Surgery EOR Flashcards
1
Q
Buzzword: Homan’s sign
A
DVT. Pain with forced dorsiflexion
2
Q
Test of choice to dx suspected DVT
A
Venous Doppler US
3
Q
Describe and associate Murphy’s sign
A
Patient’s breath “catches” during inspiration with palpation in the RUQ. Ass’d w/ cholecystitis.
4
Q
Dx test for a pt with colicky RUQ pain
A
Suspect cholecystitis:
US is initial test
Gold std is HIDA
5
Q
How can peptic esophageal strictures be prevented in pts with GERD?
A
PPIs
6
Q
Dx test and tx for pt with progressive solid food dysphagia
A
Suspect esophageal stricture
- Initial test is upper endoscopy
- If a proximal (Zenker’s, laryngeal) lesion is suspected, start with a barium esophagram instead
Management: high dose PPIs and stricture dilation
7
Q
Your 50-YO pt is complaining of feeling uncomfortably “full” after eating. How should this patient be managed?
A
This is functional dyspepsia.
Patients <60 YO should be treated depending on presence of alarm symptoms: weight loss, progressive dysphagia, pain with swallowing, persistent vomiting, GI bleeding, mass, melena, etc.
If alarm symptoms are present, proceed straight to endoscopy.
If no alarm symptoms are present, test for H pylori and consider PPI trial.
8
Q
Your 65-YO pt is complaining of early satiety. How do you proceed?
A
Any pts >/=60YO with functional dyspepsia (with or without alarm symptoms) get an endoscopy.
9
Q
Pt with extensive FHx of colon, endometrial cancers are suspect for:
A
Lynch syndrome (auto dom)
Susceptible to endometrial, ovarian, renal pelvis, ureter, stomach, small bowel, bile duct, and sebaceous neoplasms.
**ASA reduces incidence of cx in Lynch syndrome!
10
Q
Preoperative prophylaxis for a pt with acute appendicitis without perforation?
A
1 dose cefotetan 2g IV 60 minutes prior to first incision
11
Q
Your pt has intermittent claudication and ABI is performed. What value is considered diagnostic of PAD, and what is the first-line tx?
A
ABI =0.9 = PAD
Start patient on ASA, discuss RF modification (smoking cessation, exercise, managing HTN, hyperlipidemia, and DM).
Cilostazol may be used (phosphodiesterase inhibitor)
12
Q
What is the tx for PAD in a pt who has pain at rest?
A
Revascularization (endovascular or surgical)
Indicated with pain at rest, ulcerations 2/2 poor perfusion, concern for limb loss, or symptoms refractory to medical tx.
13
Q
What is the MC type of thyroid cx?
A
Papillary
14
Q
Buzzword: psammoma bodies
A
Thyroid cx (papillary is MC)
15
Q
How is thyroid cx dx?
A
PE: solitary hard nodule (lab will show non-fxn)
Initial test: US
*Dx: FNA
16
Q
What type of thyroid cx is ass’d with MEN II?
A
Medullary (calcitonin can be used as a tumor marker)
17
Q
What is the most aggressive form of thyroid cx?
A
Anaplastic, however, this is the least common
18
Q
How is a confirmed unilateral adrenal tumor surgically treated?
A
Resection via open transabdominal surgery – important for greater visualization, resection of adjacent structures if necessary.
19
Q
How is a bilateral adrenalectomy performed?
A
Posterior retroperitoneoscopic surgery
20
Q
How does pseudo-obstruction or ileus differ in presentation from an SBO?
A
Usually ileus/pseudo-obstruction does not have colicky pain, may not have n/v
21
Q
When does colon cx screening for avg risk pts begin?
A
Age 45
22
Q
Discuss timing of different modalities of colon cx screening for avg risk pt
A
All begin at 45 - 75
Colonoscopy: every 10 if negative
FOBT: Annual if negative
Sigmoidoscopy: 3-5 years if negative
23
Q
All patients presenting with acute abdomen should have what lab drawn?
