surg Flashcards
1
Q
A drop in the platelet count by >50% or a new thrombus within 5-10 days of initiating heparin should raise suspicion for heparin-induced thrombocytopenia (HIT)
If HIT is suspected what is management??
A
discontinue heparin and anticoagulation should be initiated with a nonheparin medication (eg, argatroban, fondaparinux).
2
Q
Patients with a septal hematoma require prompt ??
A
incision and drainage
3
Q
Presentation includes inspiratory stridor that is worse in the supine position and exacerbated by feeding or upper respiratory illnesses; prone positioning improves symptoms. The diagnosis is confirmed with visualization of the larynx, typically by flexible fiberoptic laryngoscopy
A
Laryngomalacia, which causes chronic stridor in infants, is typified by “floppy” supraglottic structures that collapse during inspiration.
4
Q
Patients with ??? classically have the triad of respiratory distress (eg, tachypnea, hypoxemia), neurologic dysfunction (eg, confusion), and a petechial rash; however, the rash is present in less than half of cases. The condition can occur 24-72 hours following fracture or surgical manipulation of bones that contain abundant marrow (eg, femur, pelvis)
A
fat embolism syndrome (FES)
5
Q
this imaging modality has a sensitivity of up to 97% in the detection of pancreatic cancer and can be used for staging purposes and preoperative planning.
A
abdominal CT
6
Q
classically affects boys age 3-12, with peak incidence at age 6.
Patients typically have an antalgic gait (avoids weight bearing on the affected side due to pain) and dull, chronic lower extremity pain of insidious onset. The pain may affect the hip directly or present as referred thigh or knee pain, as in this patient. Diagnosis requires a high index of suspicion as initial x-rays may be normal
A
Legg-Calvé-Perthes disease (LCP)
7
Q
patient’s acute onset of severe flank pain, syncope, and hemodynamic instability is concerning for ????
ypically occurs in patients age >60 and is more common in smokers, men, and those with a history of atherosclerosis or connective tissue disease.
A
ruptured abdominal aortic aneurysm (AAA).
8
Q
Erythema nodosum presents with tender, nonpruritic, erythematous, or violaceous nodules measuring 2-3 cm and usually located on the shins. It has a strong association with ???
A
inflammatory bowel disease (IBD), especially Crohn disease
9
Q
Peripherally inserted central catheters increase the risk of upper extremity ???. The risk is greatest in hospitalized patients, particularly those with malignancy or other hypercoagulable state. Manifestations include arm swelling, erythema, and pain.
A
DVT
The diagnosis is made with duplex ultrasonography. Treatment with 3 months of anticoagulation is required.
10
Q
Mediastinal masses are categorized according to their compartments (ie, anterior, middle, posterior). The middle compartment contains the heart and great vessels, trachea and main bronchi, esophagus, pericardium, and lymph nodes. Middle compartment masses may include ????, which arise from congenital, anomalous budding of the foregut and can cause chest discomfort and nonspecific respiratory symptoms.
A
bronchogenic cysts
**thymoma and thymus located in anterior mediastinum
11
Q
workup of a suspicious breast mass (eg, unilateral, firm, fixed, causing nipple retraction) in males is ??
A
same in men as in women: imaging (eg, mammography, ultrasound) is performed first, followed by tissue sampling (eg, core biopsy).
12
Q
??? transfusion reaction is an uncommon, life-threatening reaction which causes fever, flank pain, and hemoglobinuria within 1 hour of transfusion initiation. Continued hemolysis can lead to acute renal failure, disseminated intravascular coagulation, and shock
A
Acute hemolytic: due to transfusion of mismatched blood (eg, ABO incompatibility)
13
Q
Acquired ??? results from the oxidization of iron in hemoglobin, which is most commonly due to topical anesthetic agents or dapsone. It presents with hypoxia, a characteristic pulse oximetry reading of ~85%, and a large oxygen saturation gap.
A
methemoglobinemia
Because methemoglobin absorbs light at distinct wavelengths, pulse oximetry commonly is ~85% (as seen in this patient) regardless of the true oxygen saturation. In parallel, blood gas analysis frequently returns a falsely elevated result for oxygen saturation (eg, 99% in this patient) as it provides an estimate based only on the PaO2, not on effective hemoglobin-oxygen binding. These inaccurate readings create the large oxygen saturation gap.
14
Q
Vitamin ?? deficiency is usually due to inadequate dietary intake, intestinal malabsorption, or hepatocellular disease. An acutely ill patient with underlying liver disease can become deficient in 7-10 days. Laboratory studies usually show prolonged prothrombin time followed by prolonged partial thromboplastin time.
A
K
15
Q
??? is characterized by the triad of bilateral hip, thigh, and buttock claudication; impotence; and absent or diminished femoral pulses (often with symmetric atrophy of the bilateral lower extremities due to chronic ischemia).
A
Aortoiliac occlusion (Leriche syndrome)
16
Q
which cardiac mass can produce cytokines (eg, IL-6) that lead to systemic inflammation (evidenced by an elevated erythrocyte sedimentation rate) and constitutional symptoms (eg, fever, weight loss).
A
cardiac myxomas in the LA
17
Q
Patients with trauma following rapid deceleration are at risk for blunt thoracic aortic injury. Signs may include upper extremity hypertension with lower extremity hypotension (pseudocoarctation) and/or a hoarse voice (left recurrent laryngeal nerve stretching).
what is the best test/choice for imaging??
A
CT angiography of the chest is highly sensitive and specific for thoracic aortic injury and is readily available.
ECHO is not as good
18
Q
Pain is the most common manifestation of abdominal aortic aneurysm (AAA), and it can vary according to aneurysm location. Proximal AAA tends to cause upper abdominal, flank, or back pain. In symptomatic, hemodynamically stable patients, the diagnosis is best made by ??
A
abdominal CT
hemodynamically unstable = U/S and surgery
19
Q
patient has fever, chills, leukocytosis with left shift, new arrhythmia, and a pericardial effusion on echocardiography. This presentation is most concerning for ???
A
purulent pericarditis
20
Q
Purulent pericarditis is an acute, rapidly fatal infection most commonly caused by hematogenous spread of Staphylococcus aureus. Urgent echocardiography-guided ??? is essential for confirmation of the diagnosis and treatment
A
pericardiocentesis
21
Q
??? can occur as a local vascular complication of cardiac catheterization, and often presents with sudden hemodynamic instability and ipsilateral flank or back pain. Diagnosis is confirmed with non-contrast CT scan of abdomen and pelvis or abdominal ultrasonography. Treatment is usually supportive with bed rest, intensive monitoring, and intravenous fluids and/or blood transfusion.
