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UWORLD-Surgery > Uworld > Flashcards

Uworld Flashcards

1
Q

Wallenberg syndrome

A

Right side lateral medullary infarction
Occlusion of post inf cerebellar or vertebral artery
-vertigo, nystagmus
-ipsi face and contra trunk loss of pain and temp
-hoarse, dysphagia, dysarthria
-Horner’s syndrome

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2
Q

Nasopharyngeal carcinoma

A

Reactivation of EBV
Assoc with asia, africa, middle east
-nasal congestion with epistaxis, HA, CN palsies, otitis media, cervical LN spread

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3
Q

Amiodarone side effects

A

Antiarrhythmic for ventricular probs

  • thyroid probs, hepatotoxicity, bradycardia, heart block, neuro and vision probs
  • pulmonary toxicity (interstitial pneumonitis)
  • blue/gray skin
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4
Q

Post-op Atelectasis

A

Hypoxemia, hypocapnia, respiratory alkalosis

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5
Q

Methotrexate side effects

A

DMARD
Give with folate
Side effects: gastrointestinal symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity,
pulmonary toxicity, and bone marrow suppression (macrocytic anemia, leukopenia,
thrombocytopenia)

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6
Q

Initial management of massive hemoptysis

A

Establish patent airway
Maintain adequate ventilation and gas exchange
Keep hemodynamically stable
Place patient in dependent (lateral) position
Bronchoscopy for early intervention

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7
Q

Earliest renal abnormality in a diabetic patient

A 
Glomerular hyperfiltration
(ACEi super important to reduce intraglomerular hypertension)
Thickening of the BM is the first quantifiable change
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8
Q

Provoked DVT risk factor and treatment

A

Risk factor: major surgery, long periods of sitting
3 months of anticoagulation
If stable, start in 48-72 hours
Heparin (goal INR (2-3) then bridge to warfarin
(No LMWH if ESRD patient (metabolized by kidney), use IV unfractionated instead)

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9
Q

Prepatellar bursitis

A

“Housemaid’s knee”- repetitive kneeling

Due to Staph aureus infection

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10
Q

Complications after cardiac cath

A

bleeding, hematoma (localized or with retroperitoneal extension), arterial dissection, acute
thrombosis, pseudoaneurysm, or arteriovenous fistula formation

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11
Q

S/p cardiac cath, now hemodynamically unstable with back/flank pain
Next step?

A

Retroperitoneal hematoma

Non con CT A/P or U/S
Bed rest, fluids, ICU

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12
Q

Vitamin D toxicity

A

Super high doses

N/V, confusion, polyuria, polydipsia

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13
Q

Multiple Myeloma

A

Plasma cell neoplasm- excessive production of a single Ab
Bone pain, hypercalcemia, anemia, renal insufficiency, increased risk of fractures and infections
(hypogammaglobulinemia)

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14
Q

When to get a cholecystectomy?

For acute cholecystitis, choledocholithiasis, gallstone pancreatitis

A

Within 72 hours

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15
Q

When to get a cholecystectomy?

Gallstones with/without colic symptoms

A

With: elective
Without: no tx

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16
Q

Causes of hypoventilation with respiratory acidosis

A

Pulmonary/thoracic diseases: Chronic obstructive pulmonary disease, obstructive sleep apnea,
obesity hypoventilation, scoliosis
Neuromuscular diseases: Myasthenia gravis, Lambert-Eaton syndrome, Guillain-Barré syndrome
Drug-induced hypoventilation: Anesthetics, narcotics, sedatives
Primary central nervous system dysfunction: Brainstem lesion, infection, stroke

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17
Q

Uncal Herniation

A

Contralateral cruz cerebri- ipsi hemiparesis
Ipsi oculomotor n.- mydriasis, ptosis, down and out gaze
Ipsi post cerebral a.- contra homonymous hemianopsia
Reticular formation- AMS, coma

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18
Q

Most common tendinopathy with fluoroquinolone use

A

Achilles

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19
Q

Malaria symptoms

A

Cyclical fever: cold, hot, sweating phases
Anemia, thrombocytopenia
GI and nonspecific symptoms

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20
Q

Malignant PTH-independent hypercalcemia

A 
Humoral hypercalcemia of malignancy:
SCC- PTHrP; 1,25 vit D levels low/normal
Osteolytic bone mets- bony destruction
Lymphoma- incresed 1,25 Vit D
Multiple Myeloma- increased IL-6
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21
Q

