Surgery Flashcards
1
Q
acute mediastinitis is a possible complication of cardiac surgery usually due to what
what is presentation
A
intraoperative wound contamination
fever, tachy, cehst pain, leukocytosis and wound drainage post op
2
Q
serum phos in vitamin D def
A
low
3
Q
what is a common precipitating event to ischemic colitis
A
repair of AAA
4
Q
what helps achalasia position wise
A
upright position
5
Q
what age does child need surgery if umbilical hernia persists
A
5 or so
6
Q
pts with penetrating trauma who have what need urgent exploratory lap
A
hemodynamic instab
peritonitis
evisceration
or blood from NG tube
7
Q
managment of amputation and reimplantation
A
limb or digit wrapped in sterile gauze, moistened with sterile saline and placed in plastic bag on ice to ED
8
Q
what can be injured in a supracondylar fracture of the humerus
A
brachial artery
median nerve injury
9
Q
AE dapsone
A
hemolytic anemia (check G6PD)
10
Q
PE showing an abdominal succussion splash
A
pyloric stricture
11
Q
dysphagia, halitosis, and fullness of the throat in pts over 60
A
zenker diverticulum
12
Q
if have persistent hemoptysis and initial bronchoscopy doesnt work to localize source what is next
A
pulmonary arteriography
13
Q
clinical features of pulmonary contusion
A
presents within 24 hours of blunt thoracic trauma with
tachypnea, tachy, hypoxia
14
Q
management of complicated gallstone diseas like cholecyst, choledoch, or gallstone panc
A
choleccystectomy within 72 hours
15
Q
SBO where is location: colicky abdominal pain, delayed vomiting, prominent abdonminal distension, constipation, hyperactive BS and dilated loops of bowel on x ray
A
mid or distal
16
Q
CT scan showing ruptured aorta with blood collection in the adventitial layer is what
A
ruptured AAA
17
Q
soft signs of extremity vasular trauma
A
history of hemorrhage
diminished pulse
bone injury
neuro abnormality
tx: injured extremity index (if under 0.9 then CT)
CT scan with angiography
duplux doppler US
18
Q
steps in cervical spine trauma after a fall in pt that is hypoxic and hypopneic
A
stabilize spine
assess airway, if above C3 can cause immediate paralysis and lower C lesions can damage phrenic nerve
orotracheal intubation unless massive facial trauma
19
Q
Afib after CABG
normal or nah?
treatment
A
15-40% get it, usually self limited and resolves within 24 hours
can use BBor amiodarone
only anticoags and or cardoversion if lasts over 24 hours
20
Q
suspected scaphoid fracture managment
A
xray at time of injury is low sensitivity
CT scan or MRI to confirm
or
immobilize with splint and repeat imaging in 7-10 days
21
Q
scrotal mass that decreases with supine position and increases with standin/valsalva maneuvers
A
varicocele (dilation of pampiniform plexus)
22
Q
management in flail chest
what can occur often
A
pain control and supplemental oxygen early
resp failure can occur from pulmonary contusion leading to edema/blood in the alveoli and intubation with mechanical PPV is req in many pts
23
Q
tibial nerve supplies what muscles and what actions and sensation
A
posterior compartment of thigh and leg and plantar muscles of foot
flexion of knee and digits and plantar flexion of foot
sensation to leg (except medial side) and plantar foot
24
Q
cause of acalculous cholecystitis and what patients is it seen in
A
idiopathic and seen in pts with sever underlying illness:
dehydration, ischemia, burns, severe trauma, post op state
same signs and sx as acute cholecystitis
25
stasis dermatitis most classically involves what
the medial leg below the knee and above the medial malleolus
26
anterior spinal cord syndrome can occur in what surgery
thoracic aortic aneurysm repair (reduced radiuclar artery flow like in artery of adamkieqicz)
27
penile fracutre is rupture of what
corpus cavernosum from teari in tunica albuginea
28
for pts involved in MVA or falls from over 10 feet physicians must have high suspicion for what
blunt aortic injury
29
pt had blunt trauma in MVA then persistent pneumothorax despite chest tube placement and pneumomediatstinum and subcut emphysema
tracheobronchial perforation secondary to blunt thoracic trauma
confirm dx with Ct scan, bronchoscopy or surgical exploration
30
managment of clavicular fractures
all need neurovascular exam to r/o injury to subclavian artery and brachial plexus
31
post op measures used to decrease the risk of pneumonia
lung expansion
spirometry, deep breathing exercises, continous positive airway pressure
spirometry most effective
32
greatest danger in massive hemoptysis
what position to put pt
asphyxiation bc of airway flooding with blood
