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usmle step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

what’s the most common fracture of the wrist

A

scaphoid

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2
Q

risk in scaphoid fracture

A

avascular necrosis

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3
Q

work for scaphoid fracture

A

plain xrays

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4
Q

particularity of plain xrays in scsphoid fracture(2)

A

can be normal

needs 10 days to show abnormalities

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5
Q

negative xray in susoect scaphoide fracture next step?(2)

A

thumb spica

xray in 10 days

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6
Q

clue for scaphoid scaphoid fracture

A

pain in anatomic snuffbox

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7
Q

cause of dermatitis in lower legs

A

venous stasis

venous hypertension

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8
Q

physio patho of venous satsis

A

vein insufficiency

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9
Q

minor traumatic brain injury next step

A

glasgow 15

discharge

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10
Q

management of mild TBI

A

glasgow 13-15 and vomiting’
discharge and sent home under surveillance
if normal ct

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11
Q

Management of moderate TBI

A

glasgow 9-12

sednt home under surveillance if normal CT

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12
Q

management of severe TBI

A

glasgow < ou egal a 8

CT scan and observation

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13
Q

cause of hematochezia(5)

A 
diverticulosis
angiodysplasia
ischemia
infectious
neoplasm
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14
Q

first thing to di if you suspect lower GI bleeding

A

nasogastric tube

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15
Q

you suspect lower GI bleeding nasogastric tube has no blood next step

A

colonoscopy

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16
Q

in case of diverticulosis if colonoscopy is negative in a setting of hematochezia next step(2)

A

erythrocye scyntigraphy
or
angiography

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17
Q

technique to perfrom scintigraphy

A

technetium 99 labeled erytrocyte scynctigraphy

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18
Q

quid of lower GI bleeding

A

bhelow treitz ligament

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19
Q

patient with AFIB with abdominal pain and heme positive stools

A

bowel infarction

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20
Q

most common cause of acute mesenteric ischemia

A

embolus from the heart

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21
Q

quid of trendelenburg sign

A

drooping of controlateral pelvis occuring when the patient is standing

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22
Q

cause of trendelenburg sign(2)

A

gluteus medius muscle weakness

gluteus minus muscle

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23
Q

in case of gluteus medius mx weakness where is located the pain

A

in the knee

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24
Q

abdominal pain and bloody diarrhea following abdominal aortic aneurism repair

A

bowel ischemia

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25
Q

what to do to prevent bowel ischemia during aortic aneurism rapair surgery

A

check sigmoid perfusion following the placement of aortic graft

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26
Q

quid lugwig angina

A

cellulitis of submandibular and sublingual spaces

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27
Q

clinical clue for lugwig angina(3)

A

dysphagia
drooling
crepitus of submandibular area

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28
Q

most common cause of death in ludwig angina

A

asphyxia

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29
Q

what cause ludwig angina

A

infection in 2 et 3 e mandibular molar

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30
Q

rx of ludwig angina(2)

A

remove the infected teeth

antibiotics

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31
Q

led edema worst when the leg is dependent and improves with leg elevation

A

venous valve incompetence

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32
Q

could varice be unilateral

A

yes can be unilateral

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33
Q

pulastile mass in the groin

A

femoral artery aneurism

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34
Q

the most common peripheral aneurism

A

popliteal aneurism

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35
Q

what to do in front of peripheral aneurism

A

check abdominal aneurism

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36
Q

RLQ pain plus positive psoas sign

A

psoas abcess

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37
Q

scaphoid fracture management

A

plain xray

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38
Q

plain xray in scaphoid fracture

A

radioluscent line across the wrist

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39
Q

management of scaphoid fracture

A

wrist immobilization for 6-10 weeks

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40
Q

what to do if you suspect scaphoid fracture with negative Xray(2)

A

immobilize wrist

repeat xray in 7-10 jours

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41
Q

why immobilization in suspect scaphoid fracture

A

because of the risk of non union

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42
Q

management of spinal cord injury(4)

A

stabilize cervical spine
stabilize airway
hemodynamic stabilization
urine catheter in place

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43
Q

mechanism of spinal cord injury in traumatic patient

A

compression
contusion
shear injury
spinal cord edema leadig to hemorragic central necrosis

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44
Q

important step in teh management of spinal cord injury

A

bladder catherization

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45
Q

patient presenting whistling noise after rhinoplasty

A

nasal septal perforation

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46
Q

cause of septal of nasal septal perforation(6)

A 
self inflicted trauma during picking nose
syphilis
TB
intranasal cocaine use
sarcoidosis
wegener(granulomatosis with polyangitis)
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47
Q

what cause the perforation in the case of rhinoplasty

A

septal hematoma

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48
Q

pale and cold arm after closed reduction of humerus fracture what complication you can have in the future

A

volkman contracture

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49
Q

rx of compartment syndrome

A

immediate fasciotomy

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50
Q

widened mediatinum in patient taking KCL pills

A

perforation esophagienne compliquee de mediastinitis

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51
Q

quid of hamman sign

A

crunching sound in the haert due to emphysema in esophageal perforation

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52
Q

confirmatory test in esophageal perforation

A

esophagography with water soluble contrast

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53
Q

cause of esophageal perforation(6)

A 
trauma
pills esophagitis
Barret 
caustic substance ingestion
infection a candida
Boherhave syndrome
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54
Q

clue for esophageal perforation

A

emphysema

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55
Q

patient presents with free peritoneal fluid the most likely finding during laparotomy

A

splenic laceration

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56
Q

traumatic injuric most common cause of intraabdominal hemorrage(3)

A

1-spleen 60%
kidney
liver

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57
Q

patient with dyspnea petechiae after tibial fracture dx

A

fat embolism

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58
Q

confirmatory DX of fat embolism(2)

A

fat droplets in urine

presence of intra arterial fat globule on fondoscopy

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59
Q

rx of fat embolism

A

respiratory support

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60
Q

after trauma patient present with only upper extremities weakness

A

central cord syndrome

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61
Q

mechanism trauma causing central cord syndrome(2)

A

hyperextension injury

degenerative cervical changes in spine

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62
Q

what position of spine is reached in central cord syndrome

A

central position of anterior spinal cord

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63
Q

clue for central cord syndrome

A

weakness more prononced in upper extremities than in lower extremities

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64
Q

why pain and temperature problem in central cord syndrome

A

damage of spino thalamic tract

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65
Q

what to do if you suspect cervical spinal cord injury

A

orotracheal intubation

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66
Q

when to suspect cervical spine

A

any patient with trauma with maxillofacial and neck edema

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67
Q

patient with unRX appendicitis develops ten days later tender boggy fluctuant mass in rectal examination DX (2)

A

perforated appendix with fluid in rectovesical pouch

it’s a pelvic abscess formation

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68
Q

complication of ruptured appencitis

A

pelvic abcess

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69
Q

patietn develops pain and paresthesis below right elbow after full thickness burn Dx

A

compartment syndrome

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70
Q

rx for compartemnt syndrome induced by burne

A

escharotomy to relieve constriction

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71
Q

dx of compartment syndrome

A

doppler ultrasonography

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72
Q

what pressure during Dopler should mandate escharotomy

A

25-40 mm de Hg

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73
Q

if escharotomy fails next step in Rx compartment syndrome induced by burn

A

fasciotomy

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74
Q

child 5-7 ans with hip pain xray shows flatenned ofr fragmented left femoral head dx?

