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[2b] A- step 2 CK > Surgery > Flashcards

Surgery Flashcards

1
Q

1st and 2nd steps for treating acute variceal bleeding

A

1st: 2 Large bore IV needles vs. central line for IVF

2nd: Endoscopic clerotherapy vs. band ligation

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2
Q

Postop Cholestasis develops after surgerys that involve ____, _____ and _____. Why is this?(3)

A

hypOtension / [extensive blood loss into tissue] / [massive blood replacement]

  1. DEC Liver function from hypOtension
  2. DEC Renal bilirubin excretion from ischemic tubular necrosis
  3. INC pigment load from transfusion
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3
Q

Surgical repair for hip fractures may be delayed up to __ hours. Why?

A

72 hours; address unstable medical comorbidity first

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4
Q

How does SBO present (4)? What’s most common cause?

A
  1. Nausea
  2. Vomiting –> hypOkalemia
  3. [Bloating - Hyperactive “tinkling” Bowel Sounds]
  4. [Dilated Bowel Loops X-ray]

Adhesions! (operations)

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5
Q

When and what demographic does [Isolated Duodenal Hematoma] occur?

1st line tx? 2nd line tx?

A

[Abd trauma to children]–>blood between mucosa and submucosa –> resolves spontaneously in 1-2 weeks

Tx =

1st: [NG suction + Parenteral nutrition]

alternative: Laparascopic hematoma removal

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6
Q

Describe Varicoceles.

Etiology?

A

Tortuous Dilation of Pampiniform Venous Plexus surrounding spermatic cord & testis within scrotum

L renal vein compression (from Aorta and SMA or thrombosis) –>L side scrotal bag of worms worst with standing/valsalva and better when supine

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7
Q

[Retropharyngeal Abscess] presentation (5)

Why does this have to be treated STAT?

A

Odynophagia / [Painful Neck Extension] / Fever / Sore throat / [Trismus (inability to open mouth)]

Abscess infection may spread into mediastinum!

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8
Q

Dx(2) and Tx(2) for [Retropharyngeal Abscess]

A

Dx = CT neck vs. Lateral Radiographs–>Demonstrates cervical spine Lordosis

Tx = IV Abx + IND

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9
Q

Complications of SBO (2)?

Management (2)

A

Strangulation vs. Perforation

Mgmt = [Surgical Exploration] vs. [NPO & IVF –> NG tube suction]

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10
Q

Diverticulitis Abscess Tx

A

CT guided-percutaneous (alternative surgical) abscess I&D

Diverticulitis = Soft tissue stranding & colonic wall thickening

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11
Q

INR for normal people

A

0.8 - 1.2

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12
Q

Therapeutic INR range for pts on warfarin

A

2 - 3

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13
Q

Acute GI perforation requires emergent _____

A

Laparotomy (surgical incision thru abd wall)

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14
Q

MOD of [Mesenteric Bowel ischemic colitis] post AAA repair

A

inadequate [Left and Sigmoid Colon] arterial perfusion from IMA during aortic graft placement –> Ischemia

CT revealing air & edema in bowel wall –> thickening = MBIC

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15
Q

Step-wise process for [Blunt Abd Trauma in hemodynamically unstable pts]. Any Caveat?

A

DPL = Diagnostic Peritoneal Lavage = aspiration of 10 mL of peritoneal fluid with blood = intraperitoneal injury

Caveat = PENETRATING ABD TRAUMA (GUNSHOT/STAB) = SKIP DIRECTLY TO XLAP (Xploratory LAPARATOMY W/REPAIR)

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16
Q

Staph Aureus and Staph Epidermidis both affect prosthetic joints. What is the difference?

A

[Staph Aureus = Acute ( < 3 mo. onset)] & may only require debridement

[Staph Epidermidis] = Delayed > 3 mo. onset and must be replaced

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17
Q

PrePatellar bursitis is often due to _______, but other causes include ____ or _____

A

S.Aureus (infects bursa via trauma vs. friction vs. extending from local cellulitis); [Gout Crystalline Arthropathy], [Rheumatoid Arthritis]

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18
Q

CT scan shows ______ which indicates _____. What causes this? Tx(2)?

A

[air in DEEP tissue]; Necrotizing Fasciitis;

[Group A Strep Pyogenes] (but typically polymicrobial) spreads rapidly thru SubQ & deep fascia after minor trauma –>

PAIN OUT OF PROPORTION WITH EXAM +

hypOtension +

[Erythema & Swelling]

Tx = Debridement + Broad Abx

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19
Q

What is the first sign of hypOvolemia

A

INC HR

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20
Q

Massive Hemoptysis is defined as _____ or _____. The greatest danger for this is _____. What is the mngmt(4)?

A

[>600 mL expectorated blood over 24 hours] vs. [Bleeding > 100 mL/hour] –> Asphyxiation from blood in airway

1st: Establish airway and maintain ventilation & gas exchange
2nd: Pt is placed with bleeding lung in lateral decubitius to prevent bleeding from going to other lung
3rd: Bronchoscopy to localize bleeding site and provide suction/electrocautery
4th: Thoractomy if it’s unilateral bleeding or bleeding persist despite bronchoscopy

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21
Q

On which PostOp Day is atelectasis most common? Explain how this causes Respiratory Alkalosis

A

POD2! ; PostOp pain vs. Residual anesthesia vs. tongue prolapse —> hypOxemia and INC work of breathing –> Hyperventilation —> Respiratory Alkalosis

Acute PE may present similarly

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22
Q

Femoral n. Function (2)

A

[Knee extension] & [hip flexion]

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23
Q

Femoral n. innervation (2)

A

[ANT thigh] & [Medial leg via saphenous branch]

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24
Q

Obturator n. function

A

Thigh ADDuction

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25
Q

Obturator n. innervation

A

medial thigh

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26
Q

[PiloNidal Dz] MOD

A

sweating/friction of coccyx skin in young males with body hair –> Hair follicle infection–>spreads SubQ –> Abscess that ruptures to form [piloNidal sinus tract]

Tx = I&D + Sinus tract excision

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27
Q

Flail Chest presentation (3)

A

Pt with recently fractured ribs who has..

  1. paradoxic thoracic wall movements (inverted chest wall w/inspiration, correted when on positive pressure)
  2. [shallow tachypneic breathing]
  3. Respiratory distress despite chest tubes
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28
Q

A pt with pneumobilia, [hyperactive bowel sounds] and Dilated loops of the bowel probably has _____. What’s biggest Risk Factor for this? Dx? Tx?

