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STEP 2 > UW7 > Flashcards

UW7 Flashcards

1
Q

How do you confirm a dx of psoas abscess?

A

CT scan

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1
Q

What is the surgical standard of care for SCC

A

Moh’s Micrographic surgery

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1
Q

What nerve is responsible for the Trendelenburg sign?

A

Superior gluteal nerve (innervates gluteus maximus and medius)

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1
Q

What should be done in a hemorrhaging pt before intubating them? Why?

A

Bolus with IVF because the CVP is already low in hemorrhage so placing them on ventilator will increase the intrathoracic pressure even more leading to possible cardiac arrest

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2
Q

What humeral fractures are associated with compartment syndrome? What long term complication may arise from this?

A

Supracondylar fractures; Volkmann’s Ischemic contracture (dead muscle all replaced by fibrous tissue)

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2
Q

What is the appropriate mgmt of SBO

A

Admit, place NGT, make NPO and put on IVF as NGT will cause ongoing fluid losses with hypokalemic hypochloremic metabolic alkalosis

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2
Q

What is the most accurate test for intraductal papilloma? What is seen on US?

A

Retrograde galactogram; oftentimes, NOTHING!

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2
Q

What is the most common cause of death in Ludwig angina?

A

Asphyxiation. Due to posterior displacement of tongue

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2
Q

What needs to be given to any pt prior to surgery who is on chronic steroids (i.e. greater than 3 weeks)

A

Stress doses of steroids

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3
Q

What is the likely cause of acute pain and swelling in the midline sacrococcygeal area? Cause? Tx?

A

Pilonidal cyst infected; due to friction in the area; Tx is I/D with excision of the sinus tracts

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4
Q

Why should a hip dislocation be promptly reduced?

A

Decrease risk of AVN

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4
Q

What is the MC cause of post-rhinoplasty whistling?

A

Septal perforation (Note Wegeners, Leprosy, and congenital syphilis also often have septal issues with a saddle nose deformity)

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5
Q

What virus can cause AIHA?

A

EBV

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6
Q

What are the radiologic signs of acalculous cholecystitis? Tx?

A

GB wall thickening, distention, and pericholecystic fluid; percutaneous cholecystostomy acutely and later definitive tx with cholecystectomy

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6
Q

What is the most common cause of mesenteric ischemia?

A

Embolic as opposed to thrombotic, Afib is MC with lodging into SMA

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6
Q

A vertebral burst fracture is associated with which neurologic syndrome?

A

Anterior Cord Syndrome (total loss of motor fxn distal to the lesion with preservation of proprioception)

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7
Q

What is important to rule out when making a dx of hypoparathyroidism?

A

There must be normal renal fxn; i.e. hypocalcemia and hyperparathyroidism IN THE PRESENCE OF NORMAL RENAL FXN

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7
Q

When tx inhalational smoke injury why should you have a low threshold for intubation?

A

Progressive edema of laryngeal structures may preclude intubation further down the line if truly needed

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7
Q

What drug should be given in Afib RVR with acute CHF?

A

Digoxin; BB and CCB would be CI; However, the digoxin can increase contractility and provide rate control from increased vagal tone

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7
Q

In whom must you be careful giving etomidate to for rapid sequence intubation?

A

Pts with HPA axis suppression (i.e. on chronic corticosteroids)

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8
Q

T/F high dose steroids are indicated in severe burn injuries; why or why not

A

FALSE; they are immunosuppressive and diabetogenic; burn victims already at increased risk infxn and in their hypermetabolic phase will have excess cortisol and hyperglycemia any way

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9
Q

Surgical length greater than ____ is a risk factor for post-op PNA

A

3 hours

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9
Q

What is an important complication that may occur when an arterial puncture site is made ABOVE the inguinal ligament?

A

Retroperitoneal hematoma (can present like AAA rupture); since hematoma formation always an issue at arterial puncture sites and above the inguinal ligament it can extend retroperitoneally

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9
Q

What is an important study to obtain in any pt s/p MVA or fall from great heights?

