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AA M.D. STEP Add-On > XL2 [FACTIONLESS PAST] > Flashcards

XL2 [FACTIONLESS PAST] Flashcards

✔︎ [Step 2 (Surgery, Biochem)] ✔︎ [Factionless]

1
Q

1st and 2nd steps for treating acute variceal bleeding

A

1st: 2 Large bore IV needles vs. central line for IVF

2nd: Endoscopic sclerotherapy vs. band ligation

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2
Q

Postop Cholestasis develops after surgerys that involve ⬜, ⬜ and ⬜ .

________________

Why is this?(3)

A

hypOtension | [massive blood loss] | [massive blood transfusion]

________________

  1. hypOtension ➜ [⬇︎ Liver function] ➜ [⬇︎bilirubin excretion]
  2. [massive blood loss] ➜ [renal ischemic tubular necrosis] ➜ [⬇︎ bilirubin urine excretion]
  3. [massive blood transfusion] ➜ [⬆︎ pigment load] ➜ [⬆︎ bilirubin to excrete]
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3
Q

Surgical repair for hip fractures may be delayed up to ⬜ hours.

________________

Why?

A

72 hours

________________

address unstable medical comorbidity first

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4
Q

How does SBO present (3)?

________________

What’s most common cause?

A
  1. [NV –> hypOkalemia]
  2. [Bloating - Hyperactive “tinkling” Bowel Sounds]
  3. [Dilated Bowel Loops X-ray]

________________

Adhesions! (operations)

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5
Q

Etx for [Isolated Duodenal Hematoma] occur?

________________

1st line tx? -2

________________

2nd line tx?

A

[Abd trauma to children]–>blood between mucosa and submucosa –> resolves spontaneously in 1-2 weeks

________________

Tx =

1st: [NG suction + Parenteral nutrition]

2nd: [Laparascopic hematoma removal]

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6
Q

Describe Varicoceles

________________

Etiology?

A

Tortuous Dilation of Pampiniform Venous Plexus surrounding spermatic cord & testis within scrotum

________________

L renal vein compression (from Aorta and SMA or thrombosis) –>L side scrotal bag of worms worst with standing/valsalva and better when supine

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7
Q

[Retropharyngeal Abscess] presentation (5)

Why does this have to be treated STAT?

A

Odynophagia / [Painful Neck Extension] / Fever / Sore throat / [Trismus (inability to open mouth)]

Abscess infection may spread into mediastinum!

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8
Q

[Retropharyngeal Abscess]

Dx -2

________________

Tx -2

A

Dx = CT neck vs. Lateral Radiographs–>Demonstrates cervical spine Lordosis

________________

Tx = [Abx IV] + [I&D]

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9
Q

Complications of SBO (2)?

Management (2)

A

Strangulation vs. Perforation

Mgmt = [Surgical Exploration] vs. [NPO & IVF –> NG tube suction]

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10
Q

Diverticulitis Abscess Tx

A

CT guided-percutaneous (alternative surgical) abscess I&D

Diverticulitis = Soft tissue stranding & colonic wall thickening

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11
Q

INR for normal people

A

0.8 - 1.2

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12
Q

Therapeutic INR range for pts on warfarin

A

2 - 3

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13
Q

Acute GI perforation requires emergent _____

A

Laparotomy (surgical incision thru abd wall)

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14
Q

MOD of [AMBIC- Acute Mesenteric Bowel ischemic colitis] post AAA repair

A

inadequate [Left Descending Colon] and [Sigmoid Colon] arterial perfusion from IMA during aortic graft placement –> Ischemia

CT revealing air & edema in bowel wall –> thickening = AMBIC

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15
Q

Step-wise process for [Blunt Abd Trauma in hemodynamically unstable pts]. Any Caveat?

A

DPL = Diagnostic Peritoneal Lavage = aspiration of 10 mL of peritoneal fluid with blood = intraperitoneal injury

Caveat = PENETRATING ABD TRAUMA (GUNSHOT/STAB) = SKIP DIRECTLY TO XLAP (Xploratory LAPARATOMY W/REPAIR)

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16
Q

Staph Aureus and Staph Epidermidis both affect prosthetic joints. What is the difference?

A

[Staph Aureus = Acute ( < 3 mo. onset)] & may only require debridement

[Staph Epidermidis] = Delayed > 3 mo. onset and must be replaced

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17
Q

PrePatellar bursitis is often due to ⬜, but other causes include ⬜ or ⬜

A

S.Aureus (infects bursa via extension of local cellulitis after trauma)

________________

[Gout Crystalline Arthropathy] / [Rheumatoid Arthritis]

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18
Q

CT scan shows ⬜ which indicates what diagnosis?

________________

. What causes this?

________________

Tx(2)?

A

[air in DEEP tissue]; Necrotizing Fasciitis

________________

[Polymicrobial > GASP] spreads rapidly thru SubQ & deep fascia after minor trauma –>

PAIN OUT OF PROPORTION WITH EXAM

________________

Tx = Debridement + Broad Abx

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19
Q

What is the first sign of hypOvolemia

A

INC HR

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20
Q

Massive Hemoptysis is defined as ⬜ or ⬜ . The greatest danger with this is ⬜ .

A

[>600 mL expectorated blood over 24 hours] vs. [Bleeding > 100 mL/hour] –> Asphyxiation from blood in airway

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21
Q

What is the management for [Massive Hemoptysis] -4

A

1st: Intubate
2nd: Place bleeding lung in lateral decubitius to prevent bleeding from going to other lung
3rd: Bronchoscopy to localize & cauterize bleeding site
4th: Thoractomy if bleeding persist despite bronchoscopy or if uL bleeding

________________

[>600 mL expectorated blood over 24 hours] vs. [Bleeding > 100 mL/hour]

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22
Q

On which PostOp Day is atelectasis most common? Explain how this causes Respiratory Alkalosis

A

POD2! ; PostOp pain vs. Residual anesthesia vs. tongue prolapse —> hypOxemia and INC work of breathing –> Hyperventilation —> Respiratory Alkalosis

Acute PE may present similarly

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23
Q

Femoral n. Function (2)

A

[Hip flexion]

[Knee extension]

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24
Q

Femoral n. innervation (2)

A

[ANT thigh] & [Medial leg via saphenous branch]

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25
Q

Obturator n. function

A

Thigh ADDuction

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26
Q

Obturator n. innervation

A

medial thigh

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27
Q

[PiloNidal Dz] MOD

A

sweating/friction of coccyx skin in young males with body hair –> Hair follicle infection–>spreads SubQ –> Abscess that ruptures to form [piloNidal sinus tract]

Tx = I&D + Sinus tract excision

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28
Q

Flail Chest presentation (3)

A

Pt with recently fractured ribs who has..

  1. paradoxic thoracic wall movements (inverted chest wall w/inspiration, correted when on positive pressure)
  2. [shallow tachypneic breathing]
  3. Respiratory distress despite chest tubes
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29
Q

A pt with pneumobilia, [hyperactive bowel sounds] and Dilated loops of the bowel probably has ⬜

________________

What’s biggest Risk Factor for this?

________________

Dx? | Tx?

A

Gallstone iLeus (gallstone passes thru biliary enteric fistula into small intestine)–>air in biliary tree (pneumobilia)

________________

Cholecystitis

________________

Dx = CT

Tx = Surgery

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30
Q

Flail Chest etiology and tx(3)

A

Multiple ribs fractured in GOE 2 locations –> segment of ribs losing continuity with thoracic wall –> Rib collapse with inspiration –> shallow breahs –> Hyperventilation

Tx = Pain control + supplemental O2 + [Intubation w/CPAP]

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31
Q

Pt with suspected Claudication 2° to [Peripheral Artery Disease]

Dx test? Describe the test

A

ABI (Ankle Brachial Index) = inexpensive/noninvasive measurement of systolic BP Ankle:Brachial

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

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32
Q

Clinical presentation for [Paralytic iLeus] (4)

A

[Abd pain following trauma or abd surgery]

+

[Xray with Dilated loops of STOMACH, SMALL & LARGE intestine]

+

[hypOactive bowel sounds]

+

Obstipation (can’t pass flatus/stool)

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33
Q

Acute Mediastinitis

MOD -2

________________

cp -2

A

[cardiothoracic SSI] vs [Retropharyngeal Abscess spread] ➜

________________

  1. [purulent sternal wound drainage]
  2. [widened mediastinum]

________________

SSI = Surgical Site Infection

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34
Q

Tx for Acute Mediastinitis (3)

A
  1. Broad Abx
  2. [I&D]
  3. Debridement
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35
Q

Mngmt for [Gallstones without sx]

A

NOTHING

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36
Q

Mngmt for [Gallstones with biliary colic] (2)

A

[Elective Lap Chole] vs. [UrsoDeoxycholic acid in poor surgical candidates]

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37
Q

Mngmt for Complicated Gallstones (Acute cholecystitis vs. CholeDocholithiasis vs. Gallstone pancreatitis)

A

Cholecystectomy within 72 hours!

Acute Cholecystitis = inflammation & distension of gallbladder from [cystic duct obstruction]

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38
Q

MCL tear

Dx?