A
Retroperitoneal hematoma
22
Q
hemodynamics of thyroid storm involve ????, leading to hyperdynamic circulation and increased venous return to the heart. High-output heart failure quickly develops, leading to backup of pressure from the left ventricle with increased pulmonary capillary wedge pressure.
A
decreased systemic vascular resistance and increased cardiac output
23
Q
A ???? can develop as a complication of vascular access during cardiac catheterization. Patients typically have mild localized pain and swelling and a continuous bruit accompanied by a palpable thrill over the fistula site.
A
arteriovenous fistula
24
Q
???? is a complication of cardiac surgery characterized by separation of the bony edges of the sternum. Patients may report mild pain or sensation of chest wall instability and “clicking” with chest movement. The diagnosis can be made radiographically (eg, displaced sternal wire) or clinically; palpable rocking or clicking of the sternum confirms the diagnosis. Management involves urgent surgical exploration and repair.
A
Sternal dehiscence
25
After initial stabilization, burn patients who require aggressive fluid resuscitation (eg, due to burns covering a large total body surface area) should undergo ??? as soon as possible.
urethral catheterization
fluid is titrated to maintain adequate urine output (goal: ≥0.5 mL/kg/hr), a marker of organ perfusion. For accurate monitoring of urine output in these patients, a urethral catheter (eg, Foley catheter) is required.
26
Testicular torsion can present with acute testicular pain and swelling after mild trauma. The diagnosis may be made clinically; however, in patients in whom the diagnosis is unclear, a ??? can confirm the diagnosis and exclude other etiologies.
Doppler ultrasound of the scrotum
testicular torsion is a surgical emergency; up to 80% of patients with untreated torsion develop a nonviable testicle within 12 hours.
27
Heterogeneous echotexture seen on US is a late finding indicating testicular ???, which develops after \>12 hours of ischemia and can result in nonviability. Therefore, if testicular torsion is suspected, urgent urologic evaluation is indicated.
necrosis
28
A solid, firm, nontender testicular mass should be considered testicular cancer until proven otherwise. A diagnostic workup generally includes bilateral scrotal ultrasound, serum tumor markers, and ???
radical inguinal orchiectomy.
29
???? testicular tumors often cause feminization (eg, gynecomastia) due to the production of estrogen by tumor cells. This frequently causes secondary inhibition of FSH and LH. Serum tumor markers (eg, β-hCG, AFP) are not usually elevated.
Leydig cell
sertoli cell tumors are very rare but also can occasionally cause estrogen excretion
30
??? often presents with symptoms of recurrent urinary tract infection, **painful ejaculation**, and/or prostatic tenderness in young or middle-aged men. Patients often have transient improvement of symptoms with short courses of antibiotics. Six weeks of a fluoroquinolone is generally required for eradication.
Chronic bacterial prostatitis
\*\*some patients have NO prostate tenderness on exam
31
??? is a life-threatening necrotizing fascitis that typically affects perineal, scrotal, and lower abdominal skin. Patients generally have rapid-onset swelling, tenderness, and crepitus of the affected region and significant systemic symptoms (eg, hypotension, high fever). Rapid surgical intervention is required to prevent death and should not be delayed for imaging.
Fournier gangrene
increased rx in DM and obese
32
A varicocele is a tortuous dilation of the pampiniform plexus surrounding the spermatic cord and testis. It presents as a soft, irregular mass that increases in size with standing and Valsalva. The diagnosis is confirmed with ultrasound. Initial interventions include scrotal support and simple analgesics. Varicoceles are associated with increased risk for ???
infertility; for patients with testicular atrophy or changes in semen analysis, surgical venous ligation can improve fertility.
33
Secondary ??? is a malignant endothelial tumor that develops 4-8 years after breast cancer therapy. Risk factors include radiation therapy and chronic lymphedema. Typical lesions are red, bruise-like plaques and purple papules and nodules. Timely biopsy is recommended for diagnosis because the cancer readily metastasizes.
angiosarcoma
34
A mole may represent melanoma if it appears substantially different from others ("ugly duckling sign"), itches or bleeds, or develops ???. If melanoma is suspected, an excisional biopsy should be obtained.
nodularity
35
Hidradenitis suppurativa is a chronic, relapsing condition characterized by inflamed nodules, subcutaneous abscesses, scarring, and sinus tract formation in intertriginous areas. Treatment IS ???
Prolonged treatment with topical (eg, clindamycin) or oral (eg, tetracycline) antibiotics
36
Foot imaging (eg, x-ray, MRI) is generally recommended for all diabetic foot ulcers that are: Looking for ???
* deep (eg, exposed bone, positive probe-to-bone testing).
* long-standing (eg, present \>7-14 days).
* large (eg, ≥2 cm).
* associated with elevated erythrocyte sedimentation rate/C-reactive protein.
* associated with adjacent soft tissue infection.
signs of osteomyelitis
37
??? is the first-line treatment for nonmelanoma skin cancers that have a high risk for recurrence ex. Basal cell carcinoma on the face. It allows for the highest cure rate and maximal preservation of normal tissue, making it an ideal option for facial lesions.
Mohs micrographic surgery
This technique is characterized by sequential removal of thin skin layers with intraoperative microscopic margin inspection to ensure complete removal of the cancer.
38
Initial management of pressure ulcers includes local wound care, ???, pain control, and nutritional support.
repositioning of the patient to reduce pressure
39
??? dressings are commonly used for wounds that are infected, have just been freshly debrided, or have devitalized tissue or fibrinous slough at the base. They are typically performed twice a day and involve placing gauze that has been moistened (typically with saline) onto the wound. As the gauze dries, it adheres to the wound bed and, when it is removed, debrides devitalized tissue.
Wet-to-dry
40
Once devitalized tissue is removed and the wound has healthy granulation tissue, wet-to-dry dressings should be discontinued, because they can nonselectively debride the delicate granulation tissue that serves as a base for epithelial migration (ie, reepithelization). Instead, ??? dressings should be used. Moist wounds heal faster than dry wounds because wound fluid contains factors that promote wound healing (eg, platelet-derived growth factor, fibroblast growth factor, matrix metalloproteases). In addition, a moist environment promotes reepithelization. Because of these benefits, wounds should also not be left open to the air and allowed to dry out
Nonadherent and moisture-retaining
41
??? can cause atrophy of the small intrinsic muscles of the feet, leading to unopposed action of the large lower leg muscles, and clawing of the toes with hyperextension at the metatarsal-phalangeal joints. As a result, pressure is redistributed to the metatarsal heads, increasing susceptibility to callus formation, skin breakdown, and ulcer formation.