A
Lipase - pancreatitis can vary in severity of presentation
24
Q
What are the MC causes of acute pancreatitis?
A
Gallstones > EtOH
25
What is the pathognomonic PE finding for pancreatic cancer?
Courvoisier sign: palpable, nontender gallblader
26
What is the MC kind of pancreatic cx?
Ductal adenocarcinoma
27
What are three major modifiable RFs for pancreatic cx?
- Cigarette smoking
- Sedentary lifestyle
- High BMI
28
What is the preferred imaging and monitoring for pancreatic cx?
Dx imaging: abdominal CT
| Monitoring: CA 19-9
29
What antibiotics are used after surgical drainage of a pilonidal cyst?
None unless there are complications of superimposed cellulitis
30
Describe MET documentation
1: Can take care of self (ADLs)
3-4: Can walk up flight of stairs, or level groud 3-4 mph
4-10: Can do heavy work around the house, climb two flights of stairs
>10: Can participate in sports, etc
31
Your pt has hx of urinary retention. Before his Foley is removed, what med might you consider administering and why?
An alpha-1-adrenergic blocker like tamsulosin to relax the smooth muscle of the bladder neck and prostatic capsule. This helps relieves obstruction/prevents early recurrence of retention.
32
What are the 3 MC causes of GI bleeds?
```
Upper GI bleeds are MC than lower.
MC causes of upper GI bleeds are ulcers and esophageal varices.
- H pylori
- NSAID use
- Esophageal varices/portal HTN
```
33
What structure defines the transition from upper to lower GI?
The ligament of Treitz.
34
What HPI info might make you suspect a gastric ulcer vs a duodenal ulcer?
Gastric ulcers are worse with food (pain immediately after meals, early satiety, may have weight loss).
Duodenal ulcers are relieved with food; pain begins 1-2 hours postprandial, may wake patient from sleep. MC.
35
How are upper GI bleeds dx?
Endoscopy
36
What drugs are most likely to cause an IgE-mediated allergic reaction?
Cephalosporins and PCNs
37
What drugs often cause non-IgE-mediated allergic reactions?
Narcotics
Muscle relaxants
Vancomycin
Contrast
38
How is von Willebrand disease treated?
Desmopressin
(If this fails, consider plasma-derived VWF concentrate or recombinant VWF).
39
What physiologic process is interrupted in von Willebrand disease?
VWF is important in primary hemostasis: bridges platelets and subendothelial structures, contributing to fibrin clot formation. It carries Factor VIII.
40
Describe the pathologic histological change that can take place in chronically untreated dyspepsia
In Barrett Esophagus the squamous epithelium becomes metaplastic columnar epithelium
41
How often should a pt with Barrett Esophagus w/o dysplasia get scoped?
Every 3-5 years.
42
Tx of uncomplicated, symptomatic Crohn's dz?
Immunosuppressants.
43
How do surgical interventions vary for patients with Crohn's disease vs ulcerative colitis?
In UC, surgical resection can be curative bc affected area is contiguous.
In Crohn's, surgical resection is only indicated for complications such as stricture/obstruction, abscess, perforation, hemorrhage, or toxic colitis. Recurrence of disease is likely to occur.
44
What are some extraintestinal manifestations of Crohn Disease?
```
Pyoderma gangrenosum
Erythema nodosum
Ankylosing spondylitis
Arthritis
Uveitis
Liver disease
Nephrolithiasis
```
45
What medication is administered immediately after resection of an adenocortical carcinoma to prevent hypotension?
Hydrocortisone - the risk of adrenal insufficiency or adrenal crisis is increased in this patient.
46
What is the Parkland formula?
Determines fluid resus quantities in 2nd/3rd degree burn pts:
4mL * %BSA * Kg (weight)
Give half of this over the first 8 hours
Give the second half of this over the next 16 hours
47
What is target urine output after fluid resus in a burn patient?
0.5mL per kg per hour
48
What bacteria need to be covered in burn wound infections?
