UWorld Flashcards
1
Q
What is mech of head elevation to lower ICP?
A
increased venous outflow from brain
2
Q
What is mech for hyperventilation to lower ICP?
A
CO2 washout –> causes cerebral vasoconstriction
3
Q
What is presentation of compartment syndrome?
A
pain out of proportion
pain on passive sretch
rapid increasing and tense swelling
paresthesia
4
Q
What type of knee injury presents w/ acute knee injury w/ popping sensation and gradual development of joint swelling over days?
A
meniscus
5
Q
What is presentation of trochanteric bursitis?
A
superficial u/l hip pain exacerbated by external pressure to lateral thigh (when lying on affected side in bed)
6
Q
What is next step if pt w/ persistent sx of meniscal injury?
A
MRI, then athroscopic surgery if needed
7
Q
Dx test for syringomyelia?
A
MRI
8
Q
What is presentation of tibial stress fracture? Dx?
A
anterior part of middle 1/3 of tibia in pt involved in jumping injury
xrays frequently normal, dx by MRI or bone scan
9
Q
What is next step if pt w/ clavicular fracture?
A
do neovascular exam
if bruit –> do angiogram to rule out injury to underlying vessel
10
Q
What is tx for clavicle fracture?
A
fracture milddle third = tx nonoperatively w/ brace, rest, ice
fracture distal 1/3 = open reduction and fixation
11
Q
What is presentation of MCL tear?
A
abduction injury to knee
valgus stress test
12
Q
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?
A
medial meniscus = mcmurrays sign
13
Q
What is presentation of uncal herniation?
A
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
14
Q
What is likely cause of LE paraplegia after thoracic aortic aneurysm repair?
A
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
15
Q
What is next step if pt w/ signs of scaphoid fracture but normal xray?
A
do thumb immobilization in spica cast and repeat XR in 7-10 days
16
Q
What are complications of supracondylar fracture of humerus?
A
- brachial artery injury or median nerve injury = most common complications
- cubitus varus deformity
- compartment syndrome/volkman ischemic contracture are rare
17
Q
What nerve is likely injured in pt who has shoulder pain , holds arm in external rotation and resists internal rotation?
A
axillary nerve may be injured 2/2 anterior shoulder dislocation
18
Q
What motor and sensory function of femoral nerve?
A
- leg flexion at hip, extension at knee
- sensation anterior thigh and medial leg via saphenous
19
Q
What motor and sensory function of tibial nerve?
A
- flexion of knee and digits, plantar flexion of foot
- sensation of leg except medial side and plantar foot
20
Q
What motor and sensory function of obturator nerve?
A
- adduction of thigh
- sensation over medial thigh
21
Q
What motor and sensory function of common peroneal nerve?
A
- muscles of anterior and lateral leg
- sensation to anterolateral leg and dorsum of foot
22
Q
What is tx for scaphoid fracture?
A
wrist immobilization 6-10 wks
23
Q
What is tx for stress hairline fracture of metatarsal?
A
rest, analgesia, hard soled shoe
24
Q
What is presentation of rotator cuff tendinopathy?
A
pain w/ abduction, external rotation
normal ROM w/ positive neer/hawkins tests
25
What is presentation of rotator cuff tear?
weakness w/ external rotation, age > 40
26
What is presentation of adhesive capsulitis (frozen shoulder)?
decreased passive and active ROM
| more stiffness than pain
27
What is presentation of biceps tendinopathy/rupture?
anterior shoulder pain
pain w/ lifting, carrying or overhead reaching
weakness less common
28
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
29
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
30
How do you dx ischemic colititis?
CT: thick bowel wall, double halo sign, pneumatosis coli
colonoscopy: mucosal pallor or cyanosis, petechia, hemorrhage
31
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
```
32
What is presentation of duodenal ulcer?
periodic epigastric pain relieved by meals
33
What is next best step if pt w/ massive hemoptysis continuing to bleed?
bronchoscopy to localize bleeding site, suction to visualize and therapeutic intervention
34
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
35
What do you see on ABG in atelectasis?
- high pH
- low PO2
- low PCO2
= resp alkalosis
36
What are pre-op strategies to reduce risk of post-op pulmonary complications?
- smoking cessation 8 wks before surgery
| - control COPD
37
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
38
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
39
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
40
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
41
What is likely etiology if pt w/ respiratory acidosis but normal Aa gradient?
hypoventilation
42
How do you calculate A-a gradient? what has high Aa gradient? normal?
Aa = PAO2 - Pao2, normal
43
What is pilonidal disease?
acute pain and swelling of midline sacrococcygeal skin and SQ tissue, may present as dermal sinus tract
tx: I&D
44
What should you do if pt w/ acute GI perforation requiring emergent laparotomy but on warfarin?
pre-op FFP
45
What is initial sign of hypovolemia?
HR increase
46
What are the components of GCS?
