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MS3 Year > Surgery > Flashcards

Surgery Flashcards

1
Q

What metabolic condition is an absolute contraindication to surgery?

A

DKA

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2
Q

A malnourished pt needs to go to surgery; what’s the ideal course of action?

A

Oral feedings for 10 days; next best would be oral feeding for 5 days; then parenteral feeding for any time

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3
Q

If someone needs surrey, when should they stop smoking?

A

8 wks before surgery (quitting closer increases bronchial secretions, and makes things worse)

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4
Q

In terms of the heart, two things you don’t want to have if going to surgery?

A

JVD (EF less than 35%) or MI within 6 months

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5
Q

Risk of parenteral nutrition?

A

Fungemia

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6
Q

What are the 5 things you look at for the Child-Pugh score, and what is it used for?

A

Used to assess liver and how well the pt will be able to process anesthesia; A BEAP: Albumin (low), Bilirubin (elevations), Encephalopathy, Ascites, PT/PTT (elevation); (any 1 of these means a 40% chance of death)

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7
Q

Fever on day 0, right after induction what do you do?

A

Dantrolene (likely malignant hyperthermia!)

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8
Q

Fever on post op day 2, what is it/what do you do?

A

Pneumonia (wind); chest xray, abx

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9
Q

Fever on post op day 7, what do you do?

A

ultrasound or CT scan (wound = cellulitis) to rule out abscess

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10
Q

Fever on post op day 1, what is it/do you do?

A

atelectasis (wind); CXR (should be negative) and incentive spirometry

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11
Q

Fever on post op day 3, what is it/do you do?

A

UTI (water); urinalysis and tx with antibiotics

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12
Q

Fever on post op day 10, what is it/what do you do?

A

Abscess; U/S or CT scan, drain, abx

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13
Q

Fever on post op day 5, what is it/what do you do?

A

DVT (walking); U/S, heparin

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14
Q

What are the 5 W’s of post op fever and when do they typically occur?

A

Wind (atelectasis = day 1), Water (UTI = day 3), Walking (DVT = day 5), Wound (cellulitis/abscess = day 7/10; may also see bacteria right after surgery day 0), Wonder drugs (malignant hyperthermia = during surgery)

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15
Q

Elderly post-op, X-ray shows dilated colon. Dx and tx (2)?

A

Ogilvie’s (pseudo-obstruction); place rectal tube, give pyridostigmine

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16
Q

Treatment of MI after surgery?

A

Medical, PCI, NEVER tPA

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17
Q

How do you diagnose an MI after CABG?

A

CKMB, NOT troponins

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18
Q

When is it okay to put an IVC filter in for DVTs (2)?

A

When the next PE will kill them AND there’s a contraindication to anticoagulation

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19
Q

A wound is leaking salmon-colored fluid, but the skin is intact. Dx and what do you do (2)?

A

Dehiscence; limit straining, elective OR

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20
Q

Post-op, foley in place, 0 urine output?

A

Unkink the catheter

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21
Q

Wound opens and intestines come out, dx and what do you do (3)?

A

Evisceration; warm saline dressing, bed rest, emergent OR

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22
Q

Day 2 post-op: pt gets hypertensive, tachycardia, diaphoretic, and confused. Dx? Tx?

A

Delirium tremens; give benzos (lorazepam)

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23
Q

Post-op, has urge to void, but can’t. Dx? What do you do?

A

Urinary retention (post op ileus of ureter/urethra vs BPH); in-and-out cath (post-void residual)

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24
Q

Diagnose a pulmonary embolism?

A

CT scan (good kidneys); VQ scan (bad kidneys)

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25
Q

Post-op, low urine output, first step?

A

Give fluids (see if pre-renal vs intrinsic vs both)

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26
Q

Fistula causes (6ish)? What should you do?

A

FRIEND: foreign body; radiation; inflammation/infxn/IBD; epithelialization; neoplasm, distal obstruction; remove the fistula (LIFT procedure)

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27
Q

Painful jaundice, dx?

A

Gallstones

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28
Q

You dx primary sclerosing cholangitis with strictures. How do you treat?

A

Ursodeoxycholic acid to transplant. DO NOT stent PSC

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29
Q

What disease is associated with primary sclerosing cholangitis?

A

Ulcerative colitis

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30
Q

How do you diagnose cholangiocarcinoma?

A

ERCP with endoscopic biopsy (card says brushes?)

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31
Q

Thin-walled, distended gallbladder on US, what do you think?

A

painless jaundice caused by biliary cancer somewhere

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32
Q

What is Courvoisier’s sign?

A

distended, palpable, painless gallbladder

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33
Q

How do you diagnose pancreatic cancer?

A

Endoscopic ultrasound (EUS) with biopsy

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34
Q

Treatment for choledocolithiasis?

A

ERCP

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35
Q

How do you diagnose primary sclerosing cholangitis?

A

MRCP (beads on a string); can do ERCP if MRCP equivocal

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36
Q

What will the US show in choledocolithiasis?

A

dilated ducts

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37
Q

Lots of D bili elevated, general cause?

A

Obstruction

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38
Q

You diagnose a stricture of the biliary tree. What do you do?

A

Stent it

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39
Q

Best test in working up esophageal cancer?

A

EGD with biopsy

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40
Q

First diagnosis step in GERD?

A

Empiric PPI

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41
Q

Best tx for achalasia?

A

Myotomy (dilatation and botox need repeating)

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42
Q

How do you diagnose Boerhaave’s?

A

Gastrografin swallow (less irritating to mediastinum than barium); then barium; EGD if others are negative

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43
Q

Bird’s beak esophagus on imaging = ?

A

Achalasia

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44
Q

Self limiting upper GI bleed caused by vomiting?

A

Mallory-Weiss tear

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45
Q

Esophageal cancer at the bottom of the esophagus is what type? Most common cause?

A

Adenocarcinoma; GERD

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46
Q

When is EGD the first step in GERD?

A

alarm symptoms = anemia, N/V, weight loss

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47
Q

1st step in working up esophageal cancer?

A

barium swallow (localizes cancer)

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48
Q

Esophageal cancer at the top of the esophagus is what type? What is a common cause?

A

Squamous cell carcinoma; smoking

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49
Q

Hernia that you see after a pt has surgery?

A

Ventral hernia

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50
Q

What will you see on KUB for small bowel obstruction?

A

air fluid level

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51
Q

Hernia that you see in baby boys?

A

Indirect hernia (through inguinal ring, often in to scrotum)

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52
Q

When do reducible, irreducible, and strangulated hernias go to surgery?