Motor neuropathy
Sensory, autonomic, and motor neuropathy can all contribute to plantar foot ulcer formation in patients with diabetic neuropathy. Motor neuropathy can cause intrinsic foot muscle atrophy, toe clawing, and abnormal redistribution of pressure to the metatarsal heads.
Autonomic neuropathy causes loss of autonomic tone in the arteriolar and capillary circulation, leading to shunting of blood from the arterioles to the veins and decreased tissue perfusion.
42
Circumferential, full-thickness burns can result in the formation of constrictive eschar bands. When profound edema from aggressive fluid resuscitation and increased capillary permeability occur together, vascular compromise can result. TX?
Immediate release of the burned skin (ie, escharotomy) is required to restore perfusion.
CUT an incision through the burned skin until subcutaneous fat is observed and skin tension is released
43
Does increasing FiO2 for ARDS help oxygenation?
NO
Fluid from pulmonary edema fills the alveoli and facilitates alveolar collapse. Alveolar ventilation (V) is zero, which results in an extreme ventilation/perfusion (V/Q) mismatch (right-to-left intrapulmonary shunting), causing hypoxemia. Because diffuse pulmonary edema prevents air from reaching the alveoli throughout much of the lungs (eg, \>50%), an increase in the fraction of inspired O2 (FiO2) does not correct the hypoxemia.
44
??? is the mainstay of rib fracture management to prevent the associated complications of atelectasis and pneumonia
Adequate pain control
45
Acute lung transplant rejection (ALTR) typically occurs within 6 months of transplant and may present with progressive dyspnea and cough accompanied by low-grade fever, hypoxemia, and chest x-ray revealing perihilar opacities and interstitial edema. Because pulmonary infection can have a similar clinical presentation and the treatment for ALTR (ie, high-dose glucocorticoids) could markedly worsen an infection, ??? should be performed in the diagnostic workup of ALTR.
bronchoalveolar lavage and lung biopsy
46
Myopia, or nearsightedness, is characterized by increased anterior-posterior diameter of the eye, causing blurred distance vision. High myopia (≥6 diopters of correction) increases the risk of ???
retinal detachment and macular degeneration
47
Open globe laceration (OGL) is typically caused by small, high-velocity particles sent airborne by power tools, explosions, lawn mowers, or motor vehicle accidents. Large OGL may present with globe deformity, extrusion of vitreous or iris, or a visible entry wound. Other manifestations include a ??? pupil, asymmetric anterior chamber depth, loss of visual acuity or afferent pupillary response, and reduced intraocular pressure.
peaked or teardrop pupil
48
moa of increased oxalate causing stones in Crohn's disease patients??
Under normal circumstances, calcium binds oxalate in the gut and prevents its absorption. In patients with fat malabsorption, calcium is preferentially bound by fat leaving oxalate unbound and free to be absorbed into the bloodstream. Failure to adequately absorb bile salts in states of fat malabsorption also cause decreased bile salt reabsorption in the small intestine. Excess bile salts may damage the colonic mucosa and contribute to increased oxalate absorption
49
Blunt trauma to a full bladder can cause it to rupture at the weakest point, the dome. Diversion of urine from the urinary tract (eg, inability to void) into the peritoneal cavity can cause urinary ascites and increased ??? from peritoneal reabsorption.
blood urea nitrogen and creatinine
50
Patients with ??? develop hydronephrosis; however, symptoms can be masked initially by postoperative pain medications (post GYN surg). With continued obstruction, patients have nonradiating back pain and costovertebral angle tenderness. Because only 1 ureter is affected, patients typically have normal renal function (eg, normal creatinine and urinalysis); however, irreversible renal damage can occur if the obstruction is untreated. Diagnosis can be made by renal ultrasound. Treatment is surgical correction of the obstruction (eg, suture removal).
ureteral obstruction
51
Contributing factors to acute kidney injury (AKI) in hospitalized patients include administration of potentially nephrotoxic agents (eg, intraarterial contrast, antibiotics) and intraoperative hypotension in patients undergoing surgery. In patients without evidence of volume depletion, ??? should be initially obtained to help determine the etiology of AKI.
urinalysis and urine microscopy
52
Severe vomiting characteristically causes hypokalemic, hypochloremic metabolic alkalosis. The metabolic alkalosis is initiated by loss of gastric H+, worsened by hypovolemia-induced activation of the renin-angiotensin-aldosterone system, and perpetuated by profound total body Cl- depletion leading to hypochloremia and impaired renal bicarbonate excretion. Urine Na+ and Cl- are ??? due to total body depletion and aldosterone-mediated renal tubular reabsorption.
low
Repletion of volume and Cl- with normal saline corrects the metabolic alkalosis (saline responsive).
53
Immediate postsurgical fever occurs within hours of the operation and is usually due to ???? Acute (1-7 days postoperatively) and subacute (7-28 days postoperatively) fever is generally driven by infections.
Postoperative fever is generally mediated by cytokine release in response to tissue trauma, blood cell lysis, or infection.
54
??? are the most common causes of osteomyelitis in children with sickle cell disease. Therefore, empiric antibiotics should include antistaphylococcal (eg, clindamycin) and gram-negative (eg, ceftriaxone) coverage
Staphylococcus aureus and Salmonella
55
???? are the most common cause of catheter-related bloodstream infection.
Coagulase-negative staphylococci (CoNS)
56
3 most common bugs causing infection from central venous catheters???
Coagulase-negative staphylococci, Staph aureus, and Candida
57
n patients with severe burn injuries, ??? reduces the risk of burn wound infections.
\*most effacacious
early excision of necrotic tissue and wound closure (eg, skin grafting)
58
Budding yeast in the blood culture of a hospitalized patient should raise suspicion for candidemia, requiring empiric antifungal treatment, ????, and evaluation for metastatic foci (eg, ophthalmologic examination). Although Candida is a normal skin commensal, its presence on blood culture should never be considered a contaminant.
removal of central lines
59
Catheter-related bloodstream infections occur approximately once per year in patients with tunneled hemodialysis catheters. Most cases present with systemic signs of infection (eg, fever, malaise, chills) without localizing symptoms. The catheter site frequently appears normal. Initial therapy usually includes antibiotics, fluid resuscitation, and ????
removal of the dialysis catheter.
