Uworld11\ Flashcards
Persistent pneumothorax and significant air leak following chest tube placement in patient who has sustained blunt chest trauma suggests
tracheobronchial rupture
treatment for third degree burn
early excision and grafting
next step in management for head trauma
penetrating = surgery
linear skull fracture with not overlying wound - leave alone
management for intraoperative development of coagulopathy
platelet packs and fresh-frozen plasma
Any penetrating wound below the 4th intercostal space (below nipples) is considered what
abdomen and requires ex. lap in unstable patient
what are your post op fevers?
day of: atelectasis Day 1-3: pneumonia Day 3: UTI Day 5: deep thromnophlebitis Day 10-15: deep abscesses
Treatment of hemorrhagic shock
near trauma center: GO
not: fluids
management of cervical spine injury
ooo-tracheal intubation
3 categories in GLASCOW score
eye opening
verbal response
motor response
salmon-colored fluid coming from surgical site? next step
wound dehiscence
tape securely and go to OR
what is ALT level for gallstone pancreatitis
greater than 150
When do you do ERCP in gallstone pancreatitis
cholangitis
bile duct obstruction
increasing liver enzymes
Management of pancreatic pseudocyst
asymptomatic: expectant management
symptomatic: endoscopic drainage
difference in hepatic and splenic infarctions
hepatic: free intraperitoneal fluid
splenic: less likely
Pediatric patients, most often occurs following blunt abdominal trauma? clinical pic? treatment?
duodenal hematomas
epigastric pain, vomiting 24-36 hours after initial injury
gastric decompression and parenteral nutrition
Initial management of small bowel obstruction
conservative (bowel rest, nasogastric suction, correction of metabolic derangements)
patient develops clinical or hemodynamic instability –> emergent surgery
difference in chest X-ray in cardiac tamponade and bronchial rupture
cardiac tamponade: normal cardiac silhouette without tension pneumothorax
bronchial rupture: jugular venous dissension but with tension pneumothorax
when do you do HIDA scan?
when ultrasound is undetermined
small-and-large bowel dissension and hypoactive bowels
ileum
air-fluid levels in gallbladder? treatment
emphysematous cholecystitis
emergent cholecystectomy
difference in timing of small bowel obstruction and ileus
small bowel obstruction: weeks to years post-op
Ileus: hours to days post-op
What is a watershed area of the colon
splenic flexure and rectosigmoid junction
What is CT scan of colon for ischemic colitits
thickened bowel wall
treatment for abscess from diverticular disease
less then 3cm –> abs and abs
more than 3cm –> CT guided percutaneous drainage
Dilated common bile duct in absence of stones
sphincter of Oddi dysfunction
relate opioids and sphincter of Oddi
Opioids cause sphincter contraction and precipitate symptoms
clinical feature of rapid gastric emptying
crampy abdominal pain
vomiting
diarrhea
vasomotor symptoms (flushing, palpitations)
One of the most common post-op cholecystectomy
bile leak
fever, nausea, VOMITING, and vague abdominal pain 2-10 days after Lap cholecystectomy
fever
RUQ pain
can also cause ileus (decreased or absent bowel sounds)
emphysematous cholycestitis
Gilbert Syndrome
high unconjugated bilirubin
jaundice
strangulation
disruption of blood flow to the involved bowel segment, leading to necrosis
which is more sensitive for acute pancreatitis
lipase
succession splash may be heard over the stomach
gastric outlet obstruction
painful, fluctuant mass 4-5cm cephalic to the anus in the intergluteal region
mucoid, purulent, or bloody drainage
Pilonidal disease
difference between appendicitis and psoas abscess?
psoas: subacute
appendicitis: acute
pediatric umbilical hernia management
less than 1.5 = spontaneous closure
must close before the age of 5
Management of fleshy immobile mass in midline hard palate in pediatric patient asymptomatic
observation
mass anterior edge of sternomastoid muscle
branchial cleft cyst
mass in supraclavicular area? Management
cystic hygroma
CT before surgery because it may extend into
Vesicles on tonsils and soft plate
Herpangina –> coxsackie A virus–> observation
Management of upper neck trauma
arterio-graphic diagnosis
Cardiac index and pulmonary wedge pressure values for MI
decrease cardiac index
increase pulmonary wedge pressure
difference between thoracic aneurysm and aortic dissection
thoracic: Spiral CT no surgery
aortic dissection: surgery
GI trauma (costoverterbal tenderness) next step
contrast enhanced CT Of abdomen ( even if contrast is contraindicated in kidney failure)
DVT in chronic renal failure
unfractionated heparin followed by warfarin
how does multiple myeloma impact immune system
alters normal leukocyte population and causes hypogammagobiulenia
treatment for mild hypernatremia? Severe cases of hypernatremia hypovolemia
mild: 5 dextrose in 0.45 saline
severe: .9 saline
case-control study
compare the exposure of people with disease(case) to exposure of people with the disease (control)
what measure is case-control study associated with
exposure odds ratio
What type of study uses prevalence odds ratio
cross-sectional studies
What type of study uses median survival calculated
cohort studies or clinical trials
In what study are relative risk or relative rate calculated
cohort studies
Prominent capillary pulsation’s in the fingertips or nail beds
aortic regurgitation
What is the most common valvular abnormality detected in patients with infective endocarditits
Mitral valve disease, usually mitral valve prolapse with coexisting mitral regurgitation
treatment for inflammatory acne?
topical retinoids and benzoyl peroxide
Treatment for moderate-to-severe cases treatment?
topical retinoids and benzoyl peroxide
add topical abs
Treatment for severe or recalcitrant acne
Oral abs and isotretinoin
When is salicylic acid most useful for acne treatment
noninflammatory/comedonal acne
Effect modification
external variable positively or negatively impacts the effect of a risk factor on the disease of interest
- associated with disease (not risk factor)
What helps differentiate between confounder or an effect modifier?