Costocochondritis ssx and tx

A

Tenderness of 1+ rib or sternum joints
Sharp reproducible pain with palpation
Reassurance and OTC pain meds

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22
Q

Systemic Sclerosis symptoms

A

Thick, hard, edema, pruritis skin
GI, joint and respiratory problems
Smooth muscle atrophy and fibrosis of lower esophagus

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23
Q

Malignancy red flags

A

Anorexia, weight loss, systemic symptoms

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24
Q

Epigastric Pain: Pancreatic cancer v. Duodenal ulcer

A

P: constant, gnawing, worse at night, anorexia, weight loss, jaundice
D: episodic, relieved by meals

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25
Q

Most common hypercoagulable disorder

A

Factor V Leiden

Prothrombin mutation

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26
Q

Hereditary Hemochromatosis

A

Bronze diabetes
Hepatomegaly
Calcium pyrophosphate dihydrate crystal deposition
-chondrocalcinosis, pseudogout, chronic arthropathy
Get iron studies

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27
Q

Anterior uveitis symptoms, findings, causes

A

Painful, red eye, tearing, photophobia, decreased visual acuity
ciliary flush, pupillary constriction, a hazy “flare” in the aqueous humor, and hypopyon
Idiopathic, traumatic, systemic inflammatory disease

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28
Q

Inheritance of hypertrophic cardiomyopathy

A

Autosomal dominant

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29
Q

Signs of severe aortic stenosis

A

Pulsus parvus and tardus
Mid to late peaking murmur
Soft S2

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30
Q

Mixed cryoglobulinemia syndrome

A

Immune complex deposition disorder- sm to med blood vessels
Associated with HCV
Fatigue, palpable purpura, arthralgias, renal disease, peripheral neuropathies
Lab: cyroglobulins, hypocomplementemia, +RA, inc. ALT/AST, kidney injury

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31
Q

Bowel dilation in small bowel obstruction v. Ileus

A

SBO- sm bowel only

I- sm and large bowel

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32
Q

Crystal induced AKI

A

High dose IV acyclovir
24-48 hr after drug given
Crystalizes in renal tubules -> obstruction
Give with IV fluids

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33
Q

Lead poisoning

A

GI: abd pain, constipation
Neuro: forgetful, motor and sensory neuorpathies (stocking glove)
Microcytic anemia- basophillic stippling
Hyperuricemia
Batteries, manufacturing, plumbing, home distillation of alcohol

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34
Q

Angiosarcoma

A 
internal lining of blood and lymphatic vessels
Exposure to radiation therapy (breast cancer) (may be 4-8 years later)
Chronic lymphedema (axillary LN resection)
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35
Q

Signs of complicated SBO

A

Need surgery
Change in pain, unstabe, peritoneal signs, metabolic acidosis, fail to improve after conservative
measures

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36
Q

Mesenteric Ischemia

A

Acute- embolism from cardiac valve vegetation/afib
Acute on chronic- atherosclerosis
Pain out of proportion to exam, meta acidosis, hemoconcentration, inc amylase

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37
Q

Late findings in Alzheimer dementia

A

Hallucinations, EPS, seizures, urinary incontinence, dyspraxia

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38
Q

Acalculous cholecystitis

A

Inflammation without stones
Post surgery, hospitalized, critically ill
GB stasis/injury
Fever, leukocytosis, RUQ pain, jaundice, +/- abnl labs

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39
Q

Frostbite treatment

A

Rapid rewarming with warm water (98.6-102.2F)
Agressive analgesia
Dont rewarm if refreeze is possible

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40
Q

ARDS

A

Fluid/cytokine leak into alveoli
Decreased compliance, impaired gas exchange (V/P mismatch)
Hypoxemia (PaO2/FiO2 <= 300)
Pulm HTN

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41
Q

Second degree AV block, Mobitz type I

A

Block at AV node
Progessively prolonged PR, then drop of QRS
Low risk of complete heart block
Observation, correct reversible causes (dig, BB, CCB)

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42
Q

Alcoholic Hepatitis

A

Fever, jaundice, anorexia, tender hepatomegaly

AST x2 ALT (both less than 300)