place pt in lateral position to avoid blood collection in opp lung
33
subacute pain over the midline sacrococygeal with mucoid and blood drainage most likely has what
pionidal disease
34
treatment of pre-renal AKI
IV isotonic fluid
35
positive airway pressure is indicated in what fracture
flail chest
36
evaluation of hemoptysis if have massive bleeding do what
if stops bleed then what
if bleeding continues then what
secure the airway, breathing and circulation
- if stops bleeding then workup with CXR, coag studies, renal fnct, UA, rheum workup
- then CT scan +/- bronchoscopy
- then treat cause
if bleeding does no stop then
-straight to treating cause via bronchoscopic interventions, embolization or resection
37
bilateral cellulitis of the submandibular and sublingual spaces from infected mandibular molar
ludwig angina
see drooling
38
managment of small bowel obstruction
bowel rest, NG tube suction, IVF
surgical exploration for sinngs of complications
39
sudden onset severe unilateral lower abdominal pain immediately following strenusous or sexual activity in woman and US shows free pelvic free fluid
ruptured ovarian cyst
40
abdominal pain and hematochezia in old man with CAD getting AAA repair
colonic ischemia
41
spontaneous pneumothorax treatment if small or large
2 cm or smaller then observe and oxygen
if large and stable then needle aspiration or chest tube
42
steps of dx PAD
ABI first then arterial US bc less senstivie and specific, do in sx pts
43
preventing pre and post op bacterial parotitis
most common bug?
adequate fluid hydration and oral hygiene
staph aureus
44
treatment for anal fissures
higher fiber diet and fluids
stool softener
sitz baths
topical anesthetics and vasodilators like nifedipine and nitroglycerin
45
terminal hematuria with clots suggests what
bleeding within bladder or ureters and is concerning for urothelial cancer
46
what injury can cause posterior urethral injury and how to diagnose
pelvic fractures
retrograde urethrogram
47
atelectasis and oxygen co2 level
most severe when
ventilation perfusion mismatch leading to hypoxemia nad increased work of breathing
most severe during 2nd postoperative night
48
managment of splenic injury from BAT
hemodynamically stable, still risk factors
stable pts with AMS
hemodynam stable: FAST, if normal but high riskfeatures like anemia or guarding then CT
stable pts with AMS go straight to CT
49
dudoenal hematoma occurs after what and can lead to what
blunt abdominal trauma
can lead to partial or complete obstruction
24-36 hours after initial event get epigastric pain and comit from obstruction
50
epidural hematoma treatment in pt with focal deficits or signs of intracranial HTN
emergent neurosurgical hematoma evacuation
51
subacute post op fever timing and etiology
1 week to 1 month
SSI/cath infection
C diff
drug fever
PE/DVT
52
ingesting acid is risk factor for developing what
dx
tx
pyloric stricture
upper endoscopy
surgery
53
where to place needle thoracostomy in tension pneumo
f/u with what
2nd intercostal space in midclavicular line, if this fails then
fifth intercostal space in the midaxillary line
then do emergency tube thoracostomy
54
when would you do CT scan or US for suspected appendectomy
non classical symptoms
55
what does the LV do in hypovolemic shock
decreases in size bc of decrased filling volume so it increases its ejection fraction
56
PPV in hypovolemic shock
causes acute increase in intrathoracic pressure which in severly hypovolemic pt with low central venous pressure can collapse venous capacitance vessels like IVC and cut off venous return = sudden loss of RV preload
57
what provokes gilbert syndome
stress like infection, fasting, vig exercise, surgery
58
polymyalgia rheumatica
muscle pain and stiffness in shoulder and pelvic girdle
decreased ROM in shoulder, neck, hip
responds to glucocortiicoids
can be associated with temporal arteritis
59
when do you use bronchoscopy in hemoptysis
when have >600 mL/day or 100 mL/hr
60
delayed fever (>1month after surgery) usually caused by what
surigcal site infection
| virus
61
fibrosis and contracture of the glenohumeral joint capsule. causes persistent pain along with decreased ROM in multiple planes
adhesive capsulitits
62
blunt abdominal trauma in hemodynamically stable pt that is not alert or normal mental status
what if normal metnal status
seriel abdominal exams +/- CT
if normal
FAST
- = seriel abdominal exams +/- CT
+ = CT scan abdomen
63
small pneumothoraces in clinically stable pt treatment
observation and supplemental oxygen
64
first step if pt is ID'd to have pulmonary TB
isolation
65
varicoceles are more common on which side and why?