________________

Tx -2

A

MRI (surgical candidates only)

________________

Surgery vs. [RICE in uncomplicated MCL tears]

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39
Q

Both Hemothroax and Tension PTX produce hypOtension, tachycardia and tracheal deviation.

What’s the difference in Physical Exam?

A

Hemithorax = DULLNESS to percussion

vs.

Tension PTX = HYPERRESONANCE TO Percussion

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40
Q

[Aortic injury 2/2 to rapid deceleration]

Dx(2)

________________

Mngmt(3)

A

Dx = [Upright CXR showing (widened mediastinum/hemothorax/interrupted aortic contour)] ➜ [CT confirmation]

________________

Mngmt = [ABC] –> AntiHypertensives –> Surgery

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41
Q

[Diaphragmatic Hernia] MOD

A

INC intraabd pressure from Blunt Abd trauma causes radial tears in diaphragm muscle –> leakage of abd contents into LEFT chest (R protected by Liver) –>Lung compression & bowel strangulation –> FAST DEATH

Image showing NG tube in the upper chest

Tx = Surgical Repair

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42
Q

Umbilica hernia is most commonly associated with (⬜4)

________________

Umbilical hernias may contain ⬜ or ⬜

A

Blacks

Prematurity

[Beckwith Widemann]

hypOthyroidism

**Umbilical hernias may contain omentum vs. small intestine**

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43
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 0 - 2 Hours PostOp (4)

A
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44
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 1 Day - 1 Week PostOp (3)

A
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45
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens 1 Week - 1 Month PostOp (5)

A
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46
Q

Pt with Fever [100 F ( >38 C)].

Causes if it happens More than 1 month PostOp (2)

A
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47
Q

Syringomyelia etx

A

[Whiplash Spinal Cord Injury] vs. [Arnold Chiari Malformation] –> disrupted CSF drainage in central canal –> compression of STT and CST

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48
Q

[Pulmonary Contusion] is ⬜ of the lung that occurs within ⬜ days of injury

A

Parenchymal bruising

________________

1-2

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49
Q

How is Epidural Hematoma (think blunt head trauma) associated with Cushing’s Reflex?

A

Epi Hematoma –> INC elevated ICP –(can)–> [TUMTL herniation (COPPR)] & [Cushing’s Reflex]!

Cushing’s Reflex = HBO (HTN / Bradycardia / slOw breathing) and indicates INC ICP

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50
Q

All trauma pts should receive ⬜ stability and ⬜ immobility until ⬜ injury has been ruled out

________________

List Trauma Mgmt in order (4)

A

[ABC cardiopulm]; spine; spinal cord injury

________________

1st: [ABC/FAST]
2nd: SPINE IMMOBILITY
3rd: [Bladder protection (urinary catheter for urinary retention/bladder injury)]
4th: spine imaging

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51
Q

Dumping Syndrome MOD

________________

Dumping Syndrome Sx(5)

A

rapid emptying of hypertonic stomach contents into Duodenum & small intestine (usually after gastrectomy or RYGB) –> DDUMP

________________

Diarrhea

Diaphoresis

[Umbilical ABD Pain]

M (N)ausea

Palpitations

worst after eating and better at night

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52
Q

Pt with Blunt Abd Trauma shows spleen hemorrhage on FAST but is hemodynamically stable: Next 2 steps?

A

[CT Abdomen w/contrast] –> Repair spleen –> Remove if necessary with immunization against encapsulated bacteria

If pt responds to fluids (SBP > 100) and doesn’t require blood

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53
Q

Definition of Shock

A

Any state that causes perfusion inadquate to meet O2 and nutritional demands of tissue

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54
Q

An elevated [Pulmonary Capillary Wedge Pressure] following MVA suggest what diagnosis?

________________

How do you confirm this?

A

Myocardial Contusion

________________

Giving Saline will worsen PCWP but not change systemic BP

damage to L Vt during MVA –> INC intracardiac filling pressures

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55
Q

During a Tension PTX, what 2 anatomic sites are best for needle thoracostomy?

A

1st: [MidClavicular 2nd ICS (InterCostal Space)]
2nd: [MidAxillary 5th ICS]

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56
Q

Which part of the airway is usually perforated during blunt thoracic trauma

A

R Main Bronchus

Tracheobronchial perforation

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57
Q

What is a [Marjolin Ulcer]

A

SQC arising within a Burn wound

Note: SQC arising within chronic skin wounds are more aggressive!

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58
Q

How does shallow breathing and weak cough contribute to PostOp (POD2-5) atelectasis?

A

shallow breathing –> DEC alveoli recruitment at lung bases

weak cough –> INC small airway mucus plugs

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59
Q

Which pts are most at risk for [Acute S.Aureus Parotiditis]?(2)

________________

How do you prevent this(2)?

A

[Dehydrated PostOp pts] & Elderly

________________

[Fluid Hydration] & [Oral Hygiene]

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60
Q

Name the Rotator Cuff Muscles (4). List each of their function.

A

Supraspinatus(most commonly injured) = initiates Arm ABduction

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61
Q

Describe the “Empty-Can” test and which muscle it test for?

________________

What is the [Drop arm sign]?

A

[ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] –> Pain = [Supraspinatus Rotator cuff injury]

________________

Arm passively ABducted passed 90° that drops when released = no ADDuction which = Rototar cuff injury

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62
Q

Describe [Popeye sign] and what causes it?

A

[Bicep m. belly] pops up out of mid upper arm; [Bicep long head tendon rupture]

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63
Q

Classic sx of [Pancreatic ADC] (5)

A

Fat Guys Can Smell Terribly

  1. [Gnawing Epigastric pain-worst at night-not relieved w/AntiAcids or food]
  2. **[Courvoisier Palpable Gallbladder w/Painless Jaundice]**
  3. FFAW CA signs (Fever, Fatigue, Anorexia, Weakness)
  4. [Trousseau Migratory Thrombophlebitis]
  5. Steatorrhea
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64
Q

After arterial catheterization how long should you stay vigilant for hematoma formation?

________________

Which vascular site is highest risk?

A

12 hours

________________

Arterial puncture site above inguinal ligament –> retroperitoneal hematoma

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65
Q

Retroperitoneal Hematoma/Hemorrhage

Dx?

Tx?

A

Dx = [CT Abd/Pelvis]

Tx = [Fluid & Blood Resuscitation]

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66
Q

Describe how [Anterior Shoulder Dislocation] occurs?

________________

What neurovasucular bundle does it damage?

A

[Forceful ABduction + External Rotation] @ Glenohumeral joint –>

________________

[Axillary n. and artery] damage

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67
Q

[AMBIC - Acute Mesenteric Bowel ischemic colitis]

Sx (5)

A
  1. POOP periumbilical
  2. Bloody Diarrhea
  3. Rebound
  4. Guarding
  5. [NV ➜ hypOkalemia]

________________

  • POOP = Pain Out Of Proportion*
  • CT revealing air & edema in bowel wall–>thickening = MBIC*
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68
Q

[Pancreatic Retroperitoenal abscess] MOD

A

Blunt abd trauma compresses [Pancreas neck vs. body] against vertebral column –> contusion –>

devitalized tissue ➜ [pancreatic pseudocyst] ➜ [pancreatic retroperitoneal abscess] ➜ DEATH (if not diagnosed)

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69
Q

Explain why appendicitis pts have periumbilical pain that radiates to RLQ and then LLQ TTP

A

[Appendiceal wall stretching = periumbilical pain] and when [periTOneum becomes inflammaed = RLQ radiation].

[Rovsing sign = LLQ TTP can also occur]

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70
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

________________

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Motor] component (6)

A
  • GCS prognosis’* Brain CHIT
    1. Coma
    2. Hemorrhage (SAH)
    3. Infection (bacterial meningitis)
    4. Trauma

________________

EVM = Eyes / Verbal / Motor

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71
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

________________

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Eyes] component (4)

A
  • GCS prognosis’* Brain CHIT
    1. Coma
    2. Hemorrhage (SAH)
    3. Infection (bacterial meningitis)
    4. Trauma

________________

EVM = Eyes / Verbal / Motor

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72
Q

GCS(Glasgow Coma Scale) predicts Prognosis of what 4 things?

________________

The 3 components are EVM (Eyes/Verbal/Motor)

Describe the [Verbal Response] component (5)

A
  • GCS prognosis’* Brain CHIT
    1. Coma
    2. Hemorrhage (SAH)
    3. Infection (bacterial meningitis)
    4. Trauma

________________

EVM = Eyes / Verbal / Motor

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73
Q

DDx for Anterior Mediastinal Mass (4)

A

4 T’s

[Teratoma Germ cell tumor (Seminomatous vs. NonSeminomatous)]

Thymoma

Thyroid CA

Terrible lymphoma

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74
Q

Diagnosis?

________________

Composition?

________________

Complications (5)?