A

Gallstone iLeus (gallstone passes thru biliary enteric fistula into small intestine)–>air in biliary tree (pneumobilia); Cholecystitis

Dx = CT

Tx = Surgery

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29
Q

Flail Chest etiology and tx(3)

A

Multiple ribs fractured in GOE 2 locations –> segment of ribs losing continuity with thoracic wall –> Rib collapse with inspiration –> shallow breahs –> Hyperventilation

Tx = Pain control + supplemental O2 + [Intubation w/CPAP]

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30
Q

Pt with suspected Claudication 2° to [Peripheral Artery Disease]

Dx test? Describe the test

A

ABI (Ankle Brachial Index) = inexpensive/noninvasive measurement of systolic BP Ankle:Brachial

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

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31
Q

Clinical presentation for [Paralytic iLeus] (4)

A

[Abd pain following trauma or abd surgery]

+

[Xray with Dilated loops of STOMACH, SMALL & LARGE intestine]

+

[hypOactive bowel sounds]

+

Obstipation (can’t pass flatus/stool)

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32
Q

MOD and Presentation(3) of Acute Mediastinitis

A

[intraoperative (cardiac surgery)] wound contamination –>[Purulent Sternal wound drainage] + [infection signs] + [widened mediastinum]

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33
Q

Tx for Acute Mediastinitis (3)

A
  1. Drainage
  2. Surgical Debridement
  3. Broad Abx
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34
Q

Mngmt for [Gallstones without sx]

A

NOTHING

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35
Q

Mngmt for [Gallstones with biliary colic] (2)

A

[Elective Lap Chole] vs. [UrsoDeoxycholic acid in poor surgical candidates]

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36
Q

Mngmt for Complicated Gallstones (Acute cholecystitis vs. CholeDocholithiasis vs. Gallstone pancreatitis)

A

Cholecystectomy within 72 hours!

Acute Cholecystitis = inflammation & distension of gallbladder from [cystic duct obstruction]

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37
Q

Dx and Tx(2) for MCL tear

A

Dx = MRI (surgical candidates only)

Tx = Surgery vs. [RICE in uncomplicated MCL tears]

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38
Q

Both Hemothroax and Tension PTX produce hypOtension, tachycardia and tracheal deviation.

What’s the difference in Physical Exam?

A

Hemithorax = DULLNESS to percussion

vs.

Tension PTX = HYPERRESONANCE TO Percussion

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39
Q

Dx(2) and Mngmt(3) of [Aortic injury 2° to rapid deceleration]

A

Dx = Upright CXR showing (widened mediastinum/hemothorax/interrupted aortic contour) –>confirmed by CT

Mngmt = [ABC Cardiopulm stability] –> AntiHypertensives –> Surgery

ABC = Airway / Breathing / Circulation secure

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40
Q

[Diaphragmatic Hernia] MOD

A

INC intraabd pressure from Blunt Abd trauma causes radial tears in diaphragm muscle –> leakage of abd contents into LEFT chest (R protected by Liver) –>Lung compression & bowel strangulation –> FAST DEATH

Image showing NG tube in the upper chest

Tx = Surgical Repair

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41
Q

Umbilica hernia is most commonly associated with ____ (4). Umbilicalhernias may contain what?

A

Blacks

Prematurity

[Beckwith Widemann]

hypOthyroidism

**Umbilical hernias may contain omentum vs. small intestine**

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42
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 0 - 2 Hours PostOp (3)

A
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43
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 1 Day - 1 Week PostOp (3)

A
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44
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 1 Week - 1 Month PostOp (5)

A
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45
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens More than 1 month PostOp (2)

A
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46
Q

Syringomyelia etx

A

[Whiplash Spinal Cord Injury] vs. [Arnold Chiari Malformation] –> disrupted CSF drainage in central canal –> compression of STT and CST

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47
Q

[Pulmonary Contusion] is ___ of the lung that occurs within ____ days of injury

A

Parenchymal bruising; 1-2

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48
Q

How is Epidural Hematoma (think blunt head trauma) associated with Cushing’s Reflex?

A

Epi Hematoma –> INC elevated ICP –(can)–> [TUMTL herniation (COPPR)] & [Cushing’s Reflex]!

Cushing’s Reflex = HBO (HTN / Bradycardia / slOw breathing) and indicates INC ICP

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49
Q

All trauma pts should receive ____ stability and ____ immobility until ___ injury has been ruled out. List the mngmt in order (3)

A

[ABC cardiopulm]; spine; spinal cord injury

1st: [Cardiorespiratory stability and Spine immobility]
2nd: Urinary Catheter to assess for urinary retention and prevent bladder injury
3rd: Imaging for spinal cord injury

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50
Q

Dumping Syndrome MOD and Sx(5)

A

rapid emptying of hypertonic stomach contents into Duodenum & small intestine (usually after gastrectomy or RYGB) –> DDUMP

Diarrhea

Diaphoresis

[Umbilical ABD Pain]

M (N)ausea

Palpitations

worst after eating and better at night

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51
Q

Pt with Blunt Abd Trauma shows spleen hemorrhage on FAST but is hemodynamically stable: Next 2 steps?

A

[CT Abdomen w/contrast] –> Repair spleen –> Remove if necessary with immunization against encapsulated bacteria

If pt responds to fluids (SBP > 100) and doesn’t require blood

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52
Q

Definition of Shock

A

Any state that causes perfusion inadquate to meet O2 and nutritional demands of tissue

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53
Q

An elevated [Pulmonary Capillary Wedge Pressure] following MVA suggest what? How do you confirm this?

A

Myocardial Contusion; Giving Saline will worsen PCWP but not change systemic BP

damage to L Vt during MVA –> INC intracardiac filling pressures

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54
Q

During a Tension PTX, what 2 anatomic sites are best for needle thoracostomy?

A

1st: [MidClavicular 2nd ICS (InterCostal Space)]
2nd: [MidAxillary 5th ICS]

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55
Q

Which part of the airway is usually perforated during blunt thoracic trauma

A

R Main Bronchus

Tracheobronchial perforation

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56
Q

What is a [Marjolin Ulcer]

A

SQC arising within a Burn wound

Note: SQC arising within chronic skin wounds are more aggressive!

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57
Q

How does shallow breathing and weak cough contribute to PostOp (POD2-5) atelectasis?

A

shallow breathing –> DEC alveoli recruitment at lung bases

weak cough –> INC small airway mucus plugs

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58
Q

Which pts are most at risk for [Acute S.Aureus Parotitis]?(2)

How do you prevent this(2)?

A

[Dehydrated PostOp pts] & Elderly

[Fluid Hydration] & [Oral Hygiene]

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59
Q

Name the Rotator Cuff Muscles (4). List each of their function.

A

Supraspinatus(most commonly injured) = initiates Arm ABduction

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60
Q

Describe the “Empty-Can” test and which muscle it test for? How is this related to a [Drop arm sign]

A

[ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] –> Pain = [Supraspinatus Rotator cuff injury]

Arm passively ABducted passed 90° that drops when released = no ADDuction which = Rototar cuff injury as well

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61
Q

Describe [Popeye sign] and what causes it?

A

[Bicep m. belly] pops up out of mid upper arm; [Bicep long head tendon rupture]

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62
Q

Classic sx of [Pancreatic ADC] (5)

A

Fat Guys Can Smell Terribly

  1. [Gnawing Epigastric pain-worst at night-not relieved w/AntiAcids or food]
  2. **[Courvoisier Palpable Gallbladder w/Painless Jaundice]**
  3. FFAW CA signs (Fever, Fatigue, Anorexia, Weakness)
  4. [Trousseau Migratory Thrombophlebitis]
  5. Steatorrhea
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63
Q

After catheterization how long should you stay vigilant for hemorrhage/hematoma formation? Which vasucular site is highest risk?

A

12 hours; Arterial puncture site above inguinal ligament –> retroperitoneal hematoma

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64
Q

Retroperitoneal Hematoma/Hemorrhage

Dx?

Tx?

A

Dx = [CT Abd/Pelvis]

Tx = [Fluid & Blood Resuscitation]

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65
Q

Describe how [Anterior Shoulder Dislocation] occurs? What neurovasucular bundle does it damage?