A

CXR to rule out aortic trauma

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10
Q

Why may a perforated duodenal ulcer present similarly to acute pancreatitis? What is a major diff?

A

Both are retroperitoneal processes; duodenal ulcer perf would likely be more painful but also not assoc with N/V as much as pancreatitis and if there was vomiting it would probs be coffee ground emesis

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11
Q

What makes diverticulitis complicated?

A

When assoc. with abscess formation, perforation, obstruction, fistula formation, or medically refractory dz; if collection 3cm then IR drainage

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11
Q

What should you always think of when a pt has fx of the first or second rib?

A

Potential aortic or carotid injury; these are very hard to break so implies a very large force!

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11
Q

What is the MC complication of thyroidectomy?

A

Hypocalcemia; be esp. careful in pts with malabsorption as they may already have impaired calcium homeostasis

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12
Q

How is the presentation of acute mesenteric ischemia diff from ischemic colitis?

A

Ischemic colitis is often painful but not nearly as bad as acute mesenteric ischemia; also mesenteric ischemia does not always present with bleeding sometimes not until later

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13
Q

What is the most important diagnostic study to perform after the ABCs in chest trauma?

A

CXR

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14
Q

What is a common cause of forefoot pain in the female athlete triad

A

Stress fx

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15
Q

How does a blunt trauma pt get air embolism?

A

The blunt trauma can result in a communication between blood vessels and the airways leading to air in the vasculature; often presents AFTER positive pressure ventilation is induced

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16
Q

How do you treat a rectal lesion less than 5 cm from the anal verge? Why?

A

Abdominoperineal resection with end colostomy; it is too distal to treat with low anterior resection with maintenance of any sort of sphincter mechanism

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16
Q

When does screening colonoscopy start in pts with known FMHx of FAP?

A

10; these pts can be full of polyps by age 20

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16
Q

What is the proper tx of diphenhydramine OD?

A

Physostigmine to reverse the anticholinergic effects and probably intermittent catheterizations prn urinary retention

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18
Q

Explain the hypermetabolic phase that occurs after burns

A

There is an increase in catecholamine release and cortisol that causes increased protein wasting

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19
Q

What exactly causes a post-op ileus?

A

There is excess sympathetics because you have violated the peritoneum; additionally post-op narcotics don?t help the situation

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21
Q

What needs to be ordered in any pt with blunt chest trauma and signs of acute CHF or shock?

A

Urgent echocardiogram

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21
Q

How should you deal with hip fx in the elderly with comorbid conditions?

A

Surgery can be delayed up to 72 hours to treat acute medical conditions

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22
Q

What is important to do in any pt with spinal cord injury to monitor VS

A

Bladder catheterization

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23
Q

What is the number one cause of death in burns?

A

Hypovolemic shock

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25
Q

How do you evaluate penetrating thoracic injury below the nipple with hemodynamic instability?

A

Exploratory laparatomy because below the nipple is abdomen; indicated when there is hemodynamic instability, peritoneal signs, or clear evisceration

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27
Q

What can fat necrosis look like histologically?

A

Foamy macrophages and fat globules; if seen in breast after trauma just observe

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28
Q

How do you manage penetrating trauma to abdomen with instability

A

Ex lap; no need for CT or even US (FAST) because there is obvious intraperitoneal bleeding

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30
Q

What is the typical timeline for ventilator associated PNA and what is the MC bug?

A

usually after 48 hours of intubation; P. aeruginosa

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30
Q

What is Leriche syndrome?

A

Due to aortoiliac occlusive disease it is bilateral hip, thigh, and buttock pain with wasting and impotence

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31
Q

What is the most likely route of infection of psoas abscess? Describe the physical signs based on palpation

A

Hematogenous with S. aureus most common i.e. from cellulitis of thigh etc.; deep palpation required to elicit tenderness because is a retroperitoneal process

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31
Q

How do you manage hydroceles in kids?

