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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
Tx UC
Colectomy
26
Tx Chrons
Medications [Steriods]
27
Internal hemorrhoids
Bleed | Doesnt hurt
28
External hemorrhoids
Hurt Doesnt bleed Itch
29
Obstructive vs inflammatory pain vs perforation
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
30
Staging an ulcer
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
31
Compression ulcer location
Heels Elbows Shoulder blades Sacrum
32
Diabetic ulcer
Microvascular neuropathy Most distal Diabetic Heels Balls of feet
33
Arterial ulcers
Macrovascular Peripheral vascular disease Hairless skin Scaley skin Absent pulses Ulcer at Tips of Toes Dx: ABI U/S Doppler Angiogram Tx: Stent Bypass
34
Venous ulcer
Cant get blood out Edema Hyperpigmentation Indurated Medial Malleolus Tx: Compression stockings Elevate legs DIuretics
35
Marjolin ulcer
SCC Ulcer w/ sinus tract Breaks down and heals over and over Dx: Bx Wide resection
36
Breast cancer concerning signs
Dimpling Fixed nodes Breast mass
37
Breast cancer diagnosis
Mammogram Then Core Bx
38
Breast cancer chemo
Doxarubicin Cyclophosphamide Paclitaxel Doxarubin causes CHF HER2 positive - Traztuzumab HER2 negative - Bevacizumab ER/PR positive - SERM (premenopausal) - Aromatase Inhib (postmenopausal)
39
Congenital diaphragmatic hernia can cause
Hypoplasic lung
40
Double bubble Normal gas
Malrotation Contrast enema —> Upper GI series
41
Double bubble no gas
Duodenal atresia Annular pancreas Surgery
42
Double bubble with multiple air fluid levels
Intestinal atresia In utero infarcts Cocaine Surgery
43
Fever Leukocytosis 1-2 weeks after acute pancreatitis
Pancreatic abscess Get CT scan
44
Necrotizing pancreatitis
first 24-48 hrs Tx: Imipenem Climbing hemoglobin Falling calcium Inflamation Hypotension
45
Pain with eating Weight loss Sticky stools Difficult to flush
Chronic pancreatitis CT scan abdomen
46
Obstructive jaundice | Heme positive stools
Obstruction of the lumen of biliary tree and bleed into lumen of GI tract Ampullary cancer
47
LBBB that did not resolve w/ heart surgery Evaluate what now
Creatine kinase [Not troponins, elevated due to heart surgery]
48
Way to confirm GERD
Esophageal pH monitoring
49
68 y.o for elective abdominal surgery. Has heart condition with EF of 40%. Do what before surgery
Increase Furosemide for several days
50
Violent retching Constant pain Hamman's crunch (crunch w/ heart beat)
Mediastinitis Gastrografin swallow (water-soluble contrast esophagogram)
51
ER/PR + Her2Neu + Chemo
HER2NEU= Trastuzumab ER/PR+= SERM (Raloxifene)
52
Kidney stone exam
CT scan abdomen without contrast
53
Start to worry about absence of urine after how many hours after catheter out
6 hrs
54
Old | Total colonic dilation
Ogilvie syndrome Rectal tube for decompression Neostigmine
55
Anal fissure tx
Topical lidocaine Nitroglycerin
56
Er/PR + Post menopausal
Aromatase inhibitor Anastrozole
57
ER/PR+ | Premenopausal
SERM
58
RUQ U/S Mass on pancreas w/ CT scan Now what
Endoscopic ultrasound of pancreas
59
Breast cancer prevention with cancer past and radiation
MRI both breasts annual
60
Complication of ascending cholangitis
Pyogenic abscess Bacterial abscess in the liver Percutaneous drainage
61
Liver abscess | Mexico
Entamoeba Histolytica Tx Metronidazole
62
ERCP | MRCP
ERCP and MRCP same thing except ERCP has instruments Get MRCP if not removing gallstones
63
Onset fever in operating room
Malignant hyperthermia Tx Dantrolene
64
Think small bowel obstruction what tx Diagnose how
NG tube to intermittent suction Decompression Xray NG Tube, IV fluids, serial abdominal exams
65
Pain out of proportion
Mesenteric angiography Mesenteric ischemia
66
Suspected ethylene glycol poisoning
Evaluate his urine under a wood's lamp
67
Shot near neck what to do
Angiogram Esophagram Bronchoscopy
68
Circumferential burns Tx
Escharotomy
69
Electrical burn check what
CK level | Urine myoglobin
70
Neck trauma give what
IV methylprednisolone Then CT spine
71
Gun shot wound on left | Loss pain/ temp on right
Brown-Sequard syndrome
72
Trauma No loss of consciousness Progressive decline in cognitive fxn
Subdural hematoma
73
CT scam shows blurring of the grey white junction
Axonal shearing Risk of cortical dysfunction First step: Elevate head of bed, hyperventilation, Mannitol Craniotomy next
74
Order of IV access
Peripheral IV Intraosseous line Central access
75
Thoracostomy | Thoracotomy
Thoracostomy - chest tube Thoracotomy- - chest opened
76
Percentage of body
``` Arm 9% Leg 18% Torso 36% Head 9% Groin 1% ```
77