A 
Reducible = elective
Incarcerated = urgent
Strangulated = emergent
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53
Q

Classic appendicitis presentation: what’s the next step?

A

Surgery, not CT

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54
Q

Hernia that you see more in women?

A

Femoral (under the inguinal ligament)

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55
Q

Flushing, wheezing, diarrhea, what is the diagnosis and how do you test for it?

A

Carcinoid; 5-HIAA in urine (CT scan or octreotide scan as well)

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56
Q

Most common cause of small bowel obstruction, if pt has no prior surgery? Most common if pt has prior surgery? Name two other common causes.

A

Hernia; Adhesions; inflammatory bowel disease, cancers

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57
Q

Hernia you see in adult men?

A

Direct hernias (through the triangle - through transversals muscle)

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58
Q

Diagnose acute pancreatitis by?

A

Elevated lipase

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59
Q

Name the 3 most common causes of pancreatitis?

A

Alcohol, gallstones, and hypertriglyceridemia

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60
Q

Pancreatic pseudocyst: when do you operate?

A

6 wks or greater than or equal to 6 cm

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61
Q

Acute pancreatitis weeks ago, now early satiety?

A

pseudocyst, CT scan

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62
Q

Treatment of chronic pancreatitis?

A

Opiates (pain control - do not do surgery)

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63
Q

Antibiotic used in necrotizing pancreatitis? And when do you give it?

A

Meropenem - only if FNA proven infxn

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64
Q

Pt has fever, leukocytosis that fails to resolve days after pancreatitis, dx?

A

pancreatic abscess

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65
Q

Name 3 complications of acute pancreatitis that may require surgery

A

necrotizing pancreatitis, pancreatic abscess, pseudocysts

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66
Q

Pt has early satiety, ascited, dyspnea weeks after pancreatitis, dx?

A

Pseudocyst

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67
Q

Pt has falling hemoglobin, deteriorating, days after initial presentation of pancreatitis?

A

Necrotizing pancreatitis

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68
Q

When do you do a CT scan for a pt with high suspicion of pancreatitis (elevated lipase)?

A

CT scan if and only if no improvement after supportive treatment

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69
Q

How do you treat acute pancreatitis?

A

NPO, IVF, Analgesia (pancreatitis can cause positional chest pain)

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70
Q

Acronym for causes of pancreatitis?

A

G - Gallstones
E - EtOH
T - Trauma/Triglycerides

S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion venom
H - Hyperlipidemia/Hypothermia/Hypercalcemia
E - ERCP/Emboli
D - Drugs
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71
Q

What do you see on US of cholecystitis (3)?

A

pericholecystic fluid, thickened gallbladder wall, gallstone

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72
Q

Ultrasound finding for choledocolithiasis?

A

Dilated ducts

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73
Q

Pancreatitis: what test can you get (gallbladder question)?

A

US, rule out gallstones as a cause

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74
Q

What do you do for cholangitis?

A

Emergent ERCP (also NPO, IVFs, IV Abx)

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75
Q

Risk factors for gallstones?

A

fat, female, forty, fertile, and Native American (5F’s)

Hemolysis (pigmented gallstones)

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76
Q

Treat cholangitis with which abx (2)?

A

Metronidazole + ciprofloxacin
OR
amp + gentamycin + metronidazole

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77
Q

Best diagnostic test for cholecystitis?

A

HIDA scan (also called nuclear scan)

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78
Q

Treatment for choledocolithiasis?

A

ERCP and sphincterotomy (or straight to cholecystectomy)

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79
Q

Colicky abdominal pain is caused by what general thing?

A

Obstruction (cholelithiasis, nephrolithiasis)

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80
Q

Involuntary guarding is seen when? What should you do for this pt?

A

Peritonitis; Ex-lap

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81
Q

Image the RUQ with?

A

Ultrasound!

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82
Q

Image the LLQ with?

A

CT scan

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83
Q

Pain out of proportion to the physical exam, what do you think of?

A

Ischemia

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84
Q

Image the RLQ with?

A

CT scan

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85
Q

Colonoscopy of Ulcerative colitis shows?

A

continuous inflammation from rectum through colon

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86
Q

Treatment for familial adenomatous polyposis?

A

prophylactic colectomy

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87
Q

Bright red blood on toilet paper after bowel movement - most common diagnosis?

A

Hemorrhoids

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88
Q

Treatment for fistulas?

A

LIFT procedure = fistulotomy

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89
Q

Screening for anal cancer: how do you do it and to who?

A

anal pap; pts who have unreceptive sex, especially in HIV positive men

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90
Q

Ulcerative colitis, 8 years from diagnosis, what do you do?

A

Colonoscopy annually, prophylactic colectomy

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91
Q

1000s of colonic polyps by 20, what’s the diagnosis?

A

familial adenomatous polyposis

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92
Q

Treatment for anal cancer?

A

Nigro protocol (not surgery!)

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93
Q

Biopsy of ulcerative colitis shows?

A

Superficial inflammation with crypt abscesses

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94
Q

Treatment for anal fissures?

A

Pastes or creams for pain and muscle tone relaxation (nitroglycerin paste, CCB paste) - can also use sitz bath or botox

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95
Q

___ is an abscessed hair follicle on someone with a hairy butt. How do you treat?

A

Pilonidal cyst (it is a congenital defect); incision and drainage, resection of the cyst

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96
Q

First test to diagnose peripheral vascular disease? How to interpret?

A

ankle brachial index; greater than 1.2 = hardening of vessels due to peripheral vascular disease; less than .89 is arterial disease

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97
Q

What type of ulcers would be found on sacrum? How to treat?

A

compression ulcers; roll patient, encourage out of bed (air mattresses are better for those who can’t get out of bed)

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98
Q

Hairless leg, shiny or scaly legs, decreased pulses?

A

Peripheral vascular disease

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99
Q

What type of ulcer on medial malleolus?

A

Venous stasis

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100
Q

Ulcer that heals and breaks down over and over?

A

Marjolin ulcers (it is due to squamous cell carcinoma)

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101
Q

Best test for peripheral vascular disease?

A

Arteriogram

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102
Q

Ulcers on heels and toes, what type?

A

Diabetic neuropathic ulcers

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103
Q

Breast lump in a woman less than 30, what should you do?

A

Reassure and have them come back in 2-3 cycles

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104
Q

Treatment for localized breast cancer?

A

Mastectomy = Lumpectomy + Radiation

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105
Q

Breast lump in a woman that persists?

A

Ultrasound

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106
Q

Her2 neu negative, ER/PR positive. Premenopausal. Treatment? How would you treat for post menopausal?

