer

A

Commonly in the antrum; usually presents with Virchows or Sister Mary Joesph node on tests

RFs: ️Chronic gastritis, h. Pylori, nitrates in diet

140
Q

“biliary gas”

A

Gallstone ileus

Do a cholecystectomy, ileostomy, and take out the stone at the ileocecal valve

141
Q

Other potential causes of lower GI bleed you don’t think of

A

Diverticulosis ( usually right sided)

Angiodysplasia (usually left sided)

142
Q

If unable to take gallbladder out immediately and pt is unstable, what do you do?

A

Cholecystotomy tube

143
Q

Post op comps from cholecystectomy

A

Biliary stricture- Pt with symptoms of cholecystitis post op; treat with choledochojejunostomy

Biliary leak- Get Hida or us

144
Q

Cholangiocarcinoma

A

Presents with painless jaundice

US shows dilated Intrahepatic ducts but normal common bile duct

145
Q

Hemobilia

A

Presents with RUQ pain, jaundice, and GI ️Bleeding

Usually iatrogenic or traumatic

Control bleed with embolization

146
Q

Nodular lesion with a central scar on the liver that is radiating outwards on imaging

A

Focal nodular hyperplasia

Only resect if it is excessively large, causing symptoms, and shows signs of potential rupture

147
Q

Prognostic factor for heart failure in a patient with an AV fistula

A

Size of the fistula

148
Q

Necrotizing Fascitis

A

Can present with red streaks going up arms

Will be cause by Strep pyogenes

149
Q

Along with increased risk of aspiration, what else has an increased risk on the ventilator?

A

Abscess formation after infection

150
Q

Perioral cyanosis in a pt with a ️Chronic VSD

A

Thinks eisenmeger syndrome

151
Q

If any biopsy site comes back with positive borders

A

Reexcise the site until borders are negative, then do chemo and radio

152
Q

Hypomagnesemia

A

Possible cause of Hypocalcemia when no other signs are found

153
Q

Two days after operation, a patient presents with confusion, cyanosis, sob, fever, hypoxia, and diffuse Ronchi on lung exam.

A

Pneumonia

Probs due to a suppressed coughing mechanism

154
Q

Pt presents with Condyloma acuminatum possibly

A

Should biopsy to rule out SCC

155
Q

Pt who has a jejunostomy and needs feeding

A

Give them enteral tube feedings thru the ostomy tube

156
Q

Toxic Synovitis

A

Inflammation of the hip joint that occurs in pediatric Pts after a viral infection

Pt may have a low grade fever

157
Q

Pt who presents with an increased bilirubin and ap who also has ulcerative colitis

A

Think primary Sclerosing Cholangitis due to UC giving her a pANCA

158
Q

️Chronic GERD can cause Barrett’s but what else can it cause?

A

Esophageal strictures

These can lead to dysphagia and regurgitation of solid food

159
Q

Pts who are in pain and also depressed

A

Treat their pain and the depression might get better

160
Q

The boards may present the answer of a FAST exam as what?

A

Ultrasonography

161
Q

Treatment of abdominal compartment syndrome

A

Temporary bowel coverage and an absorbable mesh

162
Q

Suppurative thrombophlebitis

A

Excise the infected vein and give antibiotics

163
Q

Comps of aaa surgery

A

Prerenal failure if clamped above the renal arteries

Impotence from nerves crossing with the iliacs

Anterior spinal syndrome

Ischemic colitis from ima disruption.

Graft infection presenting with fever and inflamed incision

Aortoenteric fistula (massive GI ️Bleeding)

164
Q

Hurthle cells on thyroid biopsy

A

Get a Lobectomy if it’s an adenoma; total thyroidectomy

165
Q

Psammoma bodies on thyroid FNA

A

Papillary carcinoma; total thyroidectomy

166
Q

Amyloid deposits on thyroid FNA

A

Medullary carcinoma; total thyroidectomy and men workup

167
Q

Sestamibi scan

A

Determines which parathyroid gland is enlarged before operating in the setting of Hypercalcemia
-minimally invasive so not a bad idea to do this first