Burns Front two arms Face Half upper chest
Arms 9% Face 9% Chest 9% 27%
78
Tx cut knuckle from punching face
Surgical debridement
79
Acetaminophen toxicity what is depleted
Glutathione
80
Trauma | CXR shows bilateral white out of the lung
Pulmonary contusion
81
Bloody BM | Neonatal unit
Necrotizing enterocolitis NPO IV Abx Surgery
82
Failure to pass meconium Biliary Emesis Xray: gas gilled plug Give what
Meconium plug Cystic fibrosis Water-soluble contrast enema
83
Explosive diarrhea after fecal exam
Hirschbrungs disease Failure of inhibitory neurons to migrate to distal colon No auerback plexus No myenteric plexus
84
Knee to chest position relieves pain
Intussusception
85
U/S donut sign
Pyloric stenosis
86
Pyloric stenosis tx
BMP, Electrolytes IVF, electrolytes Then Pylorotomy
87
Biliary atresia
No biliary tree Worsening direct hyperbilirubemia 2 weeks Dx: U/s= no ducts Phenobarbital + HIDA Tx: Surgery
88
Turn blue when feeding Fixes when crying Snoring
Choanal atresia Failure of catheter to pass Tx: Surgery
89
Thyroid nodule risk
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
90
Gastric ulcers that doesnt get better w/ PPI or ulcers everywhere
Gastrinoma Check Gastrin level [Really high levels] Then Secretin stim test [Elevated gastrin levels] Tx: Resect [Can lead to gastric cancer]
91
Hypoglycemia even w/ fasting
Insulinoma Elevated Insulin level Elevated C-peptide [Not elevated if self injecting] Sulfonylurea screen [Negative] Get CT scan Resection
92
Migratory necrotlytic dermatitis
Glucagonoma Get glucagon level CT scan Resect
93
Primary Hyperparathyroid levels
Elevated Ca Elevated PTH Low Phosphorus
94
Primary hyperparathyroid diagnosis Tx
Sestanibi Resect Hypo-Ca —> IV Ca
95
HTN Hypokalemia Aldo: Renin > 20 Dx
Primary Hyperaldosteronism Salt Suppression CT/MRI Adrenal vein sampling
96
Old man atherosclerosis Young woman with fibromuscular dysplasia HTN Hypokalemia Aldo: Renin< 10
Renal artery stenosis U/S Doppler Angiogram Female: Stent Male: +/- medically
97
Paroxysms Headaches Palpations Perspire
Pheochromocytoma Urinary 24 hrs VMA Metanephrines CT/MRI MIBG AVS Resection (Alpha blockade)
98
Trick to resection of pheo
Alpha blockade Beta blockade Resection
99
``` Female HTN Diabetic Buffalo hump Acne Moon facies ```
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
100
L—> Shunt (7)
Increased pulmonary artery flow Increased pulm art pressure Increased pulm art resistance Increased pulm HTN RVH Noncyanotic Eissenringer's R—> L
101
Fixed split S2
ASD Echo Closure device
102
PDA tx
Indomethicin [Prostaglandins to maintain]
103
Heart condition with diabetic mother
Transposition of great vessels
104
Tetralogy of fallot (4) Dx
VSD Overriding aorta Pulmonic stenosis RVH TET spells
105
Halfs to transposition of great vessels
Blue: RA- RV- Aorta- VC Red: LA-LV- Pulm A- Pulm vein
106
Aortic stenosis tx
Can not do a balloon since due to calcification Tx: Replacement
107
Systolic head at apex Radiates to axilla Holosystolic
Mitral regurg
108
Diastolic 4th ICS Decrescendo and blowing
Aortic regurg
109
Diastole Cardiac apex Rumbing with opening snap
Mitral stenosis From rheumatic heart disease
110
Cath 1,2 vessels
Stent + Clopidogrel
111
Cath 3+ vessels or L main vessel
CABG
112
CABG
Left internal mammory artery to most important artery Other vessels grafted from saphenous vein graft Beta block Asprin Ace Statin
113
Liver lesion with focal nodular hyperplasia looks like
Firm tan lesion with fibrous septa and central stellate scar
114
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
1) Hepatocellular carcinoma 2) Nonalcoholic fatty liver disease 3) Hepatic hemagnioma 4) Hepatic adenoma
115
Fever RUQ pain Liver lesion Peripherally enhancing lesion
Hepatic abscesses
116
Cystic calcified parasellar mass Bilaterally decreased peripheral vision loss
Craniopharyngioma Mixed solid cystic tumor from remnant of rathke's pouch
117
Ataxia Cystic lesion of cerebellum
Astrocytoma
118
Headache Seizures MRI= hypodense lesion
Dermoid cyst Epidermoid tumor Contain sebaceous glands and hair follicles
119
Child Cerebellum ``` Headache Vomiting Altered mental status Ataxia Gait instability ``` Midline or paramedian mass in cerebellum
Medulloblastoma
120
Extradural mass
Meningiomas
121
Painless hematuria Palpable flank mass Smoker
Renal cell carcinoma
122
Liver lesion Asx Uses oral contraceptives
Hepatic adenoma
123
Classic central stella scaring Liver lesion
Focal nodular hyperplasia
124
After eating abdominal pain 3 months Food fear Elderly
Chronic mesenteric ischemia Mesenteric artery bypass
