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Third Year Shelf > Surgery > Flashcards

Surgery Flashcards

1
Q

Reasons to not have surgery

A

1) Cardiac
EF <35%
MI wait till 6 months
JVD

DX: ECG
ECHO
Stress

Tx: MI= stent/ CABG
beta blocker
ACE-I
Diuresing

2) Pulmonary
Ventilation > O2

Dx: PFT Increase CO2
ABC Decrease O2

Tx:
Smoking cessation at least 8 weeks

3) Liver
Decreased Albumin
Elevated PT/PTT
Elevated T. Bili
Ascites
Encephalopathy

4) Nutrition
Pt: Lost 20% BW in 3 mn
Albumin <3
Fail Skin anergy test

Dx: Prealbumin
CRP

5) Metabolic
DKA= Increased blood glucose
IVF + IV insulin

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2
Q

Post op fever

A 
Wonder drugs
Wind
Water
Walking
Wound

Fever during surgery

  • Malignant hyperthermia
  • High flow O2, Dantrolene, Cool, IVF
  • ppx[ Family hx]

Fever right after surgery

  • Postoperative fever due to release of cytokines
  • Bacteremia
  • Blood cx
  • Broad abx
  • ppx[Sterile field]

POD#1 fever

  • Atelectasis
  • CXR
  • no Tx
  • ppx[ Inhaled spirometry, walk]

POD #2 fever

  • PNA
  • CXR
  • Broad abx
  • ICS, Out of bed
POD #3 fever
- UTI
- U/A, Ucx
- ABX
[Casts= pyelonephritis]
- ppx[ Foley out]

POD#5 fever

  • DVT/ PE
  • U/S BLE
  • Heparin—> warfarin
  • ppx[LMWH, OOB]

POD#7 fever

  • Wound (cellulitis
  • U/S (negative abscess)
  • ABx for cellulitis
  • Ppx[Sterile + clean]

POD # 10-14

  • Wound (Abscess)
  • U/S + abscess
  • Abx —> Incision and drainage
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3
Q

Urine output

A

0.5 cc/kg/hr

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4
Q

Ogilvie syndrome

A

Functional (only colon)

Elderly colon

Dx: KUB

Ileus of colon
small bowel normal
Large bowel distended
No distal area good in large bowel

Tx: Decompression
Stigmine
Colonoscopy to rule out cancer

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5
Q

Dehisence

A

Failure of fascia

Pt: Hernia
Serosanguinous drainage (salmon colored)

Dx: Clx

Tx: Binders
Reduce straining
Re-operative

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6
Q

Eusceration

A

Failure of whole wound

Pt: loops of bowel pops out

Surgical emergency

Dx: Clx

Tx: Warm saline dressings
Operation

NEVER push it back in

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7
Q

Weight loss
Clay colored stools
Painless jaundice
Distended Gallbladder nonpainful

CT scan
- pancreatic mass

Also see

A

Pancreatic cancer

CT scan

Endoscopic U/S w/ biopsy

Pt: Migratory thrombophlebitis

Tx: Whipple procedure

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8
Q

Weight loss
Clay colored stools
Painless jaundice
Distended Gallbladder nonpainful

CT scan
- mass biliary tree

+ PSC

A

Cholangiocarcinoma

ERCP w/ Bx

Tx: Resection

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9
Q

Obstructive jaundice
FOBT+
Negative colonoscopy

Dx

A

Ampulla of Vater Malignancy

ERCP

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10
Q

Nocturnal asthma

A

GERD

Only wake up at night with symptoms of asthma

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11
Q

Esophagus Metaplasia tx

A

High dose PPI

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12
Q

Cause Achalesia

Diagnosis?

Tx

A

LES fails to relax

1) Barium swallow
2) Manometry

Tx: Myotomy

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13
Q

Esophageal cancer

A

Upper 1/3

  • SCC
  • Hot, smoking

Lower 1/3

  • Adeno
  • GERD
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14
Q

Boorheaver

A

Transmural tear

Career vomit
(bulimic)

Air in mediastinum

1st gastrograft and swallow
2nd barium swallow
3rd EGD

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15
Q

Borborygmi

A

High pitched crescendo sounds in bowel

Small bowel obstruction

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16
Q

Small bowel obstruction first exam

A

Upright abdominal film

Then CT scan (po contrast)

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17
Q

Flushing
Wheezing
Watery Diarrhea
R sided fibrosis

A

Carcinoid

Serotonin —> Mets to liver

Dx: 5-HIAA

Tx: CT scan
Resect

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18
Q

Pseudocyst surgery

A

<6 wks
< 6 cm

wait and watch

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19
Q

Painful jaundice

A

Choledocolithiosis

+ murmphy

MRCP

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20
Q

RUQ pain
Jaundice
Fever

A

Charcot’s triad

Cholangitis

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21
Q 
RUQ pain
Jaundice
Fever
Hypotension
Altered mental status
A

Reynolds pentad

Cholangitis

Emergent ERCP
(No HIDA or MRCP)

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22
Q

Gallbladder Abx

A

Ciproflocacin + Metronidazole

Amp-Gent + MTZ

[Dont choose pip/tazo- expensive]

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23
Q

Colon cancer right sided lesion

A

Loose stool

Blood

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24
Q

Colon cancer left sided lesion

A

Change in caliber

Obstructive symptoms

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25
Q

Tx UC

A

Colectomy

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26
Q

Tx Chrons

A

Medications

[Steriods]

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27
Q

Internal hemorrhoids

A

Bleed

Doesnt hurt

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28
Q

External hemorrhoids

A

Hurt
Doesnt bleed

Itch

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29
Q

Obstructive vs inflammatory pain vs perforation

A

Obstructive
- colicky pain comes on and off

Inflammatory pain

  • constant
  • fever
  • no position helps

Perfortation

  • Sick as shit
  • Constant pain
  • Motioness (moving causes more pain)
  • XR= free air
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30
Q

Staging an ulcer

A

Epidermis
Dermis
Fascia
Deep tissue (muscle/ bone)

Stage 1: non blancing erythema (painful on skin)
Epidermis only

Stage 2: Epidermis and dermis penetrated

Stage 3: Into fascia

Stage 4: Into bone/ muscle

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31
Q

Compression ulcer location

A

Heels
Elbows
Shoulder blades
Sacrum

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32
Q

Diabetic ulcer

A

Microvascular neuropathy

Most distal

Diabetic

Heels
Balls of feet

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33
Q

Arterial ulcers

A

Macrovascular

Peripheral vascular disease

Hairless skin
Scaley skin
Absent pulses

Ulcer at Tips of Toes

Dx: ABI
U/S Doppler
Angiogram

Tx: Stent
Bypass

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34
Q

Venous ulcer

A

Cant get blood out

Edema
Hyperpigmentation
Indurated

Medial Malleolus

Tx: Compression stockings
Elevate legs
DIuretics

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35
Q

Marjolin ulcer

A

SCC

Ulcer w/ sinus tract

Breaks down and heals over and over

Dx: Bx

Wide resection

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36
Q

Breast cancer concerning signs

A

Dimpling
Fixed nodes
Breast mass

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37
Q

Breast cancer diagnosis

A

Mammogram

Then Core Bx

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38
Q

Breast cancer chemo

A

Doxarubicin
Cyclophosphamide
Paclitaxel

Doxarubin causes CHF

HER2 positive
- Traztuzumab

HER2 negative
- Bevacizumab

ER/PR positive

  • SERM (premenopausal)
  • Aromatase Inhib (postmenopausal)
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39
Q