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43
Q

Work up of elevated transaminases

A

History: risk factors for hepatitis (alcohol, travel, transfusions, high risk behavior, medicines,
drugs)
D/C alcohol and drugs, repeat labs in 6 months
Test for hep b/c, hemochromatosis, NAFLD, etc
Test for muscle or thyroid disorders

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44
Q

Treatment for acute glaucoma

A

Mannitol, acetazolamide, pilocarpine, timolol

Avoid atropine

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45
Q

Side effects of loop diuretics

A

Hypokalemia, metabolic alkalosis, prerenal AKI

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46
Q

Bullous pemphigoid

A

Prodrome: uticarial or eczematous lesions
Pruritis and tense bullae
Dx: biopsy
Immunoflourescence linear IgG adn C3 along BM
Tx: high dose steroid

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47
Q

Sjogren Syndrome

A

Dry mouth and eyes
Lymphocytic infiltration of salivary glands
Ab against SSA (Ro) and/or SSB (La)

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48
Q

Supracondylar Fracture of the humerus

A

More common in kids

Brachial artery and median nerve entrapment

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49
Q

Initial management of osteoarthritis

A

Weight loss, exercise, strengthen quads, NSAIDs

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50
Q

Treatment for cancer related anorexia/cachexia

A

Progesterone analogues > steroids

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51
Q

Differential diagnosis of cough, hilar adenopathy, erythma nodosum, non caseating granuloms

A

Sarcoidosis, Histoplasma, Blastomyces, Coccidioides

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52
Q

Nitrates mechanism of action

A

Vasodilators- veins, arterioles and coronary arteries
Decreased preload and left vent end diastolic volume
Reduces myocardial demand and wall stress

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53
Q

Zinc deficiency

A

Hypogonadism, impaired taste, impaired wound healing, alopecia, skin rash (can be around
mouth)

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54
Q

Primary Adrenal Insufficiency

A 
Cortisol low
ACTH high
Aldosterone low
Severe symptoms (hyperpig, hyperK, hypoNa, hypoTN)
Autoimmune
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55
Q

Central Adrenal Insufficency

A 
(Seconday/pit) (tertiary/hypothal)
Cortisol low
ACTH low
Aldosterone normal
Chronic steroid use
Less severe symptoms (no hyperpig, no hyperK, possible hypoNa)
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56
Q

Differential for unilateral hip pain in middle age adult

A

Infection, trauma, arthritis, bursitis and radiculopathy

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57
Q

Most common renal stone

A

Calcium stones

Encourage low sodium diet to promote calcium reabsorption

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58
Q

Sphincter of Oddi cause and symptoms

A 
Dyskenesia or stenosis
Postcholecystectomy RUQ pain
Recurrent colicky pain
Elevations in LFTs and Alk phos
Dilated bile duct/no stones
Opioids cause sphincter contraction
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59
Q

Signs of necrotizing fasciitis

A 
Pain, edema, redness beyond surgical site
Fever, hypoTN, tachycardia
Parathesia, anesthesia on wound edges
Purulent, gray cloudy discharge
Gas or crepitus
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60
Q

Pt had blunt abdominal trauma now hypotensive, intraperitoneal fluid found on FAST, RUQ pain, bruising across abdomen and right shoulder pain

A

Liver laceration

Shoulder pain due to phrenic nerve irritation

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61
Q

Whipple’s disease

A

Tropheryma whippelii
White men 50-60s
Arthralgias, weight loss, fever, diarrhea, abdominal pain
PAS+ in lamina propria of small intestine

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62
Q

Exam findings with a medial meniscus tear

A

Clicking, palpable locking or catching when joint is extended under load

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63
Q

Weight loss, jaundice, Courvoisier sign, intra and extra hepatic billiary tract dilation

A

Pancreatic cancer

Courvoisier sign: nontender, distended, palpable gall bladder on exam

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64
Q

Treatment of urgency incontinence

A

UA
Bladder training and pelvic floor exercises
Antimuscarinic drug

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65
Q

Work up for male with urinary frequency, nocturia and hesitancy

A

UA- hematuria/infection

DRE/PSA- prostate

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66
Q

Lab results of G6PD deficiency

A

Lab results:
Low Hb, inc indirect bili, inc lactate dehydrogenase, dec haptoglobin
Neg Coombs
Bite cells