125
Acute bacterial prostatitis organism
E. Coli
126
Presurgical treatment for someone with elevated bleeding time and activated partial thromboplastin time
Desmopressin Von Willebrand disease
127
Double vision Trouble keeping eyes open Jaw tires with eating Tx
Myasthenia gravis Pyridostigmine
128
Tx recurrent acute esophageal variceal hemorrhage taht fails endoscopic tx
Transjugular intrahepatic portosystemic shunt (TIPS)
129
Aortic valve replacement
<50% ejection fraction
130
Tx keloids
Intralesional triamcinolone (corticosteroid)
131
Tx AAA
4. 0- 5.4 cm - Repeat U/S in 6 to 12 months >5.5 cm - Elective endovascular repair
132
Next step if in respiratory distress and fails endotracheal intubation and laryngeal mask airway
Surgical cricothyroidotomy
133
Diabetes Early satiety Nausea Dx
Gastroparesis Scintigraphic gastric emptying study
134
Colon cancer biomarker
CEA Carcinoembryonic antigen
135
AFP
Biomarker for hepatocellular carcioma
136
CA 125
Biomarker ovarian cancer
137
CA19-9
Pancreatic cancer
138
Small bowel obstruction imaging
Abdominal radiographs, upright and lateral
139
Gave birth Now enlarge thyroid 104 fever Confusion Vomiting Sweating
Thyroid storm Propylothiouracil
140
Young female Chest pain and pain with swallowing Sudden Series of dilations and narrowing along the length of the esophagus
Diffuse esophageal spasm
141
Anterior mediastinal mass
Four T Ectopic thyroid tissue Thymoma Teratoma Terrible lymphma
142
Anterior mediastinal mass Myasthenia gravis
Thymomas
143
IV drug use organism
Staphylococcus aureus
144
Septic arthritis organism
Staphylococcus aureus
145
Septic arthritis in IV drug user organism
E. Coli
146
Describe keloids
Thick dermis with randomly placed collagen bundles containing wavy collagen fibers
147
Imaging for dissection
CT angiogram
148
Hairless | Shiny shin
PVD Get ABI
149
PVD medications to make symptoms less
Cilostazol Pentoxyphylline
150
ABI levels
``` > 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
151
Tx conjunctivitis in newborn
Prophylaxis Topical erythromycin Tx Gonorrhea - Ceftriaxone
152
Low light eye pain Headaches Rigid eyeball
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
153
Inflammation of eye region Can they move their eye
CT scan I+D, Abx If DM/ DKA - Mucor Amphoteracin B
154
Floaters in eye
Retinal Detach Mild
155
Veil or curtain in eye
Retinal detachment
156
Curtain over eye that comes and goes
Amorasis Fugax Pending retinal artery occlusion
157
unilateral painless vision loss No other focal neurological defects
Retinal artery occlusion Intraatrial TPA
158
Cherry red spot in fovea
Retinal artery occlusion
159
Loss of central vision Chronic progressive Blood or fluid at back of eye
Wet macular degeneration Tx: Laser
160
Loss of central vision Chronic progressive Back of eye: Pigment changes or dressin
Dry Macular degeneration Tx: none
161
Pearly lesion Sun exposed Lesion fails to heal Bleeds easily dx Tx
Basal cell Excisional biopsy [NOT PUNCH Bx] Does not metastasize Tx: Face= Mohs Limb mild= excision Limb exgressive= amputate
162
Lower lip Hyperpigmentation
SCC
163
Well defined Red papule Ulcer nonhealing Dx Tx
SCC Dx: Excisonal bx Tx: Excision
164
Jet black lesion w/ no hair
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
165
Metatasis to brain
Lung Breast GI
166
Brain cancer imaging
MRI w/ contrast
167
Short stature | Calcification of sella
Craniopharyngioma
168
Pituitary tumors
Anterior fossa= adults Posterior fossa= peds Anterior fossa - Meningoma - Glioblastoma Posterior fossa - Medulloblastoma - Ependyoma
169
Progressive HA N/V Metatasis
Medulloblastoma Distal lesions Resection + radiation
170
Ependymoma
From 4th ventricle Progressive HA N/V Better when curls into ball Resection
171
Tumor attached to dura Focal neurological defecits
Meningoma Resection
172
Tumor in parenchyma (in brain tissue) Eating away at brain Ring enhancing lesion Bats wing deformity Crosses midline
Glioblastoma Crosses midline
173
N/V HL Tinnitius
Schwannoma
174
Elderly patient Abdominal distention and pain No stool in vault and heme negative
Sigmoid volvulus
175
How to decrease elevated intracranial pressure
Head of bed elevation Hyperventilation IV mannitol
176
Arm/ shoulder pain Hand weakness Atrophy of muscles Weight loss
Pancoast tumor [Superior sulcus lung tumor] Get chest Xray
177
Blunt chest trauma Pleural effusion
Have hemothorax until proven otherwise Tube thoracostomy
178
Anemia Eczema Diarrhea
Celiac disease
179
Diarrhea with HIV patient CD4 < 50
Cytomegalovirus colitis
180
HIV < 50 Mycobacterium avium complex colitis
