UWorld Flashcards
What is mech of head elevation to lower ICP?
increased venous outflow from brain
What is mech for hyperventilation to lower ICP?
CO2 washout –> causes cerebral vasoconstriction
What is presentation of compartment syndrome?
pain out of proportion
pain on passive sretch
rapid increasing and tense swelling
paresthesia
What type of knee injury presents w/ acute knee injury w/ popping sensation and gradual development of joint swelling over days?
meniscus
What is presentation of trochanteric bursitis?
superficial u/l hip pain exacerbated by external pressure to lateral thigh (when lying on affected side in bed)
What is next step if pt w/ persistent sx of meniscal injury?
MRI, then athroscopic surgery if needed
Dx test for syringomyelia?
MRI
What is presentation of tibial stress fracture? Dx?
anterior part of middle 1/3 of tibia in pt involved in jumping injury
xrays frequently normal, dx by MRI or bone scan
What is next step if pt w/ clavicular fracture?
do neovascular exam
if bruit –> do angiogram to rule out injury to underlying vessel
What is tx for clavicle fracture?
fracture milddle third = tx nonoperatively w/ brace, rest, ice
fracture distal 1/3 = open reduction and fixation
What is presentation of MCL tear?
abduction injury to knee
valgus stress test
What part of knee is likely injured if locking of knee joint during terminal extension and palpable/audible snap while slowly extending leg from full flexion with applying tibial torsion?
medial meniscus = mcmurrays sign
What is presentation of uncal herniation?
2/2 R epidural hematoma
- ipsilateral hemiparesis
- mydriasis, ptosis, down and out gaze 2/2 to compression ipsilateral oculomotor n.
- contralateral homonymous hemianopsia from compression ipsi possterial cerebral artery
- altered consciousness
What is likely cause of LE paraplegia after thoracic aortic aneurysm repair?
anterior spinal cord syndrome –> infarcation of anterior 2/3 of spinal cord
- flaccid paralysis
- loss of pain/temp
- UMN sx
- bowl and bladder dysfunction
- preserved vibration and proprioception
What is next step if pt w/ signs of scaphoid fracture but normal xray?
do thumb immobilization in spica cast and repeat XR in 7-10 days
What are complications of supracondylar fracture of humerus?
- brachial artery injury or median nerve injury = most common complications
- cubitus varus deformity
- compartment syndrome/volkman ischemic contracture are rare
What nerve is likely injured in pt who has shoulder pain , holds arm in external rotation and resists internal rotation?
axillary nerve may be injured 2/2 anterior shoulder dislocation
What motor and sensory function of femoral nerve?
- leg flexion at hip, extension at knee
- sensation anterior thigh and medial leg via saphenous
What motor and sensory function of tibial nerve?
- flexion of knee and digits, plantar flexion of foot
- sensation of leg except medial side and plantar foot
What motor and sensory function of obturator nerve?
- adduction of thigh
- sensation over medial thigh
What motor and sensory function of common peroneal nerve?
- muscles of anterior and lateral leg
- sensation to anterolateral leg and dorsum of foot
What is tx for scaphoid fracture?
wrist immobilization 6-10 wks
What is tx for stress hairline fracture of metatarsal?
rest, analgesia, hard soled shoe
What is presentation of rotator cuff tendinopathy?
pain w/ abduction, external rotation
normal ROM w/ positive neer/hawkins tests
What is presentation of rotator cuff tear?
weakness w/ external rotation, age > 40
What is presentation of adhesive capsulitis (frozen shoulder)?
decreased passive and active ROM
more stiffness than pain
What is presentation of biceps tendinopathy/rupture?
anterior shoulder pain
pain w/ lifting, carrying or overhead reaching
weakness less common
What is presentation of glenohumeral osteoarthritis?
- uncommon and usually 2/2 trauma
- gradual onset anterior or deep shoulder pain
- decreased active and passive abduction and external rotation
What are risk factors, presentation for ischemic colitits?
risks: age > 60, chronic renal dz/hemodialysis, MI, repair of AAA or ther vascular procedure
clinical: pain and tender, hematochezia, diarrhea, lactic acidosis
How do you dx ischemic colititis?
CT: thick bowel wall, double halo sign, pneumatosis coli
colonoscopy: mucosal pallor or cyanosis, petechia, hemorrhage
What are sx of pancreatic adenocarcinoma?
wt loss, anorexia ab pain/back pain --> epigastric pain worse at night jaundice recent onset DM migratory superficial thrombophlebitis hepatomegaly and ascites
What is presentation of duodenal ulcer?
periodic epigastric pain relieved by meals
What is next best step if pt w/ massive hemoptysis continuing to bleed?
bronchoscopy to localize bleeding site, suction to visualize and therapeutic intervention
What is likely dx if pt w/ fever, chills, deep abdominal pain after ab trauma?
pancreatic laceration w/ retroperitoneal abscess
pancreatic laceration can be missed by CT immediately following trauma, may need to do serial CTs
What do you see on ABG in atelectasis?
- high pH
- low PO2
- low PCO2
= resp alkalosis
What are pre-op strategies to reduce risk of post-op pulmonary complications?
- smoking cessation 8 wks before surgery
- control COPD
What are post-op strategies to decrease post-op pulmonary complications?
- incentive spirometry
- deep breathing exercises
- epidural analgesia instead of opioids
- continuous positive airway pressure
What should you think if pt w/ blunt ab trauma, delayed onset hypotension, LUQ pain, L shoulder pain? dx?
splenic injury
dx = CT w/ IV contrast
if persistent hemodynamic instability –> urgen laparotomy
What is order of next steps if pt is hemodynamically unstablee and suspected blunt ab trauma?
- immobilize cervical spine
- IVF
- FAST = U/S
- if U/S w/ blood in hemodynamically unstable –> do urgen laparotomy
- if U/S w/ blood but hemodynamically stable –> do CT w/contrast
What is presentation of dumping syndrome?
ab pain, D/N, hypotension, tachycardia, dizziness, confusion, fatigue, diaphoresis
timing: 15-30 min after meals
path: rapid emptying of hypertonic gastric contents
What is likely etiology if pt w/ respiratory acidosis but normal Aa gradient?
hypoventilation
How do you calculate A-a gradient? what has high Aa gradient? normal?
Aa = PAO2 - Pao2, normal
What is pilonidal disease?
acute pain and swelling of midline sacrococcygeal skin and SQ tissue, may present as dermal sinus tract
tx: I&D