Wait 3 mo after an attack before testing enz activity

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67
Q

Side effect of normal saline

A

Hyperchloremic metabolic acidosis

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68
Q

Single subcapsular cyst on the right hepatic lobe found on imaging

A

Amebic liver abscess
Entamoeba histolytica- protozoan
Causes colitis

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69
Q

Porphyria cutanea tarda

A

Fragile, photosensitive skin, vesicles and bullae (dorsa of hands)
Scaring, hyper/hypo pig
Assoc. with HCV
Increased plasma and urine porphyrins
TX: serial phlebotomy, hyroxychloroquinone, HCV tx

70
Q

Reason for anemia, leukopenia and thrombocytopenia in SLE

A

Anemia- chronic dx, Fe def, renal insufficiency, autoimmune hemolytic

L- autoimm destruction, meds, bone marrow dysfxn

T- immune mediated destruction, meds, TTP

71
Q

Common causes of digital clubbing

A

Lung cancer, cystic fibrosis, right to left cardia shunts

72
Q

Why is involvement of the the external ear more suggestive of erysipelas than cellulitis?

A

The skin of the external ear lacks a lower dermis level

Cellulitis involves the deep dermis and subQ fat

73
Q

Primary polydipsia v. SIADH

A

PP: serum osm <290, urine osm <100- more likely in psych patients
SIADH: serum osm <290, urine osm >100, urine Na >25- urine osm > serum osm

74
Q

Four Ts of anterior mediastinal mass

A

Thymoma

Teratoma (and other germ cell tumors):
—seminomas: bHCG
—nonseminomatous: AFP and bHCG

Thyroid neoplasm
Terrible lymphoma

75
Q

Signs of extraperitoneal bladder injury

A

Neck, anterior wall, anterolateral wall of bladder damaged
-localized pain, gross hematuria, +/- pelvic fracture
NO peritoneal signs

76
Q

Varicocele, which side is more common?

A

Dilation of pampiniform plexus veins
“Bag of worms” soft irregular mass
Inc in size with standing and valsalva

More common on left due to compression of left renal vein by the SMA and aorta

77
Q

Zollinger-Ellison Syndrome

A

Gastrin secreting tumor (>1000)
Duodenal, jejunal ulcers
Multiple peptic ulcers and diarrhea (panc enz inactivated by acid)
Assoc w/ MEN1

78
Q

Labs of prerenal AKI

A 
50% inc in Cr
Dec urine output
BUN:Cr >20:1
FENa <1%
UA is normal
79
Q

Caustic poisoning

A

Cognition not as affected
Damage to GI lining
White tongue, heavy salivation, dysphagia
Watch out for GI perf 2/2 severe ulcers

80
Q

Duodenal Ulcers

A

Pain worse on empty stomach, gnawing feeling

H. Pylori, NSAIDS

Tx: PPI and abx (amoxicillin + clarithromycin)

81
Q

Bronchogenic Carcinoma

A

Asbestos exposure

Pleural plaques with pulmonary fibrosis

82
Q

Decompensated heart failure in younger patients

A

Dilated cardiomyopathy 2/2 viral myocarditis

83
Q

What does hepatojugular reflex indicate?

A

A reflection of right heart failure
-constrictive pericarditis, right ventricular infarction, restrictive cardiomyopathy
Helps determine cardiac v liver cause of LE edema

84
Q

Treatment for chronic lower back pain

A

Exercise therapy

85
Q

Torus palatinus

A

Benign bony growth on midline of hard palate
Congenital
Young, women, asians
No tx unless ssx

86
Q

Pt with ulcerative colitis needs screening for…

A

Colorectal cancer 8-10 yrs after initial diagnosis

87
Q

Telogen effluvium

A

Non inflammatory hair loss
After pregnancy/birth, serious illness
Self limited

88
Q

Osteonecrosis (aseptic) of the femoral head

A

Occlusion of end arteries
Assoc. with sickle cell disease, chronic steroid use
Progressive hip pain, limited internal rotation and abduction
Unremarkable x rays, normal inflammatory markers

