surgery/emerg 2

Question 1

critical ill patient-acalculous cholecystitis

Answer 1

• gallbladder distension, thickening gallbladder wall, pericholecystic fluid
  tx immediate percutaneous cholecystostomy

Question 2

high pitched hyperactive bowel sounds, dilated loops of bowel, with air fluid level

Answer 2

mechanical bowel obstruction

Question 3

perforate bowel

Answer 3

emergent ex- lap

Question 4

marjolin ulcers

Answer 4

SCC developing form burn wound

Question 5

punctate hemorrhages, blurring grey white junction

Answer 5

diffuse axonal injury

Question 6

subclavian vein access or respirator

rupture of the membrane

Answer 6

air embolus

amniotic fluid

Question 7

pelvic abcess

Answer 7

males appendicitis common cause of pelvic abscess
fever, leukocytosis, painful defection, and diarrhea b.c bowel irritation from infection
tender fluctuant mass palpable with only tip of finger on rectal exam, abscess in rectovesical pouch
ct guided percutaneous drainage drainage

Question 8

diverticulitis

Answer 8

dx with CT bowel rest, antibiotics

Question 9

diabetic foot ulcers

Answer 9

point pressures plantar foot, under first metatarsal

Question 10

diaphragmatic hernia

Answer 10

more common left side
mediastinal, trachea deviaton opposite side
decrease lung sound left
respiratory distress, tachypnea
chest x ray elevation hemidiaphragm in chest
some may show bowel in chest

Question 11

necrotizing surgical wound

Answer 11

1. intensive pain with fever, tachycardia,
2. decreased sensitivity at the end of the wound
3. cloudy gray discharge
4. DM is a risk factor
5. caused by mixed aerobic and and anaerobic
   dx - early surgical exploration to assess extent of process and debridement of necrotized tissue

Question 12

posterior urethral injury

Answer 12

pelvic fracture prostatic urethra, and membranous 
blood at urethral meatus 
high riding prostate 
scrotal hematoma 
inability to void depsite urge to void 
palpable distended badder

Question 13

anterior urethral injury

Answer 13

blunt trauma o perineum - straddle injury or instrumentation of urethra
normal prostate, bleeding form urethra perineal tenderness or hematoma
extravasation of urine to scrotum, perineum or abdominal wall

Question 14

trauma hemodynamic instability

Answer 14

< 90 mmhg