Fever Night sweats Diarrhea WL Lymphadenopathy
181
``` Tired Hyperpigmentation Hepatomegaly Low platelets High Alk Phos ```
Primary biliary cholangiitis Tx: Ursodeoxycholic acid
182
Blood at meatus of penis Dx
Retrograde urethrography Urethral injury
183
Contracture of fourth digit and fifth
Dupuytren's contracture Surgery
184
Imaging for kidney stones
non-contrast helical CT scan
185
13 y.o Right hip pain Limp Joint effusion Passive external rotation
Slipped capital femoral epiphysis
186
Tx Multiple myeloma
Systemic chemotherapy
187
COPD tx
Long acting bronchodilator Inhaled glucocorticoid
188
Pancreatic mass Profuse watery diarrhea
Vasoactive intestinal peptide-secreting tumor VIPoma
189
Rheumatic fever
Mitral stenosis
190
Loud S1 Opening snap Mid-diastolic rumbling murmur at apex
Mitral stenosis
191
Dark purple discoloration and decreased mobility of the right tympanic membrane Trauma
Basilar skull fracture
192
Painless jaundice
Pancreatic cancer
193
Oliguria Hypotension Tachycardia Tense distended abdomen Previous surgery and fluid resuscitation
Abdominal compartment syndrome (ACS) Measure of bladder pressure
194
GERD | > 60 y.o
EGD [Omeprazole if under 60]
195
Left upper quadrant paint with radiation to left shoulder
Subphrenic abscess
196
Steriod use Elderly w/ hip pain Muscle atrophy
Avascular necrosis of bone get MRI
197
Bladder pain after teenager drinks alot for first time Resolves
Uretopelvic junction obstruction U/S= hydronephrosis VCUG= r/o reflux Surgery
198
Female Normal peeing Constant leak Never dry
Ectopic ureter ``` U/S= no hydro VCUG= r/o reflux ``` Radionucleotide scan to assess renal fxn
199
Testicular cancer suspicion
U/S Remove [Do not do FNA]
200
No nitrates with
PPE-inhibitors
201
Epidimyitis Dx Tx
Dx: U/S doppler (make sure not torsion) Tx: <35: Ceftriaxone + azithromycin >45: fluroquinolone
202
Newborn w/ click 4 weeks later still there
Developmental dysplasia of the Hip 4 wk u/s Harness
203
Insidious antalgic gain 6 y.o
Leg-calth perth XR Cast
204
13 y.o Hip pain Growth spirt or fat Non-traumatic joint pain
Slipped capital femoral epiphysis Frog leg x ray Surgery
205
Cant flex index finger Sports injury
Jersey finger Tear flexor tendon
206
Cant extend digit Sports injury
Mallet finger Tear extensor tendon
207
Can't extend digit No injury When pushed into extension "popping" sound
Trigger finger Stenosing tenosinovitis
208
Thumb pain Ulner deviation and pain
Dequervain's tenosynovitis Mom cradling baby Guy lifting weights Inflammatory disease Surgery not an option
209
Inability to extend Nodules on palm
Duputyens contracture ETOH Scananovians males Fascial disease NSAIDS dont help Surgical
210
Abscess Alot of pain Fever Leukocytosis Penetrating injury
Felon Abscess of pulp of finger Incision and drainage Rarely need Abx
211
Arm abducted and ER As if shaking hand Can also see
Anterior dislocation Deltoid parathesis Xray Relocate Sling
212
Massive trauma Seizures Lightning strikes Abducted IR
posterior dislocation of humerus Xray Relocate Swing
213
Old lady | Falls on outstretch wrist
Colle's fx Fracture radius and ulna Dorsally displaced
214
Blocking downward blow Upward block
Monteggia fx Ulna breaks Radius dislocates
215
Downward block | Upward blow
Galezzia Radius breaks Ulna dislocates
216
Fall on outstretched hand Pain at snuffbox
Scaphoid fx Xray -normal day 1 Cast it
217
Punches the wall 4th and 5th digit breaks
Boxer fx
218
Fx femoral head
Need prosthesis
219
Fx shaft of leg
Rods
220
Posterior trauma to leg
ACL Anterior draw sign MRI Surgery (athletes) Casting (everybody else)
221
Anterior trauma to leg
PCL Posterior draw sign MRI Surgery (athletes) Casting (everybody else)
222
Valgus
Lateral MCL MRI Surgery (athletes) Hinge Cast (everybody else)
223
Vargus
Medial LCL MRI Surgery (athletes) Hinge Cast (everybody else)
224
Knee pain Click on extension
Meniscus tear MRI of knee Arthroscopic repair
225
Weekend warriors Forced march
Stress fracture Xray normal Cast Crutches
226
Break of tibula
Fibula also broken [Can have broken fibula w/o tibula] Fall from height Pedestrian struck
227
Pain + Swelling Cant walk
Ankle Fx Xray
228
Achilles tendon rupture tx
Casting (months) Surgery (weeks)
229
Renal artery stenosis dx
Renal arteriograpy
230
HTN on max medications Whooshing several cm superior and lateral to the umbilicus on the right
Renal artery stenosis
231
Sudden onset sharp chest pain Radiating to back HTN
Aortic dissection | IV beta blockers Labetalol, esmolol
232
Aorta demonstrates two distinct lumens with a visible intimal flap
Acute aortic dissection
