UWORLD Flashcards by Richard Froude

Acute chemical peritonitis due to urine leak following trauma?

Rupture of dome of bladder

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African American kid with bulge in abdomen …

Surgery required?

umbilical hernia

Surgery not usually required

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Tx for large vs small pneumothorax in stable patients?

Large - needle thoracostomy

Small - supplemental O2

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“Catching” knee pain, poss reduced range of motion, poss intermittent?

Meniscal tear, get MRI to assess if persistent

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Early satiety, nausea, NONbilious vomiting, weight loss (esp with history of acid ingestions) - diagnx?
Common causes?

Pyloric stricture

Caused by Crohn’s, malignancy, PUD, ingestion of caustic agents

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Abd pain, gross hematuria with pelvic fracture - WITHOUT signs of peritonitis?

Extraperitoneal bladder injury (i.e. neck, anterior wall, anterolateral wall of bladder NOT the dome)

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Post-op AKI: BUN to Cr ratio? Two other signs?
Common cause?
Treat?

> 20:1, oliguria, no sediment
Intravascular volume depletion
Fluids

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Traumatic amputation - what to do with body part?

Wrap in saline gauze, put in bag, put bag in ice

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Skin cancer associated with chronic wounds/scars/inflamed skin?

SCC

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Warning signs for splenic injury following BAT?

Course of action?

Hypotension, pleuritic chest pain, left abd wall bruising, LUQ tenderness, guarging, referred pain to left shoulder
HD stable: FAST exam then CT if warning signs
AMS: straight to CT

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Nerves and vessels at risk in supracondylar fractures of humerus?

Brachial artery and nerve
(no brachial or radil pulses)
Median nerve

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Suspected urethral injury- what to do?

retrograde urethrogram

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Pancreatitis with ALT >150 think?

Treat?

Gallstone pancreatitis

Cholecystectomy when medically stable enough for surgery

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Hypotension (and HD instability) following cardiac catheterization (with possible ipsilateral flank or back pain) - THINK?
Diagnostics and tx?

Retroperitoneal hematoma
Get non-contrast CT of abd and pelvis
OR US abd
Then supportive tx, montoring and fluids/transfusion

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Diffuse abd pain, in settign of cardiac embolic events , or A-fib?
(high WBC, high HgB, high amylase, metabolic acidosis)

Ischemic bowel
Immediate surgery
Or CT angio to confirm diagnosis

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Cervical spine injuries intubation order?

stabilize the C-spine first then orotracheal intubation with rapid sequence if apneic

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Fever, chest pain, high WBC, mediastinal widening post cardiac surgery - think?
Treat?

acute mediatinitis

drainage, surgiucal debridement and ABX

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Twisting knee injury likely to be?

Meniscal tear

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HD unstable BAT: order of management?

1) fluids
2) FAST exam
3) if fluid seen on FAST then urgent lap

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Acute hemotpyysis management (4 steps):

1) establish airway
2) ensure HD stbility
3) lateral position with bleeding lung down
4) bronchoscopy to identify site

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Penetrating wound (eg GSW) below 4th intercostal space (nipple level) - management if unstable or stable?

unstable: ex lap
stable: CT

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Abd pain and bloody diarrhea (poss fever and leukocytosis) post-op on abd aorta (eg AAA repair)? Diagnosis?

Bowel ischemia/infarction

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RUQ pain that gets WORSE with morphine and opioids?

Lab elevations?

Sphincter of Oddi dysfucntion

AST/ALT, alk phos

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Pusatile groin mass (below inguinal lig) with ANTERIOR THIGH PIAN, worse with walking? Diagnx?

Femoral artery aneurysm

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Fever and lower abd/flank pain radiating to groin (PAIN WITH HIP EXTENSION) - think? Diagnose? Treat?

Psoas abscess CT Drainage/ABX

BGT trauma workup (HD stable vs unstable)

Urinalysis (If hematuria then) CT abd pelvis with contrast (if HD stable) If HD unstable, IV pyelogtpahy THEN surgical evaluation

Erythema and swelling, with SEVERE "out of proportion" pain, with creiptus, drianigs, gas in deep tissues ... and then hypotension ...THINK

Nec fasc

Sudden increase in activty, pain, second metatarsal - think? | Treat?

Stress fracture | Rest and analgesics

Best test for PAD (peripheral artery dz)?

Ankle-brachial index | better than duplex US - do after ABI if eval for intervention

Folks at greater risk for succinylcholine hyperkalemia?

Skeletal muscle trauma, burn, stroke, sedentary/paralyzed | So use rocuronium or vecuronium

How to diagnose possible diaphragm ruture when bowels in chest seen on KUB?

Hypovolemic shock: intial decrease in preload and cardiac output, followed by ...

Incr SVR, Incr HR, Incr EF

Common complication of scaphoid fratures?

Osteonecrosis

Hip pain that's bad when lying in bed, middle aged adult?

Trochanteric bursitis

How to avoid post-op parotitis? | Bug?

Hydrate well and good oral hygiene | Staph aureus

PAT: indications for ex lap?

HD unstable, peritonitis, blood in NG tube or per rectum, evisceration

Septic shock - management?

Replete fluids, then pressors to increase perfusion

Compartment syndrome when edema casues pressure to rise above ______ during reperfusion?