Congenital diaphragmatic hernia can cause

A

Hypoplasic lung

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40
Q

Double bubble

Normal gas

A

Malrotation

Contrast enema
—> Upper GI series

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41
Q

Double bubble no gas

A

Duodenal atresia
Annular pancreas

Surgery

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42
Q

Double bubble with multiple air fluid levels

A

Intestinal atresia

In utero infarcts

Cocaine

Surgery

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43
Q

Fever
Leukocytosis
1-2 weeks after acute pancreatitis

A

Pancreatic abscess

Get CT scan

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44
Q

Necrotizing pancreatitis

A

first 24-48 hrs

Tx: Imipenem

Climbing hemoglobin
Falling calcium
Inflamation
Hypotension

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45
Q

Pain with eating
Weight loss
Sticky stools
Difficult to flush

A

Chronic pancreatitis

CT scan abdomen

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46
Q

Obstructive jaundice

Heme positive stools

A

Obstruction of the lumen of biliary tree and bleed into lumen of GI tract

Ampullary cancer

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47
Q

LBBB that did not resolve w/ heart surgery

Evaluate what now

A

Creatine kinase

[Not troponins, elevated due to heart surgery]

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48
Q

Way to confirm GERD

A

Esophageal pH monitoring

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49
Q

68 y.o for elective abdominal surgery. Has heart condition with EF of 40%.

Do what before surgery

A

Increase Furosemide for several days

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50
Q

Violent retching
Constant pain
Hamman’s crunch (crunch w/ heart beat)

A

Mediastinitis

Gastrografin swallow (water-soluble contrast esophagogram)

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51
Q

ER/PR +
Her2Neu +

Chemo

A

HER2NEU= Trastuzumab

ER/PR+= SERM (Raloxifene)

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52
Q

Kidney stone exam

A

CT scan abdomen without contrast

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53
Q

Start to worry about absence of urine after how many hours after catheter out

A

6 hrs

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54
Q

Old

Total colonic dilation

A

Ogilvie syndrome

Rectal tube for decompression
Neostigmine

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55
Q

Anal fissure tx

A

Topical lidocaine

Nitroglycerin

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56
Q

Er/PR +

Post menopausal

A

Aromatase inhibitor

Anastrozole

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57
Q

ER/PR+

Premenopausal

A

SERM

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58
Q

RUQ U/S

Mass on pancreas w/ CT scan

Now what

A

Endoscopic ultrasound of pancreas

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59
Q

Breast cancer prevention with cancer past and radiation

A

MRI both breasts annual

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60
Q

Complication of ascending cholangitis

A

Pyogenic abscess

Bacterial abscess in the liver

Percutaneous drainage

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61
Q

Liver abscess

Mexico

A

Entamoeba Histolytica

Tx Metronidazole

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62
Q

ERCP

MRCP

A

ERCP and MRCP same thing except ERCP has instruments

Get MRCP if not removing gallstones

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63
Q

Onset fever in operating room

A

Malignant hyperthermia

Tx Dantrolene

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64
Q

Think small bowel obstruction what tx

Diagnose how

A

NG tube to intermittent suction

Decompression

Xray
NG Tube, IV fluids, serial abdominal exams

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65
Q

Pain out of proportion

A

Mesenteric angiography

Mesenteric ischemia

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66
Q

Suspected ethylene glycol poisoning

A

Evaluate his urine under a wood’s lamp

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67
Q

Shot near neck what to do

A

Angiogram
Esophagram
Bronchoscopy

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68
Q

Circumferential burns Tx

A

Escharotomy

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69
Q

Electrical burn check what

A

CK level

Urine myoglobin

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70
Q

Neck trauma give what

A

IV methylprednisolone

Then CT spine

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71
Q

Gun shot wound on left

Loss pain/ temp on right

A

Brown-Sequard syndrome

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72
Q

Trauma
No loss of consciousness
Progressive decline in cognitive fxn

A

Subdural hematoma

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73
Q

CT scam shows blurring of the grey white junction

A

Axonal shearing

Risk of cortical dysfunction

First step:
Elevate head of bed, hyperventilation, Mannitol

Craniotomy next

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74
Q

Order of IV access

A

Peripheral IV
Intraosseous line
Central access

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75
Q

Thoracostomy

Thoracotomy

A

Thoracostomy
- chest tube

Thoracotomy-
- chest opened

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76
Q

Percentage of body

A 
Arm 9%
Leg 18%
Torso 36%
Head 9%
Groin 1%
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77
Q

Burns
Front two arms
Face
Half upper chest

A

Arms 9%
Face 9%
Chest 9%

27%

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78
Q

Tx cut knuckle from punching face

A

Surgical debridement

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79
Q

Acetaminophen toxicity what is depleted

A

Glutathione

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80
Q

Trauma

CXR shows bilateral white out of the lung

A

Pulmonary contusion

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81
Q

Bloody BM

Neonatal unit

A

Necrotizing enterocolitis

NPO
IV Abx
Surgery

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82
Q

Failure to pass meconium
Biliary Emesis

Xray: gas gilled plug

Give what

A

Meconium plug

Cystic fibrosis

Water-soluble contrast enema

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83
Q

Explosive diarrhea after fecal exam

A

Hirschbrungs disease

Failure of inhibitory neurons to migrate to distal colon

No auerback plexus
No myenteric plexus

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84
Q

Knee to chest position relieves pain

A

Intussusception

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85
Q

U/S donut sign

A

Pyloric stenosis

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86
Q

Pyloric stenosis tx

A

BMP, Electrolytes

IVF, electrolytes

Then Pylorotomy

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87
Q

Biliary atresia

A

No biliary tree

Worsening direct hyperbilirubemia

2 weeks

Dx: U/s= no ducts
Phenobarbital + HIDA

Tx: Surgery

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88
Q

Turn blue when feeding

Fixes when crying

Snoring

A

Choanal atresia

Failure of catheter to pass

Tx: Surgery

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89
Q

Thyroid nodule risk

A

TSH
1a) Low= low risk

Get RAIV

2a) Hot= Hyperfunctioning —> Tx resect
2b) Nothing= Nonfunctioning —> U/S —> FNA

1b) Increased TSH = High risk
2a) U/S < 1 cm= small —> watch and wait —> U/S every 6 months
2b) U/S >1 cm= large —> FNA

3) FNA
a) Cancer= surgery
b) not cancer= w+W u/s ever 6 mn
c) unsure= repeat fna

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90
Q

Gastric ulcers that doesnt get better w/ PPI or ulcers everywhere

A

Gastrinoma

Check Gastrin level
[Really high levels]

Then Secretin stim test [Elevated gastrin levels]

Tx: Resect
[Can lead to gastric cancer]

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91
Q

Hypoglycemia even w/ fasting

A

Insulinoma

Elevated Insulin level

Elevated C-peptide [Not elevated if self injecting]

Sulfonylurea screen [Negative]

