Week 1-2 Flashcards
what is a colles fracture?
distal radius fracture
what can be a complication of a colles fracture?
can have radial artery impingement
what should be done if patient has colles fracture and radial artery impingement?
immediate closed reduction of the fracture
what is a common complication of a glenohumeral displacement?
rotator cuff injry
what is a test that can be done for cervical radiculopathy? how does it work?
shoulder raise test…when raising arm, patients pain will decrease if they have a cervical radiculopathy
what are the two types of burn wound infections?
invasive vs non invasive
what is difference in invasive vs non invasive burn wound infection?
invasive will show systemic signs of infection and invades non burned tissue
what is difference in management of invasive vs non invasive burn wound infections?
invasive gets really broad abx coverage (meropenem and vanc) whereas non invasive gets narrow spectrum like cefazolin
does patient who is perioperative have to have chest pain to be having an MI?
no because likely on lots of pain meds so can be masked
what is a significant GI complication of C diff?
toxic megacolon
what are sx of toxic megacolon?
severe abdominal pain, fever tachycardia and hypotension
what will be seen on imaging in toxic megacolon?
large bowel dilation
what is management of toxic megacolon?
bowel rest, NG tube and treat C diff
what is short term management of malignant pericardial effusion?
drain that baby with pericardiocentesis
what is long term management of malignant pericardial effusion?
put in a cardiac window for drainage
what are three complications of cardiac cath at site of femoral access?
hematoma, avm, and pseudoaneurysm
what are physical exam findings of pseudoaneurysm of femoral artery after cardiac cath?
systolic bruit and pulsatile mass
what are physical exam findings of avm of femoral artery and vein after cardiac cath?
continuous bruit and no mass
what is management of AVMs of femorals after cardiac cath?
if large surgery, if small observe
what is imaging to find a meckel diverticulu,?
nuclear scintigraphy
what can cause intussusception?
inflammation of peyers patches from viral illness, pathologic cuases like meckels diverticulum, tumor or polyp
when should you think a pthologic not viral illness is causing intussuscpetion?
if happens multiple times
what is a flail chest?
3 or more contiguous rib fractures that negatively impacts respiration
what is common sign of a flail chest?
chest goes inward with inspiraiton
what can happen to heart in ankylosing spondylitis?
aortic regurgitation
eggshell calcification of liver cyst means what diagnosis?
hydatid cyst from echinococcus granulosa
what is usual cause of post op fever within hours of surgery
tissue trauma and cytokine reaction
what is cause of post op fever 1 day to 28 days after?
presumed bacterial infection
name two times it is common to get compartment syndrome?
after fracture and after ischemia to leg and surgery
how do you diagnose compartment syndrome?
delta pressure (diastolic minus compartment <30)
what is acute management of cerebreal edema following traumatic injury?
hypertonic saline/mannitol and head elevation
what is initial management of hypothermia?
rewarming in bath of water btw 98-102 degress
if warm water bath does not improve hypothermia of hands, what should be done and why?
angiography of affected area to investigate for thrombosis
what is imaging for suspected appendicitis?
US if pregnant or child, otherwise CT scan
why can you get hypercalcemia with immobilization?
from osteoclasts breaking down bone that isnt being used
what is acute mediastinitis?
infection of medisatinum following cardiothoracic surgery
what are signs and symptoms of acute mediastinitis?
fever, purulent drainage from sternal incision, high WBC count, chest pain
what is an imaging finding of acute mediastinitis?
widening of mediastinum
what is rx of acute mediastinitis?
surgical drainage and abx
what are signs and sx of an ileus?
nausea, vomiting, abdominal distension, abdominal pain. lack of bowel sounds
aside from surgery what are some other causes of ileus?
intraperitoneal/retroperitoneal hemorrhages, pancreatitis and electrolyte abnormalitis
what is rx of priapism?
aspirate blood from corpora cavernosa and give phenylephrine injection into cavernosa
what can be a complication of insufflation of patients abdomen with CO2 for laprascopic procedure?
can get increased vagal tone leading to severe bradycardia
when should you get a confirmatory chest xray for placement of a central venous catheter?
if it was complicated or did not use U S
what should you monitor if patient has medullary thyroid cancer?
calcitonin (represents risk of metastasis)
how does medullary thyroid cancer present
usually asymptomatic thyroid nodule
if patient has recently had cholecystectomy and has diarrhea, what is likely cause?
bile acid diarrhea
what is rx of bile acid diarrhea?
cholstyramine
what is pilonidal disease?
abscess formation/infection of bump between butt cheeks
what is rx of pilonidal disease
drainage
what type of herniation can occur with epidural hematomas
subfalcine herniation
which type of herniation does not involve the pupils?
subfalcine
what is rx of SCFE?
surgical pinning and non weight bearing
who gets SCFE?
adolescents that are obese
what is the difference in enteral and parenteral nutritional support?
enteral means via intestines and parenteral means via IV
in a burn patient, what should nutritional support be?
enteral nutrition as soon as possible
patients undergoing dialysis are at increased risk for what infection?
bacteremia
if patient with dialysis gets bacteremic following dialysis session, what abx should be given?
ceftazadime and vanc
what can be a significant complication related to epidural anesthesia?
epidural hematoma
what are sx of epidural hematomas?
sensation and motor disturbances, can also have bowel bladder issues
if a patient can hear better in loud situations than quiet, what should you think of as issue?
otosclerosis
what is a physical exam finding of otosclerosis?
reddish hue behind tympanic membrane
what is first line therapy for toxic megacolon fromIBD?
