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Surgery Flashcards

1
Q

Prep evaluation (not for emergent) heart

A

Decompensater HF with EF <35%——if volume overload 75% die

MI-best to wait 6 months __if wait 4 months 40% die, 66 die 6% months

No surgery unless to fix heart problem

Goldman Index-higher bad…most points for JVD(EF<35%), recent MI

DX-do an EKG, echo, stress/LHC

Treat-MI=stent/CABG wait 6 month a revaluate
CHF-BB and ACE-I, volume overload diuress with loop diuretics

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2
Q

Pre op evaluation lungs

A

Ventilation more important than oxygenation

Can always Turn up oxygen but if bad lunches cant get rid of CO@ worsen acidosis, acid base status deranges

Pt-smoker, COPD, asthma, interstitial lung disease (DPLD)

Do-PFT, and day of maybe ABG look for increased CO2 or decreased O2

To-give oxygen for low oxygen, inhalers, STOP SMOKING (increas bronchial secretions immediately after…so need to stop smoking 8 week before and use nicotine patch)

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3
Q

Pre op evaluation liver

A

MELD score
Childs-pugh (a good, c dead)

Pt-albumin down, clotting factors absent PT/PTT up, total bilirubin elevated, ascites, encephalopathy
-if any of these have 40% of death, if all 5 100% death and no treatment other than transplant

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4
Q

Nutrition

A

Important for healing

Pt:thoselose 20% BW, albumin<3, skin anergy

Diagnose:prealbumin and CRP,

If albumin low, prealbumin low and CRP up no protein
If albumin low and prealbumin ok and CRP albumin liver problem

Fail skin anergy-cant go to surgery wont heal

Treat-oral>IV, give ten days of replacement>5 days

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5
Q

Metabolic preop evaluation

A

DKA=high blood sugar
NO surgery if DKA-IV fluids and IV insulin
If blood sugar out of control give insulin

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6
Q

CABG stent ok if bad

A

Yes emergent

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7
Q

Post op fever

A 
Wind
Water
Walking
Wound
Wonder drugs
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8
Q

Fever during surgery

A 
Malignant hyperthermia (wonder drugs)
Anesthesia

Treat with O2, dantrolene and cool them off

Ask if had personal or family history to anesthesia bad reaction

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9
Q

Fever right after surgery

A

Bacteremia (surgeon prob)

Diagnose with blood culture

Treat broad spectrum antibiotics-vancomycin

Prophylaxis-maintain sterile field and be careful in gut and dont poke the bowel

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10
Q

Post op day 1 fever

A

Atelectasis

Diagnosis chest x ray to make sure no consolidation pneumonia

Treat-no treat

Prophylaxis ICS and out of bed , get them to move and breathe

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11
Q

Post op fever day 2

A

Pneumonia

Diagnose-chest x ray consolidation

Treat-broad spectrum antibiotics 0vancomymic

Prophylaxis-ICS and out of bed

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12
Q

Post op day 3

A

UTI

Diagnose UA urine culture-if cast pyelonephirits and prob had before surgery

Treat abx

Prophylaxis -foley taken out

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13
Q

Post op fever day 5

A

DVT/PE especially orthopedic
-2 cm bigger one leg, Pe hypoxia hypercapnia resp alkalosis

Diagnose-US bl lower extremitt

Treat heparin to warfarin bridge to prevent hypercoagulability

Prophylaxis-up and walking around and give low molecular weight heparin, usually give it after surgery

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14
Q

Post op day 7

A

Would cellulitis
Diagnose-US negative fo abscess

Treat antibiotics

Prevent keep sterile field and keep clean post op

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15
Q

Fever day 10-17

A

Abscess

Diagnose US positive for abscess or use CT

Treat antibiotics, back to OR for IND

Prophylaxis keep wound clean

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16
Q

Post op chest pain

A

MI, PE, or something else.

Get EKG and troponins for MI

Get US LE or spiral CT scan for P

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17
Q

If MI post op

A

PCI if stemi

Heparin if troponins are elevated NSTEMI

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18
Q

If PE post op

A

Heparin bridge to warfarin

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19
Q

Altered mental status post op

A

Electrolytes issue(NA, Ca)-get BMP

Sundowning-older people-atypical antipsychotics , reorient them

Hypoxemia-PE, pneumonia, ARDS(have to have prolonged intubation, transfusions, and intubations-will need PEEP),

DT-HTN, tachycardia post op pain meds dont work, sweaty and shake, can prevent seizures 48-72hrs on way to seizures. Give benzos.

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20
Q

Decreased urinary output post op

A

Normal is 0.5cc/kg/hour
If less bad

Urge? If yes have obstruction can evaluate with bladder scan or in and out cath

No urge? Nothing in bladder might be renal failure . Look at urinary output….any at all? Non!-mechanical probably kinked foley…unkink foley or irrigate it-if some output! Give 500cc bolus challenge and if increase urinary output they were volume down and give them more fluid. If dont though intrinsic renal disease and had some big hit or allergic reactions to get this.

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21
Q

Abdominal distinction post op

A

Ileus, obstruction, oliguria

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22
Q

Ileus

A

Functional day 1,2 no stool no fart
Get KUB flat and erect
See small bowel and large bowel dilated at same time

Treatment-fluids, K, and getting them to move

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23
Q

Obstruction

A

Obstruction
Person suspect has ileus but day 5 still no stool and no gas

Diagnose -upright erect KUB
If obstructed nothing gets by and see entire bowel decompressed in SBO, if LBO large bowel decompress and proximal distended and small bowel normal.

Treat-NG tube and surgery to undo damage0usually adhesions

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24
Q

Ogilvie syndrome

A

Functional but only impacts colon and elderly

Diagnose flat erect KUB

Small bowel normal large bowel distended but no distal area that’s good. Whole thing is big
Treat decompression with rectal tube , stigmine, may need colonoscopy to rule out cancer

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25
Q

Dehissence

A

Not that bad. Failure of the fascia, wound not open but underneath fasciae planes not closed

Get a ventral hernia, see serosanguinous drainage that is salmon colored.