A

idiopathic avascular necrosis

or Legg calve perthes diseae

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75
Q

classic presentation of slipped femoral capital epiphysis

A

obese children with complaint of pain hip

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76
Q

clue for slipped femoral capital epiphysis

A

capital femoral epiphysis remains intact within the acetabulum

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77
Q

risk in patient with pelvic frasture

A

posterior uretral injury

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78
Q

clue post uretral injury(5)

A 
blood at urertral meatus
high riding prostate
scrotal hematoma
inability to void
palpable distended bladder
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79
Q

cause of anterior uretral injury(3)

A

perineal tenderness
or perineal hematoma
no inability to void

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80
Q

why patient with post uretral injury can develop sepsis

A

because of risk of extravasation of urine in the scrotum peritonerum and abdominal wall

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81
Q

quid of anterior uretra

A

uretra distal to urogenital diaphragm

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82
Q

quid of post uretra

A

prostatic and membranous uretra

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83
Q

patient with eschar on the chest , consequence of that

A

respiratory failure

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84
Q

patient with hip pain and elevated ALP

A

paget

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85
Q

complication of Paget

A

hearing loss

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86
Q

athlete or military recruit with foot pain

A

stress fracture

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87
Q

rx of stress fracture

A

rest and pain control

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88
Q

the most common metatara involved in stress fracture

A

the second

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89
Q

management of 2e 3e 4e metatarsal fracture (2)

A

conservatively

or hard soled shoe

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90
Q

patients present with epigastric pain and vomiting after trauma

A

duodenal hematoma

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91
Q

why the duodenal hematoma is formed

A

collection of blood between submucosal and muscular layer

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92
Q

mamagement of duodenal hematoma(2)

A

nasogastric tube

and parenteral nutrition

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93
Q

after an accident patient developsn decreased breath sounds after chest tube placement patient stilll has air in pleural space and pneumodiastinum Dx

A

bronchial rupture

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94
Q

dx of bronchial rupture

A

ct of the chest

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95
Q

after an accident patient develops subcutaneos emphysema and pneumomediastinum

A

tracheobronchial rupture

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96
Q

after catherisation patient develops bacvk pain and hypotension dx

A

retroperitoneal hematoma

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97
Q

dx of retroperitoneral pain

A

ct scan of abdomen

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98
Q

major complication of heart catheterization(3)

A

MI
stroke
death

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99
Q

minor complication of cardiac catheterization(7)

A 
hemostasis at access site
hematoma formation
AV fistula
pseudo aneurism
arterial thrombosis
perforation
contrast allergy
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100
Q

the most common cause of death in brain injury

A

diffuse axonal injury

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101
Q

ct scan of diffuse axonal injury

A

numerous punctuate hemorrage at gray white matter junction with blurring of gray white interface

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102
Q

hydrocele in newborn infant(2)

A

reassurance

observation

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103
Q

time limit for hydrocele to resove in children

A

12 months

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104
Q

why hydrocele should be remove if persistance after 12 months

A

because of risk of inguinal hernia

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105
Q

why the left Diapphragm is more susceptilble of trauma than the right

A

protective reffect of the liver

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106
Q

best test to Dx ruptured diaphragm

A

CT of chest and abdomen

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107
Q

cause of diaphragm rupture

A

vehicle accident

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108
Q

xray in diaphragm rupture(2)

A

shifting of mediastinum to the right

left lower lung opacity with obscure left hemidiaphragm

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109
Q

first step after central line placement

A

portable chest xray

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110
Q

why portable chest xray after central line placement

A

to rule out complications

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111
Q

complications of central line placement(6)

A 
arterial puncture
pneumothorax
hemothorax
thrombosis
air embolism
sepsis
vascular perforation
MI leading to tamponade
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112
Q

before you administer drugs in central line placement next step

A

chest xray

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113
Q

clue for fat necrosis of breast

A

breast mass with biopsy revealing foamy macrophages with fat globules

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114
Q

cause of fat necrosis of breast(2)

A

breast trauma

surgery

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115
Q

characteristics of breast calcification in breast cancer

A

microcalcification

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116
Q

characteristics of breast calcification in fat breast necrosis

A

coarse calcifivcation

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117
Q

rx of fat breast necrosis

A

no rx

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118
Q

patient with marked limitation of extension of the wrist following a midshaft humerus fracture

A

radial nerve injury

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119
Q

patient with lupus develops hypotension hyponatremia

A

adrenal crisis

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120
Q

why lupus is important in this vignette

A

association entre lupus and prednisone intake

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121
Q

condition predisposing fro adrenal crisis

A

prednisosne >/ a 20 mg par jour pendant 3 semaines

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122
Q

clue for cushing features(4)

A

buffalo hump
central obesity
moon facies
weight gain

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123
Q

what happens to patient taking prednisone

A

risk for hypothalamic pituitary adrenal axis suppression(HPA)

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124
Q

if you suspect HPA suppresion during surgery what to give in term of medication

A

ETOMIDATE

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125
Q

patient with LLQ pain older with prior dx of diverticulitis develops perisigmoid fluid collection dx?

A

perisigmoid abcess

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126
Q

rx of perisigmoid abcess

A

percutaneous drainage

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127
Q

complication of diverticulitis(4)

A

abcess
perforation
0bstruction
fistula formation

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128
Q

first step in front of clavicular fracture(2)

A

angiogram

neurovascular exam

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129
Q

why in front of clavicular fracture angiogram and neurovascular exam are mandatory

A

because of proximity of subclavian artery and plexus brachial

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130
Q

patient with clavicle fracture presents loud bruit during auscultation beneath the clavicle

A

rapidly ask angiogram

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131
Q

clue for anterior cruciate ligament tear ACL(3)

A

popping sensation
followed by rapid hemarthrosis
instability in bearing weight on the affected side

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132
Q

dx of ACL tear

A

MRI

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133
Q

physical exam finding in ACL tear

A

laxity of anterior motion of tibia relative to femur

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134
Q

knee pain with valgus stress test positive

A

medial collateral ligament tear(MCL)

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135
Q

the most common ligament involved in knee trauma

A

MCL

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136
Q

best dx test for ligament tear of knee

A

MRI of knee joint

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137
Q

rx of MCL tear(2)

