uWorld Flashcards
Classic presentation of gallstones
- Biliary colic
- nausea/vomiting
- right sided shoulder/subscapular pain (referred)
Episode caused by viscus distention
Splenic injury from blunt trauma is managed how?
By patient’s hemodynamic status and response for IV fluids.
- If responsive- CT scan
- If unresponsive- laparotomy
Solitary Pulmonary Nodule (SPN)
< 3 cm in diameter
completely surrounded by lung parenchyma
does not contact pleura, hilum, or mediastinum
Atelectasis
Lobar or segmental collapse of lung that causes decreased lung volume.
Most severe during 2nd post-op night, can last up to 5 days.
Hypovolemic shock
- Flat neck veins
- Bruising
- Abdominal distention
Eschar
Firm, necrotic tissue formed on exposed tissue following burn wounds.
Signs of compartment syndrome
- Deep pain out of proportion to injury
- Pulselessness
- Paresthesias
- Cyanosis and pallor of extremity
Treatment for Slipped Capital Femoral Epiphysis (SCFE)
Surgical pinning of of slipped epiphysis in situ (where it is) to lessen risk of avascular necrosis of femoral head and chondrolysis.
Oliguria
< 400 cc urine/day, or < 6 cc/kg/day
Psoas abcess
complication of perforated appendix
significant abdominal pain with flexion of hip against resistance
Treat with antibiotics, IVF, bowel rest
appendectomy 6-8 weeks later
Dumping syndrome
Common postgastrectomy complication.
Caused by rapid emptying of hypertonic gastric content into duodenum and sm intestine. Leads to fluid shift from intravascular space to sm intestine, release of intestinal vasoactive polypeptide, stimulation of autonomic reflexes
Nasopharyngeal carcinoma (NPC)
higher frequency in mediterranean/far east
high association with epstein barr virus (EBV)
present with recurrent otitis media, recurrent epistaxis, nasal obstruction
signs of retroperitoneal abcess
fever
chills
deep abdominal pain
CO toxicity
mild: headache, nausea, dyspnea, malaise, altered mental status, dizziness
severe: seizure, come, syncope, heart failures, arrhythmias
Tx: 100% O2 via nonrebreather
most common benign breast disease in perimenopausal women
Intraductal papilloma
fibrocystic change of breast
benign
bilateral breast pain
cystic changes of breast
cyclic symptoms with cycle
Fibroadenoma of breast
benign
solitary lesion
painless
firm, mobile mass
15-25 yars old, does NOT change w/cycle
Ductal carcinoma in situ
postmenopausal women
nipple discharge
breast mass
ductal epithelium changes, do NOT penetrate basement membrane
Paget’s disease of breast
eczematous changes of nipple
Mediastinitis
Fever Tachycardia Chest pain Leukocytosis Sternal wound drainage or purulent drainage
Tx: drainage, debridement, abx
Virchow triad
stasis
endothelial injury
hypercoaguability
Signs of posterior urethral injury
blood at urethral meatus
inability to void
high-riding prostate
Tx: retrograde urethrogram (do NOT blindly insert Foley)
Pulmonary contusion
can be caused by severe blunt trauma
sxs: dyspnea, tachypnea, chest pain, hypoxia worsened by intravascular volume expansion, patchy alveolar infiltrates on CXR
most common cause of small bowel obstruction
adhesions
Ladd’s bands
congenital adhesions in children
Complete SBO
n/v
abdominal bloating
dilated loops of bowel on xray
most common cause of lower extremity edema
venous insufficiency (valvular incompetence)
risk factors of Peripheral Artery Disease (PAD)
- increasing age
- DM
- cigarette smoking
- HTN
- HLD
Dx: ankle-brachial index (ABI) using Doppler
Ankle-Brachial Index (ABI)
ratio of systolic blood pressure of posterior tibial and dorsalis pedis arteries over systolic of brachial artery
NL: 1-1.3
abnormal 50% occlusion
< 0.4 consistent with limb ischemia
Tx: ASA and cilostazol
Post-procedure with dull abdominal pain and bloody diarrhea
Colonic ischemia
causes: loss of collateral circulation
manipulation of vessels with instruments
prolonged aortic clamping
impaired blood flow through inferior mesentaric
increased alkaline phosphatase
normal serum calcium and phosphorous
Paget’s disease of bone
Sxs of splenic injury
LUQ abd pain Abdominal wall contusion Left lower chest wall tenderness Hypotension Left shoulder pain (referred- irritation of phrenic nerve and diaphragm, Kehr's sign)
Hamman sign
crunching sound on auscultation of the heart due to mediastinal emphysema
sign of esophageal perforation
Causes of diabetic foot ulcers
neuropathy
microvascular insufficiency
immunosuppression
Minor head trauma
GCS of 15
normal mental status
normal neurologic and funduscopic exam
no physical findings of skull fracture
Tx: no neuroimaging, discharge observe for 24 hrs
Mild Traumatic Brain Imaging (TBI)
GCS 13-15 brief loss of consciousness vomiting headache disorientation
Tx: CT head, if normal discharge home
observe 4-6 hours if no symptoms
Moderate TBI
GCS 9-12 brief LOC vomiting headache disorientation
Tx: CT head, if normal discharge home
observe 4-6 hours if no symptoms
Severe TBI
GCS <8 focal neurologic signs seizure prolonged LOC evident skull fracture
Tx: CT head, admit for neuro checks
Signs of necrotizing surgical infection
Intense pain in wound Fever, hypotension, tachycardia Decreased sensation at edges of wound Cloudy-gray discharge Tense edema outside involved skin Subcutaneous gas with crepitus
Tx: early surgical exploration
Uncomplicated diverticulitis
LLQ pain, tenderness
fever
leukocytosis
inflammation and colonic wall thickening on CT
Tx: bowel rest, oral abx, observation
if elderly/immunocompromised- hospitalization
Complicated diverticulitis
diverticulitis with an abscess, perforation, obstruction, or fistula formation
Tx: < 3cm fluid collection- IV abx, observation
> 3cm fluid coll- CT guided drainage, drainage and debridement if CT guided does not work
colonic resection if recurrent symptoms
Legg-Calve-Perthes disease
idiopathic avascular necrosis of the femoral capital epiphysis
boys between 4-10
sxs: hip, knee, or groin pain with antalgic gait
Tx: observation and bracing
vaccinations after splenectomy
S. pneumoniae
N. meningitidis
H. influenzae
(encapsulated organisms)
anterior cord syndrome
commonly associated with burst fracture of vertebrae
total loss of motor function below lesion, loss of pain and temp below lesion bilaterally, intact proprioception
Systemic Inflammatory Response Syndrome (SIRS)
2 of 4
Temp > 38.5 C (101.3F) or < 35 C (95F)
HR > 90 bpm
RR > 20 /min
WBC > 12k, < 4K, or > 10% bands
seen in pancreatitis, autoimmune disease, vasculitis, burns
Glasgow Coma Scale
Eye opening (1-4), Verbal response (1-5), Motor response (1-6)
Ludwig angina
infection of submandibular and sublingual glands. Source usually from infected tooth (2nd or 3rd mandibular molar)
risk of asphyxiation
Marjolin ulcer
Squamous Cell Carcinoma arising with burn wounds
Succussion splash
indicative of pyloric stenosis/stricture
auscultate upper abdomen, rock patient at hips
Sxs of compartment syndrome
Severe pain
Pain with passive range of motion
Paresthesias
Pallor and paresis of affected limb
pulse presence does not rule out