Diagnose-Clinical

Treat-prevent evisceration, use binders , reduce straining, and need to reoperate eventuall to close ventral hernia

Don’t need to fix right away

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26
Q

Evisceration

A

Failure of whole wound. Skin and fascia beneath break down and looks of bowel pop out.
Have person stand too early or strain too soon

Diagnose clinical

Treat surgical emergency yikes and apply warm saline dressings keep everything moist and never ever push it back in …then get to the OR

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27
Q

Fistula

A 
Foreign body
EPithelization
Ttumour
Irrigation/inflamed/inflammatory bowel (crohn)
Distal obstruction

FETID

Treat-resect fistula may need to do a diversion

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28
Q

Prehepatic jaundice

A

Hemolysis and hematomas

Excess unconjugated indirect

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29
Q

INTRAhepatic jaundice

A

Genetic
Hepatitis
Mixed

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30
Q

Posthepatic jaundice

A

Obstruction
Gallstones
Cancer
Strictures

Increased conjugated

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31
Q

Gallstones

A

Dislodged in biliary tree choledectolithiasis
Mild dilation and inflammation of biliary tree and gallbladder

Expect to see increase temp and WBC and positive Murphy’s sign

Acute painful jaundice wiht inflammation

Diagnosis-RUQ US, MRCP bc can visualize with out ercp complication

Treat ercp or cholecystectomy

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32
Q

Stricturecancer

A

No inflammation bc not acute, no temp no WBC and no Murphy sign, no pain
Coursvier sign painless jaundice

Diagnose-RUQ US, MRCP

Treat-endoscopic US with biopsy, ERCP with biopsy may stent or resect dependent on underlying disease

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33
Q

Painless jaundice what do

A

Stricture or cancer
Bili20-26 (so single digits in gallstone)

Obstructive

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34
Q

Clay colored stool weight loss

A

Can’t get bilirubin into the stool
Cancer by saying in addition weight loss

Cancer

Obstructive

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35
Q

Distended gallbladder nonpainful

A

Obstructive

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36
Q

Work up obstructive jaundice weight loss clay colored stool, painless jaundice, distended non painful gallbladder

A

CT scan if +pancreatic mass its pancreatic cancer look for migratory thrombophlebitis
Diagnose pancreatic cancer with EUS with biopsy

Treat whipple remove parts of liver, pancreas duodenum

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37
Q

Positive CT with biliary tree with painless jaundice, weight loss, clay colored stool and distended gallbladder

A

Cholangiocarcinome

Diagnose-ERCP and biopsy

Treat resection

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38
Q

Negative CT with weight loss and clay stools, painless jaundice, distended gallbladder non painful

A

Ampulla of vater malignancy
-FOBT positive and negative colonoscopy

Diagnose-ERCP with biopsy can see malignancy
Treat resection

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39
Q

Obstructive jaundice stricture

A

Stenting and PSC

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40
Q

Gerd

A

Weakened LES, acid reflux retro sterna burn

Increased with flat and spices

Better sitting up and antiacids

Nocturnal asthma, gets up at night wheezing coughing acid comes up while laying on back

Diagnosis-no alarm symptoms with lifestyle and PPI
Avoid coffe peppermint chocolate and alcohol

Alarm symptoms or 4-6 week failure PPI lifestyle…EGD with biopsy
N/V, weight loss, anemia to biopsy first

If better lifestyle PPI continue treat this way. But Barrett’s metaplasia treat with high dose PPI anytime undergo metaplasia
Dysplasia now do ablation
Adenocarcinoma-resect

Nissen fundoplication-GERD surgery best test before this is 24 hr pH monitoring so want to do this before
If Ph low and symptoms consider nissen..but if too tight can creat achlasia

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41
Q

Achalasia

A

LES wont relax
Food gets stuck knot or call of food stuck at GE junction
Dysphasia-first fo barium swallow
See bird beak

But best test is monometry

Diagnosis -bird beek but next step is manometry

Before treat must do EDG with biopsy to rule out pseudo achlasia to rule out cancer

Treat-Botox temporary reserved for bad surgical candidates

  • dilation but risk perforation if cant take surgery
  • BEST WAY IS MYOTOMY remove muscle do too much get GERD
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42
Q

Upper third esophagus cancer

A

Squamous cellhot liquid, smoking

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43
Q

Lower third esophagus cancer

A

Adenocarcinoma

Related to gerd

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44
Q

Esophageal cancer

A

Dysphagia to large substances and smaller food and then water progressive dysphagia
1. Barium swallow ass asymmetric fungating mass
2,. Confirm endoscopy with biopsy

Always barium swallow first

Treat resection

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45
Q

Mallory Weiss tear

A

Superficial tear in mucosa in esophagus

Self limiting bleed
In someone vomiting as weekend warrior,

Diagnosis no-but treat like GI bleed, IV PPI call GI, CBC
Treat no

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46
Q

Boerhave

A

Trans mural tear esophageal perforation

Career vomiter
Bulemia or alcoholism

Air in mediastinum not contained crepitus in chest when breath hear and feel it

Hammands crunch from air around pericardium
Mediastinitis-fever, cough, septic

Diagnosis-1. Gastrograffin (bad for lung) swallow
2. If neg do barium swallow
3. If negative do endoscopy.
Stop when positive

Treat-surgical emergency to OR immediately

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47
Q

Small bowel obstruction

A

Adhesions if had surgery, hernia if not had surgery

Pt: positive flatus and bowel movements but then have obstipation with colicky abdominal pain with distant ion

Borborygmi->silent bowel sound

Gas and fluid proximal to obstruction and abdominal distinction.

DiagnoseL upright KUB look for air fluid levels follow that up with CT scan . If contrast material makes to rectum incomplete obstruction if non complete obstruction

  1. KUB then CT

Treat incomplete-contrast material reach rectum …conservative NG tube decomression IV fluids if no improvement surgery, if become peritoneal get emergent surgery

KUB must be upright look for air fluid levels

If complete-surgery

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48
Q

Hernia

A

Direct-adult, transversalis, i Guinean

Indirect-babies, inguinal ring, intestine in scrotum, inguinal

Femoral-female under inguinal ligament

Ventral-iatrogenic, failure of fascia to close, post op

Present as abdominal bulge-PE figure out what type.

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49
Q

Reducible hernia

A

Can push back in pops back out
In and out

Electively surgery

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50
Q

Incarcerated

A

Can’t reduce

SBO

Risk strangulation

Take care of it urgent surgery

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51
Q

Strangulated

A

Intestine dies, cuts off blood supply.

