U-World Flashcards
1
Q
Who is most likely to get acute bacterial parotitis? Most common agent?
A
Dehydrated post op patients and the elderly
S aureus most common agent
2
Q
ABI diagnostic for PAD
A
ABI
3
Q
Besides ABCs, what must always be done in trauma pt’s
A
Rigid fixation of the cervical spine
4
Q
Drug fever facts
A
Ass w/ use of anticonvulsants, antibiotics (b-lactams, sulfas) or allopuinon
Typically 1-2 weeks after initiation of therapy
5
Q
Cushing’s reflex signs
A
Hypertension, bradycardia, and respiratory depression following inc ICP
6
Q
What herniates in transtentorial herniation
A
Parahippocampal uncus
7
Q
What causes the classic coloration of stasis dermatitis
A
Erythrocyte extravasation causing hemosiderin deposition
8
Q
Most common early sign of venous stasis? late disease?
A
Xerosis early
Lipodermatosclerosis and ulcerations later
9
Q
Heparin regimen after first DVT
A
Started then transitioned to >3 months warfarin therapy with INR goal 2-3
10
Q
When do you start heparin after surgery
A
48-72 hours
11
Q
Charcot’s triad
A
Fever, severe jaundice, and RUQ pain
For ascending colangitis
(+ confusion and hypotension for Reynold’s pentad)
12
Q
First line tx in preventing post-op pneumonia
A
Incentive spirometry
13
Q
Non-displaced scaphoid fracture mgmt
A
Wrist immobilization for 6-10 weeks
If x-ray neg, immobilize for 7-10 days and follow up X-ray
14
Q
Artery and nerve likely damaged in anterior shoulder dislocation
A
Axillary
15
Q
3 main contributors to post op ileus
A
- Increased splanchnic nerve sympathetic tone following violation of peritoneum
- Local release of inflammatory mediators
- Post op pain meds
16
Q
Pro-motility antibiotic
A
Erythromycin
17
Q
Next step after inconclusive FAST? If neg?
A
DPL
If neg - look for signs of extra-abdominal hemorrhage
18
Q
Multiple air-fluid levels on abdominal x-ray
A
Small bowel obstruction
19
Q
Inc lactic acid in SMO indicates
A
Sign of strangulation –> go to OR
20
Q
Treatment of choice for sphincter of Oddi dysfunction
A
ERCP with sphincterotomy
21
Q
Most common site of acute mesenteric ischemia? Gold standard for Dx?
A
SMA
pain out of proportion to exam findings
Mesenteric angiography is gold standard for diagnosis
22
Q
Key reason for intubation in airway burn patients
A
Progressive airway edema may preclude intubation later in patients clinical course
23
Q
Abdominal succussion splash a sign of? dx test?
A
Pyloric stricture
Endoscopy is dx test
24
Q
3 symptoms of retroperitoneal abscess
A
fever, chills, and deep abdominal pain
25
What does not help in diagnosis of pancreatic trauma
Serum amylase values
26
Atelectasis blood gas picture
Respiratory alkalosis due to increased work of breathing
27
Patchy alveolar infiltrate after chest wall trauma
Pulmonary contusion
28
CXR of pericardial tamponade
Normal cardiac silhouette without tension pneumothorax
29
Most common pediatric fracture? Risks?
Supracondylar humerus fractures
| Risk of entrapment of brachial artery or median nerve
30
Femoral nerve action and senstation
Lex flexion at the hip and extension at the knee
| Gets medial aspect of thigh and lower leg
31
CXR for aortic injury
Widened mediastinum and left sided hemothorax
32
Acute back pain + profound hypotension
AAA rupture
33
What is dumping syndrome
After gastrectomy, emptying of hypertonic gastric content into duodenum --> fluid shift into small intestine, stimulating autonomic reflexes (cramps, weakness, diaphoresis)
34
Best time to take out gallbladder in cholecystitis
Within 72 hours
35
Posterior urethral injury is associated with what kind of fractures
Pelvic
36
Who can have a delayed presentation to diaphragmatic rupture
Children
37
What can increase FRC after surgery besides spirometry
Elevating the head of the bed, chest physiotherapy, and coughing
38
Virus assocaited with nasopharyngeal carcinoma
EBV
| *seen in far east and mediterranean*
39
Hypotension after cardiac cath with back or flank pain? Dx test
Retroperitoneal hematoma
| CT abdomen/pelvis
40
Cancer that arises from a non-healing burn would
SCC
41
Strangulation def
Loss of blood supply to the bowel wall
42
Blood loss % for orthostatic hypo? General hypo + Tachy
Ortho: 20-30%
| Resting tach: 30-40%
43
How much blood can one hemithorax hold
50% of blood volume
44
Leriche syndrome triad
Bilateral LE claudication, impotence, and symmetric atrophy of the bilateral LE
45
Cause of subacute presentation of delayed onset prosthetic joint infection? Tx?
Staph epi
| Removal of the infected prosthesis
46
Most commonly injured nerve in mid-shaft of the humerus fracture
Radial nerve
| *Weakness in extension - drop wrist*
47
Ulnar nerve injury causes
Claw hand
48
Immediate fever after surgery (101-103) likely?