A

[Forceful ABduction + External Rotation] @ Glenohumeral joint –> [Axillary n. and artery] damage

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66
Q

[Mesenteric Bowel ischemic colitis]

Sx (5)

A

[Periumbilical pain out of proportion to PE(i.e. may not have TTP)]

Peritoneal signs (guarding, rebound)

[NV-BloodyDiarrhea]

CT revealing air & edema in bowel wall–>thickening = MBIC

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67
Q

[Pancreatic Retroperitoenal abscess] MOD and prognosis(3)

A

Blunt abd trauma compresses [Pancreas neck vs. body] against vertebral column –> contusion –>

devitalized tissue,

pseudocyst

and ultimately DEATH if not diagnosed

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68
Q

Explain why appendicitis pts have periumbilical pain that radiates to RLQ and then LLQ TTP

A

[Appendiceal wall stretching = periumbilical pain] and when [peritoneum becomes inflammaed = RLQ radiation].

[Rovsing sign = LLQ TTP can also occur]

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69
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Verbal Response] component (5)

A

Coma / Bacterial meningitis / Brain Trauma / SubArachnoid Hemorrhage

EVM = Eyes / Verbal / Motor

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70
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Eye Opening] component (4)

A

Coma / Bacterial meningitis / Brain Trauma / SubArachnoid Hemorrhage

EVM = Eyes / Verbal / Motor

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71
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Motor Response] component (6)

A

Coma / Bacterial meningitis / Brain Trauma / SubArachnoid Hemorrhage

EVM = Eyes / Verbal / Motor

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72
Q

DDx for Anterior Mediastinal Mass (4)

A

4 T’s

[Teratoma Germ cell tumor (Seminomatous vs. NonSeminomatous)]

Thymoma

Thyroid CA

Terrible lymphoma

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73
Q

Diagnosis? Composition? Complications (5)?

A

Pancreatic Pseudocyst

Walled off [amylase-rich fluid] surrounded by a fibrous capsule –->

[Infection / [Biliary obstruction] / [Psuedoaneurysm (digestion of adjacent vessels)] / ascities / (Pleural Effusion)

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74
Q

Mngmt (2)

A

Pancreatic Pseudocyst

[Embolize pseudoaneurysm if present –> Endoscopic drainage]

CT image shows Pseudoaneurysm

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75
Q

How is an [abd succussion splash] performed? What does it indicate?

A

With stethoscope over upper Abd, pt is rocked back and forth at hips –> [meals in stomach > 3 hours] make “splash” sound

=

Gastric Outlet Obstruction

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76
Q

Diagnosis? Complications?

Image shows L arm

A

[Supracondylar Humeral FOOSA] fracture –> Entrapement of Brachial A. or Median Nerve

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77
Q

Initial mngmt of Burn pts is similar to Truama in that ABC is done first

Why is this(2)? What are the 2 options?

A

Supraglottic airway is susceptible to direct thermal injury and obstruction by edema or blistering;

Use NonRebreather Mask –> [Intubation if PE shows thermal damage to airway(Face burns/Oropharyngeal blisters/GOE 10% CarboxyHgB/Eye Singing)]

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78
Q

Mngmt for suspected [Scaphoid fracture] (2). What should be used if you need immediate diagnosis(2)?

A

[Wrist immobilization with thumb spica cast x 7-10 days] –> [Repeat X-Rays]

Use CT or MRI for immediate diagnosis

DO THIS EVEN IF INITIAL X-RAY IS NEGATIVE. CAN TAKE UP TO 10 DAYS FOR ABNORMALITIES TO SHOW!

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79
Q

Where do Stress fractures occur in pts involved in…

A: Jumping sports

B: Runners

What are the X-ray findings?

A

A: Jumping sports = [TIBIA Anterior middle third]

B: Runners = [TIBIA Posteromedial Distal third]

X-rays are typically normal initially!

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80
Q

In regards to sx presentation, what is difference between Arterial Embolism and Thrombosis?

A

Arterial Embolism = Abrupt Pain

vs.

Arterial Thrombosis = [insidious gradual pain] from progressive narrowing of vascular lumen

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81
Q

SIRS (Systemic Inflammatory Repsonse Syndrome) is defined as ______ vs. Sepsis which is ______

List Criteria for SIRS

A

[SIRS = NONinfectious] vs. [Sepsis = Infectious] cause of massive release of proinflammatory substances –> extensive tissue damage

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82
Q

Common causes of SIRS (4). How is this related to Sepsis?

A

[BVAP: Burns / Vasculitis / Autoimmune / Pancreatitis] –> SIRS –(can lead to) —> [Concomitant Staph Aureus vs. Pseudomonas infection] = Sepsis

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83
Q

When is Sepsis “Severe”?

What is the Diagnositc Criteria for Sepsis(5)

A

“Severe” Sepsis = Accompanied End Organ Dysfunction (oliguria, AMS)

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84
Q

How is AAA Repair of the ____ region related to [Anterior Spinal Cord Syndrome]

A

Thoracic AAA Repair –> [⬇︎Adamkiewicz radicular artery flow] –> [⬇︎ ANT Spinal Artery flow] —> [infarction of CST and STT areas]

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85
Q

Sx of [Leriche Syndrome] (3)

A

Arterial Dz –> “Leriche was in the CIA!”

  1. [Claudication bilaterally of Hip, Butt, Thigh]
  2. *** Impotence **** (Key sign)
  3. Atrophy bilaterally of LE
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86
Q

[Leriche Syndrome] MOD

A

“Leriche was in the CIA”

Arterial Dz (from smoking, atherosclerosis) –>Occlusion at Bifurcation of Aorta into the common iLiac arteries –> CIA

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87
Q

Causes of Compartment Syndrome (3)

A

Causes = [Trauma vs. [Prolonged Compression] vs. [Revascularization of Ischemic limb (fracture w/closed reduction)] ]–> Muscle swelling —> DEC venous blood flow –> eventually DEC arterial blood flow

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88
Q

What’s the most important prognostic indicator for Compartment Syndrome

A

Time it takes to do a Fasciotomy

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89
Q

Compartment Syndrome Sx (6)

A

The 6 P’s!

  1. POOP (Pain Out Of Proportion)
  2. [Paresthesia - EARLY finding]
  3. [Pulselessness - LATE finding]
  4. Pallor
  5. Poikilothermia (inability to regulate body temp)
  6. Paralysis
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90
Q

Tears of the ___ meniscus are more common than ___. It’s caused by _____. Initial test(2)? Confirmatory Test(2)?

A

MEDIAL > lateral; Twisting force against a fixed foot –> popping sound followed by acute pain

Initial test = Positive McMurray (palpable locking/catching when joint is rotated or extended under load) vs. Thessaly

Confirmatory = MRI vs. arthroscopy

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91
Q

3 common signs of [Blunt Aortic injury]?

What are 2 major causes?

Initial dx?

A

Tachycardia / HTN / [CXR Widened Mediastinum];

MVA vs. (Falls > 10 ft.)

CXR = Initial screening

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92
Q

Desribe Torus Palatinus

A

Congenital benign NonTender bony growth on midline of hard palate that can INC throughout life and ulcerate w/trauma

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93
Q

Adrenal Crisis Tx (2)

A

[IV Hydrocortisone vs. IV Dexamethasone] + IVS

Adrenal Crisis = Loss of Adrenal gland function

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94
Q

Pts taking Prednisone GOE __mg/day are at risk for Adrenal Crisis. How is this related to “Stress Doses”?