Peritoneal signs

Emergently to surgery

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52
Q

Appendicitis

A

Feaclith

Don’t need diagnostic steps bc clinical

Periumbilical pain go away and return at McBurney’s point , anorexia, N/V

CT scan-not needed for test but board service we like

Treat surgery

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53
Q

Carcinoid

A

Neuroendocrine tumor secretes serotonin only seen with Mets to liver to take effect
Liver and lung

Flushing, wheezing, diarrhea, heart R, fibrosisi
Diagnosis 5-HIAA

Treat CT scan and resect

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54
Q

Peritonitis

A

OR

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55
Q

Pancreatitis

A

Epigastric radiates through back
Positiona;, N/V

Lipase three times normal limit, amylase

Symptoms

Imaging CT US dont need it on day 1, but if person getting SICK hypotensive why r third spacing get CT scan bc worried about necrotizing fasciitis, WILL NEED NECROSECTOMY surgery after wait and conceal it dont go in too early ICU, do carbapenem antibiotics if FNA proven infection so need biopsy of necrotic tissue shows bug in order to give antibiotics so do FNA is nec p. OR 5 days to a week looks septic and ongoing fevers and leukocytosis might be abscess, so get CT scan and give antibiotics and tak them to surgery for IND, or early satiety weight loss and abdominal pain get CT scan might have pseudo cyst and size and time (<6 weeks and less 6 cm uncomplicated and watch and wait. If >6 weeks or greater 6 cm complicated high chance infection drainage how drain doesn’t matter. Just drain
CT scan good for complications of pancreatitis

NPO, Ivf, pain meds

Triglyceride panel

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56
Q

Chronic pancreatitis

A

Do not operate ! Pain-give pain meds, might need insulin and enzymes do not remove pancreas do not operate

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57
Q

Cholelithiasis

A

Mixed cholesterol
Fat female forty fertile
Pigmented-hemolysis

Present-colickyy RUQ pain radiates to shoulder worse with fatty foods
Figure out if have gallstones

Diagnosis-RUQ US see gallstones.

Treat-cholecystectomy elective when pt wants
-can use URODOXYCHOLIC ACID for old people not good surgical candidate

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58
Q

Cholecystitis

A

Gallstone pops out ends up in cystic duct
Have some inflammation ..proximal to stone inflamed
Gallbladder inflamed

Caused by gallstones in cystic duct see pericholecystic fluid, thickened gallbladder wall and gallstones

Present: constant RUQ pain with positive Murphy’s sign (if stop breathing bc of pain-arrest of inspiration)
Inflammation
Mild fever milld leukocytosis

Diagnosis-RUQ US look for thickened gallbladder wall and pericholcystic fluid …if not show what want get HIDA scan looking for perfusion after inject tracer if have will not fill up of gallbladder.

Treat-NPO, IV fluids, IV antibiotics and cholecystectomy URGENT have to be done 72-96 hours or will get hard and hard to get out…higher conversion to open and bad outcome

Cholecystostomy in non surgical candidate

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59
Q

Choledocolithiasis

A

Can get inflammation liver with increase AST ALT can get inflammation pancreas with increased lipase and amylase and bc liver continues to make bilirubin excreting conjugated so no where to go…..so first get dilation of duct and eventually bilirubin spill back over into blood and cause jaundice

Gallstones in common bile duct. May have hepatitis, pancreatitis, WILL HAVE JAUNDICE
Painful jaundice
May have Murphy sign
Have inflammation-mild fever and leukocytosis

Diagnosis-RUQ US for obstruction and see dilated ducts wont see an obstructing stone. If US negative get MRCP not HIDA

Treat-ERCP NPO give fluids and IV antibiotics, goal is ERCP
Can also go straight to cholecystectomy
ERCP urgent and then cholecystectomy electively

Flu-can see ball valve effect-stone move up and down get better then worse then better then worse

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60
Q

Cholangitis

A

Dilated ducts , gallstones in gallbladder and obstructing stone but have stagnant fluid and bacteria grow which ascends the biliary tree

Gallstone in common bile duct with infection usually with gut flora (gram negative rods and anaerobes)

RUQ abdominal pain, jaundice, and fever->charcots triad. If also have hypotension and altered mental status Reynolds pentad

Diagnosis-RUQ US see dilated ducts like in choledocolithiasis wont see stone but effects, then

Treat and diagnose-ERCP EMERGENT
Then can do cholecystectomy usually urgently

If spot want to jump to ercp but while get ready need IV fluid antibiotics and NPO

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61
Q

Antibiotics gallbladder

A

Cipro(gram neg) and metro(anaerobes)

Ampicillin-gentamicin (gam neg) and metronidazole(anaerobes)

WRONG IF PIP/TAZO bc expensive and covers both and covers gram positive like strep so over covering but done in hospital

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62
Q

Colon cancer diagnosis

A

Asymptomatic screening , postmenopausal man with iron defiency anemia, change in poop, bowel movement, and weight loss.

Catch with colonoscopy where see cancer (CT scan to stage and chemo radiation), FAP(thousands of polyps in young give colesectomy), polyp

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63
Q

Polyp

A

Good-small pedunculated, tubular

Bad-sessile no stalk, large and Villous

Look at polyp size a number and decide how soon should come back

  • few-come back 5 years
  • premalignant lesion-3 years
  • a lot or dysplasia-come back every year
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64
Q

Ulcerative colitis

A

Superficial mucosa of colon
Patient bloody bowel movements rectal pain and weight loss

Get colonoscopy and see continuously inflamed rectum superficial inflammation on biopsy no skip lesions treated medically until 8 years then need colon cancer screening every year and get a prophylactic colectomy . If resect colon they are cured

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65
Q

Crowns disease

A

Not surgical unless fistula

Trans mural. Skip lesions can connect to other things

Fistula bc fecal soiling

Fistula diagnosis-fistula

Treat-fistulotomy

Better to use meds bc if remove another spot will pop up

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66
Q

Hemmorhoids

A

Internal -bleed dont hurt
External-hurt and itch but dont bleed

Diagnosis-visual inspection.
Anoscopy in internal hemorrhoids, just peek in through hole

Treat-surgical banding internal hemorrhoids and respecting external hemorrhoids. If remove too much can be left with a scar prevents ability to empty the rectum. BUT not gonna start with surgery start with sitz bath and preparation h

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67
Q

Anal fissure

A

Tight sphincter

Patient presents pain on delectation lasts for hours, so hold it in and get constipated and tears it even more

Diagnosis-see it

Treat-lateral internal sphincterotomy, nitroglycerin paste, sitz bath, then move to lateral internal sphincterotomy

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68
Q

Anal cancer

A

HPV=seamen causes squamous cell carcinoma

Patient-anoreceptive see especially men who have sex with men and HIV positive.

Screen with anal pap.

Diagnosis -use chemo and radiation. Usually works, nigro protocol

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69
Q

Pilonidal cyst

A

Abscess hair follicle

Congenital disease have to have a hairy butt

Diagnose-see

Treat-IND then OR to resect the cyst.