Get CT scan

Resection

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92
Q

Migratory necrotlytic dermatitis

A

Glucagonoma

Get glucagon level
CT scan

Resect

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93
Q

Primary Hyperparathyroid levels

A

Elevated Ca
Elevated PTH

Low Phosphorus

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94
Q

Primary hyperparathyroid diagnosis

Tx

A

Sestanibi

Resect
Hypo-Ca —> IV Ca

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95
Q

HTN
Hypokalemia

Aldo: Renin > 20

Dx

A

Primary Hyperaldosteronism

Salt Suppression

CT/MRI
Adrenal vein sampling

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96
Q

Old man atherosclerosis

Young woman with fibromuscular dysplasia

HTN
Hypokalemia

Aldo: Renin< 10

A

Renal artery stenosis

U/S Doppler
Angiogram

Female: Stent
Male: +/- medically

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97
Q

Paroxysms
Headaches
Palpations
Perspire

A

Pheochromocytoma

Urinary 24 hrs
VMA
Metanephrines

CT/MRI
MIBG
AVS

Resection
(Alpha blockade)

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98
Q

Trick to resection of pheo

A

Alpha blockade

Beta blockade

Resection

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99
Q 
Female
HTN
Diabetic
Buffalo hump
Acne
Moon facies
A

Cushings

Low-dose dex [Fail to suppress]

Next 24 urine or Late night salivary cortisol

Then ACTH

1) ACTH low
- Primary adrenal tumor
[Ct/MRI]

2) ACTH elevated
- High-dose dex

a) Suppresses —> pituitary MRI resect
b) fails to suppress —> ectopic tumor CT scan

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100
Q

L—> Shunt (7)

A

Increased pulmonary artery flow

Increased pulm art pressure

Increased pulm art resistance

Increased pulm HTN

RVH

Noncyanotic

Eissenringer’s
R—> L

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101
Q

Fixed split S2

A

ASD

Echo

Closure device

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102
Q

PDA tx

A

Indomethicin

[Prostaglandins to maintain]

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103
Q

Heart condition with diabetic mother

A

Transposition of great vessels

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104
Q

Tetralogy of fallot (4)

Dx

A

VSD
Overriding aorta
Pulmonic stenosis
RVH

TET spells

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105
Q

Halfs to transposition of great vessels

A

Blue: RA- RV- Aorta- VC

Red: LA-LV- Pulm A- Pulm vein

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106
Q

Aortic stenosis tx

A

Can not do a balloon since due to calcification

Tx: Replacement

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107
Q

Systolic head at apex

Radiates to axilla

Holosystolic

A

Mitral regurg

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108
Q

Diastolic
4th ICS
Decrescendo and blowing

A

Aortic regurg

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109
Q

Diastole
Cardiac apex
Rumbing with opening snap

A

Mitral stenosis

From rheumatic heart disease

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110
Q

Cath

1,2 vessels

A

Stent + Clopidogrel

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111
Q

Cath

3+ vessels or L main vessel

A

CABG

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112
Q

CABG

A

Left internal mammory artery to most important artery

Other vessels grafted from saphenous vein graft

Beta block
Asprin
Ace
Statin

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113
Q

Liver lesion with focal nodular hyperplasia looks like

A

Firm tan lesion with fibrous septa and central stellate scar

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114
Q

Liver lesion

1) Exterior fibrous capsule with areas of necrosis
2) Macrovesicular steatosis with areas of lobular inflammation
3) Pedunculated surface with brown sponge like interior
4) Soft yellow lesion with homogenous interior

A

1) Hepatocellular carcinoma
2) Nonalcoholic fatty liver disease
3) Hepatic hemagnioma
4) Hepatic adenoma

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115
Q

Fever
RUQ pain

Liver lesion

Peripherally enhancing lesion

A

Hepatic abscesses

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116
Q

Cystic calcified parasellar mass

Bilaterally decreased peripheral vision loss

A

Craniopharyngioma

Mixed solid cystic tumor from remnant of rathke’s pouch

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117
Q

Ataxia

Cystic lesion of cerebellum

A

Astrocytoma

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118
Q

Headache
Seizures

MRI= hypodense lesion

A

Dermoid cyst

Epidermoid tumor

Contain sebaceous glands and hair follicles

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119
Q

Child

Cerebellum

Headache
Vomiting
Altered mental status
Ataxia
Gait instability

Midline or paramedian mass in cerebellum

A

Medulloblastoma

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120
Q

Extradural mass

A

Meningiomas

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121
Q

Painless hematuria

Palpable flank mass

Smoker

A

Renal cell carcinoma

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122
Q

Liver lesion

Asx

Uses oral contraceptives

A

Hepatic adenoma

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123
Q

Classic central stella scaring

Liver lesion

A

Focal nodular hyperplasia

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124
Q

After eating abdominal pain

3 months

Food fear

Elderly

A

Chronic mesenteric ischemia

Mesenteric artery bypass

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125
Q

Acute bacterial prostatitis organism

A

E. Coli

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126
Q

Presurgical treatment for someone with elevated bleeding time and activated partial thromboplastin time

A

Desmopressin

Von Willebrand disease

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127
Q

Double vision

Trouble keeping eyes open

Jaw tires with eating

Tx

A

Myasthenia gravis

Pyridostigmine

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128
Q

Tx recurrent acute esophageal variceal hemorrhage taht fails endoscopic tx

A

Transjugular intrahepatic portosystemic shunt (TIPS)

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129
Q

Aortic valve replacement

A

<50% ejection fraction

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130
Q

Tx keloids

A

Intralesional triamcinolone (corticosteroid)

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131
Q

Tx AAA

A
  1. 0- 5.4 cm
    - Repeat U/S in 6 to 12 months

> 5.5 cm
- Elective endovascular repair

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132
Q

Next step if in respiratory distress and fails endotracheal intubation and laryngeal mask airway

A

Surgical cricothyroidotomy

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133
Q

Diabetes

Early satiety

Nausea

Dx

A

Gastroparesis

Scintigraphic gastric emptying study

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134
Q

Colon cancer biomarker

A

CEA

Carcinoembryonic antigen

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135
Q

AFP

A

Biomarker for hepatocellular carcioma

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136
Q

CA 125

A

Biomarker ovarian cancer

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137
Q

CA19-9

A

Pancreatic cancer

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138
Q

Small bowel obstruction imaging

A

Abdominal radiographs, upright and lateral

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139
Q

Gave birth

Now enlarge thyroid

104 fever
Confusion
Vomiting
Sweating

A

Thyroid storm

Propylothiouracil

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140
Q

Young female
Chest pain and pain with swallowing

Sudden

Series of dilations and narrowing along the length of the esophagus

A

Diffuse esophageal spasm

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141
Q

Anterior mediastinal mass

A

Four T

Ectopic thyroid tissue

Thymoma

Teratoma

Terrible lymphma

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142
Q

Anterior mediastinal mass

Myasthenia gravis

A

Thymomas

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143
Q

IV drug use organism

A

Staphylococcus aureus

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144
Q

Septic arthritis organism

A

Staphylococcus aureus

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145
Q

Septic arthritis in IV drug user organism

A

E. Coli

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146
Q

Describe keloids

A

Thick dermis with randomly placed collagen bundles containing wavy collagen fibers