89
Q

Side effects of Cyclophosphamide

A

Hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression

90
Q

Simple renal cyst characteristics and tx

A

Thin regular wall, unilocular, no septae, homogeneous, no contrast, assx

Reassurance

91
Q

Imaging of choice for AAA

A

Abdominal U/S

92
Q

Asthma v. COPD on pulmonary function testing

A

Asthma: >12% increase in FEV1 with bronchodilator, normal or increased DLCO

93
Q

Heart compensation in hypovolemic shock

A

Decreased preload and CO —>

Inc SVR
Inc HR
Inc ejection fraction (LV is small)
Flat neck veins

94
Q

Massive PE ssx and CV collapse

A

Hypotension, syncope, acute dyspnea, pleuritic chest pain, tachycardia, hypoxia

RV dysfunction 2/2 inc pulm vasc resistance
—RV dilation, inc O2 demand, dec coronary perfusion

95
Q

Clinical Association:

Focal segmental glomerulosclerosis

A

African American, Hispanic

Obesity, HIV, Heroin

96
Q

Clinical Association:

Membranous Nephropathy

A

Adenocarcinoma, NSAIDs, Hep B, SLE

97
Q

Clinical Association:

Membranoproliferative glomerulonephritis

A

Hep B and C, lipodystrophy (abnormal fat distribution)

98
Q

Clinical Association:

Minimal Change Disease

A

NSAIDs, lymphoma

99
Q

Clinical Association:

IgA Nephropathy

A

Recent URI

100
Q

Sound and positioning of Aortic regurg

A

Early decrescendo diastolic murmur when sitting up, leaning forward, hold breath in full expiration along left sternal border at 3 and 4th intercostal space with the diaphragm

101
Q

Duodenal Hematoma

A

In kids, 24-36 hours after blunt abdominal trauma
Obstructive symptoms
NG decompression, parenteral nutrition

102
Q

Cause of muscle weakness in cushing syndrome

A

Catabolic effects of cortisol on skeletal muscle—> muscle atrophy

103
Q

Cause of hypercoagulability in nephrotic syndrome

A

loss of antithrombin 3, altered levels of C/S, increased platelet aggregation, hyperfibrinogenemia (inc hepatic synthesis), impaired fibrinolysis

104
Q

Complications of Nephrotic syndrome

A

Hypercoagulable- renal vein thrombosis, PE

Protein malnutrition

Iron resistant hypochromic anemia-(transferrin)

Vit D deficiency- (cholecalciferol-binding prot)

Increased susceptibility to infection

105
Q

Diaphragmatic rupture

A

2/2 trauma
Presentation can be delayed weeks-months (kids)
Mediastinal deviation, left diaphragm issues, bowel in the chest
Get CT

106
Q

Pilonidal Disease

A

Young, obese, sedentary males
Fluctuant mass in the intergluteal region
Occluded infected hair follicle—> pilonidal sinus tract

107
Q

Splenic Abscess

A

Fever, leukocytosis, LUQ pain
Left pleuritic pain/effusion
Splenomegaly

2/2 infective endocarditis, IV drug use, trauma, Hb-opathies
Septic emboli (staph, strep, salmonella)
108
Q

Adhesive Capsulitis

A

Frozen shoulder
Reduction in passive and active ROM
2/2 chronic inflam, fibrosis and contracture

109
Q

Anal fissures treatment

A

Fiber, fluid, stool softeners, sitz baths, topical anesthetics and vasodilators (nifedipine)

110
Q

Rupture of which part of the bladder causes peritonitis

A 
The dome 
(Anterior wall and neck are extraperitoneal)
111
Q

Most common complication of the flu

A

Pneumonia (influenza or strepneumo)

Also muscles, heart, CNS can be affected

112
Q

Cause of abnormal hemostasis in chronic renal failure

A

Platelet dysfunction
PT, PTT, platelet count normal
Prolonged bleeding time
Desmopressin (DDAVP)- increases factor 8:vWill multimers from endothelial storage sites

NO platelet transfusion

113
Q

Primary hyperaldosteronism labs

A

HTN
Hypernatremia (mild)
Hypokalemia
Metabolic alkalosis (losing H+, inc bicarb reabs)

114
Q

Causes of post op fever

A 
malignant hyperthermia, bacteremia
Wind (1): atelectasis, pneumonia
Water (3): UTI
Walk (5): DVT
Wound (7): wound
Wonder drugs
Abscess (10+)
115
Q

Dermatomyositis

A

inflam myopathy
immune mediated
paraneoplastic
symmetric proximal muscle weakness plus rash on hands or face

116
Q

Pulsatile groin mass below the inguinal ligament with anterior thigh pain

A

Femoral artery aneurysm

Popliteal is also common, both assoc. with AAA

117
Q

Treatment for acute hyponatremic encephalopathy

A

Hypertonic 3% saline, monitor electrolytes

118
Q

Indications to start statin therapy

A

Clinically significant ASCVD
LDL >190
40-75 with diabetes
10 yr ASCVD risk >7.5%

119
Q

Why do patients diagnosed with Myasthenia Gravis need a CT?