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70
Q

Somatic, visceral and neuropathic pain

A

Somatic-tissue pain prob with tissue , know where it is can point to it

Visceral pain- hijack the nerves above the skin of embryologist origin, referred…no pain receptors so what organs feel is stretch and obstruction

Neuropathic-damage to nerve, so thing it inner ages is bad and burning sensation pins and needles, nothing wrong. With the organ

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71
Q

Visceral pain forms

A

Obstructive0must be holoviscous some sort of peristalsis which comes up on obstruction and passes. Colicky in nature and since only in obstruction no fever and no leukocytosis. Think about diseases like cholelithiasis and nephrolithiasis
—no position will be comfortable writhe around

Inflammatory pain-pain becomes constant with fever and can be leukocytosis, person writhing around in agony and no comfortable position , organ is inflamed so think about cholecystitis and pyelonehpritis

Perforation-sick as shit, constant abdominal pain, motionless, moving will hurt, laying still, get an X RAY show free air have to do upright film think of cancer, penetrating trauma, or peptic ulcer dz

Ischemic pain-patient present with pain out of proportion they will be soft and writhing, touch belly soft but bowel is dying and becoming toxic or bloody bowel movement or sepsis think of ischemic injury, ppl with risk factors are CAD, afib and mesenteric ischemia ,

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72
Q

RUG

A

Lung, diaphragm, liver, gallbladder

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73
Q

LUQ

A

Lung, diaphragm, spleen,

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74
Q

RLQ

A

Kidney, ureter, appendix , ovaries and testes, colon

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75
Q

LLQ

A

Diverticulum, kidney, ureter, still have ovaries and testes

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76
Q

Supra public

A

Bladder, uterus

77
Q

Epigastric

A

Heart, aorta, esophagus, pancreases, stomach,

78
Q

Chest

A

Constipation, DNA, MI

79
Q

Ulcers

A

Compression, diabetic, arterial insuffiency, venous insuffiency, Marjolin ulcer,

80
Q

Stage 1

A

Nonbloody erythema

81
Q

Stage 2

A

Dermis

82
Q

Stage 3

A

Fascia

83
Q

Stage 4

A

Bone muscle

84
Q

Compression ulcer

A

Pressure points if lay still putting pressure on the skin you’re going to get micro vascular ischemia and tissue die and get an ulcer. Happen to people bed ridden and wheelchair bound, CONSTITUTES AS ABUSE

Diagnosis-Clinical

Treat-also prevent-roll get out of bed and cushions and air mattress

85
Q

Diabetic ulcer

A

Microvascular changes and neuropathy
DM heels and balls of feet, if touch they dont feel
Should do monofilament test
Diagnosis-Clinical

Treat0control DM, elevate leg, amputation and make sure have good shoes inspect feet loose shoes wont compress

86
Q

Arterial ulcer

A

Macro vascular

Patient have peripheral vascular disease, look for hairless legs, shiny scaly skin and absent pulses especially in person who smokes a lot ,will get ulcer furthest from vascular supply

If see ulcer tips of toes

Diagnose-get ankle brachial index followed by US Doppler and angiogram

Treat-stent or I pass graft, stent small lesion above knee, bypass large or popliteal

87
Q

Venous stasis ulcers-cant get blood out

A

Can’t get blood out

Pt have edema (CHF, cirrhosis)

Hyperpigmentation can get indurated

Medical malleolus-it is venous stasis ulcer

Diagnosis-Clinical

Treat-compression stockings to hel push fluid up, elevate legs, give diuretics

88
Q

Marjolin ulcer

A

Squamous cell carcinoma

Present-ulcer with sinus tract or one that breaks down and heals over and over
Heaped up margins

Biopsy Marjolin ulcer and treat with wide resection.

89
Q

How get breast cancer

A

Estrogen-early menarche, late menopause, nulliparity, HRT (dont give it too long), OCP are safe.

Radiation-person been treated with radiation for lymphoma leading to increased risk of cancer

3-BRCA1/2

90
Q

How present with breast cancer

A

Asymptomatic screen
Breast lump
Obvious breast cancer(skin dimpling , fixed a ill art nodes, large breast mass).

91
Q

How screen breast cancer

A

Don’t do self exams
Physician exam NO
Mammogram start at 50 and do every 2 years,

MRI is best way though it is expensive so only use in people wiht high risk people with BRCA and previous radiaiton

92
Q

How diagnose breast cancer

A

Get mammogram then biopsy with core needle biopsy. *******

FNA and excision always biopsy when know its cancer

93
Q

I found a lump what do i do about it

A

<30, just wait 1,2 cycles and goes away with cycle ignore but if come back and still there get US to tell different between mass and cyst

<30 and cyst on US get FNA (bloody-cancer, pus-abscess, fluid-benign)

<30 cyst and resolves you are done.

> 30 or had mass or bloody or recurred then go back to mammogram core biopsy

94
Q

Cancer breast treat

A

Based on stage

Local therapy-procedures radiation, and surgery recast concerving lumpectomy and radiation and auxiliary lymph node dissection (always do sentinel lymph node biopsy before and its negative chances of spreading small not worth doing auxiliary node dissection, positive sentinel do auxiliary lymph node dissection)

Systemic therapy-chemo (doxorubicinwith-cause CHF in dose dependent and irreversible way….get repeat echos. cyclophosphamide and paclitaxel)and

targeted therapy look for HER2-Neu+ give trastuzimab-also causes CHF but nothing to do with dose and reversible still get echos
Her2-Neu negative-bevecizumab

ER/PR+ serms tamoxifen and raloxifen if premenopausal, use aroma tase inhibitors if post menopausal.

95
Q

Follow up breast cancer

A

BRCA1/2 should have prophylactic mastectomy and salpingooopharectomy if not increased screening

Tamoxifen-better, cause DVT and endometrial cancer, agonist in uterus

Raloxifen-not as good but no risk DVT or cancer , estrogen receptor antagonist

96
Q

TEF fistula

A

Atresia and/or fistula multiple types

Present: gurgling connection food and air hole and bubbling

Diagnosis-coil NG tube get x ray and see coiling

Treat-surgical repair but consider vacterl

97
Q

Imperforate anus

A

Mild-close
Severe-distant

Patient present no butt hole

Diagnose-Clinical look
Need cross table x ray to see severity

Treat-surgical mild fix now, if severe give colostomy, and reverse before fixing it before toilet training.