A

If under 12 months it tends to resolve spontaneously; after 12 months it should be closed surgically to avoid developing indirect inguinal hernia

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32
Q

Describe the CXR findings of pulmonary contusion

A

Initially after injury may be normal, often worsen with fluid administration secondary to third spacing; later CXR will show a fluffy infiltrate (white out)

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34
Q

Why should a cricothyroidotomy eventually be converted to a formal tracheostomy?

A

Prolonged use of the cricothryoidotomy can lead to subglottic stenosis

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36
Q

What is triple therapy for H. pylori

A

Amoxicillin, Clarithromycin, and PPI

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36
Q

What are some signs of thermal injury to the airway? What does this tell you?

A

Presence of soot, ash, frank burns, or singed nasal hair; this is an airway emergency and rapid sequence intubation is needed

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36
Q

What is bleeding in diverticular bleed?

A

The vasa recta

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37
Q

What does fever, chills, and deep abdominal pain suggest

A

Retroperitoneal process

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38
Q

What is the Bosniak classification system used for?

A

Evaluates renal cysts on the basis of radiographic findings; contrast enhancing lesions are usually Bosniak III-IV and more likely malignant

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39
Q

How do you manage early dumping syndrome?

A

It is usually self limiting so first you do dietary modification with more frequent smaller meals, then octreotide, then if truly refractory can convert to a Roux-en-Y

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40
Q

What do you do for a pelvic fx with hemodynamic instability?

A

Monitor response to IVF and follow serial H/H. You should never explore the hematoma as bleeding is usually from several of the smaller vessels and not usually amenable to tx

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40
Q

Define massive hemoptysis? What should be done and why?

A

> 600 ml blood; you should do a bronchoscopy (for tamponade/cautery) with the bleeding lung in the dependent position; you do this bc the main risk assoc. with massive hemopytsis is asphyxiation

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41
Q

What is the first step for a nondisplaced scaphoid fx or suspected scaphoid fx without radiologic evidence?

A

Thumb spica cast 7-10 days then rescan

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41
Q

How does gastric outlet obstruction usually present?

A

Post-prandial pain, early satiety and vomiting (often due to edema from ulcer)

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42
Q

How do you manage a contrast enhancing renal cyst?

A

Nephrectomy or nephron sparing nephrectomy; this is a Bosniak III-IV lesion so risk for malignancy is high

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44
Q

Why do you have to be careful with IVF in flail chest?

A

There is likely underlying pulmonary contusion and overagressive volume rescuscitation can cause third spacing into it

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45
Q

What is the mgmt of penis fracture?

A

Retrograde urethrogram followed by surgical exploration of the penis

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46
Q

What is the likely cause of shock when the PCWP increases after IVF administration?

A

Cardiogenic

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47
Q

What is the 4-2-1 rule of maintenance fluid replacement

A

4 ml/kg for first 10 kg; 2 ml/kg for 10-20 kg and then 1 ml/kg for each kg after that

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48
Q

Explain the following interventions for lowering ICP? 1) Head elevation 2) Sedation 3) IV mannitol 4) Hyperventilation 5) Removal of CSF

A

1) increases venous outflow from brain 2) decreases metabolic demand 3) osmotic diuresis which removes free water 4) removal of CO2 allows for vasoconstriction 5) Shunt placement

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49
Q

How would you treat coagulopathy in pancreatic cancer? Cirrhosis?

A

Vitamin K since it is due to malabsorption due to CBD blockage therefore supplementation will work? In cirrhosis the liver is shot so giving vitamin K wont really help, you need to give FFP

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51
Q

Trochanteric bursitis occurs near insertion of what muscle?

A

Gluteus medius (innvervated by superior gluteal n. i.e. trendelenburg sign)

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52
Q

What goal is a labeled RBC scan trying to achieve?