IV steroids
if patient with cirrhosis has new onset of ascites, what should be done? why?
abdominal US…despite ascites being normal in cirrhosis, if it is new raises concern for HCC
what is a common cause of laryngeal papillomas in kids?
HPV 6 or 11 from mom
what is symptoms of laryngeal papillomas?
usually just hoarseness
what is rx of laryngeal papillomas?
surgical debridemen
if following a trauma a patient is hemodynamically unstable but has no signs of internal bleeding on exam, what is most likely cause?
pelvic fracture and bleeding in to retroperitenum
what meds can cause open angle glaucoma?
topical steroids
what sx does a urethral stricture cause?
leads to weak or spraying stream, incomlete emptying and can cause increased frquency
what is rx of urethral stricture?
dilation, urethroplasty
if patient has had trauma and had pneumothorax with successful chest tube placement but it still leaking significant amounts of air through chest tube, what might be going on?
trachebronchial injry leading to air leakage
how do you assess for a tracheobronchial injury?
bronchoscopy
what is rx of tracheobronchial injury?
surgical fix
a pelvic fracture can cause what type of urethral injry?
posterior urethral injury
what are sx of posterior urethral injury?
blood at meatus, inability to pee, and high riding prostate
what are 6 indications for cervical spine imaging following trauma?
high energy mechanism neurologic deficit intoxication AMS spinal tenderness distracting injury
what is a septal hematoma?
blood/fluid collection in nasal septum following trauma to nose
what are sx of septum hematoma of nose?
may have hard time breathing, will have fluctuant swelling of septum
what is management of septal hematoma of nose?
surgical drainage
if a septic joint is not responding to vancomycin and MRSA/Strep coverage, what bug should you think about and what abx?
kingella…ceftriaxone
what is blunt cardiac injury?
direct blow to chest without obvious cardiac injury leading to hemodynamic instability
what is risk with blunt cardiac injury?
big risk of arrythmias
patients with blunt cardiac injury should undergo what testing?
TEE
in shock, a low CVP means what type?
hypovolemic or distributive
in shock, a high CVP means what type?
cardiogenic or obstructive
what is management of a peritonsillar abscess if patient stable?
drain it and treat wtih antibiotics
what sx can hydronephrosis cause?
can lead to unilateral back pain and CVA tenderness
what will UA look like in hydronephrosis secondary to ureteral injury?
will look normal, as will kidney function
when do you excise hemorrhoids?
when they become thrombosed
how do you know if external hemorrhoid is thombosed?
will be purplish and patient will have severe anorectal pain
what type of hernia should be electively repaired?
femoral hernias
why are femoral hernias repaired electively but indirect and direct inguinals are not?
because femoral has much higher risk of incarceration
patient with traumatic brain injury has episodes of hypertension, fevers and diaphoresis, what is likely cause?
paroxysmal sympathetic overactivation
who gets paroxysmal sympathetic overactivation?
patients with TBIs
a breast mass with calcifications on imaging and fat globules and histiocytes on biopsy is most likely what?
fat necrosis of the breast
what breast mass looks malignant but is benign?
fat necrosis
what causes fat necrosis of the breast?
trauma and surgery
does fat necrosis of the breast increase the risk of breast cancer?
No
what is management of posterior hip dislocation?
reduction within 6 hours of injurty
what is risk with giving loads of normal saline? why?
can cause metabolic acidosis due to high levels of chloride in normal saline
a patient with severe burns should receive what fluids for resuscitation
lactated ringers
what does imaging show in ovarian torsion?
complex adnexal mass without blood flow
what is management of ovarian torsion?
laparoscopy
what is managment options for abscess from diverticulitis?
if greater than 3cm then percutaneous drainage, if less than 3cm then IV abx and observation
what is a perilymphatic fistula?
where endolymph leaks from semicircular canals and cochlea into surrounding tissue
what causes perilymphatic fistula?
brain trauma
what are sx of perilymphatic fistula?
sensorineural hearing loss, episodic vertigo
what is a complication of roux en y surgery in couple days following surgery?
anastomotic leak
what are sx of anastamotic leak from roux in y bypass?
abdominal pain, tachypnea and tachycardia
what is rx of anastamotic leak from roux in y?
surgery
what is a complication of cardiac cath that can happen at insertion site?
can get retroperitoneal hematoma if cath site is leaky
how does retroperitoneal hemorrhage present
unilateral back or flank pain and hemodynamic instability
what is imaging for retroperiotneal hemorrhage?