A

Pancreatic Pseudocyst

________________

Walled off [amylase-rich fluid] surrounded by a fibrous capsule –->

[Infection / [Biliary obstruction] / [Psuedoaneurysm (digestion of adjacent vessels)] / ascities / [Pleural Effusion]

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75
Q

Mngmt (2)

A

Pancreatic Pseudocyst

[Embolize pseudoaneurysm if present] –> [Endoscopic drainage of Pancreatic Pseudocyst]

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76
Q

How is an [abd succussion splash] performed? What does it indicate?

A

With stethoscope over upper Abd, pt is rocked back and forth at hips –> [meals in stomach > 3 hours] make “splash” sound

=

Gastric Outlet Obstruction

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77
Q

Diagnosis?

________________

Complications?

Image shows L arm

A

[Supracondylar Humeral FOOSA] fracture –>

Entrapement of Brachial A. or Median Nerve

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78
Q

Initial mngmt of Burn pts is similar to Truama in that ABC is done first

Why is this(2)? What are the 2 options?

A

Supraglottic airway is susceptible to direct thermal injury and obstruction by edema or blistering;

Use NonRebreather Mask –> [Intubation if PE shows thermal damage to airway(Face burns/Oropharyngeal blisters/GOE 10% CarboxyHgB/Eye Singing)]

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79
Q

Mngmt for suspected [Scaphoid fracture] (2).

________________

What should be used if you need immediate diagnosis(2)?

A

< [Wrist immobilization with thumb spica cast x 7-10 days] –> [Repeat X-Rays] >

________________

Use CT or MRI for immediate diagnosis

DO THIS EVEN IF INITIAL X-RAY IS NEGATIVE. CAN TAKE UP TO 10 DAYS FOR ABNORMALITIES TO SHOW!

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80
Q

WHERE do Stress fractures occur in pts involved in…

A: Jumping sports

________________

B: Runners

________________

What are the X-ray findings?

A

A: Jumping sports = [TIBIA Anterior middle third]

B: Runners = [TIBIA Posteromedial Distal third]

________________

X-rays = normal initially!

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81
Q

In regards to sx presentation, what is difference between Arterial Embolism and Thrombosis?

A

Arterial Embolism = Abrupt Pain

vs.

Arterial Thrombosis = [insidious gradual pain] from progressive narrowing of vascular lumen

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82
Q

SIRS (Systemic Inflammatory Repsonse Syndrome) is defined as ⬜ cause (vs. Sepsis which is an ⬜ cause)

of ⬜

________________

List Criteria for SIRS

A

[SIRS = NONinfectious] vs. [Sepsis = Infectious] cause of massive proinflammatory release –> extensive tissue damage

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83
Q

Common causes of SIRS (4).

________________

How is this related to Sepsis?

A

[BVAP: Burns / Vasculitis / Autoimmune / Pancreatitis] –> SIRS

–(can lead to) —> [Concomitant infection] = Sepsis

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84
Q

How is AAA Repair of the ____ region related to [Anterior Spinal Cord Syndrome]

A

Thoracic AAA Repair –> [⬇︎Adamkiewicz radicular artery flow] –> [⬇︎ ANT Spinal Artery flow] —> [infarction of CST and STT areas]

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85
Q

Sx of [Leriche Syndrome] (3)

A

Arterial Dz –> “Leriche was in the CIA!”

  1. [Claudication bilaterally of Hip, Butt, Thigh]
  2. *** Impotence **** (Key sign)
  3. Atrophy bilaterally of LE
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86
Q

[Leriche Syndrome] MOD

A

“Leriche was in the CIA”

Arterial Dz (from smoking, atherosclerosis) –>Occlusion at Bifurcation of Aorta into the common iLiac arteries –> CIA

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87
Q

Causes of Compartment Syndrome (3)

A
  1. Trauma
  2. [Prolonged Compression]
  3. [REVASCULARIZATION OF ISCHEMIC LIMB (Fx with closed reduction)]

➜

[⬆︎ swelling pressure] ➜ [⬇︎ venous blood flow] and eventually [⬇︎ arterial blood flow]

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88
Q

What’s the most important prognostic indicator for Compartment Syndrome

A

Time it takes to do a Fasciotomy

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89
Q

Compartment Syndrome Sx (6)

A

The 6 P’s!

  1. POOP (Pain Out Of Proportion)
  2. [Paresthesia - EARLY finding]
  3. [Pulselessness - LATE finding]
  4. Pallor
  5. Poikilothermia (inability to regulate body temp)
  6. Paralysis
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90
Q

Tears of the [⬜ meniscus] are more common than tears of the [⬜ meniscus]

________________

What causes meniscus tears?

A

MEDIAL meniscus > lateral meniscus

________________

Twisting force against a fixed foot –> popping sound followed by acute pain

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91
Q

What’s the Initial test for diagnosing Meniscus tears (2)?

________________

How do you confirm this? -2

A

Initial test = [McMurray (palpable locking/catching when joint is rotated)] vs. [Thessaly]

________________

Confirmatory = MRI vs. arthroscopy

________________

etx: Twisting force against a fixed foot –> popping sound followed by acute pain

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92
Q

3 common signs of [Blunt Aortic injury]?

________________

What are 2 major causes?

________________

Initial dx?

A

Tachycardia / HTN / [CXR Widened Mediastinum]

________________

MVA vs. (Falls > 10 ft.)

________________

CXR = Initial screening

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93
Q

Describe [Torus Palatinus]

A

Congenital benign NonTender bony growth on midline of hard palate that can INC throughout life and ulcerate w/trauma

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94
Q

Adrenal Gland crisis Tx (2)

A

[Hydrocortisone IV vs. Dexamethasone IV]

+

IVF

Adrenal Crisis = Loss of Adrenal gland function

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95
Q

Pts taking Prednisone ≥ ⬜ mg/day are at risk for Adrenal Gland crisis

________________

How is this related to “Stress Doses”?

A

≥ 20mg/day prednisone –> Adrenal Gland Crisis

________________

Give these pts Stress Doses of [Glucocorticoid CTS] during an acute stressor (i.e. surgery) since they won’t have functioning Adrenal Glands

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96
Q

Name the 1ST MOST COMMON peripheral artery aneurysm

________________

2nd most common?

A

1ST MOST COMMON = POPLITEAL

________________

2nd = Femoral (may compress Femoral n. –> Thigh claudication)

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97
Q

Pelvis fractures are often associated with ⬜ urethral injury

________________

What are the sx(3)?

A

Posterior (prostatic and membranous)

________________

  1. Urethral meatus Bleeding
  2. High riding prostate (prostate displacement by pelvic hematoma)
  3. Scrotal Hematoma
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98
Q

In Clavicle fractures the shoulder is displaced ⬜ and ⬜

________________

Why should a careful neurovasulcar exam be done?

A

Inferiorly and Posteriorly (pushed down and back)

________________

Clavicle is very close to Subclavian a. and Brachial plexus

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99
Q

What 2 injuries cause Clavicle fractures?

A

FOOSA vs. Directly Shoulder blow

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100
Q

[(AMBIC) Acute Mesenteric Bowel ischemic colitis]

Labs (4)

A
  • AMBIC* ⇪ WAHL products!
    1. WBC ⇪
    2. Amylase ⇪
    3. Hgb ⇪
    4. [LACTASE ⇪ ➜ metabolic acidosis]

________________

CT revealing air & edema in bowel wall –> thickening = MBIC

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101
Q

s/p rhinoplasty, Pt now has a new whistling noise during respiration

Diagnosis?

A

[Septal perforation] 2/2 septal hematoma

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102
Q

Tx for Metatarsal Stress Fracture (2)

Demographic(2)?

A

Rest + Analgesics

Athletes & Military

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103
Q

Terminal Hematuria (blood at end of peeing) suggest bleeding from where(3)?

A

[Bladder Neck/Trigone]

Prostate

[Posterior Urethra (prostatic urethra & membranous urethra)]

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104
Q

Initial Hematuria (bleeding at beginning of peeing) suggest what?

A

Urethral damage

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105
Q

Total Hematuria (blood all throughout peeing) suggest damge to what(2)?

A

Kidneys vs. Ureters

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106
Q

Which 2 organs are most frequently injured during Blunt Abdominal Trauma?

A

Spleen and Liver

BE ON THE LOOK OUT FOR SPLENIC LACERATIONS!!

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107
Q

In a pt with any Urethral injury, what’s first step in mngmt?

A

Assess and determine damage with Retrograde Urethrogram

Contrast retrogradely injected into urethra

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108
Q

Diagnosis? Explain findings (3)

A

Diaphragmatic Hernia

[L lower lobe opacity] + [Elevated Hemidiaphragm] + [Mediastinal shift]

Confirmed via CT Abd

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109
Q

Mngmt for [Small PTX in clinically stable pt]

A

[supplemental O2 (⇪ resorption)]

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110
Q

Mngmt for [LARGE PTX in clinically stable pt]

A

Large bore (14 - 18 gauge) needle thoracostomy

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111
Q

Mngmt for [LARGE PTX in clinically UNSTABLE pt]

A

Chest Tube thoracostomy

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112
Q

PostOp PNA can develop ➜ Septic shock which➜ ⬜ that ➜ Lactic Acidosis

________________

Mngmt (2)?