60
???2 bugs??? are responsible for most deep infections following puncture wounds.
Staphylococcus aureus and Pseudomonas aeruginosa
61
Patients with plantar puncture wounds through footwear are at risk for ??? osteomyelitis.
Pseudomonas aeruginosa
62
Any penetrating wound below the ??? can involve the intraabdominal organs. Patients with penetrating abdominal trauma and any of the following indications—hemodynamic instability, peritonitis, evisceration—should undergo immediate exploratory laparotomy.
fourth thoracic dermatome (ie, nipple level)
~4th rib
63
??? can present with unexplained fever and diffuse or right upper quadrant (RUQ) abdominal pain. Other findings can include jaundice, RUQ mass, leukocytosis, or abnormal liver function tests (normal results do not exclude the diagnosis). I**t is most often seen in hospitalized patients who are critically ill.** Common predisposing conditions include **recent surgery** (particularly cardiopulmonary, aortic, or abdominal), severe trauma, extensive burns, sepsis or shock, prolonged fasting or total parenteral nutrition, or critical illness requiring mechanical intubation.
Acalculous cholecystitis
These conditions likely cause gallbladder stasis or ischemia with local inflammation that can lead to gallbladder distension, necrosis, and secondary bacterial infection.
64
??? most frequently affects males age 15-30, particularly obese individuals, those with sedentary lifestyles or occupations, and those with deep gluteal clefts. The most common presenting symptoms include a painful, fluctuant mass 4-5 cm cephalad to the anus in the intergluteal region with associated mucoid, purulent, or bloody drainage.
Pilonidal disease
VS. perianal abscess presents with fever, malaise, anal pain, and a tender, erythematous bulge at the anal verge. This patient is afebrile, and his pain and swelling are located superior to the anus over the coccyx (4-5 cm cephalad to the anus).
65
??? malignancy most often occurs in those who have fibropolycystic liver disease or primary sclerosing cholangitis due to underlying ulcerative colitis. Most cases present with subacute right upper quadrant pain, weight loss, and signs of biliary obstruction such as jaundice, cholestatic liver enzyme pattern, and dilation of the intrahepatic or common bile duct.
Cholangiocarcinoma
66
serum markers in cholangiocarcinoma vs. hepatocellular carcinoma of the liver
cholangiocarcinoma (↑ CEA/CA 19-9, normal AFP) vs. hepatocellular carcinoma (normal CEA and CA-19, sometimes ↑ AFP).
colon cancer also has these markers, but look for hx of UC or primary sclerosing cholangitis for cholangiocarcinoma
67
The first step in the treatment of acute upper gastrointestinal bleeding is ????
to establish vascular access with 2 large-bore intravenous catheters to initiate resuscitation with intravenous fluids.
68
patient who received aggressive fluid resuscitation for trauma and severe burns now has a tensely distended abdomen and evidence of intraabdominal organ dysfunction (ie, renal dysfunction with decreasing urine output). This presentation is most concerning for ???
also key finding is high peak inspiratory pressures (diaphragmatic elevation compressing lungs)
abdominal compartment syndrome (ACS)
should prompt measurement of bladder pressure, which estimates intraabdominal pressure (IAP)
69
Regardless of the underlying etiology, acute cholangitis is treated with intravenous fluid, antibiotics, and urgent ???
biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP), with a sphincterotomy and/or a biliary stent is used to facilitate the flow of bile.
Once the patient has recovered from acute cholangitis, complete surgical excision of the biliary cyst should be performed to reduce the risk of developing cholangiocarcinoma.
70
Acalculous cholecystitis occurs in critically ill patients. The clinical presentation may be similar to calculous cholecystitis, though assessment may be difficult due to the underlying illness. Imaging studies show gallbladder wall thickening and distension and pericholecystic fluid. The emergency treatment of choice is antibiotics and ????, followed by cholecystectomy when the medical condition stabilizes.
percutaneous cholecystostomy
71
Trousseau syndrome is a hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites (eg, arm, chest area). It is usually associated with an occult visceral malignancy such as ???? (most common), stomach, lung, or prostate carcinoma.
pancreatic
72
Dumping syndrome is a common postgastrectomy complication characterized by gastrointestinal (eg, nausea, diarrhea, abdominal cramps) and vasomotor (eg, palpitations, diaphoresis) symptoms. The diagnosis is primarily clinical. The symptoms can be controlled with ??? and usually diminish over time
dietary modification (eg, avoiding simple sugars)
* Consume small, frequent meals, and eat slowly
* Avoid simple sugars
* Increase fiber and protein intake
* Drink fluids between rather than during meals
73
patient has typical clinical features of early ??? including gastrointestinal (eg, nausea, diarrhea, abdominal cramps) and vasomotor (eg, palpitations, diaphoresis) symptoms. It is a common postgastrectomy complication, occurring in up to 50% of patients. It is caused by loss of the normal action of the pyloric sphincter due to injury or surgical bypass and leads to rapid emptying of hypertonic gastric contents into the duodenum and small intestine. This causes fluid shifts from the intravascular space to the small intestine, leading to hypotension, stimulation of autonomic (sympathetic) reflexes, and release of intestinal vasoactive polypeptides.
dumping syndrome (DS)
74
total parenteral nutrition (ie used in some Crohn's patients) predisposes to gallstones how ???
In patients on total parenteral nutrition or prolonged fasting, the normal stimulus for CCK release and gallbladder contraction is absent. This leads to **biliary stasis** and promotes the formation of bile sludge and gallstones.
75
??? typically affects patients with recent travel from endemic regions (eg, Asia, Africa, South America). It is often asymptomatic but may cause pulmonary (eg, cough, eosinophilic pneumonitis) or intestinal (eg, abdominal pain, nausea/vomiting, malnutrition) manifestations. Complications include obstruction of the small bowel or hepatobiliary tree (eg, cholangitis, pancreatitis). Treatment includes albendazole or mebendazole.
Ascariasis
ascaris lumbricoides roundworm
76
patient with abdominal pain and distension, high-pitched bowel sounds, obstipation, and imaging demonstrating small bowel dilation with air-fluid levels has a ???
small bowel obstruction (SBO).
77
elderly patient with weeklong symptoms of likely diverticulitis (eg, vague lower abdominal discomfort, anorexia, constipation) experienced sudden, severe abdominal pain that temporarily improved and then spread to his entire abdomen. This presentation, now accompanied by fever and peritonitis (eg, guarding, rebound tenderness), is most consistent with ????.