If only three glands can be found, look around ya dingus

-Don’t forget, renal failure can cause a secondary Hyperparathyroidism
Still treat with partial parathyroidectomy

168
Q

Prolactinoma

A

Most common pituitary tumor

Tx: Bromocriptine, Cabergoline, surgery if all else fails

169
Q

Liechtenstein hernia repair

A

Uses a tension free prosthetic mesh to reapproximate the abdominal wall; very popular

Still can’t do heavy lifting for 6 weeks

Still risk of nerve transection

170
Q

Spontaneous pneumothorax Tx

A

Chest tub first time

Bluebectomy the second time

171
Q

Lung Empyema

A

Think strep pneumoniae if community acquired or staph aureus if hospital
Treat like an abscess

172
Q

Pleural effusion without heart failure in an older person

A

Cancer until proven otherwise

173
Q

Anterior Mediastinal masses

A

Thymoma: will also have MG

Teratoma: make sure to get BhCG and AFP levels

Lymphoma: Biopsy

May do a thyroid scan because there could be some tissue here

Middle mediastinal masses are Cardiac or lung related

174
Q

Congenital lobar emphysema

A

Baby with big bullae on their lungs; needs resection

175
Q

What else can you see a double bubble sign with?

A

Midgut malrotation or Volvulus

Can also see an abnormal ligament of Treitz, bilious vomiting, bloody stool

176
Q

Tx for biliary atresia

A

Kasai procedure

177
Q

Pulmonary contusion Tx

A

Intubate and manage pain

178
Q

Flail chest Tx

179
Q

Kid who hit his abdomen on the handlebars of his bike

A

Duodenal hematoma

Can obstruct the duodenal lumen; upper GI series will show a “coiled spring” of 2nd and 3rd portions of the duodenum

Tx: Observe and NPO if stable; surgery if not

180
Q

Retroperitoneal hematoma Tx

A

Penetrating trauma ➡️ Surgery

Blunt ➡️ Explore

181
Q

Supracondylar humerus fracture can damage what

A

Median nerve

Branchial artery

182
Q

Thoracic Outlet Syndrome

A

Pt will have neurologic Sx. (Can’t grab things, atrophy of hand muscles) and vascular Sx (pulselessness, ulcers)

Tx: PT, surgery if seriously severe

183
Q

Initial workup of intermittent claudication

A

Doppler studies to look for a pressure gradient to establish an ankle-brachial index

If gradient is

184
Q

Parkland formula

A

Calculates the amount of fluids to give to a burn pt

%BSA x wt x 4cc

Give half over first 8 hrs, rest over 16 hrs

185
Q

️Topical antibiotic prophylaxis for burns

A

Silver Sulfadiazine

Around eyes? ➡️ ️Topical antibiotic (normal)

186
Q

Pt who receives a blood transfusion and develops fever, n/v, hyperbilirubinemia 3 days later

A

Delayed hemolytic transfusion reaction

Usually due to incompatibility with minor RBC antigens

187
Q

Toxic lidocaine doses

A

4-5 mg/kg

With EPI ➡️ 7 mg/kg

188
Q

TPN complications

A

Hyperglycemic, Hyperosmotic nonketotic coma

Elevated LFTs (reduce transfusion rate)

Dry and scaly skin (give more lipids)

189
Q

Vent rate goals

A

Pco2 = 40 (if too high, they are Underventilated)

Po2 (increased with peep or fio2)

190
Q

Dobutamine use

A

Cardiogenic shock

Causes peripheral vasodilation and increased inotropy

191
Q

Paradoxic aciduria

A

Seen with bowel obstruction when the pt vomits and loses acid and fluid BUT the kidneys excrete H+ still in an attempt to retain Na+

192
Q

Hidrsdenitis Suppurativa

A

Chronic skin disease characterized by collections of abscesses affecting under the arms, breasts, or butt; usually occurs in outbreaks

Can form fistulas or tracts

Occur due to irritations like acne

Treat modestly

193
Q

First thing to do after placing a portable cheat catheter

A

Get an X-ray to make sure it’s in the right place

194
Q

Pt with low UOP and signs of AKF following surgery

A

Possible volume depletion, kidneys aren’t being perfumed

Look at the Pts hemoglobin to check this

195
Q

Ludwig angina

A

Abscess in the floor of the mouth with a threat to the airway

Tx with incision and drainAge

196
Q

Bell’s palsy treatment

A

Antivirals and/or steroids

197
Q

Pt with a 19 year history of GERD and presenting with the symptoms of esophageal stricture. What is the initial step in management?