CT without contrast
what is rx of retroperioneal hemorrhage?
intensive support and monitoring
what is risk of using succinylcholine as anesthetic?
can lead to cardiac arrythmias due to release of potassium
leydig and sertoli testicular tumors secrete what hormones?
testosterone or estrogen
in testicular torsion, does it get bigger or smaller?
will get bigger
why does a torsed testicle appear heterogeneous?
because of ischemia to the testicle
what is hemobilia?
bleeding from liver
what is usual cause of hemobilia?
iatrogenic liver injury from surgery or biopsy
what are signs and sx of hemobilia?
ruq pain, melena, anemia, thrombocytosis and leukocytosis
how does someone develop charcot arthropathy?
repetitive trauma to bone and joint due to impaired snesation and proprioception
what is most common cause of charcot foot?
DM
what can happen with chronic charcot arthropathy?
can get collapse of foot arch, subluxation and bone deformitites?
what is management of charcot foot that has become chronic?
orthotics and surgical fixatio
acute charcot foot can lead to what findings?
swelling and redness of foot, warmth and edema as well
what is management of acute charcot foot?
put on foot cast
if patient has trauma and has a bad pelvic fracture, what is a big concern/
retroperitoneal hemorrhage
patient with bad pelvic fracture following trauma should receive what before further work up is completed?
pelvic binder to stabilize pelvis
what is usual management of an SBO?
if not totally blocked then bowel rest pain management and NG tube
what is management of SBO if totally blocked?
surgery
when a patient is being intubated, what happens to intrathoracic pressure and venous system?
intrathoracic pressure goes up, can cause venous system collapse due to increase in pressure, can be an issue in patients with hypovolemic shock
if patient has symptomatic hyponatremia, including sx of cerebral edema, what should be given?
hypertonic saline
what are signs and symptoms of sigmoid volvulus?
slowly progressive abdominal discomfort along with potential nausea and vomiting
what can contribute to development of sigmoid volvulus?
constipation
how does pain progress/onset with sigmoid volvulus?
slowly over course of a couple days
what is management of sigmoid volvulus?
emergency endoscopic detorsion
patient with difficulty breathing following cervical trauma most likely has what?
diaphragm paralysis
what should be done for patient with diaphragm paralysis from cervical spine injury?
oral intubation
calcitonin is marker for which thyroid cancer?
medullary thyroid cancer
what is management of papillary thyroid cancer?
surgical removal
copper deficiency leads to what problems?
skin depigmentation
ataxia
anemia
brittle hair
what two things are commonly elevated in acute mesenteric ischemia?
lactate and amylase
what is an auricular hematoma?
tender blood collection on anterior pinna of ear
who gets auricular hematomas?
ppl who play contact sports
what should you do to an auricular hematoma?
drain it then give abx to prevent secondary infection
what are sx of an auricular hematoma?
nothing….just fluctuant tender hematoma on ear
patient with trauma to chest who now has stable vitals but has persistent shortness of breath, what should you consider?
diaphragmatic injury
septic arthritis in a MCP joint requires what?
surgical drainage
afp elevation is associated with what GI tumor?
hepatocellular carcinoma
what are signs of complicated SBO?
fever, vital instability, metabolic acidosis
what is a common risk factor for SBO?
previous abdominal surgery
what is most important prognostic indicator for breast cancer?
TNMstaging
if a patient falls with an object in their mouth, what can be a serious complication?
carotid artery dissection
how does carotid artery dissection present?
gradual onset hemiplegia, aphasia,, neck pain and headache
what is imaging for carotid artery dissection/
CT and MR angio
what is most common cause of nosocomial bloodtsream infections?
central venous catheters
what type of toe movement makes plantar fascitis hurt more?
dorsiflexion of toes
retroperitoneal free air after blunt abdominal trauma to central abdomen should make you think what?
duodenal tear
patient who is post transplant develops interstitial pneumonia but is taking bactrim, what bug is it?
CMV pneumonitis
how long after blunt abdominal trauma can diaphragmatic injury present?
months to years…
what is management if patient swallows a fish bone?
endoscopic removal
what is dumping syndrome?
when patients have diarrhea and nausea along with tachycardia after meals after they had gastric surgery
what is antibiotic choice for clean surgeries for surgical site inection prophylaxis?
cefazolin
if patient cant have cefazolin, what is antibiotic choice for clean surgeries for surgical site inection prophylaxis?
Vancomycin
3 symptoms of bladder rupture injury?
suprapubic fullness/tenderness
hematuria
difficulty with urination
what is management of big cerebellar hemorrhage?
surgical intervention
what can cause salivary gland enlargement that is non tender?
alcoholism