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147
Q

Imaging for dissection

A

CT angiogram

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148
Q

Hairless

Shiny shin

A

PVD

Get ABI

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149
Q

PVD medications to make symptoms less

A

Cilostazol

Pentoxyphylline

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150
Q

ABI levels

A 
> 1.4 = calcified vessel —> Toe brachial index
1.0 - 1.4 (normal)
0.9- 1.0 -> Get Exercise ABI
0.8-0.9 mild
0.4-0.8 Mod
< 0.4 severe

2) U/S dopples
3) CT angiogram

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151
Q

Tx conjunctivitis in newborn

A

Prophylaxis Topical erythromycin

Tx Gonorrhea
- Ceftriaxone

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152
Q

Low light eye pain
Headaches
Rigid eyeball

A

Closed angle glaucoma

Low light= dilates —> flow out of chamber decreases= increase pressure

Constrict pupil
Emergency

Activate alpha
Block beta
[Acetazolamide or mannitol]

Pressure—> Laser

NEVER GIVE ATROPINE

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153
Q

Inflammation of eye region

Can they move their eye

A

CT scan

I+D, Abx

If DM/ DKA
- Mucor
Amphoteracin B

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154
Q

Floaters in eye

A

Retinal Detach

Mild

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155
Q

Veil or curtain in eye

A

Retinal detachment

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156
Q

Curtain over eye that comes and goes

A

Amorasis Fugax

Pending retinal artery occlusion

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157
Q

unilateral painless vision loss

No other focal neurological defects

A

Retinal artery occlusion

Intraatrial TPA

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158
Q

Cherry red spot in fovea

A

Retinal artery occlusion

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159
Q

Loss of central vision

Chronic progressive

Blood or fluid at back of eye

A

Wet macular degeneration

Tx: Laser

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160
Q

Loss of central vision

Chronic progressive

Back of eye: Pigment changes or dressin

A

Dry Macular degeneration

Tx: none

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161
Q

Pearly lesion

Sun exposed

Lesion fails to heal

Bleeds easily

dx
Tx

A

Basal cell

Excisional biopsy

[NOT PUNCH Bx]

Does not metastasize

Tx:
Face= Mohs
Limb mild= excision
Limb exgressive= amputate

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162
Q

Lower lip

Hyperpigmentation

A

SCC

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163
Q

Well defined
Red papule

Ulcer nonhealing

Dx
Tx

A

SCC

Dx: Excisonal bx
Tx: Excision

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164
Q

Jet black lesion w/ no hair

A

Melanoma

Dx: punch bx [Large lesions, low suspicion]

Dx: Excision= small and high suspicion

Tx:
< 0.5 excision 0.5 cm margin

1-2 mm excision 1 cm margin

2-4 mm excision
2 cm margin + SLND +
(sentinal lymph node biopsy)

> 4 mm met
- chemo + radiation

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165
Q

Metatasis to brain

A

Lung
Breast
GI

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166
Q

Brain cancer imaging

A

MRI w/ contrast

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167
Q

Short stature

Calcification of sella

A

Craniopharyngioma

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168
Q

Pituitary tumors

A

Anterior fossa= adults

Posterior fossa= peds

Anterior fossa

  • Meningoma
  • Glioblastoma

Posterior fossa

  • Medulloblastoma
  • Ependyoma
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169
Q

Progressive HA
N/V

Metatasis

A

Medulloblastoma

Distal lesions

Resection + radiation

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170
Q

Ependymoma

A

From 4th ventricle

Progressive HA
N/V
Better when curls into ball

Resection

171
Q

Tumor attached to dura

Focal neurological defecits

A

Meningoma

Resection

172
Q

Tumor in parenchyma (in brain tissue)

Eating away at brain

Ring enhancing lesion

Bats wing deformity

Crosses midline

A

Glioblastoma

Crosses midline

173
Q

N/V
HL
Tinnitius

A

Schwannoma

174
Q

Elderly patient

Abdominal distention and pain

No stool in vault and heme negative

A

Sigmoid volvulus

175
Q

How to decrease elevated intracranial pressure

A

Head of bed elevation

Hyperventilation

IV mannitol

176
Q

Arm/ shoulder pain

Hand weakness

Atrophy of muscles

Weight loss

A

Pancoast tumor

[Superior sulcus lung tumor]

Get chest Xray

177
Q

Blunt chest trauma

Pleural effusion

A

Have hemothorax until proven otherwise

Tube thoracostomy

178
Q

Anemia
Eczema
Diarrhea

A

Celiac disease

179
Q

Diarrhea with HIV patient

CD4 < 50

A

Cytomegalovirus colitis

180
Q

HIV < 50

Mycobacterium avium complex colitis

A

Fever
Night sweats
Diarrhea
WL

Lymphadenopathy

181
Q 
Tired
Hyperpigmentation
Hepatomegaly
Low platelets
High Alk Phos
A

Primary biliary cholangiitis

Tx: Ursodeoxycholic acid

182
Q

Blood at meatus of penis

Dx

A

Retrograde urethrography

Urethral injury

183
Q

Contracture of fourth digit and fifth

A

Dupuytren’s contracture

Surgery

184
Q

Imaging for kidney stones

A

non-contrast helical CT scan

185
Q

13 y.o

Right hip pain

Limp

Joint effusion
Passive external rotation

A

Slipped capital femoral epiphysis

186
Q

Tx Multiple myeloma

A

Systemic chemotherapy

187
Q

COPD tx

A

Long acting bronchodilator

Inhaled glucocorticoid

188
Q

Pancreatic mass

Profuse watery diarrhea

A

Vasoactive intestinal peptide-secreting tumor

VIPoma

189
Q

Rheumatic fever

A

Mitral stenosis

190
Q

Loud S1
Opening snap
Mid-diastolic rumbling murmur at apex

A

Mitral stenosis

191
Q

Dark purple discoloration and decreased mobility of the right tympanic membrane

Trauma

A

Basilar skull fracture

192
Q

Painless jaundice

A

Pancreatic cancer

193
Q

Oliguria
Hypotension
Tachycardia
Tense distended abdomen

Previous surgery and fluid resuscitation

A

Abdominal compartment syndrome (ACS)

Measure of bladder pressure

194
Q

GERD

> 60 y.o

A

EGD

[Omeprazole if under 60]

195
Q

Left upper quadrant paint with radiation to left shoulder

A

Subphrenic abscess

196
Q

Steriod use

Elderly w/ hip pain

Muscle atrophy

A

Avascular necrosis of bone

get MRI

197
Q

Bladder pain after teenager drinks alot for first time

Resolves

A

Uretopelvic junction obstruction

U/S= hydronephrosis

VCUG= r/o reflux

Surgery

198
Q

Female

Normal peeing

Constant leak
Never dry

A

Ectopic ureter

U/S= no hydro
VCUG= r/o reflux

Radionucleotide scan to assess renal fxn

199
Q

Testicular cancer suspicion

A

U/S

Remove

[Do not do FNA]

200
Q

No nitrates with

A

PPE-inhibitors

201
Q

Epidimyitis

Dx

Tx

A

Dx: U/S doppler (make sure not torsion)