left side
bc gonadal vein on left drains to the left renal vein and can be compressed
66
atelectasis is most common postop day what
2 and 3
67
severe burn assocaited with extensive scar formation and a chronic non healing wound is what
SCC
this is a Marjolin ulcer
68
chest xray for PCP pneumonia what is often elevated in serum
bilateral interstitial infiltrates
serum LDH often elevated
69
the most important risk factor of a gallstone ileus
dx
tx
cholecystitis which predisposes to biliary-enteric adhesions
CT scan shows GB thickenink, pneumobilia (air in biliary tree) and stone
tx with remoing stone and +/- cholecystectomy
70
treatment of postoperative mediastinitis
drainage, surgical debridement with immediate closure and prolonged abx therapy
71
other studies considered in pts with blunt genitourinary trauma
radiographs for frx
US for testicle injury
retrograde cystouretrhrogram for urethral ainjury and bladder rutpure (these pts usually have gross hematuria, and difficult peeing and blood at meatus)
72
managment of ischemic colitis
IV fluids and bowel rest
abx with enteric coverage
colonic resection if necrosis develops
73
what kind of trauma causes diffuse axonal injury
accel/decel
74
pain location for mesenteric ischemia
periumbilical and hematochezia
75
gross hematuria based on stage of voiding at which it occurs
terminal
prostate, bladder neck or trigone, or posteior urethra
urothelial cancer, cystitis, urolithiasis, bph prostate cancer
76
hemodynamically unstable pt with pneumothorax treatment
immediate tube thoracostomy, if not available then urgent needle decompression
77
what part of the bladder if ruptured can lead to fluid into the peritoneum and cause acute chemical peritonitis
dome of the bladder (intraperit)
can cause referred pain to ipsilateral shoulder
78
stable pt with large pneumothoraces treatement
decompression with large bore needle in 2nd or 3rd ICS midclavicular line or at 5th ICS mid axillary line
79
what would you see in bladder rupture and diagnosis
gross hematuria nad possibly difficulty voiding
retrograde cystogram
80
what is elevated in a nonseminomatous germ cell tumor
elevated AFP and b-HCG
81
____ is episodic pain and tenderness at inferior patella and paterllar tedon. seen in athletes in jumping sports or occupations with repetitive forcefull knee extension
paterllar tendinitis
82
fistula in abdominal aortic aneurysm rutpure
can create an aortocaval fistula with IVC leading to venous congestion in retroperitoneal structures like bladder nad these viens in bladder can rupture and cause gross hematuria
83
ribs broken in flail chest
3 or more contiguous ribs fractured in 2 or more locations
84
treatment for emphysematous cholecystitis
emergent cholecystectomy
broad spectrum antibiotics with clostridium coverage (amp-sulbactam) also e coli
85
what is the most frequent cause of bloodstream infection in pts with intravasuclar devices
staph epidermidis
86
diagnosing pulmonary contusion
rales or decreased BS
CT scan or CXR with patch alveolar infiltrate not restricted by anatomical borders
87
meningioma found mainly in what pop
middle age to elderly women
thing meningioma and menses
88
SBO vs ileus which has increased BS
SBO start increased then go to absent
ileus has reduced/absent
89
ABI under .9 is dx for what
peripheral artery disease
90
pt: MVA then elevated JVP and tachycardia and hypotension
chest xray
pericardial tamponade
xray can show normal cardiac silhouette bc small amt pericardial fluid
91
treatment for dumping syndrome
small/freq meals
replace simple sugars with complex carbs
incorporate high fiber and protein rich food
92
testing for meniscal tear
thessaly test
-pt stands on 1 leg and knee flexed 20 degrees then internally and externally rotates on flexed knee
mcmurray test
passive knee flexion and extension while holding in internal or external rotation
pain, click, or catch indicates tear
93
ondansetron can contribute to what and how
serotonin receptor antagonist can contribute to constipation
94
when would you use ERCP in pancreatitis
when have cholangitis, visible CBD dilation/obstruction or increaseing liver enzyme elevels
95
infection within the retropharyngeal space drains where and can lead to what
drains inferiorly to the superior mediatstinum
spread to the carotid sheath can cause thrombosis of the internal jugular vein and deficits in CN 9-12
extension through the alar fascia into the danger space can rapidly transmit infx into posterior mediastinum to diaphragm
96
syringomyelia sx
decrased strength and diminished pain and temp sensation affecting the arms/hands or having a cape-like distribution
preservation of dorsal column function