A

ESOPHAGOSCOPE AND BIOPSY

NEED TO RULE OUT CANCER

198
Q

Management of intermittent claudication

A

Smoking cessation

Recommendation of a walking program

Cilostazol, pentoxyphylline

199
Q

Coin like lesions on X-ray of an asymptomatic woman (probs one at the jnxn of every bronchus)

A

Sarcoidosis

200
Q

Pt on 1/2 NS post op who develops ️Decreased UOP

A

Give them a Bolus of NS

201
Q

Best study for cervical trauma

A

Lateral x ray

Ct scan used if you are already going to scan the head anyways

202
Q

Pt with sunburn without blistering

A

Just observe it you fucking moron

203
Q

Cornual pregnancy

A

Carries the risk of spontaneous abortion and rupture as ectopic pregnancies so the boards may consider them one and the same

204
Q

Pt who is on ️Chronic corticosteroid therapy ( say someone with lupus) who develops hypotension after anesthesia administration

A

This patient needs corticosteroids because their adrenals are suppressed and can’t respond to stress

⭐️CLASSIC PRESENTATION⭐️

205
Q

Pt who receives massive amounts of blood and starts bleeding from every puncture site

A

Pt has thrombocytopenia

Dilution effect

206
Q

Possible cause of PVCs

A

Hypercapnia

Think of this in a patient who might have Ventilatory insufficiencies

207
Q

Pt with low hematocrit but presents with an unstable abdomen

A

I don’t give a fuck do an ex lap

208
Q

Pt with diarrhea who recently received antibiotics, any antibiotics

A

CLASSIC C DIF YOU DUMB FUCK

209
Q

Unstable pt with signs of blood in the thoracic cavity

A

Treat it just like the abdomen; open this motherfucker

210
Q

Pt with RLQ pain and WBCs in their urine

A

Consistent with the presentation of appendicitis

211
Q

Treatment for patient with suspected pituitary apoplexy

A

Urgent replacement of steroids followed by regular hormones

212
Q

Parinaud syndrome

A

Loss of upward gaze

Sunset eyes

Often indicates a pineal gland tumor

213
Q

Causalgia

A

Constant, burning, agonizing pain that does not respond to analgesics developing in an area where there was a crushing injury

Tx: Surgical sympathetomy

214
Q

Right sided cardiac ️fibrosis with flushing, wheezing, and diarrhea

A

Probable carcinoid tumor

215
Q

Septic shock treatment

A

IV NS boluses to get systolic pressure > 90

IV antibiotics

Failure to respond to IV fluids? ➡️ Dopamine

216
Q

Peritonitis signs and symptoms

A

Guarding

Rigidity

Reduced bowel sounds

Rebound tenderness

217
Q

Old man with chills, fever, dysuria, urinary frequency, diffuse low back pain, and an exquisitely tender prostate on rectal exam

A

Acute bacterial prostatitis

Tx: IV antibiotics

218
Q

Diagnosis and treatment of posterior urethral valves

A

Voiding cysts urethrogram

Tx: Endoscopic fulguration, resection

219
Q

Vesicoureteral reflux management

A

Long time antibiotics until it self resolves

220
Q

Management of BPH

A

Tamsulosin (alpha blocker)

Finasteride

TURP

221
Q

Only positive total contraindication to organ transplantation

A

Positive HIV status

-Even hepatitis livers can be given to other people with hepatitis

222
Q

Monitoring acute rejection for heart transplants

A

Routine ventricular biopsies

-Once symptoms develop, it’s too late

223
Q

Monitoring of acute rejection in liver Pts.