A

tissue hypOperfusion

________________

Abx + IVF

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113
Q

5 signs of [Necrotizing Surgical Site]

A
  1. Dishwater Drainage (cloudy gray)
  2. SubQ crepitus
  3. Systemic signs (fever/hypOtension/tachycardia)
  4. Wound edge paresthesia
  5. PAIN out of proportion with PE

Develops into Necrotizing Facititis

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114
Q

What’s the most important step in managing Necrotizing Surgical Site/Fascitis

A

Surgical exploration Debridement

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115
Q

What part of the bladder can cause Kehr sign?

________________

why?

A

Dome of Bladder

________________

it’s covered by peritoneum and allows leakage of urine into peritoneum–> Peritonitis–> Kehr sign since hemidiaphragm undersurface is covered by parietal peritoneum

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116
Q

Kehr sign

A

[referred L SHOULDER PAIN] from [diaphragm irritation] or [periTOnitis abd pain]

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117
Q

Overall lifetime dose of [Tetanus Toxoid vaccine] is ⬜ with a booster every ⬜ years.

A

[6 throughout childhood]

________________

[booster q10y starting at age 19]

This is for USA

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118
Q

Tetanus Px in a pt who has

[≥3 Lifetime Tetanus Toxoid Vaccine (TTV)]

+

[Booster 13 years ago]

+

[Clean minor wound]

A

TTV with NO [Tetanus Ig]

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119
Q

Tetanus Px in a pt who has

[Uncertain/ LOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[Clean minor wound]

A

TTV with NO [Tetanus Ig]

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120
Q

Tetanus Px in a pt who has

[DIRTY SEVERE WOUND]

+

[≥3 Lifetime TTV (Tetanus Toxoid Vaccine)]

+

[booster 7 years ago]

A

TTV with NO [Tetanus Ig]

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121
Q

Tetanus Px in a pt who has

[Uncertain/ LOE 3 Lifetime Tetanus Toxoid Vaccines(TTV)]

+

[DIRTY SEVERE WOUND]

A

TTV + [Tetanus Ig]

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122
Q

Normal range for Phosphorous

A

C1288 N3045

3.0 - 4.5

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123
Q

CRITICAL range for Phosphorous

A

C1288 N3045

1.2 > x > 8.8

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124
Q

Normal range for Mg

A

C1148 N1722

1.7 - 2.2

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125
Q

CRITICAL range for Mg

A

C1148 N1722

1.1 > x > 4.8

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126
Q

CRITICAL Range for [Total Ca+]

A

6 - 13

6.0 > x > 13.0

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127
Q

4 signs of hypOcalcemia ( total Ca+ < 6)

A
  1. Prolonged QT
  2. PeriOral tingling
  3. Muscle Cramps
  4. Seizures
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128
Q

CRITICAL Range for [ionized Ca+]

A

0.76 > x > 1.49

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129
Q

Tx for Anal Fissures (7)

A

[SNF x 2 + Lidocaine]

  1. Stool softeners
  2. Sitz Baths
  3. Nifedipine (relaxes sphincter to ⇪ blood to fissure for healing)
  4. NTG (relaxes sphincter to ⇪ blood to fissure for healing)
  5. Fluid intake
  6. Fiber
  7. Lidocaine
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130
Q

Causes of Anal Fissures (5)

A

SNF x 2 w/ Lidocaine

  • Constipation
  • Prolonged Diarrhea
  • Anal Sex
  • Crohn Dz
  • CA
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131
Q

Penile fracture MOD

A

Tunica Albuginea (wraps the corpus cavernosum) tears from bending while erect –> SNAP –>hematoma –>MORE bending

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132
Q

Penile Fracture Mngmt (2)

A

Retrograde Urethrogram –> Surgical Repair

________________

image: RUG of penis fracture

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133
Q

[(AAA) Abdominal Aortic Aneurysm] = Aorta >⬜ cm at (⬜location)

A

3

________________

[renal arteries L1-L2]

RF = Smokers / Men / CAD

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134
Q

Presentation for AAA (4)

A
  1. Back Pain
  2. [hypOtension –> Syncope]
  3. [Umbilical Pulsatile Mass]
  4. Gross Hematuria (AAA ruptures into retroperitoneum and creates aortocaval fistula with IVC –>Venous congestion in retroperitoneal structures –> vein ruptures)
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135
Q

Psoas Abscess presentation (3)

A
  1. Psoas Sign (Pain with Hip Extension)
  2. [RLQ DEEP TTP w/radiation to R Groin]
  3. Subacute Fever
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136
Q

Psoas Abscess Dx

A

CT Abd/Pelvis

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137
Q

Trochanteric Bursitis presents as ⬜ worsened by (⬜3)

A

[Mid Adult Unilateral Hip Pain]

________________

Pressure / External Rotation / Resisted ABduction

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138
Q

Risk Factors for Trochanteric Bursitis -4

A

Overuse

Trauma

Joint Crystals

Infection

139
Q

Eschar formation can compress blood & lymph circulation –> distal swelling –> Compartment Syndrome

When should an Escharotomy be performed?

A

When compartment pressure is within [25-40 mmHg]

140
Q

Explain why [Positive Pressure Mechanical Ventilation] is relatively contraindicated in hypOvolemic shock pts.

How do we circumvent this?

A

[PPMV ⇪ intraThoracic pressure] –> [DEC venous return/preload] –> circulatory collapse

Fluid Resuscitate BEFORE PPMV in these pts

141
Q

Signs of Emphysematous Cholecystitis (6)

A
  1. [Air Fluid gas] in GallBladder WALL & LUMEN
  2. Crepitus in Abd wall next to GB
  3. Fever
  4. RUQ pain
  5. Leukocytosis
  6. NV

THIS IS LIFE THREATNING!

142
Q

Causes of Emphysematous Cholecystitis (2)

A

[Gas-forming [Clostridium vs. E.Coli]] GB infection

THIS IS LIFE THREATNING!

143
Q

Emphysematous Cholecystitis Mngmt (2)

A

[Ampicillin-Sulbactam] + [Emergent Chole]

THIS IS LIFE THREATNING!

144
Q

Emphysematous Cholecystitis RF (4)

A
  1. Gallstone hx
  2. DM
  3. [cystic artery ischemia]
  4. immunosuppressio

THIS IS LIFE THREATNING!

145
Q

Earliest sign of HYPERMagnesemia

A

Loss of Deep Tendon Reflexes

  • eventually –> Resp depression*
  • ________________*

1148 1722

146
Q

Why can bypassing or losing the iLeum –> Kidney stones

A

Fatty Acids are normally absorbed @ terminal iLeum.

No Terminal iLeum = intestinal Fatty acids combine with Ca+ –> [⇪ Free Oxaluria absorption] –>[⇪ retangular (Ca+Oxalate renal stone) excretion]

147
Q

How should you volume replete hypovolemic shock in NON-urban setting?

A

[2L Lactated Ringer w/NO sugar] —> [Packed RBC] until

Urinary Output = [(0.5-2 cc/kg) /hr]

but not exceeding 15 mmHg CVP

________________

Urban setting = Take directly to Trauma Center

148
Q

What causes [Neurocardiogenic Vasomotor] shock? (2)

A
  1. Spinal Cord Injury
  2. Anesthesia
149
Q

Subdural Hematoma

Mngmt if midline is deviated?

Mngmt if midline structures are fine?

A

Subdural Hematoma

Craniotomy ONLY if midline is deviated

[Monitor/Prevent further ICP] if no midline deviation(elevate head/hyperventilate/mannitol/furosemide)

150
Q

Key signs of Pulmonary Contusion? (3)

A

Chest wall bruising

[DEC breath sounds on affected side]

[CXR: Patchy irregular alveolar infiltrate]

151
Q

Pt develops Coagulopathy (can NOT coagulate) during prolonged abd surgery for trauma.

Next Step? (2)

________________

When would you terminate the surgery?

A

[10U Fresh Frozen Plasma 10U] + [10U Platelet Packs]

________________

TERMINATE IF PT DEVELOPS [hypOthermia & acidosis]

152
Q

Gunshot to upper anterolateral thigh away from vessels. 1st step in mngmt? (2)

A

TTV (Tetanus Toxoid Vaccine) + Wound Cleaning

Doppler vs. [Spiral CT angio] if near vessels

153
Q

Why is it important to monitor Peripheral pulses & Cap Refill in Circumferential Burns?

________________

Mngmt?

A

Circumferential Burns eventually —> Eschar which allows underlying edema to cutoff perfusion ➜ compartment syndrome (at >30 mmHg)

________________

Escharotomy

154
Q

signs of [Developmental Dysplasia of Hip] (2)

A

Congenital Hip dysplasia –>

  1. Easy Posterior Hip dislocation with a click & then snap when returned
  2. Uneven Gluteal Folds
155
Q

[Developmental Dysplasia of Hip] Dx? Tx?

A

Dx = US

Tx = [ABduction splinting with Pavlik harness x 6 mo.]

156
Q

Why is angulation of a fractured bone in kids ok, but not ok in adults?

A

Kids have accelerated bone Remodeling and as long as the fracture is reduced & immobilized, they’re fine

157
Q

How are Clavicular fractures managed?