97
burn wound sepsis odd changes
oliguria, hyperglycemia, thrombocytopenia and AMS
98
sings and sx suggestive of necrotizing surgical site infection
```
pain, edma, erythema beyone surgical site
systemic signs
paresthesia at edge of wound
purulent cloudy-gray discharge
subcut gas or crepitus
```
99
hard signs of extremity vascular trauma and treatment
observed pulsatile bleed
bruit/thrill over injury
expanding hematoma
sings distal ischemia
surgically explore
100
RUQ or epigastric pain with elevated aminotransfereases and alk phos. give morphine and makes worse
visualization of dilated CBD with no stones is big key
sphincter of oddi dysfunction bc causes contraction
101
ST depression on ECG indicate what
ischemia
102
urine sodium under 25
volume depletion
CHF
cirrhosis
103
chronic dysphagia to both solids and liquids, difficulty belching, and mild weight loss are all common manifestations of what
achalasia
104
what is given pre-operatively to patients with mild hemophilia A in order to prevent excessive bleeding
desmopressin
105
what injury is associated with aotic injury
rapid deceleration injury like MVA over 30 mph
falls from 10 ft or more
severe crush injury
106
alternative agents for PCP besides TMP-SMX
pentamidine
atovaquone
Trimethoprim + dapsone
clindamycin + primaquine
107
bugs in necrotizing fascitis
strep pyogenes
staph aureus
c perfringens
108
fractures of the middle third clavicle treated how
what obout distal third
middle, nonop ,with brace, rest and ice
distal third: open reduction and internal fixation
109
what other sx of tension pneumo that you know is diff from spont pneumothor
hemodynamic instability
tracheal deviation away from affected side
110
bilateral flaccid paralysis and loss of P and T below level of injury
then UMN signs develop over days to weeks
vibration and proprioception are preserved
anterior spinal cord syndrome
111
cerebellar dysfunction from alcoholic cerebellar degen features
progressive gait dysfunction
truncal ataxia
nystagmus
intention tremor or dysmetria (tremor when trying to touch target
impaired rapid alt movement (dysdiadochokinesia)
muscle hypotonia--> pendular knee reflex
112
what is required to diagnose a psoas abscess
treatment?
CT scan
drain and abx
113
what innervates quadriceps femoris, sartorius and pectineus and responisble for what action of knee and hip
femoral nerve
knee extension and hip flexion
114
metoclopramide is what
dopamine antagonist with promotility effects
115
treatement for ruptured AAA
exploratory abdominal surgery no time for laparoscopy
116
gold standard for diagnosis of sphincter of ODdi dysfunction is what and treatment
manometry
sphincterotomy is treatment of choice
117
gallstone pancreatitis should be suspected in pts who have evidence of pancreatitis with ALT over what
150
118
what is the most common complications of cardiac catheterization
how long after does occur
local vascular comp at insertion site like:
```
bleeding or
hematoma,
arterial dissection,
acute thrombosis,
pseudoaneurysm or
AV fistula
```
usually 12 hours later
119
old pt with hip fracture should undergo definitive surgical correction as soon as reasonably possible but surgery ma be delayed up to ___ hours to evaluate surgical risk and ensure medical stability
72
120
extra axial well circumscribed round dural based mass on mri with calcifications is what and treatment
meningioma
benign so resect to cure
121
managment of blunt genitourinary trauma with renal injury and stable
GU exam
UA
contrast enhanced CT if have hematuria and stable
122
tx for pt with acalcuous cholecystitis
ABX and emergent cholecystectomy
pts who can't have srgy do percutaneous drainage of GB with choleccytostomy
123
swelling of feed with dorsa of feet being affected and marked thickening and rigidity of the skin
lymphatic obstruction
124
how to diagnose GI perforation
upright x rahy of chest and abdomen
shows free air under diaphragm
125
complications of central venous cath tip placement in wrong spot
venous perforation
lung puncture ---> pneumothorax
myocardial perf --> pericardial tamponade
126
most common cause of massive hemothorax are lacerations to what
lung parenchyma or damage to intercostal or internal mammary artery
127
pts with appendicits that have delayed presentation and longer duration of symptoms usually have what and how to diagnose
tx
appendiceal rupture with contained abscess
palpation will be negative but things like
psoas sign, obturator sign, and rectal exam may be positive, CT can confirm
tx: IV ABX, and drainage if needed. can get appendectomy electively 6-8 weeks later
128
cervical radiculopathy typically presents with what