\*\* free air is typically visible on abdominal imaging (eg, upright x-ray, CT scan).
diverticular perforation
78
Patients with ???? of the gastrointestinal tract in the setting of ongoing inflammation (eg, diverticulitis) often have a classic pain sequence:
* Moment of perforation: sudden, severe pain (± vomiting, lightheadedness or syncope)
* After perforation to 2 hours: temporary relief or decreased pain as the inflamed organ decompresses
* \>2 hours after perforation: generalized, constant pain due to peritonitis (± sepsis/septic shock)
free perforation
79
Burn victims frequently develop intravascular volume depletion and require aggressive resuscitation with crystalloid solutions. ??? solution, a balanced fluid, is preferred because it contains near-physiologic levels of electrolytes and includes a buffer that helps correct acidosis and maintain normal blood pH.
Lactated Ringer
Normal saline is associated with the development of hyperchloremic metabolic acidosis.
80
Prophylactic antibiotics reduce surgical site infections and are indicated when there is a high risk of infection or when infection would lead to significant morbidity/mortality. Patients undergoing clean procedures (ie, without infection or viscus entry) should receive coverage against gram-positive skin flora, ideally with a ???
first- or second-generation cephalosporin (eg, cefazolin) or, alternatively, with vancomycin or clindamycin.
81
Constant (≥1 month) or progressive hoarseness is often related to a vocal cord lesion and requires evaluation by laryngoscopy. This patient with irregular, exophytic growths in clusters on the surfaces of his vocal cords likely has laryngeal papillomas due to recurrent ??
respiratory papillomatosis (RRP)
laryngeal papillomas are caused by human papillomavirus (HPV) subtypes 6 and 11. the mainstay of treatment remains surgical debridement, and patients often require many procedures.
82
Serum ???? measurements are used as a tumor marker once the normally functioning thyroid tissue is removed in patients with thyroid cancer
thyroglobulin
Thyroglobulin (Tg) is the precursor to active thyroid hormones (T3 and T4) and is produced by normal thyroid tissue or differentiated (ie, papillary, follicular) thyroid cancer.
83
??? is a benign, noninflammatory swelling of the salivary glands. It can result from overaccumulation of secretory granules in acinar cells (possibly due to abnormal autonomic innervation) in patients with chronic alcohol use, bulimia, or malnutrition. It can also result from fatty infiltration of the glands in patients with diabetes mellitus or liver disease.
Sialadenosis
84
If a patient develops a whistling noise during respiration following rhinoplasty, one should suspect ??? likely resulting from a septal hematoma.
nasal septal perforation
complications are common after rhinoplasty
85
Medullary thyroid cancer arises from the calcitonin-secreting parafollicular C cells. Serum ??? levels correlate with the risk of metastasis and recurrence, and are measured serially following surgery.
calcitonin
86
An enlarged, ulcerated tonsil with ipsilateral cervical adenopathy is likely oropharyngeal (head and neck) squamous cell carcinoma. ??? is the likely etiology in the absence of traditional risk factors (smoking, alcohol).
Human papillomavirus
87
Retropharyngeal abscess presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. Infection within the retropharyngeal space can extend where???
Extension through the alar fascia into the "danger" space can transmit infection into the posterior mediastinum and result in acute necrotizing mediastinitis.
88
A ??? can occur after head trauma and result in episodic vertigo triggered by sudden pressure changes (eg, Valsalva maneuvers) or loud noises (Tullio phenomenon).
perilymphatic fistula
89
Nasopharyngeal carcinoma is associated with ??? and occurs most commonly in those from Asia (particularly southern China) and parts of Africa and the Middle East. Manifestations include nasal congestion with epistaxis, headaches, cranial nerve palsies, and otitis media. Early spread to the cervical lymph nodes is common.
reactivation of Epstein-Barr virus
90
In a patient with risk factors for malignancy, ear pain with a normal ear examination may be referred from the base of the tongue or hypopharynx/larynx. Associated cervical adenopathy makes ??? the most likely diagnosis. .
head and neck squamous cell carcinoma
The most common causes of referred otalgia are dental disease and temporomandibular joint disorders. However, referred otalgia is commonly a presenting symptom of mucosal head and neck squamous cell carcinoma (HNSCC), especially in an older patient with a history of smoking, alcohol use, occupational exposure to welding fumes, and cervical lymphadenopathy
91
This patient with an enlarging fluid collection (ballotable neck swelling) developing after thyroidectomy likely has an expanding neck hematoma. An expanding neck hematoma is life-threatening due to the potential for airway obstruction, either from direct airway compression or from vascular compression causing venous congestion leading to laryngeal edema
Tx??
immediete wound exploration and drainage
92
Peritonsillar abscess is characterized by fever, pharyngeal pain, and dysphagia. Examination findings include trismus, muffled voice, and swelling of the soft palate with deviation of the uvula. Treatment involves ???
needle aspiration or incision and drainage plus antibiotic therapy.
93
Surveillance after colon cancer resection ??
for stage I: Colonoscopy in 1 yr & then every 3-5 yr
greaters stage = more tests; scans, CEA level
94
Acute ??? is characterized by inflammation and distension of the gallbladder due to obstruction of the cystic duct by a gallstone. Typical features include acute right upper quadrant pain and tenderness, fever, and leukocytosis. Palpation (or an ultrasound probe) under the costal margin at the midclavicular line may elicit acute tenderness, especially during inspiration (Murphy sign).
cholecystitis
95
??? commonly presents subacutely with fever and lower abdominal or flank pain radiating to the groin. The main sign is: **abdominal pain with hip extension**, can often be detected on examination. CT scans are required to confirm the diagnosis
Psoas abscess
drainage with antibiotics is the mainstay of therapy.
96
patients with HCC are often asymptomatic. Therefore, in any patient with cirrhosis, screening abdominal ultrasound is recommended every ??? to evaluate for new-onset HCC.
6 months
97
??? is the best diagnostic test for diagnosing acute diverticulitis and differentiating it from other causes of abdominal pain.
