Surg/Sports/ENT Flashcards
what does FAST stand for?
focused assessment with sonography for trauma, used to assess for intraperitoneal hemorrhage in patients with blunt abdominal trauma; HD stable patients with positive findings may undergo subsequent testing (abdominal CT); HD unstable patients - Xlap
anterior drawer vs Lachman test
test ACL injury
anterior drawer - patient supine with knee flexed; grip proximal tibia with both hands and pull
Lachman - place knee at 30 degree flexion, stabilize distal femur with 1 hand and pull proximal tibia with the other
laxity = positive test
Thessaly vs McMurray test
test meniscal tear
Thessaly - patient stands on 1 leg with knee flexed 20 degrees; patient then internally and externally rotates on flexed knee
McMurray - passive knee flexion and extension while holding the knee in internal or external rotation
culprits in emphysematous cholecystitis
Clostridium perfringers (must cover with ampicillin-sulbactam) and some E. coli strains
Fitx-Hugh Curtis syndrome
perihepatitis in the setting of PID, imaging shows inflammation of hepatic capsule
torus palatines
young individual with benign bony growth located on the midline suture of the hard palate, no tx required unless sx’tic
old man w acute onset severe back pain, syncope, hypoTN, and hematuria
AAA rupture –> venous congestion in retroperitoneum –> venous congestion –> rupture of bladder veins –> hematuria
acalculous cholecystitis is most often seen in …
severely ill patients in the ICU with multi organ failure, severe trauma, surgery, burns, sepsis, prolonger parenteral nutrition; likely d/t cholestasis and gallbladder ischemia leading to secondary infection by enteric organism and resultant edema/necrosis; tx immediately with abx followed by percutaneous cholecystostomy and then cholecystectomy once patient is stable
mesenteric ischemia usually presents with
sudden periumbilical pain out of proportion to exam findings in patients with older age, A fib, and CVD
tx of anal fissures
dietary modifications, soon softener, sitz bath, topical anesthetics (topical lidocaine) and vasodilators (nifedipine)
adhesive capsulitis
fibrosis and contracture of glenohumeral joint capsule –> frozen shoulder; decreased passive and active ROM; stiffness > pain
female athlete triad
low caloric intake, hypo/amenorrhea, low bone destiny –> risk factors for stress fractures
retropharyngeal abscess progression
presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. swelling fish bone). Infection within the retropharyngeal space can drain into the superior mediastinum. Infection through the alar fiascos into the danger space can transmit into the posterior mediastinum and result in acute necrotizing mediastinitis
Ludwig angina
rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces, most often arising from an infected mandibular molar
3 criteria for x lap in patient w abdominal trauma (blunt or penetrating)
1) HD instability
2) peritonitis
3) evisceration
hypocalcemia ECG finding
QT prolongation
psoas abscess presentation
subacute fever, abdominal/flank pain radiating to the groin, anorexia/wt loss, psoas sign (pain with hip extension)
blunt abdominal trauma timing
may take several days to present, i.e. patients may not initially show evidence of mesenteric vessel injury and should be considered for longer period of obs/monitoring
vascular complication of cardiac catheterization
retroperitoneal hematoma - i.e. bleeding from arterial access site - occurs within 12 Horus of catheterization; presents with sudden HD instability and flank/back pain
other complications: arterial dissection, acute thrombosis, pseudoaneurysm, AV fistula formation
stress fracture radiologic finding
x-ray may be initially normal but can show hairline lucency or periosteal thickening
tx of metatarsal fx
fx of metatarsal 2-4 are managed conservatively as the surrounding metatarsal act and splits and nonunion is uncommon
postgrastrectomy complication, presents with GI and vasomotor sxs after meals (nausea, diarrhea, cramps, palpitations, diaphoresis); caused by loss of normal action of the pyloric sphincter d/t injury or surgical bypass –> rapid emptying of hypertonic gastric contents into small intestine –> causes shifts in intravascular space to small intestine; managed with dietary modification (eating freq smaller meals with increased fiber/protein rather than simple sugars)
dumping syndrome
patients with revised cardiac risk index (RCRI) >/= 2 must receive what to reduce cardiac mortality during surgery?