A

GOE 20mg/day prednisone –> Adrenal Crisis; Give these pts Stress Doses of glucocorticoids during an acute stressor (i.e. surgery)

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95
Q

Name the 1st and 2nd most common peripheraly artery aneurysm

A

1st/most common = Popliteal

2nd = Femoral (may compress Femoral n. –> Thigh claudication)

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96
Q

Pelvis fractures are often associated with ___urethral injury. What are the sx(3)?

A

Posterior (prostatic and membranous);

  1. Urethral meatus Bleeding
  2. High riding prostate (prostate displacement by pelvic hematoma)
  3. Scrotal Hematoma
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97
Q

In Clavicle fractures the shoulder is displaced ____ and ____. Why should a careful neurovasulcar exam be done?

A

Inferiorly and Posteriorly (pushed down and back); Clavicle is very close to Subclavian a. and Brachial plexus

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98
Q

What 2 injuries cause Clavicle fractures?

A

FOOSA vs. Directly Shoulder blow

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99
Q

[Mesenteric Bowel ischemic colitis]

Labs (5)

A

Labs: [⇪ Lactate –> Metabolic acidosis & ⇪Amyalse] [Leukocytosis] / [⇪HgB]

CT revealing air & edema in bowel wall –> thickening = MBIC

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100
Q

Pt with new whistling noise during respiration s/p rhinoplasty. Diagnosis?

A

Septal perforation 2° to Septal Hematoma

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101
Q

Tx for Metatarsal Stress Fracture (2)

Demographic(2)?

A

Rest + Analgesics

Athletes & Military

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102
Q

Terminal Hematuria (blood at end of peeing) suggest bleeding from where(3)?

A

[Bladder Neck/Trigone] vs. Prostate vs. [Posterior Urethra]

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103
Q

Initial Hematuria (bleeding at beginning of peeing) suggest what?

A

Urethral damage

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104
Q

Total Hematuria (blood all throughout peeing) suggest damge to what(2)?

A

Kidneys vs. Ureters

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105
Q

Which 2 organs are most frequently injured during Blunt Abdominal Trauma?

A

Spleen and Liver

BE ON THE LOOK OUT FOR SPLENIC LACERATIONS!!

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106
Q

In a pt with any Urethral injury, what’s first step in mngmt?

A

Assess and determine damage with Retrograde Urethrogram

Contrast retrogradely injected into urethra

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107
Q

Diagnosis? Explain findings (3)

A

Diaphragmatic Hernia

[L lower lobe opacity] + [Elevated Hemidiaphragm] + [Mediastinal shift]

Confirmed via CT Abd

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108
Q

Mngmt for [Small PTX in clinically stable pt]

A

[supplemental O2 (⇪ resorption)]

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109
Q

Mngmt for [LARGE PTX in clinically stable pt]

A

Large bore (14 - 18 gauge) needle thoracostomy

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110
Q

Mngmt for [LARGE PTX in clinically UNSTABLE pt]

A

Chest Tube thoracostomy

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111
Q

PostOp PNA can develop –> Septic shock which can —> Lactic Acidosis from _____. Mngmt (2)?

A

PostOp PNA can develop –> Septic shock which can —> Lactic Acidosis from tissue hypOperfusion.

Abx + [IV normal 0.9% saline]

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112
Q

5 signs of [Necrotizing Surgical Site]

A
  1. Dishwater Drainage (cloudy gray)
  2. SubQ crepitus
  3. Systemic signs (fever/hypOtension/tachycardia)
  4. Wound edge paresthesia
  5. PAIN out of proportion with PE

Develops into Necrotizing Facititis

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113
Q

What’s the most important step in managing Necrotizing Surgical Site/Fascitis

A

Surgical exploration

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114
Q

What part of the bladder can cause Kehr sign and why?

A

Dome of Bladder; it’s covered by peritoneum and allows leakage of urine into peritoneum–> Peritonitis–> Kehr sign since hemidiaphragm undersurface is covered by parietal peritoneum

115
Q

Kehr sign

A

Abd pain that refers to shoulder; caused by peritonitis and diaphragm irritation

116
Q

Overall lifetime dose of [Tetanus Toxoid vaccine] is ____ with a booster every ___ years.

A

[6 throughout childhood]; [q10 starting at age 19]

This is for USA

117
Q

Tetanus Px in a pt who has

[GOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[Booster not UpToDate]

+

[Clean minor wound]

A

TTV with NO [Tetanus Ig]

118
Q

Tetanus Px in a pt who has

[Uncertain/ LOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[Clean minor wound]

A

TTV with NO [Tetanus Ig]

119
Q

Tetanus Px in a pt who has

[GOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[Booster UpToDate]

+

[DIRTY SEVERE WOUND]

A

TTV with NO [Tetanus Ig]

120
Q

Tetanus Px in a pt who has

[Uncertain/ LOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[DIRTY SEVERE WOUND]

A

TTV + [Tetanus Ig]

121
Q

Normal range for Phosphorous

A

C1288 N3045

3.0 - 4.5

122
Q

CRITICAL range for Phosphorous

A

C1288 N3045

1.2 > x > 8.8

123
Q

Normal range for Mg

A

C1148 N1722

1.7 - 2.2

124
Q

CRITICAL range for Mg

A

C1148 N1722

1.1 > x > 4.8

125
Q

CRITICAL Range for [Total Ca+]

A

6 - 13

6.0 > x > 13.0

126
Q

4 signs of hypOcalcemia ( 6 > x total Ca+)

A
  1. Prolonged QT
  2. PeriOral tingling
  3. Muscle Cramps
  4. Seizures
127
Q

CRITICAL Range for [ionized Ca+]

A

0.76 > x > 1.49

128
Q

Tx for Anal Fissures (7)

A

SNF x 2 w/ Lidocaine

  1. Stool softeners
  2. Sitz Baths
  3. Nifedipine (relaxes sphincter to ⇪ blood to fissure for healing)
  4. NTG (relaxes sphincter to ⇪ blood to fissure for healing)
  5. Fluid intake
  6. Fiber
  7. Lidocaine
129
Q

Causes of Anal Fissures (5)

A

SNF x 2 w/ Lidocaine

  • Constipation
  • Prolonged Diarrhea
  • Anal Sex
  • Crohn Dz
  • CA
130
Q

Penile fracture MOD

A

Tunica Albuginea (wraps the corpus cavernosum) tears from bending while erect –> SNAP –>hematoma –>MORE bending

131
Q

Penile Fracture Mngmt (2)

A

Retrograde Urethrogram –> Surgical Repair

132
Q

An Abdominal Aorta > ___ cm at level of renal a. = Aneurysm

A

3

RF = Smokers / Men / CAD

133
Q

Presentation for AAA (4)

A
  1. Back Pain
  2. [hypOtension –> Syncope]
  3. [Umbilical Pulsatile Mass]
  4. Gross Hematuria (AAA ruptures into retroperitoneum and creates aortocaval fistula with IVC –>Venous congestion in retroperitoneal structures –> vein ruptures)
134
Q

Psoas Abscess presentation (3)

A
  1. Psoas Sign (Pain with Hip Extension)
  2. [RLQ DEEP TTP w/radiation to R Groin]
  3. Subacute Fever
135
Q

Psoas Abscess Dx

A

CT Abd/Pelvis

136
Q

Trochanteric Bursitis presents as _____ worsened by ___ (3)

A

[Mid Adult Unilateral Hip Pain]; Pressure / External Rotation / Resisted ABduction

137
Q

Risk Factors for Trochanteric Bursitis

A

Overuse

Trauma

Joint Crystals

Infection

138
Q

Eschar formation can compress blood & lymph circulation –> distal swelling –> Compartment Syndrome

When should an Escharotomy be performed?