A

bracing

early ambulation

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138
Q

origin of torus mandibularis/palatinus

A

congenital

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139
Q

hard palate mass with bony hard consistence

A

torus mandibularis or palatinus

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140
Q

when to operate torus

A

when the mass interferes with eating or speaking

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141
Q

patient presenting with with crepitus in suprasternal notchafter effort of vomiting

A

esophagus perforation Known as boherhave syndrome

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142
Q

condition to have boherhave syndrome

A

when the patient is resisting the urge to vomit

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143
Q

complication of Boherhave

A

pneumomediastinum

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144
Q

meniscal injury

A

Knee pain

popping sensation under the examination fingers

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145
Q

work up of meniscal injury

A

MRI

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146
Q

rx of meniscal injury

A

surgery

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147
Q

worsening substernal chest pain and mild shortness of breath after endoscipy

A

esophageal rupture

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148
Q

next step if you suspect esophageal rupture

A

esophagoghraphy with water soluble contrast substance

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149
Q

common chest xray finding in in esophageal rupture(3)

A

left pleural effusion
pneumomediastinum
pneumothorax

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150
Q

test of choice to Dx esophageal rupture

A

esophagoghraphy with water soluble contrast substance

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151
Q

after surgery patient develops fever cloudy grey discharge and dusky friable subcutaneous tissue
decreased sensation on the edges of the woung dx?

A

necrotizing surgical infection

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152
Q

rx of necrotizing surgical infection

A

urgent surgical exploration

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153
Q

risk factor for necrotizing surgical infection

A

diabetics

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154
Q

cause of medial meniscus injury

A

twisting of the knee with fixed foot

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155
Q

clue for meniscal injury(2)

A

popping sensation

no effusion following the injury

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156
Q

why no effusion in meniscal tear

A

meniscus are not perfused

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157
Q

quid of murray sign

A

audible snap during slowly extending the leg at the knee from full extension while simultaneously applying tibial torsion

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158
Q

why the knee is locked at terminal extension in Murray sign

A

bucket handle tear

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159
Q

patient presenting one arm weakness after clonic tonic seizures

A

posterior shoulder dislocation

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160
Q

clue for posterior shoulder dislocation(2)

A

inability to externally rotate the right arm
or
arm is adducted and internally rotate

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161
Q

what cause the dislocation of shoulder during seizure

A

violent muscle contraction during tonic clonic seizure

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162
Q

popping sensation at the knee and knee swelling occuring 12-24 h later

A

meniscal tear

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163
Q

clue for ligamentous tear(2)

A

after the trauma immediate effusion

popping sensation

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164
Q

indicator in glasgow(3)

A

eye opening
speech
motor response

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165
Q

motor response

A 
0bey =6
localizes pain=5
withdrawal=4
decortication=3
decerebration=2
no mvt =1
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166
Q

which is worst decortication or decerebration

A

decerebration

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167
Q

decerebration(3)

A

extension
3 E
you got 3 in glasgow

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168
Q

back pain plus hypotension plus syncope

A

ruptured AAA

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169
Q

physiopatho of hematuria in AAA rupture

A

blood in retroperitoneum creates aorto caval fistula leading to venous congestion in tretroperitoneal structure (bladder)
fragile the bladder can dbe distended and rupture

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170
Q

one YO patient comes with lesion of epidermolysis first thing to do

A

admit the patient and do a skeletal suvey

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171
Q

3 steps to tkae if you suspect child abuse(4)

A

physical examination
skeletal survey
report to care to child protective services
admit the patient

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172
Q

patient with brain trauma simple measur eto decrease high ICP(4)

A

head elevation
or sedation
or IV mannitol
hyperventilation

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173
Q

eye mvt in glasgow(4)

A

open spontanously=4
open a la demande=3
open with pain stimulation=2
closed eyes =1

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174
Q

speech in glasgow(5)

A 
oriente=5
confuse=4
inapropppriate words=3
whisper incomprehensive words=2
say nothing=1
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175
Q

how elevation helps in decreasing high ICP

A

by decreasing venous flow from the head

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176
Q

how sedation helps in decreasing high ICP

A

by decreasing the metabolic demand

control of the hypertension

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177
Q

how iv mannitol helps in decreasing high ICP

A

extraction of free water out the brain tissue causing osmotic diuresis

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178
Q

how hyperventilation helps in decreasing high ICP

A

allowing co2 wash out leading to cerebral vasoconstriction

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179
Q

appropriate next step in penile fracture(2)

A

retrograd uretrogram
plus
surgical exploration

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180
Q

risk factor for penile fracture

A

woman on top of the man during sexual intercourse

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181
Q

pain of Mac Burney(1)

A

RLQ pain

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182
Q

rovsing sign

A

palpation of LLQ causes pain in RLQ

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183
Q

Dx of appendicitis(3)

A

it’s clinic
if all the symptoms are present no image needed
surgery tet dwat

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184
Q

when asking sono or CT for appendicitis

A

whrn the typical features are absent

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185
Q

physiopatho of ombilical pain in appendicitis

A

it’s visceral pain

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186
Q

physiopatho of RLQ pain in appendicitis(2)

A

it’s somatic

irritation locale of parietal peritoneum

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187
Q

dx differentiel of appendicitis(3)

A

diverticulitis
ileitis
IBD

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188
Q

subluxation of radial head in kid cause(2)

A

risky behavior

lifting the child with with child’s forearm

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189
Q

management of subluxation of radial head in kid

A

gentle passive elbow flexion and forearm supination

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190
Q

maneuver to reduce radial head subluxation(3)

A

extend the elbow and distract it
supinate the forearm
hyperflex the elbow with your thumb over the radial head in order to feel the reduction

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191
Q

patient with head trauma lost consciousness and has lucid interval followed by progressive deteriorationof consciousness DX?

A

epidural hematoma

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192
Q

dilated pupil in epidural hematoma why?

A

oculomotor compression in the side of the lesion

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193
Q

ct of epidural hematoma

A

biconvex hematoma

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194
Q

rx of epidural hematoma

A

emergent craniotomy

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195
Q

burn injury becoming chronically drained and painfull

A

SCC

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196
Q

condition favorising SCC(3)

A

skin over chronic osteomyelitis
radiotherapy scars
venous ulcers

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197
Q

all chronic wound with failure to heal next step?