98
Q

VACTERL

A

If find any one of them dont just go to surgery first look for ther features

TEF , can INTUBATE?
Echocardiogram can tolerate surgery or another before pick

Look out for diagnostic steps for vacterl before proceed to surgery

99
Q

Congenital diaphragmatic hernia

A

Bachdalect posterior
Anterolater morgangi

Hole in diaphragm and bowel into chest

See scaphoid abdomen
Bowel sound in chest

Diagnosis-x ray

Treat-surgery
Premature lung even though normal term may need to INTUBATE and give surfactant to expand lung MANAGE HYPOPLASTIC LUNG

100
Q

Necrotizing enterocolitis

A

Premature
Present with bloody bowel movement

Diagnosis:x ray and see air in the wall of the intestine -pneumatosis intestinalis -air in the wall of the intestine

Treat-immediate bowel rest NPO->TPN bowel is dying not sterile put on IV antibiotics. Some babies can get through without surgery but if fail to improve surgery cut out bad segment
Also recognize other diseases of premature infants that can arise
Intracranila hemorrhage, bronchopulmonary dysplasia,retinopathy of prematurity.

101
Q

Intusseption

A

Sudden onset ab pain, fetal position better knees to chest relieves the pain

Sausage shaped mass
Currant jelly diarrhea is infarcter bowel -want to intervene before that happens s

Diagnosis-x ray
Treat-air contrast enema both diagnostic and therapeutic.

102
Q

Biliary atresia

A

No biliary tree worsening bili 2 weeks

Diagnose US if neg
Phenobarbital and HIDA

Treat-surgery

103
Q

Choanal atresia

A

Can’t get air from nose to pharynx

Present-unlatch cant feed blue with feeding
Pink while crying
Hear snoring baby
Diagnosis-passing a catheter can do a flexible scope not necessary

Treat-surgical removal

104
Q

Endocrine

A

1watch endocrine lectures

105
Q

Htn and hypokalemia

A 
Primary hyperaldosteronism(conn)-HTN and hypoK
Diagnosis-aldo/renin ratio>20, if positive follow up with salt suppression test, fail to suppress in Conn to then CT MRI, but want to so adrenal vein sampling 
Treat-resection

RAS-old man with atherosclerosis or young women with fibrovascular dysplasia,
Renal artery stenosis decrease volume to kidney s increase renting and aldosterone . Aldo/renin<10. Do US with Doppler , best test is angiogram
Treat-young woman should be stunted, old guy medically manage by blocking with ACE-I, ARB, or aldosterone antag like spironolactone

106
Q

Pheochromocytoma

A 
Catecholamines cause HTN and tachycardia 
5Ps
Paroxysms bc pulsation and random 
Pressure
Pain
Palpitations
Perspire

Diagnosis-urinary VMA and metanephrines over 24 hours
—then CT or MIBG to identify where it is, renal vein sampling as well

Treat-resect but if poke get HTN crisis, have to reduce BP first catecholamines stimulate alpha and beta so stop both. First have alpha blockade then beta blockade then resection.

107
Q

Cushing syndrome

A

Cortisol up
ACTH driven or not?
Present: HTN, diabetic, woman, buffalo hump, striae, moon fancies, acne,

Diagnose -low dose dexamethasone suppression test fail to suppress. Late night salivary cortisol or 24 our urine NEED ONE OF THOSE TWO to support….so Cushing need to know if acth or not. So not acth dependent and acth low it is primary adrenal tumor so get imaging (CT/MRI) Cain sampling ,and resect
If acth elevated it is acth dependent so is it from pituitary or somewhere else. If pituitary can suppress high dose dexamethasone test CUSHING DISEASE PITUITARY ADENOMA GET MRI AND RESECT . If fails then coming from somewhere else and ectopic tumor usually lung cancer, get CT to identify.

108
Q

Coarctation or the aorta

A

Somewhere after the great vessels

Torso HTN so legs hypotension
Usually in kids with Claudia toon will refuse to walk bc hurts so stay crawling, arm warm, leg cold.
Teenager or early twenties

Adult-get collaterals or rib notching

Diagnosis-angiogram
Treat-resect and reanastomose

109
Q

Adults

A

Murmurs grade 3 or higher or diastolic murmur investigate with echo

Kids diagnose get echo

110
Q

Aortic stenosis

A

Path Calcifications
Patient-old men with CAD, CP, syncope, CHG
Heard intercostal space right eternal border, crescendo. Decrescendo in systole and radiates to carotid

Diagnose with echo
Treatment-replacement . Can’t do balloon!
F/u TAVI/TAVR

111
Q

Mitral regurgitation

A

Infection, infarction (papillary muscle**(more common or chordae tendinae rupture)

Systolic murmur
Heard best at cardiac apex
Radiates to Avila
Holosystolic

Diagnose: echo
Treatment replacement

112
Q

Aortic regurgitation

A

Infection, infarction, dissection

Acute presentation
Or
Chronic (insidious)

Diastolic, heard best at 4th intercostal space left eternal border. Decrescendo, blowing
Diagnosis confirmed by echo
Treat-replacement
F/u CABG

113
Q

Mitral stenosis

A

Path: rheumatic heart disease

Heard during diastole at cardiac apex rumbling murmur with opening snap -occur earlier the worse the murmur is. May present with CHF or Afib

Diagnose echo
Treatment medical therapy, can do balloon valvotomy, replaced.

114
Q

Bovine organic valves replaced

A

<10 years and dont need anticoagulation

115
Q

Mechanical valve

A

10-20 years last
Need anticoagulation
Warfarin INR 2.5-3.5

116
Q

CAD

A

Obese, HTN, DM female over 55, male over 45

Present: substernal chest pain , worse pain with exercise, improved with nitroglycerin and rest

Diagnose-ekg->STEMI to cath emergently
EKG normal troponins elevated ->cath urgently
If no change get stress test and have symptomatic CAD->left heart cath

Treat LIMA tether to most important artery. Every other vessel with saphenous vein graft and bypass other blockages you can find after put on bb, aspirin, ace-I and statin

117
Q

Cath 1-2 vellels

A

Stent and clopidogrel

118
Q

Cath 3+ vessels or left main stem equivalent (left main or LAD and left circ)

A

CABG

119
Q

AAA

A

Product of atherosclerosis
Male, smoker(d)
Asymptomatic pulsating mass.
Diagnose-men over 65 who ever smoke get one time screen
Or get CT scan for ab pain and happen to identify but US is right.

Treat >3.5 screen every year
>4.5 cm get rescreened every 6 months
>5 cm or growing .5 cm per 6months go to surgery

Endovascular repair=open fix

*person old smoke but tender pulsation mass and back pain means about to burst take to OR immediately

120
Q

Aortic dissection.