- eye opening
- verbal response
- motor response
47
What is next step if pt in hemodynamic shock w/ sharp penetrating ab trauma?
do emergent laparotomy (do not delay for imaging procedure)
48
What is presentation of postop ileus?
- N/V, ab distension, failure to pass flatus/stool
| - hypoactive bowel sounds (vs obstruction = hyperactive tinkling)
49
What is likely etiology of nontender bony mass on hard palate?
torus palatinus = chronic benign bony growth
| - congenital
50
What are likely causes of immediate post op fever (w/in 2 hrs)?
- prior trauma/infection
- blood products
- malignant hyperthermia
51
What are likely causes of acute post op fever (24hr-1wk)?
- nosocomial infection
- surgical site infection
- MI
- PE
- DVT
52
What are likely causes of subacute post op fever (1k - 1mo)?
- surgical site infeciton
- catheter infection
- CDiff
- Drug fever
- PE/DVT
53
What are likely causes of delayed post op fever (> 1 mo)?
viral
| surgical site infection
54
What is next step if pt w/ eschar constriction of hand?
present: decreased pulses, edema distal to burn
tx: eschartotomy to relive pressure on vascular supply
55
What is presentation of psoas abscess?
- subacute fever, ab/flank pain radiating to groin
- anorexia, wt loss
- ab pain w/ hip extension (psoas sign)
56
How do you dx psoas abscess? tx?
CT ab/pelvis
tx: drain, abx
57
What is presentation of hemothorax?
- pt w/ signs of hemorrhage/vol depletion
- trachial deviation to opposite site
- decreased breath sounds, dullness to percussion
58
What is presentation of pulm contusion?
- chest wall bruise, decreased breath sounds, CXR w/ patchy irregular alveolar infiltrates
- differentiate from ARDS b/c occurs w/in 24 hrs and U/l (vs ards 24-48 hrs and B/L)
59
What are some things you can do to increase functional residual capacity post-op?
- control pain
- avoid too many narcotics which decrease resp drive
- sit upright if obese
- encourage deep breaths, IS
60
What is presentation of umbilical hernia? tx?
defect at linea alba covered by skin, sometimes has bowel in it, umbicilar cord inserts at apex of defect
associated w/ hypothyroid, premature, beckwith wiedemann
if small --> close spontaneously
if hasnt closed by 5yo --> surgical closure
61
What is presentation of gastroschisis?
defect to R of cord insertion and not covered by membrane or skin
umbilical cord next to defect
tx: surgical emergency
62
What is presentation of omphalocele?
midline ab wall defect covered by peritoneum containing ab organs
tx: immediate surgery
63
What is next step if pt w/ small bowel obstruction?
initially conservative w/ NGT, pain control, fluid resuscitation
fever, tachycardia, leukocytosis, met acidosis or other sx of strangulation --> do urgent surgery
64
What is next step if FAST exam inconclusive in hemodynamically unstable pt?
do diagnostic peritoneal lavage
65
What does it mean if pt has ab succussion splash?
gastric outlet obstruction
66
What is common complication of acid ingestion causing N/V, early satiety?
pyloric stricture
67
What is leriche syndrome?
aortoiliac occlusion
riad = bilateral hip, thigh, and buttock claudication, impotence, symmetric atrophy of B/L lower extremities
68
What is next step if pt w/ duodenal hematoma following blunt ab trauma?
usually resolves spontaneously --> NG suction and parental nutrition
surgery to evacuate hematoma if fails to resolve
69
What is tx for DVT?
heparin, to warfarin for 3 months
70
What is presentation of pulm contusion?
- hypoxia, resp distress, pulm edema
- worse w/ IVF
- resp alkalsosis, hypocarbia
71
What is presentation of myocardial contusion?
present w/ arrhythmia, HF, chest pain
| high PCWP
72
What is a marjolin ulcer?
SCC arising within burn mound
73
What sould you think if pt w/ pulsatile groin mass and thing pain?
femoral artery aneurysm causing compression of femoral nerve lateral to the artery
74
What is classic presentation of appendicitis such that you don't need to get CT and can go straight to appendectomy?
- migratory pain, nausea, vomiting, fever, leukocytosis, mcburney point tenderness, rovsing sign
75
What is next step if suspect penile fracture?
retrograde urethrogram to rule out urethral injury and then surgical exploration
76
How do you dx aortic dissection?
contrast chest CT or TEE
77
What should you think if pt w/ neck pain, fever, limited neck mobility 2/2 pain, inability to open mouth normally, and limited cervical extension?
retropharyngeal abscess
78
what is dx? tx? for retropharyngeal abscess?
dx: CT neck or lateral radiographs
tx: IV abx and drainage
79
What does it mean if pt has high respiratory quotient (ratio co2 produced to O2 consumed)?
net lipogenesis and high oxidation of carbohydrates
80
What should you think if pt presents w/ acute onset severe back pain, syncope, and hypotension?