A

biopsy

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198
Q

SCC from burn woung

A

marjolin ulcer

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199
Q

cause of paralytic ileus(3)

A

abdominal surgery

retroperitoneal hemorrage associated with vertebral fractures

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200
Q

radio of ileus paralytic(2)

A

air fluid levels

distended fas filled loops

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201
Q

history clinical of retroperitoneal hemorrage(2)

A

history of falling back

vertebral fracture

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202
Q

first thing to do if you suspect post yretral injury

A

retrograde uretrogram

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203
Q

what to not to if uretral injury is suspected

A

foley catheterization

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204
Q

why to not use foley catheterization if uretral injury is suspected

A

risk of abcess formation

worsen of uretral damage

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205
Q

why can you have atelectasia and pneumonia in rib fracture

A

hypoventilation

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206
Q

goal in rib fracture

A

ensure appropriate analgesia

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207
Q

patient hemodynamically unstable with sharp penetrating abdominal trauma and gunshot wound next step

A

exploratory laparotomy

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208
Q

why you should act emergently on unstable blunt abdominal trauma(2)

A

to prevent sepsis

to repair bleeding organ

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209
Q

patient begins to develop shortness of breath after placement of central venous catheter in the right subclavian vein dx

A

tension pneumothorax

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210
Q

rx of tension pneumothorax induced by placement of central venous catheter

A

needle thoracostomy

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211
Q

unstable patient after blunt ntrauma abdomen what to do

A

1-Fast

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212
Q

quid of fast

A

focused assessment with sono for trauma

213
Q

Fast shows blood in the peritoneum next step

A

laparotomy

214
Q

if fast is not available what to do in any patient with unstable blunt trauma

A

laparotomy

215
Q

patient with blunt trauma with low TA first step

A

2 IV lines placement

216
Q

Patient with blunt trauma TA stable FAST shows blood in spleno renal angle next step

A

CT of abdomen

217
Q

blunt trauma abdominal in a patient unstable and fails to respond to hydration next step

A

Laparotomy

218
Q

blunt trauma abdominal in a patient with low TA after rehydration SBP> ou egal a 100 mm de HG next step

A

CT is the best next step

219
Q

what to do if perform splenectomy for a patient

A

immunization against encapsulated bacteria

220
Q

patient with gastrectomy develops digestive symptoms 20-30 mn after eating:cramps,weakness,diaphoresis,light headedness Dx?

A

Dumping syndrome

221
Q

physio patho of dumping syndrome

A

rapid emptying of gastric content into duodenum and small intestine

222
Q

first thing to do in dumping syndrome(2)

A

dietary changes

small and frequent diet

223
Q

second thing to do in dumping syndrome

A

octreoctide if failure of dietary changes

224
Q

what to in refractory case of dumping syndrome

A

reconstructive surgery

225
Q

clue for co poisonning(3)

A

wheezing
confusion
seizure

226
Q

confirmatory dx of carbon monoxyde poisonning(2)

A

carboxyhemoglobin level >3% in non smoker

> 15% in smoker

227
Q

Rx of carbon monoxyde poisonning

A

100% face mask oxygen

228
Q

Rx of carbon monoxyde poisonning 100% face mask oxygen failure

A

hyperbaric oxygen

229
Q

most commonly affected part of the colon following procedures on aortoilliac vessels

A

distal left colon

230
Q

which procedure on artery can cause problem in colon

A

AAA procedure

231
Q

what causes distal left colon ischemia during AAA procedure

A

prolonged clamping and impaired blood flow through the < mesenteric artery

232
Q

Patient presents with enlarged breast with edema and erythema dx

A

inflammatory breasst carcinoma

233
Q

pathognomonic sign of breast ca

A

scant bloody discharge in nipple

234
Q

first step in breast ca

235
Q

patietn presents severe abdominal pain with hypotension suddenly

A

rupture of AAA

236
Q

next step in AAA rupture(2)

A

bedside U/S

surgery

237
Q

rarely patient with AAA rupture is stable next step

A

CT of abdomen

238
Q

the first cause of acute biliairy pancreatitis

A

gallstones

239
Q

other causes of acute pancreatitis(3)

A

alcohol
post ERCP
hypertriglyceridemia

240
Q

clue for acute biliairy pancreatitis(4)

A

epigastric pain
high lipase
high ALP
high alanine amino transferase

241
Q

first thing to to in acute biliary pancreatitis

A

right upper quadrant U/S

242
Q

what to do in acute biliairy pancreatitis(2)

A

rx pancreatitis

schedule cholecystestomy

243
Q

clue for tension pneumothorax(3)

A

trachea deviated to the left
decreased breath sound on the right
neck veins distended bilaterally

244
Q

rx of tension pneumothorax

A

needle thoracostomy

245
Q

where to place the needles in needle thoracostomy

A

between first and second ribs

246
Q

dx of needle thoracostomy(2)

A

it’s clinic

no image needed to make decision

247
Q

patient with epigastric pain develops pneumoperitoneum dx?

A

viscus organ perforation

248
Q

clue for viscus organ perforation

A

air blelow hemicoupole diaphragm in the right

249
Q

penetrating abdominal trauma in unstable patient

250
Q

patient with distal humerus fracture develops pain and paresthesia of fingers after close reduction dx

A

compartment syndrome

251
Q

longterm complication of compartment syndrome

A

volkman ischemis contracture

252
Q

most common fracture involved in compartment syndrome

A

supracondylar fractures

253
Q

mechanism of volkman ischemis contracture

A

dead muscle is replaced by fibrous tissue

254
Q

clue for splenic injury in a context of blunt abdominal trauma

A

epigastric or LUQ pain

shoulder pain in the left

255
Q

quid of Kehr sign

A

shoulder pain in the left in a context of splenic injury

256
Q

patient with blunt trauma abdomen develops later epigastric pain and hypotension

A

splenic injury with delayed onset

257
Q

patient with blunt trauma abdomen develops later epigastric pain and hypotension in the USMLE next step

A

laparotomy

258
Q

dx of splenic injury

A

CT of abdomen only in stable patient

259
Q

dancer presenting with shin pain ,right leg and normal xray dx?

A

stress fracture

260
Q

activities linked with stress fracture(2)

A

athletes

military recruits

261
Q

zone of tibia invoved in stress fracture

A

distal third of tibia

262
Q

cause of foot ulcer in diabetics

A

peripheral neuropathy

263
Q

charcot joint

A

deformed foot seen in diabetics

264
Q

3 main factors in diabetic foot in diabetics

A

1-Neuropathy causes painless trauma
2-Microvx insuffciency causes poor wound healing
3-immunosuppression causes infection

265
Q

localisation of ulcer in diabetics foot and why

A

first metatarsal bone the head

zone of greater pressure

266
Q

patient in ICU for brain trauma develops epigastric pain

A

cholecystitis

267
Q

risk for cholecustitis(6)

A 
hospitalizsed patient
severe trauma
multiorgan failure
prolonged parenteral diet
sepsis
burn
268
Q

physiopatho of cholecystitis in hosptialized patient(2)

A

cholestasis

gallbladder ischemia

269
Q

patient in ICU for brain trauma develops cholecystitis next step(2)