A

HTN , mar fans, syphilis

  1. Tearing chest pain radiates to the back2. Asymmetric BP arm to arm
  2. Widen mediastinum

Ascending-A
After great vessels-type B descending

Diagnosis-CT angiogram looking for false lumen
TEE=MRI if cant do CT angiogram

Treat A-operate and replace the aortic valve
Treat B-treat medically get BP and HR down with IV BB

121
Q

Peripheral vascular disease

A

CAD in a different place. Associated wiht Cholesterol, DM, HTN, smoker, women

Present with leg claudication pain distal to obstruction. If butt pain aortic problem
Or
Non healing wounds
If severe have pain at rest or change position)leg pale dangle purple ad blood return)

Physical-shiny shins or loss of hair PVD. Problems with pulses and cooler temperatures especially left to right.

Diagnose-ankle brachial index .if>1.4 calcified have to. Go to toe brachial index
1-1.4 normal
.9-1 equivocal-get exercise ABI
.8-.9 mild 
.4-.8 mod
122
Q

Acute limb ischemia

A 
Path cholesterol following cath . Embolism-afib. thrombus form on top of PVD no time to get collaterals
Pt Pulselessness
Pallor
Poikilothermia(cold limb)
Pain
Parasthesias
Paralysis

Diagnosis-US Doppler angiogram

Treat embolectomy or TPA
NoteL assess compartment syndrome in anyone refer fused

123
Q

Closed glaucoma

A

Path: pressure after dilation

Present low light causes pupils to dilate
Flow out of chamber decreases
Increased pressure=eye pain, HA, rigid eyeball
Increased pressure=worsens condition dilated pupil that’s non reactive

Diagnose-Clinical measure ocular pressures
Treat-constricted pupil
Activate alpha block beta
and relieve pressure with laser drill hole in eyeball

Never give atropine will precipitate acute crisis.

124
Q

Periorbital cellulitis

A

Inflammation around eye region
Can they move their eye? If yes its a periorbital cellulitis just need antibiotics get CT scan and if find something treat with I and D, antibiotics.
F/u DM/DKA consider mucor=amphotericin B

125
Q

Corneal abrasions

A

Path-something getting in the eye
Pt hobby/job without goggles
Pain, tear, red

Treat-irrigate a lot
Diagnosis-flarevn dye
With or without surgery

126
Q

Retinal detachment

A

Path-trauma=mva or HTN crisis.

Floater-mild
Curtain-severe

Diagnosis-Clinical retina not attached

Treat-spot weld with laser

If floaters or curtain come and go it is anorasir fugox impending retinal artery occlusion

127
Q

Retinal artery occlusion

A 
Path-eye stroke. 
Painless acute loss of vision
1.unilateral painless vision loss
No other focal neurologic deficits
Cherry red spot in the fovea

Diagnosis-Clinical
Treat-stroke intra arterial TPA
Hyperventilation, global pressure

128
Q

Cataracts

A

Age and DM

Present chronic, progressive vision loss
Night vision
White thing in anterior chamber

Diagnosis clinical

Treat resection

129
Q

Macular degeneration

A

Wet (20%) dry (80%)
Pt chronic progressive loss of central vision diagnose wet: blood/fluid
Dry drusen and pigment changes

Treat wet laser
Treat dry nothing

130
Q

Substrate for skin cancer

A

Jobs in sun-navy and ships, outdoor labor, farmer, construction, landscaping

Areas that get sun-face and hands, back of shoulders

Sun people -people with fair skin and fair hair
Bad burns previously

Prevent with wide brim hate sun screen and avoidance of the sun

131
Q

Basal cell carcinoma

A

Cancer of basal layer
Will not metastasize but locally invade

Present-pearly lesion on sun exposed areas. But also described as lesion that fails to heal and bleeds easily.

Diagnosis-excision always biopsy (incisional biopsy)

Treat-face-mohs, limb-excision always biopsy, limb aggressive-amputate limb

132
Q

Squamous cell carcinoma

A

Path-keratinocytes
Can metastasis and locally invade

Present-well definedred papules or like Marjolin ulcer that heals and breaks down over and over

Lower lip hyperpigmentation. Do after squamous cell carcinoma.

No paraneoplastic syndrome

Diagnose same as BCC
Treat BCC

133
Q

Melanoma

A

Path-melanocytes
Metastasize and can locally invade tiny lesion may kill you

Hey black lesion without any hair 
ABCDE
Asymmetric
Irregular borders
Colors
Diameter 5 mm
Evolution over time

Diagnosis-punch biopsy=large lesions and los suspicion , excisional biopsy when small or high index of suspicion. BRESLOW depth

Treat-how deep tumor went
4 mm-chemo and radiation. Already been metastasized and debulking for palliative care.

134
Q

Subarachnoid hemorrhage

A

Aneurysm either leaks or bleed and got HTN generally (sex, exercise causes rupture)

Thunderclap headache, may have history of sentinel bleed
Neck stiffness to HA, FND, COMA

Diagnosis-CT scan of the head if negative can get LP-looking for old blood xanthochronia
Bleeding in meninges blood filling cisterns or ventricles
Once make diagnosis look at vessels with MR/CT angiogram

Treat-early(within 48 hours)-bleeding decrease MAP <140/90 with IV BB CCB then coiling or clipping -hydrocephalus do serial LP or VP shunt. .

Late(5-7d)-seizures prophylactic with levetiracetam, increased ICP give hypertonic solutions like mannitol or hypertonic saline, elevate bed, hyperventilate. -vasospasm-CCB if it happens increase BP with vasopressin if fail not for test just for wards

135
Q

Intraparenchymal hemorrhage IPH

A

Path-HTN,
Present-FND< HA, N/V, coma

Diagnosis-CT scan

Treat-decrease CIP, craniotomy if need, evacuate hematoma

Follow up with daily CT scans looking for expanding hematoma may crosss midline. Midline shift eventually herniate . Uncalled herniation through foramen magnum fixed dilated pupils and dead.