Abdominal CT scan
98
Patients with ??? present with abdominal pain (usually lower left quadrant), fever, nausea/vomiting, and leukocytosis. Some (10%-15%) have urinary urgency, frequency, or dysuria due to bladder irritation from an inflamed sigmoid colon. Abdominal CT scan (oral and intravenous contrast) is the best diagnostic test
diverticulitis
99
??? is recommended for complicated diverticulitis with abscess formation (5-cm rim-enhancing perisigmoid fluid collection)
CT-guided percutaneous drainage
Sigmoid resection is generally reserved for patients with fistulas, perforation with peritonitis, obstruction, or recurrent attacks of diverticulitis
100
CT scan of the abdomen with intravenous and oral contrast can identify features typical of ???:
* Colonic dilatation \>6 cm (diagnostic)
* Loss of normal haustral pattern
* Irregular mucosal pattern, with areas of ulceration alternating with areas of edema
toxic megacolon
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patient with 6 weeks of lower abdominal pain, bloody diarrhea, and fecal urgency likely has undiagnosed inflammatory bowel disease (IBD). However, for the past 2 days, he has had worsening symptoms, abdominal distension and tenderness, leukocytosis, and systemic toxicity (eg, fever, hypotension, tachycardia). This presentation is concerning for ????, which can complicate IBD, often early in the disease (eg, initial presentation).
toxic megacolon (TM)
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Patients with ??? typically experience sudden onset of severe periumbilical pain that appears to be out of proportion to examination findings. It is commonly due to abrupt arterial occlusion from cardiac embolic events (eg, ventricular thromboembolism). Laboratory studies typically show **leukocytosis, elevated hemoglobin (hemoconcentration), elevated amylase, and metabolic acidosis** due to increased serum lactate levels. In this patient, metabolic acidosis is suggested by the very low bicarbonate level.
acute mesenteric ischemia
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which finding?
what management??
intraperitoneal free air. The free air establishes the diagnosis of perforated viscus, which warrants immediate surgical exploration
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Inadvertent damage to vagal nerve [CN X] branches can occur during Nissen fundoplication, a surgical procedure used to treat gastroesophageal reflux disease. This may result in ????, a disorder that causes bloating, early satiety, postprandial emesis, food aversion, and weight loss. A scintigraphic gastric emptying scan is diagnostic in the absence of obstruction (eg, negative esophagogastroduodenoscopy ± small bowel imaging).
gastroparesis
Nissen fundoplication, a surgical procedure used to treat gastroesophageal reflux disease. During this procedure, the fundus is folded and sewn around the lower esophageal sphincter to decrease the amount of gastric acid that refluxes into the esophagus.
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patient developed abdominal pain and absent bowel sounds following a traumatic injury. Abdominal x-ray demonstrates gastric dilation and gas-filled loops of both the small and large intestines, suggesting ??
paralytic (adynamic) ileus.
Contributors to the pathophysiology of ileus include irritation and temporary paralysis of the abdominal sympathetic and parasympathetic nervous system, local release of inflammatory mediators, and opioid analgesic use.
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Patients who undergo Roux-en-Y gastric bypass are at risk for multiple vitamin deficiencies. Fat-soluble vitamins and vitamin B12 deficiency are most common, but vitamin ?? deficiency can occur in the setting of poor postoperative diet. It is associated with ecchymosis, petechiae, poor wound healing, perifollicular hemorrhage, coiled hairs, and gingivitis; platelet count, prothrombin time, and partial thromboplastin time will be normal.
Vitamin C deficiency
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Features that distinguish biliary colic from cholecystitis are ??? and absence of abdominal tenderness, fever, and leukocytosis.
pain resolution within 4-6 hours
Ingestion of a large (usually fatty) meal stimulates gallbladder contraction. The intra-gallbladder pressure increases on gallbladder contraction against an obstructed cystic duct and causes pain. Subsequent gallbladder relaxation allows the stone to fall back from the duct with subsequent pain resolution.
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biliary colic can have reffered pain where???
right-sided shoulder/subscapular discomfort
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Approximately 1 day after sustaining blunt abdominal trauma (BAT), this patient has fever, diffuse abdominal tenderness with epigastric guarding, and retroperitoneal free air on imaging. This delayed presentation is concerning for a perforated viscus within the retroperitoneum, most likely where ????
duodenal tear
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??? is a common complication of cholecystectomy and occurs due to the overly rapid release of bile into the intestines, where it overwhelms the resorptive capacity of the terminal ileum and spills into the colon, resulting in secretory (fasting) diarrhea.
Bile acid diarrhea
Bile-acid binding resins (eg, cholestyramine, colestipol, colesevelam) are first-line therapy.
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??? is primarily used for suspected choledocholithiasis, which generally causes abdominal pain, nausea/vomiting, and laboratory abnormalities (eg, elevated transaminases, bilirubin, and alkaline phosphatase).
Endoscopic retrograde cholangiopancreatography
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??? is primarily used to exclude cholecystitis in patients with suggestive symptoms (eg, severe right upper quadrant pain, fever, tachycardia, leukocytosis with left shift) but no gallbladder inflammation or biliary obstruction on ultrasound.
HIDA scan
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patient has been receiving aggressive fluid resuscitation in the setting of acute pancreatitis, an inflammatory condition that can cause abdominal swelling from visceral edema, intraabdominal third spacing of fluids, and ileus (evidenced by decreased bowel sounds). Now, he has a tensely distended abdomen and clinical signs concerning for ????, including difficulty breathing and basilar atelectasis (from diaphragmatic elevation causing lung compression) and decreased urine output (from increased intraabdominal pressure reducing renal perfusion).
abdominal compartment syndrome (ACS)
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Occult gastrointestinal bleeding usually presents with unexplained iron deficiency anemia and/or a positive fecal occult blood test. Initial workup includes ????; small bowel evaluation (eg, video capsule endoscopy, deep enteroscopy) may be required if initial tests are unrevealing. The presence of hemorrhoids should not preclude this evaluation.
colonoscopy and upper endoscopy
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Anal fissures present with pain and rectal bleeding on defecation. Treatment includes increased fiber and fluid intake, stool softeners, sitz baths, and ???(2 more)
topical anesthetics and vasodilators (eg, nifedipine, nitroglycerin)
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??? should be suspected in patients who develop worsening abdominal pain, unstable vital signs, or signs (eg, fever, leukocytosis) of infection 7-10 days after onset of acute necrotizing pancreatitis. CT scan of the abdomen demonstrating gas within the pancreatic necrotic collection is diagnostic.