Pseudomonas
49
What is the tx for carotid artery stenosis?
For patients with life expectancy 5+ years, an accessible plaque, stenosis of 70%+, M&M risk <6%, and no previous endarterectomy: Carotid endartectomy.
For other patients: either stenting or medical management (antiplatelet and statin therapy).
50
How is carotid artery stenosis diagnosed?
Angiography is gold std
US is often initial imaging performed
51
A 65-YO obese man with HTN presents to the clinic complaining of worsening SOB with physical exertion for the past two weeks. PE reveals bibasilar lung crackles, normal heart sounds, and 1+ pitting edema in both ankles. Which of the following is the best next step?
Echo to identify HF
52
Differentiate the types of hiatal hernias
Type 1: Sliding, the stomach herniates with the esophagus at least 2 cm
Types 2-4: Paraesophageal, the gastroesophageal junction is displaced with the fundus of the stomach herniated through the phrenoesophageal membrane.
53
How are hiatal hernias managed?
Sliding: conservative, manage GERD symptoms
Paraesophageal: conservative unless symptoms cannot be controlled, then surgery
54
Your patient just underwent laparoscopic surgery for an SBO and now has a metabolic disturbance. What is it most likely, and why?
During laparoscopic surgery, a lot of third-spacing occurs = volume contraction. This fluid is high in Na and low in bicarb, leading to an alkalosis. Additionally, NG decompression likely occurred p/op, and loss of HCl causes HCO3- to be released into the serum (adding to the alkalosis). This patient is likely in metabolic alkalosis.
55
What is the most likely metabolic disturbance after massive blood loss?
Metabolic acidosis
56
What is the most common metabolic disturbance ass'd with post-op respiratory depression?
Respiratory acidosis
57
What is the medical treatment for hyperthyroidism?
Methimazole or PTU if pregnant
58
What is the MC cause of hyperthyroidism?
Graves disease: autoimmune condition in which TRAbs activate thyrotropin receptors, stimulating thyroid hormone synthesis
59
What is the ideal modality for dx SBO?
Abdominal CT with contrast
60
What measure of dilation is necessary to dx an SBO on CT?
2.5+ cm
61
What is the MC cause of SBO?
Adhesions
| Then hernias, then malignancy
62
What is the non-operative tx of SBO?
NG decompression
NPO
IVF
63
What is the MC cause of large bowel obstruction?
Malignancy (adults)
64
If a CT is non-diagnostic, what could you order to help dx patient presenting with "the worst headache of my life"?
LP: a subarachnoid hemorrhage will cause hemoglobin degradation products to be present in the CSF (xanthochromia).
65
Your patient presents with a severe headache and positive meningeal signs. After confirming your suspected diagnosis, what medication should be administered to prevent a common complication?
Nimodipine (CCB) should be given to decrease vasospasm
66
How is pheochromocytoma diagnosed?
In high-risk patients: plasma fractionated metanephrines
In lower-risk patients: 24-hour urine fractionated metanephrines and catecholamines
67
You want to r/o a dx of pheochromocytoma in your patient. What drug class could interfere with the necessary diagnostic test?
Tricyclic antidepressants can interfere with 24-hours urine fractionated metanephrine/catecholamine tests, which are used for patients with lower risk of pheochromocytomas
68
Your patient presents with Charcot's triad. What is it, and what is the best management of the ass'd dx?
Charcot's Triad: RUQ pain, jaundice, fever
Sus for cholangitis
ERCP is the tx (plus broad spectrum antibiotics: IV zosyn or metro + cephalosporin/levoflox)
69
Name 5 instances in which non-surgical management is warranted in pts with bowel obstruction?
- Early post op
- IBD patients
- Gallstone ileus
- Infectious small bowel disease
- Colonic diverticular disease
70
How is testicular cancer dx'd and monitored?
Initial: US
Confirm: CT
Monitor: b-hCG, LDH, or AFP if non-seminoma
71
What is the MC type of testicular cx?