A

Localize the bleeding when colonoscopy failed to visualize a source so that either mesenteric angio can be done or repeat colonoscopy

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52
Q

How does central cord syndrome present? What predisposes to it?

A

Hyperextension injuries in pts with pre-existing degenerative changes; paralysis of upper extremities more than lower

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53
Q

What is the mgmt of acute mediastinitis s/p CABG?

A

Surgical Debridement with immediate closing and prolonged abx

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54
Q

What happens when a pt with flail chest gets intubated and put on positive pressure ventilation?

A

The paradoxical respiratory motion will correct

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56
Q

What is the next best step in diagnosing subacute knee pain s/p twisting injury?

A

MRI, likely medial meniscus

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58
Q

What is the most likely type of parotid neoplasm to be there if it is recurrent?

A

Pleomorphic adenoma

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59
Q

Why does general anesthesia increase risk of gastric aspiration?

A

It impairs laryngeal functioning

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60
Q

What if rib fracture pain is not adequately controlled with NSAIDs? Major risk of this tx?

A

Intercostal nerve block; PTX

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61
Q

What is the most important goal in rib fx? Why?

A

Adequate pain control to prevent splinting, atelectasis, and pneumonia

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61
Q

What is the next best step in abdominal trauma if a pt is hemodynamically stable after a fluid challenge?

A

CT scan; esp. with splenic injury because you want to grade the injury so you can hopefully salvage rather than take it out

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61
Q

What is an interval appendectomy and when is it used?

A

Appendectomy in a situation in which a pt has presented with ruptured appendix; so they drain it via IR drainage and then wait 6 weeks after the abdomen has cooled down and do an “interval appendectomy”

61
Q

Why do meniscal injuries cause late knee joint swelling as opposed to ACL?

A

Not well perfused, ACL has a vessel

62
Q

What is a pulsatile mass located below the inguinal ligament?

A

Femoral artery aneurysm

64
Q

What labs are required in a pt to treat them with IFN alpha and emtracitabine for chronic HCV? What is the better regimen and why?

A

You need detectable viral load with both INR and creatinine less than 1.5; now tenofovir and entacavir are used and are ok for use in decompensated cirrhosis

65
Q

What causes lipodermatosclerosis?

A

Erythrocyte extravasation secondary to venous HTN leads to hemosiderin deposition

66
Q

What are some good physical findings that can help diff DVT from compartment syndrome?

A

neurologic signs often affected in compartment syndrome

67
Q

A CXR with an NGT in the chest after trauma indicates what?

A

Traumatic rupture of the diaphragm; do ex lap with repair and repair of other injuries

68
Q

What is seen on colonoscopy for ischemic colitis?

A

Cyanotic bloody mucosa with sharp transition points

69
Q

What is the cause of thigh pain in a pt with a pulsatile mass lying just below the inguinal ligament?

A

Compression of the femoral nerve (anterior thigh pain) by femoral artery aneurysm

71
Q

What abdominal landmark is important to feel for a AAA?

A

AAA should be a pulsatile mass at or above the umbilicus

71
Q

What is the best way to confirm a dx of fat embolism syndrome?

A

Normally you can base it off the clinical picture but technically you can confirm with fat droplets in urine

72
Q

What is the cause of Ludwig angina? Tx? Major concern?

A

Usually strep and anaerobes from an infected molar; remove the molar and give abx; major concern is airway obstruction due to posterior displacement of the tongue

73
Q

What do you give preoperatively to pts with hemophilia A?

A

DDAVP (note that you may anticipate a low UOP)

74
Q

What is the next step in mgmt after placing a central line?

A

Check a portable CXR

75
Q

What do you do if a pt needs to be intubated and has a ptx?

A

Place thoracostomy first because positive pressure ventilation often worsens the ptx

77
Q

If there is tracheal deviation how do you know based on clinical exam whether it is from tension pneumo vs. hemothorax?

A

Tension ptx will be hyperresonant whereas hemothorax will be dull

79
Q

How would you differentiate post-pericardiotomy syndrome from acute mediastinitis?