30mmHg

What anti-coag can you give with ESRD?

Unfractionated heparin and warfarin

PostOp PNA risks? | Prevention?

smoking, pulm dz, age >50, thoracic or abd surgery, longer than 3 hours, poor health Prevent with incentive spirometry/deep breathing exercises

If hypocalcemic - look at what other electrolyte to check for hypoparathyroid?

Phosphorus

Mild jaudice post surgery with unconjugated bilirubin the ONLY lab elevations?

Gilbert

Acute cholecystitis confirmed - management?

Lap chole within 72 hours

Very sick patient with gallstone cholecystitis sx but no gallstones (wal thickeing, distension, pericholecystic fluid - think? Treat?

Acalculous cholecystitis | Treat with abx and percutaneous cholecystostomy then surgery when stable

Infection organisms for burn patients? | Sign of infection?

Early: GP (staph) After 5 days: GN (pseudomonas) or fungi (candida) Sign: change in burn wound appearance or loss of skin graft

Blunt trauma, widened mediastinum and left-sided hemothorax? (if pt not already dead)

aortic injury

Pericardial tamponade - normal or abnormal cardiac contours/silhouette?

Normal

Shock after MVA with elevated baseline PCWP that goes even higher with fluid bolus?

Hypovolemic shock 2/2 myocardial contusion

Most common cause of SBO?

Post-surgical adhesions, even months ago

Effect of positive pressure ventilation on decreased CVP (eg hypovolemic shock)?

Increased intrathoracic pressure that leads to ... Acute loss of RV preload, loss of cardiac output, and sudden cardiac death

Gallstone passes through biliary-enteric fistula casues?

``` Gallstone ileus (a mechanical bowel obstruction), then you get air in loops of bowel Treat with surgical stone removal and cholecystectomy ```

Infections of prosthesis organisms and presentation (early vs late)?

Early: staph aureus (first 3 months) - acute pain, fever, local infx signs LAte: cog-neg staph - chronic pain, implant loose, gait impairment, sinus tract formation

GI and vasomotor sx (sweating, palps) post-gastectomy - think? Treat?

``` Dumping syndrome (rapid emptying of stomach contents) Treat with dietary modification ```

Appearance of ischemic bowel on imaging (post vasc surg)? | And on colonscopy?

Thickening of bowel wall Cyanotic mucosa and hemorrhagic ulcerations

Knee pain with erythema after repetitive kneeling? | Organism?

Prepatellar bursitis | Staph aureus

Initial hematuria suggests? Terminal hematuria? Totoal hematuria?

Urethral damage Bladder or prostate Kidney or ureter (no clots here)

Kid with epigastric pain and obstruction (bilious vomiting) following trauma?

Duodenal hematoma

Anal fissure tx?

Increase fiber and fluid intake, stool softeners, sitz baths, topical anesthetics and vasodilators

LE edema that worsen throughout day and resolves at night?

venous insufficiency

Whistling post rhinoplasty?

nasal septal perforation

Persistent pneumothorax with air leak following chest tube placement (also pseumomediastinum and sub-C emphyseam)?

tracheobronchial rupture

Eschar in third degree (full thickness, circumferential) burns restrcicts venous and lymphatic drainage and leads to ...

compartment syndrome

Multiple rib fractures and resp distress (with lung contusion on CXR) .. think?

Flail chest

Fever, sore throat, earache with muffled voice, tonsillar swelling, deviation of uvula - think? Treat?

Peritonsillar abscess | Aspiration or I and D

Retropharyngeal abscess (after trauma to posterior pharynx) can spread to??

Mediastinum (acute necrotizing)

Folks at risk for emphysematous cholecystitis? Arise due to? Treat?

Immunosuppressed (eg diabetic) Infx of gallbladder wall with gas-forming bacteria Emergent cholecystectomy

intense pain in wound, decreased sensivity, cloudy gray (dishwater) discharge, poss crepitus - signs of? Treat?

Necrotizing surgical infx | Surgical debridement and abx

4 Ts of mediastinal tumor?

Thymoma, teratoma, thyroid neoplasm, terrible lymphoma

Most common areas for ischemic bowel?

Splenic flexure, rectosigmoid junction

Tachypnea, tachycardia and hypoxia developingp in 24 hours after trauma with patchy alveolar infiltrate on CXR?

pulmonary contusion

Acute-onset, sever, mid abdominal pain out of proportion to physical exam findings (can be after infected valve leaflets)?

Acute mesenteric ischemia

Diverticulitis with abscess formation treatment?

Percutaneous dranage with CT and surgical drainage if that fails

Irregular scrotal mass that increases in size with standing and Valsalva - do not transilluminate?

Dilation of pampniform plexus (varicocele)

After placing central line, always next step?

Check placement with CXR

Three Ps of compartment syndrome?

severe PAIN PAIN with PASSIVE ROM PARESTHESIAS Then sensory and motor defecits

Define ileus?

Functional defect in bowel motility without associated physical obstruction

Acute abdomen in women - don't forget on differential?

Ruptured ovarian cyst

Constant gnawing epigastric pain, worse at night, anorexia with weight loss, jaundice, esp in smoker with fatigue?

Pancreatic cancer