A

To look for an acetylcholine receptor antibody producing thymoma

120
Q

Acute symmetrical arthralgias with mild synovitis primarily involving the small joints of the hand

A

Parvovirus B19
Self limited
Assoc with daycare centers

121
Q

Lab findings in mesenteric ischemia

A

Leukocytosis
Hemoconcentration
Elevated Amylase
Metabolic acidosis (low bicarb)

122
Q

Paget disease

A 
Disordered osteoclastic bone resorption
Inc. Alk Phos, mixed osteolytic/sclerotic bone lesions
Bone enlargement, weakness, fracture
Frontal bossing, headaches, hearing loss
Tx: bisphosphonates (alendronate)
123
Q

EKG: irregularly irregular rhythm with loss of P waves

A

Atrial fibrilation

124
Q

Most common valve problem 2/2 rheumatic fever

A 
Mitral stenosis (diastolic rumble)
70% with ms will develop afib because of left atrial enlargement
125
Q

Lung cancers and paraneoplastic syndromes

A

Squamous cell: sCa++mous PTHrP

Small cell: ACTH, SIADH

126
Q

Acute calcium pyrophosphate crystal arthritis

A

Pseudogout
Acute inflam arthritis in the setting of surgery or illness

Synovial fluid: 15k-30k WBCs, rhomboid crystals
Chondrocalcinosis on Xray

127
Q

Chrons disease

A

Skip lesions
Noncaseating granulomas
Transmural inflam, cobblestoning, creeping fat, linear ulcerations
Fistulas

128
Q

Arrhythmia associated with digitalis toxicity

A

Atrial tachycardia with AV block

Increased ectopy and increased vagal tone

129
Q

Flow volume loop of a fixed upper airway obstruction

A

Flat on the top and bottom

130
Q

Indications for urethrogram

A

Blood at the meatus
Hematuria
Dysuria
Urinary retention

131
Q

First step after placing a central venous catheter

A

CXR for placement

132
Q

Hard signs of vascular injury

A

Pulsatile bleeding
Bruits/thrills
Expanding hematoma
Distal ischemia

Needs urgent surgery

133
Q

Treatment of Idiopathic Intracranial Hypertension

A

Acetazolamide +/- furosemide

Weight loss

134
Q

Joints of osteoarthritis v. Rheumatoid arthritis

A

OA- DIPs and PIPs

RA- MCP

135
Q

Post op from cardiac surgery: Fever, chest pain, leukocytosis with mediastinal widening on CXR

A

Mediastinitis

drainage, surgical debridement, prolonged abx

136
Q

Endocarditis plus 2:1 second degree AV block

A

Perivalvular abscess

137
Q

Concern when there is a change in a burn wound or loss of a skin graft

A

Infection
Gram +
After 5 days: Gram -, fungi

138
Q

Hypopituitarism

A

Low cortisol and ACTH (central adrenal insuff)
Low FSH and LH (hypogonadotropic hypogonadism)
Low T4 and low or normal TSH (central hypothyroid)
Aldosterone normal (may have mild hypoNa though)

139
Q

Ventricular aneurysm

A

Months after MI
EKG: persistent ST elevations, deep Q waves
LV enlargement with dyskinetic wall motion-> heart failure

140
Q

Polymalgia Rheumatica

A 
50+
1+ mo pain in shoulder, hip, neck
Morning stiffness 1+ hour
ESR > 40
Constitutional ssx
Tx: low dose steroids
141
Q

Concern after thyroidectomy

A 
Hypoparathyroidism
Low Ca, high Phos
Fatigue, anxiety, depression
Tetany, seizures
QT prolongation
142
Q

Fever + acute monoarticular arthritis

First test

A

Synovial fluid analysis to rule out septic arthritis

Risk factors: gout, osteoarthritis etc.

143
Q

Watershed areas of the colon

A

Splenic flexure- SMA and IMA

Rectosigmoid junction- Sigmoid a and superior rectal a

144
Q

Where are dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) made?
Why would increased levels cause hirsuitism?