A

When compartment pressure is within [25-40 mmHg]

139
Q

Explain why [Positive Pressure Mechanical Ventilation] is relatively contraindicated in hypOvolemic shock pts.

How do we circumvent this?

A

[PPMV ⇪ intraThoracic pressure] –> [DEC venous return/preload] –> circulatory collapse

Fluid Resuscitate BEFORE PPMV in these pts

140
Q

Signs of Emphysematous Cholecystitis (6)

A
  1. [Air Fluid gas] in GallBladder WALL & LUMEN
  2. Crepitus in Abd wall next to GB
  3. Fever
  4. RUQ pain
  5. Leukocytosis
  6. NV

THIS IS LIFE THREATNING!

141
Q

Causes of Emphysematous Cholecystitis (2)

A

[Gas-forming [Clostridium vs. E.Coli]] GB infection

THIS IS LIFE THREATNING!

142
Q

Emphysematous Cholecystitis Mngmt (2)

A

[Unasyn Ampicillin-Sulbactam] + [Emergent Chole]

THIS IS LIFE THREATNING!

143
Q

Emphysematous Cholecystitis RF (4)

A
  1. Gallstone hx
  2. DM
  3. [cystic artery ischemia]
  4. immunosuppressio

THIS IS LIFE THREATNING!

144
Q

Earliest sign of HYPERMagnesemia

A

Loss of Deep Tendon Reflexes

eventually –> Resp depression

145
Q

Why can bypassing or losing the iLeum –> Kidney stones

A

Fatty Acids are normally absorbed @ terminal iLeum. No Terminal iLeum = Fatty acids combine with Ca+ –> [⇪ Free Oxaluria absorption] –>[⇪Ca+Oxalate stone renal excretion]

146
Q

How should you volume replete hypovolemic shock in NON-urban setting?

A

[2L Lactated Ringer w/NO sugar] —> [Packed RBC] until Urinary Output =

[0.5-2 mL/kg/hr but not exceeding 15 mmHg CVP]

Urban setting = Take directly to Trauma Center

147
Q

What causes Vasomotor shock? (2)

A

Anaphylaxis or [Spinal Cord Transection vs. Anesthesia]

These pts are PINK and WARM

148
Q

Subdural Hematoma

Mngmt if midline is deviated?

Mngmt if midline structures are fine?

A

Subdural Hematoma

Craniotomy ONLY if midline is deviated

[Monitor/Prevent further ICP] if no midline deviation(elevate head/hyperventilate/mannitol/furosemide)

149
Q

Key signs of Pulmonary Contusion? (3)

A

Chest wall bruising

[DEC breath sounds on affected side]

[CXR: Patchy irregular alveolar infiltrate]

150
Q

Pt develops Coagulopathy during prolonged abd surgery for trauma. Next Step? (2) When would you terminate the surgery?

A

[10 units Fresh Frozen Plasma] + [10 units Platelet Packs]

TERMINATE IF PT DEVELOPS [hypOthermia & acidosis]

151
Q

Gunshot to upper anterolateral thigh away from vessels. 1st step in mngmt? (2)

A

TTV (Tetanus Toxoid Vaccine) + Wound Cleaning

Doppler vs. [Spiral CT angio] if near vessels

152
Q

Why is it important to monitor Peripheral pulses & Cap Refill in Circumferential Burns? Mngmt?

A

Circumferential Burns eventually —> Eschar which allows underlying edema to cutoff perfusion; Escharotomy

153
Q

signs of [Developmental Dysplasia of Hip] (2)

A

Congenital Hip dysplasia –>

  1. Easy Posterior Hip dislocation with a click & then snap when returned
  2. Uneven Gluteal Folds
154
Q

[Developmental Dysplasia of Hip] Dx? Tx?

A

Dx = US

Tx = [ABduction splinting with Pavlik harness x 6 mo.]

155
Q

Why is angulation of a fractured bone in kids ok, but not ok in adults?

A

Kids have accelerated bone Remodeling and as long as the fracture is reduced & immobilized, they’re fine

156
Q

How are Clavicular fractures managed?

A

Arm Sling

Clavicular fractures occur at junction of mid & distal third

157
Q

Classic presentation for Hip fracture (3)

A

[Elderly post fall] with affected Leg being shortened and rotated (internal vs. external)

158
Q

Tx for Intertrochanteric Fractures (2)

A

[Open reduction + internal fixation] –> [PostOp AntiCoags]

159
Q

Tx for Femoral Neck fractures

A

Replace femoral head with prosthesis

160
Q

Dx for Compartment Syndrome (2)

A

Dx = [Clinical in Revascularization pts] vs.

[Compartment pressures > 30 mmHg]

161
Q

pts who’ve fallen from high heights will have [foot/leg] fractures AND possibly _____ fractures as well

A

[Spinal Thoracic/Lumbar]

162
Q

Pt with triad of

  1. Digoxin
  2. Diuretics
  3. Abdominal Pain

..should make you suspect what dz?

A

MBIC! (Mesenteric Bowel ischemic colitis)

Digoxin = aFib

Diuretics = HF

Abd pain occurs after SMA or IMA are occluded

163
Q

[Mesenteric Bowel ischemic colitis]

Mngmt (6)

A
  1. O2
  2. IVF
  3. [Abx: CefTriaxone vs. (Levoflox + flagyl)]
  4. Pain control
  5. Heparin
  6. Laparatomy

CT revealing air & edema in bowel wall –> thickening = MBIC

164
Q

Causes of SBO in Adults (3)

A

Surgical Adhesions

Hernias

CA

165
Q

Causes of SBO in Kids (3)

A

Intussuception

Intestinal Atresia

Volvulus

166
Q

PE findings for Appendicitis (5)

A

PMR PD

  1. Peritoneal signs (Rebound, Guarding)
  2. McBurney’s point TTP
  3. [Rovsing’s LLQ TTP]
  4. [Psoas & Obturator sign]
  5. DEC bowel sounds
167
Q

DDx for SBO (14)

A

GIVES BAD CRAMPS

Gallstone iLeus

Intussuception (kids)

Volvulus (kids)

External compression (CA)

SMA syndrome

Bowel wall hematoma

Abscess

Diverticulitis

Crohn’s Dz

Radiation Enteritis

Annular Pancreas

Meckles Diverticulum

Peritoneal adhesion

Stricture

168
Q

Labs for SBO (3)

A

[⬇︎ K / H+(alkalosis) / Cl]

169
Q

Appendicitis DDx (8)

A
  1. Ectopic Pregnancy
  2. Ovarian Cyst/Torsion
  3. PID
  4. Crohn’s
  5. Pyelo
  6. Gastroenteritis
  7. Perforated ulcer
  8. Pancreatitis
170
Q

Acute Appendicitis mnmgt (3 steps)

A

LAS

1st: LR
2nd: [Abx: FUCCC= Flagyl, Unasyn, Cipro, Cefoxitin, Cefotetan]
3rd: Surgery? [Nonperf = Appy within 24 hours] vs. [Perf = Prompt appy with postop abx for 1 week] vs. [Abscess = perQ drainage + abx + interval appy]