136
Q

Brain cancer

A

70% metastatic -lung, breast, GI, melanoma
See multiple lesions stuck at the grey white junction

30% primary-never metastasize brain cancer doesn’t leave he brain

Present-FND, seizure, HA, N/V

Diagnosis-neuroimagine, MRI if contrast able yes>CT try to give with contrast
Biopsy

Best MRI, biopsy

Treat-resection, radiation, chemo , steroids(palliative only), seizure prophylaxis for everyone with brain tumor

137
Q

Craniopharyngioma

A

Asymptomatic pituitary tumor in kids

Short stature bc consumes hormone producing centers

Calcification of the sella on CT or xray

Can resect

138
Q

Anterior vs posterior

A

Anterior-adults

Posterior-peds

139
Q

Pituitary tumors

A

Prolactinoma, acromegaly, craniopharyngioma

140
Q

Posterior tumor

A

Medulloblastoma, ependynoma

Both hydrocephalus

Meduloblastoma-highly malignantand seeds arachnoid space and spreads can get distal spinal cord lesions
Do surgery and radiation with it to get after lesions.
Ependymoma-4th ventricle obstructive hydrocephalus predominates look for kid that’s better int he fetal position, not distal lesions so just do resection

141
Q

Anterior tumors

A

Meningioma-product of dura, can diagnose on CT and resection is curative and reverse FND

Glioblastoma -in parenchyma, highly necrotic and mitotic can try to resect dismal prognosis of less than a year, ring enhancing lesion or bats wing deformity.

142
Q

Urethra pets pathology

A

Posterior urethral valve,

Hypo/epi spadias

143
Q

Bladder

A

Hematuria(non glomerular)

144
Q

Level or ureters

A

Ureteropelvic junction obstruction
Ectopic ureter-low implantation
Vesiculouretreal reflux

145
Q

Level of kidney

A

Malignancy(wilms)

Hematuria (glomerular)

146
Q

Hematuria

A

U/A to see if micro or macro

Micro-self limiting unless blunt trauma then do CT scan otherwise watch and wait..

Macro-need more-look at urine micro

  • dysmorphic cells or RBC cast-glomerular disease so get U/A and kidney biopsy
  • normal RBC and no casts have nonglomerular causes (in lumen for kidney to urethra, trauma, stones, cancer) first get US then cystoscopy versus systemic imaging like ct or MRI
147
Q

US

A

1st step usually

Hydro or not-usually obstruction, but in kids can also be reflux so differentiate this with VCUG

148
Q

VCUG

A

Put cath in inject dye in dye should go out, but if ends up in ureters sign reflux. So reflux or no. AfterUS can show diverticula too

Is hydro from reflux

149
Q

CT scan/cystoscopy

A

Usually as last steps to investigate if bleeding/lesion is in lumen or on top of kidney

CT-trauma also use IV contrast want to know if leaking.
-if think there are stones use non contrast wanna see radioopaque stone and contrast is radiopaque

Cystoscopy-intraluminal , access to ureters so can also fix

150
Q

Posterior urethral valves

A

Baby cant get urine out of bladder from day 1

Redundant tissue causes a post o structure uropathy

Present-oligohydramnios during pregnancy, no urinary output and a distended bladder, prenatal US, increased CR

Diagnosis-US, show hydro
then VCUG to rule out reflux, start catheter and get massive urinary output

Treat-catheter

151
Q

Hypo/epispadias

A

Path-
Epi dorsal, hypo ventral

Present-Clinical
Diagnosis-Clinical

Treat-never do a Circumscision!! Need the extra tissue to rebuild the urethra, will need to foreskin to reconstruct

152
Q

Ureteropelvic junction obstruction

A

Narrow lumen -normal for must of life but when have increased flow they simulate an obstruction.

Present teenager been through life wiht no difficulty first alcohol binge and large diuretics gives colicky abdominal pain that spontaneously resolves

Diagnosis US see hydronephrosis without hydroureter
VCUG to rule out reflux,

Treat-surgery may stent

153
Q

Ectopic ureter/low implantation

A

Normal=bladder
Abnormal-ectopic

Boys completely asymptomatic
Girls normal urinry behavior and have constant leak never have been dry

Diagnosis US
VCUG
Radionucleotide

Treat-reimplant

154
Q

Vesiculoureteral reflux

A

Path-retrograde flow

Patient-diagnosed on prenatal US showing hydro
Recurrent UTI if not diagnosed prenatal and pyelonephriritis (not good reason to have it in kids so have this)

Diagnosis-US hydro
VCUG-+ reflux

Treat-suppressive antibiotics if not severe and grow out
Or surgery

155
Q

Prostate cancer

A

5-DHT
Old men over 70
Screen if has family history
Think about it when have obstructive symptom of BPH diagnosed on DRE find firm NODULAR prostate***

Diagnosis-if firm NODULAR prostate get PSA if elevated get a biopsy transrectal (usually cancer is posterior so rectal sample best or transurethral
Gleesan score? Higher more likely prostate cancer

Treat-resection=radiation=brachytherapy and can use anti androgens like flutamide, GNRH analogs like leuprolide, can do bilateral orchioectomy (if very old bc it is testosterone driven

F/u with PSA if haverise in PSA but no signs it is biochemical evidence of recurrence and use antiandrogens. If symptoms and increased PSA use radiation and antiandrogens.

156
Q

Bladder cancer

A

Transitional cell carcinoma associated with beta alanine dyes, and smoking.

Present with painless hematuria may also see obstructive symptoms if just have hematuria: US, but best is cystoscopy!!!!** bc look up and take a biopsy.

Treat-remove transurethrally andgive intravesicular BCG or chemo
Only remove bladder if invasive to muscular or a lot of recurrences(cystectomy)-if do chemo cisplatin based

F/u cystoscopy regularly and remove

157
Q

Testicular cancer

A

Germ cell
Young male
18-35
Painless mass does not transiluminate (means solid mass not fluid)

Diagnosis: US DO NOT DO VIOPSY..orchioectomy

Treat-resect
And separate into seminoma(cisplatin chemo and radiation) and non seminoma (endodermis sinus tumorAFP, choriocarcinoma bHCG, teratomas (being in women malignant in men)
Just remove it do not biopsy

158
Q

Renal cell carcinoma

A

Flank pain, palpable mass, painless hematuria , paraneoplastic of erythrocytosis, anemia

Diagnos-CT scan and nephrectomy to diagnose.

Treat-resect

159
Q

BPH

A

Prostate enlarges and closes urinary flow
Over 50, lower urinary tract symptoms, DRE smooth rubbery prostate

Diagnosis-UA, urinary culture which willl be negative.