A

Arm Sling

Clavicular fractures occur at junction of mid & distal third

158
Q

Classic presentation for Hip fracture (3)

A

[Elderly post fall] with affected Leg being shortened and rotated (internal vs. external)

159
Q

Tx for Intertrochanteric Fractures (2)

A

[Open reduction + internal fixation] –> [PostOp AntiCoags]

160
Q

Tx for Femoral Neck fractures

A

Replace femoral head with prosthesis

161
Q

Dx for Compartment Syndrome (2)

A

Dx = [Clinical in Revascularization pts] vs.

[Compartment pressures > 30 mmHg]

162
Q

pts who’ve fallen from high heights will have foot fractures, leg fractures AND possibly ⬜ fractures as well

A

[Thoracolumbar spine]

163
Q

Pt with triad of

  1. Digoxin
  2. Diuretics
  3. Abdominal Pain

..should make you suspect what dz?

A

MBIC! (Mesenteric Bowel ischemic colitis)

Digoxin = aFib

Diuretics = HF

Abd pain occurs after SMA or IMA are occluded

164
Q

[(AMBIC) Acute Mesenteric Bowel ischemic colitis]

Mngmt (6)

A
  1. O2
  2. IVF
  3. [Abx: CefTriaxone vs. (Levoflox + flagyl)]
  4. Pain control
  5. Heparin (if clot present)
  6. Laparatomy

CT revealing air & edema in bowel wall –> thickening = MBIC

165
Q

Causes of SBO in Kids (3)

A

Intussuception

Intestinal Atresia

Volvulus

166
Q

PE findings for Appendicitis (5)

A

PMR PD

  1. Peritoneal signs (Rebound, Guarding)
  2. McBurney’s point TTP
  3. [Rovsing’s LLQ TTP]
  4. [Psoas & Obturator sign]
  5. DEC bowel sounds
167
Q

DDx for SBO (14)

A

GIVES BAD CRAMPS

Gallstone iLeus

Intussuception (kids)

Volvulus (kids)

External compression (CA)

SMA syndrome

Bowel wall hematoma

Abscess

Diverticulitis

Crohn’s Dz

Radiation Enteritis

Annular Pancreas

Meckles Diverticulum

Peritoneal adhesion

Stricture

168
Q

Labs for SBO (3)

A

[⬇︎ K / H+(alkalosis) / Cl]

169
Q

Appendicitis DDx (8)

A
  1. Ectopic Pregnancy
  2. Ovarian Cyst/Torsion
  3. PID
  4. Crohn’s
  5. Pyelo
  6. Gastroenteritis
  7. Perforated ulcer
  8. Pancreatitis
170
Q

Acute Appendicitis mnmgt (3 steps)

A

LAS

1st: LR
2nd: [Abx: FUCCC= Flagyl, Unasyn, Cipro, Cefoxitin, Cefotetan]
3rd: Surgery? [Nonperf = Appy within 24 hours] vs. [Perf = Prompt appy with postop abx for 1 week] vs. [Abscess = perQ drainage + abx + interval appy]

171
Q

[(AMBIC) Acute Mesenteric Bowel ischemic colitis]

Dx (2)

A

Dx = [CT contrast] vs. [Mesenteric Angiogram]

CT revealing air & edema in bowel wall –> thickening = MBIC

172
Q

Mngmt for Diverticulitis (4)

A
  • Colonic Bacterial Abx
  • NPO
  • IVF
  • rule out colon CA
173
Q

Diveriticulitis Dx

A

CT showing [bowel wall FREE AIR & edema]

174
Q

Acute Pancreatitis Mngmt (5)

A
  • NPO
  • IVF
  • Pain control
  • [NG decompression if emesis]
  • Possibly: [Postpyloric TF vs. TPN]
175
Q

Difference between [Jersey and Mallet finger]

Tx

A

Jersey = flexed finger is forcefully extended–>flexor tendon damage –> Distal phalanx won’t flex

Mallet = (THINK VOLLEYBALL) = EXTENDED finger is forcefully flexed –> extensor tendon rupture –> Distal phalanx won’t extend

Tx = Splint

176
Q

How can nutritional depletion be circumvented in surgical candidates?

A

7-10 day PreOp nutritional support directly to gut

177
Q

Parameters for Nutritional Depletion (4)

A
  • Albumin < 3
  • Transferrin < 200
  • [GOE 20% wt. loss over prior 2 months]
  • Skin Antigen Anergy

NUTRITIONAL DEPLETION ⇪ OPERATIVE RISK

178
Q

Green fluid draining from hemigastrectomy wound likely indicates ⬜

________________

Mngmt?-3

A

Fistula(bowel –>wound)

________________

  1. Abd Wall protection
  2. fluid
  3. nutrition
179
Q

Name one of the key lab differences between

Acute Hemorrhagic Pancreatitis vs. Acute Edematous Pancreatitis

A

Hemorrhagic = lower Hematocrit

Edematous = HIGHER Hematocrit

180
Q

What is Ranson’s Criteria and what does it refer to?

A

chUG

[⬇︎ca+/ ⬇︎hct / ⇪︎WBC / ⇪︎ Glucose]

Indicates Acute Hemorrhagic Pancreatitis

181
Q

[Ground Glass appearance of lower abd] is pathognomonic for _____

A

Meconium iLeus

MOTHER WILL HAVE CYSTIC FIBROSIS!

182
Q

Why is Gastrografin used as both diagnostic and therapy for Meconium iLeus

A

Diagnostic = it’ll show inspissated pellets of meconium in terminal iLeum

Therapeutic = Gastrografin draws fluid in and dissolves pellets

183
Q

Signs of Congenital Vascular Rings

A
  1. Stridor
  2. Crowing Respiration with positional hyperextension
  3. Dysphagia
184
Q

Vascular Rings MOD

A

Two Aortic Arches wrap around Trachea & Esophagus –> Segmental tracheal compression on Bronchoscopy

185
Q

Amblyopia MOD

A

Infants who don’t have Vision impairment (such as [Strabismus CrossEye]) fixed within first 6 years of life –> Permanent Cortical Blindness in affected eye since Brain eventually suppresses 1 of the overlapping images

186
Q

Demographic for SQC of Head & Neck

A

Old Men who smoke, drink, rotten teeth

187
Q

Dx for SQC of Head & Neck (2)

A

[Triple Panendoscopy to look for 1° tumor] –> CT to demonstrate extent

188
Q

Tx for [Mitral Stenosis s/p Rheumatic Fever] (2)

A

Surgical Commissurotomy vs. Balloon Valvuloplasty

189
Q

Pt with Frontal or Ethmoid Sinusitis is at risk for what serious complication?

________________

Tx?-2

A

Cavernous Sinus Thrombosis!

________________

Drain affected sinuses + IV Abx

190
Q

What is the classic presentation for [Ureteropelvic Junction Obstruction]?

________________

why?

A

16 yom on a beer-binge for first time w/colicky flank pain

________________

Large diuresis in a narrow area will produce flank colicky pain

191
Q

What should first be assessed in a deteriorating >5 day old Liver after transplant-2? Why?

A

[Biliary Obstruction via US] & [Thrombosis via Doppler]; Technical problems are more common than rejection in Liver transplants!

192
Q

In a compromised airway pt, what is the next option if intubation can not be done?

A

Cricothyrotomy

193
Q

What are 2 scenarios that predispose to Air Embolism

A
  1. Trauma pt intubated and on respirator
  2. Subclavian vein opened to air (Central venous line placement,supraclavicular node biopsies)

Air Embolism –> Sudden Death from Cardiac Arrest!

194
Q

[Trauma pt intubated and on respirator] develops air embolism!

Mngmt?

A

Cardiac Massage w/pt L side down

195
Q

Mngmt for pts with trace hematuria post trauma

A

NONE! This is normal

196
Q

Method for biopsing breast masses

A

Mammographically/Sonographically-guided Multiple Core Biopsy

197
Q

Examples of Alkaline burns-2? Mngmt?

A

Liquid Plumer vs. Drano; H20 Irrigation for GOE 30 min –> ER

198
Q

[Knock Knee Valgus] is normal between what ages?

A

4 - 8 (No tx needed)

199
Q

[Bowlegged Varus] is normal between what ages?

A

birth - 3

[Bowlegged Varus] beyond 3 = Blount Dz which needs surgery

200
Q

Demographic for Dupuytren Contracture

A

Older Norwegian Men

201
Q

What are the Hepatic predictors of mortality during a surgery-4?

A

BAPE

(GOE 3 = 85% Mortality)

  1. Bilirubin > 2 ( > 4 alone = 85% Mortality )
  2. Albumin < 3 ( < 2 alone = 85% Mortality)
  3. PT time > 16
  4. Encephalopathy (Ammonia alone > 150 = 85% Mortality**)
202
Q

Wound Dehiscence

Difference between Superficial and Deep?
________________

Onset?

A

> Superficial = epidermis|subQ separate but with rectus fascia intact 2/2 accumulation of [pink salmon peritoneal fluid accumulation = seroma] -> use regular dressing changes

> > DEEP = dehiscence involving fascia could –> bowel evisceration/strangulation so = surgical 911

________________

POD5

203
Q

Wound Dehiscence Mngmt(Superficial vs Deep) ?