pain and paresthesias of the neck and arm along with upper extremity weakness
129
acute mesenteric ischemia is most commonly due to abrupt arterial occlusion from either of the following:
cardiac embolic events like afib or valve disease (IE) or cardiovascular aneurysms
acute thrombosis due to PAD or low CO states
130
treatment for varicocele
gonadal vein ligation
scrotal support and NSAIDs in older men who don't want more children
131
acute cholecystitis without stones obstructing the cystic duct
acalculous cholecystitis
same signs and sx
132
complicated diverticulitis is diverticulitis with what and managment
abscess, perforation, obstrucation or fistula formation
-fluid uder 3 cm can be treated with IV abx and observation
>3 cmfluid have CT guided percutaneous drainage
then surgical drain and debridement if this does not work
133
what nerve damaged in anterior shoulder dislocation
what m does it innervate and weakness with what
axillary
teres minor and deltoid
weak shouder abduction
134
AE TMP-SMX
rash, neutropenia, hyperkalemia, elevated transaminases
135
diagnsosing acalculous cholecystitis
imagin that shows GB wall thickening and distension and presence of pericholecystic fluid
136
pain out of proportion to injury, pain on pasive stretch, swelling and paresthesia
arterial pulses?
compartment syndrome
arterial pulses usually present
137
lab testing in acute mseneteric ischemia
leukocytosis, hemoconcentration, elevated amylase, and metabolic acidosis
138
decreased breath sounds at the right lung base with no wheezes or prolonged expiration and normal temp. Chest xray shows dense opacity at right lung base
dx?
atelectasis
139
____ following major thoracic trauma that presents with acute circulatory failure or neurological signs and tracheobronchial
air embolism
140
what kind of hernia is associated with af americans, premautre birth ehlers danlos and beckwith wiedeamann syndrome and hypothyroid
umbilical
141
managment of someone with acute pancreatitis from gallstones
cholecystectomy
142
platelet count greater than what provides adequate hemostasis for most invasive procedures
50,000/mm3
143
prostehetic joint infection bugs
under 3 months
3-12 months
>12 months
under 3 = staph aureus
3-12 = coagulase neg staph, propionibacterium, enterococci (PEC)
>12 = staph aureus, gram neg rods, beta hemolytic strep
144
when does aspiration of gastric contents usually take place after surgery and sings?
within the first few hours after surgery
sx: sudden onset dyspnea, cough, fever, and rhonchi/crackles on exam
145
when do you do surgery for anal fissure
fissures that are refractory to medical managment
146
porgressive proximal muscle weakness and atrophy without pain or tenderness in LE muscles most common
normal ESR and CK
drug induced
glucocorticoid induced myopathy
147
DVT treatment with pt taht has ESRD
unfractionated heparin then warfarin
148
path of dumping syndrome
common postgastrectomy complication in 50% of pts
loss of normal action of pyloric sphincter, leads to rapid emptying of hypertonic gastric contents into the duodenum and SI
-fluid shift from intravascular space to SI, = hypotension and stim of autonomic reflexes and release of intestinal VIP
149
imaging for penile fracture
retrograde urethrogram when suspected urethral injury:
blood at meatus
hematuria
dysuria
urinary retention
150
most sensitive test to achalasia
manometry
151
intraperitoneal bladder rupture
rupture of the dome of the bladder
intraperitoneal urine leak with signs of chemical peritonitis (diffuse abdom tenderness, guarding and rebound)
152
most comon cause of acute liver failure
drug tox and acute viral hepatitis
153
bowel ischemia post AAA repair from what arteries lost
loss IMA during aortic graft placement
left and sigmoid colon perfusion lost
154
when would you add ccorticosteroids when treating PCP pneumonia
partial pressure of oxygen (PaO2) @ or under 70 mm hg or an A-a gradient of 35 or more
155
ABG in atelectasis
pH elevated, PO2 decreased, PCO2 decreased
156
acute post op fever
timing nad cause
24 hrs to 1 weeks
nosocomial infx
SSI
noninfection like MI, PE, DVT
157
emphysematous cholecystitis risk factors
take a VID for EC
vascular compromise
immunosupp
DM
158
lab values in acute mesenteric ischemia
leukocytosis, hemoconcentration, elevated amylase and metaboic acidosis
159
most common peripheral artery aneurysms
popliteal and femoral
160
impaired cough and shallow breathing following a abdominal or thoracoabominal surgery can lead to what
atelectasis
161
left sided abdominal pain with radiation to the shoulder, fever, and vomiting and free fluid not common
splenic infarct
162
nerve?