Infected pancreatic necrosis
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She was gaining weight well as an infant likely due to being on an all-liquid diet (requiring less esophagus distension). With the introduction of solid foods (around age 6 months), dysphagia became more pronounced and the patient's growth rate slowed due to increasing reliance on solid foods for her caloric needs. She had recurrent food impactions at the site of esophageal compression, seen on fluoroscopic esophagography at around the level of the aortic arch (eg, T3-T4). Her episodes of middle-lobe pneumonia were possibly due to aspiration.
what is the cause??
Vascular rings encompass congenital malformations of the aortic arch system that encircle the trachea and/or esophagus and cause compressive symptoms. Tracheal compression leads to biphasic stridor that increases with increased work of breathing (eg, crying, feeding).
Vascular rings can also present with esophageal compression symptoms, as in this patient with severe solid-food dysphagia.
**CT scan can delineate the anatomy forming the vascular ring and evaluate associated tracheal abnormalities.**
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??? is a rare cause of upper gastrointestinal bleeding that usually occurs as a complication of hepatic or biliopancreatic procedures. It presents with right upper quadrant pain, jaundice, and upper gastrointestinal bleeding.
Hemobilia (bleeding into the biliary tract)
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Clostridioides difficile infections can occasionally be complicated by ???, which usually presents with severe systemic symptoms (eg, high fever, tachycardia), leukocytosis, abdominal distension, and significant colonic distension on abdominal radiograph. Suspicion is often raised when a patient with C difficile infection stops having diarrhea and symptoms clinically worsen.
toxic megacolon
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patient with Clostridioides (formerly Clostridium) difficile infection (CDI) has worsening abdominal pain, signs of peritonitis, and severe colonic dilation (ie, toxic megacolon) despite appropriate medical management. The best next step is ??? to evaluate for colonic necrosis or perforation and to treat (eg, resect, lavage) the diseased colon.
laparotomy
clinical indicators warrant surgical evaluation:
* Signs of peritonitis: Diffuse abdominal tenderness, rebound tenderness (ie, tenderness with release of palpation pressure)
* Colonic dilation: Megacolon (ie, colonic diameter \>6 cm) on abdominal x-ray, with associated loss of smooth muscular tone (eg, decreased diarrhea)
* Increased serum lactate: Possible marker of colonic ischemia
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Patients with inflammatory bowel disease (IBD) are at highest risk of developing toxic megacolon (TM) early in the disease, sometimes at initial presentation. Patients with IBD-induced TM should receive ??
intravenous corticosteroids
Other management includes supportive care (eg, intravenous fluids, electrolyte repletion), bowel rest and decompression (eg, nasogastric tube), and broad-spectrum antibiotics. Nonoperative management is often successful; however, surgical intervention (eg, subtotal colectomy with end-ileostomy) may be required if symptoms fail to improve.
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?? may lead to fracture nonunion. Common symptoms include intermittent pain and swelling and sinus tract formation. Diagnosis is suggested by this patient's x-ray, which shows fragmentation of the bone and ragged, irregular fracture lines.
Chronic osteomyelitis
Open bone biopsy is recommended for microbiologic assessment, and treatment requires surgical debridement of the infected and necrotic bone
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Post-traumatic neuromas are due to the transection of nerve fibers and form over several weeks to months following injury or amputation. They cause pain with local pressure that can complicate fittings for amputational prosthetics. Injection of a local anesthetic can provide transient pain relief and confirm the diagnosis. Management typically involves ???
excision of the neuroma.
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A Salter-Harris type III (juvenile Tillaux fracture) is characterized by fracture of the distal tibial epiphysis and lateral physis (ie, growth plate) and most commonly occurs in adolescents when the physis is partially fused. Injury to the growth plate can cause ???
growth arrest and lead to persistent limb-length discrepancy
125
tx for phantom limb pain ??
Treatment of PLP is typically multimodal and may include:
* pharmacotherapy: antidepressants (eg, tricyclics), antiepileptics (eg, gabapentin), N-methyl-d-aspartate (NMDA) receptor antagonists (eg, ketamine), and analgesics (eg, acetaminophen, opioids).
* adjuvant therapies: biofeedback, cognitive behavioral therapy, and **mirror therapy** (ie, using a mirror to watch the reflection of the residual limb moving at the location of the absent limb).
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??? should be suspected in patients with back pain who have pain worse at night and unrelieved with rest, and focal vertebral tenderness.
Vertebral metastasis
Other features may include neurologic deficits, unexpected weight loss, and hypercalcemia. The most common cancers associated with vertebral metastasis include prostate, breast, kidney, thyroid, and non–small cell lung cancer, as well as non-Hodgkin lymphoma.
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posterior tibial fracture (tibia goes posterior) requires what work-up
ankle-brachial index to rule out vascular injury to posterior lying popliteal artery
+ Duplex US
+ palpation of popliteal and distal pulses
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Older patients with hip fracture should undergo definitive surgical correction as soon as reasonably possible. However, surgery may be delayed up to 72 hours to evaluate surgical risk and ensure medical stability.
what tests??
Echo, cardiac markers, chest x-ray
depends on what the patient is presenting with
129
Chronic neuropathic (Charcot) arthropathy is characterized by bone deformities resulting from repetitive trauma to the foot and ankle. what is the pathogenesis??
It develops in patients who have impaired sensation and joint proprioception (eg, diabetic peripheral neuropathy) that prevent the patient from adjusting weight bearing to avoid mechanically induced wear and tear.
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??? can present in either of 2 stages:
* Acute: Characterized by inflammatory erythema, warmth, and edema of the foot 1-2 days after minor trauma. X-rays at this stage usually show only soft tissue swelling without bone involvement.
* Chronic: Characterized by bone deformities noted on x-ray that typically include osseous fragmentation, new bone formation, and subluxation/dislocation predominantly in the mid and hind foot. Other common signs are loss of the metatarsal heads (pencil pointing) with osteopenia and phalangeal osteolysis. These changes often lead to neuropathic ulcers, arch collapse (rocker bottom feet), and callus formation.
Neuropathic arthropathy
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fat embolism syndrome (FES) occurs when fracture of a large, marrow-rich bone (eg, the femur) releases fat into the ?? circulation.
venous
\*can affect both pulmonary and CNS system
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??? is a benign but locally destructive neoplasm that is most common at the epiphysis of long bones in young adults. Most patients have local manifestations (eg, pain, swelling), but pulmonary metastasis and malignant transformation may occur. X-ray shows an eccentric lytic lesion, often resembling soap bubbles. The diagnosis is confirmed with biopsy, and surgery is first-line treatment.
