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Emergency and Surgical Medicine > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Treatment for the bends:

A
  • O2, analgesics, crystalloid fluids

- Immediately put in hyperbaric chamber

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2
Q

What should you do with asymptomatic near-drowning patients?

A

Observe for 8 hours and admit if deterioration

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3
Q

Mgmt of altitude sickness:

A
  • Immediate descent to below 5000 ft
  • Analgesics and antiemetics
  • Dexamethasone, acetazolamide, nifedipine or mannitol for HAPE/HACE
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4
Q

True or false: anything that increases metabolism also increases fluid need.

A

True. Fever, tachypnea, burns, etc. all increase fluid needs.

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5
Q

What does a subdural hematoma look like on CT?

A

Crescent shaped

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6
Q

What does an epidural hematoma look like on CT?

A

Football or lens shaped

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7
Q

How should you manage a patient with a basilar skull fracture?

A

Admit and possibly prophylax for meningitis (cefazolin)

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8
Q

Treatment options for severe chillblains:

A

Nifedipine and steroids

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9
Q

Beck’s Triad:

A
  • Classic finding in cardiac tamponade

- Hypotension, muffled heart sounds, and JVD

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10
Q

What lab finding distinguishes alcoholic pancreatitis from gall stone pancreatitis?

A

Lipase and amylase: very elevated in gall stone pancreatitis, only moderately with alcoholic.

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11
Q

Treatment for cholangitis:

A

Abx and ERCP to remove obstruction

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12
Q

What IV fluid would you use for DKA or a hyperosmolar hyperglycemic state?

A
  • 1/2 NS for hyperosmolar hyperglycemic state

- NS or 1/2 NS for DKA, depending on whether you want to treat low volume or shift fluid into intracellular compartment

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13
Q

What IV fluid should you use to treat hypernatremia?

A

D5W

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14
Q

What should you do before closing a laceration on the eyelid, nose, mandible, or around the orbit?

A

Get an x-ray

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15
Q

What should you get before closing a scalp laceration in which the pt suffered a loss of consciousness?

A

CT

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16
Q

Possible complications of septal hematoma if it isn’t drained immediately:

A

Saddle deformity and/or necrosis

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17
Q

What should antibiotic therapy be directed towards in a patient with a nasal fracture or septal hematoma?

A

Staph (augmentin, cephalexin, erythromycin, etc.)

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18
Q

Management of posterior epistaxis:

A
  • Nasal balloon (Nasostat, Epistat)

- ENT consult

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19
Q

Most common bone fractured in an orbital blow out fracture:

A

Maxillary bone

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20
Q

S/S of orbital blowout fracture:

A
  • Diplopia (upward gaze)
  • Enophthalmos
  • Ipsilateral anesthesia (V2)
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21
Q

What do you want your patients to avoid if they have an orbital blowout fx?

A
  • Valsalva
  • Prophylax for vomiting
  • Don’t blow nose
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22
Q

How should you manage an avulsed tooth?

A
  • Chest x-ray if it can’t be found
  • Hanks Balanced Salt Solution for transport
  • Re-implant directly in socket and splint
  • Get dental consult
  • Abx X 5d
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23
Q

Medical treatments for central retinal artery occlusion:

A

Timolol, acetazolamide or inhaled carbogen

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24
Q

Important risk factor for general anesthesia:

A

Malignant hyperthermia

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25
Drugs used for general anesthesia:
- Propofol - Inhaled ethers or propofol drip for maintenance - Others: ketamine, etomidate
26
How should you treat someone with a hemolytic transfusion reaction?
Fluids, mannitol and/or furosemide (Lasix), vasopressors for shock
27
How would you treat someone with an anaphylactic transfusion reaction?
- Antihistamines if mild | - Epi injection in thigh or brochodilators if severe
28
Fluid of choice for resuscitation and maintenance:
- NS | - Can also give LR for resuscitation
29
Good fluid to give for GI loss, fistula drainage, and burns/trauma patients:
LR
30
Fluid to use for maintaining daily body fluid requirements:
D5 1/2NS
31
Good option for someone with a history of transfusion reactions:
Leukocyte poor blood
32
Used to transfuse patients with liver disease or who are over-anticoagulated and need clotting factors:
Fresh frozen plasma
33
Fresh vs frozen packed red blood cells:
- Both used to treat anemia due to blood loss | - Frozen is better for rare blood types.
34
Other colloids sometimes given intravenously:
- Synthetics: Dextran and Hespan (hetastarch) | - Plamanate (plasma protein fraction)
35
What drugs are most commonly used in epidural or spinal anesthesia?
- Bupivacaine, lidocaine, ropivacaine and chloroprocaine are commonly used, along with narcotics, in epidurals - Bupivacaine (mostly), lidocain, ropivacaine and sometimes epinephrine in spinal blocks
36
Two potential uses for a penrose drain:
- Large abscesses | - Peritoneal space
37
Medical and surgical treatment for ectopic pregnancy:
- Medical = methotrexate | - Surgical = laparoscopic surgery and salpingectomy if tube isn't salvageable
38
Medical and surgical treatment for leiomyoma:
- Medical = Mifepristone | - Surgical = myomectomy or hysterectomy
39
Workup for endometrial cancer:
Biopsy, then hysterectomy + pelvic and aortic lymphadenectomy
40
Labs suggestive of testicular carcinoma:
- Hcg, alpha fetoprotein, lactate dehydrogenase
41
Workup for suspected testicular cancer:
Abdominal CT + chest x ray or chest CT for mets, scrotal ultrasound
42
Do you biopsy a suspected testicular carcinoma?
No
43
Features of a solitary pulmonary nodule (coin lesion):
- Less than 1 cm, stable for 2 years | - Target/popcorn appearance
44
Workup for coin lesion:
- CT - Fine needle aspiration - PET scan - Sputum culture - Bronchoscopy
45
Indications for wedge resection:
- Secondary lung cancers except solitary SCC or adenocarcinoma - Benign neoplasms such as hamartomas and fibromas
46
Treatment for non small cell lung cancer:
Lobectomy, radiation and chemo
47
Mnemonic for acute coronary syndrome treatment:
MONA = morphine, O2, Nitroglycerin, ASA
48
Presurgical medical interventions for aortic dissection:
Esmolol (beta blocker) and nitroprusside
49
Surgical management of ruptured spleen:
Splenectomy
50
Imaging for suspected splenic rupture:
FAST or CT if stable
51
Workup for perforated bowel:
- 3 view x ray or CT for suspected duodenal perf | - Blood and urine cultures
52
Surgical mgmt of cholecystitis, cholangitis
- Laparoscopic cholecystectomy then abx | - Cholangitis is surgical emergency with ERCP
53
Imaging for diverticulosis/diverticulitis:
- Barium enema x ray for diverticulosis | - CT for diverticulitis
54
Management of diverticulitis:
- IV abx, surgical resection, drainage of abscesses
55
Evisceration:
- Usually occurs 5 - 8 days post op - Return to OR, rinse peritoneal cavity with LR - Abx
56
Time frame for fat embolism:
12 - 72 hours post op
57
Time frame for ileus:
- Peristalsis usually returns after about 72 hours | - During this time fecal impaction likely
58
Time frame for urinary retention:
4 - 5 days post op
59
Most common cause of fever after third day post op:
Phlebitis
60
Timeline for post surgical wound infection:
5 - 10 days
61
Most common pathogen in furuncle/carbuncle:
Staph
62
Most common pathogen in cellulitis:
Group A strep
63
Drugs to use for cellulitis:
Dicloxicillin (Bactrim if staph), IV PCN for strep, Nafcillin or Vanco for staph.
64
Treatment for gas gangrene:
IV PCN, clindamycin may be useful to reduce production of toxins
65
Timeline for post op pneumonia:
24 - 96 hours

Emergency and Surgical Medicine (2 decks)

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