Germ cell
72
Without imaging, what kind of head injury are you sus of if the patient passed out, then had a lucid interval, and then experienced progressive neuro deterioration?
Epidural hematoma
73
CT shows a lens-shaped collection of blood in the cranium. What is the affected vessel?
Middle meningeal artery is torn in an epidural hematoma
74
What electrolyte imbalance is ass'd with respiratory alkalosis and why?
Hypokalemia: in alkalotic states, K+ leaves extracellular space in exchange for H+.
75
Pt presents with decreased breath sounds, dull percussion, decreased tactile fremitus, and CXR shows blunting of the costophrenic angle. How is this condition managed?
Thoracentesis (pleural effusion)
76
You want to know the etiology of your patient's pleural effusion- you order pleural and serum labs of what two values?
Lactate dehydrogenase and protein
77
What is the gold std eval for patients with sus PUD?
Histologic tissue evaluation
78
When is surgery considered appropriate for patients with PUD?
Ulcers >3cm
Or pts with complications: bleeding, perf, obstruction
Or pts refractory to medical therapy
79
Pt presents with amenorrhea, headaches, and loss of temporal vision. What is the treatment for the most likely dx?
Dopamine agonists such as cabergoline or bromocriptine.
If unsuccessful, transphenoidal resection of pituitary should be considered.
80
Buzzword: string sing
Seen on UGI series, pyloric stenosis
81
Buzzword: target sign
Seen on US, pyloric stenosis
82
What measurements, seen on US, are definitive for pyloric stenosis?
Thickened pylorus >4mm
| Elongated pylorus >14mm
83
What electrolyte and metabolic disturbances are likely present with pyloric stenosis?
Metabolic alkalosis
Hypokalemia
Hypochloremia
84
MC type of gallstone?
Cholesterol
85
MC type of kidney stone?
Ca oxalate
86
Pts with recurrent upper UTIs are more likely to form what kind of stones?
Struvite
87
What is the MC site for kidney stones to lodge?
Ureterovesical junction
88
Describe size parameters to consider when deciding on treatment for nephrolithiasis
<5 mm stones are likely to pass spontaneously
>8 mm are unlikely to pass, consider lithotripsy
89
How is nephrolithiasis diagnosed?
Helical CT
90
Labs on your patient show an electrolyte imbalance and EKG shows peaked T waves. What is the electrolyte imbalance, and what do you do?
Hyperkalemia
Administer Ca gluconate to stabilize the cardiac membrane before correcting K+.
Insulin, albuterol, and sodium bicarb are used to cause redistribution of K+.
Furosemide is used to eliminate excess K+.
91
What is the initial imaging of choice when pneumothorax is suspected?
CXR
92
Painless hematuria in a smoker?
Bladder cx
93
Differentiate dx of cholecystitis vs cholelithiasis
Cholecystitis: HIDA scan is gold std
Cholelithiasis: US
94
Differentiate some common causes of unconjugated vs conjugated hyperbilirubinemia.
Unconjugated:
HF, liver disease, intravascular hemolysis, Wilson disease, Gilbert syndrome
```
Conjugated:
Biliary obstruction (choledocolithiasis, acute/chronic pancreatitis, cholangiocarcinoma), viral hepatitis, cholangitis
```
95
MC cause of inherited unconjugated hyperbilirubinemia?
Gilbert syndrome
96
Compare the management of a Type A vs Type B aortic dissection
Type A includes the Ascending aorta and is a surgical emergency.
Type B ONLY includes descending aorta and may be managed medically + imaging surveillence:
- Reduce BP to lowest tolerable level
- Reduce HR <60
- IV propranolol, labetalol, or esmolol
- Nitroprusside after HR is controlled
- Pain control
97
What is the MC site of diverticula formation?
Sigmoid colon
98
What is the MC cause of lower GI bleeding?
Diverticulosis
99
What type of hernia has only a portion of the intestinal wall involved?
Richter hernia (just the antimesenteric wall of the intestine)
100
What is the MOA of cilostazol, and what condition does it treat?