A

Superficial WD = tape wounds, regular dressing changes
DEEP WD = temporary bind abd → schedule surgical repair to prevent evisceration/ventral hernia

✏️Superficial WD: separation of epi/SQ but with intact fascia → tx = reg dressing ∆
✏️DEEP WD: = surgical 911

204
Q

[Zollinger Ellison Gastrinoma] Dx

A

[Measure Gastrin] –> [If Gastrin is equivocal Measure Secretin(normally ⬇︎ Gastrin secretion = would be HIGH because of feedback)] –> [Locate Pancreatic Tumor with CT] —> Remove tumor

205
Q

What conditions cause this-3?

A

[Newborn Green Emesis] + DOUBLE BUBBLE SIGN = DAM!

Duodenal Atresia

Annular Pancreas

Malrotation (Most dangerous)

206
Q

Cardiac Catheterization showing [Square Root Sign] and [Equilization of Pressures] indicates what dx?

A

Constrictive Pericarditis

207
Q

Sx for Retinal Detachment-3

A

THIS IS AN EMERGENCY!

  1. Flashes of light
  2. Floaters (⇪# = ⇪ Severity)
  3. [Dark Cloud vs. Snow storm vs. MANY floaters] in upper visual field = Extreme Retinal Detachment!
208
Q

Tx for Retinal Detachment

A

Laser spot welding

209
Q

What is Cushing’s Reflex?

A

Cushing’s Reflex = HBO Compensatory response to ⬆︎ ICP that preserves perfusion of the brainstem

HBO (HTN / Bradycardia / slOw breathing)

210
Q

Kidney stones of what size are eligible for invasive intervention?

A

≥7mm

211
Q

Tx for [Kidney stone ≥ 7 mm]

What are the Contraindications to this-3?

A

[ExtraCorporeal Shockwave Lithotripsy]

Cx = Pregnancy, [Coagulopathic Bleeding Diathesis], [Size > 1 centimeter]

212
Q

Demographic for Chronic Subdural hematomas-2 and why this is?

A

Old and Alcoholics; Shrunken Brain has EASY venous sinus tearing

213
Q

Hemothorax Mngmt. When is more invasive intervention indicated-2?

A

[Chest Tube Thoracostomy] ; Surgery only indicated if [> 1500 mL total] or [> 600 in 6 hours] is recovered

214
Q

Normally [Penetrating Abd Stab wounds require XLap]

In what situations is digital exploration of Abd stab wounds sufficient-3?

A
  1. NO evisceration (protruding viscera)
  2. NO peritoneal signs
  3. NO HemoDynamic instability
215
Q

Mngmt for Abd wound that can’t be closed due to tension-2

A

[Temporary Abd Cover (absorbable mesh vs. plastic)] –> [Graft over mesh vs. Remove Plastic] Later

216
Q

Dx for Bladder Injuries post trauma

A

[Retrograde Cystogram with Postvoid films]

Postvoid films needed to see xtraperitoneal leaks @ bladder base that are hidden by dyed bladder

217
Q

What determines Rabies px-2

A

[If animal is alive = Examine Animal Brain] vs. [Mandatory if animal n/a]

rabies px = IgG AND Vaccine

218
Q

Presentation of [SCFE - Slipped Capital Femoral Epiphysis] -4

A
  1. 13 yom with
  2. [Knee / Groin Pain + Limping]
  3. sole of affected foot pointed toward other foot
  4. Thigh can NOT be rotated internally during hip flex

Tx= immediate Surgery to avoid AVN

219
Q

What determines closed vs. open reduction in fractures involving growth plates?

A

Fractures involving [epiphysis and growth plate displaced laterally from metaphysis but in 1 piece = Closed Reduction]

but if fractures crosses epiphysis vs. involves joint = OPEN REDUCTION

220
Q

What bone pathology is associated with uncoordinated muscle contractions (seizure)? How do pts present?

A

Posterior Shoulder Dislocation; Internally rotated (arm held clsoe to body)

221
Q

Posterior Shoulder Dislocation Dx-2

A

Axillary vs. Scapular Lateral Xray

222
Q

Ankle fractures occur when _________ and leads to breakage of ______. Mngmt?

A

Falling on inverted OR everted foot –> BOTH malleoli breakage; [Open Reduction + internal fixation]

223
Q

Where does Lumbar disk herniation occur-2?

A

(L4-5) vs. (L5-S1)

224
Q

What is Morton Neuroma and what causes it?

A

tender inflammation of [Common Digital n.] between 3rd and 4th toe; High-heel shoes (forces toes to be bunched)

225
Q

Which drugs cause Malignant Hyperthermia-2?

A

Halothane vs. Succinylcholine

226
Q

Sx of Malignant Hyperthermia-3

A

MMalignant Hyperthermia

  1. Muscle contraction from Hypercalcemia
  2. Metabolic Acidosis
  3. Hyperthermia (Fever)
227
Q

Mngmt of Malignant Hyperthermia-4 and what should you be watching for?

A
  1. IV Dantrolene
  2. 100% O2
  3. Metabolic Acidosis Correction
  4. Cooling Blankets

BE ON THE LOOKOUT FOR MYOGLOBINURIA!

228
Q

Although ___ is gold standard for PE dx, ____ is more commonly used

A

Pulmonary Angiogram; [Spiral CT angiogram]

Image: Spiral CT Angio showing [R Pulm artery clot]

229
Q

PE Tx-2

A

Heparin –> [IVC filter if recurrence or Heparin contraindicated]

230
Q

Other than Free water changes, which fluid is HYPERnatremia corrected with?

A

D5 1/2NS (HYPERtonic)

231
Q

Other than Free water changes, which fluid is hypOnatremia corrected with-2?

A

NS vs. LR (both isotonic**)

232
Q

Mngmt for pt with [Long standing GERD + Barretts and peptic esophagitis]? Tx if there are SEVERE dysplatic changes?

A

Nissen Fundoplication; Resection

233
Q

[Obstructive Jaundice 2° to tumor] often has _____ on US. What is the dx w/u-3

A

[Courvoisier Palpable Gallbladder w/Painless Jaundice]

1st: US (did that) - shows distended GB
2nd: CT upper abd
3rd: ERCP

234
Q

Fever and Leukocytosis develops 10 days after onset of Pancreatitis. Diagnosis?

A

Acute Suppurative Pancreatic Abscess

235
Q

[Fibroademona] and [Cystosarcoma Phyllodes] are both [Firm, rubbery Breast masses, that occur in young women]

Name 3 things that make Cystosarcoma Phyllodes different from Firbroademona?

A
  1. CP has malignant potential! Removal MANDATORY
  2. CP grows over many years, distorting breast
  3. CP requires Core (Not FNA or US) Biopsy
236
Q

in [Congenital intra-utero Diaphragmatic Hernia], what’s the biggest issue? How is this addressed-2?

A

Lung hypOplasia in-utero; [Extracorporeal membrane oxygenation] –> Repair after 3 days postpartum

237
Q

Necrotizing Enterocolitis Presentation-3

A

Premature infant who just started feeding and develops [RAPID PLATELET DROP(sign of neonatal sepsis)], feeding intolerance, abd distension

238
Q

Necrotizing Enterocolitis Mngmt-5

A
  1. STOP FEEDINGS
  2. Broad Abx
  3. IVF
  4. IV nutrition
  5. Surgery (if abd wall erythema/portal vein air/pneumatosis/pneumoperitoneum develops)
239
Q

When is Surgical intervention indicated in Necrotizing Enterocolitis-4?

A
  • Abd Wall Erythema
  • Portal Vein air
  • Intestinal Pneumatosis (intestinal wall gas)
  • Pneumoperitoneum
240
Q

What is Foster Kennedy Syndrome-4

A

Tumor at [Base of Frontal Lobe] that makes u BOAP

  1. Behavior inappropriate
  2. [Optic n. atrophy ipsilateral to tumor]
  3. Anosmia
  4. [Papilledema CONTRAlateral to tumor]
241
Q

What’s the most common Postop maintenance fluid

A

D5 1/2NS (Hypertonic)

242
Q

When does Acute organ rejection occur and how do you manage it-2?

A

[5 Days - 3 mo. post op]; [Steroid Boluses and AntiThymocyte serum]

243
Q

Pt with a ureteral stone suddenly develops fever and flank pain. What’s Diagnosis and what needs to be done-2?

A

OBSTRUCTIVE PYELONEPHRITIS

1st: IV Abx
2nd: IMMEDIATE PROXIMAL TO STONE DECOMPRESSION (via Ureteral stent vs. PerQNephrostomy)

244
Q

Diagnosis? Describe-4

A

Venous Stasis Ulcer

Above Medial Malleolus

Chronically Edematous

Indurated (Hard)

Hyperpigmented

245
Q

How would you confirm this diagnosis? Tx-2?

