UW Flashcards by Niccia Va

3 RFs of acalculous cholecystitis?

critical illness (sepsis, ICU pts), severe trauma or recent surgery, prolonged fasting or TPN

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Typical presentation of acalculous cholecystitis

fever, leukocytosis, RUQ pain (possibly a mass/jaundice), LFTs might be elevated

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typically presents w jaundice, RUQ pain, and elevated alk phosphatase? usually due to?

acute cholangitis;

obstruction by a gallstone or malignancy

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Perihepatitis in the setting of PID, assoc w RUQ pain w inspiration

Fitz-Hugh Curtis syndrome

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presents w high fever, RUQ pain, crepitus in abdominal wall adjacent to gallbladder, hyperbilirubinemia, air-fluid levels in/gas in wall of gallbladder ? 3 risk factors?

Emphysematous cholecystitis;

DM, vascular compromise, immunosuppression

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can be seen with vitamin K deficiency, ABX use, liver disease, certain hereditary coag disorders, and warfarin use?

prolonged prothrombin time

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changes in BUN and BUN/Cr ratio seen in pts with upper (but NOT lower) GI bleeding?

they will often have an elevated BUN and elevated BUN/Cr ratio

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Acute liver failure is defined as acute onset of severe liver injury with ____ and _____ in a pt without what?

hepatic encephalopathy (confusion, asterixis) and impaired synthetic fxn (defined as INR of 1.5 or greater);
cirrhosis or underlying liver disease

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Tx of hepatic encephalopathy?

identify and correct underlying precipitant (ie fluids, ABXs if infection) and decrease blood ammonia (lactulose, lactitol, rifaximin)

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both folate and cobalamin (Vit B12) deficiency impair DNA synthesis in cells w rapid turnover, manifestations of both include?

Megaloblastic anemia- macrocytic RBCs and hypersegmented neutrophils, Low/nml retic count, elevated homocysteine levels, pancytopenia if severe deficiency

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Unlike cobalamin (Vit B12) deficiency, folate deficiency is assoc with??

NO neurological manifs, and Normal methylmalonic acid levels

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Rovsing sign

RLQ pain w deep palpation of LLQ, typical of appendicitis

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ileus is MC due to ? other causes?

abdominal surgery;

retroperitoneal/abdominal hemorrhage or inflamm, intestinal ischemia and electrolyte abnormalities

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S/Sxs of ileus?

abd x-rays show?

N, V, abd distension, obstipation, hypoactive or absent bowel sounds;
dilated gas-filled loops of bowel no transition pt.

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diagnosis of acute pancreatitis requires atleast 2 of the following?

Acute epigastric pain radiating to the back, increased amylase or lipase greater than 3xs nml limit, consistent abnormalities on imaging

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presents w fever, jaundice, RUQ pain? if severe pt may also have confusion and hypoTN

acute cholangitis

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lab results usually seen in pts with acute cholangitis?

leukocytosis, neutrophilia, elevated alk phosph, GGT, transpeptidase, CRP and direct bilirubin

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U/S or CT scan can help confirm Dx of acute cholangitis and most frequently show?

common bile duct dilation

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in acetaminophen overdose, transaminases are frequently?

over 3000 U/L

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Giardiasis: preferred Dx test?

first line Tx?

stool antigen assay;

metronidazole

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appear as symmetric, circumferential narrowing of esophagus on barium swallow

esophageal (peptic) strictures

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chronic epigastric pain that suddenly worsens and becomes diffuse w. a pneumoperitoneum (free air under diaphragm) is concerning for?

perforated peptic ulcer

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Somatostatin analogs such as octreotide are a mainstay in management of what kind of bleeding?

variceal

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when are platelet transfusion typically given?