foot eversion
sensation overlateral leg and dorsum of foot
superficial peroneal nerve
163
in blunt abdominal trauma if have right shoulder pain from what
Hepatic laceration has hemorrhage that irritates the phrenic nerve
164
necrotizing surgical site infections occur more commolnly in what pts and what bugs
treatement?
pts with diabets usually poymicrobial
emergency early surgical exploration with debridement
also broad spectrum abx
165
if cannot abduct over 90 degrees what nerve and m may be compromised
long thoracic
| serratus anterior
166
when do you not need an xray for CVC placement
if use US guided CVC placement
167
acute necrotizing mediastintis can be from spread from where and sx and tx
spread from retropharyngeal abscess
fever, chest pain, dyspnea, odynophagia
need surgical intervention
168
most essential managment of pt with rib fracture that has atelectasis and hypovent an dpneumoina
pain control
169
primaquine AE
methemoglbinemia, hemolytic anemia
170
fluid filled cyst of head of epididymis that presents as painless mass at the superior pole of the testis
spermatocele
171
burn wound sepsis is associated with what systemic findings
temp above 102 or below 98
tachycardia
tachypnea
hypotension
172
first 15 degrees of abduction shoulder
15-90 degrees
muscles
first 15 = supraspinatous
| deloid = rest
173
what is cerebral angiography a useful diagnostic tool for
ID cerebral aneurysms and AV malformations
174
criteria for long term home oxygen therapy in pts with progresive hypoxemia from COPD
1) resting arterial oxygen tension of 55 mm hg or less (PaO2) or pulse ox at or under 88%
2) PaO2 at or under 59 or SaO2 at or under 89% in pts with cor pulmonale, evidence of R heart failure or hematocrit under 55%
175
hematocrit with rupruted ovarian cyst
referred pain
chest pain?
decresed
to shoulder
pleuritic
176
pts on long term glucocorticoid therapy who have cushingoid features are at high risk for what
adrenal crisis
can be seen in 3 weeks in pts taking 20 or more mg/day of prednisone
177
SBO where is location: early vomiting, abdominal discomfort, and abnormal contast filling on x-ray
proximal
178
what is almost always present in an extraperitoneal bladder injury?
pelvic fracture and gross hematuria
sometimes urinary retention
179
IV corticosteroids may be indicated in pts with intracranial HTN due to what
brain tumor or abscess
180
JVD with PE?