Tx: <35: Ceftriaxone + azithromycin

> 45: fluroquinolone

202
Q

Newborn w/ click

4 weeks later still there

A

Developmental dysplasia of the Hip

4 wk u/s

Harness

203
Q

Insidious antalgic gain

6 y.o

A

Leg-calth perth

XR

Cast

204
Q

13 y.o
Hip pain

Growth spirt or fat

Non-traumatic joint pain

A

Slipped capital femoral epiphysis

Frog leg x ray

Surgery

205
Q

Cant flex index finger

Sports injury

A

Jersey finger

Tear flexor tendon

206
Q

Cant extend digit

Sports injury

A

Mallet finger

Tear extensor tendon

207
Q

Can’t extend digit

No injury

When pushed into extension “popping” sound

A

Trigger finger

Stenosing tenosinovitis

208
Q

Thumb pain

Ulner deviation and pain

A

Dequervain’s tenosynovitis

Mom cradling baby
Guy lifting weights

Inflammatory disease

Surgery not an option

209
Q

Inability to extend

Nodules on palm

A

Duputyens contracture

ETOH
Scananovians males

Fascial disease

NSAIDS dont help

Surgical

210
Q

Abscess

Alot of pain

Fever
Leukocytosis

Penetrating injury

A

Felon

Abscess of pulp of finger

Incision and drainage

Rarely need Abx

211
Q

Arm abducted and ER

As if shaking hand

Can also see

A

Anterior dislocation

Deltoid parathesis

Xray
Relocate
Sling

212
Q

Massive trauma
Seizures
Lightning strikes

Abducted IR

A

posterior dislocation of humerus

Xray
Relocate
Swing

213
Q

Old lady

Falls on outstretch wrist

A

Colle’s fx

Fracture radius and ulna

Dorsally displaced

214
Q

Blocking downward blow

Upward block

A

Monteggia fx

Ulna breaks
Radius dislocates

215
Q

Downward block

Upward blow

A

Galezzia

Radius breaks
Ulna dislocates

216
Q

Fall on outstretched hand

Pain at snuffbox

A

Scaphoid fx

Xray
-normal day 1

Cast it

217
Q

Punches the wall

4th and 5th digit breaks

A

Boxer fx

218
Q

Fx femoral head

A

Need prosthesis

219
Q

Fx shaft of leg

A

Rods

220
Q

Posterior trauma to leg

A

ACL

Anterior draw sign

MRI
Surgery (athletes)
Casting (everybody else)

221
Q

Anterior trauma to leg

A

PCL

Posterior draw sign

MRI
Surgery (athletes)
Casting (everybody else)

222
Q

Valgus

A

Lateral

MCL

MRI
Surgery (athletes)
Hinge Cast
(everybody else)

223
Q

Vargus

A

Medial

LCL

MRI
Surgery (athletes)
Hinge Cast
(everybody else)

224
Q

Knee pain

Click on extension

A

Meniscus tear

MRI of knee

Arthroscopic repair

225
Q

Weekend warriors

Forced march

A

Stress fracture

Xray normal

Cast
Crutches

226
Q

Break of tibula

A

Fibula also broken

[Can have broken fibula w/o tibula]

Fall from height

Pedestrian struck

227
Q

Pain + Swelling

Cant walk

A

Ankle Fx

Xray

228
Q

Achilles tendon rupture tx

A

Casting (months)

Surgery (weeks)

229
Q

Renal artery stenosis dx

A

Renal arteriograpy

230
Q

HTN on max medications

Whooshing several cm superior and lateral to the umbilicus on the right

A

Renal artery stenosis

231
Q

Sudden onset sharp chest pain

Radiating to back

HTN

A

Aortic dissection

IV beta blockers
Labetalol, esmolol

232
Q

Aorta demonstrates two distinct lumens with a visible intimal flap

A

Acute aortic dissection

233
Q

Painless rectal bleeding

A

Diverticulosis

234
Q

Scrotal mass

Dx

A

Skip Dx

Tx: Radical orchiectomy

235
Q

Tx Appendicitis

A

Broad spectrum antibiotics

Then laparoscopic appendectomy

236
Q

Undermining of skin surround wound

A

Necrotizing fasciitis

237
Q

Broca aphasia located

A

Inferior frontal gyrus of the frontal lobe

238
Q

Medially rotated

Hand pronated

A

Erb’s palsy

Superior trunk of the brachial plexus

239
Q

Recent sinusitis

Headache

Fever

Double vision in left eye

Difficulty with lateral gaze on the left

A

Cavernous sinus thrombosis

240
Q

Tx Peritonsillar abscess

A

Needle aspiration

241
Q

Elevated ammonia tx

A

Lactulose

242
Q

Falls on outstretch hand

Pain on ulnar aspect of wrist

A

Triquetrum fracture

243
Q

Bilateral hearing loss in 30 y.o

A

Otosclerosis

Conductive hearing loss

244
Q

Scoliosis Tx

A

Cobb angle <20 = observation

Cobb angle > 20= Bracing

245
Q

Symptomatic hepatic adenoma

A

Surgery

246
Q

Ankylosing spondylitis

A

NSAIDS

Indomethacin

247
Q

Tachycardia

Narrow regular qrs complexes

regular rhythm

P waves appear buried within the QRS complexes throughout all leads

A

Paroxysmal supraventricular tachyarrhythmia

Cardioversion

Adenosine if stable

248
Q

GI bleed

INR > 1.5

A

Give Fresh frozen plasma

249
Q

LUQ pain
Weight loss
Bad breath`

Patchy broken hair

A

Gastric bezoar

250
Q

HTN

HA
focal increase in signal density in brain parenchyma

A

Intracerebral hemorrhage

251
Q

ABCs

A

1) Airway
- can they maintain airway
- Full sentences
- No accessory muscle use
- B/L Breathing sounds

GCS < 8 —> emergent

2) Breathing

3) Circulation
- systolic BP < 90
- Urinary output < 0.5 cc/kg/hr

252
Q

Hyperressonance

Decreased breathe sounds one side

A

Tension pneumo

Needle decompression

253
Q

Distant heart sounds
Hypotension
Engorged enck veins

A

Pericardial tamponade

FAST= echo

Pericardiocentesis

254
Q

Raccoon eyes

A

Basilar skull fracture

255
Q

battle signs

Hematoma around ear

A

Basilar skull fraucture

256
Q

Looks of otorhea or rhinorhea

A

CSF

Basilar skull fracture

Get CT scan

257
Q

Angular trauma
(Spinning)

Loss of consciousness

Coma

A

Diffuse axonal injury

258
Q

Grey white blurring on CT scan

A

Diffuse axonal injury

259
Q

Neck zones

A

Zone 3: Top
- Arteriogram

Zone 2: Middle
- Surgery

Zone 3: Bottom

  • Arterogram
  • Esophogram
  • Bronch
260
Q

Proprioception

Vibration

A

Back portion

Dorsal columns and Medical lemincus system

Cross at brain and down to spinal cord

261
Q

Pain and temperature

A

Middle portion

ALS

Cross at level and to other side

262
Q

Motor

A

Side portion

Cross and brain and comes down

263
Q

Lost half the cord

Sharp blade in neck

A

At the site of the lesion= Lower motor neuron lesion

Lose pain & temp C/L

Lose sensation (prop/vib) Ipsl

Lose motor ispl
(flacid paralysis, no relfexes)

Below lesion= UMN

  • Loss pain/temp
  • loss sensation
  • still have motor (spastic paralysis and increased reflexes)
  • babinski
264
Q