A

Post-pericardiotomy syndrome occurs several weeks s/p CABG and is autoimmune in nature

80
Q

How is it that a ruptured AAA could present with gross hematuria?

A

It can dissect through the retroperitoneum causing an aortocaval fistula with the IVC leading to distention of the bladders venous plexus with gross hematuria

81
Q

What will you typically see on CT of acute pancreatitis?

A

Enlarged pancreas with stranding of adjacent fat planes

82
Q

Name 3 drugs that should be held prior to cardiac stress test?

A

Nitrates, BB, and CCB as they all affect the severity of ischemia

84
Q

When is it safe to start anticoagulation in a post op pt

A

48-72 hours in a hemodynamically stable pt

85
Q

How do you manage fracture of metatarsal heads? Why?

A

Usually can be managed conservatively because the surrounding metatarsals act as splints and nonunion is pretty uncommon; rest and pain control

87
Q

What is the most important prognostic indicator for compartment syndrome

A

time to fasciotomy

88
Q

Explain the mechanism of diffuse axonal injury? What is the most accurate test?

A

Sudden deceleration causes shearing due to different densities between gray matter and white matter leading to hemorrhage; MRI is the most accurate though CT will most likely pick it up

89
Q

How can you tell if a cold leg was from embolus or thrombosis?

A

Embolic causes tend to present with acute pain, often the pt can tell you exactly where they were; thrombosis is a more insidious process and will occur slower

91
Q

What is the best mgmt for 1st time uncomplicated diverticulitis?

A

Clear liquid diet with 7-10 d abx that cover anaerobes and gram negative (i.e. moxifloxacin or amoxacillin clavulanate)

92
Q

Why would you not give neostigmine in a pt who has developed ileus secondary to pancreatitis?

A

It will contract the sphincter of oddi and lead to worsening of pancreatitis

94
Q

What nerve is affected in tarsal tunnel syndrome?

A

Tibial n

95
Q

Discuss the surgical mgmt of carcinoid tumors

A

Carcinoid tumor 2 cm then needs right hemicolectomy

96
Q

What is the best mgmt for a pt with maxillary or mandibular fx and poor SaO2? What potential issue should be anticipated?

A

Cricothyroidotomy; CO2 retention, draw serial ABG

98
Q

What is the best initial test for workup of PAD?

A

ABI; Arterial US is typically used later on when planning for invasive procedures

99
Q

What is torus palatinus? What is the tx?

A

It is an exostosis of the midline suture of the hard palate; the epithelium may ulcerate due to poor blood supply; surgery indicated if it is symptomatic

100
Q

When does TRALI develop? What is it?

A

Typically within 6 hours of transfusion; resp distress with noncardiogenic (normal PCWP) pulmonary edema

102
Q

How is invasive monitoring of ICP done?

A

With a ventriculostomy

102
Q

T/F: delayed capillary refill is an early sign of blood loss?

A

False only occurs when about 15% blood volume lost; tachycardia is one of the earliest

103
Q

How can duodenal hematoma present after trauma?

A

Basically with an obstruction due to bleeding between submucosal and muscular layers

104
Q

What is the cause of medial thigh pain in an obturator hernia?

A

Howship-Romberg sign; compression of obturator n

104
Q

What is the one abnormality that may be seen on neuroimaging for pseudotumor cerebri?

A

Empy sella

105
Q

How does raising the head of the bed affect FRC

A

Increases FRC (good for fat fucks) and takes pressure off the diaphragm allowing for more alveolar expansion

106
Q

What bugs tend to cause emphysematous cholecystitis? Typical group?

A

Clostridium; elderly DM II

108
Q

What is the classic physical finding for gastric outlet obstruction?

A

Abdominal succussion splash

109
Q

What is SCC arising within a burn wound or assoc with Crohn’s fistula called?