A

SERM = Tamoxifen; Aromatase inhibitor

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107
Q

Doxorubicin//danorubicin side effects?

A

Irreversible and dose-dependent CHF

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108
Q

Woman less than 30 with a breast mass on ultrasound, what should you do?

A

Biopsy

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109
Q

Her2 neu positive, ER/PR negative, post-menopausal. Treatment?

A

Trastuzumab

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110
Q

Woman less than 30 with a cyst on US, what’s the next step?

A

drain, FNA

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111
Q

What’s the screening timing for breast cancer?

A

50q2 (USPSTF) or 40q2 (ACOG)

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112
Q

Woman less than 30 with a cyst that recurs, what should you do?

A

Biopsy

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113
Q

When should you do a mammogram and core needle breast biopsy in a woman with a breast mass (4)?

A

Greater than 30 OR US shows mass OR Aspirate is bloody OR cyst recurs after aspiration

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114
Q

Trastuzumab side effects?

A

Reversible and dose-independent CHF

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115
Q

What are the side effects of tamoxifen vs raloxifene?

A

Tamox: better, increase DVT risk, increase Endo cancer
Ralox: worse, decresase DVT risk, decrease endo cancer
(tamoxifen is an ER agonist in the uterus and an antagonist in the breast)

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116
Q

What’s the first test performed on a large trauma victim?

A

FAST (ultrasound)

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117
Q

JVD, Distant heart sounds, no lung sounds, hypotension = ?

A

Tension pneumothorax

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118
Q

JVD, distant heart sounds, crackles on lungs, hypotension = ?

A

cardiogenic shock (echocardiogram)

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119
Q

JVD, distant heart sounds, clear lungs, hypotension = ?

A

Beck’s triad = pericardial tamponade

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120
Q

Hypotension in the setting of fever, tachypnea, and a chest XR positive for pneumonia, what type of shock? How do you treat (3)?

A

vasomotor shock (aka distributive shock); fluids, antibiotics and give pressors

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121
Q

MAP = __ x __

A

CO x SVR (or TPR)

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122
Q

CO = ___ x ___

A

HR x SV

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123
Q

Stroke volume is based on __ and __

A

preload and contractility

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124
Q

CT scan shows crescent shaped bleed - dx? How do you tx if acute? How do you treat if chronic?

A

Subdural hematoma; decrease ICP; craniotomy and drain it

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125
Q

Name 4 ways you can decrease ICP?

A

Elevate the head of bed, hyperventilate, mannitol, ventriculostomy

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126
Q

Large motor vehicle accident, coma, blurring of grey-white matter, dx?

A

Diffuse axonal injury

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127
Q

CT scan shows lens shaped bleed - dx? How do you tx?

A

Epidural hematoma; craniectomy

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128
Q

Football player passes out after colliding with another player - what do you do?

A

CT scan; if negative, call it a concussion and send him home - rest needed with gradual return

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129
Q

Pt with raccoon eyes likely has what?

A

basilar skull fracture

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130
Q

Old person has a fall and gets rapidly worsening dementia, what do they likely have? What should you do?

A

Subdural hematoma; CT scan

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131
Q

Young skier collides with tree. At first they are passed out, then regains consciousness and goes out again. What do they have?

A

Epidural hematoma (walk-talk-and-die)

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132
Q

Mechanism of injury that gives an old demented person a subdural?

A

simple falls (atrophy of brain and tense bridge veins predispose)

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133
Q

Stable wound to the neck just under the mandible (zone 3). What do you order?

A

Arteriogram

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134
Q

Old person with hyperextension injury, now can’t feel pain or temperature, has loss of motor in upper extremities. Dx?

A

Central cord syndrome

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135
Q

Left sided weakness and loss of proprioception, right sided loss of pain and temperature after a gunshot wound?

A

Brown-Sequard = hemisection of spinal cord

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136
Q

How do you treat a tension pneumothorax?

A

Needle decompression

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137
Q

How do you diagnose a pneumothorax?

A

CXR shows vertical lung shadow

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138
Q

How do you treat a sucking chest wound?

A

Occlusive dressing (taped on 3 sides) - this is caused by a penetrating trauma from the outside (aka not a rib)

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139
Q

How do you diagnose a myocardial contusion?

A

ECG and troponins

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140
Q

You see a sternal fracture, scapular fracture, or flail chest. Name 3 things you should be worried about.

A

Myocardial contusion, pulmonary contusion, aortic dissection

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141
Q

How do you treat a pulmonary contusion?

A

Diuresis, avoid large volume fluids (can also use PEEP to help push fluid back in to capillaries)

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142
Q

Paradoxical wall motion on respiration, what does the pt have?

A

Flail chest (caused by blunt trauma - 2 or more ribs broken in 2 or more places)

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143
Q

How do you treat a pneumothorax?

A

chest tube; thoracostomy

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144
Q

If the hemothorax produces greater than 1500ccc on initial drain, what should you do?

A

Cut the chest open = thoracotomy (they are likely bleeding from a large artery)

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145
Q

How do you treat a hemothorax? What does it look like on CXR?

A

Chest tube, thoracostomy; horizontal lung shadow

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146
Q

How do you diagnose an aortic dissection?

A

CTA! (cxr may show widening of the mediastinum)

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147
Q

When does pulmonary contusion often occur with regards to the traumatic event?

A

24-48 hours after trauma

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148
Q

Blunt trauma to the abdomen, next step?

A

FAST

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149
Q

Rectal injury in pelvic fracture. Next step?

A

Protoscope (then may need surgery)

150
Q

Blood at the urethral meatus, high riding prostate. What test do you get?

A

Retrograde urethrogram (RUG)

151
Q

What do you do before a splenectomy?

A

Vaccinate against encapsulated organisms

152
Q

Maneuver to stop liver hemorrhage? What are you compressing?

A

Pringle maneuver (compression of the hepatoduodenal ligament - contains the portal vein and hepatic artery and CBD)

153
Q

22 Caliber revolver shot a fat guy; what do you do?

A

Explore the wound, FAST

154
Q

Gunshot wound below T4 gets what?

A

Ex Lap

155
Q

Options to treat bleeding spleen?

A

Repair if able (capsule), resect if necessary

156
Q

Crepitus on hip rocking = ?

A

pelvic fracture

157
Q

With a pelvic hematoma, what should you do?

A

Transfuse, do NOT explore (can also do IR guided embolization)

158
Q

With urethral injury, how do you treat?

A

Surgery; suprapubic catheter (NO foley!)