AAA rupture
81
What levels of ABI are normal?
normal 0.91-1.3
| > 1.3 = calcified
82
What should you think if pt w/ persistent pneumothorax and air leak after chest tube pt in pt w/ blunt chest trauma?
tracheobronchial rupture
| dx high rest CT or bronchoscopy
83
What should you think if pt w/ blunt ab/pelvis trauma and pain referring to shoulder? what urological injury could cause this?
intraperitoneal rupture of bladder dome can cause chemical peritonitis
84
What is presentation of posterior urethral injury?
associated w/ pelvic fracture
| blood at urethral meatus, high riding prostate, scrotal hematoma, inability to void despite urge, distended bladder
85
What is presentation of anterior urethral injury?
2/2 straddle injury
or instrumentation
sx: perineal tender, hematoma, normal prostate, bleeding from urethra, no inability to urinate
86
What should you think if pt w/ blunt thoracic trauma presents w/ hypotension, tahcycardia, elevated JVP with normal CXR?
cardiac tamponade
tx: decompress by pericardiocentesis or surgical pericardiotomy
87
What is mc organism in prosthetic joint infection w/in 3 mo of arthroplasty? presentation? tx?
mc = staph aurea, gram neg, anaerobes
wound drains, erythema, swelling, fever
tx: remove implant or debride and retain implant
88
What is mc organism in prosthetic joint infection after 3 mo of arthroplasty? presentation? tx?
mc = coag neg staph, enterococci
persistent joint pain, implant loosening
tx: usually remove/exchange implant
89
What is next step in dx workup if concern for retroperitoneal hematoma?
noncontrast CT abdomen/pelvis or ab US
90
What are the 4Ts of anterior mediastinal masses?
- thymoma
- teratoma + other germ cell tumors
- thyroid neoplasma
- terrible lymphoma
91
What is tx for appendiceal abscess?
IV abx, bowel rest, possible percutaneous drainage
| interval appendectomy in 6-8 wks once inflammation has gone down a bit
92
What should you suspect if pt following cardiac surgery w/ fever, CP, leukocytosis, mediastinal widening on CXR? next step?
likely post op mediastinitis, also see pus in mediastinum
| tx = surgical debride and immediate closure w/ abx
93
What is tx for complicated diverticulitis w/ abscess, perforation, obstruction, or fistula?
fluid collection > 3cm should have CT guided percutaneous drainage
if sx not controlled by d5 do surgical drain and debride
sigmoid resection only for pt w/ fistula, perforation w/ peritonitis, obstruction
94
When do you give just tetanus vaccine in pt w/ wound? what about both vaccine and IG?
just vacine = if clean wound and last dose > 10 yrs ago, or dirty wound w/ last dose > 5 yrs ago
OR if unimmunized and clean/minor wound
do vaccine + IG if dirty wound and unimmunized or uncertain
95
What is presentation of chronic pancreatitis?
chronic epigastric ab pain radiating to back and relieved by leanding fwd
+ steatorrhea, wt loss, diarrhea
96
What are lynch syndrome criteria? what types of tumors?
1. 3 relatives w/ CRC one must be first degree of other two
involves 2+ genereations
one case dx
97
What is workup of minimal BRBPR?
50 or red flags: do colonoscopy
98
What is next step after suspect cirrhosis?
assess for complications:
- do EGD yearly (and start BB for prevention)
- screen for ascites, HE
99
What screening exams should pts w/ cirrhosis have?
- yearly EGD for varices
| - US q6mo for HCC surveillance
100
What is initial dx test for toxic megacolon?
ab xr w/ colon > 6cm
101
What is tx for toxic megacolon?
NGT, NPO, steroids or abx
| will need emergent surgery if does not respond to medical therapy
102
What does initial hematuria suggest? terminal hematuria? total hematuria?
initial: urethral damage
terminal: bladder or prostate
total: kidney or ureters
clots = rarely seen w/ renal
103
What FeNa, Urine Na, Urine Osm suggest ATN?
urine osm 300-350
Urine Na > 20
FeNa > 2%
104
What does urine Cl >20 suggest in metabolic alkalosis?
high urine chloride suggests saline unresponsive metabolic alkalosis
105
How do you assess acutely compensation in metabolic acdiosis? met alk? resp acid? resp alk?
met acidosis: winters
- expected PO2 = 1.5 x HCO3 + 8 +/-2
met alk:
- increase PCO2 by 0.7 for every 1 increase in HCO3
resp acid:
- increase HCO3 by 1 for every 10 increase in PCO2
resp alk:
- decrease HCO3 by 2 for every 10 decreased in PCO2
106
What electrolyte disturbances in adrenal insufficiency?
non-gap metabolic acidosis
- hyponatremia
- hyperkalemia
107
What electrolyte disturbances associated w/ loop diuretic?
- elevated BUN 2/2 losing volume
- metabolic alkalosis
- prerenal AKI
- hypokalemia
108
What is tx for SIADH?
fluid restriction
| if sever symptomatic or resistant hyponatremia can give hypertonic saline