A

Marjolin ulcer

110
Q

What is the next best step when the physical exam is classic for appendicitis?

A

Laparoscopic appendectomy; you don?t need CT but can be used if picture not clear

111
Q

What is the most likely part of the bladder to rupture and why?

A

Bladder dome due to an attenuated area caused by the urachus embryologically (becomes median umbilical ligament)

112
Q

What is the cause of shock in a post-op pt until proven otherwise?

A

Presumed to be hemorrhage until proven otherwise

113
Q

What is the preferred mgmt of MCL tears

A

Bracing with early ambulation is preferred over surgery

114
Q

Which IBD is most heavily assoc with rectal bleeding

A

UC

115
Q

What is the most common route of infxn for endocarditis, osteomyelitis, muscle abscesses, and septic joints?

A

Hematogenous

117
Q

What is the MC cause of syringomyelia in an adult?

A

Old SPC trauma that underwent cystic degneration (in kid it is Chiari Malformation)

119
Q

What is the next best step if axr shows free air

A

Ex lap; CT is of little use and it may not even identify the site of injury

120
Q

What structure is most likely injured in a supracondylar fracture?

A

Brachial artery

121
Q

What is the cause of the snapping sound in a penis fracture? Why does it bend?

A

Rupture of the tunica albuginea covering the corpus cavernosum; it bends because a hematoma forms

122
Q

How should you dx a pt with suspected ruptured AAA who is unstable?

A

Do a FAST at the bedside then take to surgery

123
Q

What are 4 diseases that are due to follicular occlusion (i.e. hair follicles)?

A

Hidradenitis suppurativa, Pilonidal dz, Dissecting folliculitis, Acne congoblata

124
Q

What are the MC causes of post-op fever immediately after surgery?

A

Malignant hyperthermia and transfusion rxns

125
Q

Why may a pt with Courvosier’s sign have elevated PT?

A

Pancreatic CA with CBD dilation will result in decreased absorption of ADEK so no K = elevated PT

126
Q

Explain abdominal distention in a pt with ureteral colick?

A

Can be ileus secondary to vagal reaction

127
Q

Discuss the mgmt of fluid collections in complicated diverticulitis

A

If less than 3 cm collection you can give IV abx and observe; If greater than 3 cm then you can do IR drainage; if not better in 5 days then surgery

128
Q

How can you prevent acute bacterial parotitis in a surgical pt?

A

Provide adequate fluid hydration and oral hygiene pre and postoperatively

129
Q

What needs to be added to the preop orders in a pt who needs emergent ex lap but is on warfarin?

A

FFP

130
Q

What would you expect to see on CXR of pt s/p CABG with tachycardia and sternal wound drainage?

A

Mediastinal widening, this is acute mediastinitis

131
Q

What is required to have carcinoid syndrome? Tx for sx?

A

Mets to liver; Octreotide for symptoms

132
Q

What is the most significant etiology for morbidity in pts with traumatic brain injury?

A

Diffuse Axonal Injury (punctate hemorrhages at gray-white jxn)

134
Q

In words, what is the respiratory quotient?

A

The rate of CO2 produced to O2 consumed; depends on what is being used to make ATP (if close to 1.0 it is carbs); a respiratory quotient can make it tough to wean a pt from the vent

136
Q

If you have strong clinical evidence for gastric CA what is the next best step?

A

EGD for tissue confirmation; likely then CT for staging with decision made based on that; limited stage gets resection high stage gets chemo and palliative surgery

137
Q

What should you think if a pt has new onset JVD and hypotension unresponsive to fluids?

A

Possible cardiac tamponade

139
Q

What does diffuse rebound tenderness indicate

A

Generalized peritonitis = immediate surgery

139
Q

What should you be thinking for a pneumothorax that persists despite placement of a chest tube?

A

Rupture of a tracheobronchial structure

140
Q

What is a good basic test for rotator cuff tears?

A

Drop arm test

141
Q

What test is used to confirm iatrogenic esophageal rupture?