159
Q

Circumferential burn, now pt has no distal pulses. What do you do?

A

Escharotomy (remove eschar because it is compressing vessels in extremity) - can be done at bedside because eschar has no sensation

160
Q

A child swallows lye - what do you do?

A

Observe for perf/aspiration and likely scope (do NOT neutralize with acid) (irrigation?)

161
Q

A chemist working in a lab pours some solution on his hand and it starts to burn, what do you do?

A

Irrigate vigorously!

162
Q

Pt is struck by lightning. What 2 things should you check?

A

ECG to look for arrythmia; CK to look for muscle breakdown you can’t see (bones conduct electricity and will burn the neighboring muscles)

163
Q

3rd degree burn on the anterior thigh. What medical therapy do you give?

A

Silver sulfadiazine (ppx) and early mobilization

164
Q

Man trapped in a burning building has singed nose hairs and soot in mouth. What do you do?

A

Intubate - a burn will respond with edema and you can lose the airway!

165
Q

Pt has posterior shoulder dislocation - name 2 causes of this. How does it occur?

A

Electrical burn (lightning strike or high voltage lines) or seizure; nervous system causes muscles to contract with such great force that shoulder gets dislocated

166
Q

Snakebite victim comes in with swollen, painful extremity turning purple. What do you do?

A

Give pt anti-venom!

167
Q

A pt gets stung by a bee, gets hypotension, wheezing, and becomes flushed. Tx?

A

SubQ Epi (anaphylaxis!!)

168
Q

Man comes in with a bite on chest, says he got it from a girl he just met. Tx?

A

Amoxicillin/clavulanate (ampicillin/sulbactam works too)

169
Q

If a wild dog bites a little girl, what should you do?

A

Capture it, kill it and biopsy it; if can’t cath give IgG and vaccine

170
Q

If a domesticated dog bites a little girl, what should you do?

A

Observe dog

171
Q

What bite causes pancreatitis?

A

Black widow spider bite

172
Q

A girl gets stung by a bee, pincer is removed. The sting site is a little red. Next step?

A

Observe (bee stings don’t have venom - only problematic when they cause anaphylaxis)

173
Q

How do you treat a black widow spider bite?

A

IV calcium

174
Q

What bite causes a necrotic ulcer with ring of erythema? How do you tx?

A

Brown recluse spider (see them in the South - think attics and old boxes); Wide debridement and skin grafts

175
Q

Acetaminophen toxicity leads to?

A

Hepatic failure

176
Q

How do you treat salicylate toxicity?

A

Alkalinize the urine

177
Q

Treatment for acetaminophen toxicity?

A

N-Acetyl-Cysteine

178
Q

Cherry red skin, cherry red blood, smoke inhalation = which toxin? How do you treat?

A

Cyanide; Thiosulfate

179
Q

Smoke inhalation, 100% pulse ox, confused, nausea- what do you do?

A

100% FiO2 (ABG is ok too)

180
Q

Lacrimation, rhinorrhea, defectaiton, urination, salivation…what is the toxin? How do you treat (3)?

A

Organophosphate; Decontamination, atropine, pralidoxime

181
Q

Urine bag glowing under a special lamp - toxin?

A

Ethylene glycol

182
Q

Two meds you give to an organophosphate poisoning?

A

Atropine (first), pralidoxime (second)

183
Q

How do you treat ethylene glycol toxicity?

A

Fomepizole

184
Q

Intestines are out of newborn, in the midline, and are contained in a sac. What’s the dx? How do you treat?

A

Omphalocele; give a silo

185
Q

What 3 other things should you look for in a pt with necrotizing enterocolitis?

A

Intraventricular hemorrhage (US with doppler); Retinopathy of prematurity (optho exam); Bronchopulmonary dysplasia

186
Q

If you find an imperforate anus in a newborn, what do you do next?

A

Up-side-down babygram (XR)

187
Q

Scaphoid abdomen and bowel sounds in the chest in a newborn, what’s the diagnosis?

A

Diaphragmatic hernia

188
Q

Coiled NG tube in an esophagus in a newborn, what’s the dx? What should you do before surgery?

A

Esophageal atresia; look for VACTERL! (vertebra, anus, cardiac, trachea, esophagus, renal, limb)

189
Q

Premature neonate develops bloody diarrhea, what’s the dx? How do you confirm?

A

Necrotizing enterocolitis; XR

190
Q

XR findings in necrotizing enterocolitis?

A

Pneumatosis intestinalis (air in the wall of the bowel)

191
Q

Intestines are out of newborn, they are to the R of midline, and have no membrane - dx? Tx?

A

Gastroschisis; give a silo

192
Q

Bilious vomiting in vignette, a double-bubble with multiple air fluid levels on XR image?

A

Intestinal atresia (vascular accident - can be caused by mom doing cocaine)

193
Q

You diagnosed pyloric stenosis, now what do you do?

A

Assess for electrolyte abnormalities, fix those, then fix the pylorus (myotomy)

194
Q

How do you diagnose biliary atresia?

A

HIDA scan after 1 wk of phenobarbital

195
Q

Treatment for intussusception?

A

Air enema

196
Q

Failure to pass meconium, X-ray shows dilated proximal colon and distal normal colon - dx? Tx?

A

Hirschsprung’s; remove the “normal” looking bad colon segment

197
Q

Currant jelly diarrhea in a child, pain relieved by fetal position; dx and how do you dx it? Tx?

A

Intussusception; Dx with KUB first (sausage shaped mass) then air enema, which is also the tx; may need resection of dead bowel

198
Q

Pt has paroxysms of pain, pressure, palpitations, and perspiration - what’s the dx and how do you dx it? Tx?

A

pheochromocytoma; 24hr urinary VMA and metanephrines (can do MIBG scan - which is taken up by neuroblastoma cells); tx with alpha blockade, then beta blockade, then resection (to prevent catecholamine surge)

199
Q

Old man with hypertension and a bruit over his renal artery - what’s the diagnosis? Tx?

A

Renovascular HTN; medical mgmt with high dose Ace-I/ARBs or aldosterone antagonists

200
Q

What’s the Aldosterone:Renin ratio in renal artery stenosis? Conn’s syndrome?

A

RAS: less than 10

Conn’s (hyperaldosteronism): greater than 20

201
Q

Child with claudication but does not turn blue - what’s the dx?

A

Coarctation of aorta (rib notching would only be seen in an adult because it takes time to develop)

202
Q

HTN and Hypokalemia points to which diagnosis?