171
Q

[Mesenteric Bowel ischemic colitis]

Dx (2)

A

Dx = [CT contrast] vs. [Mesenteric Angiogram]

CT revealing air & edema in bowel wall –> thickening = MBIC

172
Q

[MBIC-Mesenteric Bowel ischemic colitis] mngmt (4)

A
  • [NPO + IVF w/NGT decompression]
  • [minimal analgesics to watch for ⇪sx]
  • Colonic Bacteria Abx
  • [Surgery: Superceliac Aortic Graft vs. Intestinal resection vs. embolectomy]
173
Q

Mngmt for Diverticulitis (3)

A
  • [NPO + IVF]
  • Colonic Bacteria Abx
  • Rule out Colon CA!
174
Q

Diveriticulitis Dx

A

CT showing Edematous bowell wall & Free Air

175
Q

Acute Pancreatitis Mngmt (4)

A
  • [NPO + IVF]
  • Pain control
  • [NG decompression if emesis]
  • Possibly: [Postpyloric TF vs. TPN]
176
Q

Difference between [Jersey and Mallet finger]

Tx

A

Jersey = flexed finger is forcefully extended–>flexor tendon damage –> Distal phalanx won’t flex

Mallet = (THINK VOLLEYBALL) = EXTENDED finger is forcefully flexed –> extensor tendon rupture –> Distal phalanx won’t extend

Tx = Splint

177
Q

How can nutritional depletion be circumvented in surgical candidates?

A

7-10 day PreOp nutritional support directly to gut

178
Q

Parameters for Nutritional Depletion (4)

A
  • Albumin < 3
  • Transferrin < 200
  • [GOE 20% wt. loss over prior 2 months]
  • Skin Antigen Anergy

NUTRITIONAL DEPLETION ⇪ OPERATIVE RISK

179
Q

Green fluid draining from hemigastrectomy wound likely indicates _____. Mngmt?-3

A

Fistula(bowel –>wound);

  1. Fluids
  2. Nutrition
  3. Abd wall protection
180
Q

Name one of the key lab differences between

Acute Hemorrhagic Pancreatitis vs. Acute Edematous Pancreatitis

A

Hemorrhagic = lower Hematocrit

Edematous = HIGHER Hematocrit

181
Q

What is Ranson’s Criteria and what does it refer to?

A

[⇪WBC / ⇪ Glucose / ⬇︎Ca+] in the setting of low Hematocrit

Indicates Acute Hemorrhagic Pancreatitis

182
Q

[Ground Glass appearance of lower abd] is pathognomonic for _____

A

Meconium iLeus

MOTHER WILL HAVE CYSTIC FIBROSIS!

183
Q

Why is Gastrografin used as both diagnostic and therapy for Meconium iLeus

A

Diagnostic = it’ll show inspissated pellets of meconium in terminal iLeum

Therapeutic = Gastrografin draws fluid in and dissolves pellets

184
Q

Signs of Congenital Vascular Rings

A
  1. Stridor
  2. Crowing Respiration with positional hyperextension
  3. Dysphagia
185
Q

Vascular Rings MOD

A

Two Aortic Arches wrap around Trachea & Esophagus –> Segmental tracheal compression on Bronchoscopy

186
Q

Amblyopia MOD

A

Infants who don’t have Vision impairment (such as [Strabismus CrossEye]) fixed within first 6 years of life –> Permanent Cortical Blindness in affected eye since Brain eventually suppresses 1 of the overlapping images

187
Q

Demographic for SQC of Head & Neck

A

Old Men who smoke, drink, rotten teeth

188
Q

Dx for SQC of Head & Neck (2)

A

[Triple Panendoscopy to look for 1° tumor] –> CT to demonstrate extent

189
Q

Tx for [Mitral Stenosis s/p Rheumatic Fever] (2)

A

Surgical Commissurotomy vs. Balloon Valvuloplasty

190
Q

Pt with Frontal or Ethmoid Sinusitis is at risk for what serious complication? Tx?-2

A

Cavernous Sinus Thrombosis!;

Drain affected sinuses + IV Abx

191
Q

Testicular Torsion and Acute Epididymitis

Similarities-1 and Differences-2

A

Sim = Both have [Acute Testicular Pain]

Differences =

  1. TT has High Riding testes
  2. [AE has Fever, Pyuria & CORD TTP]
192
Q

What is the classic presentation for [Ureteropelvic Junction Obstruction] and why?

A

16 yom on a beer-binge for first time w/colicky flank pain; Large diuresis in a narrow area will produce flank colicky pain

193
Q

What should first be assessed in a deteriorating >5 day old Liver after transplant-2? Why?

A

[Biliary Obstruction via US] & [Thrombosis via Doppler]; Technical problems are more common than rejection in Liver transplants!

194
Q

In a compromised airway pt, what is the next option if intubation can not be done?

A

Cricothyroidotomy

195
Q

What are 2 scenarios that predispose to Air Embolism

A
  1. Trauma pt intubated and on respirator
  2. Subclavian vein opened to air (Central venous line placement,supraclavicular node biopsies)

Air Embolism –> Sudden Death from Cardiac Arrest!

196
Q

[Trauma pt intubated and on respirator] develops air embolism!

Mngmt?

A

Cardiac Massage w/pt L side down

197
Q

Mngmt for pts with trace hematuria post trauma

A

NONE! This is normal

198
Q

Method for biopsing breast masses

A

Mammographically/Sonographically-guided Multiple Core Biopsy

199
Q

Examples of Alkaline burns-2? Mngmt?

A

Liquid Plumer vs. Drano; H20 Irrigation for GOE 30 min –> ER

200
Q

[Knock Knee Valgus] is normal between what ages?

A

4 - 8 (No tx needed)

201
Q

[Bowlegged Varus] is normal between what ages?

A

birth - 3

[Bowlegged Varus] beyond 3 = Blount Dz which needs surgery

202
Q

Demographic for Dupuytren Contracture

A

Older Norwegian Men

203
Q

What are the Hepatic predictors of mortality during a surgery-4?

A

BAPE

(GOE 3 = 85% Mortality)

  1. Bilirubin > 2 ( > 4 alone = 85% Mortality )
  2. Albumin < 3 ( < 2 alone = 85% Mortality)
  3. PT time > 16
  4. Encephalopathy (Ammonia alone > 150 = 85% Mortality**)
204
Q

Cause of PostOp Fever specifically on POD3

A

UTI

205
Q

Cause of PostOp Fever specifically on POD5

A

Deep Thromboplebitis

Do Doppler and Anticoag w/Heparin!

206
Q

Cause of PostOp Fever specifically on POD7

A

SSI

207
Q

Cause of PostOp Fever specifically on POD10-15

A

Deep Abscess (Suphrenic / Pelvic / SubHepatic)

208
Q

Cause of PostOp Fever specifically on POD1

A

Atelectasis (which –> PNA in 3 days if not resolved)

209
Q

Wound Dehiscence

Description of draining fluid? Onset?

A

[Pink Salmon Peritoneal fluid] / POD5

210
Q

Wound Dehiscence Mngmt-3?

A

1st: Tape Wounds
2nd: Bind Abd
3rd: Schedule Operation to prevent Evisceration vs. Ventral hernia

211
Q

[Zollinger Ellison Gastrinoma] Dx-4

A

[Measure Gastrin] –> [If Gastrin is equivocal Measure Secretin(would be HIGH)] –> [Locate Pancreatic Tumor with CT] —> Remove tumor

212
Q

What conditions cause this-3?