A

Duplex Scan;

Tx = [Keep Veins empty (compression stockings/Unna boot)] vs. [Surgery(vein stripping/ulcer graft)]

246
Q

Hypernatremia and hypOnatremia both manifest with ____ and ____. What sx differentiates them?

A

BOTH = Confusion & Possible Coma

[HYPER = Lethargy] vs. [hypO = seizures]

247
Q

Paralytic iLeus is prolonged by which metabolic abnormality?

A

low K+

248
Q

Demographic-2 for Primary Peritonitis and tx

A

Demographic = [Child w/Ascites and nephrosis] vs. [Adult w/Ascites]

Tx = Abx only

Primary Peritonitis = Mild Generalized Acute Abd

249
Q

What are Hepatic Adenomas a complication of and why are they dangerous?

A

OCP; They can rupture and bleed into abd

250
Q

What class of drugs can be given to temporarily alleviate Biliary Colic

A

Anti-Cholinergics

251
Q

HTN in BUE + [Normal-to-No Pulses] in BLE typically indicates ______. What would CXR reveal?

A

Coarctation of Aorta; [Scalloping of lower edge of Ribs(from Dilated collateral intercostal a.)]

252
Q

Coarctation of Aorta Dx

A

Spiral CT Angio

253
Q

Pt with hemoptysis comes in with [Coin lesion on CXR]

What determines whether or not he needs w/u?

A

1ST: LOCATE PREVIOUS (At least 1 year prior or older) CXR! If lesion unchanged = NO CA

Coin lesions = 80% chance malignancy

254
Q

Brain tumors in kids are mostly located where? How does this manifest-2?

A

Posterior Fossa; Cerebellar Dysfunction + [Knee-chest position to relieve HA]

255
Q

Pt with Human Bite on knuckle: Mngmt-2?

A

Extensive irrigation and Debridement in OR

Human Bites are the DIRTIEST Bites!!

256
Q

Pt who’s been vomiting now has metabolic aLKalosis and needs fluid resuscitation: What do you give?

A

NS with added KCl

257
Q

[Osgood Schlatter Dz] MOD

A

Osteochondrosis of Tibial Tubercle –> Persistent Teenager Pain

258
Q

[Osgood Schlatter Dz] Tx-2

A

RICE —> [Cylinder cast x 4-6 weeks]

259
Q

What is the abx px for elective surgery? What about Complex prolonged procedures?

A

A = single dose abx [no more than 1 hour prior] to surgery;

Prolonged procedures = A + Redose abx during procedure

260
Q

What are the 4 main causes of somnolence?

A

He’s totally somnolent and GONE

Abnormalities with…

Glucose

Oxygenation

Narcotics

Electrolytes

261
Q

Pt on POD4 develops PNA and septic shock

What two tx are most important right now?

A
  1. IV NS to maintain intravascular pressure
  2. Abx
262
Q

What modality is necessary to confirm Diaphragmatic Hernia?

A

CT Abd

263
Q

When is it ok for pts concerning for appendicitis to skip CT and go directly to Lap appy?

A

Pts can skip CT if they have classic appendicitis signs (PMR PD)

Appendicitis can be based on lab and clinical findings!

264
Q

Syringomyelia presentation - 2

A

[Whiplash Spinal Cord Injury] vs. [Arnold Chiari Malformation] –>

[Cape distributed Loss of Pain & Temp] –> Burning and eventually Muscle Weakness

265
Q

Tubocurarine and Atracurium MOA ; Indication

A

Non-Depolarizing Nicotinic R Blockers; Muscle paralysis for endotracheal intubation and Surgery

266
Q

How do you evaluate a pt with mild TBI (concussion)?-2 ; When is it ok to discharge them?

A

NonContrast Head CT vs [5 hr observation period]; Pts can be DC’d with reliable guarden if the above is negative

267
Q

When should you do endovascular repair on an AAA? - 3

A
  1. Aneurysm > 5.5 cm
  2. Expansion rate is >1/2 cm in 6 months or >1 cm in 1 year
  3. Classic s/s present (abd/back pain, gross hematuria)
268
Q

In Vascular extremity trauma, when HARD signs of injury are present _____ is warranted immediately

What are the HARD signs of vascular injury?- 4

A

XLap

269
Q

In Vascular extremity trauma, when HARD signs of injury are present _____ is warranted immediately

What are the soft signs of vascular injury?- 4

A

XLap

Soft signs in image

270
Q

Legg Calve Perthes disease etx ;demographic

A

idiopathic Avascular Necrosis of the hip ; boys 5-7 yo

271
Q

Developmental Hip Dysplasia etx

A

abnml development of hip during utero –> leg length discrepancy and poorly formed femoral head

272
Q

Hydrocele etx ; Tx?-2

A

transilluminative fluid accompanies testis during scrotal descent and/or if processus vaginalis fails to obliterate this –. communicating hydrocele ;

Self Limited to 1 year old –> surgery if it doesn’t

273
Q

MOD for Cryptorchidism ; What are the 2 biggest complications for this disorder?; tx?

A

failure of testicular descent that can –> Torsion uncorrected and [⬇︎Fertility even if corrected].

Tx = if not naturally descended by 6 months –> Orchiopexy BEFORE 1 year old

274
Q

cp of Chronic Prostatis Pelvic pain syndrome - 4; Dx?

A
  1. chronic perineal pelvic pain worst with ejaculation
  2. chronic testicular pelvic pain worst with ejactulation
  3. Urinary Urgency with NO dysuria
  4. Urinary Frequency with NO dysuria

Dx = Clinical symptoms with Sterile urine cx

Dont confuse this with BPH which should NOT have back/pelvic pain

275
Q

tx for Chronic Prostatis Pelvic pain syndrome - 3

A
  1. Tamsulosin
  2. Abx if UTI hx present
  3. Finasteride

Dx = Clinical symptoms with Sterile urine cx

Dont confuse this with BPH which should NOT have back/pelvic pain

276
Q

cp for Acute Bacterial Prostatitis

A

UTI sx PLUS PERINEAL PAIN

277
Q

What are the 5 steps to appropriately transport an amputated extremity?

________________

How long will this sustain viability?

A

“SPLIT extremity!? wrap in… “

Saline moistened gauze. THEN put in-

Plastic bag.

Lid seal bag shut before putting it on

Ice bed. to keep

Temperature ideal (33.8 - 50 F) as to NOT FREEZE extremity

________________

24 hours

278
Q

What is Von Gierkes’ Disease

A

[Type 1 Glycogen Storage - Glucose6Phosphatase deficiency] in Liver/Kidney/Intestine

279
Q

Von Gierkes’ Disease CP - 4

A
  1. Seizures 2/2 hypOglycemia
  2. Lactic Acidosis
  3. Doll-Like Fat cheeks
  4. Protuberant Abd (Hepatomegaly)
280
Q

[McArdle Glycogen Storage Dz 5] etx

A

Myophosphorylase Deficiency–> DEC Muscle Glycogenolysis

281
Q

[McArdle GSD5 Muscle Phosphorylase deficiency] CP

A

Myoglobinuria with Exercise

282
Q

[Cori GSD3 Debranching deficiency] CP (3)

________________

GSD = Glycogen Storage Disease

A
  1. SHORT STATURE
  2. hypOglycemia
  3. Muscle weakness & hypOtonia
283
Q

[Cori GSD3 Debranching deficiency] etx

A

Debranching enzyme deficiency –> accumulation of glycogen with abnormal short outer chains (inability to degrade at alpha1-6 branch points)

284
Q

What is Pompe Disease

________________

CP-2

A

[Type 2 Glycogen Storage - Acid Maltase deficiency] –>

________________

Floppy baby & HF

285
Q

What is AmyLoPectinosis?

________________

CP?

A

[Type 4 GSD Glycogen Branching deficiency]

________________

Progressive Cirrhosis

286
Q

How do pts with Liver phosphorylase deficiency present - 2

A

Hepatomegaly and growth retardation early in childhood

287
Q

Slit Lamp Exam indication

A

Evalutes for abnormalities of ANT eye (conjunctiva, cornea, ANT chamber, iris)

288
Q

[Niemann Pick] MOD

A

Sphingomyelinase Deficiency –> accumulation of Sphingomyelin

289
Q

[Niemann Pick] Clinical Presentation (3)

A
  1. Cherry Red Macular Spot
  2. Neuro Regression
  3. Hepatosplenomegaly (differentiates from Tay-Sachs)
290
Q

Tay-Sachs Clinical Presentation (2)

A
  1. Cherry Red Macular Spot
  2. Neuro Regression
291
Q

Tay-Sachs MOD

A

[B-Hexosaminidase A Deficiency] –> GM2 accumulation in neurons

292
Q

Hurler Syndrome CP-5

A
  1. Coarse face
  2. Corneal Clouding
  3. Claw Hand
  4. HepatoSplenomegaly
  5. Hernias (umbilical vs inguinal)

________________

lysosomal Hydrolase deficiency

293
Q

Gaucher Dz CP-3

A
  1. anemia
  2. thrombocytopenia
  3. Hepatosplenomegaly

________________

auto recessive Glucocerebrosidase deficiency –> accumulates in macrophages –> crumbled newspaper appearance

294
Q

Krabbe Disease etx

________________

CP-3

A

[auto recessive GalactoCerebrosidase deficiency]

________________

  1. Retard
  2. hypOreflexia
  3. hypOtonia
295
Q

CP for Retinal Detachment - 3

A
  1. Floaters
  2. Visual Curtain descending from periphery
  3. Photopsia Flashes of Light
296
Q

Identify

A

Central Retinal VEIN Thrombosis

  • Blood & Thunder appearance 2/2 scattered hemorrhage
  • Cotton Wool Spots
  • Disk Swelling
297
Q

diagnosis?