A

Conn’s (primary hyperaldosteronism)

203
Q

A question about HTN and they show you a close up of a rib, what’s the dx?

A

Coarctation of the aorta

204
Q

First treatment of pheochromocytoma?

A

Alpha blockade!

205
Q

1st step in diagnosing primary hyperaldosteronism?

A

Aldo:Renin ratio (will be greater than 20)

206
Q

Young woman with hypertension and a bruit over her renal artery - what’s the diagnosis? Tx?

A

Fibromuscular dysplasia; stent it!

207
Q

Pt with recent gastrectomy presents with abdominal pain, diarrhea, nausea, hypotension/tachycardia, dizziness/confusion, fatigue and diaphoresis 15-30 minutes after meals. What is the dx? Pathogenesis? Tx?

A

Dumping syndrome; due to loss of normal action by pyloric sphincter causing rapid emptying of hypertonic gastric contents in to duodenum and small intestine - leads to fluid shift from intravascular to intestine leading to hypotension, stimulation of autonomic reflexes, and release of intestinal vasoactive peptides; tx with small/frequent meals, replacing simple sugars with complex carbs, and high fiber and protein rich foods

208
Q

You see a cushingoid pt - what should you ask about in your history?

A

prednisone

209
Q

Passing out with low glucose, C-peptide high and on sulfonylurea, but med screen negative - dx?

A

Insulinoma

210
Q

You see the words “migratory necrolytic dermatitis” - what’s the diagnosis?

A

Glucagonoma

211
Q

In the setting of Cushing’s syndrome, the ACTH is low, what’s the dx?

A

Primary adrenal tumor

212
Q

In the setting of Cushing’s the ACTH is high, what test is next?

A

High-dose dexamethasone suppression test

213
Q

When do you biopsy a thyroid nodule?

A

When there is a mass with either a cold nodule on RAIU or if there is normal thyroid function

214
Q

Low dose dexamethasone suppression test fails to suppress - what’s the dx?

A

Cushing’s syndrome (not disease)

215
Q

You feel a thyroid nodule, first step?

A

TSH/FT4

216
Q

Many nasty virulent ulcers refractory to treatment, what’s the dx?

A

Gastrinoma (Zollinger-Ellison syndrome)

217
Q

Holosystolic murmur that radiates to the axilla is?

A

Mitral regurgitation

218
Q

You want to assess if the pt is having a post-op heart attack on a CABG pt - what do you do?

A

CKMB

219
Q

How long do you give clopidogrel for with a drug eluting stent?

A

One year

220
Q

Aortic stenosis is treated with?

A

Valve replacement (TAVR or TAVI = transcatheter aortic valve implantation/replacement)

221
Q

When you replace the aortic valve, what test is required first?

A

Left heart cath; may need a CABG also

222
Q

Crescendo-decrescendo murmur in systole, what’s the dx?

A

Aortic stenosis

223
Q

Which coronary diseases get CABG?

A

3+ vessels or a left mainstem equivalent

224
Q

Diastolic rumbling with opening snap, what’s the dx?

A

Mitral stenosis

225
Q

You hear a murmur and the test wants you to order a diagnostic test. You get?

A

Echo

226
Q

What causes fixed split S2?

A

Atrial septal defect

227
Q

You want to close the PDA, what do you give? Open?

A

indomethacin; prostaglandins

228
Q

Cyanotic congenital heart disease at age 3 = ?

A

Tetralogy (all the others are immediate at birth)

229
Q

Holosystolic murmur in an adult; what’s the diagnosis? In a neonate?

A

Mitral regurg; VSD

230
Q

When do you treat a ventricular septal defect, and how do you choose what time to fix it?

A

All VSDs must be closed by year 1; if CHF, failure to thrive, or dyspnea, close immediately

231
Q

Mom has diabetes and the question is about congenital heart disease - dx?

A

Transposition of the great vessels

232
Q

Treatment for a descending aortic dissection? ascending?

A

Medical mgmt = keep systolic bp less than 120 (MAP 60-65); Emergent surgery

233
Q

How do you screen for AAA and who gets screened?

A

U/S abdomen; men older than 65 who have ever smoked

234
Q

Tearing chest pain that radiates to the back in a pt who is very hypertensive, dx?

A

Aortic dissection

235
Q

How do you diagnose an aortic dissection (2)?

A

start with CXR; CT Angiogram is best

236
Q

If the creatinine is elevated, how do you diagnose an aortic dissection?

A

TEE then MRI if TEE not available (CTA no good b/c of contrast)

237
Q

Biggest risk factor for AAA?

A

Smoking

238
Q

What’s definitive tx for acute severe glaucoma? What meds can you give to help? What should you avoid?

A

Laser drill; constrict pupil with alpha agonists and beta antagonists (activate alpha and block beta!); avoid atropine!!

239
Q

AAA - at what values do you need to act?

A

greater than 5.5 cm or growing greater than 0.5 cm/year

240
Q

How do you diagnose peripheral vascular disease?

A

ABIs then U/S then arteriogram

241
Q

Pt with tender, pulsatile abdominal mass, what should you do?

A

Emergent surgery (AAA)

242
Q

You’re thinking hydronephrosis vs hydroureter - what test do you get?

A

Ultrasound

243
Q

What are the 5 P’s of acute limb ischemia?

A

pain, pulselessness, poikilothermic (cold), paresthesias, pale

244
Q

Which PVD can be stented?

A

In femoral artery and short lesions (less than 3cm)

245
Q

PVD non medical mgmt (3)

A

control risk factors, smoking cessation, exercise

246
Q

What ABI is normal? When is it severe?

A

normal = 0.9-1.2; Severe is less than 0.5 (greater than 1.2 is unable to assess)

247
Q

How do you diagnose acute glaucoma?

A

Increased ocular pressures

248
Q

Intense colicky pain after a teenager first experiments with alcohol, what’s the dx?

A

Ureteropelvic junction obstruction

249
Q

CT scan of the kidneys - when do you use contrast and when do you not?

A

IV contrast for trauma - checking for leaks

Non-contrast for stones!

250
Q

A person in a MVA has floaters in their vision; likely dx?

A

Retinal detachment (look with opthalmoscope)

251
Q

Swelling of the eye, inability to move the eyeball, fever, leukocytosis - dx? How to diagnose? Tx?

A

orbital cellulitis; CT scan; emergent surgery

252
Q

Carpenter doing metal work without eyewear complains of scratches in their eye - dx and how do you diagnose it? Tx?

A

Corneal abrasion; fluoresceine dye; irrigate a lot and surgery or medical mgmt if needed

253
Q

What’s definitive tx for acute severe glaucoma? What meds can you give to help? What should you avoid?

