Surgery Rotation 7 Flashcards
Presentation of syringomyelia
• Anterior white commissure:
o Loss of pain and temp with sparing of fine touch and position “cape-like” distribution
• Anterior horn involvement can occur with progression of disease
o Lower motor neuron effects
• Lateral horn of hypothalamospinal tract
o Horner syndrome
Presentation of ALS
UM and LMN deficits (twitching, muscle weakness, cramping)
NO loss of sensory function
Presentation of multiple sclerosis
Due to autoimmune demyelination of CNS ♣ Charcot triad of symptoms SIN: • Scanning speech • Intention tremor, Incontinence, Internuclear ophthalmoplegia • Nystagmus ♣ Hemiparesis, hemisensory symptoms
What are the 3 components of Glasgow coma scale (GCS)
Eye opening
Verbal response
Motor response
What is the “psoas sign”
Abd pain with hip extension
Presentation of Toxic shock syndrome
Fever, hypotension, diffuse rash
What is the difference between conductive and sensorineural hearing loss
Conductive
• Obstruction of external sound to inner ear
Sensorineural
• Involves the inner ear, cochlea, or auditory nerv
Describe Rinne test and how results differ in conductive vs. sensorineural hearing loss
♣ Vibrating tuning fork placed on mastoid bone until patient can’t hear it
♣ Still-vibrating fork then held outside auditory canal until patient can’t hear it
♣ Results:
• Normal = Air-conducted (AC) sound should be heard twice as long as bone-conducted (BC) sound
• Conductive hearing loss = BC > AC in affected ear; AC > BC in unaffected ear
• Sensorineural hearing loss = AC > BC in both ears
Describe Weber test and how results differ in conductive vs. sensorineural hearing loss
♣ Vibrating tuning fork placed on middle of head or forehead equidistant from both ears
♣ Results:
• Normal:
o Midline
• Conductive hearing loss:
o Lateralizes to the affected ear because that ear cannot hear ambient noise of the room
• Sensorineural hearing loss:
o Lateralize to the unaffected ear because the inner ear of the affected ear cannot sense the vibration
What type of hearing loss is caused by ototoxic antibiotics
Sensorineural
What is otosclerosis
Abnormal remodeling of the otic capsule though to be a possible autoimmune process; the stapes footplate becomes fixed to the oval window
Causes conductive hearing loss
What is Meniere disease
• Increased pressure and volume of endolymph • Features: o Recurrent vertigo o Ear fullness/pain o Unilateral sensorineural hearing loss o Tinnitus
Cause and content of transudative pleural effusion
Low protein content (Think: TRANSudate = TRANSparent)
Due to increased hydrostatic pressure (e.g. CHF) or decreased oncotic pressure (e.g. cirrhosis or nephrotic syndrome)
Cause and content of exudative pleural effusion
High protein content, cloudy
Due to pleural and lung inflammation resulting in increased capillary and pleural membrane permeability (e.g. malignancy, pneumonia, trauma, connective tissue disease)
What is atrioventricular nodal reentry tachycardia
Subtype of SVT
Caused by a reentrant circuit formed by 2 separate conducting pathways (one fast and the other slow) within the AV node
Characterized by sudden onset and termination, rapid (140-250/min) regular rhythm, narrow QRS complexes, and absence of definite P waves
What are the non-dihydropyridine CCBs?
Verapamil
Diltiazem
Potential complication of thoracic aortic aneurysm surgery that causes bilateral flaccid paralysis and loss of pain/temp in lower extremities
Spinal cord infarction (due to aortic cross-clamping) leading to anterior spinal cord syndrome
Treatment of Prinzmetal / Vasospastic angina
- Calcium channel blocker (preventive)
- Sublingual nitroglycerin (abortive)
Vitelline duct vs. urachus
Vitelline duct = connects the midgut to the yolk sac (persistance = Meckel’s_
Urachus = connection between bladder and belly button (remnant of allantois)
First step in management of patients with acute stroke
CT scan of the head without contrast to rule out hemorrhage
Most important intervention in COPD for prolonged survival
Long-term supplemental oxygen therapy
Uses of interferon alpha
Hep B and C, hairy cell leukemia, malignant melanoma, Kaposi sarcoma, Condyloma accuminata, RCC
Uses of interferon beta
Relapsing type multiple sclerosis
Uses of interferon gamma
Chronic granulomatous disease (CGD)
How do you differentiate between Serotonin syndrome and Neuroleptic malignant syndrome
SS = altered mental status, autonomic instability, and HYPERREFLEXIA and MYOCLONUS
NMS = altered mental status, autonomic instability, RIGIDITY and HYPOREFLEXIA
What is the cause and classical presentation of multiple myeloma
- Malignant proliferation of monoclonal plasma cell within the marrow
- Increased production of IgG and IgA (M spike on electrophoresis)
- Lytic bone lesions -
back pain (plasma cells activate osteoclasts) - Hypercalcemia
- Rouleaux formation of RBCs (increased serum protein leads to decreased charge between RBCs)
- Anemia (plasma cells packed in bone marrow inhibit production of other cells)
- Renal insufficiency (excessive antibodies plug up kidney)
Treatment of A-fib in a patient with hemodynamic instability
Direct current cardioversion
What is the cause of S3 heart sound
Rapid flow of blood from atria to ventricles
Caused by volume overload (e.g. CHF, mitral/tricuspid regurg)
What is the cause of S4 heart sound
Atrium contracting against a stiff ventricle (e.g. hypertrophic cardiomyopathy, aortic stenosis, LV hypertrophy)
Contents of lateral, medial, and medial umbilical folds
Lateral = inferior epigastric vessels
Medial = obliterated umbilical artery
Median = obliterated urachus; para-umbilical veins
Causes of acute pancreatitis
I GET SMASHED:
Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP, Drugs (e.g. Sulfa, NRTIs, protease inhibitors)
What type of fluid is used for maintenance IVF?
D5 1/2NS
+ 20 KCl (if pt is peeing)
What is the significance of singed nose hairs / soot around mouth/nose in a pt who was in a fire?
Low threshold for intubation
What causes bleeding with isolated decrease in platelets
ITP
What causes bleeding with nl platelets but increased BT and PTT
von Willebrand disease (genetic deficiency in vWF)
Increased BT = decreased platelet adhesion
Increased PTT = vWF normally stabilizes factor VIII
Bleeding in pt with low platelets, increased PT, PTT, BT, low fibrinogen, Ddimer, and schistocytes
DIC
What are the 3 types of topical abx given to burn patients?
- Silver nitrate
- Silver sulfadiazine
- Mafenide
Which abx does not penetrate eschar and can cause leukopenia
Silver sulfadiazine
THINK: sulfaDIazine = DIE WBCs! DIE!
Which abx penetrates eschar but is very painful
Mafenide
Which abx does not penetrate eschar and causes hypokalemia and hyponatremia
Silver nitrate
First step of management in chemical burn
Irrigation
First step of management in electrical burn
EKG - most likely cause of death will be arrhythmias
If electrical burn pt has urine dipstick + blood but neg for RBC under microscope, what does this mean?
Rhabdomyolysis causes myoglobinuria
What must you check if you find myoglobinuria?
K+ levels (this would be the cause of death)
What is it called if burned extremity is tender, numb, white, cold, with barely dopplerable pulses?
Compartment syndrome