A

percutaneous cholecystostomy

cholecystectomy after stablization

270
Q

clue for cholecystitis in hosptialized patient

A

pericholecystic fluid in U/S

271
Q

patietn develops falccid paralysis after AAA repair

A

spinal cord ischemia

272
Q

the most common cause of spinal cord ischemia or infarct

A

surgery to repair thoracic or thoracoabdominal aneurism

273
Q

what artery is reached in cord ischemia following AAA repair

A

adamchiewics artery

274
Q

quid of adamchiewics artery

A

it arises from the aorta

feed the anterior spinal artery in the T9-T12 level

275
Q

vessel feeding the spinal cord(2)

A

anterior spinal artery ASA

two post spinal arteries PSA

276
Q

origin of ASA and PSA

A

vertebral artery

277
Q

artery feeding ASA(3)

A

radicular artery from
vertebral artery
intercostal arteries
aorta

278
Q

why during cord ischemia after AAA surgery,proprioception and vibration are preserved

A

post circulation are preserved

279
Q

other finding in cord ischemia after AAA surgery(2)

A

bowel

bladder dysfunction

280
Q

first indicator of hypovolemia

A

pulse rate

281
Q

after a fall patient develops paraplegia with loss of pain and T. in both legs

A

anterior cord syndrome

282
Q

condition to have anteriod cord syndrome

A

burst fracture

283
Q

clue for anterior cord syndrome(2)

A

motor problem below the level of lesion with loss of pain and T on both sides below the lesion
proprioception is intact

284
Q

best test to DX anterior cord syndrome

285
Q

after an accident patient presents with sensory problem over the medial side of the right lower thigh and leg what’s nerve is involved

A

femoral nerve

286
Q

motor role of femoral nerve(2)

A

hip flexion

knee extension

287
Q

sensory role of femoral nerve(2)

A

anterior thigh

medial leg via saphenous branch

288
Q

quid of leg flexion at the hip

A

hip flexion

289
Q

quid of leg extension at the knee

A

knee extension

290
Q

stress fracture tetrad(4)

A

female
amenorrhea
osteoporosis
poor eating habit

291
Q

dx differentiel in in painful sore foot (4)

A

stress fracture
arthritis
bursitis
mortin neuroma

292
Q

clue for stress fracture(2)

A

sharp and localised pain over bony surface

worse with palpation of taht area

293
Q

clue for arthritis

A

all the metatarsal joints are involved

294
Q

clue for Morton neuroma

A

pain in 3e et 4 e toe on plantar surface with clicking sensation

295
Q

clue for mulder sign

A

when simultaneously palpate space of 3e and 4e and squeezing the metatarsal joints, you have a clicking sensation

296
Q

risk of foot bursitis

A

poor fitting shoes during extended period leading to inflammation of the metatarsal heads

297
Q

quid of trochanteric bursitis(2)

A

patient with hip pain when pressure is applied when sleeping on the affected side
pain with external rotation or resisted abduction

298
Q

dx differentiel of unilateral pain(5)

A 
infection
trauma
arthritis
bursitis
radiculopathy
299
Q

after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum next step(2)

A

surgical debridement and drainage

antibiotherapy

300
Q

after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum dx

A

post op mediastinitis

301
Q

risk for mediastinitis

A

any sternotomies

302
Q

patient with RLQ pain and absent bowel sounds present with normal WBC and urine sediment:15 rbc par HPf
examination shows needle shape crystals

A

kidney stones with paralytic ileus

303
Q

best test to DX kidney stones

A

CT of abdomen

304
Q

why ct abdomen is the best test now to Diagnose kidney stones

A

to see radioluscent stones

to ruleout appendix abcess

305
Q

rx of stone < 0,6 mm

A

may pass with
liquid
analgesia

306
Q

best way to evaluate acid uric stone (2)

A

abdomen CT
or
IV pyelography

307
Q

breast mass work up in woman < 30 ans

308
Q

breast mass work up in woman > 30 ans(2)

A

U/S +

mammo

309
Q

patient < 30 ans with simple cyst a U/S

A

needle aspiration

310
Q

patient < 30 ans with complex mass cyst in U/S next step

A

image guided biopsy

311
Q

woman of > 30 ans with suspiscion of malignancy in U/s and mammo next step

A

core biopsy

312
Q

quid of diverticulosis

A

mucosa and muscularis mucosa herniation through bowell wall

313
Q

why bleeding in diverticula

A

diverticula can erode penetrating artery

314
Q

most common site of diverticulosis

315
Q

dx of diverticulosis(2)

A

CT abdomen
or
fluoroscopy

316
Q

what to suspect in any appendix perforation

A

abcess formation

317
Q

clue for appendix perforation and abcess formation

A

longer duration of symptom more than 5 jours

318
Q

meaning of psoas sign (2)

A

retrocaecal appendix

abcess adjacent to psoas

319
Q

quid of psoas sign

A

extension of hip against resistance elicits abdominal pain

RLQ pain with extension of right thigh

320
Q

appendix abcess in stable patient(4)

A

rehydration
antibiotherapy
bowel rest and drainage
surgery in 6-8 weeeks—->appendectomy

321
Q

obturator sign

A

RLQ pain with internal rotation of right thigh

322
Q

meaning of obturator sign(2)

A

pelvic appendix
or
pelvic abcess

323
Q

rovsign sign

A

pressure in LLQ elicits pain in RLQ

324
Q

meaning of rovsign sign(2)

A

pelvic appendicitis

pelvic abcess

325
Q

2 types of femoral neck fractures(2)

A

intracapsular

extracapsular

326
Q

risk of avx necrosis

A

intracapsular fracture of femoral neck

327
Q

older patient during a fall develops neck femoral fracture what’s the next step) and why(5)

A 
EKG
cardiac marker
chest Xray
 raison:bilan cardio pulmonaire pre op
rule out a cardiac syncope responsable for the fracture
328
Q

when the surgery will take place for the neck femoral fracture

A

delay surgery up to 72 h to evaluate heart and lung

329
Q

older patient with femoral neck fracture why don’t you pick crystalloid in vignette

A

because intracapsular fracture has low risk of bleeding and hypotension

330
Q

amputation injury next step(2)

A

place the amputed finger in saline moistured gauze in a plastic bag
place the bag on a bed of ice and bring it along with the patient to the emergency department

331
Q

clinical indication of thermal injury of the upper respiratory airway(8)

A 
burn of the face
singing of eyebrows
oropharyngeal inflammation or blistering
oropharyngeal carbon deposits
carboneceous sputum
stridor
carboxyhb>10%
history of confinement in burning building
332
Q

what to do if you have one indicator of thermal injury of upper respiratory airway