233
Painless rectal bleeding
Diverticulosis
234
Scrotal mass Dx
Skip Dx Tx: Radical orchiectomy
235
Tx Appendicitis
Broad spectrum antibiotics Then laparoscopic appendectomy
236
Undermining of skin surround wound
Necrotizing fasciitis
237
Broca aphasia located
Inferior frontal gyrus of the frontal lobe
238
Medially rotated | Hand pronated
Erb's palsy Superior trunk of the brachial plexus
239
Recent sinusitis Headache Fever Double vision in left eye Difficulty with lateral gaze on the left
Cavernous sinus thrombosis
240
Tx Peritonsillar abscess
Needle aspiration
241
Elevated ammonia tx
Lactulose
242
Falls on outstretch hand Pain on ulnar aspect of wrist
Triquetrum fracture
243
Bilateral hearing loss in 30 y.o
Otosclerosis Conductive hearing loss
244
Scoliosis Tx
Cobb angle <20 = observation Cobb angle > 20= Bracing
245
Symptomatic hepatic adenoma
Surgery
246
Ankylosing spondylitis
NSAIDS Indomethacin
247
Tachycardia Narrow regular qrs complexes regular rhythm P waves appear buried within the QRS complexes throughout all leads
Paroxysmal supraventricular tachyarrhythmia Cardioversion Adenosine if stable
248
GI bleed INR > 1.5
Give Fresh frozen plasma
249
LUQ pain Weight loss Bad breath` Patchy broken hair
Gastric bezoar
250
HTN HA focal increase in signal density in brain parenchyma
Intracerebral hemorrhage
251
ABCs
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
Hyperressonance | Decreased breathe sounds one side
Tension pneumo Needle decompression
253
Distant heart sounds Hypotension Engorged enck veins
Pericardial tamponade FAST= echo Pericardiocentesis
254
Raccoon eyes
Basilar skull fracture
255
battle signs Hematoma around ear
Basilar skull fraucture
256
Looks of otorhea or rhinorhea
CSF Basilar skull fracture Get CT scan
257
Angular trauma (Spinning) Loss of consciousness Coma
Diffuse axonal injury
258
Grey white blurring on CT scan
Diffuse axonal injury
259
Neck zones
Zone 3: Top - Arteriogram Zone 2: Middle - Surgery Zone 3: Bottom - Arterogram - Esophogram - Bronch
260
Proprioception | Vibration
Back portion Dorsal columns and Medical lemincus system Cross at brain and down to spinal cord
261
Pain and temperature
Middle portion ALS Cross at level and to other side
262
Motor
Side portion Cross and brain and comes down
263
Lost half the cord Sharp blade in neck
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
Proprioception good Lose motor Lose Pain/temp
Anterior cord Spinal artery occlusion
265
Loss of pain/ temp in cape like distribution Gradually
Syringomelia Loss ALS
266
Loss of sensation only
Posterior cord
267
Hemothorax vs pneumothorax
Hemothorax - dullness to percussion Pneumothorax - resonnance
268
Hemothorax when to take to surgery
20 cc/kg right away or 3 cc/kg/hr
269
Sucking chest wound
Penetrating Air in but not out Tx Occlusive dressing
270
Flail chest
Hugh blunt trauma 2+ ribs 2+ places Paradoxical motion Segments not attached except my muscle Visual CXR Binders/ weights —> plates
271
Chest trauma 1st day CXR clear 2nd day CXR white out Tx
Pulmonary contussion Tx - avoid crystalloids - use colloids - PEEP (positive end-expiratory pressure) - diuresis
272
Trauma Abdominal bleed
Most common= ruptured liver Pringle manuever Repair or lobectomy
273
Pelvic fx
Bleeding into pelvis External fixation
274
Ureter injury
IV pyelogram
275
Electrical burns
Lightning strike high voltage Arrythmias Muscular burns —> rhabdo CK level Cr Tx: IV fluids Mannitol
276
Poisonous snakes
Slit like eyes Cobra cowl Rattle Skin changes Erythema Pain Dx: Clx Tx: Antivenum
277
Spider with red hour glass on belly
Black widow Abdominal pain Pancreatitis IV Ca
278
Southern state Attack or old boxes Bite —> ulcerate Necrosis
Brown recluse Debridement Grift
279
Bite of dog or cat
Pasteurella Irrigation Leave open Amox/Clav
280
wood lamp test
Antifreeze Ethylene glycol
281
Moonshine Blindness
Methanol Give ETOH or fomepizole
282
Cherry red skin Cherry red blood Super sick Tx
Cyanide poisoning Smoke inhalation Nitroprusside Tx: Thiosulfate
283
Organophosphate poisoning
Atropine Then pralidoxime
284
Acute colonic pseudo-obstruction after surgery Tx
Ogilvie sydrnome Plain radiography demonstrating colonic dilation > 9 cm Wait 48 hrs Neostigmine Then decompression
285
Pulmonary nodule > 30 mm No calcifications Dx
Video-assisted thoracic surgery (VATS)
286
Pulmonary nodule >8 mm but less than 30 No calcifications Dx
18-fluorodeoxyglucose positron emission tomogrpahy (FDG-PET)
287
Cyanosis at birth Single heart sound LVH Right atrial enlargement
Tricuspid atresia
288
Cocaine Now chest pain Tx