Proprioception good

Lose motor
Lose Pain/temp

A

Anterior cord

Spinal artery occlusion

265
Q

Loss of pain/ temp in cape like distribution

Gradually

A

Syringomelia

Loss ALS

266
Q

Loss of sensation only

A

Posterior cord

267
Q

Hemothorax vs pneumothorax

A

Hemothorax
- dullness to percussion

Pneumothorax
- resonnance

268
Q

Hemothorax when to take to surgery

A

20 cc/kg right away

or 3 cc/kg/hr

269
Q

Sucking chest wound

A

Penetrating

Air in but not out

Tx Occlusive dressing

270
Q

Flail chest

A

Hugh blunt trauma

2+ ribs
2+ places
Paradoxical motion

Segments not attached except my muscle

Visual CXR

Binders/ weights —> plates

271
Q

Chest trauma

1st day CXR clear

2nd day CXR white out

Tx

A

Pulmonary contussion

Tx

  • avoid crystalloids
  • use colloids
  • PEEP (positive end-expiratory pressure)
  • diuresis
272
Q

Trauma

Abdominal bleed

A

Most common= ruptured liver

Pringle manuever

Repair or lobectomy

273
Q

Pelvic fx

A

Bleeding into pelvis

External fixation

274
Q

Ureter injury

A

IV pyelogram

275
Q

Electrical burns

A

Lightning strike
high voltage

Arrythmias
Muscular burns —> rhabdo

CK level
Cr

Tx: IV fluids
Mannitol

276
Q

Poisonous snakes

A

Slit like eyes
Cobra cowl
Rattle

Skin changes
Erythema
Pain

Dx: Clx

Tx: Antivenum

277
Q

Spider with red hour glass on belly

A

Black widow

Abdominal pain
Pancreatitis

IV Ca

278
Q

Southern state

Attack or old boxes

Bite —> ulcerate

Necrosis

A

Brown recluse

Debridement

Grift

279
Q

Bite of dog or cat

A

Pasteurella

Irrigation
Leave open
Amox/Clav

280
Q

wood lamp test

A

Antifreeze

Ethylene glycol

281
Q

Moonshine

Blindness

A

Methanol

Give ETOH or fomepizole

282
Q

Cherry red skin
Cherry red blood

Super sick

Tx

A

Cyanide poisoning

Smoke inhalation
Nitroprusside

Tx: Thiosulfate

283
Q

Organophosphate poisoning

A

Atropine

Then pralidoxime

284
Q

Acute colonic pseudo-obstruction after surgery

Tx

A

Ogilvie sydrnome

Plain radiography demonstrating colonic dilation > 9 cm

Wait 48 hrs

Neostigmine

Then decompression

285
Q

Pulmonary nodule > 30 mm

No calcifications

Dx

A

Video-assisted thoracic surgery (VATS)

286
Q

Pulmonary nodule >8 mm but less than 30

No calcifications

Dx

A

18-fluorodeoxyglucose positron emission tomogrpahy (FDG-PET)

287
Q

Cyanosis at birth

Single heart sound

LVH

Right atrial enlargement

A

Tricuspid atresia

288
Q

Cocaine

Now chest pain

Tx

A

Myocardial ischemia

Tx: percutaneous coronary intervention

289
Q

Carotid artery stenosis tx

A

Carotid endarterectomy (CEA)

[If significant cardiac (CHF) or pulm disease (COPD) then do this carotid artery angioplasty and stenting]

290
Q

Tx DKA

A

IV normal saline

Then insulin

Next IV 5% dextrosein 1/2 normal saline

291
Q

First line tx small bowel obstruction

A

NG tube placement

292
Q

Foot ulcer tx

A

Antibiotic tx

Then MRI to confirm osteomyelitis

293
Q

Elevated Ca and PTH

dx

A

Sestamibi scan

Primary hyperparathyroidism

294
Q

Asplenic at risk for what infxn

A

Streptococcus pneumoniae

Haemophilus influenzae

Neisseria meningitidis

295
Q

HIV

Solitary (single) ring enhanging lesion in brain

Causing mass effect

Tx

A

Primary CNS lymphoma

Dx: Stereotactic brain biopsy

Then Methotrexate

296
Q

Hereditary non-polyposis colorectal cancer at risk for what other cancer

A

Endometrial

297
Q

Tx of choice for diabetic foot ulcer that has yellow purulent discharge

Fever
Hypotension

A

Vancomycin

Purulent ccellulitis`
Systemic toxicity

298
Q

Painful knee joint

100,000 leukocytes or more

75% polymorphonuclear

No crystals

A

Septic arthritis

299
Q

Trauma

Left eye constricted and minimally reactive to light

Left eye drooping

Right normal

Dx

A

Carotid artery dissection

Magnetic resonance angiography of head and neck

300
Q

Renal artery stenosis in young female

A

Fibromuscular dysplasia

301
Q

Unstable angina tx

A 
Pain control
Beta blockers
Aspirin
Heparin
Antiplatlet therapy (clopidogrel, ticagrelor)
302
Q

Rib fracture tx

A

Intercostal nerve block

303
Q

Tx Afib

A

Diltiazem

304
Q

Epiglottitis caused by

A

Haemophilus influenzae

Asplenic pts at risk

305
Q

Intussusception tx

A

Air enema

306
Q

Apple core lesion

A

Colon cancer

307
Q

Tx bacterial endocarditis

A

IV vancomycin

308
Q 
Neck pain
Swelling
SOB
Fever
Pooling of saliva
Submandibular swelling
Elevated tongue

Sickle cell disease

A

Ludwig’s angina

Due to streptococcus viridans

309
Q

Hypoglycemic
Nurse

Elevated serum insulin concentration

Decreased C peptide

A

Exogenous source of insulin

310
Q

Incidental liver lesion finding

Nonspecific well demarcated homogenous mass

A

Hemangiomas

MRI w/ contrast

311
Q

MI

Hypotension
Tachycardia
New-onset holosystolic murmur

A

Ventricular septal rupture

3-5 days post MI

[Loss of pulse]

312
Q

Tx dumping syndrome

A

Octreotide

313
Q

Tx Lung abscess

A

IV beta lactam-beta lactamase inhibitor

314
Q

Suspected endocarditis

A

Get echo

315
Q

Symptoms in calf is what artery

A

Superficial femoral artery

316
Q

Barretts esophagus

A

Columnar epithelium with goblet cells

317
Q

HTN headache tx

A

Sodium nitroprusside

318
Q

Tx Acute goutoy arthritis

A

NSAID

Naproxen

319
Q

HIV

CD4 < 50

Painful swallowing
Inflammed thrat with ulcerations in esophagus

Tx

A

CMV

Infectious esophagitis

Tx: Ganciclovir

320
Q

Fever

BP 80/54

Post surgery

IV fluid not helping

A

Give Norepinephrine

321
Q

Tx Bells palsy

A

Prednisone

322
Q

Ptosis
Miosis
Anhidrosis

A

Horner’s syndrome

Carotid artery dissection

323
Q

Post surgery decrease in urine output

IV fluids given

2+ edema
Brown casts
Creatinine elevated

Next step

A

Acute tubular necrosis

Hemodialysis

324
Q

Most common in sickle cell

A

Staphylococcus aureus

Salmonella

325
Q

Fever chills
SOB
1-6 hrs post receiving blood

A

Febrile nonhemolytic transfusion rxn

326
Q

tx acute bacterial sinosinusitis

A

Amox-clav

327
Q

Tx acute angle-closure glaucoma

A

Optic timolol and pilocarpine

Oral acetazolamide

328
Q

Prophylaxis for clots in patient with chronic kidney disease

A

Unfractionated heparin

329
Q

No gallbladder

Direct bilirubin?
Gamma-glutamyl transpeptidase?