A

Laser drill; constrict pupil with alpha agonists and beta antagonists (activate alpha and block beta!); avoid atropine!!

254
Q

If you have cataracts on the first day of life, what is the most likely cause?

A

TORCH infxn

255
Q

Purulent eye discharge, bilateral, 2-5 days into life, what should you have used for ppx?

A 
topical erythromycin (used to use silver nitrate, may still?)
(can ppx for gonorrhea only)
256
Q

Mucopurlent eye discharge, unilateral, 7-12 days into life, what’s the dx?

A

Chlamydia

257
Q

Purulent discharge, bilateral, 2-5 days into life, what would gram stain show? What would it show for a mucuopurulent discharge unilateral 7-12 days into life?

A

gram negative diplococci; nothing (chlamydia is intracellular)

258
Q

What do you do about congenital cataracts?

A

Remove them before amblyopia sets in (amblyopia is cortical blindness)

259
Q

You see what looks like melanoma on the face that is small - what should you do? What if it was on the arms? What if it is on the back but is very large?

A

Punch biopsy; excisional biopsy; punch biopsy (in melanoma, wide excisional bx is preferred but punch is ok if large or on the face)

260
Q

How do you treat epididymitis (2)?

A

If less than 40, more likely Gc/Chla = ceftriaxone and doxy

If greater than 40, more likely e coli = cipro

261
Q

Melanoma greater than 4mm deep gets?

A

Debulking, palliation

262
Q

Melanoma 2-4mm deep gets what? 1-2mm deep? Less than 0.5mm?

A

Wide excision and sentinal lymph node biopsy (2cm margins); wide resection and SLND bx (1cm margins); local resection

263
Q

Squamous cell caricnoma, small, on an extremity gets?

A

excisional biopsy (excisional if small and not on face; incisional if large OR on face)

264
Q

A head CT scan shows blood between the cisterns, dx?

A

subarachnoid hemorrhage

265
Q

Teenager with a non traumatic knee pain. Diagnosis and how?

A

Slipped capital femoral epiphysis; XR (frog leg)

266
Q

A pt presents with progressively worsening dementia after a fall; what’s the dx?

A

Chronic subdural hemorrhage

267
Q

Worst headache of their life, sudden onset, not responsive to morphine, dx? What do you do?

A

Subarachnoid hemorrhage; non con head CT

268
Q

A pt presents with stroke like symptoms. A non con CT shows a bleed. What should you do?

A

Keep the MAP less than 110 with esmolol

269
Q

Child with a brain tumor has metastasis to the spine. What’s the dx?

A

Medulloblastoma

270
Q

What do you do to treat metastatic lung cancer to the brain?

A

Whole brain radiation

271
Q

CT scan shows a knot attached to the skull, digging into the parenchyma, dx?

A

Meningioma

272
Q

How do you treat De Quervain’s tenosynovitis and where are they symptomatic?

A

Tendonitis of the thumb = thumb pain; treat with NSAIDs, then splinting/NSAIDs, then steroids (surgery doesn’t help since it’s an inflammatory disease)

273
Q

CT scan shows a mass that crosses midline. Dx?

A

Glioblastoma multiforme

274
Q

What’s the FIRST test when trying to identify a brain cancer?

A

CT scan

275
Q

Pathology shows psammoma bodies; dx?

A

Meningioma

276
Q

CT scan shows multiple brain lesions; dx?

A

Metastatic disease

277
Q

One kind of testicular cancer is really sensitive to chemo and radiation - what is it?

A

Seminoma

278
Q

You see asymptomatic hematuria in a pt without any bleeding disorder, what’s the dx? How do you assess?

A

bladder cancer; cystoscopy (can do US if there are obstructive signs)

279
Q

Young person falls on to hand and has pain snuff box - dx? Tx (2)?

A 
Scaphoid fracture (XR will be normal on day 1 and show necrosis on day 3); cast if normal xr on day 1; ORIF if fracture on day 1
(tenuous blood supply to distal scaphoid)
280
Q

You know you shouldn’t, but you screened for prostate cancer and got an elevated PSA. Next step?

A

biopsy (transrectal = transurethral)

281
Q

How do you treat hip fractures depending on where the fracture is (3)?

A 
All ORIF (closed for poor surgical candidates);
Femoral head = hip replacement
Intertrochanteric = plates
Shaft = rods
282
Q

First step to diagnose a testicular cancer?

A

Transillumination (should fail to transilluminate if it is cancer)

283
Q

How do you treat ACL or PCL tear?

A 
athletes = surgical repair
non-athletes = conservative
284
Q

How do you diagnose with imaging knee injuries?

A

MRI (can also use MRI for achilles tendon tear - though can be just clinically dx’d)

285
Q

How do you treat collateral ligament tears?

A

One ligament = hinge cast

Multiple ligaments = surgery

286
Q

Oligohydramnios, no urine output on first day of life, elevated creatinine, what’s the dx? How do you tx?

A

Posterior urethral valves; surgery for resection and reimplantation (but first catheter to relieve pressure)

287
Q

A girl who is able to void, is toilet trained, but leaks constantly anyway - dx? How do you dx (3)?

A

Ectopic ureter (aka low implantation of the ureter); first get US (no hydronephrosis), then VCUG (rules out reflux), then radionucleide scan

288
Q

Pt who is out of shape does a lot of activity and ends up with pinpoint tibia pain - dx? How to diagnose? How to treat?

A

Stress fracture; XR (normal on day 1, fracture on day 7); cast and crutches even if the XR is normal

289
Q

How do you treat small bowel obstruction (4)?

A

Bowel rest, NG tube suction, IV fluids, surgical exploration (if severe = hemodynamic instability, guarding, leukocytosis, significant metabolic acidosis)

290
Q

How do you manage a small spontaneous pneumothorax (less than or equal to 2cm)?

A

Supplemental oxygen and observation (oxygen enhances the speed of resorption)

291
Q

Any pyelo in a child should prompt investigation for what?

A

Vesicoureteral reflux

292
Q

You want to diagnose vesicoureteral reflux, what test do you get?

A

(after getting U/S first!) VCUG

293
Q

Intense colicky pain after a teenager first experiments with alcohol, what’s the dx?

A

Ureteropelvic junction obstruction

294
Q

CT scan of the kidneys - when do you use contrast and when do you not?

A

IV contrast for trauma - checking for leaks

Non-contrast for stones!

295
Q

Tender prostate means? Tx?