A

If liver enzymes rise, first get us and doppler to make sure it isn’t of obstructive or thrombotic nature

224
Q

Usual source of ️Bleeding in a Hemothorax

A

The lung, also typically will stop on its own

225
Q

Look out for this with a sternal fracture

A

Myocardial contusion

226
Q

Pt with subcutaneous emphysema in their chest after receiving an endoscopy

A

Probs an iatrogenic esophageal perforation

227
Q

Air embolism scenarios

A

Pt with chest trauma on a respirator

Central vein line placement

Supraclavicular node biopsy

Tx: Cardiac massage, prevent by keeping a pt in the Trendelenburg position when entering the subclavian vein

228
Q

What do you do if you get a positive FAST test?

A

Surgical exploration of some kind

229
Q

Older man with iron deficiency anemia

A

Work up for colorectal cancer

230
Q

Pt who has had UC for 8 years

A

Colonoscopy every year

Probably prophylactic Colectomy

231
Q

Surgical treatment for internal hemorrhoids

232
Q

Pt who has had UC for 8 years

A

Colonoscopy every year

Probably prophylactic Colectomy

233
Q

Surgical treatment for internal hemorrhoids

234
Q

Pt who has had UC for 8 years

A

Colonoscopy every year

Probably prophylactic Colectomy

235
Q

Surgical treatment for internal hemorrhoids

236
Q

Caudal displacement of the left main bronchus

A

Aortic dissection sign

⭐️UNUSUALLY HIGH BLOOD PRESSURES ARE A SIGN OF AORTIC RUPTURE

237
Q

Management for acute Mesenteric ischemia

A

Exploratory celiotomy

238
Q

Pt with internal hemorrhoids that are not significant but the patient is also over 50

A

DO A COLONOSCOPY; NEED TO PROVE THERE ISNT UNDERLYING CANCER

239
Q

Pt with a lap choley who did not have an IOCP performed and presents two weeks later with signs of jaundice

A

Choledocholithiasis; dumbshits forgot the stone

240
Q

Pt who is going to undergo serious surgery can have his intra operative risk of an MI assessed by what test?

A

Radionuclide scan with thallium and dipyridamole

241
Q

What anesthetic provides the longest duration of analgesia?

A

Bupivacaine

242
Q

Hidrsdenitis Suppurativa involves what glands?

A

Apocrine sweat glands; these are the sweat glands found in mature areas whereas eccrine ones are found everywhere

243
Q

Cystadenoma found in the pancreas

A

Remove it, could become Cancer

244
Q

Treatment for severe ovarian torsion

A

Some sort of exploratory surgery

245
Q

What happens when there is excessive nasogastric suction?

A

Metabolic acidosis; due to the fact that the body is getting ️Decreased nutrients

Take the motherfucker out

246
Q

Common cause of infertility in male with lumpy mass in BALSAC

A

Varicocele

247
Q

Choledochal cyst

A

Present as a mass next to the gall bladder somewhere in the tract; produce abnormal lab values depending on the obstruction

Typically not too painful, question will have to describe it as a cystic structure

Tx: Removal

248
Q

Best management of pelvic fracture with ongoing ️Bleeding

A

ARteriographic embolization

249
Q

Treatment of bladder injury

A

Extraperitoneal ➡️ Foley cath

Intraperitoneal ➡️ Surgery

250
Q

Possible sequelae of renal injury

A

Av fistula formation ➡️ CHF

251
Q

Scrotal hematoma

A

Observation; unless testicle is proven to be ruptured

252
Q

Treatment of compartment syndrome after a crushi injury

A

IV fluids

Diuretics

Alkalinization of the urine

Helps the Myoglobinuria and Hyperkalemia

253
Q

First aid for a venomous snake bite

A

Just splint it and nothing else

Then gene CROFAB antivenin when possible

254
Q

Black widow spider antivenin

A

Calcium gluconate

255
Q

Brown recluse spider bite

A

Skin ulcer with necrotic center, may need surgery

256
Q

Most important factor of gold mans index

A

JVD, treat with BBs, ACEIs p, digoxin

Followed by:

Previous MI
PVCs
Age > 70
️EMERGENCY surgery
Aortic valve stenosis
257
Q

Nutritional RFs for surgery

A

Loss of > 20% body weight
Serum albumin < 3
Transferrin < 200

Tx: 4-5 days of nutritional support actually helps, 7-10 if possible

258
Q

DKA with a septic process

A

Treat the sepsis along with the DKA even if it requires surgery

259
Q

Treatment of MI perioperatively

A

️EMERGENCY angioplasty

260
Q

Diagnosis and management of renal artery stenosis

A

Tx: Fibromuscular dysplasia? ➡️ Stent

  Renal stenosis in old man ➡️ ACEIs and arbs
261
Q

Treatment of Pheochromocytoma

A

Start a and b blockade before resecting

262
Q

Aortic stenosis

A

Presents with chest pain, syncope, or CHF in an old man possibly with CAD

Tx: Replacement

263
Q

Mitral stenosis

A

Commonly arises from rheumatic fever

Can lead to CHF and or a-fib

Tx: Medical
Balloon valvuloplasty
Replacement (mechanicals need anticoag; bovine don’t)

264
Q

CAD management

A

1 or 2 vessels ➡️ stent, Clopidogrel

3 vessels or left descending ➡️ CABG

265
Q

Immediate treatment of aspiration

A

Bronchoscopic Lavage to remove particulate matter followed by bronchodilators and respiratory support

Done to prevent chemical injury

266
Q

Blunt trauma who becomes increasingly difficult to bag

A

Intra operative tension pneumothorax

267
Q

Pt who hasn’t urinated after surgery 6 hrs later, first step in management

A

Foley cath

268
Q

Evisceration management

A

Cover bowels in saline wrap and emergently operate

269
Q

Factors preventing fistula healing

A

Foreign body

Epithelialization

Tumor

Infection, irradiated tissue, IBD

Steroids

270
Q

Treatment of Hyponatremia

A

Rapidly developing ➡️ Careful infusions of hypertonic saline

Slowly ➡️ Fluid restriction

271
Q

Rate limit of k+ administration

272
Q

Hyperkalemia treatment

A

Hemodialysis

But while you’re waiting, IV calcium and insulin

273
Q

AAA sizes

A
  1. 5➡️ screen q1yr
  2. 5➡️ screen q6month
  3. 5➡️ operate

Growing at a rate of greater than .5/6months➡️ operate

274
Q

Aortic dissection triad

A

Tearing chest pain

Asymmetric blood pressures

Widened mediastinum

275
Q

PVD testing

A
  1. ABI
  2. Duplex
  3. CT angiogram
276
Q

Acute limb ischemia management

A

1 Duplex

2 CT angiogram

Treat with embolectomy or tPA and follow up to check for compartment syndrome

277
Q

Medulloblastoma Tx

A

Resection followed by radiation

Radiation because Medulloblastoma can seed thru the spinal tract

278
Q

Pt who develops a fever after esophagoscopy

A

Presentation of perforation

Perform a water soluble contrast upper GI study

279
Q

Pt who has milky chylous fluid in their abdomen

A

Presentation of lymphoma or lymphatic prob

Ascites would be clear fluid

280
Q

Atrial Myxoma presentation

A

Pt with a physiologically split S2 and a low pitched rumbling diastolic murmur best heard at the apex that DISAPPEARS WHEN THE PATIENT LAYS ON HIS RIGHT SIDE

Typically will also present with a Cancer presentation or tuberous sclerosis

281
Q

High output congestive heart failure

A

Pt will have sob, shallow respirations, normal is bp, JVD, crackles in the lungs, and an s3 and s4 (indicating high output)

These Pts will likely have had too many fluids infused or have some sort of av shunt

282
Q

Globus tumor

A

Hemangioma underneath the nailbeds; exquisitely painful

283
Q

Nipple sensory innervation

284
Q

Aldosteronoma

A

Can also present with increased bun and hco3

285
Q

Lung cancer with Hypercalcemia

A

SQUAMOUS CELL CARCINOMA

286
Q

Charcot effusion

A

“Neuropathic joint”

