UWORLD Flashcards
Acute chemical peritonitis due to urine leak following trauma?
Rupture of dome of bladder
African American kid with bulge in abdomen …
Surgery required?
umbilical hernia
Surgery not usually required
Tx for large vs small pneumothorax in stable patients?
Large - needle thoracostomy
Small - supplemental O2
“Catching” knee pain, poss reduced range of motion, poss intermittent?
Meniscal tear, get MRI to assess if persistent
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
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)
Post-op AKI: BUN to Cr ratio? Two other signs?
Common cause?
Treat?
> 20:1, oliguria, no sediment
Intravascular volume depletion
Fluids
Traumatic amputation - what to do with body part?
Wrap in saline gauze, put in bag, put bag in ice
Skin cancer associated with chronic wounds/scars/inflamed skin?
SCC
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
Nerves and vessels at risk in supracondylar fractures of humerus?
Brachial artery and nerve
(no brachial or radil pulses)
Median nerve
Suspected urethral injury- what to do?
retrograde urethrogram
Pancreatitis with ALT >150 think?
Treat?
Gallstone pancreatitis
Cholecystectomy when medically stable enough for surgery
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
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
Cervical spine injuries intubation order?
stabilize the C-spine first then orotracheal intubation with rapid sequence if apneic
Fever, chest pain, high WBC, mediastinal widening post cardiac surgery - think?
Treat?
acute mediatinitis
drainage, surgiucal debridement and ABX
Twisting knee injury likely to be?
Meniscal tear
HD unstable BAT: order of management?
1) fluids
2) FAST exam
3) if fluid seen on FAST then urgent lap
Acute hemotpyysis management (4 steps):
1) establish airway
2) ensure HD stbility
3) lateral position with bleeding lung down
4) bronchoscopy to identify site
Penetrating wound (eg GSW) below 4th intercostal space (nipple level) - management if unstable or stable?
unstable: ex lap
stable: CT
Abd pain and bloody diarrhea (poss fever and leukocytosis) post-op on abd aorta (eg AAA repair)? Diagnosis?
Bowel ischemia/infarction
RUQ pain that gets WORSE with morphine and opioids?
Lab elevations?
Sphincter of Oddi dysfucntion
AST/ALT, alk phos
Pusatile groin mass (below inguinal lig) with ANTERIOR THIGH PIAN, worse with walking? Diagnx?
Femoral artery aneurysm
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?
CT
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