A

Water soluble contrast esophagogram; first test is CXR though

142
Q

What is the Tx of a pt with a Mulder sign in the foot?

A

Bar or padded shoe in BOTH shoes to ensure even walking; this is tx for a Morton Neuroma (mechanical induced neuropathic degeneration)

144
Q

What is the clicking sound of Morton Neuroma called

A

Mulder Sign

145
Q

What kind of peritonitis is present if there is bladder rupture? Radiation to the L shoulder is called what?

A

Chemical peritonitis; Kehr sign

147
Q

In general, how do obstructions of hollow organs tend to present?

A

With writhing and colicky pain in which the pt just cant seem to get comfortable

148
Q

How do you manage spinal ischemia s/p repair of thoracoabdominal AAA?

A

Emergent MRI with placement of lumbar drains to decrease SPC pressure

149
Q

What side do diaphragmatic ruptures occur on?

A

L side bc liver protects R

149
Q

What is the likely etiology of a subacute septic joint in a prosthetic limb?

A

S. epidermidis; S. aureus and P. aeruginosa tend to have much more rapid onset

150
Q

What kind of cancer is nasopharyngeal carcinoma? Associations?

A

Undifferentiated SCC; EBV and Asians

152
Q

Explain the pathophysiology of increased risk of renal stones in Crohn’s dz

A

The fat malabsorption means more fat in the gut lumen which chelates calcium to essentially form soap; this leaves the oxalate unbound by calcium and is freely resorbed back into bloodstream where it can precipitate out in the kidneys as calcium oxalate

153
Q

What is the cause of fever, leukocytosis and parotid inflammation?

A

Acute Bacterial Parotitis most often due to S. aureus

154
Q

How is an SBO different from an ileus of critical illness, radiographically?

A

SBO will have air-fluid levels with high pitched bowel sounds and NO air in colon and rectum; Ileus of critical illness develops in critical illness and has air in colon

155
Q

What test would best confirm that there is an acute hemolytic transfusion rxn?

A

Coombs

157
Q

What is the best way to evaluate bleeding that is thought to be from a small bowel source (i.e. after all other tests are negative)

A

Capsule endoscopy

159
Q

How do you manage an episode of paroxysmal HTN in a pt with pheochromocytoma?

A

FIRST you must give an alpha blocker then give a beta blocker as giving BB alone will lead to unopposed alpha with worsening of HTN

160
Q

What should NEVER be used for rapid sequence intubation in a pt on chronic steroids?

A

Etomidate as it can inhibit steroid synthesis and increase risk for adrenal crisis

161
Q

What is the best way to diagnose anterior cord syndrome? What is the MC cause?

A

MRI; vertebral burst fx

163
Q

In the trauma setting a pt who is hypotensive and still is after fluid challenge, what is the cause? Next step?

A

Ongoing hemorrhage so take to surgery; if pt also has JVD you want to be thinking of tension ptx or cardiac tamponade

164
Q

What is the most effective tool to prevent post-op PNA

A

Incentive spirometry

165
Q

What is a good first step in an oliguric pt?

A

Switch out the catheter then IV bolus if suspect prerenal azotemia

167
Q

What may compensate blood supply to limb after burn? Tx?

A

Formation of eschar; Escharotomy (just incise the eschar not all of the fascia, i.e. not a fasciotomy)

168
Q

Explain the cause of tachypnea when a pt has atelectasis?

A

The shallow breathing decreases recruitment which then causes mucus plugging, this causes hypoxia which increases the respiratory drive

169
Q

If you suspect retroperitoneal hematoma s/p arteriotomy what is the best dx test?

A

Non-contrast CT

170
Q

What is the preferred surgical mgmt for recurrent duodenal ulcers?