A

[Newborn Green Emesis] + DOUBLE BUBBLE SIGN = DAM!

Duodenal Atresia

Annular Pancreas

Malrotation (Most dangerous)

213
Q

Cardiac Catheterization showing [Square Root Sign] and [Equilization of Pressures] indicates what dx?

A

Constrictive Pericarditis

214
Q

Sx for Retinal Detachment-3

A

THIS IS AN EMERGENCY!

  1. Flashes of light
  2. Floaters (⇪# = ⇪ Severity)
  3. [Dark Cloud vs. Snow storm vs. MANY floaters] in upper visual field = Extreme Retinal Detachment!
215
Q

Tx for Retinal Detachment

A

Laser spot welding

216
Q

What is Cushing’s Reflex?

A

Cushing’s Reflex = HBO Compensatory response to ⬆︎ ICP that preserves perfusion of the brainstem

HBO (HTN / Bradycardia / slOw breathing)

217
Q

Kidney stones of what size are eligible for invasive intervention?

A

≥7mm

218
Q

Tx for [Kidney stone ≥ 7 mm]

What are the Contraindications to this-3?

A

[ExtraCorporeal Shockwave Lithotripsy]

Cx = Pregnancy, [Coagulopathic Bleeding Diathesis], [Size > 1 centimeter]

219
Q

Demographic for Chronic Subdural hematomas-2 and why this is?

A

Old and Alcoholics; Shrunken Brain has EASY venous sinus tearing

220
Q

Hemothorax Mngmt. When is more invasive intervention indicated-2?

A

[Chest Tube Thoracostomy] ; Surgery only indicated if [> 1500 mL total] or [> 600 in 6 hours] is recovered

221
Q

Normally [Penetrating Abd Stab wounds require XLap]

In what situations is digital exploration of Abd stab wounds sufficient-3?

A
  1. NO evisceration (protruding viscera)
  2. NO peritoneal signs
  3. NO HemoDynamic instability
222
Q

Mngmt for Abd wound that can’t be closed due to tension-2

A

[Temporary Abd Cover (absorbable mesh vs. plastic)] –> [Graft over mesh vs. Remove Plastic] Later

223
Q

Dx for Bladder Injuries post trauma

A

[Retrograde Cystogram with Postvoid films]

Postvoid films needed to see xtraperitoneal leaks @ bladder base that are hidden by dyed bladder

224
Q

What determines Rabies px-2

A

[If animal is alive = Examine Animal Brain] vs. [Mandatory if animal n/a]

rabies px = IgG AND Vaccine

225
Q

Presentation of [SCFE - Slipped Capital Femoral Epiphysis] -4

A
  1. 13 yom with
  2. [Knee / Groin Pain + Limping]
  3. sole of affected foot pointed toward other foot
  4. Thigh can NOT be rotated internally during hip flex

Tx= immediate Surgery to avoid AVN

226
Q

What determines closed vs. open reduction in fractures involving growth plates?

A

Fractures involving [epiphysis and growth plate displaced laterally from metaphysis but in 1 piece = Closed Reduction]

but if fractures crosses epiphysis vs. involves joint = OPEN REDUCTION

227
Q

What bone pathology is associated with uncoordinated muscle contractions (seizure)? How do pts present?

A

Posterior Shoulder Dislocation; Internally rotated (arm held clsoe to body)

228
Q

Posterior Shoulder Dislocation Dx-2

A

Axillary vs. Scapular Lateral Xray

229
Q

Ankle fractures occur when _________ and leads to breakage of ______. Mngmt?

A

Falling on inverted OR everted foot –> BOTH malleoli breakage; [Open Reduction + internal fixation]

230
Q

Where does Lumbar disk herniation occur-2?

A

(L4-5) vs. (L5-S1)

231
Q

What is Morton Neuroma and what causes it?

A

tender inflammation of [Common Digital n.] between 3rd and 4th toe; High-heel shoes (forces toes to be bunched)

232
Q

Which drugs cause Malignant Hyperthermia-2?

A

Halothane vs. Succinylcholine

233
Q

Sx of Malignant Hyperthermia-3

A

MMalignant Hyperthermia

  1. Muscle contraction from Hypercalcemia
  2. Metabolic Acidosis
  3. Hyperthermia (Fever)
234
Q

Mngmt of Malignant Hyperthermia-4 and what should you be watching for?

A
  1. IV Dantrolene
  2. 100% O2
  3. Metabolic Acidosis Correction
  4. Cooling Blankets

BE ON THE LOOKOUT FOR MYOGLOBINURIA!

235
Q

Although ___ is gold standard for PE dx, ____ is more commonly used

A

Pulmonary Angiogram; [Spiral CT angiogram]

Image: Spiral CT Angio showing [R Pulm artery clot]

236
Q

PE Tx-2

A

Heparin –> [IVC filter if recurrence or Heparin contraindicated]

237
Q

Other than Free water changes, which fluid is HYPERnatremia corrected with?

A

D5 1/2NS (HYPERtonic)

238
Q

Other than Free water changes, which fluid is hypOnatremia corrected with-2?

A

NS vs. LR (both isotonic**)

239
Q

Mngmt for pt with [Long standing GERD + Barretts and peptic esophagitis]? Tx if there are SEVERE dysplatic changes?

A

Nissen Fundoplication; Resection

240
Q

[Obstructive Jaundice 2° to tumor] often has _____ on US. What is the dx w/u-3

A

[Courvoisier Palpable Gallbladder w/Painless Jaundice]

1st: US (did that) - shows distended GB
2nd: CT upper abd
3rd: ERCP

241
Q

Fever and Leukocytosis develops 10 days after onset of Pancreatitis. Diagnosis?

A

Acute Suppurative Pancreatic Abscess

242
Q

[Fibroademona] and [Cystosarcoma Phyllodes] are both [Firm, rubbery Breast masses, that occur in young women]

Name 3 things that make Cystosarcoma Phyllodes different from Firbroademona?

A
  1. CP has malignant potential! Removal MANDATORY
  2. CP grows over many years, distorting breast
  3. CP requires Core (Not FNA or US) Biopsy
243
Q

in [Congenital intra-utero Diaphragmatic Hernia], what’s the biggest issue? How is this addressed-2?

A

Lung hypOplasia in-utero; [Extracorporeal membrane oxygenation] –> Repair after 3 days postpartum

244
Q

Necrotizing Enterocolitis Presentation-3

A

Premature infant who just started feeding and develops [RAPID PLATELET DROP(sign of neonatal sepsis)], feeding intolerance, abd distension

245
Q

Necrotizing Enterocolitis Mngmt-5

A
  1. STOP FEEDINGS
  2. Broad Abx
  3. IVF
  4. IV nutrition
  5. Surgery (if abd wall erythema/portal vein air/pneumatosis/pneumoperitoneum develops)
246
Q

When is Surgical intervention indicated in Necrotizing Enterocolitis-4?

A
  • Abd Wall Erythema
  • Portal Vein air
  • Intestinal Pneumatosis (intestinal wall gas)
  • Pneumoperitoneum
247
Q

What is Foster Kennedy Syndrome-4

A

Tumor at [Base of Frontal Lobe] that makes u BOAP

  1. Behavior inappropriate
  2. [Optic n. atrophy ipsilateral to tumor]
  3. Anosmia
  4. [Papilledema CONTRAlateral to tumor]
248
Q

What’s the most common Postop maintenance fluid

A

D5 1/2NS (Hypertonic)

249
Q

When does Acute organ rejection occur and how do you manage it-2?