Reticulocyte count

A

Biliary atresia

Elevated direct bilirubin

Elevated gamma-glutamyl transpeptidase

Normal reticulocyte count

330
Q

Acute pancreatitis exam

A

RUQ Ultrasound

331
Q

Mediastinal mass

Elevated beta-HCG and alpha fetoprotein

A

Nonseminomatous germ cell tumors

332
Q

Astrocytoma presents with

A

Seizures

333
Q

Hematocrit > 48%

Elevated EPO levels

A

Polycythemia

Get CT scan of abdomen

334
Q

Hyperreflexia
Wide based gait

Enlarged ventricles

A

Normal pressure hydrocephalus

Tx: High volume Lumbar puncture

335
Q

Exam for diverticulitis

A

Abdominal CT

336
Q

Hypovolumic shock —>

Due to

A

Decreased cardiac output

Loss of right ventricular preload

337
Q

Turner syndrome at risk for

A

Bicuspid aortic valve

Aortic dissection (changes in pregnancy can cause)

Coarctation of aorta

Aortic root dilation

338
Q

Intermittent dysphagia in young man

A

Eosinophilic esophagitis

339
Q

Hypovolemic shock

CVP (right sided preload)

CWP (left-sided preload)

Cardiac index (LV output)

SVR afterload

SvO2

A

All decreased except

SVR (afterload) is increased

340
Q

Hypotension after catheter

Flank/ back pain

A

Retroperitoneal hematoma

341
Q

Back pain

Elevated alpha feto protein

A

Hepatocellular carcinoma

342
Q

Chronic diarrhea

Ulcerations on colonoscopy in rectum and sigmoid colon

Tx

A

Mesalamine enema

Ulcerative colitis

343
Q

Green drainage from chest tube

A

Esophageal perforation

344
Q

Upper body muscle weakness

Loss of sensation

Impaired pain and temperature

A

Syringomyelia

Disruption of CSF drainage from central canal leading for fluid filled cavity

345
Q

Deep infection from puncture wound

A

Staph aureus

Pseudomonas

346
Q

Rapidly growning nodule w/ ulceration

Spontaneous regression

A

Keratoacanthoma

347
Q

Crescent shaped patch at medial malleolus

A

Ruptured popliteal cyst

348
Q

Carpal tunnel caused by

38 y.o

tingling in hands
Tired
constipation
Lethargy
Dry skin
A

Mucinous infiltration

Hypothyroidism

349
Q

Management of osteoarthritis

A

1) Quadriceps strengthening + weight loss
2) NSAIDS
3) Surgery

350
Q

Hx aortic aneurysm avoid what medication

A

Fluroquinolones

[Levofloxacin]

351
Q

SE Doxycycline

A

Skin photosensitivity

Medication induced esophaggitis

352
Q

Pearl pink nodule

Next step

A

Basal cell carcinoma

Excisional biopsy with narrow margins

353
Q 
Several UTI
30 y.o male
Painful ejaculation
Smokes
Smooth nontender prostate
A

Chronic bacterial prostatitis

Fluoroquinolones (ciprofloxacin) 6 wks

354
Q

Day after surgery

Acidosis
Increased PaCO2

A

Alveolar hypoventilation

355
Q

Purple papules where had previous radiation

A

Angiosracoma

Internal lining of blood vessels

4-8 yrs post

Lesion biopsy

356
Q

Fever
RUQ pain

Distended gallbladder iwth gas in gallbladder wall and lumen

A

Emphysematous cholecystitis

Crepitus in abdominal wall adjacent to gallbladder

Clostridium
Ecoli

Emergency cholecystecotmy
ABx- piperacillin-tazobactam

357
Q

RUQ pain
Jaundice

Elevated Alk phos

Bile duct dilation
No gas in biliary tree

A

Acute cholangitis

358
Q

Nasal packing from epistaxis

Fever
Hypotension
Erythematous macules on trunk
Vomiting
Diarrhea
Dizziness

Thrombocytopenia

A

Toxic shock syndrome

Staph aureus

359
Q

Tx Polycytsic kidney disease

A

Control risk factors of CV and CKD

ACE inhibitors

360
Q

Anterior knee pain

Reproduced by squatting

A

Patellofemoral pain syndrome

Tx strengthening quadriceps and hip abductors

361
Q

Medial knee pain

Distal to joint line

A

Pes anserinus pain

362
Q

Lateral pain

Pain w/ running

A

Iliotibila band

363
Q

Sudden severe abdominal pain

Hypotension

Flank ecchymoses

A

Ruptured abdominal aortic aneurysm

> 60
smoker
atheroscloerosis

Focused abdominal ultrasound

364
Q

Rinne positive on right

BC > AC in right ear

A

Conductive hearing loss on right

Otitis media
Cholesteatoma
Otosclerosis

365
Q

Rinne positive on right

AC> BC

A

Sensorineural hearing loss on left

Aminoglycoside antibiotic toxic effect

Meniere
Vesticular schwannoma

366
Q

Episodic vertigo

Fluctuating hearing loss

A

Meniere disease

367
Q

27 y.o w/ conductive hearing loss and normal exam

A

Otosclerosis

368
Q

Elderly woman with shorted leg

Externally rotated

A

Femoral neck fracture

369
Q

Sudden pain

Testicular swelling (enlarge right testicle)

Heterogeneous testicular echotecture w/ small hydrocele

A

Testicular torsion

Twisting of spermatic cord

Get doppler

370
Q

Must common source of liver metastases

A

Colorectal cancer

371
Q

What to do if suspected esophageal perforation

A

Water soluble contrast esophagography

372
Q

Progressive hoarseness

Irregular exophytic growths on vocal cords

Caused by

A

Laryngeal papillomas

HPV

373
Q

Mitral regurgitaion effects on heart

LA
LV
LV Ejection fraction

A

LA: normal

LV: normal

LV ejection fraction: increased

LA can not stretch —> transmitted backward to pulmonary circulation= pulmonary edema

LV receives increased blood volume from left atrium resulting in increased LV end-diastolic pressure

374
Q

Fever 2 hrs after surgery

A

Postoperative fever

> 38 C 100.4 F

Cytokine release

Observe

375
Q

Distended neck veins

Hypotension

Car accident

Normal cardiac silhouette

A

Acute cardiac tamponade

376
Q

Female

Recurrent headaches

HTN

Bruit below right ear

A

Fibromuscular dysplasia (FMD)

377
Q

Hemodialysis

Tingling and numbness in hands

A

Carpal tunnel syndrome

Dialysis related amyloidosis

378
Q

Shin splints vs stress fracture

A

Shin splints

  • anterior leg pain
  • runners
  • diffuse are of tenderness (not point)