Cilostazol is a phosphodiesterase inhibitor that treats claudication
101
What medications are common causes of orthostatic hypotension?
a-adrenergic blockers (doxazosin)
Antihypertensives
Nitrates
Antidepressants
102
What is the first-line tx for acute ischemic stroke?
In eligible patients, fibrinolytic therapy with alteplase
103
Buzzword: widened mediastinum on CXR
Aortic dissection
104
What is the murmur ass'd with aortic dissection?
A decrescendo diastolic murmur at the right sternal border - aortic regurg
105
What are erosions or ulcers occurring in the sac of a hiatal hernia called?
Cameron lesions
106
What is the gold std test to dx acute angle closure glaucoma?
Gonioscopy showing intraocular pressure >22mmHg
107
What is the management of choledocolithiasis?
ERCP stone retrieval (+ cholecystectomy)
108
How is diverticulitis diagnosed?
Abdominal CT with contrast
- Pericolonic fat stranding
- Localized bowel wall thickening >4mm
- Colonic diverticula
109
Describe the tremor ass'd with hyperthyroidism
High frequency
| Low amplitude
110
What is the best initial imaging for a patient presenting with hemoptysis?
CXR
111
What is one indicator of unresectability of gastric cx?
Disease encasement of the hepatic artery
112
An LP should NOT be performed in a patient who has what kind of head injury? Why?
Subdural hematoma - risk of brain herniation
113
CT shows a crescent-shaped hematoma- what vessel is involved?
Bridging veins/emissary eins
114
A pt w/hx of partial gastrectomy presents with neurological deficits. What nutritional deficiency may be responsible?
B12 (lack of intrinsic factor = no absorption in terminal ileum)
115
Where does most colonic bleeding occur?
R side of colon
116
What imagining is used to dx pancreatic cx?
CT with contrast
117
How is an arterial embolism diagnosed?
CTA of the pelvis with runoff.
118
What is the MC limb artery to be affected by acute arterial occlusion?
Superficial femoral artery
119
Buzzword: bilateral hilar adenopathy with noncaseating granulomas
Sarcoidosis
120
Buzword: lupus pernio
Chronic, violaceous, raised plaques and nodules found on cheeks, nose, around eyes in sarcoidosis
121
What are some appropriate therapies for cellulitis?
Bactrim
Clindamycin (C diff risk)
Doxycycline or minocycline
Should cover MRSA
122
What antibiotics should be used in the conservative tx of cholecystitis?
Metro + 3rd gen cephalosporin, cover E coli
123
What painkiller should be avoided in patients with cholecystitis?
Morphine - can cause Sphincter of Oddi spasm. Use meperidine instead.
124
What antibiotic should be used for necrotizing pancreatitis?
Imipenem
125
MC positioning of an anal fissure?
Posterior midline
126
Prophylactic antibiotic for non-ruptured appendicitis in a patient with a PCN or cephalosporin allergy?
Clinda + cipro/levo/gent
127
Buzzword: air fluid levels in stair step/ladder patterns seen on XR
Bowel obstruction
128
Best imaging to dx bowel obstruction?
CT with contrast
129
MC metabolic disturbance s/p SBO?
Metabolic alkalosis (hypochloremic, hypokalemic metabolic alkalosis)
130
MC portion of the bowel to be involved in volvulus?
Sigmoid, cecum
131
Elevated ALP, GGT, ALT, AST, bilirubin, IgM and +P-ANCA - dx?
Primary sclerosing cholangitis - dx via ERCP (gold std)
132
Antibiotics used to treat ascending cholangitis?
PCN + aminoglycoside (gentamicin, tobramycin)
133
Triple therapy for H pylori
C(L) AP:
Clarithromycin
Amoxicillin (or metronidazole)
PPI
134
Quad therapy for H pylori
```
T(reat) M(y) B(elly) P(ain):
Tetracycline
Metronidazole
Bismuth
PPI
```
135
MC esophageal cx worldwide?