A

[5 Days - 3 mo. post op]; [Steroid Boluses and AntiThymocyte serum]

250
Q

Pt with a ureteral stone suddenly develops fever and flank pain. What’s Diagnosis and what needs to be done-2?

A

OBSTRUCTIVE PYELONEPHRITIS

1st: IV Abx
2nd: IMMEDIATE PROXIMAL TO STONE DECOMPRESSION (via Ureteral stent vs. PerQNephrostomy)

251
Q

Diagnosis? Describe-4

A

Venous Stasis Ulcer

Above Medial Malleolus

Chronically Edematous

Indurated (Hard)

Hyperpigmented

252
Q

How would you confirm this diagnosis? Tx-2?

A

Duplex Scan;

Tx = [Keep Veins empty (compression stockings/Unna boot)] vs. [Surgery(vein stripping/ulcer graft)]

253
Q

Hypernatremia and hypOnatremia both manifest with ____ and ____. What sx differentiates them?

A

BOTH = Confusion & Possible Coma

[HYPER = Lethargy] vs. [hypO = seizures]

254
Q

Paralytic iLeus is prolonged by which metabolic abnormality?

A

low K+

255
Q

Demographic-2 for Primary Peritonitis and tx

A

Demographic = [Child w/Ascites and nephrosis] vs. [Adult w/Ascites]

Tx = Abx only

Primary Peritonitis = Mild Generalized Acute Abd

256
Q

What are Hepatic Adenomas a complication of and why are they dangerous?

A

OCP; They can rupture and bleed into abd

257
Q

What class of drugs can be given to temporarily alleviate Biliary Colic

A

Anti-Cholinergics

258
Q

HTN in BUE + [Normal-to-No Pulses] in BLE typically indicates ______. What would CXR reveal?

A

Coarctation of Aorta; [Scalloping of lower edge of Ribs(from Dilated collateral intercostal a.)]

259
Q

Coarctation of Aorta Dx

A

Spiral CT Angio

260
Q

Pt with hemoptysis comes in with [Coin lesion on CXR]

What determines whether or not he needs w/u?

A

1ST: LOCATE PREVIOUS (At least 1 year prior or older) CXR! If lesion unchanged = NO CA

Coin lesions = 80% chance malignancy

261
Q

Brain tumors in kids are mostly located where? How does this manifest-2?

A

Posterior Fossa; Cerebellar Dysfunction + [Knee-chest position to relieve HA]

262
Q

Pt with Human Bite on knuckle: Mngmt-2?

A

Extensive irrigation and Debridement in OR

Human Bites are the DIRTIEST Bites!!

263
Q

Pt who’s been vomiting now has metabolic aLKalosis and needs fluid resuscitation: What do you give?

A

NS with added KCl

264
Q

[Osgood Schlatter Dz] MOD

A

Osteochondrosis of Tibial Tubercle –> Persistent Teenager Pain

265
Q

[Osgood Schlatter Dz] Tx-2

A

RICE —> [Cylinder cast x 4-6 weeks]

266
Q

What is the abx px for elective surgery? What about Complex prolonged procedures?

A

A = single dose abx [no more than 1 hour prior] to surgery;

Prolonged procedures = A + Redose abx during procedure

267
Q

What are the 4 main causes of somnolence?

A

He’s totally somnolent and GONE

Abnormalities with…

Glucose

Oxygenation

Narcotics

Electrolytes

268
Q

Pt on POD4 develops PNA and septic shock

What two tx are most important right now?

A
  1. IV NS to maintain intravascular pressure
  2. Abx
269
Q

What modality is necessary to confirm Diaphragmatic Hernia?

A

CT Abd

270
Q

When is it ok for pts concerning for appendicitis to skip CT and go directly to Lap appy?

A

Pts can skip CT if they have classic appendicitis signs (PMR PD)

Appendicitis can be based on lab and clinical findings!

271
Q

Syringomyelia presentation - 2

A

[Whiplash Spinal Cord Injury] vs. [Arnold Chiari Malformation] –>

[Cape distributed Loss of Pain & Temp] –> Burning and eventually Muscle Weakness

272
Q

Tubocurarine and Atracurium MOA ; Indication

A

Non-Depolarizing Nicotinic R Blockers; Muscle paralysis for endotracheal intubation and Surgery

273
Q

How do you evaluate a pt with mild TBI (concussion)?-2 ; When is it ok to discharge them?

A

NonContrast Head CT vs [5 hr observation period]; Pts can be DC’d with reliable guarden if the above is negative

274
Q

When should you do endovascular repair on an AAA? - 3

A
  1. Aneurysm > 5.5 cm
  2. Expansion rate is >1/2 cm in 6 months or >1 cm in 1 year
  3. Classic s/s present (abd/back pain, gross hematuria)
275
Q

In Vascular extremity trauma, when HARD signs of injury are present _____ is warranted immediately

What are the HARD signs of vascular injury?- 4

A

XLap

276
Q

In Vascular extremity trauma, when HARD signs of injury are present _____ is warranted immediately

What are the soft signs of vascular injury?- 4

A

XLap

Soft signs in image

277
Q

Legg Calve Perthes disease etx ;demographic

A

idiopathic Avascular Necrosis of the hip ; boys 5-7 yo

278
Q

Developmental Hip Dysplasia etx

A

abnml development of hip during utero –> leg length discrepancy and poorly formed femoral head

279
Q

Hydrocele etx ; Tx?-2

A

transilluminative fluid accompanies testis during scrotal descent and/or if processus vaginalis fails to obliterate this –. communicating hydrocele ;

Self Limited to 1 year old –> surgery if it doesn’t

280
Q

MOD for Cryptorchidism ; What are the 2 biggest complications for this disorder?; tx?

A

failure of testicular descent that can –> Torsion uncorrected and [⬇︎Fertility even if corrected].

Tx = if not naturally descended by 6 months –> Orchiopexy BEFORE 1 year old

281
Q

cp of Chronic Prostatis Pelvic pain syndrome - 4; Dx?

A
  1. chronic perineal pelvic pain worst with ejaculation
  2. chronic testicular pelvic pain worst with ejactulation
  3. Urinary Urgency with NO dysuria
  4. Urinary Frequency with NO dysuria

Dx = Clinical symptoms with Sterile urine cx

Dont confuse this with BPH which should NOT have back/pelvic pain

282
Q

tx for Chronic Prostatis Pelvic pain syndrome - 3

A
  1. Tamsulosin
  2. Abx if UTI hx present
  3. Finasteride

Dx = Clinical symptoms with Sterile urine cx

Dont confuse this with BPH which should NOT have back/pelvic pain

283
Q

cp for Acute Bacterial Prostatitis

A

UTI sx PLUS PERINEAL PAIN

284
Q

What are the 3 steps to appropriately transport an amputated extremity? ; How long will this sustain viability?

A

Save People’s ice!

1st: Place extremity in (S)aline moistened gauze - NOT DIRECTLY ON ICE
2nd: Place gauze with the extremity in a (P)lastic bag and seal
3rd: Place plastic bag on bed of (i)ce and do NOT allow extremity to freeze

24 hours

[2b] A- step 2 CK (16 decks)

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