Myocardial ischemia Tx: percutaneous coronary intervention
289
Carotid artery stenosis tx
Carotid endarterectomy (CEA) [If significant cardiac (CHF) or pulm disease (COPD) then do this carotid artery angioplasty and stenting]
290
Tx DKA
IV normal saline Then insulin Next IV 5% dextrosein 1/2 normal saline
291
First line tx small bowel obstruction
NG tube placement
292
Foot ulcer tx
Antibiotic tx Then MRI to confirm osteomyelitis
293
Elevated Ca and PTH dx
Sestamibi scan Primary hyperparathyroidism
294
Asplenic at risk for what infxn
Streptococcus pneumoniae Haemophilus influenzae Neisseria meningitidis
295
HIV Solitary (single) ring enhanging lesion in brain Causing mass effect Tx
Primary CNS lymphoma Dx: Stereotactic brain biopsy Then Methotrexate
296
Hereditary non-polyposis colorectal cancer at risk for what other cancer
Endometrial
297
Tx of choice for diabetic foot ulcer that has yellow purulent discharge Fever Hypotension
Vancomycin Purulent ccellulitis` Systemic toxicity
298
Painful knee joint 100,000 leukocytes or more 75% polymorphonuclear No crystals
Septic arthritis
299
Trauma Left eye constricted and minimally reactive to light Left eye drooping Right normal Dx
Carotid artery dissection Magnetic resonance angiography of head and neck
300
Renal artery stenosis in young female
Fibromuscular dysplasia
301
Unstable angina tx
``` Pain control Beta blockers Aspirin Heparin Antiplatlet therapy (clopidogrel, ticagrelor) ```
302
Rib fracture tx
Intercostal nerve block
303
Tx Afib
Diltiazem
304
Epiglottitis caused by
Haemophilus influenzae Asplenic pts at risk
305
Intussusception tx
Air enema
306
Apple core lesion
Colon cancer
307
Tx bacterial endocarditis
IV vancomycin
308
``` Neck pain Swelling SOB Fever Pooling of saliva Submandibular swelling Elevated tongue ``` Sickle cell disease
Ludwig's angina Due to streptococcus viridans
309
Hypoglycemic Nurse Elevated serum insulin concentration Decreased C peptide
Exogenous source of insulin
310
Incidental liver lesion finding Nonspecific well demarcated homogenous mass
Hemangiomas MRI w/ contrast
311
MI Hypotension Tachycardia New-onset holosystolic murmur
Ventricular septal rupture 3-5 days post MI [Loss of pulse]
312
Tx dumping syndrome
Octreotide
313
Tx Lung abscess
IV beta lactam-beta lactamase inhibitor
314
Suspected endocarditis
Get echo
315
Symptoms in calf is what artery
Superficial femoral artery
316
Barretts esophagus
Columnar epithelium with goblet cells
317
HTN headache tx
Sodium nitroprusside
318
Tx Acute goutoy arthritis
NSAID Naproxen
319
HIV CD4 < 50 Painful swallowing Inflammed thrat with ulcerations in esophagus Tx
CMV Infectious esophagitis Tx: Ganciclovir
320
Fever BP 80/54 Post surgery IV fluid not helping
Give Norepinephrine
321
Tx Bells palsy
Prednisone
322
Ptosis Miosis Anhidrosis
Horner's syndrome Carotid artery dissection
323
Post surgery decrease in urine output IV fluids given 2+ edema Brown casts Creatinine elevated Next step
Acute tubular necrosis Hemodialysis
324
Most common in sickle cell
Staphylococcus aureus Salmonella
325
Fever chills SOB 1-6 hrs post receiving blood
Febrile nonhemolytic transfusion rxn
326
tx acute bacterial sinosinusitis
Amox-clav
327
Tx acute angle-closure glaucoma
Optic timolol and pilocarpine Oral acetazolamide
328
Prophylaxis for clots in patient with chronic kidney disease
Unfractionated heparin
329
No gallbladder Direct bilirubin? Gamma-glutamyl transpeptidase? Reticulocyte count
Biliary atresia Elevated direct bilirubin Elevated gamma-glutamyl transpeptidase Normal reticulocyte count
330
Acute pancreatitis exam
RUQ Ultrasound
331
Mediastinal mass Elevated beta-HCG and alpha fetoprotein
Nonseminomatous germ cell tumors
332
Astrocytoma presents with
Seizures
333
Hematocrit > 48% Elevated EPO levels
Polycythemia Get CT scan of abdomen
334
Hyperreflexia Wide based gait Enlarged ventricles
Normal pressure hydrocephalus Tx: High volume Lumbar puncture
335
Exam for diverticulitis
Abdominal CT
336
Hypovolumic shock —> Due to
Decreased cardiac output Loss of right ventricular preload
337
Turner syndrome at risk for
Bicuspid aortic valve Aortic dissection (changes in pregnancy can cause) Coarctation of aorta Aortic root dilation
338
Intermittent dysphagia in young man
Eosinophilic esophagitis
339
Hypovolemic shock CVP (right sided preload) CWP (left-sided preload) Cardiac index (LV output) SVR afterload SvO2
All decreased except SVR (afterload) is increased
340
Hypotension after catheter Flank/ back pain
Retroperitoneal hematoma
341
Back pain Elevated alpha feto protein