A

DHEA- ovaries and adrenals
DHEAS- adrenals

Converted to testosterone and androstenedione

145
Q

Management of acute pain in a pt with hx of opioid abuse

A

Treat all acute patients the same despite hx (give morphine)

Close f/u to avoid relapse

146
Q

Treatment of acute pancreatitis

A 
Uncorrectable causes(ischemia/emboli): NPO, IVF
Necrotizing, local infection: abx also
147
Q

Parkinsons + autonomic dysfunction

A

Multiple system atrophy

148
Q

Dumping syndrome

A

Postgastrectomy complication
Nausea, diarrhea, cramps, palps, diaphoresis
Hypertonic stomach contents quickly dump into sm bowel
Eat small meals, slowly
Inc fiber and prot

149
Q

Ludwig Angina

A

cellulitis of the submandibular space
Arise from dental infections- polymicrobial
elevated tongue, crepitus, mass effect from edema, watch the airway
CT, IV abx, remove tooth

150
Q

Bronchial rupture

A

persistent pneumothorax despite chest tube, pneumomediastinum, subQ emphysema
CT, bronchoscopy, surgery

151
Q

Effect of acetaminophen, NSAIDs, amiodarone and abx on warfarin

A

potentiates anticoag effects -> inc bleeding

152
Q

Pt with fatigue, malaise, sore throat, fever, LAD, splenomeg, atypical lymphocytes with neg heterophile Ab test

A

EBV infectious mononucleosis
(25% false neg rate of heterophile test in the first week)
repeat test

153
Q

Cat bite tx

A

Amoxicillin/clavulanate abx ppx

154
Q

malabsorption, iron def anemia, villous atrophy

A

celiac disease

IgA anti-tissue transglutaminase abs and anti-endosomal abs may be neg due to IgA deficiency

155
Q

hypocalcemia, hyperphosphatemia with normal renal function

A

hypoparathyroidism

-post surgery, autoimmune, non autoimm destruction, defective Ca sensors

156
Q

How much does arterial/systolic pressure normally fall during inspiration?

A

<10mmhg

157
Q

Pulsus paradoxus definition and causes

A

> 10mmhg drop in systolic pressure during inspiration

pericardial effusion, asthma, COPD

158
Q

Triad of fat embolism

A

respiratory distress, neuro dysfxn, petechial rash

159
Q

Early post-op renal transplant dysfxn

A

Ureteral obstruction, acute rejection (IV steroids), cyclosporine toxicity, vascular obstruction, acute tubular necrosis

Radioisotope scanning, renal U/S, MRI, renal biopsy

160
Q

A-a gradient in PE

A

Elevated due to VQ mismatch

Cytokine induced bronchoconstriction

161
Q

Salicylate intoxication

A

Fever, tinnitus, tachypnea
Mixed respiratory alkalosis and anion gap metabolic acidosis
Normal pH, low PaCO2, low HCO3

162
Q

Gastric outlet obstruction

A

Postprandial pain, vomiting, early satiety
Abdominal succussion splash

Obstruction: malignancy, PUD, Crohns, strictures with pyloric stenosis, bezoars

163
Q

Complications of MI

Acute

A

Right RV failure
RCA
HypoTN, kussmal sign, clear lungs

164
Q

Complications of MI

Acute/ 3-5 days

A

Papillary Muscle rupture
-RCA, pulm edema, new holosytolic murmur

Intervent septum rupture

  • LAD or RCA
  • chest pain, new holosytolic murmur, bivent failure, shock, L to R shunting, inc O2 in RV
165
Q

Complications of MI

5 days- 2 weeks

A

Free wall rupture
-LAD
chest pain, shock, distant heart sounds, pericardial eff/tamponade

166
Q

Complications of MI

Months

A

LV aneurysm
-LAD
Subacute heart failure, stable angina

167
Q

Skin cancer on the lip

A

Squamous cell carcinoma

168
Q

Unstable pt with penetrating trauma, FAST inconclusive

A

Ex lap

169
Q

Unstable pt with blunt trauma, FAST inconclusive

A

Dx peritoneal lavage

But actually ex lap

170
Q

Aortoilliac occlusion

A

BL hip, thigh, butt claudication
Impotence
Absent/diminished femoral pulses

UWORLD-Surgery (2 decks)

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