Transfusion reaction
49
Paget's lab
Elevated bone specific alk phos
50
Most common cause of lower extremity edema
Venous insufficiency (valvular incompetence)
51
Unstable fall in elderly with broken hip first step
Cardiac workup (concerning for syncope)
52
Rapid decompensation after subclavian catheter placement could be
Tension pneumothorax -> do needle decompression
53
Neck pain, fever, and limited neck mobility secondary to pain
Retropharyngeal abscess
54
Where should a needle thoracostomy be performed
Second intercostal space (b/w 3rd and 4th ribs) at the midclavicular line
55
First step in limb ischemia treatment
Heparin bolus followed by continuous heparin infusion
56
PEEP in hypovolemic shock
Bad, decreases venous return to heart, thus decreasing preload
57
Procedure of choice for bad lung bleeding
Bronchoscopy - identifies site of bleed and helps attempt early therapeutic intervention
*Thoractomy after*
58
Superficial unilateral hip pain exacerbated by external pressure to upper lateral thigh (like when lying in bed)
Trochanteric bursitis
59
After trauma, slightly elevated PCWP that increases greatly after volume repletion
Left ventricular dysfunction caused by myocardial contusion
60
First two indicators of hypovolemia
Tachycardia and peripheral vascular constriction
61
Most common predisposing factor for aortic dissection
Hypertension
62
Most common cause of hypoparathyroidism
Post-surgical
| *hypocalcemia and hyperphosphatemia in presence of normal renal function*
63
Serum PO4 in vit D def
Usually low
64
Most common bone to be affected by stress fracturs
Tibia
65
Colonoscopy of bowel ischemia
Discrete segment of cyanotic and ulcerated bowel
66
Patients who present with appendicitis >5 days after onset of symptoms have a high incidence of?
Perforation with abscess formation
67
Nasal septum perforation likely a result of?
Septal hematoma
68
Standard treatment approach for complicated diverticulitis with abscess formation
CT guided percutaneous drainage
69
Most feared complication of retropharyngeal abscess
Infection into the mediastinum --> can lead to acute necrotizing mediastinitis
70
Type of hypoxia narcotics can cause
```
Alveolar hypoventilation
(normal A-a gradient and respiratory acidosis)
```
71
What is torus palantinus
Benign bony growth located on the midline suture of the hard palate
72
Most important early steps in flail chest
Pain control and supplemental oxygen
| *PEEP causes flail chest to move normally*
73
Oliguria and inc. BUN > Cr ratio post op likely? Rule out what first
Likely acute pre-renal from hypovolemia
| Rule out catheter obstruction
74
Tx for duodenal hematoma
NG tube with parenteral nutrition
75
4 T's for mediastinal mass diff fx
Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma
76
Seminoma tumor marker
Elevated b-HCG
| Normal AFP
77
RLQ pain without guarding or rigidity could be
Psoas abscess
| Do CT abdomen
78
MCC of blood nipple discharge
Intraductal papilloma
| *US can be normal b/c can only pickup 1 cm and greater*
79
Odd pancreatic Ca features
constant, gnawing epigastric pain that is frequently worse at night
Anorexia with weight loss
Jaundice
80
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
81
Penile fracture tx
Retrograde urethrogram followed by surgical exploration of the penis
82
Ab x-ray of paralytic ileus shows
air-fluid levels and distended gas filled loops of both the small and large intestines
83
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
84
Amputated finger prep
Wrap part in saline-moisturized gauze, seal in a plastic bag, and place on ice
85
Positive arm drop sign in shoulder injury indicats
Rotator cuff tear
86
Long thoracic nerve injury causes
Winged scapula
87
Who gets acalculous cholecystitis? Tx?
Critically ill patients -> Tx if Ab and percutaneous cholecystostomy followed by cholecystectomy when medical condition stabilizes
88
Acalculous cholecystitis likely from
Cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms, leading to edema and necrosis
89
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
90
Mediastinitis presentation
Post op (w/in 14 days) with fever, tachycardia, CP, leukocytosis, and sternal wound drainage
91
Mediastinitis treatment
Drainage, Surgical debridement and antibiotic therapy
92
3 most reliable signs of blunt abdominal trauma
Abdominal pain
Tenderness
Peritoneal signs
93
Valgus stress test for what ligament
MCL
94
Hypoparathyroidism characterized by?
Low calcium and elevated PO4 levels in presence of normal renal function
95
Most common complication of thyroidectomy
Hypocalemia
96
Prolonged surgery followed by hypotension, extensive blood loss into tissues, and massive blood replacement likely
Postoperative cholestasis
97
Parotid surgery involving the deep lobe of the parotid gland carries and significant risk of?
Facial nerve palsy resulting in facial droop
98
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
99
When is a penetrating would considered to involve the abdomen
Any below the 4th intercostal space (i.e below the nipples)
100
What can aortic dissection cause when it extends into the major vessels
Impending stroke, acute renal failure, and LE weakness or paraplegia
101
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
102
Why shouldn't you put a foley in w/ suspect urethral trauma
Predisposes patient to abscess formation and worsening of the urethral damage
103
What is eschar
Firm necrotic tissue classical formed on exposed tissue following burn wounds
104
Quickest way to reverse warfarin anti-coagulation
Infusion of FFP
105
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
106
How does short term hyperventilation decrease ICP
Causing cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow
107
When do patients have risk of adrenal insufficiency following surgery
Daily prednisone > 20 mg taken for > 3 weeks
108
What is Kehr's sign
Abdominal pain that refers to the shoulder from subdiaphragmatic peritonitis
*must be peritoneal*
109
Only part of the bladder that is peritoneal
Bladder dome