Stress fracture

  • Running/ gymnastics
  • Point tenderness
379
Q

Uncontrolled HTN
Progressive dyspnea

Lower extremity swelling

JVD

Prominent V waves

A

Decompensated left sided heart failure

Tricuspid regurgitation

Tricuspid annular dilation

380
Q

Multiple ulcers in duodenum and jejunum

A

Zolliger-Ellison syndrome

Excess gastrin secretion

Inactivation of pancreatic enzymes —> ulcers

381
Q

Anterior mediastinum mass

Middle mediastinum mass

Posterior mediastinum mass

A

Anterior

  • thymoma
  • retrosternal thyroid
  • teratoma
  • lymphoma

Middle
- Bronchogenic cyst

Posterior

  • [All neurogenic tumors]
  • Meningocele
  • Lymphoma
  • esophageal tumors
  • aortic aneurysms
382
Q

CABG done a week ago

Pleuritic chest pain

Fever

Leukocytosis

Pleural effusion of echo

A

Dressler syndrome

post cardiac injury

383
Q

Thyroglobulin (Tg)

A

Precursor to active thyroid homrones T3 T4 produced by thyroid tissue

384
Q

Intracardiac mass in atrium

A

Atrial myxoma

385
Q

Glasgow coma scale (GCS)

A

Eye opening

  • Spontaneous (4)
  • Verbal command (3)
  • To pain (2)
  • None (1)

Verbal response

  • oriented (5)
  • disoriented/ confused (4)
  • Inappropriate words (3)
  • Incomprehensible sounds (2)
  • none (1)

Motor response

  • Obeys (6)
  • Localizes (5)
  • Withdraws (4)
  • Flexion posturing (3)
  • Extension posturing (2)
  • None (1)
386
Q

Central portion of lung mass

A

SCC

387
Q

14 days post CABG

Fever
Tachycardia
Chest pain

Cloudy fluid in drain
Widening of mediastinum

A

Acute mediastinitis

Tx:
Debridement and Abx

388
Q

Suspected corneal abrasion

A

Fluorescein drops

Stains abrasion

389
Q

Enlarged firm neck mass

Ulcerated tonsillar

A

Squamous cell carcinoma

HPV

390
Q

INR for mechanical valve

A

2-3

391
Q

Painless blindness in right eye and headache Cerebellar & retinal hemangioblastomas

Very high BP

Intracranial hemorrhage in father

A

Von Hippel LIndau disease

Cerebellar & retinal hemangioblastomas

Pheochromocytoma

Renal cell carcinoma

392
Q

Progressive hearing loss

Can hear better when its noisy

Reddish hue behind tympanic membrane

A

Otosclerosis

393
Q

In groin after surgery

Palpable thrill

Continuous murmur

A

Abnormal arteriovenous communication

[AV fistula]

No mass
Continuous bruit

394
Q

Tender mass

Pulsatile

A

Pseudoaneurysm

395
Q

Dock injury

Fever
Rigors
Bullous lesions

A

Vibrio vulnificus

IV ceftriaxone + doxycycline

Risk: those w/ liver disease

396
Q

Pulmonary capillary wedge pressure elevated

Bilateral crackles

SOB

Blood transfusion during surgery

Hypotension

Decreased cardiac index

A

Myocardial infarction

397
Q

Fixed breast mass

Calcifications on mammography

Hyperechoic mass

Fat globules and foamy cells

A

Fat necrosis

[Post trauma/ surgery]

Benign

398
Q

Zenker diverticulum caused by

A

Abnormal spasm or diminished relaxation of the cricophyarngeal muscles during swallowing (cricophyarngeal motor dysfunction) is underlying mechanism

399
Q 
RUQ pain
Melena
Jaundice
Anemia
Hyperbilirubinemia

Liver biopsy recently

A

Hemobilia

bleeding into biliary tract

400
Q

Earlier oropharyngeal infection

Internal jugular vein thrombosis

Neck pain, swelling along SCM

Fever, rigors, dysphagia

A

Lemierre syndrome

Fusobacterium necrophorum

401
Q

Tx ureteral stone

A

Tamsulosin

Alpha 1 antagonist

402
Q

Bloody ascites

A

Red blood cells leaking into intraperitoneal fluid

Malignancy

Hepatocellular carcinoma

403
Q

Erythematous nodules on shins

Chronic diarrhea
Abdominal pain

A

Erythema nodosum

Crohns disease

404
Q

Pustules on lower legs

what organism

A

Pseudomonas aeruginosa folliculitis

405
Q

Previous cardiac bypass

Reduce urine output
Cool extremities
Hypotension

Elevated RA, RV and pulmonary capillary wedge pressure

SInus tachycardia, nonspecific T wave changes

A

Impairment of venous return

Cardiac tamponade

Get Echo

406
Q

Retrocardiac air fluid level

A

Stomach bubble within the thoracic cavity

Sliding hernias

407
Q

Intranasal desmopressin can cause

A

hyponatremia

analogue of Antidiuretic hormone

408
Q

Risk factors for ventilator associated pneumonia

A

1) Acid suppression (PPI, H2R blocker, antacid)
2) Supine position
3) Pooled subglottic secretions
4) paralysis & excessive sedation
5) Excessive patient movement while intubated
6) Frequent ventilator circuit changes

409
Q

Unilateral hydronephrosis

Dysuria
Frequency
Hematuria
Acute right sided flank pain

A

Bladder cancer

410
Q

Indurated erytehmatous mass near the anal orifice

Severe and constant anal pain

Low grade fever

A

Perianal abscess

Infection of an occlued anal crypt gland

411
Q

Need to reverse warfarin concentration

A

Prothrombin complex concentrate

412
Q

Anterior cord syndrome

Central cord syndrome

Posterior cord syndrome

A

Anterior: bilateral weakness in upper and lower extremities

Central: Loss of pain and temp in upper limbs

Posterior: loss of vibration/proprioception sensation, lower extremities

413
Q

Postoperative atelectasis

A

Decreased PaCO2

Increased pH

414
Q

Tumor of parafollicular cells

A

Medullary thyroid cancer

Check Calcitonin levels

415
Q

Tx acute bacteria prostatitis

A

Levofloxacin

Ecoli

416
Q 
Osteoporosis
Ataxia
Anemia
Skin depigmentation
Brittle hair

Vit def

A

Copper

417
Q

DVT tx

A

Renal disease

- give unfractionate heparin followed by warfarin

418
Q

DIC

A

THrombocytopenia
Prolonged PT and PTT
Decreased fibrinogen

419
Q

Yellow sputum
Non productive cough

WL
Night sweats

Cavitary lesion in right lower lobe

A

Lung abscess

420
Q

Lymphangitis tx

A

Cephalexin

Tender erythematous streaks proximal to wound

421
Q

MRCP shows luminal irregularities with mild focal dilations within both intrahepatic and extrahepatic biliary ducts

Elevated Gamma-glutamyl transpeptidase

A

Primary sclerosing cholangitis

Colonoscopy (inflammatory bowel disease)

422
Q

Check lung capacity after partial removal

A

FEV1

Diffusion capacity of the lung for carbon monoxide (DLCO)

423
Q

Prosthetic joint infection bacteria

A

Early onset
- Staph aureus

Delayed onset ( 3-12 months) 
- Staph epidermidis

> 12 months
- Staph aureus

Third Year Shelf (7 decks)

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