A

early intubation to prevent upper airway obstruction by edema

333
Q

patient on endotracheal intubation with mechanical ventilation has a rate of c02 produced to the rate of 02 uptake of 1,05 why

A

carbon dioxyde excess in the diet

334
Q

quid of respiratory quotient close 1.0

A

predominant oxydation of carbohydrates and net lipogenesis

335
Q

respiratory quotient for protein

336
Q

respiratory quotient for lipid

337
Q

after accident patient develops hypotension ,flat veins neck tachycardia and cold extremities despite of IV fluid resuscitation why

A

hypovolemic shock

338
Q

pulmonary post op complication in the first 24 h after surgery

A

atelectasia

339
Q

why atelectasia in post op(3)

A

narcotic use in decreases the respiratory drive
anesthetics agent decreases mucociliary clearance
pickwikian like syndrome

340
Q

cause of pickwikian like syndrome

A

patient is kept supine after surgery

341
Q

what can be done to increase functionnal residual capacity FRC after surgery(4)

A

chest physiotherapy
incentice spirometry
coughing and frequent positionning
early ambulation

342
Q

simple measure to increase the FRC de 20 a 35%

A

elevation of the head of the bed

343
Q

patietn develops shortness of breath and chest pain after motor vehicle accident ,xray shows alveolar opacity dx?

A

pulmonary contusion

344
Q

clue for pulmonary contusion

A

when you rehydrate these patients PO2 decreases

345
Q

clue for flail chest(2)

A

inward motion of the right side ot the chest during respiration
also called paradoxical motion

346
Q

rx of flail chest

A

positive pressure mechanical ventilation

347
Q

clue for post op atelectasia(2)

A

hyperventilation

dense opactity in chest xray

348
Q

gas sanguin in atelectasis(3)

A

hypoxie
hypocapnie
respiratory alkalosis

349
Q

critical period for post op atelectasis

A

2 e jor post op a 5 e jour

350
Q

rx preventive of post op atelectasis(4)

A

incentive spirometry
deep breathing exercices
epidural anesthesia instead of opiod
comtinuous positive airway pressure

351
Q

pulmonary post op complications(4)

A

atelectasis plus infection
bronchospasm
exacerbation of COPD
prolonged mechanical ventilation

352
Q

risk factor for pulmonary post op complication(7)

A 
> 50 ans
emergency surgery
surgery duration more than 3 h
heart failure
COPD
poor general health
abdominal and thoracic surgery
353
Q

strategies to reduce risk of post op atelectasis prior to surgery(4)

A

smoking cessation at least 8 weeks prior to surgery
control symptom of COPD
rx of any respiratory infection
patient education

354
Q

clue for pulmonary contusion(2)

A

symptoms begin 24 h after he accident

patchy alveolar infiltrate on chest xray

355
Q

after an accident patient develops hypotension dyspnea distension of neck veins and deviation of trachea

A

tension pneumothorax

356
Q

best rx of tension pneumothorax

A

needle insertion in the second intercostal spacein the left midclavicular line (left pneumothorax)

357
Q

3 types of pneumothorax

A

primary spontanoeus
secondary spontaneous
tension pneumothorax

358
Q

primary spontaneous pneumothorax

A

no preceding event

359
Q

quid of secondary spontaneous pneumothorax

A

complication of a lung disease COPD for instance

360
Q

tension pneumothorax

A

lifethreatning trapped air wuth mediastinal shift and compromised cardiopulmonary function

361
Q

rx of tension pneumothorax

A

depends on the size of the pneumothorax

362
Q

small tension pneumothorax management(2)

A

observation

O2

363
Q

large stable tension pneumothorax management(2)

A

urgent needle decompression

later chest tube placement

364
Q

why to never use positive ventilation in tension pneumothorax

A

it will exacerbate it

365
Q

quid of massive hemothorax

A

more than 1,5 l in pleural space

366
Q

most common cause of massive hemothorax

A

traumatic laceration of the lung parenchyma

367
Q

arteries damaged in massive hemothorax(2)

A

intercostal artery
or
internal mammary artery

368
Q

clue for hemothorax(3)

A

hypotension
absent breath sounds
flat neck veins

369
Q

patient in hemorragic shock develops cardiac arrest after being placed on mechanichal ventilation what measure would prevent that

A

volume resucitation

370
Q

why mechanical ventilation could cause cardiac arrest in unstable patient(2)

A

positiv pressure mechanical ventilation increase intra thoracic pressure which decreases venous return to the haert and thereby decrease ventricular preload

in patient with hypovolemic shock this can cause circulatory collapse

371
Q

evaluation of solitary nodule

A

first compare with old xray

followed by chest CT

372
Q

from what depends the decision of biosy,abserve or resection of solitary nodule(3)

A

size of lesion
age of patient
smoking history

373
Q

risk of cancer in solitary pulmonary nodule(4)

A

Diameter > ou egal a 2,3
age > 60
smoker > 20 paquets/day
corona radiate or spiculated appearance

374
Q

when smoking cessation lowes risk of cancer

A

when you stop smoking > ou egal 7 ans

375
Q

best way to decrease the incidence of of atelectasis in post op(2)

A

incentive spirometry

deep breathing exercices

376
Q

in the vignette cause of atelectasis(2)

A

impaired cough

shallow breathing causes atelectasis in post op

377
Q

patient from mexico develops hemoptysis with dense opacity inthe right upper lobe the first step?

A

respiratory isolation

378
Q

first step in patietn with massive hemoptysis

A

place the bleeding lung in a dependent position

379
Q

second step in massive hemoptysis

A

bronchoscopy to localize the bleeding site and attempt early therapeutic intervention

380
Q

quid massive hemoptysis(2)

A

> 600 ml/24 h
or
100 ml/h

381
Q

patietn with vehicle motor accident or fall > 10 feet with mediastinal enlargement dx?

A

rule out aortic injury

382
Q

screening test for aortic injury

A

chest xray

383
Q

eqivococal chest xray in aortic injury(2)

A

CT chest
or
angiography

384
Q

how ‘s TA in aortic injury(3)

A 
normal
or
HTA
or
hypotension
385
Q

patient after accident with hypotension with high pulmonary capillary wedge pressure (12 mm)
after 1 l de liquide PCWP a 22

A

Myocardial contusion

386
Q

type of shock in trauma

A

hypovolemia

387
Q

patient with hypotension after accident ,aftee IV fluids ,failure to correct the hypotension and development of high PCWP

A

rule out myocardial contusion

388
Q

dx of myocardial contusion(2)

A

EKG

positive cardiac markers

389
Q

patient with intermittent claudication and pain in buttock,hip and thigh muscles dx

A

aorto illiac occlusion

390
Q

additionnal finding in aorto illiac occlusion

391
Q

quid of leriche syndrome(3)

A

hip and thigh buttock pain
impotence
symetric atrophy of bilateral loweer extremities