Hepatocellular carcinoma
342
Chronic diarrhea Ulcerations on colonoscopy in rectum and sigmoid colon Tx
Mesalamine enema Ulcerative colitis
343
Green drainage from chest tube
Esophageal perforation
344
Upper body muscle weakness Loss of sensation Impaired pain and temperature
Syringomyelia Disruption of CSF drainage from central canal leading for fluid filled cavity
345
Deep infection from puncture wound
Staph aureus Pseudomonas
346
Rapidly growning nodule w/ ulceration Spontaneous regression
Keratoacanthoma
347
Crescent shaped patch at medial malleolus
Ruptured popliteal cyst
348
Carpal tunnel caused by 38 y.o ``` tingling in hands Tired constipation Lethargy Dry skin ```
Mucinous infiltration Hypothyroidism
349
Management of osteoarthritis
1) Quadriceps strengthening + weight loss 2) NSAIDS 3) Surgery
350
Hx aortic aneurysm avoid what medication
Fluroquinolones [Levofloxacin]
351
SE Doxycycline
Skin photosensitivity Medication induced esophaggitis
352
Pearl pink nodule Next step
Basal cell carcinoma Excisional biopsy with narrow margins
353
``` Several UTI 30 y.o male Painful ejaculation Smokes Smooth nontender prostate ```
Chronic bacterial prostatitis Fluoroquinolones (ciprofloxacin) 6 wks
354
Day after surgery Acidosis Increased PaCO2
Alveolar hypoventilation
355
Purple papules where had previous radiation
Angiosracoma Internal lining of blood vessels 4-8 yrs post Lesion biopsy
356
Fever RUQ pain Distended gallbladder iwth gas in gallbladder wall and lumen
Emphysematous cholecystitis Crepitus in abdominal wall adjacent to gallbladder Clostridium Ecoli Emergency cholecystecotmy ABx- piperacillin-tazobactam
357
RUQ pain Jaundice Elevated Alk phos Bile duct dilation No gas in biliary tree
Acute cholangitis
358
Nasal packing from epistaxis ``` Fever Hypotension Erythematous macules on trunk Vomiting Diarrhea Dizziness ``` Thrombocytopenia
Toxic shock syndrome Staph aureus
359
Tx Polycytsic kidney disease
Control risk factors of CV and CKD ACE inhibitors
360
Anterior knee pain Reproduced by squatting
Patellofemoral pain syndrome Tx strengthening quadriceps and hip abductors
361
Medial knee pain Distal to joint line
Pes anserinus pain
362
Lateral pain Pain w/ running
Iliotibila band
363
Sudden severe abdominal pain Hypotension Flank ecchymoses
Ruptured abdominal aortic aneurysm >60 smoker atheroscloerosis Focused abdominal ultrasound
364
Rinne positive on right BC > AC in right ear
Conductive hearing loss on right Otitis media Cholesteatoma Otosclerosis
365
Rinne positive on right AC> BC
Sensorineural hearing loss on left Aminoglycoside antibiotic toxic effect Meniere Vesticular schwannoma
366
Episodic vertigo Fluctuating hearing loss
Meniere disease
367
27 y.o w/ conductive hearing loss and normal exam
Otosclerosis
368
Elderly woman with shorted leg Externally rotated
Femoral neck fracture
369
Sudden pain Testicular swelling (enlarge right testicle) Heterogeneous testicular echotecture w/ small hydrocele
Testicular torsion Twisting of spermatic cord Get doppler
370
Must common source of liver metastases
Colorectal cancer
371
What to do if suspected esophageal perforation
Water soluble contrast esophagography
372
Progressive hoarseness Irregular exophytic growths on vocal cords Caused by
Laryngeal papillomas HPV
373
Mitral regurgitaion effects on heart LA LV LV Ejection fraction
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
Fever 2 hrs after surgery
Postoperative fever >38 C 100.4 F Cytokine release Observe
375
Distended neck veins Hypotension Car accident Normal cardiac silhouette
Acute cardiac tamponade
376
Female Recurrent headaches HTN Bruit below right ear
Fibromuscular dysplasia (FMD)
377
Hemodialysis Tingling and numbness in hands
Carpal tunnel syndrome Dialysis related amyloidosis
378
Shin splints vs stress fracture
Shin splints - anterior leg pain - runners - diffuse are of tenderness (not point) Stress fracture - Running/ gymnastics - Point tenderness
379
Uncontrolled HTN Progressive dyspnea Lower extremity swelling JVD Prominent V waves
Decompensated left sided heart failure Tricuspid regurgitation Tricuspid annular dilation
380
Multiple ulcers in duodenum and jejunum
Zolliger-Ellison syndrome Excess gastrin secretion Inactivation of pancreatic enzymes —> ulcers
381
Anterior mediastinum mass Middle mediastinum mass Posterior mediastinum mass
Anterior - thymoma - retrosternal thyroid - teratoma - lymphoma Middle - Bronchogenic cyst Posterior - [All neurogenic tumors] - Meningocele - Lymphoma - esophageal tumors - aortic aneurysms
382
