U-World Flashcards
Who is most likely to get acute bacterial parotitis? Most common agent?
Dehydrated post op patients and the elderly
S aureus most common agent
ABI diagnostic for PAD
ABI
Besides ABCs, what must always be done in trauma pt’s
Rigid fixation of the cervical spine
Drug fever facts
Ass w/ use of anticonvulsants, antibiotics (b-lactams, sulfas) or allopuinon
Typically 1-2 weeks after initiation of therapy
Cushing’s reflex signs
Hypertension, bradycardia, and respiratory depression following inc ICP
What herniates in transtentorial herniation
Parahippocampal uncus
What causes the classic coloration of stasis dermatitis
Erythrocyte extravasation causing hemosiderin deposition
Most common early sign of venous stasis? late disease?
Xerosis early
Lipodermatosclerosis and ulcerations later
Heparin regimen after first DVT
Started then transitioned to >3 months warfarin therapy with INR goal 2-3
When do you start heparin after surgery
48-72 hours
Charcot’s triad
Fever, severe jaundice, and RUQ pain
For ascending colangitis
(+ confusion and hypotension for Reynold’s pentad)
First line tx in preventing post-op pneumonia
Incentive spirometry
Non-displaced scaphoid fracture mgmt
Wrist immobilization for 6-10 weeks
If x-ray neg, immobilize for 7-10 days and follow up X-ray
Artery and nerve likely damaged in anterior shoulder dislocation
Axillary
3 main contributors to post op ileus
- Increased splanchnic nerve sympathetic tone following violation of peritoneum
- Local release of inflammatory mediators
- Post op pain meds
Pro-motility antibiotic
Erythromycin
Next step after inconclusive FAST? If neg?
DPL
If neg - look for signs of extra-abdominal hemorrhage
Multiple air-fluid levels on abdominal x-ray
Small bowel obstruction
Inc lactic acid in SMO indicates
Sign of strangulation –> go to OR
Treatment of choice for sphincter of Oddi dysfunction
ERCP with sphincterotomy
Most common site of acute mesenteric ischemia? Gold standard for Dx?
SMA
pain out of proportion to exam findings
Mesenteric angiography is gold standard for diagnosis
Key reason for intubation in airway burn patients
Progressive airway edema may preclude intubation later in patients clinical course
Abdominal succussion splash a sign of? dx test?
Pyloric stricture
Endoscopy is dx test
3 symptoms of retroperitoneal abscess
fever, chills, and deep abdominal pain
What does not help in diagnosis of pancreatic trauma
Serum amylase values
Atelectasis blood gas picture
Respiratory alkalosis due to increased work of breathing
Patchy alveolar infiltrate after chest wall trauma
Pulmonary contusion
CXR of pericardial tamponade
Normal cardiac silhouette without tension pneumothorax
Most common pediatric fracture? Risks?
Supracondylar humerus fractures
Risk of entrapment of brachial artery or median nerve
Femoral nerve action and senstation
Lex flexion at the hip and extension at the knee
Gets medial aspect of thigh and lower leg
CXR for aortic injury
Widened mediastinum and left sided hemothorax
Acute back pain + profound hypotension
AAA rupture
What is dumping syndrome
After gastrectomy, emptying of hypertonic gastric content into duodenum –> fluid shift into small intestine, stimulating autonomic reflexes (cramps, weakness, diaphoresis)
Best time to take out gallbladder in cholecystitis
Within 72 hours
Posterior urethral injury is associated with what kind of fractures
Pelvic
Who can have a delayed presentation to diaphragmatic rupture
Children
What can increase FRC after surgery besides spirometry
Elevating the head of the bed, chest physiotherapy, and coughing
Virus assocaited with nasopharyngeal carcinoma
EBV
seen in far east and mediterranean
Hypotension after cardiac cath with back or flank pain? Dx test
Retroperitoneal hematoma
CT abdomen/pelvis
Cancer that arises from a non-healing burn would
SCC
Strangulation def
Loss of blood supply to the bowel wall
Blood loss % for orthostatic hypo? General hypo + Tachy
Ortho: 20-30%
Resting tach: 30-40%
How much blood can one hemithorax hold
50% of blood volume
Leriche syndrome triad
Bilateral LE claudication, impotence, and symmetric atrophy of the bilateral LE
Cause of subacute presentation of delayed onset prosthetic joint infection? Tx?
Staph epi
Removal of the infected prosthesis
Most commonly injured nerve in mid-shaft of the humerus fracture
Radial nerve
Weakness in extension - drop wrist
Ulnar nerve injury causes
Claw hand
Immediate fever after surgery (101-103) likely?
Transfusion reaction
Paget’s lab
Elevated bone specific alk phos
Most common cause of lower extremity edema
Venous insufficiency (valvular incompetence)
Unstable fall in elderly with broken hip first step
Cardiac workup (concerning for syncope)
Rapid decompensation after subclavian catheter placement could be
Tension pneumothorax -> do needle decompression
Neck pain, fever, and limited neck mobility secondary to pain
Retropharyngeal abscess
Where should a needle thoracostomy be performed
Second intercostal space (b/w 3rd and 4th ribs) at the midclavicular line
First step in limb ischemia treatment
Heparin bolus followed by continuous heparin infusion
PEEP in hypovolemic shock
Bad, decreases venous return to heart, thus decreasing preload
Procedure of choice for bad lung bleeding
Bronchoscopy - identifies site of bleed and helps attempt early therapeutic intervention
Thoractomy after
Superficial unilateral hip pain exacerbated by external pressure to upper lateral thigh (like when lying in bed)
Trochanteric bursitis
After trauma, slightly elevated PCWP that increases greatly after volume repletion
Left ventricular dysfunction caused by myocardial contusion
First two indicators of hypovolemia
Tachycardia and peripheral vascular constriction
Most common predisposing factor for aortic dissection
Hypertension
Most common cause of hypoparathyroidism
Post-surgical
hypocalcemia and hyperphosphatemia in presence of normal renal function
Serum PO4 in vit D def
Usually low
Most common bone to be affected by stress fracturs
Tibia
Colonoscopy of bowel ischemia
Discrete segment of cyanotic and ulcerated bowel
Patients who present with appendicitis >5 days after onset of symptoms have a high incidence of?
