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UW Flashcards

1
Q

3 RFs of acalculous cholecystitis?

A

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

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2
Q

Typical presentation of acalculous cholecystitis

A

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

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3
Q

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

A

acute cholangitis;

obstruction by a gallstone or malignancy

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4
Q

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

A

Fitz-Hugh Curtis syndrome

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5
Q

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?

A

Emphysematous cholecystitis;

DM, vascular compromise, immunosuppression

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6
Q

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

A

prolonged prothrombin time

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7
Q

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

A

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

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8
Q

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

A 
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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9
Q

Tx of hepatic encephalopathy?

A

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

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10
Q

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

A

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

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11
Q

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

A

NO neurological manifs, and Normal methylmalonic acid levels

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12
Q

Rovsing sign

A

RLQ pain w deep palpation of LLQ, typical of appendicitis

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13
Q

ileus is MC due to ? other causes?

A

abdominal surgery;

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

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14
Q

S/Sxs of ileus?

abd x-rays show?

A

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

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15
Q

diagnosis of acute pancreatitis requires atleast 2 of the following?

A

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

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16
Q

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

A

acute cholangitis

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17
Q

lab results usually seen in pts with acute cholangitis?

A

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

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18
Q

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

A

common bile duct dilation

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19
Q

in acetaminophen overdose, transaminases are frequently?

A

over 3000 U/L

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20
Q

Giardiasis: preferred Dx test?

first line Tx?

A

stool antigen assay;

metronidazole

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21
Q

appear as symmetric, circumferential narrowing of esophagus on barium swallow

A

esophageal (peptic) strictures

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22
Q

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

A

perforated peptic ulcer

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23
Q

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

A

variceal

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24
Q

when are platelet transfusion typically given?

A

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

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25
Q

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

A 
Acute diverticulitis;
abdominal CT (scope is contraindicated in acute setting d/t risk of perf)
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26
Q

Mx of acute diverticulitis?

A

bowel rest and ABXs (cipro, metronidazole..)

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27
Q

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

A

Upright x-ray of chest and abdomen;

free intraperitoneal air under the diaphragm (pneumoperitoneum)

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28
Q

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

A

biliary colic

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29
Q

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

A

Mallory-Weiss tear

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30
Q

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

A

esophageal perforation

ie Boerhaave syndrome

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31
Q

cholestatic liver fxn test pattern?

A

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

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32
Q

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

A

Respiratory isolation to prevent spread of infection

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33
Q

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

A

1.5

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34
Q

GCS assesses pts ability to?

A

open their eyes, motor response, verbal response

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35
Q

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

A

aorta

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36
Q

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?

A

left sided hemothorax, widened mediastinum w deviation to R

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37
Q

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

A

Esophageal rupture

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38
Q

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

A

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

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39
Q

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

A

pancreatic pseudocyst

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40
Q

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

A

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

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41
Q

DDx for an anterior mediastinal mass?

A

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

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42
Q

Lab findings seen in acute bowel ischemia?

A

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

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43
Q

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

A

lipase is both more sensitive and specific than amylase

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

Peritonsillar abscess

47
Q

Tx of peritonsillar abscess?

what must ABXs cover?

A

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

48
Q

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

A

ruptured AAA

49
Q

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

A

Dumping syndrome;

diet modifications

50
Q

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

A

30

51
Q

Brain mets typically appear as? at?

A

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

52
Q

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

A

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

53
Q

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

A

Femoral n.;

anterior thigh and medial leg via saphenous branch

54
Q

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

A

Malignant hyperthermia;

inhaled anesthetics

55
Q

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

A

pleuritic chest pain, tachypnea, dyspnea, tachycardia, hypoxia

56
Q

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

A

volume depletion;

IV fluid bolus

57
Q

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

A

CT scan of abdomen

58
Q

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

A

chronically wounded, scarred (burns), or inflamed

59
Q

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

A

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

60
Q

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?

A

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

61
Q

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

A

decreased; improves toward nml

62
Q

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

A

Supracondylar fracture of humerus;

entrapment of brachial a. or median n.

63
Q

preferred long-term anticoagulant in ESRD pts?

short-term?

A

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

64
Q

what level of direct bilirubin is cause for concern?

A

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

65
Q

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

A

pancreatic insufficiency

66
Q

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?

A

ruptured bronchus

67
Q

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

A

NG suction, IV fluids, bowel rest;

emergency abdominal exploration

68
Q

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

A

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

69
Q

What is an abdominal succussion splash and what causes it?

A

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

70
Q

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

A

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

71
Q

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

A

old age, Afib, CHF, atherosclerotic vascular disease;

focal or segmental bowel wall thickening, small-bowel dilation and mesenteric stranding

72
Q

Tx for acalculous cholecystitis?

A

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

73
Q

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

A

gallstone pancreatitis

74
Q

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

A

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

75
Q

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

A

CXR, mediastinal widening;

suffer blunt deceleration trauma ie MVA or fall from more than 10ft

76
Q

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

A

Etomidate

77
Q

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

A

propofol

78
Q

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

A

facial n.;

facial droop

79
Q

triad of S/Sx of fat embolism

A

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

80
Q

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?

A

acute mediastinitis;

drainage, surgical debridement, prolonged ABXs

81
Q

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

A

ruptured ovarian cyst presenting w acute abdomen d/t hemoperitoneum

82
Q

S/Sxs of hemoperitoneum?

A

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

83
Q

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

A

volume-depleted state;

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

84
Q

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?

A

IV isotonic fluid

if they are on Mx fluids when they develop AKI give bolus

85
Q

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

A

pyoderma gangrenosum

86
Q

strongest indep RF for septic arthritis?

Kocher criteria for septic arthritis?

A

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

87
Q

ESR in toxic synovitis vs septic arthritis?

A

synovitis: ESR less than 20

Septoc arthritis: ESR more than 40

88
Q

dysphagia?

A

difficulty swallowing

89
Q

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

A

Gilbert Syndrome

90
Q

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

A

Primary sclerosing cholangitis

91
Q

subperiostial bone resorption is pathognomonic for?

A

hyperparathyroidism

92
Q

cardiogenic shock is?

A

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

93
Q

Chancroid?

A

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

94
Q

Tx for high aldosterone d/t bilateral adrenal hyperplasia

A

spironolactone

95
Q

what typically causes small bowel ischemia vs ischemic colitis?

A

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

96
Q

pain in small bowel ischemia vs ischemic colitis?

A

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

97
Q

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

A

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

98
Q

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

A

Lipase!

99
Q

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

A

tension: hyperresonance
hemothorax: dullness

100
Q

Nml bicard levels

A

22-28

101
Q

Nml BUN

A

7-18 mg/dL

102
Q

Nml AST? ALT?

A

both 8-40 U/L

103
Q

evaluate urethral trauma/bleeding in unstable pt with?

A

retrograde urethrography

104
Q

celiotomy?

A

laparotomy

105
Q

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

A

urine output

30-40mL/hr

106
Q

glands specific to groin and axilla?

A

apocrine

Surg (1 decks)

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