Stratified analysis
Cofounder
same as effect modification but
- associated to both disease and risk factor
how do you look at stratified analysis?
higher the RR, stronger the association
weight loss, jaundice and a contender, distended gallbladder on examination
pancreatic cancer
ulcerating, pustular nodules at the site of inoculation and associated lymphatic channels
Sporotrichosis
difference between acute tubular necrosis and tubulointersitial nephritis
ATN: acute onset
TN: insidious, no need for rash, NSAIDs
When do you use tetanus immune globulin
symptomatic patients
its who have not received 3 initial doses in childhood
pain scale for CMV retinitis
painless
right for right ventricular heart attack
fluids
how does positive pressure mechanical ventilation change pressure? impact in hypovolemic patients
increases intrathoracic pressure
- acute loss of right ventricular preload
- loss of cardiac output
- cardiac arrest
high ADH and high urine sodium
SIADH
what is associated with dermatomyositits
internal malignancy
If a test result is negative, what is the probability of having the disease
1-negative predictive value
What type of shock is the only one with decreased systemic vascular resistance
septic shock
difference between secondary PTH due to CKD and primary hyperparathyroidism
uric aciCKD: phsophorus high. calcium low
Primary: low PTH and high calcium
so basically with CKD the PTH will increase but it won’t actually fix the problem
needle-shaped crystal in U/A indicates what?
uric acid stones –> radiolucent on CT
subacute (de Quervain) thyroiditis? treatment?
fever, neck pain, tender goiter following URI
beta blockers and NSAIDs
Suppurative thyroid
rare
euthryoid
painless thyroiditis (silent thyroiditis)
thyrotoxicosis with mild thyroid enlargement
suppressed TSH
thyroid scintigraphy shows decreased radio iodine uptake
Parents who themselves are minors, can they give consent for medical treatment of their child?
yes
from an unemanciapted minor, do you need consent from both parents
one will do
Parents refuse to consent to treatment of their child for a non-emergency but fatal medical condition. next step
seek court order
Spondylolithesis
forward slip of vertebrae
- preadolescent children
- back pain, urinary incontinence, “Step-off” at the lumbosacral area
Bone cancer: central lytic lesion, onion skinning, and moth-eaten appearance with some extension into the soft tissue
Ewing sarcoma
Bone cancer: central lytic bone defect with surrounding sclerosis
osteomyelitis
equines and various of calcaneum and talus
varus of midfoot
adduction of forefoot
clubfoot
management of clubfoot
stretching and manipulation of foot immediately
serial plaster casts
surgery between 3-6 months of age
Down syndrome patient with upper motor neuron findings
atlantoaxial instability
How do you diagnose Henoch Schonlein Purpura
clinical diagnosis
confirmed with skin biopsy in unclear cases
How does a child get a supracondylar fracture of the humerus
fall on an outstretched hand most common
What is a rare but potentially devastating complication of supracondylar fracture
Compartment syndrome accompanied by forearm fractures which can lead to Volkmann contracture
Clinical features of juvenile idiopathic arthritis
daily fever and rash
chronic uveitis
Lab values for juvenile idiopathic arthritis
Leukocytosis
thrombocytosis
elevated inflammatory markers
Treatment for juvenile idiopathic arthritits
NSAID and steroids
what should be on the differential for a solitary, painful lytic long bone lesion with overlying swelling and hypercalcemia in a child
langerhans cell histiocytosis
bone cancer: sunburst pattern
osteosarcoma
Flexible positioning
Medial deviation of forefoot
Neutral position of hind foot
Metatarsus adducts
Treatment for metatarsus adductus
reassurance
traction of apophysitis of tibial tubercle
Osgood-Schlatter
Difference between Ehler’s Danlos and Osteogenesis imperfecta
Ehlers: no fractures
Osteogenesis: fractures
Blue sclera
Opalescent teeth/Dentinogensis imperfect (teeth translucent and gray)
Osteogenesis imperfecta
how long does arthritis need to be present for to diagnose juvenile idiopathic arthritis
greater than 6 weeks
type of patient who gets slipped capital femoral epiphysis
obese boys
thin adolescents who recently went through growth spurt
Management of slipped capital femoral epiphysis
surgical pining
well-circumscribed mass that does not transilluminate in the inferior portion of the sternocleidomastoid muscle can be seen in what child condition
torticollis
what causes Trendelenburg sign
weakness or paralysis of gluteus medium and minimum muscles
- innervated by superior gluteal nerve
risk factor for vitamin D deficiencies in children
exclusive breastfeeding
increased skin pigmentation
lack of sun exposure