for a platelet count less than 10,000; or less than 50,000 with active bleeding

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presents in old pts with LLQ pain, F, N, V, and leukocytosis? Best test for Dx?

``` Acute diverticulitis; abdominal CT (scope is contraindicated in acute setting d/t risk of perf) ```

Mx of acute diverticulitis?

bowel rest and ABXs (cipro, metronidazole..)

Dx of GI perforation is confirmed with what test? which typically shows?

Upright x-ray of chest and abdomen; | free intraperitoneal air under the diaphragm (pneumoperitoneum)

pain in RUQ or epigastric region, can be referred to right shoulder/subscapular region, resolves within 6hrs

biliary colic

incomplete mucosal tear at G-E jxn, presents w self-limited hematemesis

Mallory-Weiss tear

this surgical emergency presents w severe retrosternal pain, dyspnea, sub-q emphysema, odynophagia, and sign of sepsis

esophageal perforation | ie Boerhaave syndrome

cholestatic liver fxn test pattern?

predominantly elevated alk phos, smaller increases in serum aminotransferases (these less than 300)

1st step in stable pts with hemoptysis and high suspicion for pulmonary TB, before further Dx eval or Tx?

Respiratory isolation to prevent spread of infection

FFP should be given to pts w known/suspected coagulopathy as the cause of hemoptysis, ie an INR greater than?

1.5

GCS assesses pts ability to?

open their eyes, motor response, verbal response

High-energy rapid decel trauma to the chest commonly causes injury to?

aorta

in most cases of aortic rupture, death is immediate result, and Dx must be made quickly in pts who make it to hospital with contained rupture, classic CXR shows?

left sided hemothorax, widened mediastinum w deviation to R

typically presents with severe restrosternal chest pain and mediastinal free air on CXR, does not cause massive blood loss

Esophageal rupture

Should be suspected in all adult pts w blunt chest trauma who present w persistent JVD, tachycardia, and hypoTN despite IV fluids? CXR findings?

Acute cardiac tamponade d/t sudden rise in intrapericardial pressure; nml cardiac silhouette w/o tension pnuemo

Can present days to wks after abdominal trauma w N/V, and a palpable abdominal mass

pancreatic pseudocyst

pts (MC in kids) classically present 2-3days after blunt abd trauma with epigastric pain, and vomiting? Mx?

Duodenal hematomas; NG tube decompression, parenteral nutrition (bike handlebar injury)

DDx for an anterior mediastinal mass?

"4Ts" thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma

Lab findings seen in acute bowel ischemia?

leukocytosis, elevated Hb (hemoconcentration), elevated Amylase!, metabolic acidosis d/t incr serum lactate (low bicarb)

why is a pt with elevated amylase and nml lipase unlikely to have acute pancreatitis?

lipase is both more sensitive and specific than amylase

should be given preop to pts with mild hemophilia A in order to prevent excessive bleeding?

Desmopressin (DDAVP)- it indirectly incr factor VIII levels by causing vWF release

acute GI perf requires emergent laparotomy, what must be done pre-op if affected pt is on warfarin?

reversal of anticoagulation must be rapidly achieved by pre-op infusion of FFP

presents as fever, sore throat, difficulty swallowing/opening mouth wide (trismus), uvula deviated away from enlarged tonsil, pooling of saliva, muffled voice

Peritonsillar abscess

Tx of peritonsillar abscess? | what must ABXs cover?

needle aspiration or I and D, plus ABX that cobers GAS and respiratory anaerobes

Pts who present w acute onset of back pain and profound hypoTN should be evaluated for Dx of? and taken emergently to OR

ruptured AAA

common postgastrectomy complication c/b GI (N, D, cramps) and vasomotor (palpitations, diaphoresis) Sxs? Sxs can be controlled with?

Dumping syndrome; | diet modifications

compartment syn may occur when edema causes the P within a muscular fascial compartment to rise above ___ mmHg?

Brain mets typically appear as? at?

multiple ring-enhancing lesions at the grey-white jxn (intra-axial)