________________

What’s the most common cause?

A

Vitreous Hemorrhage

________________

DM

Fundoscopy = Dark Red Glow with Loss of Fundus details

298
Q

Causes of Corneal Abrasion - 3

________________

How do you diagnose Corneal Abrasion?

A
  1. Trauma
  2. Foreign Body under eyelid
  3. Contact lens –> Corneal epithelial defect

________________

Fluorescein exam revealing corneal staining defect

299
Q

Pralidoxime MOA

________________

Indication

A

ReActivates AChenesterase

________________

Organophosphate poisoning (along with giving Atropine)

300
Q

How do Benzodiazepines affect Blood Pressure

A

⬇︎ BP

301
Q

Glaucoma etx

A

⬆︎ intraocular pressure from [⬆︎ production vs. ⬇︎ outflow of Aqueous humor]

Topical Prostaglandins = latanoprost (open angle glaucoma)

302
Q

Tx approaches for Glaucoma (3)

________________

how specifically does B-blockers work?

A

B-Blockers –> ⬇︎ Ciliary Epithelium Aqueous humor secretion!

Topical Prostaglandins = latanoprost (open angle glaucoma)

303
Q

What target organ does the M3 Receptor work in (6)

A

“[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges”

“An M3 BEGS for Private Lounges”

Bladder(contraction) / Eyes / GI / Skin / [Peripheral Vasculature] / Lungs

304
Q

What are the causes of [Acute Closed Angle Glaucoma]? -3

A

Anticholinergics / Sympathomimetics / Dim light

305
Q

What are the 2 options for reversing Warfarin

A
  1. [VitK IV + PCC]
  2. FFP (Fresh Frozen Plasma)

  • ________________*
  • Give [VitK IV + PCC] since [VitK IV] has 12-24 hr onset*
  • PCC = Prothrombin Complex Concentrate*
306
Q

Tranexamic Acid MOA

________________

Indication-2

A

Prevents Fibrin Lysis

________________

Menorrhagia and [Hemorrhage px]

307
Q

What is the major complaint pts with Glaucoma have?

A

Gradual Tunnel Vision

308
Q

Gabapentin MOA

A

a2-delta Ca+ channel ligand

Structurally similar to GABA

309
Q

Acetazolamide contraindications - 2

A
  1. Pregnancy
  2. Sulfa Allergy

SE = NV

310
Q

Clinical Manifestation of DRESS Syndrome (6)

A

Dysfunctional Internal organs

Really Hot (Fever)

Eosinophilia w/LAD

Skin Rash

Swollen Face

311
Q

Vomiting is a reflex regulated by which receptors? (5)

A

5 Days of Having Nauseating Moomoo :-(

  1. 5HT3 (ondansetron tx) ****
  2. D2
  3. H1 Histamine
  4. [NK1 Neurokinin 1] ***
  5. M1 muscarinic
312
Q

High Tone hearing loss = ⬜ hearing loss

A

Sensorineural

313
Q

Which is more efficient at transmitting sound between Bone and Air?

________________

Why?

A

AIR!

________________

Air interacts with ossicles FIRST, which Amplifies the sound conduction to cochlea

314
Q

Major SE of Atorvastatin - 3

A
  1. Myalgia
  2. Rhabdomyolysis–>myoglobinuria–>Acute Kidney Injury
  3. Liver Dysfunction
315
Q

Major SE of Metoprolol - 3

A
  1. Bradycardia
  2. hypotension
  3. heart block
316
Q

Major SE of HCTZ - 5

A
  1. Dehydration
  2. hyponatremia
  3. hypokalemia
  4. renal dysfunction
  5. gout attack 2/2 ⬆︎serum uric acid
317
Q

Major SE of [Lisinopril ACE inhibitors] - 4

A
  1. Angioedema
  2. Cough
  3. HyperKalemia
  4. Renal dysfunction
318
Q

Which Anti-HTN drugs can cause infertility secondary to hyperprolactinemia? - 3

A
  1. Verapamil
  2. Methyldopa
  3. Reserpine
319
Q

From MOST effective to least effective, list non-Rx options for controlling BP -5

A

We Don’t Exercise At All!

Weight control = BEST

DASH diet

Exercise

sAlt

Alcohol

320
Q

Macular degeneration affects [⬜ central | peripheral] vision, while Glaucoma affects [⬜ central | peripheral] vision

A

MaCular –> CENTRAL vision loss

with straight lines appearing curvy (wet/exudative-neovascular= aggressive and uL while dry/atrophic=gradual and BL)

________________

Glaucoma –> peripheral vision loss (gradual tunnel vision)

321
Q

Ophthalmoscopy findings include cupping of the optic disc

Diagnosis?

A

Glaucoma

________________

Glaucoma affects peripheral vision –> tunnel vision! OAG is more common in Blacks

322
Q

etx of Cataracts

________________

What are the most common presenting sx of Cataracts? -2

A

[⬆︎ lens opacity] –>

  1. [gradual BL NIGHT VISION ⬇︎]
  2. halos around lights

________________

Fundoscopy eventually shows lost of red reflex and retinal details

323
Q

How can you differentiate conjunctivitis from Adenovirus and conjunctivitis from IgE mediated allergy response? - 2

A
  1. Adenovirus does NOT cause pruritus. Allergies does
  2. Adenovirus is preceded by viral prodrome
324
Q

Dacryocystitis etx

________________

which organisms cause this?-2

A

infection of lacrimal sac in medial canthal region

________________

  1. Staph A
  2. GASP
325
Q

What is the treatment for Emergent [Acute Closed angle Glaucoma] - 4

A

“PMAT his glouck’d eye!”

Pilocarpine

Mannitol

Acetazolamide

Timolol

326
Q
A

Retinoblastoma leukocoria

327
Q

Dx for [Acute Closed angle Glaucoma] -2

A

Gonioscopy vs Ocular Tonometry

328
Q

cp for Uveitis - 3

A
  1. Blurred painful vision
  2. conjunctival injection
  3. miosis
329
Q
A

Zoster Ophthalmicus

________________

finding = Dendriform Corneal Ulcer

330
Q

Tx for Central Retinal Artery occlusion - 2

Painless loss of monocular vision

A
  1. HiFlo O2
  2. Ocular massage
331
Q

What type of immunity do polysaccharide vaccines (like the pneumococcal vaccine) produce?

A

B cell response that is independent of T cells

332
Q

MOD for Trachoma

_________________

cp for Trachoma-2

A

Repeated infections with Chlamydia Trachomatis A,B,C –> Inversion of Eyelashes = Trachoma (PALE FOLLICLES with Conjunctival injection) –> Blindness from lash ulceration

333
Q

How does this abnormality clinically present? - 2

A

[Sudden uL Vision Loss] + Floaters

________________

  • dx = Vitreous Hemorrhage*
  • Fundoscopy = Dark Red Glow with Loss of Fundus details*
334
Q

When can you hospitalize a mentally competent pt against their will?

A

when their ailment poses a serious threat to public health

335
Q

When can you mandate parents against their will to accept treatment for a [non emergent ailment] for their child?

A

when the [non-emergent ailment] is a fatal medical condition (i.e. Cancer), M.D. can obtain a court order to give tx

________________

PARENTS ARE NOT ALLOWED TO REFUSE LIFE SAVING TREATMENT FOR THEIR CHILD (EVEN IF BASIS IS RELIGIOUS)

336
Q

Describe ophthalmoscopy findings for Diabetic Retinopathy-3

A
  1. microaneurysms = simple type
  2. retinal edema = simple type
  3. newly formed vessels if malignant type
337
Q

Hurler Syndrome etx

A

lysosomal Hydrolase deficiency

338
Q

Gaucher Dz etx

A

auto recessive Glucocerebrosidase deficiency –> accumulates in macrophages –> crumbled newspaper appearance

339
Q

low tone hearing loss = ⬜ hearing loss

A

conductive

340
Q
A

Glaucoma

341
Q

cp for Acute Closed angle Glaucoma - 3

A
  1. Red Painful eye uL
  2. Fixed Dilated pupil
  3. Cloudy Cornea
342
Q

Prognosis for [Acute Closed angle Glaucoma]

A

Permanent Vision Loss within 2-5 hrs of onset!

343
Q

Identify finding

A

Dendriform Corneal Ulcer

________________

dx = Zoster Ophthalmicus

344
Q

what is [Charcot-Marie-Tooth] disease?

A

hereditary peripheral neuropathy = {[foot drop w/ LE weakness] f/b late onset tremor}

AA M.D. STEP Add-On (4 decks)

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