A

Parietal cell vagotomy (highly selective vagotomy) and this preserves stomach tone and peristalsis

171
Q

Why is 100% O2 via nonrebreather useful for smoke inhalation

A

Decreases the half life of carboxyhemoglobin (note if > 20 you need to do hyperbaric O2)

172
Q

What is true of CT scans for detection of pancreatic injuries

A

Often are missed in first 6 hours s/p injury

173
Q

What is the major difference between medial tibial stress syndrome and a tibial stress fx?

A

Point tenderness indicates stress fx

174
Q

What is the classic sequelae to leaving nasal packing in too long after a rhinoplasty?

A

Development of Toxic Shock Syndrome (S. aureus super antigen binds MHC II and TCR leading to cytokine storm)

174
Q

How do you diagnose central vein thrombosis?

A

Magnetic resonance venography

175
Q

What 3 things are tested in GCS

A

Best eye opening, best motor response, best verbal response

176
Q

What may develop in a hyperextension injury in a pt with preexisting degenerative changes?

A

Central Cord Syndrome with PARALYSIS MORE IN THE UPPER EXTREMITIES THAN LOWER

177
Q

Explain the physiology of the HIDA scan

A

Hydroxy Imino Diacetic acid is absorbed by bloodstream and secreted by hepatocytes into bile. In acute cholecysitis the GB would not be visualized since there is an obstructing stone

179
Q

What is the next best step for dx of suspected pancreatic CA?

A

CT scan; note that endoscopic US can also be useful

180
Q

How do you tx perforated appendix without abscess? With abscess?

A

Emergent appendectomy with post op IV Abx and delayed primary closure; Percutaneous drainage (if not getting better over several days may require surgery)

181
Q

What should you be thinking if there is a sternal fx with tachycardia and new onset bundle branch block? Mgmt?

A

Myocardial contusion; aimed at complications

182
Q

What is the best advice to give a pt who has just severed their finger?

A

Put the finger in saline moistened gauze and then put it on ice this will allow it to be viable for 24 hours

183
Q

Why would a pt with s/s of pheochromocytoma have elevated calcitonin?

A

May be assoc with MEN2A (pheo, medullary thyroid CA (calcitonin is the marker), hyperparathyroidism)

184
Q

What is the best initial test in any young woman presenting with appendicitis like pain?

A

B-hCG as it could be ectopic or because she may be pregnant (with intrauterine pregnancy) in which case you still don?t want CT

186
Q

What are some signs of end organ dysfunction what would make sepsis into severe sepsis?

A

decreased UOP or rising BUN CR, platelets drop below 80,000, hypoxemia, hypotension, metabolic acidosis

187
Q

Why may PE p/w acute onset JVD? Echo finding?

A

RV strain; McConnels sign

188
Q

What is the most important question to ask if a resident tells you that a pt has a scaphoid fx?

A

Displaced or nondisplaced?

189
Q

What is the tx for phimosis and paraphimosis?

A

Circumcision

190
Q

What is required (biologically) for a pt to survive when there is aortic trauma?

A

Intact adventitial layer

191
Q

How does mesenteric ischemia often present?

A

Sudden onset periumbilical pain OOP to physical exam

192
Q

What gene is amplified in neuroblastoma what is the surgical mgmt?

A

N-myc (trascription factor); Nephrectomy with ipsilateral adrenalectomy

193
Q

How can you CONFIRM a dx of traumatic rupture of diaphragm

A

CT chest abdomen i.e. done if the AXR or CXR suggests this

194
Q

What is the number one cause of death in the setting of burns with adequate fluid resuscitation (pt is euvolemic)

A

Superimposed bacterial infection (sepsis) i.e. P. aeruginosa

195
Q

What is the most important initial step anytime a pt with active TB presents?

A

Respiratory isolation

196
Q

Why may worsening hyperglycemia indicate sepsis?

A

Increasing insulin resistance occurs

197
Q

Though a parietal cell vagotomy is often better than truncal vagotomies and selective vagotomies, what is the main issue when used as tx for medically refractory PUD?

A

This type of surgery has the highest recurrence rate

STEP 2 (13 decks)

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