yes bc of pulnonary vascular resistance and R side HF
181
treatment of pilonidal disease
drain abscess and collect debris followed by excision of sinus tracts
ope closure too
182
treatment for postpericardiotomy syndome
NSAIDs or steroids bc immune reaction
183
rotator cuff muslces
supraspinatous (MC injury)
infraspinatus
teres minor
subscapularis
184
pt with subacute shoulder pain on abduction most likely has what
rotator cuff tendinopathy
from repetitive activity above shoulder heigt
185
most common cause of syringomyelia are what
arnold chiari malformations and prior spinal cord injuries
186
fever and abdominal pain radiating to groin and pain with hip extension
psoas abscess
187
nerve damaged in humeral mid shaft fracture
radial nerve
188
uncal herniation lesions and cause
compression contralat crus cerebri = ipsilat hemiparesis
compression ipsilateral CN III = loss paraymp innervation (mydriasis, down and out gaze)
compression ipsilat PCA = contralat homnymous hemianopsia
compression of reticular formation = Altered consciousness, coma
189
atelectasiss occurs often after what surgery
abdominal and thoracoabdominal procedures
190
abdominal pain, diarrhea, nausea, hypotension/tachycardia, dizziness/confusion, fatigue, diaphoresis 15-30 minutes after meals
dumping syndrome
191
differential diagnosis for an anterior mediastinal mass includes what
4 Ts
thymoma, teratoma, thyroid neoplasm, terrible lymphoma
teratoma (and other germ cell tumors)
192
treatment for peritonsillar abscess
needle aspiration or I and D plus antibiotic therapy to cover GAS and anerobes
193
clinical presentation of bowel ischemia
abdominal pain and blood diarrhea
fever and leukocytosis may also be present
194
pt: use of NSAIDs and several day history of episodic postprandial epigastric pain followed by acute onset severe constant pain =
perforated peptic ulcer
| urgent exploratory lap
195
pt is hemodynamically unstable after blunt abdominal trauma and FAST is inconclusive, what should you do next
diagnostic peritoneal lavage
196
managment of duodenal hematoma
decompression by NG tube, and possible parenteral nutrition
197
treatment of acute adrenal insufficiency
hydrocortisone or dexamethaasone
high flow IVF
198
spontaneous pneumothorax pts
thin young men or underlying lung disease like COPD
199
diagnostic requirements of acute liver failure
ALT and AST in 1000 or more
signs of hepatic encephalopathy
synthetic liver dysfunction (INR at or above 1.5)
200
if arterial puncture site is above where then a hematoma can extend into the retroperitoneal space
and what are clx features
and diagnosing it
and treatment
above inguinal ligament
hemodynamic instability and flank or back pain
confirm with non contrast CT scan of A and P or abdominal US
supportive treatment usually
201
unilateral LE edema that worsens when the leg is dependent (pt at work) and improves with leg elevation (when pt sleeping)
pathophys
venous valvular incompetence
decreases intravscular volume bc fluid out of caps into interstiial fluid and stimulates kidney to retain water which makes even worse
202
myocaredial contusion classically causes what
tachycardia, new BBB or arrhytmia
often see sternal fx
203
HF and angina several months following an MI with possible ventricular arrhythmia and systemic embolization
left ventricular aneurysm
204
immediately after a severe burn, what organisms dominate, then 5 days later what does
gram positive at first like staph aureus
5 days later gram negs like pseudomonas and candida
205
fracture of surgical neck of humerus may cause what
axillary nerve injury
206
femoral nerve provides sensation to what
anterior thigh and medial leg via saphenous branch
207
what is the most common nonsurgical hypoparathyroidism
lab findings
autoimmune
hypocalcemia, and hyperphosphatemia in presence of normal renal function
208
ECG shows persisten ST elevation and deep Q waves
LV aneurysm
209
pain out of proportion to clinical findings is first presenting sx and worsening pain may occur with passive stretch of affected muscle compartment
acute compartment syndrome
210
pts on what meds are at increaesd risk for hemoperitoneum from a ruptured ovarian cyst
anticoagulation
211
AE atovaquone
GI distress, rash
212
eval of hyponatremia: urine osmolality under 100
primary polydipsia
| malnutrition (beer drinkers phenom)
213
urethral injury
blood at urethral meatus, high riding prostate
214
echo shoes thin and dyskinetic myocardial wall
LV aneursym
215
opoid withdrawal has signs of what activation
sypathetic nervous system
216
management of a stress fractutre
reduce weight bearing for 4-6 weeks
217
blood at urethral meauts, eccyhmosis of scrotum and high riding prostate
posteior urehtral injury
218
infection with nasopharyngeo carcinoma
epstein barr
219
what is cushings reflex and what does it mean
HTN, bradycardia and resp depression (BRH)
incresed ICP
220
what infection considered in ventilator associated pneumonia
pseudomonas
221
what pts most get pilnidal disease