Squamous cell, ass'd w/tobacco and EtOH
136
MC esophageal cx in US?
Adenocarcinoma (usually younger pt, ass'd w/ Barrett's)
137
Dx study for esophageal strictures?
Barium esophagram
138
Buzzword: Schatzki ring
Mucosal constriction in the lower esophagus at the squamocolumnar jxn, ass'd with hiatal hernias
139
MC gastric cx?
Adenocarcinoma
140
What are some indicators of unresectability of gastric cx?
Vascular involvement of the aorta
Involvement of hepatic artery
Involvement of proximal splenic artery
Distant mets
141
What is the gold std dx study for GERD?
24 hour ambulatory pH monitoring- not usually done.
Endoscopy or manometry is usually used.
142
Surgical procedure for refractory GERD?
Nissen fundoplication
143
What is a TIPS procedure and what are some complications?
Placing a stent in the liver to shunt blood away from the portal vein into the hepatic vein - bypassing cirrhotic liver parenchyma.
Complications include encephalopathy bc blood is not being filtered adequately
144
What is a tumor marker for hepatic carcinoma?
AFP
145
What are the boundaries of Hesselbach's Triangle?
Lateral border of rectus abdominis muscle
Epigastric vessels
Inguinal ligament
146
Qualifications for liver transplant in hepatic carcinoma
Tumors small and few:
Single <5 cm OR
<3 tumors all <3 cm and only in liver
147
Buzzword: Stovepipe sign
Seen on barium study, indicative of ulcerative colitis (loss of haustral markings in large intestine)
148
Buzzword: String sign
Seen on barium study, flow through narrowed/inflamed bowel seen in Crohn's disease
149
P-ANCA
Ulcerative Colitis
150
ASCA
Crohn's disease
151
Dx imaging for Crohn's?
Upper GI series with small bowel follow through in acute disease
Colonoscopy for guiding treatment
152
Dx imaging for Ulcerative Colitis?
Flex sig
Colonoscopies are CIx!!! Also avoid barium enema
153
Tx for UC?
```
5-aminosalicylates:
- Oral mesalamine, best for maintenance
- Topical mesalamine
- Sulfasaline, give with folic acid
Steroids for acute flares
```
154
Ratio of LFT values in EtOH hepatitis
AST>ALT 2:1
155
What blood test results would support the assumption that hemolysis was causing jaundice in a patient?
Decreased haptoglobin and Hct
| Increased LDH, reticulocytes, and fragmented RBCs on peripheral smear
156
Pt with Afib with abdominal pain out of proportion to exam findings
Consider mesenteric infarction. Pt may be on OCPs rather than A-fib in scenario.
Emergent surgical intervention.
157
Tumor marker in small bowel carcinoma
CEA
158
What AG value signifies AG metabolic acidosis, and what are the causes?
```
16+
MUDPILES:
**Methanol
**Uremia
**DKA
Paraldehyde
**Infection
Lactic acidosis
Ethylene glycol
Salicylates
```
159
Common causes of non-anion gap metabolic acidosis?
Diarrhea
Pancreatic or biliary drainage
Renal tubular acidosis
160
Earliest sign of compartment syndrome?
Loss of two-point discrimination
161
Normal compartment pressure? Diagnostic pressure for compartment syndrome?
Normal: 0-8 mmHg
| Compartment syndrome: >30mmHg
162
Tx for DVT?
IV heparin then bridge to warfarin
163
MC cause of arterial embolus from heart?
AFib
164
Gold std dx for arterial embolism?
Angiography
165
Surgical tx of arterial embolism?
Preop: anticoagulation with IV heparin, angiogram
Embolectomy via cutdown or fogarty balloon if embolectomy fails
166
Tx of unstable angina
- Admission, continuous cardiac monitoring, IV access, O2
- Morphine and nitro
- ASA +/- clopidogrel
- LWMH for at least 2 days (enoxaparin/lovenox)
- BBlockers
- ACEi and statin if high LDL
- Stress test, consider revascularization if no response to medical therapy
167
Inverted U waves and angina in a smoker, not associated with exertion; dx and tx?