CABG done a week ago Pleuritic chest pain Fever Leukocytosis Pleural effusion of echo
Dressler syndrome | post cardiac injury
383
Thyroglobulin (Tg)
Precursor to active thyroid homrones T3 T4 produced by thyroid tissue
384
Intracardiac mass in atrium
Atrial myxoma
385
Glasgow coma scale (GCS)
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
Central portion of lung mass
SCC
387
14 days post CABG Fever Tachycardia Chest pain Cloudy fluid in drain Widening of mediastinum
Acute mediastinitis Tx: Debridement and Abx
388
Suspected corneal abrasion
Fluorescein drops Stains abrasion
389
Enlarged firm neck mass Ulcerated tonsillar
Squamous cell carcinoma HPV
390
INR for mechanical valve
2-3
391
Painless blindness in right eye and headache Cerebellar & retinal hemangioblastomas Very high BP Intracranial hemorrhage in father
Von Hippel LIndau disease Cerebellar & retinal hemangioblastomas Pheochromocytoma Renal cell carcinoma
392
Progressive hearing loss Can hear better when its noisy Reddish hue behind tympanic membrane
Otosclerosis
393
In groin after surgery Palpable thrill Continuous murmur
Abnormal arteriovenous communication [AV fistula] No mass Continuous bruit
394
Tender mass | Pulsatile
Pseudoaneurysm
395
Dock injury Fever Rigors Bullous lesions
Vibrio vulnificus IV ceftriaxone + doxycycline Risk: those w/ liver disease
396
Pulmonary capillary wedge pressure elevated Bilateral crackles SOB Blood transfusion during surgery Hypotension Decreased cardiac index
Myocardial infarction
397
Fixed breast mass Calcifications on mammography Hyperechoic mass Fat globules and foamy cells
Fat necrosis [Post trauma/ surgery] Benign
398
Zenker diverticulum caused by
Abnormal spasm or diminished relaxation of the cricophyarngeal muscles during swallowing (cricophyarngeal motor dysfunction) is underlying mechanism
399
``` RUQ pain Melena Jaundice Anemia Hyperbilirubinemia ``` Liver biopsy recently
Hemobilia | bleeding into biliary tract
400
Earlier oropharyngeal infection Internal jugular vein thrombosis Neck pain, swelling along SCM Fever, rigors, dysphagia
Lemierre syndrome Fusobacterium necrophorum
401
Tx ureteral stone
Tamsulosin Alpha 1 antagonist
402
Bloody ascites
Red blood cells leaking into intraperitoneal fluid Malignancy Hepatocellular carcinoma
403
Erythematous nodules on shins Chronic diarrhea Abdominal pain
Erythema nodosum Crohns disease
404
Pustules on lower legs what organism
Pseudomonas aeruginosa folliculitis
405
Previous cardiac bypass Reduce urine output Cool extremities Hypotension Elevated RA, RV and pulmonary capillary wedge pressure SInus tachycardia, nonspecific T wave changes
Impairment of venous return Cardiac tamponade Get Echo
406
Retrocardiac air fluid level
Stomach bubble within the thoracic cavity Sliding hernias
407
Intranasal desmopressin can cause
hyponatremia analogue of Antidiuretic hormone
408
Risk factors for ventilator associated pneumonia
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
Unilateral hydronephrosis Dysuria Frequency Hematuria Acute right sided flank pain
Bladder cancer
410
Indurated erytehmatous mass near the anal orifice Severe and constant anal pain Low grade fever
Perianal abscess Infection of an occlued anal crypt gland
411
Need to reverse warfarin concentration
Prothrombin complex concentrate
412
Anterior cord syndrome Central cord syndrome Posterior cord syndrome
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
Postoperative atelectasis
Decreased PaCO2 Increased pH
414
Tumor of parafollicular cells
Medullary thyroid cancer Check Calcitonin levels
415
Tx acute bacteria prostatitis
Levofloxacin Ecoli
416
``` Osteoporosis Ataxia Anemia Skin depigmentation Brittle hair ``` Vit def
Copper
417
DVT tx
Renal disease | - give unfractionate heparin followed by warfarin
418
DIC
THrombocytopenia Prolonged PT and PTT Decreased fibrinogen
419
Yellow sputum Non productive cough WL Night sweats Cavitary lesion in right lower lobe
Lung abscess
420
Lymphangitis tx
Cephalexin Tender erythematous streaks proximal to wound
421
MRCP shows luminal irregularities with mild focal dilations within both intrahepatic and extrahepatic biliary ducts Elevated Gamma-glutamyl transpeptidase
Primary sclerosing cholangitis Colonoscopy (inflammatory bowel disease)
422
Check lung capacity after partial removal
FEV1 Diffusion capacity of the lung for carbon monoxide (DLCO)
423
Prosthetic joint infection bacteria
Early onset - Staph aureus ``` Delayed onset ( 3-12 months) - Staph epidermidis ``` >12 months - Staph aureus

Third Year Shelf (7 decks)

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