Perforation with abscess formation
Nasal septum perforation likely a result of?
Septal hematoma
Standard treatment approach for complicated diverticulitis with abscess formation
CT guided percutaneous drainage
Most feared complication of retropharyngeal abscess
Infection into the mediastinum –> can lead to acute necrotizing mediastinitis
Type of hypoxia narcotics can cause
Alveolar hypoventilation (normal A-a gradient and respiratory acidosis)
What is torus palantinus
Benign bony growth located on the midline suture of the hard palate
Most important early steps in flail chest
Pain control and supplemental oxygen
PEEP causes flail chest to move normally
Oliguria and inc. BUN > Cr ratio post op likely? Rule out what first
Likely acute pre-renal from hypovolemia
Rule out catheter obstruction
Tx for duodenal hematoma
NG tube with parenteral nutrition
4 T’s for mediastinal mass diff fx
Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma
Seminoma tumor marker
Elevated b-HCG
Normal AFP
RLQ pain without guarding or rigidity could be
Psoas abscess
Do CT abdomen
MCC of blood nipple discharge
Intraductal papilloma
US can be normal b/c can only pickup 1 cm and greater
Odd pancreatic Ca features
constant, gnawing epigastric pain that is frequently worse at night
Anorexia with weight loss
Jaundice
All patients with a clavicle fracture should have what? Why?
Careful neuromuscular exam (angiogram and physical for neuro)
Rules out injury to underlying brachial plexus and subclavian artery
Penile fracture tx
Retrograde urethrogram followed by surgical exploration of the penis
Ab x-ray of paralytic ileus shows
air-fluid levels and distended gas filled loops of both the small and large intestines
What is the RQ
Respiratory quotient: depends on the proportion of metabolic fuels being oxidized for ATP
1.0 = predominant oxidation of carbs and net lipogenesis
>1 carbs
0.8 = protein
0.7 = lipids
Amputated finger prep
Wrap part in saline-moisturized gauze, seal in a plastic bag, and place on ice
Positive arm drop sign in shoulder injury indicats
Rotator cuff tear
Long thoracic nerve injury causes
Winged scapula
Who gets acalculous cholecystitis? Tx?
Critically ill patients -> Tx if Ab and percutaneous cholecystostomy followed by cholecystectomy when medical condition stabilizes
Acalculous cholecystitis likely from
Cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms, leading to edema and necrosis
What causes bowel ischemia after AAA repair
Inadequate colonic collateral arterial perfusion to left and sigmoid colon after loss of IMA during aortic graft placement
Mediastinitis presentation
Post op (w/in 14 days) with fever, tachycardia, CP, leukocytosis, and sternal wound drainage
Mediastinitis treatment
Drainage, Surgical debridement and antibiotic therapy
3 most reliable signs of blunt abdominal trauma
Abdominal pain
Tenderness
Peritoneal signs
Valgus stress test for what ligament
MCL
Hypoparathyroidism characterized by?
Low calcium and elevated PO4 levels in presence of normal renal function
Most common complication of thyroidectomy
Hypocalemia
Prolonged surgery followed by hypotension, extensive blood loss into tissues, and massive blood replacement likely
Postoperative cholestasis
Parotid surgery involving the deep lobe of the parotid gland carries and significant risk of?
Facial nerve palsy resulting in facial droop
What is indicated for circumferential full-thickness burns of an extremity with an eschar? Why?
Escharotomy
Eschar formation can compromise circulation, causing significant edema distal to burn
When is a penetrating would considered to involve the abdomen
Any below the 4th intercostal space (i.e below the nipples)
What can aortic dissection cause when it extends into the major vessels
Impending stroke, acute renal failure, and LE weakness or paraplegia
Most important steps in management of lactic acidosis from septic shock
IV normal saline with or without vasopressor therapy to maintain pressure and Ab to correct underlying infection
Why shouldn’t you put a foley in w/ suspect urethral trauma
Predisposes patient to abscess formation and worsening of the urethral damage
What is eschar
Firm necrotic tissue classical formed on exposed tissue following burn wounds
Quickest way to reverse warfarin anti-coagulation
Infusion of FFP
When to give T-dap shot vs T-dap + Tetanus Ig
Tdap + tetanus IV in severe dirty wound and unclear immunization history
Just Tdap if pt had a booster 5 years ago with dirty wound or 10 years with mildly clean wound
How does short term hyperventilation decrease ICP
Causing cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow
When do patients have risk of adrenal insufficiency following surgery
Daily prednisone > 20 mg taken for > 3 weeks
What is Kehr’s sign
Abdominal pain that refers to the shoulder from subdiaphragmatic peritonitis
must be peritoneal
Only part of the bladder that is peritoneal
Bladder dome