A

prostatitis; cipro

296
Q

Flank pain and hematuria - dx? How to diagnose?

A

Kidney stone; non-con CT

297
Q

Sudden onset pain without urgent frequency or dysuria, without bacteriuria without fever, chills, n/v - testicle is in horizontal lie and there is pain with elevation - dx?

A 
Testicular torsion (clinical dx but can use doppler US showing no flow) - surgery!
(may have absence of cremaster reflex)
298
Q

Sudden onset pain without urgent frequency or dysuria, without bacteriuria without fever, chills, n/v - testicle is in vertical lie and there is relief with elevation - dx?

A

Epididymitis (tenderness above the testes)

299
Q

First step in working up erectile dysfunction?

A

Nighttime tumescence (if it breaks - you’re having morning erections and problem is psych; if it doesn’t break - organic problem)

300
Q

Contraindication to sildenafil?

A

Nitrates! (causes dangerous hypotension when used together)

301
Q

Test to diagnose testicular torsion?

A

US with doppler

302
Q

How do you treat BPH in the chronic setting (1)? Acute (2)?

A

Finasteride (5-alpha reductase inhibitor); tamsulosin or doxazosin (alpha blockers)

303
Q

How do you treat kidney stones based on their size?

A

Less than 5 mm = IVF and analgesia
Between = lithotripsy
Greater than 3cm = surgical (nephrostomy)

304
Q

Tender prostate with sterile urinalysis means? How do you tx?

A

Sterile prostatitis; NSAIDs (or maybe Abx and alpha blockers)

305
Q

How do you treat epididymitis (2)?

A

If less than 40, more likely Gc/Chla = ceftriaxone and doxy

If greater than 40, more likely e coli = cipro

306
Q

A young kid with fever and pain in any joint - dx and how do you dx?

A

Septic joint - arthrocentesis (gt 50,000 WBCs)

307
Q

Tx for fracture in kids that does not involve the growth plate? That does involve the growth plate?

A

Cast; ORIF

308
Q

Kid is 6 years old and has funky gait - dx?

A

Legg-calve-perthes disease

309
Q

How do you make the diagnosis of scoliosis?

A

Adam’s test (lean forward and see asymmetry)

310
Q

Teenager with a non traumatic knee pain. Diagnosis and how?

A

Slipped capital femoral epiphysis; XR (frog leg)

311
Q

Scandinavian man with a contracted hand, what’s the diagnosis? How do you treat?

A

Duputryen’s contracture; surgical release (fascial disease)

312
Q

Pt has carpal tunnel - what do you try first?

A

NSAIDs (not splint, not steroids, not nerve conduction)

313
Q

Abscess of nail pulp - what is it called and how do you treat?

A

Felon; Incision and drainage, antibiotics

314
Q

What is it called and how do you treat the injury where the finger is unable to flex?

A

Jersey finger - splinting

315
Q

When do you do nerve conduction velocity for carpal tunnel?

A

After everything else (NSAIDs, splinting, steroids) has failed and you’re about to do surgery

316
Q

Pop with forced flexion of a digit - dx? Tx?

A

Trigger finger; steroids

317
Q

How do you treat De Quervain’s tenosynovitis and where are they symptomatic?

A

Tendonitis of the thumb = thumb pain; treat with NSAIDs, then splinting/NSAIDs, then steroids (surgery doesn’t help since it’s an inflammatory disease)

318
Q

Pt’s holding arm adducted and externally rotated - what did they dislocate?

A

Anterior dislocation of shoulder (hand shaking position)

319
Q

How does a a pt hold their arm after posterior dislocation of shoulder?

A

Adducted and Internally rotated

320
Q

FOOSH where the radius is dorsally displaced is also called ___.

A

Colles’ fracture

321
Q

Which fracture is caused by upward block of a downward blow and what is fractured and what is dislocated? How do you tx?

A

Monteggia fracture = fractured ulna, dislocated radius

tx with ORIF or casting depending on severity

322
Q

Which fracture is caused by downward blow on a pronated arm and what is fractured and what is dislocated? How do you tx?

A

Galeazzi fracture = fractured radius, dislocated ulna

tx with ORIF or casting depending on severity

323
Q

What is fractured in a Boxer’s fracture? How do you tx?

A

4th and 5th digit; casting

324
Q

Young person falls on to hand and has pain snuff box - dx? Tx (2)?

A 
Scaphoid fracture (XR will be normal on day 1 and show necrosis on day 3); cast if normal xr on day 1; ORIF if fracture on day 1
(tenuous blood supply to distal scaphoid)
325
Q

Whole leg is shortened and externally rotated - what’s the dx?

A

Hip fracture (major trauma in your; minor trauma in old/osteoporosis)

326
Q

How do you treat hip fractures depending on where the fracture is (3)?

A 
All ORIF (closed for poor surgical candidates);
Femoral head = hip replacement
Intertrochanteric = plates
Shaft = rods
327
Q

Young healthy athlete with knee pain, and the knee clicks on full extension. No valgus/varus or anterior/posterior draw sign - dx? Tx?

A

Meniscal tear; athletes = arthroscopic repair; non-athletes = conservative

328
Q

How do you diagnose with imaging knee injuries?

A

MRI

329
Q

How do you treat collateral ligament tears?

A

One ligament = hinge cast

Multiple ligaments = surgery

330
Q

Reperfusion injury in the leg can lead to ___.

A

compartment syndrome (edema)

331
Q

How do you treat compartments syndrome?

A

Fasciotomy

332
Q

Pt who is out of shape does a lot of activity and ends up with pinpoint tibia pain - dx? How to diagnose? How to treat?

A

Stress fracture; XR (normal on day 1, fracture on day 7); cast and crutches even if the XR is normal

333
Q

How do you treat small bowel obstruction (4)?

A

Bowel rest, NG tube suction, IV fluids, surgical exploration (if severe = hemodynamic instability, guarding, leukocytosis, significant metabolic acidosis)

334
Q

How do you manage a small spontaneous pneumothorax (less than or equal to 2cm)?

A

Supplemental oxygen and observation (oxygen enhances the speed of resorption)

335
Q

____ classically presents with acute-onset, severe, mid abdominal pain out of proportion to physical exam findings. How do you diagnose (3)?

A

Acute mesenteric ischemia; CT (preferred) or MR angiography (mesenteric angiography if diagnosis is unclear)

336
Q

Name 3 risk factors for acute mesenteric ischemia

A

Atherosclerosis (acute on chronic); embolic source (thrombus, vegetations); hyper coagulable disorders

337
Q

Persistent pneumothorax and significant air leak following chest tube placement in a pt who sustained blunt chest trauma suggests ___. Name two other findings.