Prinzmetal angina, dx with angiography
CCB and nitro
AVOID BB, aspirin, and triptans
168
Tx of PAD
Cilostazol, aspirin, clopidogrel/plavix
BB CIx in isolated PAD!
Surgical: fem-pop graft bypass, angioplasty, endarterectomy, or surgical patch angioplasty
169
Buzzword: water bottle sign
Seen on CXR, suggestive of pleural effusion
170
What are indications for CABG in patients with left main coronary artery stenosis?
50%+ stenosis
171
What are some indications for CABG based on number of vessels involved?
3 vessel dz in asymptomatic - mild angina
1-2 vessel dz + large area of viable myocardium in high risk area
2-3 vessel dz in DM patients
172
What are indications for CABG in a patient with LAD stenosis?
70%+ stenosis of LAD and proximal circumflex
70%+ LAD stenosis plus:
- EF <50% or
- Symptoms of ischemia
173
What is the pre-op tx of a functional adrenal carcinoma (such as a pheochromocytoma or a cortisol-producing adenoma)?
Phenoxybanzamine or phentolamine 7-14 days: a-blocker to reduce HTN and to preempt the increase in catecholamines that will occur from handling the adrenal glands during surgery. Pts are advised to increase salt intake during this time
Followed by BB 2-3 days preoperatively.
174
Tx for adrenal crisis
Hydrocortisone and IV NS
During illness, double hydrocortisone maintenance dose
During crisis, 5-10x increase
175
A thyroid nodule is found on US. What are some attributes that would justify proceeding to FNA?
- Cold nodule (on uptake scan)
- Taller than wide
- Microcalcifications
- Hypoechogenicity
- Solid
- Irregular margins
176
Tx for cellulitis
PO for mild cellulitis: cephalexin or dicloxacillin
Severe: Empiric TMP/SMX or clinda, consider IV vanc if concern for MRSA
Cat bite: Augmentin (amox/clav) or doxy
Puncture wound: cover pseudomonas with cipro
177
Compare anterior, central, or complete cord transections
Anterior: loss of pain/temp below level; preserved joint position and vibration sense
Central: Loss of pain/temp at level of lesion, other senses preserved
Complete: No sensation below level of injury, urinary retention/bladder distention if above pelvis
178
Describe findings in a Brown Sequard syndrome patient
This is hemisection of the cord:
- Loss of join position and vibration sense on ipsilateral side
- Loss of temp and pain on contralateral side
179
Potential causes of "the worst headache of my life"
Subarachnoid hemorrhage causes:
- Ruptured cerebral arterial aneurysm or AVM --> bleeding into CSF in subarachoid space
- Ruptured berry aneurysm, usually nontraumatic (RF: smoking, HTN, EtOH, hypercholesterolemia)
180
Someone in CKD might have what kind of metabolic disturbance?
AG metabolic acidosis
181
What is the ideal vessel to use for an AV fistula?
Cephalic vein: >5mm large and close to the skin for 20cm+
182
Common causes of microcytic anemia
TICS:
- Thalassemia
- Iron deficiency***
- Chronic dz
- Sideroblastic anemias
183
Common causes of normocytic anemia
ABCD:
- Acute blood loss
- Bone marrow failure
- Chronic disease
- Destruction (hemolytic anemias)
184
Common causes of macrocytic anemia
FATRBC:
- Fetus
- Alcohol**
- Thyroid (hypothyroidism)
- Reticulocytosis
- B12/folate deficiency**
- Cirrhosis
185
Compare small and non-small cell lung cx
Small: highly aggressive, almost exclusively in smokers, not surgically treatable (chemo only). Ass'd with hyponatremia and hypercalcemia.
Non-small:
- Adenocarcinoma MC, likely non-smoker on exam
- Squamous cell: likely smoker w/hemoptysis on exam
- Large cell: rapidly doubles