preoperative beta blockage
number one limiting factor prior to surgery is
history of CVD; patients must be medically optimized prior to surgery
prior to surgery, patient with hx of cardiac disease, regardless of age, needs
an ECG, stress testing, and an Echo
if patient is under 35 and has no CVD hx, only ECG
shock occurs when
tissues in the body do not receive enough O2 and nutrients to allow cell function; you’ll see tachycardia and hypoTN but also
brain - confusion kidney - increased BUN:Cr ration liver - high enzymes heart - chest pain and SOB blood - increased lactic acid
CO =
SV =
TPR =
BP =
CO = SV x HR SV = EDV - ESV TPR = MAP - MVP* BP = CO x TPR
*mean venous pressure
Kehr sign
pain in the left shoulder –> splenic rupture
Hamman sign
crunching heard upon palpation of the thorax d/t subcutaneous emphysema
Boerhaave syndrome diagnostic test
Gastrografin esophagogram showing leakage
Gastrografin = diatrizoate meglumine and diatrizoate sodium solution
the most common cause of esophageal perforation is
iatrogenic
mgmt of gastric perforation
make patient NPO, place NG tube, IVFs and broad spectrum abx’s –> surgery
most common complication after diverticulitis
abscess formation
right-sided (cecal) diverticulitis
often misdiagnosed as appendicitis; tx medically (abx’s)
acute pancreatitis dx
CT best, amylase most sensitive, lipase most specific
biliary colic caused by
contraction of the gallbladder against stone –> increases in intra-gallbladder pressure –> pain
tx of acute cholangitis
remember Charcot’s triad and Reynold’s pentad; U/S shows dilated CBD (MRCP more accurate)
give abx’s then decompress CBD
if patient HD stable –> ERCP
HD unstable –> PTC (percutaneous transhepatic cholangiogram)
later - elective cholecystectomy
small bowel obstruction vs ileus
small bowel obstruction - hx of surgery; dissension and increased bowel sounds; small bowel dilation
ileus - recent surgery / metabolic or pharmacological causes; reduced/absent bowel sounds; small and large bowel dilation
trigger finger
acutely flexed and painful finger, caused by stenosis of tendon sheath; tx with steroid injections
Dupuytren contracture
men >40, palmar fascia becomes contracted and hand cannot be fully extended open, tx surgically
special tx of fat embolism
requires oxygen to keep PO2 over 95%
herniated disk disease
lifting injury, electric pain shooting down dermatomal distribution, + straight leg raise
management of AAA by size
3-4 cm - US every 2-3 years
4-5.4 cm - US every 6-12 months
>5.5 cm - repair
the most common ECG finding for PE
nonspecific ST segment changes (NOT S1-Q3-T3)
dx of PE in patient who has allergy to IV contrast
V/Q scan
ischemia-reperfusio syndrome
repercussion of limb following arterio-ocussive ischemia for 4-6 h –> edema –> compartment syndrome (occurs when pressure within a muscular fascial compartment rises above 30 mmHg)
5 causes of hypoPTHism
1) post surgical
2) autoimmune
3) congenital (DiGeorge)
4) defective calcium-sensing receptor on PTH glands
5) infiltrative disease (hemochromatosis, Wilson, radiation)
mgmt of c spine injury
initial stabilization of the c spine, unless there is significant facial trauma, orotracheal intubation with rapid-sequence intubation is the preferred method of establishing airway in apnea patient with cervical spine injury
labs in acute mesenteric ischemia
leukocytosis, elevated Hb (d/t hemoconcentration), elevated amylase, and metabolic acidosis (d/t lactate)
sxs of opioid withdrawal
GI sxs with increased bowel sounds, flu-like sxs, signs of sympathetic nervous system activation (mydriasis, agitation, anxiety)
colicky RUQ pain in patient with previous cholecystectomy, elevated enzymes, worsened by opioid analgesics
sphincter of Oddi dysfunction