15-30 year old young males, obese and sedentary lifestyles
222
what gallbladder path uses HIDA scan and when
cholecystitis when US inderterminate
223
preferred points of central venous access cath are where
internal jugular vein
subclavian vein
224
MC cause of ureteral injury
iatrogenic trauma during abdominal surgery
rare from blunt trauma but when happens its at ureteropelivc junction
-hematuria, fever, flank pain and hydronephrosis
225
diagnosing ischemic colitits
CT scan: colonic wall thickening, fat stranding
endoscopy: edematous and friable mucosa
226
hyponatremia
serum osmolality over 290
marked hyperglycemia
| advanced RF
227
esophageal webs
most commonly located in the upper esophagus and only cause mild focal narrowing (dysphagia to solids but not liquids) IDA too plummer vinson
228
management of blunt genitourinary trauma in hemodynamically unstable pt with renal trauma eveidence
undergo IV pyelography prior to surgical evaluation
229
any penetrating wound below the ___ ICS is considered to involve the abdomen and requires what
4th
laparotomy in unstable pts
230
left sided hemothorax could cause what findings
some tracheal deviation to right and reduced breath sounds and dullness to percussion over involved side
231
pt with motor vehicle accident and chest x ray showing bowel loops within thoracic cavity and shift of mediatstinum suggest what and next step managment
diaphragmatic rutpure
Chest CT can confirm diagnosis
232
____ is chronic anterior knee pain and MC in women. PEripatellar pain worsened by activity or prolonged sitting
patellfemoral pain syndrome
233
erythema sweeling POOP to PE and CT scan showing air in deep tissue
necrotizing faciitis
234
initial stream hematuria
urethritis
| trauma to urethra like foley cath
235
was is acute adrenal insufficiency characterized by
severe and often refract hypotension, vomiting, abdo pain and fever
hyponatremia and hyperkalemia (normal potassium in central AI)
236
RA often involves what joints
MCP
237
benign bony growth located on the midline suture of the hard palate
torus palantinus
genetic and environmentla
common in young women asians
238
nasal septal perforation is common following what surgery
presents how
rhinoplasty
post op whistling noise with respiration
perf from septal hematoma
239
what is common in occupations requirng repetivie kneeling and carpet laying and plumbing
prepatellar bursitis from staph aureus
aspirate and cell count and gram stain
if neg then NSAIDs and rest
if positive then drain and abx
240
bilateral lower extremity edema and stasis dermatitis is what
LE venous valvular incompetence
241
treating burn wound sepsis
pipe/tazo, carbapenum with vanco or aminoglycoside
242
axillary nerve injured during what humerus fracture
proximal
243
massive PE typically presents with what bp and neck veins
hypotension and distended neck veins
244
compartment pressure over ____nmm Hg or (diastolic - comparment pressure) under what indicates significant compartment syndrome
30
under 20-30
245
how to reduce warfarin anticoagulation
FFP
246
fever 1 week after surgery usually due to what
drug fever
surgical site infx
PE
247
leukocytosis with neutrophilic predominance is side effect of what med
systemic glucocorticoids
248
nerve?
foot dorsiflexion and toe extension and sensation where flip flops are
deep peroneal nerve
249
ideal placement of a central venous cath tip is where
lower superior vena cava
250
multiple, recurrent, painful nodules in the axillae, inguinal folds and perineal areas
hidradenitis suppurativa
251
ABI interpretation
abnormal, normal and low
0. 90 or lower = abnormal
0. 91-1.30 = normal
1. 30 and over = calcified and uncompressible vessles, do more studies
252
symtomatic pancreatic pseudocyst treatment
endocsopic drainage
if no sx then expectant managment
253
fever occuring immediately (within a few hours) in the operative or postop period is typically due to what
prior infection or trauma, inflammation due to surgery, malignant hyperthermia, or meds or blood produts given prior to surgery
254
hip pain when pressure is applied as when sleeping and with external rotation or resisted abduction
from excess friction
trochanteric bursitis
255
hemodynamically stable pts with intraperitoneal fluid ID'd on FAST should have what done
CT scan of abdomen
can distinguish blood from urine or ascites and show site
256
obturator nerve innervates what comparment and muscles of thigh and action and sensation
medial compartment
gracillis adductor longus, adductor brevis, anterior portion of adductor magnus
adduction of thigh
sensation over medial thigh
257
AE pentamidine
nephrotox, hypotension, hypoglycemia, cardiac arrhythmias, pancreatitis, elevated transaminases
258
adrenal insufficieny and water stuff
presents with hypovolemia which leads to increased ADH and hyponatremia
this would concentrate urine
259
uncomplicated diverticulitis in stable patients can be managed how
outpatient setting with bowel rest, oral antibiotics and observation
if really old or CIP then hospital IV abx
