uworld 3 surg Flashcards
positive impingement tests (neer, hawkins), think…
rotator cuff tendionopathy/impingement
rotator cuff impingement presentation
pain with abduction, external rotation
from repetitive activity above shoulder height
test to do for intermittent claudication
ABI
results of ABI and significance
<0.9: abnormal (occlusive PAD)
0.9-1.30: normal
>1.30: calcified, uncompressible vessels
which region of abdomen does mesenteric ischemia usually present
periumbilical
labs of mesenteric ischemia
high WBCs
elevated amylase and phosphate
metabolic acidosis (lactate)
what should be done right after chest venous catheter placement?
CXR to confirm correct placement (want to avoid pneumo or pericardial tamponade)
–unless US guided placement
reasons for post op fever within 2 hours of surgery
malignant hyperthermia
blood transfusion rxn
prior trauma/infection
reasons for post op fever within 1 week of surgery
nosocomial infections (UTI, pneumonia) MI, DVT, PE
drug fever
diagnosis of exclusion
1-2 weeks after med
rash, eosinophilia, subacute fever
signs of retroperitoneal hematoma
hypotension, tachy, flat neck veins
recent cardiac catheterization, heparin
most hemorrhage or hematoma forms __ hours after cardiac catheterization
12
diagnosis and treatment of retroperitoneal hematoma
dx: CT without contrast (or US)
tx: supportive
atelectasis most common which days post op
2-5
atelectasis has what blood gases levels
low O2, low CO2
resp alkalosis
emphysematous cholecystitis pathology
threatening
infection of gall bladder wall with gas-forming bacteria (clostridium, e coli)
emphysematous cholecystitis presentation
common in: gallstones, immunosupressed, vascular compromise
crepitus
diagnosis of emphysematous cholecystitis
air fluid levels in gall bladder
gas in gallbladder
pneumobilia
labs: hyperbilirubinemia, elevation in AST/ALT
treatment of emphysematous cholecystitis
emergent broad spectrum, broad abx
initial mangaement of hemoptysis
patent airway, adequate ventilation/perfusion
hemodynamic stability
put in dependent position (lateral)
initial imaging and therapy of choice for hemoptysis
bronchoscopy- suctions, can do electrocautery, baloon tamponade, etc.
Leriche syndrome
artial occlusion at bifurcation of aorta into iliacs
triad:
- bilateral, hip, thigh claudication
- impotence!!! always impotence
- symmetric atrophy of lower extremities (ischemia)
can you do a lap appendectomy just based on clinical diagnosis?
yes!
interpret blood with voiding in beginning, end, or throughout urinating
initial: urethritis, trauma
terminal: bladder, prostate, posterior urethra problems
throughout: kidney or ureter issues (eg. glomerular dz)
duodenal hematoms occur in
blunt abdominal trauma
duodenal hematoma presentation
peds patient- trauma
epigrastric pain, vomiting 24-36 after trauma
resolve in 1-2 weeks
what to do if duodenal hematoma doesnt resolve?
gastric decompression, percutaneous drainage
parenteral nutrition
bile reflux gastritis cause and symptoms
incompetent pyloric sphincter (following surgery) –> retrograde flow of bile into stomach and esophagus
–> vomiting, heartburn, abd. pain
sphincter of oddi presentation
recurrent, episodic RUQ or epigastric pain
aminotransferase and alk phos elevations
worse with opioids (cause sphincter contraction)
diagnosis and treatment of sphicter of oddi
dx: manometry
treat: sphincterotomy
2 separate pathophys mechanisms of sphincter of oddi
dyskinesia
stenosis
eval of blunt genitourinary trauma should always include what 2 things in hemodynamically stable patients
- UA
- CT of abdomen and pelvis
criteria for flail chest
> 3 contiguous ribs fractured in >2 locations
population for pilonidal cyst
obese, sedentary males aged 15-30
pilonidal cyst pathophys
hair follice infected in intergluteal region–> abscess
cyst distribution of pilonidal cyst vs folliculitis vs hidrantenitis suppurativa
pilnidal cyst: single 4-5 cm fluctuant mass
folliculitis: multiple small pruritic pustules
hidra: multiple recurrent painful nodules in axilla, inguinal and perianal areas
trochanteric bursitis presentation
pain when:
- pressure applied (eg. sleeping)
- external rotation
- resisted abduction
trochanteric bursitis cause
excessive frictional forces (overuse, trauma, crystals, infection)
how best to transport body organs
wrap in saline-moistened gauze in plastic bag
place bag on bed of ice