Giant cell tumor of bone
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?? is characterized by anterolateral and superior displacement of the proximal femur along the physis (growth plate). It most commonly presents in adolescents with chronic hip pain. However, 15% of patients have only **referred thigh or knee pain**. Due to the referred nature of the pain, knee examination is normal. Characteristic findings on hip examination, however, include limited internal rotation, which causes the **foot to point laterally**, and thigh abduction and external rotation with passive hip flexion.
Slipped capital femoral epiphysis (SCFE)
\*typically in obese
Bilateral hip x-rays are diagnostic and show a posteriorly displaced femoral head.
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??? can be diagnosed based on clinical and x-ray findings, with no need for additional diagnostic testing. This patient's x-ray reveals osseous resorption, architectural foot disorganization, and midfoot arch collapse (ie, anatomical alignment between the intertarsal and tarsometatarsal articulations)
Chronic neuropathic arthropathy (complication of diabetic neuropathy)
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Sudden, forceful contraction of the quadriceps muscle can cause ???. Symptoms include an audible pop, rapid swelling, and inability to actively extend the knee against gravity. The patella rides low, with a palpable defect above the patella
rupture of the quadriceps–patellar tendon complex
diagnosis and extent of the injury can be assessed on MRI. Management of complete tears of the quadriceps tendon requires surgical intervention.
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??? is most common in obese, middle-aged adults, but it may also be seen in younger, well-conditioned individuals who participate in high-impact exercise or spend extended periods in bare feet. The pain is often worst when first standing from rest; it may lessen with activity but may again worsen after long periods of standing or walking. Physical examination typically shows tenderness at the calcaneus, especially with the toes passively dorsiflexed. Patients frequently have preexisting abnormalities of the arch (eg, pes planus, high arch)
Plantar fasciitis
Plantar fasciitis is characterized by inflammation and degeneration of the plantar aponeurosis (deep plantar fascia), a thick, fibrous band that extends from the calcaneus to the toes and supports the longitudinal arch of the foot. It is thought to be due to chronic overuse and repetitive microtrauma to the aponeurosis and its insertion point at the calcaneus.
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??? are typically seen in inexperienced athletes after initiation of a high-impact exercise program. Like plantar fasciitis, they cause pain at the heel that is worse with weight bearing. However, the pain can often be elicited by firm palpation at the sides of the heel (squeeze test).
Calcaneal stress fractures
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Plantar fasciitis initial management includes activity modification (eg, avoiding walking barefoot, reducing high-impact exercise), physical therapy (eg, fascial stretching, muscle strengthening exercises), and ??? , which reduce strain on the fascia. About 80% of patients recover within 1 year.
Calcaneal spurs are incidental and do not require treatment.
padded heel inserts
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??? cause pain and weakness at the shoulder. With the arm abducted over the head, the patient may be unable to lower the arm smoothly (drop arm test). An MRI scan can confirm the diagnosis.
Rotator cuff tears
140
Osteonecrosis (aseptic necrosis) of the femoral head / avascular necrosis of the femoral head can have what x-ray finding ??
can be negative for months; MRI is better for diagnostic
141
??? is most common in patients who perform repetitive arm movement above shoulder height. It presents with subacute pain on abduction. Impingement syndrome refers to compression of soft tissue structures between the humeral head and acromion and is a characteristic feature of this
Rotator cuff tendinopathy (RCT)
142
Displaced supracondylar fractures of the humerus most commonly present after a fall onto an outstretched hand with posterior displacement of the distal humerus fragment. The anteriorly displaced proximal humerus fragment can entrap the ??? (2), which pass anterior to the humerus.
brachial artery and median nerve
143
Stress fractures of the metatarsals are associated with a sudden increase in activity and are common in athletes and military recruits; the second metatarsal is most commonly injured. Initial treatment includes cessation of the offending activity and simple analgesics. Stress fractures of the ??? metatarsal are at increased risk for nonunion and warrant more aggressive treatment.
fifth (usually need casting or internal fixation)
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initial management of osteoarthritis of the knee includes weight loss, regular moderate activity, and topical or oral nonsteroidal anti-inflammatory drugs. In addition, exercises to strengthen ??? can reduce abnormal loading on the joint and protect the articular cartilage from further stress.
the quadriceps muscles
145
Succinylcholine is a depolarizing neuromuscular blocker that can cause life-threatening ??? in patients with a condition leading to upregulation of postsynaptic acetylcholine receptors (eg, skeletal muscle trauma, burn injury, stroke). Nondepolarizing neuromuscular blocking agents (eg, vecuronium, rocuronium) should be used with these patients.
Succinylcholine is a depolarizing neuromuscular blocker that works by binding to postsynaptic acetylcholine receptors to trigger influx of sodium ions and efflux of potassium ions through ligand-gated ion channels; depolarization occurs and temporary paralysis ensues (delayed repolarization of the skeletal muscle membrane). Patient has experienced an extensive skeletal muscle crush injury, which places him at risk for hyperkalemia due to skeletal muscle cell lysis (rhabdomyolysis). In addition, skeletal muscle injury leads to upregulation of postsynaptic acetylcholine receptors, which can result in massive efflux of potassium following administration of succinylcholine. Other relevant conditions that cause upregulation of acetylcholine receptors include burn injury, disuse muscle atrophy, and **denervation** (eg, **stroke, Guillain-Barré syndrome, critical illness polyneuropathy**).
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On initial examination, mild swelling was noted, although compartment pressures were measured as normal. However, over the next 12 hours, reperfusion (due to relief of the compression) and likely fluid resuscitation led to increased edema, evidenced by tense swelling and pain (eg, grimacing) on passive manipulation on reexamination. This is indication of?
Compartment syndrome can arise multiple hours after injury as swelling progresses. Serial examinations are essential for timely diagnosis. When compartment syndrome is suspected (eg, tense swelling, pain with passive manipulation), emergency surgical consultation for fasciotomy should be obtained.
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??? can be caused by trauma or prolonged compression of an extremity or by revascularization procedures. Symptoms include severe pain that is worsened on passive range of motion, paresthesias, and sensory and motor deficits.
Compartment syndrome
The diagnosis is confirmed by measuring compartment pressures but can be made on clinical grounds in high-risk patients. Management includes urgent fasciotomy.
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Dorsal displacement of the radius (as occurs in Colles fracture) can result in compression of the ???, which enters the wrist through the carpal tunnel and provides sensation to the lateral 3½ digits and motor innervation to the thenar muscles (eg, opponens pollicis, abductor pollicis brevis).
median nerve
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