PUD often occurs w NSAID use, can be complicated by perforation which presents as?

severe epigastric pain and intraperitoneal free air on plain film (Mx: urgent ex lap)

What nerve inn. the mm. of the ant. compartment of thigh thus responsible for hip flexion and knee ext? it provides sensation to?

Femoral n.; | anterior thigh and medial leg via saphenous branch

this is a cause of immediate post-op high fever (ie 104), m. rigidity, rhabdomyolysis, met acidosis, and hemodynamic instability? typically caused by?

Malignant hyperthermia; | inhaled anesthetics

The risk of PE increases in the first few wks after major surgery and pts present with?

pleuritic chest pain, tachypnea, dyspnea, tachycardia, hypoxia

postop pts with BUN:Cr ration greater than 20:1, oliguria, and unremarkable urine sediment likely have AKI d/t? correct with?

volume depletion; | IV fluid bolus

hemodynamically stable pt that suffered BAT, w neg FAST exam but high-risk features should undergo?

CT scan of abdomen

SCC is MC d/t UV exposure but may also arise in skin that is?

chronically wounded, scarred (burns), or inflamed

Succinylcholine can cause life-threatening arrhythmias d/t hyperkalemiain pts with what conditions?

any that upregulate AChRs ie. skeletal m. injuries, burns, disuse m. atrophy, and denervation (ie stroke, G-B Sy)

Pt comes to ER in shock after MVA and has a slightly incr PCWP that incr significantly after IV bolus w/o appreciable change in BP, suggests?

myocardial dysfxn likely d/t cardiac conrusion, get an urgent echo

Pts w hypovolemic shock have ____ PCWP at baseline, how does it respond to saline infusion?

decreased; improves toward nml

This is the MC fracture in pediatric pop., majority result from fall on outstretched hand? MC complication?

Supracondylar fracture of humerus; | entrapment of brachial a. or median n.

preferred long-term anticoagulant in ESRD pts? | short-term?

Warfarin unfractionated heparin (LMW heparin CI in pts w ESRD) (warfarin can not be started alone d/t transient prothrombotic state)

what level of direct bilirubin is cause for concern?

more than 2mg/dL or more than 20% of the total bilirubin

pt w h/o acute pancreatitis and alcoholism has weight loss, chronic epigastric pain, steatorrhea, malnutrition, high glucose likely has?

pancreatic insufficiency

Pt in head-on MVC presents in severe resp distress w. crepitant swelling of face, neck, x-ray shows pneumo, if extensive air leak persists after chest tube placed, likely Dx?

ruptured bronchus

initial conservative Mx for SBO? if pts fail that and become hemodynamically unstable and/or develop fever, guarding, leukocytosis, met acidosis.. next step?

NG suction, IV fluids, bowel rest; | emergency abdominal exploration

Pts on long-term glucocorticoid therapy w cushingoid features are at very high risk of what complication from surgery? which presents with? Tx?

adrenal crisis; hypoTN, V, abd pain, fever; hydrocortisone or dexamethasone w/ aggressive fluid support

What is an abdominal succussion splash and what causes it?

with stethoscope placed over upper abdomen, rocking pt back and forth at hips elicits a splash sound if there is retained gastric material more than 3hrs after a meal ie d/t gastric outlet obstruction

fat embolism syndrome presents 24-72hrs after inciting event (ie femur fracture) w what clinical triad?

severe resp distress (tachypnea, tachycardia, hypoxemia), neuro dysfxn (confusion), petechial rash

Mesenteric ishemia usually presents w sudden periumbilical abd pain out of proportion to exam, 4 RFs? CT of abdomen typically shows?

old age, Afib, CHF, atherosclerotic vascular disease; | focal or segmental bowel wall thickening, small-bowel dilation and mesenteric stranding

Tx for acalculous cholecystitis?

ABXs and percutaneous cholecystostomy, followed by cholecystectomy when medical condition stabilizes

ALT greater than 150 U/L has a high PPV for Dxing ?

gallstone pancreatitis

initial hematuria suggests? terminal hematuria? hematuria throughout urinary stream suggests?

urethral damage; bladder or prostatic damage; damage in kidneys or ureters