Triggered by a combo of mechanical, vascular, and biological factors leading to loss of sensation to the foot with a ️Chronic history of joint swelling and bony hypertrophy, there will also be osteopenia

Most commonly caused by diabetes but also syringomyelia, tabes dorsalis
Pulses will be intact usually, there will be no ulcerations

287
Q

Borheave syndrome

A

Prolonged forceful vomiting that leads to esophageal perforation

Low sternal pain and epigastric pain of sudden onset soon followed by fever, Leukocytosis

⭐️very common after esophagoscope and may also present with emphysema in the lower neck

Contrast swallow is diagnostic

288
Q

Sigmoid Volvulus x ray

A

“Parrots beak”

Hugely distended upper right colon

289
Q

Large, thin walled and distended gall bladder

A

Think malignant obstruction of the gall bladder

290
Q

Ampullae cancer

A

Malignant obstructive jaundice alongside anemia and blood in the stools

Dx: Endoscopy

291
Q

Acute ascending Cholangitis treatment

A

IV abs, ERCP, followed by ️EMERGENCY cholecystectomy

Look for an extremely elevated AP

292
Q

Treatment of biliary colic

A

Anticholinergics followed by elective cholecystectomy

293
Q

Epididymitis causes

A

Under 35 ➡️ STD, treat with ceftriaxone and Azithromycin

Over 55 ➡️ E. Coli, treat with Cipro

294
Q

Test to order for urinary stones

295
Q

Nocturnal asthma

A

Sign of GERD

296
Q

Heller Myotomy

A

Surgery to relieve the increased LES pressure found in GERD

297
Q

Esophageal biopsy results and Tx

A

Metaplasia ➡️ High dose PPIs

Dysplasia ➡️ Ablation

Adenocarcinoma ➡️ Resect

And always follow up with fundoplication

298
Q

Dx of bore heaves

A

Gastrografin

Then barium

Then EGO

299
Q

Ischemia-Reperfusion syndrome

A

️Occurs due to reperfusion after a period of ischemia and after something like an embolectomy and the increased perfusion pressure swells the fascial compartment

Diagnosed with compartment pressure > 30

300
Q

Diagnosis of diaphragmatic rupture

A

X ray

Follow up ct of chest

Can happen weeks after the initial injury

301
Q

Varicocele findings

A

Increases in size with standing and Valsalva

️Decreases in size when laying down

⭐️Dilation of the Pampiniform plexus

⭐️ Does not Transilluminate

302
Q

Hydrocele

A

Peritoneal fluid collection between the parietal and visceral layers of the tunica vaginalis

Fluid is easily Transilluminated ⭐️

303
Q

Drug to use with Cholelithiasis if pt is not a surgical candidate

A

Ursodeoxycholic acid

Say it the pt is really old or has really bad liver disease or some shit

304
Q

Treatment of acute cholecystitis in non surgical candidates

A

Cholecystotomy

305
Q

Choledocholithiasis Tx

A

ERCP

Also will do a cholecystectomy but don’t forget the ERCP

306
Q

Acute infectious pancreatitis treatment

A

Imipenem if infectious

307
Q

️Chronic pancreatitis comps

A

Diabetes

Steatorrhea

Constant pain

308
Q

Fibrocystic Breast disease

A

Bilateral Breast tenderness related to the menstrual cycle with lumps that come and go

If you perform an aspiration of a consistent mass and the fluid is clear, you’re done

If bloody or mass persists, send it for cytology

309
Q

Drug to give a woman post mastectomy

A

Premenopausal ➡️ Tamoxifen

Postmenopausal ➡️ Anostrazole

310
Q

DCIS treatment

A

Typically a total mastectomy so you don’t miss any Cancer but you do not need to do axillary sampling unless you find Cancer

311
Q

Diarrhea with c dif

A

Actually isn’t bloody it’s just watery

Surgery (6 decks)

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