Treat-alpha blockers tamsulosin most bladder specific least orthostatic hypotension. Add 5-a reductive inhibitors like finasteride undo the BPH part willundo the blockade help down road while tamsulosin helps now

If fail TURP-but can causes incontinence or ED

F/u obstructive uropathy from BPH have put in catheter before TURP

Never biopsy for BPH , dont do a PSA

160
Q

Erectile dysfunction

A

Psych or organic

Inability to acheive or maintain an erection

Diagnose-night time tumescence take if breast its psych
If not break then cant get erection and its an organic disease

Organic treat-phosphodiesterase inhibitors , pumps, prosthesis

F/u no nitrates with phsophodiesterase inhibitors

161
Q

Testicular torsion

A

Testicle twists about pedicle

Spontaneous pain horizontal lie, pain on elevation

Diagnosis-US with Doppler shows no blood flow

Treat untwist OR emergency if stay gross after surgery remove it

Do bl orchiplexy if one does it other can do it too. If remove one tac down the other

162
Q

Epididymitis

A

Infection of epididymitis <35 STD, >55 E. coli

Spontaneous scrotal pain testical in vertical lie and relief of pain on elevation

Diagnosis US with Doppler to r/o torsion

Treat-<45 ceftriaxone and azithromycin if >55 use ciprofloxacin (fluoroquionlone)

163
Q

Prostate tissue

A

Bacterial or inflammatory? Must separate bc treatments are different

Present old male with pyelo, urgency dysuria, frequency, vomiting but no CVA tenderness or casts in urine and DRE very tender.

Treat never repeat the DRE bc increase chance of send to blood stres

Diagnose-UA and urine culture

Treat antibiotics if bacterial,NSAIDS if inflammatory

164
Q

Kidney stones

A

Calcium oxalate most common
Colicky flank pain radiates to groin often with hematuria

Diagnosis-UA, non contrast CT of abdomen ->US look for hydro if pregnant ofcant do CT

Treat

165
Q

Carpal tunnel

A

Inflammatory disorder compression of median nerve

Control sensation and move first three digits
Ulnar digits four and five sensation and motor

Pain progress to paresthesias->paralysis in first three digits
Flexion make symptoms worse phablets sign , tap on median nerve tinsel’s sign worse, the air atrophy

Hypothyroid, DM, ppl moving, pregnant

Diagnosis-EMG

Treat-1. Splinting and NSAIDS,2. Interarticular steroids. 3. Surgery
F/u could be presenting symtpom of rheumatoid arthritis

166
Q

Jersey finger

A

Tear flexor tendon patient cant flex that finger . When make a fist that finger stays up open hand and try to close that finger remains extended

Diagnosis clinical

Treatment-splinting NSAIDS, steroids, surgery last resort

167
Q

Mallet finger

A

Catching some sort of ball. Tear extensor tendon . Can’t extend digit person makes fist fine try to open bad finger doesn’t go up. Can I’ve passively

Diagnosis clinical

Treat standard. 1 splint NSAIDS, steroids, surgery last

168
Q

Trigger finger

A

Can’t extend digit a stenosis tenosynovitis inflammation compresses the tendon when forced into extension there is a pop.

Diagnosis clinical
Treat standard splint NSAIDs, steroids, surgery.

169
Q

Dequervain tenosynosynoviitis

A

Path: tendinitis

Thumb pain -pregnant, men lifting weights

Diagnosis: fist thumb twist test(thumb inside fist stretches tendon hurts

Treat-splinting NSAIDs, steroids, then SURGERY IS NOT AN OPTION BC inflammatory dz

170
Q

Duputyreins contracture

A

German and Scandinavian men

Present: contracture fascia balls up and pulls fingers together, inability to extend and palpable fasciae nodules on palm and hand contracture

Diagnosis-clinical

Treatment-release surgically fasciae dz NSAIDs dont do anything

171
Q

Felon

A

Abscess of pulp of the finger. Pain, fever, leukocytosis

Usually from penetrating injury

Diagnosis-Clinical

Treat-IND…rarely may need antibiotics

172
Q

Fracture

A

Two x rays perpendicular to each other

Pain, swelling

Treat with open reduction internal fixation (open, angular, comminuted) OR casting (hope line up right way have to have closed wound with good approximation)
Open-go to OR for emergent wash out

173
Q

Anterior dislocation

A

Any trauma
Abducted and externally rotated as though shaking hands
May have deltoid paresthesias bc of Szilard nerve

Diagnosis-Clinical can get x ray

Treat-relocate and sling

174
Q

Posterior dislocation

A

Massive trauma-MVA, seizures, lightening strike

Abducted and internal rotated

Diagnose x ray

Treat relocate sling

175
Q

Collies fracture

A

Old lady fall on outstretched wrist common osteoporosis fracture radius and ulna dorsally displaced

Diagnose x ray

Treat cast or surgery

176
Q

Monteggia fracture

A

Upward block downward blow

Ulna breaks, radius dislocated

Diagnose x ray

Treat cast vs surgery

177
Q

Galezzia

A

Downward block
Upward blow

Breaks radius and displaces ulna

Diagnose x ray

Treat surgery vs cast

178
Q

Scaphoid fracture

A

FOSH not old lady then pain at an atomic snuff box

X ray-normal
Cast anyways bc turns positive

Don’t want a vascular necrosis

179
Q

Boxers fracture

A

Punch against wall where fourth and 5th digits break

180
Q

Hip fracture

A

A lot of trauma or old lady wiht osteoporosis

Leg shortened and externally rotated want make sure ok pulses below

Femoral head had tenuous vascular supply so if have fracture of femoral head will have to do prosthesis

Intratrochanteric fracture-use plates

Shaft-use rods

Open-emergency wash out in OR traction will help

Rehabilitation

181
Q

ACL/PCL injuries

A

Locked leg with some sort of force

Posterior trauma-ACL injury anterior drawer sign

Anterior trauma=PCL injury posterior draw sign

Diagnosis-MRI

Treat surgery(athletes)
Casting (everyone else)
182
Q

MCL/LLL

A

Valgus-MCL
Varus-LLL

Hit from lateral side injur MCL called valves stress and opposite

Diagnosis MRIsurgery(athletes)
Hinge cast(everyone else)
183
Q

Meniscus

A

Knee pain and click on extension

Diagnosis MRI
Treat arthroscopic repair

184
Q

Stress fracture

A

Weekend warriors or forced march
Xray-normal probably
Cast anyway with crutches
Back in few days x ray positive

185
Q

Tib/fib fracture

A

Usually both together
Trauma-fall from height, pedestrian struck

Diagnose-X ray

Treat cast or surgery

186
Q

Ankle fracture

A

Over eversion
Over inversion
Pain and swelling after and is non ambulatory (if can walk dont need x ray)

Diagnosis x ray

Treat surgery

187
Q

Achilles’ tendon

A

Run hear pop then they limp reach back gap where tendon should be

Diagnosis clinically

Treat cast takes months to heal
Surgery takes weeks

188
Q

Compartment syndrome

A

When reperfuse ischemic injury get edema and if get tense can shut off vascular supply

Upon repercussion if get tense painful leg that is hard as rock if elevated compartment pressure do fasciotomy

OME (4 decks)

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