392
Q

cause of leriche syndrome

A

aorto illiac occlusion

393
Q

after accident patient develops hypotension and neck veins distended adn tachycardia dx

A

tamponnade

394
Q

quantity of blood to cause tamponnade

A

100-200 ml

395
Q

in chronic disease amount of fluid to cause acute cardiac tamponnade

396
Q

chest ray in cardiac tamponnade post trauma

397
Q

clue ofro cardiac tamponnade

A

hypotension despite of rehydration

398
Q

clue for aortic injury(4)

A

widened mediastinum
large sided hemothorax
deviation of the mediastinum to the right
disruption of the normal aortic contour

399
Q

ABI < 0,9

400
Q

ABI > 1,33

A

calcified or uncompressed vessels

401
Q

clue for arterial embolism(5)

A 
pain
pulselessness
pallor
peresthesia
paralysis
402
Q

casue of arterial embolism

403
Q

PAD

A

chronic disease in artery

404
Q

arterial occlusion

A

acute embolic event

405
Q

origin of emboli(2)

A

ventricle from MI

atrium from AFIB

406
Q

patient develops right calf pain after femoral artery embolectomy cause of the pain

A

soft tissue swelling

407
Q

patient develops right calf pain after femoral artery embolectomy dx

A

ischemia reperfusion syndrome

408
Q

quid of ischemia reperfusion syndrome

A

it’s a compartment syndrome

409
Q

condition predisposing to ischemia reperfusion syndrome

A

ischemia lasting more than 4 a 6 hours

410
Q

quid of compartment syndrome

A

increased pressure within an enclosed facial space causing ischemia of muscles and nerves

411
Q

indication of fasciotomy in compartment syndrome

A

pressure excess 30 mm de hg

412
Q

what will happen after 4 a 6 hours of ischemia you reperfuse an area

A

both intra cellular and intersticial edema upon reperfusion

413
Q

complication of pancreatic injury(2)

A

pancreatic abcesss

also called retro peritoneal abcess

414
Q

accident causing pancreatic trauma

415
Q

best step in suspect pancreatic trauma and why?(2)

A

serial CT

because early CT less than 6 hours coul not show anything

416
Q

complication of untreated pancreatic injury

A

pseudocyst formation

417
Q

patient develops abdominal discomfort afterabdominal surgery with distended abdomen and decreased bowel sounds DX

A

post surgery ileus

418
Q

cause of post surgery ileus

A

use of morphine

419
Q

cause of post surgical ileus(3)

A

opiods use
penetrating cavity peritoneal
local relaese of inflammatory mediators

420
Q

clue for pyloric stricture

A

succussion splash

421
Q

cause of gastric outlet obstruction(6)

A 
ca
PUD
chron
strictures
caustic agent
bezoar
422
Q

patient with abdominal pain no bowel mvts for 2 days dx

A

small bowell obstruction

423
Q

cause # 1 of small bowell obstruction

A

any surgery on abdominal wall

424
Q

whyany surgery on abdominal wal can cause small bowell obstruction

425
Q

congenital adhesion causing obstruction of small bowell

A

Ladd’s bands

426
Q

xray for small bowel obstruction

A

dilated loops of bowel

427
Q

most common etiology of small bowel obstruction

428
Q

patient presenting with pain and swelling over the coccyx dx?

A

pilonidal abcess

429
Q

rx of pilonidal abcess(2)

A

drainage

excision of sinus tract

430
Q

patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room

A

fresh frozen plasma

431
Q

patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room why using fresh frozen plasma ti correct this problem(2)

A

the most common way to normalize the PF
and
restoration of vit K dependent factors

432
Q

clue for pancreatic cancer(2)

A

epigastric pain

weight loss

433
Q

trousseau sign in pancreatic cancer

A

migratory thrombophlebitis

434
Q

pancreatic cancer with jaundice

A

head pancreas tumor

435
Q

first thing in pancreas head tumor

436
Q

localisation ca pancreatic with no jaundice(2)

A

body
and
tail

437
Q

dx of body and tail pancreatic cancer

A

Ct scan of abdomen

438
Q

incase of blunt trauma abdominal with hypotension what the first thing to do(2)

A

assess intraperitoneum free fluid

bedside ultra sonography

439
Q

quid of FAST

A

focused assess sono for trauma

440
Q

what you assess during FAST(2)

A

pericardium

peritoneum after trauma

441
Q

if FAST equivococal next step

A

diagnostic peritoneal lavage (DPL)

442
Q

patietn with positive FAST or positive DPL next step

A

laparotomy

443
Q

hemodynamicaly stable patient with negative FAST next step

A

CT of abdomen

444
Q

cause of syringomyelia(2)

A

prior spinal cord injury type whiplash

arnold chiari

445
Q

what fibers are reached in syringomyelia

A

spinothalamic tract

446
Q

manif of spinothalamic tract problem(2)

A

pain

Temperature are decreased

447
Q

manif of syrigomyelie(2)

A

motor fiber s problem in upper extremities

Pain and T

448
Q

physio patho of syringomyelia

A

csf drainage from the central canal of spinal cord is disrupted leading to a fluid filled cavity that compress surrrounding normal tissue

449
Q

DX synringomyelia

450
Q

Laps of tiem between the accident and beginning of syringomyelia

A

month to years later

451
Q

risk in complete excision of parotid tumor

A

facial droop caused by facial nerve problem

452
Q

cause of transtentorial herniation(uncal)

A

right sided epidural hematoma

453
Q

artery rupture in epidural hematoma

A

middle menigeal artery

454
Q

what nerve can be involed in transtentorial herniation

A

oculomotor nerve

455
Q

manif of oculomotor problem(5)

A 
ipsilateral hemiparesis
Mydriasis
strabismus
controlateral hemianopsia
altered mentation
456
Q

quid of drop arm test

A

doctors abduct passively both arm above head end then ask to bring arm down slowly
in case of Rotator cuff tear, arm drops rapidly

457
Q

signification of drop arm test

A

rotator cuff tear problem

458
Q

Mx of rotator cuff tendon(4)

A

supra spinatus
infraspinatus
teres minor
subscpularis muscles

459
Q

pain shoulder with arm in external rotation with resistance in internal rotation

A

axillary nerve is injured

460
Q

pain shoulder with arm in external rotation with resistance in internal rotation

A

anterior dislocation of shoulder

461
Q

arm in ant dislocation

A

external rotation

462
Q

quid of oliguria(2)

A

< 6 cc kg/day

463
Q

first thing to do in patient with foley catheter developping prerenal azotemia

A

remove the catheter to see if it’s not clogged

464
Q

how’ s K+ in prerenal azotemia

465
Q

first thing to do in prerenal azotemia with high K+

A

bolus of IV fluids

466
Q

indicator of prenal azotemia

A

BUN/Creat>20/1

FeNA< 1

467
Q

patient with pain in scrotumdevelops left sided scrotal swelling which increases with valsalva maneuver dx