A

Tracheobronchial rupture; subcutaneous emphysema and pneumomediastinum

338
Q

Name four cases of ileus

A

abdominal surgery; retroperitoneal/abdominal hemorrhage or inflammation; intestinal ischemia; electrolyte abnormalities

339
Q

Describe xray findings in a pt with a paralytic ileus

A

Uniformly distended, gas-filled loops of both small and large intestines as well as gastric dilatation

340
Q

What is the differential diagnosis for anterior mediastinal mass?

A

4 T’s: thymoma, teratoma, thyroid neoplasm, terrible lymphoma

341
Q

Abdominal succussion splash on physical exam points to which diagnosis?

A

Gastric outlet obstruction

342
Q

Name 5 common causes of gastric outlet obstruction

A

gastric malignancy; peptic ulcer disease; Crohn’s disease; strictures (w/pyloric stenosis) secondary to ingestion of caustic agents; gastric bezoars

343
Q

Treatment for anal fissures include increased fiber and fluid intake, stool softeners, sitz baths, and these two other options (before moving on to surgical management)

A 
topical anesthetics (lidocaine) and vasodilators (nifedipine! or nitroglycerin)
(the vasodilators reduce pressure in, and increase blood flow to the anal sphincter facilitating healing)
344
Q

Males with evidence of urethral injury should undergo __. Name 4 of these indications

A

retrograde urethrogram; blood at the meatus, hematuria, dysuria, urinary retention

345
Q

Patient comes in with penetrating abdominal trauma - name 4 criteria that demonstrate significant abdominal injury and are an indication for urgent exploratory laparatomy

A

hemodynamic instability
peritonitis (rebound tenderness, guarding)
evisceration (externally exposed intestines)
blood from a nasogastric tube or on rectal exam

346
Q

Acute adrenal insufficiency is characterized by these 4 symptoms. Treatment includes __ or __ with aggressive __.

A

hypotension; vomiting; abdominal pain; fever; hydrocortisone or dexamethasone; fluid support

347
Q

Knee injury; exam shows palpable locking or catching or clicking when the joint is extended under load, dx? How to confirm dx (2)?

A

Meniscal tear; MRI or arthroscopy

348
Q

Rupture of this part of the bladder causes urine to leak into the peritoneal cavity and can lead to chemical peritonitis, which presents with these 2 symptoms.

A

Dome of the bladder; diffuse abdominal pain and guarding (can have referred shoulder pain as well)

349
Q

Rupture of the anterior bladder wall and bladder neck is seen almost always with this injury. It leads to exztraperitoneal leakage of urine resulting in ___.

A

pelvic fracture; localized lower abdominal pain

350
Q

The diagnosis of gastrointestinal perforation is confirmed with ___, which shows ___.

A

upright X-ray of the chest and abdomen; free intraperitoneal air under the diaphragm

351
Q

A simple small bowel obstruction refers to what?

A

Luminal occlusion (strangulation refers to loss of blood supply to the bowel wall)

352
Q

A sliding inguinal hernia is a direct/indirect hernia. It has a much higher risk of __ injury during repair than other hernias.

A

Indirect; colonic injury (this is because the posterior wall of the hernia sac is formed by a retroperitoneal organ (colon or bladder))

353
Q

Asymptomatic pt is diagnosed with a femoral hernia. What should you do?

A

Surgical repair since there is a high risk of strangulation (associated with multigravida)

354
Q

What is a Richter’s hernia?

A

Hernia in which only one wall of the bowel is herniated - increased risk of strangulation and harder to diagnose (will not present with symptoms of SBO since there is still open lumen)

355
Q

Genital branch of the genitofemoral nerve provides sensation to the __ and the __. The femoral branch of the genitofemoral nerve provides sensation to the __.

A

scrotum; cremasteric reflex; proximal medial thigh

356
Q

The __ nerve supplies the gluteal region. The __ nerve provides sensation to the lateral thigh as low as the knee. The __ nerve provides sensation to the lower abdomen and medial thigh.

A

iliohypogastric; lateral femoral cutaneous nerve; ilioinguinal

357
Q

Name 4 major predictors of adverse postoperative cardiac events

A

1) recent MI (within 1 month); 2) Unstable or severe angina; 3) Decompensated CHF; 4) significant arrhythmias

358
Q

Most common cause of death 0-48 hours after STEMI?

A

Ventricular arrhythmia

359
Q

At what time point post STEMI do you see ventricular septal or free wall rupture? What about Dressler syndrome (post-MI pericarditis)

A

4-5 days post MI; weeks to months after MI

360
Q

What is the most significant risk factor for aortic dissection?

A

Hypertension

361
Q

Name 3 common causes of large bowel obstruction

A

1) volvulus; 2) diverticulitis/ischemic strictures; 3) colorectal cancer

362
Q

Necrolytic migratory erythema (annular (ring-like), erythematous erosions with blisters over the lower abdomen) is associated with which tumor?

A

Glucagonoma

363
Q

MEN2A?

A

Pheochromocytoma, hyperparathyroidism, and medullary thyroid cancer

364
Q

MEN1?

A

3Ps = parathyroid, pituitary, pancreatic tumors

365
Q

Morton neuroma is a benign neuroma of the ___. How do you make diagnosis? Tx (2)?

A

3rd plantar interdigital nerve (causes numbness/burning/tingling btwn the 3rd and 4th toes); diagnosis is made by eliciting exquisite pain on palpation of that area; conservative tx = no high heels; surgery = removal of neurom

366
Q

Every ___ mEq/L that serum sodium concentration os greater than normal = approximately __ L of water deficit

A

3; 1 (so a sodium of 152, means a deficit of 4L)

367
Q

When is a sestamibi scan used?

A

To localized parathyroid adenomas (allows surgeon to use a less invasive approach)

368
Q

Acute appendicitis is triggered by an obstruction in the appendiceal lumen - in adults, the obstruction is most common caused by ___. In children it is most often caused by ___.

A

fecalith; lymphoid hyperplasia (w/in the appendix triggered by antecedent viral infxn)

369
Q

What is the unhappy triad and what causes it?

A

Medial meniscal tear, MCL tear, and ACL tear; caused by medially directed blow to the lateral knee (valgus stress!)

370
Q

Acute bacterial prostatitis is most often caused by these 2 organisms. How do you treat?

A

E coli or chlamydia; fluoroquinolones (such as ofloxacin, levofloxacin, and cipro) for 4-6 wks)

MS3 Year (18 decks)

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