initial screening test and most sensitive finding for blunt aortic injury? this needs to be ruled out in all pts that?

CXR, mediastinal widening; | suffer blunt deceleration trauma ie MVA or fall from more than 10ft

this IV anesthetic inhibits 11B-hydroxylase and can lead to adrenal insuff, esp in pts that are elderly or critically ill/septic

Etomidate

this IV anesthetic can cause severe hypoTN d/t myocardial depression

propofol

Parotid surgery involving the deep lobe carries significant risk of injuring what CN? resulting in?

facial n.; | facial droop

triad of S/Sx of fat embolism

hypoxemia (SOB), altered mental status (confusion..), petechial rash of neck, chest or axilla

poss complication that presents w/in 2wks postop of cardiac surg with fever, tachycardia, chest pain, leukocytosis, sternal wound drainage, widened mediastinum on CXR? Tx?

acute mediastinitis; | drainage, surgical debridement, prolonged ABXs

female w sudden-onset, severe unilateral lower abd pain following strenuous activity (sport/sex) w S/sxs of hemoperitoneum and decr Hct

ruptured ovarian cyst presenting w acute abdomen d/t hemoperitoneum

S/Sxs of hemoperitoneum?

diffuse severe abd pain, pleuritic chest pain, referred shoulder pain, abd rigidity, rebound/guarding

most pre-renal AKI is d/t? AKI is c/b what 3 CFs?

volume-depleted state; | BUN:Cr ratio more than 20:1, oliguria (less than 500mL urine/24hrs), bland urine sediment (no casts, cells or protein)

HF can cause prerenal AKI in setting of hypervolemia but most prerenal AKI is d/t hypovolemia so if no clear signs of vol overload (JVD/lung crackles) treat with?

IV isotonic fluid | if they are on Mx fluids when they develop AKI give bolus

ulcerative skin condition assoc w many systemic conditions such as SLE, RA and esp IBD

pyoderma gangrenosum

strongest indep RF for septic arthritis? | Kocher criteria for septic arthritis?

CRP more than 20; | 3/4 of these strongly suggests it: WBC 12,000+, fever, ESR more than 40, non weight-bearing on affected side

ESR in toxic synovitis vs septic arthritis?

synovitis: ESR less than 20 | Septoc arthritis: ESR more than 40

dysphagia?

difficulty swallowing

Pts with this have unconjugated hyperbilirubinemia and are usually ASx, levels may rise after infection/fasting causing jaundice

Gilbert Syndrome

UC is a strong predisposing factor for this hepatobiliary complication that causes markedly elevated alk phos levels

Primary sclerosing cholangitis

subperiostial bone resorption is pathognomonic for?

hyperparathyroidism

cardiogenic shock is?

decreased CO and tissue hypoperfusion in the presence of adequate intravascular vol. low cardiac index, high PCWP

Chancroid?

STD caused by the bacteria Haemophilis ducreyi, PAINful ulcers, genital LNs become hard and swollen (buboes)

Tx for high aldosterone d/t bilateral adrenal hyperplasia

spironolactone

what typically causes small bowel ischemia vs ischemic colitis?

small: atheroembolic (endovascular procedures) or thromboembolic (a fib) events; colon: episodes of hypoTN, older pts w atherosclerotic disease are at high risk

pain in small bowel ischemia vs ischemic colitis?

small: severe poorly localized pain out of prop; colon: acute mild pain and tenderness

if pt has massive hemoptysis (600+mL/24hr or 100mL/hr) secure airway, B and C then if bleeding conts next step is?

Bronchoscopy -it can localize the bleeding site, provide suction, and attempt early intervention w balloon tamponade/ electrocautery

is lipase or amylase more specific/sens for acute pancreatitis ?

Lipase!

both can present w hypoTN, tachycardia, tachypnea and decr breath sounds on that side, compare percussion of tension pneumo vs hemothorax

tension: hyperresonance hemothorax: dullness

Nml bicard levels

22-28

Nml BUN

7-18 mg/dL

Nml AST? ALT?

both 8-40 U/L

evaluate urethral trauma/bleeding in unstable pt with?

retrograde urethrography

celiotomy?

laparotomy

patient comes in hypotensive and fluids are given, what is the best indicator of adequate resuscitation?

urine output | 30-40mL/hr

glands specific to groin and axilla?

apocrine