A

varicocele

468
Q

quid of varicocele

A

dilation of pampiniform plexus

469
Q

why varicocle happens in the left

A

left testicular vein enters left renal vein inferiorly at a right angle thereby predisposing to impaired drainage

470
Q

physical exam of varicocele

A

impression of bag of worms

471
Q

why you can have shoulder irradiated pain during abdominal pain

A

intraabdominal pathology can cause peritonitis and irritation of diaphragm

472
Q

patient with direct blow to the lower abdomen has pain in hypogastre radiated to the left shoulder

A

dome vesical rupture

473
Q

the only part of the bladder covered by peritoneum

A

dome of bladder

474
Q

cause of chemical peritonitis(5)

A

hemoperitoneum
spillage of bowel contents
bile pancreatic secretions
urine in peritoneum

475
Q

most susceptible point of rupture of bladder

476
Q

why irritation of parietal peritoneum will cause shoulder pain (2)

A

peritoneur covers undersurface of diaphragm is innervated by C3 to C5 spinal levels
C3 to C5 also bring sensation to shoulder

477
Q

best dx test for urolithiasis

A

CT of abdomen and pelvis without contrast

478
Q

test for urolithiasis in pregnant women

479
Q

cause of post op fever(5)

A 
pneumonia
UTI
DVT
wound infection
drugs
480
Q

cause of post op fever and chronology(5)

A 
wind-----1 a 2 jours
water--------3 a 5 jours
walking-----4 a 6 jours
woung-----5 a 7 jours
wonder drugs --more than  7 days
481
Q

fever with coagulase - in bacteria culture cause

A

indwelling catheter

482
Q

femoral catheter infection

A

gram negative bacteria(enteric organism)

483
Q

IV catheter or indwelling catheter

A

staph epidermidis

484
Q

fever develops 1-6 months post op in a patient who has received blood products

A

febrile non hemolytic transfusion reaction

485
Q

8 e day after surgery patient develops pain and swelling of the left angle of the jaw dx

A

post op parotiditis

486
Q

what can prevent post op parotiditis(2)

A

adequate fluid intake

oral hygiene

487
Q

bug causing of post op parotiditis

A

staph aureus

488
Q

fever and knee swelling after right total knee replacement 6 months after the procedure

A

prosthetic joint infection

489
Q

bugs in cause of prosthetic joint infection within 3 months after arthroplasty(3)

A

staph aureus
gram negative rods
anaerobes

490
Q

bugs in cause of prosthetic joint infection more than 3 months after arthroplasty(3)

A

staph epidermidis
propionibacterium
enterococci

491
Q

rx of prosthetic joint infection

A

remove the prothesis

492
Q

patient 32 yo with intermittent bloody nipple discharge

A

intraductal papilloma

493
Q

physical exam of intraductal papilloma

A

can be normal

494
Q

size of tumor in intraductal papilloma

A

no larger than 2 mm

495
Q

size of intraductal papilloma to be detected by US

A

greater than 1 cm

496
Q

difference between intraductal papilloma and paget

A

in paget you eczematous changes in nipple

497
Q

after thyroidectomy patietn develops mx cramps prolonged corrected qt interval(N<460ms) dx?

A

hypocalcemia caused by secondary hypoparathyroidism

498
Q

why hypoparathyroidism after thyroidectomy

A

removal of 4 parathyroid glands

499
Q

consequence of hypocalcemia(2)

A

tetany

seizure

500
Q

patient with DVT and clot in distal portion of femoral vein CAT

501
Q

quid virchow triad(3)

A

stasis
endothelial injury
hypercoagulable state

502
Q

guideline to prevent DVT after major surgery

A

stable patient begin anticoagulation 48-72 h after surgery

503
Q

quid acute cholecystitis(2)

A

inflammation and distension of gallbladder

obstruction of cystic duct by calcul

504
Q

Murphy sign

A

palpation on RUQ elicits shoulder pain

505
Q

US of acute cholecystitis(3)

A

gallstones
thickened gallbladder with edema
normal common bile duct

506
Q

management of acute cholecystitis(2)

A

rx conservatively

3 jours later laparoscopic cholecystectomy

507
Q

vaccine in splenectomised patient

A

against encapsulated germs

508
Q

most common encapsulated germs in sepsis chez les splenectomises(3)

A

S pneumoniae
meningoccoque
Hi flu

509
Q

role of the spleen(4)

A

antigen uptake by dendritic cells in spleen
presentation to T cell
T cell activates B cells
b cell become plasma cells and form antibody

510
Q

why you have sepsis in splenectomy

A

you need antibody to opsonise encapsulated gems to make phagocytosis effective

511
Q

when to to give vaccine for encapsulated germs

A

before surgery on spleen

512
Q

physiopatho of colicky pain in gallstones

A

fatty meal cause contraction of gall bladder

gallstone block the contraction causing intra gallbladder pressure to rise distend and cause the pain

513
Q

how to differentiate acute cholecystitis from biliairy colic(3)

A

the second is intermittent
in relation with food
absence of fever

514
Q

why the pain is intermittent in biliary colic

A

relaxation of the gallbladdder causes the gallstone to fallback from the duct

515
Q

quid of bilairy colic

A

pain occurring when gallblader distends against an obstructed cystic duct

516
Q

patietn burn 2e degree on day 3 develops hypothermia,hypotension and WBC >10000 dx

A

burn sepsis

517
Q

clue for sepsis(5)

A 
fever or hypothermia< 35
pulse >90/mn
resp>20/mn
wbc >12000 or< 4000
or 10 % bands
518
Q

when to consider sepsis(6)

A 
when you have ended organ damage
oliguria
hypotension
low platelet
metabolic acidosis
hypoxemia
519
Q

quid of systemic inflammatory response syndrome(2)

A

you can have non infectious inflammatory response

can be infectious

520
Q

cause of non infectious inflammatory response(4)

A

pancreatitis
Burn
vasculitis
autoimmune disease

521
Q

quid of sepsis

A

systemic inflammatory response caused by infection

522
Q

how’s glucose in sepsis and why(2)

A

high

worsening insulin resistance

523
Q

cause of death in patient with burn(2)

A

hypovolemic shock

later sepsis

524
Q

clue for morton neuroma(2)

A

foot pain

mulder sign

525
Q

quid of mulder sign

A

clicking sensation when simultaneously palapating 3e et 4 e metatarsal heads and squeezind

526
Q

people at risk for morton neuroma

527
Q

rx of morton neuroma

A

bilateral shoe inserts

528
Q

failure of bilateral shoe inserts in morton neuroma

usmle step 2 (22 decks)

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